Avian Influenza, Human - Netherlands (10): Fatal Case

AVIAN INFLUENZA, HUMAN - NETHERLANDS (10): FATAL CASE **************************************************** A ProMED-mail post <http://www.promedmail.org> ProMED-mail is a program of the International Society for Infectious Diseases <http://www.isid.org> Date: Sat, 19 Apr 2003 From: ProMED-mail <promed@promedmail.org> Source: Letter POG/ZP 2.375.366 from the secretary of health to the chair of the Dutch parliament, 19 Apr 2003 [translated from Dutch by Mod. AS, edited] <http://www.minvws.nl/document.html?folder=393&page=19598> Avian Influenza --------------- On Thu, 17 Apr 2003, a 57-year-old veterinarian died in the Jeroen Bosch Hospital due to serious pneumonia. Since fowl-plague (Highly Pathogenic Avian Influenza -- HPAI) virus was detected in the lungs while no other possible explanation for the described disease picture was found, there is a strong indication that the man's death is the outcome of infection with the HPAI virus. The veterinarian became sick 2 days after working on an infected farm. He did not use antiviral preparations. According to the Outbreak Management Team (OMT), which held a meeting Friday, 18 Apr 2003 evening, this is a very rare situation. Until now, HPAI has been causing only conjunctivitis; the death of the veterinarian is an exceptional course. He had no conjunctivitis. Investigations should find-out if the virus has undergone changes which might explain this serious development. These are being carried out in the National Influenza Centre (Erasmus Medical Centre) in Rotterdam. Following the advise of OMT, the close contacts of the veterinarian are [as a precaution being] treated with the antiviral preparation oseltamivir (Tamiflu). This is meant to prevent any further spread of the virus, including close family members, engaged physicians and medical personnel from the relevant hospital's departments and the pathologists. The OMT indicates that the antiviral prescription is effective in preventing human infections with the HPAI virus. They stress the necessity of all those involved in the culling activities and those living or working on HPAI infected or suspected premises, to apply the prescribed protective measures and take the antivirals. During the last 2 weeks, only few infection cases were recorded in culling personnel, mostly in persons who did not apply sufficient protective measures. Taking oseltamivir (Tamiflu) for extended periods has no drawbacks. The Municipal Health Services in the relevant regions will provide the antiviral preparations, as well as flu vaccines, to all those directly engaged with suspected poultry farms and people coming in direct contact with infected chickens. Netherlands maintains an intensive influenza monitoring system which is engaged -- cooperatively with the practitioners -- in the detection of flu infections, including avian flu viruses. On Tue, 15 Apr 2003, the Minister of Agriculture, Nature Management and Fisheries [LNV] informed you about the detection of antibodies against avian influenza in pigs in 5 mixed farms in the Gelders Valley. Following the advise of OMT and BAO (Board of administrators; see footnotes), and after consultation with NLV, it has been decided to remove pigs from the relevant farms. This has been already begun in 4 of those farms -- the 5th to follow. Further investigations on those farms have shown that no further spread of the virus has occurred; no influenza virus was detected in any pig. Investigations on mixed farms where culling [of poultry only?!.- Mod. AS] had already preventively been carried out, as well as in exclusive-pig farms, show that spread seems most unlikely. The matter is under further investigation. The monitoring is continued on mixed farms. The movement restrictions, applied by LNV in pig farms within the protection and buffer zones, are to be maintained. The State Secretary for Public Health, Welfare and Sports, Drs Clemence Ross-van Dorp -- ProMED-mail <promed@promedmail.org> [Obviously, the recent death of a veterinarian involved in the HPAI control activities, has triggered the final decision to cull pigs on infected mixed farms. The letter includes additional data on the fatal human case, as well as new epidemiological data on the situation on pig farms, where investigations are still continued. Communicable disease control in the Netherlands is undertaken by municipal health services (GGD). Coordination between the 54 municipal health services and the national service has since 1995, been controlled by Landelijke Coordinatiestructuur voor de Infectieziektenbestrijding (LCI), which draws up guidelines and coordinates outbreak management. LCI consists of a professional advisory team (Outbreak Management Team, OMT, consisting of five permanent members with clinical, microbiological, and public health backgrounds and sometimes other specialists), a board of administrators (Bestuurlijk Afstemmings Overleg, BAO), and a small professional helpdesk (bureau LCI). The OMT advises the Permanent Secretary of Health (Minister van Volksgezondheid, Welzijn en Sport) through the Bestuurlijk Afstemmings Overleg. Local professional clinical, microbiological, and public health staff report data and join in the discussions of the OMT. The BAO check advice for practical feasibility and decide on the policy to be implemented (under the responsibility of Minister van Volksgezondheid). - Mod.AS] [see also: Avian influenza, human - Netherlands 20030311.0594 Avian influenza, human - Netherlands (02) 20030313.0615 Avian influenza, human - Netherlands (03) 20030314.0628 Avian influenza, human - Netherlands (04) 20030315.0643 Avian influenza, human - Netherlands (05) 20030316.0656 Avian influenza, human - Netherlands (06) 20030318.0674 Avian Influenza, human - Netherlands (07) 20030319.0687 Avian Influenza, human - Netherlands (08) 20030327.0762 Avian Influenza, human - Netherlands (09): fatal case 20030419.0959 Avian influenza - Netherlands (21): pig involvement 20030418.0950] ----------------------arn/dk *##########################################################* ProMED-mail makes every effort to verify the reports that are posted, but the accuracy and completeness of the information, and of any statements or opinions based thereon, are not guaranteed. 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