Avian Influenza

Dr.Kedar Karki

Avian Influenza Update

• What is Avian Influenza? • Why all the concern?

What is Avian Influenza?
• The H5N1 AI virus mainly affects domestic & wild birds • The AI is closely related to influenza viruses that cause annual “flu” outbreaks among humans • AI viruses can mutate rapidly and able to evade human immune systems • H5N1 AI virus very lethal to animals and humans • - 55 countries affected, 38 new in 2006 • - estimated 250 million birds killed • - 256 lab-confirmed human cases with 151 deaths in 8 countries – a 59% mortality rate

How is “AI” spread?
• Animal & human populations in close proximity • - farm animals and pets in/under/next to houses • - live animal markets (many species from many countries) • Poor agricultural practices • - inadequate infection control on farms • - poultry excrement used in agriculture (e.g. fed to pigs) • Poor food hygiene • - food preparation practices • - consumption of raw/undercooked meat • Frequent travel/trade involving humans and birds • - movement of people/animals among farms • - legal and illegal animal trade • - wild bird migration

1850 1850

Is a Pandemic Possible? 1847
42 yrs 1889 1918 1957 1968 1900 29 yrs
30 – 40 years cycle

1900 1950

39 yrs 11 yrs

1950
2000

2000

No Pandemic for > 35 years

Is it Deja Vu all over again? - the 1918 Pandemic
• Three epidemic waves in close succession • March 1918 Sept 1918 Feb 1919 • Estimated 50 -100 million deaths worldwide • In the U.S.:
• 10 million hospitalizations • 2 million deaths

Could AI cause a pandemic?
Requirements for pandemic flu: 2. Novel virus 3. Ability to replicate in humans and cause serious damage 4. Ability to pass efficiently from person to person H5N1: Yes

Yes Not yet

“Take Home” Lessons
• To-date: H5N1 principally an “animal” based infection • Spreading of virus appears linked to a combination of bird migration and unregulated “bird trade” • Effective response needs to be “cross-sectoral” spanning animal and human health • Early detection and rapid response to outbreaks essential for containment • An “informed public” and adoption of “low risk behaviors” key • National “leadership” is critical

International Response
• WHO and FAO providing international leadership • International Partnership for Avian and Pandemic Influenza key forum for international coordination • $1.9 billion pledged by international community at Beijing Conference –January 2006 • U.S. pledged $334 million – and is actively working in more than 50 countries to contain AI

International AI Strategy
• Goal: to contain and mitigate the effect of an outbreak of pandemic influenza • Objectives: • prevent and contain H5N1 outbreaks in animals • prevent animal-to-human infections • prepare for a human influenza pandemic

International AI Strategy
Key principles:
• • • • • an emergency response use existing platforms for efficiency support WHO, FAO/OIE as the lead technical organizations work closely across the USG cross-sector approach bridging animal and human health

Tactical Pillars:
• • • • •

Preparedness and Planning Early Warning Surveillance & Diagnosis Rapid Response and Containment Behavior Change Communications & Advocacy Stockpiling and Deployment of key commodities

Poverty and Newly Emergent Diseases
The Chicken that Lays the Golden Egg

Overview
• Household Economics and Avian Influenza. • The Role of Poverty in the Emergence and Spread of AI. • Time for a “Transformational” Strategy.

General Observations
• In the past year more than 4,000 AI outbreaks have been reported to OIE • Of these an estimated 75% have been in backyard or “mom and pop” farms

General Observations
• These small-farm holders largely fall into the lowest economic quintiles • Poultry farming make significant contributions to household:
– Nutrition – Livelihood

The Viet Nam Example*
In Viet Nam • ½ of all households – rural and urban – keep chickens • In rural areas 7/10 households – a total of 8 million HHs – own chickens • Average flock size is 16 birds (4 hens, 1 cock, and 11 growers and chicks) • Only 1% of flocks consist of more than 100 birds

The Viet Nam Example*
• Chickens mostly kept as backyard flocks by small holders with an average per capita income of less than 100 USD per year • A flock of 12 hens yield a month income of around 18 USD through the sale of eggs and birds • Based on an initial investment of 2.50 USD for the purchase of a hen and 0.65 USD required for a “fraction of a cock” the annual return to “capital investment” is nearly 700%

The Viet Nam Example*
• In addition to the “high rate of return” – a further advantage of investing in poultry is the flexibility to partition the investment in small amounts of cash throughout the year, as needed.

The Viet Nam Example*
• At a national level cessation of “back yard” farming in Viet Nam would lead to a lost income of 550 million USD per year, or 5% of agricultural GDP, or 2.5 million “full time” jobs at minimum rural wage rate

The Viet Nam Example*
• Applying these findings, even partially, across the 4,000 outbreaks recorded over the past year highlights the important contribution poultry rearing makes to the economic and nutritional welfare to the poor.

A Double Edged Sword
• Conclusion 1: for reasons of equity and economic efficiency it is important that the socio-economic impact of AI control measures be assessed before applied.

A Double Edged Sword
• Conclusion 2: this very attractiveness has contributed to an explosion of poultry rearing to meet the nutritional and economic needs of ever expanding populations

The China Syndrome
• In China in 1969 there were an estimated 50 million poultry being raised to feed a population of 750 million. • By 1999 this number increased to 15 billion • In China, and elsewhere in the region this dramatic increase in poultry farming was largely on non-industrial farms following traditional animal husbandry practices

The China Syndrome
• The mixture of high populations of people and poultry has created a cauldron of “emergent infectious diseases” where there is the increased probability that poultry viruses – such as H5N1 – can infect humans and give rise to new pandemic strains.

Newly Identified Infectious Diseases and Pathogens
SARS

• 2004 • 2003 H5N1 (AI A virus) • 1999 • 1997 Kaposi’s sarcoma virus • 1996 Hantavirus • 1995 • 1994 Guanarito virus • 1993 • 1992 Hepatitis E; human herpesvirus 6 • 1991 • 1989 • 1988 • 1983

• Avian Influenza • Nipah Virus • New variant CreutzfeltJacob disease • Savia virus; Hendra virus • Vibrio choerae 0139 • Hepatitis C • HIV

Recomendation
• While much of the public and political discussion on how best to respond to AI has been dominated by “emergency responses” – which are of critical importance – these strategies will not be sufficient to lower risk of a pandemic influenza from actually happening

Recomendation
• Short of reversing the size of the global population – we need to ask how the animal husbandry and market place practices that are driving the emergence of new human pathogens can themselves be transformed

Recomendation
• By focusing exclusively on building a protective shield of vaccines, drugs and early warnings – we will do little to limit the emergence of newer and deadlier pathogens

Recomendation
• What we do risk is making influenza and other zoonotic diseases a scourge inflicted on those who can’t afford or access vaccines and drugs ….. In short, diseases of the poor – as has happened with malaria, tuberculosis and HIV/AIDS

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