Published Date: 2005-10-03 23:50:00
Subject: PRO/AH/EDR> Avian influenza, human - East Asia (138): WHO review
Archive Number: 20051003.2892
AVIAN INFLUENZA, HUMAN - EAST ASIA (138): WHO REVIEW
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Date: Mon 3 Oct 2005
From: ProMED-mail <promed@promedmail.org>
Source: New England Journal of Medicine online, Mon 3 Oct 2005 [edited]
<http://content.nejm.org/cgi/reprint/353/13/1374.pdf>
Avian Influenza A (H5N1) Infection in Humans - A Review
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A review article entitled "Avian Influenza A (H5N1) Infection in
Humans" has been compiled by The Writing Committee of the World
Health Organization (WHO) Consultation on Human Influenza A/H5 [see
below for a list of participants] and published in the Current
Concepts section of the New England Journal of Medicine (online).
The authors have tabulated available data on human cases of avian
H5N1 influenza virus infection, covering: incidence, transmission,
clinical features, pathogenesis, case detection and management, and
prevention. This review is an invaluable repository of information
not otherwise available on human cases of avian H5N1 influenza virus
infection.
The authors have drawn the following conclusions. Infected birds have
been the primary source of influenza A (H5N1) infections in humans in
Asia. Transmission between humans is very limited at present, but
continued monitoring is required to identify any increase in viral
adaptation to human hosts. Avian influenza A (H5N1) in humans differs
in multiple ways from influenza due to human viruses, including the
routes of transmission, clinical severity, pathogenesis, and perhaps,
response to treatment. Case detection is confounded by the
non-specificity of initial manifestations of illness, so that
detailed contact and travel histories and knowledge of viral activity
in poultry are essential. Commercial rapid antigen tests are
insensitive, and confirmatory diagnosis requires sophisticated
laboratory support. Unlike human influenza, avian (H5N1) influenza
may have higher viral titers in the throat than in the nose, and
hence, analysis of throat swabs or lower respiratory samples may
offer more sensitive means of diagnosis. Recent human isolates are
fully resistant to M2 inhibitors, and increased doses of oral
oseltamivir may be warranted for the treatment of severe illness.
Despite recent progress, knowledge of the epidemiology, natural
history, and management of influenza A (H5N1) disease in humans is
incomplete. There is an urgent need for more coordination in clinical
and epidemiologic research among institutions in countries with cases
of influenza A (H5N1) and internationally.
The WHO writing committee consisted of the following: John H. Beigel,
M.D., National Institute of Allergy and Infectious Diseases, National
Institutes of Health, Bethesda, Md.; Jeremy Farrar, D.Phil., Hospital
for Tropical Diseases, Ho Chi Minh City, Viet Nam; Aye Maung Han,
M.B., B.S., Department of Child Health, Institute of Medicine,
Yangon, Myanmar; Frederick G. Hayden, M.D. (rapporteur), University
of Virginia, Charlottesville; Randy Hyer, M.D., World Health
Organization, Geneva; Menno D. de Jong, M.D., Ph.D., Hospital for
Tropical Diseases, Ho Chi Minh City, Viet Nam; Sorasak Lochindarat,
M.D., Queen Sirikit National Institute of Child Health, Bangkok,
Thailand; Nguyen Thi Kim Tien, M.D., Ph.D., Pasteur Institute, Ho Chi
Minh City, Viet Nam; Nguyen Tran Hien, M.D., Ph.D., National
Institute of Hygiene and Epidemiology, Hanoi; Tran Tinh Hien, M.D.,
Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam;
Angus Nicoll, M.Sc., Health Protection Agency, London; Sok Touch,
M.D., Ministry of Health, Phnom Penh, Cambodia; and Kwok-Yung Yuen,
M.D., University of Hong Kong, Hong Kong SAR, China.
Address reprint requests to Dr. Hayden at the Department of Internal
Medicine, P.O. Box 800473, University of Virginia Health Sciences
Center, Charlottesville, VA 22908, or at <fgh@virginia.edu>.
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ProMED-mail
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See Also
Avian influenza - Asia (04): EU update, H5N1 20050818.2426Avian influenza, human - East Asia (117): WHO Update 20050818.2423
Avian influenza, human - East Asia (105): CDC update 20050724.2144
Avian influenza, human - East Asia (79): WHO update 20050519.1376
Avian influenza, human - East Asia (09): CDC update 20050116.0144
2004
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Avian influenza, human - East Asia (52): update 20041004.2738
Avian influenza, human - East Asia (35): Update 20040717.1939
Avian influenza - Thailand: OIE update 20040207.0438
2000
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Avian influenza virus, update 20001028.1878
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