KARACHI, Jan 10: In the wake of Pakistan’s first human death caused by the deadly H5N1 bird flu virus in the NWFP recently, the Sindh health department has been provided with necessary laboratory kits for collection of samples from suspected persons and their onward transportation to the influenza laboratory of the National Institute of Health (NIH) Islamabad.
Confirming that the viral transport medium and relevant applicators and throat swabs, along with standard operating procedure (SOP) for collection, storage and transportation of specimens from suspected cases of avian influenza have been received from the NIH recently, the focal person on infectious diseases of the Sindh health department said that hospitals or physicians could contact the health department for the testing kits in case of an emergency.
Avian influenza (bird flu) is an infection caused by bird influenza viruses. Infection with bird flu virus in domestic poultry in its highly pathogenic form spreads more rapidly through flocks of poultry and affects multiple internal organs and has a mortality rate that can reach to 90-100 per cent often within 48 hours.
About human infection from avian influenza viruses, it is said that usually the avian influenza virus is found chiefly in birds, but infections from these viruses can occur in humans too. Confirmed cases of human infection from several sub-types of avian influenza infection, though rare, have been reported since 1997 in different parts of the world.
A health official in the Sindh government, Dr Shakeel A. Mullick, said so far no case of bird flu has been reported in Sindh, but poultry farmers and citizens needed to be kept abreast of the preventive measures in regard to maintenance of farms and consumption of chicken foods.
According to the NIH SOP, the viral transport medium should compulsorily be stored at 20 degrees centigrade prior to use, while personnel collecting or handling the specimen from a suspected case should wear gloves and masks. Personnel who transport specimens should be trained in safe handling practices and decontamination procedures.
Symptoms and signs
About symptoms and signs, the guidelines on clinical management of bird flu provided by the NIH mention the rapid onset of flu symptoms like nasal and oral irritation with profuse watery secretions followed by immediate high grade fever with throbbing headache and generalised muscular aches. The syndrome, if not controlled with medical treatment and nursing care, is liable to progress in subsequent complications, i.e. widespread pneumonia, which can lead to acute respiratory failure in a short span of time.
Treatment included keeping suspected patients in the isolation ward and immediate maintenance of IV line for infusion or antibiotics and immediate commencement of oral capsules of Oseltamivir 75mg BD up to five days.
A possible bird flu patient can be a person coming from an area where bird flu has been identified or suggested by livestock experts and is hospitalised with pneumonia, which has not improved within 24 hours of hospitalisation or a person hospitalised with pneumonia and having:
1) Recently (less than one week) visited a poultry farm in an area known to have an outbreak of highly pathogenic avian influenza (HPAI)
2) Or worked in a laboratory that is processing samples from persons or animals that are suspected for HPAI virus infection
3) Or contacted with a confirmed case of influenza A (H5N1) during the infection period.
A confirmed case of influenza A/H5 infection is an individual with an acute respiratory febrile illness for whom laboratory testing demonstrates one or more of the following:
* Positive viral culture for influenza A/H5;
* Positive polymerase chain reaction (PCR) for influenza A/H5;
* Positive immunofluorescence antibody (IFA) test to H5 antigen using H5 monoclonal antibodies;
* Four-fold rise in H5 specific antibody titre in paired serum samples, said the guidelines on case identifications.