1 Cross-Species Transmission of Avian Influenza (H5N1) to HumansThomas Thacker, B.S., PA-S Frank Romanelli, Pharm. D., MPH, BCPS

2 Why did the chicken cross the road?

3 HOW did the chicken cross the road?

4 Why should we care? 1918 “Spanish” Flu Pandemic1957 “Asian” Flu Pandemic 1958 “Hong Kong” Flu Pandemic 1997 Avian Influenza (H5N1) in Humans “Bird” Flu Pandemic ? > 50% Mortality

5 Why should we care? Avian influenza (H5N1) has caused more severe human infections than any other AIV Avian Influenza (H5N1) Mutation? Person-to-Person Transmission? NO Human Immunity/NO Vaccine High Rates of Dz & Mortality? Resistance to Antivirals

6 Epidemiology Transmission: direct, close, or indirect contact with infected birds or their biological products

7 Numerous Instances of Avian Influenza (H5N1) Infections in Humans

8 Human Cases of Avian Influenza (H5N1)

9 Pathophysiology

10 Modalities of Cross-Species Transmission of Avian Influenza (H5N1):

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12 Antigenic Shift

13 Antigenic Shift

14 Dx Findings Associated with Dz Caused by Avian Influenza (H5N1)Leukopenia Lymphopenia Thrombocytopenia Elevated aminotransferases DIC Pancytopenia Hyperglycemia Elevated creatinine Infiltrates & consolidation on CXR

15 Sxs of Dz Caused by Avian Influenza (H5N1): FLU-LIKE

16 Management & Tx of Dz Caused by Avian Influenza (H5N1)Mechanical ventilation Intensive care Corticosteroids Empirical broad-spectrum antibiotics

17 Management & Tx of Dz Caused by Avian Influenza (H5N1)Tamiflu™ (oseltamivir) Relenza™ (zanamivir)

18 Prevention of Dz Caused by Avian Influenza (H5N1): GOOD HYGIENE

19 Recipe for an Avian Influenza (H5N1) Pandemic in HumansInfect humans and cause Dz Evoke an ineffective immune response Spread from human to human? I had a little bird, Its name was Enza, I opened the window, And in-flu-enza. -Children’s Rhyme, 1918 “Spanish” Flu Pandemic

20 References

21 References

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