Transcript Surveillance for Avian Influenza among Humans and Animals

Surveillance for Avian
Influenza among Humans and
Animals
Presentation Overview
• Federal Agencies
• Animal Influenza Surveillance
– Poultry
– Wild Birds
• Human Influenza Surveillance
– Routine
– Enhanced
Federal Agencies
• US Department of Health and Human
Services (DHHS)
– CDC
• US Department of Agriculture (USDA)
• US Department of the Interior (DOI)
Influenza
Surveillance
Among
Humans
Routine National Surveillance
1. Virologic - laboratory reporting
2. Sentinel Providers Network
3. State and territorial epidemiologists
reports
4. Emerging Infections Program
5. New Vaccine Surveillance Network
6. 122 Cities Mortality Reporting System
7. Influenza-associated pediatric mortality
Human Surveillance
Upon confirmed HPAI in animal species…
1. Conduct active case finding
2. Assess exposures
3. Classify and test potential cases
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Suggested guideline:
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CDC case definitions for detection
WHO case definitions for reporting
Enhancing Local Surveillance
• Enhance surveillance and record review in
hospitals
• Public Service Announcements
• Telephone hotlines
• Door-to-door surveys
• Occupational surveillance
Poultry Outbreak and Human
Surveillance Activities
• Limit case definition
• Disseminate case definition
– Health Alert Network (HAN)
– Epi-X
• Create and disseminate outbreak reporting
questionnaire
• Consider database and reporting tools
• Identify and interview potential cases and
contacts
Surveillance Activities cont.
• Conduct surveillance for human illness linked to
affected premises
• Ensure timely reporting of cases to CDC
• Characterize seasonal influenza strains
• Notify other states that might receive cases or
contacts
• Advise contacts to monitor symptoms for 10
days post-exposure
Possible Contacts
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Poultry workers
Agriculture responders
Farmers
Veterinarians
People purchasing poultry products
Farm visitors
Travelers
Possible Contacts
Also:
• Healthcare workers
• Family members and other close contacts
• Emergency Medical Services staff
Local Surveillance During
Pandemic Alert
Continue routine surveillance activities AND
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Investigate clusters of influenza-like
illness with a) recent travel to area with
documented novel or avian flu, or b)
severe morbidity and mortality
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Facilitate viral testing for persons with ILI
and epidemiologic risk factors
Goals of Human Surveillance
for Pandemic Influenza
• Virologic Surveillance
– Detect initial cases of pandemic strain
– Track introduction of virus to local areas
– Monitor changes in virus
• Disease-based Surveillance
– Early warning of increased ILI
– Monitor health effects of pandemic
– Track trends in disease activity
Influenza
Surveillance
Among
Animals
AI Surveillance
• Active and passive surveillance currently
conducted by various means:
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NPIP testing of commercial poultry
Live bird market system testing
Testing prior to export of poultry products
State active surveillance programs
Diagnostic laboratory evaluation of ill birds
Foreign animal disease diagnostician (FAD)
investigations of suspect FADs
• Wild bird surveillance
Protecting American Agriculture
Avian Influenza Surveillance
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Markets
Laboratories
On Farms
During Outbreaks
Labs
Markets
On-farm
Outbreak
Protecting American Agriculture
Notifiable Avian
Influenza (NAI)
“Avian influenza in its notifiable form (NAI) is defined
as an infection of poultry caused by any influenza A
virus of the H5 or H7 subtypes or by any AI virus
with an intravenous pathogenicity index (IVPI)
greater than 1.2 (or as an alternative at least 75%
mortality) as described… NAI viruses can be
divided into highly pathogenic notifiable avian
influenza (HPNAI) and low pathogenicity notifiable
avian influenza (LPNAI)”
Protecting American Agriculture
Commercial Flocks
National Poultry Improvement Plan (NIPP)
• USDA program
• Monitor poultry production facilities
• Random testing of flocks
– Test all ill birds
• Coordinate with states for response and
containment plans
Wildlife Surveillance
Five components to surveillance
1) Investigation of morbidity and mortality
2) Surveillance in live wild birds
3) Surveillance in hunter-killed birds
4) Sentinel species monitoring
5) Environmental sampling
Reporting HPAI in Poultry
• Reporting varies by state
– Industry
– Backyard flocks
– H5 or H7 LPAI
• Presumptive positive cases reported to USDA or
DOI will be immediately reported to:
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OIE
Trade partners
Other Federal agencies
States
Industry
Response in the Event of an HPAI
Outbreak
• Response actions for domestic
flocks:
– Surveillance
– Quarantine and humane euthanasia
– Cleaning and disinfection of premises
– Possible use of vaccine in poultry
– Indemnity payments
– Communication to media and the
public
Responding to Influenza among
Poultry
• LPAI outbreak
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Affected State takes the lead
Clean, disinfect, depopulate affected premises
USDA provides funding
Close attention to H5 and H7 strains
• HPAI outbreak
– USDA takes the lead
– Quarantine, clean, disinfect, and cull the infected and
exposed bird population
– CDC is notified
– Bird owners compensated
Summary
• Avian influenza surveillance among animals and
humans involves collaboration among many
local, state, and federal agencies
• Surveillance among humans occurs routinely,
and would be enhanced under an increased
threat of pandemic influenza
• Surveillance among animals involves domestic,
wild, and imported birds
References
• USDA National HPAI Response Plan, Aug 2006,
http://www.aphis.usda.gov/newsroom/hot_issues
/avian_influenza/contents/printable_version/Draf
tSummaryNationalHPAIresponseplan08-3106.pdf
• An early detection system for highly pathogenic
H5N1 avian influenza in wild migratory birds,
U.S. Interagency Strategic Plan, March 2006,
http://www.doi.gov/issues/birdflu_strategicplan.p
df
• Morgan, A. Avian influenza: an agricultural
perspective. J Infect Diseases. 2006;194(Suppl
2):S139-S146
References
• USDA’S Role in the Implementation Plan for the National
Strategy for Pandemic Influenza, May 6, 2006.
http://www.usda.gov/documents/AI_Fact_Sheet_Implem
entation_Plan.pdf
• USDA Avian Flu Brochure
http://www.usda.gov/documents/AvianFluBrochure.pdf
• US Department of the Interior, Issues of Interest: Avian
Influenza (Bird Flu).
http://www.doi.gov/issues/avianflu.html
• WHO Case Definitions:
http://www.who.int/csr/disease/avian_influenza/guideline
s/case_definition2006_08_29/en/print.html