This note aims at summarising the situation of Avian Influenza (AI) in Asia and the actions taken recently.
I. Recent events following confirmation of AI in asia
Situation in Asia
In addition to the outbreaks that have continued to occur in south-eastern Asia since early 2004 (China, Thailand, Vietnam and Indonesia, the situation in Cambodia, Laos and Malaysia is unclear), a wide geographic spread of disease has occurred in the last five months in central Asia, involving both domestic poultry and wild birds and resulted in the loss of more than 140 million poultry.
At the end of April 2005, the disease had spread to central China. At least 6000 wild birds (mainly waterfowl) have since then died due to AI in the Qinghai Lake, an area with a high concentration of migratory birds. In June 2005, outbreaks were also reported in western China, at the border with Kazakhstan.
On 24 July 2005, outbreaks of AI were notified by Russia (Siberia). The final confirmation that the outbreaks were caused by the H5N1 highly pathogenic virus was made available on 5 August 2005. In the last four weeks, the disease has been reported in six different provinces in Russia, including one close to the Ural Mountains, at around 2,200 Klm from the closest EU borders (Baltic States). The occurrence of the disease close to the Caspian Sea in the European part of Russia, has been refuted by the Russian authorities.
In early August, outbreaks of the disease were notified by Mongolia (in wild waterfowl, only) and Kazakhstan. To date, outbreaks in Russia and Kazakhstan have involved some large farms as well as small backyard flocks, with around 120,000 birds dead or destroyed in Russia and more than 9,000 affected in Kazakhstan.On 10 August 2005, an outbreak of the disease was also confirmed in Tibet (China).
However it should be pointed out that no human case has been reported so far in the new areas of Central Asia, the disease having affected there only poultry and wild birds. On the contrary and since its beginning, this unprecedented epidemic has caused so far 57 human deaths in south-eastern Asia.
Dutch measures taken on 16 August 2005
As a result of the suspicion of Avian Iinfluenza near the Caspian see (which has been officially denied by the Russian authorithies), the Netherlands have taken “unilateral preventive measures” based on their own experts who advised of a low risk that the migratory birds may bring the virus with them during the autumn migration to the Netherlands.
According to the Dutch decision, as of Monday 22 August 2005 all commercial poultry must be kept indoors in order to limit the contact between domestic poultry and migrating waterfowl. The Dutch measures were notified on 26 August 2005 and are currently being examined by the Commission’s services.
Suspicion of AI in a seagull in Finland
On Friday 26 August 2005, the Finnish authorities issued a press release informing of a suspicion of AI in a seagull found dead in Oulu in the North of Finland. We have now the confirmation that the virus present in that bird is not the one circulating in Asia and the experts can exclude any links with the Asian AI epidemic. The virus identified belongs to a strain commonly found in birds in Europe.
II. Actions in the animal health area
Imports from Asia
As a precautionary measure, the Commission adopted as early as January 2004 several decisions to ensure that no poultry meat, untreated meat products and birds other than poultry (such as ornamental and pet birds) are imported from countries where Avian Influenza has occurred. Following recent events, on 18 August 2005, such decisions were amended to include Russia and Kazakhstan in the list of concerned countries.
Prevention and control measures in the EU
A wide range of measures is already in place at Community level to prevent and control AI.
In April 2005, the Commission adopted a proposal for a new Directive on the control of AI, basically updating and imrpoving existing measures as laid down in existing legislation (Directive 92/40/EEC). This proposal has a comprehensive approach and thus takes fully into account the potential risk for a flu pandemic originating from AI.
The Member States have already introduced on a volontary basis the most important changes foreseen by the proposal such as surveillance programmes in domestic and wild birds. It it worth mentioning that the EU is the only region in the world where such surveillance programmes have been regularly implemented in the last years. Up to 1,2 Million Euro will soon be made available for this purpose when the Commission adopts a Decision (expected by mid-September), that will approve the co-financing of individual Member States’ surveillance programmes for the 2005-2006.
On 25 August 2005, the Commission also convened an emergency expert meeting to review the situation in Asia and the measures adopted by the Netherlands. The Member States’ experts concluded that a generalised ban from keeping poultry outside was not justified by the recent events due to the very low risk of spread of the disease by migrating birds.
III. Public health possible implications
Because of the current characteritics of the virus H5N1 responsible for the Asian epidemic, no transmission from “human-to-human” has yet taken place. All the reported human cases have resulted from a transmission from infected animals to human beings. Morever, these transmission cases have all occurred after direct and close contacts between infected animals and the affected people. However the WHO has warned that a wide spread of the animal disease may promote the emergence of a mutated Influenza virus fully adapted to humans, which could rapidly spread worldwide due to a new “human-to-human” transmission possibility and cause through a pandemic millions of deaths in the world. Taking into account this eventuality, I have already taken a series of actions which will be reinforced further in the coming weeks.
Actions undertaken and planned by the EU for the near future in the public health area
At the last June EPSCO Council I reiterated the need of increased efforts to improve pandemic influenza preparedness. As a follow-up I personally wrote a letter to all EU Health Ministers reminding them to increase the annual influenza vaccination coverage in the next influenza season and to inform us about advance purchase agreements for vaccines to be used in case of a pandemic flu or other similar measures that are implemeted at national level. In particular, I requested ministers to actively promote a better co-ordination of national preparedness plans at European level in close cooperation with the Commission. It should be pointed out that these plans have been originally put in place following a specific request of the Commission.
To this end, the Commission is currently reviewing the working paper on “EU pandemic influenza preparedness and response planning” adopted in March 2004. The paper will serve as a guide to Member States in preparing and updating their national preparedness plans in order to ensure coordinated and efficient approachs throughout the EU.
The Commission is also preparing, together with the European Centre for Disease Control (ECDC), a Technical Guidance Document on procedures for communication to Member States, the ECDC and the Commission about influenza H5N1 events in humans. The document is intended, in particular, to establish criteria for the reporting of cases among Member States. The ECDC is also working on the development of guidelines for risk assessment to better qualify the risk.
Over the summer, and following the recent outbreaks of avian flu in Russia and Kazakhstan we have asked the Member States to inform the Commission regularly through the EU Early Warning and Response System (EWRS) about all public health measures undertaken and planned at national level.
More generally and as a follow up to the joint workshop convened by the Commission with Member States and the World Health Organisation in March of this year, the Commission is collaborating with the ECDC and WHO on the assessment of the preparedness status of selected Member States (United Kingdom, Poland, Greece) and third countries (Turkey) through country visits, in addition to an overall survey on the progress made. The survey is expected to be completed this autumn.
Regarding treatments with antivirals and possible vaccines, and following my request to Health Ministers to inform the Commission on their policies vis-à-vis medicinal products including stockpiling, we are now receiving relevant information which is regularly summarised and circulated to all of them as well as to the European Centre for Disease Control.
My services also continue, in collaboration with the European Medicines Evaluation Agency (EMEA) the dialogue with the manufacturers of influenza vaccines with a view to improving their availability in the event of a pandemic.
It is important also to bear in mind in this context that last April, the College adopted a proposal for a European Parliament and Council Regulation to establish a Solidarity Fund that will allow the reimbursement of part of the costs incurred by the use of vaccines and antivirals in case of a pandemic flu. Moreover, under the ongoing Research Framework Programme, the Commission is co-financing a number of research projects aimed at improving the availability of vaccines in the event of a pandemic.
In a couple of months, the Commission services will also be organising a command-post exercise to test communications, exchanges of information and interaction between the competent authorities at EU level and the coordination and inter-operability of national plans.
Financial support is also provided in the context of international collaboration with Asian countries currently affected by avian influenza to improve their surveillance and disease control capacities. I am in close contact with Benita Ferrero-Waldner and her services in order to explore the possibility of a donors’ conference in order to address the problem at its source. A number of conferences recently held in the affected regions including Viet Nam have contributed to raising global awareness and have in particular called for a global master coordinated plan at the international, regional, sub regional and national levels to be prepared, with a proper road map and timetable, to be endorsed by the international and regional organizations as well as by the national governments.