1. Avian Influenza "bird flu" Contagious disease of animals caused by viruses that normally infect only birds and pigs H5N1 can infect people (very rarely) First outbreak in 1997 in Hong Kong 70% chance of dying when infected Incubation period usually 3-7 days

2. Why is Avian Influenza so dangerous? Antigenic “Drift” Antigenic “Shift” No immunity in human population No effective vaccine available

3. Testing for influenza A when: Hospitalized Eye infections (Viral)pneumonia Acute respiratory distress Contact with poultry Case to case Documented temp > 38 influenza-like symptoms cough, sore throat, muscle aches, shortness of breath Contact with poultry Documented avian influenza infections in humans (1997-2003)

4. diagnostic Identification of influenza A, H5N1 virus is possible in humans. Diagnostic tests: –Serology test ( 2 wks) –Viral culture test ( 3-10 days) –PCR ( 24 hours) –Directigen© kit for detection of any influenza A virus internal antigen ( <30 minutes) Searching for a fast diagnostic test, that has a high sentivity and specificity

5. Outbreaks Hong Kong, 1997 China and Hong Kong, 1999 Virginia, 2002 China and Hong Kong, 2003 Netherlands, 2003 Hong Kong, 2003 New York, 2003 Thailand and Vietnam, 2003 Canada, 2004 Thailand and Vietnam, 2004

7. Treatment M2 inhibitors (amantadine* and rimantadine) and the neuraminidase inhibitors (oseltamivir and zanimivir) New trail for new drugs like oseltamivi (H5N1) *mutations and resistance

8. Prevention and intervention Banning imports Culling of birds Protective clothing Decontamination Anti viral drugs for high-risk groups Travelers should avoid risk areas and monitor their health Quarantine measurements Traffic control

9. Present Since mid-December 2003 a growing number of Asian countries have reported outbreaks of highly pathogenic avian influenza in chickens and ducks Great concern for human health as well as for agriculture EU and WHO experts discussed influenza pandemic preparedness on 2 and 3 March

10. Pandemic Rapid spread (global trafficking) High death rates and mortality Short supply of vaccines and antibiotics Medical facilities overwhelmed Great social disruption and shortage of personnel Economic consequences Obliged reporting of new cases of avian influenza

11. Preparing for a pandemic 1. Preparing for an emergency 2. Surveillance 3. Case investigation and treatment 4. Preventing spread of the disease in the community 5. Maintaining essential services 6. Research and evaluation 7. Implementation, testing and revision of the national plan

12. Negative Socio-Economic effects: Human Casualties Discontinued imports of poultry by non-effected countries, leading to reduced export by effected countries Tourism affected (in Thailand) Culling of poultry, oImpact on livelihood for poultry owners oSmallholders hardest hit and least able to recover from crisis