A (Avian Flu) to Z (Zika) Emerging and Re-emerging Diseases · Emerging and Re-emerging Diseases Dr...

A (Avian Flu) to Z (Zika) – the threat of

Emerging and Re-emerging

Diseases

Dr Jharna Kumbang, Consultant in Communicable Disease Control

Public Health England - East Midlands

East Midlands 5 + 1 Programme 2017/18 , 9th Nov 2017

5+1, 2017/2018, emerging & re-emerging diseases JK/09112017 2 5+1, 2017/2018, emerging & re-emerging diseases JK/09112017

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Infections which spread

between animals and humans

A few diseases to cover today …………

•Avian Influenza - Poultry/Birds

•Ebola - Bat/Monkeys

•Zika Virus - Mosquitos


Managing Avian Influenza (AI) H5N8

outbreaks in Lincolnshire, 2016- 2017

What is Avian Influenza (AI)

- Caused by the influenza A virus - a variety of subtypes

- Birds particularly water fowl and shore birds are the hosts

- Domestic poultry are especially vulnerable and the virus

can rapidly cause epidemics in flocks.

- Human infections with avian influenza are rare. However,

some viruses, such as H5N1 or H7N9, have been

associated with human disease.


How does AI virus spread?

Exposure of poultry to migratory waterfowl, AI -infected flocks



- Contact with AI-infected live bird markets

Dr. S. Trock Dr. S. Trock



- Manure, equipment, vehicles, egg flats, crates, contaminated shoes and clothing


Low Pathogenic AI

Highly

Pathogenic AI

Types of Avian Influenza


Lincolnshire Outbreaks : AI (H5N8)

- Highly pathogenic avian influenza (HPAI).

- On 6th December 2016, the Chief Veterinary Officer (CVO)

declared a Prevention Zone to help protect poultry and captive

birds from HPAI A (H5N8) A prevention zone remains in place in

England until the end of April 2017.

- As of 20th March 2017, there had been 30 confirmed outbreaks

across the UK (4 of the outbreaks occurred in Lincolnshire).


Outbreak notifications

PHE EM HPT received notification of:

• Outbreak 1 – 16th December 2016, Poultry farm

• Outbreak 2 – 30th December 2016, Wild bird incident

• Outbreak 3 – 16th January 2017, Poultry farm

• Outbreak 4 – 26th January 2017, Poultry farm


Numbers offered antivirals and surveillance


Start date End

date Description

Affected

birds

Active

surveillance

Passive

surveillance

Total

exposed

15/12/16 5/1/17 Farm 5,000 10 24 34

23/12/16 5/1/17 Nature

reserve 6 1 0 1

16/1/17 19/2/17 Farm 7,000 15 39 54

26/1/17 15/2/17 Farm 22,000 14 37 51

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2017


Key issues

• Managing an ever changing response plan

• Plans agreed at OCT would often need frequent revision before

operational delivery

• Multi-agency working and understanding of roles in an incident

requiring management for both humans and animals

• Two separate incidents were managed for each outbreak

• Antivirals and Managing surveillance



Should we be worried ?

Should we be worried


Ebola Virus Disease

Ebola : the disease

20

- Caused by Ebola virus.

- Named after Ebola river in the Congo

- Also known as Ebola haemorrhagic Fever

- Fatal disease in humans and nonhuman primates

(monkeys,gorillas, and chimpanzees)

- Case fatality rate :between 50-90% of all clinical cases fatal

- Incubation period 2-21 days, Infectious while symptomatic

- Person to person spread (blood / body fluids)

- No vaccine or specific treatment


Reservoir and transmission to humans

• Natural reservoir is unknown

• Fruit bats implicated as reservoir of virus

- Drop partially eaten fruits

•Bats infect chimpanzees, gorillas, forest

antelopes, porcupines

•Humans handle and eat bush meat (bats,

chimpanzees, gorillas)

•Infected human passes from person to

person

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Ebola Outbreaks of 2014


Ebola Outbreaks of 2014

- Primarily affected 3 countries in West Africa: Guinea, Liberia and

Sierra Leone.

- In total, more than 28,600 cases and 11,300 deaths have been

reported by the World Health Organisation (6 January 2016).

- The first imported case of Ebola virus disease in the UK was

reported on 29 December 2014

- Enhanced screening had been carried out at Heathrow, Gatwick

and Birmingham airports; and St Pancras (Eurostar)

- WHO declares Ebola outbreak over on 14th January 2016


http://www.who.int/csr/disease/ebola/situation-reports/en/

Context for outbreak

• Affected large cities

• Weak and fragile infrastructure

• Lack of knowledge of the disease

• Distrust of government and foreigners

• Not seeking health care

• Social rituals / burial rituals

• Delayed response; more resources needed


Is Ebola still a risk?

- There's still a small chance occasional cases of Ebola may occur in

Africa as the virus is present in several countries there, but the risk

for people travelling to Africa is minimal.

- The Foreign and Commonwealth Office no longer advises against all

but essential travel to previously affected areas.

- People who remain most at risk are those who care for infected

people or handle their blood or fluid, such as hospital workers,

laboratory workers and family members.

- The risk of an Ebola outbreak occurring in the UK remains negligible.

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https://www.gov.uk/government/organisations/foreign-commonwealth-office

Zika – An Old Virus with New

Threats?

Zika is ( relatively) old:

Zika virus - Flaviviridae family, mosquito-borne

First isolations

• 1947 Sentinel monkey, Zika forest, Uganda

• 1948 Aedes africanus – mosquito, Zika forest, Uganda

• 1952 Human, Nigeria ( 3 patients)

Low level circulation in Africa and Asia

• 2007- outbreak Yap island

• 2013/14 outbreak French Polynesia



World Map of Areas with Risk of Zika

Transmission

Vector borne transmission - Aedes mosquitoes

• Primary vector in urban settings: Aedes aegypti

• Competent vector: Aedes albopictus

Other routes of transmission:

• Trans-placental transmission

• Sexual transmission through semen

• Potential risk of transmission via blood transfusion


• For people with symptoms, the

most common symptoms of Zika

are • Fever

• Rash

• Headache

• Joint pain

• Conjunctivitis (red eyes)

• Muscle pain

• Symptomatic treatment

• There is no vaccine or specific

antiviral treatment

• Focus is on preventing transmission

( mosquito bites; sex; blood

products)

Symptoms, Treatment and vaccine

Why all the fuss?


Congenital Zika syndrome

Microcephaly

Guillain-Barré syndrome (GBS)

Mother to baby transmission

Risk to UK population

• Introduction could occur via imported infected

mosquitoes or viraemic individuals.

• However, onward transmission of ZIKV in the UK is

contingent on the presence of competent mosquito

vectors.

• None are currently present in the UK


Zika cases diagnosed in the UK

- The vector is not found in the UK, and almost all cases are associated with travel

- The majority of Zika cases in the UK have travelled to the Caribbean and South and

Central America.

-


2015 2016 2017 Total

Total travel associated cases 4 283 14 301

Total travel associated cases in

pregnant women - 7 - 7

Non travel-associated cases - Likely

sexual transmission - 1 - 1

Aedes mosquitoes in Europe

Distribution of the Aedes mosquito as of September 2017

Aedes aegypti Aedes albopictus

Established Introduced Absent No data/unknown

ECDC, 19 February 2016


Mosquito surveillance in UK Port Mosquito Surveillance

- Mosquito Surveillance conducted at 34 ports/airports.

- Ports reducing trap checks to monthly for the period mid-October to mid-

March. To date, no invasive mosquitoes found at ports.

Finding of Aedes albopictus in South-East England ( Kent) in Sept 2016 and

July 2017

- A control strategy was implemented within 300 metres of the finding.

- Action was taken to eradicate eggs and larvae of an invasive species of

mosquito

- PHE ongoing enhanced surveillance – no further evidence

These detections do not affect the very low risk Zika virus presents to the UK

population.



Local Authority Vector Borne Disease Preparedness

Survey

Aim was to :

• Raising awareness

• Assessment of current

capabilities

• Development of LRF plans

Thank you

Any questions?

A (Avian Flu) to Z (Zika) Emerging and Re-emerging Diseases · Emerging and Re-emerging Diseases Dr...

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