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Slide 1-

High Pathogenicity Avian Influenza Fowl Plague Grippe Aviaire
Slide 2-

Overview Organism History Epidemiology Transmission Disease in Humans Disease in Animals Prevention and Control Center for Food Security and Public Health, Iowa State University, 2013
Slide 3-

The Organism
Slide 4-

The Organism Avian influenza virus Genus Influenzavirus A Family Orthomyxoviridae Classified into subtypes based on surface antigens Hemagglutinin 16 types Neuraminidase 9 types Center for Food Security and Public Health, Iowa State University, 2013
Slide 5-

Pathogenicity High pathogenicity avian influenza (HPAI) Causes severe disease in poultry Contains subtypes H5 or H7 Low pathogenicity avian influenza (LPAI) Causes mild disease in poultry Contains other H subtypes Includes non-HPAI H5 and H7 LPAI H5 or H7 subtypes can mutate into HPAI Center for Food Security and Public Health, Iowa State University, 2013
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Reservoirs Waterfowl and shorebirds Natural reservoirs for influenza A Carry all known H and N antigens Usually in the LPAI form Predominant subtypes change periodically Center for Food Security and Public Health, Iowa State University, 2013
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Influenza Virus Emergence Avian influenza virus closely related to other influenza A viruses Humans, horses, pigs, dogs Influenza viruses found in each species usually infect only that species Center for Food Security and Public Health, Iowa State University, 2013
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Antigenic Drift and Shift Antigenic drift Small changes in influenza virus due to point mutations accumulated during virus replication Antigenic shift Abrupt change in virus subtype Genetic reassortment between subtypes Direct transfer of virus Re-emergence of virus Center for Food Security and Public Health, Iowa State University, 2013
Slide 9-

Influenza Epidemics Epidemic requirements New influenza subtype must emerge in species with little to no immunity Virus must produce disease in that species Sustainable transmission must occur in new species Note: Asian lineage H5N1 has NOT met third criteria in humans Center for Food Security and Public Health, Iowa State University, 2013
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History
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History: U.S. HPAI eliminated from domesticated poultry in the U.S. Viruses could be reintroduced Imported poultry Wild birds Pet birds Center for Food Security and Public Health, Iowa State University, 2013
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History: Asia H5N1 avian influenza virus re-emerged in 2003-4 Poultry About 470 human cases 60% case fatality rate Concern remains that a severe human pandemic could occur Center for Food Security and Public Health, Iowa State University, 2013
Slide 13-

Center for Food Security and Public Health, Iowa State University, 2013 Economic Impact 1997: Hong Kong outbreak (H5N1) $13 million for depopulation and indemnities 1.4 million birds 2001: Hong Kong outbreak (H5N1) 1.2 million birds $3.8 million 2003: European outbreak (H7N7) 30 million birds destroyed $314 million
Slide 14-

Epidemiology
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Geographic Distribution LPAI occurs worldwide Wild birds and poultry HPAI Eradicated from domestic poultry in most developed nations Epidemic ongoing in parts of Asia, the Pacific, Middle East, and Africa Center for Food Security and Public Health, Iowa State University, 2013
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Morbidity and Mortality: Humans Asian lineage H5N1 High case fatality rate (60%) Prevalence unknown H7, H9 viruses Human disease reported Resembles human influenza Antibodies to other H subtypes found in people who work with birds Center for Food Security and Public Health, Iowa State University, 2013
Slide 17-

Morbidity and Mortality: Birds Domesticated poultry HPAI morbidity and mortality rates approach 90-100% Wild birds Typically asymptomatic Some H5N1 viruses may cause death Center for Food Security and Public Health, Iowa State University, 2013
Slide 18-

Morbidity and Mortality: Mammals Antibodies found Cats and dogs Fatalities reported Captive tigers, leopards Ferrets, mice Severity of disease varies Pikas (China), pigs No evidence of significant illness Center for Food Security and Public Health, Iowa State University, 2013
Slide 19-

Transmission
Slide 20-

Transmission in Wild Birds Influenza virus shed in feces, saliva, nasal secretions Fecal-oral Predominant mode of transmission Other possible modes Fecal-cloacal Respiratory Center for Food Security and Public Health, Iowa State University, 2013
Slide 21-

Influenza Virus Survival Virus persistence in aquatic environments Weeks to months Preferred conditions Low temperatures, brackish water May survive indefinitely when frozen Virus persistence in feces Weeks to months Center for Food Security and Public Health, Iowa State University, 2013
Slide 22-

Transmission in Poultry In an infected flock, virus can spread in multiple ways Fecal-oral Aerosol Fomites Mechanical vectors Virus introduction Migratory birds Infected poultry, pet birds Center for Food Security and Public Health, Iowa State University, 2013
Slide 23-

Transmission in Mammals Close contact with dead or sick birds Indirect exposure Contact with feces Swimming in contaminated water Ingestion Other routes (experimental) Respiratory, oral, intraocular Transplacental Center for Food Security and Public Health, Iowa State University, 2013
Slide 24-

Center for Food Security and Public Health, Iowa State University, 2013 Human Transmission Previously considered non-pathogenic for humans 1997, Hong Kong 18 humans infected, 6 died H5N1 virus linked to outbreak in live bird market and area farms 2003, the Netherlands 83 confirmed cases in humans, 1 death H7N7 strain Swine are proposed “mixing vessel”
Slide 25-

Disease in Animals
Slide 26-

Species Affected Wild birds Waterfowl Shorebirds Cage birds Passerines Poultry Mammals Pigs, horses, mink, cats, dogs, ferrets, stone martens, palm civets, and others Center for Food Security and Public Health, Iowa State University, 2013
Slide 27-

Incubation in Animals Poultry: 1-7 days Disease control purposes 21-day incubation period used Accounts for virus transmission dynamics Incubation period for mammals thought to be short Center for Food Security and Public Health, Iowa State University, 2013
Slide 28-

Disease in Poultry Highly virulent Clinical signs Sudden death Systemic disease Drop in egg production Neurological signs Depression, anorexia, ruffled feathers Combs swollen, cyanotic Conjunctivitis and respiratory signs Most birds in an affected flock die Center for Food Security and Public Health, Iowa State University, 2013
Slide 29-

Disease in Wild Birds Disease often subclinical Some strains cause illness Clinical signs Minimal in ducks and geese Swans may be found dead Experimental infections Gulls, passerines, psittacines Center for Food Security and Public Health, Iowa State University, 2013
Slide 30-

H5N1 Infections in Mammals Felids Fatal infections Respiratory distress Other mammals Dogs Palm civets Neurological, respiratory, CNS, and liver disease Center for Food Security and Public Health, Iowa State University, 2013
Slide 31-

H5N1 Infections in Mammals Susceptible to infection with all subtypes of avian influenza A Called a “mixing vessel” Receptors for both avian and human influenza virus Mild or asymptomatic Mild respiratory disease Few other clinical signs Center for Food Security and Public Health, Iowa State University, 2013
Slide 32-

H5N1 Infections in Mammals Experimental infections Foxes: asymptomatic Ferrets: mild to severe disease Mice: clinical signs variable Cattle: asymptomatic Center for Food Security and Public Health, Iowa State University, 2013
Slide 33-

Other Avian Influenza Infections in Mammals Ferrets Experimentally infected with both LPAI and HPAI avian influenza viruses Seals, pilot whales Outbreaks of pneumonia Co-infections may have increased severity of clinical signs Center for Food Security and Public Health, Iowa State University, 2013
Slide 34-

Communicability: Birds Avian influenza viruses readily transmitted between birds Viral shedding Begins 1-2 days after infection Last up to 36 days (chickens) or 72 days (turkeys) Birds-to-mammal transmission uncommon Center for Food Security and Public Health, Iowa State University, 2013
Slide 35-

Communicability: Mammals Cats Shed virus by third day post-infection (experimental) Naturally infected cats excrete virus sporadically and for < 2 weeks Shed from intestinal and respiratory tracts Horizontal transmission not observed in cats or other mammals Center for Food Security and Public Health, Iowa State University, 2013
Slide 36-

Post Mortem Lesions: Birds Chickens and turkeys Swollen sinuses Edematous comb and wattle Subcutaneous edema Petechiae Trachea Lungs Proventriculus Center for Food Security and Public Health, Iowa State University, 2013
Slide 37-

Center for Food Security and Public Health, Iowa State University, 2013 Sampling Before collecting or sending any samples, the proper authorities should be contacted Samples should only be sent under secure conditions and to authorized laboratories to prevent the spread of the disease HPAI samples may be zoonotic
Slide 38-

Post Mortem Lesions: Mammals Multiple lesions possible Pulmonary edema, pneumonia Conjunctivitis Cerebral, renal and splenic congestion Multifocal hepatic necrosis Hemorrhages in the intestinal serosa, lymph nodes, perirenal tissue and/or diaphragm Severe hemorrhagic pancreatitis Center for Food Security and Public Health, Iowa State University, 2013
Slide 39-

Center for Food Security and Public Health, Iowa State University, 2013 Differential Diagnosis Virulent Newcastle disease Avian pneumovirus Infectious laryngotracheitis Infectious bronchitis Chlamydia Mycoplasma Acute bacterial diseases Fowl cholera, E. coli infection
Slide 40-

Diagnosis Clinically indistinguishable from virulent Newcastle Disease (END) Virus isolation Oropharyngeal, tracheal, and/or cloacal swabs Feces Organ samples Virology and serology necessary for definitive diagnosis AGID, ELISA, RT-PCR Center for Food Security and Public Health, Iowa State University, 2013
Slide 41-

Diagnosis, cont’d RT-PCR Clinical samples Can distinguish different subtypes Viral antigen detection Best for flocks, not individuals Serology AGID Hemagglutination inhibition ELISA Center for Food Security and Public Health, Iowa State University, 2013
Slide 42-

Treatment No specific treatment HPAI in poultry usually not treated Outbreaks controlled by eradication Antivirals (amantadine) effective in reducing mortality Not approved in food animals Results in resistant viruses Center for Food Security and Public Health, Iowa State University, 2013
Slide 43-

Disease in Humans
Slide 44-

Incubation in Humans Difficult to determine 2-17 days possible Symptoms usually appear in 2-5 days Center for Food Security and Public Health, Iowa State University, 2013 World Health Organization Recommends using incubation period of seven days for field investigations and monitoring patient contact
Slide 45-

H5N1 Infections in Humans Cause severe disease High fever Upper respiratory symptoms Mucosal bleeding Gastrointestinal symptoms Patients may deteriorate rapidly Late symptoms Organ failure, DIC Center for Food Security and Public Health, Iowa State University, 2013
Slide 46-

Communicability Rare cases of person-to-person transmission NO cases of sustained transmission Fecal shedding and transplacental transmission may occur Center for Food Security and Public Health, Iowa State University, 2013
Slide 47-

Diagnosis in Humans RT-PCR Primary test to identify H5N1 Antigen detection Virus isolation WHO Reference Laboratories Serology Microneutralization Center for Food Security and Public Health, Iowa State University, 2013
Slide 48-

Treatment in Humans Antiviral drugs Amantadine Rimantadine Zanamivir Oseltamivir Currently circulating H5N1 viruses may be resistant to amantadine, rimantadine Center for Food Security and Public Health, Iowa State University, 2013
Slide 49-

Prevention and Control
Slide 50-

Recommended Actions Notification of Authorities Federal: Area Veterinarian in Charge (AVIC) www.aphis.usda.gov/wcm/connect/aphis_content_library/sa_our_focus/sa_animal_health/sa_contact_us/sa_area_offices/ct_area_offices_avic State veterinarian www.aphis.usda.gov/traceability/downloads/StateAnimalHealthOfficials.pdf Quarantine Center for Food Security and Public Health, Iowa State University, 2013
Slide 51-

Prevention in Humans People working with infected poultry Follow good hygiene practices Wear protective clothing (gloves, masks) Consider antiviral prophylaxis Be vaccinated against human influenza Do not have contact with sick birds if experiencing symptoms of influenza Center for Food Security and Public Health, Iowa State University, 2013
Slide 52-

Prevention in Humans If Asian lineage H5N1 is present, avoid contact with: Domesticated poultry Poultry farms Live bird markets Prepare food properly Practice good hygiene Cook chicken and eggs thoroughly Center for Food Security and Public Health, Iowa State University, 2013
Slide 53-

Prevention in Humans Avoid wild bird contact Report dead or diseased wildlife Do not handle or eat sick game Wear gloves while handling or cleaning wild birds Wash hands Cook game thoroughly Center for Food Security and Public Health, Iowa State University, 2013
Slide 54-

Pandemic Precautions If a pandemic occurs: Avoid crowded conditions and close contact with other people Consider wearing respirators or other protective equipment Follow good hygiene measures Practice social distancing Quarantine ill individuals Vaccination Center for Food Security and Public Health, Iowa State University, 2013
Slide 55-

Prevention in Birds All-in/all-out flock management Prevent contact with wild birds or their water sources Do not allow birds to return to the farm from live markets Practice strict hygiene and biosecurity measures Center for Food Security and Public Health, Iowa State University, 2013
Slide 56-

Prevention in Birds Depopulation of infected flocks Proper carcass disposal Burying Composting Rendering Strict biosecurity measures Quarantine Cleaning and disinfection Center for Food Security and Public Health, Iowa State University, 2013
Slide 57-

Prevention in Birds Vaccination Not used routinely in the U.S. Usually autogenous Requires approval of State veterinarian and USDA (H5, H7 vaccines) May not prevent virus shedding Differentiating Infected from Vaccinated Animals (DIVA) strategy used to recognize field viruses in vaccinated flocks Center for Food Security and Public Health, Iowa State University, 2013
Slide 58-

Center for Food Security and Public Health, Iowa State University, 2013 USDA Prevention Activities Import restrictions No live birds or bird products from infected countries Increasing surveillance of wild birds National H5 and H7 control program Training for disease recognition Improving diagnostics for rapid detection
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Center for Food Security and Public Health, Iowa State University, 2013 Protection of Humans from H5N1 Avian Influenza Surveillance Avoid contact with poultry U.S. Border AI Response Plan Food Safety Inspection Service q q q q q Biosecurity q Proper food handling and preparation q
Slide 60-

Prevention in Mammals Do not feed infected poultry or birds to mammals Prevent contact with potentially infected flocks and wild birds Keep cats and dogs indoors during avian influenza outbreaks Center for Food Security and Public Health, Iowa State University, 2013
Slide 61-

Disinfection Sodium hypochlorite 70% ethanol Oxidizing agents Quaternary ammonium compounds Aldehydes Phenols Acids Povidone-iodine Center for Food Security and Public Health, Iowa State University, 2013
Slide 62-

Disinfection, cont’d Heat 56°C (133°F) for a minimum of 60 minutes Ionizing radiation Low pH (pH 2) Center for Food Security and Public Health, Iowa State University, 2013
Slide 63-

Additional Resources Center for Food Security and Public Health www.cfsph.iastate.edu Centers for Disease Control and Prevention (CDC) www.cdc.gov World Organization for Animal Health (OIE) www.oie.int World Health Organization (WHO) www.who.int Center for Food Security and Public Health, Iowa State University, 2013
Slide 64-

Acknowledgments Development of this presentation was made possible through grants provided to the Center for Food Security and Public Health at Iowa State University, College of Veterinary Medicine from the Centers for Disease Control and Prevention, the U.S. Department of Agriculture, the Iowa Homeland Security and Emergency Management Division, and the Multi-State Partnership for Security in Agriculture. Authors: Kerry Leedom Larson, DVM, MPH, PhD, DACVPM; Danelle Bickett-Weddle, DVM, MPH, DACVPM; Anna Rovid Spickler, DVM, PhD Reviewers: Glenda Dvorak, DVM, MPH, DACVPM Center for Food Security and Public Health, Iowa State University, 2013