Two recent stories regarding Indonesia share a common theme. That theme appears to be the growing concern within the Indonesian government that the H5N1 that has killed so many of their young people is gaining Tamiflu resistance.
The standard protocol for treating H5N1 patients is the same as for regular flu: Two capsules daily for at least five days, administered within 48 hours of the onset of symptoms. That regimen is continued until the patient either recovers or dies. The concern is that H5N1 may be evolving to circumvent Tamiflu the same way it has circumvented amantadine and rimantadine, two M2 inhibitors (M2 is the surface protein of influenza A).
Taking no chances, the Indonesian government is racing to create its own H5N1 vaccine, in partnership with US company Baxter. Indonesia's stark change in attitude last January, to force the world community to earmark the first prepandemic and pandemic H5N1 vaccines for the island nation, therefore, comes more clearly into focus. It would appear that the Indonesian leaders may have known of this change in sensitivity to Tamiflu and could see far enough down the road to know it needed vaccine NOW, rather than later -- and needed it based on its homegrown H5N1, not some other formulation.
The Indonesian health minister disputes the Australian claim of Tamiflu resistance. Of course they will, because they do not yet have the vaccine, and they certainly do not want to shut off their access to the drug. But actions speak louder than words. The Indonesian diplomatic health crisis, therefore, appears to be less posturing and more of a desperate attempt to resolve a growing crisis within the country.
Taken in the larger context -- the activation of the Indonesian army to help with mass culls of poultry, the house-to-house sweep in Jakarta and other cities to test housecats, the reference to the Karo cluster of May, 2006 -- all of these actions speak much louder than words of reassurance that Tamiflu continues to be effective.
JAKARTA, June 22 (Reuters) - A vaccine to combat human bird flu could be ready as early as July, Indonesia said on Friday, adding it was prepared to use it immediately despite calls from the WHO to build up a stockpile first. Health Minister Siti Fadillah Supari said the World Health Organisation's advice was not realistic in the case of Indonesia, which has the highest number of bird flu deaths. Read the full story at: www.alertnet.org/thenews/newsdesk/JAK138707.htm
Indonesian bird flu Tamiflu resistant
Canadian Press
June 21, 2007 at 9:07 PM EDT
TORONTO — An Australian researcher says H5N1 avian flu viruses from Indonesia are markedly less susceptible to the antiviral drug Tamiflu than a previous line of the H5N1 family of viruses.
Jennifer McKimm-Breschkin says laboratory testing shows the viruses from Indonesia are 20 to 30 times less susceptible to the drug as compared to H5N1 viruses that circulated in Cambodia a couple of years ago.
Dr. McKimm-Breschkin, who's attending a conference on infectious diseases in Toronto, says the findings are not good news.
And she says they may help to explain the high death toll from H5N1 in Indonesia, where 80 of 100 patients have died of the disease.
A scientist from the World Health Organization says it's not clear what the impact of the reduced susceptibility to Tamiflu means for people from that part of the world who become infected with the virus.
Dr. Frederick Hayden says a lot of factors can have an impact on whether oseltamivir treatment of H5N1 patients is successful, including how much time passes between infection and the start of drug therapy.
Scott McPherson
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