1. Avian Influenza - The Human Health Perspective Dr. Andrew Larder FRCPC

2. Overview Influenza – the virus Why you should be concerned Why I am concerned What we can do

3. Basic Influenza Facts

4. Human vs. Avian Influenza HumanAvian Sub-typesH: 1,2,3 N: 1,2 H: 1 – 16 N: 1 - 9 HA TargetAlpha 2,6-sialic acid receptors Alpha 2,3-sialic acid receptors Duration of virus shedding 7 days2-4 weeks Infective materialRespiratory secretions Fecal, respiratory secretions Survival in environment 24-48 hours> 100 days

8. Overview Influenza – the virus Why you should be concerned Why I am concerned What we can do

9. Avian Influenza and Human Exposure Poultry exquisitely susceptible Large numbers of birds in confined spaces – Petri dish Vast numbers of virus particles Secretions, feathers, litter, walls, dust Genetically diverse

10. Avian Influenza and Human Disease TypePathSxCases (Deaths) Person to person H10N7LPILI2 (0)No H9N2LPILI8 (0)No H7N7LPConjunctivitis1 (0)No HPILI, conjunct. hepatitis, pneumonia 90 (1)Yes

11. Avian Influenza and Human Disease TypePathSxCases (Deaths) Person to person H7N3LPConjunctivitis1 (0)No HPConjunctivitis1 (0)No H7N2LPILI2 (0)No H5N1HPILI, gastro, pneumonia, encephalitis 204 (111)Yes

12. Other Evidence VirusGroup% Antibody Positive ExposureNo Exposure H7N4, H4N4 1993, LP PW6- H5N1 1997-8, HP PW100 HCW3.70.7 Contacts3.80 H7N7 2003, HP PW500 Contacts58.90 H7N3 2003, LP PW3.8-

13. Avian Influenza and Human Disease Infected poultry spread avian viruses to poultry workers Multiple viruses can cause human illness Both HP and LP can cause illness Serious illness and person to person spread can occur

14. Overview Influenza – the virus Why you should be concerned Why I am concerned What we can do

15. Pandemic Influenza Novel virus Frequent human exposure No previous immunity Ability to cause illness Ability to spread person to person efficiently an epidemic occurring world-wide, or over a very large area, affecting a large number of people

16. Influenza Pandemics Through the Ages Average Interval Between Pandemics = 39 years (95% CI 8-70 years) Spanish H1N1 Case fatality = 3.25% Deaths = 20-50 million Hong Kong H3N2 SAR = 65%, CAR = 21% Case fatality = 0.2% Deaths = 1- 3 million Asian H2N2 SAR = 67%, CAR = 31% Case fatality = 0.5% Deaths = 3-7 million

17. Phases of Pandemic Alert - WHO Interpandemic New virus in animals, no human cases Low risk of human cases 1 Higher risk of human cases 2 Pandemic Alert New virus causes human cases No or very limited human to human transmission 3 Evidence of increasing human to human transmission 4 Evidence of significant human to human transmission 5 Pandemic Efficient and sustained human to human transmission 6

18. Impact of Influenza SeasonalPandemic Infected5 million26 million Hospitalized50,00034-106,000 Deaths4,5009-51,000 Cost 1 billion 1.4-2.5 billion 10-24 billion

19. Pandemic – A Possible Scenario PW exposed to large numbers of genetically shifting AI PW and families become infected Human infections allow adaptation to human host increasing ability to infect, and spread person to person PW and families disseminate pandemic strain to population at large

20. Pandemic – It Will Happen When Where Which Virus Who How Severe Utility of antivirals Effectiveness of vaccine

21. What Can We Do? The canary in the coal mine approach OR Be aggressively proactive Stop poultry from getting infected Prevent PW from getting infected with AI PPE, antiviral medications, vaccination, surveillance