Influenza Virus In Norway Resistant Against Oseltamivir (Tamiflu(R))
Main Category: Flu / Cold / SARSAlso Included In: MRSA / Drug Resistance; Bird Flu / Avian Flu; Infectious Diseases / Bacteria / Viruses
Article Date: 03 Feb 2008 - 0:00 PDT
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Influenza activity in Norway is still low, but is expected to increase in the coming weeks. Thirty-eight of 58 studied influenza viruses (66 %) are resistant against the anti-flu drug oseltamivir (Tamiflu®). The Norwegian Institute of Public Health (NIPH) is asking physicians who are treating patients for influenza to be aware of this when deciding on medicinal treatment.
The dominant influenza virus this winter, A(H1N1) gives milder symptoms than A(H3N2) which dominated last winter. Influenza vaccination is recommended for people in the high risk-groups as they can become seriously ill with the virus. Anti-influenza medicines are intended mainly for patients who have become seriously ill with influenza and for those with underlying illnesses.
NIPH collects influenza viruses from the whole country for closer inspection. Some of these viruses are forwarded to the WHO collaboration centre in London for further study and resistance tests. The dominant virus this season - in Norway and the rest of Europe - is influenza A (H1N1) Solomon Islands. Thirty-eight out of 58 A(H1N1) viruses from different patients and from different parts of the country in the period November- January have shown a mutation that indicates high-grade resistance against oseltamivir. The virus is sensitive to other anti-influenza medicines. This year's virus is expected to produce milder symptoms than normal.
Characterisation of some of the A (H1N1) virus stems in Norway show resemblance to those in the vaccine. This good match means that the vaccine will be effective against this year's dominant virus. Now it is important that those who want to be vaccinated do so before the main influenza outbreak strikes.
Norway takes part in international collaboration to monitor and advise on infectious diseases through the European Centre for Disease Prevention and Control, (ECDC), the influenza monitoring network EISS and the World Health Organization (WHO).
Centre for Disease Prevention and Control
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Influenza: Primary - Initial - Spread Triggered Off By The Abiotic Vehicle “cold Drinking Water”
posted by Dipl.-Ing. Wilfried Soddemann on 3 Feb 2008 at 9:12 pmInfluenza: Primary - initial - spread triggered off by the abiotic vehicle “cold drinking water”
Trigger of human influenza epidemics by the “warm biotic droplet infection” improbably
Wilfried Soddemann
Contact:
Bauassessor Dipl.-Ing. Wilfried Soddemann
Mühlenstraße 5b
D - 48351 Everswinkel
Germany
eMail: soddemann-aachen@t-online.de
The primary - initial - trigger of from the human influenza epidemics by the biotic droplet infection is unproved and (BRANKSTON et al. 2007) and extremely improbably because influenza epidemics
• only in 9% of the cases (season 2004/2005 in Germany) together with recognized cluster arise.
• virological locally singularly arise (influenza-subtypes and fine classification).
• arise geographically locally singularly.
• in large cities and densely populated areas to be proven not with priority.
• predominantly in the colder regions of Germany arise.
• their maxima regularly in certain districts/cities reach.
• strictly parallel to the course of the winter cooling sum run.
• by saliva droplets hardly can spread. Saliva contains far less Influenza viruses than the - heavier - droplets from throat and nose.
The facts
Influenza epidemics in Germany occur together with recognized cluster rarely (9% of the cases in the season 2004/2005) (RKI 2006).
Influenza epidemics occur virological locally singularly (influenza-subtypes and fine classification) (AGI 2007).
Influenza epidemics run also geographically locally singularly. They are not proven with priority in large cities and densely populated areas. They arise predominantly in the colder regions of Germany (the east in the winter cold continental climate, southeast, altitudes) (RKI 2007). They reach their maxima regularly in certain districts/cities (absolute maxima: Frankenthal, Worms, district Stollberg) (RKI 2007).
Influenza epidemics run strictly parallel to the course of the winter cooling sum.
Influenza epidemics hardly can spread by saliva droplets. Saliva contains far less Influenzaviruses than the substantially heavier droplets from throat and nose (ANONYMOUS 2003) (GOLDMANN 2001).
Human Influenzaviruses could being proven in the excretions of mammals such as pigs (faecal and oronasal), wild boar (faecal and oronasal), cattle and goats, so that in principle the transmission path from the environment is over waters and the drinking water possible (BROWN 2004) (GRAVES et al. 1975) (KADEN et al. 2001) (KAWAOKA et al. 1986) (LANDOLT et al. 2003) (MARKOWSKA DANIEL et al. 1999) (RKI 1999) (VICENTE et al. 2002) (WEBSTER 1998) (ZHOU et al. 1996) (CARPENTER 2001). With considerable security in the future still further animal species infected with influenza A are discovered (WEBSTER 1998).
Elimination and inactivating of viruses during the drinking water treatment
Drinking water is often not filtered in Germany or only roughly. The very small viruses are not removed surely thereby. For groundwater treating fast spread filtration plants for the elimination of iron and manganese do not possess any effect regarding the elimination of viruses (WHO 2004). Even in Germany as particularly efficiently valid plants for the flocculation and filtration, also with consideration of the common disinfection procedures, whose efficiency with sinking water temperature decreases [Chlorine and ozone treatment] and with micro organisms clumped in the water are only reduced effective [Chlorine, ozone treatment and UV irradiation], can not reach from the WHO demanded eliminations and inactivating goals (WHO 2004).
"Cooling chain of the public water supply"
Coldness is the most important parameter for the preservation of virulent Influenzaviruses in water. The temperature minimum of the dam water in Germany amounts to in the months January and February 3-4°C. River water has its temperature minimum likewise in January and February. Ground water near the surface has in Germany at the ground water surface - similar to the soil in 100 cm depth - its temperature minimum of for instance 3°C in February and March. Also from wells of larger depth taken ground water can be colder with unsatisfactory sealing between the fountain and the surrounding rock by infiltration by surface water affected and therefore than the deeper ground water. River water trickling away arrives on short ways at the wells, can have the same effect. Bank filtrate from wells, which were bored near the bank by surface waters, accepts the temperature of the cold surface water. Same applies to wells, from which with surface water enriched ground water is pumped. The soil temperatures in a meter of depth correspond to the temperatures of the drinking water pipelines shifted frost-protected in the soils. The temperature minima of the soil temperatures in 100 cm depth amount to in Germany during the months February and March 3-5°C (DWD 2007). The temperatures of the drinking water pipelines and the drinking water transported in them adapt themselves to the soil temperatures. In the winter cold raw water remains cold in the drinking water treatment plants and after the treatment to drinking water in the water tanks and water pipelines up to the annexe of the consumers. The temperature minimum of the drinking water follows in particular the run of the wintry cold sum in the soil and in the water pipelines. It arises in the months February/March. The cold drinking water is just mixed in the dwellings at the taps with warm water from the house installation. Thus the "cooling chain of the public water supply" is described from the water winning to the consumers with a drinking water temperature of for instance 4-5°C in the months February/March. Cold, young, freshly drinking water, taken out of surface water and badly protected ground water near the surface as well as out of ground water from roc, contaminated by Influenzaviruses, can be the abiotic vehicle, which transports virulent Influenzaviruses in the winter with 4-5°C conserved over the "cooling chain of the public water supply" to humans.
Transmission paths of the drinking water
Infections by drinking water will not be transmitted alone by drinking the water. Further transmission paths are the inhalation of aerosols and the contact with the drinking water. Entrance gates with humans are conjunctiva, the nose mucous membrane, the mouth mucous membrane, the eardrum, wounds and by catheters affected other mucous membranes.
Conclusions
The primary transmission of the influenza by the biotic “warm” droplet infection from human to human is already because of the strict dependence on environmental temperatures extremely improbable. The influenza must be triggered by an abiotic vehicle increasingly efficient for the spread of infections with increasing cold environmental temperatures. Therefore must be searched for the transmission of the influenza for abiotic vehicles dependent on cold environmental temperatures. Drinking water is such an abiotic vehicle.
The stated references and indications show that cold drinking water can be that abiotic vehicle, with which virulent human Influenza viruses from the reservoirs arrives to humans and triggers predominantly the seasonal influenza epidemics.
That applies in particular also to the extremely lethal H5N1 bird flu, whose faecal transmission is indisputable.
References
AGI (2007): Arbeitsgemeinschaft Influenza http://influenza.rki.de/agi
ANONYM (2003): Understanding Sars and other Respiratory Infections May 2003.
http://www.ifh-homehygiene.org/2003/2downloadabledoc/SARS.pdf
BRANKSTON et al. (2007): Transmission of influenza A in human beings. Lancet Infect Dis. 2007 Apr;7(4):257-65. http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17376383&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
BROWN (2004): Influenza Virus Infections of Pigs, Part 1: swine, avian & human influenza viruses. http://www.pighealth.com/influenza.htm ; Part 2: Transmission between pigs and other species. Veterinary Laboratories Agency, UK.
http://www.pighealth.com/influenzaB.htm
DWD (2007): Deutscher Wetterdienst (DWD), Wetterstation Erfurt-Bindersleben, Erdbodentemperaturen aus 100 cm Tiefe
GOLDMANN (2001): Epidemiology and Prevention of Pediatric Viral Respiratory Infections in Health-Care Institutions, Children’s Hospital and Harvard Medical School, Boston, Massachusetts, USA, Emerging Infectious Diseases, Special Issue.
http://www.cdc.gov/ncidod/eid/vol7no2/goldmann.htm
GRAVES et al. (1975): Human viruses in animals in West Bengal: An ecological analysis, Human Ecology, Volume 3, Number 2 / April, 1975, 105-130.
http://www.springerlink.com/content/u5408wx5t622ll82/
KADEN et al. (2001): Gefährliche Verwandtschaft. Schwarzwild - ein natürliches Reservoir für Infektionserreger und Ansteckungsquelle für Hausschweine? Bundes-forschungsanstalt für Viruskrankheiten der Tiere: Forschungsreport 1/2001: 24-28.
http://ticker-grosstiere.animal-health-online.de/20010902-00002/
KAWAOKA et al. (1986): Intestinal replication of influenza A viruses in two mammalian species, Archives of Virology, Volume 93, Numbers 3-4 / December, 1987, 303-308.
http://www.springerlink.com/content/g352726672xj5703/
LANDOLT et al. (2003): Comparison of the Pathogenesis of Two Genetically Different H3N2 Influenza A Viruses in Pigs, J Clin Microbiol. 2003 May; 41(5): 1936–1941.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&rendertype=abstract&artid=154671
MARKOWSKA-DANIEL et al. (1999): Seroprevalence of influenza virus among wild boars in Poland. National Veterinary Research Institute, Swine Diseases Departement, Pulawy, Poland. http://www.medwet.lublin.pl/Year%201999/vol99-05/art222-98.htm
RKI (1999): Robert Koch-Institut (RKI) Merkblatt für Ärzte Influenza – Verhütung und Bekämpfung (Stand 1999).
http://www.gapinfo.de/gesundheitsamt/alle/seuche/infekt/viru/grippe/mba/index.htm
RKI (2006): Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2005, Datenstand: 1. März 2006)
RKI (2007): Robert Koch-Institut Berlin, RKI, Datenbank der nach Infektionsschutzgesetz meldepflichtigen Infektionskrankheiten in Deutschland; http://www3.rki.de/SurvStat/
VICENTE et al. (2002): Antibodies to selected viral and bacterial pathogens in European wild boars from southcentral Spain. J Wildl Dis. 38(3): 649-52.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12238391&dopt=Abstract
WEBSTER (1998): Influenza: An Emerging Disease. Emerging Infectious Diseases 4(3). http://www.cdc.gov/ncidod/eid/vol4no3/webster.htm
WHO (2004): World Health Organization (WHO), 2004, Guidelines for drinking-water quality, 3rd Ed., http://www.who.int/water_sanitation_health/dwq/gdwq3/en/print.html
ZHOU et al. (1996): Influenza infection in humans and pigs in southeastern China, Archives of Virology, Volume 141, Numbers 3-4 / March, 1996, 649-661. http://www.springerlink.com/content/p220471r1r337521/
ZIMMERMANN (2001): Krankheiten des Schweines. Veterinärmedizinische Fakultät der Universität Bern, Vorlesungsskript: 49-51.
http://www.vetmed.unibe.ch/studvet/download/year4/Erkr%20der%20Schweine_Skript_WZimmermann_234JK_WS0102_081101.pdf
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