title: WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus.
abstract: Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.
authors.affiliation: Italian National Cancer Institute Regina Elena, INFORMA Unit, Department of Epidemiology, Istituto Regina Elena, Rome, Italy. Schuneh@mcmaster.ca
authors.forename: Holger J
authors.initials: HJ
authors.lastname: Schünemann
authors.forename: Suzanne R
authors.initials: SR
authors.lastname: Hill
authors.forename: Meetali
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authors.lastname: Kakad
authors.forename: Richard
authors.initials: R
authors.lastname: Bellamy
authors.forename: Timothy M
authors.initials: TM
authors.lastname: Uyeki
authors.forename: Frederick G
authors.initials: FG
authors.lastname: Hayden
authors.forename: Yazdan
authors.initials: Y
authors.lastname: Yazdanpanah
authors.forename: John
authors.initials: J
authors.lastname: Beigel
authors.forename: Tawee
authors.initials: T
authors.lastname: Chotpitayasunondh
authors.forename: Chris
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authors.lastname: Del Mar
authors.forename: Jeremy
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authors.lastname: Farrar
authors.forename: Tinh Hien
authors.initials: TH
authors.lastname: Tran
authors.forename: Bülent
authors.initials: B
authors.lastname: Ozbay
authors.forename: Norio
authors.initials: N
authors.lastname: Sugaya
authors.forename: Keiji
authors.initials: K
authors.lastname: Fukuda
authors.forename: Nikki
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authors.lastname: Shindo
authors.forename: Lauren
authors.initials: L
authors.lastname: Stockman
authors.forename: Gunn E
authors.initials: GE
authors.lastname: Vist
authors.forename: Alice
authors.initials: A
authors.lastname: Croisier
authors.forename: Azim
authors.initials: A
authors.lastname: Nagjdaliyev
authors.forename: Cathy
authors.initials: C
authors.lastname: Roth
authors.forename: Gail
authors.initials: G
authors.lastname: Thomson
authors.forename: Howard
authors.initials: H
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authors.initials: AD
authors.lastname: Oxman
mesh_terms: D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use*; D001717:Birds; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000187:drug effects; D005585:Influenza in Birds / Q000453:epidemiology; D007251:Influenza, Human / Q000188:drug therapy* / Q000517:prevention & control*; D009439:Neuraminidase / Q000037:antagonists & inhibitors*; D053139:Oseltamivir / Q000494:pharmacology*; D011200:Poultry; D014944:World Health Organization
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir; D009439:Neuraminidase