case management of suspect influenza a h5n1 infection in humans l.
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Case Management of Suspect Influenza A (H5N1) Infection in Humans. Learning Objectives. Recognize clinical features of H5N1 in humans Treatment of cases Public health action. Clinical Features. General Information. Signs and Symptoms. Laboratory Findings.

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Presentation Transcript
learning objectives
Learning Objectives
  • Recognize clinical features of H5N1 in humans
  • Treatment of cases
  • Public health action
laboratory findings
Laboratory Findings

Commonly associated with avian influenza H5N1:

  • Drop in white blood cell count (lymphocytes)
  • Mild to moderate drop in blood platelet count
  • Increased aminotransferases (liver enzymes)
exposure to avian influenza
Exposure to Avian Influenza
  • Infected poultry, particularly contact with respiratory secretions
  • Infected wild or pet birds
  • Other infected animals (e.g., pigs, cats)
  • Wild bird feces, poultry manure and litter containing high concentrations of virus
  • Contaminated surfaces
exposures continued
Exposures Continued
  • Under- or uncooked poultry meat or eggs from infected birds
  • Contaminated vehicles, equipment, clothing, and footwear at affected sites, such as poultry farms with outbreaks
  • Contaminated air space (e.g., a barn, hen-house, or the air space proximal to barn exhaust fans)
  • Bodies of water with infected bird carcasses
  • Close contact with (within 3 feet of) confirmed cases

Cultural context can produce unique exposures

clinical specimens for testing influenza a h5n1
Clinical Specimens for Testing Influenza A (H5N1)
  • Lower Respiratory Tract*
    • Broncheoalveolar lavage
    • Tracheal aspirate
    • Pleural fluid tap
    • Sputum
  • Upper Respiratory Tract
    • Nasopharyngeal swab/aspirate
    • Oropharyngeal swabs*
    • Nasal Swab

* Preferred specimens

clinical specimens for testing
Clinical Specimens for Testing
  • Serology
    • Acute and convalescent serum specimens
      • Acute collected within 1 week of symptom onset
      • Convalescent collected 2-4 weeks after symptom onset
    • Other infections or concurrent illness
  • Specimens should be collected within 3 days of symptom onset
  • Collect all possible specimens, serial collection
avian influenza h5n1 chest x ray
Avian Influenza H5N1 Chest X-Ray

Chest x-ray of an avian influenza H5N1 patient, shown by day of illness

Day 5

Day 7

Day 10

Tran Tinh Hien, Nguyen Thanh Liem, Nguyen Thi Dung, et al. New England Journal of Medicine. 18 March, 2004. vol. 350 no. 12. pp 1179-1188.

treatment options
Treatment Options
  • Antivirals
  • Antibiotics
  • Supportive care
neuraminidase inhibitor
Neuraminidase Inhibitor
  • Two drugs available
    • Oseltamivir (Tamiflu®) and Zanamivir (Relenza ®)
    • Should be given as soon as possible
    • Effective for treatment and prevention
    • Used for seasonal and avian influenza
other treatments
Other Treatments?
  • Amantadine and Rimantadine
    • H5N1 resistant in some isolates
    • Not as effective as neuraminidase inhibitors
  • Corticosteroids
    • Low dose for sepsis
    • Unclear if high dose useful
    • Risk of side effects
  • Ribavirin
    • Ineffective against influenza viruses
response overview
Response Overview
  • Collect Case Information
    • Classify case according to case definition for surveillance
  • Facilitate specimen collection and laboratory testing
  • Information on avian influenza illness
  • Infection control measures in the home
  • Active case follow up
  • Identify close contacts and recommend chemoprophylaxis
case definitions
Case Definitions
  • Confirmed
  • Suspect
  • Report under investigation
  • Non-case
  • Refine for outbreaks
active follow up
Active Follow Up
  • Reasons for follow up
    • Specimens for testing
    • Timely notification of results
    • Monitor delivery of antiviral therapy
    • Secure antivirals if shortage
    • Note unusual clinical presentations or complications
  • Follow up by telephone
    • Patient
    • Healthcare provider (when available)
    • Surrogate (e.g. spouse)
identifying close contacts
Identifying Close Contacts
  • List of contacts from patient’s case report form
  • Close contact = Within 3 feet
    • Sharing utensils, close conversation, direct contact
  • Follow Up
    • Characterize exposure
    • Identify signs and symptoms
  • Those with symptoms treated as potential avian influenza case
recommendations to contacts
Recommendations to Contacts

No symptoms

  • Receive current influenza vaccine
  • PEP for close contacts of a confirmed avian influenza H5N1 case
    • Antiviral (neuraminidase inhibitor) and dosage information in Background section
instruction to contacts
Instruction to Contacts

No symptoms (continued)

  • Self monitor for 10 days after last exposure
    • Fever, respiratory symptoms, diarrhea, and/or conjunctivitis
    • Seek medical care if symptoms present
    • Notify public health authorities
  • Follow infection control measures in the home
  • For suspect cases, ask about recent exposure and contact with humans or animals that may have had avian influenza H5N1 infection
  • Important appropriate clinical specimens need to be collected and tested
  • Begin treatment with neuraminidase inhibitor immediately! Do not wait!
  • Case management also means identifying contacts