AVIAN INFLUENZA-CURRENT SITUATION
Avian Influenza: Current Situation
On this page:
* Summary
* Human H5N1 Cases
* Animal H5N1 Cases
* Assessment of Current Situation
* Bird Import Ban
* Travel
* CDC Response
*
Avian Flu Outbreaks
* Current Situation
* Past Outbreaks
* Embargo of Birds
* Quarantine Executive Order
(From the White House)
* Quarantine Executive Order Q & A
Summary
Influenza A (H5N1) is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them. Outbreaks of H5N1 among poultry are ongoing in a number of countries. While H5N1 does not usually infect people, human cases of H5N1 infection associated with these outbreaks have been reported Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few rare cases of human-to-human spread of H5N1 virus have occurred, though transmission has not continued beyond one person.
Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population and an influenza pandemic (worldwide outbreak of disease) could begin. Experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily from person to person.
Human H5N1 Cases
Human Cases: Summary of Current Situation
Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries:
* East Asia and the Pacific:
o Cambodia
o China
o Indonesia
o Thailand
o Vietnam
* Europe & Eurasia:
o Azerbaijan
(see update)
o Turkey
* Near East:
o Iraq
For additional information about these reports, visit the
World Health Organization Web Site.
Updated March 21, 2006
During August to October 2004, sporadic human cases of avian influenza A (H5N1) were reported in Vietnam and Thailand. Beginning in December 2004, a resurgence of poultry outbreaks and human cases were reported in Vietnam.
On February 2, 2005, the first of four human cases of H5N1 infection from Cambodia were reported. On July 21, 2005, the first human case of H5N1 in Indonesia was reported. Indonesia continued to report human cases from August 2005 into February 2006. Thailand reported new human cases of H5N1 in October, November, and December 2005, and Vietnam reported new human cases in November 2005. China reported the country’s first confirmed human cases in November 2005 and continued to report human cases in December 2005 and into 2006. Turkey reported the country’s first confirmed human cases on January 5, 2006 and has continued to report human cases. The first confirmed human infection with avian influenza A (H5N1) in Iraq was reported on February 2, 2006. In Azerbaijan, the country’s first human cases were reported on March 21, 2006 (see Azerbaijan update).
Animal H5N1 Cases
Animal Cases: Summary of Current Situation
Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries:
* Africa:
o Cameroon
o Niger
o Nigeria
* East Asia & the Pacific:
o Cambodia
o China
o Hong Kong (SARPRC)
o Indonesia
o Japan
o Laos
o Malaysia
o Mongolia
o Myanmar (Burma)
o Thailand
o Vietnam
* Europe & Eurasia:
o Albania
o Austria
o Azerbaijan
o Bosnia & Herzegovina (H5)
o Bulgaria
o Croatia
o Denmark (H5)
o France
o Georgia (H5)
o Germany
o Greece
o Hungary
o Italy
o Poland
o Romania
o Russia
o Serbia and Montenegro (H5)
o Slovak Republic
o Slovenia
o Sweden
o Switzerland
o Turkey
o Ukraine
* Near East:
o Egypt
o Iraq (H5)
o Iran
o Israel
* South Asia:
o Afghanistan
o India
o Kazakhstan
o Pakistan (H5)
For additional information about these reports, visit the
World Organization for Animal Health Web Site.
Updated March 21, 2006
* Beginning in late June 2004, new outbreaks of lethal avian influenza A (H5N1) infection among poultry were reported by several countries in Asia: Cambodia, China, Indonesia, Malaysia, Thailand, and Vietnam.
* Since May 2005, outbreaks of H5N1 disease have been reported among poultry in China, Kazakhstan, Romania, Russia, Turkey, and Ukraine. China, Croatia, Mongolia, and Romania also reported outbreaks of H5N1 in wild, migratory birds since May 2005.
* In January 2006, Hong Kong (SARPRC) reported one dead wild bird.
* Since February 1, 2006, the first cases of H5N1 or H5 infections in poultry or wild birds have been reported in the following countries: Iraq (H5), Nigeria, Azerbaijan, Bulgaria, Greece, Italy, Slovenia, Iran, Austria, Germany, Egypt, India, France, Bosnia and Herzegovina (H5), Slovak Republic, Switzerland, Niger, Hungary, Serbia and Montenegro (H5), Pakistan (H5), Albania, Poland, Georgia, Cameroon, Myanmar (Burma), Sweden, Denmark (H5), Israel, and Afghanistan.
* For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.
Assessment of Current Situation
The avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe is not expected to diminish significantly in the short term. It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry will continue to occur. So far, the spread of H5N1 virus from person-to-person has been rare and has not continued beyond one person. No evidence for genetic reassortment between human and avian influenza A virus genes has been found; however, the epizootic in Asia continues to pose an important public health threat.
There is little pre-existing natural immunity to H5N1 infection in the human population. If these H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death. In addition, genetic sequencing of influenza A (H5N1) viruses from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This would leave two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 virus. Efforts to produce vaccine candidates that would be effective against avian influenza A (H5N1) viruses are under way. However, it will likely require many months before such vaccines could be mass produced and made widely available.
Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease (pathogenic) in mammals than were earlier H5N1 viruses. One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well. Additionally, other findings have documented H5N1 infection among pigs in China and H5N1 infection in felines (experimental infection in housecats in the Netherlands and isolation of H5N1 viruses in tigers and leopards in Thailand ).
Notable findings of epidemiologic investigations of human H5N1 cases in Vietnam during 2005 have suggested transmission of H5N1 viruses to at least two persons through consumption of uncooked duck blood. One possible instance of limited person-to-person transmission of H5N1 virus in Thailand has been reported. This possibility is being further investigated in other clusters of cases in Vietnam and Indonesia.
The majority of known human H5N1 cases have begun with respiratory symptoms. However, one atypical fatal case of encephalitis in a child in southern Vietnam in 2004 was identified retrospectively as H5N1 influenza through testing of cerebrospinal fluid, fecal matter, and throat and serum samples. Further research is needed to ascertain the implications of such findings.
Bird Import Ban
There is currently a ban on the importation of birds and bird products from H5N1-affected countries. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the following countries: Afghanistan, Albania, Azerbaijan, Burma (Myanmar), Cambodia, Cameroon, China, Egypt, France (USDA – defined restricted zone only), India, Indonesia, Israel, Japan, Laos, Kazakhstan, Malaysia, Niger, Nigeria, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, Vietnam and Israel (current as of March 20, 2006). For more information, see Embargo of Birds from Specified Countries.
Travel
Updated Information for Travelers about Avian Influenza A(H5N1) is available at the CDC Travelers’ Health Web site. Also see Guidelines and Recommendations - Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad.
CDC Response
Domestic Activities
* In May 2005, CDC joined a new, inter-agency National Influenza Pandemic Preparedness Task Force organized by the U.S. Secretary of Health and Human Services. This task force is developing and refining preparedness efforts with international, state, local, and private organizational partners to help ensure the most effective response possible when the next influenza pandemic occurs. For more information about the Pandemic Influenza Preparedness Plan of the U.S. Health and Human Services Department and other aspects of this coordinated federal initiative, please visit www.pandemicflu.gov.
* In February 2004, CDC issued recommendations for enhanced domestic surveillance of avian influenza A (H5N1). Following the reports of human deaths in Vietnam in August 2004 and additional human cases in the following months, CDC issued follow-up Health Alert Network (HAN) notices on August 12 and February 4, 2005, reiterating criteria for domestic surveillance, diagnostic evaluation, and infection control precautions for avian influenza A (H5N1). The HAN notice also detailed laboratory testing procedures for H5N1.
* CDC has collaborated with the Association of Public Health Laboratories to conduct training workshops for state laboratories on the use of molecular techniques to rapidly identify H5 viruses.
* CDC is working collaboratively with the Council of State and Territorial Epidemiologists and other partners to assist states with pandemic planning efforts.
* CDC is working with other agencies, such as the Department of Defense and the Department of Veterans Affairs, on antiviral stockpile issues.
International Activities
* CDC is one of four WHO Collaborating Centers and in this capacity provides ongoing support for the global WHO surveillance network, laboratory testing, training, and other actions.
* CDC has worked collaboratively with WHO to conduct investigations of human H5N1 infections in China, Indonesia, Thailand, Vietnam, and Turkey and to provide laboratory diagnostic and training assistance.
* CDC has performed laboratory testing of H5N1 viruses from Vietnam, Thailand, and Indonesia.
* CDC is implementing a multi-million dollar initiative to improve influenza surveillance in Asia.
* CDC has led or taken part in 9 training sessions to enhance local capacities in Asia to conduct surveillance for possible human cases of H5 and to detect avian influenza A H5 viruses using laboratory techniques.
* CDC has developed and distributed a reagent kit for the detection of the currently circulating influenza A H5 viruses.
* CDC has worked with other international and national agencies in Asia to develop a training course for rapid response teams that will be used to help prepare the region to respond to outbreaks when they occur.
CDC is monitoring the situation closely, along with WHO and other international partners. In addition, CDC continues to work collaboratively with WHO and the National Institutes of Health (NIH) on the development and testing of vaccine seed candidates for influenza A (H5N1).
NOTE: The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1).
Page last modified March 22, 2006
On this page:
* Summary
* Human H5N1 Cases
* Animal H5N1 Cases
* Assessment of Current Situation
* Bird Import Ban
* Travel
* CDC Response
*
Avian Flu Outbreaks
* Current Situation
* Past Outbreaks
* Embargo of Birds
* Quarantine Executive Order
(From the White House)
* Quarantine Executive Order Q & A
Summary
Influenza A (H5N1) is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them. Outbreaks of H5N1 among poultry are ongoing in a number of countries. While H5N1 does not usually infect people, human cases of H5N1 infection associated with these outbreaks have been reported Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few rare cases of human-to-human spread of H5N1 virus have occurred, though transmission has not continued beyond one person.
Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population and an influenza pandemic (worldwide outbreak of disease) could begin. Experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily from person to person.
Human H5N1 Cases
Human Cases: Summary of Current Situation
Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries:
* East Asia and the Pacific:
o Cambodia
o China
o Indonesia
o Thailand
o Vietnam
* Europe & Eurasia:
o Azerbaijan
(see update)
o Turkey
* Near East:
o Iraq
For additional information about these reports, visit the
World Health Organization Web Site.
Updated March 21, 2006
During August to October 2004, sporadic human cases of avian influenza A (H5N1) were reported in Vietnam and Thailand. Beginning in December 2004, a resurgence of poultry outbreaks and human cases were reported in Vietnam.
On February 2, 2005, the first of four human cases of H5N1 infection from Cambodia were reported. On July 21, 2005, the first human case of H5N1 in Indonesia was reported. Indonesia continued to report human cases from August 2005 into February 2006. Thailand reported new human cases of H5N1 in October, November, and December 2005, and Vietnam reported new human cases in November 2005. China reported the country’s first confirmed human cases in November 2005 and continued to report human cases in December 2005 and into 2006. Turkey reported the country’s first confirmed human cases on January 5, 2006 and has continued to report human cases. The first confirmed human infection with avian influenza A (H5N1) in Iraq was reported on February 2, 2006. In Azerbaijan, the country’s first human cases were reported on March 21, 2006 (see Azerbaijan update).
Animal H5N1 Cases
Animal Cases: Summary of Current Situation
Since December 2003, avian influenza A (H5N1) infections in poultry or wild birds have been reported in the following countries:
* Africa:
o Cameroon
o Niger
o Nigeria
* East Asia & the Pacific:
o Cambodia
o China
o Hong Kong (SARPRC)
o Indonesia
o Japan
o Laos
o Malaysia
o Mongolia
o Myanmar (Burma)
o Thailand
o Vietnam
* Europe & Eurasia:
o Albania
o Austria
o Azerbaijan
o Bosnia & Herzegovina (H5)
o Bulgaria
o Croatia
o Denmark (H5)
o France
o Georgia (H5)
o Germany
o Greece
o Hungary
o Italy
o Poland
o Romania
o Russia
o Serbia and Montenegro (H5)
o Slovak Republic
o Slovenia
o Sweden
o Switzerland
o Turkey
o Ukraine
* Near East:
o Egypt
o Iraq (H5)
o Iran
o Israel
* South Asia:
o Afghanistan
o India
o Kazakhstan
o Pakistan (H5)
For additional information about these reports, visit the
World Organization for Animal Health Web Site.
Updated March 21, 2006
* Beginning in late June 2004, new outbreaks of lethal avian influenza A (H5N1) infection among poultry were reported by several countries in Asia: Cambodia, China, Indonesia, Malaysia, Thailand, and Vietnam.
* Since May 2005, outbreaks of H5N1 disease have been reported among poultry in China, Kazakhstan, Romania, Russia, Turkey, and Ukraine. China, Croatia, Mongolia, and Romania also reported outbreaks of H5N1 in wild, migratory birds since May 2005.
* In January 2006, Hong Kong (SARPRC) reported one dead wild bird.
* Since February 1, 2006, the first cases of H5N1 or H5 infections in poultry or wild birds have been reported in the following countries: Iraq (H5), Nigeria, Azerbaijan, Bulgaria, Greece, Italy, Slovenia, Iran, Austria, Germany, Egypt, India, France, Bosnia and Herzegovina (H5), Slovak Republic, Switzerland, Niger, Hungary, Serbia and Montenegro (H5), Pakistan (H5), Albania, Poland, Georgia, Cameroon, Myanmar (Burma), Sweden, Denmark (H5), Israel, and Afghanistan.
* For additional information about H5N1 and other avian influenza outbreaks among animals, visit the World Organization for Animal Health Web site.
Assessment of Current Situation
The avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe is not expected to diminish significantly in the short term. It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry will continue to occur. So far, the spread of H5N1 virus from person-to-person has been rare and has not continued beyond one person. No evidence for genetic reassortment between human and avian influenza A virus genes has been found; however, the epizootic in Asia continues to pose an important public health threat.
There is little pre-existing natural immunity to H5N1 infection in the human population. If these H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result, with potentially high rates of illness and death. In addition, genetic sequencing of influenza A (H5N1) viruses from human cases in Vietnam and Thailand shows resistance to the antiviral medications amantadine and rimantadine, two of the medications commonly used for treatment of influenza. This would leave two remaining antiviral medications (oseltamivir and zanamivir) that should still be effective against currently circulating strains of H5N1 virus. Efforts to produce vaccine candidates that would be effective against avian influenza A (H5N1) viruses are under way. However, it will likely require many months before such vaccines could be mass produced and made widely available.
Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease (pathogenic) in mammals than were earlier H5N1 viruses. One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well. Additionally, other findings have documented H5N1 infection among pigs in China and H5N1 infection in felines (experimental infection in housecats in the Netherlands and isolation of H5N1 viruses in tigers and leopards in Thailand ).
Notable findings of epidemiologic investigations of human H5N1 cases in Vietnam during 2005 have suggested transmission of H5N1 viruses to at least two persons through consumption of uncooked duck blood. One possible instance of limited person-to-person transmission of H5N1 virus in Thailand has been reported. This possibility is being further investigated in other clusters of cases in Vietnam and Indonesia.
The majority of known human H5N1 cases have begun with respiratory symptoms. However, one atypical fatal case of encephalitis in a child in southern Vietnam in 2004 was identified retrospectively as H5N1 influenza through testing of cerebrospinal fluid, fecal matter, and throat and serum samples. Further research is needed to ascertain the implications of such findings.
Bird Import Ban
There is currently a ban on the importation of birds and bird products from H5N1-affected countries. The regulation states that no person may import or attempt to import any birds (Class Aves), whether dead or alive, or any products derived from birds (including hatching eggs), from the following countries: Afghanistan, Albania, Azerbaijan, Burma (Myanmar), Cambodia, Cameroon, China, Egypt, France (USDA – defined restricted zone only), India, Indonesia, Israel, Japan, Laos, Kazakhstan, Malaysia, Niger, Nigeria, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, Vietnam and Israel (current as of March 20, 2006). For more information, see Embargo of Birds from Specified Countries.
Travel
Updated Information for Travelers about Avian Influenza A(H5N1) is available at the CDC Travelers’ Health Web site. Also see Guidelines and Recommendations - Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad.
CDC Response
Domestic Activities
* In May 2005, CDC joined a new, inter-agency National Influenza Pandemic Preparedness Task Force organized by the U.S. Secretary of Health and Human Services. This task force is developing and refining preparedness efforts with international, state, local, and private organizational partners to help ensure the most effective response possible when the next influenza pandemic occurs. For more information about the Pandemic Influenza Preparedness Plan of the U.S. Health and Human Services Department and other aspects of this coordinated federal initiative, please visit www.pandemicflu.gov.
* In February 2004, CDC issued recommendations for enhanced domestic surveillance of avian influenza A (H5N1). Following the reports of human deaths in Vietnam in August 2004 and additional human cases in the following months, CDC issued follow-up Health Alert Network (HAN) notices on August 12 and February 4, 2005, reiterating criteria for domestic surveillance, diagnostic evaluation, and infection control precautions for avian influenza A (H5N1). The HAN notice also detailed laboratory testing procedures for H5N1.
* CDC has collaborated with the Association of Public Health Laboratories to conduct training workshops for state laboratories on the use of molecular techniques to rapidly identify H5 viruses.
* CDC is working collaboratively with the Council of State and Territorial Epidemiologists and other partners to assist states with pandemic planning efforts.
* CDC is working with other agencies, such as the Department of Defense and the Department of Veterans Affairs, on antiviral stockpile issues.
International Activities
* CDC is one of four WHO Collaborating Centers and in this capacity provides ongoing support for the global WHO surveillance network, laboratory testing, training, and other actions.
* CDC has worked collaboratively with WHO to conduct investigations of human H5N1 infections in China, Indonesia, Thailand, Vietnam, and Turkey and to provide laboratory diagnostic and training assistance.
* CDC has performed laboratory testing of H5N1 viruses from Vietnam, Thailand, and Indonesia.
* CDC is implementing a multi-million dollar initiative to improve influenza surveillance in Asia.
* CDC has led or taken part in 9 training sessions to enhance local capacities in Asia to conduct surveillance for possible human cases of H5 and to detect avian influenza A H5 viruses using laboratory techniques.
* CDC has developed and distributed a reagent kit for the detection of the currently circulating influenza A H5 viruses.
* CDC has worked with other international and national agencies in Asia to develop a training course for rapid response teams that will be used to help prepare the region to respond to outbreaks when they occur.
CDC is monitoring the situation closely, along with WHO and other international partners. In addition, CDC continues to work collaboratively with WHO and the National Institutes of Health (NIH) on the development and testing of vaccine seed candidates for influenza A (H5N1).
NOTE: The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1).
Page last modified March 22, 2006
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