Diagnosis

Timely diagnosis of avian influenza virus infections is critical to limit spread, initiate early therapy and alert health authorities. The usual diagnostic methods for detecting seasonal influenza A and B include rapid antigen tests, viral culture, immunofluorescent antibody assays and RT-PCR [49]. In countries where avian influenza activity has been identified or suspected, the critical issues are laboratory safety and the need to distinguish avian influenza viruses from human A/H1, A/H3 and B infections. The use of rapid antigen assays may rapidly identify influenza A or B virus infection, but will not differentiate between human and avian influenza A virus subtypes. Specimens from cases of potential avian influenza should be forwarded to a national or a WHO H5 Reference Laboratory for confirmatory testing. Since limited data exist describing shedding of avian influenza virus in humans, several respiratory specimens should be collected on different

Table 4. Pediatric cases of H5N1 infection and mortality in countries other than Thailand and Vietnam

Country

Total no. of cases

No. of pediatric cases (%)

Pediatric mortality

(%)

Azerbaijan

8

6 (75)

17

Cambodia

6

3 (50)

100

China

19

7 (37)

43

Djerbouti

1

1 (100)

0

Egypt

14

7 (50)

14

Indonesia

52

23 (44)#

70

Iraq

2

1 (50)

100

Turkey

21*

19 (90)

21

*Confirmed by laboratory testing in Turkey; 9 cases not yet confirmed by WHO testing. #Four additional untested pediatric deaths in siblings of confirmed cases. Source: Weekly Epidemiological Record (WER) 2005-2006, World Health Organization. Accessible at: http://www.who.int/wer/en/

*Confirmed by laboratory testing in Turkey; 9 cases not yet confirmed by WHO testing. #Four additional untested pediatric deaths in siblings of confirmed cases. Source: Weekly Epidemiological Record (WER) 2005-2006, World Health Organization. Accessible at: http://www.who.int/wer/en/

days for testing. Rapid tests for the diagnosis of avian influenza infection should be used only in combination with clinical findings and exposure history, due to the unknown sensitivity of these assays for avian influenza viruses. A negative rapid test result does not exclude human infection with avian influenza viruses. Specimens from highly suspect cases should not be cultivated under routine conditions in the clinical virology laboratory, but transported to a reference laboratory under appropriate biosafety conditions for confirmatory RT-PC testing.

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