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Avian flu?
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In humans?
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Avian Influenza in Humans-2004
Silvio Pitlik, MD Mar 17, 2004
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Avian Influenza in Humans-2004
Silvio Pitlik, MD Mar 17, 2004
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Outline How Mother Nature ignites emerging infections
Historical perspective Clinician’s perspective Back to the future
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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
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one giant leap for mankind
one small step for man, one giant leap for mankind Neil Armstrong
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Crossing the species barrier — one small step to man,
one giant leap to mankind NEJM, Mar 18, 2004
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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
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How Mother Nature Ignites an Emerging Infection
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How Mother Nature Ignites an Emerging Infection
Wild-life reservoir
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How Mother Nature Ignites an Emerging Infection
Wild-life reservoir Man-made amplifier
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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
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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
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Healthy aquatic birds
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Bird-flu in humans Year Place Strain # of cases # of deaths
Case fatality 1997 Hong Kong H5N1 18 6 0.33 1999 H9N2 2 0.00 2003 1 0.50 Netherlands H7N7 84 0.01 2004 Viet Nam 22 15 0.68 Thailand 11 7 0.64 Total 140 30 0.21
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Outbreak of influenza A (H5N1) in Hong Kong in 1997
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Age and sex distribution of patients infected with influenza A (H5N1)
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Geographical distribution of influenza A (H5N1) infected cases in Hong Kong
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Diagnostic algorithm for the rapid diagnosis of H5N1 infection.
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5 - conjunctivitis and influenza-like illness
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
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Sick chicken
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Dead chicken
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Radiological Findings
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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
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Culling Quarantine Disinfection Vaccination against circulating flu H5N1 vaccine development Stockpiling of antivirals
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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
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We have to prepare for the next pandemic!!!
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Clinical features of mild and severe influenza A (H5N1)
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