Outbreak of avian influenza A(H5N8) among fattening ducks

from the public health point of view Hungary, 2015

Avian influenza workshop

Stockholm, 6-7 October, 2015

Relationships of the Office of the Chief Medical Officer and the County Government Offices

Ministry for Presidency Under-secretary resp. for

government

Ministry of Human Resources Under-secretary resp. for

human health

Office of the Chief Medical Officer

County Government Offices

ÁNTSZ

District Government Offices

Department of animal health

Egy költségvetési szerv

(2015.04.01-től hatályos állapot szerint)

professional management

Vonatkozó jogszabályok: 2010. évi CXXVI. Tv. és 323/2010. (XII.27.) Korm. rendelet 2015.04.01-től hatályos változata (tervezet); ……/2015. (……..) Korm. Rendelet a fővárosi és megyei kormányhivatalokról, valamint a járási (fővárosi kerületi) hivatalokról

National Institute of Health Development

National Institute of Environmental Health

Office of Animal Health and Food Safety

National Institute of Medical Stock Management

National Centre for Epidemiology

Office of Public Health

Other offices

Department of Public Health

Other department

Ministry of Agriculture

Communication flow between animal and public health side

• 24th February: information on the website of the National Food Chain Safety Office about avian influenza in Füzesgyarmat

• 25th February: letter of director of Animal Health and Food Safety Office of County Government Office Békés county to the director of County Government Office Békés county (includes office of Public Health Office of Békés county) – laboratory confirmation of avian influenza (24th February) in Füzesgyarmat National Centre for Epidemiology

• 25th February: letter of the Chief Veterinary Officer to the Chief Medical Officer : confirmation of highly pathogenic A(H5N8) influenzavirus the agent of the outbreak in Füzesgyarmat National Centre for Epidemiology

• 25th February: Mass media

How was the outbreak managed to warrant occupational safety? 1.

• It was made an ad hoc recommendation of NCE based on – Hungarian legislation and

– Rapid Risk Assessment of ECDC about the outbreaks of HP avian influenza A(H5N8) in Europe, 20th November 2014.

• The recommendation was incorporated in the circular of Chief Medical Officer sent not only to County Government Office of Békés county, but to every County Gov. Offices (date: 26th February, 2015)

How was the outbreak managed to warrant occupational safety? 2.

Recommendations of NCE: – Identify the persons affected in the former exposition and / or

involved in the culling – Persons with specific conditions (with underlying diseases,

(immundeficients, pregnants, olders than 62 years) should be excluded from culling

– Provide the personal protective equipments (incl. respiratory protection)

– Inform exposed persons about the risk, the sings and symptoms of the disease and the methods of prevention

– Assign a doctor responsible for monitoring of health of the exposed persons for 10 days (when identifying ill person, samples taken and send to ref. lab of NCE)

– It should be offered seasonal influenza vaccine for exposed persons

– It should be provided oseltamivir antiviral prophylaxis for 10 days for exposed persons

How was the outbreak managed to warrant occupational safety? 3.

Implemented measures of the occupational health service of the company (in formal letter on 1st March 2015):

– Identified the persons affected in the former exposition and / or involved in the culling (39 persons – 26th February, Thursday)

– Persons with specific conditions (with underlying diseases, immundeficients, pregnants, olders than 62 years) were excluded from culling

– Provide the personal protective equipments (incl. respiratory protection – available FFP3 masks 26th February)

– Inform exposed persons about the risk, sings and symptoms of the disease and the methods of prevention (list with signatures, 26th Febr.)

– Assign a doctor responsible for monitoring of health of the exposed persons for 10 days (when identifying ill person, samples taken and send to ref. lab of NCE) – doctor of occupational health service 26th Febr.

How was the outbreak managed to warrant occupational safety? 4.

• It should be offered seasonal influenza vaccine for exposed persons Nine persons were vaccinated at the beginning of influenza season, vaccine was offered also for others, but not accepted at the end of February

• It should be provided oseltamivir antiviral prophylaxis

for 10 days for exposed persons - the medicament should be ensured by the affected company

- it was shortage for some days in the pharmacies during the 1st week of March because of seasonal influenza epidemic - Roche company declared the shortage to the pharmaceutical authority on 2nd of March (Monday) - specific import would have been possible, but did not happened - there is stockpile of oseltamivir powder for pandemic situation, but the problem was not known in time for authority (and it is time to dose the powder)

Preparedness plan

• Avian influenza of humans is a notifiable disease in Hungary

(the suspicion of the disease also notifiable) • Strengthening human surveillance

Everyday information exchange with vet authority - necessary to strengthen Syndromic surveillance of humans - exists

identify clusters of respiratory tract diseases

catch hospitalised single cases with severe respiratory tract diseases

identify death cases suffered from respiratory tract symptoms

with appropriate occupation/activity in the anamnesis and test them to avian influenza virus

• Human laboratory diagnostic capacity is available

Preparedness plan

• Legislation exists on the level of laws and of the decrees of the minister of health regarding the avian influenza – What to do when a patient is identified,

• with the patient • with the persons living around the patient • or exposed from the same source as the patient?

• There is a gap of SOP: protocol of public/occupational health

activity when the exposure comes from the animals (during the event in February 2015 it was used an ad hoc recommendation)

It is necessary to prepare by the animal health, occupational health and public health authorities together.

• Stockpile of PPE, oseltamivir, vaccine