avian flu transmission

7/29/2019 Avian Flu Transmission

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Avian InfluenzaEpidemiologi & Penularanpada Manusia

Sri Rezeki S Hadinegoro

Divisi Infeksi & P.TropisDep Ilmu Kesehatan Anak FKUI-RSCM


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Virus avian influenza (H5N1) berasal dariburung liar (wild birds) menyerang unggas(burung, ayam), babi, kuda

Menyebar cepat diantara populasi unggasdengan kematian tinggi

Dapat menyebar antar peternakan

Penularan melalui udara, air tercemar,berasal dari tinja unggas sakit

Dapat menyerang manusia (penyakitzoonosis)

Avian influenza

(bird flu, flu burung)


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Avian influenza

(bird flu, flu burung) Secara epidemiologi

Low pathogenic avian influenza (LPAI)

Highly pathogenic avian influenza (HPAI)

Perbedaan pada susunan genetik virus

HPAI sangat virulen menyebabkan kematian ternak

ayam 90-100% LPAI

infeksi ringan atau tidak tampak sakit


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Wabah Avian Influenza

1997, avian influenza A (H5N1), Hongkong,menyerang ayam dan manusia

1999 Hongkong: avian flu A (H9N2), 2 kasus anak, hidup

Cina: H9N2

2003

Hongkong: avian flu A (H5N1), 2 kasus, 1 meninggal,riwayat perjalanan ke Cina

Netherland: avian flu A (H7N7), 83 kasus pekerjapeternakan, 1 meninggal

Hongkong : avian flu A (H9N2), 1 kasus hidup


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Situasi Virus Influenza H5N1 di Asia6 Februari 2004

Penyebab wabah flu di Hongkong,

Vietnam, Thailand, dan Jepang

Dilaporkan 20 kasus pada manusia Vietnam 15

Thailand 5

Kematian 16 kasus

Vietnam 11

Thailand 5

CFR 80%


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Situasi Virus Influenza H5N1 di Asia21 Juli 2005

Kasus avian influenza A (H5N1) pada

manusia 109 orang

Vietnam 87

Thailand 17

Kamboja 4

Indonesia 2 (WHO), 1 belum ada hasil

Kematian 55 orang (50,45%)

http://www.who.int/csr/disease/avian_influenza/en/
http://www.who.int/csr/disease/avian_influenza/en/http://www.who.int/csr/disease/avian_influenza/en/


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Situasi di Indonesia 2004 Virus menyerang ternak ayam sejak bulan

Okt 2003-Feb 2004

4,7 juta ayam mati Belum ada laporan menyerang manusia

Serosurvai virus influenza A(H5N1)terhadap peternak semua negatif, dari 2

daerah Bali 102 sera, 28 kontrol, 8 swab hidung

Tangerang: 100 sera, 25 kontrol, 6 swab hidung


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Daerah tertular Avian Flu

di Indonesia

September 2003-Desember 2004

17 provinsi, 108 kabupaten/kota P Sumatera: 5 prop, 17 kab/kota

P Jawa: 6 prop, 71 kab/kota

P Kalimantan: 3 prop, 5 kab/kota Nusa Tenggara: 2 prop, 7 kab/kota

Sumber: Dirjen Peternakan, Deptan; Kompas 31 Juli 2005


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Analisis Epidemiologi

Outbreak of highly pathogenic avianinfluenza A (H5N1)

2003-2004 wabah di 8 negara Asia : Kamboja,Cina, Indonesia, Jepang, Laos, Korea Selatan,Thailand, Vietnam

>100 juta burung mati/ dimusnahkan

Des 2003-Maret 2004: 12 confirmed human avianinfluenza A di Thailand, 23 Vietnam, kematian 23orang

Tidak ada laporan penularan manusia ke manusia


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Analisis Epidemiologi Akhir Juni 2004: epizootic outbreakof new lethal

avian influenza(H5N1) pada ayam di Kamboja,Cina, Indonesia, Malaysia, Thailand, & Vietnam

Agustus

Oktober 2004: kasus pada manusiasecara sporadis di Vietnam, Thailand

Sept 2004: probable limited human to humantransmission(Thailand)

Des 2004: ayam & manusia (Vietnam) Feb 2005: infeksi pada manusia (Kamboja)

Juli 2005 : infeksi pada manusia (Indonesia)

www.cdc.gov/flu/avian.htm


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Penularan dari binatang ke manusia

Infeksi virus influenza A spesifik manusia : H3N2, H2N2, H1N1

babi : H7N7

kuda : H3N8

AS, tahun 1998 ditemukan H1N1 pada babi

H3N2 dari manusia terdapat pada babi

Masa inkubasi 1-3 hari

Penularan ke manusia melalui 2 cara langsung dari unggas atau lingkungan yang tertular virus

melalui hostperantara, misalnya babi


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HA subtypes

ManSwine

Horse

Seal

Turkey

Duck

++

+

+H1

+

+H2

++

+

+H3

+

+

+H4

+

+

+H5

+

+H6

+

+

+

+H7

+H8

+

+H9

+

+H10

+H11

+H12

NA subtypes

++

+

+N1

++

+

+N2

+

N3

+

+N4

+

+N5

+N6

+

+

+

+N7

+

+

+N8

+N9

H1N1, H2N2, H3N2 and H5N1, H1N2 subtypes have been isolated in humans Today, H1N1 and H3N2 and H1N2 (less) subtypes of influenza A co-circulate

No subtypes exist for B or C viruses

Host distribution of influenza Asubtypes


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Masalah yang akan timbul

Epizootic outbreakmerupakan ancaman kesehatanmasyarakat

Imunitas alami infeksi H5N1 pada manusia rendah Mengakibatkan pandemi avian influenza (H5N1) pada

manusia

Penularan dari manusia ke manusia terbukti (jaringanautopsi, nasofarings, usapan tenggorok dg RT-PCR)pada 3 kasus dalam 1 keluarga di Thailand

Kasus Vietnam & Thailand resistans terhadap antivirus

amantadine & rimantadine (sensitif thd antivirus lainoseltamivir & zanamivir)

Belum ada vaksin avian influenza (H5N1) untukmanusia


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"Flu spreads across the world and ages"

INFLUENZAa devastating AIRBORNE infectious disease

Murphy B.R., Webster R.G., Virology, IInd edition, New York, 1990, 1091-2Ghendon Y. Introduction to pandemic influenza through history Eur Jour of Epid, 1994;10: 451-453

412 B.C

Middle ages1781 & 1830

1918

1933

1957

1968

1977

"Asian flu A (H2N2)

"Hong Kong" flu A (H3N2)

"Russian" flu

First human influenza virus isolated

"Spanish influenza" killed 20-40 million people

A(H1N1)Epidemics spread across Russia from Asia

Numerous episodes described

Epidemicrecorded

by Hippocrates


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Epizootic outbreak

Recent research: circulating strain H5viruses are becoming more capable ofcausing diseases (pathogenic) for mammals(pig, cat, tiger, leopard) than earlier H5viruses and more widespread in birds(ducks) in the region

Reassortment of avian influenza genomes ismost likely to occur when these virusesdemonstrate a capacity to infect multiplespecies, as is now the case in Asia

www.cdc.gov/flu/avian.htm


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Frequent with Influenza A, less for type B, never for

type C

To escape population immunity

Involves the external antigens : HA and NA

Two types of mutations depending on whether the

RNA segment variation is small or great

Antigenic drift Antigenic shift

Each year, evolution can induce a different virus

Antigenic variation :intelligence of influenza viruses

Betts FR, Douglas RG, Mandell G.L., Douglas R. G., Bennett J.E., Principles andpractice of infectious diseases, 3rd ed., 1990;39:1306-25


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Antigenic drift minor changes inHA or NA

Affects Influenza A and B viruses

Occurs every year or every few years within an influenza

subtype

Mutations affecting RNA amino acids Does not result in new subtype

Can result in significant epidemics

A/H3N2

Viral population

RNA point mutations

Infected

host cell

RNA segment

one or more

amino acids

change

DRIFTA/H3N2

Betts FR, Douglas RG, Mandell G.L., Douglas R. G., Bennett J.E., Principles and

practice of infectious diseases, 3rd ed., 1990;39:1306-25


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Historical antigenic driftsfor H3N2 and H1N1 subtypes

Assaad F, Bektirimov T, Ljungars-Esteves K. influenza- world experience.

In: Stuart-Harris C, Potter CW eds. The molecular virology

andepidemiology of influenza London, New York and Orlando, Academic

Press 1984- 5-15

?

A/Chile/83

A/Mississipi/85

A/Singapore/86

A/England/80

A/India/80

A/USSR/77

H1N1

A/Brazil/78

A/Johannesburg/94

?

A/Wuhan/95

A/Hong Kong/68

A/Philippines/82

A/Port Chalmers/73

A/Scotland/74

A/Victoria/75

A/Texas/77

A/Bangkok/79

A/Beijing/89

A/Shangha/87

A/Shangdong/93

H3N2

A/England/72


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Antigenic shift

emergence of a "new" virus worldwide Affects only Influenza A virus

Major and sudden genetic variations in HA and/or NA

No immunity in population

Results in pandemics every 10 to 40 years

RNA recombination

Infected

host cell"New" virus

Genetic reassortment

hybrid strain RNA

Result in new subtypes: "new" HA and/or "new" NA

human strain

RNA

avian strain

RNA SHIFT


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H3 H3'H3''

H3 H3'antibody (ab)

to former(H2) virus

anti-H3 abanti-H3 abanti-H3' ab

PANDEMICINTRODUCTION

INTERPANDEMICPERIOD

Shift Drifts

Kilbourne ED Inactivated influenza vaccines. In: Vaccines IInd edition Re 59; 1994:565-81

Influenza viruses:two ways of avoiding population immunity


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InfluenzaPandemics

1918 1957 1968 1977 1997

1998/9

2003

H1

H1

B

H2

H7H5H5

H9

Spanish

Influenza

Asian

Influenza

RussianInfluenza

AvianInfluenza

Hong KongInfluenza

H3

Pandemic

vaccines

Regularvaccines

Ellina, 2004


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Seasonal occurrence of influenza

J F M A M J J A S O N DJ F M A M J J A S O N D

Southern hemisphere Tropical Northern hemisphere

Reichelderfer PS, Kendal AP, Shortridge KF, Hampson A. and al. Influenza surveillance in the pacifi

In: Current topics in medical virology 1988:412-38

Summary of influenza activity and occurrence in different climates


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Choice of vaccine strains procedure

Hannoun C.

Role of international networks for the surveillance of influenza.

Eur Journal of Epidemiol 1994;10:459-61

Sentinel Doctors

National influenza Centers

(110 national laboratories in over 80 countries)

World Health Organisation

(WHO - Geneva)

Collaborating Reference Centers for

Research against influenza

(London, Atlanta, Melbourne and

Tokyo)

Vaccine Manufacturers

International surveillance network


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Influenza vaccines in practice

Age group

6-35 mos

3-8 yrs

9-12 yrs

>12 yrs

Dosage

0.25 ml

0.50 ml

0.50 ml

0.50 ml

Product

Split or subunit

Split or subunit

Split or subunit

Split, subunit or whole

1 or 2*

1 or 2*

1

1

No. of doses

ACIP Recommendations

*at least 1 month apart for children receiving vaccine for the first time

MMWR, ACIP 1996

Whole virus vaccine is prohibited for subjects under 13 years


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Rekomendasi WHOVaksinasi Influenza

Vaksinasi influenza untuk kelompok risikotinggi (populasi yang berhubungan denganpeternakan ayam)

Awam perlu dilindungi terhadap virusinfluenza manusia

Tidak melindungi virus influenza A (H5N1)

Mengurangi kesempatan terjadinya viralshift(subtipe baru yang dapat menyebabkan pandemi)

http://www.who.int/csr/disease/avian_influenza/en/
http://www.who.int/csr/disease/avian_influenza/en/http://www.who.int/csr/disease/avian_influenza/en/


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Travel Warning

Before any international travel

Always educate yourself and others who maybe traveling with you about any disease risksin areas you plan to visit

http://www.cdc.gov/flu/avian/index.htm

Be sure you are up to date with all yourshots, and see your doctor or health-care

provider, ideally 4

6 weeks before travel toget any additional shots, medications, orinformation you may needhttp://www.cdc.gov/travel/seasia.htm
http://www.cdc.gov/flu/avian/index.htmhttp://www.cdc.gov/travel/seasia.htmhttp://www.cdc.gov/travel/seasia.htmhttp://www.cdc.gov/flu/avian/index.htm


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Travel Warning

Before any international travel Assemble a travel health kit containing basic

first aid and medical supplies. Be sure toinclude a thermometer and alcohol-basedhand rub for hand hygiene.http://www.cdc.gov/travel/other/travelers-health-kit.htm

Identify in-country health-care resources inadvance of your trip

Check your health insurance plan or getadditional insurance that covers medicalevacuation in case you become sick.www.travel.state.gov/medical.html
http://www.cdc.gov/travel/other/travelers-health-kit.htmhttp://www.cdc.gov/travel/other/travelers-health-kit.htmhttp://www.travel.state.gov/medical.htmlhttp://www.travel.state.gov/medical.htmlhttp://www.cdc.gov/travel/other/travelers-health-kit.htmhttp://www.cdc.gov/travel/other/travelers-health-kit.htmhttp://www.cdc.gov/travel/other/travelers-health-kit.htmhttp://www.cdc.gov/travel/other/travelers-health-kit.htmhttp://www.cdc.gov/travel/other/travelers-health-kit.htm


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Travel Warning

During Travel Avoid places such as poultry farms and bird markets

where live poultry are raised or kept , and avoidhandling surfaces contaminated with poultry feces orexcretions.

Frequent handwashing. Influenza viruses are destroyed by heat; all foods from

poultry, including eggs and poultry blood, should bethoroughly cooked.

If you become sick with symptoms such as a fever,difficulty breathing, cough, or any illness that requiresprompt medical attention, and informing your family orfriends.

http://www.cdc.gov/travel/other/illness-abroad.htm.
http://www.cdc.gov/travel/other/illness-abroad.htmhttp://www.cdc.gov/travel/other/illness-abroad.htmhttp://www.cdc.gov/travel/other/illness-abroad.htmhttp://www.cdc.gov/travel/other/illness-abroad.htm


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Travel Warning

After your return Monitor your health for 10 days

If you become ill with fever, difficulty breathing,

cough, or any illness during this period, consult a

health-care provider

Before you visit a health-care setting,

tell the provider about your symptoms,

if you have had direct poultry contact,and where you traveled.

This way he or she can be aware you have traveled

to an area reporting avian influenza


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Avian influenza- situation in Indonesia29 July 2005

Laboratory evidence now shows that the 8-year-oldgirl from Tangerang, Banten Province, is a probableavian influenza A/H5 case, based on analysis of

serological samples. She was the daughter of theconfirmed case reported previously

Two WHO Reference Laboratories at the Universityof Hong Kong and the Centers for Disease Control

and Prevention USA, detected high positive risingmicroneutralisation titres specific for H5N1 in 2samples taken 3 days apart

www.who.int/disease/avian_influenza/html
http://www.who.int/csr/don/2005_07_29c/en/%20http:/www.who.int/csr/don/2005_07_21a/en/index.htmlhttp://www.who.int/csr/don/2005_07_29c/en/%20http:/www.who.int/csr/don/2005_07_21a/en/index.html


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Avian influenza- situation in Indonesia

29 July 2005 Laboratory results for the 1-year-old

daughter are still pending.

Genotyping of the PCR-amplified isolate

from the confirmed case (father) shows highhomogeneity with other H5N1 isolates frompoultry in Java, and no evidence ofreassortment.

Extensive epidemiological and environmentalstudies are ongoing around this familycluster.


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Avian influenza- situation in Indonesia29 July 2005

The Minister of Agriculture stated thatlaboratory results detected H5-infected birdfaeces in a bird cage opposite side of the

road of the family's house; cloacal andthroat swabs of the pet bird inside the cagewere negative for H5.

This is the first, and thus far, the onlyindication of a possible source of exposure.Other environmental sampling wasnegative.


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Rekomendasi Depkes

Kerjasama antara Depkes & Deptan

Survailans (seroepidemiologi)

Biosecurity Deteksi dini kasus, spesimen

Perawatan kasus

Imunisasi (terutama terindikasi pada orangyang berhubungan dengan peternakan)

Tim SARS diaktifkan kembali


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Bacaan www.cdc.gov/flu : basic information

www.cdc.gov/flu/han020302.htm : updating

www.who.int/csr/disease/avian_influenza/avian-

faqs/en/html: frequently asked questions www.who.int/csr/disease/influenza/vaccinerecomm

endations1/en/print.html: influenza vaccine

www.cdc.gov/flu/avian/outbreaks/asia.htm:

influenza antiviral drugs Depkes RI 2004. Pedoman penanggulangan Avian

flu
http://www.cdc.gov/fluhttp://www.cdc.gov/flu/han020302.htmhttp://www.who.int/csr/disease/avian_influenza/avian-faqs/en/htmlhttp://www.who.int/csr/disease/avian_influenza/avian-faqs/en/htmlhttp://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/print.htmlhttp://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/print.htmlhttp://www.cdc.gov/flu/avian/outbreaks/asia.htmhttp://www.cdc.gov/flu/avian/outbreaks/asia.htmhttp://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/print.htmlhttp://www.who.int/csr/disease/influenza/vaccinerecommendations1/en/print.htmlhttp://www.who.int/csr/disease/avian_influenza/avian-faqs/en/htmlhttp://www.who.int/csr/disease/avian_influenza/avian-faqs/en/htmlhttp://www.who.int/csr/disease/avian_influenza/avian-faqs/en/htmlhttp://www.cdc.gov/flu/han020302.htmhttp://www.cdc.gov/flu


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avian flu transmission

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