Infectious Diseases 2008

Infectious Diseases 2008

Indonesia: Factors associated with case fatality of human H5N1 virus infections

Research 19 August, 2008 Indonesia has had the most human cases of highly pathogenic avian influenza A (H5N1) and one of the highest case-fatality rates worldwide.
A recent study, published online Aug 15 in The Lancet includes data from public health investigations and, when available, patients' clinical information. The evaluation covered all confirmed human cases between Jun 22, 2005 to Feb 1, 2008.
Of the 127 patients with confirmed H5N1 infections, 103 (81%) died. Median time to hospitalisation was 6 days (range 1–16). Of the 122 hospitalised patients for whom data were available, 121 (99%) had fever, 107 (88%) cough, and 103 (84%) dyspnoea on reaching hospital. However, for the first 2 days after onset, most had non-specific symptoms; only 31 had both fever and cough, and nine had fever and dyspnoea. Median time from onset to oseltamivir treatment was 7 days (range 0–21 days); treatment started within 2 days for one patient who survived, four (36·4%) of 11 receiving treatment within 2–4 days survived, six (37·5%) of 16 receiving treatment within 5–6 days survived, and ten (18·5%) of 44 receiving treatment at 7 days or later survived (p=0·03). Initiation of treatment within 2 days was associated with significantly lower mortality than was initiation at 5–6 days or later than 7 days (p<0·0001). Mortality was lower in clustered than unclustered cases (odds ratio 33·3, 95% CI 3·13–273). Treatment started at a median of 5 days (range 0–13 days) from onset in secondary cases in clusters compared with 8 days (range 4–16) for primary cases (p=0·04).