[From diagnosis to the detection of avian influenza virus]

Until now the avian influenza A (H5N1) virus is only adapted to birds. But even so infections in man are observed sporadically. Why is this possible and how big is the risk that the virus becomes fully adapted to man so that he can be transmitted easily from man to man. Two major mechanisms for the adaptation to a new host have been described: Adaptation by the accumulation of mutations in important places of the genome and adaptation through the exchange of genome segments between two different types of viruses. But there are indications that the adaptation is not linked to only one event. It is probably a multifactor event where its requirements are not all known or understood. Until now avian influenza is not adapted to man. Infection is primarily observed after close contact with infected birds or their contaminated secretions. It seems that the virus needs to reach the lower respiratory tract in order to be able to infect. The disease starts with the clinical symptoms of influenza but progresses rapidly involving primarily the lower respiratory tract causing sometimes live threatening complications. Because of the similarity of symptoms with normal flu laboratory testing is necessary to clarify the situation. Ideally a rapid test would give in a short time a result. Unfortunately this type of test shows insufficient sensitivity and for this reason is not recommended to screen suspect cases for avian influenza. For this reason the detection of the avian virus by RT-PCR in throat swabs is the method of choice in order to be able to confirm or exclude a suspect case.