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Avian Influenza / Pandemic Influenza

Avian Influenza / Pandemic Influenza. Neyla Gargouri Darwaza, M.D. Surveillance Department Directorate of Disease Control Ministry of Health, Jordan. Outline. Influenza virus Avian influenza Influenza pandemic. Influenza viruses. Orthomyxoviruses Influenza virus   A, B, C  

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Avian Influenza / Pandemic Influenza

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  1. Avian Influenza / Pandemic Influenza Neyla Gargouri Darwaza, M.D. Surveillance Department Directorate of Disease Control Ministry of Health, Jordan

  2. Outline • Influenza virus • Avian influenza • Influenza pandemic

  3. Influenza viruses • Orthomyxoviruses • Influenza virus   A, B, C   • A: birds, pigs, humans • B & C: humans

  4. Neuraminidase (NA) Hemagglutinin (HA) Influenza virus type A • 16 different HA and 9 NA • All subtypes found in birds • Only H5 and H7 caused severe disease in birds • Human disease caused by H1, H2, H3, N1, N2

  5. Influenza virus type A • 24–48 hours or hard non porous surfaces • 8–12 hours on cloth, paper, tissue • 5 min on hands • 4 days in water 22ºC • 30 days at 0ºC • 30 min at 60ºC • Inactivated by 70% alcohol, chlorine and disinfectants

  6. Genetic reassortment

  7. Pandemic influenzastrain Migratory water birds

  8. Understanding pandemic influenza • Pandemics* occur when a novel influenza strain emerges that has the following features: • readily transmitted between humans • genetically unique (i.e., lack of preexisting immunity in the human population) • increased virulence * Very widespread epidemic that affects a whole region, a continent or the world.

  9. Previous pandemics

  10. Avian influenzaH5N1 • Since mid-2003, H5N1 virus has caused the largest and most severe outbreaks in poultry on record.

  11. Cambodia China Croatia Indonesia Japan Kazakhstan Laos Malaysia Mongolia Romania Russia South Korea Turkey Thailand Ukraine Vietnam H5N1 among poultry or wild birds

  12. High Risk At-Risk Endemic Epidemic Pandemic risk Global risk of avian influenza outbreaks Category 1 Category 2 Category 3 Category 4

  13. Why is H5N1 very dangerous? • Present in healthywaterfowl (e.g. ducks), shed in feces • Very lethal to poultry and other animals including humans • Big impact on trade and economics • Crossed species barrier in 1997 in Hong Kong, caused 18 human cases & 6 deaths

  14. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

  15. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO 10 January 2006 Total number of cases includes number of deaths.WHO reports only laboratory-confirmed cases.

  16. Pandemic alert • H5N1 currently lacks ability for efficient spread among humans • But, continual H5N1 transmission in animals (and humans): • increases viruses in environment and chances of humans being infected • increases chances of mutations/reassortments to create pandemic virus

  17. Interpandemic Pandemic alert Pandemic Phase 1: Phase 2: Phase 3: Phase 4: Phase 5: Phase 6: No new virus in humans Animal viruses low risk to humans No new virus in humans Animal viruses high risk to humans New virus in humans Little/no spread among humans Small clusters, localized limited spread among humans Larger cluster, localized limited spread among humans Increased and sustained spread in general human population ? Current status of H5N1 Present situation

  18. Influenza pandemic • “Once a fully contagious virus emerges, its global spread is inevitable” • “Given the speed and volume of international travel today, the disease could reach all continents in less than 3 months” • 2 waves of 6 weeks each

  19. Influenza pandemic • Worldwide • 30-50% human population • 2 to 7.4 million deaths (conservative estimates, based on 1957 pandemic) • In Jordan • 1.75 million cases (AR* 35%) • 10,000 deaths (CFR† 0.6%) *Attack rate †Case fatality rate

  20. Influenza pandemic • Recent studies1,2 suggest that 1918 H1N1 and H5N1 are similar • macrophage activities with high levels of cytokine production maybe a factor in the lung and other organ damage (cytokine storm) 1Kobasa et al; Nature 2004;431:703 2Peiris et al; Lancet 2004;363:617

  21. If influenza pandemic takes place… • It will take several months before any vaccine becomes available • Vaccines, antiviral agents and antibiotics will be in short supply & unequally distributed • Medical facilities will be overwhelmed • It will affect essential community services • It will cause social and political disruption and considerable economic losses

  22. Can a pandemic be prevented? • Theory: • antiviral drugs can contain/eliminate pandemic virus • soon after it develops ability to spread human to human • WHO antiviral stockpiles for rapid deployment in initially affected countries

  23. Can a pandemic be prevented? • Requirements: • good surveillance and rapid reporting • rapid response teams • stockpile of antiviral drugs, PPE*, etc. * Personal protective equipment

  24. Can a pandemic be prevented? • Challenges: • limited money • limited staff and training • limited planning, coordination, cooperation within government and with other countries

  25. Which antiviral? • M2 protein inhibitor: amantadine, rimantadine • up to 30% resistance, one passage in cell culture • not effective against H5N1 • Neuraminidase inhibitors: oseltamivir*, zanamivir† • multiple passages in cell culture required to produce resistance • effective against H5N1 • Susceptibility or resistance to antivirals of the new strain of influenza virus??? * Tamiflu, † Relenza

  26. Suspected case of H5N1 • Symptoms: • Flu illness or respiratory illness AND • History within 10 days of onset : • Travel to a country with documented H5N1 in poultry or humans, and/or • Contact with poultry or domestic birds, or known or suspected patient withinfluenza H5N1

  27. How to reduce risk of infection? • Thorough cookingof all foods from poultry, including eggs • Avoiding contactwith poultry and any surfaces that may have been contaminated by poultry or their feces/secretions

  28. How to reduce risk of infection? • Frequent hand washing with soap & water • after touching birds • after cooking food involving poultry or eggs • Simple etiquette like covering nose & mouth when sneezing & coughing

  29. Conclusion • “The next pandemic is just a matter of time” • “For the first time in human history we have a chance to prepare ourselves for a pandemic before it arrives” • Pray, plan and practice

  30. References • http://www.who.int/csr/disease/avian_influenza/en/index.html • http://www.cdc.gov/flu/avian/outbreaks/asia.htm

  31. MOH/ Disease Control Tel 5607144 Fax 5686965 epijor@wanadoo.jo neylagd@yahoo.com MOH Tel 5200230 MOA/ Hotline Tel 5657756 Contact

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