Avian Influenza in Humans2004

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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
• Clinicians 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 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-1990s

• 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
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How Mother Nature Ignites an Emerging Infection
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How Mother Nature Ignites an Emerging Infection
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How Mother Nature Ignites an Emerging Infection
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Healthy aquatic birds
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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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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)