Clinical Updates
17 February 2006
Avian Influenza - Italy, Greece, Bulgaria, Iran, Romania, Germany
Italy
On 11 February 2006, the World Organisation for Animal Health (OIE) confirmed H5N1 avian influenza in five swans; three were found dead in Sicily, one in Calabria and one in Puglia [1]. These cases were first reported on the 2 February 2006.
Control measures that have been approved by Food and Agriculture Organisation (FAO) [2] have been implemented by Italian authorities, and include increased veterinary and agricultural checks and a restriction on the movement of poultry in the affected areas [3].
Greece
Three swans that were found dead in the sea-area of Paralia-Katerini in Pieria prefecture, and in Stavros village and Neoi Epivates village in Thessaloniki were confirmed as infected with H5N1 avian influenza by the OIE on 13 February 2006. The swans all belonged to the same flock and were found between 30 January and 1 February 2006. Samples were confirmed as H5N1 avian influenza by the OIE reference laboratory in Weybridge, England. The OIE has also confirmed that a goose found dead on the island of Skyros on the 3 February 2006 died of H5N1 avian influenza [1].
Current control measures include setting up a protective zone around the affected areas and strict biosecurity measures on backyard poultry and farms [1].
Bulgaria
On 12 February 2006, the first case of H5N1 avian influenza in Bulgaria was confirmed in a swan that was found dead on the riverside of the Danube near Vidin on 31 January 2006 [1]. Access to the areas of wetlands concerned has been restricted, danger signs are to be erected in the area [3] and restricted movement of poultry has been enforced [1].
Iran
On 14 February 2006, the OIE confirmed two cases of H5N1 avian influenza in swans that were found dead on 2 February 2006 in Anzali wetlands in the Sume’eh Sara district.
All farms in the area surrounding the wetlands are now subject to biosecurity measures, movement of poultry products and other risk material is controlled and there is a 2km protection zone around each site [1].
Romania
H5N1 avian influenza was first reported in Romania in October 2005. On 10 February 2006, the OIE confirmed a further outbreak in poultry starting on the 6 February 2006 in the Jurilovca district, Tulcea County. Several outbreaks have previously been reported in this county, although this is the first in the Jurilovca district. Birds on the infected farm and neighbouring premises have been culled and movement controls on people and poultry have been applied [1].
Germany
On 16 February 2006 the OIE confirmed that four swans and one goshawk found dead on the island of Reugen died of H5N1 avian influenza. The swans were found in the village of Wiek on14 February 2006 and the goshawk in Dranske on 15 February 2006.
Wildlife reservoirs are being controlled and the movement of poultry has been restricted in the affected area [1].
Further reports
There have been further reports of H5N1 avian influenza infection in birds in Europe, the middle east, and Russia, which as yet have not been confirmed by the OIE. These include wild birds in the Caspian Sea, Azerbaijan [4], a swan in Maribor, Slovenia [5], wild fowl in Krasnodar and Dagestan, Russia, and further cases in swans in Italy [3].
There have been reports of H5 avian influenza infection in swans in Slovenia [1], Italy, Austria, and Hungary [6]. It is not yet known whether these swans were infected with the H5N1 strain.
Advice for travellers
There remain no restrictions for travel to countries that have been infected with avian influenza. Nevertheless, travellers should exercise precautions that have been previously posted [7].
Management of returning travellers or visitors
The Health Protection Agency (HPA), Centre for Infections has revised the algorithm for the management of travellers or visitors arriving from countries affected by avian influenza [8]. The countries listed to date are: Bulgaria, Cambodia, Croatia (Zdenci municipality), China (including Tibet and Hong Kong), Indonesia, Iraq (North east corner close to the border with Iran & Turkey), Japan, Kazakhstan, Laos, Mongolia, Nigeria (Kaduna state), Romania, Russia (Novosibirsk region), Turkey, Thailand, Ukraine and Vietnam. These areas and countries will be revised as new information from the WHO and OIE is forthcoming on detection of avian influenza.
The HPA algorithm provides guidance on the recognition, investigation and management of persons with fever or history of fever and respiratory symptoms, and who have travelled to, or lived in countries affected by avian influenza within seven days of their arrival in the UK.
Physicians who see persons whom they suspect may have avian influenza, should evaluate them according to this HPA algorithm [8].
References
1. World Organisation for Animal Health (OIE). Update on avian influenza in animals [cited 16 February 2006]. Available at: http://www.oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm
2. Food and Agriculture Organisation. Bird flu: Early detection and control measures highly effective in Italy. FAO newsroom. Accessed on 15 February 2006, [cited 16 February 2006] Available at: http://www.fao.org/newsroom/en/news/2006/1000231/index.html
3. ProMED mai., Avian influenza - Worldwide (14): Europe, Africa, 13 February 2006, [cited 16 February 2006] Available at:
http://www.promedmail.org/pls/promed/f?p=2400:1001:7266213
416123105627::NO::F2400_P1001_BACK_PAGE,F2400_P1001
4. ProMED mail, Avian influenza - Worldwide (06): Azerbaijan, Romania. 10 February 2006, [cited 16 February 2006] Available at:http://www.promedmail.org/pls/promed/f?p=2400:1001:12424
912150188288129::NO::F2400_P1001_BACK_PAGE,F2400_P1
5. ProMED mail, Avian influenza - Worldwide (20): Europe, Africa. 16 February 2006, [cited 17 February 2006] Available at: http://www.promedmail.org/pls/promed/f?p=2400:1001:9963647
69641389922::NO::F2400_P1001_BACK_PAGE,F2400_P1001_
6. Department of Environment, Food and Rural Affairs, Highly pathogenic avian flu in dead swans in Europe, 15 February 2006 [cited 16 February 2006] Available at:
http://www.defra.gov.uk/animalh/diseases/monitoring/pdf/hpai-europe160206.pdf
7. NaTHNaC. Avian influenza - advice for travellers to affected areas. 4 November 2005. [cited 16 February 2006] Available at: http://www.NaTHNaC.org/pro/clinical_updates/avianinfluenza_advi
8. Health Protection Agency. Algorithm for the management of returning travellers from countries affected by avian influenza presenting with a febrile illness: recognition, investigation and initial management. 15 February 2006. [cited 16 February 2006] Available at: http://www.hpa.org.uk/web/HPAweb&HPA
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