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Tamiflu distributed in Madiun - Indonesia - Event Date: February 08 2009
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ElleM View Drop Down
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Posts: 11 		  Quote ElleM Quote  Post ReplyReply Direct Link To This Post Calendar Event: Tamiflu distributed in Madiun - Indonesia
    Posted: February 07 2009 at 10:38pm
Strangely translated article.... Question why are they dispensing Tamiflu in several Clinics in Indonesia??????

Start Tamiflu distributed in 5 health at Madiun


FRIDAY, 6 FEBRUARY 2009 | 17:24 WIB
MADIUN, FRIDAY - Tamiflu, bird flu medicine, began to be distributed in five health centers by Madiun Madiun City Health Department following a number of dead poultry in the district Kelun, Kartoharjo, Madiun, which is positive of H5N1 virus affected (bird flu).

Five health centers that are distributed tamiflu Puskesmas Oro Oro Ombo, Patihan, Demangan, Banjarejo, and Manguharjo. Each health center distributed 600 tablets tamiflu. The health Tawangrejo the region is the duty of Kelun, thus not get tamiflu.

"Health is new, so we still find a place there for the placement of drugs. However, we will distribute it immediately," said City Health Office Head of Madiun Wardani, Friday (6 / 2).

"Currently Madiun City Health Department still has a reserve of tamiflu tablets 1300. Number of tamiflu is this enough to cope with bird flu," he said.

Until yesterday, no one of Madiun, especially Kelun, suffering symptoms such as bird flu. However, the health Tawangrejo already Kelun remind residents that have a fever with a temperature over 38 degrees celsius, shortness of breath, sore throat and to immediately to a health clinic.


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Posts: 1830 		  Quote Penham Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2009 at 11:22am
Anybody have any further information on this?  This sounds kind of fishy to me? Would like any further info if anyone finds some? 5 centers gave out 600 tablets of Tamilfu, so each center distributed to 60 patients? According to the package of Tamilflu I have (which is one treatment for 1 person, it is 10 tablets per treatment). So according to this article each center is treating at least 60 patients if they each gave out 600 tablets, IF they are giving out the same dosage we would get here in the US for the treatment of one person.
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  Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2009 at 4:01pm
Why are they still using Tamiflu especially in Indonesia?  Tamiflu was never designed for Bird Flu, there have been strains developing that are resistant, and it often masks the tests producing false negatives when patients are infected.

once more with feeling

http://www.ask.com/bar?q=tamiflu+is+as+effective+as+M&Ms+vietnam&page=1&qsrc=0&zoom=<KW>Tamiflu</KW>+Side+Effects|<KW>Tamiflu</KW>+Purchase|<KW>Tamiflu</KW>+and+<KW>Effectiveness</KW>+and+Safety&ab=1&u=http://209.157.64.201/tag/influenza/index

http://tinyurl.com/c7m7co

  • DECEMBER 19, 2008, 2:00 P.M. ET

CDC Says Flu Strain Resistant to Tamiflu

considering we have known this for 4 years - and despite the fact Roche keeps pushing the value of its drug - really isn't it about time - someone stopped stockpiling an ineffective medicine and put our resources into something that works. IMHO

http://www.medicalnewstoday.com/articles/35339.php

Article Date: 23 Dec 2005 - 16:00 PDT

According to a study reported in the New England Journal of Medicine, Tamiflu may not be as effective against bird flu as first thought. The report revealed that there are signs of resistance to Tamiflu.

In Vietnam, four out of eight infected humans died of bird flu despite being administered Tamiflu. Two of the deaths can be attributed to late treatment (the infection had already developed too far when Tamiflu was administered). However, the H5N1 virus had resisted the antiviral in the other two fatal cases.

A spokesperson for Roche, the makers of Tamiflu, said it may be necessary to raise the Tamiflu dosage and perhaps extend the duration of treatment. He also added that the medical profession should perhaps look into treating patients with a combination of antiviral medications.

A spokesman for the World Health Organisation, Keiji Fukuda, said resistance happens with all drugs - it is not uncommon and not something to be alarmed about. He added that Tamiflu is still the best drug for human bird flu infection.

If a drug is not administered at the right dose - too low - or for long enough, the risk of drug resistance developing is higher.

Written by: Christian Nordqvist
Editor: Medical News Today

Posted: December 04, 2005
1:00 am Eastern

© 2009 WorldNetDaily.com

After treating 41 victims of H5N1, the deadly form of the bird flu virus, a Vietnamese doctor has concluded Tamiflu, the drug most widely stockpiled around the world to combat a feared pandemic, is "useless."

Dr. Nguyen Tuong Van, who runs the intensive care unit of the Center for Tropical Diseases in Hanoi, followed World Health Organization guidelines in her treatment of patients but concluded it had no effect on the disease.

"We place no importance on using this drug on our patients," she said. "Tamiflu is really only meant for treating ordinary type A flu. It was not designed to combat H5N1 ... [Tamiflu] is useless."

Van said bird flu is far worse that SARS, an avian-linked respiratory illness, which she has also treated. Caring for H5N1 victims requires intensive patient "support" with modern technology, like ventilators and dialysis machines, if patients are to be kept alive. Even Western countries with wide access to technology would see there medical infrastructure strained to the limit if the dreaded pandemic comes.

Van did not criticize governments for stockpiling the drug but said doctors had to inform the public about its performance.

Roche, the Swiss pharmaceutical, has sold stockpiles of its Tamiflu to 40 countries and insists it's effective if administered within 48 hours of infection. Roche recently licensed Indonesia to manufacture Tamiflu for its own population.

As WorldNetDaily has reported, officials in at least two nations now suspect the avian flu bug has mutated into a virus that is being transmitted from human to human – a development world health authorities have estimated could result in the deaths of tens of millions.

The WHO confirms Van's experience, admitting Tamiflu has not been "widely successful in human patients," but speculates the drug has not been administered until late in the disease in many Asian countries.

comment: The sad part is I have been posting this for 3 years. Roche and those with huge stocks in Roche continue to proclaim the effectiveness of this drug. And billions of dollars continue to flow around the world to buy it.

Relenza is an effective drug but who makes it?

http://www.fda.gov/cder/news/relenza/default.htm

So far it would appear there are few if any Avian strains developing resistance against Relenza. However in almost every Avian outbreak we ship bottles of Tamiflu.

Quote:

Flu experts say they found no documented evidence that the drug Tamiflu is effective. In Beijing the world pledges US$ 1.9 billion in the battle against the virus. More outbreaks and deaths in China and Turkey have been announced

In an article published in The Lancet medical journal today, researchers from the Cochrane Vaccines Field in Rome and the University of Queensland in Australia warn against over-reliance on Tamiflu. Focus should be on implementing quarantine measures and improving personal hygiene.

and finally today - from Korea

http://theseoultimes.com/ST/?url=/ST/db/read.php?idx=2865



TAMIFLU NOT THE ANSWER TO BIRD FLU

Monday February 9, 2009

Experts doubt effectiveness of stockpiled drug.

By Melissa Cullen
Associate Editor/Staff Writer


credit to : Melissa Cullen, who serves as an associate editor and staff writer for The Seoul Times, studied Linguistics at University College London before making the move abroad. She has lived in the USA, the Middle East and is currently living in South Korea. Her writing covers a variety of local and global topics.

The leading drug used against the virus that causes bird flu may not be successful in preventing a pandemic, according to a New England Journal of Medicine report.

The H5N1 virus, which has killed 71 people in Asia thus far, seems to be developing a resistance to the drug currently being stockpiled in many countries around the world. The authors of the article describe this as "very worrying," but unsurprising. All microbes, regardless of whether they are parasites, viruses or bacteria, eventually develop resistance against drugs, said lead researcher Dr. Jeremy Farrar of Oxford University.

The study, conducted by Dr. Menno de Jong at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, found that four out of eight patients stricken by avian flu died despite being administered with Tamiflu. Medication such as Tamiflu does not cure avian flu in humans, but experts hope it can save lives if taken early enough.

The greatest concern is still that the H5N1 virus might mutate into a form capable of passing from human to human. If this happens, and Tamiflu is not effective in the battle against the virus, the world has a serious problem on its hands. "We don't have a back-up at the moment, so we can't combine it with another drug, as we would with HIV, to prevent drug resistance developing," said Dr. Farrar. However, he also explained that there is evidence to suggest that viruses with a developed resistance to drugs are less likely to mutate into a form passable between humans.

Other available drugs are limited. GlaxoSmithKline's Relenza is one possible contender, and others are in development. French drug company Sanofi Pasteur has reported promising results in its early clinical trials for a prototype bird flu vaccine. With the latest disappointing news about Tamiflu, the pressure is on to find a better alternative.

The Swiss firm Roche AG that produces the drug is currently trying to discover why the drug has been effective in some cases but not others.

The recent demand for Tamiflu has been so great that Roche AG has licensed a couple other companies to produce the drug generically - firstly a Chinese firm, the Shanghai Pharmaceuticals Group, and most recently a little-known pharmaceutical company in India, Hetero Drugs. Countries have been stockpiling for months in order to prepare for a pandemic, but no government is believed to have collected an adequate quantity of the medication to treat all its citizens.

With this in the news, it is easy to see why demand for the drug within the private sector is growing. People are asking their doctors to prescribe them Tamiflu so that they can stockpile privately. But the authors of the report warn against doctors prescribing Tamiflu for this reason, as this is likely to increase the likelihood of resistance. With no viable alternative to Tamiflu at present, this could be a risk the world cannot afford to take.

comment: This is an absolutely untrue statement. Relenza, while more difficult to administer is an effective alternative to Tamiflu.

quote:

As things stand, if an Avian Flu pandemic breaks out before a vaccine has been .... shows that Relenza may be more effective than Tamiflu against H5N1

Medclinician

(synopsis next post)
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  Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2009 at 4:32pm
They produced a ton of it ...and long ago sent it over there as a ..First line defence.
 
The west doing something to help...a pill.  They have to give out something.
 
 
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  Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: February 08 2009 at 4:45pm

The Other Drug for Avian Flu
 

            As things stand, if an Avian Flu pandemic breaks out before a vaccine has been developed, the first line of defense is Roche’s much-ballyhooed antiviral drug, Tamiflu.  As a second choice, doctors will turn to GlaxoSmithKline’s Relenza, a drug that is more expensive and harder to obtain.

            In the freewheeling drugstores of Hong Kong, pharmacists have seen neither Tamiflu nor Relenza for several months.  The local agents for GSK and Roche no longer deliver the drugs to private drugstores, pharmacists say.  But whereas drugstore managers expect Tamiflu to soon become available again in local shops, they aren’t holding their breath for Relenza.

            The World Health Organization (WHO) says that oseltamivir and zanamivir – Tamiflu and Relenza, respectively, by their generic names – have proven effective in reducing the severity and duration of the seasonal flu.  Therefore, the drugs “may improve the prospects of survival [from avian flu], if administered early,” the agency says.

            Peter Corkingley, a Manila-based WHO spokesman, says it may be a good idea to stockpile both drugs in order “to have several options, since we don’t know what kind of virus would a pandemic.”  The bird flu virus, also known as H5N1, is still evolving and has not yet developed into a strain that can transmit from human to human.

            Kenneth W. T. Tsang, a specialist in respiratory medicine who is an honorary professor at both the University of Hong Kong and Hong Kong Polytechnic University, has a slight preference for Relenza.  The possible side effects of Relenza include bronchospasms, which he says are manageable.  But trials have shown that a quarter of Tamiflu users develop flulike symptoms that could be the source of much confusion during a pandemic.

            Tsang has studied respiratory infections for 15 years and managed patient care in the West Hong Kong region during the 2003 severe acute respiratory syndrome (SARS) crisis.  Despite his bias toward Relenza, he does not have much confidence in the effectiveness of either medicine against the H5N1 virus.  It’s too virulent, he says.  Avian flu deaths in Vietnam and Thailand have exceeded 60% even after patients received Tamiflu.

            Still, available drugs should be more rigorously tested for their efficacy against the bird flu, he says.  Unlike SARS, which hit medical authorities without warning, the avian flu is providing much advance notice of its arrival.

            Several governments have ordered Relenza, although Tamiflu remains by far their first choice.  Last month, for example, the U.S. Department of Health & Human Services ordered 16.2 million Tamiflu treatment courses but only 3.95 million Relenza treatment courses.

            WHO prefers Tamiflu to Relenza, partly because Relenza is more expensive and partly because it believes the GSK drug is unsuitable for people with chronic respiratory problems such as asthma.  Similarly, the Hong Kong government, which has ordered 1.5 million Relenza treatments, believes zanamivir to have “relatively low systemic bioavailability.”

            At issue is the way Relenza is administered.  A major difference between Tamiflu and Relenza is that the former is ingested while the latter is inhaled.  Roche packs Tamiflu in a box containing 10 blisters.  A full course of treatment involves taking the 10 pills over five days.  GSK similarly sells Relenza as one course of treatment.  The Relenza package contains 20 pills that are to be inhaled over five days with the help of a device know as the Diskhaler.

            The GSK inhaler is the source of controversy.  WHO spokesman Cordingley syas it is too complicated to use.  “It is expected to be very difficult to teach people who cannot read or who are not familiar with such devices,” he says.  He adds that the presence of the inhaler in each box makes stockpiling Relenza difficult.  Finally, he says, the device is costly to produce and prevents GSK from offering volume discounts.

            The inventor of Relenza, the Australian company Biota, is suing GSK over its allegedly poor performance in promoting the antiviral drug.  Part of the problem, Biota says, is that GSK “did not adequately pursue alternative or improved inhalation systems.”  Biota agreed to license Relenza to GSK in 1990 in exchange for a 7% royalty on global sales of the drug.

            Yusuf K. Hamied, the chairman and managing director of Indian generic drug company Cipla, says there is no need to administer Relenza with a complex device like the Diskhaler.  His company has developed a generic version of Relenza and has applied to market it in India and the U.S. in conjunction with a lower cost inhaling device.

            Cipla will sell its generic zanamivir for the same price as its generic oseltamivir, Hamied predicts.  He expects that the U.S. Food & Drug Administration will approve generic oseltamivir and zanamivir in the event of a pandemic.

            Controversy has dogged Relenza almost since the product was first approved in 1999 as a treatment for seasonal flu.  It led the biostatistician Michael Elashoff to leave FDA.  The holder of a Ph.D. in biostatistics from Harvard University, Elashoff was one of the officials reviewing Relenza’s clinical trials data.  He opined that Relenza should not be approved given that the data he reviewed did not show much effectiveness and that it has potential side effects such as bronchospasms.

            In an interview aired by the Public Broadcasting Service in 2003, Elashoff said some asthmatic patients who took Relenza later died from severe bronchospasms.  He left FDA, claiming that senior officials relieved him of most of his duties because of his views on Relenza.

            Today, Elashoff does not believe that Relenza will work against the bird flu either.  “Since it had such limited efficacy against regular flu, it would seem unlikely to have much efficacy against the bird flu,” he tells C&EN.  Elashoff now runs his own biostatistics consultancy.

            In the U.K., where GSK is headquartered, Relenza gave rise to a battle in 1999 between the drug company and the National Health Service, the government agency that funds most hospitals.  Then-health minister Frank Dobson instructed doctors not to prescribe Relenza for the seasonal flu because of its price and the potential risks posed by side effects.  This led Richard Sykes, chairman of what was then Glaxo Wellcome, to threaten to pull the company out of the U.K. in view of the government’s “antagonistic” attitude toward the drug industry.

            These setbacks early in the commercial life of Relenza are not water under the bridge as bird flu fears intensify.  Until new drugs, or a vaccine, emerge, Relenza is still one of the only two possible ways to treat H5N1, and demand for Relenza is outstripping GSK’s ability to meet it.

            Relenza had until very recently been a disappointing drug for GSK.  According to the pharmaceutical market consultancy IMS Health, worldwide sales of Relenza, based on the manufacturer price, were a mere $8.1 million last year.

            According to Sarah J. Stuckey, a GSK spokeswoman based in Australia, it takes more than a year for GSK to fulfill new Relenza orders.  “Orders placed now, if in excess of the available existing installed capacity (due to other health agency pandemic stockpiling orders), could not be supplied for at least 18 months,” she says.

            This suggests that GSK’s ability to supply the drug is declining.  Diana Kam, a spokeswoman for Hong King’s Department of Health, says GSK took five months to fulfill an order the agency made last September for 1.5 million Relenza treatments.

            Roche recently announced that its capacity for Tamiflu will reach 190 million treatments this year and 400 million in 2007.  The company has licensed production of Tamiflu to other companies and is also working with subcontractors to boost supplies.

            By contrast, it is difficult to gauge how much progress GSK is making in boosting Relenza capacity.  The company answered only a few of C&EN’s questions on this subject numerous inquiries.  Stuckey does say GSK is not spending close to $100 million on expanding production of Relenza.  Of this amount, the company recently spent $15 million to boost Relenza output at a plant in Australia.

            As to GSK’s current capacity, “we don’t provide specific numbers because the number changes as we work on increasing capacity,” Stuckey says.  She adds that GSK is “open to voluntary licenses with any companies that can assist in our efforts to supply Relenza.”

            GSK would not provide details on the process it uses to synthesize zanamivir, though Stuckey insists it is complex.  A paper published in 1996 in Drugs of the Future describes an eight-to-nine-step process.  The starting material for Relenza is N-acetylneuraminic acid (NANA), which at present costs $3,000-$4,000 per kg, according to Cipla’s Hamied.  He says he obtains his material from China.

            CMS Chemicals, a British specialty chemical manufacturer, recently announced that it will be producing several tons of NANA in Slovakia, making use of an enzymatic process developed by Germany’s Julich Research Center.  The process was later refined by CMS and Julich Chiral Solutions, an enzyme developer based near the research center.  CMS says the NANA produced could be used to make Relenza and in nutraceutical formulations.

            Although some research shows that Relenza may be more effective than Tamiflu against H5N1, GSK is focusing mostly on the development and production of an effective vaccine.  The $100 million or so the company is spending to boost Relenza’s output pales in comparison to the almost $2 billion it claims to be investing in bird flu vaccine development.  GSK announced late last month that it was initiating clinical trials of two avian flu vaccines in Europe.

            In Hong Kong, respiratory diseases specialist Tsang agrees that R&D efforts should be applied to developing a vaccine rather than new courses of treatments.  Immunizing humans will allow life to continue more normally in the event of a pandemic, he says.  Furthermore, he adds, H5N1 has shown it can grow resistant to antiviral drugs.

            But the possibility of a pandemic should be kept in perspective, Tsang says.  Since 2003, roughly 100 people worldwide have died of the bird flu.  A clearer danger is posed by the seasonal flu, which according to the Centers for Disease Control & Prevention, kills about 50,000 per year in the U.S. alone.


Medclinician


comment to Mary : what is not good is that we have evidence Tamiflu a) causes resistant strains. Given to large numbers of people this will do more to cause a Pandemic than stop one.  b) It definitely throws off the titer for testing and is often given before the test. This obscures the positives. One young girl given Tamiflu tested positive only after she died from the disease.

c) Of course realistically, just as million of antibiotics are given out every day for viral diseases, because huge amounts of money are being made, this will continue. I was told an essential ingredient used in Relenza was being produced by China. d) it is the danger of masking many positive cases which can be tested for in 2 hours with new equipment that at least the drug should be withheld until the blood draw.


One can only watch. But IMHO and backed by a hundred articles in my files, if not more, this is not a good idea.


Medclinician
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