Avian Influenza

Bird Flu
Taxonomic name: Avian influenza virus (Horimoto and Kawaoka, 2001).
Common names: bird flu (English), fowl plague (English), HPAI (English),
LPAI (English)
Life form: micro-organism
Avian Influenza (AI) or "Bird Flu" is a highly contagious viral infection which
can affect all species of birds and can manifest itself in different ways
depending mainly on the pathogenicity of the virus involved and on the
species affected.
Influenza infections in birds are divided in two groups on the basis of their
ability to cause disease:
 Highly Pathogenic Avian Influenza (HPAI): causing serious
disease with high mortality (up to 100%).
 Low Pathogenic Avian Influenza (LPAI): causing generally a
mild disease.
Even if in certain cases LPAI virus may mutate in HPAI virus and cause a
serious disease, the two infections are well distinct and should not be
confused.
While domestic birds are generally highly susceptible to the clinical
manifestation of the disease, wild birds, and especially waterfowls, are usually
naturally resistant and often don’t show any clinical sign. Therefore, wild
waterfowl represent a natural reservoir for these viruses and can be
responsible for the primary introduction of infection into domestic poultry.
Causative Agent
The virus causing avian influenza is an Influenzavirus A virus of the family
Orthomyxoviridae. Several virus subtypes exist, which are divided on the
bases of the antigenic relationships in the virus glycoproteins haemagglutinin
(H) and neuraminidase (N). At present 15 H subtypes have been recognised
(H1-H15) and nine neuraminidase subtypes (N1-N9).
Description
AI viruses have a similar structure and consist of two glycoprotein spikes,
hemagglutinin (HA) and neuraminidase (NA) and a limited number of M2
proteins that project from the viral surface (NIAID, 2004). The virus is highly
pleomorphic, roughly spherical, and filamentous (NIAID, 2004). Inside the
virion are eight single-stranded RNA segments waiting to be copied by a host
(NIAID, 2004).
Similar species
Acute Fowl Cholera, Chronic Respiratory Disease (CRD), Infectious
laryngotracheitis (ILT), Newcastle Disease (ND)
Influenza A viruses infecting poultry can also be divided on the basis of their
pathogenicity (ability to cause disease).

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The very virulent viruses cause highly pathogenic avian influenza (HPAI) with
high mortality in poultry up to 100%. In the whole world there have been only
21 reported primary isolates of such viruses from domestic poultry since 1959.
A severe epidemic occurred in Italy in 1999/2000 causing 413 outbreaks with
16 Million birds affected.
Other AI viruses cause a much milder disease (low pathogenic avian
influenza, LPAI). Clinical signs are much less evident or even absent and
mortality is much lower.
Sometimes secondary infections or environmental conditions may cause
exacerbation of LPAI infections leading to more serious disease.
Evidence suggests that certain avian influenza virus subtypes of low
pathogenicity may, after circulation for some time in a poultry population,
mutate into highly pathogenic virus strains.
To date only viruses of H5 and H7 subtype have been shown to cause HPAI
in susceptible species, but not all H5 and H7 viruses are highly pathogenic.
Nutrition
AI, like most viruses, has no metabolism. Therefore, the virus does not require
any nutrition (Horimoto and Kawaoka, 2001).
Reproduction
AI needs a host to reproduce. Once inside, the virus uses the hosts DNA to
replicate itself (Horimoto and Kawaoka, 2001).
Lifecycle stages
The virus replicates itself once inside a host cell. AI uses the genetic material
of the host for energy and for the replication process. After viral components
are made inside the host cell, the components are released (Sander, 2004).
Clinical Symptoms
The main symptoms of HPAI in poultry are depression, loss of appetite,
cessation of egg laying, nervous signs, swelling and blue discoloration of
combs and wattles due to disturbance of blood circulation, coughing, sneezing
and diarrhoea. Sudden death can occur without any previous signs. The
mortality rate may reach up to 100% depending on the species, their age, the
virus type involved and environmental factors like concurrent bacterial
infections.
Clinical signs of LPAI consist primarily of mild respiratory disease, depression
and drop in egg production in laying birds.
The incubation period for these viruses range from as short as a few hours to
3 days in individual birds and up to 14 days to spread throughout a flock.
Transmission & Spread
All the available evidence suggests that the most common primary
introduction of AI viruses into an area is by wild birds, usually waterfowl, but
gulls and shorebirds have also been implicated. Direct contact between wild
bird and poultry is not always necessary for introduction of virus into poultry
farms, as infected waterfowl may spread AI viruses by infective faeces into an
area and these may then be introduced to poultry farms by a variety of

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mechanisms that may transfer the virus mechanically. If contaminated with
influenza viruses, surface water used as drinking water may also be a source
of infection. Poultry kept in free range or poultry which have access to surface
water are at specific risk.
AI is transmitted within a farm by direct contact of infected animals with
healthy animals, or indirect contacts with contaminated equipment or farm
staff. Spread of AI viruses from farm to farm is mainly by mechanical transfer
of infective faeces, in which virus may be present at high concentrations and
may survive for considerable periods. Shared water or food may also become
contaminated.
However, man is a very important cause of secondary spread of AI for
domestic poultry. Caretakers, farmers, workers, trucks and drivers visiting
farms, moving birds or delivering food have caused the spread of AI virus both
on to and within farms.
Vaccination
The existence of a large number of virus subtypes together with the known
variation of different strains within a subtype pose serious problems when
selecting strains to produce influenza vaccines and to use vaccination as a
routine tool for disease prevention.
In accordance with Directive 92/40/EEC vaccination against AI may be used
to supplement the control measures carried out after confirmation of disease.
Birds vaccinated against the HA subtype corresponding to the one which is
circulating are protected against the worst effects of AI.
Threats to Human Health
The transmission of Influenza virus strains of avian origin from birds to
humans has been demonstrated on a few occasions.
The exact mode of transmission of these viruses to humans is not known.
Exposure to poultry through direct contact is however considered a risk factor,
whilst human-to-human transmission of strains of avian origin appears to be
an extremely rare event.
Links between humans and animal Influenza
In recent years three different subtypes of avian influenza viruses (H5N1,
H7N7 and H9N2) have been detected in humans causing disease of varying
degrees of seriousness.
In 1996, a H7N7 virus of avian origin was isolated in England from the eye of
a woman with conjunctivitis who kept ducks.
 In March 1999 two independent isolates of influenza virus
subtype H9N2 were obtained from two young girls who recovered from
flu-like-illness in Hong Kong. Subsequently five isolations of H9N2
virus from humans on mainland China were reported in August the
same year.
 The first most serious cases occurred in 1997 in Hong Kong. A
H5N1 subtype was isolated in 18 people, 6 of whom died. In February
2003, also in Hong Kong a strain of the same subtype was isolated

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 from two members of a family one of whom died. Other members of
the same family were also affected.
 During the 2003 HPAI H7N7 outbreaks in the Netherlands 260
people were involved in some aspects of the outbreak and presenting
with conjunctivitis and/or influenza-like illness. In 82 cases there was
confirmation of infection with H7 virus. There was also evidence of
three cases of human transmission within families. Six people tested
positive for H3N2 (typical human influenza strain), but none were also
positive for H7N7. Following these cases all staff involved in the
outbreaks received prophylactic treatment with antiviral drugs and
were subjected to vaccination against human influenza to reduce the
chance of re-assortment between human and avian viruses.
During this outbreak a human fatality also occurred. The victim was a
57-year-old veterinarian who had not received prophylactic antiviral
drugs and had contact with infected birds during outbreak
management. He was admitted to the hospital with strong headache
and fever. Subsequently he developed a severe respiratory condition,
kidney failure and died. H7 virus was recovered from his lung tissue
nine days after the onset of illness.
 In December 2003 an H9N2 case was confirmed in a boy who
was admitted to a Hong Kong hospital with mild clinical symptoms and
discharged 2 days later. According to WHO information this appears to
be an isolated case with no evidence of further spread or human-to-
human transmission.
The risk for public health posed by the Influenza viruses of avian origin should
be seen in the wider context of the risk posed by the Influenza viruses of
human origin. The human population all over the world is continuously
affected by epidemic waves of influenza due to virus strains of human origin,
causing mainly respiratory infections and fatalities in risk groups, such as
elderly people, persons with concurrent illnesses and depression of their
immune system. Vaccines are available and their use is recommended for
risk groups.
In this wider context surveillance of influenza viruses in humans and animals
is relevant for health. The disease requires a high level of preparedness. The
Commission has put in place a disease surveillance network (EISS: European
Influenza Surveillance Scheme) within the Community Network for
Communicable Diseases to monitor virological and clinical data on influenza
within the human population in 18 European countries. These activities are
carried out in collaboration with the other surveillance networks co-ordinated
by WHO. These networks are also following the current avian outbreaks.
EU Legislation on Control Measures
The O.I.E (Office International des Epizooties, the World Organisation for
Animal Health) has classified HPAI as a "list A" disease, signifying a rapidly
spreading animal disease of major economic importance, such as foot and
mouth disease or classical swine fever.

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EU legislation to control avian influenza is laid down in Directive 92/40/EEC.
All suspected cases of AI must be investigated and appropriate measures
taken in case of confirmation of HPAI. To limit the spread, infected poultry
must be killed in a humane way and disposed off safely. Feeding stuffs,
contaminated equipment and manure must be destroyed or treated to
inactivate the virus.
To prevent further spread of disease the veterinary authorities are required to
immediately put in place movement restrictions on the affected holdings and
on all farms in a radius of at least 10-km around these holdings, the so called
surveillance zone. If necessary, stamping-out measures can also be extended
to poultry farms in the vicinity of or which have had dangerous contacts with
infected farms.
In accordance with Community legislation, all Member States have AI
contingency plans in place to ensure that the most appropriate measures are
immediately implemented.
At farm level preventive hygienic measures such as cleaning and disinfection
are crucial. Disease awareness amongst farmers and cooperation by all
people in the poultry sector must ensure that the strictest biosecurity
measures are applied to prevent disease spread.

Treatment and vaccination for H5N1 virus in humans

The H5N1 virus that has caused human illness and death in Asia is resistant
to amantadine and rimantadine, two antiviral medications commonly used for
influenza. Two other antiviral medications, oseltamavir and zanamavir, would
probably work to treat influenza caused by H5N1 virus, but additional studies
still need to be done to demonstrate their effectiveness.

There currently is no commercially available vaccine to protect humans

against H5N1 virus that is being seen in Asia and Europe. However, vaccine
development efforts are taking place. Research studies to test a vaccine to
protect humans against H5N1 virus began in April 2005, and a series of
clinical trials is under way.

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Avian Influenza in Egypt

From: OIE Animal Health Information Department

Information received on 18 February 2006 from Dr Ahmed Tawfik Mohamed,

Chairman of the General Organization for Veterinary Services, Ministry of
Agriculture, Cairo:

Report date: 19 February 2006.

A total of 7 outbreaks of Highly Pathogenic Avian Influenza were reported in

five governorates in Egypt.

Cairo
Giza
Menia
Quena
Qualiubia
Behera
Dakahlia

The cases were diagnosed by Animal Health Research Institute (national

laboratory) and confirmed by NAMRU-3 as H5N1.

Date of first confirmation of the event: 17 February 2006

Control measures:

-Quarantine of infected areas.

-Disinfection of infected premises.
-Condemnation and sanitary disposal of birds at infected areas.

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 Documented avian influenza infections in humans
(1997-2006)
Human
Cases Deaths
to
PeriodSubtype Site (lab (lab Carriers
human
confirmed) confirmed)
transmission
Chicken
Hong Kong
1997 H5N1 18 6 Ducks Yes
SAR
Geese
Hong Kong 2(plus 5 in
1999 H9N2 0 Chicken Uncertain
SAR mainland)
Virginia,
2002 H7N2 1 0 Chicken No
USA
Netherlands
2003 H7N7 Belgium 89 1 Chicken Yes *
Germany
Hong Kong
2003 H5N1 2 1 Chicken No
SAR
Hong Kong
2003 H9N2 1 0 Chicken No
SAR
New York,
2003 H7N2 1 0 Unknown No
USA
2003 H5N1 Vietnam 3 3 Poultry No
2004 H7N3 Canada 2 0 Poultry No
Thailand 17 12 Poultry No
2004 H5N1
Vietnam 29 20 Poultry No
Cambodia 4 4 Poultry No
China 8 5 No
2005 H5N1 Indonesia 17 11 No
Thailand 5 2 No
Vietnam 61 19 Yes
China 4 3
Poultry No
Indonesia 9 8
2006 H5N1
Irak 1 1
Turkey 12 4

A(H5N1) subtypes
Data as of 21.02.2006
* Evidence of conjunctivitis in three cases within families

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Referances:

World Health Organization WHO,

Food and Agriculture Organization FAO,

World Organization for Animal Health O.I.E

European Commission EU