Avian flu: Big Challenge for Chest Physicians

The following is an abstract of the above lecture to be given at the Presidential Symposium on Wednesday 22^nd November 2006 by:

There are 240 patients with H5N1 avian flu, with 141 deaths (59%) so far in the world (up to the end of August 2006). It is predicted that there will be an outbreak of avian flu pandemic in human beings in the following years. Owing to the high mortality, vaccination and isolation of the patients will be the keystone in preventing an outbreak. In addition to the direct contact with avian flu virus infected poultry, it is still unknown about the transmission route from poultry to human. There are 21 patients with avian flu in China up to the beginning of September 2006, including 14 deaths, constituting 67% of mortality. Reasons of high mortality may be:

1. delay in proven diagnosis
2. multi-organ failure developed soon after the onset of disease
3. lack of effective medication
4. secondary infection with fungi as well as pseudomonas

What are we going to do? A nation-wide monitoring network of critical pneumonia with "unknown cause" is to be set up to identify patients with AI. Patients with suspected AI should receive antiviral agents as early as possible. Patient isolation should be started in the first place. Similar to SARS, there will be a cytokine/chemokine release cascade during the early stage of avian flu, leading to an immunopathological inflammation (or immuno-deviation) of the target organs. Administration of immunomodulators may be effective in alleviating the development of the disease. Infusion of convalescent serum appears to be favorable in neutralizing AI virus. Apart from supportive treatment, early identification and management of secondary infection (in particular, fungal and pseudonomal) is an important issue for chest physicians.