8 April 2009

No Deaths in 12 Patients with Avian Influenza A (H5N1) Reported from Egypt<= /st1:place> since January 1, 2009=

Today the World Health Organization (WHO) posted on their avian flu website that = the Egyptian Ministry of Health and Population reported their 10th, 11th, and 1= 2th patients with H5N1 avian influenza since January 1, 2009. Notably, none of these 12 patients have died, in contrast to 23/51 patients (45%) from 2006-2008. (www.who.int/csr/disease/avian_influenza/en/index.html= ).

A short time interval of < 3 days was reported between the onset of illness and the time to hospitalization for 11 of the 12 patients. In some cases, a relatively short interval between hospitalization and time of laboratory diagnosis of H5N1 virus infection was provided, or implied based= on the date of the WHO posting of the case (e.g., “by 14 Jan, by 26 Jan,= by 5 Feb” in the table below created by this author based on the WHO case reports for the 12 patients).

Importantly, in four of the last five patients (in the table below) a time interval of 0= -3 days was noted between illness onset and starting antiviral treatment with oseltamivir. The 12^th patient had a 12-day interval between illness onset 22 March and starting therapy with oseltamivir on 3 April. That patient was reported today to be in critical condition.

Illness Onset	Hospitalization	Lab Diagnosis	Antiviral started<= /b>
9 January	10 January	(by 14 Jan)	Not stated
23 January	23 January	(by 26 Jan)	Not stated
2 February	3 February	3 February)	Not stated
6 February	7 February	(by 9 Feb)	Not stated
25-February	26 February	1 March	Not started
3 March	3-4 March	4 March	Not stated
6 March	9 March	18 March	14 March
23 March	24 March	26 March	24 March
27 March	30 March	(by 7 April )	30 March
31 March	1 April	(by 7 April)	1 April
22 March	28 March	(by 7 April	3 April

It would be informative to tabulate for each H5N1 patient the date of:

(1) Illness onset

(2) “Hospitalization” * (see below)

(3) Laboratory diagnosis of H5N1 avian flu infection

(4) Antiviral treatment initiation (with dose/frequency of drug(s))

This information could provide better understanding of how to decrease the very = high mortality rate of H5N1 avian flu infection.

Clinically, one could argue that the single most important variable in predicting whether an H5N1 av= ian flu virus infection was going to be fatal is the time interval between onse= t of symptoms and therapeutic levels of anti-influenza medication(s) (e.g., oseltamivir).

 “= ;Hospitalization” could be further detailed as the date(s) of entering the health care system initially, at either an outpatient clinic or inpatient facility, AND (whene= ver applicable) the date of transfer to an avian flu referral hospital or other health care facility.

Daniel R. Lucey, MD, MPH

EROne Institutes, Department of Emergency Medicine

Washington Ho= spital Center<= /o:p>

Adjunct Professor of Microbiolo= gy and Immunology

Georgetown University Medical Center, Washington, D.C.

Website for this posting (requi= res Internet Explorer): www= .BePast.org

e-mail= :DRL23@Georgetown.edu