[health-vn] just published - Clinical Features of Human Influenza A (H5N1) Infection in Vietnam: 2004?2006

[Peter Higgs]

http://www.journals.uchicago.edu/doi/pdf/10.1086/599031



Clinical Features of Human Influenza A (H5N1) Infection in Vietnam:
2004-2006 <http://www.journals.uchicago.edu/doi/abs/10.1086/599031#fn1>

Nguyen Thanh Liem, Cao Viet Tung, Nguyen Duc Hien, Tran Tinh Hien, Ngo Quy
Chau, Hoang Thuy Long, Nguyen Tran Hien, Le Quynh Mai, Walter R. J. Taylor,
Heiman Wertheim, Jeremy Farrar, Dinh Duy Khang, and Peter Horby



Clinical Infectious Diseases 2009 48:12, 1639-1646



Background.The first cases of avian influenza A (H5N1) in humans in Vietnam
were detected in early 2004, and Vietnam has reported the second highest
number of cases globally.

Methods.We obtained retrospective clinical data through review of medical
records for laboratory confirmed cases of influenza A (H5N1) infection
diagnosed in Vietnam from January 2004 through December 2006. Standard data
was abstracted regarding clinical and laboratory features, treatment, and
outcome.

Results.Data were obtained for 67 (72%) of 93 cases diagnosed in Vietnam
over the study period. Patients presented to the hospital after a median
duration of illness of 6 days with fever (75%), cough (89%), and dyspnea
(81%). Diarrhea and mucosal bleeding at presentation were more common in
fatal than in nonfatal cases. Common findings were bilateral pulmonary
infiltrates on chest radiograph (72%), lymphopenia (73%), and increased
serum transaminase levels (aspartate aminotransferase, 69%; alanine
aminotransferase, 61%). Twenty‐six patients died (case fatality rate, 39%;
95% confidence interval, 27%-51%) and the most reliable predictor of a fatal
outcome was the presence of both neutropenia and raised alanine
aminotransferase level at admission, which correctly predicted 91% of deaths
and 82% of survivals. The risk of death was higher among persons aged 16
years, compared with older persons ( ), and the risk of death was higher
among patients who did not receive oseltamivir treatment ( ). The benefit of
oseltamivir treatment remained after controlling for potential confounding
by 1 measure of severity (odds ratio, 0.15; 95% confidence interval,
0.026-0.893; ).

Conclusion.In cases of infection with Influenza A (H5N1), the presence of
both neutropenia and raised serum transaminase levels predicts a poor
outcome. Oseltamivir treatment shows benefit, but treatment with
corticosteroids is associated with an increased risk of death.

Received 11 November 2008; accepted 21 January 2009; electronically
published 12 May 2009.





Peter Higgs

NHMRC Post doctoral fellow

Viral Hepatitis Epidemiology & Prevention Program

National Centre in HIV Epidemiology & Clinical Research

University of NSW

Sydney NSW 2010

+ 61 (0) 421 030 456



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