Avian Influenza October 27, 2006 Mini University

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Avian InfluenzaOctober 27, 2006Mini University
Dr. Dennis Carroll, Director USAID Avian and
Pandemic Influenza Preparedness and Response Unit
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Presentation Overview

• Part 1
• Avian Influenza Update
• Part 2
• Poverty and Newly Emergent Diseases

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• If this is Y2K, all over again .
• . If so,
• when is January 1, 2000?

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• Part 1
• What is Avian Influenza?
• Why all the concern?
• What is being done internationally?

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What is Avian Influenza?

• The H5N1 AI virus mainly affects domestic wild
  birds
• The AI is closely related to influenza viruses
  that cause annual flu outbreaks among humans
• AI viruses can mutate rapidly and able to evade
  human immune systems
• H5N1 AI virus very lethal to animals and humans
• - 55 countries affected, 38 new in 2006
• - estimated 250 million birds killed
• - 256 lab-confirmed human cases with 151
  deaths in 8 countries a 59 mortality rate

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How is AI spread?

• Animal human populations in close proximity
• - farm animals and pets in/under/next to
  houses
• - live animal markets (many species from
  many countries)
• Poor agricultural practices
• - inadequate infection control on farms
• - poultry excrement used in agriculture
  (e.g. fed to pigs)
• Poor food hygiene
• - food preparation practices
• - consumption of raw/undercooked meat
• Frequent travel/trade involving humans and birds
• - movement of people/animals among farms
• - legal and illegal animal trade
• - wild bird migration

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Is a Pandemic Possible?
30 40 years cycle
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and FAO
Map courtesy of FAO using data from OIE
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Is it Deja Vu all over again? - the 1918 Pandemic

• Three epidemic waves in close succession
• March 1918 Sept 1918 Feb 1919
• Estimated 50 -100 million deaths world-wide
• In the U.S.
• 10 million hospitalizations
• 2 million deaths

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Could AI cause a pandemic?

• Requirements for pandemic flu
• Novel virus
• Ability to replicate in humans and cause serious
  damage
• Ability to pass efficiently from person to person

H5N1 Yes Yes Not yet
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Take Home Lessons

• To-date H5N1 principally an animal based
  infection
• Spreading of virus appears linked to a
  combination of bird migration and unregulated
  bird trade
• Effective response needs to be cross-sectoral
  spanning animal and human health
• Early detection and rapid response to outbreaks
  essential for containment
• An informed public and adoption of low risk
  behaviors key
• National leadership is critical

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U.S. and International Response

• WHO and FAO providing international leadership
• International Partnership for Avian and Pandemic
  Influenza key forum for international
  coordination
• 1.9 billion pledged by international community
  at Beijing Conference January 2006
• U.S. pledged 334 million and is actively
  working in more than 50 countries to contain AI

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US International AI Strategy

• Goal to contain and mitigate the effect of an
  outbreak of pandemic influenza
• Objectives
• prevent and contain H5N1 outbreaks in
  animals
• prevent animal-to-human infections
• prepare for a human influenza pandemic

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US International AI Strategy

• Key principles
• an emergency response
• use existing platforms for efficiency
• support WHO, FAO/OIE as the lead technical
  organizations
• work closely across the USG
• cross-sector approach bridging animal and human
  health
• Tactical Pillars
• Preparedness and Planning
• Early Warning Surveillance Diagnosis
• Rapid Response and Containment
• Behavior Change Communications Advocacy
• Stockpiling and Deployment of key commodities

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National Strategy for Pandemic Influenza A
coordinated USG approach
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Part 2. Poverty and Newly Emergent Diseases
The Chicken that Lays the Golden Egg
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Presentation Overview

• Household Economics and Avian Influenza.
• The Role of Poverty in the Emergence and Spread
  of AI.
• Time for a Transformational Strategy.

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General Observations

• In the past year more than 4,000 AI outbreaks
  have been reported to OIE
• Of these an estimated 75 have been in backyard
  or mom and pop farms

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General Observations

• These small-farm holders largely fall into the
  lowest economic quintiles
• Poultry farming make significant contributions to
  household
• Nutrition
• Livelihood

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The Viet Nam Example

• In Viet Nam
• ½ of all households rural and urban keep
  chickens
• In rural areas 7/10 households a total of 8
  million HHs own chickens
• Average flock size is 16 birds (4 hens, 1 cock,
  and 11 growers and chicks)
• Only 1 of flocks consist of more than 100 birds

Sources Pro-Poor Livestock Initiative
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• Chickens mostly kept as backyard flocks by small
  holders with an average per capita income of less
  than 100 USD per year
• A flock of 12 hens yield a month income of around
  18 USD through the sale of eggs and birds
• Based on an initial investment of 2.50 USD for
  the purchase of a hen and 0.65 USD required for a
  fraction of a cock the annual return to
  capital investment is nearly 700

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• In addition to the high rate of return a
  further advantage of investing in poultry is the
  flexibility to partition the investment in small
  amounts of cash throughout the year, as needed.

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• At a national level cessation of back yard
  farming in Viet Nam would lead to a lost income
  of 550 million USD per year, or 5 of
  agricultural GDP, or 2.5 million full time jobs
  at minimum rural wage rate

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• Applying these findings, even partially, across
  the 4,000 outbreaks recorded over the past year
  highlights the important contribution poultry
  rearing makes to the economic and nutritional
  welfare to the poor.

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• Conclusion 1 for reasons of equity and economic
  efficiency it is important that the
  socio-economic impact of AI control measures be
  assessed before applied.

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A Double Edged Sword

• Conclusion 2 this very attractiveness has
  contributed to an explosion of poultry rearing
  to meet the nutritional and economic needs of
  ever expanding populations

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The China Syndrome

• In China in 1969 there were an estimated 50
  million poultry being raised to feed a population
  of 750 million.
• By 1999 this number increased to 15 billion
• In China, and elsewhere in the region this
  dramatic increase in poultry farming was largely
  on non-industrial farms following traditional
  animal husbandry practices

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• The mixture of high populations of people and
  poultry has created a cauldron of emergent
  infectious diseases where there is the increased
  probability that poultry viruses such as H5N1
  can infect humans and give rise to new pandemic
  strains.

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Newly Identified Infectious Diseases and Pathogens
Avian Influenza Nipah Virus New variant
Creutzfelt-Jacob disease Savia virus Hendra
virus Vibrio choerae 0139 Hepatitis C HIV
SARS H5N1 (AI A virus) Kaposis sarcoma
virus Hantavirus Guanarito virus Hepatitis E
human herpesvirus 6
2004 2003 1999 1997 1996 1995 1994 1993 1992 1991
1989 1988 1983
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A. Fauci, NIAID
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• While much of the public and political discussion
  on how best to respond to AI has been dominated
  by emergency responses which are of critical
  importance these strategies will not be
  sufficient to lower risk of a pandemic influenza
  from actually happening

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• Short of reversing the size of the global
  population we need to ask how the animal
  husbandry and market place practices that are
  driving the emergence of new human pathogens can
  themselves be transformed

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• By focusing exclusively on building a protective
  shield of vaccines, drugs and early warnings we
  will do little to limit the emergence of newer
  and deadlier pathogens

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• What we do risk is making influenza and other
  zoonotic diseases a scourge inflicted on those
  who cant afford or access vaccines and drugs
• .. In short, diseases of the poor as has
  happened with malaria, tuberculosis and HIV/AIDS