Table of Contents
INTRODUCTION AND BACKGROUND
BACKGROUND INFORMATION - DVS
Poultry Production Systems
Situation Analysis
PANDEMIC PREPAREDNESS
CO-ORDINATION AND RESOURCES MOBILISATION
EPIDEMIOLOGY AND SURVEILLANCE EMERGENCY PREPAREDNESS PLAN
EPIDEMIOLOGY AND SURVEILLANCE (DOMESTIC BIRDS) WORK PLAN
EPIDEMIOLOGY AND SURVEILLANCE (HUMANS) WORK PLAN
EPIDEMIOLOGY AND SURVEILLANCE (WILD BIRDS) WORK PLAN
LABORATORY AND RESEARCH
INFECTION PREVENTION AND CONTROL
CASE MANAGEMENT
INFORMATION, EDUCATION AND COMMUNICATION
SUMMARY AVIAN FLU GUIDELINE
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Executive summary
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ACRONYMNS AND ABBREVIATIONS
WHO
FAO
USAID
OIE
AU-IBAR
MOH
MOLFD
IEC
IPC
UNDP
DANIDA
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THE NATIONAL AVIAN INFLUENZA STRATEGIC EMERGENCY PREPAREDNESS AND RESPONSE PLAN
INTRODUCTION AND BACKGROUND
THE COUNTRY
The contemporary Republic of Kenya was founded on 12th December 1963 when the country gained her independence. It lies on the eastern part of the African continent East Africa and is bisected by the Equator. It covers an area of some 582,000 Sq Km and has a human population of 32 million persons. It is classified as a developing country and is characterized by a continuing search for solutions to problems of poverty, ignorance and disease inherited from the past and exacerbated by a plethora of international and local circumstances that are sometimes beyond its capacity to resolve fully at the present time. At the international level some of the problems arise from disadvantaged historical position in trade, investment, finance, development and political economy. At the nationnal level, problems have arisen from leadership and governance systems that leave quite some room for improvement. The country has however continued to grapple with these problems and has received tremendous support from the international community while still addressing local level problems in all sectors of the economy, health included, in order to ensure a better future for its contemporary citizens and residents and visiters and for posterity.
BACKGROUND INFORMATION - DVS
THE DISEASE
Avian influenza is a viral disease of poultry caused by RNA viruses. There are three main groups of influenza viruses: Type A, B, and C. Avian variants of influenza virus are classified as type A. These naturally occur in domestic fowls, ducks, geese, turkeys, guinea fowl, quail and pheasants. Disease outbreaks occur most frequently in domestic fowl and turkeys. Influenza B and C viruses are generally restricted to humans. Influenza A viruses are widespread in birds and mammals although most avian and other non-human variants do not infect humans.
There are two known pathotypes of Avian Influenza:
Highly Pathogenic Avian Influenza (HPAI)
This pathotype causes severe disease with high mortality of up to 100%.
To date, only (but not all) viruses of H5 or H7 subtype are in this pathotype
Low Pathogenic Avian Influenza (LPAI)
mild respiratory disease, depression, egg production problems
may exacerbate other infections/conditions
Influenza A viruses infecting poultry can be divided into 2 distinct groups. The most virulent viruses cause fowl plague, now referred to as highly pathogenic avian influenza (HPAI) while other viruses cause a milder, primarily, respiratory disease designated low pathogenic avian influenza (LPAI). HPAI can cause up to 100% mortality. LPAI may under certain conditions cause a more serious disease depending on environmental conditions and other concurrent infections.
Most outbreaks in domestic poultry probably start with direct or indirect contact with water birds and migratory birds in which the disease is inapparent. Many of the strains that circulate in wild birds are either non pathogenic or mildly pathogenic for poultry and may become virulent through either genetic mutation or re-assortment. 0nce AI is established in domestic poultry, it is a highly contagious disease and wild birds are no longer essential for spread. Infected birds secrete the virus in high concentration in their faeces, nasal and ocular discharges. Within a flock, the disease spreads rapidly by direct contact and airborne transmission. The virus is then spread from flock to flock by the usual methods involving the movement of infected birds, contaminated equipment, egg cartons, feed trucks, human traffic and airborne transmission for birds in close proximity. There is a possibility of vertical transmission though this has not been resolved.
Clinical signs are variable and are influenced by factors such as virulence of the infecting virus, species affected, age, sex, concurrent disease and environment. In HPAI, infected birds show signs of depression, inappetence, ruffled feathers, fever, cyanotic and oedematous combs and wattles, profuse watery diarrhoea and respiratory distress. Neurological signs may also be observed.
VIRULENCE OF AVIAN INFLUENZA VIRUSES
•The presence of multiple basic amino acids at the HAO cleavage site means the viruses are able to spread systemically in all tissues
•Without additional basic amino acids at the cleavage site the viruses are restricted to replication in the respiratory and intestinal tracts
Poultry Production Systems
The poultry population in Kenya is estimated at 30,000,000, 80% of which are indigenous chicken under backyard production, 19% commercially reared broilers and layers, and 1% made up of other poultry (ducks, turkeys, geese etc). Commercially poultry keeping is mainly practiced in urban and peri-urban areas of the country. On the average, every rural Kenyan household has 2-3 backyard chicken.
Poultry is mainly kept for supply of domestic protein, income generation and for social purposes.
Situation Analysis
Avian influenza has not been diagnosed in Kenya. However, Kenya is at high risk because it lies along the migratory route of birds from Europe to Southern Africa and its water points serve as a stop-over. Virus excreted by these birds can survive in the environment for long, especially in ponds, waterways and cool damp areas.
However, the low population of intensively farmed turkeys, ducks or water fowls reduces the risk of spread of the virus if introduced. In contrast, pigs and poultry are kept in close proximity and thereby pose a public health risk.
Retrospective analyses of avian diseases diagnosed at the Central Veterinary Laboratory, Kabete between 1935 and 2004 do not indicate the occurrence of avian influenza in poultry in the country. Studies looking for heamagglutinating viruses in wild birds, water fowls, domestic and indigenous chicken only showed presence of Avian Paramyxovirus (APMV) type 2 in migratory birds, APMV type 2,3 and 8 in ducks, APMV type 3 in chickens and APMV type 4 in flamingos (Kasiti J. L, MSc Thesis 2000).
Avian influenza was declared a notifiable in Kenya, with effect from 1996 through a gazette notice. Following recent outbreaks in different parts of the world, Kenya has placed a ban on the importation of poultry and their products from South Africa , Asia, Turkey, Greece, Romania and any other country reporting avian influenza. Veterinary personnel at ports of entry have been placed on high alert over possible entry of poultry and their products. A circular on disease recognition and the need for prompt reporting of suspicious cases has been sent to all field offices.
Kenya has an elaborate national epidemiological surveillance network comprising both public and private veterinary professionals (veterinarians and paravets) and other stakeholders including livestock keepers and traders. The public structures include District and Provincial offices, Abattoir inspectorate, National and Sub-national Veterinary Laboratories and a Central Epidemiology Unit. Other collaborators are Kenya Wildlife Services and Research institutions.
Though the National Veterinary Laboratory has some capacity to diagnose avian influenza, it requires reagents, consumables, training and some equipment to be able to confirm avian influenza cases. The Sub-national laboratories are poorly equipped for diagnostic work.
BACKGROUND INFORMATION - HEALTH
Kenya faces with a burden of communicable diseases that comprise 70% of all outpatient morbidity. The country has adopted The Integrated Diseases Surveillance and Response (IDSR) Strategy for the purpose of promptly detecting priority diseases, re-emerging and emerging diseases. The country’s health system is beset with severe inherent weaknesses, among them the following:-
- Poor disease surveillance system (in terms of timeliness, completeness, human capacity),
- Inadequacy of emergency stocks of vaccines, anti viral drugs and protective gear & other non-pharmaceuticals
- Limited laboratory capacity
- Inadequate funding for research
Past Influenza Pandemics
The following are milestones in the outbreak of influenza pandemics:
•Before 1880: Influenza was thought to be‘The Influence of Stars on epidemics of Cough and Fever’
•1880-1933 : H. Influenza thought to be the causative agent for the disease
•1918: Pandemic Alerts world on potentials of influenza
•1933: First Isolation of influenza virus
•1946: First Vaccine against influenza developed and tested in USA
•1947: WHO: Establishment of first influenza Centre in London
Influenza pandemics are associated with high mortality, morbidity, social & economic disruption. Deaths in pandemics are usually caused by Primary Viral Pneumonia and Pneumonia caused by secondary Bacterial Infections. Three pandemics were reported in the 20th C at intervals of 10-50 years. The 1918 pandemic is regarded as the most deadly event in human history. It is reported to have killed more than 40 million people in one year compared to total military deaths of 8.3 million over 4 yrsof the First World war Most pandemics have originated from Asia where humans live close to pigs and ducks.
The main challenge is provision of adequate hospital and medical facilities due to a surge in medical care needsThe capacity of the virus to cause severe disease in ‘non traditional age groups’ e.g. young adults determines overall impact. Milder pandemics cause excess mortality in the very young and old and in those with underlying chronic conditions (at risk groups for seasonal epidemics). Countries with good vaccination programs expect better outcome due to experience in logistics of vaccine delivery and conversely.
Avian Influenza Risk Information
The main sources of avian Flu risk arises from importation of wild birds, poultry and their products from affected countries, migratory birds flying from affected countries an international tourism as Nairobi is a hub for international travel. This may be exacerbated by risk behaviour inherent in local cultural practices such as consumption of inadequately cooked poultry and their products, consumption of birds when signs of illness appear and living in the same dwellings with poultry. These practices may expose our population to H5N1 virus infection.
Kenya lies along the migratory birds route from Europe to Southern Africa and is a stop over point for many species thereof. Birds start to arrive in mid September and peak in mid November. Migratory birds stop at water points and mix freely with local water birds. Water birds mix freely with domestic poultry. It is estimated that some 270 species of birds migrate into Kenya. Kenya’s poultry population is estimate at 30 million of which indigenous birds account for 70%, commercial birds 28% and others such as (geese, turkeys, ducks etc.) 2% of the total bird population. The figure below shows the migratory bird routes.
H5N1Outbreaks in 2004 have become a major global concern since January 2004 when Thailand and Vietnam reported their first case of human infection with avian Influenza previously reported in chicken . These cases are directly linked to outbreaks of highly pathogenic H5NI avian Flu reported in 2003. The fear is that the virus may improve transmissibility in humans and therefore represents a serious pandemic in waiting.
H5N1 is mainly feraed for its documented ability to pass from birds to humans. It also has the ability to cause severe disease conditions with high mortality (42/55 have reportedly died, and only 13 recovered). It ha the undoubted potential to ignitea pandemic. Available vidence indicates that H5N1 is now endemic in parts of Asia and the risk fis that the virus may expand its range of mammalian hosts. For example the Oct 2004 outbreak in captive tigers and domestic cats in Thailandin which some 147 tigers were affected. H5N1 is also being excreted by asymptomatic ducks in highly pathogenic form maintaining silent transmission. Studies in the outbreak for the first time show H5N1 strain can infect humans directly who serve as the mixing vessel for exchange of virus genes. The first probable case of human to human transmission was reported from in Thailand in December 2004.
Main issues facing Kenya’s Response system
The Kenyan response system is characterised by
Weak surveillance system
Inadequate support to laboratory
Inadequate human resources
inadequate research funding
Inadequacy of supplies of
- Anti-viral drugs
- Vaccines
- Protective material
PANDEMIC PREPAREDNESS
Main objectives of the WHO global agenda for FLU are:-
•To strengthen the WHO Global influenza Surveillance Network
•To assess the burden of influenza and benefits of prevention and control
•To generate Global and National influenza pandemic preparedness
•To develop policies for influenza vaccine and antiviral usage during influenza pandemics and epidemics
•To increase influenza vaccine usage and support acceleration of vaccine development
WHO urges all countries to develop/update their Influenza pandemic preparedness plans. It is recognised that global spread is impossible to stop but preparedness will undoubtedly reduce impact the final death toll. Planning should include estimates of the nunber of people to be affected and likely deaths. Estimates of deaths are expected to range from 2-50 million based on extrapolations from past pandemics.
National preparedness
National preparedness for the pandemic is being addressed from the vantage point of this strategic preparedness plan which aims to facilitate mobilisation of resources needed to mount an efficient and effective response. The plan has been developed by an ad hoc multi-sectoral task force which has been set up to respond to the impending threat of the Avian Influenza outbreak. The task force has followed WHO guidelines in developing the National emergency preparedness and response plan
The plan focuses on the following issues:
- Co-ordination, Resource Mobilisation and Human Resource Management
- Epidemiologial Surveillance
- Laboratory and Research
- Case Management
- Infection Prevention and Control
- Information, Education, Communication and Social Mobilisation
The purpose of this plan is to mobilise resources and crystallise action to facilitate effective surveillance, research, coordination, diagnosis, infection control, case management and information dissemination and hence handling of the problem.
Main Assistance needed from the International Community
Response activities are coordinated by the multi-sectoral task force through its 6 technical working groups. International community are partners in the National Avian Influenza Multi-Sectoral Task Force. The main forms of assistance expected from the international community include :
- Technical assistance and information
- Mobilisation of resources and funding
- International liaison & coordination
- Harmonisation of monitoring and evaluation indicators
- Strengthen at least one of the existing laboratories to the level of a regional Influenza reference facility
ACTION TAKEN OR COMPLETED BY STAKEHOLDERS
Various stakeholders from the privare, pubic, civil society and development partner sectors have taken, planned and/or contemplated some activities geared towards addressing the Avian Flu problem among them the following:-
i)Ministry of Health
- Multisectoral Taskforce in place, formed during the first avian influenza WHO alert in 2004.
- Integrated disease surveillance being implemented by the in all districts and will be strengthened for influenza surveillance.
- MOH in collaboration with KEMRI is currently undertaking the Flu surveillance through a Flu surveillance network of private medical practitioners. This surveillance is limited in Nairobi & will be expanded through additional sentinile sites.
- Diagnostic laboratory capacity to identify the virus is available in the country at KEMRI. Additional facilities will however be required.
- An alert issued to all health facilities with instructions to start preparing isolation units should need arise.
- Treatment: There is currently no vaccine available for H5N1 virus strin.
- The drug for treatment is Tamiflu but is not available in the country and supply not adequate. Discussed with WHO to assist in availing it to the country
- Infection Prevention and Control: Protective gear ordered in advance, but there is need to establish requirements for the current response & gaps. Some materials available for normal preparedness.
- The workload in health facilities is anticipated to be very high. The health facilities should be stocked with all necessities for response.
- All ports of entry have been alerted. Wild birds would still migrate into the country with or without immigration controls. Winter is approaching in Europe and birds are expected to fly into the country.
- Importation of poultry and poultry products will be contained through the ports.
- KEMRI - the personnel is available, but need upgrading of the lab to protect staff.
ii)Ministry of Livestock and Fisheries Development
- Addressed a press conference on 18th October 2005 stating government position.
- Mobilised all veterinary officials for a technical briefing on Avian Flu and actions required of them.
- Established a hotline for the public to ask questions on Avian Flu manned by technical staff at Kabete. The Numbers are 020-631639 and 0722-726682
- Prepared IEC materials for electronic and print media, for use in public education.
- Assessed the laboratories at the headquarters and regionally to see whether they meet surveillance requirements with requirements & costs.
- Assessed the available veterinary expertise and found adequate
- Assessed required funds and set priorities thus:.
- Materials for professionals, media & public sensitisation;
- protective clothing for professionals safety and
- laboratory reagents that may cost Ksh 1 million
- A Veterinary preparedness task force of 7 is meeting at Kabete and a vehicle has been made available to it.
- An AU-IBAR ymposium was held in Sept to inform stakeholders on the threat from Avian flu and adopt a strategy to enable the region to cope. Country delegates were asked for proposals on disease control and review of epidemiology. During the neeting it was reported that:
Africa is estimated to have 1.1billion chicken population and 2% may get affected and require to be culled.