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ECDC Avian Influenza Preparedness Workshop –

Lesson learned from the H7N7 outbreak to H5N8 - The Netherlands Stockholm, 6-7 October 2015

2003 H7N7 outbreak

• 450 human cases of whom 86 H7 lab confirmed; 1 death

• 30 million birds killed

• 5000 workers exposed

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Eurosurveillance, Volume 17, Issue 19, 10 May 2012 Case registry systems for pandemic influenza A(H1N1)pdm09 in Europe: are there lessons for the future? J Whelan, K Greenland, M Rondy, W van der Hoek, M Robert-Du Ry van Beest Holle Still available: - Baseline questionnaire - Q animal contact (= diary for cullers and others) - Q for patients (= clinical registration) - Q for patient contacts (= diary for contacts) - Standing medical ethical approval since 2007 for ‘Study on avian or new human influenza virus in humans’

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Lessons learned from Q-fever epidemic 2007-2009

● Need collaboration human – veterinary sectors in surveillance and control ● Potential conflicts between human health and economic interests ● Simple mapping very useful (but need to know where everything is) ● Methods for detection ‘hot spots’, clusters

New zoonosis structure:

• Example Schmallenberg 2011

• Monthly meeting zoonotic signals

• Intersectoral research projects

http://www.rijksoverheid.nl/documenten-en-publicaties/kaarten/2013/06/01/kaart-1km-gebied-vogelgriep-leusden.html

Farm animals in the Netherlands:

• Poultry 100 million birds • Pigs 12 million • Cattle 4 million heads • Sheep 1.1 million • Goats 300,000

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Rules and regulations ● For H5 and H7 AI national legislation in accordance with European

rules and regulations ● National RIVM guideline ‘Influenza of animal origin’, with semi-legal

status ● Mandatory notification of infection with influenza of animal origin by

the attending physician and by the laboratory making the diagnosis ● Operational manual ‘Avian influenza on a farm: Preventive

measures for public health’ ● Farmers and veterinarians must report suspicion of AI to NVWA ● Laboratory examination at CVI and results to NVWA ● NVWA informs RIVM and public health service

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Preventive measures – tailor made

● Use of personal protective equipment and hygiene measures (LPAI and HPAI)

● Monitor symptoms until 10 days post exposure (LPAI and HPAI)

● Chemoprophylaxis (HPAI H5H7): to prevent severe illness in exposed workers; stop transmission; and reduce the risk of reassortment. A national supply of antivirals is kept at RIVM.

● Vaccination against seasonal influenza: if during influenza season (HPAI H5H7).

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Response to the 2014 H5N8 outbreaks ● Expert meeting ● Tamiflu (75 mg 1 dd for 10 days) for all cullers and workers at the

affected farms. About 500 doses Tamiflu were issued. ● Exposed workers are instructed to monitor symptoms up to 10 days

after the last animal contact. In case of conjunctivitis or fever with respiratory symptoms, sampling material is obtained for diagnostic testing.

● Diagnostics at RIVM and Erasmus Medical Centre.

The Government commissioned an evaluation of the 2014 control measures. Report due October 2015.

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Ongoing RIVM-coordinated research projects:

● Livestock farming and neighbouring residents’ health (VGO) – air sampling / serological study 2500 people

● Rapid risk assessment of zoonotic pathogens by integrated analysis of transmission patterns in livestock and humans

● Study on avian or new influenza virus in humans: serology at T0 and T4wks – analysis for different human, avian, swine influenza viruses with microarray

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Alternative assays (sero-surveys) ● Assays are developed based on recombinant proteins with multiplex capabilities

to profile exposure to many subtypes of influenza virus in a single test.

● Protein micro-array

– Use of recombinant proteins: no virus isolate needed sequences are enough

(Flexible) – Easy to adjust for the new circulating viruses – Small volumes (2-5 µl) of sample needed (dry bloodspots) – Detection of different Ig subclasses (IgM recent infection, IgA mucosal

replication)