Recommended prevention of Avian Flu - WHO

In a nonpandemic situation, recommendations for treatment of patients with confirmed or strongly suspected infection with avian influenza A (H5N1) are as follows: Patients should receive oseltamivir treatment as soon as possible (strong recommendation). Clinicians might administer zanamivir (weak recommendation). If neuraminidase inhibitors are available, clinicians should not administer amantadine alone as a first-line treatment (strong recommendation). If neuraminidase inhibitors are not available and especially if the virus is known or likely to be susceptible, clinicians might administer amantadine as a first-line treatment (weak recommendation). If neuraminidase inhibitors are available, clinicians should not administer rimantadine alone as a first-line treatment (strong recommendation). If neuraminidase inhibitors are not available and especially if the virus is known or likely to be susceptible, clinicians might administer rimantadine as a first-line treatment (weak recommendation). If neuraminidase inhibitors are available and especially if the virus is known or likely to be susceptible, clinicians might administer a combination of neuraminidase inhibitor and M2 inhibitor (weak recommendation). This should only be done in the context of prospective data collection. High-risk exposure groups should receive oseltamivir as chemoprophylaxis continuing for 7 to 10 days after the last known exposure (strong recommendation). In moderate-risk exposure groups, oseltamivir may be administered as chemoprophylaxis, continuing for 7 to 10 days after the last known exposure (weak recommendation). Low-risk exposure groups should probably not receive oseltamivir for chemoprophylaxis (weak recommendation). Additional recommendations address prophylaxis and treatment with other agents and in specific groups including pregnant women. "The greatest barrier to implementation results from the limited availability of the neuraminidase inhibitors and the lack of resistance data," the panel concludes. "Emergence of novel human influenza A viral subtypes or a change in the pathogenicity or transmissibility of H5N1 virus strains, availability of new pharmacological agents, or important clinical research data on H5N1 will necessitate an update of these guidelines. In view of the potential for rapid change in the situation in relation to avian influenza, WHO will continue to monitor these factors carefully before deciding when to revise or update the recommendations. Lancet Infect Dis. 2007;7:21-31.