AVIAN INFLUENZA (Bird flu)

Be Alert, But not scared.

Dr.Y.Damodar Singh
Assistant Professor
Department of Pathology
College of Veterinary Sciences, CAU
Aizawl, Mizoram.
 INTRODUCTION

Avian influenza, commonly known as

“Bird flu”, is a highly contagious viral
disease of many species of birds including
migratory birds and cage birds. It can also
affects humans, horses, pigs, and some
other animals.
Migratory water fowls, especially wild ducks
act as reservoir hosts for this virus and
spread the disease to various parts of the
world.
 HISTORY

• AI is not a new disease, but having a history

of 129 years.
• First noticed in Italy in 1878, killing many
birds and named as Fowl plaque at that time.
• However, its viral etiology was identified in
1901 only.
• Its relationship with Human influenza-A virus
was established in 1955 only.
 Influenza Pandemics during the
20th Century
1918-19, "Spanish flu," [A (H1N1)], caused
the highest number of known influenza
deaths. More than 500,000 people died in
the United States , and up to 50 million
people may have died worldwide. Many
people died within the first few days after
infection, and others died of secondary
complications. Influenza A (H1N1) viruses
still circulate today after being introduced
again into the human population in 1977.
-1957-58, "Asian flu," [A (H2N2)], caused about
70,000 deaths in the United States . First
identified in China in late February 1957, the
Asian flu spread to the United States by June
1957.
-1968-69, " Hong Kong flu," [A (H3N2)], caused
about 34,000 deaths in the United States .
First detected in Hong Kong in early 1968.
Influenza A (H3N2) viruses still circulate today.
Both the 1957-58 and 1968-69 pandemics were
caused by viruses containing a combination of
genes from a human influenza virus and an avian
influenza virus. The 1918-19 pandemic virus
appears to have an avian origin.
 ETIOLOGY
• Influenza virus type-A of the family
Orthomyxoviridae.
• Having several strains/types, basing
on types of Haemagglutinin (H) and
Neuraminidase (N) antigens.
• Presently, 16 H & 9 N (i.e. 16x9=144)
strains are identified.
• But only few are pathogenic like H5
& H7 with N1,2,3,7 & 9
combinations.
• H5N1 is highly pathogenic to birds
and also affects humans.
 Environmental Survival of HPAI Virus
Influenza A virus remains viable at moderate temperatures for
long periods in the environment and can survive indefinitely in
frozen material. It can survive for 4 days in water at 22°C and for
over 30 days at 0°C.
Inactivation of the virus occurs under the following
conditions.
Temperatures of 56°C for 3 hours or 60°C or more for
30 minutes
Acidic pH conditions
Presence of oxidizing agents such as sodium dodecyl
sulfate, lipid solvents, and B-propiolactone
Exposure to disinfectants: formalin, iodine compounds
Hosts:
It is likely that all birds are susceptible to HPAI. Species that have been
shown to be susceptible either experimentally or naturally include:
•Chickens •Quail
•Turkeys •Pigeons
•Ducks •Ostriches and other ratites
•Partridges •Geese
•Pheasants •Guinea fowl
Migratory waterfowl, sea birds, shore birds, and imported pet birds have been
found to be carriers of highly-pathogenic influenza A viruses without clinical
signs.
Transmission:

Routes of infection include:

Oral
Conjunctival
Respiratory

Vertical transmission is not known to

occur
Common modes of infection include:
Direct transmission through secretions (feces,
respiratory secretions) of infected birds.
Broken contaminated eggs in incubators
infecting healthy chicks.
Movement of infected birds between flocks.
Fomites such as contaminated equipment, egg
flats, feed trucks, and clothing and shoes of
employees and service crews.
Contact with wild birds and waterfowl, which
appear to be natural reservoirs for the virus.
Fecal contamination of drinking water.
Garbage flies (suspected of transmitting
the virus during the 1983-1984 epidemic
in Pennsylvania).
Airborne transmission if birds are in
close proximity.
The disease is highly contagious. One
gram of contaminated manure can
contain enough HPAI virus to infect 1
million birds.
Occurrence of HPAI in Avian Populations:
Outbreaks of HPAI have occurred throughout the world:

An H5 strain affected Pennsylvania in 1983 and caused

severe clinical disease and high mortality rates in chickens,
turkeys, and guinea fowl.
A total of 17 million birds were culled.
Retail egg prices increased by 30 cents.
An H5N1 strain of AI was responsible for a significant
outbreak of influenza in domestic poultry in 1997 in Hong
Kong.

Prior to this outbreak, H5N1 was not known to infect

humans.
Six human deaths were attributed to this strain.
The virus was isolated from chickens, and mortality rates
were high.
A total of 1.5 million birds were culled in 3 days.
A monitoring system was instituted for birds in live markets.
 An H7N1 strain occurred in the Veneto region of
Italy in December 1999.

 A total of 30,000 turkeys died or were destroyed to

contain the outbreak.

 In 1998, H5N2 strains of the virus were responsible

for at least eight outbreaks on Italian farms.

 Other countries that have had outbreaks include

Australia (H7), England (H7), South Africa (H5),
Scotland (H5), Ireland (H5), Mexico (H5), and
Pakistan (H7).
 An outbreak of HPAI occurred in the Netherlands
in 2003. Over 28 million birds out of a total 100
million birds in the country were killed. There were
reports of over 80 human cases, and one
veterinarian died. The disease spread to Belgium
but was quite rapidly contained.

 An outbreak of H5N1 in poultry in Asia started in late 2003

and continues to spread at a rate that is historically
unprecedented.
So far, it involves South Korea, Vietnam, Japan, Thailand,
Cambodia, Indonesia, Laos, China and Bangladesh (plus low-
pathogenic avian influenza [H5N2] in Taiwan and an H7 HPAI
strain in Pakistan). Also reported from our country in the month
of Feb and March’06 in Maharashtra, July’07 in Manipur, and
recently in Bengal during Jan’08.

Of special concern is the fact that in Vietnam

and Thailand, the avian strain (H5N1) has now
been confirmed in several cases of fatal human
respiratory disease.
What is the risk to humans from bird flu?
The risk from bird flu is generally low to most
people. However, during an outbreak of bird flu
among poultry, there is a possible risk to people who
have contact with infected birds or surfaces that have
been contaminated with excretions from infected birds.
The current outbreak of avian influenza A (H5N1)
among poultry in Asia and Europe is an example of a
bird flu outbreak that has caused human infections
and deaths.
In rare instances, limited human-to-human
spread of H5N1 virus has occurred, and transmission
has not been observed to continue beyond one person.
Transmission of Influenza Viruses from Animals to
People:
Pigs can be infected with both human and avian
influenza viruses in addition to swine influenza viruses.
For example, if a pig were infected with a human
influenza virus and an avian influenza virus at the same
time, the genes of viruses could mix (reassort) and
produce a new virus that had most of the genes from the
human virus, but a hemagglutinin and/or
neuraminidase from the avian virus.
The resulting new virus would likely be able to infect
humans and spread from person to person, but it would
have surface proteins (hemagglutinin and/or
neuraminidase) not previously seen in influenza viruses
that infect humans.
 Reassortment
(in Human)
Migratory
water birds

Source: WHO/WPRO
 Reassortment
(in Pigs)
Migratory
water birds

Source: WHO/WPRO
VIRUS INFECTION CYCLE
 Cumulative No. of confirmed Human cases of HPAI
reported to WHO (as on 12 Feb. 2008)

Year Country Cases Deaths

2006-08 Azerbaijan 8 5

2005-08 Cambodia 7 7

2003-08 China 27 17

2006-08 Djibouti 1 0

2006-08 Egypt 43 19

2005-08 Indonesia 127 103

 Confirmed Human cases of HPAI (contd)
2006-08 Iraq 3 2
2007-08 Lao 2 2
2007-08 Myanmar 1 0
2007-08 Nigeria 1 1
2007-08 Pakistan 1 1
2004-08 Thailand 25 17
2006-08 Turkey 12 4
2003-08 Vietnam 102 48
Total 360 226
 Influenza Pandemics 20th Century
Pandemic are major epidemics characterised by the rapid spread of a
novel type of virus to all areas of the world resulting in an unusually high
number of illnesses and deaths in most age groups for approximately 2 to
3 years.

Next pandemic is "overdue"

1918: 1957: 1968:
“Spanish Flu” “Asian Flu” “Hong Kong Flu”

20 - 40 million deaths 1 - 4 million deaths 1 - 4 million deaths

A(H1N1) A(H2N2) A(H3N2)
Clinical Features of Highly Pathogenic A I in CHICKENS
Incubation Period: 3-7 days
Clinical signs:
1. Sudden death.
2. Severe depression with ruffled feathers.
3. Inappetence.
4. Drastic decline in egg production.
5. Edema of head and neck.
6. Swollen and cyanotic combs and wattles.
7. Petechial hemorrhages on internal membrane surfaces.
8. Excessive thirst.
 Clinical features (contd)
9. Watery diarrhea that begins as bright green
and progresses to white
10. Swollen and congested conjunctiva with
occasional hemorrhage
11. Diffuse hemorrhage between hocks and feet
12. Respiratory signs are dependent on tracheal
involvement
13. Nasal and ocular discharge
14. Mucus accumulation (varies)
15. Lack of energy
16. Coughing/sneezing
17. Incoordination
19. Nervous system signs such as paralysis
 HPAI – Clinical Disease
High morbidity and high mortality
 HPAI – Gross Lesions

Shank hemorrhage Subcutaneous edema

Virus infects endothelium throughout the body.
Complications:
Cessation of egg production, and eggs laid
immediately prior to infection often soft-shelled and
misshapen

Surviving birds are in poor condition and resume

laying only after a period of several weeks
Case fatality rate:
Can be as high as 100%
Death may occur prior to any symptoms or as late as a week
after symptoms, though it is frequently within 48 hrs.
LESIONS:
Lesions may be absent in young birds and birds that die from
peracute disease.
Severe congestion of musculature.
Severe congestion of conjunctivae, sometimes with petechiae.
Excessive mucous exudates in lumen of trachea.
Severe hemorrhagic tracheitis.
Petechiae on inside of sternum.
Petechiae on serosal and abdominal fat and in body cavity.
Clinical signs and lesions:
 HPAI – Gross Lesions

Wattle edema Tracheal hemorrhage

Gross lesions (contd)
 Gross Lesions (contd):

• Severe kidney congestion, sometimes with urate deposits in

tubules.
• Hemorrhages on mucosal surface of proventriculus,
especially at juncture with gizzard.
• Hemorrhages and erosions of gizzard lining.
• Hemorrhagic foci on lymphoid tissues in intestinal mucosa.
• Ovary may be hemorrhagic or degenerated with darkened
areas of necrosis.
• Peritoneal cavity often filled with yolk from ruptured ova.
Symptoms of Avian Influenza in Humans:

The reported symptoms of avian influenza in humans have

ranged from:

• Typical influenza-like symptoms

(e.g., fever, cough, sore throat and muscle aches)
• Eye infections, pneumonia, acute respiratory distress, viral
pneumonia, and other severe and life-threatening complications.
Differential diagnosis:
Velogenic (exotic) Newcastle disease
Infectious laryngotracheitis
Acute Escherichia coli infections
Acute fowl cholera (Pasteurella multocida)
Bacterial sinusitis (ducks)
Laboratory diagnosis:
Sample Collection:
Dead birds: Live birds:
Lungs Tracheal and cloacal swabs
or feces.
Air sacs
Clotted blood or serum from
Trachea
several birds.
Brain
Pancreas
Spleen
Serum(ducks and geese).
 WHAT ARE GENERAL INFECTION
CONTROL PRECAUTIONS
Standard precautions :

• Hand washing with antiseptic solution.

• Use personal protective equipments (Gloves,high
efficiency mask, long sleeved cuffed gown,
protected eyewear, cap).

• Environment cleaning and spill management.

• Appropriate management of waste.
Personal protective equipments
Additional precautions

Droplet precaution

Contact precaution

Airborne precaution
 CLEANING AND DISINFECTING SOLUTIONS
• Sodium hypochloride 1% : Material containing
blood, body
fluid
• Bleaching powder 7g/L : Toilet, basin

• Alcohol 70%, isopropanol,

Ethanol, spirit : Table top, soft tissue
 WHO ARE IN HIGH RISK GROUPS
• Farmers and farm workers.
• Veterinarians and health workers.
• Laboratory workers.
• Wild life workers.
• Food handlers.
 WHAT PRECAUTIONS THEY CAN ADOPT
FARM WORKERS / ANIMAL HANDLER
1. Immediate culling of infected and exposed birds

2. All workers involved in the culling, transport, or

disposal should use Protective clothing ( an
impermeable apron or surgical gowns with long
cuffed sleeves plus an impermeable apron)
Gloves capable of being disinfected or
disposed, Respirators, Goggles, Boots or
protective foot covers .
3. Environmental cleaning up in areas of culling.
4. Unvaccinated workers should be vaccinated

5. Workers should receive antiviral drug

( neuramindase inhibitor oseltamavir is the first
choice,otherwise amantadine or rimantadine).

6. Potentially exposed workers monitor health for 1

week after last exposure

 LABORATORY WORKERS
Highly pathogenic avian influenza A (H5N1) must be
worked with under Biosafety Level (BSL) 3+ laboratory
conditions.
Respiratory virus cultures should not be performed in
most clinical laboratories.
Influenza A (H5N1) suspected cases may be tested by
PCR assays using standard a BSL 2 work practices in
Class II biological safety cabinet.
In addition, commercial antigen detection testing can be
conducted under BSL 2 levels to test for influenza.
All employers processing biologic specimens suspected
of being infected with influenza A (H5N1) must ensure
protection.
VETERINARIANS / WLLDLIFE WORKERS

1. Standard Precautions:
Pay careful attention to hand hygiene
before and after handling animals/birds.
2. Contact Precautions :
Use gloves and gown for all patient contact.
3. Eye protection :
Wear when within 3 feet of the patient.
 MEDICAL WORKERS THAT TRANSPORT/TREAT

AVIAN FLU PATIENTS

1. Standard Precautions: Pay careful attention to
hand hygiene before and after all patient contact.

2. Contact Precautions : Use gloves and gown for

all patient contact.

3. Eye protection : Wear when within 3 feet of the

patient.

4. Airborne Precautions : Place the patient in an

airborne isolation room (i.e., monitored negative
air pressure) The CDC has recommended
recommended respirator.
GUIDANCE FOR FOOD HANDLERS

Roasted ducks and boiled

chickens at a market in Hanoi,
Vietnam, October, 2005.
(©AP/WWP)
 Good hygiene and cooking practices for
poultry products would lower potential risk to
insignificant levels.
 Eggs from infected poultry could also be
contaminated with the virus and therefore care
should be taken in handling shell eggs or raw
egg products.
 Chicken and eggs should be cooked to reach
an internal temperature of 180ºF
 Ensure cross-contamination and thorough
cooking of poultry products.
 Person working in the poultry meat
processing/ slaughter unit must wear PPE
 ANTIVIRAL DRUGS
• Neuraminidase Inhibitors (Zanamivir, Oseltamivir).
Children – 10mg twice daily.
Adult - 10mg twice daily / 75mg twice daily.
• Adamantane Derivatives (Amantadine,
Rimantadine).
Children - 5mg/kg/day up to 150 mg in
2 divided doses.
Adult - 100mg twice daily.
 VACCINE AGAINST H5N1 AI
* Sanofi pasteur (Swiftwater, PA) and
Chiron (Emeryville, CA) are developing
vaccines against H5N1 AI.

* Seasonal Influenza vaccination should be

continued.