title: Recognizing true H5N1 infections in humans during confirmed outbreaks.
abstract: BACKGROUND
  The goal of this study was to evaluate whether any characteristics that are evident at presentation for urgent medical attention could be used to differentiate cases of H5N1 in the absence of viral testing.
  
  
  METHODS
  Information about exposure to poultry, clinical signs and symptoms, treatments, and outcomes was abstracted from existing data in the global avian influenza registry (www.avianfluregistry.org) using standardized data collection tools for documented and possible cases of H5N1 infection who presented for medical attention between 2005-2011 during known H5N1 outbreaks in Azerbaijan, Indonesia, Pakistan and Turkey.
  
  
  RESULTS
  Demography, exposure to poultry, and presenting symptoms were compared, with only the common symptoms of fever and headache presenting significantly more frequently in confirmed H5N1 cases than in possible cases. Reported exposure to  infected humans was also more common in confirmed cases. In contrast, unexplained respiratory illness, sore throat, excess sputum production, and rhinorrhea were more frequent in possible cases. Overall, oseltamivir treatment showed a survival benefit, with the greatest benefit shown in H5N1 cases who were treated within two days of symptom onset (51% reduction in case fatality).
  
  
  CONCLUSIONS
  Since prompt treatment with antivirals conferred a strong survival benefit for H5N1 cases, presumptive antiviral treatment should be considered for all possible cases presenting during an outbreak of H5N1 as a potentially life-saving measure.
authors: Khyber Teaching Hospital, Khyber Medical University, Peshawar, Pakistan. mza@hotmail.com.
authors: Mukhtiar
authors: M
authors: Zaman
authors: Viktor
authors: V
authors: Gasimov
authors: Ahmet Faik
authors: AF
authors: Oner
authors: Nazim
authors: N
authors: Dogan
authors: Wiku
authors: W
authors: Adisasmito
authors: Richard
authors: R
authors: Coker
authors: Ebun L
authors: EL
authors: Bamgboye
authors: Paul K S
authors: PK
authors: Chan
authors: Wanna
authors: W
authors: Hanshaoworakul
authors: Nelson
authors: N
authors: Lee
authors: Bounlay
authors: B
authors: Phommasack
authors: Sok
authors: S
authors: Touch
authors: Owen
authors: O
authors: Tsang
authors: Anna
authors: A
authors: Swenson
authors: Stephen
authors: S
authors: Toovey
authors: Nancy Ann
authors: NA
authors: Dreyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000998:Antiviral Agents / Q000627:therapeutic use; D001382:Azerbaijan / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007214:Indonesia / Q000453:epidemiology; D007223:Infant; D053124:Influenza A Virus, H5N1 Subtype / Q000302:isolation & purification*; D005585:Influenza in Birds / Q000453:epidemiology* / Q000635:transmission; D007251:Influenza, Human / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D053139:Oseltamivir / Q000627:therapeutic use; D010154:Pakistan / Q000453:epidemiology; D011200:Poultry; D012307:Risk Factors; D014421:Turkey / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D053139:Oseltamivir