Singaporean measures against avian influenza

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Singapore has taken a series of measures against avian influenza and the potential threat of a pandemic.

Contents

Status

As of 17 October 2005, there were no cases of H5N1 avian influenza detected in Singapore, either in humans or poultry.

Threat

A major avian influenza pandemic will be very costly in terms of human lives as well as economic losses, especially in the densely populated city-state of Singapore.

Bird flu has infected poultry in large parts of Asia since 2003, killing at least 65 people, mostly in Vietnam and Thailand. Millions of birds have been culled to stop the spread of the disease. In October 2005, strain of the bird flu virus was detected in Turkey and Romania indicating that the avian flu was spreading from Asia to Europe. Most of the human deaths so far have been linked to contact with sick birds. But the World Health Organization has said that the virus could mutate into a form that is more easily transmitted from human to human and possibly triggering a pandemic reminiscent of the 1918 flu epidemic that killed tens of millions worldwide.

In Thailand, a probable case of human-to-human transmission of H5N1 virus was reported in the northern province of Kamphaeng Phet. This is consistent with current knowledge of the behaviour of H5N1 virus that inefficient, limited human-to-human transmission may occur on rare occasions. As of 17 October 2005, evidence indicated that spread among humans has been limited to this cases, nonetheless, surveillance has been intensified in the province.

Risk assumption

When planning the response, it is assumed that the first local human case is likely to be imported from affected countries and is difficult to prevent. The virus, which is more infectious than SARS, is likely to spread quickly and has a high morbidity and mortality.

There will not be any vaccine initially, and the vaccine development will take at least 4 to 6 months. Even when developed, initial supply of the vaccine will be limited.

Measures

Health advisory

On 24 October 2005, the Ministry of Health issued a public advisory calling for several groups of people to get themselves vaccinated against flu. [1] They include

Those planning to travel to the Northern Hemisphere over the next few months are also encouraged to get a flu vaccine at least a week or two before departure.

The Ministry also advised extra precaution for travellers to areas affected by the avian influenza outbreak including countries in Asia (Indonesia, Thailand, Vietnam and China) and Europe (Turkey, Romania, Greece, Russia). Travellers are advised avoid contact with poultry such as chickens, geese, ducks, pigeons and wild birds and not go to places such as commercial or backyard poultry farms and markets selling live birds. They are advised not to handle or eat raw or undercooked poultry or foods containing uncooked poultry, including eggs.

Those who develop flu-like symptoms should seek medical help promptly, and inform the doctors of their travel history.

Surveillance

Surveillance for influenza involves monitoring for virus strains and disease activity. A nationwide reporting scheme for acute respiratory infections has been established. The National Influenza Centre routinely carried out virological testing of respiratory samples from hospitals and polyclinics.

The Agri-Food and Veterinary Authority of Singapore (AVA) also carries out routine surveillance on poultry.

The Jurong Bird Park has put 19 chickens, bred without any immunity, in all its aviaries to help detect the presence of any infectious disease.

Ban on live poultry

In June 2005, a ban was imposed on keeping live poultry in Pulau Ubin, this is to prevent infection on the livestock by migratory birds.

Hospital and medicine

To tackle a possible outbreak of bird flu, Singapore is increasing its resource such as isolation facilities in hospitals and stockpiling medicine. These medicines include Tamiflu and Relenza. As of November 2005, the country has supplies to treat 430,000 people. By sometime in 2006, there will be enough stockpile anti-viral medication for one quarter of the population. A priority plan has been outlined as to who will get these anti-viral drugs first when a bird flu pandemic breaks out and the first people to receive the drugs would be health workers, and those involved in essential services like power and public order. [2]

Outbreak response plan

In the event of an outbreak, Singapore will resume health screening of all visitors, as during the 2003 SARS crisis and quarantine suspected victims. Travel restrictions or advisories would be issued to restrict travel to and from countries which had outbreaks of bird flu.

All persons presenting with the abrupt onset of signs and symptoms will be treated with anti-virals. Front-line healthcare workers in hospitals and polyclinics will also be given anti-viral prophylaxis for the duration of the pandemic.

Funding

In January 2006, Singapore announced that it will contribute S$1 million over three years to the global fund-raising effort to fight bird flu, specifically for ASEAN countries. [3]

Related Research Articles

<i>Influenza A virus</i> Species of virus

Influenza A virus (IAV) causes influenza in birds and some mammals, and is the only species of the genus Alphainfluenzavirus of the virus family Orthomyxoviridae. Strains of all subtypes of influenza A virus have been isolated from wild birds, although disease is uncommon. Some isolates of influenza A virus cause severe disease both in domestic poultry and, rarely, in humans. Occasionally, viruses are transmitted from wild aquatic birds to domestic poultry, and this may cause an outbreak or give rise to human influenza pandemics.

Avian influenza Influenza caused by viruses adapted to birds

Avian influenza, known informally as avian flu or bird flu, is a variety of influenza caused by viruses adapted to birds. The type with the greatest risk is highly pathogenic avian influenza (HPAI). Bird flu is similar to swine flu, dog flu, horse flu and human flu as an illness caused by strains of influenza viruses that have adapted to a specific host. Out of the three types of influenza viruses, influenza A virus is a zoonotic infection with a natural reservoir almost entirely in birds. Avian influenza, for most purposes, refers to the influenza A virus.

Influenza A virus subtype H5N1 Subtype of influenza A virus

Influenza A virus subtype H5N1 (A/H5N1) is a subtype of the influenza A virus which can cause illness in humans and many other animal species. A bird-adapted strain of H5N1, called HPAI A(H5N1) for highly pathogenic avian influenza virus of type A of subtype H5N1, is the highly pathogenic causative agent of H5N1 flu, commonly known as avian influenza. It is enzootic in many bird populations, especially in Southeast Asia. One strain of HPAI A(H5N1) is spreading globally after first appearing in Asia. It is epizootic and panzootic, killing tens of millions of birds and spurring the culling of hundreds of millions of others to stem its spread. Many references to "bird flu" and H5N1 in the popular media refer to this strain.

Swine influenza Infection caused by influenza viruses endemic to pigs

Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.

Influenza pandemic Epidemic of a flu that spreads on a worldwide scale and infects a large proportion of the human population

An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The most recent, the 2009 swine flu pandemic, resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.

Influenza A virus subtype H2N2 Subtype of Influenza A virus

Influenza A virus subtype H2N2 (A/H2N2) is a subtype of Influenza A virus. H2N2 has mutated into various strains including the "Asian flu" strain, H3N2, and various strains found in birds. It is also suspected of causing a human pandemic in 1889. The geographic spreading of the 1889 Russian flu has been studied and published.

Global spread of H5N1

The global spread of H5N1 influenza in birds is considered a significant pandemic threat. While other H5N1 influenza strains are known, they are significantly different on a genetic level from a recent, highly pathogenic, emergent strain of H5N1, which was able to achieve hitherto unprecedented global spread in 2008. The H5N1 strain is a fast-mutating, highly pathogenic avian influenza virus (HPAI) found in multiple bird species. It is both epizootic and panzootic. Unless otherwise indicated, "H5N1" in this timeline refers to the recent highly pathogenic strain of H5N1.

Transmission and infection of H5N1 Spread of an influenza virus

Transmission and infection of H5N1 from infected avian sources to humans has been a concern since the first documented case of human infection in 1997, due to the global spread of H5N1 that constitutes a pandemic threat.

Influenza A virus subtype H5N2 Virus subtype

H5N2 is a subtype of the species Influenzavirus A. The subtype infects a wide variety of birds, including chickens, ducks, turkeys, falcons, and ostriches. Affected birds usually do not appear ill, and the disease is often mild as avian influenza viral subtypes go. Some variants of the subtype are much more pathogenic than others, and outbreaks of "high-path" H5N2 result in the culling of thousands of birds in poultry farms from time to time. It appears that people who work with birds can be infected by the virus, but suffer hardly any noticeable health effects. Even people exposed to the highly pathogenic H5N2 variety that killed ostrich chicks in South Africa only seem to have developed conjunctivitis, or a perhaps a mild respiratory illness. There is no evidence of human-to-human spread of H5N2. On November 12, 2005 it was reported that a falcon was found to have H5N2.

Social effects of H5N1

The social impact of H5N1 is the effect or influence of H5N1 in human society; especially the financial, political, social, and personal responses to both actual and predicted deaths in birds, humans, and other animals. Billions of dollars are being raised and spent to research H5N1 and prepare for a potential avian influenza pandemic. Over ten billion dollars have been lost and over two hundred million birds have been killed to try to contain H5N1. People have reacted by buying less chicken causing poultry sales and prices to fall. Many individuals have stockpiled supplies for a possible flu pandemic.

H5N1 genetic structure

H5N1 genetic structure is the molecular structure of the H5N1 virus's RNA.

Disease surveillance Monitoring spread of disease to establish patterns of progression

Disease surveillance is an epidemiological practice by which the spread of disease is monitored in order to establish patterns of progression. The main role of disease surveillance is to predict, observe, and minimize the harm caused by outbreak, epidemic, and pandemic situations, as well as increase knowledge about which factors contribute to such circumstances. A key part of modern disease surveillance is the practice of disease case reporting.

Global spread of H5N1 in 2006

The global spread of H5N1 in birds is considered a significant pandemic threat.

Global spread of H5N1 in 2005

The global spread of H5N1 in birds is considered a significant pandemic threat.

Global spread of H5N1 in 2004

The global spread of H5N1 in birds is considered a significant pandemic threat.

Fujian flu

Fujian flu refers to flu caused by either a Fujian human flu strain of the H3N2 subtype of the Influenza A virus or a Fujian bird flu strain of the H5N1 subtype of the Influenza A virus. These strains are named after Fujian, a coastal province in Southeast China.

Human mortality from H5N1

Human mortality from H5N1 or the human fatality ratio from H5N1 or the case-fatality rate of H5N1 refer to the ratio of the number of confirmed human deaths resulting from confirmed cases of transmission and infection of H5N1 to the number of those confirmed cases. For example, if there are 100 confirmed cases of humans infected with H5N1 and 10 die, then there is a 10% human fatality ratio. H5N1 flu is a concern due to the global spread of H5N1 that constitutes a pandemic threat. The majority of H5N1 flu cases have been reported in southeast and east Asia. The case-fatality rate is central to pandemic planning. Estimates of case-fatality (CF) rates for past influenza pandemics have ranged from to 2-3% for the 1918 pandemic to about 0.6% for the 1957 pandemic to 0.2% for the 1968 pandemic. As of 2008, the official World Health Organization estimate for the case-fatality rate for the outbreak of H5N1 avian influenza was approximately 60%. Public health officials in Ontario, Canada argue that the true case-fatality rate could be lower, pointing to studies suggesting it could be 14–33%, but warned that it was unlikely to be as low as the 0.1–0.4% rate that was built into many pandemic plans.

Influenza Infectious disease, "the flu"

Influenza, commonly known as "the flu", is an infectious disease caused by influenza viruses. Symptoms range from mild to severe and often include fever, runny nose, sore throat, muscle pain, headache, coughing, and fatigue. These symptoms begin from one to four days after exposure to the virus and last for about 2–8 days. Diarrhea and vomiting can occur, particularly in children. Influenza may progress to pneumonia, which can be caused by the virus or by a subsequent bacterial infection. Other complications of infection include acute respiratory distress syndrome, meningitis, encephalitis, and worsening of pre-existing health problems such as asthma and cardiovascular disease.

Influenza A virus subtype H7N9 Subtype of the influenza A virus

Influenza A virus subtype H7N9 (A/H7N9) is a bird flu strain of the species Influenza virus A. Avian influenza A H7 viruses normally circulate amongst avian populations with some variants known to occasionally infect humans. An H7N9 virus was first reported to have infected humans in March 2013, in China. Cases continued to be reported throughout April and then dropped to only a few cases during the summer months. At the closing of the year, 144 cases had been reported of which 46 had died. It is known that influenza tends to strike during the winter months, and the second wave, which began in October, was fanned by a surge in poultry production timed for Chinese New Year feasts that began at the end of January. January 2014 brought a spike in reports of illness with 96 confirmed reports of disease and 19 deaths. As of April 11, 2014, the outbreak's overall total was 419, including 7 in Hong Kong, and the unofficial number of deaths was 127.

Influenza A virus subtype H5N6 Virus subtype

H5N6 is a subtype of the species Influenza A virus. Infected birds shed the virus in their saliva, mucous, and feces. The virus was first detected in poultry in 2013, since then spreading among wild bird populations and poultry around the world. Humans can be infected through unprotected contact with infected birds or contaminated surfaces. The virus transmits by getting into a person's eyes, nose, mouth, and through inhalation. Human infections are rare. Since 2014, at least 65 cases have occurred in humans. 29 people have died. A spike in human cases was reported in 2021. There have been no confirmed cases of human-to-human transmission. Some infections have been identified where no direct contact with infected birds or contaminated surfaces has been known to had occurred. Only one infected woman has said that she never came into any contact with poultry.

References

  1. "Health Ministry issues advisory on flu vaccinations". Channel NewsAsia. 25 October 2005.
  2. "Singapore outlines priority plan for anti-virals if bird flu pandemic strikes". Channel NewsAsia. 4 November 2005. – by Glenda Chong and Barry Porter
  3. "Singapore pledges S$1m to fight bird flu in ASEAN". Channel NewsAsia. 18 January 2006. – by Camie de Souza

Other sources