Threat of an Avian flu Human Pandemic and

preparedness in Pakistan

By

Dr Zubaida Lodhi
Roll No 29
 What is an influenza pandemic?

Global disease outbreak

A new influenza strains emerges
Causes serious illness to large
populations worldwide
25% of worlds population may fall ill
 Definition

• Avian influenza is Contagious viral disease of

birds (rarely crosses the species barrier and infects
humans
• It has three types A,B,C,
• Influenza is caused by strain A
• Sub type pathogenic for human are
• H7N3
• H7N7
• H9N2
• and H5N1(human to human)
 Avian flu

• All birds are thought to be

• susceptible to infection with avian influenza viruses,

• Chicks and many wild bird and species carry these

viruses with no apparent signs of harm.

• Domestic ducks are silent carrier

 RISK GROUP

1. Poultry growers and their workers

2. Service technicians of poultry processing companies

3. Caretakers,and chick workers at egg production

facilities

4. Workers involved in disease control and eradication

 Clinical types of avian Influenza

There are two types:

1.The highly pathogenic viruses (HPIV) spread quickly

and may kill nearly an entire poultry flock within 48
hours.

2.The low pathogenic viruses (LPIV) cause only mild

symptoms in chickens (such as ruffled feathers or a
drop in egg production
 H5NI serious issue

“Young people more on risk < 25 years of age”

1. “Bird flu.” (H5N1 strain) now spreading rapidly

among birds and in turn infect human .

2. To date, people infected with H5N1 virus have

shown a very high mortality rate

3. Ducks can carry H5N1 without symptoms

4. human–to–human transmission H5N1 can

present with diarrhea and brain inflammation
 Spread through

1.The H5N1 virus is excreted in the (Birds)

• droppings,
• saliva,
• and nasal secretions of infected birds.
2.The virus is believed to enter humans through the
• mouth,
• nose,
• eyes,
• and lungs :
3.Flu Pandemic
• Spreads easily like seasonal flu
• Humans have little immunity as viruses are new
 Historical facts

Credit: US National Museum of Health and

Medicine

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

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

A(H1N1) A(H2N2) A(H3N2)

 Current world situation
160 141
140
115 111
120
100
80 cases
56 deaths
60
38
40 25 25
17 12
20 8 5 4 3 2 3 1
0

q
am
ina

ey
a

n
a

ira
lan
i
di

ta
es

rk
ch

itn
bo

kis
tu
on

ia

ve
m

th

Pa
ind
co

25th sep 2009

 Alarming situation
• Gene Mutation and Viral human to human spread is
random and cannot be controlled

Once a pandemic virus emerges, it is too late to begin

planning or to begin collaboration. There will only be a
20-30 day window between emergence and
pandemic.”
SO

we have to prepare to fight against viral illness

 Preparedness in Pakistan
Suggestive
11 Multi sectoral strategies
collaboration

2 DEWS

Availability
3 of vaccines?

Education Simple
4 concept by
mass media
 1.Multi sectoral coll0bration for avian
influenza control

Private Other
Sectors Agencies

Dept. of National Avian Public

Livestock sector
and dairy Influenza
Cell
 1.National Influenza cell

1. Preparedness of rapid test, stock pile, PPE,

ventilator,

2. Capacity building

3. Health Management information system

4. Respiratory isolation room and vaccine

5. Dissemination of information
 2. Disease early warning system

• No existing polices regarding avian influenza and its

control

• Avian flu is not part of (DEWS) in Pakistan

• So there is need to introduce avian flu in disease

early warning system

• It is good for early deduction and disease control

Disease early warning system (DEWS)
Central
& Regional
Provincial DEWS
DEWS

District
DEWS

Sub-district
Health Centers

Village Health Volunteers

& Community Leaders
 Suspected avian’s flu Performa for
DEWS
1.Personal information
Name
• Age
• Sex
Place
• 2. Singh of avian flu
• Fever >38 Celsius
• Sneezing and running nose
• Rapid breathing
• Diarrhea
• 3. History
• Contact with bird and chicken
• Handling ,eggs, meat and litter
 DEWS‘s response for avian influenza

Control
Isolation of patient
Use of mask both by the patient and attendant
Blood investigation for H5N1
Treatment
Oseltamivir (Tamiflu) may be of benefit
(75 mg BID x 7 days)
Symptomatic support
 Availability of vaccine?

• H5N1vaccine is under trail

• Limited amount of safety data available

• regarding use of vaccine

• Animal trials are successful but human trials are not so far
done (due to ethical issues)

• Developed countries already allocated money for up coming

vaccine but not underdeveloped countries
 4.Education – Simple Concepts By mass media

• Teach hygiene practices regularly to children and

adults
• Inform people about hazardous health effect of avian
influenza
• Aware public about mode of transmission protective
measure and control
• Share information about avian flu current situation
• Eat well, exercise and practice healthy lifestyle
 Further monitoring

1. Reduction of flights/air cargo and ships form

suspected avian flu reported area
2. Travel restrictions
3. Border closures
 Reference
article Genome Analysis Linking Recent European and African Influenza (H5N1) Viruses EID
Journal Home > Volume 13, Number 5–May 2007 Volume 13, Number 5–May 2007

Payungporn S, Chutinimitkul S, Chaisingh A, Damrongwantanapokin S, Nuansrichay B,

Pinyochon W, Amonsin A, Donis RO, Theamboonlers A, Poovorawan T. (2006).

"Discrimination between Highly Pathogenic and Low Pathogenic H5 Avian Influenza A Viruses ^
Shinya K, Ebina M, Yamada S, Ono M, Kasai N, Kawaoka Y. (2006). "Avian flu:
influenza virus receptors in the human airway". Nature 440 (7083): 435–436.

van Riel D, Munster VJ, de Wit E, Rimmelzwaan GF, Fouchier RA, Osterhaus AD, Kuiken T.
(2006). "H5N1 Virus Attachment to Lower Respiratory Tract". Science 312 (Epub ahead
of print): 399

Ortiz JR, Katz MA, Mahmoud MN, et al. (December 2007). "Lack of evidence of avian-to-human
transmission of avian influenza A (H5N1) virus among poultry workers