Presents

LYMLeague of Young Masters

1 -Veterinary’s point of view

2 -Agriculturist’s Point of view

3 -Pharmacist’s Point of View

H5N1

Chronology of HChronology of H55NN11

•Hong Kong 1997 ?Hong Kong 1997 ?•Before 1997 Birds only (that was wrong!!!).Before 1997 Birds only (that was wrong!!!).•Why? Outbreak 18 hospitalized 6 died Why? Outbreak 18 hospitalized 6 died Subsequently 1.5 millions chickens killed. Subsequently 1.5 millions chickens killed.•In 1878, firstly recorded in Italy [fowl plague].In 1878, firstly recorded in Italy [fowl plague].•USA 1924 – 1925 1929.USA 1924 – 1925 1929.•1955 [fowl plague] determined one of influenza virus.1955 [fowl plague] determined one of influenza virus.•H5N1 avian influenza: Timeline of major events

H5N1Veterinary’s point of view

Main points :-Main points :-

•Hint about Influenza viruses.

•The simplified Structure of Influenza viruses.

•What are mechanisms of antigenic variation of H5N1?

•What is the problem of detection of the virus?

•Transmission.

•Clinical features.

Hint about the Influenza Hint about the Influenza viruses.viruses.

Antigenic subtypes

Year

H1N11918

H2N21957

H3N21968

H1N11977

H5N11997

H5N12003

H5N12004

H5N12005

•Influenza A Virus.

1.Human 2.Animal 3.Avian

Equine Swine (H7N7,H3N8) (H1N1)

•Influenza B virus.

•Influenza C virus.Only Human

•The Major influenza pandemic antigenic subtypes.•Classification of Influenza viruses

The simplified Structure of The simplified Structure of the virus.the virus.•Neuclic acid.

•Capsid.

•Envelope.

a)Haemagglutinin.

b)Neuraminidase.

RNA segmentFunctions

1RNA polymerase

2RNA polymerase

3RNA polymerase

4Hemagglutinin

5Ribonucleoprotein

6Neuraminidase

7Matrix protein

8Non structure protein

HA - Haemagglutinin

NA - Neuraminidase

Helical neucleocapsid (RNA PLUS NP protein)

Lipid bilayer membranePolymerase (3 proteins)

M1 Protein

H5N1

as seen under

E.M

What are mechanisms of antigenic What are mechanisms of antigenic variation of Hvariation of H55NN11??

•Antigenic drift.

•Antigenic shift.H1N1 + H2N2 H1N2 + H2N1

Infection Immune response Point mutation

Little change in antigenic structure

Accumulation of point mutation over (10-20) years

Major change in antigenic structure

2 Antigenic different I.V infect the same cell

Genetic reassortment Genetic shift

Evolution of new subtype

•Example of genetic reassortment

What is the problem of detection What is the problem of detection of the virus ?of the virus ?

•The mutation

Influenza viruses are inherently unstable. As these viruses lack a genetic proof-reading mechanism, small errors that occur when the virus copies itself go undetected and uncorrected.

TransmissionTransmission

•The cycle of the virus

Man

Intermediate Host

Reservoir

H.A of human I.V.A Receptor in the body

H subtype of A.I.A.V Another receptor

Combination Infection

•Infection

Infected droplets may settle on conjunctival, nasopharyngeal or other respiratory mucosal epithelium.

The respiratory epithelium of pigs contains the receptors of the human virus and avian virus, so pigs can be infected by both human and avian influenza viruses.

Clinical features.Clinical features.

•Incubation

•Initial symptoms

•Clinical course

•Mortality

H5N1Agriculturist’s Point of view

انتشار قبل الدواجن انتشار استثمارات قبل الدواجن استثماراتالفيروسالفيروس

حوالى • مصر فى الدواجن استثمارات 17كانتجنيه . مليار

المزارع • وإغالق تضرر بسبب النسبة هذه وقلتالصغيرة .

حوالى • الدواجن فى يعمل فرد 2وكان مليونمباشرة غير بطريقة بها ويعمل مباشرة بطريقة

فرد . مليون ربع حوالىلحوم • على مصر سكان معظم يعتمد وكان

بالمقارنة نسبيا الثمن رخيصة النها الدواجنلحوم صافى نسبة الن وايضا الحمراء باللحوم

حوالى حوالى% 75الدواجن الحمراء واللحوم55. %

الدجاج على االصابة الدجاج اعراض على االصابة اعراض

والعرف .• الوجه فى ورمالدجاج .• على عصبية اعراضالتنفس .• صعوبةبالمفاصل .• دمويه بقع و أحتقانالمرض • يظهر ال واالوز البط فى بينما

واضح . بشكل

الوجه تورم

وانتاج الدجاج على الفيروس وانتاج تاثير الدجاج على الفيروس تاثيرالبيضالبيض

يضع • ال الطيور بانفلونزا المصاب الدجاجوضع عن تمتنع عادة الدجاجة الن البيض

البيض .الى • الدجاجة من ينتقل ال الفيروس

البيضة كانت اذا الكتكوت الى او البيضةمخصبة .

؟ بالعدوى االنسان يصاب كيف

الطيور مع المباشر مع المباشر التعامل يعتبرالسبب بذرقها الملوثة االسطح او المصابة

بالعدوى . االنسان الصابة الرئيسىالصحية . النظافة بضرورة الريفية المناطق جهلمن المصابة الدواجن مع الخنازير قطعان تربية

لالصابة الرئيسية . االسباب

لحوم معاملة فى خاطئة لحوم اجراءات معاملة فى خاطئة اجراءاتمصر فى مصر الدواجن فى الدواجن

تم • العدوى انتشار عندالكتاكيت اطالق

كبيرة باعداد الصغيرةوعلى الشوارع فى

الزراعية . الطرقيتم • الدواجن ذبح عند

اناء فى وضعهاالمملوء التنظيف

المغلية . بالمياة

الدواجن لحوم مأمونية الدواجن مدى لحوم مأمونية مدىومشتقاتهاومشتقاتها

ويرى • جدا امنه ومشتقاتها الدواجن لحوم انالبالد فى االحتياطات ببعض االخذ ينبغى انهفى اما المرض من اصابات حاليا تشهد التىتحضير فيمكن المرض من الخالية المناطقكالعادة . وطهيها ومشتقاتها الدواجن لحوم

H5N1Pharmacist’s Point of View

Symptoms and signsSymptoms and signs

cold-like symptoms fever, cough, sore throat and myalgia

conjunctivitis

Pneumonia with acute respiratory distress

Gastrointestinal symptoms such as diarrhea

Investigations Investigations

• direct culture

• reverse-transcriptase polymerase chain reaction analysis

• Serum antibody analysis

Treating affected individualsTreating affected individuals

• anti-viral agents amantadine rimantadine oseltamavir Zanamivir

• Supportive therapy: oxygen, artificial ventilation , IV fluids& antibiotics

Neuraminidase

Protein))

Flu Virus

Flu virus with

Neuraminidase inhibition

OseltamivirOseltamivir

• As the flu multiplies, neuraminidase enables it to move on and infect other host cells (left). When you inhibit neuraminidase (right), the flu can't escape from its host cell, which prevents it from spreading.

Is there a vaccine against bird flu?Is there a vaccine against bird flu?

• Clinical trials are underway to test a vaccine that has been made against the H5N1 strain of influenza A virus. However, if a virus emerges to produce a flu pandemic, it will be a mutation from the H5N1 strain. So, it will be a slightly different strain.

• If a new virus does emerge, then as soon as it is identified scientists will try to develop a specific vaccine as soon as possible.

• mild-to-moderate nausea or vomiting in one out of 10 people

• diarrhea• bronchitis• abdominal pain• dizziness• headache• cough• insomnia & vertigo ) reported in few cases )

• Additional adverse events in <1% for treatment included unstable angina, anemia, pseudomembranous colitis& humerus fracture.

• Taking oseltamivir with food may reduce the potential for these side effects. Other less common side effects may include bronchitis, sleeplessness and vertigo.

Side Side effectseffects

What is the Food and Drug What is the Food and Drug Administration (FDA) announcing? Administration (FDA) announcing?

• FDA is announcing the licensure of the first vaccine in the United States for humans against the H5N1 influenza virus, commonly referred to as avian influenza or "bird flu."

FDA Approves First U.S. Vaccine for Humans Against FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1the Avian Influenza Virus H5N1

• Proper Name: Influenza Virus Vaccine, H5N1.• Manufacturer: Sanofi Pasteur Inc, License #1725 .• Date: April 17, 2007.• Indication: For active immunization of persons 18

through 64 years of age at increased risk of exposure to the H5N1 influenza virus subtype contained in the vaccine.

• Type of Vaccine: Inactivated influenza virus vaccine.

First vaccine in the United States for First vaccine in the United States for humans against the H5N1humans against the H5N1

• Of the various doses tested, the study showed that the 90 microgram dose had the better immune response, meaning that at this particular dose, the vaccine induced the most antibodies in the blood against the H5N1 influenza virus strain. The 90 microgram two-dose regimen produced levels of antibodies expected to reduce the risk of getting H5N1 influenza in 45% of those who received it.

Will the vaccine be available to anyone Will the vaccine be available to anyone who wants it? who wants it?

• No, the manufacturer has stated that the vaccine won't be available to the public commercially. It has been purchased by the federal government for inclusion within the country's National Stockpile, for distribution by the Department of Health and Human Services in case it is ever needed.

Bush Outlines Strategy to Combat Bird Bush Outlines Strategy to Combat Bird Flu Flu

• White House• 01 November 2005 • President Bush is

asking the U.S. Congress to spend more than $7 billion to help prepare for a possible bird flu pandemic.

What can I do to avoid catching bird What can I do to avoid catching bird

flu from a bird?flu from a bird? • avoid places such as chicken farms and

bird markets where live birds are kept )Srtict hyegienic measures to be followed)

• regular hand washing.

• avoid eating raw eggs.

• make sure poultry such as chicken is cooked thoroughly.

We hope you could understand And thank you for listening…