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Abstrak :
First identified in humans in Hong Kong, influenza A/H5N1, known commonly as avian influenza, has caused human disease in 15 countries around the world. Although the current number of confirmed patients is tiny compared to seasonal and the recently emerged H1N1 swine influenza, H5N1 remains a candidate for the next highly pathogenic influenza pandemic. Currently, H5N1 has very limited ability to spread from person-to-person but this may change because of mutation or reassortment with other influenza viruses leading to an influenza pandemic with high mortality. If this occurs travellers are likely to be affected and travel medicine doctors will need to consider avian influenza in returning febrile travel-lers. The early clinical features may be dismissed easily as the flu resulting in delayed treat-ment. Treatment options are limited. Oral oseltamivir alone has been the most commonly used drug but mortality remains substantial, up to 80% in Indonesia. Intravenous peramivir has been filed for registration and IV zanamivir is being developed. This review will focus on the epide-miological and clinical features of influenza A/H5N1 avian influenza and will highlight aspects relevant to travel medicine doctors.

Abstrak :
Background: Limited understanding of the presentation and course of infl uenza A(H5N1) infection in humans hinders evidence-based management. Methods: We reviewed the case records of patients admitted to the Persahabatan Hospital (RSP), Jakarta, Indonesia, with infl uenza A(H5N1) confi rmed by real-time polymerase chain reaction. Results: Twenty-two previously well patients, aged 3 to 47 years (median 24.5 years), were identifi ed. All attended a clinic or hospital after a median of 2 days of illness (range 0-7). Times to fi rst dose of oseltamivir (three died before receiving oseltamivir) were 2 to 12 days (median 7 days), administered mostly (n 5 15) at RSP. Nineteen patients required mechanical ventilation. Deaths numbered 18 (case fatality 5 82%) occurring within hours to 6 days of RSP admission, corresponding to 6 to 16 days of illness. Admission hyperglycemia (  140 mg/dL), unrelated to steroids or known underlying diabetes mellitus, and elevated D-dimer levels (0.81-5.2 mg/L, upper limit of normal , 0.5 mg/L) were present in 14/21 (67%) and 20/21 (95%) patients, respectively. Fibrinogen concentrations were mostly low/normal at 129.9 to 517.9 mg/dL (median 241.1, normal 200-400 mg/dL), whereas C-reactive protein (9/11) and ferritin (6/8) levels were increased. Risk factors for death (univariate analysis) included: (1) increased D-dimers, (2) hyperglycema, (3) increased urea, (4) more extensive chest radiograph shadowing, and (5) lower admission oxygen saturation. Conclusions: Early diagnosis and effective treatment of human infl uenza A(H5N1) infection remains challenging. Most patients were referred late with advanced disease. Oseltamivir had limited clinical impact. Elevated D-dimer levels, consistent with fi brinolysis, and hyperglycemia warrant more research to determine their underlying mechanisms and optimal treatment.