Avian Influenza in Romania

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Avian Influenza in Romania

• Health Unit
• U.S. Embassy, Bucharest
• March 2006

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Influenza Definitions

• Seasonal Influenza human viruses
• Avian Influenza (AI) viral disease that affects
  primarily birds
• Pandemic Influenza (PI) when a new influenza
  virus appears that people have not been
  previously exposed to before

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H5N1 Among Animals

• Avian influenza A (H5N1) infections in poultry or
  wild birds have occurred in many countries in
  Asia, Europe and Africa.
• Several cases of infected domestic cats have been
  discovered in Europe.

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Countries Affected by Avian Influenza in Animals
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H5N1 Among Humans

• WHO has reported human cases of avian influenza A
  (H5N1) in the following countries
• Cambodia
• China
• Indonesia
• Thailand
• Turkey
• Vietnam
• Iraq
• Azerbaijan
• 184 cases, 103 deaths (as of 21 March 2006)

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Countries With Confirmed Human Cases of H5N1
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H5N1 AI In Our Region

• October 15, 2005 outbreak in Romanias Danube
  Delta confirmed as H5N1
• October 16, 2005 outbreak in Turkey confirmed as
  H5N1
• October 26, 2005 Croatia confirms H5N1 in wild
  birds
• December 5, 2005 Ukraine reports H5N1 in domestic
  birds
• January 4, 2006 human infection first announced
  in Turkey
• February 11, 2006 Bulgaria, Greece and Italy
  confirm H5N1 in wild birds
• February 21, 2006 Hungary confirms H5N1 in wild
  birds
• February 25, 2006 Bonsia-Herzegovina confirms
  H5N1 in wild birds
• March 2, 2006 Serbia-Montenegro reports H5N1 in
  wild birds

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H5N1 Transmission to Humans

• Reservoir water fowl
• Spread through domestic and wild fowl
• Direct contact with sick or infected birds
• Saliva, blood, feces
• Contaminated surfaces
• Human-to-human transmission extremely rare

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H5N1 Among Humans in Turkey

• Human cases have now been reported in 9 provinces
• Laboratory confirmed disease according the
  Turkish Ministry of Health is 20.
• Total deaths from laboratory confirmed disease 4

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H5N1 Among Humans in Turkey

• Affected primarily young children
• NO evidence of human-to-human transmission
• All cases have had direct contact with sick or
  dead poultry or wild birds

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Whats Being Done?
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Ministry of Agriculture

• Information
• Quarantines
• Culling birds
• Effect on commercial operations

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Ministry of Health

• Working with International Organizations
• Care for the sick
• Testing suspected cases
• Tamiflu

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U.S. Government

• U.S. Embassy is monitoring the situation
• Warden notices, information on website
• Inter-agency team (USDA, USAID, HHS) here in
  Romania, meeting with GOR counterparts
• Assessing situation and ways USG can support
  Romania

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Pandemic Influenza vs Avian Influenza What is the
Difference?

• Avian Influenza (AI) large group of influenza
  viruses that primarily affect birds
• Pandemic influenza (PI) when a new sub-strain
  emerges not previously circulated in humans
• Once adaptation occurs, it will be a human
  influenza virus
• H5N1 strain has pandemic potential

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Requirements for a Pandemic

• A new virus emerges for which the population has
  no immunity
• The new virus must be able to replicate in humans
  and cause disease
• The new virus must be efficiently transmitted
  from human to human

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Is a Pandemic imminent?

• Influenza pandemics are rare but recurring events
• Some scientists believe it is only a matter of
  time until next pandemic
• Timing and severity cannot be predicted
• Influenza pandemics occurred three times in last
  century 1918, 1957 1968

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Characteristics and Challenges of a Pandemic

• Rapid world wide spread
• Global spread is inevitable
• Border closures and travel restrictions may delay
  arrival of virus, but cannot stop it
• Occurs in waves from 6-12 weeks long
• Second wave occurs 3-12 months after first

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Health Care Challenges

• Most people have little or no immunity
• Infection and illness rates will dramatically
  increase
• Many people will require some form of medical
  care
• Inadequate supplies of anti-viral drugs
• Resistance to anti-viral drugs

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What is the US Government Doing?

• www.pandemicflu.gov
• Collaborating with WHO to monitor and contain
  outbreaks
• Developing stockpiles of medications
• Support testing and manufacture of vaccines
• Helping local and international govts and
  businesses to prepare for PI outbreak

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Department of State Plan

• Well along in development modeled after
  Federal Govt plan
• Information
• Preparation
• Washington
• Field

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Embassy/Consulate Plan

• Monitoring
• Planning
• Preparing

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What can you do?
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What can you do?

• Inform yourself
• Avoid contact with poultry and wild birds
• Avoid backyard farms
• Avoid live poultry markets
• Wash your hands frequently (soap and water, or
  alcohol based hand gels)

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Model good hygiene

• Preventing respiratory infection is key
• Cover your nose/mouth when coughing or sneezing
• Use disposable tissues then dispose of them!
• Wash hands frequently with soap and water or
  alcohol hand gel.
• Stay away from sick people.
• STAY HOME from work and school if sick!

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When Preparing Food

• Separate raw meat and its juices from cooked or
  ready-to-eat foods
• Use separate cutting boards
• Do not place cooked meat back on same surface or
  plate it was on before it was cooked
• Wash eggs (shells) in soapy water
• Cook all poultry products thoroughly (70C or
  158F)
• Wash all surfaces with soap and water

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Plan for a Pandemic

• Store a supply of food and water
• Obtain an extra supply of your regular
  prescription medication
• Have other nonprescription drugs and
  medical/health supplies on hand
• Plan how you or your family members would obtain
  or give care at home if sick

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Items to have on hand for an extended stay at home
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Food and Non-perishables

• Ready to eat canned meats, fruits, vegetables and
  soups
• Protein or fruit bars
• Dried fruit
• Crackers
• Bottled water
• Pet food

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Medical Health Supplies

• Prescription medications
• Acetaminophen, Ibuprofen
• Anti-diarrhea medication
• Vitamins
• Fluids and electrolytes
• Thermometer
• Alcohol based hand wash

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Emergency Supplies

• Clorox or water purification tablets
• Flashlight / candles
• Batteries
• Portable radio
• Manual can opener
• Garbage bags
• Tissues, toilet paper, disposable diapers

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If a Pandemic Occurs

• Avoid people who are sick
• If you are sick STAY HOME
• Contact your health care provider

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Summary

• Be informed
• Be prepared
• Practice healthy
• habits