Meeting Report: Risk Assessment of Tamiflu Use Under Pandemic Conditions

Abstract

On 3 October 2007, 40 participants with diverse expertise attended the workshop Tamiflu and the Environment: Implications of Use under Pandemic Conditions to assess the potential human health impact and environmental hazards associated with use of Tamiflu during an influenza pandemic. Based on the identification and risk-ranking of knowledge gaps, the consensus was that oseltamivir ethylester-phosphate (OE-P) and oseltamivir carboxylate (OC) were unlikely to pose an ecotoxicologic hazard to freshwater organisms. OC in river water might hasten the generation of OC-resistance in wildfowl, but this possibility seems less likely than the potential disruption that could be posed by OC and other pharmaceuticals to the operation of sewage treatment plants. The work-group members agreed on the following research priorities: a) available data on the ecotoxicology of OE-P and OC should be published; b) risk should be assessed for OC-contaminated river water generating OC-resistant viruses in wildfowl; c) sewage treatment plant functioning due to microbial inhibition by neuraminidase inhibitors and other antimicrobials used during a pandemic should be investigated; and d) realistic worst-case exposure scenarios should be developed. Additional modeling would be useful to identify localized areas within river catchments that might be prone to high pharmaceutical concentrations in sewage treatment plant effluent. Ongoing seasonal use of Tamiflu in Japan offers opportunities for researchers to assess how much OC enters and persists in the aquatic environment.

Fate and removal of pharmaceuticals and illicit drugs in conventional and membrane bioreactor wastewater treatment plants and by riverbank filtration

“…Another factor to consider is the outbreak of certain diseases, such as the case of pandemic of avian influenza, that would lead, as predicted for selected US and UK catchments, to high concentrations of antiviral drugs (especially of oseltamivir carboxylate (OC), the main metabolite of tamiflu). Concentrations of OC in catchments with low flow and high populations are predicted to be more than 20 mg l −1 , which may affect the function and stability of WWTP (Singer et al 2007(Singer et al , 2008.…”

Antibody targeting of TSG101 on influenza-infected cells

“…Many human and avian virus strains have become resistant to conventional influenza antiviral drugs. [43][44][45][46][47][48][49][50] The fact that seemingly unrelated viruses, such as HIV and Ebola viruses, utilize TSG101 in a manner analogous to our present findings with influenza suggests that these viruses have not evolved alternative mechanisms to facilitate viral budding. This raises an intriguing question of whether TSG101-independent viral variants could arise.…”

Pharmaceuticals in the environment: an educational perspective

“…Oseltamivir is relatively persistent, and its dispersion into the environment could foster the development of resistance (Singer et al 2007;Fick et al 2007). Though recent environmental risk assessments (ERA) according to the European Medicines Agency (EMEA; Committee for Medicinal Products for Human Use 2006) alleviate worries concerning potential risks (Hutchinson et al 2009;Straub 2009), we consider the resistance aspect to be important because the possibility for resistance cannot be categorically ruled out (Singer et al 2008). However, resistance has not yet been considered in the ERA concept of EMEA.…”