Early Diagnosis Could Cut Bird Flu Deaths in Indonesia

August 14, 2008

About 80 percent of human cases of highly pathogenic avian influenza A (H5N1) confirmed in Indonesia between June 2005 and February 2008 were fatal, with early antiviral treatment improving the likelihood of survival, according to a report published online Aug. 14 in The Lancet.

THURSDAY, Aug. 14 (HealthDay News) -- About 80 percent of human cases of highly pathogenic avian influenza A (H5N1) confirmed in Indonesia between June 2005 and February 2008 were fatal, with early antiviral treatment improving the likelihood of survival, according to a report published online Aug. 14 in The Lancet.

I. Nyoman Kandun, M.D., from the Ministry of Health in Jakarta, Indonesia, and colleagues examined factors associated with death from H5N1 in 127 confirmed human cases of infection in Indonesia.

The researchers report that 81 percent of the patients died, with hospitalization occurring in a median of six days. Among 122 hospitalized patients, 99 percent had fever, 88 percent had cough and 84 percent had dyspnea on reaching the hospital, although most had non-specific symptoms in the first two days after onset, the report indicates. Oseltamivir treatment was started a median seven days after onset. Survival increased with earlier treatment, with significantly lower mortality if started within two days compared with five to six days or later, the investigators found. Mortality was considerably lower in clustered compared with unclustered cases (odds ratio 33.3), with treatment beginning after a median of five days for clustered cases compared with eight days for unclustered cases, the report indicates.

"Development of better diagnostic methods and improved case management might improve identification of patients with H5N1 influenza, which could decrease mortality by allowing for earlier treatment with oseltamivir," Kandun and colleagues conclude.

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