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Avian Influenza Update from the CDC


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Hi All,

I did my own self-required search and since this didn't really fit into the existing posts on the subject I started a new thread. For those who are interested here's some more recent info on Avian Influenza from the CDC.

This update provides revised interim guidance for testing of suspected human cases of avian influenza A (H5N1) in the United States and is based on the current state of knowledge regarding human infection with H5N1 viruses. The epidemiology of H5N1 human infections has not changed significantly since February 2004. Therefore, CDC recommends that H5N1 surveillance in the United States remain at the enhanced level first established at that time. However, this revised interim guidance provides an updated case definition of a suspected H5N1 human case for the purpose of determining when testing should be undertaken and also provides more detailed information on laboratory testing. Effective surveillance will continue to rely on health care providers obtaining information regarding international travel and other exposure risks from persons with specified respiratory symptoms as detailed in the recommendations below. This guidance will be updated as the epidemiology of H5N1 changes. Note: CDC is revising its interim guidance for infection control precautions for avian influenza A (H5N1). These will be issued as soon as they are available.

Current Situation

The avian influenza A (H5N1) epizootic (animal outbreak) in Asia has expanded to wild birds and/or poultry in parts of Europe, the Near East and Africa. Sporadic human infections with H5N1 continue to be reported and have most recently occurred in China, Egypt, Indonesia, Azerbaijan, Cambodia, and Djibouti. In addition, rare instances of probable human-to-human transmission associated with H5N1 viruses have occurred, most recently in a family cluster in Indonesia. So far, however, the spread of H5N1 virus from person to person has been rare, inefficient, and unsustained. The total number of confirmed human cases of H5N1 reported as of June 7, 2006 has reached 225. The case fatality rate for these reported cases continues to be approximately 50 percent. As of this date, H5N1 has not been identified among animals or humans in the United States.

The epizootic in Asia and parts of Europe, the Near East and Africa is not expected to diminish significantly in the short term and it is likely that H5N1 infection among birds has become enzootic in certain areas. It is expected that human infections resulting from direct contact with infected poultry will continue to occur in affected countries. Since no sustained human-to-human transmission of influenza H5N1 has been documented anywhere in the world, the current phase of alert, based on the World Health Organization (WHO) global influenza preparedness plan, remains at Phase 3 (Pandemic Alert).* In addition, no evidence for genetic reassortment between human and avian influenza A virus genes has been found. Nevertheless, this expanding epizootic continues to pose an important and growing public health threat. CDC is in communication with WHO and other national and international agencies and continues to monitor the situation closely.

Reporting and Testing Guidelines

CDC recommends maintaining the enhanced surveillance efforts practiced currently by state and local health departments, hospitals, and clinicians to identify patients at increased risk for avian influenza A (H5N1). Guidance for enhanced surveillance was first described in a HAN update issued on February 3, 2004 and most recently updated on February 4, 2005.

Testing for avian influenza A (H5N1) virus infection is recommended for:

A patient who has an illness that:

¡× requires hospitalization or is fatal; AND

¡× has or had a documented temperature of ¡Ã38¡ÆC (¡Ã100.4¡Æ F); AND

¡× has radiographically confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness for which an alternate diagnosis has not been established; AND

¡× has at least one of the following potential exposures within 10 days of symptom onset:

A) History of travel to a country with influenza H5N1 documented in poultry, wild birds, and/or humans,¢Ó AND had at least one of the following potential exposures during travel:

• direct contact with (e.g., touching) sick or dead domestic poultry;

• direct contact with surfaces contaminated with poultry feces;

• consumption of raw or incompletely cooked poultry or poultry products;

• direct contact with sick or dead wild birds suspected or confirmed to have influenza H5N1;

• close contact (approach within 1 meter [approx. 3 feet]) of a person who was hospitalized or died due to a severe unexplained respiratory illness;

:P Close contact (approach within 1 meter [approx. 3 feet]) of an ill patient who was confirmed or suspected to have H5N1;

C) Worked with live influenza H5N1 virus in a laboratory.

Testing for avian influenza A (H5N1) virus infection can be considered on a case-by-case basis, in consultation with local and state health departments, for:

• A patient with mild or atypical disease¢Ô (hospitalized or ambulatory) who has one of the exposures listed above (criteria A, B, or C); OR

• A patient with severe or fatal respiratory disease whose epidemiological information is uncertain, unavailable, or otherwise suspicious but does not meet the criteria above (examples include: a returned traveler from an influenza H5N1-affected country whose exposures are unclear or suspicious, a person who had contact with sick or well-appearing poultry, etc.)

Clinicians should contact their local or state health department as soon as possible to report any suspected human case of influenza H5N1 in the United States.

Specimen Collection and Testing Guidelines

¡× Oropharyngeal swab specimens and lower respiratory tract specimens (e.g., bronchoalveolar lavage or tracheal aspirates) are preferred because they appear to contain the highest quantity of virus for influenza H5N1 detection, as determined on the basis of available data. Nasal or nasopharyngeal swab specimens are acceptable, but may contain less virus and therefore not be optimal specimens for virus detection.

¡× Detection of influenza H5N1 is more likely from specimens collected within the first 3 days of illness onset. If possible, serial specimens should be obtained over several days from the same patient.

¡× Bronchoalveolar lavage is considered to be a high-risk aerosol-generating procedure. Therefore, infection control precautions should include the use of gloves, gown, goggles or face shield, and a fit-tested respirator with an N-95 or higher rated filter. A loose-fitting powered air-purifying respirator (PAPR) may be used if fit-testing is not possible (for example, if the person has a beard). Detailed guidance on infection control precautions for health care workers caring for suspected influenza H5N1 patients is available.||

¡× Swabs used for specimen collection should have a Dacron tip and an aluminum or plastic shaft. Swabs with calcium alginate or cotton tips and wooden shafts are not recommended.¡× Specimens should be placed at 4¡ÆC immediately after collection.

¡× For reverse-transcriptase polymerase chain reaction (RT-PCR) analysis, nucleic acid extraction lysis buffer can be added to specimens (for virus inactivation and RNA stabilization), after which specimens can be stored and shipped at 4¡ÆC. Otherwise, specimens should be frozen at or below -70¡ÆC and shipped on dry ice. For viral isolation, specimens can be stored and shipped at 4¡ÆC. If specimens are not expected to be inoculated into culture within 2 days, they should be frozen at or below -70¡ÆC and shipped on dry ice. Avoid repeated freeze/thaw cycles.

¡× Influenza H5N1-specific RT-PCR testing conducted under Biosafety Level 2 conditions¢Ò is the preferred method for diagnosis. All state public health laboratories, several local public health laboratories, and CDC are able to perform influenza H5N1 RT-PCR testing, and are the recommended sites for initial diagnosis.

¡× Viral culture should NOT be attempted on specimens from patients suspected to have influenza H5N1, unless conducted under Biosafety Level 3 conditions with enhancements.¢Ò

¡× Commercial rapid influenza antigen testing in the evaluation of suspected influenza H5N1 cases should be interpreted with caution. Clinicians should be aware that these tests have relatively low sensitivities, and a negative result would not exclude a diagnosis of influenza H5N1. In addition, a positive result does not distinguish between seasonal and avian influenza A viruses.

¡× Serologic testing for influenza H5N1-specific antibody, using appropriately timed specimens, can be considered if other influenza H5N1 diagnostic testing methods are unsuccessful (for example, due to delays in respiratory specimen collection). Paired serum specimens from the same patient are required for influenza H5N1 diagnosis: one sample should be tested within the first week of illness, and a second sample should be tested 2-4 weeks later. A demonstrated rise in the H5N1-specific antibody level is required for a diagnosis of H5N1 infection. Currently, the microneutralization assay, which requires live virus, is the recommended test for measuring H5N1-specific antibody. Any work with live wild-type highly pathogenic influenza H5N1 viruses must be conducted in a USDA- approved Biosafety Level 3 enhanced containment facility. Visit http://www.cdc.gov/flu/h2n2bsl3.htm for more information about procedures and facilities recommended for manipulating highly pathogenic avian influenza viruses.

Laboratory testing results positive for influenza A (H5N1) in the United States should be confirmed at CDC, which has been designated as a WHO H5 Reference Laboratory. Before sending specimens, state and local health departments should contact CDC¡¯s on-call epidemiologist at (404) 639-3747 or (404) 639-3591 (Monday – Friday, 8:30 AM - 5:00 PM) or (770) 488-7100 (all other times).

Travel Health Notice

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1. However, CDC does recommend that travelers to these countries avoid poultry farms and bird markets or other places where live poultry are raised or kept. For details about other ways to reduce the risk of infection, see http://www.cdc.gov/travel/other/avian_infl...e_asia_2005.htm.

More Information

Department of Health and Human Services at www.pandemicflu.gov

World Health Organization at

World Organization for Animal Health (OIE) at http://www.oie.int/eng/en_index.htm

*For the current WHO Pandemic Phase, see http://www.who.int/csr/disease/avian_influ...e/en/index.html.

¢Ó For a listing of influenza H5N1-affected countries, visit the CDC website at http://www.cdc.gov/flu/avian/outbreaks/current.htm; the OIE website at http://www.oie.int/eng/en_index.htm; and the WHO website at http://www.who.int/csr/disease/avian_influenza/en/.

¢Ô For example, a patient with respiratory illness and fever who does not require hospitalization, or a patient with significant neurologic or gastrointestinal symptoms in the absence of respiratory disease.

|| Interim recommendations for infection control in health-care facilities caring for patients with known or suspected avian influenza are available at http://www.cdc.gov/flu/avian/professional/infect-control.htm.

¡× Specimens can be transported in viral transport media, Hanks balanced salt solution, cell culture medium, tryptose-phosphate broth, veal infusion broth, or sucrose-phosphate buffer. Transport media should be supplemented with protein, such as bovine serum albumin or gelatin, to a concentration of 0.5% to 1%.

¢Ò Information regarding Laboratory Biosafety Level Criteria can be found at http://www.cdc.gov/od/ohs/biosfty/bmbl4/bmbl4s3.htm.

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. Links to non-Federal organizations are provided solely as a service to our users. Links do not constitute an endorsement of any organization by CDC or the Federal Government, and none should be inferred. The CDC is not responsible for the content of the individual organizations.

Hope this helps,

ACE844

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  • 1 month later...

(Vol. 296 No. 3 @ July 19, 2006

Avian Flu Clue

Joan Stephenson, PhD

JAMA. 2006;296:272.)

Scientists from Hong Kong report new findings that support the hypothesis that some H5N1 avian influenza viruses are particularly deadly to humans because they can trigger a "cytokine storm" that causes the immune system to overreact (Zhou J et al. J Infect Dis. 2006;194:61-70).

The researchers infected cultured human immune cells (monocyte-derived macrophages [MDMs]) with human influenza virus or with the H5N1 strain that caused a deadly 1997 outbreak in Hong Kong. They found that the H5N1-infected MDMs produced much higher levels of chemokines, a type of cytokine that directs white blood cells to inflammation sites. In addition, levels of chemokines and chemokine receptors were higher in MDMs from adults than in MDMs from newborns, suggesting that chemokines might be a key to the 1997 outbreak's higher mortality rate among adults.

Scientists have suggested that a cytokine storm played a role in the virulence of the 1918 Spanish flu pandemic. Previous research frequently noted severe lung damage in those who died in the 1918 pandemic; similar damage has been found in lung tissue of individuals killed in recent avian flu outbreaks.

The strong induction of chemokines and their receptors by avian flu viruses, particularly in adult immune cells, "may account for the severity of H5N1 disease," the researchers noted.

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You must have misunderstood what was reported about a vaccine. I attended a conference on this subject this month, and the epidemiologist stated that a vaccine could not be developed until about 6-8 months after the virus crossed over to humans. That has occured in central Asia, so a vaccine may be available for that particular strain. That will not do any good for anyone who gets it in the future, as the virus will change by then. Everyone should read up on this one, as it will kill more 20-40 year olds than the previous flus due to the immune system issues that were mentioned above (usually children and elderly are hit worse). The flu of the early 1900s killed 600 million people world-wide, the experts are predicting this one to be far worse.

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You must have misunderstood what was reported about a vaccine. I attended a conference on this subject this month, and the epidemiologist stated that a vaccine could not be developed until about 6-8 months after the virus crossed over to humans. That has occured in central Asia, so a vaccine may be available for that particular strain. That will not do any good for anyone who gets it in the future, as the virus will change by then. Everyone should read up on this one, as it will kill more 20-40 year olds than the previous flus due to the immune system issues that were mentioned above (usually children and elderly are hit worse). The flu of the early 1900s killed 600 million people world-wide, the experts are predicting this one to be far worse.

"GAMEDIC,"

I am going to say this once, and politely. Kindly don't tell me what I do and don't understand because as you can see I was the one who posted the majority of the information here about this. Also, based on your posts it appears to be YOU who needs to evaluate what is and isn't understood in your world. There are a number of threads initiated on this board which are awaiting your replies to overwhelming evidence which contradict the things you have posted and reported as fact. So in closing, until you post facts, and answer the other posts with verifiable and 'reputable' information, don't come here and preach to me about what I do and don't understand..Here's your:

7ff353322b.jpg

OUT HERE,

ACE844

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You must have misunderstood what was reported about a vaccine. I attended a conference on this subject this month, and the epidemiologist stated that a vaccine could not be developed until about 6-8 months after the virus crossed over to humans. That has occured in central Asia, so a vaccine may be available for that particular strain. That will not do any good for anyone who gets it in the future, as the virus will change by then. Everyone should read up on this one, as it will kill more 20-40 year olds than the previous flus due to the immune system issues that were mentioned above (usually children and elderly are hit worse). The flu of the early 1900s killed 600 million people world-wide, the experts are predicting this one to be far worse.

GA

Sorry, I didn't misunderstand what was reported. I just included the links so people could read the articles for informational purposes. I was not advocating there is a vaccine, just reporting what I read.

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GA

Sorry, I didn't misunderstand what was reported. I just included the links so people could read the articles for informational purposes. I was not advocating there is a vaccine, just reporting what I read.

I think he was trying to talk at us again with no room for discourse, and or made a vague personal attack as he posted right below me...either way, this poster needs to stow the pulpit..

ACE

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Go to www.pandemicflu.gov --- everything I have stated is fact, and will make it's way to you soon. Our public health agency is taking great pains to educate ems, fire, and PD to this upcoming threat. I imagine other states will do so also. And there was no attack, I just wanted to state the "Facts".

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