BIRD FLUAVIAN INFLUNZA

essential learning Dr.T.V.Rao MD

An acute respiratory illness resulting from infection with an Influenza virus

Highly infectious and can spread rapidly from person to person

Some strains cause more severe illness than others

What is influenza?

Dr.T.V.Rao MD 2

History of influenza

412 BC - first

mentioned by

Hippocrates

1580 - first

pandemic described

1580-1900 - 28

pandemics

Pandemic influenza in the

20th Century

1920 1940 1960 1980 2000

H1N1 H2N2 H3N2

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

20-40 million deaths 1 million deaths 1 million deaths

Dr.T.V.Rao MD 4

1918

Pandemic

Highest mortality in people 20-40 years of age

- 675,000 Americans died of influenza

- 43,000 U.S. soldiers died of influenza

Dr.T.V.Rao MD 5

Emergency hospital, Camp Funston, Kansas 1918 Courtesy of National Museum of Health and Medicine

Dr.T.V.Rao MD 6

Dr.T.V.Rao MD 7

Types of influenza viruses

Influenza viruses are divided into three main types: influenza A, B, and C

A viruses – infect birds and other animals, as well as humans

A viruses – source of seasonal influenza epidemics and all pandemics

B and C viruses – infect humans only and do not cause pandemics

Dr.T.V.Rao MD 8

Avian InfluenzaAvian influenza refers to the disease caused by infection with avian (bird) influenza (flu) Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Avian flu viruses do not normally infect humans. However, sporadic human infections with avian flu viruses have occurred.

Migratory

water birdsDomestic birds

Where does influenza

A virus come from?

Humans

and other

animals

Human influenza A viruses start as avian (bird) influenza viruses

Dr.T.V.Rao MD 10

Avian Influenza in Birds

Avian influenza refers to infection of birds with avian influenza Type A viruses. These viruses occur naturally among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species. Wild aquatic birds can be infected with avian influenza A viruses in their intestines and respiratory tract, but usually do not get sick. However, avian influenza A viruses are very contagious among birds and some of these viruses can sicken and even kill certain

domesticated bird species including chickens, ducks, and turkeys.

Avian Influenza

A Viral disease of Domestic and Wild Birds characterized by the full range of responses from almost no signs of the disease to very high mortality. The incubation period is also highly variable, and ranges from a few days to a week ( 3 to 7 days).

Spread of H5 N1

Dr.T.V.Rao MD 13

Highly Pathogenic Avian InfluenzaWorldwide Occurrences

Dr.T.V.Rao MD 14

Intercontinental Spread of Avian Flu

Transport of live poultry,

frozen poultry meat and

untreated hatching eggs

over long distances. Trade

of poultry by-products

unheated and egg

products and possibly

frozen poultry semen.

Least importance are free

living migrating birds

International Spread of Avian Flu

Trade of commercial poultry including liv birds, vehicles, crates, containers. Also, international exhibitions, shows, bird markets and similar events. Least important are birds which displays seasonal migration pattern.

Local

Local Spread of

Avian Flu Farm personnel, technical

crew

(debeaker, vaccinators,

catchers, etc.). Also,

contaminated poultry

manure and waste stuff as

well as airborne particle

and dust. Significant are

live birds in close vicinity

to poultry houses

Infected Birds Can Spread the Virus

Infected birds can shed avian influenza A viruses

in their saliva, nasal secretions, and feces.

Susceptible birds become infected when they

have contact with the virus as it is shed by

infected birds. They can also become infected by

coming in contact with surfaces that are

contaminated with virus from infected birds.

Dr.T.V.Rao MD 18

Avian Influenza in Wild Birds

Avian influenza A viruses have been isolated from more than 100 different species of wild birds.. The majority of the wild birds from which these viruses have been recovered represent gulls, terns and shorebirds or waterfowl such as ducks, geese and swans. These wild birds are often viewed as reservoirs (hosts) for avian influenza A viruses.

Avian Influenza in Poultry

(Domesticated Birds)Domesticated birds (chickens, turkeys, etc.) may become infected with avian influenza A viruses through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces that have been contaminated with the viruses.

depopulation (or culling,

also called “stamping out”) When H5 or H7 avian influenza outbreaks occur in poultry, depopulation (or culling, also called “stamping out”) of infected flocks is usually carried out. In addition surveillance of flocks that are nearby or linked to the infected flock(s), and quarantine of exposed flocks with culling if disease is detected, are the preferred control and eradication methods

Avian influenza outbreaks are of concern in

domesticated birds for several reasons:

The potential for low pathogenic H5 and H7 viruses to evolve into highly pathogenic viruses

The potential for rapid spread and significant illness and death among poultry during outbreaks of highly pathogenic avian influenza

The economic impact and trade restrictions from a highly pathogenic avian influenza outbreak

The possibility that avian influenza A viruses could be transmitted to humans

Dr.T.V.Rao MD 22

How influenza spreadsSpreads easily from person to person through coughing and sneezing

Transmitted by:

inhaling respiratory aerosols containing the virus, produced when infected person talks, coughs, or sneezes

touching an infected person or an item contaminated with the virus and then touching your eyes, nose, or mouth

Dr.T.V.Rao MD 23

Disease containment measures

Isolation: restriction of movement/separation of illinfected persons with a contagious disease

Quarantine: restriction of movement/separation of wellpersons presumed exposed to a contagious disease

Self-shielding: self-imposed exclusion from infected persons or those who may be infected

Social distancing: reducing interactions between people to reduce the risk of disease transmission

Snow days: days on which offices, schools, transportation systems are closed or cancelled, as if there were a major snowstorm

Dr.T.V.Rao MD 24

How can someone with the flu infect

someone else?

Infected people may be able to

infect others beginning 1 day

before symptoms develop and

up to 7 or more days after

becoming sick.

That means that you may be able

to pass on the flu to someone

else before you know you are

sick, as well as while you are

sick.

Dr.T.V.Rao MD 25

In adults, emergency warning signs that

need urgent medical attention include:

Difficulty breathing or

shortness of breath

Pain or pressure in the

chest or abdomen

Sudden dizziness

Confusion

Severe or persistent

vomiting

Dr.T.V.Rao MD 26

Dr.T.V.Rao MD 27

DiagnosisTo diagnose swine or Birds influenza A infection, a respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus Dr.T.V.Ra

o MD

28

Specimen Collection for

DiagnosisSample Collection and handling is same as

for human avian flu or seasonal influenza

like illness (Refer CD Alert on AI). Sample

Collection: should be labelled clearly and

include patient’s complete information and

should be sent to designated Laboratory.

Laboratory biosafety measures

should be followed for collection,

storage, packaging and shipping of

influenza samples.Dr.T.V.Rao MD 29

Currently Available Tests

Rapid Antigen Tests: not as sensitive as other available tests. RT–PCR Virus isolation Virus Genome Sequencing Four–fold rise in swine influenza A (H1N1) virus specific neutralizing antibodies. It is important to note that samples from all cases, once the Pandemic starts, are not required to be tested.

Dr.T.V.Rao MD 30

Diagnosis of FluFor diagnosis of swine influenza A

infection, respiratory specimen (NP

(nasopharyngeal swab), throat swab

, nasal aspirate, nasal washing)

would generally need to be collected

within the first 4 to 5 days of illness

(when an infected person is most

likely to be shedding virus). However,

some persons, especially children,

may shed virus for 10 days or longer.Dr.T.V.Rao MD 31

Dr.T.V.Rao MD 32

Rapid Diagnosis

RT PCR

can make

rapid

Diagnosis

Dr.T.V.Rao MD 33

How we control Health

care Associated Spread

Combination of infection control strategies

is recommended to decrease transmission

of influenza in health-care settings. These

include placing influenza patients in

private rooms when possible and having

health-care personnel wear masks for

close patient contact (i.e., within 3 feet)

and gowns and gloves if contact with

respiratory secretions is likely .

Dr.T.V.Rao MD 34

Slide 6-

35

Recommendation for all individuals with

respiratory symptoms

Cover the nose/mouth when coughing or sneezing

Perform hand hygiene if contact

respiratory secretions and

contaminated objects

Put on a surgical mask

Respiratory hygiene and cough etiquette

• Use tissue paper to contain

respiratory secretions and

dispose in the waste receptacle

Dr.T.V.Rao MD

Use of Mask by Patients

and Health care WorkersThe use of surgical or

procedure masks by infectious

patients may help contain their

respiratory secretions and

limit exposure to others.

Likewise, when a patient is not

wearing a mask, as when in an

isolation room, having health-

care personnel mask for close

contact with the patient may

prevent nose and mouth

contact with respiratory

droplets

Dr.T.V.Rao MD 36

Can the Mask Prevent the

Spread of Flu ???

However, no studies

have definitively

shown that mask use

by either infectious

patients or health-

care personnel

prevents influenza

transmission

Dr.T.V.Rao MD 37

Prevention is best option

Covering your

nose and mouth

with a tissue

when you cough

or sneeze. Throw

the tissue in the

trash after you

use it.

Dr.T.V.Rao MD 38

Using N95 mask reduces the Risk

You can cut your

risk of contracting

the flu or other

respiratory viruses

by as much as 80

percent by wearing a

mask over your

nose and mouth,

according to a new

study.

Emerging Infectious Diseases, the journal of

the Centres for Disease Control and

Prevention (CDC) . Dr.T.V.Ra

o MD

39

Health Care Personal

Should Protect WithDuring a surgical or procedure mask

should be worn by health-care personnel

who are in close contact (i.e., within 3 feet)

with a patient who has symptoms of a

respiratory infection, particularly if fever is

present, as recommended for standard and

droplet precautions. These precautions

should be maintained until the patient has

been determined to be non infectious or

for the duration recommended for the

specific infectious agent.Dr.T.V.Rao MD 40

Slide 6- 41

Isolation

Precautions

Patient

Transport

Linen & laundry Waste Management

Decontamination

PPE

Hand hygiene

Patient

placement

Isolation Precautions

Strategy of Patient Placement

1. Isolate suspected or confirmed cases in a negative pressure isolation room

2. When single rooms are fully occupied

Cohort patients with same confirmed diagnosis in same cubicles, maintaining a minimum of 1 metre distance from each other

3. Confirmed and suspected cases should be nursed in separate cubicle

Dr.T.V.Rao MD 42

Slide 6-

43

Waste

Management

1. All waste generated from room/ area housing suspected or confirmed avian influenza patients should be treated as clinical waste

2. Biohazard labeling

3. Wear appropriate PPE when handling clinical waste

Dr.T.V.Rao MD

Institutional Measures

Use of antiviral drugs for treatment and chemoprophylaxis of influenza is a key component of influenza outbreak control in institutions that house patients at higher risk for influenza complications. In addition to antiviral medications, other outbreak-control measures include instituting droplet and contact precautions and establishing cohorts of patients with confirmed or suspected influenza, re-offering influenza vaccination (if available) to unvaccinated staff and patients, restricting staff movement between wards or buildings, and restricting contact between ill staff or visitors and patients.

Dr.T.V.Rao MD 44

Dealing Patients with suspected Influenza

1. Follow Respiratory Hygiene and Cough Etiquette precautions

2. Triage: Fever, Travel history, Occupational exposure, Contact history and Cluster of persons with fever and pneumonia symptoms.

3. Designated areas for suspected patients while waiting for referral and arrange speedy consultation and management

4. Wear appropriate PPE

5. Environment and equipment cleaning and disinfection

Dr.T.V.Rao MD 45

Antiviral Drugs Can Be Used

to Treat Illness

For treatment (and

prevention) of human

infection with avian

influenza A viruses, CDC

and WHO currently

recommend oseltamivir

or zanamivir, two of four

prescription antiviral

medications currently

licensed for use in the

United States.

Dr.T.V.Rao MD 46

Control with Antiviral DrugsBoth adamantine and neuraminidase inhibitors have been used successfully to control outbreaks caused by susceptible strains when antiviral medications are combined with other infection-control measures.

Currently Oseltamivir has gained importance as safe and effective Antiviral agent.

Dr.T.V.Rao MD 47

• No Visitors• A sign-in log

• Clean clothing and sanitized footwear• Properly maintained foot pans with

disinfectant solution• Rodent and insect control

• No other animals, esp. wild birds • Vaccination • All in, all out• Sanitize hands

MINIMUM BIOSECURITY

STANDARDS

HAND WASHING REDUCES

SPREAD OF INFLUENZA

Dr.T.V.Rao MD 49

Clean Hands – Safe Hands

Even Reduces Influenza

Washing your

hands often with

soap and water,

especially after you

cough or sneeze.

You can also use

alcohol-based

hand cleaners.

Dr.T.V.Rao MD 50

Avian influenza A(H7N9) virus

An Emerging Strain

The latest avian influenza

virus strain added to the

list of agents causing "bird

flu" is called avian

influenza A(H7N9) virus -

a colourfully exciting

reference to its key

surface proteins

Dr.T.V.Rao MD 51

Dr.T.V.Rao MD 53

References

Centre for Disease Control (CDC)

World Health Organization ( WHO)

Google Images

Dr.T.V.Rao MD 54

Visit me for More Articles of Interest

on Infectious Diseases at ..

Dr.T.V.Rao MD 55

Programme Created By

Dr.T.V.Rao MD for Medical and

Health Care Professionals

Email

doctortvrao@gmail.com

Dr.T.V.Rao MD 56