Five patients catch new strain of drug-resistant swine flu

David Sapsted, Foreign Correspondent

• Last Updated: November 21. 2009 11:03PM UAE / November 21. 2009 7:03PM GMT

LONDON // The first cases of a Tamiflu-resistant strain of swine flu being passed from person to person have been reported from a hospital in Wales, in the United Kingdom. All the victims were existing hospital patients with serious underlying medical conditions.

Health authorities in Britain reported that five patients at University Hospital Wales in Cardiff became infected while, in the US, a cluster of four Tamiflu-resistant cases of the H1N1 virus at Duke University Medical Center, where three of the patients died, was being investigated yesterday.

The World Health Organisation (WHO) in Geneva and other international bodies are now monitoring the situation to see if a strain of the virus with an ability to overpower Tamiflu, the most commonly used antiviral, mutates in the wider community.

Although there have been more than 50 previous cases worldwide where people have developed a resistance to Tamiflu, the cases in Wales and, perhaps, North America are believed to be the first where the drug-resistant virus has been passed on to others.

The development is another worry for the health authorities in Saudi Arabia as they prepare for the Haj, which begins this week. An estimated 2.5 million people from more than 160 countries are expected to make the pilgrimage this year.

So far, there have been only 20 swine flu cases reported among pilgrims arriving in the Kingdom, although the Saudi health ministry said yesterday that there had been four deaths from the virus. It said the victims were a Moroccan woman, a Sudanese man and an Indian man – all aged 75 – and a 17-year-old girl from Nigeria. The ministry said the four had not followed recommended procedures and had not been vaccinated against swine flu.

The Saudi authorities, with help from the United States and medical institutions across the Arab world, are gearing up in case of a full-scale outbreak.

Abdullah al Rabeeah, the Saudi health minister, told a press conference in Jeddah: “Our focus this year has been on swine flu and the department for preventive medicine and Haj agencies have appointed 80 consultants for the intensive care centres during the current season.” The kingdom has stockpiled 1.5 million doses of the H1N1 vaccine for pilgrims. In Mecca itself, 14 hospitals with 2,782 beds will be available in addition to 48 health centres in the area, including four in the Grand Mosque itself.

“The Haj has always been a breeding ground for illness, particularly the transmission of respiratory diseases. It is inevitable when, at any one time, you might have a million people jostling together in one place,” said an expert in communicable diseases in London yesterday who wished to remain anonymous due to the sensitivity of the issue.

“This year, swine flu is an added and very potent problem. The circumstances could be ideal for the virus to mutate. The real danger, though, is not caused by Tamiflu-resistant strains emerging – the real problem is how many people will have actually had the treatment in the first place.”

Although Saudi Arabia is requiring pilgrims to have been given the swine flu vaccine if it is available in their country – all pilgrims from the UAE, for example, are required to be immunised by local authorities – those from poorer countries are being recommended to get the seasonal flu vaccine if it is available.

The Saudis, in conjunction with WHO, are also recommending that children under the age 12 and adults over 65 do not attend the Haj this year, along with pregnant women, overweight individuals and sufferers of heart disease, respiratory illnesses and other conditions that make them vulnerable to H1N1.

Those that do attend are being asked to attend closely to their personal hygiene, to avoid close contact with sick people, and to wear masks in crowds.

Khaled Marghlani, a spokesman for the Saudi ministry of health, said that the authorities were “relaxed” as they waited for the peak of the Haj on Thursday when pilgrims gather at Mount Arafat.

“The situation is under control and, God willing, it is very reassuring,” he told Agence France-Presse.

Ziad Memish, the assistant deputy to the Saudi health minister and co-author of a paper on Haj and H1N1 published in Science magazine, said that the government had consulted 50 experts, including 25 from other countries, on preparations for the pilgrimage. “We have relied on a collaborative programme with the US Centers for Disease Control and Prevention, where they are helping us set up a system that was used in the Hurricane Katrina disaster, and I think the system has already been tested and it is working perfectly well.”

Roland Salmon, the director of the Communicable Disease Surveillance Centre in Britain, added that there were “very special” circumstances involved in the cases in Wales where Tamiflu-resistant strains of H1N1 had been passed on.

All those affected, he said, were hospital patients with serious underlying conditions and suppressed immune systems.

“This is a very special set of circumstances and it remains to be seen whether this would actually happen out in the community, where most of the people you would meet would have perfectly normal immune systems,” Dr Salmon said.

dsapsted@thenational.ae