Update on Avian Influenza for Critical Care Physicians

  • C. Sandrock
Conference paper
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 2007)


Human influenza pandemics over the last 100 years have been caused by H1, H2, and H3 subtypes of influenza A viruses. More recently, avian influenza viruses have been found to directly infect humans from their avian hosts. The recent emergence, host expansion, and spread of a highly pathogenic avian influenza (HPAI) H5N1 subtype in Asia has heightened concerns globally, both in regards to mortality of HPAI H5N1 in humans and the potential of a new pandemic. In response, many agencies and organizations have been working collaboratively to develop early detection systems, preparedness plans, and objectives for further research. As a result, there has been a large influx of published information regarding potential risk, surveillance, prevention and control of highly pathogenic avian influenza, particularly in regards to animal to human and subsequent human to human transmission. This chapter will review the current human infections with avian influenza and its public health and medical implications.


Avian Influenza Severe Acute Respiratory Syndrome H5N1 Virus Avian Influenza Virus Highly Pathogenic Avian Influenza 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    World Health Organization Expert Committee (1980) A revision of the system of nomenclature for influenza viruses: a WHO Memorandum. Bull WHO. 58:585–591Google Scholar
  2. 2.
    Fouchier RAM, Munster V, Wallensten A, Bestebroer TM, Herfst S (2005) Characterization of a novel influenza A virus hemagglutinin subtype (H16) obtained from black-headed gulls. J Virol 79:2814–2822CrossRefPubMedGoogle Scholar
  3. 3.
    Kawaoka Y, Webster RG (1988) Molecular mechanism of acquisition of virulence in influenza virus in nature. Microb Pathog 5:311–318CrossRefPubMedGoogle Scholar
  4. 4.
    Kendal AP (1987) Epidemiologic implications of changes in the influenza virus genome. Am J Med 82:4–14CrossRefPubMedGoogle Scholar
  5. 5.
    Couceiro JN, Paulson JC, Baum, LG (1993) Influenza virus strains selectively recognize sialyloligosaccharides on human respiratory epithelium: the role of the host cell in selection of hemagglutinin receptor specificity. Virus Res 29:155–165CrossRefPubMedGoogle Scholar
  6. 6.
    Ito T, Couceiro JN, Kelm S, et al (1998) Molecular basis for the generation in pigs of influenza A viruses with pandemic potential. J Virol 72:7367–7373PubMedGoogle Scholar
  7. 7.
    Matrosovich MN, Matrosovich TY, Gray T, et al (2004) Human and avian influenza (AI) viruses target different cell types in cultures of human airway epithelium. Proc Natl Acad Sci USA 101:4620–4624CrossRefPubMedGoogle Scholar
  8. 8.
    Pensaert M, Ottis K, Vandeputte J, Kaplan MM, Bachman PA (1981) Evidence for the natural transmission of influenza A virus from wild ducks to swine and its potential importance for man. Bull World Health Organ 59:75–78PubMedGoogle Scholar
  9. 9.
    Scholtissek C, Burger H, Bachmann PA, Hannoun C (1983) Genetic relatedness of hemagglutinins of the H1 subtype of influenza A viruses isolated from swine and birds. Virology 129:521–523CrossRefPubMedGoogle Scholar
  10. 10.
    Hinshaw VS, Webster RG, Easterday BC, Bean WJ Jr (1981) Replication of avian influenza A viruses in mammals. Infect Immun 34:354–361PubMedGoogle Scholar
  11. 11.
    Fouchier RA, Schneeberger PM, Rozendaal FW, et al (2004) Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci USA 101:1356–1361CrossRefPubMedGoogle Scholar
  12. 12.
    Subbarao K, Klimov A, Katz J, et al (1998) Characterization of an avian influenza A (H5N1) virus isolated from a child with a fatal respiratory illness. Science 279:393–396CrossRefPubMedGoogle Scholar
  13. 13.
    Ellis TM, Bousfield RB, Bissett LA, et al (2004) Investigation of outbreaks of highly pathogenic H5N1 avian influenza in waterfowl and wild birds in Hong Kong in late 2002. Avian Pathol 33:492–505CrossRefPubMedGoogle Scholar
  14. 14.
    Liu J, Xiao H, Lei F, et al (2005) Highly pathogenic H5N1 influenza virus infection in migratory birds. Science 309:1206CrossRefPubMedGoogle Scholar
  15. 15.
    Webster RG, Geraci J, Petursson G, et al (1981) Conjunctivitis in human beings caused by influenza A virus of seals. N Engl J Med 304:911PubMedGoogle Scholar
  16. 16.
    Kurtz J, Manvell RJ, Banks (1996) J Avian influenza virus isolated from a woman with conjunctivitis. Lancet 348:901–902CrossRefPubMedGoogle Scholar
  17. 17.
    Yuen KY, Chan PKS, Peiris M, et al (1998) Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet 351:467–471CrossRefPubMedGoogle Scholar
  18. 18.
    Peiris, M, Yuen, KY, Leung, CW, et al (1999) Human infection with influenza H9N2. Lancet 354:916–917CrossRefPubMedGoogle Scholar
  19. 19.
    Peiris JS, Yu WC, Leung CW, et al (2004) Re-emergence of fatal human influenza A subtype H5N1 disease. Lancet 363:617–619CrossRefPubMedGoogle Scholar
  20. 20.
    Koopmans, M, Wilbrink, B, Conyn, M, et al (2004) Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Lancet 363:587–593CrossRefPubMedGoogle Scholar
  21. 21.
    World Health Organization (2006) Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO, 16 October, 2006. Available at: Accessed October 17, 2006Google Scholar
  22. 22.
    Tweed, SA, Skowronski, DM, David, ST, et al (2004) Human illness from avian influenza H7N3, British Columbia. Emerg Infect Dis 10:2196–2199PubMedGoogle Scholar
  23. 23.
    Chan PKS (2002) Outbreak of avian influenza A (H5N1) virus infection in Hong Kong in 1997. Clin Infect Dis 34(Suppl 2):S58–S64CrossRefPubMedGoogle Scholar
  24. 24.
    Bridges CB, Lim W, Primmer JH, et al (2002) Risk of influenza A (H5N1) infection among poultry workers, Hong Kong, 1997–1998. J Infect Dis 185:1005–1010CrossRefPubMedGoogle Scholar
  25. 25.
    Bridges CB, Katz JM, Seto WH, et al (2000) Risk of influenza A (H5N1) infection among health care workers exposed to patients with influenza A (H5N1), Hong Kong. J Infect Dis 181:344–348CrossRefGoogle Scholar
  26. 26.
    Ungchusak, K, Auewarakul, P, Dowell, SF, et al (2005) Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med 352:333–340CrossRefPubMedGoogle Scholar
  27. 27.
    Liem NT, Lim W (2005) World Health Organization International Avian Influenza Investigation Team, Vietnam. Lack of H5N1 avian influenza transmission to hospital employees, Hanoi, 2004. Emerg Infect Dis 11:210–215PubMedGoogle Scholar
  28. 28.
    Schultsz, C, Dong, VC, Chau, NVV, et al (2005) Avian influenza H5N1 and healthcare workers. Emerg Infect Dis 11:1158–1159PubMedGoogle Scholar
  29. 29.
    Koopmans M, Wilbrink B, Conyn M, et al (2004) Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Lancet 363:587–593CrossRefPubMedGoogle Scholar
  30. 30.
    Tran TH, Nguyen TL, Nguyen TD, et al (2004) Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med 350:1179–1188CrossRefPubMedGoogle Scholar
  31. 31.
    Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, et al (2005) Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis 11:201–209PubMedGoogle Scholar
  32. 32.
    The Writing Committee of the World Health Organization (WHO) (2005) Consultation on Human Influenza A/H5. Avian influenza A (H5N1) infection in humans. N Engl J Med 353:1374–1385CrossRefGoogle Scholar
  33. 33.
    de Jong MD, Bach VC, Phan TQ, et al (2005) Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med 352:686–691CrossRefPubMedGoogle Scholar
  34. 34.
    Gruber PC, Gomersall CD, Joynt GM (2006) Avian Influenza (H5N1): implications for intensive care. Intensive Care Med 32:823–829CrossRefPubMedGoogle Scholar
  35. 35.
    To KF, Chan PKS, Chan KF, et al (2001) Pathology of fatal human infection associated with avian influenza A H5N1 virus. J Med Virol 63:242–246CrossRefPubMedGoogle Scholar
  36. 36.
    Yu IT, Li Y, Wong TW, et al (2004) Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med 350:1731–1739CrossRefPubMedGoogle Scholar
  37. 37.
    Payungporn S, Phakdeewirot P, Chutinimitkul S, et al (2004) Single-step multiplex reverse transcription-polymerase chain reaction (RT-PCR) for influenza A virus subtype H5N1 detection. Viral Immunol 17,588–593CrossRefPubMedGoogle Scholar
  38. 38.
    Li KS, Guan Y, Wang J, et al (2004) Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. Nature 430:209–213CrossRefPubMedGoogle Scholar
  39. 39.
    Le QM, Kiso M, Someya K, et al (2005) Avian flu: isolation of drug-resistant H5N1 virus. Nature 437:1108CrossRefPubMedGoogle Scholar
  40. 40.
    Leneva IA, Roberts N, Govorkova EA, et al (2000) The neuraminidase inhibitor GS4104 (oseltamivir phosphate) is efficacious against A/Hong Kong/156/97 (H5N1) and A/Hong Kong/ 1074/99 (H9N2) influenza viruses. Antiviral Res 48:101–115CrossRefPubMedGoogle Scholar
  41. 41.
    Kiso M, Mitamura K, Sakai-Tagawa Y, et al (2004) Resistant influenza A viruses in children treated with oseltamivir: descriptive study. Lancet 364:759–765CrossRefPubMedGoogle Scholar
  42. 42.
    Inouye RT, Panther LA, Hay CM, et al (2002) Antiviral agents. In: Richman DD Whitley RJ Hayden, FG eds. Clinical virology 2nd ed. 2002, 171–242 ASM Press. Washington DCGoogle Scholar
  43. 43.
    Cheng VC, Tang BS, Wu AK, et al (2004) Medical treatment of viral pneumonia including SARS in immunocompetent adult. J Infect 49:262–273CrossRefPubMedGoogle Scholar
  44. 44.
    De Jong MD, Tranh TT, Khanh TH, et al (2005) Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med 353:2667CrossRefPubMedGoogle Scholar
  45. 45.
    Nicholson KG, Colegate AE, Podda A et al (2001) Safety and antigenicity of non-adjuvanted and F59-adjuvanted influenza A/Duck/Singapore/97 (h5N3) vaccine: a randomized trial of two potential vaccines against H5N1 influenza Lancet 357:1937CrossRefPubMedGoogle Scholar
  46. 46.
    Nicholson KG, Colegate AE, Podda A, et al (2001) Safety and antigenicity of nonadjuvanted and MF59-adjuvanted influenza A/duck/Singapore/97 (H5N3) vaccine: a randomised trial of two potential vaccines against H5N1 influenza. Lancet 2001;357,1937–1943CrossRefGoogle Scholar
  47. 47.
    Stephenson I, Bugarini R, Nicholson KG, et al (2005) Cross-reactivity to highly pathogenic avian influenza H5N1 viruses after vaccination with nonadjuvanted and MF59-adjuvanted influenza A/Duck/Singapore/97 (H5N3) vaccine: a potential priming strategy. J Infect Dis 191:1210–1215CrossRefPubMedGoogle Scholar
  48. 48.
    Lipatov AS, Webby RJ, Govorkova EA, et al (2005) Efficacy of H5 influenza vaccines produced by reverse genetics in a lethal mouse model. J Infect Dis 191:1216–1220CrossRefPubMedGoogle Scholar
  49. 49.
    Van Riel D Munster VJ de Wit E, et al (2006) H5N1 Virus attachment to lower respiratory tract. Science 312:399CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media Inc. 2007

Authors and Affiliations

  • C. Sandrock
    • 1
  1. 1.Department of Pulmonary and Critical Care MedicineDavis Medical CenterSacramentoUSA

Personalised recommendations