Avian Influenza A (H5N1) Infection in Humans The Writing Committee of the World Health Organization (WHO) Consultation on Human Influenza A/H5 The writing committee consisted of the following: John H. Beigel, M. D., National Institute of Allergy and Infectious Diseases,NIH, Bethesda, Md.; Jeremy Farrar, D.Phil., Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Aye Maung Han, M.B., B.S., Department of Child Health, Institute of Medicine, Yangon, Myanmar; Frederick G. Hayden, M.D. (rapporteur), University of Virginia, Charlottesville; Randy Hyer, M.D., World Health Organization, Geneva; Menno D. de Jong, M.D., Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Sorasak Lochindarat, M.D., Queen Sirikit National Institute of Child Health, Bangkok, Thailand; Nguyen Thi Kim Tien, M.D., Ph.D., Pasteur Institute, Ho Chi Minh City, Vietnam; Nguyen Tran Hien, M. D., Ph.D., National Institute of Hygiene and Epidemiology, Hanoi; Tran Tinh Hien, M.D., Ph.D., Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam; Angus Nicoll, M.Sc., Health Protection Agency, London; Sok Touch, M.D., Ministry of Health, Phnom Penh, Cambodia; and Kwok-Yung Yuen, M.D., University of Hong Kong, Hong Kong SAR, China. Address reprint requests to Dr. Hayden at the Department of Internal Medicine, P.O. Box 800473, University of Virginia Health Sciences Center, Charlottesville, VA 22908, or at fgh@virginia.edu. N Engl J Med 2005; 353:1374-85. Copyright c 2005 Massachusetts Medical Society. H5N1 WHO2005 5 10 12 H5N1 H5N1 1 H5N1 1 H5N1 2004 2005 1 H5N1 2,3 4,5 H5N1 1997 H5N1 6 7 2 3 Reprinted from THE NEW ENGLAND JOURNAL OF MEDICINE (ISSN 0028-4793)Vol. 353:1374-1385(September 29, 2005). Copy right 2005 c Massachuselts Medical Society. All rights reserved. Printed in CHINA, Tel: (8610) 64036988 Fax: (8610) 64064469
1 2003 WHO * 2003 12 26 2004 3 10 23 16 12 8 0 0 0 0 35 24 2004 7 19 2004 10 8 4 4 5 4 0 0 0 0 9 8 2004 12 16 2005 8 5 63 20 0 0 4 4 1 1 68 25 90 40 17 12 4 4 1 1 112 57 * 2 * 1997 MN,ELISA,WB 51 6(12) 6 Katz 8 26 1(4) 5 47 0 9 1 1997 MN,WB 293 9(3) 1 Bridges 7 1997 MN,WB 1525 Bridges 7 10% 1997 MN,WB 217 8 (4) 2 Buxton Bridges 9 2004 MN 51 0 83 0 2004 MN 25 0 2004 MN 83 0 2 Liem 10 2004 MN,RT PCR 60 0 Schultsz 11 2004 54 0 2004 35 0 Apisarntha- narak 12 2005 MN 79 1 1 17,18 19 11 1
3 * 1997 2004 2004 2005 2005 (N=18) (N=17) (N=10) (N=10) (N=4) 9.5 14 13.7 19.4 22 1~60 2~58 5~24 6~35 8~28 % 8(44) 9(53) 6(60) 3(30) 1(25) NS 4 3 NS NS 2~8 2~4 1 2 1 1 11/16(70) 14/17(82) 8/9(89) 6/6(100) 3/4(75) / % 4 3 NS 6 6 8 1~7 3~8 4~7 5~8 % >38 17/18(94) 17/17(100) 10/10(100) 10/10(100) 4/4(100) 4/18(22) NS NS 1/10(10) 4/4(100) 2/18(11) 9/17(53) 0 2/10(20) NS 3/18(17) 7/17(41) 7/10(70) NS 2/4(50) 3/18(17) 4/17(24) NS NS 2/4(50) 6/18(33) 4/17(24) NS 1/10(10) 0 12/18(67) 16/17(94) 10/10(100) 10/10(100) 4/4(100) NS 13/17(76) 5/10(50) 3/10(30) NS 4/12(33) 12/17(71) 0 0 1/4(25) 7/12(58) 9/17(53) 0 0 NS 1/18(6) 13/17(76) 10/10(100) 10/10(100) NS 11/18(61) 17/17(100) 10/10(100) 10/10(100) 4/4(100) 11/18(61) 7/12(58) NS 8/10(80) 1/2(50) NS 4/12(33) NS 8/10(80) 1/2(50) 11/18(61) 8/12(67) 5/6(83) 7/10(70) NS H5N1 3 12 2 RT-PCR 1997 21 8 2 2
3 ( ) 1997 2004 2004 2005 2005 (N=18) (N=17) (N=10) (N=10) (N=4) (%) 8(44) 13(76) 9(90) 7(70) 4(100) NS 7(41) NS 0 NS 4(22) 5(29) 1(10) 2(20) NS 10(56) 0 0 0 NS 1(6) 0 2(20) 0 0 10(59) 5(50) 10(100) ** 5(28) 8(47) 7(70) 5(50) NS NS 8(47) 2(20) NS 23 12 9 12.8 8 8~29 9~30 4~17 4~21 6~10 (%) 6(33) 12(71) 8(80) 8(80) 4(100) 10,11 2 1 H5N1 H5N1
12,21,22 3 ARDS 15 ARDS 6 H5N1 4~13 1997 2~4 13 15,16 14-16,24 8 3 2~5 8~17 Reye 21 > 3 1997 38 1 3 13 H5N1 23 H7 15 H5N1 89 9 10 15,16 6~30 14-16,24 25 1 16 2 15 3 11 15 3 5 1~16 15 H5 RNA H5N1 26 H5N1 RNA 7 3~17 RNA 15 2 2~15 5.5 4~8 H5N1 H3N2 H1N1 10
27 H5N1 Z 15 33 RT-PCR 2 4~18 H5N1 11 436 21 H5N1 15,16 48 3 H5N1 1997 1,15,16 6.5 1~16 2 3 3~16 27 RNA 9 7 RNA 18 1 1 41 1997 2 Glu627Lys 28,29 28,29,39,40 1 4~9 Asp92Glu 6 RNA 1 TNF RNA 18 30 TNF 31 32-34 1997 H5N1 35,36 37,38 17,18 H5N1 39,40
H5N1 1997 6 TNF- 2 42 2003 3~8 10 1 27 6 8 1 1 Simmons C 3 ARDS 10~14 H5N1 27,41 42 43 2 41 42 13,15,27,42 H5N1 H5N1 4 H5N1 H5N1 H5N1 H5N1 RNA H5N1 RNA PCR H5 H5 4 44 H5N1 5 1 SARS H5N1 46,47
4 * 2003 10 1 H5 7~14 1 1 6 1 2003 10 1 H5 7~14, H5 1 6 45 5 2 48,49 1997 15 kg 30 mg 15~23 kg 45 mg 2004 23~40 kg 60 mg >40 kg 75 mg H5N1 8 50 150 mg 2 7~10 N1 His274Tyr 15 51,52 53 H1N1 16 54 2 21 55 75 mg 2 5 1 H1N1
1 NIOSH N-95 2 >38 75 mg 1 7~10 1 2 7 75 mg 1 7~10 >38 45 2 10 5 *
54 peramivir 57 58 1997 H5N1 M2 peramivir 59 60 60 1997 5 2 ARDS 4 H5 H5 2 62 MF 59 63 3 1997 H5 2004 64 ( ) H5 65 66 2004 H5N1 67 68 ( ) 4,5 SARS 5 1 69 N95 75 mg 1 7~10 70 71 H5N1 H5N1 5 1 H5N1 H5N1 H5N1 H5N1
M2 H5N1