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Conventional medicine’s drug-of-choice for H1N1, Tamiflu, has now been found downstream in some Japanese rivers.  Of course, the main concern, for those that believe that Tamiflu is a harmless and helpful drug, is that birds, which naturally carry the influenza virus, are now being exposed through the water to residues of Tamiflu’s active form (oseltamivir phosphate).  This could definitely result in the posibility of eventually spreading drug-resistant strains of the seasonal and avian flu. 

According to chemists, discharge water was sampled from three of the local sewage treatment plants as well as several areas along two rivers into which the treated water flowed.  The sampling began in December 2008 at the beginning of flu season. Samples were taken again during the height of flu season in February and then once more as the flu season came to a close.

Not surprisingly, since many drugs have been found in our rivers and streams, oseltamivir carboxylate was found in the treated sewage at every testing attempt which was reported online on September 28 in Environmental Health Perspectives. The values were actually in the low nanograms per liter range at the first and last samplings but reached a high of almost 300 ng/L during the flu’s peak, when there were 1,738 recorded flu cases in Kyoto.

According to Wolf von Tumplling Jr. of the Helmholtz Center for Environmental Research, Magdeburg, Germany, computer modeling has shown that OC should survive sewage treatment.  His own data show that once exposed to sunlight, OC will slowly break down by half every three weeks. If early predicted correlations are correct, the concentrations measured at some river sites in the Kyoto study are possibly “high enough to lead to antiviral resistance in waterfowl.”  von Tumpling also indicates that it is interesting to note that the Kyoto team didn’t test during a time of flu pandemic, when Tamiflu prescriptions would be at an all-time high.

According to environmental chemist Jerker Fick of Umea University in Sweden, virtually all Tamiflu, once ingested, ends up in the environment in the active form. This is because Tamiflu becomes active once the body converts it into a carboxylate form.  About 80 percent of an ingested dose of Tamiflu will become OC, which the body eventually excretes. The body does shed the remaining 20 percent of Tamiflu in its original form, but this phosphate form is immediately turned into the active, carboxylate form when it reaches a water treatment plant, he says.

Two years ago, Fick’s team published data that showed that most sewage-treatment technologies removes “zero percent” of any OC present. Since ducks love hanging out around warm, nutrient-rich outflows of treated water during winter-flu season we can see that a definite concern exists. Fick said that he personally witnessed this while in Japan.

William Schaffner from Vanderbilt University School of Medicine in Tennessee suggests that should Tamiflu resistance develop out-right in exposed birds, the most affected flu strains will likely be conventional seasonal and avian flu strains and not H1N1.  This is because H1N1 has the tendency to bypass birds as it spreads among people.

Supposedly U.S. policy regarding Tamiflu use is more conservative than Japan’s. Federal guidelines recommend that “Tamiflu be reserved for treatment of the very sick and anyone who is immunocompromised.”  Unfortunately I have not seen this conservative policy among most doctors.  It seems that the first thing that most people ask for is Tamiflu and usually their request is approved.