Published Date: 2003-03-11 23:50:00
Subject: PRO/AH/EDR> Avian influenza, human - Netherlands
Archive Number: 20030311.0594
AVIAN INFLUENZA, HUMAN - NETHERLANDS
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[1]
Date: Tue, 11 Mar 2003
From: R.A.M. Fouchier <r.fouchier@erasmusmc.nl>
H7N7 Conjunctivitis; human
---------------------------
A veterinarian who visited several farms with [poultry] flocks infected
with HPAI [highly pathogenic avian influenza] developed acute
conjunctivitis. The symptoms in the first eye started 30 hours after
his last farm visit; within the next 24 hours similar problems
occurred in the other eye. The man did not suffer from keratitis or
other signs of disease.
Approximately 60 hours after the onset of symptoms, swabs were
collected from both eyes in virus transport medium. Part of the
sample was used to inoculate tertiary monkey kidney cells, which
started to display cytopathic effects 2 days later. RT-PCR targeting
the matrix gene of influenza A virus using RNA isolated from the
clinical sample revealed the presence of influenza A virus.
Subsequently, RT-PCR amplification with primers specific for the H7
hemagglutinin and N7 neuraminidase were also positive. Direct
sequencing of the HA, NA, and MA PCR products revealed
sequences identical to those detected in HPAI-infected chickens for
all 3 PCR fragments.
Our data show that the H7N7 virus causing the current HPAI
outbreak in The Netherlands may cause conjunctivitis in humans, as
was reported for other H7N7 viruses detected in the past (N Engl J
Med. 304:911. 1981 & Arch Virol. 143:781-7, 1998).
Ron Fouchier, Marion Koopmans, Adam Meijer, Berry Wilbrink, Jan
van Wijngaarden & Ab Osterhaus
National Influenza Centre
Rotterdam/Bilthoven
The Netherlands.
(Jan van Wijngaarden is Inspector of infectious diseases of the
Ministry of Health, Welfare and Sport).
--
Ron A.M. Fouchier, PhD
Dept. Virology
Erasmus MC Rotterdam
The Netherlands
<r.fouchier@erasmusmc.nl>
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[2]
Date: Tue, 11 Mar 2003
From: Jim van Steenbergen <JvanSteenbergen.LCI@ggd.nl>
Protective measures and surveillance of symptoms in humans
(persons possibly exposed)
-------------------------------
As of Mon, 3 Mar 2003, all workers involved in [culling] of poultry are
advised to wear protective eye glasses and mouth masks.
Coincidentally, this week, data from routine influenza virus
surveillance indicate the start of the regular seasonal peak for
influenza virus (based on currently available preliminary data, mostly
influenza A/H3N2). Following the confirmation of an influenza virus
A/H7N7-associated conjunctivitis in a veterinarian involved in the
control measures of the HPAI epizootic, it has been agreed by all
responsible authorities that -- while the risk of reassortment remains
low -- the incidental exposure of a small group of persons to [both]
avian and human influenza viruses [at the same time] calls for active
reinforcement of this recommendation, as well as enhanced
surveillance.
To reduce the risk of a possible mixing of avian and human
influenza virus in one person, all workers are to be vaccinated;
workers with influenza-like symptoms should be exempted from work.
However, it took several days for these recommendations to be
implemented. No workers have been vaccinated as yet. The
veterinarian from whose conjunctiva the H7N7 has been isolated
(See item 1 above) was reported to have been noncompliant with the
protective recommendations.
As of Mon, 11 Mar 2003, all involved workers (approximately 200)
are reported to have complied. The local Municipal Health Service
(GGD) offers (at the workplace) the regular flu vaccine to all
workers, and records any clinical signs (conjunctivitis, flu-like
symptoms) observed in workers, farmers, and their contacts. Local
GPs have been notified to report cases to the local GGD for further
evaluation and laboratory investigation, to be carried out by the
National Institute for Public Health and the Environment (RIVM,
Bilthoven, M. Koopmans) and by the National Influenza Centre
(A.D.M.E. Osterhaus, Ron A.M.Fouchier).
Individuals suspected of infection will be interviewed, and samples
will be taken (nasal and conjunctiva swabs). If H7N7 is detected,
contacts will be similarly monitored (interview, sampling).
In addition, RIVM (M.A.E. Conyn-van Spaendonck) will conduct a
retrospective cohort study in all persons involved in the poultry
culling activities, including farmers and their families, in order to
quantify risks of transmission and morbidity.
--
Jim van Steenbergen
LCI: Co-ordinator Communicable Disease Control for The
Netherlands
<JvanSteenbergen.LCI@ggd.nl>
< www.infectieziekten.info>
[ProMED-mail is grateful to Ron Fouchier et al. & Jim van
Steenbergen for their authoritative, first-hand information. The swift,
thorough, and transparent handling of this grave situation by the
Dutch authorities is exemplary; we wish them success in their
continuing efforts to control the further spread of HPAI. We would
also like to express thanks to Jan Braakman for kindly bringing the
initial information on this human case to our attention.
It is worth mentioning that Newcastle disease virus -- another avian
paramyxovirus -- has been known for decades to cause
(sporadically) conjuctivitis in humans, especially people engaged in
disease control activities and those handling live-attenuated
vaccines. - Mod.AS]
See Also
Avian influenza - Netherlands: suspected 20030301.0503Avian influenza - Netherlands (02): suspected 20030301.0509
Avian influenza - Netherlands (03) 20030302.0528
Avian influenza - Netherlands (04) 20030304.0540
Avian influenza - Netherlands (05): OIE 20030304.0545
Avian influenza - Netherlands (06) 20030304.0546
Avian influenza - Netherlands (07) 20030305.0549
Avian influenza - Netherlands (08) 20030306.0552
Avian influenza - Netherlands (09) 20030307.0563
Avian influenza - Netherlands (10) 20030310.0583
................arn/pg/jw
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