Tamiflu is one of a number of medications which the average sewage treatment plant can't break down. It tends to go through us as well.
For their new study, Gopal Ghosh and his colleagues at Kyoto University sampled water discharged from three local sewage treatment plants and water at several points along two rivers into which the treated water flowed. Sampling started early in December 2008, as flu season got underway. The researchers sampled again at the height of the seasonal flu’s onslaught in early February and again as infection rates waned.
Tamiflu’s active form, oseltamivir carboxylate or OC, turned up in the treated sewage on every occasion, the researchers report online September 28 in Environmental Health Perspectives. Values were in the low nanograms per liter range during the first and last samplings, and reached a high of almost 300 ng/L at one outflow during the flu’s peak, a week when there were 1,738 recorded flu cases in Kyoto.
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Once ingested, virtually all Tamiflu will end up in the environment in the active form, notes environmental chemist Jerker Fick of Umeå University in Sweden. The reason: Tamiflu becomes active once the body converts it into a carboxylate form. Roughly 80 percent of an ingested dose becomes this OC, which the body eventually excretes. The body sheds 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.
The worry is that waterfowl could be exposed to sufficient concentrations of the compound that some flu viruses could develop resistance to Tamiflu.
If Tamiflu resistance does develop in exposed birds, the affected flu strains will probably be conventional seasonal and avian flu strains, which claim thousands of lives each year, and not H1N1. That’s because H1N1 seems to bypass birds as it spreads among people, notes William Schaffner, chair of preventive medicine at the Vanderbilt University School of Medicine in Nashville, Tenn.
The latest World Health Organization numbers (Sept 20) show that H1N1 has killed 3,917.
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