sars and avian influenza public health priorities
Download
Skip this Video
Download Presentation
SARS and Avian Influenza: Public Health Priorities

Loading in 2 Seconds...

play fullscreen
1 / 30

SARS and Avian Influenza: Public Health Priorities - PowerPoint PPT Presentation


  • 110 Views
  • Uploaded on

SARS and Avian Influenza: Public Health Priorities. Scott F. Dowell, MD, MPH International Emerging Infections Program Thailand Ministry of Public Health - US CDC Collaboration. Chest Xray, Day 2. Dr. Carlo Urbani. Chain of transmission among guests at Hotel M—Hong Kong, 2003.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' SARS and Avian Influenza: Public Health Priorities' - dani


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
sars and avian influenza public health priorities

SARS and Avian Influenza:Public Health Priorities

Scott F. Dowell, MD, MPH

International Emerging Infections Program

Thailand Ministry of Public Health - US CDC Collaboration

slide4

Chain of transmission among guests at Hotel M—Hong Kong, 2003

2 family members

2 close contacts

Guangdong Province, China

4 family members

10 HCWs

4 HCWs*

Hospital 2Hong Kong

Canada

F

A

A

F

G †

G †

3 HCWs

K †

K †

Ireland

156 close contacts of HCWs and patients

A

Hospital 3 Hong Kong

H

H

I

Hotel MHong Kong

J

I

United States

E

99 HCWs (includes 17 medical students)

J

D

B

Hospital 1 HK

C

C

D

E

B

Germany

0 HCWs

Singapore

HCW

HCW

B

Vietnam

Hospital 4 Hong Kong

34 HCWs

28 HCWs

2 family members

37 HCWs

HCW

37 close contacts

4 other Hong Kong Hospitals

Unknown numberclose contacts

HCW

 * Health-care workers; † All guests except G and K stayed on the 9th floor of the hotel. Guest G stayed on the 14th floor, and Guest K stayed on the 11th floor; § Guests L and M (spouses) were not at Hotel M during the same time as index Guest A but were at the hotel during the same times as Guests G, H, and I, who were ill during this period.

Bangkok

Data as of 3/28/03

airline transmission of sars
Airline Transmission of SARS

“Index” Case

No illness (person interviewed)

No illness (person not interviewed)

Crew

Probable case

Empty seat

0

4

5

6

7

8

9

0

1

2

3

2

1

1

8

9

1

1

1

2

3

4

6

7

1

1

1

1

1

2

2

5

1

1

2

F

E

D

C

B

A

Olsen et al. NEJM 2003;349:2414

measures to reduce airline transmission of sars
Measures to Reduce Airline Transmission of SARS

Aircraft Decontamination

Voluntary Use of Masks

Fever Screening

clues to the causative agent
Clues to the Causative Agent
  • Epidemiology – highly transmissible respiratory pathogen
  • Clinical – unusually severe disease
  • Laboratory – generally consistent with virus
  • Pathology – possibly paramyxovirus
  • No known agent could explain all features
personal protective equipment
Personal Protective Equipment
  • N-95 or better respirator
  • Head cover
  • Goggles or face shield
    • eyeglasses not adequate
  • Double gown
  • Double gloves
  • Double shoe covers
sars on hospital surfaces
SARS on Hospital Surfaces

Dowell et al. CID 2004;39:652

intensive pneumonia surveillance
Intensive Pneumonia Surveillance

Nakorn Phanom

  • Active
  • Population-based
  • CXR-confirmed
  • Laboratory testing
    • Influenza
    • Other viruses
    • Bacterial agents
  • Community surveys

Sa Kaeo

poultry exposure is common
Poultry Exposure is Common
  • There are ~6 birds to every person in Sa Kaeo Province
  • 1.3% of poultry is on commercial farms
    • 178 farms
    • 31,221 poultry
  • 98.7% of poultry is in backyards
    • 2,410,820 poultry
a cluster of h5 cases
A Cluster of H5 Cases
  • Three family members linked coincidentally during investigation of another pneumonia case
  • Urgent concern about person-to-person transmission
  • At the time cluster was recognized;
    • Index case dead, cremated
    • Mother dead, body embalmed
    • Aunt admitted to hospital
  • Interviews rapidly conducted on family, contacts, neighbors, and healthcare workers
laboratory investigation
Laboratory Investigation
  • Immediate and urgent effort to collect specimens
  • Specimens promptly shared with WHO network
  • Index patient dead, cremated
    • 0.5ml serum from day 6 of illness
  • Mother’s body embalmed
    • Lung and other tissues tested by PCR
  • Aunt survived
    • NP and OP swabs tested by cell culture, RTPCR
    • Acute and convalescent serum (neutralization, ELISA)
mother lung tissue pathology
Mother: Lung Tissue Pathology

Photo courtesy of S. Zaki

slide28

0.1

Mdk/Vietnam/4/2004

Mdk/Vietnam/17/2004

Chicken/Laos/44/2004

  • HA Gene Sequence:
  • Genotype Z
  • Resistant to amandatine

Thailand/Kan/353/2004

Thailand/2SP33/2004

Vietnam/3218/2004

Thailand/1KAN1/2004

Thailand/PCBR/6231/2004

Vietnam/HN30262/2004

Thailand/PCB2031/2004

ipGoose/Cambodia/25/2004

Vietnam/1203/2004

Vietnam/1194/2004

Thailand/Pranom5147/2004

Thailand/Pranee5223/2004

Thailand/SP83/2004

Mdk/Vietnam/MDGL/2004

Chicken/Laos/7192/2004

Chicken/Vietnam/ncvd31/2004

Vietnam/3212/2004

Chicken/Vietnam/CM/2004

Vietnam/HN30259/2004

Thailand/16/2004

Thailand/Chai622/2004

serplChicken/Indonesia/11/2003

Chicken/Korea/ES/2003

Duck/China/e3192/2003

hvriDuck/Harbin/15/2004

Hong Kong/213/2002

Duck/Hong Kong/739/2002

RBPochard/Hong Kong/821/2002

Teal/Hong Kong/2978/2002

Chicken/Hong Kong/3175/2001

Hong Kong/156/1997

Goose/Guangdong/96

conclusions from family cluster
Conclusions from Family Cluster
  • Probable person-to-person transmission
  • No further spread to contacts
  • No significant mutation of virus
    • All gene segments were of avian origin
    • Critical binding and cleavage sites unchanged
  • Isolation precautions needed for H5 patient care
  • Future clusters also warrant intensive investigation
summary sars and avian influenza
Summary: SARS and Avian influenza
  • SARS redefined emerging zoonoses
    • Broad economic and public health impact
  • Avian flu: unprecedented & unpredictable
    • Scale of the epizootic unprecedented
    • Ongoing potential for re-assortment event
ad