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Regional Office for Europe

Wild birds and the risk of a Wild birds and the risk of a Wild birds and the risk of a Wild birds and the risk of a Wild birds and the risk of a Wild birds and the risk of a Wild birds and the risk of a Wild birds and the risk of a

pandemicpandemicpandemicpandemicpandemicpandemicpandemicpandemic

FAO/OIE International Scientific Conference FAO/OIE International Scientific Conference FAO/OIE International Scientific Conference FAO/OIE International Scientific Conference

on Avian Influenza and Wild Birdson Avian Influenza and Wild Birdson Avian Influenza and Wild Birdson Avian Influenza and Wild Birds

Rome, 31 May, 2006Rome, 31 May, 2006Rome, 31 May, 2006Rome, 31 May, 2006

Caroline S. BrownTechnical Officer, Communicable Diseases Surveillance and Response

WHO Regional Office for Europe


AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements

Ministries of Health of Turkey, Iraq and

Azerbaijan

WHO Country Offices

WHO teams (GOARN):

EC, ECDC, ECDC/EPIET, FAO, INVS, Swedish CFG, Rabin MC Tel Aviv,

CDC, Robert Koch Institute Berlin, SZU

Prague, NAMRU-3 Cairo, WHO (Euro,

Emro, Geneva, Rome), WHO CC Mill

Hill.


Overview of the presentationOverview of the presentationOverview of the presentationOverview of the presentationOverview of the presentationOverview of the presentationOverview of the presentationOverview of the presentation

•Current situation regarding avian

influenza in the European region

•Outcome of the Turkey, Iraq and

Azerbaijan outbreaks

•epidemiological findings•virological findings

•Risk to humans: wild birds vs poultry


Current situation regarding avian Current situation regarding avian Current situation regarding avian Current situation regarding avian Current situation regarding avian Current situation regarding avian Current situation regarding avian Current situation regarding avian

influenza in the European regioninfluenza in the European regioninfluenza in the European regioninfluenza in the European regioninfluenza in the European regioninfluenza in the European regioninfluenza in the European regioninfluenza in the European region

2

Russian Federation

Kazakhstan

Turkey

UK

Sweden

Ukraine

Spain

France

Finland

Norway

Italy

PolandGermany

Uzbekistan

Belarus

Turkmenistan

Romania

Kyrgyzstan

BiH

Bulgaria

Austria Hungary

Tajikistan

Latvia

Greece

Ireland

Portugal

Lithuania

Georgia

Estonia

Croatia

Azerbaijan

SlovakiaCzech Republic

Serbia and Montenegro

Belgium

Switzerland

Albania

Denmark

Armenia

Netherlands

Israel

SloveniaRepublic of Moldova

FYR of Macedonia

Cyprus

Luxembourg

Andorra

Malta

San MarinoMonaco

WHO/Europe - Avian Influenza Infections A/H5N1

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

0 1,000 2,000500Kilometers

Data source: World Organisation for Animal Health (OIE); WHO Collaborative Centers; National Governments; UN Cartographic Section; ArcWorld, ESRI

Map production: WHO EUROCommunicable Diseases Surveillance and Response (CSR)© WHO 2006. All rights reserved.

¯

Legend

H5N1 Outbreaks

Area with poultry case confirmed

Area with wild bird case confirmed

Confirmed affected country

Number of WHO confirmed human cases

Areas affected since - Status as of 19 May 20061 July 2005

34 out 52 countries affected

Surveillance in wild birds??

Russian Federation

Kazakhstan

Turkey

UK

Sweden

Ukraine

Spain

France

Finland

Norway

Italy

PolandGermany

Uzbekistan

Belarus

Turkmenistan

Romania

Kyrgyzstan

BiH

Bulgaria

Austria

Tajikistan

Latvia

Greece

Ireland

Hungary

Portugal

Lithuania

Georgia

Estonia

Croatia

Azerbaijan

SlovakiaCzech Republic

Serbia and Montenegro

Belgium

Switzerland

Albania

Denmark

Armenia

Netherlands

Israel

Slovenia

Republic of Moldova

FYR of Macedonia

Cyprus

Luxembourg

Andorra

Malta

San MarinoMonaco

WHO/Europe - Avian Influenza Infections A/H5N1

The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement.

0 1,000 2,000500Kilometers

Data source: World Organisation for Animal Health (OIE); WHO Collaborative Centers; National Governments; UN Cartographic Section; ArcWorld, ESRI

Map production: WHO EUROCommunicable Diseases Surveillance and Response (CSR)© WHO 2006. All rights reserved.

¯

Legend

H5N1 Outbreaks

Area with poultry case confirmed

Area with wild bird case confirmed

Confirmed affected country

Number of WHO confirmed human cases

Areas affected since - Status as of 19 May 20061 May 2006


0

5

10

15

20

25

30

11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5

Date of onset

No

. o

f cas

es

Viet Nam (N=93) Thailand (N=22) Cambodia (N=6) Indonesia (N=33)

China (N=18) Turkey (N=12) Iraq (N=2) Azerbaijan (N=8)

Egypt (N=13) Djibouti (N=1)

Human Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian InfluenzaHuman Case of H5N1 Avian Influenza-------- since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 since 2003 and as of 11 May 2006 --------

142 / 208 (68.3%)

cases occurred in the

December – March

period

142 / 208 (68.3%)

cases occurred in the

December – March

period

2006200520042003

Die-off at Qinghai lake


Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and Outcome of the Turkey, Iraq and

Azerbaijan outbreaksAzerbaijan outbreaksAzerbaijan outbreaksAzerbaijan outbreaksAzerbaijan outbreaksAzerbaijan outbreaksAzerbaijan outbreaksAzerbaijan outbreaks

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Epidemiological findingsEpidemiological findingsEpidemiological findingsEpidemiological findingsEpidemiological findingsEpidemiological findingsEpidemiological findingsEpidemiological findings

•Age groups, number of cases and

case fatality rates

•Asymptomatic infection (AZ)

•Nature of exposure

•Family clustering


Age groups, number of cases and Age groups, number of cases and

case fatality rates case fatality rates

2:61:14:5#Male:female

16-9#Median age

16.5279.5#Average age

62%100%33%Case fatality rates

524No. Deaths

8212No. cases

AzerbaijanIraqTurkey

# data from nine casesAs of 23 May 2006:

218 human cases

including 124 deaths

(CFR 57%)

As of 23 May 2006:

218 human cases

including 124 deaths

(CFR 57%)


Asymptomatic infection (AZ)Asymptomatic infection (AZ)Asymptomatic infection (AZ)Asymptomatic infection (AZ)Asymptomatic infection (AZ)Asymptomatic infection (AZ)Asymptomatic infection (AZ)Asymptomatic infection (AZ)

•Clinical specimens were taken from 18 household contacts on 21 March

•No detection of H5N1 virus in throat swabs nor antibodies in serum

•Specimen from mother in close contact with two patients also negative for virus

•Three asymptomatic cases picked up by active surveillance


Nature of exposure: poultryNature of exposure: poultryNature of exposure: poultryNature of exposure: poultryNature of exposure: poultryNature of exposure: poultryNature of exposure: poultryNature of exposure: poultry

Turkey and Iraq

Clear contact with sick backyard poultry

– Slaughtering, preparation for consumption

– Poultry had been brought indoors due to cold weather (Turkey)

– Caring for sick chickens (Turkey)

– Playing with parts of dead chickens (Turkey)

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Nature of exposure: wild birdsNature of exposure: wild birdsNature of exposure: wild birdsNature of exposure: wild birdsNature of exposure: wild birdsNature of exposure: wild birdsNature of exposure: wild birdsNature of exposure: wild birds

Azerbaijan

Exposure to dead wild swans

– Feathers were plucked for sale

– Indoors or outdoors??

– Exposure to carcasses before/after de-feathering?

– Consumption of carcasses?


Risk to humans: wild birdsRisk to humans: wild birdsRisk to humans: wild birdsRisk to humans: wild birdsRisk to humans: wild birdsRisk to humans: wild birdsRisk to humans: wild birdsRisk to humans: wild birds

Involvement of wild birds in AZ complicated and delayed the investigation:

•the situation in poultry in AZ was unclear•affected families had healthy poultry•affected families did not believe their children had avian ‘flu•affected families denied wild bird contact for fear of punishment


1.649

0

300

600

900

1.200

1.500

1.800

17-1

-200

6

24-1

-200

6

31-1

-200

6

7-2

-200

6

14-2

-200

6

21-2

-200

6

28-2

-200

6

7-3

-200

6

14-3

-200

6

21-3

-200

6

28-3

-200

6

AZ AZ AZ AZ AZ AZ AZ AZ -------- Number of Dead Wild Animals Number of Dead Wild Animals Number of Dead Wild Animals Number of Dead Wild Animals Number of Dead Wild Animals Number of Dead Wild Animals Number of Dead Wild Animals Number of Dead Wild Animals

Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Mostly Wild Birds (animal/day)Courtesy of Ministry of EcologyCourtesy of Ministry of EcologyCourtesy of Ministry of EcologyCourtesy of Ministry of EcologyCourtesy of Ministry of EcologyCourtesy of Ministry of EcologyCourtesy of Ministry of EcologyCourtesy of Ministry of Ecology

* *

Peak of swan die-off

Total dead swans counted 17.01.06 - 12.03.06: 1952


Age groups: Age groups: behaviourbehaviour related?related?

Mainly children treated chickens as pets.Mainly teenagers responsible for slaughtering sick poultry.

Mainly teenagers involved in plucking swans.Azerbaijan Male:female was 2:6

Or possibly higher susceptibility of this Or possibly higher susceptibility of this

group??group??

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Family clusteringFamily clusteringFamily clusteringFamily clusteringFamily clusteringFamily clusteringFamily clusteringFamily clustering

Family clusters were seen in all 3 countries

•In Turkey, 2 families had 2 and 3 cases

respectively

•In Iraq, one family had 2 cases

•In Azerbaijan, there were:

• 2 cases in one family

• 6 cases from 5 families were cousins


Family clustering in AzerbaijanFamily clustering in AzerbaijanFamily clustering in AzerbaijanFamily clustering in AzerbaijanFamily clustering in AzerbaijanFamily clustering in AzerbaijanFamily clustering in AzerbaijanFamily clustering in Azerbaijan

7 cases


Family clustering: significance? Family clustering: significance?

Most likely due to sharing of a common

exposure.

Human to human transmission cannot be excluded.

Implications for prophylaxis:

household members of cases should receive antiviral prophylaxis quickly upon identification of a case due to same (high) risk of common exposure


VirologicalVirological findings: findings: phylogeneticphylogenetic

comparison comparison

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Many H5N1 viruses

Human viruses 100% avianHuman viruses 100% avianHuman viruses 100% avianHuman viruses 100% avianHuman viruses 100% avianHuman viruses 100% avianHuman viruses 100% avianHuman viruses 100% avian

European and Middle Eastern

H5N1 isolates from human and

animals show phylogenetic

relationship.

These isolates segregate from the

earlier Asian isolates (Clade 1) and

exhibit antigenic differences

(Clade 2)

IMPLICATIONS FOR VACCINE

DEVELOPMENT

Courtesy of Alan Hay (WHO Collaborating

Centre, London), YiPu Lin and associates, and VLA, Weybridge.


Antigenic analyses of avian and human influenza A H5N1viruses (HI test)

Haemagglutination-inhibition titre

A/ck/Scot/59 A/HK/156/97 A/HK/213/03 RG-14 (Viet/1194)Qu/Cirebon/BB/05 A/Ind/5/05 A/ty/Turkey/1/05

NIBSC Sh NIBSC SH382 RGW Goat 358 WIC hyp F CDC F61/05 CDC F89/05 WIC f C6/05

A/ck/Scotland/59 1,280 320 80 160 40 80 80

A/Hong Kong/156/97 320 640 80 320 80 40 20

A/Hong Kong/213/03 640 160 160 640 80 <40 <20

A/Vietnam/1194/04 2,560 160 80 10,240 40 40 <20

A/qu/Cirebon/BBVet/05 640 80 40 160 640 160 <20

A/Indonesia/5/05 160 40 40 160 640 320 <20

A/ty/Turkey/I/05 640 80 160 2,560 80 160 640

A/Azerbaijan/115TS/06 320 80 80 1,280 40 80 320

A/Azerbaijan/161ser/06 640 160 80 2560 80 160 640

A/Azerbaijan/162ser/06 640 160 80 2560 80 160 320

Courtesy of Alan Hay (WHO Collaborating Centre, London), YiPu Lin and associates


Risk to humans: wild birds Risk to humans: wild birds Risk to humans: wild birds Risk to humans: wild birds Risk to humans: wild birds Risk to humans: wild birds Risk to humans: wild birds Risk to humans: wild birds vsvsvsvsvsvsvsvs poultrypoultrypoultrypoultrypoultrypoultrypoultrypoultryCurrent assessmentsCurrent assessmentsCurrent assessmentsCurrent assessmentsCurrent assessmentsCurrent assessmentsCurrent assessmentsCurrent assessments

WHO All evidence to date indicates that close contact with dead or sick birds is the principal source of human infection with the H5N1 virus. Especially risky behaviours identified include the slaughtering,defeathering, butchering and preparation for consumption of infected birds.

ECDC Group 1 – Low but Real RiskThe risk of infection is confined to those who have close and intense contact with sick poultry. Group 2 – Theoretical Risk – Precautions requiredIncludes where H5N1 may be present:

HCW, cullers, farm workers and people who may have close contact with infected wild birds eg. some ornithologists and hunters.

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ConclusionsConclusionsConclusionsConclusionsConclusionsConclusionsConclusionsConclusions

•Virus acquired by exposure to wild birds is not different to virus acquired from poultry

•Close human contacts with infected wild birdsfar less numerous than with infected poultry

•Therefore virus from wild birds will have less opportunity to adapt/reassort in humans

•Therefore wild birds constitute a lower pandemic risk


PreventionPreventionPreventionPreventionPreventionPreventionPreventionPrevention

Emphasis should be on the education of the population and identification of vulnerable populations, including hunting communities.


Thank YouThank YouThank YouThank YouThank YouThank YouThank YouThank You

[email protected]

www.euro.who.intwww.euro.who.int/flu//flu/

Acknowledgements Wild birds and the risk of a pandemic ... · PDF fileWild birds and the risk...

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