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update in H5N1 (from WHO)
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update in H5N1 (from WHO)
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Avian influenza A(H5N1) in humans in Viet Nam and poultry in Asia - update
14 January 2004
Investigation of cases of acute respiratory illness are continuing in Viet Nam with support from WHO staff. The investigation has been undertaken in response to concerns over the laboratory confirmation, on Sunday, of the presence of avian influenza virus H5N1 in three patients who died of severe respiratory illness in late December and early January.
The H5N1 strain implicated in the outbreak has now been partially sequenced. All genes are of avian origin, indicating that the virus that caused death in the three confirmed cases had not yet acquired human genes. The acquisition of human genes increases the likelihood that a virus of avian origin can be readily transmitted from one human to another.
Investigations are focusing on the source of infection and possibilities of human-to-human transmission.
An outbreak of highly pathogenic H5N1 avian influenza was detected in southern Viet Nam in the beginning of January. The outbreak is now known to have spread to other provinces in the country. Reports indicate that pigs and ducks have also been infected.
Yesterday, officials in the Republic of Korea announced the spread of H5N1 avian influenza to an additional farm. Japan is also experiencing an outbreak in poultry caused by the H5N1 virus.
In response to these developments, WHO has initiated a series of activities. These include support to national authorities in investigating the outbreaks and enhanced surveillance activities in Asia. WHO has also initiated the development of candidates and reagents for vaccine production, and antigenic and genetic assessments of the H5N1 strain to provide up-to-date diagnostic tests to national influenza centres.
The WHO Global Influenza Network will receive virus and clinical specimens shortly. As a precautionary measure, network laboratories will immediately begin work on the development of a strain that can be used to produce a vaccine.
14 January 2004
Investigation of cases of acute respiratory illness are continuing in Viet Nam with support from WHO staff. The investigation has been undertaken in response to concerns over the laboratory confirmation, on Sunday, of the presence of avian influenza virus H5N1 in three patients who died of severe respiratory illness in late December and early January.
The H5N1 strain implicated in the outbreak has now been partially sequenced. All genes are of avian origin, indicating that the virus that caused death in the three confirmed cases had not yet acquired human genes. The acquisition of human genes increases the likelihood that a virus of avian origin can be readily transmitted from one human to another.
Investigations are focusing on the source of infection and possibilities of human-to-human transmission.
An outbreak of highly pathogenic H5N1 avian influenza was detected in southern Viet Nam in the beginning of January. The outbreak is now known to have spread to other provinces in the country. Reports indicate that pigs and ducks have also been infected.
Yesterday, officials in the Republic of Korea announced the spread of H5N1 avian influenza to an additional farm. Japan is also experiencing an outbreak in poultry caused by the H5N1 virus.
In response to these developments, WHO has initiated a series of activities. These include support to national authorities in investigating the outbreaks and enhanced surveillance activities in Asia. WHO has also initiated the development of candidates and reagents for vaccine production, and antigenic and genetic assessments of the H5N1 strain to provide up-to-date diagnostic tests to national influenza centres.
The WHO Global Influenza Network will receive virus and clinical specimens shortly. As a precautionary measure, network laboratories will immediately begin work on the development of a strain that can be used to produce a vaccine.
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update in H5N1 (from WHO)
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Avian influenza H5N1 infection in humans:
urgent need to eliminate the animal reservoir - update 5
22 January 2004
Epidemics of highly pathogenic avian influenza, caused by various H5N1 strains, have been reported in parts of Asia since mid-December 2003. Millions of domestic poultry have either died or been destroyed as a result. Thousands of workers have been involved in the culling operations.
The current situation is of serious concern for human health as well as for agriculture and the poultry industry. Rapid elimination of the H5N1 virus in bird populations should be given high priority as a matter of international public health importance.
WHO is collaborating closely, at high levels, with FAO and the World Organisation for Animal Health (OIE) to ensure that appropriate measures in the agricultural sector are introduced as a matter of urgency, and in the interest of protecting public health at the international level. Joint investigations are currently under way in Viet Nam.
Of all the avian influenza viruses, which normally cause infection in birds and pigs only, the H5N1 strain may have a unique capacity to cause severe disease, with high mortality, in humans.
The simultaneous occurrence in several countries of large epidemics of highly pathogenic H5N1 influenza in domestic poultry is historically unprecedented. The present situation may grow worse. In bird populations, the disease is highly contagious and rapidly fatal, and spreads easily from farm to farm. Wild migratory waterfowl can spread infection to domestic flocks. The potential for further spread of ongoing poultry epidemics, both within affected countries and to other countries, is therefore great.
For all these reasons, the H5N1 strain may be more widely established in bird populations and in the environment in this part of the world than presently appreciated. Studies have shown that infected birds can shed large amounts of the virus in their faeces. The virus can survive for long periods in the tissues and faeces of diseased birds and in water, especially when temperatures are low. In water, the virus can survive for up to four days at 22oC and more than 30 days at 0oC. The virus survives in frozen material indefinitely.
The large epidemics of highly pathogenic avian influenza currently seen in poultry, and possible widespread presence of the virus in the environment, increase opportunities for human exposure and infection. They also increase opportunities for human and avian influenza viruses to exchange genes This can occur when humans are simultaneously infected by human and avian influenza viruses. The frequency of such co-infections increases the likelihood that a completely new influenza virus subtype might emerge, carrying sufficient human genes to allow efficient and sustainable person-to-person transmission.
Research has shown that the risk of direct transmission of H5N1 infection from birds to humans is greatest in persons having close contact with live infected poultry. Contact with poultry kept in live markets is considered the source of infection for 17 of the 18 human cases of H5N1 infection that occurred in Hong Kong in 1997. The additional case the first in the outbreak has been linked to contact with poultry at farms experiencing epidemics of highly pathogenic avian H5N1 influenza. Six of the 18 cases were fatal.
Occupational exposure can occur among poultry workers, and among workers involved in culling operations.
Rapid elimination of the H5N1 virus in animal populations is an essential measure to prevent the emergence of a new influenza virus subtype with pandemic potential. This measure not only helps prevent further spread in bird populations, but also reduces opportunities for human infection. However, in the present situation, the problem of controlling all human exposures is compounded by the large number of back yard farms where chickens are kept in rural areas.
While rapid culling of infected or exposed flocks is strongly recommended, prevention of infection during culling operations must also be given high priority. Culling operations can place large numbers of workers at risk of brief but intensive exposure to the virus.
In 1997, Hong Kong authorities culled the entire poultry population, an estimated 1.5 million birds, within three days. This rapid and comprehensive action is thought by many experts to have averted an influenza pandemic. Culling operations were performed by trained government workers, most of whom wore protective masks, gloves, and gowns. Although subsequent investigation detected H5 antibodies, indicating exposure to the virus, in around 3% of persons involved in the culling of infected poultry, no case of severe respiratory disease was detected as a result of this exposure.
In the Netherlands in 2003, an outbreak of highly pathogenic H7N7 avian influenza in poultry caused infection, with mild illness, in 83 persons, and fatal illness in a veterinarian. An estimated 30 million poultry were culled within a week.
Further information about highly pathogenic avian influenza is available in a WHO fact sheet, at the FAO web site , and the OIE web site . Information on safety precautions during culling operations will be issued soon by the WHO Regional Office for the Western Pacific.
Laboratory characterization of the 2004 H5N1 viruses
Laboratories in the WHO Global Influenza Surveillance Network have today discussed results from the sequencing and antigenic characterization of H5N1 strains isolated from humans and poultry in Viet Nam. Initial results show significant differences between these viruses and strains obtained during outbreaks of H5N1 avian influenza in Hong Kong, in 1997 and 2003, indicating that the virus has mutated.
Work continues on the updating of WHO diagnostic kits for the rapid detection of H5N1 infection in humans, and on the development of a prototype virus for use in vaccine manufacturing. Viruses from birds in other currently affected countries are urgently needed in order to conduct additional laboratory investigations. Such investigations are part of the information needed by WHO to recommend and develop a vaccine strain that can protect humans against circulating H5N1 strains
urgent need to eliminate the animal reservoir - update 5
22 January 2004
Epidemics of highly pathogenic avian influenza, caused by various H5N1 strains, have been reported in parts of Asia since mid-December 2003. Millions of domestic poultry have either died or been destroyed as a result. Thousands of workers have been involved in the culling operations.
The current situation is of serious concern for human health as well as for agriculture and the poultry industry. Rapid elimination of the H5N1 virus in bird populations should be given high priority as a matter of international public health importance.
WHO is collaborating closely, at high levels, with FAO and the World Organisation for Animal Health (OIE) to ensure that appropriate measures in the agricultural sector are introduced as a matter of urgency, and in the interest of protecting public health at the international level. Joint investigations are currently under way in Viet Nam.
Of all the avian influenza viruses, which normally cause infection in birds and pigs only, the H5N1 strain may have a unique capacity to cause severe disease, with high mortality, in humans.
The simultaneous occurrence in several countries of large epidemics of highly pathogenic H5N1 influenza in domestic poultry is historically unprecedented. The present situation may grow worse. In bird populations, the disease is highly contagious and rapidly fatal, and spreads easily from farm to farm. Wild migratory waterfowl can spread infection to domestic flocks. The potential for further spread of ongoing poultry epidemics, both within affected countries and to other countries, is therefore great.
For all these reasons, the H5N1 strain may be more widely established in bird populations and in the environment in this part of the world than presently appreciated. Studies have shown that infected birds can shed large amounts of the virus in their faeces. The virus can survive for long periods in the tissues and faeces of diseased birds and in water, especially when temperatures are low. In water, the virus can survive for up to four days at 22oC and more than 30 days at 0oC. The virus survives in frozen material indefinitely.
The large epidemics of highly pathogenic avian influenza currently seen in poultry, and possible widespread presence of the virus in the environment, increase opportunities for human exposure and infection. They also increase opportunities for human and avian influenza viruses to exchange genes This can occur when humans are simultaneously infected by human and avian influenza viruses. The frequency of such co-infections increases the likelihood that a completely new influenza virus subtype might emerge, carrying sufficient human genes to allow efficient and sustainable person-to-person transmission.
Research has shown that the risk of direct transmission of H5N1 infection from birds to humans is greatest in persons having close contact with live infected poultry. Contact with poultry kept in live markets is considered the source of infection for 17 of the 18 human cases of H5N1 infection that occurred in Hong Kong in 1997. The additional case the first in the outbreak has been linked to contact with poultry at farms experiencing epidemics of highly pathogenic avian H5N1 influenza. Six of the 18 cases were fatal.
Occupational exposure can occur among poultry workers, and among workers involved in culling operations.
Rapid elimination of the H5N1 virus in animal populations is an essential measure to prevent the emergence of a new influenza virus subtype with pandemic potential. This measure not only helps prevent further spread in bird populations, but also reduces opportunities for human infection. However, in the present situation, the problem of controlling all human exposures is compounded by the large number of back yard farms where chickens are kept in rural areas.
While rapid culling of infected or exposed flocks is strongly recommended, prevention of infection during culling operations must also be given high priority. Culling operations can place large numbers of workers at risk of brief but intensive exposure to the virus.
In 1997, Hong Kong authorities culled the entire poultry population, an estimated 1.5 million birds, within three days. This rapid and comprehensive action is thought by many experts to have averted an influenza pandemic. Culling operations were performed by trained government workers, most of whom wore protective masks, gloves, and gowns. Although subsequent investigation detected H5 antibodies, indicating exposure to the virus, in around 3% of persons involved in the culling of infected poultry, no case of severe respiratory disease was detected as a result of this exposure.
In the Netherlands in 2003, an outbreak of highly pathogenic H7N7 avian influenza in poultry caused infection, with mild illness, in 83 persons, and fatal illness in a veterinarian. An estimated 30 million poultry were culled within a week.
Further information about highly pathogenic avian influenza is available in a WHO fact sheet, at the FAO web site , and the OIE web site . Information on safety precautions during culling operations will be issued soon by the WHO Regional Office for the Western Pacific.
Laboratory characterization of the 2004 H5N1 viruses
Laboratories in the WHO Global Influenza Surveillance Network have today discussed results from the sequencing and antigenic characterization of H5N1 strains isolated from humans and poultry in Viet Nam. Initial results show significant differences between these viruses and strains obtained during outbreaks of H5N1 avian influenza in Hong Kong, in 1997 and 2003, indicating that the virus has mutated.
Work continues on the updating of WHO diagnostic kits for the rapid detection of H5N1 infection in humans, and on the development of a prototype virus for use in vaccine manufacturing. Viruses from birds in other currently affected countries are urgently needed in order to conduct additional laboratory investigations. Such investigations are part of the information needed by WHO to recommend and develop a vaccine strain that can protect humans against circulating H5N1 strains
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update in H5N1 (from WHO)
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Avian influenza A(H5N1) in humans in Thailand - update 6
23 January 2004
The Ministry of Public Health in Thailand has today informed WHO of two cases of H5N1 avian influenza in humans. Both cases, which are in children, are laboratory confirmed.
A WHO influenza reference centre in Thailand has been involved in the testing.
The first case is a 7-year-old boy from Suphanburi province who developed fever and cough on 3 January, and progressed to acute respiratory distress syndrome on 13 January. Test results received today have detected the H5N1 avian influenza virus strain in specimens taken from this patient.
The second case is a 6-year-old boy from Kanchanaburi province. He developed fever on 6 January, followed a week later by severe pneumonia with acute respiratory distress syndrome. Test results, made available to the Ministry of Public Health this morning, have detected the H5N1 avian influenza virus strain in specimens taken from this patient.
Both patients are alive.
WHO has also received official information that a 49-year-old man in Nakornsawan province, hospitalized with severe pneumonia, has been treated with antibiotics. His condition is now improving, suggesting that his illness has a bacterial, and not a viral cause
23 January 2004
The Ministry of Public Health in Thailand has today informed WHO of two cases of H5N1 avian influenza in humans. Both cases, which are in children, are laboratory confirmed.
A WHO influenza reference centre in Thailand has been involved in the testing.
The first case is a 7-year-old boy from Suphanburi province who developed fever and cough on 3 January, and progressed to acute respiratory distress syndrome on 13 January. Test results received today have detected the H5N1 avian influenza virus strain in specimens taken from this patient.
The second case is a 6-year-old boy from Kanchanaburi province. He developed fever on 6 January, followed a week later by severe pneumonia with acute respiratory distress syndrome. Test results, made available to the Ministry of Public Health this morning, have detected the H5N1 avian influenza virus strain in specimens taken from this patient.
Both patients are alive.
WHO has also received official information that a 49-year-old man in Nakornsawan province, hospitalized with severe pneumonia, has been treated with antibiotics. His condition is now improving, suggesting that his illness has a bacterial, and not a viral cause
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