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JENNIFER K. THOMAS, PHARM.D., is Clinical Assistant Professor, Experiential Program, School of Pharmacy, University of Maryland, Baltimore, and Clinical Pharmacy Specialist, Antimicrobial Stewardship, Emergency Preparedness, St. Agnes Hospital, Baltimore. JENNIFER NOPPENBERGER, R.N., CIC, is Director, Infection Control and Emergency Preparedness, St. Agnes Hospital.

Address correspondence to Dr. Thomas at St. Agnes Hospital, 900 Caton Avenue, Baltimore, MD 21229 (jthomas{at}stagnes.org).

Purpose. A review of the avian influenza A/H5N1 virus, including human cases, viral transmission, clinical features, vaccines and antivirals, surveillance plans, infection control, and emergency response plans, is presented. Summary. The World Health Organization (WHO) considers the avian influenza A/H5N1 virus a public health risk with pandemic potential. The next human influenza pandemic, if caused by the avian influenza A/H5N1 virus, is estimated to have a potential mortality rate of more than a hundred million. Outbreaks in poultry have been associated with human transmission. WHO has documented 258 confirmed human infections with a mortality rate greater than 50%. Bird-to-human transmission of the avian influenza virus is likely by the oral–fecal route. The most effective defense against an influenza pandemic would be a directed vaccine to elicit a specific immune response toward the strain or strains of the influenza virus. However, until there is an influenza pandemic, there is no evidence that vaccines or antivirals used in the treatment or prevention of such an outbreak would decrease morbidity or mortality. Surveillance of the bird and human populations for the highly pathogenic H5N1 is being conducted. Infection-control measures and an emergency response plan are discussed. Conclusion. Avian influenza virus A/H5N1 is a public health threat that has the potential to cause serious illness and death in humans. Understanding its pathology, transmission, clinical features, and pharmacologic treatments and preparing for the prevention and management of its outbreak will help avoid its potentially devastating consequences. Index terms: Antivirals; Epidemiology; Immunization; Infection control; Influenza; Influenza vaccines; Mortality; Vaccines

 

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