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News Archives 6 April 2006

Last updated: Volume 16, No. 14 (PDF file, 228 KB)

Archives | News Archives 2006: Page 1| News 6 April 2006

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• H5N1 Avian influenza confirmed in wild bird in Scotland
• Influenza A in a north east Lincolnshire care home

H5N1 Avian influenza confirmed in wild bird in Scotland

The Department for the Environment Food and Rural Affairs (Defra) and the Scottish Executive have announced that a mute swan (Cygnus olor) found dead in Cellardyke, Fife, on the east coast of Scotland, died of highly pathogenic H5N1 avian flu.
In accordance with a recent European Union decision, Defra has put in place a Protection Zone of a minimum of three kilometres radius and a Surveillance Zone of 10 kilometres. Keepers of birds in the protection zone are being instructed to isolate their birds from wild birds, by taking them indoors where ever possible. Measures to restrict the movement of poultry, eggs, and poultry products from these zones have been brought into effect.
More details can be found on the Defra website at <http://www.defra.gov.uk/news/latest/2006/index.htm>, and the Scottish Executive website at <http://www.scotland.gov.uk/Home>.

The current level of risk to the general public from avian flu is very low. H5N1 avian flu remains predominantly a disease of birds. A small number of human cases have been reported in south east Asia and eastern Europe, almost all of which have been associated with close contact with dead or dying poultry. In all human cases to date there has been no evidence of efficient human-to-human transmission. For further information see the World Health Organization at <http://www.who.int/csr/disease/avian_influenza/en/>.

European and UK veterinary experts have agreed that no extra precautionary steps for human health are required at the moment.

Influenza A in a north east Lincolnshire care home

The Humber Health Protection Unit (HPU) has been managing an outbreak of a respiratory illness in a care home in north east Lincolnshire. This has been confirmed as influenza A, following positive PCR in one of eight cases tested. The initial onset date was 23 March 2006, with the last known case having an onset of 1 April 2006. Symptoms lasted around four to five days and included fever, sweats, cough, headache, and sore throat, with a range of severity.

Naso-pharyngeal swabs were taken from eight symptomatic residents. Although national consultation rates for influenza-like illness had declined below 30 per 100,000 per week (the threshold for prescription of antiviral drugs), as the clinical illness was compatible with influenza, and influenza A had been identified in specimens from elsewhere in the region, unaffected residents were started on a ten day course of prophylactic oseltamivir, and residents with an onset in the preceding 48 hours were started on five days treatment. Staff in clinical high-risk groups were also given oseltamivir prophylaxis.

Thirty-four out of 54 exposed residents have been unwell, including two frail elderly residents who died and four others who were admitted to hospital. All residents were aged 65 years or over, with three-quarters aged 75 years or over. Sixteen of 55 staff have also had symptoms.

Eighty-one per cent of residents had received this season’s flu vaccine. The attack rate in residents was 63% overall and 59% in those vaccinated.

Immunity from influenza wanes six to twelve months after vaccination (1). Also, vaccine protection in the elderly is known to be around 40% (2). Both of these factors may contribute to the likelihood of outbreaks late in the flu season. Where vaccine efficacy is in question, testing of acute sera will show if the population is susceptible to infection, and should be considered.

1. Nicholls S, Carroll K, Crofts J, Ben-Eliezer E, Paul J, Zambon M, et al. Outbreak of influenza A (H3N2) in a highly-vaccinated religious community: a retrospective cohort study. Commun Dis Public Health 2005; 7(4): 272-7.

2. Nicholson KG, Wood JM, Zambon M. Influenza. Lancet 2003 362:1733-45