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Advances needed in bird flu reaction

14/08/2008

Health officials have been urged to do more to speed up the identification of bird flu cases in humans.

Research conducted in Indonesia has shown the benefit of improved diagnostic methods and improved case management to diagnose patients with H5N1 influenza.

And UK experts are recommending the advice be taken on board now, rather than in "the teeth of a pandemic".

H5N1 can be fatal to humans, with Indonesia having one of the highest bird flu mortality rates.

Research published in health journal the Lancet hails the combined effect of antiviral drugs – oseltamivir – and better case management.

Dr Toni Wandra of the Indonesian ministry of health and colleagues analysed the factors associated with bird flu fatality in the south-east Asian country.

Between June 2005 and February 2008 127 confirmed bird flu infections were recorded.

Investigation teams were deployed to investigate and manage each confirmed case; they obtained epidemiological and clinical data from case-investigation reports when possible and through interviews with patients, family members and key individuals.

The researchers found that 81 per cent of infected patients died, with patients taking an average of six days to be taken to hospital.

On reaching hospital the vast majority had a fever and nine in ten had breathing problems.

However, for the first two days after onset, most patients had non-specific symptoms; only 31 had both fever and cough, and nine had fever and breathing problems.

The average time taken from the beginning of treatment with the antiviral drug oseltamivir was seven days; treatment started within two days for one patient, who survived.

One third of patients receiving treatment within six days survived compared to one fifth for treatment after seven days.

Starting treatment within two days was associated with significantly lower mortality than was starting treatment at days five to six or later.

"Early case identification and treatment with oseltamivir is key to addressing the high case-fatality rate in Indonesian cases. There is a clear need to identify definite causes for high-case fatality," the authors write.

Dr Wandra is also advocating greater poultry surveillance and for healthcare workers to be trained in case management of early H5N1 influenza.

Professor Sheila Bird from the Medical Research Council and Oxford University professor of tropical medicine Jeremy Farrar said:

"Consideration needs to be given now - not in the teeth of a pandemic, and not deflected by either proprietary defensiveness or opportunistic profiteering - to gauging the comprehensiveness of national surveillance for human H5N1 cases.

"The world also needs to find a more equitable way to ensure that all share in the benefits of such important research. Indonesia could give the lead here."