Avian Influenza

Avian Flu Riham Raafat
Avian Influenza (Bird Flu)

-Definition:
Avian influenza is an infection caused by avian (bird) influenza (flu)
viruses which occur naturally among birds in their intestines, but usually
do not get sick from them. However, avian influenza (H5N1 influenza A
subtype) is very contagious among birds and can make some
domesticated birds, including chickens, ducks, and turkeys, very sick and
kill them & does not usually infect people, but infections with these
viruses have occurred in humans.
-Modes of Infection:
Infected birds shed influenza virus in their saliva, nasal secretions, and
feces  contact with contaminated secretions or excretions or with
surfaces that are contaminated with secretions or excretions from infected
birds  two main forms of disease that are distinguished by low and high
extremes of virulence. (The “low pathogenic” form may go undetected
and usually causes only mild symptoms & the "highly pathogenic" form
spreads more rapidly affecting multiple internal organs and has a
mortality rate that can reach 90-100% often within 48 hours) 
confirmed cases of human infection from several subtypes of avian
influenza infection have been reported since 1997 then again in 2003 and
in Egypt since 2006.
*N.B. The H5N1 virus does not infect humans easily, and if a person is
infected, it is very difficult for the virus to spread to another person (by
very close contact).
1
-Clinical Picture: Ranging from:

1. Typical human influenza-like symptoms (e.g., fever, cough, sore
throat, and muscle aches), To
2. Eye infections, Pneumonia, Severe respiratory diseases (such as acute

respiratory distress), and other severe and life-threatening
complications.
-Investigations:
Throat swab is taken from the suspected case & PCR is done in specific
labs.
-Risk Groups:
a. High risk exposure groups:
Household or close family contacts (< 1 meter) of a strongly suspected or
confirmed H5N1 patient, because of potential exposure to a common
environmental or poultry source as well as exposure to the index case
b. Moderate risk exposure groups:

• Personnel involved in handling sick animals or decontaminating
affected environments (including animal disposal) if personal protective
equipment may not have been used properly.
• Individuals with unprotected and very close direct exposure to sick or
dead animals infected with the H5N1 virus or to particular birds that have
been directly implicated in human cases.
• Health care personnel in close contact with strongly suspected or
confirmed H5N1 patients, for example during intubation or performing
tracheal suctioning, or delivering nebulised drugs, or handling
inadequately screened/sealed body fluids without any or with insufficient
2
personal protective equipment or laboratory personnel who might have an

unprotected exposure to virus containing samples.
c. Low risk exposure groups:

• Health care workers not in close contact (distance greater than 1 meter)
with a strongly suspected or confirmed H5N1 patient and having no direct
contact with infectious material from that patient.
• Health care workers who used appropriate personal protective
equipment during exposure to H5N1 patients.
• Personnel involved in culling non-infected or likely non-infected animal
populations as a control measure.
• Personnel involved in handling sick animals or decontaminating
affected environments (including animal disposal), who used proper
personal protective equipment.
-Treatment:
1. Drugs used: It is resistant to amantadine and rimantadine (M2
inhibitors), but oseltamivir and zanamivir (neuraminidase inhibitors)
are used to treat it twice daily for 5 days (see the table in swine flu) 
no clinical benefits detected from combining the 2 groups together.
2. Prophylaxis: by neuraminidase inhibitors can be used with strong

recommendation in high risk groups and with weak recommendations
in moderate risk groups for 7-10 days but not used in low risk groups.
3. Antibiotics: used only in CAP and VAP with the usual guidelines if
indicated.
4. Steroids: there is currently no basis to make a recommendation for the

use of corticosteroids in the management of acute H5N1 disease in
3
humans, and there may be theoretical reasons to be cautious in using

immuno-suppressants in patients with viral illness but sequelae and
complications such as shock and ARDS may require use of steroids
independent of the viral infection.
5. Interferon alpha: on the theoretical basis, it has antiviral and

immunomodulatory activities but it can cause anemia, hypotension
and leucopenia as well as other adverse effects, and limited in vitro
data suggest that H5N1 virus may be resistant to the antiviral effects of
interferons  so not used.
6. Immunoglobulins: as a co-intervention, it may modify the immune

response but there is no direct or in vitro evidence that this is the case
in H5N1 disease as they are highly unlikely to contain specific
antibodies against the virus besides carrying a risk of blood born
infections.
7. Ribavirin: prevent viral replication, it has been used as a co-

intervention in the management of H5N1 patients in Hong Kong and
Viet Nam, and in SARS associated coronavirus infections; but no
basis to be used here.

Avian Influenza

Uploaded by

Copyright:

Available Formats

Avian Influenza

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Avian Influenza

Uploaded by

Copyright:

Available Formats

Avian Flu Riham Raafat

Avian Influenza (Bird Flu)

-Clinical Picture: Ranging from:

2. Eye infections, Pneumonia, Severe respiratory diseases (such as acute

b. Moderate risk exposure groups:

personal protective equipment or laboratory personnel who might have an

c. Low risk exposure groups:

2. Prophylaxis: by neuraminidase inhibitors can be used with strong

4. Steroids: there is currently no basis to make a recommendation for the

humans, and there may be theoretical reasons to be cautious in using

5. Interferon alpha: on the theoretical basis, it has antiviral and

6. Immunoglobulins: as a co-intervention, it may modify the immune

7. Ribavirin: prevent viral replication, it has been used as a co-

You might also like