WHO Releases a Summary of its Second Consultation on Human H5N1 Infection
By Eric Toner, M.D., April 20, 2007
On April 19, 2007, the World Health Organization (WHO) posted a summary of its second expert meeting on clinical aspects of H5N1 infection in humans. This second meeting was held in Antalya, Turkey on March 19-21; the first was held in Hanoi in May, 2005.
Early treatment with oseltamivir appears to be effective in reducing mortality from H5N1 infection.
Because there is evidence of prolonged viral replication in human H5N1 infection, treatment with oseltamivir is warranted, even if a patient presents late in the course of the illness.
Oseltamivir given at 2x the standard dose and for a longer course of treatment may be beneficial for some, and should be considered on a case by case basis for patients with pneumonia or progressive disease.
Corticosteroids have not been beneficial and have resulted in serious complications and should therefore not be used unless there is another indication.
Routine antibiotic prophylaxis should not be used in patients with confirmed H5N1 infections.
Patients with H5N1-associated Acute Respiratory Distress Syndrome (ARDS) should receive lung-protective mechanical ventilation with low tidal volumes.
A full report of the meeting and revised clinical guidance will be published in the future.
Summary of the second WHO consultation on clinical aspects of human infection with avian influenza A(H5N1) virus. WHO web site. Available online at: http://www.who.int/influenza/human_animal_interface/epidemiology_clinical/clinical_meeting_h5n1_19_03_2007/en/. Accessed April 20, 2007.