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Information on Bird flu, from NEJM and W.H.O. [View All]

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bluedawg12 Donating Member (1000+ posts) Send PM | Profile | Ignore Tue Oct-11-05 05:09 PM
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Information on Bird flu, from NEJM and W.H.O.
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Edited on Tue Oct-11-05 05:35 PM by bluedawg12
From what I have read the concern for avian flu is that it has jumped species. Bird to human infection occurred from poultry workers.

Felids, tigers, got infected by eating infected poultry in zoos and by experimentation on domestic cats.

As of 9-29-05 NEJM article no human to human infection has occurred.

The concern is that the virus may mutate. There is speculation that anti-viral medications used on poultry in China may have hastened resistence and or mutation.

The infection is particularly lethal and death rate is high even among patients who receive hospital ICU care.

The medication currently recommended is an anti-viral called osletamivir, but concern about resistence to this medication has been raised.

If the virus mutated and became a pathogen that could be spread person to person early treatment with in 48 hours may reduce the seriousness of the infection. But patients with serious infection require ICU ventilator support- clearly a situation that could not be handled on a large scale.

Instead of catastrophizing, the government needs to make sure that there are sufficient doses of oseltamivir for early treatment with in 48 hours of symptoms.

The first outbreak of avian influenza A(H5N1) virus in humans occurred in Hong Kong in 1997. Infection was confirmed in 18 individuals, 6 of whom died. Infections were acquired by humans directly from chickens, without the involvement of an intermediate host. The outbreak was halted by a territory-wide slaughter of more than 1.5 million chickens at the end of December 1997. The clinical spectrum of H5N1 infection ranges from asymptomatic infection to fatal pneumonitis and multiple organ failure. Reactive hemophagocytic syndrome was the most characteristic pathologic finding and might have contributed to the lymphopenia, liver dysfunction, and abnormal clotting profiles that were observed among patients with severe infection.

Gastrointestinal manifestations, raised liver enzymes, renal failure unrelated to rhabdomyolysis, and pancytopenia were unusually prominent. Factors associated with severe disease included older age, delay in hospitalisation, lower-respiratory-tract involvement, and a low total peripheral white blood cell count or lymphopenia at admission
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World Health Organization. WHO interim guidelines on clinical management of humans infected by influenza A(H5N1). February 20, 2004. (Accessed September 2, 2005, at

http://www.who.int/csr/disease/avian_influenza/guidelin...

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http://www.who.int/csr/disease/influenza/globalagenda/e...
Info at the WHO link.

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New England Journal of Medicine

Previous Volume 353:1374-1385 September 29, 2005 Number 13

Avian Influenza A (H5N1) Infection in Humans
The Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5

An unprecedented epizootic avian influenza A (H5N1) virus that is highly pathogenic has crossed the species barrier in Asia to cause many human fatalities and poses an increasing pandemic threat. ..Because many critical questions remain, modifications of these recommendations are likely...

>Animal to Human

In 1997, exposure to live poultry within a week before the onset of illness was associated with disease in humans, whereas there was no significant risk related to eating or preparing poultry products or exposure to persons with influenza A (H5N1) disease.6


Human to Human
Human-to-human transmission of influenza A (H5N1) has been suggested in several household clusters16 and in one case of apparent child-to-mother transmission (Table 3).20 Intimate contact without the use of precautions was implicated, and so far no case of human-to-human transmission by small-particle aerosols has been identified.
Serologic surveys in Vietnam and Thailand have not found evidence of asymptomatic infections among contacts.Recently, intensified surveillance of contacts of patients..and an increased number and duration of clusters in families in northern Vietnam,21 findings suggesting that the local virus strains may be adapting to humans.
However, epidemiologic and virologic studies are needed to confirm these findings.

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...
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. <
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