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Poliovirus cases rise in India
Newsdesk
Following confirmation of an outbreak of highly pathogenic avian influenza A (H7N7) in several Dutch poultry farms, health officials were contending with an unexpectedly high number of H7N7-associated eye infections among people exposed to infected flocks, and were examining the possibility that two cases represented person-to-person spread of H7N7. “All we can say at this stage is that the number of new infections seems to be on the decline, even though the AI [avian influenza] epidemic in poultry is by no means under control”, Marion Koopmans (Virology Section, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment, Bilthoven, Netherlands) told TLID. In early March, workers involved in the screening and culling of millions of birds were advised to wear protective clothing, eye glasses, and masks. As of March 31, surveillance by a multiorganisational partnership had identified 255 people with clinical symptoms; of these, 169 had conjunctivitis and 34 had conjunctivitis and other symptoms indicative of influenza-like illness. H7N7positivity was confirmed in 66 cases, or 35% of people reporting with conjunctivitis. Two people who were close contacts of an infected worker, but who had no exposure to infected flocks themselves, also had H7N7-positive conjunctivitis. Roughly one-third of the cases with H7N7-negative conjunctivitis had in fact been infected with H7N7 but were probably sampled too late, Koopsman says. No dual infections with circulating human influenza A and avian influenza A (H7N7) have been seen. The influenza vaccine was offered to all people involved in the screening and culling, and to those living on poultry farms within a 3 km zone around infected flocks to reduce the risk of co-infection with circulating human influenza; more than 4000 people were vaccinated between March 11 and April 2. Also, oseltamivir
264
USDA, APHIS
Avian influenza outbreak linked to eye infections
Avian influenza: a risk to people
prophylaxis was given to about 2500 exposed workers and more than 600 farmers and family members. Treatment was given to approximately 100 people with clinical symptoms. “Both measures combined are meant to reduce the risk of mixing of influenza viruses from human beings
and poultry, by reducing the likelihood of infection with human viruses through vaccination and prophylactic treatment, and with avian viruses through prophylaxis”, Koopmans explains. Risk of transmission and pathogenic potential in human beings will be examined in a retrospective study currently underway. “We will also closely monitor the persons that still have a lot of work ahead of them to contain the avian epidemic”, says Koopsman. “At the start of this, we were faced with many questions for which we had no answers, as there were very few reports on avian influenza viruses in human beings other than H5 viruses.” Mary Quirk
Poliovirus cases rise in India The US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) have reported an increase in the number of poliovirus cases in India for 2002, up from 268 in the previous year to 1599 at March 26, 2003. This increase indicates a failure of current vaccination programmes to reach children in high-risk areas. Another factor may be the decline in the number of supplemental vaccinations as a result of a decline in cases before 1999. Fears that such a figure could signal a major setback to the campaign to eradicate poliovirus have been allayed by experts in the field. Stephen Cochi (Global Immunization Division, CDC) says: “The increase in polio cases in India in 2002 was certainly alarming. But this increase should be viewed within the context of the extraordinary global progress towards polio eradication, and the steps that are being taken to address problems in India. Only seven countries continue to have polio transmission, the lowest number of countries in history. Polio eradication by 2005 remains feasible”. These views were echoed by Bruce Aylward, global coordinator of the
Polio Eradication Initiative of the WHO, who stated that poliovirus can rapidly be eradicated from India if sufficient numbers of high-quality mass-vaccination campaigns are conducted (at least six in both 2003 and 2004). In February this year, India launched the largest ever mass immunisation campaign against poliovirus, targeting 165 million children. More than 1·3 million teams of volunteers and health workers, equipped with nearly 200 million doses of vaccine, will go house-tohouse and work at booths in communities to reach every child under the age of 5 years. The original eradication target of 2005 would have required the last wild case of polio to have occurred in 2002. Unfortunately, this aim has not been realised. Aylward says that the current target is that, “all regions are to be certified polio free by 2005 or be in the process of certification”. So far, three of the six WHO regions are poliovirus free: the Americas, Western Pacific region, and Europe. This leaves Southeast Asia, Eastern Mediterranean, and Africa yet to be cleared of poliovirus. Cathel Kerr
THE LANCET Infectious Diseases Vol 3 May 2003
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
Following confirmation of an outbreak of highly pathogenic avian influenza A (H7N7) in several Dutch poultry farms, health officials were contending with an unexpectedly high number of H7N7-associated eye infections among people exposed to infected flocks, and were examining the possibility that two cases represented person-to-person spread of H7N7. “All we can say at this stage is that the number of new infections seems to be on the decline, even though the AI [avian influenza] epidemic in poultry is by no means under control”, Marion Koopmans (Virology Section, Diagnostic Laboratory for Infectious Diseases and Perinatal Screening, National Institute of Public Health and the Environment, Bilthoven, Netherlands) told TLID. In early March, workers involved in the screening and culling of millions of birds were advised to wear protective clothing, eye glasses, and masks. As of March 31, surveillance by a multiorganisational partnership had identified 255 people with clinical symptoms; of these, 169 had conjunctivitis and 34 had conjunctivitis and other symptoms indicative of influenza-like illness. H7N7positivity was confirmed in 66 cases, or 35% of people reporting with conjunctivitis. Two people who were close contacts of an infected worker, but who had no exposure to infected flocks themselves, also had H7N7-positive conjunctivitis. Roughly one-third of the cases with H7N7-negative conjunctivitis had in fact been infected with H7N7 but were probably sampled too late, Koopsman says. No dual infections with circulating human influenza A and avian influenza A (H7N7) have been seen. The influenza vaccine was offered to all people involved in the screening and culling, and to those living on poultry farms within a 3 km zone around infected flocks to reduce the risk of co-infection with circulating human influenza; more than 4000 people were vaccinated between March 11 and April 2. Also, oseltamivir
264
USDA, APHIS
Avian influenza outbreak linked to eye infections
Avian influenza: a risk to people
prophylaxis was given to about 2500 exposed workers and more than 600 farmers and family members. Treatment was given to approximately 100 people with clinical symptoms. “Both measures combined are meant to reduce the risk of mixing of influenza viruses from human beings
and poultry, by reducing the likelihood of infection with human viruses through vaccination and prophylactic treatment, and with avian viruses through prophylaxis”, Koopmans explains. Risk of transmission and pathogenic potential in human beings will be examined in a retrospective study currently underway. “We will also closely monitor the persons that still have a lot of work ahead of them to contain the avian epidemic”, says Koopsman. “At the start of this, we were faced with many questions for which we had no answers, as there were very few reports on avian influenza viruses in human beings other than H5 viruses.” Mary Quirk
Poliovirus cases rise in India The US Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA) have reported an increase in the number of poliovirus cases in India for 2002, up from 268 in the previous year to 1599 at March 26, 2003. This increase indicates a failure of current vaccination programmes to reach children in high-risk areas. Another factor may be the decline in the number of supplemental vaccinations as a result of a decline in cases before 1999. Fears that such a figure could signal a major setback to the campaign to eradicate poliovirus have been allayed by experts in the field. Stephen Cochi (Global Immunization Division, CDC) says: “The increase in polio cases in India in 2002 was certainly alarming. But this increase should be viewed within the context of the extraordinary global progress towards polio eradication, and the steps that are being taken to address problems in India. Only seven countries continue to have polio transmission, the lowest number of countries in history. Polio eradication by 2005 remains feasible”. These views were echoed by Bruce Aylward, global coordinator of the
Polio Eradication Initiative of the WHO, who stated that poliovirus can rapidly be eradicated from India if sufficient numbers of high-quality mass-vaccination campaigns are conducted (at least six in both 2003 and 2004). In February this year, India launched the largest ever mass immunisation campaign against poliovirus, targeting 165 million children. More than 1·3 million teams of volunteers and health workers, equipped with nearly 200 million doses of vaccine, will go house-tohouse and work at booths in communities to reach every child under the age of 5 years. The original eradication target of 2005 would have required the last wild case of polio to have occurred in 2002. Unfortunately, this aim has not been realised. Aylward says that the current target is that, “all regions are to be certified polio free by 2005 or be in the process of certification”. So far, three of the six WHO regions are poliovirus free: the Americas, Western Pacific region, and Europe. This leaves Southeast Asia, Eastern Mediterranean, and Africa yet to be cleared of poliovirus. Cathel Kerr
THE LANCET Infectious Diseases Vol 3 May 2003
http://infection.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.