Thursday, December 18, 2014
Wednesday, December 10, 2014
IMA PRESIDENTIAL ADDRESS
IMA PRESIDENTIAL ADDRESS, 9th November 2014, Thiruvananthapuram
Distinguished personalities, invited guests, members of media, brothers and sisters in IMA and dear family members,
It’s a huge privilege for a grass root worker like me, to be elevated as the President of the most dynamic state branch of this historic organisation, Indian Medical Association, the largest scientific NGO in the world, devoted to upholding esteem of medical profession and care of the society. At this majestic conference at Thiruvananthapuram, its my proud honour to deliver the Presidential oration as the 57th President of Indian Medical Association, Kerala state branch, that too in front of this galaxy of distinguished personalities and the valiant army of the front line leaders of IMA, to whom I too belong.
The mind is everything. What you think you become. –Buddha
It had been our dream, to have this most noble profession on earth, dedicate every bit of its might to ensure scientific and compassionate care to the society. Ladies and gentle men, it would be my earnest attempt to keep both the profession and the people in mind in all our deeds.
Gone are the days, some lament, when doctors used to live in the hearts of people and command their love, affection and respect. We disagree. From the umpteen inputs which I could gather during my exercise in collecting ideas for framing the policy of IMA, both from medical men and community, I could feel the passion and empathy of the medical fraternity and the love and affection of the society. My job is just to form that bridge, to amply portray the mutual goodwill. None of the words spoken here are my own. I am simply echoing the voice of the esteemed members of this association who came up with these ideas in the policy poll held through out the state. I thank all of you for the valuable inputs.
Our lives begin to end the day we become silent about things that matter.–Martin Luther King Jr. Ethics do matter and will definitely come first. Ethics committees will be decentralised to reach every branch so that it gets known and becomes active to cater to all the citizens of the state. Ethical adherence will be implemented through channelising the tremendous good will of the medical community. Community help desk and grievance redressal forum will be established in all districts, comprising of eminent citizens and medical leaders. Though the treatment cost is primarily determined by policy makers and the industry, what ever containment becomes possible from the medical fraternity will be ensured through rational prescriptions and investigations. We will eradicate commissions and kick backs, will ensure transparency of medical care and patient’s confidentiality. Policy document on patient rights, citizens health charter and formulary for radical prescription will be published.
“Give the ones you love wings to fly, roots to come back and reasons to stay.” Dali Lama
We really value social relation. Citizen advisory panel will be constituted at state, district and branch level comprising of social leaders, prominent citizens and people’s representatives. Their opinion will be sought in matters of care delivery and public health. I would urge all hospitals also to consider establishing such bodies. Family doctor concept will be actively promoted.
Quality of Medical care, would receive top priority. Quality assurance committee would be created. Effective documentation, developing soft skills such as communication and positive attitude and random auditing of medical documents and prescriptions would be promoted. Basic and advanced life support training for medics and paramedics will be carried out. Agency for setting standards and facilitating accreditation of health care facilities will be established. IMA institute will conduct courses for medics and paramedics on various subjects. System to ensure quality of drugs will be initiated. Efforts will be made to publish treatment guidelines in consultation with speciality organisations. Medical education policy is an urgent need of the hour. A white paper on medical education in the state defining the need and standards to be adopted will be published.
"Not everything that can be counted counts, and not everything that counts can be counted. It has become appallingly obvious that our technology has exceeded our humanity."Albert Einstein
Technology will not be allowed to overshadow human values in medical care. Community service will be the key area for the coming year. The theme subject for community intervention will be cancer awareness and screening. A specific programme Citizens Health Empowerment Campaign, Kerala (checK) is being launched for this purpose. Effective interventions to combat communicable and non communicable diseases, and alcohol and substance abuse will also be in place. Life support training to police, taxi, auto drivers, ensuring child health and safety, programmes for differently abled, mental health initiatives, care of elderly and palliative services are the other specific interventions planned. Each branch should adopt a school and a village in their area for promotion of health interventions and education. An elaborate programme will be established for health policy empowerment of peoples representatives and local self government at state and branch level. IMA will strongly intervene in issues of public safety like road safety and environmental pollution. The National Initiative for Safe Sound (NISS) will be actively implemented in the state. A special project to promote organ donation will also be set up. A food policy would be drawn up and measures to ensure food safety will be implemented.
IMA would seek Government’s help for providing environment for safe Medical practice and adequate public health. Government has to provide better placement for meritorious doctors, give priority to common PSC entrance and establish medical service recruitment board. IMA should get representation in Hospital development committees. Private sector should also be actively involved in Government’s health care programmes and Public Private partnership should be promoted. Policy towards sharing medical facility between Government and private institutions should be implemented rather than increasing investment on duplicating investigation and treatment facilities. Government should support private hospitals with aids and rebates on taxes and get free treatment for poor patients in return. It’s extremely disheartening to note that Doctors are being framed with criminal charges for matters arising out of medical practice. There should be effective legislation to prevent this. We have to also ponder on whether we need a clinical establishment act in this state which has a proven medical record vouched by our excellent health indices. Though the Hospital protection bill is enacted, effective implementation is overdue. Encroachment into modern medicine by other systems and wide spread quackery too have to be contained. IMA feels that mono faculty Medical University is required for due patronage and development of Modern medical faculty in the state.
Whether you think you can or you think you can’t, you’re right. –Henry Ford
Doctors who think ‘they can’ are naturally in IMA and are determined to achieve. We aim to reach Nammude arogyam, the most credible and reliable health magazine of the state, published by IMA, to every Malayali. Needless to say that all our members should subscribe to the magazine and all schemes should promote Nammude Arogyam. IMA will start a mass communication wing for publishing articles on disease control and life style and circulate through print and internet. Media cell will be constituted which will ensure our presence on health matters in print, audio and visual media as well as maintain good liaison with media houses and personnel.
IMA will have a strong presence online. The website would be made fully functional and will enable members to do all transaction and access information online. Effective use of social media will also be ensured.
Great emphasis would be given for academic programmes, research and scientific publications. KMJ will be highly patronised. I request the schemes to ear mark fund to facilitate research especially in public health. IMA will compile quality data to enable planning and implementation of Public health activities.
IMA will champion the cause of professional solidarity. We greatly value the activities of KGMOA, KGMCTA, KGIMOA, QPMPA and all other organisations championing the cause of Modern medicine. An apex medical council with representation of all modern medical organisations will be established. An academic consortium with participation of all academic bodies is also being planned. We will develop tie up with AKMG and other organisations for effective utilisation of the talents and commitment of the medical community who have settled abroad. Hospitals in private sector are facing innumerable hardships. The Hospital board of India will be ably supported to solve these. Doctors working in private sector too face lot of problems. A committee will be established to effectively intervene to ensure job security and adequate working conditions for Doctors in Private sector. Subcommittees for Government sector, medical education and private medical teachers will also be established for strong liaison with respective organisations to provide effective support to their causes. IMA salute the dedication and commitment of our paramedical workers, especially nurses, lab technicians and pharmacists and will do every thing possible to protect their interests and improve their scientific capabilities.
IMA’s strength definitely lies in its membership. The huge patronage we receive from all quarters is undoubtedly due to our enormous membership strength being the parent body of more than twenty seven thousand doctors. This year we would target to enrol all modern medicine Doctors in the state as members of IMA. A highly professional body will be set up to achieve this ambitious target.
We are so very proud of our schemes. It will be the earnest endeavour of my team to ensure smooth functioning of all our schemes in IMA.
World over many young leaders are emerging not only in organisations but also to head states and nations. We too will not be found wanting to encourage our youngsters to take up the mantle of the profession and association. Student IMA and young doctors will be especially patronised. We are equally determined to empower our women leaders too. The future of IMA and the profession, I’m sure, will be safe in your hands.
"Nothing is permanent in this wicked world - not even our troubles." Charlie Chaplin
As Doctors often we are over worked and also over burdened with umpteen other responsibilities. We have to ease out our stress. A film club, literary club and lot of sports and cultural activities are in store. Do await IMA picnics and formation of ‘Family circle’, a gang of great friends of IMA statewide. IMA KTDC venture - ‘God’s own offer’ is also taking shape.
Our members and families should maintain good health and live long productive years. A special programme aimed at Doctors and family member’s health is also being contemplated.
We are fortunate to have so many great leaders. I whole heartedly congratulate all those who have won the elections. Now our job is to shape a better profession, with single minded dedication. The State executive board comprising of the President, Immediate past president, Vice Presidents, Secretary, Joint secretaries and Treasurer will be in charge of formulating and implementing our policies for this year. The vice presidents and joint secretaries will be allotted portfolios to effectively implement various activities planned. They will represent the state in all regional programmes.
Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do, so throw off the bowlines, sail away from safe harbor, catch the trade winds in your sails. Explore, Dream, Discover. –Mark Twain
Friends, you gave all these ideas. You have dreamt of each one of these projects.
I am really confident of this great army of thirty thousand valiant men, who have silently toiled all these years to ensure a better profession and due public care. Please allow me, as your President to dream big. Such is my confidence in you that at the end of this year I am sure we would not only have achieved most of these but also surpass many. I need all of you in the team, with your characteristic charisma. I owe a lot to all of you out there, who allowed me to dream, to speak and to lead. No words can express my feelings, my sincere sentiments to each one of you. I am so very grateful. A big thank you. And to my branch and this great organising team, I just want to say that this life time is not enough for me to repay.
Be kind whenever possible. It is always possible- Dalai Lama.
Please allow me to share a big dream, the ‘Patient care fund’. We will compile a sum through donations primarily from the medical sector, small and big, to create a fund which would be made available to our patients in times of need. A little solace, to those who rely on us, so that we don't turn them away the next time when they say they cant afford a drug or a bed. I appeal to all good men to generously contribute, all schemes to patronise and all corporates to aid this noble venture. Together let us show that we care.
With your blessings and permission I declare the motto for this year
‘for the profession, for the people’
“In a gentle way, you can shake the world.” Mahatma Gandhi
Come, lets earnestly attempt.
JAI HIND, JAI IMA
Dr Sreejith N Kumar
President, IMA Kerala
Sunday, November 30, 2014
ആരോഗ്യം ജനങ്ങളുടെ അവകാശമാണ്.
IMA - 'for the profession, for the people'
A Historic Moment... IMA's 'Trivandrum Declaration' find place in today's (30 Nov 2014) Mathrubhumi editorial. This is surely going to be a gold standard for all the future health reforms...
ആരോഗ്യം ജനങ്ങളുടെ അവകാശമാണ്.
കേരളത്തിലെ എല്ലാ ജനങ്ങള്ക്കും കുടുംബങ്ങള്ക്കും താങ്ങാനാവുന്ന ചെലവില് അടിസ്ഥാനപരമായ ആരോഗ്യപരിചരണത്തിന് അവകാശമുണ്ട് എന്ന പ്രഖ്യാപനത്തെ ഭരണകൂടവും ജനങ്ങളും അങ്ങേയറ്റത്തെ ഗൗരവത്തോടെ കാണേണ്ടതുണ്ട്. ഇന്ത്യന് മെഡിക്കല് അസോസിയേഷന്റെ കേരളഘടകം അതിന്റെ 57ാം സംസ്ഥാനസമ്മേളനത്തില് പുറപ്പെടുവിച്ച 'തിരുവനന്തപുരം പ്രഖ്യാപനം 2014' എന്ന ആരോഗ്യരേഖയിലാണ് ജനങ്ങളുടെ ആരോഗ്യാവകാശത്തെയും പൊതുജനാരോഗ്യത്തെയും കുറിച്ചുള്ള സങ്കല്പങ്ങള് പുനര്നിര്വചിക്കുന്ന ഈ നിരീക്ഷണമുള്ളത്. കേരളത്തിലെ ആരോഗ്യസ്ഥിതിയെയും ആരോഗ്യസേവനങ്ങളെയും വിലയിരുത്തിക്കൊണ്ട് ഭാവിയിലെ ആരോഗ്യപരിരക്ഷാ പ്രവര്ത്തനങ്ങള്ക്ക്, വിശേഷിച്ചും പൊതുജനാരോഗ്യരംഗത്ത് ആവശ്യമായ കര്മപരിപാടികള്ക്കുള്ള ഒരു മാര്ഗരേഖയാണ് 'തിരുവനന്തപുരം പ്രഖ്യാപനം' മുന്നോട്ടുെവക്കുന്നത്. ചികിത്സച്ചെലവ് സാധാരണക്കാര്ക്കു താങ്ങാനാവാത്തവിധം ഉയരുകയും പുതിയ വ്യാധികളും ജീവിതശൈലീരോഗങ്ങളും വര്ധിക്കുകയും ചെയ്തിരിക്കുന്ന ഇപ്പോഴത്തെ സാഹചര്യത്തില് കേരളം നേരിടുന്ന വലിയ പ്രശ്നങ്ങളിലൊന്നാണ് ആരോഗ്യനിലവാരത്തിലെ അസമത്വം. ആരോഗ്യരക്ഷയിലും സേവനത്തിലും അനുനിമിഷം വര്ധിച്ചുവരികയാണ് അസമത്വത്തിന്റെ അളവ്. അതു പരിഹരിച്ചുകൊണ്ടുള്ള സമഗ്രമായ പൊതുജനാരോഗ്യനയം രൂപപ്പെടുത്താന് രാഷ്ട്രീയനേതൃത്വത്തെ സഹായിക്കുന്ന രേഖയാണ് ഭിഷഗ്വരന്മാരുടെ സംഘടനയായ ഐ.എം.എയുടേത്.
ആരോഗ്യമേഖലയിലെ സര്ക്കാര് നിക്ഷേപം ഏറ്റവും കുറവുള്ള രാജ്യങ്ങളിലൊന്നാണ് ഇന്ത്യ. ഹയ്തിയും സിയറാ ലിയോണുമാണ് നമുക്കുപിന്നില്. മൊത്തം ആഭ്യന്തര ഉത്പാദനത്തിന്റെ ഒരുശതമാനമേ ഇന്ത്യ ജനങ്ങളുടെ ചികിത്സ ഉള്പ്പെടെയുള്ള ആരോഗ്യരക്ഷാ പ്രവര്ത്തനങ്ങള്ക്കായി ചെലവിടുന്നുള്ളൂ. അത് രണ്ടുമുതല് മൂന്നുവരെ ശതമാനമായി ഉയര്ത്തുമെന്ന് 2002ലെ ദേശീയ ആരോഗ്യനയത്തില് വിഭാവനംചെയ്തിരുന്നെങ്കിലും
2025ല് കേരളത്തിലെ ജനസംഖ്യയില് 25 ശതമാനം അറുപതു വയസ്സുള്ളവരായിരിക്കുമെന്നാ
A Historic Moment... IMA's 'Trivandrum Declaration' find place in today's (30 Nov 2014) Mathrubhumi editorial. This is surely going to be a gold standard for all the future health reforms...
ആരോഗ്യം ജനങ്ങളുടെ അവകാശമാണ്.
കേരളത്തിലെ എല്ലാ ജനങ്ങള്ക്കും കുടുംബങ്ങള്ക്കും താങ്ങാനാവുന്ന ചെലവില് അടിസ്ഥാനപരമായ ആരോഗ്യപരിചരണത്തിന് അവകാശമുണ്ട് എന്ന പ്രഖ്യാപനത്തെ ഭരണകൂടവും ജനങ്ങളും അങ്ങേയറ്റത്തെ ഗൗരവത്തോടെ കാണേണ്ടതുണ്ട്. ഇന്ത്യന് മെഡിക്കല് അസോസിയേഷന്റെ കേരളഘടകം അതിന്റെ 57ാം സംസ്ഥാനസമ്മേളനത്തില് പുറപ്പെടുവിച്ച 'തിരുവനന്തപുരം പ്രഖ്യാപനം 2014' എന്ന ആരോഗ്യരേഖയിലാണ് ജനങ്ങളുടെ ആരോഗ്യാവകാശത്തെയും പൊതുജനാരോഗ്യത്തെയും കുറിച്ചുള്ള സങ്കല്പങ്ങള് പുനര്നിര്വചിക്കുന്ന ഈ നിരീക്ഷണമുള്ളത്. കേരളത്തിലെ ആരോഗ്യസ്ഥിതിയെയും ആരോഗ്യസേവനങ്ങളെയും വിലയിരുത്തിക്കൊണ്ട് ഭാവിയിലെ ആരോഗ്യപരിരക്ഷാ പ്രവര്ത്തനങ്ങള്ക്ക്, വിശേഷിച്ചും പൊതുജനാരോഗ്യരംഗത്ത് ആവശ്യമായ കര്മപരിപാടികള്ക്കുള്ള ഒരു മാര്ഗരേഖയാണ് 'തിരുവനന്തപുരം പ്രഖ്യാപനം' മുന്നോട്ടുെവക്കുന്നത്. ചികിത്സച്ചെലവ് സാധാരണക്കാര്ക്കു താങ്ങാനാവാത്തവിധം ഉയരുകയും പുതിയ വ്യാധികളും ജീവിതശൈലീരോഗങ്ങളും വര്ധിക്കുകയും ചെയ്തിരിക്കുന്ന ഇപ്പോഴത്തെ സാഹചര്യത്തില് കേരളം നേരിടുന്ന വലിയ പ്രശ്നങ്ങളിലൊന്നാണ് ആരോഗ്യനിലവാരത്തിലെ അസമത്വം. ആരോഗ്യരക്ഷയിലും സേവനത്തിലും അനുനിമിഷം വര്ധിച്ചുവരികയാണ് അസമത്വത്തിന്റെ അളവ്. അതു പരിഹരിച്ചുകൊണ്ടുള്ള സമഗ്രമായ പൊതുജനാരോഗ്യനയം രൂപപ്പെടുത്താന് രാഷ്ട്രീയനേതൃത്വത്തെ സഹായിക്കുന്ന രേഖയാണ് ഭിഷഗ്വരന്മാരുടെ സംഘടനയായ ഐ.എം.എയുടേത്.
ആരോഗ്യമേഖലയിലെ സര്ക്കാര് നിക്ഷേപം ഏറ്റവും കുറവുള്ള രാജ്യങ്ങളിലൊന്നാണ് ഇന്ത്യ. ഹയ്തിയും സിയറാ ലിയോണുമാണ് നമുക്കുപിന്നില്. മൊത്തം ആഭ്യന്തര ഉത്പാദനത്തിന്റെ ഒരുശതമാനമേ ഇന്ത്യ ജനങ്ങളുടെ ചികിത്സ ഉള്പ്പെടെയുള്ള ആരോഗ്യരക്ഷാ പ്രവര്ത്തനങ്ങള്ക്കായി ചെലവിടുന്നുള്ളൂ. അത് രണ്ടുമുതല് മൂന്നുവരെ ശതമാനമായി ഉയര്ത്തുമെന്ന് 2002ലെ ദേശീയ ആരോഗ്യനയത്തില് വിഭാവനംചെയ്തിരുന്നെങ്കിലും
2025ല് കേരളത്തിലെ ജനസംഖ്യയില് 25 ശതമാനം അറുപതു വയസ്സുള്ളവരായിരിക്കുമെന്നാ
Monday, November 24, 2014
Avian influenza
Avian influenza
Fact sheet
Updated March 2014
Updated March 2014
Key facts
Avian influenza (AI), commonly called bird flu, is an infectious viral disease of birds.
Most avian influenza viruses do not infect humans; however some, such as A(H5N1) and A(H7N9), have caused serious infections in people.
Outbreaks of AI in poultry may raise global public health concerns due to their effect on poultry populations, their potential to cause serious disease in people, and their pandemic potential.
Reports of highly pathogenic AI epidemics in poultry, such as A(H5N1), can seriously impact local and global economies and international trade.
The majority of human cases of A(H5N1) and A(H7N9) infection have been associated with direct or indirect contact with infected live or dead poultry. There is no evidence that the disease can be spread to people through properly cooked food.
Controlling the disease in animals is the first step in decreasing risks to humans.
Avian influenza (AI) is an infectious viral disease of birds (especially wild water fowl such as ducks and geese), often causing no apparent signs of illness. AI viruses can sometimes spread to domestic poultry and cause large-scale outbreaks of serious disease. Some of these AI viruses have also been reported to cross the species barrier and cause disease or subclinical infections in humans and other mammals.
AI viruses are divided into 2 groups based on their ability to cause disease in poultry: high pathogenicity or low pathogenicity. Highly pathogenic viruses result in high death rates (up to 100% mortality within 48 hours) in some poultry species. Low pathogenicity viruses also cause outbreaks in poultry but are not generally associated with severe disease.
Avian influenza A(H5N1) and A(H7N9) background
The A(H5N1) virus subtype, a highly pathogenic AI virus, first infected humans in 1997 during a poultry outbreak in Hong Kong SAR, China. Since its widespread re-emergence in 2003 and 2004, this avian virus has spread from Asia to Europe and Africa and has become entrenched in poultry in some countries, resulting in millions of poultry infections, several hundred human cases, and many human deaths. Outbreaks in poultry have seriously impacted livelihoods, the economy and international trade in affected countries.
The A(H7N9) virus subtype, a low pathogenic AI virus, first infected 3 humans – 2 residents of the city of Shanghai and 1 resident of Anhui province - in March 2013. No cases of A(H7N9) outside of China have been reported. Containment measures, including the closure of live bird markets for several months, have impacted the agriculture sectors of affected countries and international trade. Continued surveillance for A(H7N9) will be necessary to detect and control the spread of the virus.
Ongoing circulation of A(H5N1) and A(H7N9) viruses in poultry, especially where endemic, continues to pose threats to public health, as these viruses have both the potential to cause serious disease in people and may have the potential to change into a form that is more transmissible among humans. Other influenza virus subtypes also circulate in poultry and other animals, and may also pose potential threats to public health.
Avian influenza A(H5N1) and A(H7N9) infections and clinical features in humans
The case fatality rate for A(H5N1) and A(H7N9) virus infections in people is much higher compared to that of seasonal influenza infections. The A(H7N9) virus particularly affects people with underlying medical conditions.
Clinical features
In many patients, the disease caused by the A(H5N1) virus follows an unusually aggressive clinical course, with rapid deterioration and high fatality. Like most emerging disease, A(H5N1) influenza in humans is not well understood.
The incubation period for A(H5N1) avian influenza may be longer than that for normal seasonal influenza, which is around 2 to 3 days. Current data for A(H5N1) infection indicate an incubation period ranging from 2 to 8 days and possibly as long as 17 days. Current data for A(H7N9) infection indicate an incubation period ranging from 2 to 8 days, with an average of five days.1 WHO currently recommends that an incubation period of 7 days be used for field investigations and the monitoring of patient contacts.
Initial symptoms include high fever, usually with a temperature higher than 38°C, and other influenza-like symptoms (cough or sore throat). Diarrhea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients.
One feature seen in many patients is the development of lower respiratory tract early in the illness. Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen. Sputum production is variable and sometimes bloody.2 Complications of A(H5N1) and A(H7N9) infection include hypoxemia, multiple organ dysfunction, and secondary bacterial and fungal infections.3
Antiviral treatment
Evidence suggests that some antiviral drugs, notably oseltamivir, can reduce the duration of viral replication and improve prospects of survival.
In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset) to maximize its therapeutic benefits. However, given the significant mortality currently associated with A(H5N1) and A(H7N9) infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered in patients presenting later in the course of illness. The use of corticosteroids is not recommended.
In cases of severe infection with the A(H5N1) or A(H7N9) virus, clinicians may need to consider increasing the recommended daily dose or/and the duration of treatment.
In severely ill A(H5N1) or A(H7N9) patients or in patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing these patients.4 Moreover, most A(H5N1) and A(H7N9) viruses are predicated to be resistant to adamantine antiviral drugs, which are therefore not recommended for use.
Risk factors for human infection
The primary risk factor for human infection appears to be direct or indirect exposure to infected live or dead poultry or contaminated environments, such as live bird markets. Controlling circulation of the A(H5N1) and A(H7N9) viruses in poultry is essential to reducing the risk of human infection. Given the persistence of the A(H5N1) and A(H7N9) viruses in some poultry populations, control will require long-term commitments from countries and strong coordination between animal and public health authorities.
There is no evidence to suggest that the A(H5N1)and A(H7N9) viruses can be transmitted to humans through properly prepared poultry or eggs. A few A(H5N1) human cases have been linked to consumption of dishes made of raw, contaminated poultry blood. However, slaughter, defeathering, handling carcasses of infected poultry, and preparing poultry for consumption, especially in household settings, are likely to be risk factors.
Human pandemic potential
Influenza pandemics (outbreaks that affect a large proportion of the world due to a novel virus) are unpredictable but recurring events that can have health, economic and social consequences worldwide. An influenza pandemic occurs when key factors converge: an influenza virus emerges with the ability to cause sustained human-to-human transmission, and the human population has little to no immunity against the virus. With the growth of global trade and travel, a localized epidemic can transform into a pandemic rapidly, with little time to prepare a public health response.
The A(H5N1) and A(H7N9) AI viruses remain two of the influenza viruses with pandemic potential, because they continue to circulate widely in some poultry populations, most humans likely have no immunity to them, and they can cause severe disease and death in humans.
However, whether the influenza A(H7N9) virus could actually cause a pandemic is unknown. Experience has shown that some animal influenza viruses that have been found to occasionally infect people have not gone on to cause a pandemic while others have done so. Surveillance and the investigations now underway will provide some of the information needed to make this determination.
In addition to A(H5N1) and A(H7N9), other animal influenza virus subtypes reported to have infected people include avian H9, and swine H1 and H3 viruses. H2 viruses may also pose a pandemic threat. Therefore, pandemic planning should consider risks of emergence of a variety of influenza subtypes from a variety of sources.
WHO response
WHO, in its capacity for providing leadership on global health matters, is monitoring avian influenza very closely, developing and adjusting appropriate interventions in collaboration with its partners. Such partners include animal health agencies and national veterinary authorities responsible for the control and prevention of animal diseases, including influenza.
Specifically, WHO, the World Organisation for Animal Health (OIE), and the Food and Agriculture Organization (FAO) collaborate through a variety of mechanisms to track and assess the risk from animal influenza viruses of public health concern, and to address these risks at the human animal interface wherever in the world they might occur. In short, WHO is monitoring the situation as it evolves, and as more information becomes available, will revise its guidance and actions accordingly.
Info from Wikepedia
Avian influenza — known informally as avian flu or bird flu — refers to "influenza caused by viruses adapted to birds."[1][2][3][4][5][6][7] The version with the greatest concern is highly pathogenic avian influenza (HPAI).
"Bird flu" is a phrase similar to "swine flu," "dog flu," "horse flu," or "human flu" in that it refers to an illness caused by any of many different strains of influenza viruses that have adapted to a specific host. All known viruses that cause influenza in birds belong to the species influenza A virus. All subtypes (but not all strains of all subtypes) of influenza A virus are adapted to birds, which is why for many purposes avian flu virus is the influenza A virus. (Note, however, that the "A" does not stand for "avian").
Adaptation is not exclusive. Being adapted toward a particular species does not preclude adaptations, or partial adaptations, toward infecting different species. In this way, strains of influenza viruses are adapted to multiple species, though may be preferential toward a particular host. For example, viruses responsible for influenza pandemics are adapted to both humans and birds. Recent influenza research into the genes of the Spanish flu virus shows it to have genes adapted to both birds and humans, with more of its genes from birds than less deadly later pandemic strains.
While its most highly pathogenic strain (H5N1) had been spreading throughout Asia since 2003, avian influenza reached Europe in 2005, and the Middle East, as well as Africa, the following year.[8] On January 22, 2012, China reported its second human death due to bird flu in a month following other fatalities in Vietnam and Cambodia.[9] Companion birds in captivity and parrots are highly unlikely to contract the virus, and there has been no report of a companion bird with avian influenza since 2003. Pigeons do not contract or spread the virus.[10][11][12] 84% of affected bird populations are composed of chicken and farm birds, while the 15% is madeup of wild birds according to capture-and-release operations in the 2000s, during the SARs pandemic. The first deadly Canadian case was confirmed on January 3, 2014.[13]
Genetics[edit]
Genetic factors in distinguishing between "human flu viruses" and "avian flu viruses" include:
PB2: (RNA polymerase): Amino acid (or residue) position 627 in the PB2 protein encoded by the PB2 RNA gene. Until H5N1, all known avian influenza viruses had a Glu at position 627, while all human influenza viruses had a Lys.[citation needed]
HA: (hemagglutinin): Avian influenza HA viruses bind alpha 2-3 sialic acid receptors, while human influenza HA viruses bind alpha 2-6 sialic acid receptors. Swine influenza viruses have the ability to bind both types of sialic acid receptors. Hemagglutinin is the major antigen of the virus against which neutralizing antibodies are produced, and influenza virus epidemics are associated with changes in its antigenic structure. This was originally derived from pigs, and should technically be referred to as "pig flu" [14]
Subtypes[edit]
There are many subtypes of avian influenza viruses, but only some strains of four subtypes have been highly pathogenic in humans. These are types H5N1, H7N3, H7N7, H7N9, and H9N2.[15] At least one person, an elderly woman in Jiangxi Province, China, died of pneumonia in December 2013 from the H10N8 strain, the first human fatality confirmed to be caused by that strain.[16]
Contraction/spreading of avian influenza[edit]
Most human contractions of the avian flu are a result of either handling dead infected birds or from contact with infected fluids. While most wild birds mainly have only a mild form of the H5N1 strain, once domesticated birds such as chickens or turkeys are infected, it could become much more deadly because the birds are often within close contact of one another. There is currently a large threat of this in Asia with infected poultry due to low hygiene conditions and close quarters. Although it is easy for humans to become infected from birds, it's much more difficult to do so from human to human without close and lasting contact.
Spreading of H5N1 from Asia to Europe is much more likely caused by both legal and illegal poultry trades than dispersing through wild bird migrations, being that in recent studies, there were no secondary rises in infection in Asia when wild birds migrate south again from their breeding grounds. Instead, the infection patterns followed transportation such as railroads, roads, and country borders, suggesting poultry trade as being much more likely. While there have been strains of avian flu to exist in the United States, such as Texas in 2004, they have been extinguished and have not been known to infect humans.
Examples of avian influenza A virus strains:[17]
HA subtype
designation
NA subtype
designation
Avian influenza A viruses
H1
N1
A/duck/Alberta/35/76(H1N1)
H1
N8
A/duck/Alberta/97/77(H1N8)
H2
N9
A/duck/Germany/1/72(H2N9)
H3
N8
A/duck/Ukraine/63(H3N8)
H3
N8
A/duck/England/62(H3N8)
H3
N2
A/turkey/England/69(H3N2)
H4
N6
A/duck/Czechoslovakia/56(H4N6)
H4
N3
A/duck/Alberta/300/77(H4N3)
H5
N3
A/tern/South Africa/300/77(H4N3)
H5
N4
A/Ethiopia/300/77(H6N6)
H5
N9
A/turkey/Ontario/7732/66(H5N9)
H5
N1
A/chick/Scotland/59(H5N1)
H6
N2
A/turkey/Massachusetts/3740/65(H6N2)
H6
N8
A/turkey/Canada/63(H6N8)
H6
N5
A/shearwater/Australia/72(H6N5)
H6
N6
A/jyotichinara/Ehiopia/73(H6N6)
H6
N1
A/duck/Germany/1868/68(H6N1)
H7
N7
A/fowl plague virus/Dutch/27(H7N7)
H7
N1
A/chick/Brescia/1902(H7N1)
H7
N9
A/chick/China/2013(H7N9)
H7
N3
A/turkey/England/639H7N3)
H7
N1
A/fowl plague virus/Rostock/34(H7N1)
H8
N4
A/turkey/Ontario/6118/68(H8N4)
H9
N2
A/turkey/Wisconsin/1/66(H9N2)
H9
N6
A/duck/Hong Kong/147/77(H9N6)
H9
N6
A/duck/Hong Kong/147/77(H9N6)
H9
N8
A/manishsurpur/Malawi/149/77(H9N8)
H9
N7
A/turkey/Scotland/70(H9N7)
H10
N8
A/quail/Italy/1117/65(H10N8)
H11
N6
A/duck/England/56(H11N6)
H11
N9
A/duck/Memphis/546/74(H11N9)
H12
N5
A/duck/Alberta/60/76/(H12N5)
H13
N6
A/gull/Maryland/704/77(H13N6)
H14
N4
A/duck/Gurjev/263/83(H14N4)
H15
N9
A/shearwater/Australia/2576/83(H15N9)
Influenza pandemic[edit]
Further information: Influenza pandemic
Pandemic flu viruses have some avian flu virus genes and usually some human flu virus genes. Both the H2N2 and H3N2 pandemic strains contained genes from avian influenza viruses. The new subtypes arose in pigs coinfected with avian and human viruses, and were soon transferred to humans. Swine were considered the original "intermediate host" for influenza, because they supported reassortment of divergent subtypes. However, other hosts appear capable of similar coinfection (e.g., many poultry species), and direct transmission of avian viruses to humans is possible.[18] The Spanish flu virus strain may have been transmitted directly from birds to humans.[19]
In spite of their pandemic connection, avian influenza viruses are noninfectious for most species. When they are infectious, they are usually asymptomatic, so the carrier does not have any disease from it. Thus, while infected with an avian flu virus, the animal does not have a "flu". Typically, when illness (called "flu") from an avian flu virus does occur, it is the result of an avian flu virus strain adapted to one species spreading to another species (usually from one bird species to another bird species). So far as is known, the most common result of this is an illness so minor as to be not worth noticing (and thus little studied). But with the domestication of chickens and turkeys, humans have created species subtypes (domesticated poultry) that can catch an avian flu virus adapted to waterfowl and have it rapidly mutate into a form that kills over 90% of an entire flock in days, can spread to other flocks and kill 90% of them, and can only be stopped by killing every domestic bird in the area. Until H5N1 infected humans in the 1990s, this was the only reason avian flu was considered important. Since then, avian flu viruses have been intensively studied; resulting in changes in what is believed about flu pandemics, changes in poultry farming, changes in flu vaccination research, and changes in flu pandemic planning.
Influenza A/H5N1 has evolved into a flu virus strain that infects more species than any previously known strain, is deadlier than any previously known strain, and continues to evolve, becoming both more widespread and more deadly. This caused Robert G. Webster, a leading expert on avian flu, to publish an article titled "The world is teetering on the edge of a pandemic that could kill a large fraction of the human population" in American Scientist. He called for adequate resources to fight what he sees as a major world threat to possibly billions of lives.[20]
Vaccines for poultry have been formulated against several of the avian H5N1 influenza varieties. Vaccination of poultry against the ongoing H5N1 epizootic is widespread in certain countries. Some vaccines also exist for use in humans, and others are in testing, but none have been made available to civilian populations, nor are produced in quantities sufficient to protect more than a tiny fraction of the Earth's population in the event of an H5N1 pandemic outbreak. The World Health Organization has compiled a list of known clinical trials of pandemic influenza prototype vaccines, including those against H5N1.
H5N1[edit]
H5N1
• subtype H5N1
• in 2004
• in 2005
• in 2006
• in 2007
• Pandemic
• Vaccine
Further information: Influenza A virus subtype H5N1 and Transmission and infection of H5N1
The highly pathogenic influenza A virus subtype H5N1 is an emerging avian influenza virus that has been causing global concern as a potential pandemic threat. It is often referred to simply as "bird flu" or "avian influenza", even though it is only one subtype of avian influenza-causing virus.
H5N1 has killed millions of poultry in a growing number of countries throughout Asia, Europe, and Africa. Health experts are concerned that the coexistence of human flu viruses and avian flu viruses (especially H5N1) will provide an opportunity for genetic material to be exchanged between species-specific viruses, possibly creating a new virulent influenza strain that is easily transmissible and lethal to humans. The mortality rate for humans with H5N1 is 60%.
Since the first H5N1 outbreak occurred in 1987, there has been an increasing number of HPAI H5N1 bird-to-human transmissions, leading to clinically severe and fatal human infections. Because a significant species barrier exists between birds and humans, though, the virus does not easily cross over to humans, though some cases of infection are being researched to discern whether human to human transmission is occurring.[18] More research is necessary to understand the pathogenesis and epidemiology of the H5N1 virus in humans. Exposure routes and other disease transmission characteristics, such as genetic and immunological factors that may increase the likelihood of infection, are not clearly understood.[21]
On January 18, 2009, a 27-year-old woman from eastern China died of bird flu, Chinese authorities said, making her the second person to die from the deadly virus at that time. Two tests on the woman were positive for H5N1 avian influenza, said the ministry, which did not say how she might have contracted the virus.[22]
Although millions of birds have become infected with the virus since its discovery, 359 humans have died from the H5N1 in twelve countries according to WHO data as of August 10, 2012.[23]
The avian flu claimed at least 300 humans in Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Laos, Nigeria, Pakistan, Thailand, Turkey, and Vietnam. Epidemiologists are afraid the next time such a virus mutates, it could pass from human to human; however, the current A/H5N1 virus does not transmit easily from human to human. If this form of transmission occurs, another pandemic could result. Thus, disease-control centers around the world are making avian flu a top priority. These organizations encourage poultry-related operations to develop a preemptive plan to prevent the spread of H5N1 and its potentially pandemic strains. The recommended plans center on providing protective clothing for workers and isolating flocks to prevent the spread of the virus.[24]
The Thailand outbreak of avian flu caused massive economic losses, especially among poultry workers. Infected birds were culled and slaughtered. The public lost confidence with the poultry products, thus decreasing the consumption of chicken products. This also elicited a ban from importing countries. There were, however, factors which aggravated the spread of the virus, including bird migration, cool temperature (increases virus survival) and several festivals at that time.[25]
H7N9[edit]
Further information: Influenza A virus subtype H7N9
Influenza A virus subtype H7N9 is a novel avian influenza virus first reported to have infected humans in 2013 in China.[26] Most of the reported cases of human infection have resulted in severe respiratory illness.[27] In the month following the report of the first case, more than 100 people had been infected, an unusually high rate for a new infection; a fifth of those patients had died, a fifth had recovered, and the rest remained critically ill.[28] The World Health Organization (WHO) has identified H7N9 as "...an unusually dangerous virus for humans."[29] As of June 30, 133 cases have been reported, resulting in the deaths of 43.
Research regarding background and transmission is ongoing.[30] It has been established that many of the human cases of H7N9 appear to have a link to live bird markets.[31] As of July, there has been no evidence of sustained human-to-human transmission, however a study group headed by one of the world’s leading experts on avian flu reported that several instances of human-to-human infection are suspected.[32] It has been reported that H7N9 virus does not kill poultry, which will make surveillance much more difficult. Researchers have commented on the unusual prevalence of older males among H7N9-infected patients.[33] While several environmental, behavioral, and biological explanations for this pattern have been proposed,[34] as yet, the reason is unknown.[35] Currently no vaccine exists, but the use of influenza antiviral drugs known as neuraminidase inhibitors in cases of early infection may be effective.[36]
The number of cases detected after April fell abruptly. The decrease in the number of new human H7N9 cases may have resulted from containment measures taken by Chinese authorities, including closing live bird markets, or from a change in seasons, or possibly a combination of both factors. Studies indicate that avian influenza viruses have a seasonal pattern, thus it is thought that infections may pick up again when the weather turns cooler in China.[37]
In domestic animals[edit]
Several domestic species have been infected with and shown symptoms of H5N1 viral infection, including cats, dogs, ferrets, pigs, and birds.[38]
Birds[edit]
Attempts are made in the United States to minimize the presence of HPAI in poultry thorough routine surveillance of poultry flocks in commercial poultry operations. Detection of a HPAI virus may result in immediate culling of the flock. Less pathogenic viruses are controlled by vaccination, which is done primarily in turkey flocks (ATCvet codes: QI01AA23 for the inactivated fowl vaccine, QI01CL01 for the inactivated turkey combination vaccine).[39]
Seals[edit]
A recent strain of the virus is able to infect the lungs of seals.[40]
Cats[edit]
Avian influenza in cats can show a variety of symptoms and usually lead to death. Cats are able to get infected by either consuming an infected bird or by passing it to other cats.
Influenza Prevention[edit]
People who have fewer chances to contact with birds do not belong to the high-risk group of HPAI. If people take precautions correctly and be more careful, the chance of infection will be very low, even among farmers.
In the aware of bird flu pandemic, people should have careful thought to adopt suitable Infection Control Procedures. Try to avoid flu infection in any situation will be necessary. Protecting eyes, nose, mouth and hands from virus particles will be a major priority because these are the most common passageways for a flu virus to transfer into the body.[41] Bird flu virus particles may also be transferred through clothing or even shoes. The final step is people should always have sanitized hands in order to further reduce the chances of cross-contamination. Any unprotected clothing or footwear should be disinfected. Avoid contact with poultry, and maintaining good personal hygiene is very important, too. Someone who has normal flu should be more careful in avoiding contact with fowl because the epidemic situation will become even more serious if the receptor protein of normal flu and the genes of Avian Flu combine with each other.[41]
from cdc
Types of Influenza Viruses
Language:
English
Share
There are three types of influenza viruses: A, B and C. Human influenza A and B viruses cause seasonal epidemics of disease almost every winter in the United States. The emergence of a new and very different influenza virus to infect people can cause an influenza pandemic. Influenza type C infections cause a mild respiratory illness and are not thought to cause epidemics.
Influenza A viruses are divided into subtypes based on two proteins on the surface of the virus: the hemagglutinin (H) and the neuraminidase (N). There are 18 different hemagglutinin subtypes and 11 different neuraminidase subtypes. (H1 through H18 and N1 through N11 respectively.)
Influenza A viruses can be further broken down into different strains. Current subtypes of influenza A viruses found in people are influenza A (H1N1) and influenza A (H3N2) viruses. In the spring of 2009, a new influenza A (H1N1) virus (CDC 2009 H1N1 Flu website) emerged to cause illness in people. This virus was very different from the human influenza A (H1N1) viruses circulating at that time. The new virus caused the first influenza pandemic in more than 40 years. That virus (often called “2009 H1N1”) has now replaced the H1N1 virus that was previously circulating in humans.
Influenza B viruses are not divided into subtypes, but can be further broken down into lineages and strains. Currently circulating influenza B viruses belong to one of two lineages: B/Yamagata and B/Victoria.
CDC follows an internationally accepted naming convention for influenza viruses. This convention was accepted by WHO in 1979 and published in February 1980 in the Bulletin of the World Health Organization, 58(4):585-591 (1980) (see A revision of the system of nomenclature for influenza viruses: a WHO Memorandum[854 KB, 7 pages]). The approach uses the following components:
• The antigenic type (e.g., A, B, C)
• The host of origin (e.g., swine, equine, chicken, etc. For human-origin viruses, no host of origin designation is given.)
• Geographical origin (e.g., Denver, Taiwan, etc.)
• Strain number (e.g., 15, 7, etc.)
• Year of isolation (e.g., 57, 2009, etc.)
• For influenza A viruses, the hemagglutinin and neuraminidase antigen description in parentheses (e.g., (H1N1), (H5N1)
For example:
• A/duck/Alberta/35/76 (H1N1) for a virus from duck origin
• A/Perth/16/2009 (H3N2) for a virus from human origin
Influenza A (H1N1), A (H3N2), and one or two influenza B viruses (depending on the vaccine) are included in each year’s influenza vaccine. Getting a flu vaccine can protect against flu viruses that are the same or related to the viruses in the vaccine. Information about this season’s vaccine can be found at Preventing Seasonal Flu with Vaccination. The seasonal flu vaccine does not protect against influenza C viruses. In addition, flu vaccines will NOT protect against infection and illness caused by other viruses that also can cause influenza-like symptoms. There are many other non-flu viruses that can result in influenza-like illness (ILI) that spread during flu season.
Subscribe to:
Posts (Atom)
-
Yes! I am an Army Doctor. We were curious and excited when ‘Hisar' flashed on TV, that too on BBC. A small town in Hary... -
What do I eat? What should my family eat? Food undoubtedly is every body's concern. Food, beyond a means of survival is also a sym...
