REFERAT

AVIAN INFLUENZA

DITA MAULIDA ANGGRAINI 130110120078

KAFI HARRIDHI KHAIBAR 130110120087
MARIA FRANSISKA 130110120190

UNIVERSITAS PADJADJARAN
FAKULTAS KEDOKTERAN
BANDUNG
2015
 DAFTAR ISI

BAB 1 PENDAHULUAN...........................................................................................3
BAB 2 TINJAUAN PUSTAKA.................................................................................4
2.1 Etiology.........................................................................................................4
2.2 Morphological Feautures Of Orthomyxoviruses......................................4
2.3 Epidemiology................................................................................................5
2.4 Pathogenesis.................................................................................................6
2.5 Signs and Symptoms....................................................................................6
2.6 Specimen Collection and Transport...........................................................7
2.7 Diagnostic Testing and Laboratory Findings............................................9
2.8 Differential Diagnosis..................................................................................9
2.9 Prevention and Control.............................................................................10
2.9.1 Handling poultry...................................................................................10
2.9.2 Personal hygiene...................................................................................11
2.9.3 Environmental hygiene.........................................................................11
2.9.4 Vaccination...........................................................................................12
2.9.5 Antiviral drugs......................................................................................12
2.9.6 Travel advice........................................................................................13
2.10 Complications.............................................................................................14
DAFTAR PUSTAKA................................................................................................15
 BAB 1
PENDAHULUAN

Avian influenza (AI), often called as Bird Flu, 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.1 Besides, AI is a disease that can be transmitted from
animals to humans (zoonoses) so that prevention and control of this disease require
attention and appropriate action.

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.1

WHO in November 2004 stated that the first invasion of pandemic H5N1
outbreaks, the majority of developing countries do not have access to the vaccine, so
the pandemic is expected to spread and expand rapidly. Pandemic is an outbreak
resulting in changes that affects all sectors of life, including social and economic
sectors. Therefore, a step in the right management and prevention are indispensable
related to the threat of pandemic H5N1 deadly virus that occurs at this time.
 BAB 2
TINJAUAN PUSTAKA

2.1 Etiology2

Influenza viruses are members of Orthomyxoviridae family. The designation

of influenza viruses as type A, B, or C is based on antigenic characteristic of the

nucleoprotein (NP) and matrix (M) protein antigens. Influenza A then subtyped

based on the hemagglutinin (H) and neuraminidase (N) antigens. So far there are 16

subtypes of HA (H1 H15) and 9 subtypes of NA (N1 N9) recovered from birds,

animals and humans,of which only H1, H2, H3, N1 and N2 have been associated

with epidemics of disease in humans.

2.2 Morphological Feautures Of Orthomyxoviruses3

The virions are irregularly shaped spherical particles, measure 80 120 nm

in diameter, and have lipid envelope from the surface of which the H and N

glycoproteins project. The hemagglutinin is the site by which the virus binds to

sialic acid cell receptors, whereas the neuroaminidase degrades the receptor nad

plays role in the release of the virus from the infected cells after replication

completed. Influenza viruses enter cells by receptor-mediated endocytosis, forming a

virus-contaning endosome. Immune responses to the H antigen are the major

determinants of protection against infection with influenza virus. The lipid envelope

of influenza A virus also contains M proteins M1 and M2, which are involved in

stabilization of the lipid envelope and in virus assembly. The virion also contains NP
antigen, which is associated with the viral genome, as well three polymerase protein

that are essential for transcription and synthesis of viral RNA.

2.3 Epidemiology4

The virus was first detected in 1996 in geese in China. Asian H5N1 was first

detected in humans in 1997 during a poultry outbreak in Hong Kong and has since

been detected in poultry and wild birds in more than 50 countries in Africa, Asia,

Europe, and the Middle East. Six countries are considered to be endemic for Asian
HPAI H5N1 virus in poultry (Bangladesh, China, Egypt, India, Indonesia, and

Vietnam). Most human infections with avian influenza viruses, including HPAI

Asian H5N1 viruses, have occurred after prolonged and close contact with infected

birds. Rare human-to-human spread with this virus has occurred, but it has not been

sustained and no community spread of this virus has ever been identified.

2.4 Pathogenesis

2.5 Signs and Symptoms

The reported signs and symptoms of low pathogenic avian influenza* (LPAI)

A virus infections in humans have ranged from conjunctivitis to influenza-like illness

(e.g., fever, cough, sore throat, muscle aches) to lower respiratory disease

(pneumonia) requiring hospitalization. Highly pathogenic avian influenza (HPAI) A

virus infections in people have been associated with a wide range of illness from
conjunctivitis only, to influenza-like illness, to severe respiratory illness (e.g.

shortness of breath, difficulty breathing, pneumonia, acute respiratory distress, viral

pneumonia, respiratory failure) with multi-organ disease, sometimes accompanied by

nausea, abdominal pain, diarrhea, vomiting and sometimes neurologic changes

(altered mental status, seizures). LPAI H7N9 and HPAI Asian H5N1 have been

responsible for most human illness worldwide to date, including the most serious

illnesses and deaths.

2.6 Specimen Collection and Transport5

Specimens should be obtained for novel influenza A virus testing as soon as

possible after illness onset, ideally within 7 days of illness onset. However, as some

persons who are infected with seasonal influenza viruses are known to shed virus for

longer periods (e.g., children and immunocompromised persons), specimens should

be tested for novel influenza A virus even if obtained after 7 days from illness onset.

Prolonged influenza viral shedding in the lower respiratory tract has been

documented for critically ill patients with HPAI H5N1 virus and LPAI H7N9 virus

infections.

The following should be collected as soon as possible after illness onset: (i) a

nasopharyngeal swab, or (ii) a nasal aspirate or wash, or (iii) two swabs combined

into one viral transport media vial (e.g., nasal or nasopharyngeal swab combined

with an oropharyngeal swab). If these specimens cannot be collected, a single nasal,

or oropharyngeal swab is acceptable. For patients with lower respiratory tract illness,

a lower respiratory tract specimen (e.g., an endotracheal aspirate or bronchoalveolar

lavage fluid) is preferred because these specimens have a higher yield for detecting

avian influenza H5N1 and H7N9 viruses. Specimens should be placed into sterile

viral transport media and immediately placed on refrigerant gel-packs or at 4C

(refrigerator) for transport to the laboratory. If possible, in order to increase the

potential for H7N9 or H5N1 virus detection, multiple respiratory specimens from

different sites should be obtained from the same patient on at least two consecutive

days.

Swab specimens should be collected using swabs with a synthetic tip (e.g.,

polyester or Dacron) and an aluminum or plastic shaft. Swabs with cotton tips and

wooden shafts are not recommended. Specimens collected with swabs made of

calcium alginate are not acceptable. The swab specimen collection vials should

contain 1-3ml of viral transport medium (e.g., containing protein stabilizer,

antibiotics to discourage bacterial and fungal growth, and buffer solution).

Respiratory specimens should be kept at 4C (2-8C) for no longer than 3

days. Specimens can alternatively be frozen at -70C. Avoid freezing and thawing

specimens if at all possible. If clinical specimens will be examined within 72 hours

after collection, keep the specimen at 4C (2-8C) and ship on refrigerant gel-packs,

otherwise store frozen at -70C and ship on dry ice. Avoid freezing and thawing

specimens. Viability of some pathogens from specimens that were frozen and then

thawed is greatly diminished. All specimens should be labeled clearly and include

information requested by your state public health laboratory.

2.7 Diagnostic Testing and Laboratory Findings2

During acute influenza, virus may be detected in throat swabs,

nasopharyngeal swabs or washes, or sputum. Reverse-transcriptase polymerase chain

reaction (RT-PCR) is the most sensitive and specific technique for detection of

influenza viruses. RT-PCR can differentiate among influenza subtypes and is used

for detection of avian influenza viruses. Rapid influenza diagnostic tests (RIDTs)

detect influenza virus antigens by immunologic or enzymatic techniques. RIDTs

yield results quickly, and some tests can distinguish between influenza A and B

viruses. Although relatively specific, RIDTs vary in sensitivity with the technique

and the virus to be detected. Serologic methods for diagnosis require comparison of

antibody titers in sera obtained during the acute illness with those in sera obtained

1014 days after the onset of illness and are useful primarily in retrospect and for

epidemiologic studies.

Other laboratory tests generally are not helpful in the specific diagnosis of

influenza virus infection. Leukocyte counts are variable, frequently being low early

in illness and normal or slightly elevated later. Severe leukopenia has been described

in overwhelming viral or bacterial infection, whereas leukocytosis with >15,000

cells/L raises the suspicion of secondary bacterial infection.

2.8 Differential Diagnosis

The following diseases must be considered in the differential diagnosis of HPAI

because of their ability to cause a sudden onset of disease accompanied by high

mortality or haemostasis in wattles and combs:

 Velogenic Newcastle disease

Infectious laryngotracheitis (chickens)

Duck plague

Acute poisonings

Acute fowl cholera (Pasteurellosis) and other septicaemic diseases

Bacterial cellulitis of the comb and wattles

Less severe forms of HPAI can be clinically even more confusing. Rapid laboratory

diagnostic aid, therefore, is pivotal to all further measures.

2.9 Prevention and Control6

Infected birds and poultry (live or dead) or their droppings may carry avian

influenza virus. Therefore, members of the public should pay attention to the following

issues to better prevent them from contracting avian influenza:

2.9.1 Handling poultry

When buying and handling live chickens, try not to touch them or their

droppings. Do not blow at their bottoms. Wash eggs with household detergent if

they are soiled with faecal matter or stained with dirt. Washed eggs should be
 consumed immediately. Observe food hygiene when cooking chickens and eggs.

Always wash the hands thoroughly with liquid soap and water after handling

chickens and eggs.

Eggs should be cooked well until the white and yolk become firm. Do not eat

raw eggs or dip cooked food into any sauce containing raw eggs. Poultry should

be cooked thoroughly. If there is pinkish juice running from the cooked poultry

or the middle part of its bone is still red in colour, the poultry should be cooked

again until fully done.

There is no evidence so far that avian influenza can be transmitted through

eating poultry or eggs. However, it is important to make sure poultry and eggs

have been thoroughly cooked.

2.9.2 Personal hygiene

Keep hands clean, wash hands frequently with liquid soap, especially before

eating, touching the mouth, nose, or eyes, handling food or eating, and after

going to toilet, touching public installations or equipment such as escalator

handrails, elevator control panels or door knobs, or when hands are dirtied by

respiratory secretion after coughing or sneezing.

Cover the mouth and/or nose with tissue paper when coughing or sneezing.

Dispose of the soiled tissues properly into a lidded rubbish bin, and then wash

hands thoroughly.
 Wear a mask if developing fever or respiratory symptoms, going to a hospital or

clinic, or if caring for a patient with fever or respiratory symptoms.

If flu-like symptoms develop, stay at home and avoid going to crowded or

poorly ventilated places.

Good body resistance helps prevent infections including influenza. This can be

achieved through a balanced diet, regular exercise and adequate rest, reducing

stress and not smoking. Normally, extra supplement is not required.

2.9.3 Environmental hygiene

Maintain good indoor ventilation.

Home should be cleaned thoroughly at least once per week with 1 in 99 diluted

household bleach (mixing 10 ml of bleach containing 5.25% sodium

hypochlorite with 990 ml of water).

U-trap should be prevented from drying up and drain outlets should be

disinfected regularly about once a week.

Repair immediately if there is defect in the U-trap or foul odour coming out

from drain outlets. Qualified technicians can be hired for inspection and repair.

2.9.4 Vaccination

At present, there is no vaccine to prevent avian influenza in humans.

 Seasonal influenza vaccine cannot prevent avian influenza, however it can help

reduce the chance of complications and hospitalization from seasonal influenza.

Given influenza vaccines are safe and effective and that serious influenza

infection can occur even in healthy individuals, seasonal influenza vaccination

is suitable for personal protection against clinical influenza for all persons

except those with known contraindications.

Moreover, the Scientific Committee on Vaccine Preventable Diseases

recommends a number of target groups with higher priority in seasonal

influenza vaccination. These target groups have been determined based on a

range of scientific considerations taking into account local disease burden and

international experience.

2.9.5 Antiviral drugs

Whether a doctor prescribes antiviral drugs (e.g. Tamiflu) to a patient will

depend on the circumstances and health needs of the patient, taking into

consideration the presence of any contraindication and balancing the benefits of

taking the antiviral drugs against the possible adverse side effects.

Indiscriminate use of antiviral drugs may give rise to drug resistance.

Prophylaxis should be prescribed by registered doctors. Its effectiveness lasts as

long as the drugs are being taken and ceases once the drugs are stopped. Self-
 medication is not encouraged because of the potential side effects and

possibility of emergence of antiviral resistance.

2.9.6 Travel advice

Avoid touching birds, poultry or their droppings and visiting poultry markets or

farms when travelling outside Hong Kong.

Travellers if feeling unwell when outside Hong Kong, especially if having a

fever or cough, should wear a mask and inform the hotel staff or tour leader and

seek medical advice at once.

Travellers returning from affected areas with avian influenza outbreaks should consult

doctors promptly if they have flu-like symptoms, and inform the doctor of the travel

history and wear a mask to help prevent spread of the disease.

2.10 Complications7

Life-threatening complications are the most serious concern with avian

influenza. More than half of known cases have resulted in fatal complications. Known

complications include:

pneumonia

respiratory failure

collapsed lung

kidney problems

heart problems
 sepsis

multiple organ failure

DAFTAR PUSTAKA

1. WHO. Avian influenza fact sheet 2014 [updated March 2014; cited 2015
November 12]. Available from:
http://www.who.int/mediacentre/factsheets/avian_influenza/en/.

2. Dolin R. Influenza. In: Longo D, Fauci A, Kasper D, Hauser S, Jameson J, et

al., editors. Harrison's Principles of Internal Medicine. 1. 18 ed: McGraw-Hill
Education; 2011. p. 1497.

3. Butel J. Orthomyxoviruses (Influenza Viruses). In: Brooks G, Carroll K,

Butel J, Morse S, Mietzner T, editors. Jawetz, Melnick & Adelberg's Medical
Microbiology 26 ed: McGraw-Hill Education; 2012. p. 577.
4. CDC. Highly Pathogenic Asian Avian Influenza A (H5N1) Virus 2015
[updated October 14, 2015; cited 2015 November 12]. Available from:
http://www.cdc.gov/flu/avianflu/h5n1-virus.htm.

5. CDC. Interim Guidance for Specimen Collection, Processing, and Testing for
Patients with Suspected Infection with Novel Influenza A Viruses Associated
with Severe Disease in Humans 2015 [updated June 11, 2015; cited 2015
November 12]. Available from:
http://www.cdc.gov/flu/avianflu/h7n9/specimen-collection.htm.

6. Schrijver RS, Koch G. Avian influenza: prevention and control. Springer

Science & Business Media. 2005;8.

7. Rothberg MB, Haessler SD, Brown RB. Complications of viral influenza.

The American Journal of Medicine. 2008;121(4).