Avian influenza A (H5N1) virus infection - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Avian influenza A(H5N1) virus infection is a notifiable condition. Infection prevention and control measures such as patient isolation and standard, contact, and airborne (including eye protection) precautions are recommended.
Sporadic human infections have been reported since 1997; however, there has been no evidence of sustained human-to-human transmission.
High case-fatality proportion of approximately 52% among patients with laboratory-confirmed infection.
Most patients present with fever and features of lower respiratory tract infection on admission. Infection should be considered in anyone showing signs or symptoms of acute respiratory illness who has a relevant exposure history. Molecular testing is recommended to confirm diagnosis; however, it is usually not available in most clinical settings.
Antiviral therapy is recommended as soon as possible in symptomatic patients with suspected or confirmed infection. Supportive care and specialized intensive care management are indicated for respiratory failure and other severe complications.

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History & Exam
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Definition

Epidemiology

Etiology

Pathophysiology

Citations

Key Articles

Centers for Disease Control and Prevention. Highly pathogenic avian influenza A(H5N1) virus in animals: interim recommendations for prevention, monitoring, and public health investigations. Jun 2024 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Interim guidance on the use of antiviral medications for treatment of human infections with novel influenza A viruses associated with severe human disease. Sep 2024 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Interim guidance on specimen collection and testing for patients with suspected infection with novel influenza A viruses associated with severe disease or with the potential to cause severe disease in humans. Sep 2024 [internet publication].[Full Text]
World Health Organization. Clinical practice guidelines for influenza. Sep 2024 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Interim guidance for follow-up of close contacts of persons infected with novel influenza A viruses associated with severe human disease or with potential to cause severe human disease, and use of antiviral medications for post-exposure prophylaxis. Aug 2024 [internet publication].[Full Text]

Other Online Resources

BMJ talk medicine podcast: avian influenza - a guide to recognition, reporting and referral with Dr Mary-Margaret Fill
CDC: H5 bird flu - current situation
WHO: surveillance - avian influenza
UK Health Security Agency: avian influenza: guidance, data and analysis
CDC: Interim guidance for employers to reduce the risk of novel influenza A for people working with or exposed to animals
WHO: zoonotic influenza - candidate vaccine viruses and potency testing reagents
CDC: case definitions for investigations of human infection with avian influenza A viruses in the United States
WHO: influenza (avian and other zoonotic)
WHO: influenza (avian and other zoonotic) fact sheet
CDC: avian influenza (bird flu)

Referenced Articles

1. Ungchusak K, Auewarakul P, Dowell SF, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med. 2005 Jan 27;352(4):333-40.[Abstract][Full Text]
2. Wang H, Feng Z, Shu Y, et al. Probable limited person-to-person transmission of highly pathogenic avian influenza A (H5N1) virus in China. Lancet. 2008 Apr 26;371(9622):1427-34.[Abstract]
3. Centers for Disease Control and Prevention. Current H5N1 bird flu situation in dairy cows. Oct 2024 [internet publication].[Full Text]
4. Skowronski DM, Tweed SA, Petric M, et al. Human illness and isolation of low-pathogenicity avian influenza virus of the H7N3 subtype in British Columbia, Canada. J Infect Dis. 2006 Mar 15;193(6):899-900.[Abstract]
5. Peiris M, Yuen KY, Leung CW, et al. Human infection with influenza H9N2. Lancet. 1999 Sep 11;354(9182):916-7.[Abstract]
6. Uyeki TM, Chong YH, Katz JM, et al. Lack of evidence for human-to-human transmission of avian influenza A (H9N2) viruses in Hong Kong, China 1999. Emerg Infect Dis. 2002 Feb;8(2):154-9.[Abstract][Full Text]
7. Eurosurveillance editorial team. Avian influenza A/(H7N2) outbreak in the United Kingdom. Euro Surveill. 2007 May 31;12(5):E070531.[Abstract][Full Text]
8. Kurtz J, Manvell RJ, Banks J. Avian influenza virus isolated from a woman with conjunctivitis. Lancet. 1996 Sep 28;348(9031):901-2.[Abstract]
9. Zhuang Y, Wang M, Liang L, et al. First known human death after infection with the avian influenza A/H3N8 virus: Guangdong Province, China, March 2023. Clin Infect Dis. 2024 Mar 20;78(3):646-50.[Abstract][Full Text]
10. Qi X, Qiu H, Hao S, et al. Human infection with an avian-origin influenza A (H10N3) virus. N Engl J Med. 2022 Mar 17;386(11):1087-8.[Abstract][Full Text]
11. Tong XC, Weng SS, Xue F, et al. First human infection by a novel avian influenza A(H7N4) virus. J Infect. 2018 Sep;77(3):249-57.[Abstract]
12. Tweed SA, Skowronski DM, David ST, et al. Human illness from avian influenza H7N3, British Columbia. Emerg Infect Dis. 2004 Dec;10(12):2196-9.[Abstract][Full Text]
13. Nguyen-Van-Tam JS, Nair P, Acheson P, et al. Outbreak of low pathogenicity H7N3 avian influenza in UK, including associated case of human conjunctivitis. Euro Surveill. 2006 May 4;11(5):E060504.[Abstract][Full Text]
14. Pan M, Gao R, Lv Q, et al. Human infection with a novel, highly pathogenic avian influenza A (H5N6) virus: virological and clinical findings. J Infect. 2016 Jan;72(1):52-9.[Abstract]
15. Yang ZF, Mok CK, Peiris JS, et al. Human infection with a novel avian influenza A (H5N6) virus. N Engl J Med. 2015 Jul 30;373(5):487-9.[Abstract][Full Text]
16. World Health Organization/World Organisation for Animal Health/Food and Agriculture Organization H5N1 Evolution Working Group. Revised and updated nomenclature for highly pathogenic avian influenza A (H5N1) viruses. Influenza Other Respir Viruses. 2014 May;8(3):384-8.[Abstract][Full Text]
17. World Health Organization. Evolution of the influenza A(H5) haemagglutinin: WHO/OIE/FAO H5 Working Group reports a new clade designated 2.3.4.4. Jan 2015 [internet publication].[Full Text]
18. Smith GJ, Donis RO; World Health Organization/World Organisation for Animal Health/Food and Agriculture Organization (WHO/OIE/FAO) H5 Evolution Working Group. Nomenclature updates resulting from the evolution of avian influenza A(H5) virus clades 2.1.3.2a, 2.2.1, and 2.3.4 during 2013-2014. Influenza Other Respir Viruses. 2015 Sep;9(5):271-6.[Abstract][Full Text]
19. World Health Organization. Genetic and antigenic characteristics of zoonotic influenza A viruses and development of candidate vaccine viruses for pandemic preparedness. Feb 2023 [internet publication].[Full Text]
20. Centers for Disease Control and Prevention. Technical report: June 2024 highly pathogenic avian influenza A(H5N1) viruses. Jun 2024 [internet publication].[Full Text]
21. World Health Organization. Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses. Dec 2022 [internet publication].[Full Text]
22. Centers for Disease Control and Prevention. H5 bird flu: current situation. Oct 2024 [internet publication].[Full Text]
23. World Health Organization. Genetic and antigenic characteristics of clade 2.3.4.4b A(H5N1) viruses identified in dairy cattle in the United States of America. May 2024 [internet publication].[Full Text]
24. Centers for Disease Control and Prevention. Technical update: summary analysis of the genetic sequence of a highly pathogenic avian influenza A(H5N1) virus identified in a human in Michigan. May 2024 [internet publication].[Full Text]
25. World Health Organization. Update on human cases of highly pathogenic avian influenza A(H5N1) virus infection, 2010. Wkly Epidemiol Rec. 2011 Apr 22;86(17):161-6.[Abstract][Full Text]
26. Uyeki TM. Human infection with highly pathogenic avian influenza A (H5N1) virus: review of clinical issues. Clin Infect Dis. 2009 Jul 15;49(2):279-90.[Abstract][Full Text]
27. de Jong MD, Bach VC, Phan TQ, et al. Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med. 2005 Feb 17;352(7):686-91.[Abstract][Full Text]
28. Rajabali N, Lim T, Sokolowski C, et al. Avian influenza A (H5N1) infection with respiratory failure and meningoencephalitis in a Canadian traveller. Can J Infect Dis Med Microbiol. 2015 Jul-Aug;26(4):221-3.[Abstract][Full Text]
29. Kandeel A, Manoncourt S, Abd el Kareem E, et al. Zoonotic transmission of avian influenza virus (H5N1), Egypt, 2006-2009. Emerg Infect Dis. 2010 Jul;16(7):1101-7.[Abstract][Full Text]
30. International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). Outbreak of mild respiratory disease caused by H5N1 and H9N2 infections among young children in Dhaka, Bangladesh, 2011. Health Sci Bulletin. 2011;9:1-12.[Full Text]
31. Oner AF, Dogan N, Gasimov V, et al. H5N1 avian influenza in children. Clin Infect Dis. 2012 Jul;55(1):26-32.[Abstract][Full Text]
32. Shinde V, Hanshaoworakul W, Simmerman JM, et al. A comparison of clinical and epidemiological characteristics of fatal human infections with H5N1 and human influenza viruses in Thailand, 2004-2006. PLoS One. 2011 Apr 29;6(4):e14809.[Abstract][Full Text]
33. Chan PK. Outbreak of avian influenza A(H5N1) virus infection in Hong Kong in 1997. Clin Infect Dis. 2002 May 1;34(suppl 2):S58-64.[Abstract][Full Text]
34. Peiris JS, Yu WC, Leung CW, et al. Re-emergence of fatal human influenza A subtype H5N1 disease. Lancet. 2004 Feb 21;363(9409):617-9.[Abstract][Full Text]
35. World Health Organization. Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2024, 19 July 2024. Jul 2024 [internet publication].[Full Text]
36. UK Health Security Agency. Avian influenza (influenza A H5N1): risk to human health. Jul 2024 [internet publication].[Full Text]
37. Centers for Disease Control and Prevention. Highly pathogenic avian influenza A(H5N1) virus in animals: interim recommendations for prevention, monitoring, and public health investigations. Jun 2024 [internet publication].[Full Text]
38. Centers for Disease Control and Prevention. Interim guidance on the use of antiviral medications for treatment of human infections with novel influenza A viruses associated with severe human disease. Sep 2024 [internet publication].[Full Text]
39. World Health Organization. Disease outbreak news: avian influenza A(H5N1) - United States of America. Apr 2024 [internet publication].[Full Text]
40. Centers for Disease Control and Prevention. Highly pathogenic avian influenza A (H5N1) virus infection reported in a person in the U.S. Apr 2024 [internet publication].[Full Text]
41. Centers for Disease Control and Prevention. CDC reports second human case of H5 bird flu tied to dairy cow outbreak. May 2024 [internet publication].[Full Text]
42. Centers for Disease Control and Prevention. CDC confirms second human H5 bird flu case in Michigan; third case tied to dairy outbreak. May 2024 [internet publication].[Full Text]
43. Centers for Disease Control and Prevention. CDC reports fourth human case of H5 bird flu tied to dairy cow outbreak. Jul 2024 [internet publication].[Full Text]
44. Drehoff CC, White EB, Frutos AM. Cluster of influenza A(H5) cases associated with poultry exposure at two facilities -- Colorado, July 2024. Weekly. 2024 Aug; 73(34):734-9.[Full Text]
45. Centers for Disease Control and Prevention. CDC confirms human H5 Bird flu case in Missouri. Sep 2024 [internet publication].[Full Text]
46. Centers for Disease Control and Prevention. CDC confirms new human cases of H5 bird flu in California. Oct 2024 [internet publication].[Full Text]
47. Centers for Disease Control and Prevention. CDC confirms 3rd human case of H5 bird flu in California. Oct 2024 [internet publication].[Full Text]
48. World Health Organization. Avian influenza A(H5N1) - Cambodia. Sep 2024 [internet publication].[Full Text]
49. World Health Organization. Avian influenza A (H5N1): Australia. Jun 2024 [internet publication].[Full Text]
50. World Health Organization. Disease outbreak news: avian influenza A(H5N1) - Viet Nam. Apr 2024 [internet publication].[Full Text]
51. World Health Organization. Disease outbreak news: avian influenza A (H5N1) - Cambodia. Feb 2024 [internet publication].[Full Text]
52. World Health Oragnization. Disease outbreak news: avian influenza A (H5N1) - Cambodia. Nov 2023 [internet publication].[Full Text]
53. World Health Organization. Disease outbreak news: avian influenza A H5N1 - United Kingdom of Great Britain and Northern Ireland. May 2023 [internet publication].[Full Text]
54. World Health Organization. Disease outbreak news: human infection caused by avian Influenza A (H5N1) - Chile. Apr 2023 [internet publication].[Full Text]
55. Castillo A, Fasce R, Parra B, et al. The first case of human infection with H5N1 avian Influenza A virus in Chile. J Travel Med. 2023 Sep 5;30(5):taad083.[Abstract][Full Text]
56. Centers for Disease Control and Prevention. Human infection with highly pathogenic avian influenza A(H5N1) virus in Chile. Mar 2023 [internet publication].[Full Text]
57. World Health Organization. Disease outbreak news: avian influuenza A (H5N1) - Cambodia. Feb 2023 [internet publication].[Full Text]
58. World Health Organization. Disease outbreak news: human infection caused by avian influenza A(H5) - Ecuador. Jan 2023 [internet publication].[Full Text]
59. Bruno A, Alfaro-Núñez A, de Mora D, et al. First case of human infection with highly pathogenic H5 avian Influenza A virus in South America: A new zoonotic pandemic threat for 2023? J Travel Med. 2023 Sep 5;30(5):taad032.[Abstract][Full Text]
60. World Health Organization. Update: WHO-confirmed human cases of avian influenza A (H5N1) infection, November 2003-May 2008. Wkly Epidemiol Rec. 2008 Nov 14;83(46):415-20.[Abstract]
61. Le MQ, Horby P, Fox A, et al. Subclinical avian influenza A(H5N1) virus infection in human, Vietnam. Emerg Infect Dis. 2013 Oct;19(10):1674-7.[Abstract][Full Text]
62. Capelastegui F, Smith J, Kumbang J, et al. Pilot of asymptomatic swabbing of humans following exposures to confirmed avian influenza A(H5) in avian species in England, 2021/2022. Influenza Other Respir Viruses. 2023 Aug;17(8):e13187.[Abstract][Full Text]
63. Aznar E, Casas I, González Praetorius A, et al. Influenza A(H5N1) detection in two asymptomatic poultry farm workers in Spain, September to October 2022: suspected environmental contamination. Euro Surveill. 2023 Feb;28(8):2300107.[Abstract][Full Text]
64. Oliver I, Roberts J, Brown CS, et al. A case of avian influenza A(H5N1) in England, January 2022. Euro Surveill. 2022 Feb;27(5):2200061.[Abstract][Full Text]
65. Qi Y, Ni HB, Chen X, et al. Seroprevalence of highly pathogenic avian influenza (H5N1) virus infection among humans in mainland China: a systematic review and meta-analysis. Transbound Emerg Dis. 2020 Sep;67(5):1861-71.[Abstract]
66. Gomaa MR, El Rifay AS, Abu Zeid D, et al. Incidence and seroprevalence of avian influenza in a cohort of backyard poultry growers, Egypt, Aug 2015-Mar 2019. Emerg Infect Dis. 2020 Sep;26(9):2129-36.[Abstract][Full Text]
67. Tong S, Zhu X, Li Y, et al. New world bats harbor diverse influenza A viruses. PLoS Pathog. 2013;9(10):e1003657.[Abstract][Full Text]
68. Centers for Disease Control and Prevention. Bird flu in animals and people: causes and how it spreads. May 2022 [internet publication].[Full Text]
69. Areechokchai D, Jiraphongsa C, Laosiritaworn Y, et al. Investigation of avian influenza (H5N1) outbreak in humans: Thailand, 2004. MMWR Morb Mortal Wkly Rep. 2006 Apr 28;55(1):3-6.[Abstract][Full Text]
70. Dinh PN, Long HT, Tien NT, et al. Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004. Emerg Infect Dis. 2006 Dec;12(12):1841-7.[Abstract][Full Text]
71. World Health Organization. Update on human cases of highly pathogenic avian influenza A(H5N1) virus infection, 2011. Wkly Epidemiol Rec. 2012 Mar 30;87(13):117-23.[Abstract][Full Text]
72. Mounts AW, Kwong H, Izurieta HS, et al. Case-control study of risk factors for avian influenza A (H5N1) disease, Hong Kong, 1997. J Infect Dis. 1999 Aug;180(2):505-8.[Abstract]
73. Zhou L, Liao Q, Dong L, et al. Risk factors for human illness with avian influenza A (H5N1) virus infection in China. J Infect Dis. 2009 Jun 15;199(12):1726-34.[Abstract][Full Text]
74. Wan XF, Dong L, Lan Y, et al. Indications that live poultry markets are a major source of human H5N1 influenza virus infection in China. J Virol. 2011 Dec;85(24):13432-8.[Abstract][Full Text]
75. Cavailler P, Chu S, Ly S, et al. Seroprevalence of anti-H5 antibody in rural Cambodia, 2007. J Clin Virol. J Clin Virol. 2010 Jun;48(2):123-6.[Abstract]
76. Kandun IN, Tresnaningsih E, Purba WH, et al. Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series. Lancet. 2008 Aug 30;372(9640):744-9.[Abstract]
77. Horby P, Sudoyo H, Viprakasit V, et al. What is the evidence of a role for host genetics in susceptibility to influenza A/H5N1? Epidemiol Infect. 2010 Nov;138(11):1550-8.[Abstract][Full Text]
78. Human cases of avian influenza A (H5N1) in North-West Frontier Province, Pakistan, October-November 2007. Wkly Epidemiol Rec. 2008 Oct 3;83(40):359-64.[Abstract]
79. Aditama TY, Samaan G, Kusriastuti R, et al. Risk factors for cluster outbreaks of avian influenza A H5N1 infection, Indonesia. Clin Infect Dis. 2011 Dec;53(12):1237-44.[Abstract][Full Text]
80. Aditama TY, Samaan G, Kusriastuti R, et al. Avian influenza H5N1 transmission in households, Indonesia. PLoS One. 2012;7(1):e29971.[Abstract][Full Text]
81. Kandun IN, Wibisono H, Sedyaningsih ER, et al. Three Indonesian clusters of H5N1 virus infection in 2005. N Engl J Med. 2006 Nov 23;355(21):2186-94.[Abstract][Full Text]
82. Beigel JH, Farrar J, Han AM, et al. Avian influenza A (H5N1) infection in humans. N Engl J Med. 2005 Sep 29;353(13):1374-85.[Abstract][Full Text]
83. Imai M, Watanabe T, Hatta M, et al. Experimental adaptation of an influenza H5 HA confers respiratory droplet transmission to a reassortant H5 HA/H1N1 virus in ferrets. Nature. 2012 May 2;486(7403):420-8.[Abstract][Full Text]
84. Centers for Disease Control and Prevention. Study shows ferrets became sick with A(H5N1) virus after eye exposure. Jun 2024 [internet publication].[Full Text]
85. Neumann G, Macken CA, Karasin AI, et al. Egyptian H5N1 influenza viruses-cause for concern? PLoS Pathog. 2012;8(11):e1002932.[Abstract][Full Text]
86. Russell CA, Fonville JM, Brown AE, et al. The potential for respiratory droplet-transmissible A/H5N1 influenza virus to evolve in a mammalian host. Science. 2012 Jun 22;336(6088):1541-7.[Abstract][Full Text]
87. Uyeki TM, Bresee JS. Detecting human-to-human transmission of avian influenza A (H5N1). Emerg Infect Dis. 2007 Dec;13(12):1969-71.[Abstract][Full Text]
88. Refaey S, Azziz-Baumgartner E, Amin MM, et al. Increased number of human cases of influenza virus A(H5N1) infection, Egypt, 2014-15. Emerg Infect Dis. 2015 Dec;21(12):2171-3.[Abstract][Full Text]
89. Garten RJ, Davis CT, Russell CA, et al. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science. 2009 Jul 10;325(5937):197-201.[Abstract][Full Text]
90. Horimoto T, Kawaoka Y. Influenza: lessons from past pandemics, warnings from current incidents. Nat Rev Microbiol. 2005 Aug;3(8):591-600.[Abstract]
91. Yamada S, Suzuki Y, Suzuki T, et al. Haemagglutinin mutations responsible for the binding of H5N1 influenza A viruses to human-type receptors. Nature. 2006 Nov 16;444(7117):378-82.[Abstract]
92. van Riel D, Munster VJ, de Wit E, et al. H5N1 virus attachment to lower respiratory tract. Science. 2006 Apr 21;312(5772):399.[Abstract]
93. Shu Y, Li CK, Li Z, et al. Avian influenza A(H5N1) viruses can directly infect and replicate in human gut tissues. J Infect Dis. 2010;201:1173-1177.[Abstract]
94. Chandrasekaran A, Srinivasan A, Raman R, et al. Glycan topology determines human adaptation of avian H5N1 virus hemagglutinin. Nat Biotechnol. 2008 Jan;26(1):107-13.[Abstract]
95. Auewarakul P, Suptawiwat O, Kongchanagul A, et al. An avian influenza H5N1 virus that binds to a human-type receptor. J Virol. 2007 Sep;81(18):9950-5.[Abstract][Full Text]
96. Chan MC, Cheung CY, Chui WH, et al. Proinflammatory cytokine responses induced by influenza A (H5N1) viruses in primary human alveolar and bronchial epithelial cells. Respir Res. 2005 Nov 11;6(1):135.[Abstract][Full Text]
97. de Jong MD, Simmons CP, Thanh TT, et al. Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia. Nat Med. 2006 Oct;12(10):1203-7.[Abstract][Full Text]
98. Gu J, Xie Z, Gao Z, et al. H5N1 infection of the respiratory tract and beyond: a molecular pathology study. Lancet. 2007 Sep 29;370(9593):1137-45.[Abstract]
99. Apisarnthanarak A, Erb S, Stephenson I, et al. Seroprevalence of anti-H5 antibody among Thai health care workers after exposure to avian influenza (H5N1) in a tertiary care center. Clin Infect Dis. 2005 Jan 15;40(2):e16-8.[Abstract]
100. Liem NT, Lim W. Lack of H5N1 avian influenza transmission to hospital employees, Hanoi, 2004. Emerg Infect Dis. 2005 Feb;11(2):210-5.[Abstract][Full Text]
101. Schultsz C, Dong VC, Chau NV, et al. Avian influenza H5N1 and healthcare workers. Emerg Infect Dis. 2005 Jul;11(7):1158-9.[Abstract][Full Text]
102. Ortiz JR, Katz MA, Mahmoud MN, et al. Lack of evidence of avian-to-human transmission of avian influenza A (H5N1) virus among poultry workers, Kano, Nigeria, 2006. J Infect Dis. 2007 Dec 1;196(11):1685-91.[Abstract][Full Text]
103. World Health Organization. Practical interim guidance to reduce the risk of infection in people exposed to avian influenza viruses. Aug 2024 [internet publication].[Full Text]
104. UK Health Security Agency. Management of contacts of highly pathogenic avian influenza H5N1 during the 2023 to 2024 avian influenza season. Feb 2024 [internet publication].[Full Text]
105. Prieto-Lara E, Llanos-Mendez A. Safety and immunogenicity of prepandemic H5N1 influenza vaccines: a systematic review of the literature. Vaccine. 2010 Jun 11;28(26):4328-34.[Abstract]
106. Vesikari T, Forstén A, Herbinger KH, et al. Safety and immunogenicity of an MF59(®)-adjuvanted A/H5N1 pre-pandemic influenza vaccine in adults and the elderly. Vaccine. 2012 Feb 8;30(7):1388-96.[Abstract]
107. Langley JM, Risi G, Caldwell M, et al. Dose-sparing H5N1 A/Indonesia/05/2005 pre-pandemic influenza vaccine in adults and elderly adults: a phase III, placebo-controlled, randomized study. J Infect Dis. 2011 Jun 15;203(12):1729-38.[Abstract][Full Text]
108. US Food and Drug Administration. Influenza virus vaccine, H5N1 (for national stockpile). Feb 2018 [internet publication].[Full Text]
109. Qualls N, Levitt A, Kanade N, et al; CDC Community Mitigation Guidelines Work Group. Community mitigation guidelines to prevent pandemic influenza - United States, 2017. MMWR Recomm Rep. 2017 Apr 21;66(1):1-34.[Abstract][Full Text]
110. Centers for Disease Control and Prevention. Case definitions for investigations of human infection with avian influenza A viruses in the United States. May 2024 [internet publication].[Full Text]
111. World Health Organization. Interim guidelines for avian influenza case management. Sep 2007 [internet publication].[Full Text]
112. Centers for Disease Control and Prevention. Interim guidance on specimen collection and testing for patients with suspected infection with novel influenza A viruses associated with severe disease or with the potential to cause severe disease in humans. Sep 2024 [internet publication].[Full Text]
113. World Health Organization. Clinical practice guidelines for influenza. Sep 2024 [internet publication].[Full Text]
114. European Centre for Disease Prevention and Control. Enhanced surveillance of severe avian influenza virus infections in hospital settings in the EU/EEA. Jun 2023 [internet publication].[Full Text]
115. Centers for Disease Control and Prevention. Interim guidance for infection control within healthcare settings when caring for confirmed cases, probable cases, and cases under investigation for infection with novel influenza A viruses associated with severe disease. Mar 2022 [internet publication].[Full Text]
116. World Health Organization. Collecting, preserving and shipping specimens for the diagnosis of avian influenza A(H5N1) virus infection. Oct 2006 [internet publication].[Full Text]
117. UK Health Security Agency. Laboratory investigations for suspected avian influenza A(H7) and A(H5) human infections in England. 2022 [internet publication].[Full Text]
118. UK Health Security Agency. Avian influenza: guidance for managing human cases. Feb 2024 [internet publication].[Full Text]
119. Centers for Disease Control and Prevention. Symptom monitoring among persons exposed to HPAI. Jun 2024 [internet publication].[Full Text]
120. Clinician brief: evaluating and managing patients exposed to animals or persons infected with novel influenza A viruses of public health concern. Sep 2024 [internet publication].[Full Text]
121. Centers for Disease Control and Prevention. Interim guidance for follow-up of close contacts of persons infected with novel influenza A viruses associated with severe human disease or with potential to cause severe human disease, and use of antiviral medications for post-exposure prophylaxis. Aug 2024 [internet publication].[Full Text]
122. Patel RB, Mathur MB, Gould M, et al. Demographic and clinical predictors of mortality from highly pathogenic avian influenza A (H5N1) virus infection: CART analysis of international cases. PLoS One. 2014 Mar 25;9(3):e91630.[Abstract][Full Text]
123. Centers for Disease Control and Prevention. Influenza antiviral medications: summary for clinicians. Dec 2023 [internet publication].[Full Text]
124. Adisasmito W, Chan PK, Lee N, et al. Effectiveness of antiviral treatment in human influenza A (H5N1) infections: analysis of a Global Patient Registry. J Infect Dis. 2010 Oct 15;202(8):1154-60.[Abstract][Full Text]
125. Chan PK, Lee N, Zaman M, et al. Determinants of antiviral effectiveness in influenza virus A subtype H5N1. J Infect Dis. 2012 Nov;206(9):1359-66.[Abstract]
126. Duval X, van der Werf S, Blanchon T, et al. Efficacy of oseltamivir-zanamivir combination compared to each monotherapy for seasonal influenza: a randomized placebo-controlled trial. PLoS Med. 2010 Nov 2;7(11):e1000362.[Abstract][Full Text]
127. Kayali G, Webby RJ, Ducatez MF, et al. The epidemiological and molecular aspects of influenza H5N1 viruses at the human-animal interface in Egypt. PLoS One. 2011 Mar 21;6(3):e17730.[Abstract][Full Text]
128. Fiebig L, Soyka J, Buda S, et al. Avian influenza A(H5N1) in humans: new insights from a line list of World Health Organization confirmed cases, September 2006 to August 2010. Euro Surveill. 2011 Aug 11;16(32):19941.[Abstract][Full Text]
129. Arabi Y, Gomersall CD, Ahmed QA, et al. The critically ill avian influenza A (H5N1) patient. Crit Care Med. 2007 May;35(5):1397-403.[Abstract]
130. de Jong MD, Tran TT, Truong HK, et al. Oseltamivir resistance during treatment of influenza A (H5N1) infection. N Engl J Med. 2005;353:2667-2672.[Abstract][Full Text]
131. Le QM, Kiso M, Someya K, et al. Avian flu: isolation of drug-resistant H5N1 virus. Nature. 2005 Oct 20;437(7062):1108.[Abstract]
132. Le MT, Wertheim HF, Nguyen HD, et al. Influenza A H5N1 clade 2.3.4 virus with a different antiviral susceptibility profile replaced clade 1 virus in humans in northern Vietnam. PLoS One. 2008 Oct 6;3(10):e3339.[Abstract][Full Text]
133. Centers for Disease Control and Prevention. Interim guidance on influenza antiviral post-exposure prophylaxis of persons exposed to birds or other animals with novel influenza A viruses associated with severe human disease or with the potential to cause severe human disease. Sep 2024 [internet publication].[Full Text]
134. Taylor WR, Thinh BN, Anh GT, et al. Oseltamivir is adequately absorbed following nasogastric administration to adult patients with severe H5N1 influenza. PLoS One. 2008;3(10):e3410.[Abstract][Full Text]
135. Zhou B, Zhong N, Guan Y. Treatment with convalescent plasma for influenza A (H5N1) infection. N Engl J Med. 2007 Oct 4;357(14):1450-1.[Abstract][Full Text]
136. Yu H, Gao Z, Feng Z, et al. Clinical characteristics of 26 human cases of highly pathogenic avian influenza A (H5N1) virus infection in China. PLoS One. 2008 Aug 21;3(8):e2985.[Abstract][Full Text]
137. Centers for Disease Control and Prevention. CDC Yellow Book 2024: health information for international travel. Section 5: travel-associated infections & diseases - influenza. May 2023 [internet publication].[Full Text]
138. World Health Organization. Zoonotic influenza A virus outbreak toolbox. May 2024 [internet publication].[Full Text]
139. Australian Government Department of Health and Aged Care. Avian influenza in humans (bird flu). May 2024 [internet publication].[Full Text]
140. UK Health Security Agency. Avian influenza: guidance, data and analysis. Jul 2024 [internet publication].[Full Text]
141. Lee CM, Hudson LD. Long-term outcomes after ARDS. Semin Respir Crit Care Med. 2001 Jun;22(3):327-36.[Abstract]
142. Ehlenbach WJ, Hough CL, Crane PK, et al. Association between acute care and critical illness hospitalization and cognitive function in older adults. JAMA. 2010 Feb 24;303(8):763-70.[Abstract][Full Text]