Giuseppe
Emeritus
The Lancet DOI:10.1016/S0140-6736(08)61125-3 - Articles
Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series
I Nyoman Kandun MD a, Erna Tresnaningsih MD a, Wilfried H Purba DVM a, Vernon Lee MBBS c, Gina Samaan MAppEpid c, Syahrial Harun MSc b, Eka Soni BSc a, Chita Septiawati MD a, Tetty Setiawati MD a, Elvieda Sariwati MD a and Toni Wandra MD a
Summary
Background
Indonesia has had the most human cases of highly pathogenic avian influenza A (H5N1) and one of the highest case-fatality rates worldwide.
We described the factors associated with H5N1 case-fatality in Indonesia.
Methods
Between June, 2005, and February, 2008, there were 127 confirmed H5N1 infections.
Investigation teams were deployed to investigate and manage each confirmed case; they obtained epidemiological and clinical data from case-investigation reports when possible and through interviews with patients, family members, and key individuals.
Findings
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).
Interpretation
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.
Funding
None.
Affiliations
a. Directorate General of Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia
b. National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
c. WHO, Indonesia Country Office, Jakarta, Indonesia
Correspondence to: Toni Wandra, Directorate General of Disease Control and Environmental Health, Ministry of Health, Jl Percetakan Negara 29, Katak Pos 223, Jakarta 10560, Indonesia
-
http://www.thelancet.com/journals/lancet/article/PIIS0140673608611253/abstract?iseop=true
-------
Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series
I Nyoman Kandun MD a, Erna Tresnaningsih MD a, Wilfried H Purba DVM a, Vernon Lee MBBS c, Gina Samaan MAppEpid c, Syahrial Harun MSc b, Eka Soni BSc a, Chita Septiawati MD a, Tetty Setiawati MD a, Elvieda Sariwati MD a and Toni Wandra MD a
Summary
Background
Indonesia has had the most human cases of highly pathogenic avian influenza A (H5N1) and one of the highest case-fatality rates worldwide.
We described the factors associated with H5N1 case-fatality in Indonesia.
Methods
Between June, 2005, and February, 2008, there were 127 confirmed H5N1 infections.
Investigation teams were deployed to investigate and manage each confirmed case; they obtained epidemiological and clinical data from case-investigation reports when possible and through interviews with patients, family members, and key individuals.
Findings
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).
Interpretation
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.
Funding
None.
Affiliations
a. Directorate General of Disease Control and Environmental Health, Ministry of Health, Jakarta, Indonesia
b. National Institute of Health Research and Development, Ministry of Health, Jakarta, Indonesia
c. WHO, Indonesia Country Office, Jakarta, Indonesia
Correspondence to: Toni Wandra, Directorate General of Disease Control and Environmental Health, Ministry of Health, Jl Percetakan Negara 29, Katak Pos 223, Jakarta 10560, Indonesia
-
http://www.thelancet.com/journals/lancet/article/PIIS0140673608611253/abstract?iseop=true
-------