1. Pandemic Influenza & H5N1 Bird Flu Virus DxNA LLC 3879 South River Road St. George, Utah 84790 United States of America

2. A worldwide disease outbreak due to a new influenza A virusA worldwide disease outbreak due to a new influenza A virus 1)that causes serious illness and death 2)for which people have little or no immunity Pandemic influenzas occur again and again over time.Pandemic influenzas occur again and again over time. The question is when and how severe will the new pandemic be?The question is when and how severe will the new pandemic be? Early detection is essential to their control.Early detection is essential to their control. Pandemic Influenza

3. Historical Perspective 412 BC A pandemic influenza documented for the first time by Hippocrates A pandemic influenza documented for the first time by Hippocrates1580 The first well-documented influenza pandemic The first well-documented influenza pandemic Began in Asia and spread to Europe and ultimately North America via Africa Began in Asia and spread to Europe and ultimately North America via Africa Over 90 percent of humans infected, mortality very high Over 90 percent of humans infected, mortality very high Since 1580 31 worldwide influenza outbreaks recorded 31 worldwide influenza outbreaks recorded

4. 1729 Started in Russia and spread across the world over a three-year period Started in Russia and spread across the world over a three-year period1781 Spread from China to Russia, Europe, Africa and North America Spread from China to Russia, Europe, Africa and North America Infected 2/3 of the population of Rome and 3/4 of people in the British Isles Infected 2/3 of the population of Rome and 3/4 of people in the British Isles High morbidity, more than 1 million dead High morbidity, more than 1 million dead1889 Russian flu spread from Central Asia to to the rest of the world Russian flu spread from Central Asia to to the rest of the world More than 1 million dead More than 1 million dead

5. The 1781 and 1889 influenza pandemics rank with the 1918 Spanish Flu as among the most widespread and dramatic disease outbreaks in history.

6. The influenza pandemic of 1918-19 killed more humans than any other disease in a period of similar duration in the history of the world. Alfred W. Crosby Americas Forgotten Pandemic: The Influenza of 1918 1918 Spanish Flu

7. An avian influenza (as is the H5N1 virus) that mutated to easily infect humansAn avian influenza (as is the H5N1 virus) that mutated to easily infect humans Spread around the world in 6 monthsSpread around the world in 6 months 25-30% of the world population infected25-30% of the world population infected 50-100 million people dead50-100 million people dead 675 thousand dead in the United States675 thousand dead in the United States Most victims healthy adults, 18-40 years oldMost victims healthy adults, 18-40 years old Unlike typical influenzas which mostly affect infants (0-2 years old) and elderly as well as immunocompromised peopleUnlike typical influenzas which mostly affect infants (0-2 years old) and elderly as well as immunocompromised people

8. 20th Century Influenza Pandemics 1957 Asian Flu Strain H2N2 3 million dead 1968 Hong Kong Flu Strain H3N2 1 million dead 1918 Spanish Flu Strain H1N1 50-100 million dead Photos: US National Archives, BBC

9. Global Influenza Pandemics Recur Multiple times per century (Multiple times per century (every 10-42 years) Driven by recurrent virus mutation and genetic reassortmentDriven by recurrent virus mutation and genetic reassortment Past 3 pandemics -- avian influenzas became dangerous human diseasesPast 3 pandemics -- avian influenzas became dangerous human diseases H5N1 avian influenza – considered the No.1 candidate for causing the next pandemicH5N1 avian influenza – considered the No.1 candidate for causing the next pandemic

10. H5N1 Avian Influenza Photo: WHO

11. Highly pathogenic type now in Asia, Europe, the Middle East and AfricaHighly pathogenic type now in Asia, Europe, the Middle East and Africa An aggressive, deadly animal disease – quickly kills entire chicken flocksAn aggressive, deadly animal disease – quickly kills entire chicken flocks Can infect humans – so far, mostly people living and working with poultryCan infect humans – so far, mostly people living and working with poultry Almost 400 known human infections – more than 240 deathsAlmost 400 known human infections – more than 240 deaths H5N1 mortality rate possibly more than 20 times that for the 1918 Spanish Flu (1-2%)H5N1 mortality rate possibly more than 20 times that for the 1918 Spanish Flu (1-2%) Not yet easily spread from person to personNot yet easily spread from person to person H5N1 Avian Influenza -- Basics

12. H5N1 – Pandemic Attributes 1.A novel (mutated and/or reassorted) virus to which humans have no immunity YES for H5N1 2.The virus causes severe illness and death YES for H5N1 3.The virus can spread rapidly/easily from person to person NOT YET for H5N1 H5N1 Avian so far has 2 out of 3 … An influenza virus must have 3 attributes to become a pandemic disease:

13. The H5N1 virus can spread from birds to mammals and in some circumstances to humans.The H5N1 virus can spread from birds to mammals and in some circumstances to humans. 391 known human cases, 247 deaths391 known human cases, 247 deaths WHO, 16 December 2008 Photos: UNICEF, China Daily

14. Human Influenza Virus Virus How can H5N1 flu develop the ability to easily spread from human to human? Avian Influenza Virus Genetic Mutation Genetic Mutation AND/OR Reassortment, the genetic mixing in animals (or human) infected with both human and avian influenza viruses Photo: China Daily (as in 1957 and 1968) (as in 1918)

15. With horrible consequences 6 billion people today6 billion people today But only 1.5 billion in 1918But only 1.5 billion in 1918 Rapid disease spread globally via jet travelRapid disease spread globally via jet travel Still no specific antiviral treatmentsStill no specific antiviral treatments Still no vaccine (seasonal vaccine NOT protective)Still no vaccine (seasonal vaccine NOT protective) The H5N1 virus may trigger a pandemic like the 1918 Spanish Flu

16. WHO Situational Assessment May 2006 Risk of an H5N1-caused pandemic is great.Risk of an H5N1-caused pandemic is great. The risk will persist for a long time.The risk will persist for a long time. When the threat will become reality cannot be predicted.When the threat will become reality cannot be predicted. Reduction of H5N1 morbidity and mortality will be impeded by inadequate medical supplies.Reduction of H5N1 morbidity and mortality will be impeded by inadequate medical supplies. Early detection and isolation the best protectionEarly detection and isolation the best protection So far, appropriate early warning technology weak and largely unavailable.So far, appropriate early warning technology weak and largely unavailable.

17. The best way to prevent international spread of diseases is to detect public health threats early and implement effective response actions when the problem is small. Pan American Health Organization Pandemic Influenza -- Current Situation and Global Preparedness