29 September 2005
UN Director General appoints WHO Expert to Lead Avian Flu Efforts, New WHO paper on H5N1, and more cases in Indonesia
On September 29 the UN Secretary General Kofi Annan appointed Dr. David Nabarro, a senior WHO official, to coordinate the fight against H5N1 avian influenza and catalyze pandemic flu international planning across all UN agencies and the private sector. The Director-General of the WHO, Dr. Lee Jong-wook reiterated yesterday that “the WHO has been very clear about the imminent threat of a human influenza pandemic”.
In the Jakarta Post of 29 September Indonesia was reported to be evaluating at least 63 persons with suspected H5N1 avian influenza infection. On Sept 22 and Sept 29 the WHO reported two more lab-confirmed patients with H5N1 infection in Indonesia. This beings the official lab-confirmed number of persons with H5N1 infection to four, with three being fatal, and other tests still pending. Worldwide, the WHO total number of lab-confirmed patients and deaths is now 116 persons/60 fatalities (52% fatality rate).
In the 29 September issue of the New England Journal of Medicine (NEJM) two articles related to avian influenza and the pandemic threat were published. The first was a detailed review article on the two drugs (“neuraminidase inhibitors”), one oral and one inhaled, that are effective against this H5N1 virus now circulating in Asia. This article is an excellent resource for information about these drugs, their limitations, side effects, and potential role in the ongoing avian H5N1 outbreak and in the potential coming human pandemic if and when the current H5N1 virus changes in a way that allows it to spread form person-to-person in a sustained and efficient manner.
The second article is a “Current Concepts” detailed review of human H5N1 avian influenza infections (NEJM 2005;353:1374-1384). It was published by the WHO “Writing Committee” on” Human Influenza A/H5” comprised of multiple influenza experts from around the world, including from affected nations in Asia. This paper is the one best comprehensive paper now in print and complements that by Yuen and Wong in the June 2005 issue of the Hong Kong Medical Journal on the same topic.
The NEJM review paper on H5N1 human infections includes detailed sections on transmission, clinical symptoms, signs, lab diagnosis, pathogenesis, antiviral drugs for prophylaxis and therapy, vaccine development, infection control issues and ways to lessen the risk of infections in a nonpandemic situation (Table 5, page 1382). Specific mention is made of using “High efficiency masks” (N-95 or equivalent) as part of personal protective equipment (PPE) by health care workers under isolation precautions in health care facilities, and as a consideration for household contacts of persons with H5N1 influenza virus infection.
The timing of this detailed paper from the WHO is welcomed, as was the WHO Pandemic Influenza plan posted last April on the WHO website. The revised US pandemic influenza plan that will update the August 26, 2004 draft plan is anticipated to be released later this autumn.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterterrorism and Emerging Diseases
ER One Institutes, Washington Hospital Center
Adjunct Professor of Microbiology and Immunology
Georgetown University School of Medicine, Washington, DC