Avian influenza natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Natural History

• Following initial exposure to the virus, the usual incubation period for the H5N1 avian influenza is approximately 2 to 3 days, but possibly as long as 17 days in some individuals. For the H7N9 avian influenza, the incubation period ranges from 2 to 8 days, with an average of 5 days.
• The majority of patients present with a high grade fever, cough, headache, sore throat, vomiting, diarrhea, abdominal pain.
• The illness is has an very aggressive clinical course, often with rapid deterioration.
• Most patients develop significant lower respiratory tract involvement, with aggressive viral pneumonia, pleural effusions, and ARDS.
• The rate of complications is very high with approximately 50% of patients suffering from life-threatening complications.

Complications

• Acute respiratory distress syndrome
• Acute pulmonary hemorrhage
• Pneumonia
• Pleural effusion
• Acute renal failure
• Multiple organ dysfunction syndrome
• Sepsis / Septic shock
• Disseminated intravascular coagulopathy
• Reye's syndrome

Prognosis

Of the human cases associated with the ongoing H5N1 outbreaks in poultry and wild birds in Asia and parts of Europe, the Near East and Africa, more than half of those people reported infected with the virus have died. Most cases have occurred in previously healthy children and young adults and have resulted from direct or close contact with H5N1-infected poultry or H5N1-contaminated surfaces. In general, H5N1 remains a very rare disease in people. The H5N1 virus does not infect humans easily, and if a person is infected, it is very difficult for the virus to spread to another person.