Although the most notable outbreak of the swine-flu peaked in 2009, the reports regarding the virus and its treatment have continued to make headlines in mainstream media. A few days ago, researchers in Australia presented findings that indicated that a cluster of virus samples showed that it was resistant to oseltamivir in around 10% of cases in New South Wales. Oseltamivir is the active ingredient in Tamiflu.

These findings were presented at the Annual Scientific Meeting of the Australasian Society for Infectious Diseases. The emergence of this resistant strain of this virus, which is called H1N1pdm09, gave rise to several concerns among public health experts. The first concern came from the fact that this virus was found in the community, rather than with sick patients who had pre-existing conditions, which resulted in a weak immune system. This implied that the concern for the spread of the virus would not only be for particularly vulnerable patients, but also for healthy individuals. The second concern came from the fact that the H1N1pdm09 had spread to individuals who had never been treated with Tamiflu. This indicated that the virus could spread quite effectively from one person to another even if there is an oseltamivir intervention. The final concern, which was never stated by researchers, but has been noted in mainstream media, was the controversy regarding the efficacy of Tamiflu that had been reported in the last 12 months.

We were not surprised to read about a treatment resistant virus developing, as it has happened in the past with other diseases and treatments. Adamanatane was used to treat influenza but this is now largely obsolete for this purpose following a development of resistance. However, we were surprised to see that not all the reports had put the findings into context. The Australian researchers reported that they had found this to affect two per cent of their study sample, and a total of eight resistant cases were confirmed in the UK to date. Naturally it could be argued that these numbers are concerning, however they are far from alarming. Similarly, while it is important not to underestimate a new resistant strain of the virus, this strain is just one of many viruses that are circulating. This is in stark contrast to how it was when the swine flu was the dominant virus in 2009. Perhaps the most encouraging news was the fact that although H1N1pdm09 appears to be resistant to oseltamivir, other reports suggested that the same virus might be sensitive to zanamivir (which is the active ingredient in Relenza). Relenza operates in a different way from Tamiflu (even although it also disables the influenza virus through neuraminidase inhibition).

We feel that once these findings have been put into context, they show a more realistic version of the implications of this new virus. The importance of monitoring the spread of new viruses and strains of viruses is understandable, but our interpretation of the findings to date suggests that it is too early to be alarmed by these reports. The really scary flu virus is H5N1. If that started to pass from human to human in meaningful numbers then we may have a very serious problem.

The editor or the BMJ has written to the chairman of NICE requesting that they withdraw their recommendation on Tamiflu. While we support the open data campaign by the BMJ, we are not supportive of the NICE recommendation being withdrawn prior to the review of the data that have been withheld by Roche. It is our view that Roche must comply with its promise made back in 2009 to provide access to all data relating to oseltamivir, the active ingredient in Tamiflu. GSK, the manufacturer of Relenza, has already promised to make anonymised patient level data available to researchers. This level of access really should be the norm; it is actually outrageous that commercial organisations can withhold this sort of information from genuine interested parties such as academics, the medical profession and regulators such as NICE. Issuers of marketing authorisations can request this information but we understand that no request was made by the European Medicines Agency for these data. The recent infringement proceedings brought against Roche by the EMA would suggest that the company itself has not even properly evaluated the data gathered. We know from clinical practice that Tamiflu works but the profession and regulators need to know the full story.

It has been reported that supplies of Tamiflu, the antiviral prescribed for the treatment of flu, are low and according to the Department of Health, this is not a national shortage but rather local supplies experiencing temporary depletion. The NHS however says that this is an issue concerning the national supply. Where the NHS cannot provide immediate supplies, private healthcare can.

For Tamiflu to prove effective, it must be taken in the early stages and within 48 hours of symptoms developing. Tamiflu is also taken to prevent the virus from manifesting if you has been in close contact with an infected person.

The manufacturers say that they can meet the demand of the public but the warning goes out to pharmacists and those who have the power to prescribe Tamiflu, to ensure they order sensible amounts of the drug and to avoid stockpiling. It is stockpiling that will cause a national shortage.

Tamiflu and Relenza are available for next day delivery at The Online Clinic following a short online consultation with one of our doctors.

Previously criticised for its ineffectual role in the H1N1 pandemic of 2009, Tamiflu is now to be praised for its effects on flu patients thanks to research carried out by the Chinese Centre for Disease Control and Prevention.

The study published in the British Medical Journal showed that out of 1,200 patients who were being treated in a hospital for swine flu, those who were treated with Tamiflu were 80% less likely to develop pneumonia.

Moreover, the research uncovered that beginning the course of Tamiflu (oseltamivir) within 2 days of experiencing flu symptoms, reduced the spell of fever and the patients became less contagious.

Two of the swine flu centres opened to cope with the pandemic are to close this week after demand for the service fell. The Department of Health say that the decision was made after infection rates fell back quickly.

The two centres scheduled to close are in Watford and Farnborough.

1,200 posts will go but the spokesperson from the Department of Health said that as the service was flexible it could be scaled back up if infection rates rose. They have warned that they expect a second wave of infection in Autumn as the schools start their new term and in Winter, the traditional flu season.

The swine flu centres opened to take the strain of GPs and NHS staff when they were swamped with cases and patients afraid that they might have contracted the strain of Influenza. The staff in the centres, some of which remain open, are able to authorise prescriptions of the anti-viral Tamiflu, which designated ‘flu friends’ can pick up for the patient.

The service is run by NHS Professionals and a private company, Teleperformance. NHS Professionals said the move was due to “much lower than expected call volumes”.

This week the WHO gave the advice that healthy patients whose illness was uncomplicated did not need to be prescribed anti-viral drugs like Tamiflu. There has been growing controversy about the prescription of Tamiflu in the UK, especially regarding its being given to children.

Andy Burham, the health secretary, has refuted claims that giving Tamiflu to children may be more dangerous than leaving them to fight the infection of by themselves.

A study in the British Medical Journal indicated that both Tamiflu and Relenza rarely prevented children suffering from seasonal flu from developing complications, but did leave them with a variety of side effects.

Burnham went on GMTV (his favourite place) and was forced to respond to presenter Andrew Sweet when he claimed that his 16-year old daughter nearly died after being given Tamiflu without being properly diagnosed. She has asthma.

The secretary was sympathetic but said that advice to parents regarding Tamiflu had not changed. He described the government strategy as “very much a safety-first approach.” He then concluded that as swine flu hit children especially hard, Tamiflu was the only option.

University of Oxford researchers urgently called on the Department of Health to reconsider its pandemic strategy, as they said that the government was pursuing an “inappropriate strategy.” Their study showed that children without underlying health problems recovered only between half a day to a day quicker.

However 1 in 20 children given the medicine suffered from vomiting, which can lead to dehydration and eventual hospitalisation. There have also been reports of under-14s experiencing hallucinations and nightmares.

The Oxford team said that wide-spread prescription of Tamiflu was unnecessary and could lead to the virus becoming resistant against anti-virals. Since the National Pandemic Flu Service was launched a few weeks ago, over 300,000 people have been prescribed anti-virals, with the largest group being the under-15s.

After prospective mothers were issued with alarming advice to consider putting off getting pregnant until the swine flu pandemic has passed, Andy Burnham, the health secretary, today urged the British public to have confidence in how the NHS was handling the crisis.

The weekend saw a spate of worrying headlines hit the newspapers, from conflicting advice about what pregnant women should do to protect themselves to criticism of the handling of the pandemic hotline.

The NHS Website had advised pregnant women to reduce their chances of getting infected by avoiding public transport and crowded spaces. The Royal College of Midwives went further and suggested expectant mothers might want to leave earlier or later to avoid rush hour tubes. It is believed pregnant women are particularly at risk from swine flu, as their immune systems work less well to prevent the baby being rejected.

However the website was then changed on Sunday and later the department of heath released a statement saying that they “might consider” avoiding crowds but that it was important to carry on with their routine.

The National Childbirth Trust advised women to consider postponing pregnancy, but the chairman of the Royal College of GPs dismissed the advice as ‘scaremongering.”

Meanwhile, the Observer newspaper carried a story claiming that the national pandemic hotline, providing advice to patients and helping distribute anti-viral drugs, was severely delayed by infighting between different Whitehall departments.

Andy Burnham went on to GMTV (he seems to like it there – he’s made a couple of “don’t panic” type statements from the comfort of their squishy sofas) to deny that there had been any conflicting advice issued.

He said that Britain had the best preparations in place to cope with the pandemic and was dealing with it “fantastically well.” There have, however, been reports of chaos at the first distribution centre for anti-virals in London and we have noticed a deluge of new enquiries from members of the public who do not trust the Government's system of distribution to get Tamiflu to them in time.  There has also been concern that the new Swine Flu hotline will be staffed by people without any medical training.

A memo leaked to The Times has revealed that senior healthcare officials are concerned that the NHS is not well enough prepared to deal with the expected swine flu explosion over the next few months.

In correspondence between the officials, they seemed to express views that plans to hand out medication and relieve the strain on GP and hospital services are a “complete waste” of time. A memo leaked from the health service indicated that current emergency plans are contradictory and confused.

The memo accused the government of “muddled” thought processes. Its author suggested that the creation of Tamiflu vouchers, where someone diagnosed over the phone with swine flu can send a representative to pick up their prescription, could actually hamper efforts to distribute medication. He argued that existing prescription forms would work just as well.

Sir Liam Donaldson, the chief medical officer, has admitted that they can not be sure of how many people in the UK have contracted swine flu as many people, as the symptoms are mild, will have chosen to stay at home and not contract their doctor.

The chief medical officer for the government, Sir Liam Donaldson, has warned the public not to panic-buy anti-viral drugs to treat swine flu on the internet. As well as reminding the population that the NHS has stockpiled large amounts of the drug Tamiflu, he warned that many companies were selling counterfeit versions of the medication.

The instructions come as the government admitted that the virus was no longer containable. It is now expected that within a month as many as 100,000 new cases could be diagnosed each day. Andy Burnham, the health secretary, said the NHS had now moved to ‘treatment phase’ in dealing with the pandemic. This means that schools will no longer close as a matter of course when a case is diagnosed and anti-viral medications will not routinely be given as a preventative measure when someone comes into contact with the virus.

Some experts have predicted that this will lead people to seek the medication from online pharmacies. The Royal Pharmaceutical Society’s Director of Policy David Pruce warned that internet sites could be based anywhere in the world and added that counterfeiters had become so good at copying the medication it was impossible to tell the fakes from the real thing.

As a guideline, Tamiflu and Relenza are both prescription-only medications. You should only be able to buy the drugs with a prescription, and if online clinics claim that they can provide you with this, check the registration details of the prescribing doctor. Then check that the pharmacy is registered with the Royal Pharmaceutical Society.

In a fairly uncharacteristic move, the European Medicines Agency said that the anti-viral medication Tamiflu could be used as long as two years after the given shelf life expires. The agency said that in response to the possibility of a pandemic, they were recommending that stocks of Tamiflu not be thrown away for at least seven years after the date of manufacture. It is hoped that their statement will ease pressure on Roche, the pharmaceutical company that manufactures the drug. Roche has recently received large-scale orders from the British government.  

Roche today themselves announced plans to donate 5.64 million doses of Tamiflu to the World Health Organisation, to assist them in their efforts to combat swine flu. In a statement, the company said that production would be massively boosted over the coming months. Over the next five months they said they were intending to produce another 110 million doses of the anti-viral medication.

We now have enough Tamiflu in stock to guarantee next day delivery. This only applies to Tamiflu hard capsules as it has been impossible to obtain further supplies of the suspension that is used for people who find it difficult to swallow capsules or children who require a dosage adjustment.

We are still unable to supply Relenza at the momet but we are doing our best to obtain stocks of this item.

If you have any questions about obtaining antivirals to treat influenza, please do not hesitate to get in touch with us by e-mail or by calling us on 020 7419 5064. You can of course request a free influenza consultation through our website.

We have managed to secure a supply of Tamiflu and this will be dispensed on a first come, first served basis. The medication will be dispensed on Thursday 7th May for delivery on Friday 8th May.

The supply that we have secured is sufficiently large for us to start taking new orders again. You can register for a free consultation at Tamiflu.

Following the unprecedented media coverage of the outbreak of swine flu we have received a huge number of orders for Tamiflu and Relenza, both of which appear to be effective against this H1N1 strain of the influenza virus. The Government has placed a restriction on the sale of Tamiflu and Relenza by their respective manufacturers for the time being so the whole of the UK pharmaceutical supply network is now out of stock.  We are doing our best to obtain supplies for our customers but we cannot do so until the Government modifies or lifts the restriction on the sale by the manufacturers.

We are now restricting patients to one course of Tamiflu or Relenza per person and we will not prescribe for children in an online environment. Children require a dosage adjustment based on weight for Tamiflu and Relenza cannot be taken by children under the age of 5. We will modify the order restriction when we have a clear idea of the amount of stock that will be released to the supply chain.

We are still prepared to take orders for both Tamiflu and Relenza and place customers on a waiting list which will be satisfied in strict sequential order. We will be providing regular updates via e-mail to anyone who has bought either of these medications up until the time that the medication is dispatched.

If any customer has any query then they should call the helpline on 020 7419 5064.

Most of us are aware of huge number of fake goods that are being produced in the Far East. Handbags, clothes, and electronic goods…the list goes on. Go to any street corner or market in a large city and you will be able to pick up the latest designer bag or sunglasses, which, to the untrained eye, are almost identical to the real thing.

Recently this trend for counterfeit goods has moved into far more dangerous territory- prescription drugs. Buying a fake handbag will, perhaps, cause a loss of profit to the manufacturers of the real things but buying fake drugs could cause real damage to your body.

Every day of the year hundreds of millions of spam emails arrive in the in-boxes of practically every computer around the world advertising unlicensed anti-impotence drugs. These emails contain links to the thousands web of sites selling untested and unlicensed products which are, at best, not as effective as the real thing and at worst contain ingredients which can be dangerous to your health

Whilst it might have seemed that the counterfeiters were concerned predominantly with anti-impotence medication, however, now it seems that they have many other drugs on the agenda: the market for counterfeit drugs is expanding at an alarming rate into ‘cancer treatment’ drugs and even into Tamiflu. It might be hard to fathom that people would stoop so low as to sell fake influenza medication. The production of Tamiflu, however, is big business.

The good news is that scientists in Georgia in the United States have come up with a simple test, which can quickly determine the authenticity of Tamiflu. The whole process takes one minute, twenty times faster than the previously available test. The test uses a process called Desorption Electrospray Ionisation Mass Spectrometry or DESI-MS and is able to determine whether the purported Tamiflu medication is genuine or counterfeit.

Dr. Facundo Fernandez, of the Georgia Institute of Technology said that people should be extremely wary of websites selling very cheap Tamiflu, as it is unlikely to be real. The Online Clinic is one of the few websites in the UK that prescribes genuine Tamiflu following an online consultation. Always check that your medication is coming from a registered pharmacy. If the price looks too good to be true then it probably is!

The UK Government has finally caved in and ordered a further 15 million courses of Tamiflu, the influenza anti-viral medication which would be used in the event of a flu pandemic in an effort to contain the virus.  Without any intervention whatsoever, it is predicted that a flu pandemic could infect up to half of the population.  The new order will mean that the Government has ordered around 30 million courses of Tamiflu which would cover half of the population.  It was originally intended that the medication would only be prescribed to those displaying symptoms but this flew in the face of medical advice which we have stated here before.  In order to contain the virus it will be essential to prescribe the medication to immediate family members of infected patients as this should mean that those who do get infected will have only minor symptoms or no symptoms whatsoever as the virus is unable to replicate itself, thereby reducing the death toll.

Government ministers have also agreed to a spend of £155 million on a vaccine but this can only be developed after we know what the human to human virus looks like.  It will take a few months to develop after the shape of the virus becomes known but it should stop a second wave of infections.

We have had quite a few e-mails about the latest outbreak of bird flu in Suffolk.  Essentially we are advising people not to panic.  There is no real risk to the public at this stage and the Food Standards Agency has insisted that there is no danger of the virus being transferred to humans through the consumption of poultry so long as the birds are cooked properly.  This means that the poultry should be cooked until the juices run clear and make sure there is no red or pink meat.

The World Health Organisation continues to advise governments to stockpile Tamiflu in case of a pandemic and we are prepared to give private prescriptions for Tamiflu as a precaution.

A Swedish scientist has warned of the severe dangers of abusing Tamiflu as the active ingredient survives the sewerage process, which presents the danger that a Tamiflu resistant version of bird flu may develop.  This was the claim earlier today by Jerker Fick of the Umea University.

It was pointed out that Japan (probably the largest consumers of Tamiflu worldwide) was beginning to become resistant to the therapeutic benefits of Tamiflu.  In the flu season of 2004 -2005, 16 million Japanese people caught the flu and 6 million were prescribed Tamiflu!  Studies have confirmed that there appears to be an emerging resistance to Tamiflu.  A study in 2004 showed that 18% of a group of flu infected children had a mutated form of the virus which made them up to 100,000 times more resistant to Tamiflu.

This comes at a time when Roche (the Tamiflu manufacturer) has just announced that it has enough stocks for the upcoming flu season and also that it has received regulatory approval in Europe for smaller dose capsules suitable for paediatrics. The normal dose is 75 mg for an adult but children weighing less than 40 kg require a dosage adjustment and this is normally effected through Tamiflu suspension but this is complicated and it does not have a long shelf life.  The new dosages are in 30 mg and 45 mg.

The Department of Health has finally accepted the argument that we have been making for the last year or so that the order that they have placed for a stock pile of 14.6 million doses of Tamiflu will not be sufficient to contain a flu pandemic.  It is our view that the most effective way to treat a flu outbreak is to prescribe on the basis of preventative therapy and the stock that the government has in place would not allow for that given their estimates of the infection rate.

Government figures have suggested that a flu pandemic could infect up to half of the population and kill up to 750,000 people.  A further study has suggested that those figures could be reduced by 40-50 per cent if the Tamiflu antiviral is available to treat everyone who requires it.

Tamiflu is available on prescription through The Online Clinic on the basis of immediate need or as a precautionary measure in advance of need.  Studies have shown that Tamiflu can stop 89 per cent of those exposed to the flu virus of falling ill.

Tests have shown that the Thai-made generic version of the anti-viral drug Oseltamivir, better known as Tamiflu, appears to be safe and effective in the treatment and prevention of avian influenza, according to a top official a Thai state-owned drug firm.

The Thai-produced Oseltamivir, called “A” Flu, which is manufactured by the Government Pharmaceutical Organization (GPO), is due to be submitted to Thailand’s Food and Drug Administration for approval consideration within the coming two months.

According to GPO, the Faculty of Medicine at Siriraj Hospital carried out bio-equivalence studies and clinical trials in 30 patients. The tests showed the Thai-made drug to be bio-equivalent to Tamiflu in terms of absorption, disposition and efficacy.

The Thai government has said it planned to build a stockpile of one million courses of the antiviral drug as a defence against a possible flu pandemic.

The Thai produced generic Tamiflu cannot be exported to any country where Roche has a patent for its original Tamiflu product. Anyone in the UK wishing to purchase Tamiflu should either visit their GP or get a free consultation with The Online Clinic or another reputable online healthcare provider.