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. 2013 Jun 11:13:571.
doi: 10.1186/1471-2458-13-571.

Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation

Wiku Adisasmito, Dewi Nur Aisyah, Tjandra Yoga Aditama, Rita Kusriastuti, Trihono, Agus Suwandono, Ondri Dwi Sampurno, Prasenohadi, Nurshanty A Sapada, M J N Mamahit, Anna Swenson, Nancy A Dreyer, Richard Coker

Human influenza A H5N1 in Indonesia: health care service-associated delays in treatment initiation

Wiku Adisasmito et al. BMC Public Health. .

Abstract

Background: Indonesia has had more recorded human cases of influenza A H5N1 than any other country, with one of the world's highest case fatality rates. Understanding barriers to treatment may help ensure life-saving influenza-specific treatment is provided early enough to meaningfully improve clinical outcomes.

Methods: Data for this observational study of humans infected with influenza A H5N1 were obtained primarily from Ministry of Health, Provincial and District Health Office clinical records. Data included time from symptom onset to presentation for medical care, source of medical care provided, influenza virology, time to initiation of influenza-specific treatment with antiviral drugs, and survival.

Results: Data on 124 human cases of virologically confirmed avian influenza were collected between September 2005 and December 2010, representing 73% of all reported Indonesia cases. The median time from health service presentation to antiviral drug initiation was 7.0 days. Time to viral testing was highly correlated with starting antiviral treatment (p < 0.0001). We found substantial variability in the time to viral testing (p = 0.04) by type of medical care provider. Antivirals were started promptly after diagnosis (median 0 days).

Conclusions: Delays in the delivery of appropriate care to human cases of avian influenza H5N1 in Indonesia appear related to delays in diagnosis rather than presentation to health care settings. Either cases are not suspected of being H5N1 cases until nearly one week after presenting for medical care, or viral testing and/or antiviral treatment is not available where patients are presenting for care. Health system delays have increased since 2007.

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References

    1. FLU NEWS SCAN. H5N1 case in Egypt, flu vaccine and birth weight. http://www.who.int/influenza/human_animal_interface/EN_GIP_20120222Cumul.... (Accessed February 23, 2012)
    1. Chan PKS, Lee N, Zaman M, Adisasmito W, Coker R, Hanshaoworakul W, Gasmiov V, Oner AF, Dogan N, Tsang O, Phommasack B, Touch S, Swenson A, Toovey S, Dreyer N. Determinants of Antiviral Effectiveness in H5N1 Avian Influenza. J Infect Dis. 2012;206:1359–1366. doi: 10.1093/infdis/jis509. - DOI - PubMed
    1. Adisasmito W, Chan PKS, Lee N, Faik Oner A, Gasimov V, Aghayev F, Zaman M, Bangboye E, Dogan N, Coker R, Starzyk K, Dreyer NA, Toovey S. Effectiveness of antiviral treatment in human influenza H5N1 infections: analysis from a global patient registry. J Infect Dis. 2010;202:1154–1160. doi: 10.1086/656316. - DOI - PubMed
    1. Kandun IN, Wibisono H, Sedyaningsih ER, Yusharmen Hadisoedarsuno W, Purba W. et al. Three Indonesian Clusters of H5N1 Virus Infection in 2005. N Engl J Med. 2006;355(21):2186–2194. doi: 10.1056/NEJMoa060930. - DOI - PubMed
    1. Dreyer NA, Starzyk K, Wilcock K, Toovey S. Bangkok International Conference on Avian Influenza. Bangkok: National Center for Genetic Engineering and Biotechnology; 2008. A global registry for understanding clinical presentation, treatment outcomes, and survival from human avian influenza; p. 155. Jan 23.

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