Re: WHO Situation Updates - Avian Influenza Archive
Re: WHO Situation Updates - Avian Influenza Archive
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Avian influenza – situation in Iraq - update 4
1 March 2006
A WHO collaborating laboratory in the United Kingdom has verified H5N1 avian influenza as the cause of death in a 39-year-old Iraqi man,
previously announced by the Ministry of Health.
This brings the number of laboratory-confirmed cases in Iraq, listed in the WHO cumulative table, to 2. Both cases were fatal.
Virus has been isolated from the samples and genetic sequencing is presently under way.
The UK laboratory is also conducting tests on samples taken from additional cases under investigation from the northern province of Sulaimaniyah and the southern provinces of Basra and Missan.
Diagnostic testing was initially delayed by problems encountered in the shipment of samples from Iraq. Most of these problems have now been solved.
To date, poultry outbreaks of H5 avian influenza have been confirmed in Sulaimaniyah and Missan provinces. Both outbreaks are thought to have begun in mid-January.
http://www.who.int/csr/don/2006_03_01a/en/print.html
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Avian Influenza: Review of the Current Situation
1 March 2006
Introduction
The emergence of avian influenza caused by the highly pathogenic H5N1 influenza A virus, and its rapid
spread among poultry across the world in recent years, has been a cause for grave concern as it has the
potential to trigger a pandemic. It is a rapidly evolving situation.
Current Outbreak Threat: The extent, and geographical spread of the current outbreak, and its impact on
human beings, is unusual. Since 1959 there have been 24 such outbreaks with 10 recorded cases of human
infection with avian influenza virus. This is less than one-tenth the number of cases reported since December
2003 in the current outbreak.
Unstable Virus: The influenza A virus is highly unstable. It can result in major genetic changes leading to a
new subtype of virus to which populations have no immunity. If this new subtype can then replicate easily in,
and transmit efficiently among, human beings, it can lead to a pandemic that can kill millions, and have a
cataclysmic social and economic impact.
Historic Evidence: Supporting such fears is historic evidence. Three such pandemics have occurred in the last
century, in 1918, 1957 and 1968. Each of these pandemics was preceded by the emergence of a new virus due
to a re-assortment of genes of human and animal viruses. The most severe, the 1918 pandemic, caused 20-40
million deaths, and there is some evidence that it could have been caused by a virus that originated in birds.
Global Situation
Rapid Spread: With 33 countries reporting avian influenza in birds since 2003, the current rapid geographical
spread of the H5N1 virus is unprecedented. In February 2006 alone, 13 countries reported their first case of
H5N1 infection in birds. More than 200 million chickens have died or been culled since 2003. More than 170
human beings in seven countries have been infected by the virus, and 93 have died.
Migratory birds: Migratory birds are a reservoir of this virus and could play a major role in spreading the virus across the world.
Expanding Host Range: Most recently H5N1 has been reported from a domestic cat in Germany. Cats are not known to play any role in the transmission cycle of H5N1. In 2005, some tigers in Thailand also died of H5N1.
Factors for novel subtype: Recent studies also show that the virus is becoming progressively more pathogenic in poultry. All of these factors increase the possibility that human beings could be the ‘mixing vessel’ of avian and human
influenza viruses, which could produce a novel, lethal subtype.
Avian Influenza in the South-East Asia Region
The countries of the South-east Asia Region are vulnerable to avian influenza. Thailand and Indonesia have
reported outbreaks in both poultry and humans. There have been 27 human cases of avian influenza in
Indonesia to date, out of which 20 have died. Since 2003, Thailand has reported 22 human cases and 14
deaths. On 18 February 2006, India reported a large outbreak of avian influenza in poultry in Maharashtra.
More than 200,000 chickens have been culled.
Why the Region is vulnerable: Human beings in this Region often live in close contact with animals. It is
common to have backyard poultry farms, where free-ranging chickens and ducks mingle. Wet markets, where
chicken are openly slaughtered and dead birds are displayed are common in Asia. This continuous close
contact increases the chances of a pandemic virus spreading among human beings.
In densely populated SEAR countries, the potential for the rapid spread of any disease is considerable.
The danger is exacerbated by a poor public health infrastructure which, in most countries, is ill-equipped
to cope with a large and devastating pandemic.
Key Issues
Effective outbreak containment in poultry: The key to preventing the emergence of a pandemic virus is to
limit the exposure of human beings to animal viruses that can be lethal in humans.
Surveillance and outbreak management: In the case of a limited outbreak, it is important for it to be contained
in that geographical location and not be allowed to spread. Both of these need good early warning and
surveillance systems to detect cases early and respond effectively. Strengthened laboratory capacity is also
important to identify any genetic changes in the virus.
Sharing information: A mechanism (FLUNET) is available for rapid and regular sharing of information on
outbreaks with data on distribution and determinants.
Risk communication: To successfully prevent large numbers of deaths due to a pandemic, public awareness of
the situation, and what they should do, is crucial. Relevant communication and information material on the risks
of avian influenza therefore needs to be developed and shared with the public and the media.
Role of antivirals: Some experts believe that early and strategic use of antivirals such as oseltamivir, along with
social distancing, could pre-empt the outbreak at the source. It is important to have adequate stockpiles of
antivirals at the regional and national levels.
The Way Forward
Political commitment: Political commitment at the highest level is needed to help rally and mobilize support
for pandemic preparedness and response.
Multi-sectoral involvement and coordination: Multi-sectoral planning and coordination among health,
agriculture, animal and livestock, transport and other sectors, as well as with private sector partners, is crucial
for effective pandemic preparedness.
Formulation and implementation of national multi-sectoral pandemic preparedness plans: An effective
and systemic national response to the threat of the avian influenza pandemic needs a national pandemic
preparedness plan that involves multiple stakeholders and takes into account their concerns.
Inter-country and inter-regional collaboration: An avian influenza pandemic is a global threat, and a response
would therefore require extensive inter-country and inter-regional cooperation.
Role of WHO
Advocacy: Advocacy at senior levels of governments of countries.
Technical support: WHO provides technical support in investigation of outbreaks, preparation of National
Pandemic Preparedness Plans, assessment of capacity and implementation of national plans, and assistance
with simulation of pandemic situations as part of the preparedness strategy.
Documents/guidelines preparation and dissemination: These include IEC material; a generic National
Pandemic Preparedness Plan; Step-by-Step approach for preparing National Pandemic Plans; Guidelines on
managing a stockpile of oseltamivir ; Assessment of regional capacity for antiviral production; Assessment of
regional capacity in influenza vaccine development.
Procurement and stockpiling of antivirals: WHO can assist countries in stockpiling of treatment courses and
protective material.
Capacity building: WHO can provide training on outbreak investigation, rapid containment, risk
communication and clinical management.
Information exchange and collaboration with partners: WHO collaborates and coordinates with FAO, OIE
and other international agencies. Information is also shared through daily outbreak updates and the website.
Resource mobilization: The Organization can initiate mobilization of resources from major international
donors. WHO’s international network can be mobilized to help any nation in crisis.
http://w3.whosea.org/LinkFiles/Update_2006_aireview010306.pdf
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