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• W2130722018 abstract "To the Editor: We read with interest the article by Chen et al1Chen J.M. Chen J.W. Dai J.J. Sun Y.X. A survey of human cases of H5N1 avian influenza reported by the WHO before June 2006 for infection control.Am J Infect Control. 2007; 35: 351-353Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar and would like to add some comments relevant to improving avian influenza (H5N1) diagnostics. Before 2006, most cases of avian influenza (H5N1) were initially made using rapid influenza tests at the point of care.2Oner A.F. Bay A. Arslan S. Akdeniz H. Sahin H.A. Cesur Y. et al.Avian influenza A (H5N1) infection in east Turkey in 2006.N Engl J Med. 2006; 355: 2179-2185Crossref PubMed Scopus (161) Google Scholar, 3Kitphati R. Apisarnthanarak A. Chittaganpitch M. Tawatsupha P. Auwanit W. Puthavathana P. et al.A nationally coordinated laboratory system for human avian influenza A (H5N1) in Thailand: program design, analysis and evaluation.Clin Infect Dis. 2008; 46: 1394-1400Crossref PubMed Scopus (8) Google Scholar, 4Apisarnthanarak A. Kitphati R. Mundy L.M. Difficulty in the rapid diagnosis of avian influenza A infection: Thailand experience.Clin Infect Dis. 2007; 44: 1252-1253Crossref PubMed Scopus (7) Google Scholar In 2006, the 2-3 sialic acid receptor, a specific receptor for H5N1, was identified in the human lower respiratory tract.5Shinya K. Ebina M. Yamada S. Ono M. Kasai N. Kawaoka Y. Avian flu: influenza virus receptors in the human airway.Nature. 2006; 440: 435-436Crossref PubMed Scopus (1087) Google Scholar The relevance of this finding has been applied to experiences with human case detection of avian influenza (H5N1) in Thailand. Historically, the rapid surge in clinical cases of H5N1 in 2003 prompted the Thai Ministry of Public Health to stockpile antiviral drugs in H5N1-endemic regions and to establish the Thai National Coordinating Laboratory System (NCLS) for expedited case detection of human infections.3Kitphati R. Apisarnthanarak A. Chittaganpitch M. Tawatsupha P. Auwanit W. Puthavathana P. et al.A nationally coordinated laboratory system for human avian influenza A (H5N1) in Thailand: program design, analysis and evaluation.Clin Infect Dis. 2008; 46: 1394-1400Crossref PubMed Scopus (8) Google Scholar The Thai NCLS emphasized field-based training focused on the procurement of multiple deep respiratory tract specimens before the administration of antiviral medication. They identified 5 core NCLS program components: (1) a national, centralized laboratory; (2) trained, dedicated personnel; (3) H5N1 laboratory surveillance of throat and NP specimens through reverse-transcription polymerase chain reaction (RT-PCR) and real-time RT-PCR and viral culture; (4) laboratory reporting algorithms; and (5) a national secured website to provide education on proper clinical specimen collection and for reporting the results (http://www.cctls.or.th). Compared with the pre-NCLS period, there was a significant increase in clinical respiratory specimens appropriate for confirmatory testing (from 85% to 95%; P < .001). Median time from procurement to results declined from 17 days (range, 14 to 24 days) to 1.8 days (range, 0.25 to 4 days; P < .001), and median time for specimen transport decreased from 46.5 to 21.1 hours (P < .001).3,4 Efforts to optimize laboratory surveillance through comparative results of nasopharyngeal and throat specimens via RT-PCR, real-time RT-PCR, and viral culture affirmed the limited test utility with rapid diagnostic studies and confirmed the benefits of tiered screening and confirmatory testing. Since 2005, no human cases of H5N1 have been reported in Thailand, whereas sporadic case presentations have continued in surrounding countries without NCLS programs. Our experience with human case detection of H5N1 in an endemic region suggests that accurate detection can be improved through a coordinated surveillance program, physician education, and proper specimen procurement.4Apisarnthanarak A. Kitphati R. Mundy L.M. Difficulty in the rapid diagnosis of avian influenza A infection: Thailand experience.Clin Infect Dis. 2007; 44: 1252-1253Crossref PubMed Scopus (7) Google Scholar Collection of multiple deep respiratory tract specimens should be performed before the administration of antiviral medication to the index patient. A survey of human cases of H5N1 avian influenza reported by the WHO before June 2006 for infection controlAmerican Journal of Infection ControlVol. 35Issue 5PreviewH5N1 avian influenza has been widely spreading in fowls in the Eastern Hemisphere and caused hundreds of severe human cases. Here, the information of the 224 human cases of H5N1 avian influenza reported by the World Health Organization before June 2006 were surveyed and analyzed. The results suggested that human infections escalated in the past 3 years, and control of animal H5N1 influenza, avoidance of high-risk behaviors, and proper disposal of diseased or dead fowls are vital for the prevention of the human infections. Full-Text PDF" @default.
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• W2130722018 title "Improving avian influenza (H5N1) diagnositics: What do we need?" @default.
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• W2130722018 doi "https://doi.org/10.1016/j.ajic.2008.02.003" @default.
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