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Andradng, Frances E
Balaoi

What is Bird Flu?

! Avian Influenza (Latin: avis meaning
bird)
! influenza A virus found in poultry and
other birds
! H5N1 and H7N9

Influenza Virus
! Spherically, longitudinally shaped enveloped
particles
! Eight-fold segmented, single-stranded RNA
genome of negative polarity
! Orthomyxoviridae family
! types A, B or C

Influenza A virus
! responsible for the deadly
influenza pandemics.
! infects both people and
animals
! main antigenic determinants
the haemagglutinin (H) and
Neuraminidase (N)
! cluster into sixteen H (H1 H16) and nine N (N1 - N9)
subtypes

Influenza A (H5N1) Virus

! Haemagglutinin

! Lipid envelope

! Neuraminidase

! NS-1

! M1 matrix proteins

! Viral Polymerase
genes

! M2 ion channel

Epidemiology
! 1878: First identified case in Italy (Bird to Bird)
! 1997: Hong Kong (Bird to Human)
18 humans infected, 6 died
H5N1 virus linked to outbreak in live bird market
and farm areas

! 2004: Thailand (Human to Human)

! June 2006: Indonesia (Human to Human)

! March 2009: 409 cases from 15 countries

! December 2009: Affected a total of 447 people
and claimed 263 lives.
! 2011: 62 human H5N1 cases and 34 deaths were
reported from five countriesBangladesh,
Cambodia, China, Egypt, and Indonesia.

As of November 2008, the WHO had summarized

the epidemiology of H5N1.
! 90% of cases were aged ! Case fatality proportion:
<40 years
~60%
! Median age: 18 years
(range 3 months - 75
years)

! Highest case fatality:

10-19 years (76%)

! Median time to
hospitalization: 4 days

! Median time to death: 9

days (range 2 31 days)

! Lowest case fatality: 50

! Male to female ratio = 1:1 years (40%)

How is H5N1 transmitted?

! Bird to Bird
! Bird to humans
! Human to human

Bird to bird transmission

! Droppings, nasal secretion
and saliva
! Contaminated surfaces
(secretions or excretions)
contaminated materials (water
or feed)
! Direct contact with infected
waterfowl or other infected
pou

Avian-to-human (Direct)
! Exposure to infected poultry
! Preparing or consuming uncooked or
undercooked H5N1 virus-infected poultry or
poultry products (rare cases)

Avian-to-human (Indirect)
! Inhalation of aerosolized H5N1 virus-infected
debris (e.g. while visiting a live poultry market)
! Contact with surfaces that are contaminated
with poultry feces containing H5N1 virus
! Contact with other infected animals (cat, dog)
that ate dead poultry

Human to human
transmission
! Extremely rare
! Patient with confirmed or strongly suspected H5N1
infected patient
! Occurred during close, prolonged, unprotected
contact with a human H5N1 case
! Mostly in family members
! Transmission in hospital setting reported

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! Incubation period: 2-7 days

! Viral shedding period for H5N1 virus
! May be 2 weeks or longer
! Longer for children and immune compromised

! At least 2 weeks after illness onset: Contagious

Signs and symptoms (birds)

! May go undetected
! Usually causes mild symptoms:
! Ruffled feather
! Drop in egg production

Signs and Symptoms (HUMANS)

! COMMON:

! LESS COMMON:

! Fever 38C

! Sore throat

! Cough

! Headache

! Shortness of breath
! Difficulty breathing

! Muscle aches
! Runny nose
! Diarrhea
! Sputum (may be bloody)

Possible Complications
! Most common:
pneumonia

! Multi-organ failure
! Neurologic
symptoms

! Acute respiratory
distress syndrome
! Abnormal Lab
(ARDS)
values
! Gastrointestinal
! Eye infection
disease

Diagnostic and Laboratory Testing

! Clinical specimen collection
! Diagnostic tests
! Imaging

Clinical specimen collection

! Best specimens for detecting ! Upper respiratory tract has
H5N1 viruses:
worse virus yield than lower
respiratory tract
! Lower respiratory tract
! Endotracheal aspirates from
intubated, mechanically ventilated
patients
!

Bronchioalveolar lavage (BAL)

! H5N1 virus has also been

detected in:
! Rectal swab and stool
! Blood serum and plasma
! Cerebrospinal fluid (CSF) speciment

! Throat swabs better for detecting H5N1

virus than other upper respiratory tract
locations
! Use for ambulatory patients

! Respiratory
! Collect
endotracheal
specimens from
mechanically
ventilated patients
! Collect throat and
nasal swabs from
all patients
! Collect specimens
as soon as
possible

! Blood
! May be useful for
detection of H5N1
antibodies three
weeks after infection
! Not useful for rapid
detection of H5N1
virus infection for
rapid detection of
outbreaks
! Need to collect
paired sample: acute
and convalescent

! Rectal swab or
diarrheal stool
! Not primary
specimen for
confirming H5N1
virus infection

DIAGNOSIS
Tests on respiratory samples
(most common):

Tests on serum:

! RT-PCR

! Measurement of specific
antibodies

! Virus isolation

! PCR-based techniques

! Immunofluorescence
! Rapid antigen detection (Flu A or B)

Other tools:
! Chest X-Ray

Reverse-transcription
polymerase chain reaction
! highly sensitive and specific for the
presence of H5N1.
! detects the presence of H5N1 viral RNA
or the genetic material of the virus

Imaging
! Radiologic Imaging (X-ray)

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ANTIVIRALS
! Neuraminadase inhibitors:
! Oseltamivir (DOC)
! Zanamivir

! Other possible treatments

! Amantadine

! Rimantadine

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! Practice hygiene and safety measures

! Regularly clean bird feeders and birdbaths.
! Conventional Cooking ( temperatures at or above 70) will
inactivate the H5N1 virus
! Avoid Home slaughtering and preparation of sick or dead
poultry for food
! Eggs from areas with H5N1 outbreaks in poultry should
not be consumed raw or partially-cooked (runny yolk)

! Rapid culling of all infected or exposed birds, proper disposal of carcasses,

the quarantining and rigorous disinfection of farms and the
! Restrictions on the movement of live poultry, both within and between
countries.
! Antiviral prophylaxis
! Eating a healthy diet
! Travelers should avoid visiting live poultry markets
! Avoid people with suspected or confirmed A(H5N1) virus

VACCINATION
! Three H5N1 vaccines for humans have been
licensed as of June 2008:
! Sanofi Pasteur's vaccine
! GlaxoSmithKline's vaccine Prepandrix
! CSL Limited's vaccine Panvax

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THREAT ASSESMENT
! Illegal trade of live poultry and exotic bird
! Migratory bird habitat
! Human cases from other countries

Prevention Programs
! Minimum Biosecurity Measures
! Surveillance and Prevention Programs in Airports and
Seaports
! Surveillance of Poultry in Critical Areas in the Philippines
! Enforcement of the Wildlife Act
! Preventive Measures in Humans
! Ban on Importation of all Live Domestic and Wild Poultry and
All Poultry Products from AI-Affected Countries

GOOD PRACTICES
! 1. Avian Influenza Protection Program (AIPP)
! 2. Localization of AIPP to local government units
called Project Blue
! 3. Strong participation of government agencies in
the National Avian Influenza Task Force under the
network of the NDCC
! 4. Launch of intensified information campaign
dubbed Bird Flu Watch

! 5. Planning workshops
! 6. Reporting of cases through Short Messaging System
! 7. Strong private sector participation in all levels of the
program
! 8. Business Continuity Planning
! 9.Training of field personnel, epidemiologists, hospitals,
Speakers Bureau

Proposals
! Short-term training exchange program on various
competencies of member countries
! Establishment of a web-based information
exchange
! Research funds of priority avian flu-related issues
! Funding support for the establishment of HAIS and
SILIPPs and enhancement of ILISS with SMS
integration

! Advocate equity of pandemic vaccine

distribution
! Involvement of more sectors for preparedness
! National and international financial support for
development activities for pandemic vaccine
and for stockpiling of antiviral agents

Protective and Mitigating responses

against H5N1 virus (In California)
! Governmental preparedness
! Cross Sector planning and collaboration
! Expansion of Surveillance, Case tracking and
Epidemiology
! Laboratory Diagnostic Enhancement
! Improved information systems

REFERENCES
!

Applebaum, B & Haider, M. (n.d.) Disease Management of

Avian Influenza H5N1 in Bangladesh -- A Focus on
Maintaining Healthy Live Birds. Retrieved from
http://cdn.intechopen.com/pdfs-wm/24991.pdf

Mandal, Ananya. (2014) Bird Flu (H5N1) Epidemiology.

Accessed on October 3, 2014 from http://www.newsmedical.net/health/Bird-Flu-(H5N1)-Epidemiology.aspx

Madal, Ananya. (2014). What is Bird Flu (H5N1)? Accessed on

October 3, 2014 from http://www.news-medical.net/
health/What-is-Bird-Flu-(H5N1).aspx

Center for Disease Control and Prevention. (2006) Information about Avian Influenza (Bird
Flu) and Avian Influenza A (H5N1) Virus. Retrieved from
http://www.cdc.gov/flu/avian/gen-info/pdf/avianflufacts.pdf

The Center for Food Security and Public Health. (2005) Avian Influenza (Highly Pathogenic)
[Powerpoint Slides] Retrieved from http://www.powershow.com/view/3bf2a5-NDVkZ/
Avian_Influenza_Highly_Pathogenic_powerpoint_ppt_presentation

U.S Geological Survey. (2005) The Avian Influenza H5N1 Threat. Retrieved from
http://www.nwhc.usgs.gov/publications/fact_sheets/pdfs/ai/HPAI082005.pdf

World Health Organization. (2005) WHO Handbook for Journalists: Influenza Pandemic.
Retrieved from http://www.who.int/csr/don/Handbook_influenza_pandemic_dec05.pdf

Hseni. (n.d.) Bird flu (Avian Influenza). Retrieved from

http://www.hseni.gov.uk/avian_flu_english.pdf

Kayman. H. (n.d.) Information about Avian Influenza [Powerpoint slides.] Retrieved from
sjgov.org/ems/files/AvianInfluenza.ppt