WHO Committee Cites Major Gaps in H1N1 Knowledge

Panel says more research is needed to understand transmission patterns and improve management
By Rick Ansorge
HealthDay Reporter

WEDNESDAY, May 5 (HealthDay News) -- Although researchers have obtained important information about the natural history and clinical management of 2009 H1N1 virus infection, considerable research gaps remain, according to a review published in the May 6 issue of the New England Journal of Medicine.

The Writing Committee of the World Health Organization Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza reviewed virologic, epidemiologic, and clinical data on 2009 H1N1 infections, and summarized significant issues for clinicians around the world.

The committee confirmed that the virus is susceptible to the neuraminidase inhibitors oseltamivir (Tamiflu) and zanamivir (Relenza) but is usually resistant to amantadine and rimantadine, and that therapy with a neuraminidase inhibitor is especially important for patients with underlying risk factors (such as pregnancy) and severe or progressive clinical illness. However, they identified major gaps in the understanding of viral transmission, disease pathogenesis, genetic and other host factors that have a role in susceptibility or disease severity, as well as ideal management of severe illness.

"Available findings highlight the importance of early use of antiviral drugs and antibiotics in the treatment of serious cases and of the potential value of influenza-specific and pneumococcal vaccines for prevention. Both the gaps in knowledge and the experience to date underline the urgent need for better international collaboration in clinical research, particularly in the case of diseases with pandemic potential, for which rapid detection, investigation, and characterization of clinical syndromes are prerequisites for improved mitigation of their public health consequences," the authors write.

One committee member disclosed a financial relationship with Roche related to studies of oseltamivir, and another member disclosed financial relationships with Baxter, Novartis, and GlaxoSmithKline.

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