Published Date: 2003-03-16 23:50:00
Subject: PRO/AH/EDR> Avian influenza, human - Netherlands (05)
Archive Number: 20030316.0656
AVIAN INFLUENZA, HUMAN - NETHERLANDS (05)
******************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Sun, 16 Mar 2003
From: Jim van Steenbergen <JvanSteenbergen.LCI@ggd.nl>
More preventive measures
-------------------------
Based on the virology update of Fri, 13 Mar ([see ref 20030313.0615], by
workers of the National Influenza Centre, Erasmus University, Rotterdam and
RIVM, Bilthoven, The Netherlands) the state secretary for Public Health of
The Netherlands, Mrs. Ross, announced Friday evening that preventive
measures are stepped up.
Of the first 22 sampled patients with conjunctivitis, 19 have been
confirmed to be infected with influenza A/H7N7; from 2 patients, A/H3N2
influenza virus was isolated and one patient was found negative for
influenza virus. In addition, influenza A/H7N7 virus was isolated from a
sample of a household contact (daughter) of one of the patients. This girl
had no chicken contact. The epidemiological data and sampling of
conjunctivitis cases is still in progress (Gerard Natrop, HVD, Gelderland
Midden, Ede).
So far, 2 cases are reported with serious kerato-conjuncivitis. In general,
recovery seems complete. Preliminary data suggest that 75 out of 1100
exposed persons have had eye complaints during the course of the epizootic
(suggesting an attack rate of 7 percent).
Since there are no signs that the spread of the disease in chickens has
come to an end, the high number of confirmed H7N7 infections among the
first investigated 22 samples and the recorded human to human transmission
prompted the following measures for individuals who are at high risk for
acquiring infection:
- Personal protection to be improved, with additional attention to washing
hands after leaving the workplace and attention to personal hygiene at home
as well.
- Immediate treatment with oseltamivir for all new conjunctivitis cases in
high risk individuals (including household contacts of workers).
- Indication for vaccination is extended to all poultry farmers and their
families in the protection area (3 km radius around infected and suspected
poultry farms).
Experts discussed the prophylactic use of antiviral drugs. The
considerations, favouring oseltamivir treatment of all individuals at high
risk of infection with H7N7, were:
- workers are non compliant with regard to personal protection measures;
- oseltamivir reduces virus replication, thereby will most likely reduce
transmission (no data available);
- might equally reduce severity of the conjunctivitis (no data available);
- oseltamivir reduces replication of both influenza A/H3N2 and H7N7 and
thus effectively reduces the possibility of co-infection and consequently
reduces the small risk of re-assortment.
Besides, it was speculated that the present vaccination strategy might,
unwillingly, increase co-infection of both viruses in one individual as
vaccine protection is incomplete thus increasing the relative number of
people with milder symptoms, when infected with H3N2. People undergoing
mild flu symptoms might have the tendency to continue working, consequently
undergoing the risk of being exposed to co-infection with H7N7.
On the other hand, the arguments against massive use of oseltamivir were:
- unnecessary use of a drug -- with potential side effects -- in 85 percent
of the treated population (assuming that silent infection equals the attack
rate);
- development of resistance (insufficient data);
- effect of implemented and improved personal protection measures might be
as effective;
- the rate of non compliance (to the oseltamivir application) might be as
high as the rate of non-compliance to personal protection.
The state secretary for Public Health, Mrs. Ross, decided that, starting
Sun, 16 Mar 2003, all workers with high risk of infection will receive
oseltamivir (75 mg daily) during exposition, to be continued for 2 days
after last exposure.
--
Jim van Steenbergen
LCI: Co-ordinator Communicable Disease Control for The Netherlands
<JvanSteenbergen.LCI@ggd.nl>
< www.infectieziekten.info>
[ProMED-mail is very grateful to Dr van Steenbergen for this candid report,
adding important data on the recent results of the Dutch investigations in
humans exposed to the HPAI virus. These data are complementary to the ones
included in our earlier posting "Avian influenza, human - Netherlands (04)".
The presented considerations pro and con the use of an antiviral treatment
in these circumstances should be of particular interest to all those
engaged in the handling of emerging infectious diseases. - Mod.AS]
See Also
Avian influenza, human - Netherlands 20030311.0594Avian influenza, human - Netherlands (02) 20030313.0615
Avian influenza, human - Netherlands (03) 20030314.0628
Avian influenza, human - Netherlands (04) 20030315.0643
................mpp/cp/arn/mpp
*##########################################################*
ProMED-mail makes every effort to verify the reports that
are posted, but the accuracy and completeness of the
information, and of any statements or opinions based
thereon, are not guaranteed. The reader assumes all risks in
using information posted or archived by ProMED-mail. ISID
and its associated service providers shall not be held
responsible for errors or omissions or held liable for any
damages incurred as a result of use or reliance upon posted
or archived material.
************************************************************
Visit ProMED-mail's web site at <http://www.promedmail.org>.
Send all items for posting to: promed@promedmail.org
(NOT to an individual moderator). If you do not give your
full name and affiliation, it may not be posted. Send
commands to subscribe/unsubscribe, get archives, help,
etc. to: majordomo@promedmail.org. For assistance from a
human being send mail to: owner-promed@promedmail.org.
############################################################
############################################################