Final Issue: Volume 16 Number 51	Published on: 21 December 2006	Final Issue in PDF PDF format (283 Kb)

News Archives 5 May 2006

Last updated: Volume 16, No. 18 (PDF file, 224 KB)

Archives | News Archives 2006: Page 1| News 5 May 2006

News Archives: | 2006 | 2005 | 2004 | 2003

• Avian influenza A/H7N3 in poultry in Norfolk
• A pilot of enhanced surveillance of enteric fever in England, Wales, and Northern Ireland
• New web resource on infections in pregnancy

Avian influenza A/H7N3 in poultry in Norfolk

On 26 April 2006, the Department for the Environment, Food and Rural Affairs (DEFRA) reported an outbreak of A/H7 avian influenza (AI) in a 35,000-bird housed poultry flock in the county of Norfolk, eastern England. As a precautionary measure, all birds on the premises were culled, and restrictions were placed on the farm (1). The virus was subsequently confirmed as H7N3 and initial indications are that it is a low pathogenic virus [2]. Both low and high pathogenicity H7N3 avian influenza viruses acquired from birds have infected humans in Europe and elsewhere in the past. For people who handled infected birds, this has tended to result in mild illness (usually conjunctivitis with flu-like symptoms) or asymptomatic infection [3,4].

On 27 April 2006, a poultry worker from the farm presented with conjunctivitis [5]. Conjunctival and combined nose/throat swabs were taken. Infection with influenza A/H7N3 was confirmed and the patient was placed on a treatment course of oseltamivir.

The local Health Protection Unit and colleagues are carrying out serological surveillance on samples taken from other poultry workers who had contact with the birds on the farm. Additionally, conjunctival and combined nose/throat swabs for PCR testing are being taken from any additional workers who present with influenza-like illness (ILI) or conjunctivitis. Oseltamivir and seasonal influenza vaccine are being offered to all those who have had contact with birds on the farm. Over 100 people have so far been given oseltamivir, and serological specimens have been obtained from the majority of these individuals.

On 29 April 2006, three workers from a processing plant serving the original premises reported eye irritation. A worker involved in the initial response at the farm and already taking prophylactic oseltamivir also reported feverishness and respiratory symptoms on 29 April 2006. On 1 May 2006, a culler taking prophylactic oseltamivir, presented with itchy eyes and a sore throat. All five of these individuals tested negative for influenza A by PCR.

On 29 April 2006, two free-range poultry farms about 1.5 km from the original premises were tested by DEFRA (6). Results showed serological evidence of previous infection with H7N3 in the flocks, which were subsequently culled. It is not clear which of the three units was first infected or how disease may have passed between them. At present no further premises appear to be involved.

In 2003, a different high pathogenicity avian influenza virus, A/H7N7 affected chickens in the Netherlands, Belgium, and Germany (7,8,9). The virus was responsible for the deaths of many chickens, and also infected some people working with the chickens. A small number of these patients then passed the infection onto close family members, although no further person-to-person spread was reported. The Dutch patients experienced only mild to moderate symptoms (conjunctivitis and influenza-like illness), with the exception of one patient, a veterinarian with some degree of reduced immunity, died as a result of his infection (10). Such a severe illness, however, has never been reported with an low pathogenicity avian influenza or with A/H7N3 (high or low pathogenicity avian influenza). Similarly, person-to-person spread of low pathogenicity avian influenza has never been reported.

This is not the first reported case of conjunctivitis due to an avian influenza in the UK. In the 1990s conjunctivitis attributed to an low pathogenicity avian influenza (H7N7) from the waste products of domestic poultry was reported in a woman who had been cleaning a poultry shed (10).

Compared with seasonal influenza, avian influenza A/H7 does not transmit easily from human to human, so the risk to those in contact with the infected poultry worker is considered low and the risk to the general public is very low. In almost all cases of human H7 infection to date, the virus in both low and highly pathogenic forms, has only caused a mild disease, usually conjunctivitis.

References

1. Avian influenza test result on dead chickens. Pess release 182/06. London: Department for Environment, Food and Rural Affairs, 26 April 2006. Available at <http://www.defra.gov.uk/news/latest/2006/animal-0426.htm>.

2. Confirmation of type of avian influenza in chickens: Dereham, Norfolk. Press release 187/06,. London: Department for Environment, Food and Rural Affairs, 28 April 2006. Available at <http://www.defra.gov.uk/news/2006/060428c.htm>.

3. Puzelli S, Di Trani L, Fabiani C, Campitelli L, De Marco MA, Capua I, et al. Serological analysis of serum samples from humans exposed to avian H7 influenza viruses in Italy between 1999 and 2003. J Infect Dis 2005; 192(8):1318-22. Epub 2005 Sep 12.

4. Tweed SA, Skowronski DM, David ST, Larder A, Petric M, Lees M, et al. Human illness from avian influenza H7N3, British Columbia. Emerg Infect Dis [online serial] 2004; 110 (12). Available from <http://www.cdc.gov/ncidod/EID/vol10no12/04-0961.htm>.

5. Conjunctivitis caused by H7 avian influenza in poultry worker. Health Protection Agency (HPA) [London], press release 28 April 2006. Available at <http://www.hpa.org.uk/hpa/news/articles/press_releases/2006/060428_avian_flu_h7.htm>.

6. Test results positive for avian influenza in two more poultry farms in Norfolk. Department for Environment, Food and Rural Affairs (DEFRA) [London], press release 188/06, 29 April 2006. Available at <http://www.defra.gov.uk/news/2006/060429a.htm>.

7. Du Ry van Beest Holle M, Meijer A, Koopmans M, de Jager C. Human-to-human transmission of avian influenza A/H7N7, The Netherlands, 2003. Eurosurveillance 2005 1;10(12) Available at <http://www.eurosurveillance.org/em/v10n12/1012-222.asp>.

8. Koopmans M, Wilbrink B, Conyn M, Natrop G, van der Nat H, Vennema H, et al. Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Lancet 2004; 363(9409): 587-93.

9. Fouchier RA, Schneeberger PM, Rozendaal FW, Broekman JM, Kemink SA, Munster V, et al. Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci 2004; 101(5):1356-61. Epub 2004 Jan 26.

10. Kurtz J, Manvell J, Banks J. Avian influenza virus isolated from a woman with conjunctivitis. Lancet 1996; 348: 901-2

A pilot of enhanced surveillance of enteric fever in England, Wales, and Northern Ireland

A pilot for enhanced surveillance of enteric fever in England, Wales, and Northern Ireland has been launched. A standardised questionnaire to be piloted both for local purposes and for national surveillance, has been produced. Enhanced surveillance of enteric fevers will be piloted on all cases with specimen dates on or after 1 May 2006 and will run for one calendar year. The pilot has been approved by the Health Protection Agency’s Local and Regional Services (LaRS) Surveillance Committee and will be administered by the Travel and Migrant Health Section at the HPA’s Centre for Infections.

All cases of enteric fever should be followed up by the Health Protection Unit (HPU) or relevant Environmental Health Department depending on local arrangements; this should not change current practice. HPUs are, however, asked to use the new standardised questionnaire for each case. The enhanced surveillance pilot does not replace the statutory notification system. The questionnaire and the accompanying protocol, which includes more information about the pilot and details on how to fill out the form, are available on the HPA website at <http://www.hpa.org.uk/infections/topics_az/typhoid/Enhanced/EnhancedSurveillance.htm>.
Any queries about the pilot should be directed to the Travel and Migrant Health Section at <tmhs@hpa.org.uk> or telephone 0207 327 6412/7442/7565.

In 2005, there were 445 cases of enteric fever (typhoid and paratyphoid) reported in England, Wales, and Northern Ireland, the highest number reported in ten years [1]. Up until 1993, all cases of enteric fever were followed up by CDSC*; this is no longer the case. Considered against a background of changing global epidemiology of enteric fevers, ie, increasing reports – particularly of S. Paratyphi A in parts of the world and antibiotic resistant disease globally [2], there is a need to improve epidemiological understanding of both travel associated and non-travel associated enteric fever. This will contribute to the evidence base on which pre-travel advice is given, identify particular population subgroups at risk, and inform disease control within the UK.

Stakeholders
The questionnaire was designed by a steering committee (comprised of representatives from the LaRS, the Environmental and Enteric Diseases Department [including the Laboratory of Enteric Pathogens] at CfI, Local Authorities Coordinators of Regulatory Services, the National Travel Health Network and Centre, and the Travel and Migrant Health Section at CfI).

References
1. Recent increase in S. Paratyphi A phage type 1 and S. Typhi Vi-phage type E1 in England and Wales, associated with travel to the Indian subcontinent. Eurosurveillance 2006;11(3) Available at <http://www.eurosurveillance.org/ew/2006/060309.asp#4>.
2. Threlfall EJ, Day M, de Pinna E, Lewis H, Lawrence J. Drug resistant enteric fever in the UK (letter). Lancet 2006 (In Press).

*CDSC (Communicable Disease Surveillance Centre), is now part of the HPA Centre for Infections

New web resource on infections in pregnancy

The Health Protection Agency has launched a new section of its website on infections in pregnancy, available at <http://www.hpa.org.uk/infections/topics_az/pregnancy/rashes/default.htm>. The starting point for the pages was the existing guidance on the rash illness and contact with rash illness in pregnancy published in Communicable Disease and Public Health in 2002 [1]

By having the information readily accessible to hospital and primary care professionals as well as to the general public, the Agency aims to promote best practice in protecting mothers and their children from the effects of infection during pregnancy.

References

1. Morgan Capner P, Crowcroft NS, on behalf of the PHLS Joint Working Party of the Advisory Committees of Virology and Vaccines and Immunisation. Guidelines on the management of, and exposure to, rash illness in pregnancy (including consideration of relevant antibody screening programmes inpregnancy). Commun Dis Public Health 2002; 5(1): 59-71. Available at <http://www.hpa.org.uk/cdph/issues/CDPHVol5/no1/rash_illness_guidelines.pdf>.