To: The Harding Township Committee From: Roberta Shields

September 8, 2005

Re: Avian Influenza, Canada Geese and Human Health This memo acknowledges the current world-wide concern over avian influenza, and tries to put that concern and Harding Townships resident Canada geese in some kind of context. Sections I, II and III below are my laymans interpretation of the information on the websites of the US Centers for Disease Control and Prevention (CDC), the US Animal and Plant Health Inspection Service (APHIS), the World Organization for Animal Health (OIE) and the World Health Organization (WHO). Excerpts from these websites, on which my interpretations are based, are shown in Section IV. The websites addresses and titles of documents from which the excerpts were drawn are listed in Exhibit A. I. THE CONCERN Avian influenza has been around for thousands of years. It is common and usually a non-event in wild birds, but can be devastating to poultry flocks, which are subject to a particularly lethal form of the disease. The economic consequences to poultry farms can be significant, as flocks are destroyed to prevent spread of the disease. Such outbreaks in poultry have been relatively rare. Past significant North American outbreaks mentioned include Pennsylvania in 1983-84, Mexico from 1992 to 1995, and British Columbia and Texas in 2004. Until relatively recently, avian influenza was not believed to be infectious to humans. That changed in 1997, when concurrent with a deadly epidemic in poultry, humans in Hong Kong were infected with high rates of mortality. Since then, a highly pathogenic form of the virus has been circulating in parts of Asia and has become established in poultry populations there, despite efforts to eradicate it. This summer, both Russia and Kazakhstan reported outbreaks in poultry. Deaths in migratory birds infected with the virus have also been reported. Human cases of infection have been rare. So far, the virus does not transmit easily from poultry to humans. Most, but not all, human cases have been linked to direct exposure to dead or diseased poultry, notably during slaughtering, defeathering and food preparation. If bird to human transmission were to occur more often, there would then be a greater likelihood that the virus in humans would change to a form that would be easily transmitted from person to person, which could produce a world-wide human epidemic.

II. NATIONAL AND INTERNATIONAL AGENCY PLANS AND RECOMMENDATIONS New facts emerge daily on the suspect virus, where it has been found, how it is changing and how those changes are likely to affect human health. World health authorities are monitoring the situation closely, recommending current action and planning for adverse outcomes. Clearly, international, Federal and State health authorities will be advising communities on appropriate actions to protect human health, as the need arises. Their websites already contain information about responses to threats of avian flu, known or anticipated. Nothing in any of those websites contains anything to indicate that there is, or ever has been, any recommendation that mass culling action be taken against wild birds. Culling of poultry flocks has been done not only to stop the spread of the virus and resulting economic disaster for poultry farmers, but also to reduce the pool of virus to which humans are exposed, and thereby reduce the risk of a human epidemic. The following excerpt from an August 30, 2005 press release by the OIE (World Organization for Animal Health) is of particular interest: Following the recent concerns caused by outbreaks of avian influenza in Russia and Kazakhstan and by the risk of spread of the virus to other regions of the world by migratory birds, the OIE recalls the necessity of intensifying the fight against the disease at its sourcethat is in the avian production plants in contaminated countries. This represents the best way of limiting the spread of the disease, of eradicating it and of reducing the risk of the virus concerned acquiring the attributes necessary for a human pandemic to occur. (OIE page 1) The World Health Organization (WHO) issued the following endorsement in August 2005: WHO fully agrees with FAO (Food & Agriculture Organization of the UN) and OIE that control of avian influenza infection in wild bird populations is not feasible and should not be attempted. Wild waterfowl have been know for some time to be the natural reservoir of all influenza A viruses. Migratory birds can carry these viruses, in their low pathogenic form, over long distances, but do not usually develop signs of illness and only rarely die of the disease. The instances in which highly pathogenic avian influenza viruses have been detected in migratory birds are likewise rare, and the role of these birds in the spread of highly pathogenic avian influenza remains poorly understood. (WHO UPDATE page 1) Once the virus jumps easily from person to person, (not yet the case), chances are that the virus that would then be the problem for humans would look different from the virus now being tracked. People, not birds, would be the likely primary carrier of the virus to humans. All available resources likely would be busy vaccinating the human population and treating the sick, not culling wild bird populations, which might not even carry the form of the virus then dangerous to humans.

III. CONCLUSIONS RE HARDINGS RESIDENT CANADA GEESE I could find no reports that the suspect highly pathogenic avian influenza virus is present in New Jerseys resident Canada geese or any wild birds in North America. Even if it were, it would be unlikely that these birds would be the source of human infection. So far, the virus is hard for humans to catch and it is believed that direct contact with uncooked infected poultry is the likely source. Based on the current facts, slaughtering Hardings resident (non-migratory) Canada Geese would do nothing to protect Hardings citizens from the highly pathogenic form of bird flu now of concern in Asia, Russia and Kazakhstan. * * *

The excerpts from which my interpretations were drawn begin on the next page.

Roberta Shields

CC: Wildlife Management Committee and Staff

IV. DETAILED EXCERPTS The excerpts that follow have been taken verbatim from the sources indicated. A list of those sources appears in Appendix A. The headings have been added to assist the reader. What is Avian Flu? Avian influenza, or bird flu is a contagious disease of animals caused by type A strains of influenza virus that normally infects only birds and, less commonly, pigs.(WHO/FAQ page 1) The disease, first recognized as a serious disease of chickens in Italy in 1878, occurs worldwide. (WHO page 1) Which Birds Get Avian Flu? All birds are thought to be susceptible to infection with avian influenza, though some species are more resistant to infection than others.(WHO page 1) Influenza A viruses of all subtypes have been detected in more than 90 species of apparently healthy wild birds. (WHO AI page 36) Wild waterfowl, most notably ducks, are by far the most frequent carriers of the largest variety of viruses. It is now recognized that wild waterfowl, gulls and shorebirds are the natural reservoir of all influenza A viruses. These birds have carried the viruses without developing symptoms-presumably for thousands of years- in a relationship thought to represent optimal adaptation of a virus to its host. This huge, stable, benign and perpetual reservoir of viruses is also highly mobile. Wild waterfowl can carry viruses over great distances and excrete large quantities in their feces, yet remain perfectly healthy. (WHO AI page 36 ) or develop mild and short lived illnesses. (WHO/FAQ 2) Other bird species, including domestic poultry, are less fortunate. In poultry, avian influenza causes two distinctly different forms of disease-one common and mild, the other rare and highly lethal. (WHO AI page 36) Domestic poultry, including chickens and turkeys, are particularly susceptible to epidemics of rapidly fatal influenza.(WHO page 1) Outbreaks of avian influenza, especially the highly pathogenic form, can be devastating for the poultry industry and for farmers. For example, an outbreak of highly pathogenic avian influenza in the USA in 1983-84, largely confined to the state of Pennsylvania, resulting in the destruction of more than 17 million birds at a cost of nearly $65 million US dollars (WHO/FAQ page 2) In the absence of prompt control measures backed by good surveillance, epidemics can last for years. For example an epidemic of H5N2 avian influenza which began in Mexico in 1992, started with low pathogenicity, evolved to the highly fatal form and was not controlled until 1995. (WHO page 1) Recent research has shown that viruses of low pathogenicity can, after circulation for sometimes short periods in a poultry population, mutate into highly pathogenic viruses. (WHO page 1)

Emergence of H5N1 and human infection Fifteen subtypes of influenza virus are known to infect birds, thus providing an extensive reservoir of influenza viruses potentially circulating in bird populations. To date, all outbreaks of the highly pathogenic form have been caused by Influenza A viruses of subtypes H5 and H7 (WHO page 1) Avian influenza virus do not normally infect species other than birds and pigs. The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, of whom 6 died.(WHO page 2) At some unknown time prior to 1997, the H5N1 strain of avian influenza virus began circulating in the poultry populations of parts of Asia, quietly establishing itself. Like other avian viruses of the H5 and H7 subtypes, H5N1 initially caused only mild disease with symptoms, such as ruffled feathers and reduced egg production, that escaped detection. After months of circulation in chickens, the virus mutated to a highly pathogenic form that could kill chickens within 48 hours, with a mortality approaching 100%. The virus first erupted in its highly pathogenic form in 1997, but did not appear again. The 1997 outbreak in Hong Kong SAR ended after all of Hong Kong SARs 1.5 million poultry were slaughtered within 3 days (29-31 December) (WHO AI page 8) Then towards the end of 2003, H5N1 suddenly became highly and widely visible. (WHO AI page 7) Since mid-December 2003, a growing number of Asian countries have reported outbreaks of highly pathogenic avian influenza in chickens and ducks. Infections in several species of wild birds and in pigs have also been reported. (WHO/FAQ page 2) Of all viruses in the vast avian influenza pool, H5N1 is of particular concern for human health for two reasons. First, H5N1, though strictly an avian pathogen, has a documented ability to pass directly from birds to humans. Second, once in humans, H5N1 causes severe disease with very high mortality. These two features combine to make H5N1 of concern for a third and greater reason: its potential to ignite an especially severe pandemic. (WHO AI page 7) The detection so far of only a few human cases suggests that the virus may not be easily transmitted from birds to humans at present. However, the situation could change quickly, as the H5N1 strain has been show to mutate rapidly and has a documented propensity to exchange genes with influenza viruses from other species. (WHO/FAQ page 4) Attempts to Keep H5N1 from Spreading to Humans Opportunities for both the occurrence of further human cases and the emergence of a pandemic virus are intrinsically linked to the presence of the H5N1 virus in poultry. (WHO AI page 35) The spread of infection in birds increases the opportunities for direct infection of humans. If more humans become infected over time, the likelihood also increases that humans, if concurrently infected with human and avian influenza strains, could serve as the mixing vessel for the emergence of a novel subtype with sufficient

human genes to be easily transmitted from person to person. Such an event would mark the start of an influenza pandemic (WHO page 3) The first priority, and the major line of defense, is to reduce opportunities for human exposure to the largest reservoir of the virus: infected poultry. This is achieved through the rapid detection of poultry outbreaks and the emergency introduction of control measures, including the destruction of all infected or exposed poultry stock, and the proper disposal of carcasses. (WHO/FAQ page 4) In addition to the rapid destruction of infected animals, another opportunity to prevent human cases is through the protection of workers involved in culling operations. Workers involved in the culling of poultry flocks must be protected by proper clothing and equipment , against infection. These workers should also receive antiviral drugs as a prophylactic measure.(WHO page 3) The large outbreak in captive tigers, which occurred in October (2004) in Thailand, is thought to be linked to the feeding of contaminated whole chicken carcasses. If this hypothesis is substantiated, it will provide further evidence that contact with raw poultry carcasses can be a significant source of exposure to the virus (WHO AI page 39). Restrictions on the movement of live poultry, both within and between countries, are another important control measure. (WHO/FAQ page 2) Current Developments Epidemiologists can point to at least three conditions, not anticipated at the start of 2004, that have subsequently become apparent. First the virus is now firmly entrenched in the poultry populations of parts of Asia. Although most affected countries launched massive campaigns to eliminate the disease in poultry, only a few have been entirely successful. Even in those few instances, the risk that the disease may be reintroduced remains ever-present. (WHO AI pg 41) Second, no high-risk group, defined by occupation, exists for the targeting of protective measures. Surprisingly, no cases of H5N1 infection have occurred in poultry workers, cullers, veterinarians, or laboratory workers. Nor have cases been detected in health care workers, despite several instances of close unprotected contact with severely ill patients. Instead, the most vulnerable population has turned out to be rural subsistence farmers and their families, and these people constitute the true risk group. (WHO AI pg 41) Third, the health threat for this group has been compounded by the increasing tendency of human cases to occur in the absence of reported outbreaks in poultry. (WHO AI page 42) Though far fewer outbreaks, affecting far fewer birds, were detected in the second half of the year (2004) the threat to humans has actually become more dangerous. The virus is no longer causing large and highly conspicuous outbreaks on commercial farms. Nor have poultry workers or cullers turned out to be an important risk group that could be targeted for protection. Instead, the virus has become stealthier: human cases are now occurring with no discernible exposure to H5N1 through contact with diseased or dead birds. This change has created a community-wide risk

for large numbers of rural households and-for unknown reasons- most especially for children and young adults. (WHO AI page 35) True to the nature of influenza A viruses, H5N1 is certain to continue to mutate, though the direction these changes will take cannot be predicted. If the virus continues to expand its avian and mammalian host range, the prospects for eliminating the disease in animals will be come even grimmer. (WHO AI page 35) The present high lethality of H5N1 would probably not be retained in an H5N1-like pandemic virus, as an avian influenza virus is expected to lose pathogenicity when it acquires the improved transmissibility needed to ignite a pandemic. More certain-and more relevant to preparedness planning-is the fact that no virus of the H5 subtype has probably ever circulated among humans, and certainly not within the lifetime of todays world population. Population vulnerability to an H5N1-like pandemic virus would be universal (WHO AI page 19) The recent detection of highly pathogenic H5N1 in dead migratory birds-long considered asymptomatic carriersmay suggest another ominous change, but more research is needed before any conclusion can be reached.(W HO AI page 38) The history of all know human infections with avian influenza viruses readily reveals the significance of the 2004 outbreaks for human health. They have caused the largest number of severe cases of avian influenza in humans on record. Compared with the Hong Kong SAR outbreak in 1997, the 2004 H5N1 outbreak in humans has also been far more deadly. (WHO AI page 38) Experience in south-east Asia indicates that human cases of infection are rare, and that the virus does not transmit easily from poultry to humans. To date, the majority of human cases have occurred in rural areas. Most, but not all, human cases have been linked to direct exposure to dead or diseased poultry, notably during slaughtering, defeathering, and food preparation. No cases have been confirmed in poultry workers or cullers. No cases have been linked to the consumption of properly cooked poultry meat or eggs. (WHO UPDATE page 2) The Work Ahead With the virus now endemic in poultry and expanding its avian and mammalian host range, the objective of averting a pandemic by eliminating further opportunities for human exposure no longer appears feasible. A second opportunity to avert a pandemic could arise if the virus gradually improves its transmissibility among humans through adaptive mutation. Clusters of cases would be indicative, and sensitive surveillance might detect them. It is not know, however, whether rapid intervention with a pandemic vaccine,-if available in time- and antiviral drugs- if quantities are sufficient-could successfully interrupt transmission, as this has never been attempted.(WHO AI page 19) H5N1 causes a disease with many disturbing and unusual features that are poorly understood. The virus has crossed the species barrier twice in the past, in 1997 and 2003, but the cases in 2004 and early 2005 constitute the largest and most deadly human outbreak on record. With the virus now endemic in parts of Asia, sporadic cases and occasional family clusters need to be anticipated. The continuing risk of more cases, combined with the extremely high fatality, make it imperative to understand the disease and find an effective treatment. In response to this need,

WHO is creating a network of clinical experts to expedite the exchange of experience with cases, compare results with different treatments and coordinate urgent research on pathogenicity The expected outcomes are better diagnostic tools, more specific treatments and improved infection control. (WHO AI page56) The Response to a Pandemic Based on historical patterns, influenza pandemics can be expected to occur, on average, three to four times each century when new virus subtypes emerge and are readily transmitted from person to person. However, the occurrence of influenza pandemics is unpredictable. In the 20th century, the great influenza pandemic of 1918-1919, which caused an estimated 40 to 50 million deaths world wide, was followed by pandemics in 1957-1958 and 1968-69. All measures that could mitigate the impact of a pandemic and can be set up in advance are best undertaken now rather than during the chaos of a pandemic. Such measures fall into three main categories: advance warning that the virus is improving its transmissibility, early intervention to halt further adaptation or forestall international spread, and urgent development of a pandemic vaccine. (WHO AI page 44) At the earliest stage of a pandemic, when large numbers of cases are not yet occurring, measures such as simple hand-washing, the use of masks, and voluntary quarantine of patients might help reduce transmission. If only a few countries are affected, travel-related measures, such as exit screening for persons departing from affected areas, might delay international spread somewhat, but cannot stop it. Once efficient and sustained human to human transmission has been established, the containment of pandemic influenza is not considered feasible. (WHO AI page 53) When large numbers of cases begin to occur, priorities need to change, moving away from efforts to reduce transmission and international spread and towards the reduction of morbidity and mortality. Several measures, such as contact tracing and follow up will no longer be either effective or feasible because of the sheer number of cases. Other measures, such as entry screening at airports and borders, will have no impact (WHO AI pg 53) The banning of public gatherings and the closing of schools were considered the only measures that could dampen the spread of pandemic influenza. Even the most extreme option-severe restrictions on international travel and trade-was thought to bring nothing more than a few weeks of freedom from a disease whose international spread might be forestalled, but never stopped. (WHO AI page 29) For health authorities, the biggest challenge presented by the 1957 pandemic was the provision of adequate medical and hospital services. Measures to delay the speed of spread and thus flatten the peak occurrence of cases were considered justified if they allowed the maintenance of medical and other essential services. (WHO AI page 29) In Lessons from the 3 pandemics of the last century: (No mention of the need to kill wild birds.) It does say: Over the centuries, most pandemics have originated in parts of Asia where dense populations of humans live in close proximity to ducks and pigs. In this part of the world, surveillance for both animal influenza and clusters of unusual respiratory disease in humans performs an important early warning function. (WHO AI page 32)

Some public health interventions may have delayed the international spread of past pandemics, but could not stop them. Quarantine and travel restrictions have shown little effect. As spread within countries has been associated with close contact and crowding, the temporary banning of public gatherings and closure of schools are potentially effective measures. The speed with which pandemic influenza peaks and then disappears means that such measures would probably not need to be imposed for long. (WHO AI page 32)

A list of documents from which these excerpts were taken is on the next page.

Exhibit A Primary Sources: Centers for Disease control: www.cdc.gov Animal and Plant Health Inspection Service: www.aphis.usda.gov World Health Organization: www.who.int World Organization for Animal Health: www.oie.int
(OIE was created in 1924 by 28 countries, it predates the UN)

Excerpts taken from these documents: WHO: Avian influenza, Avian influenza (bird flu) and the significance of its transmission to humans, January 15, 2004. (This 4 page document is found at: www.who.int/mediacentre/factsheets/avian_influenza/en/print.html ) WHO/FAQ: Avian influenza frequently asked questions, January 29, 2004. (This 6 page document is found at: www.who.int/csr/disease/avian_influenza/avian_faqs/en/print.html ) WHO AI: Avian influenza: assessing the pandemic threat, January, 2005, WHO/CDS 2005.29 (This 62 page document is found at: www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en , then click on English[pdf.2.61 Mb]) WHO UPDATE: Geographical spread of H5N1 avian influenza in birds-update 28 situation assessment and implications for human health, August 18, 2005. (This 3 page document is found at www.who.int/csr/don/2005_08_18/en/print.html ) OIE: Evolution of the animal health situation with regard to avian influenza August 2005 (this 1 page document is found at www.oie.int/eng/press/en_050829.htm * * *

Printed documents are available on request

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