Filed under Wellbaby/Vaccination

신종플루와 타미플루에 대해서 쓴 기사입니다.

아무 원칙도 없이 그냥 타미 플루에 달라고 하시는 분들 때문에 아주 많은 어려움을  격고 있습니다. 그냥 콧물과 기침만 있어도 타미플루를 처방하라는 지침으로만 신문에 기사가 나면서 왜 처방을 하지 않는지에 대해서 문의하고 심지어는 항의하시는 분들도 계시거던요...

의사가 아무 책임을 지지 않을려고 하면 그냥 무조건 처방하면 되지만 귀찮치도 않고 나중에 내성이 생기거나 말거나 신경쓰지 않고 그냥 주면 되지만 그것이 과연 환자에게 이득이 되는 것이지 모르겠습니다.

증상의 경중도를 진찰해 보고 거기에 맞게 주기도 하는 것이 가장 합리적이고 이성적인 판단이라고 생각이 듭니다. 나중에 마구 처방되어 지고 마구 먹고 난후에 생길 수있는 합병증이나 내성 또는 변종 바이러스의 출현이 범 국가적인 재난이 될 수도 있는 것인데 이러한 것에 대한 논의나 대책은 없이 아주 편안한 재고 물량 소진을 위해서 정부가 이러한 정책을 펴는 것은 비 이성적인 것으로 생각이 됩니다. 고위험군이 아닌 이상 그러한 처방은 국민 전체에게 더 해가 될 가능성이 있으니까요

또한  조금 더 합리적이고 편한 방법이 겨울 방학 땡겨서 하기를 하면 이러한 학생들의 공동체감염을 막을 수 있는 데 말입니다.

아무튼 큰 걱정입니다. 하루에 12만명분의 타미플루가 처방되고 있다고 합니다. 이러한 것이 우리나라의 앞으로의 재난에 큰 장해가 되지 않기를 간절히 기원해 봅니다.

사용자 삽입 이미지

Filed under Illbaby/감기

Antiviral drugs and pandemic (H1N1)

6 October 2009 (originally posted on 21 May 2009)


Antiviral drugs: definitions
and treatment


What are antiviral drugs?

Antiviral drugs are medicines that act directly on viruses to stop them from multiplying.

Are antiviral drugs used for treatment of pandemic (H1N1) 2009 infection?

Yes, two antiviral drugs are being used to treat pandemic (H1N1) 2009 infection. These are oseltamivir and zanamivir, which both block the action of an influenza virus protein called neuraminidase. In clinical trials with seasonal influenza, these antiviral drugs have been shown to reduce the symptoms and duration of illness and may also contribute to preventing severe disease and death. Since these antivirals have been effective in treating seasonal influenza, they are also expected to be effective for pandemic (H1N1) 2009 infections.

For the treatment of pandemic (H1N1) 2009, how many antiviral drugs are there?

There are two approved antiviral drugs for influenza that are available for treatment of pandemic influenza. These are the neuraminidase inhibitors oseltamivir and zanamivir, more commonly known by their trade names Tamiflu and Relenza.

Another class of approved antiviral drugs known as M2 inhibitors (amantadine and rimantadine) can be effective for treating seasonal influenza. However, the pandemic (H1N1) 2009 virus has been shown to be resistant to these particular antiviral drugs.

What is WHO’s guidance on the use of antiviral drugs?

Studies show that early treatment, preferably within 48 hours after the first sign of symptoms, appear associated with better clinical outcome.

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends that treatment with oseltamivir should start immediately, no matter when illness started and without waiting for laboratory results.

For patients at risk for serious disease, including those with certain underlying medical conditions, WHO recommends treatment with either oseltamivir or zanamivir as soon as possible after the onset of symptoms and without waiting for the results of laboratory tests.

In all cases, where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

Are antiviral drugs suitable for everyone?

Antivirals should only be used when prescribed by a qualified health care provider, as they will be able to assess each situation and make the appropriate decisions on care. WHO recommends that all patients (including pregnant women) and all age groups (including young children and infants) should be treated with oseltamivir in the event of severe or deteriorating illness. Treatment with either oseltamivir or zanamivir should also be offered to all patients in at-risk groups in the event of illness, even if mild or uncomplicated.

What is meant by at-risk groups?

Individuals that have been identified as “at-risk” of more complicated or severe illness associated with infection by influenza virus include:

  • pregnant women (particularly in the later stages of pregnancy);
  • infants and children (<5 years);
  • patients with chronic health conditions, such as cardiovascular, respiratory or liver disease, or diabetes;
  • patients with immunosuppression related to treatment for transplant surgery, cancer, or due to other diseases.

The elderly (>65) appear less susceptible to infection by pandemic H1N1 influenza virus, but are assumed to be at higher risk of more severe or complicated illness if infected.

Is it necessary to wait for a laboratory result before starting antiviral drug treatment?

No, if antiviral drug treatment is indicated by the clinical presentation, then treatment should start as soon as possible. If there is a delay, treatment may be less effective.

What is the standard treatment regimen for antiviral drugs?

For oseltamivir, the standard adult treatment course is one 75 mg capsule twice a day for five days. For severe or prolonged illness, physicians may decide to use a higher dose or continue the treatment for longer.

Zanamivir is taken as a powder by inhalation. The recommended dose for treatment of adults and children from the age of 5 years is two inhalations (2 x 5mg) twice daily for five days.

Antiviral drugs and pandemic (H1N1) 2009: 1,2,3 | Next page 3

사용자 삽입 이미지

Filed under Illbaby/감기

Antiviral use and the risk of drug


Pandemic (H1N1) 2009 briefing note 12

25 SEPTEMBER 2009 | GENEVA -- Growing international experience in the treatment of pandemic H1N1 virus infections underscores the importance of early treatment with the antiviral drugs, oseltamivir or zanamivir. Early treatment is especially important for patients who are at increased risk of developing complications, those who present with severe illness or those with worsening signs and symptoms.[1]

The experience of clinicians, including those who have treated severe cases of pandemic influenza, and national authorities suggests that prompt administration of these drugs following symptom onset reduces the risk of complications and can also improve clinical outcome in patients with severe disease.

This experience further underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance.

High-risk situations for development of drug resistance

WHO encourages clinicians to be alert to two situations that carry a high risk for the emergence of viruses resistant to oseltamivir.

The risk of resistance is considered higher in patients with severely compromised or suppressed immune systems who have prolonged illness, have received oseltamivir treatment (especially for an extended duration), but still have evidence of persistent viral replication.

The risk of resistance is also considered higher in people who receive oseltamivir for so-called “post-exposure prophylaxis” following exposure to another person with influenza, and who then develop illness despite taking oseltamivir.

In both of these clinical situations, health care staff should respond with a high level of suspicion that oseltamivir resistance has developed. Laboratory investigation should be undertaken to determine whether resistant virus is present and appropriate infection control measures should be implemented or re-enforced to prevent spread of the resistant virus.

When a drug-resistant virus is detected, WHO further recommends that an epidemiological investigation be undertaken to determine whether onward transmission of the resistant virus has occurred. In addition, community surveillance for oseltamivir-resistant pandemic H1N1 virus strains should be enhanced.

In general, WHO does not recommend the use of antiviral drugs for prophylactic purposes. For people who have had exposure to an infected person and are at a higher risk of developing severe or complicated illness, an alternative option is close monitoring for symptoms, followed by prompt early antiviral treatment should symptoms develop.

WHO has also recommended against the use of a particular antiviral where the virus is known or highly likely to be resistant to it. For this reason, zanamivir is the treatment of choice for patients who become ill while on oseltamivir prophylaxis.

Oseltamivir-resistant viruses

Systematic surveillance conducted by the Global Influenza Surveillance Network, supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to oseltamivir. To date, 28 resistant viruses have been detected and characterized worldwide.[2]

All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir. Zanamivir remains a treatment option in symptomatic patients with severe or deteriorating illness due to oseltamivir-resistant virus.

Twelve of these drug-resistant viruses were associated with the use of oseltamivir for post-exposure prophylaxis. Six were associated with the use of oseltamivir treatment in patients with severe immunosuppression. Four were isolated from samples from patients receiving oseltamivir treatment.

A further two were isolated from patients who were not taking oseltamivir for either treatment or prophylaxis. Characterization of the remaining viruses is under way.

These numbers are comparatively small at present. Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

Current conclusions

These data support several conclusions. Cases of oseltamivir-resistant viruses continue to be sporadic and infrequent, with no evidence that oseltamivir-resistant pandemic H1N1 viruses are circulating within communities or worldwide.

To date, person-to-person transmission of these oseltamivir resistant viruses has not been conclusively demonstrated. In some situations, however, local transmission may have occurred, but without any further onward or ongoing transmission.

Except for immunocompromised patients, those infected with an oseltamivir-resistant pandemic H1N1 virus have experienced typical uncomplicated influenza symptoms. No evidence suggests that oseltamivir-resistant viruses are causing a different or more severe form of illness.

The occurrence of oseltamivir-resistant viruses is expected and is consistent with observations from early clinical trials. As use of antiviral drugs continues to grow, further reports of drug-resistance viruses are certain to occur. WHO and its network of collaborating laboratories are closely monitoring the situation and will issue information and advice on a regular basis as indicated.


[1] Briefing Note on recommendations for use of antivirals
[2] Weekly updates on cases of oseltamivir resistant pandemic H1N1 virus

사용자 삽입 이미지

Filed under 기사모음
[머니투데이 신수영기자][국내입국 미국인 및 접촉자 등 6명 늘어...감염자 총 10명으로]

국내에서 하루 사이에 6명이 신종플루 확진환자로 판명됐다.
보건복지가족부 질병관리본부는 23일 국내 어학원에서 외국어 강사로 일하려 입국했던 미국인 여성(23세)이 신종플루 환자로 확인된 데 이어 이 환자와 같은 오피스텔에 거주했던 5명이 신종플루에 감염된 것으로 확인됐다고 밝혔다.

이에 따라 국내 신종플루 확진환자는 현재까지 총 10명으로 늘었다. 이들과 접촉한 사람이 많을 것으로 보여 지역사회에 신종플루 확산 우려가 제기되고 있다.

하루 만에 6명의 확진환자가 확인된 것은 지난 16일 미국 샌프란시스코에서 국내 입국했던 23세 여성이 이날 새벽 확진환자로 판명되면서부터다.

이 여성은 국내 한 어학원이 모집한 외국어 강사로 입국 후 서울의 한 오피스텔에 머물며 다른 외국어 강사 65명과 업무교육을 받고 있었다.

추적 조사 결과, 이날 늦은 오후 이들 중 한명인 26세 한국 국적의 강사가 확진환자로 확인됐으며 밤 11시 경에는 추정환자로 분류됐던 4명이 모두 확진으로 확인됐다.

강사 가운데 34명은 지난 22일 서울, 경남, 부산 등으로 발령을 받은 상황이라 이들의 행적 등에 따라 추가로 추적조사를 해야 하는 대상이 늘어날 전망이다.

질병관리본부는 이들이 아직 강의를 시작하지는 않았다고 밝혔다. 그러나 일주일간 같은 장소에 머문 만큼 해당 오피스텔을 통제하고 검사를 진행하고 있다.

아울러 본부는 23세 미국인 여성 환자가 국내 입국할 때 탑승했던 비행기 승객에 대해서도 추적조사를 벌이고 있다.

앞서 국내에서 발생한 확진환자는 수녀 2명, 첫 환자 입국 비행기의 탑승객, 베트남 환승객 등 4명이었다. 보건당국은 지금까지의 확진환자가 생활반경이 적은 등 확산 우려가 없었던 반면 이번에는 지역사회로의 확산 가능성이 커진 것으로 보고 있다.

이종구 질병관리본부장은 "전국적으로 접촉자들이 파견됐다"며 "항공기 승객 추적조사를 하던 지금까지와는 달리 광범위한 추적조사를 해야 할 상황"이라고 밝혔다.

신종플루 감염 美강사 접촉한 1명도 감염

국내 체류 美강사, 신종플루 감염(상보)

모바일로 보는 머니투데이 "5200 누르고 NATE/magicⓝ/ez-i"
신수영기자 imlac@
< 저작권자 ⓒ '돈이 보이는 리얼타임 뉴스' 머니투데이, 무단전재 및 재배포 금지 >