Drug-resistant strains of swine flu are cropping up around the globe - with four cases confirmed at a North Carolina hospital on Friday. The virus reported at Duke University Medical Center doesn't respond to Tamiflu, one of two medications used to treat severe cases of the bug.
Health officials are keeping a close eye on drug-resistant strains that spread from person to person because they could be signs H1N1 is mutating.
The Duke cases involve four very ill patients who caught the virus on a cancer unit, and three have died, officials said.
As the Centers for Disease Control launched an investigation, there were reports out of Britain that five patients with H1N1 in a Welsh hospital have not responded to Tamiflu.
The British Health Protection Agency said the patients had an underlying health condition that can cause resistance. All of them did respond to the antiviral Relenza.
"At present we believe the risk to the general healthy population is low," the agency said in a statement.
Meanwhile, the World Health Organization said it's investigating samples of variant swine flu linked to two deaths and one severe case in Norway.
The significance of the mutation is unclear, though Norwegian officials said it "could possibly...cause more severe disease" because it infects tissue deeper in the airway than usual.
Health experts say extraordinary measures against swine flu - most notably quarantines imposed by China, where entire planeloads of passengers were isolated if one traveler had symptoms - have failed to contain the disease.
Despite initially declaring success, Beijing now acknowledges its swine flu outbreak is much larger than official numbers show.
China's official count of nearly 70,000 reported illnesses with 53 deaths is dwarfed by estimates of millions of cases with nearly 4,000 deaths in the United States, a nation with about a third of China's population.
Dr. Michael O'Leary, WHO's top representative in China, says there has been a dramatic spike in Chinese swine flu cases recently and those reported by the government are only "minimum numbers."
"We have new cases occurring all the time," he told The Associated Press last week. "There's always more deaths than we could possibly know about."
He said there is little data to prove interventions like mass quarantines and school closures slow down disease transmission. "To draw a causal link ... is not always possible," O'Leary said, adding that WHO expected a disease as contagious as swine flu to spread regardless of what measures countries impose.
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