Finding the real case-fatality rate of H5N1 avian influenza
Identifieur interne : 000100 ( 1968/Analysis ); précédent : 000099; suivant : 000101Finding the real case-fatality rate of H5N1 avian influenza
Auteurs : F C K. Li [Canada] ; B C K. Choi [Canada] ; T. Sly [Canada] ; A W P. Pak [Canada]Source :
- Journal of Epidemiology and Community Health [ 0143-005X ] ; 2008-06.
English descriptors
- Teeft :
- Accurate estimation, Avian, Avian influenza, Avian influenza virus, Avian influenza viruses, Cambodia, Clade, Current outbreak, Eastern turkey, Emerg, Epidemiol, Epidemiol community health, Health policy, Healthcare workers, Hong kong, Household contacts, Human cases, Infectious disease prevention, Influenza, Influenza pandemic, Influenza pandemics, Influenza virus, International community, Major form, Mild cases, Other hand, Other reasons, Outbreak, Pandemic, Pandemic planning, Paper reviews, Poultry workers, Public health agency, Public health policy, Respiratory syndrome, Scenario, Sialic acid, Virus infection, Wkly epidemiol, World health organization.
Abstract
Background: Accurate estimation of the case-fatality (CF) rate, or the proportion of cases that die, is central to pandemic planning. While estimates of CF rates for past influenza pandemics have ranged from about 0.1% (1957 and 1968 pandemics) to 2.5% (1918 pandemic), the official World Health Organization estimate for the current outbreak of H5N1 avian influenza to date is around 60%. Methods and results: The official estimate of the H5N1 CF rate has been described by some as an over-estimate, with little relevance to the rate that would be encountered under pandemic conditions. The reasons for such opinions are typically: (i) numerous undetected asymptomatic/mild cases, (ii) under-reporting of cases by some countries for economic or other reasons, and (iii) an expected decrease in virulence if and when the virus becomes widely transmitted in humans. Neither current data nor current literature, however, adequately supports these scenarios. While the real H5N1 CF rate could be lower than the current estimate of 60%, it is unlikely that it will be at the 0.1–0.4% level currently embraced by many pandemic plans. We suggest that, based on surveillance and seroprevalence studies conducted in several countries, the real H5N1 CF rate should be closer to 14–33%. Conclusions: Clearly, if such a CF rate were to be sustained in a pandemic, H5N1 would present a truly dreadful scenario. A concerted and dedicated effort by the international community to avert a pandemic through combating avian influenza in animals and humans in affected countries needs to be a global priority.
Url:
DOI: 10.1136/jech.2007.064030
Affiliations:
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Pak</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:5BA5C68C5BA30E97A42BB1388C016E3E11F61B20</idno><date when="2008" year="2008">2008</date><idno type="doi">10.1136/jech.2007.064030</idno><idno type="url">https://api.istex.fr/ark:/67375/NVC-KP9CZ780-C/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000766</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000766</idno><idno type="wicri:Area/Istex/Curation">000766</idno><idno type="wicri:Area/Istex/Checkpoint">000363</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Checkpoint">000363</idno><idno type="wicri:doubleKey">0143-005X:2008:Li F:finding:the:real</idno><idno type="wicri:Area/Main/Merge">001343</idno><idno type="wicri:Area/Main/Curation">001330</idno><idno type="wicri:Area/Main/Exploration">001330</idno><idno type="wicri:Area/1968/Extraction">000100</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main" xml:lang="en">Finding the real case-fatality rate of H5N1 avian influenza</title><author><name sortKey="Li, F C K" sort="Li, F C K" uniqKey="Li F" first="F C K" last="Li">F C K. Li</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Choi, B C K" sort="Choi, B C K" uniqKey="Choi B" first="B C K" last="Choi">B C K. Choi</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario; Department of Public Health Sciences, University of Toronto, Toronto, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Sly, T" sort="Sly, T" uniqKey="Sly T" first="T" last="Sly">T. Sly</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>School of Occupational and Public Health, Ryerson University, Toronto, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author><author><name sortKey="Pak, A W P" sort="Pak, A W P" uniqKey="Pak A" first="A W P" last="Pak">A W P. Pak</name><affiliation wicri:level="1"><country xml:lang="fr">Canada</country><wicri:regionArea>Pak Consulting, Ottawa, Ontario</wicri:regionArea><wicri:noRegion>Ontario</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">Journal of Epidemiology and Community Health</title><title level="j" type="abbrev">J Epidemiol Community Health</title><idno type="ISSN">0143-005X</idno><idno type="eISSN">1470-2738</idno><imprint><publisher>BMJ Publishing Group Ltd</publisher><date type="published" when="2008-06">2008-06</date><biblScope unit="volume">62</biblScope><biblScope unit="issue">6</biblScope><biblScope unit="page" from="555">555</biblScope></imprint><idno type="ISSN">0143-005X</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0143-005X</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Accurate estimation</term><term>Avian</term><term>Avian influenza</term><term>Avian influenza virus</term><term>Avian influenza viruses</term><term>Cambodia</term><term>Clade</term><term>Current outbreak</term><term>Eastern turkey</term><term>Emerg</term><term>Epidemiol</term><term>Epidemiol community health</term><term>Health policy</term><term>Healthcare workers</term><term>Hong kong</term><term>Household contacts</term><term>Human cases</term><term>Infectious disease prevention</term><term>Influenza</term><term>Influenza pandemic</term><term>Influenza pandemics</term><term>Influenza virus</term><term>International community</term><term>Major form</term><term>Mild cases</term><term>Other hand</term><term>Other reasons</term><term>Outbreak</term><term>Pandemic</term><term>Pandemic planning</term><term>Paper reviews</term><term>Poultry workers</term><term>Public health agency</term><term>Public health policy</term><term>Respiratory syndrome</term><term>Scenario</term><term>Sialic acid</term><term>Virus infection</term><term>Wkly epidemiol</term><term>World health organization</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract">Background: Accurate estimation of the case-fatality (CF) rate, or the proportion of cases that die, is central to pandemic planning. While estimates of CF rates for past influenza pandemics have ranged from about 0.1% (1957 and 1968 pandemics) to 2.5% (1918 pandemic), the official World Health Organization estimate for the current outbreak of H5N1 avian influenza to date is around 60%. Methods and results: The official estimate of the H5N1 CF rate has been described by some as an over-estimate, with little relevance to the rate that would be encountered under pandemic conditions. The reasons for such opinions are typically: (i) numerous undetected asymptomatic/mild cases, (ii) under-reporting of cases by some countries for economic or other reasons, and (iii) an expected decrease in virulence if and when the virus becomes widely transmitted in humans. Neither current data nor current literature, however, adequately supports these scenarios. While the real H5N1 CF rate could be lower than the current estimate of 60%, it is unlikely that it will be at the 0.1–0.4% level currently embraced by many pandemic plans. We suggest that, based on surveillance and seroprevalence studies conducted in several countries, the real H5N1 CF rate should be closer to 14–33%. Conclusions: Clearly, if such a CF rate were to be sustained in a pandemic, H5N1 would present a truly dreadful scenario. A concerted and dedicated effort by the international community to avert a pandemic through combating avian influenza in animals and humans in affected countries needs to be a global priority.</div></front></TEI><affiliations><list><country><li>Canada</li></country></list><tree><country name="Canada"><noRegion><name sortKey="Li, F C K" sort="Li, F C K" uniqKey="Li F" first="F C K" last="Li">F C K. Li</name></noRegion><name sortKey="Choi, B C K" sort="Choi, B C K" uniqKey="Choi B" first="B C K" last="Choi">B C K. Choi</name><name sortKey="Pak, A W P" sort="Pak, A W P" uniqKey="Pak A" first="A W P" last="Pak">A W P. Pak</name><name sortKey="Sly, T" sort="Sly, T" uniqKey="Sly T" first="T" last="Sly">T. 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