| Country
| 2003 | 2004 | 2005 | 2006 | Total | |||||
| cases | deaths | cases | deaths | cases | deaths | cases | deaths | cases | deaths | |
Azerbaijan | 0 | 0 | 0 | 0 | 0 | 0 | 7 | 5 | 7 | 5 |
| Cambodia | 0 | 0 | 0 | 0 | 4 | 4 | 0 | 0 | 4 | 4 |
| China | 0 | 0 | 0 | 0 | 8 | 5 | 7 | 5 | 15 | 10 |
| Indonesia | 0 | 0 | 0 | 0 | 17 | 11 | 12 | 11 | 29 | 22 |
| Iraq | 0 | 0 | 0 | 0 | 0 | 0 | 2 | 2 | 2 | 2 |
| Thailand | 0 | 0 | 17 | 12 | 5 | 2 | 0 | 0 | 22 | 14 |
| Turkey | 0 | 0 | 0 | 0 | 0 | 0 | 12 | 4 | 12 | 4 |
| Viet Nam | 3 | 3 | 29 | 20 | 61 | 19 | 0 | 0 | 93 | 42 |
| Total | 3 | 3 | 46 | 32 | 95 | 41 | 40 | 27 | 184 | 103 |
The World Bank estimates that the cost to the global economy of a flu pandemic would be upwards of $800 billion (US). According to Congressional Budget Office in the US, the impact of a pandemic would cost up to 5 per cent of GDP.
Assuming Canada would be similarly affected and considering our reliance on trade, Canada’s economy could suffer by as much as $60 billion due to a pandemic outbreak – even more if the Canada-US border were to experience serious difficulties.
“As a nation, we can’t afford to be unprepared,” added Beatty. “CME’s guide equips all Canadian business with tools and information to minimize the risk that influenza pandemic poses to the health and safety of employees, the continuity of business operations and the bottom line.”
The 87-page guide highlights key considerations when coping with a pandemic, including the critical elements of a continuity plan plus a summary checklist; a how-to guide to develop a continuity plan; medical precautions and human resource considerations.
“A business continuity plan should be an essential element of any business strategy or operating procedures, as we have learned from SARS, 9/11 and even the ice storm,” said Beatty. “I cannot think of any reason not to be prepared, but 60 billion reasons why we should.”
CME’s Continuity Planning Guide for Canadian Business can be downloaded, free of charge at www.manufacturingourfuture.ca. The direct link to the PDF file is here:
http://www.cme-mec.ca/pdf/CME_Pandemic_Guide.pdf
To date, four patients with respiratory symptoms and a history of exposure to diseased poultry have been investigated for possible infection. This number includes a woman who died of an acute respiratory illness on 16 February. The three remaining patients are all in good condition.
Arrangements are being made to send samples from all four patients for testing at a WHO collaborating laboratory in the United Kingdom.
The initial outbreak in Kaduna state is now known to have begun on 10 January, raising the possibility that earlier human exposures and cases may have occurred in that area and elsewhere. At hospitals in Kaduna, Kano, and Katsina near affected farms, staff from the WHO-led teams have now examined hundreds of patient records, searching for possible cases that may have occurred earlier. No such cases have been identified to date.
The scale of the outbreak in birds is not yet fully understood. Most investigations have followed poultry deaths on large commercial farms, where outbreaks are highly visible. Little is known about the presence of the virus in small backyard flocks, where the greatest risk of human exposures and infections resides.
Nigeria has an estimated poultry population of around 140 million birds, largely concentrated in the south-western part of the country. As is the case in several affected parts of South-east Asia, around 60% of Nigeria’s poultry production takes place in small backyard flocks. Large-scale commercial farming of poultry occurs mainly in the northern states, where outbreaks have been confirmed.
Rapid spread of the virus within Nigeria has raised concern over possible spread to neighbouring countries. Borders are porous and restrictions on the movement of people and poultry are difficult to enforce. WHO staff at offices in these countries are monitoring the situation closely in collaboration with government officials. Rumours of possible human cases in neighbouring countries are also being closely monitored.
Source: World Health Organization
]]>The situation in these recently affected countries varies greatly. Most European countries with good veterinary surveillance have detected the virus in a small number of wild birds only, with no evidence to date of spread to domestic birds.
In Azerbaijan, detection of the virus has coincided with die-offs of domestic birds. In Egypt, outbreaks in domestic poultry have now been confirmed in 10 governorates; deaths have also been reported in exotic zoo birds. In Iraq, presence of the virus in birds was found only after the country confirmed its first human case.
In Nigeria, as in India, the first cases were detected in large commercial farms, where the disease is highly visible and outbreaks are difficult to miss.
Apart from Iraq, none of the countries newly affected during February has reported human cases. Iraq has reported two human cases, both of which were fatal; samples from several other patients are currently undergoing tests.
For human health, experience elsewhere over the past two years has shown that the greatest risk of cases arises when the virus becomes established in small backyard flocks, which allow continuing opportunities for close human contact, exposures, and infections to occur.
All available evidence indicates that the virus does not spread easily from poultry to humans. To date, very few cases have been detected in poultry workers, cullers, or veterinarians. Almost all cases have been linked to close contact to diseased household flocks, often during slaughtering, defeathering, butchering, and preparation of poultry for consumption.
No cases have been linked to the consumption of properly cooked poultry meat or eggs, even in households where disease was known to be present in flocks.
Source: World Health Organization
]]>Although the H5N1 strain of avian influenza is difficult to spread from birds to humans, its arrival in Africa is very troubling. So far, human contagion in other parts of the world has been kept low, thanks in part to aggressive monitoring and rapid and widespread culling of domestic bird populations. Africa's combination of close human/poultry contact and a weak medical and communications infrastructure makes it a likely location for the flu to spread and mutate into a much greater danger to human populations. The continuing AIDS epidemic on the African continent is a perfect example of how its lack of infrastructure and money leave it unable to deal with large scale health threats. In reaching Africa, H5N1 avian fluenza may now have the incubator it needs to launch a pandemic.
]]> More From the World Health Organization:The confirmation of highly pathogenic H5N1 avian influenza in domestic birds in northern Nigeria marks the further geographical spread of this virus. Although all evidence to date indicates that the virus does not spread easily from birds to humans, careful monitoring of the situation is warranted.
Experience in several other countries has shown how quickly the H5N1 virus can spread and become firmly established in poultry. The ability of this virus to cause rare but severe disease in humans is well documented.
At present, the only confirmed H5N1 outbreak is thought to be confined to a large commercial farm, located in Kaduna State in the northern part of the country, where thousands of chickens were kept in battery cages. Investigations are urgently needed to determine whether the outbreak, which began almost a month ago, has spread from the farm to affect household flocks. Poultry deaths in the adjacent province of Kano have been reported, but the cause has not yet been determined.
The most immediate public health need is to reduce opportunities for human infections to occur. Investigations of human cases in Asia and elsewhere have identified close contact with diseased or dead household poultry as the most important source of human exposure to the virus.
In Nigeria, as in other parts of Africa, most village households maintain free-ranging flocks of poultry as a source of income and food. Close human contact with poultry is extensive.
If the virus has spread to household flocks in Nigeria, public information campaigns will be needed to warn populations to avoid high-risk behaviours, including the slaughtering, defeathering, butchering, and preparation for consumption of diseased poultry.
WHO is ready to respond to requests from Nigeria for support, including assessment teams and the provision of essential supplies and equipment. Infectious disease staff at WHO’s regional office in Harare, Zimbabwe held an emergency meeting today to assess the situation, plan a response, and evaluate the possible risk to other African countries. A team of experts experienced in the investigation of outbreaks has been placed on standby.
No clear information about the source of the Nigerian outbreak is presently available, but the country is known to lie along a flight route for birds migrating from central Asia.
Full sequence information about the virus in the Nigerian outbreak is expected later this week. This information will allow comparison with viruses that have caused human cases elsewhere and thus assist in the assessment of risks to human health. Sequence information may also shed some light on the origins of the outbreak.
The committee set up to fight the spread of the flu virus reported that they have killed a total of 500,000 birds. In some areas, up to 50% of the bird population was slaughtered.
More information can be found from the BBC website:
http://news.bbc.co.uk/go/pr/fr/-/2/hi/middle_east/4666360.stm
Ironically, the use of this modern technology may require vital IT personnel to quarantine themselves in the data center so they can ensure the system's uptime. They would have to be locked in with the computers and communications gear along with large caches of food and water for the duration of the outbreak.
]]>Outbreaks in poultry: significance for human health
The arrival of highly pathogenic H5N1 avian influenza on the African continent would be of great concern for human as well as animal health. Though the densities of human and poultry populations are generally lower in Africa than in South-east Asia, the poultry production systems have many similarities which would create multiple opportunities for human exposure, should outbreaks occur in African poultry. In Africa as in affected Asian nations, large numbers of households keep backyard flocks, which often mingle freely with wild birds. Most such flocks scavenge for food, often entering households or sharing outdoor areas where children play.
With few exceptions, notably in large commercial farms, surveillance for avian disease is non-existent. Nutrition of the birds is poor and high mortality is common, increasing the likelihood that outbreaks of H5N1 will be missed. Few governments are in a position to offer support for disease control – let alone compensation to farmers for destroyed birds, thus further discouraging early and open reporting. As experience in Asia has shown, late detection of outbreaks increases the likelihood that the virus will become endemic. Deaths of large numbers of poultry, whether due to disease or culling for control purposes, would deprive already impoverished populations of an important source of dietary protein.
Human cases
In Africa, the risk of human infection from an avian H5N1 virus can be expected to be similar to that seen in Asia. To date, the majority of human cases in Asia have been linked to close contact with infected domestic birds, with especially high risks thought to occur during home slaughter, defeathering, butchering, and preparation for cooking. Consumption of inadequately cooked poultry and poultry products (including eggs and blood) is an additional risk. As in Asia, African households, especially in rural areas, traditionally slaughter and consume birds when signs of illness appear in backyard flocks. As in Asia, such practices could prove difficult to change.
The occurrence of human cases – even when sporadic – would create enormous new challenges for health systems and services that are already fragile and overburdened. Should human cases occur, their early detection – when treatment with antiviral drugs is most likely to improve prospects of survival – is unlikely. Surveillance systems are weak and unlikely to pick up cases of a disease with symptoms similar to illness from many other common causes. Health capacity and human and financial resources have been overwhelmed by the demands of diseases such as AIDS, tuberculosis and malaria. Laboratory confirmation of human H5N1 infections is technically challenging, expensive, and demanding on human resources. Management of H5N1 patients is very demanding. Infection control in most hospitals is difficult to introduce and sustain. Sporadic cases of H5N1 infection and the frequent reluctance of residents to comply with recommended reporting and isolation measures during outbreaks of severe disease could push fragile health systems close to the brink of collapse. Surveillance systems, with rare exceptions, are not sufficiently sensitive to pick up clusters of human cases – a critical early warning signal that the virus is improving its transmissibility. Africa has some well-equipped laboratories, but these might rapidly prove inadequate should large numbers of samples need to be tested rapidly.
]]>"The development of a prototype pandemic vaccine is an important component of our preparedness strategy," said Minister Dosanjh. "Vaccines are the most effective line of defence for reducing illness and death in the event of an influenza pandemic. The investment in the development and testing of a prototype pandemic vaccine represents a significant step towards improving our preparedness. We need to invest now in building our scientific knowledge and production capacity so that we can produce a vaccine as quickly as possible when it's needed."
]]> A specific vaccine against a pandemic virus cannot be produced until the new strain has emerged and has been identified. In the meantime, work on the production and testing of a prototype vaccine using the H5N1 seed strain will allow the manufacturer to gain the experience needed to "ramp up" production when a pandemic happens. Production of the prototype and vaccine trials will also increase our knowledge on the appropriate formulation and number of doses needed, as well as the safety and effectiveness of the vaccine."Canada is recognized as a world leader in pandemic preparedness," said Minister of State (Public Health) Carolyn Bennett. "Work on the development of a prototype pandemic influenza vaccine is important to building Canada's capacity to respond effectively during a pandemic, and is one important part of our comprehensive plan to mitigate the outcome of an influenza pandemic."
Budget 2005 provided funding for the development and production of a prototype vaccine, and clinical trials to study the effectiveness of the vaccine. In addition to work on a prototype vaccine, ID Biomedical is under contract to provide the infrastructure and capacity to produce sufficient vaccine for all Canadians in the event of an influenza pandemic.
ID Biomedical will build a pilot production facility to produce sufficient vaccine for use in clinical trials. Production and clinical trials are scheduled to begin next fall.
Vaccines provide immunity by stimulating the body to produce antibodies to fight off a virus. Immunization has been used for many years in Canada and around the world to effectively prevent, control and eradicate serious illnesses such as polio and smallpox.
Scientists and governments continue to monitor the H5N1 animal influenza virus, which has affected many poultry populations and some humans in South East Asia and parts of Europe. Because of the widespread infection in birds, there is the possibility that this H5N1 avian influenza virus might change or mix with another strain, creating a new virus capable of infecting humans and causing a pandemic.
Pandemic vaccine production is a key component of Canada's approach to pandemic preparedness, which also includes antivirals, international collaboration and leadership, public education, and public health measures, including enhanced monitoring and alert systems.
In the event of a pandemic, the goal is to have vaccines provided to all Canadians. Until a pandemic strain emerges, however, antivirals will be an important part of our response to a pandemic. The Government of Canada contributed $24 million for the establishment of a National Antiviral Stockpile. Currently, federal, provincial and territorial governments have a stockpile of 35 million capsules of oseltamivir, with another five million on order.
Given Canada's population of around 30 million, this is a significantly better preparation than that of the United States.
]]>According to recent reports from the U.K., numerous websites, including two Canadian sites, have been selling illegal Tamiflu to U.K. customers. Other reports indicate the U.S. Customs Border Patrol has intercepted more than 50 shipments of counterfeit Tamiflu at their border. Health Canada and the RCMP are currently looking into these reports.
As with any medication purchased online, consumers should only buy Tamiflu with a prescription from a doctor they know, using a pharmacy where they have an established relationship."
Source: Health Canada
]]>Infected birds shed influenza virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated secretions or excretions or with surfaces that are contaminated with secretions or excretions from infected birds. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.
Infection with avian influenza viruses in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The “low pathogenic” form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production). However, the highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100% often within 48 hours.
Human infection with avian influenza viruses
There are many different subtypes of type A influenza viruses. These subtypes differ because of changes in certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 known HA subtypes and 9 known NA subtypes of influenza A viruses. Many different combinations of HA and NA proteins are possible. Each combination represents a different subtype. All known subtypes of influenza A viruses can be found in birds.
Usually, “avian influenza virus” refers to influenza A viruses found chiefly in birds, but infections with these viruses can occur in humans. The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997. Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been observed to continue beyond one person.
“Human influenza virus” usually refers to those subtypes that spread widely among humans. There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. It is likely that some genetic parts of current human influenza A viruses came from birds originally. Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans.
During an outbreak of avian influenza among poultry, there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds.
Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which virus caused the infection.
Studies done in laboratories suggest that the prescription medicines approved in the United States for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to demonstrate the effectiveness of these medicines.
Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control. Since late June 2004, however, new outbreaks of influenza H5N1 among poultry were reported by several countries in Asia (Cambodia, China [Tibet], Indonesia, Kazakhstan, Malaysia, Mongolia, Russia [Siberia], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Influenza H5N1 infection also has been reported among poultry in Turkey Romania, and Ukraine. Outbreaks of influenza H5N1 have been reported among wild migratory birds in China, Croatia, Mongolia, and Romania.
Human cases of influenza A (H5N1) infection have been reported in Cambodia, China, Indonesia, Thailand, and Vietnam. For the most current information about avian influenza and cumulative case numbers, see the World Health Organization (WHO) website at http://www.who.int/csr/disease/avian_influenza/en/.
Human health risks during the H5N1 outbreak
H5N1 virus does not usually infect people, but more than 140 human cases have been reported by the World Health Organization since January 2004. Most of these cases have occurred as a result of people having direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 have occurred.
Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 has caused the largest number of detected cases of severe disease and death in humans. In the current outbreaks in Asia and Europe, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults. However, it is possible that the only cases currently being reported are those in the most severely ill people, and that the full range of illness caused by the H5N1 virus has not yet been defined.
So far, the spread of H5N1 virus from person to person has been rare and has not continued beyond one person. Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population. If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. For more information about influenza pandemics, see http://www.cdc.gov/flu/pandemic/ and http://www.pandemicflu.gov.
No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.
Treatment and vaccination for H5N1 virus in humans
The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness.
There currently is no commercially available vaccine to protect humans against H5N1 virus that is being seen in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way. For more information about H5N1 vaccine development process, visit the National Institutes of Health website.