During his visit to isolation wards in Surat, Vadodara, Rajkot and Ahmedabad, Chief Minister Vijay Rupani on August 17 had proposed the slogan “Any Flu Tamiflu” in an attempt to curb swine flu outbreak. But, experts working on antibiotic resistance have expressed concern about monotherapy in the cases of H1N1 infection, which they apprehended would eventually lead to resistance towards Oseltamivir, the anti-viral medication used to treat and prevent influenza A and influenza.
Infectious diseases specialist Dr Harsh Toshniwal said, “We have been giving Oseltamivir since 2009 and according to the government there haven’t been any cases of resistance towards the anti-viral. But, that does not mean that it is not possible. Going by the slogan people are giving and consuming Oseltamivir, indiscriminately. The virus will keep changing and will develop a resistance to the anti-viral. Also, we do not have a surveillance system to keep a close tab on people who are given the anti-viral.”
“We do not have the faintest idea about how many people have actually recovered because of the anti-viral,” added Dr Toshniwal. World Health Organization’s 2014 ‘Antimicrobial resistance – Global report on Surveillance’ states , “The emergence and rapid global spread in 2007-2008 of Oseltamivir resistance in the seasonal A (H1N1) viruses has shown that viruses resistant to neuraminidase inhibitors could pose a serious threat to public health, and has raised the priority given to antiviral susceptibility surveillance in the WHO GISRS (Global Influenza Surveillance and Response System )”.
The report adds that “should anti-influenza drug resistance emerge undetected, the public health applications of influenza anti-virals could be undermined, increasing the threat of pandemics and severity of the illness. Widespread resistance to currently circulating A (H1N1) and A (H3N2) viruses have left neuraminidase inhibitors the primary anti-viral agents recommended for influenza prevention and treatment, but resistance to these drugs is a growing concern”.
Dr Dhiren Shah, bacteriologist at Green Cross Pathology Labs, said, “There are constant mutations in the H1N1 strain of virus and the anti-viral is just a preventive measure. Most people do not finish the entire course of the anti-viral prescribed and like we see in tuberculosis, it is possible that the virus develops resistance.” Green Cross Pathology Labs is among the five private laboratories that have the government permission to conduct swine flu tests.
“As per government rules, we conduct a test when the patient is at Stage C, but from what they tell us, the doctors start the medicine for any flu or flu like symptoms before that. Maybe they should start tests at type A and then give the anti-viral only if needed. We need to keep researching and observing how the anti-viral is working on people who consumed it,” added Dr Shah.
A study which appeared in the National Centre for Biotechnology Information’s (NCBI) journal suggests that constant surveillance and data gathering of patients who have consumed Oseltamivir has to be undertaken and continuously updated. The 2010 study titled ‘Oseltamivir-Resistant Influenza Viruses A (H1N1) during 2007-2009 Influenza Seasons, Japan’ states that “although Oseltamivir remained a valuable drug for treatment of pandemic (H1N1) 2009, many oseltamivir-resistant influenza viruses were isolated after prophylaxis with a half dose of the drug. Therefore, prophylaxis with Oseltamivir may not be recommended as stated by WHO. Rapid and continuous monitoring of NAI-resistant viruses, including pandemic (H1N1) 2009 virus, and dissemination of the findings in timely manner remains essential”.
Dr Asha Shah, head of medicine, B J Medical College, said, “We recommend the anti-viral because it helps people.When there is an outbreak we rely on the tried and tested methods. We have not yet found proof of resistance.”