Changes

The incubation period for influenza is relatively short, ranging from 7 to 67 hours with a median of 34 hours for influenza A and a median of 14 hours for influenza B.<ref> ''The communicable disease management and control handbook'', Hawker, Begg et al</ref> At this point most patients infected with both H5N1 and H7N9 have presented with signs and symptoms of severe respiratory infection, often with pneumonia which progresses to acute respiratory disease syndrome, impaired coagulation, multiorgan dysfunction (similar to that seen with seasonal influenza and H5N1 infection), fever and lymphopenia. However as H7N9 is the first of its type to infect humans the full spectrum of presentations is not well understood at this time.

The incubation period for influenza is relatively short, ranging from 7 to 67 hours with a median of 34 hours for influenza A and a median of 14 hours for influenza B.<ref> ''The communicable disease management and control handbook'', Hawker, Begg et al</ref> At this point most patients infected with both H5N1 and H7N9 have presented with signs and symptoms of severe respiratory infection, often with pneumonia which progresses to acute respiratory disease syndrome, impaired coagulation, multiorgan dysfunction (similar to that seen with seasonal influenza and H5N1 infection), fever and lymphopenia. However as H7N9 is the first of its type to infect humans the full spectrum of presentations is not well understood at this time.

==Management==

==Management==

Clinical suspicion is essential in symptomatic travellers returning from areas where avian influenza transmission has been confirmed. Local policies will guide identification and management of cases. Current understanding of avian influenza suggests that the potential for human-to-human transmission is unknown and therefore infection control guidance advocates isolation and the use of appropriate PPE in cases under investigation for H7N9 infection.<ref>''Centers for Disease Control and Prevention: Interim Guidance for Infection Control Within Healthcare Settings When Caring for Patients with Confirmed, Probable, or Cases Under Investigation of Avian Influenza A(H7N9) Virus Infection.'' Available at: http://www.cdc.gov/flu/avianflu/h7n9-infection-control.htm Accessed on 23rd June 2013</ref><ref>Public Health England: Investigation & management of possible human cases of avian influenza A/H7N9, in travellers returning to the UK. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317138620910 Accessed on 23rd June 2013.</ref>

Clinical suspicion is essential in symptomatic travellers returning from areas where avian influenza transmission has been confirmed. Local policies will guide identification and management of cases. Current understanding of avian influenza suggests that the potential for human-to-human transmission is unknown and therefore infection control guidance advocates isolation and the use of appropriate PPE in cases under investigation for H7N9 infection.<ref>''Centers for Disease Control and Prevention: Interim Guidance for Infection Control Within Healthcare Settings When Caring for Patients with Confirmed, Probable, or Cases Under Investigation of Avian Influenza A(H7N9) Virus Infection.'' Available at: http://www.cdc.gov/flu/avianflu/h7n9-infection-control.htm Accessed on 23rd June 2013</ref><ref>Public Health England: Investigation & management of possible human cases of avian influenza A/H7N9, in travellers returning to the UK. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317138620910 Accessed on 23rd June 2013.</ref>

==Diagnostics==

==Diagnostics==

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Rapid antigen detection methods have also been developed, mostly for diagnosing infection in humans though more recently some have been used in birds. Antigen detection methods have the advantage of being quick to use and are able to detect all influenza type A infections (due to the use of a monoclonal antibody against the nucleoprotein), however they have a low sensitivity and are expensive.  

Rapid antigen detection methods have also been developed, mostly for diagnosing infection in humans though more recently some have been used in birds. Antigen detection methods have the advantage of being quick to use and are able to detect all influenza type A infections (due to the use of a monoclonal antibody against the nucleoprotein), however they have a low sensitivity and are expensive.  

==Treatment==

==Treatment==

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<references />

[[:Category:Orthomyxoviridae]] [[:Category:Avian_Viruses]] [[:Category:One Health]]

19 World Health Organisation: Overview of the emergence and characteristics of the avian influenza A(H7N9) virus. Available at: http://www.who.int/influenza/human_animal_interface/influenza_h7n9/WHO_H7N9_review_31May13.pdf Accessed on 23rd June 2013

20 Centers for Disease Control and Prevention: Interim Guidance on the Use of Antiviral Agents for Treatment of Human Infections with Avian Influenza A (H7N9). Available at: http://www.cdc.gov/flu/avianflu/h7n9-antiviral-treatment.htm Accessed on 23rd June 2013.

21 Health Protection Agency: Management of asymptomatic contacts of confirmed human case(s) of avian influenza A/H5N1. Available at: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1230540128869 Accessed on 23rd June 2013.