Avian Influenza

An infectious disease in chickens, ducks and other birds caused by different subtypes
of the influenza A virus .It Ranges from mild infection to acute, fatal disease. Two
types depending on severity of illness:
Highly Pathogenic Avian Influenza (HPAI)- With mortality in poultry as high as
100%
Low Pathogenic Avian Influenza (LPAI) - Clinical signs much less evident or
even absent.Mortality much lower
How bird flu spreads within a country
Domestic birds can get the infection when they roam freely and share water
supply that that might be contaminated by infected droppings
Contaminated equipment, vehicles, feeds, cages, or clothing, especially shoes
can carry the virus from farm to farm
Wet markets -live chickens and other birds in crowded and often unsanitary
conditions
Movement of infected birds -trading or smuggling
Transmission to humans
Close contact with live infected birds through infected aerosols, discharges
and surfaces
Birds excrete the virus in their feces, which dries and becomes pulverized, and
is then inhaled
Flapping of wings hastens the transmission
Social,

economic and political implications

Economic loss in agriculture and the poultry industry
Loss of livelihood of small-scale poultry players
Threat to food security
Widespread public anxiety
Global and national attention on governments response

Human Public Health Implications

High mortality of H5N1 to humans
Emergence of a new influenza virus with pandemic potential
Efficient human to human transmission
Vast majority of people have no immunity
No protective vaccine/ Inadequate quantity of developed
vaccines for the world
High number of cases and deaths worldwide (pandemic)
Avian Flu and Influenza Pandemic, Impact

During the current H5N1 > 150 million birds culled or died: direct economic
cost to affected countries $8-12billion
Next pandemic may cause very high morbidity and mortality in few weeks. It
could cause 1 billion cases and 2-7 million deaths
A modest pandemic lasting over one year might cause losses as high as 3% of
Asia GDP and 0.5% of world GDP. Presently equivalent to a loss of $ 150-200
billion in GDP

Signs and symptoms in humans

A (H5N1) infection very similar to other influenza viruses, most are selflimiting
Initial symptoms are fever, malaise, myalgia, sore throat and cough.
Conjunctivitis in some patients
Persistently high fever
Complications and death due to severe pneumonia, respiratory distress
syndrome and multi-organ failure.
Individuals at risk
Poultry handlers/workers
People living near poultry farms
Sellers/people involved in live chicken sale
Aviary workers
Ornithologists
Cullers involved in destruction of poultry
Diagnosis
If the patient has had direct or indirect contact through handling or having
taken care or getting near sick chickens or other birds.
A laboratory confirmation of the bird flu infection and epidemiologic link with
unusual death or epidemics of chickens will support the diagnosis of bird flu.
Prevention
Hand hygiene
Cleaning and disinfection
Avoiding contact with wild birds
Safe food practices

Practice of proper hand washing and cleaning and disinfection procedures in

poultries

Vaccination
No vaccine developed against H5N1
Routine influenza vaccine to prevent humans as mixing vessel for re-assortment
into a new virus subtype
Selected groups for vaccination:

cullers involved in destruction of poultry

people living and working in poultry farms

health care workers involved in the daily

care of H5N1 human cases

health care workers in emergency care

facilities in areas where there is confirmed
occurrence of influenza H5N1 in birds.
Treatment
Treatment for H5N1, infection is essentially the same as for other influenza
viruses.
Antiviral drugs for both treatment and prevention, but have some limitations
OSELTAMIVIR: 1 tab BID x 5 days; Prophylactic: 1 tab OD x7 days
Four Lines of Defense
1. First Line of Defense Out Border
Containment in affected countries
2. Second Line of Defense Entry-Exit
Management of International Passengers
Intensified quarantine measures
Infrared thermal monitors are routine at international ports
Travelers with unknown fever and respiratory symptoms will be examined
further
If WHO issues a notification of confirmed human-to-human transmission of avian flu
Travelers will be asked to undertake self-quarantine for 10 days.
People under self-quarantine will need to check temperature twice daily, and
report to local health authorities if they have influenza symptoms.
3. Third Line of Defense - In Communities
Personal hygiene
Use of Personal Protective Equipment (PPE)
Cleaning and disinfection
Anti-viral agents
Quarantine for 10 days
Immediate admission of symptomatic persons to referral hospital
Prophylaxis and monitoring of contacts
4. Fourth Line of Defense Health Care System
Avian Influenza : Referral Hospitals (21)
Clinical management of cases
Infection control
Early Signals
Bird/animal death (unexplained/unusual)
Human respiratory infections assoc. with bird/animal deaths
Unusual respiratory disease/deaths-cluster of cases among

Stage

- Travelers
- Cullers
- Poultry Handlers
- Health care worker
- Laboratory workers
Rumor surveillance in the early warning phase to identify possible cases of
pandemic strain influenza that might not be notified by routine or enhanced
surveillance
1: Keeping the Philippines Bird Flu Free
Ban of all poultry and poultry products from AI-infected countries
Border control
Ban on sale, keeping in captivity of wild birds
Biosecurity measures
Standardized footbath
Confiscation and destruction of unlicensed cargo
Surveillance of Poultry in Critical Areas
Influenza vaccination for all poultry workers, handlers

Minimum Biosecurity Measures

Biosecurity control points e.g.gates, shower rooms, footbaths, fumigation
boxes
Proper rest period and disinfection between flocks

Inaccessible to stray animals and free-flying birds

Proper disposal of mortalities
No domestic ducks and free-range poultry in migratory bird areas, especially
wetlands
No mixing of poultry and swine in same holding facility
Record all movement to and from the facility e.g. visitors, vehicles, deliveries

Enforcement of Wildlife Act

To be led by PAWB-DENR, in coordination with the LGUs and local PNP
No permits for poultry wildlife or exotic poultry species from AI-affected
countries
No collection of migratory birds, regardless of purpose or collection technique
Preventive Measures in Humans
Influenza vaccination for all poultry workers, handlers
STAGE 2: Avian Influenza in Domestic Fowl in the Philippines
Prevention of spread from birds-to birds: early recognition and reporting, mass
culling, quarantine of affected area
Prevention of spread from birds to humans: human protection through proper
handling of infected birds, use of protective gear by residents, poultry
handlers, and response teams
Community Response to sick or dead birds
Protection of exposed residents gloves/ plastic material in handling sick or
dead birds, hand washing
Personal protective equipment for cullers caps, masks, goggles, gowns
Slowly remove clothing and take a bath immediately after handling birds
Identification of exposed individuals and quarantine for 10 days
Inform the local health and agricultural officers

Controlling and Eradicating Bird Flu in Domestic Fowl

In case of an outbreak, a 3-kilometer quarantine zone shall be established and all
birds within this area shall be stamped out. Moreover, a 7kilometer control zone
shall be secured so that intensive surveillance can be conducted to detect further
outbreaks

What should be done when there is a suspected case of avian influenza

Protection of caregiver : face mask and goggles or eye glasses, hand
washing, self-monitoring for signs and symptoms
Patient: face mask, in a separate area or at least 1 meter distance from other
people
Monitoring of contacts of the case
Immediate transfer to the Referral Hospital Protection of the transporting team
and disinfection of vehicle
What should be done when there is a suspected case of avian influenza?
Through the Local Health Officer, immediately notify the Provincial Health
Office and the Regional Epidemiology and Surveillance Unit regarding a
suspected case of HPAI.
A holding area in the community or in the health center will be set aside while
awaiting transport.
Personal Protective Equipment. Who should use PPE?
Cullers and animal husbandry/veterinary staff and all those who are handling
infected or suspected poultry and poultry products.
All doctors, nurses and health care workers who provide direct patient care to
avian influenza cases
All support staff including medical aides, X-ray technicians, cleaners, transport
staff, laundry staff
All laboratory staff who handle patient specimens from suspect cases
Family members who care for avian influenza patients (no visits)
The patient(s) should wear a mask (N95 preferable) when other people are in
the isolation area.
Contacts and international travellers during home isolation/quarantine must
wear a mask (N95 preferable).
Quarantine of contacts
Stay at home for 10 days
Monitor self for fever, cough or difficulty of breathing or any sign and
symptoms of illness.
Refer sick persons to the Referral Hospital for SARS and other severe
emerging infections.
Referral of Avian Influenza Cases
A. Satellite Referral Hospitals
Regional Hospitals/ Medical Centers of 16 Regions

B. Sub-national Referral Centers

San Lazaro Hospital
Lung Center of the Philippines
Vicente Sotto Memorial Medical Center
Davao Medical Center
C. National Referral Hospital
Research Institute for Tropical Medicine
STAGE

4: Human-to-human transmission of influenza (pandemic influenza)

High morbidity and mortality
Increased demand for health services
Maintaining essential services disaster response team, security, peace and
order, transportation, communication and utilities
Public anxiety epidemic of fear

Coping with increased demand for health services and goods

Primary care
manpower augmentation
antipyretics, analgesics, liniments and antibiotics
Secondary care
Shortage of beds, equipment and supplies

Only serious and urgent cases will be admitted

Back-up / buddy system

Supplies of relevant drugs (e.g. antibiotics) and equipment (e.g. Ventilator)

What is the government doing
Organization/ Coordination
Management Committee on Prevention and Control of Emerging and Reemerging Infectious Diseases (DOHMC PCEREID)
National AI Task Force for Avian Influenza Protection Program (NATF-AIPP)
Formulated structure for Regional and Local TF-AIPP
Planning Policy/ Technical Guidelines Development
Preparedness and Response Plan for Avian and Pandemic Influenza
Work and Financial Plan
Guidelines:
Consensus on the Prevention and Management of Influenza (with medical
specialties)
Clinical Management of HPAI
Infection Control
Planning workshops
Mobilization of DOH-Management Committee for PCEREID
Interagency Avian Influenza Task Force Meeting
Table top exercises
Orientation on Avian Influenza and Pandemic Influenza Preparedness
Regional Directors and Chiefs of Hospitals in the National Staff Meeting
Regional Coordinators and Epidemiology and Surveillance Units
Rural Health Midwives- Olongapo City, Cebu City
Ongoing Regional Meetings
Training on Infection Control (NCHFD)
NCR Hospitals
Advocacy

Legislators : Committee on Health, Lower House

National Anti-Poverty Commission
National Disaster Coordinating Council Medical specialty organizations PPS,
PSMID, PIDSP
Diplomatic Corps
American Chamber of
Commerce
Asian Development Bank
Japanese Consuls to Asian Countries
Business Sector

Advocacy and Information Dissemination

Regional Summits (Joint DOH-DA activity)
6 regions Regions 3, 4, 9, 10, 11 and Palawan
Development of IEC Materials Target audience-based,
Cough manners, proper handwashing
Quadri-media
DOH website for bird flu
Lectures to other agencies, offices
Planning with UP-CPH for Training on Risk Communication
Elements of the Preparedness Plan
1. Management structure, planning and policy formulation
2. Surveillance system for HPAI and pandemic influenza
3. Antiviral agents and pandemic influenza vaccine
4. Readiness of health facilities, service, manpower and supplies
5. Maintaining non-health essential services
6. Public health interventions
7. Information, education and communication
8. Networking