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Thewholetruthaboutbirdflu

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ByDrShahanAzeem&ProfDrM.A.Muneer

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It'sanearlymorninginKarachi.Asapoultryfarmergetsupandgoestohis
flock,heseessomeofthebirdsgasping.Theirheadsareswollen,legsthave
turnedreddishandwaterisrunningfromtheireyes.
Somehavedied,and
manymorearedying.
Hegetsalarmed
becausehehas
investedafortuneinthe
flock.Onpostmortem,it
isrevealedthatthebirds
hadrespiratorytract
infectionwith
hemorrhageintrachea.

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Bloodserumtestsaredoneonsomelivebirds.
Serumanalysisrevealsinfluenzavirusinfection.Withnocureforthedisease,
thewholeflockdiesahugelossforthefarmer.Soonthediseasespreadsto
nearbyfarms.
Commercializationofanimalrearingenterpriseshasleadtoincreased
populationdensityofbirdsperfarm.Overcrowdingoffarmsinanareaand
increasedmeansofcommunicationandtransportationhaveraisedthe
incidenceofinfectiousdiseasestomuchhigherlevelascomparedtopast
years.
TherecentoutbreakofbirdfluinsoutheastAsiaanditspotentialtoinfect
humanbeingshasraisedenormousconcernsallovertheglobe.
Duetowidespreadpublicityviamassmediaandarecentoutbreakofhighly
pathogenicavianinfluenza(HPAI)inpoultryfarmsofKarachi,whichkilledover
3.5millionlayerbirds,mostpeoplearenotconsumingeggsandmeat,theonly
economicalsourcesofproteinsinthecountry.
AreportinDawn(Jan.31)saystheconsumptionofchickenitemshasdropped

by2530percent.AccordingtothePakistanPoultryAssociation,daily
consumptionofchickeninKarachihadgonedownto125,000150,000birds
currentlyascomparedtothenormalconsumptionof300,000350,000daily.
Beforedelvingdeepintothenatureofthebirdfluanditsimplicationsonpublic
health,letusunderstandthenatureofinfluenzavirusfirst.
ThecausativeagentbelongstothevirusfamilyOrthomyaxoviridaeandgenus
influenzaA.Thevirusinfectshumanbeings,pigs,equinesandvariousavian
speciesincludingpoultryandwildaquaticbirds.Thevirusisabout100nmin
diameterandsphericalformsarecommonlyseenwithanucleocapsid
containingitsgeneticmaterial.
Thegenomeissegmentedwitheightsegments.ItisasinglestrandedRNA
virus,thegenomeisminussense.
Apeculiarcharacteristicofthevirusisthatitcontainsarodshaped
glycoproteincalledhaemagglutinin(H)andamushroomshapedglycoprotein
calledneuraminidase(N).Thesearecalledspikesorpeplomers.
Theseareveryimportantinsubtypingofvirusandhencetoidentifytheexact
virustypeinvolvedinaparticularoutbreak.Tilltoday15subtypesofH(H1
H15)and9subtypesofN(N1N9)havebeenreportedandcanbefoundinany
combination.Sotherecouldbe276possiblecombinationsofHandN.
Commoncombinationsreportedin
recentoutbreaksareasfollows:
SpeciesVirusStrain
HumanBeingsH2N8,H3N8,H1N1,H2N2,H3N2
HorsesUsuallyH7N7orH3N8
PigsPredominantlyH1N1andH3N2
Birds/ChickensH5N1,H5N3,H7N3,H5N9,H7N7,H5N2,H5N8,H7N4,H7N1
(InPakistanH7andH9havebeenreported).

*H5N1(BirdfluinHongKongin1997,1999,2003)
Thevirusisrelativelyunstableintheenvironmentandiskilledat56Cforthree
hoursor60Cfor30minuteshenceitiseasilydestroyedbyboiling.Itiseasily
inactivatedbycommonlyuseddisinfectantslikeformalin,sodiumhypochlorite,
sodiumhydroxideandiodinecompounds.
Influenzavirusesareprotectedbyorganicmaterialsuchasnasalsecretionsor
faeces,whichincreaseresistancetophysicalandchemicalagents.
Coolandmoistconditionsfavorlongsurvivalofinfluenzavirusesinthe

environment.AIviruseshavebeenviableinliquidmanurefor105daysinthe
winterandinfaecesfor3035daysat4Candfor7daysat20C.
AIVirusSubtypeNumberaffectedA/chicken/Pennsylvania/1370/83H5N2
17mbirdsmostlychickens.A/chicken/Pakistan/447/95
A/chicken/Pakistan/1369CR2/95H7N33.2mbroilers&broilerbreeder
chickens.
A/chicken/HongKong/220/97H5N11.4mchickens&variousotherdomestic
birds.A/turkey/Italy/4580/99H7N110.5mchickens&2.7mturkeys.
A/chicken/HongKong/2001H5N11millionbirds.
Fluinbirds
Influenzaisoftentermedas"FowlPlague"Duetosignificantmorbidityand
mortalityacrosstheglobe.Someimportantoutbreaksresultinginmillionsof
mortalitiesandeconomicclassesaregiveninthechartabove.
Thediseasepresentsavariablepictureaccordingtothetypeofvirusinvolved
anditsvirulence.ButintypicaloutbreakwithH7orH9followingsymptomsmay
befound:respiratorydistress,laboredbreathing,diarrhoea,swollenhead,eye
discharge,cyanosisandswellingofwattlesandcombs,subcutaneous
hemorrhagesonunfeatheredskin/cyanosisofshankandtoe.Inlayerflock
markeddeclineineggproductionhasalsobeenreported.
Spreadofdisease
Thefirstincidenceofbirdtohumaninfectionwasreportedin1997inHong
Kongwhere18peoplegotinfectedand6ofthemdied.
Extensiveinvestigationrevealedthatclosecontactwithliveinfectedpoultry
wasthesourceofhumaninfection.
AgaininFebruary,2003,anoutbreakofH5N1avianinfluenzainHongKong
caused2casesofhumaninfection.Twootheravianinfluenzaviruseshave
recentlycausedillnessinhumans.AnoutbreakofHPAI(H7N7)inThe
NetherlandsinFebruary,2003,causedthedeathofoneveterinarianandmild
illnessesin83otherhumans.Mildcasesof
avianinfluenzastrainH9N2occurredinchildreninHongKongin1999andin
midDecember,2003.H9N2isnothighlypathogenicinbirds.
AvianfluinPakistan
Avianinfluenza(serotypesH9andH7)isendemicinPakistan.Inthis
reference,aseriousoutbreakhadbeenreportedin1994wherebybroilerbreeder
flockswereaffectedinnorthernareasofthecountry,andaboutamillionbirds
succumbedtodeath.
ThescientistsisolatedthepurevirusandtypeditasH7N3.Aninactivated
vaccinebytheisolatewaspreparedbyvariouslaboratoriesandhasbeenquite
effectiveincontrollingtheavianinfluenzaproblemsince1994.

However,anoutbreakofavianinfluenzaH9N2continuestooccurparticularlyin
Karachiandadjoiningareastilltoday.Thisvirusisolatewasalsopurified
likewiseandavaccinewaspreparedwhichprovidedsatisfactoryprotection.
DuringMarch2003,anotherepidemicofavianinfluenzaoccurredandheavy
mortalityincommerciallayersofKarachiwasreported.Thisviruswasisolated
andcharacterizedasH7atvariouspublicandprivatediseasediagnostic
laboratories.
Thisoutbreakoccurredincommerciallayerflockattheirpeakproduction.
Despiteallthis,nohumancontracthasyetbeenreportedfromanyofthe
20,000poultry
farmsofthecountry.
Difficulttocontrol
Influenzavirusesdepictsomepeculiarpropertiesknownasantigenicdriftand
shift.Antigenicdriftisduetoaccumulationofpointmutationsinthegenes
resultinginaminoacidchangesintheprotein.Virusdoesnothavea
proofreadingmechanismandasaresulterroneousversionsofvirusare
releasedwithdifferentantigenicnature.
Sincethemammalian/avianbodyhasnotbeenexposedtothisnewsubtype
andhencenotimmunetoit,itwouldresultinoccurrenceofdiseaseasthe
antigenicnatureischanged.
Ontheotherhandgeneticreassortmentresultsindevelopmentofnew
subtypesandiscalledantigenicshift.Swinecanserveasmixingvesselof
avianandhumanviruses.
Heregenesareswappedresultinginemergenceofcompletelynewsubtypes
towardswhichthereisnopreviousimmunity.Avianandhumaninfluenza
virusescanexchange
geneswhenapersonissimultaneouslyaffectedwithvirusesfromboth
species.
Theaddeddangerincaseofbirdstohumantransmissionisthatifthevirus
persistsinhumanpopulationforsometimeandacquiresufficienthumangenes
itwouldbeveryeasilyeffectinghumanpopulationviahumantohuman
infection(ratherthanbirdtohumaninfection)andcouldleadtoserious
epidemicresultinginmillionofcasualtiesaroundtheworld.
Sourcesofspread
Sincethevirusisshedinbirddroppings,secretionsfromtherespiratorytrack
andconjunctiva.Followingfactorscouldbeattributedtotheperpetuationof
infection:
(1)Movementofcontaminatedvehicles,equipment,feed,cages,etc,fromone
farmtoanothercancarrythevirus

(2)Technicalpersonnelvisitingvariouspoultryfarmsinadayconsecutively
withoutchangingclothscouldbeasourceofspread
(3)Droppingsfrominfectedwildbirdscanintroducethevirustobackyardas
wellascommercialpoultryflocks
(4)Theplaceswherelivebirdsaresoldareanimportantsourceofspreadof
infection.Inthesemarkets,birdscaughtorboughtareplacedincagesunder
stressandincloseproximitywhichserveasanidealplaceofspreadof
infection
(5)Domestic/backyardpoultryisatcontinuousriskasitfrequentlycomesin
contactwithwildbirdssometimeseventothelevelofsharingthewater
sources,etc
(6)Migratorywaterfowlarethenaturalreservoirofbirdfluvirusesandthese
birdsarealsomostresistanttoit.Theycancarrythevirusovergreat
distances
(7)Scavengeranimalsorbirdscanplayapartinthespreadofinfection
(8)Movementofliveinfectedbirdsfromoneplacetoanothercanspreadthe
virus
(9)Mechanicalvectorslikerodents,fliesandotherinsectscanalsocarrythe
virusfromoneplacetoanother
(10)Noneffectivepoorqualityvaccination
(11)Abilityofvirustoincreaseitspathogenicityifallowedtocirculateinpoultry
populations
(12)Climaticconditionsalsoplayapartashighlypathogenicvirusescan
surviveforlongperiodsintheenvironmentspeciallywhentemperaturesare
low.
Followingtestsarecommonlyusedfordiagnosisofinfluenzavirus
infectioninvariousspeciesofanimalsincludinghumanbeingsandbirds:
(1)Isolationofthevirus
(2)Identificationofinfluenzaisolatebyhemagglutinationinhibition
(3)Serologicdiagnosisbyhemagglutinationinhibition
(4)Neuraminidaseassayforantibodydetection
(5)Directdetectionofinfluenzaviralproteinsornucleicacids
(6)IdentificationbyReverseTranscriptasePolymeraseChainReaction(RT
PCR)

(7)IntravenousPathogenicityTest(IVPI)
(8)Agargelprecipitationtest(AGPT)forthedetectionofantibodiestoavian
influenzausingtypespecificRibonucleoprotein(RNP)antigen.
Dr.ShahanAzeemisamicrobiologistandassistantdirectorresearchatthe
UniversityofVeterinaryandAnimalSciences,Lahore.
Prof.DrM.A.MuneerisarenownedavianmicrobiologistandDean,Facultyof
VeterinaryScience,atthesameuniversity..

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