Browsing by Author "Zaman, Mukhtiar"

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Determinants of Antiviral Effectiveness in Influenza Virus a Subtype H5n1
(Oxford Univ Press inc, 2012) Chan, Paul K. S.; Lee, Nelson; Zaman, Mukhtiar; Adisasmito, Wiku; Coker, Richard; Hanshaoworakul, Wanna; Dreyer, Nancy A.
Background. Oseltamivir is widely used as treatment for influenza virus A subtype H5N1 (hereafter, "H5N1") infection but, like any intervention, is not always effective. Methods. We used Avian Influenza Registry data from 10 countries to examine the risk of death in 215 patients with confirmed H5N1 infection who were treated with oseltamivir, according to viral clade, age, respiratory failure, and adjunctive treatment with corticosteroids or antibiotics. Results. The median age of infected individuals was 18 years, and 50% were male. The highest fatality rate occurred in a country with clade 2.1 virus circulation, and the lowest occurred in countries with clade 2.2 virus circulation (P < .001). In univariate analyses, age of <= 5 years and treatment <= 2 days after symptom onset were protective against fatality. When accounting for all risk factors, early initiation of oseltamivir was found to be particularly effective in individuals without respiratory failure (odds ratio, 0.17; P = .04). Patients who had advanced respiratory failure requiring ventilatory support at the time of oseltamivir initiation were more likely to die from the episode of H5N1 infection than patients who did not (P < .001). Adjunctive therapy did not improve the likelihood of surviving the episode. Conclusions. Oseltamivir is especially effective for treating H5N1 infection when given early and before onset of respiratory failure. The effect of viral clade on fatality and treatment response deserves further investigation.
Multiple Imputation: Application To a Global Avian Influenza Registry
(Wiley-blackwell, 2011) Swenson, Anna J.; Mack, Christina D.; Dreyer, Nancy A.; Adisasmito, Wiku; Bamgboye, Ebun; Chan, Paul K. S.; Zaman, Mukhtiar
Recognizing True H5n1 Infections in Humans During Confirmed Outbreaks
(J infection developing Countries, 2014) Zaman, Mukhtiar; Gasimov, Viktor; Oner, Ahmet Faik; Dogan, Nazim; Adisasmito, Wiku; Coker, Richard; Dreyer, Nancy Ann
Introduction: The goal of this study was to evaluate whether any characteristics that are evident at presentation for urgent medical attention could be used to differentiate cases of H5N1 in the absence of viral testing. Methodology: Information about exposure to poultry, clinical signs and symptoms, treatments, and outcomes was abstracted from existing data in the global avian influenza registry (www.avianfluregistry.org) using standardized data collection tools for documented and possible cases of H5N1 infection who presented for medical attention between 2005-2011 during known H5N1 outbreaks in Azerbaijan, Indonesia, Pakistan and Turkey. Results: Demography, exposure to poultry, and presenting symptoms were compared, with only the common symptoms of fever and headache presenting significantly more frequently in confirmed H5N1 cases than in possible cases. Reported exposure to infected humans was also more common in confirmed cases. In contrast, unexplained respiratory illness, sore throat, excess sputum production, and rhinorrhea were more frequent in possible cases. Overall, oseltamivir treatment showed a survival benefit, with the greatest benefit shown in H5N1 cases who were treated within two days of symptom onset (51% reduction in case fatality). Conclusion: Since prompt treatment with antivirals conferred a strong survival benefit for H5N1 cases, presumptive antiviral treatment should be considered for all possible cases presenting during an outbreak of H5N1 as a potentially life-saving measure.
Strengthening Observational Evidence for Antiviral Effectiveness in Influenza a (H5n1)
(Oxford Univ Press inc, 2011) Adisasmito, Wiku; Chan, Paul K. S.; Lee, Nelson; Oner, Ahmet Faik; Gasimov, Viktor; Zaman, Mukhtiar; Toovey, Stephen