AVIAN INFLUENZA (123): REVIEW, GERMANY, FRANCE, WILD BIRDS
 **********************************************************
 A ProMED-mail post
   ProMED-mail is a program of the
 International Society for Infectious Diseases

 
 Date: Thu 5 Jul 2007
 From: Justin Brown

 Re: Request for information on experimental infection trials in wild
 birds
 -----------------------------------------------------
 We would like to submit the following information in response to the
 moderator's request for information on experimental infection trials
 in wild avian species [included in archive 20070629.2090; 29 Jun
 2007].

 Further experimental infection studies are needed to evaluate the
 susceptibility and the carrier efficiency of different wild avian
 species infected with H5N1 HPAI virus. However, significant published
 literature does exist on this topic.

 Drs. Laura Perkins and David Swayne published, between 1999-2003,
 several papers (listed below) on the pathobiology of H5N1 HPAI virus
 in a wide variety of avian species including chickens, turkeys,
 domestic ducks and geese, bobwhite and Japanese quail, chukar
 partridges, ringed-neck pheasants, guinea fowl, budgerigars, European
 starlings, house sparrows, laughing gulls, emus, and house and zebra
 finches. These studies were conducted with a March 1997 isolate of

 H5N1 HPAI isolated from chickens in Hong Kong and have been a valuable
 resource on this topic.

 More recently, we published a paper on the susceptibility of 5 non-
 domestic duck species (wood ducks, Northern Pintails, redheads,
 blue-winged teal and mallards) and laughing gulls to an H5N1 HPAI
 virus isolated from a dead whooper swan in 2005, and Klopfleisch et
 al. (2006) reported the findings from pigeons experimentally infected
 with another H5N1 virus (also listed below).

 In addition, further studies have evaluated multiple recent H5N1 HPAI
 virus infections in domestic waterfowl, such as Pekin ducks (_Anas

 platyrhyncos_) (Pantin-Jackwood and Swayne, 2007) and American crows
 and rock doves (Swayne, 2007).

 We recently have completed an experimental infection study evaluating
 the susceptibility of different swan and goose species to H5N1 HPAI
 virus, which is currently being reviewed for publication. In this
 study, we experimentally infected 4 species of swans and 2 species of
 geese with H5N1 HPAI virus to evaluate their susceptibility, clinical
 response, and viral shedding. The highest mortality rates were
 observed in swans and species-related differences in clinical response
 and viral shedding were evident.
 Based on our results, mute swans, cackling geese, and bar-headed geese
 were identified as waterfowl species that pose the greatest
 susceptibility to lethal infection and some species shed virus for up
 to 4 days before becoming ill. Such findings suggest some waterfowl
 species could spread H5N1 HPAI virus between limited geographic
 regions, but results do not suggest that these species would be
 long-term reservoirs for this virus.

 Though major gaps still exist in our understanding of H5N1 HPAI in
 wild birds, good experimental data is in the literature which can help
 us understand the transmission, susceptibility, and pathogenesis of
 this virus in wild avian species.

 References

 Zhou JY, Shen HG, Chen HX, Tong GZ, Liao M, Yang HC, Liu JX.
 Characterization of highly pathogenic H5N1 influenza virus derived
 from bar-headed geese in China. Journal of General Virology 87:

 1823-1833. 2006.

 Sturm-Ramirez KM, Ellis T, Bousfield B, Bissett L, Dyrting K, Rehg JE,
 Poon L, Guan Y, Peiris M, Webster RG. Reemerging H5N1 influenza
 viruses in Hong Kong in 2002 are highly pathogenic to ducks.
 Journal of Virology 78: 4892-4901. 2004.

 Hulse-Post DJ, Sturm-Ramirez KM, Humberd J, Seiler P, Govorkova EA,
 Krauss S, Scholtissek C, Puthavathana P, Buranathai C, Nguyen TD, Long
 HT, Naipospos TS, Chen H, Ellis TM, Guan, Y, Peiris JS, Webster RG.
 Role of domestic ducks in the propagation and biological evolution of
 highly pathogenic H5N1 influenza viruses in Asia.

 Proceedings of the National Academy of Sciences of the United States
 of America 102: 10682-10687. 2005.

 Pantin-Jackwood MJ, Swayne DE. Pathobiology of Asian highly pathogenic
 avian influenza H5N1 virus infection in ducks. Avian Diseases 51:
 250-259. 2007.

 Perkins LEL, Swayne DE. Pathobiology of A/chicken/Hong Kong/220/97
 (H5N1) avian influenza virus in seven gallinaceous species.
 Veterinary Pathology 38: 149-164. 2001.

 Perkins LEL, Swayne DE. Pathogenicity of a Hong Kong-origin H5N1
 highly pathogenic avian influenza virus for emus, geese, ducks, and
 pigeons. Avian Diseases 46: 53-63. 2002.

 Perkins LE, Swayne DE. Comparative susceptibility of selected avian
 and mammalian species to a Hong Kong-origin H5N1 high-pathogenicity
 avian influenza virus. Avian Diseases 47: 956-967. 2003.

 Perkins LE, Swayne DE. Varied pathogenicity of Hong Kong-origin
 H5N1 avian influenza virus in four passerine species and budgerigars.

 Veterinary Pathology 40: 14-24. 2003.

 Brown JD, Stallknecht DE, Beck JR, Suarez DL, Swayne, DE.
 Susceptibility of North American Ducks and Gulls to H5N1 Highly
 Pathogenic Avian Influenza Viruses. Emerging Infectious Diseases 12:

 1663-1670. 2006.

 Klopfleisch R, Werner O, Mundt E, Harder T, Teifke JP. Neurotropism of
 highly pathogenic avian influenza virus A/Chicken/Indonesia/2003

 (H5N1) in experimentally infected pigeons (Columbia livia f.
 domestica). Veterinary Pathology 43: 463-470. 2006.

 Swayne DE. Understanding the complex pathobiology of high
 pathogenicity avian influenza viruses in birds. Avian Diseases 51:

 242-249. 2007.
 --
 Justin Brown and David Stallknecht
 Southeastern Cooperative Wildlife Disease Study University of Georgia
 Athens, Georgia, USA

 David E. Swayne
 Southeast Poultry Research Laboratory
 Agricultural Research Service
 U.S. Department of Agriculture
 Athens, Georgia, USA

 [The above firsthand, updated information and references of multi-
 disciplinary research, received from leading experts, is impressive,
 encouraging and very much appreciated.

 The recent, yet-to-be-published study, is of particular interest.
 According to the authors, the study's results indicate the following:

 "Mute swans, cackling geese and bar-headed geese were identified as
 waterfowl species that pose the greatest susceptibility to lethal
 infection and some species shed virus for up to 4 days before becoming
 ill. Such findings suggest some waterfowl species could spread H5N1
 HPAI virus between limited geographic regions, but results do not
 suggest that these species would be long-term reservoirs for this
 virus".

 The distances such infected waterfowl could fly within up-to 4 pre-
 clinical days are considerable and should be kept in mind.

 The species which would be long-term H5N1 HPAI reservoires, supposedly
 by undergoing viraemia (of extended duration?) without becoming ill,
 remains to be further investigated. As the authors rightly say,
 further experimental infection studies are needed to evaluate the
 susceptibility and the carrier efficiency of different wild avian
 species infected with H5N1 HPAI virus.

 Information on such investigations, and any results becoming
 available, will be welcomed. - Mod.AS]

 ******
 ΐ]
 Date: Thu 5 Jul 2007
 Source: Eurosurveillance weekly releases, Vol 12, Issue 7 [edited]
 

 Highly pathogenic avian influenza A/H5N1 in birds within the EU -
 Implications for Public Health
 ---------------------------------------------------------------------
 Since the later part of June 2007, 3 European Union (EU) Member States
 (Czech Republic, Germany, and France) have recorded cases of highly
 pathogenic avian influenza (HPAI) of the subtype A/H5N1 in bird
 populations.

 On 21 Jun 2007, authorities in the Czech Republic confirmed an
 outbreak of HPAI A/H5N1 in a domestic poultry flock in the Pardubicky
 region in the centre of the country Ώ] [For the said reference 1 and
 the others mentioned in the article, subscribers are referred to the
 URL above. - Mod. AS]. A few days later a 2nd infected flock, located

 4 km ΐ.48 miles] from the first, was identified through the enhanced
 surveillance of flocks in the area that was introduced after discovery
 of the first infected premise ΐ]. Subsequently, virus was isolated
 from a wild bird (swan) found dead on 28 Jun
 2007 in the Jihomoravsky region in south of the country, near the
 border to Austria Α].

 At almost the same time, on 26 and 28 Jun 2007, German authorities
 reported that HPAI A/H5N1 had been identified in wild birds in 2
 locations in Germany; six wild birds (5 swans and one Canada goose) in
 Bavaria in southern Germany Β], and 3 wild swans in Saxony in eastern
 Germany Γ].

 On 5 Jul 2007, France also confirmed the first occurrence this year of
 3 wild swans infected with influenza A/H5N1. They were found in the
 Mosel region in the north-east of France Δ].

 Samples from the infected birds from all 3 countries were identified
 as part of the EU supported active surveillance programme for avian
 influenza in wild birds, which requires all EU Member States to test
 wild birds for avian influenza viruses in order to provide an early
 warning of the presence of the virus in the EU Ε].

 Virus strain analysis
 ---------------------
 Initial phylogenetic analysis of the virus subtype from the outbreaks,
 conducted by the EU's Community Reference Laboratory for Avian
 influenza in the United Kingdom (UK) and the Friedrich- Loeffler
 Institut in Germany, suggests that the viruses recently identified in
 the Czech Republic and Germany are highly similar.
 However, they are of different origin from those identified during
 other EU poultry outbreaks earlier this year (UK and Hungary) and in
 2006. Instead, the current virus is more closely related to a lineage
 originating from the Middle East (including Bangladesh, Pakistan and
 Azerbaijan) and Russia Ζ]. However, as for all H5N1 viruses to date,
 there has been no indication of a significant phylogenetic change
 which would alter the behaviour of the A/H5N1 virus in humans.

 Control measures in animals
 ---------------------------
 In accordance with EU animal health legislation prompt and vigorous
 animal disease control measures have been taken in both countries.

 Understandably, measures are more stringent for outbreaks in domestic
 poultry where the onus is to remove the source of infection, and to
 dampen down or stamp out the level of virus in the vicinity as quickly
 as possible so as to prevent spread. In this case legislation dictates
 a containment strategy involving culling all birds on the affected
 premises followed by cleaning and disinfection. In addition,

 2 roughly concentric zones must be established around the affected
 farms: A 3-km Ώ.86 miles] protection zone and a 10-km Δ.21 miles]
 surveillance zone, which constitute Area A (high risk), and a
 surrounding buffer zone called area B (lower risk) Η].

 If A/H5N1 is discovered in wild birds, EU legislation allows a less
 stringent approach but still requires that a control area and a
 surrounding monitoring area are established around the infected birds.
 This can be adapted on a case by case basis following a risk
 assessment taking into account the local geographical, ecological and
 epidemiological circumstances. Measures are aimed at preventing the
 spread of avian influenza from wild birds to poultry or other captive
 birds and include strengthening of on-farm biosecurity and disease
 awareness, temporary banning of wild bird hunting and restrictions on
 the movement of poultry and poultry products ⎖].

 Epidemiological investigations as to the possible source of the
 domestic poultry outbreaks in the Czech Republic are ongoing. No cases
 of influenza A/H5N1 have been recorded in wild birds in the vicinity
 of any of the domestic poultry cases in 2007 (the case of

 A/H5N1 reported in a wild bird in the Czech Republic was over 150km to
 the south of the infected farms). However, the fact that the outbreaks
 in domestic poultry coincided with the first reports of cases in wild
 birds in the EU in 2007 is probably more than a coincidence. It may
 indicate that the virus remains present intermittently in wild bird
 populations within some Member States.

 This also places domestic poultry flocks at risk. The high genetic
 similarity of the strain in wild and domestic birds in the current
 outbreaks is at least consistent with interaction between wild birds
 and domestic poultry Ζ].

 General implications
 --------------------
 The re-emergence of influenza A/H5N1 in EU bird populations is of
 concern, but not an unexpected development since A/H5N1 viruses are
 highly persistent across the world. In some countries (all outside

 Europe) the viruses are now endemic. However, in other areas like the
 European Member States, they are appearing intermittently through
 uncontrollable movements of wild birds and perhaps also illicit or
 poorly controlled poultry trading ⎗]. The fact that active
 surveillance has been underway throughout the EU since 2002, and was
 increased in 2006 and 2007, and the fact that the cases described were
 the first isolations of A/H5N1 in wild birds this year, suggest that
 infection is neither as widespread nor as intense as in the early
 spring of 2006. However, the cases in wild birds are a timely reminder
 to all Member States to continue veterinary surveillance activities in
 bird populations (wild and domestic). This provides an essential early
 warning of the presence of the virus. If it is found in birds, it is
 vital that containment measures are rapidly deployed to control
 infection to prevent the virus from becoming established in domestic
 poultry. This is important in order to preserve the health of animals,
 and also to minimise the risk of human exposure to the virus.

 Public health implications
 --------------------------
 Wherever cases of avian influenza are suspected, close collaboration
 between public health specialists and veterinarians remains crucial.

 This is especially the case for A/H5N1 because, although the virus is
 predominantly an infection in animals, and to date it has proved very
 difficult to transmit from birds to man, it has a high case fatality
 rate in those humans that become infected ⎗]. The aim is to ensure
 that people that have close contact with infected birds are given
 appropriate levels of advice and support. Because the recent incident
 in the Czech Republic involved outbreaks in domestic poultry, with
 large numbers of potentially infected animals requiring culling to
 minimise the spread of infection, public health authorities have been
 actively involved in:

 - providing advice to workers involved in the culling operations on
 the use of personal protective equipment (e.g. masks and gloves);

 - providing advice on the use of prophylactic antiviral drugs; and
 - following up exposed workers.

 The cases in Germany occurred in individual wild birds and hence the
 risk of potential human exposure was much lower than in cases
 involving infected domestic poultry. However, there has been a cluster
 of human cases associated with slaughtering and plucking of feathers
 from wild birds that were suspected to have been infected with A/H5N1
 (swans in Azerbaijan). This indicates that there is potential human
 health risk from wild birds, although it is likely to be low, and very
 dependant on how birds are handled and the precautions taken (12). It
 is however important that general precautions messages are
 communicated to the population to avoid handling birds found dead,
 and, as demonstrated in Germany, that authorities engage with those
 individuals that may have handled infected wild birds to advise them
 of how to protect themselves, the need to monitor their health, and
 provide advice and reassurance as necessary, along with antiviral
 prophylaxis if considered necessary.

 The recent outbreak of low pathogenicity avian influenza A/H7N2 in the
 UK has shown how people with home and hobby flocks can easily be
 infected if they are unaware of the risk ⎚].

 Since the autumn of 2005, ECDC has been producing technical guidelines
 for minimising the risk of humans acquiring avian influenza
 (specifically H5N1) from exposure to infected birds or animals. A
 portfolio of guidance documents and risk assessments on other public
 health aspects of A/H5N1 is available for public health authorities
 and the public ⎛]. These documents highlight the importance of
 removing the source of infection as quickly as possible, while also
 implementing risk-minimising public health measures. ECDC has also
 produced a more general risk assessment of the public health risk
 posed by highly pathogenic avian influenza viruses emerging in Europe,
 with specific reference to type A/H5N1 ⎘].

 Pandemic Risk
 -------------
 The 3 pandemics of the 20th century all had their origins to varying
 extents in genetic material introduced from avian into human influenza
 viruses, with the virus that caused the 1918 Spanish Influenza being
 the one most closely related to an avian strain ⎜].

 There is no prima facie reason why the genes in A/H5N1 should
 contribute to the next pandemic rather than other avian influenzas
 (H2, H7, H9, etc.) that are currently circulating. What makes
 scientists and public health officials more nervous about A/H5N1 is
 its unprecedented mortality rate in humans of over 60 percent.
 Unlike most other avian influenza viruses it is exceptionally
 persistent in birds and keeps coming into contact with humans in
 countries where it is endemic in domestic birds ⎗,12]. Therefore the
 EU is sensibly preparing for any influenza pandemic, while watching
 influenza A/H5 viruses in particular ⎝].

 Conclusions
 -----------
 Influenza A/H5N1 viruses remain 'a group of influenza viruses of
 birds, poorly adapted to humans whom they find hard to infect except
 at high doses. They are dangerous as they are highly pathogenic in
 those few humans that do become infected, but then they generally do
 not transmit on to other humans' ⎗]. This, together with veterinary
 measures and application of public health guidelines, is probably the
 reason why, to date, influenza A/H5N1 infection in wild and domestic
 birds in Europe has not resulted in human infections. However, there
 is no room for complacency. Ongoing vigilance, control of infection in
 poultry, communication to those at risk, and prompt response (case
 finding and management) to human cases remain the cornerstones of
 protecting humans against A/H5N1 viruses.

 [Byline: Influenza Team
 European Centre for Disease Prevention and Control, Stockholm, Sweden
 

 [The web site of ECDPC's influenza team is available at
   Mod.AS]

 --
 Communicated by:
 ProMED-mail
 

 ******
 Α]
 Date: Fri 6 Jul 2007
 Source: Deutche Welle [edited]
 

 Germany, France Raise Bird Flu Risk Level After New H5N1 Cases
 --------------------------------------------------------------
 Germany's top state veterinary laboratory raised the risk level after
 more wild birds had tested positive for H5N1 in the eastern states of
 Saxony-Anhalt and Thuringia.

 "We will raise the threat level," a spokeswoman for the Friedrich
 Loffler Institute told reporters.

 The regional authorities in Sangerhausen in Saxony-Anhalt reported
 that 38 dead birds found on the shores of an artificial lake near the
 town of Kelbra had all tested positive. Saxony-Anhalt is the 4th of
 Germany's 16 states to report cases of H5N1 bird flu since late last
 month [June 2007], when it struck down 6 wild birds in the southern
 city of Nuremberg in Bavaria.

 On Tue 3 Jul 2007 a bird found on the other side of the lake which is
 in Thuringia was confirmed to have had H5N1 bird flu. Cases have also
 been reported near Leipzig in the neighboring eastern state of Saxony,
 bordering the Czech Republic which is battling a more severe outbreak
 of the H5N1 avian flu.

 The Friedrich Loffler Institute suggested the disease could have
 jumped the border from the Czech side where it has infected turkey and
 chicken farms. So far in Germany the new outbreak has been restricted
 to swans, geese and other wild birds and has not affected poultry
 farms.

 Germany battled a widespread bird flu epidemic in 2006. It broke out
 on the Baltic Sea island of Rugen and spread to 6 states, including
 Bavaria. The disease spread to mammals, infecting 3 cats and a stone
 marten, but did not affect humans.

 In neighboring France, Europe's biggest poultry producer, authorities
 stepped up surveillance after tests on 3 dead swans confirmed an H5N1
 outbreak. Agriculture Minister Michel Barnier raised the threat level
 from bird flu from "moderate" to "high" following the test results on
 the swans that were found dead in northeast France last week. It is
 France's second outbreak of the deadly strain of bird flu in 17
 months, but Health Minister Roselyne Bachelot said there was no reason
 for alarm. "France is not threatened by a bird flu pandemic as there
 has not been, for the moment, a human contamination from the
 H5N1 virus," Bachelot said. But she added "we must be vigilant as the
 great flu epidemic that followed the war of 1914, the Spanish flu"
 came from a strain of bird flu.

 Scientists believe a strain related to today's bird flu virus caused
 the death of tens of millions of people during the Spanish flu
 pandemic.

 "We must do what is necessary to ensure that all of the agencies, the
 entire health system is ready to deal with a mutation of the virus"
 that could attack humans, said Bachelot on French television.

 Fresh measures were ordered to ensure that chickens and other poultry
 did not enter into contact with wild birds and that they underwent
 monthly veterinary checks. Pigeon competitions have been banned and
 security around a one-km (0.6 mile) exclusion zone established around
 the pond in the Moselle department where the dead swans were
 discovered has been beefed up.

 A second 15-km Η.32 miles] "observation" zone was set up around the
 pond at Assenoncourt but a spokesman for the local municipality said
 no other dead birds had been found there, which he described as a
 "reassuring" sign.

 "These measures apply to all farms that must be protected from wild
 birds that fly overhead. These protective measures are nets and a ban
 on bringing birds together in public places and at markets," Barnier
 said.

 Officials put 3 farms in the observation zone under quarantine, and
 restricted access to roads in the area.

 "With these measures that we are taking, the risk of contamination
 will be very small," said Philippe Hestroffer, of the regional
 veterinary services.

 A first outbreak of H5N1 in February 2006 was detected in 62 dead
 birds in central France and spread to a farm near the town of
 Versailleux where hundreds of turkeys were slaughtered. It was also
 the first outbreak of the virulent strain in the European Union.
 France produces 900 million poultry per year including 700 million
 chickens, according to the Confederation of French Poultry Producers.
 The sector employs 80 000 people and generated 4 billion euros (USD
 5.4 billion) last year.

 In the Netherlands, the authorities ordered all poultry to be kept
 inside. They announced the measure after what they called the
 discovery of a bird flu case "not far from the Netherlands."

 While the bird flu virus is highly contagious among poultry and can
 spread to an entire flock, it remains difficult for humans to catch.
 A total of 191 people worldwide have died of bird flu, according to
 the World Health Organization [WHO], which has reported 317 cases in
 its 29 Jun 2007 tally. Indonesia, Vietnam and Thailand top the list of
 most-affected countries.

 --
 Communicated by:
 ProMED-mail
 

 [A graph showing the number of Avian Influenza (subtype H5N1)
 outbreaks in poultry, reported to the OIE from the end of 2003 to 05
 July 2007 by 43 countries, is available at:
   2005_07_2007.pdf.
 Cases in wild birds are not included.

 More information on avian influenza in wild birds is available in
 ProMED-mail's thread "Avian influenza, poultry vs migratory birds." -
 Mod.AS]

 [see also:
 Avian influenza (122): Germany (Thuringia), France, Austria, wild
 birds  20070705.2135 Avian influenza (120): France, wild birds, Viet
 Nam  20070704.2119
 Avian influenza (119): Germany, France, wild birds, susp.  
 20070703.2116
 Avian influenza (118): Czech-German virus sequence  20070701.2104
 Avian influenza (117): Germany, wild birds  20070629.2090
 Avian influenza (114): Viet Nam, Pakistan, Czech Republic  
 20070627.2069
 Avian influenza (112): Germany (Saxony), wild birds  20070626.2064
 Avian influenza (109): Germany (Bavaria), wild birds, conf.  
 20070624.2041
 Avian influenza (108): Germany (Bavaria), wild birds  20070624.2040
 Avian influenza (106): Czech Republic, turkeys, DEFRA  20070622.2018
 Avian influenza (104): Russia (Siberia), wild ducks  20070620.1983]