Avian influenza

The highly pathogenic avian flu strain H5N1 has ravaged poultry populations in many parts of Asia and killed over 60 people in Southeast Asia since 2003. Even before it reached in Europe in October 2005 the Commission together with the member states had joined the worldwide race against time to combat the disease that may well trigger the first pandemic of the 21 century.

Avian influenza

Avian influenza AI (bird flu) is a contagious viral infection first identified in Italy in the early 1900s. It occurs worldwide and all birds are susceptible to infection by it. Migratory birds, especially wild ducks, are the natural reservoir of avian influenza viruses and domestic poultry flocks are particularly susceptible to infections that can rapidly turn into epidemics. In the EU, recent major outbreaks of a highly pathogenic avian flu H7N7 occurred in Italy (1999-2000) and the Netherlands, with incidences in Belgium and Germany (2003). 

The H5N1 is a highly pathogenic avian influenza strain causing serious disease with high mortality (up to 100%) and its occurrence in the world needs to be notified to the World Organisation for Animal Health (OIE). 

From avian influenza to human influenza pandemic

Humans are rarely affected by the avian influenza but human infections with the highly pathogenic viruses may be fatal. Limited human-to-human transmission of H5N1 has occurred in association with outbreaks in poultry. Each new human case gives the virus an opportunity to improve its transmissibility in humans and thus to develop into a pandemic virus. Therefore, avoiding bird flu outbreaks and eradicating them as soon as possible is of the outmost importance. 

As flu viruses mutate easily and exchange genetic material when they co-infect an animal the current fear is that a common human flu virus and the bird flu virus H5N1 could mix genes and create a new type of lethal human bird flu virus. 

Influenza pandemic

Historically, influenza pandemics occur on average three to four times each century, but the occurrence of pandemics is unpredictable. In the 20th century, the (Spanish) influenza pandemic of 1918–1919 caused up to 50 million deaths worldwide and was followed by pandemics in 1957–58 and 1968–69. Experts agree that another influenza pandemic is inevitable and possibly imminent

Protection measures 

Mass vaccination of poultry is seen as the main way to stop the spread of the disease. One option is for the vaccine to be administered via feed. Currently vaccines need to be given to each chicken individually. However, the EU is divided on the pros and cons of mass vaccination of commercial poultry. 

The Commission recommends member states stockpile anti-viral drugs, strengthen bio-security (hygiene) on poultry farms and avoid contact between poultry and wild birds in farms. 

The Commission has also endorsed the World Health Organisation's (WHO) recommendation to vaccinate one fourth of the population and three fourths of the high-risk group (elderly, children, people suffering from chronic diseases) against seasonal flu. 

At this point, the virus has the potential to become a worldwide pandemic, but it is not yet a pandemic because H5NI virus has not changed to a form transmissible for human to human. Health officials cannot know how to combat the virus until it actually mutates so that its composition can be studied and the appropriate vaccines and drugs developed. 

Vaccine development 

Currently no vaccine is available to protect humans against the current H5N1 virus but vaccine development efforts are under way in several countries. However, as the vaccine needs to closely match the pandemic virus, large-scale commercial production will not start until the new virus has emerged and no vaccines are expected to be widely available until several months after the start of a pandemic. 

The Commission is in contact with vaccine manufacturers to try to increase their capacities and to speed up the vaccine production process. The aim is to significantly reduce the normal production cycle of around 6 months. 


Tamiflu
, known as oseltamivir, is currently considered as the most effective antiviral drug available for avian influenza. This drug, produced by Roche, is recommended by the WHO to be stockpiled in preparation for a flu pandemic. Tamiflu does not cure a flu infection but might prevent illness from developing. Its effectiveness against H5N1 is unknown although laboratory tests suggest that if taken in higher doses, it should have some effect. A recent study conducted by the Pasteur Institute in Hanoi argues that the H5N1 virus has become resistant to Tamiflu. 

EU developments 

Following confirmation of the H5N1 virus in Turkey, Romania and Croatia, as well as other suspected cases in various parts of Europe since October 2005, the EU has stepped up vigilance and preventative measures against avian influenza. The H5N1 virus was also found in an imported parrot in quarantine in the UK, prompting the EU to ban imports of certain live birds from third countries.

  • Commission responses to outbreaks in member states and third countries in 2004/2005/2006. Chronology of main events and list of Decisions adopted by the Commission;
  • Commission responses to outbreaks in third countries in 2004/2005. Chronology of main events and list of Decisions adopted by the Commission.
  • Commission press releases on avian influenza;
  • Commission's avian influenza webportal;
  • European centre for disease prevention and control (ECDC) news on avian influenza;
  • Standing committee on the food chain and animal health (SCFCAH).

National (member states) preparations 

Interministerial committees are being created in many member states to coordinate the national preparedness in the event of a pandemic. Individual member states have also placed orders for large amounts of antiviral drugs. For specific actions see positions below.

National anti-influenza plans: BelgiumThe Czech RepublicDenmarkEstoniaFrance [EN] ; FinlandGermanyGreece ; HungaryIrelandItaly ; Luxembourg ; The Netherlands ; The Slovak RepublicSpainSwedenThe United Kingdom ; more

Others: WHO global influenza preparedness plan (2005)WHO checklist for influenza pandemic preparedness planningThe United Statesmore

A recent Eurobarometer survey (July 2006) on EU citizens' knowledge about bird flu points to some misunderstandings about the risks related to the consumption of poultry. 

The World Health Organization (WHO) is concerned that European countries might focus on domestic preparedness and forget the fact that ground zero is Southeast Asia. The organisation warns that this could divert funding and attention away from Southeast Asia. The WHO has said that if it was to become a pandemic, the influenza could kill as many as 150 million people but considers the most likely scenario to be a toll of 2 million to 7.4 million people. 

European Health Commissioner Markos Kyprianou said in October 2005 that "more than half" of EU countries are not yet prepared in terms of being able to treat 25% of their population with antiviral drugs. Afterer the simulation exercise, on 29 November, he said that "we're still in the early phase of readiness". 

According to the Director General for Health and Consumer Protection, Robert Madelin (July 2006) the EU-25 is far better prepared to new outbreaks now, than in autumn 2005. "We're half-way up in the preparedness," he said. "We now need to avoid panic by correctly informing citizens and to engage in a dialogue with the media." 

The Belgian authorities have voiced concerns about EU countries competing with each other for orders of anti-virals and the problem that big countries' orders are taking precedence over the small ones. They propose that the Commission should co-ordinate the production and distribution of antiviral drugs in Europe so that they are made available where absolutely necessary. Commissioner Kyprianou has responded that "the Commission does not have such powers but is willing to assist and co-ordinate the member states in this respect". 

France has announced that it is stocking all necessary tools to fight against the possible pandemic such as masks, antivirals and vaccines. The government's action plan is co-ordinated by a an interministerial delegate, Professor Didier Houssin, who will initiate interventions as the risk gets higher. Fourteen million treatments were expected to be stocked by the end of 2005 and, in case of pandemic, distributed free of charge. France has ordered forty million vaccines. France has also ordered 15 million doses of Tamiflu from the Roche laboratory.

At least Spain has created a permanent interministerial commission to follow and analyse avian flu. 

The UK government's top medical adviser Sir Liam Donaldson said that adults aged 20 to 40 are the likeliest bird flu victims and that a similar flu hit exactly that group almost 100 years ago. He also cautioned that the bug could strike more than once, re-emerging again and again to sweep through the population in 'waves'. The UK has ordered 15 million doses of Tamiflu from the Roche laboratory.

The United States President George W. Bush has announced a 6 billion euro national plan to prepare for a possible influenza pandemic. The largest share of the money, €2.3 billion, would be allocated for vaccine development and new technologies to speed up vaccine production. A total of €1 billion has been requested to buy 20 million doses of vaccine. President Bush has also asked Congress to consider giving him powers to use the military to enforce quarantines in case of an avian influenza epidemic. 

The Swiss drug maker 
Roche
, has said it will allow rival firms and governments to produce its antiviral flu drug Tamiflu under licence for emergency pandemic use. Roche has an exclusive patent to make Tamiflu until 2016.

Eurogroup for Animal Welfare and the Royal Society for the Prevention of Cruelty to Animals believe that temporary bans of the imports of wild-caught birds should be made permanent. "This would prevent suffering by the birds and allow them to live freely in their natural state."

  • Autumn 2005: number of serious outbreaks of H5N1 in EU-27.
  • Nov. 2005: Commission adopts two communications on strengthening EU coordination on generic preparedness for public health emergencies and on influenza pandemic preparedness and response planning.
  • Nov. 2005: pan-European simulation exercise on EU's response to an influenza pandemic.
  • June 2006: EU health ministers fail to agree to proceed with the creation of a European strategic stockpile of anti-virals against influenza.
  • Dec. 2005: Council adopts the proposal for a Directive updating EU control measures for avian influenza. The Directive must be transposed into the national legislation by the EU member states by 1 July 2007.
  • Jan. 2006: An international ministerial pledging conference on avian influenza in China raised €1.57 billion to support short, medium and long term initiatives in affected countries and countries at risk.
  • Current situation of AI and human cases related to the H5N1 virus subtype. The WHO level of pandemic alert is still in phase three, which means that a new influenza virus subtype is "causing disease in humans but is not yet spreading effectively and sustainably among humans".
  • Feb 2007: ECDC report on pandemic influenza preparedness in the EU.
  • 25-27 Sept 2007: 4th European Pandemic Preparedness Workshop (EC/ECDC/WHO).
  • 2007: Chronology of main events and latest confirmations of H5N1 in the EU.

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