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Avian flu? In humans? Avian Influenza in Humans2004 Silvio Pitlik, MD Mar 17, 2004 Avian Influenza in Humans2004 Silvio Pitlik, MD Mar 17, 2004 Outline – How Mother Nature ignites emerging infections – Historical perspective – Clinician’s perspective – Back to the future Influenza Virus • • • • Highly unstable Sloppy Promiscuous Completely unpredictable Dr Anarfi Asamoa-Baah, Assistant Director-General, WHO Communicable Diseases Opening address-Technical consultation on influenza pandemic preparedness- March 16, 2004 one small step for man, one giant leap for mankind Neil Armstrong Crossing the species barrier — one small step to man, one giant leap to mankind NEJM, Mar 18, 2004 Emerging Infections-1990’s • • • • • • • • • • • • • Andes virus Banna virus Bartonella henselae Bayou virus Cycloscopora cayetanensis Ehrlichia chaffeensis Ehrlichia equi Equine morbillivirus Fakeeh virus Guanarito virus Hendra virus Hepatitis G virus HIV-1 • Picobirnavirus • • • • • • • • • • • • • Influenza A H5N1 Influenza A H9N2 Juquitiba virus Laguna Negra virus Lechiguanas virus New York virus Nipah virus Oran virus Oscar virus Prion protein Rotavirus 116E P360 Sabia virus Sin nombre virus Current Opinion in ID, 2000 How Mother Nature Ignites an Emerging Infection How Mother Nature Ignites an Emerging Infection Wild-life reservoir How Mother Nature Ignites an Emerging Infection Wild-life reservoir Man-made amplifier How Mother Nature Ignites an Emerging Infection Disease Wild-life reservoir Man-made amplifier AIDS Pan troglodites troglodites Promiscuous sex, drug adiction, blood products SARS Paguma larvata Restaurants, hotels, hospitals WNV Wild birds Geese farms Monkeypox Wild rodents in Africa Pet retailers and stores How Mother Nature Ignites an Emerging Infection Disease Wild-life reservoir Man-made amplifier AIDS Pan troglodites troglodites Promiscuous sex, drug adiction, blood products SARS Paguma larvata Restaurants, hotels, hospitals WNV Wild birds Geese farms Monkeypox Wild rodents in Africa Pet retailers and stores Influenza Wild aquatic birds Poultry farms Healthy aquatic birds Natural hosts of influenza viruses Haemagglutinin subtype H1 H2 H3 H4 H5 H6 H7 H8 H9 H10 H11 H12 H13 H14 H15 Neuraminidase subtype N1 N2 N3 N4 N5 N6 N7 N8 N9 Bird-flu in humans Year Place 1997 Hong Kong H5N1 18 6 0.33 1999 Hong Kong H9N2 2 0 0.00 2003 Hong Kong H5N1 2 1 0.50 2003 Netherlands H7N7 84 1 0.01 2003 Hong Kong H9N2 1 0 0.00 2004 Viet Nam H5N1 22 15 0.68 2004 Thailand H5N1 11 7 0.64 140 30 0.21 Total Strain # of cases # of deaths Case fatality Outbreak of influenza A (H5N1) in Hong Kong in 1997 Age and sex distribution of patients infected with influenza A (H5N1) Geographical distribution of influenza A (H5N1) infected cases in Hong Kong Diagnostic algorithm for the rapid diagnosis of H5N1 infection. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of ARDS- Netherlands 2003 • • • • • • Overall - 89 patients 78 - conjunctivitis 5 - conjunctivitis and influenza-like illness 2 - influenza-like illness 4 - did not fit the case definitions Illnesses were generally mild, except for a fatal case of pneumonia in combination with ARDS Sick chicken Dead chicken Radiological Findings Prerequisites for the Start of a Pandemic • First, a novel virus must emerge to which the general population will have no or little immunity • Second, the new virus must be able to replicate in humans and cause disease • Third, the new virus must be efficiently transmitted from one human to another. Efficient transmission is expressed as sustained chains of transmission causing community-wide outbreaks 19 00 . 19 03 . 19 06 . 19 09 . 19 12 . 19 15 . 19 18 . 19 21 . 19 24 . 19 27 . Life expectancy-USA, 1900-28 70 60 50 40 30 19 00 . 19 03 . 19 06 . 19 09 . 19 12 . 19 15 . 19 18 . 19 21 . 19 24 . 19 27 . Life expectancy-USA, 1900-28 70 60 50 40 30 • • • • Culling Quarantine Disinfection Vaccination against circulating flu • H5N1 vaccine development • Stockpiling of antivirals Take-home messages • The threat to public health will remain so long as the virus continues to cause disease in domestic poultry • The outbreaks in poultry are likely to take a very long time to control • Should the final prerequisite for a pandemic be met, the consequences for human health around the world could be devastating • Regardless of how the present situation evolves, the world needs to be better prepared to respond to the next influenza pandemic We have to prepare for the next pandemic!!! Clinical features of mild and severe influenza A (H5N1)
