1. Avian flu?

2. In humans?

3. Avian Influenza in Humans- 2004 Silvio Pitlik, MD Mar 17, 2004

4. Avian Influenza in Humans- 2004 Silvio Pitlik, MD Mar 17, 2004

5. Outline –How Mother Nature ignites emerging infections –Historical perspective –Clinician’s perspective –Back to the future

7. Influenza Virus Highly unstable Sloppy Promiscuous Completely unpredictable Dr Anarfi Asamoa-Baah, Assistant Director-General, WHO Communicable Diseases Opening address-Technical consultation on influenza pandemic preparedness- March 16, 2004

11. one small step for man, one giant leap for mankind Neil Armstrong

12. Crossing the species barrier — one small step to man, one giant leap to mankind NEJM, Mar 18, 2004

13. Emerging Infections-1990’s Andes virus Banna virus Bartonella henselae Bayou virus Cycloscopora cayetanensis Ehrlichia chaffeensis Ehrlichia equi Equine morbillivirus Fakeeh virus Guanarito virus Hendra virus Hepatitis G virus HIV-1 Picobirnavirus Influenza A H5N1 Influenza A H9N2 Juquitiba virus Laguna Negra virus Lechiguanas virus New York virus Nipah virus Oran virus Oscar virus Prion protein Rotavirus 116E P360 Sabia virus Sin nombre virus Current Opinion in ID, 2000

14. How Mother Nature Ignites an Emerging Infection

15. Wild-life reservoir

16. How Mother Nature Ignites an Emerging Infection Wild-life reservoir Man-made amplifier

17. How Mother Nature Ignites an Emerging Infection DiseaseWild-life reservoir Man-made amplifier AIDS Pan troglodites troglodites Promiscuous sex, drug adiction, blood products SARS Paguma larvataRestaurants, hotels, hospitals WNV Wild birdsGeese farms Monkeypox Wild rodents in AfricaPet retailers and stores

18. How Mother Nature Ignites an Emerging Infection DiseaseWild-life reservoir Man-made amplifier AIDS Pan troglodites troglodites Promiscuous sex, drug adiction, blood products SARS Paguma larvataRestaurants, hotels, hospitals WNV Wild birdsGeese farms Monkeypox Wild rodents in AfricaPet retailers and stores Influenza Wild aquatic birdsPoultry farms

19. Healthy aquatic birds

26. Bird-flu in humans YearPlaceStrain# of cases# of deathsCase fatality 1997 Hong Kong H5N11860.33 1999 Hong Kong H9N2200.00 2003 Hong Kong H5N1210.50 2003 Netherlands H7N78410.01 2003 Hong Kong H9N2100.00 2004 Viet Nam H5N122150.68 2004 Thailand H5N11170.64 Total 140300.21

27. Outbreak of influenza A (H5N1) in Hong Kong in 1997

28. Age and sex distribution of patients infected with influenza A (H5N1)

29. Geographical distribution of influenza A (H5N1) infected cases in Hong Kong

30. Diagnostic algorithm for the rapid diagnosis of H5N1 infection.

33. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of ARDS- Netherlands 2003 Overall - 89 patients 78 - conjunctivitis 5 - conjunctivitis and influenza-like illness 2 - influenza-like illness 4 - did not fit the case definitions Illnesses were generally mild, except for a fatal case of pneumonia in combination with ARDS

36. Sick chicken Sick chicken

37. Dead chicken Dead chicken

41. Radiological Findings

43. Prerequisites for the Start of a Pandemic First, a novel virus must emerge to which the general population will have no or little immunity Second, the new virus must be able to replicate in humans and cause disease Third, the new virus must be efficiently transmitted from one human to another. Efficient transmission is expressed as sustained chains of transmission causing community-wide outbreaks

46. Culling Quarantine Disinfection Vaccination against circulating flu H5N1 vaccine development Stockpiling of antivirals

48. Take-home messages The threat to public health will remain so long as the virus continues to cause disease in domestic poultry The outbreaks in poultry are likely to take a very long time to control Should the final prerequisite for a pandemic be met, the consequences for human health around the world could be devastating Regardless of how the present situation evolves, the world needs to be better prepared to respond to the next influenza pandemic

49. We have to prepare for the next pandemic!!!

52. Clinical features of mild and severe influenza A (H5N1)