Published 9 July 2009, doi:10.1136/bmj.b2798
Cite this as: BMJ 2009;339:b2798

News

WHO to call on nations with high rates of swine flu to move away from testing all suspected cases

¹ Geneva

The World Health Organization said on Tuesday (7 July) that with the A/H1N1 influenza pandemic evolving rapidly, it plans to issue new guidelines for nations with large infection rates, advising them to move away from conducting laboratory testing on all suspected cases and to focus instead on monitoring big trends in the spread of disease.

Keiji Fukuda, the WHO’s interim assistant director general, said that because the number of cases had increased in so many countries "it’s very hard to keep up" and added that in the next few days the agency would be issuing "updated surveillance recommendations to countries." This should also help ease the burden on laboratories, he said.

In an update on the pandemic, Dr Fukuda said that 137 countries and territories had reported over 98 000 cases to the global agency, including over 440 deaths.

The shift in the guidelines will put the focus on tracking larger, national indicators of the disease (including flu), such as illnesses or pneumonia cases, and mutations.

But for countries that don’t have any cases or only a few, the WHO will continue to recommend that "people who are suspected [of having] pandemic influenza be tested, so that the presence of this virus can be confirmed."

In addition, the WHO will continue to emphasise, Dr Fukuda said, that "if a country has unusual cases, or perhaps unusual severe cases, or clusters of cases, or patients who are developing symptoms that have not been reported before, these kinds of cases continue to be tested to confirm that [their symptoms] are due to pandemic influenza."

"The cases and the clusters should also be investigated, to see if there are changes going on in the epidemiology and in the clinical picture of the illness," he said.

In relation to the three viruses resistant to oseltamivir (Tamiflu) that were isolated recently from people in Denmark, Japan, and in Hong Kong, Dr Fukuda said the cases have raised some questions about the possible implications of this.

"Right now these examples of oseltamivir resistance remain sporadic cases. We do not see any evidence of widespread movement of oseltamivir resistant viruses, and so far we have not heard of any additional viruses, including among close contacts of these persons," he told reporters.

However, he noted that the resistant viruses are sensitive to the other effective antiviral drug, zanamivir (Relenza), and that the three patients had fully recovered.

Dr Fukuda also argued that it was not unexpected that some viruses would be resistant to oseltamivir. "This normally happens when you treat any infection with any drug," he said, but he underlined the importance of monitoring the situation "very closely" to ensure that it’s not the beginning of any large spread of resistant viruses.

Dr Fukuda also said the mutations do not represent any mixture with the current seasonal flu viruses. "Right now they look like spontaneous mutations in these patients."

Concerning the cases resistant to oseltamivir, Dr Fukuda emphasised that "at this point, we are not recommending any clinical changes to the approach of treating patients. So I think that’s the most important point for physicians, and countries, to know."

Cite this as: BMJ 2009;339:b2798

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