Sick Poultry Research Articles

Risk factors for human illness with avian influenza A (H5N1) virus infection in China.

In China, 30 human cases of avian influenza A (H5N1) virus infection were identified through July 2008. We conducted a retrospective case-control study to identify risk factors for influenza H5N1 disease in China. A questionnaire about potential influenza H5N1 exposures was administered to 28 patients with influenza H5N1 and to 134 randomly selected control subjects matched by age, sex, and location or to proxies. Conditional logistic regression analyses were performed. Before their illness, patients living in urban areas had visited wet poultry markets, and patients living in rural areas had exposure to sick or dead backyard poultry. In multivariable analyses, independent risk factors for influenza H5N1 were direct contact with sick or dead poultry (odds ratio [OR], 506.6 [95% confidence interval {CI}, 15.7-16319.6]; P<.001), indirect exposure to sick or dead poultry (OR, 56.9 [95% CI, 4.3-745.6]; P=.002), and visiting a wet poultry market (OR, 15.4 [95% CI, 3.0-80.2]; P=.001). To prevent human influenza H5N1 in China, the level of education about avoiding direct or close exposures to sick or dead poultry should be increased, and interventions to prevent the spread of influenza H5N1 at live poultry markets should be implemented.

Highly pathogenic H5N1 avian influenza virus: Cause of the next pandemic?

Since 1997, when human infections with a highly pathogenic (HP) avian influenza A virus (AIV) subtype H5N1 - previously infecting only birds - were identified in a Hong Kong outbreak, global attention has focused on the potential for this virus to cause the next pandemic. From December 2003, an unprecedented H5N1 epizootic in poultry and migrating wild birds has spread across Asia and into Europe, the Middle East, and Africa. Humans in close contact with sick poultry and on rare occasion with other infected humans, have become infected. As of early March 2007, 12 countries have reported 167 deaths among 277 laboratory-confirmed human infections to WHO. WHO has declared the world to be in Phase 3 of a Pandemic Alert Period. This paper reviews the evolution of HP AIV H5N1, molecular changes that enable AIVs to infect and replicate in human cells and spread efficiently from person-to-person, and strategies to prevent the emergence of a pandemic virus.

(Yet) another human A/H5N1 influenza case and cluster – when should Europe be concerned?

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Review of clinical symptoms and spectrum in humans with influenza A/H5N1 infection

Influenza A/H5N1 infection has become the major emerging infectious disease of global concern again since late 2003. A history of exposure to dead or sick poultry or wild birds occurs in over 60% of cases of human H5N1 infection. The incubation period of avian-to-human transmission is generally between 2 and 5 days and the median duration of symptoms before hospitalization is about 4.5 days. The clinical spectrum has ranged from asymptomatic infection or mild influenza-like illness to severe pneumonia and multi-organ failure. Fever > 38 degrees C, cough and dyspnoea are the major symptoms on presentation, whereas gastrointestinal symptoms such as watery diarrhoea, vomiting and abdominal pain are common early in the course of the disease. In contrast, upper respiratory tract symptoms are less prominent in human H5N1 infection when compared to seasonal influenza. Laboratory features of human H5N1 infection include leucopoenia, especially lymphopenia, elevated amino-transaminases, thrombocytopenia, prolonged prothrombin time and activated partial thromboplastin time, increased D-Dimer, increased serum lactate dehydrogenase and creatinine phospho-kinase, and hypoalbuminemia. A low absolute lymphocyte count on admission is associated with more severe disease and death. Radiographic abnormalities include multi-focal airspace consolidation, interstitial infiltrates, patchy or lobar involvement, with rapid progression to bilateral and diffuse ground-glass opacities consistent with ARDS. However, none of the clinical, laboratory and radiographic features are specific to H5N1 infection. A detailed exposure history needs to be elicited, including any close contact with sick or dead poultry, wild birds, other severely ill persons, travel to an area with A/H5N1 activity or work in laboratory handling samples possibly containing A/H5N1 virus.

Global epidemiology of human infections with highly pathogenic avian influenza A (H5N1) viruses

From 1997 through 2007, human infections with highly pathogenic avian influenza A (H5N1) viruses resulted in rare, sporadic, severe and fatal cases among persons in 14 countries in Asia, the Middle East, Eastern Europe and Africa. Of 369 reported human H5N1 cases that occurred from 1997 through 2007, overall mortality was 60%. Ten antigenically and genetically distinct clades of H5N1 viruses have been identified to date, and strains from four clades have infected humans. Surveillance has focused upon hospitalized cases of febrile acute lower respiratory tract disease among persons with exposure to sick or dead poultry, or to a human H5N1 case. Detection of H5N1 virus infection is based primarily upon collection of respiratory tract specimens from suspected cases for RT-PCR testing. Most human H5N1 cases were previously healthy children or young adults who developed severe acute pulmonary or multi-organ disease following direct or close contact with sick or dead H5N1 virus-infected poultry. Occasional clusters of H5N1 cases have occurred, predominantly among blood-related family members. Limited human-to-human H5N1 virus transmission has been reported or could not be excluded in some clusters. The frequency of asymptomatic or clinically mild H5N1 virus infection is unknown, but limited investigations suggest that such infections have been rare since 2003. There is no evidence of sustained human-to-human H5N1 virus spread. However, H5N1 viruses continue to circulate and evolve among poultry in many countries, and there are many unanswered questions about human infection with H5N1 viruses. Thus, the pandemic influenza threat presented by H5N1 viruses persists.

Epidemiology of Cases of H5N1 Virus Infection in Indonesia, July 2005–June 2006

Highly pathogenic avian influenza A (H5N1) virus was detected in domestic poultry in Indonesia beginning in 2003 and is now widespread among backyard poultry flocks in many provinces. The first human case of H5N1 virus infection in Indonesia was identified in July 2005. Respiratory specimens were collected from persons with suspected H5N1 virus infection and were tested by reverse-transcriptase polymerase chain reaction and viral culture. Serum samples were tested by a modified hemagglutinin inhibition antibody and/or microneutralization assay. Epidemiological, laboratory, and clinical data were collected through interviews and medical records review. Close contacts of persons with confirmed H5N1 virus infection were investigated. From July 2005 through June 2006, 54 cases of H5N1 virus infection were identified, with a case-fatality proportion of 76%. The median age was 18.5 years, and 57.4% of patients were male. More than one-third of cases occurred in 7 clusters of blood-related family members. Seventy-six percent of cases were associated with poultry contact, and the source of H5N1 virus infection was not identified in 24% of cases. Sporadic and family clusters of cases of H5N1 virus infection, with a high case-fatality proportion, occurred throughout Indonesia during 2005-2006. Extensive efforts are needed to reduce human contact with sick and dead poultry to prevent additional cases of H5N1 virus infection.

Compensation for Avian Influenza Cleanup

To the Editor: Since 2003, highly pathogenic avian influenza (HPAI) H5N1 has shaken the world. In 10 countries, 258 confirmed cases in humans and 154 deaths have been reported (1). The number of countries with confirmed HPAI in poultry and wild birds jumps to 54 (2). Almost all persons infected with H5N1 have had close contact with sick or dead poultry by having butchered them, plucked them, or played (children) with them (3). Because H5N1 can potentially mutate or reassort into a strain capable of efficient human-to-human transmission, rapid elimination of the H5N1 virus in poultry and other risk-reduction interventions are thought to be essential for preventing further spread of HPAI (4). As a result, thousands of workers around the world have culled millions of domestic poultry (5). Preemptive culling creates a major concern with regard to compensation. In Nigeria, for example, affected farmers have yet to be compensated >50 million Nigerian Naira (>US$ 0.4 million) because of the ministry’s cash flow problems (6). On the other hand, US poultry farmers who participate in a US Department of Agriculture (USDA) program to prevent the spread of disease would be fully compensated for loss of poultry and equipment if even a low-pathogenic strain of avian influenza were found in the United States (7). This rule not only strengthens US protection against avian influenza but also minimizes any negative effect on the US poultry trade. As discussed by the World Bank (8), the situations of these 2 countries raise several questions: Who should pay the compensation? For what should compensation be paid? Who should be compensated? With regard to the first question, each country’s government is an exclusive funding source. However, in Nigeria, the amount of compensation overwhelms the government’s capacity. Some countries, like Australia, may get additional funding from alternative sources such as private sectors, regional economic groups, or international funds (9). Because national resources are often scarce, most developing countries must rely on international donors for a great deal of the funding for compensation programs. The response to the second question, extent of compensation, varies. In Nigeria, farmers are partially compensated for loss of poultry; however, in the United States, farmers who are part of the USDA program are fully compensated for loss of poultry and equipment. Setting the amount of compensation is difficult and can affect the outcome of culling efforts. In Thailand, to take advantage of the program in which compensation was perceived as high, some farmers reportedly moved infected poultry into previously uninfected areas. In Vietnam, where compensation was perceived as low, culling compliance was poor (8). The last question, who should be compensated, seems straightforward for the United States, where only farmers who participate in the USDA program would be fully compensated. However, H5N1 does not affect only farmers who sign up for such a program. And not all poultry are raised in commercial operations, especially in developing countries. In Thailand, for example, >80% of infected poultry are reportedly raised in backyards (10). Reasonable assumptions are that those backyard farmers do not honestly report dying poultry or that they rush sick and dying poultry to market, causing the disease to spread. Additional questions revolve around potential compensation for those who are involved in the poultry industry but who do not own poultry (e.g., poultry processing plant operators and their staff). Because each country’s needs and circumstances differ, building a coherent plan for tackling HPAI is difficult. However, each stakeholder should consider compensation as part of an overall package of prevention, preparedness, and response strategies toward controlling and preventing the spread of HPAI. Because H5N1 does not respect international boundaries, donors worldwide should step forward to support the most affected and vulnerable developing countries.

Flulike Illness and Exposure to Sick or Dead Poultry

Flulike Illness and Exposure to Sick or Dead Poultry

Flulike Illness and Exposure to Sick or Dead Poultry—Reply

Flulike Illness and Exposure to Sick or Dead Poultry—Reply

Hostellers’ knowledge of transmission and prevention of avian influenza when travelling abroad

Little is known about hostellers' knowledge of transmission and prevention of avian influenza when travelling abroad. This study was designed to investigate these in the Australian context. In 2006, hostellers attending a travellers' information evening in Brisbane, Queensland, were asked to complete self-administered questionnaires. Forty-two questionnaires (60.8%) were returned. Over two-thirds of attendees were females (71.4%, 30). About two-thirds of the hostellers attending the travellers' information evening reported being aged 29 years or younger (64.2%, 27). On a five-point rating scale, the median rating of hostellers indicated that they were moderately concerned about avian influenza (3.0) with the range being 1-5. About one-fifth of hostellers did not know or were not sure what the source of avian influenza infection in humans was and most of this group also did not know how bird flu was prevented (p<0.05). Almost all hostellers (40, 95.2%) responded to the question concerning the source of infection for avian influenza. Nominated sources of infection included handling sick poultry (69.0%, 29), eating poultry (45.2%, 19), contact with humans who have avian influenza (38.1%, 16), and handling healthy poultry (26.2%, 11). More than four-fifths 35 (83.3%) of hostellers responded to the question concerning precautions against avian influenza. Nominated precautions included hand washing (28.6%, 12), avoiding birds (23.8%, 10), avoiding affected areas (14.3%, 6), not eating poultry (7.1%, 3), and avoiding poultry droppings (7.1%, 3). Hand washing was the only measure to prevent bird flu that was significantly more likely to be nominated following the travel health lecture (p<0.05). Hostellers attending the travellers' information night in Australia reported having moderate concern about avian influenza. They also had a variable knowledge of the sources of infection of avian influenza. Most hostellers correctly identified infected poultry as a source; however, human-to-human transmission as the predominant current source of avian influenza infections in humans was incorrectly identified by nearly two-fifths of hostellers. Although hostellers responded positively to hand washing advice provided in the travel health lecture, reinforcement of other possible measures to prevent avian influenza, particularly the possible role of antiviral drugs, may be needed.

Lethal Avian Influenza A (H5N1) Infection in a Pregnant Woman in Anhui Province, China

To the Editor: On November 2, 2005, fever, chills, and cough developed in a previously healthy woman who was four months pregnant. Chickens and ducks in her household had become ill and had died during October. From October 25 through October 30, the patient had been actively involved in slaughtering and defeathering sick poultry before they were cooked for family consumption. She presented to the hospital in Tongling City, China, on November 7 with dyspnea, cyanosis, a temperature of 38.8°C, a pulse of 118 beats per minute, a respiratory rate of 37 breaths per minute, and an oxygen saturation of . . .

Is Exposure to Sick or Dead Poultry Associated With Flulike Illness?

The verified human cases of highly pathogenic avian influenza in Vietnam may represent only a selection of the most severely ill patients. The study objective was to analyze the association between flulike illness, defined as cough and fever, and exposure to sick or dead poultry. A population-based study was performed from April 1 to June 30, 2004, in FilaBavi, a rural Vietnamese demographic surveillance site with confirmed outbreaks of highly pathogenic avian influenza among poultry. We included 45 478 randomly selected (cluster sampling) inhabitants. Household representatives were asked screening questions about exposure to poultry and flulike illness during the preceding months; individuals with a history of disease and/or exposure were interviewed in person. A total of 8149 individuals (17.9%) reported flulike illness, 38,373 persons (84.4%) lived in households keeping poultry, and 11,755 (25.9%) resided in households reporting sick or dead poultry. A dose-response relationship between poultry exposure and flulike illness was noted: poultry in the household (odds ratio, 1.04; 95% confidence interval, 0.96-1.12), sick or dead poultry in the household but with no direct contact (odds ratio, 1.14; 95% confidence interval, 1.06-1.23), and direct contact with sick poultry (odds ratio, 1.73; 95% confidence interval, 1.58-1.89). The flulike illness attributed to direct contact with sick or dead poultry was estimated to be 650 to 750 cases. Our epidemiological data are consistent with transmission of mild, highly pathogenic avian influenza to humans and suggest that transmission could be more common than anticipated, though close contact seems required. Further microbiological studies are needed to validate these findings.

Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004.

To evaluate risk factors for human infection with influenza A subtype H5N1, we performed a matched case-control study in Vietnam. We enrolled 28 case-patients who had laboratory-confirmed H5N1 infection during 2004 and 106 age-, sex-, and location-matched control-respondents. Data were analyzed by matched-pair analysis and multivariate conditional logistic regression. Factors that were independently associated with H5N1 infection were preparing sick or dead poultry for consumption < or =7 days before illness onset (matched odds ratio [OR] 8.99, 95% confidence interval [CI] 0.98-81.99, p = 0.05), having sick or dead poultry in the household < or =7 days before illness onset (matched OR 4.94, 95% CI 1.21-20.20, p = 0.03), and lack of an indoor water source (matched OR 6.46, 95% CI 1.20-34.81, p = 0.03). Factors not significantly associated with infection were raising healthy poultry, preparing healthy poultry for consumption, and exposure to persons with an acute respiratory illness.

Human Disease from Influenza A (H5N1), Thailand, 2004

Influenza A (H5N1) is endemic in poultry across much of Southeast Asia, but limited information exists on the distinctive features of the few human cases. In Thailand, we instituted nationwide surveillance and tested respiratory specimens by polymerase chain reaction and viral isolation. From January 1 to March 31, 2004, we reviewed 610 reports and identified 12 confirmed and 21 suspected cases. All 12 confirmed case-patients resided in villages that experienced abnormal chicken deaths, 9 lived in households whose backyard chickens died, and 8 reported direct contact with dead chickens. Seven were children <14 years of age. Fever preceded dyspnea by a median of 5 days, and lymphopenia significantly predicted acute respiratory distress syndrome development and death. Among hundreds of thousands of potential human cases of influenza A (H5N1) in Asia, a history of direct contact with sick poultry, young age, pneumonia and lymphopenia, and progression to acute respiratory distress syndrome should prompt specific laboratory testing for H5 influenza.

Studies on chemotherapy of animal diseases with spectinomycin (author's transl)

Spectinomycin (SPE) is an antibiotic isolated from Streptomyce.s spectabilisNRRL 2792 and S. flavopersicus sp. n. NRRL-B-2820. It was active against most Grampositive and Gram-negative bacteria in vitro. Mycoplasrna gallisepticum was especiallysensitive to this antibiotic. Most strains of Escherichia coli and the genus Salmonellafreshly isolated from sick poultry were sensitive to SPE, showing no cross-resistance toother antibacterials. The activity of SPE was hardly affected by the addition of horseserum or soditum cholate, but was weakened by an acidic pH or a large bacterial inoculum.When 5-day-old chickens were administered subcutaneously with a single dose of 100 mg/kg of SPE, the average plasma level of SPE attained a peak of 121 pg/ml 30 minutes afteradministration and then descended gradually to attain 9.8 jtg/ml 6 hours. When chickenswere administered orally with a single dose of 200 mg/kg of SPE, the average plasma levelreachecl a plateau of about 7, pg/ml from 3 to 6 hours after aclministration. In the systemicinfection with E. coli or Salmonella species in mice and chicken, SEE was effective byparenteral administration. Its efficacy was also observed in the air-sac infections with M.gallisepticum in chickens.From these results obtained, it is concluded that SPE may be worth being applied to thecontrol of some animal diseases.

Aspergillosis in fowls

1. A severe and fatal outbreak of Aspergillosis was reported from several places in the Central Provinces. 2. Young birds are most liable to an acute infection, but the older individuals are more resistant. 3. Symptoms of the disease are given. 4. Aspergillus fumigatus has been isolated from the heart and cutaneous blood, lungs and other organs of sick birds, eggs and poultry feed. 5. A detailed microscopic study of the organism is given. 6. Besides fowls the fungus has been found pathogenic to human beings, goats and rats. 7. Eggs from sick birds hardly ever hatched out andAspergillus fumigatus has been isolated from most of them.