Avian flu

Prof. DR. RAED MANSOUR .

Al Azhar University

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Influenza (the flu)

is one of the most common infectious diseases in humankind. is a contagious disease that is caused by the influenza virus. It affects the upper and/or lower respiratory tract and is often accompanied by systemic manifestations

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Influenza viruses are spread from infected individual to susceptible person Inhalation: primarily through the coughing and sneezing of infected persons. Touching a surface that has viruses on it (e.g. a door handle) and then touches his or her nose or mouth.
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The incubation period is 1--4 days, --4 days, with an average of 2 days
If not neutralized by secretory antibodies, the virus invades airway and respiratory tract cells. Cellular dysfunction and degeneration occur, along with viral replication and release of viral progeny. Systemic symptoms result from inflammatory mediators, similar to other viruses.
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Influenza usually comes on suddenly and may include these symptoms:

Fever Headache Tiredness (can be extreme) Dry cough Sore throat Nasal congestion Body aches

These symptoms are usually referred to as "flu-like symptoms.

Children: otitis media, nausea, and

vomiting are also commonly reported.
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 People age >65 years people with chronic medical conditions (heart or pulmonary disease, asthma,
diabetes, or HIV infection)

Children 6-23 months of age Pregnant women

are more likely to get complications

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COMPLICATIONS OF INFLUENZA
Pneumonias:

-primary influenza viral pneumonia, - secondary bacterial pneumonia, or - mixed viral and bacterial. worsening of COPD and exacerbation of chronic bronchitis and asthma.
Myocarditis and pericarditis Reye's syndrome CNS diseases: encephalitis, transverse myelitis, and Guillain-Barre syndrome Myositis, rhabdomyolysis, and myoglobinuria.
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Influenza Viruses
Orthomyxoviridae family Based on antigenic characteristics of the nucleoprotein (NP) and matrix (M) protein antigens 3 types. Types A or B viruses: epidemics almost every winter. Influenza type C: a mild respiratory illness and are not thought to cause epidemics.
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Influenza A viruses can be divided into subtypes

on the basis of their surface proteins (HA hemagglutinin (HA) and neuraminidase (NA (NA). There are 16 known H subtypes and 9 N subtypes. While all subtypes can be found in birds, only 3 subtypes of HA (H1, H2 and H3) (H1 H2 H3 and two subtypes of NA (N1 and N2) are (N1 N2 known to have circulated widely in human. human.
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Reassortment of genes during infection is high

Influenza viruses can change in two different ways. Antigenic drift: small changes in the virus that happen drift: continually over time new virus strains reinfection can occur. Antigenic shift: an abrupt, major change (occasionally) in shift: abrupt, the influenza A viruses, new H and/or new H&N proteins a new subtype (most people have little or no protection) spread easily from person to person an influenza pandemic can occur.

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A pandemic is a worldwide epidemic of a disease.

During the last 100 years 3 pandemics: 1918-19, Spanish flu, [influenza A(H1N1)]: >20-50 million people died worldwide, almost half of them were young and healthy adults.
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 1957-58, Asian flu, [influenza A(H2N2)], It was first identified in late February, 1957 in China. 1968-69, Hong Kong flu, [influenza A(H3N2)]. This pandemic H3N2 virus was first detected in Hong Kong in early 1968. A(H3N2) viruses still circulate today
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Potential Flu Pandemic

pandemics did not develop after new flu viruses were discovered in humans Vaccination: 1976, Swine flu outbreak, [influenza A(H1N1)]. infected soldiers at Fort Dix, New Jersey 40 million Americans were vaccinated. A new type of virus that was previously seen only in birds in Hong Kong . 1997, Avian flu outbreak, [influenza A(H5N1) infected both chickens and humans ]. 18 people were hospitalized and 6 of them died. authorities killed about 1.5 million chickens to remove the source of the virus.
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 1999, [avian influenza A(H9N2)] were confirmed in 2 children in Hong Kong. Several additional human H9N2 infections were reported from mainland China in 1998-99.
2003: -Two cases in Hong Kong of avian influenza A (H5N1) infection. - A (H7N7) > 80 cases (the symptoms were mostly confined to eye infections, with some respiratory symptoms), and 1 patient died.
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 Experts are concerned that a slight mutation could convert H5N1 to a H5 strain that would spread from human to human. human. Such a strain could spread rapidly and result in very high human mortality rates around the world. As a result of this concern, efforts are currently underway to develop an effective vaccine.
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17 October 2007
2003 2004
cases deaths

2005
cases deaths

2006
cases deaths

2007
cases deaths

Total
cases deaths

Country Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Democra tic Nigeria Thailand Turkey Viet Nam Total

cases

deaths

0 0 1 0 0 0 0 0 0 0 0 3 4

0 0 1 0 0 0 0 0 0 0 0 3 4

0 0 0 0 0 0 0 0 0 17 0 29 46

0 0 0 0 0 0 0 0 0 12 0 20 32

0 4 8 0 0 20 0 0 0 5 0 61 98

0 4 5 0 0 13 0 0 0 2 0 19 43

8 2 13 1 18 55 3 0 0 3 12 0 115

5 2 8 0 10 45 2 0 0 3 4 0 79

0 1 3 0 20 34 0 2 1 0 0 0 68

0 01 2 0 5 30 0 2 1 0 0 0 45

8 7 25 1 38 109 3 2 1 25 12 100 331

5 7 16 0 15 88 2 2 1 17 4 46 203

31 May 2007
2003 2004
cases deaths

2005
cases deaths

2006
cases deaths

2007
cases deaths

Total
cases deaths

Country Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Democr atic Nigeria Thailand Turkey Viet Nam Total

cases

deaths

0 0 1 0 0 0 0 0 0 0 0 3 4

0 0 1 0 0 0 0 0 0 0 0 3 4

0 0 0 0 0 0 0 0 0 17 0 29 46

0 0 0 0 0 0 0 0 0 12 0 20 32

0 4 8 0 0 20 0 0 0 5 0 61 98

0 4 5 0 0 13 0 0 0 2 0 19 43

8 2 13 1 18 55 3 0 0 3 12 0 115

5 2 8 0 10 45 2 0 0 3 4 0 79

0 1 3 0 16 23 0 2 1 0 0 0 46

0 01 1 0 4 20 0 2 1 0 0 0 29

8 7 25 1 34 98 3 2 1 25 12 93 309

5 7 15 0 14 78 2 2 1 17 4 42 187

Symptoms of Avian Influenza in Humans The reported symptoms have ranged influenzafrom typical influenza-like symptoms (e.g., fever, cough, sore throat and muscle aches) infections, pneumonia, to eye infections, pneumonia, acute respiratory distress, viral pneumonia, and other severe and lifelife-threatening complications. complications.
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Characteristics of Avian Flu in Birds

Certain water birds act as hosts by carrying the virus in their intestines Infected birds shed virus in saliva, nasal secretions and feces. Fecal-to-oral transmission is the most common mode of spread. susceptible birds. symptoms in birds varies greatly depending on the strain (H5 and H7) of virus and the type of bird.

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In domestic poultry
2 main forms of disease, distinguished by low and disease, high extremes of virulence. The low pathogenic form commonly causes pathogenic only mild symptoms (ruffled feathers, a drop in egg production) and may easily go undetected. The highly pathogenic form is far more dramatic. It spreads very rapidly through poultry flocks, causes disease affecting multiple internal organs, and has a mortality that can approach 100% 100%, often within 48 hours.
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How does bird flu spread?

Infected birds shed flu virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated excretions or surfaces that are contaminated with excretions. It is believed that most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces. Does the virus spread easily from birds to humans? 24R.MANSOUR

 There is no evidence at this stage of human to human transmission, -none of the healthcare workers treating the patients have become sick. -most of the infections occurred in children (by playing in yards contact with infected faeces). "We are principally worried about the possibility that the avian virus could acquire full capability to transmit from one person to another," said Dr Shigeru Omi, WHO's regional director for the Western 25R.MANSOUR Pacific.

What are the implications for human health?

2 main risks for human health. very severe disease. Unlike normal seasonal influenza, where infection causes only mild respiratory symptoms in most people, the disease caused by H5N1 follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure are common. In the present outbreak, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults. A second risk, of even greater concern, is that the virus if given enough opportunities will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak (a pandemic). 26R.MANSOUR

How do people become infected?

Direct contact with infected poultry, or surfaces and objects contaminated by their faeces. -most human cases have occurred in rural or periurban areas where many households keep small poultry flocks -opportunities for exposure to infected droppings or to environments contaminated by the virus are abundant under such conditions. Exposure is considered most likely during slaughter, defeathering, butchering, and preparation of poultry for cooking. -many households depend on poultry for income and food, many families sell or slaughter and consume birds when signs of illness appear in a flock, and this practice has proved difficult to change.
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LONG CONTACT

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Is it safe to eat poultry and poultry products?

Avian influenza is not transmitted through cooked food. In areas experiencing outbreaks, poultry and poultry products can be safely consumed provided these items are properly cooked and properly handled during food preparation. The H5N1 virus is sensitive to heat. Normal temperatures used for cooking (70 oC in all parts of the food) will kill the virus. also be aware of the risk of cross-contamination. NB: cold temp 3 months, 0 oC 30 days, water (22 oC) days, 56oC 3 hours, 60oC 30 min.,
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What is the status of vaccine development and production?

Vaccines effective against a pandemic virus are not yet available. Vaccines are produced each year for seasonal influenza but will not protect against pandemic influenza. Although a vaccine against the H5N1 virus is under development in several countries, no vaccine is ready for commercial production
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What drugs are available for treatment?

S e le c t iv e N e u r a m in id a s e In h ib it o r s
T a m iflu ( o s e lta m iv ir p h o s p h a te ) In d ic a tio n T re a tm e n t in a d u lts , a d o le s c e n ts a n d c h ild re n u 1 y r P ro p h y la x is in a d u lts a n d a d o le s c e n ts u 1 3 y rs S p e c tru m A d m in is tra tio n T y p e A , ty p e B O ra l T y p e A , ty p e B In h a le d R e le n z a ( z a n a m iv ir ) T re a tm e n t in a d u lts , a d o le s c e n ts a n d c h ild re n u 7 y rs

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What are the implications for human health?

2 main risks for human health. very severe disease. Unlike normal seasonal influenza, where infection causes only mild respiratory symptoms in most people, the disease caused by H5N1 follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Primary viral pneumonia and multi-organ failure are common. In the present outbreak, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults. A second risk, of even greater concern, is that the virus if given enough opportunities will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak (a pandemic). 33R.MANSOUR