Abstract
BackgroundIndonesia 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.MethodsData 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.ResultsData 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).ConclusionsDelays 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.
Highlights
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
The purpose of this study is to determine whether delays in treatment in Indonesia result from delays in presentation for care, subsequent virological testing, or the timing of the initiation of antiviral drug treatment by health care providers
This report is based on 124 laboratory confirmed human avian influenza H5N1 cases for which data were collected between 1st September 2005 – 31st December 2010
Summary
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. The cumulative number of cases reported from Indonesia by the same date is 185, or 32% of the world’s cases. The case fatality rate associated with influenza A H5N1 infection is high, with 346 deaths (59%) reported from delaying seeking health care or whether delays in the health care service itself are important. The purpose of this study is to determine whether delays in treatment in Indonesia result from delays in presentation for care, subsequent virological testing, or the timing of the initiation of antiviral drug treatment by health care providers. To the best of our knowledge this is the first analysis of health service barriers to care for human H5N1 cases
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