1. Avian Influenza Prof Angus Nicoll, Influenza Co-ordinator Advisory Forum, 29-30 September 2005

2. Acknowledgements Department of Animal Health, Viet Nam European Commission – Human Health and Animal Health and Welfare Food and Agriculture Organization Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro –Padova, Italy Ministry of Health of Viet Nam National Centre for Veterinary Diagnosis National Institute of Hygiene & Epidemiology, Ha Noi Pasteur Institute, Ho Chi Minh City World Health Organization (Ha Noi)

3. Confusion about types of influenza

4. Highly Pathogenic Avian Influenza in Europe

5. Avian influenza outbreaks in domestic poultry worldwide Between 1959 and 1999 18 outbreaks - Approximate number of birds in all outbreaks : 23 million in 40 years Between 2000 and December 2004 15 outbreaks involving approximately 200 million birds in 4 years

6. Increasing impact – Why? Ecology of the virus? –Global warming? –Changes in migratory routes or periods? –Changes in species migrating? Development of Densely Populated Poultry Areas (DPPA) in which it is difficult to sustain high biosecurity Increase of free-range farming (EU)

7. DENSITY OF POULTRY IN DPPA in EU The Netherlands (Geldersvalley) 20-25 flocks /km 2 Maximum density 12 flocks /km 2 (Verona province)

8. Controlling Spread?

9. Method of Spread? Commercial movement of birds and bird products - Yes Movements of people – fomites - Yes Smuggling - Yes Migrating birds – possible, plausible but as yet unproven

10. Controlling Spread Prevention Biosecurity Controlling outbreaks Stamping out – Culling - Netherlands Stamping out + Vaccination Culling, Vaccinate and Monitor – Italy

11. Threat to human health from AI in poultry Including the A/H5N1 crisis

12. Pandemic Geographic spread: 1918-19 ? 01/19 ? 03/18 04/18 06/18 05/18 06/18 ? C.W. Potter, Textbook of Influenza, 1998

13. The Threat to Human Health from A/H5N1 WHO Statistics as of September 30th: Infection of humans – Yes 115 cases Human disease and death – Yes 59 deaths Transformation to become a human pandemic strain ???

14. Poultry density, HPAI outbreaks and human cases Source: FAO, Vietnam DAH

15. The risk is not just from A/H5N1 and not just from the East Q – where has the most person to person spread of an avian influenza been reported?

16. The risk is not just from A/H5N1 and not just from the East Q – where has the most person to person spread of an avian influenza been reported? A – the Netherlands 2003 (A/H7N7) Koopmans M, Wilbrink B, Conyn M et al. Lancet 2004; 363: 587-593

17. ECDC actions - Avian Influenza Formed a partnership with European Commission and European Food Safety Authority Identified risk groups for acquiring AI infection in Europe Produced educational material on AI Addressed meetings including first ever EU CVO and CMO Meeting Developing Guidance for protecting human health around outbreaks

18. Specific Questions to the Advisory Forum Members are asked to comment upon Are there key areas of work that ECDC is missing and are not being covered by other European Bodies? ECDC has recently produced some guidance on Influenza on its web-site which includes a section on Avian Influenza could the members comment on it? Are there national plans for an Avian Influenza Outbreak in their countries (apart from Ireland, Netherlands, UK) ? Do these plans include a section on protection of those working with infected birds? If so ECDC would especially like to see these Time for discussion at the Forum meeting will be so short members are asked to also send comments to influenza@ecdc.eu.int influenza@ecdc.eu.int