( Michael S. Singer M.D. Ph.D. Corre...)Avian (Bird) Flu: Is There a Role for Rapid Tests?,Health

With human infections of bird flu (avian influenza) reported in Asia and Eastern Europe, public health officials have moved swiftly to develop policies on surveillance, diagnosis, and treatment. The virus in question is the H5N1 subtype of influenza A, which has become epidemic in poultry and wild fowl in numerous countries. First in 1997 and now recently, some humans in close contact with infected birds have contracted the virus. Now that the H5N1 subtype has crossed the species barrier to humans, there is concern for human-to-human transmission. Given the presumed paucity of human resistance to the H5N1 subtype, infections could then reach pandemic proportions. This is particularly worrisome since the observed case fatality rate for human H5N1 infections has been over 50%. Furthermore, the H5N1 subtype shows resistance to two mainstays of influenza therapy, amantadine and rimantadine. While medications of choice currently include oseltamivir and zanamivir, there have also been reports of oseltamivir resistance (de Jong, MD et al, New Engl J Med 2005, 353:2667-2672). As news on avian flu evolves, local medical personnel naturally have questions about avian flu, even if they live in unaffected countries. A key question is the applicability of rapid or point-of-care tests.

Since up-to-date information on this topic is crucial, interested readers should keep current with the CDC or WHO (websites below). The WHO has published detailed guidelines on the use of rapid flu tests, including commentary on countries where avian flu is confirmed or suspected. These guidelines (link below) convey a number of important points. Overall, information is limited on the characteristics of rapid assays toward avian flu. A confirmatory test, such as RT-PCR or viral culture, must be performed on all suspected patients. One must bear in mind
'"/>