New England Journal of Medicine: Review of AI in humans by WHO

The WHO has published a synthesis of the what we know about avian influenza (H5N1) in humans in the New England Journal of Medicine (pdf here).


The summary posted on ProMED is here:

"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 discussion of the efficiency of case detection, critically important to managing the disease, is particularly interesting.  You can't treat or quarantine someone if you don't know they are infected!

Damien