Avian Influenza

Avian Influenza: What it Means to an Environmental Health Specialist Larry D. Michael, RS, MPH Program Manager Dairy and Food Protection Branch NCDENR Overview  Pandemic Influenza  Why the Concern?  Current Status of Avian Influenza  Public Health Impact  Avian Influenza and Poultry Consumption  What Should You Do? Pandemic Influenza  Worldwide epidemics – Potential excess death and illness – Multiple waves possible  Six to eight weeks long Goode., B., Avian Influenza Seminar, April 2007 Pandemic “Prerequisites”  New flu virus emerges  New flu virus causes disease in humans  Novel virus can be efficiently transmitted person to person Dr. Asamoa-Baah, Assistant Director General, WHO Communicable Diseases WHO Pandemic Alert Phase Avianflu.gov Osterholm, M., University of Minnesota Avian Influenza (AI) “Bird Flu”  Migratory waterfowl are the natural reservoir – Carry virus in intestines – Virus shed in feces and respiratory secretions – Usually do not get sick – Many more flu types  Source of potential pandemic strains Goode, B., Avian Influenza Seminar, April 2007 Why the Concern over H5N1?  Pandemic influenza viruses – Appear in the human population periodically – H5N1 is a likely candidate, but is not a pandemic virus yet  Antigenic drift – Genetic composition of the viruses change as they mutate in their replications  Antigenic shift – Reassortment of genetic material from two different species as virus subtypes merge. Key Prevention Method! Nations w/ Confirmed Cases H5N1  Avianflu.gov www.pandemicflu.gov, April 2007 Federal Pandemic Plans  National Strategy for Pandemic Influenza  Homeland Security Council Implementation Plan for the National Strategy for Pandemic Influenza  HHS Pandemic Influenza Plan – Strategic Plan – Public Health Guidance for State and Local Partners – HHS Operational Plan (incl. continuity of operations NC Pandemic Influenza Plan  Communicable Disease Control Section, DHHS – http://www.epi.state.nc.us/epi/gcdc/pandemic.html Planning Assumptions in the US  Susceptibility to pandemic influenza will be universal.  Overall, 30% of the population will become ill.  50% of those who are ill will seek outpatient medical care.  The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Smith, N.M., CDC US Burden of Influenza  Seasonal – >200,000 hospitalizations – 36,000 deaths  Pandemic Moderate (1957-like) Severe (1918-like) 90 million (30%) 45 million (50%) 9, 900,000 1,485,000 90 million (30%) 45 million (50%) 865,000 128,750 Illness Outpatient medical care Hospitalization ICU care Mechanical ventilation Deaths 64,875 209,000 CDC 745,500 1,903,000 North Carolina Impact Seasonal Doctor visits Hospital visits Deaths 750,000 6,000 1,100 Moderate Pandemic* 1.6 million 35,000 7,950 Severe Pandemic* 1.6 million 290,000 65,300 * Based on CDC software FluAid 2.0: Assumes a 35% attack rate, NC population of 8.5 million people. In North Carolina…   290,000 Needing hospitalization – How many licensed and staffed beds in NC? Between 2,600 and 6,100 will need ventilation equipment – How many ventilators do we have? Planning Assumptions in the US       The typical incubation period for influenza averages 2 days. Persons who become ill may transmit infection for one-half to one day before the onset of illness. On average about 2 secondary infections will occur as a result of transmission from someone who is ill. In an affected community, a pandemic outbreak will last about 6 to 8 weeks. Work/school absenteeism may be as high as 40% at the peak. At least two pandemic disease waves are likely. CDC Potential Strategies to Decrease the Impact of a Pandemic  Antiviral treatment and isolation  Quarantine  Social for those exposed distancing when available  Vaccine Deaths Rates / 100,000 Population (Annual Basis) 9/ 14 10000 12000 14000 16000 2000 4000 6000 8000 0 Goode, B., Avian Influenza Seminar, April 2007 1918 Death Rates: Philadelphia v St. Louis Date Graphic from Brant Goode (CDC) /1 9/ 91 21 8 /1 9/ 91 28 8 /1 10 918 /5 10 /19 /1 18 2/ 10 191 /1 9/ 8 10 19 /2 18 6/ 1 11 918 /2 /1 11 91 /9 8 / 11 191 /1 6/ 8 11 19 /2 18 3 11 /191 /3 0/ 8 1 12 91 /7 8 / 12 191 /1 8 4/ 12 19 /2 18 1/ 12 19 /2 18 8/ 19 18 Philadelphia St. Louis St. Louis St. Louis Death Rate / 100,000 Population (Annual Basis) 14000 12000 10000 8000 6000 4000 2000 0 Estimated attack rate before interventions: First death recorded 2.2% Mayor closes “theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions until further notice” Closing order withdrawn 21 8 /1 91 9/ 28 8 /1 91 10 8 /5 /1 91 10 8 /1 2/ 19 10 18 /1 9/ 19 10 18 /2 6/ 19 18 11 /2 /1 91 11 8 /9 /1 91 11 8 /1 6/ 19 11 18 /2 3/ 19 11 18 /3 0/ 19 18 12 /7 /1 91 12 8 /1 4/ 19 12 18 /2 1/ 19 12 18 /2 8/ 19 18 9/ 14 /1 9/ 91 Date Source: Lipsitch M, Hatchett R, Mecher C Is Avian Influenza a Concern in Food? Overreaction? What if H5N1 Made it to the US (No Human Cases)?  Survey in NE USA – 46% would stop buying/eating poultry – 25% would reduce buying/eating poultry – 27% would keep buying/eating – 2% don’t know Harvard School of Public Health Project on the Public and Biological Security, January 17-25, 2006 Adapted from Slenning, B.D., 2006 Value of Poultry to NC  Primary production of poultry is worth approximately 2.7 Billion to the state.  Approximately 16 Billion when you add the entire poultry food chain (processing, marketing, transportation, restaurants, etc.)  Nearly 20% of NC population works in an agriculture/food-related job. Adapted from Slenning, B.D., 2006. Data excerpted from NCDA and Consumer Services Is Poultry Safe?  Food products of concern – Raw Poultry – Raw Eggs  No documented cases of Avian Influenza from eating poultry products  Extensive monitoring and control program Approved Source – Inspected by NCDA & Consumer Services, Meat and Poultry Inspection Service – USDA   USDA Poultry Inspection Legend USDA Red Meat Inspection Legend Asian Sources  Restrictions on live birds, poultry and poultry products from Asian countries  Processed poultry is not imported from Asia. Birds on a Two-wheeler World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf Lack of Hygiene World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf Asian Wet Market World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf Intermingling World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf Slaughtering/Selling in Same Area World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf What’s the Worst-case Scenario?  Finding it in Food?  Sustained Person-to-Person Transmission of H5N1? Proper Cooking Will Kill H5N1 What Now?  Vaccination  Good personal hygiene  Stay home if ill  Develop a COOP at work  Educate  Stay informed  Get involved Pandemic Flu Planning        Two weeks supply of water and food – Fluids with electrolytes RTE canned meats, fish, fruits, vegs, soups Protein or fruit bars Dry cereal or granola Peanut butter or nuts Dried fruit Pet food Pandemic Flu Planning         Prescription and nonprescription drugs Soap/hand sanitizing gel Thermometer Flashlight Batteries Portable radio Manual can opener Toilet paper Online Resources www.who.org www.cdc.gov www.ncpublichealth.com Dairy and Food Protection Branch  Larry Michael – (919) 715-0927 – Larry.Michael@ncmail.net