Low Pathogenic Strains vs. Highly Pathogenic Strains

H5N1 Infection in Cats

Study looked at 500 blood samples taken from stray cats taken from poultry markets in Java. Of these cats, 20% had antibodies to H5N1. Unusually high numbers of dead cats have been found near many of the outbreaks. Unlike humans, cats shed virus in high titers and pass it to each other.

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: •Cambodia

•China •Indonesia •Thailand •Vietnam

•Europe & Eurasia: •Azerbaijan

•Turkey •Near East:

•EgyptIraq

  For additional information about these reports, visit the

World Health Organization Web Site.

Updated January 2007

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO March 14, 2007

Country 

2003 2004 2005 2006 2007 Total

cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths

Azerbaijan 0 0 0 0 0 0 8 5 0 0 8 5

Cambodia 0 0 0 0 4 4 2 2 0 0 6 6

China 1 1 0 0 8 5 13 8 0 0 23 14

Djibouti 0 0 0 0 0 0 1 0 0 0 1 0

Egypt 0 0 0 0 0 0 18 10 1 1 24 13

Indonesia 0 0 0 0 19 12 56 46 7 6 83 65

Iraq 0 0 0 0 0 0 3 2 0 0 3 2

Nigeria 0 0 0 0 0 0 0 0 1 1 1 1

Thailand 0 0 17 12 5 2 3 3 0 0 25 17

Turkey 0 0 0 0 0 0 12 4 0 0 12 4

Viet Nam 3 3 29 20 61 19 0 0 0 0 93 42

Total 4 4 46 32 97 42 116 80 8 7 280 170

Responding to the Avian Influenza Pandemic Threat

Recommended Strategic Actions

World Health Organization 2005

WHO Proposals

1. Reduce opportunities for human infection - education

2. Strengthen the early warning system

3. Contain or delay spread at source - drugs, quarantine

4. Reduce morbidity, mortality and social disruption

5. Conduct research to guide response measures

Problems With Early Warning Systems

most outbreaks are occurring in poor countries

no funds to pay farmers for culled flocks(10 billion $$ to date)

no funds for information systems or labs

home slaughter of sick chickens

poor or no health care services

New WHO Pandemic PhasesInterpandemic Period

Phase 1 – No new influenza subtypes in humans, subtype that has caused human infection may be present in animals

Phase 2 – As above, but circulating animal subtype poses substantial risk of human disease

Pandemic Alert PeriodPhase 3 – Human infection with new subtype, no human-to-human

(HTH) spreadPhase 4 – Small clusters with limited HTH transmission, highly

localized spread, suggesting the virus is not well adapted to humans

Phase 5 – Larger clusters, but HTH spread is still localized, virus is increasingly better adapted to humans, but not yet fully transmissible

Pandemic Period – Increased and sustained transmission in general population

Current WHO phase of pandemic alert

Pandemic Vaccine Supply

Assumptions Imported vaccine will not be available

Two doses will be needed for protection

4-8 months until first vaccine doses are available

U.S Manufacturing CapacityOnly Sanofi has a completely domestic supplychain

Estimated production sufficient to deliver 5 millionmonovalent doses per week

Implication – less than 1% of the population may be protectedper week

Health Care and Emergency Response

Address hospital surge capacity issues

Address roles of triage centers, volunteers, home care

Develop hospital employee health guidance

Develop infection control guidelines

Address mass mortality issues

Develop system for tracking hospital resources

CDC PANDEMIC RANKINGFebruary 1, 2007

Category 1 Pandemic 90,000 additional deaths

Isolate the sick at home, reduce visitors

Category 3 Pandemic 90,000 – 450,000 additional deaths

consider closing schools for no more than a month

Category 5 Pandemic >900,000 additional deaths

Close schools (including universities) for up to 3 months, avoid gatherings and encourage people to work from home

“What we all learned from Katrina is that sometimes we have to think very clearly about the unthinkable, because the unthinkable often happens.”

Michael Leavitt

Health and Human Services Secretary

http://pandemicflu.gov

http://www.pandemicflu.state.pa.us

http://pandemicflu.gov/plan/pdf/CIKRpandemicInfluenzaGuide.pdf

http://www.pandemicflu.gov

HMC PANDEMIC PLAN

http://emergencyhomepreparation.org/

http://www.influenzareport.com/influenzareport2006.pdf

Birdflubook.com

“We’re all holding our breaths. H5N1 is the most important threat the world is facing.”

“People who fail to prepare for a flu pandemic are going to be tragically mistaken.”

Julie Gerberding, Head of the CDC