WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus

Holger J. Schünemann, Suzanne R. Hill, Meetali Kakad, Richard Bellamy, Timothy M. Uyeki, Frederick G. Hayden, Yazdan Yazdanpanah, John Beigel, Tawee Chotpitayasunondh, Chris Del Mar, Jeremy Farrar, Tran Tinh Hien, Bülent Özbay, Norio Sugaya, Keiji Fukuda, Nikki Shindo, Lauren Stockman, Gunn E. Vist, Alice Croisier, Azim Nagjdaliyev & 4 others Cathy Roth, Gail Thomson, Howard Zucker, Andrew D. Oxman

Research output: Contribution to journalReview articleResearchpeer-review

150 Citations (Scopus)

Abstract

Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.

Original languageEnglish
Pages (from-to)21-31
Number of pages11
JournalThe Lancet Infectious Diseases
Volume7
Issue number1
DOIs
Publication statusPublished - Jan 2007

Fingerprint

H5N1 Subtype Influenza A Virus
Influenza in Birds
Influenza A virus
Pharmacology
Guidelines
Chemoprevention
Pandemics
Infection
Human Influenza
Oseltamivir
Neuraminidase
Virus Diseases
Poultry
Birds
Antiviral Agents
Virulence
Costs and Cost Analysis
Population

Cite this

Schünemann, Holger J. ; Hill, Suzanne R. ; Kakad, Meetali ; Bellamy, Richard ; Uyeki, Timothy M. ; Hayden, Frederick G. ; Yazdanpanah, Yazdan ; Beigel, John ; Chotpitayasunondh, Tawee ; Del Mar, Chris ; Farrar, Jeremy ; Hien, Tran Tinh ; Özbay, Bülent ; Sugaya, Norio ; Fukuda, Keiji ; Shindo, Nikki ; Stockman, Lauren ; Vist, Gunn E. ; Croisier, Alice ; Nagjdaliyev, Azim ; Roth, Cathy ; Thomson, Gail ; Zucker, Howard ; Oxman, Andrew D. / WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus. In: The Lancet Infectious Diseases. 2007 ; Vol. 7, No. 1. pp. 21-31.
@article{a9ce7aeeedd74f3a8d2c5e758f524cb0,
title = "WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus",
abstract = "Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.",
author = "Sch{\"u}nemann, {Holger J.} and Hill, {Suzanne R.} and Meetali Kakad and Richard Bellamy and Uyeki, {Timothy M.} and Hayden, {Frederick G.} and Yazdan Yazdanpanah and John Beigel and Tawee Chotpitayasunondh and {Del Mar}, Chris and Jeremy Farrar and Hien, {Tran Tinh} and B{\"u}lent {\"O}zbay and Norio Sugaya and Keiji Fukuda and Nikki Shindo and Lauren Stockman and Vist, {Gunn E.} and Alice Croisier and Azim Nagjdaliyev and Cathy Roth and Gail Thomson and Howard Zucker and Oxman, {Andrew D.}",
year = "2007",
month = "1",
doi = "10.1016/S1473-3099(06)70684-3",
language = "English",
volume = "7",
pages = "21--31",
journal = "The Lancet Infectious Diseases",
issn = "1473-3099",
publisher = "Elsevier",
number = "1",

}

Schünemann, HJ, Hill, SR, Kakad, M, Bellamy, R, Uyeki, TM, Hayden, FG, Yazdanpanah, Y, Beigel, J, Chotpitayasunondh, T, Del Mar, C, Farrar, J, Hien, TT, Özbay, B, Sugaya, N, Fukuda, K, Shindo, N, Stockman, L, Vist, GE, Croisier, A, Nagjdaliyev, A, Roth, C, Thomson, G, Zucker, H & Oxman, AD 2007, 'WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus' The Lancet Infectious Diseases, vol. 7, no. 1, pp. 21-31. https://doi.org/10.1016/S1473-3099(06)70684-3

WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus. / Schünemann, Holger J.; Hill, Suzanne R.; Kakad, Meetali; Bellamy, Richard; Uyeki, Timothy M.; Hayden, Frederick G.; Yazdanpanah, Yazdan; Beigel, John; Chotpitayasunondh, Tawee; Del Mar, Chris; Farrar, Jeremy; Hien, Tran Tinh; Özbay, Bülent; Sugaya, Norio; Fukuda, Keiji; Shindo, Nikki; Stockman, Lauren; Vist, Gunn E.; Croisier, Alice; Nagjdaliyev, Azim; Roth, Cathy; Thomson, Gail; Zucker, Howard; Oxman, Andrew D.

In: The Lancet Infectious Diseases, Vol. 7, No. 1, 01.2007, p. 21-31.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - WHO Rapid Advice Guidelines for pharmacological management of sporadic human infection with avian influenza A (H5N1) virus

AU - Schünemann, Holger J.

AU - Hill, Suzanne R.

AU - Kakad, Meetali

AU - Bellamy, Richard

AU - Uyeki, Timothy M.

AU - Hayden, Frederick G.

AU - Yazdanpanah, Yazdan

AU - Beigel, John

AU - Chotpitayasunondh, Tawee

AU - Del Mar, Chris

AU - Farrar, Jeremy

AU - Hien, Tran Tinh

AU - Özbay, Bülent

AU - Sugaya, Norio

AU - Fukuda, Keiji

AU - Shindo, Nikki

AU - Stockman, Lauren

AU - Vist, Gunn E.

AU - Croisier, Alice

AU - Nagjdaliyev, Azim

AU - Roth, Cathy

AU - Thomson, Gail

AU - Zucker, Howard

AU - Oxman, Andrew D.

PY - 2007/1

Y1 - 2007/1

N2 - Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.

AB - Recent spread of avian influenza A (H5N1) virus to poultry and wild birds has increased the threat of human infections with H5N1 virus worldwide. Despite international agreement to stockpile antivirals, evidence-based guidelines for their use do not exist. WHO assembled an international multidisciplinary panel to develop rapid advice for the pharmacological management of human H5N1 virus infection in the current pandemic alert period. A transparent methodological guideline process on the basis of the Grading Recommendations, Assessment, Development and Evaluation (GRADE) approach was used to develop evidence-based guidelines. Our development of specific recommendations for treatment and chemoprophylaxis of sporadic H5N1 infection resulted from the benefits, harms, burden, and cost of interventions in several patient and exposure groups. Overall, the quality of the underlying evidence for all recommendations was rated as very low because it was based on small case series of H5N1 patients, on extrapolation from preclinical studies, and high quality studies of seasonal influenza. A strong recommendation to treat H5N1 patients with oseltamivir was made in part because of the severity of the disease. Similarly, strong recommendations were made to use neuraminidase inhibitors as chemoprophylaxis in high-risk exposure populations. Emergence of other novel influenza A viral subtypes with pandemic potential, or changes in the pathogenicity of H5N1 virus strains, will require an update of these guidelines and WHO will be monitoring this closely.

UR - http://www.scopus.com/inward/record.url?scp=33845567555&partnerID=8YFLogxK

U2 - 10.1016/S1473-3099(06)70684-3

DO - 10.1016/S1473-3099(06)70684-3

M3 - Review article

VL - 7

SP - 21

EP - 31

JO - The Lancet Infectious Diseases

JF - The Lancet Infectious Diseases

SN - 1473-3099

IS - 1

ER -