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avian influenza A; H5N1 influenza; H5 influenza

H5N1 strain of avian flu is infecting some people in Asia. [1,2] see CDC for further information [15] Epidemiology: 1) spread to people by contact with infected birds or droppings 2) evidence of human to human transmission [3,14] 3) 100 reported infections in 2003-2004 4) 1918 pandemic Spanish influenza may be avian flu [5] 5) in New England in the fall of 2011, a strain of avian flu spread to seal pups, then gained the ability to pass from seal to seal & killed over 160 seal pups [15] Pathology: - in monkeys Avian Flu of 1918 (Spanish flu) provoked & excessively vigorous immune response in monkeys Clinical manifestations: 1) respiratory symptoms may not be observed [3] 2) diarrhea [3] 3) encephalitis a) seizures b) coma Laboratory: 1) viral culture from throat, serum, feces, CSF [3] 2) elevated protein only CSF abnormality [3] 3) avian flu/acute respiratory virus testing Complications: 50% mortality [3,4] Management: 1) prevention a) influenza vaccine not proven effective [13] b) H5N1 avian flu vaccine in development 2) antivirals may be of benefit a) virus apparently sensitive to Tamiflu & Relenza [4] - resistance to oseltamivir (Tamiflu) emerging [7,9] b) amantadine & rimantadine of no benefit

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avian flu/acute respiratory virus testing influenza travel medicine (traveler's health)

General

influenza A virus animal disease

References

  1. Prescriber's Letter 11(3):18 2004 Detail-Document#: 200309 (subscription needed) http://www.prescribersletter.com
  2. Li KS, Guan Y, Wang J, Smith GJ, Xu KM, Duan L, Rahardjo AP, Puthavathana P, Buranathai C, Nguyen TD, Estoepangestie AT, Chaisingh A, Auewarakul P, Long HT, Hanh NT, Webby RJ, Poon LL, Chen H, Shortridge KF, Yuen KY, Webster RG, Peiris JS. Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. Nature. 2004 Jul 8;430(6996):209-13. PMID: 15241415
  3. Journal Watch 25(5):42-43, 2005 Ungchusak K, Auewarakul P, Dowell SF, Kitphati R, Auwanit W, Puthavathana P, Uiprasertkul M, Boonnak K, Pittayawonganon C, Cox NJ, Zaki SR, Thawatsupha P, Chittaganpitch M, Khontong R, Simmerman JM, Chunsutthiwat S. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med. 2005 Jan 27;352(4):333-40. Epub 2005 Jan 24. PMID: 15668219 - de Jong MD, Bach VC, Phan TQ, Vo MH, Tran TT, Nguyen BH, Beld M, Le TP, Truong HK, Nguyen VV, Tran TH, Do QH, Farrar J. Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med. 2005 Feb 17;352(7):686-91. PMID: 15716562 - Stohr K. Avian influenza and pandemics--research needs and opportunities. N Engl J Med. 2005 Jan 27;352(4):405-7. Epub 2005 Jan 24. PMID: 15668221 - Monto AS. The threat of an avian influenza pandemic. N Engl J Med. 2005 Jan 27;352(4):323-5. Epub 2005 Jan 24. PMID: 15668220
  4. Prescriber's Letter 12(9): 2005 Influenza Update 2005 Detail-Document#: 210904 (subscription needed) http://www.prescribersletter.com
  5. Tumpey TM, Basler CF, Aguilar PV, Zeng H, Solorzano A, Swayne DE, Cox NJ, Katz JM, Taubenberger JK, Palese P, Garcia-Sastre A. Characterization of the reconstructed 1918 spanish influenza pandemic virus. Science. 2005 Oct 7;310(5745):77-80. PMID: 16210530 - [No authors listed] The 1918 flu virus is resurrected. Nature. 2005 Oct 6;437(7060):794-5. No abstract available. PMID: 16208326 - Kaiser J. VIROLOGY: Resurrected Influenza Virus Yields Secrets of Deadly 1918 Pandemic. Science. 2005 Oct 7;310(5745):28-9. PMID: 16210501 - Taubenberger JK et al, Characterization of the 1918 influenza virus polymerase genes Nature 2005 Oct 6;437(7060):889-93 PMID: 16208372
  6. Beigel JH, Farrar J, Han AM, Hayden FG, Hyer R, de Jong MD, Lochindarat S, Nguyen TK, Nguyen TH, Tran TH, Nicoll A, Touch S, Yuen KY; Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5. Avian influenza A (H5N1) infection in humans. N Engl J Med. 2005 Sep 29;353(13):1374-85. Review. PMID: 16192482
  7. Le QM, Kiso M, Someya K, Sakai YT, Nguyen TH, Nguyen KH, Pham ND, Ngyen HH, Yamada S, Muramoto Y, Horimoto T, Takada A, Goto H, Suzuki T, Suzuki Y, Kawaoka Y. Avian flu: isolation of drug-resistant H5N1 virus. Nature. 2005 Oct 20;437(7062):1108. PMID: 16228009
  8. Prescriber's Letter 13(1): 2006 FDA alerts to Protect Public form Fraudelent Avian Flu Therapies Detail-Document#: 220113 (subscription needed) http://www.prescribersletter.com
  9. de Jong MD et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 2005 Dec 22; 353:2667-72. PMID: 16371632 - Moscona A. Oseltamivir resistance - Disabling our influenza defenses. N Engl J Med 2005 Dec 22; 353:2633-6. PMID: 16371626
  10. Shu Y et al, Lethal avian influenza A (H5N1) infection in a pregnant woman in Anhui provcixne, China N Engl J Med 2006; 354:1421 PMID: 16571888
  11. Oner AF et al, Avian influenza A (H5N1) infection in eastern Turkey in 2006. N Engl J Med 355:2179 http://content.nejm.org/cgi/content/full/355/21/2179 - Kandun IN et al, Three Indonesian clusters of H5N1 virus infection in 2005. N Engl J Med 355:2186 http://content.nejm.org/cgi/content/full/355/21/2186 - Webster RG & Govorkova EA H5N1 influenza - continuing evolution and spread. N Engl J Med 355:2174 http://content.nejm.org/cgi/content/full/355/21/2174
  12. Kobasa D et al, Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus. Nature 2007, 445:319 PMID: 17230189
  13. Prescriber's Letter 14(5): 2007 FDA Approves Avian Flu Vaccine for Humans Detail-Document#: 230510 (subscription needed) http://www.prescribersletter.com
  14. Wang H, Feng Z, Shu Y, Yu H, Zhou L, Zu R, Huai Y et al Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China. Lancet. 2008 Apr 26;371(9622):1427-34. Epub 2008 Apr 8. PMID: 18400288
  15. Anthony SJ et al Emergence of Fatal Avian Influenza in New England Harbor Seals MBio 3(4):e00166-12, Juy 31, 2012 PMID: 22851656 http://mbio.asm.org/content/3/4/e00166-12.full
  16. Laine C, Qaseem A, Moyer DV, Cotton D. H5N1 Influenza: What Physicians Need to Know. Ann Intern Med. 2024 Sep 10. PMID: 39250807 https://www.acpjournals.org/doi/10.7326/ANNALS-24-02440
  17. Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/flu/avian/ - Key Facts About Avian Influenza (Bird Flu) & Avian Influenza A (H5N1) Virus http://www.cdc.gov/flu/avian/gen-info/facts.htm
  18. Pandemic/Avian Flu http://www.pandemicflu.gov http://www.pandemicflu.gov/plan/healthcare/index.html http://www.pandemicflu.gov/plan/healthcare/index.html#guidelines