Published on March 30, 2008
Avian Influenza: Avian Influenza Chuck Wright, RMO American Embassy Jakarta September 27,2005 Picture of Chickens: Picture of Chickens What is Influenza (also called Flu)?: What is Influenza (also called Flu)? The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times can lead to death. Every year in the United States, on average: 5% to 20% of the population gets the flu; more than 200,000 people are hospitalized from flu complications, and; about 36,000 people die from flu. Flu : Flu Flu is not the “common cold” that produces runny nose, cough, low grade fever. Flu occurs at certain times of the year in the Northern and Southern Hemispheres and year round in the Tropics Symptoms of Flu: Symptoms of Flu Symptoms of flu include: fever (usually high) headache extreme tiredness dry cough sore throat runny or stuffy nose muscle aches Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults Bird Flu Cartoon: Bird Flu Cartoon Complications of Flu: Complications of Flu Complications of flu can include bacterial pneumonia, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes. Children may get sinus problems and ear infections. How Flu Spreads: How Flu Spreads Flu viruses spread in respiratory droplets caused by coughing and sneezing. They usually spread from person to person, though sometimes people become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you can pass on the flu to someone else before you know you are sick, as well as while you are sick. Cartoon: Cartoon Preventing the Flu: Get Vaccinated: Preventing the Flu: Get Vaccinated The "flu shot" -- an inactivated vaccine (containing killed virus) that is given with a needle. The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions. Influenza Pandemics During the 20th Century: Influenza Pandemics During the 20th Century 1918-19, "Spanish flu," [A (H1N1)], caused the highest number of known influenza deaths: more than 500,000 people died in the United States, and up to 50 million people may have died worldwide. Many people died within the first few days after infection, and others died of complications later. Nearly half of those who died were young, healthy adults. Influenza A (H1N1) viruses still circulate today after being introduced again into the human population in the 1970s. 1957-58, "Asian flu," [A (H2N2)], caused about 70,000 deaths in the United States. First identified in China in late February 1957, the Asian flu spread to the United States by June 1957. 1968-69, " Hong Kong flu," [A (H3N2)], caused about 34,000 deaths in the United States. This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Influenza A (H3N2) viruses still circulate today. Both the 1957-58 and 1968-69 pandemics were caused by viruses containing a combination of genes from a human influenza virus and an avian influenza virus. The origin of the 1918-19 pandemic virus is not clear. Pandemic: A Worldwide Outbreak of Influenza: Pandemic: A Worldwide Outbreak of Influenza An influenza pandemic is a global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population, causes serious illness, and then spreads easily from person to person worldwide. Pandemics are different from seasonal outbreaks or “epidemics” of influenza. Seasonal outbreaks are caused by subtypes of influenza viruses that are already in existence among people, whereas pandemic outbreaks are caused by new subtypes or by subtypes that have never circulated among people or that have not circulated among people for a long time. Past influenza pandemics have led to high levels of illness, death, social disruption, and economic loss. Flu Travel Pic: Flu Travel Pic What is Avian Flu?: What is Avian Flu? Avian Flu is the bird version of our Human Flu. The current one is designated H5N1. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them. How are bird flu viruses different from human flu viruses?: How are bird flu viruses different from human flu viruses? When we talk about “bird flu” viruses, we are referring to those flu A subtypes that continue to occur mainly in birds. They do not usually infect humans, even though we know they can do so. When we talk about “human flu viruses” we are referring to those subtypes that occur widely in humans. There are only three known subtypes of human flu viruses (H1N1, H1N2, and H3N2); it is likely that some genetic parts of current human flu A viruses came from birds originally. Flu A viruses are constantly changing, and they might adapt over time to infect and spread among humans. Instances of Avian Influenza Infections in Humans: Instances of Avian Influenza Infections in Humans H5N1, Hong Kong, 1997 : Avian influenza A (H5N1) infections occurred in both poultry and humans. This was the first time an avian influenza virus had ever been found to transmit directly from birds to humans. During this outbreak, 18 people were hospitalized and six of them died. To control the outbreak, authorities killed about 1.5 million chickens to remove the source of the virus. H9N2, China and Hong Kong, 1999 : Avian influenza A H9N2 illness was confirmed in two children. Both patients recovered, and no additional cases were confirmed. H7N2, Virginia, 2002: Following an outbreak of H7N2 among poultry in the Shenandoah Valley poultry production area, one person was found to have serologic evidence of infection with H7N2. H5N1, China and Hong Kong, 2003 : Two cases of avian influenza A (H5N1) infection occurred among members of a Hong Kong family that had traveled to China. One person recovered, the other died. H7N7, Netherlands, 2003 : The Netherlands reported outbreaks of influenza A (H7N7) in poultry on several farms. Later, infections were reported among pigs and humans. In total, 89 people were confirmed to have H7N7 influenza virus infection associated with this poultry outbreak. These cases occurred mostly among poultry workers. H9N2, Hong Kong, 2003 : H9N2 infection was confirmed in a child in Hong Kong. The child was hospitalized but recovered. H7N2, New York, 2003: In November 2003, a patient with serious underlying medical conditions was admitted to a hospital in New York with respiratory symptoms. One of the initial laboratory tests identified an influenza A virus that was thought to be H1N1. The patient recovered and went home after a few weeks. Subsequent confirmatory tests conducted in March 2004 showed that the patient had been infected with an H7N2 avian influenza virus H5N1, Thailand and Vietnam, 2004: H7N3 in Canada , 2004: In February 2004, human infections of H7N3 among poultry workers were associated with an H7N3 outbreak among poultry. The H7N3-associated illnesses consisted of eye infections. H5N1, Thailand and Vietnam, 2004 and 2005: Beginning in late June 2004, new lethal outbreaks of H5N1 among poultry were reported by several countries in Asia. The new outbreaks of H5N1 in poultry in Asia were followed by renewed sporadic reporting of human cases of H5N1 infection in Vietnam and Thailand beginning in August and continuing into 2005. Of particular note is one isolated instance of probable limited human-to-human transmission occurring in Thailand in September. Symptoms of Avian Influenza in Humans: Symptoms of Avian Influenza in Humans The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications. Transmission of Influenza A Viruses Between Animals and People : Transmission of Influenza A Viruses Between Animals and People Influenza A viruses are found in many different animals, including ducks, chickens, pigs, whales, horses, and seals. Avian influenza viruses may be transmitted to humans in two main ways: Directly from birds or from avian virus-contaminated environments to people. `Through an intermediate host, such as a pig. Bird Flu Cartoon: Bird Flu Cartoon How Influenza Viruses Change: Drift and Shift: How Influenza Viruses Change: Drift and Shift Influenza viruses can change in two different ways. One type is called "antigenic drift," which occurs through small changes in the virus that happen continually over time. Antigenic drift produces new virus strains that may not be recognized by antibodies to earlier influenza strains. The other type of change is called "antigenic shift." Antigenic shift is an abrupt, major change in the influenza A viruses, resulting in a new influenza virus that can infect humans and has a hemagglutinin protein or hemagglutinin and neuraminidase protein combination that has not been seen in humans for many years. Influenza viruses are changing by antigenic drift all the time, but antigenic shift happens only occasionally. The Worry?: The Worry? That the H5N1 virus will mutate into a “person to person” transmissible version and spread. The virus can share genetic material with a human flu virus through “reassortment” and become more virulent Pigs could be the intermediary host (receptors for both avian and human flu). No one knows if this will happen. What is the risk to humans from the H5N1 virus in Asia?: What is the risk to humans from the H5N1 virus in Asia? The H5N1 virus does not usually infect humans. So far, spread of H5N1 virus from person to person has been rare and spread has not continued beyond one person. How is bird flu in humans treated?: How is bird flu in humans treated? Studies suggest that the prescription medicines approved for human flu viruses would work in preventing bird flu infection in humans. However, flu viruses can become resistant to these drugs, so these medications may not always work. Bird Flu Cartoon: Bird Flu Cartoon Slide25: Graph from USAID; August 2005 Avian Influenza in Indonesia: Avian Influenza in Indonesia Confirmed in birds in 2003 Expanding epidemic in birds during 2004 Found among many species of birds and mammals (pigs) during 2004 and 2005 Human infections confirmed in July, August and September 2005 No current evidence of efficient and sustained transmission among humans Slide27: 60% of Indonesians live on Java & Bali Slide28: Confirmed H5N1 in Bird Populations Slide29: NAMRU-2 Influenza Surveillance Network Established Sites Expanded Sites (to rural clinics) Slide30: Where are we now? Flu and Media: Flu and Media How is infection with H5N1 virus in humans treated?: How is infection with H5N1 virus in humans treated? The H5N1 virus currently infecting birds in Asia that has caused human illness and death is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir (Tamiflu) and zanamavir, would probably work to treat flu caused by the H5N1 virus, though studies still need to be done to prove that they work. Is there a vaccine to protect humans from H5N1 virus?: Is there a vaccine to protect humans from H5N1 virus? There currently is no vaccine to protect humans against the H5N1 virus that is being seen in Asia. However, vaccine development efforts are under way. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005. (Researchers are also working on a vaccine against H9N2, another bird flu virus subtype.) Recommendations: Recommendations Avoid all contact with poultry (e.g., chickens, ducks, geese, pigeons, quail) or any wild birds, and avoid settings where H5N1-infected poultry may be present, such as commercial or backyard poultry farms and live poultry markets. Do not eat uncooked or undercooked poultry or poultry products, including dishes made with uncooked poultry blood. As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often, using either soap and water (or waterless, alcohol-based hand rubs when soap is not available and hands are not visibly soiled), removes potentially infectious materials from your skin and helps prevent disease transmission. CDC does not recommend the routine use of masks or other personal protective equipment while in public areas. Get a Flu Shot: Get a Flu Shot Prevents flu (but not Avian Flu) and thus keeps you healthy and avoids a disease that can look like Avian Flu Less loss of time from work Less chance that Avian Flu will mix with Human Flu When to get the Flu Shot: When to get the Flu Shot Embassy is giving it to all FSNs, their spouses and children around Oct 23rd. Embassy Americans can get it in the Health Unit once it arrives (watch for an announcement). Non Embassy employees – consult your doctor (SOS has it). Food Hygiene: Food Hygiene Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or the same knife for preparing raw meat and cooked or ready-to-eat foods. Do not handle either raw or cooked foods without washing your hands in between. Do not place cooked meat back on the same plate or surface it was on before it was cooked. All foods from poultry, including eggs and poultry blood, should be cooked thoroughly. Egg yolks should not be runny or liquid. Because influenza viruses are destroyed by heat, the cooking temperature for poultry meat should reach 70°C (158° F). Wash egg shells in soapy water before handling and cooking, and wash your hands afterwards. Do not use raw or soft-boiled eggs in foods that will not be cooked. After handling raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with soap and water. IF You Have Been Exposed: IF You Have Been Exposed Monitor your health for 10 days. If you become ill with fever and develop a cough or difficulty breathing, or if you develop any illness during this 10-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following: 1) your symptoms 2) if you have had direct poultry contact, and 3) where you traveled. The U.S. embassy or consulate also can provide names and addresses of local physicians. Do not travel while sick, and limit contact with others as much as possible to help prevent the spread of any infectious illness. Tamiflu : Tamiflu The Embassy has this medication and can provide it to employees who are infected or exposed. Non-Embassy employees should contact their doctor about how to access a supply if they are infected Sources of Information: Sources of Information http://jakarta.usembassy.gov/ http://www.cdc.gov/flu/avian/ http://www.wpro.who.int/avian_flu/ Questions????: Questions????