Transcript of excerpts from bi-weekly UNIS Press Briefing on Avian Flu outbreak in Nigeria
Press Conferences
Dr. Michael Perdue, epidemiologist Global Influenza Program at WHO, Dr. Bruce Aylward, the coordinator of the Polio Eradication Initiative at WHO, and Fadela Chaib, WHO Spokesperson
Dr. Michael Perdue: We have recently been told that the H5N1 virus has arrived in Nigeria, the focus outbreak is apparently in the State of Kaduna, which is in the north central part of the country. There is also anecdotal evidence of outbreak in birds occurring in the State adjacent to it in Kano. Thus far we have no evidence of any human infections but it represents a fear that this virus is perhaps being carried by a migratory waterfowl. We don't know the genetic sequence of this yet but hope to soon, which will tell us exactly whether it is the same virus we have seen in Turkey and in the region surrounding the Black Sea area where we have seen a lot of outbreaks in the last six months. We are concerned with the fact that this particular strain of H5N1 has now moved through central Asia; Kazakhstan, Russia, Mongolia, Romania, Ukraine, Turkey, Iraq, and now down into Africa.
We don't know presently the risk of the virus infecting humans in Africa, but obviously we are concerned with the fact that birds have died and that the virus is there. The immediate issues are responding to WHO's office in Africa, in Nigeria, in any way that they need. We have a team immediately arranged to leave on Sunday organised by the WHO Office in Harare and we will be identifying team members from Headquarters to join this assessment team to Nigeria.
Question: It wasn't quite clear. Did you say Saturday or Sunday for the team going to the region?
Dr. Michael Perdue: Just this morning we heard that it would either be Saturday or Sunday. It will be this weekend. There are some clearance issues underway, but it will be very soon.
Question: How many people and what kinds of experts are you going to have on the team, and what are you actually doing on the ground? I would imagine that information and education plays a central role in this area. So if you could elaborate on what the government is doing, what you are doing immediately in order to try and control this outbreak.
Dr. Bruce Aylward: We have already had a lot of questions about the implications of this for polio, both in terms of our infrastructure on the ground and our activities. As you know, this is overlapping geographically and temporally with the major operation we have there with our polio campaign kicking off on Saturday covering the whole of the country, including the areas infected with Avian flu. But this actually is not the first time we have dealt with these two epidemics concurrently. In Indonesia last year, we were dealing with avian flu and a polio outbreak concurrently and we ran a joint operation in close collaboration with the EPR [Epidemic and Pandemic Alert Response] group, Mike Ryan's group. So this is the second time. And if there is any silver lining in what's happened in Nigeria it's actually that we are detecting disease, avian flu in birds, in the place where we have one of the strongest surveillance and operations infrastructures in Africa.
As people have watched the movement of Avian flu, there's been great concern about what happens when this gets into areas with a very weak infrastructure – Sub-Saharan Africa, South Asia – but in fact we have a much stronger infrastructure surveillance-wise there [compared to] many of the countries that have already been infected by the disease. There are about 450 people on the ground through the polio infrastructure alone, a combination of nationals and internationals. The Government has an avian flu response plan, which Mike alluded to, and that plan actually sits largely on the polio infrastructure. The immediate thing the Government is doing is launching a massive communications plan to raise community awareness as to the risk posed by infected sick or dead fowl. So that is the immediate thing with concentration very much on the Kaduna, Kano and Plateau states, which are just contiguous to Kaduna. As they are launching that mass media campaign they are looking at how they can use, if possible, this house-to-house polio campaign, which is being launched on Saturday to reinforce in these areas the appropriate behavior. The critical thing at this point in the Avian flu epidemic is to prevent human exposure to the virus to prevent human cases, if they have not already occurred, which is the major goal. We have tried to use all of the major activities that are on the ground to actually do that.
At the same time, we are orienting the whole polio surveillance system to actually be able to look for and investigate potential cases of human disease. So we are in the process now, with EPR, of orienting that team. Remember, what it does right now is it visits every major health facility in Nigeria at the national, State and sub-State level on a weekly basis. There is a system already going to the major facilities looking for paralyzed kids, and what we are looking to do right now is orient that, very quickly, to be able to look for severe, unexplained deaths or disease due to pneumonia so they can then be investigated.
The second major element of the work we are doing with Mike's group is to try and facilitate, if necessary, the collection of national and international transport and diagnostic specimens. This is always a major challenge in places where we may have avian flu. And we have a system already established to move polio specimens through that country and internationally into which we would put this.
The third major element of the collaboration is on the logistics of the operation. As Mike mentioned, they're putting in a team, which will be seven or eight people, within a couple of days. And we have on the ground a transport satellite communications security network right down to the sub-State level of Kano and Kaduna. So we actually have an infrastructure, it's not like going in right after the tsunami where the first thing we had to do is establish a logistics platform, and we have this on the ground in Nigeria.
The last major area we are working with Mike's group is on the risk communication within the health system making sure that primary providers understand the risks and are able to operate appropriately as we move into the investigation and response aspect of the Avian flu outbreak.
That is in a nutshell what we are doing. But it's a major collaborative effort on both parts sides to respond to both of these issues.
Question: Are you only having this immunization campaign in Nigeria, or is it elsewhere in Africa? And since Nigeria has avian flu it's now quite likely that other African countries have Avian flu. What you have outlined in terms of your polio surveillance system and the collaboration, will that also work in these other countries? Is this now unstoppable?
Dr. Bruce Aylward: It's definitely not unstoppable. In terms of our collaboration, we have a system that works on human disease, so we are really focusing on that element of it. The first signal should be disease in animals, and when that occurs we immediately orient our system to be able to look for disease in humans. There's been some discussion as to whether we should be looking for dead chickens, but that is not our area of expertise. We will keep focusing on our area of expertise and leave the agricultural people to be informing us on that side. The first trigger would be when we actually have animal disease. But we are, of course, through AFRO [WHO Regional Office for Africa] and others, alerting all the surrounding countries so that they're aware of this. We are also priming the system in Nigeria to be able to assist on avian flu. We will prime it in all the surrounding countries, obviously Niger, Benin, and Cameroon. The disease right now is smack in the middle of Nigeria; it is not in the bordering areas that we've detected, although that is still under investigation.
In terms of immunization activities, Nigeria is the only one taking off right now, but then a number of other countries follow in the first week of March, including Chad, Cameroon, Benin and Niger.
Dr. Michael Perdue: We are also working closely with FAO and OIE [World Organization for Animal Health], who also have people on the way. We coordinate with them from the beginning. We will try to make sense of the animal situation and the risk to humans in the surrounding area. We always depend on those organizations to give us the animal information.
The question as to whether it is unstoppable, I have worked with viruses for many years and I wouldn't make any predications about what they will or won't do. I will tell you a story in the United States where for many years we had migratory birds bringing flu viruses to the State of Minnesota and they would infect the free-range turkeys in the State. Each year we would get a different sub-type of virus showing up, and some years there would hardly be any virus there. The point is, not knowing exactly which birds, if these birds are carrying it around the world, which ones are carrying it and what their ecology is. It is very difficult to say that the virus might go away tomorrow, for example. It is very difficult to predict without knowing anything about the ecology of these migrating birds where the virus is going to show up next. It is problematic that we are seeing such an extension from China of apparently the same virus. On the other hand, it appears to be a single sub-strain that's being spread. In other words, we are not spreading all the viruses of South East Asia all over Asia and Europe. We're looking at what I think is probably limited species that are infected with what appears to be a single sub-strain of the Asian viruses, which is better news than thinking that all the birds are spreading the virus all over the world, that's not happening. In that sense, it's not as grim as perhaps it looks.
Question: I was wondering if you could give us some more details about the team going. Do you have a full green light from the authorities to go in, and are these experts just from WHO or is it also a GOARN [Global Outbreak Alert and Response Network] response?
Dr. Michael Perdue: We haven't activated the GOARN response yet. That may be depending upon what we hear about the human situation. Right now there is enough personnel in the African region to do the immediate response. We talked to our regional adviser this morning and he said the team would be leaving Sunday. Therefore, we assume we have country clearance. There are about seven people on board, logistics and laboratory people, from the region who will be heading out this weekend.
Question: [Translated from French] The measures taken to help for Iraq recently announced by the deputy director of WHO, we have not heard anything on that. What is the situation in this regard, most of all concerning the dispatch of the doses of Tamiflu?
Fadela Chaib: [Translated from French] In fact I received some information this morning from our Amman desk. They indicated that the samples that were sent from Sulamaniyah to Baghdad will very soon be sent to the Cairo and London laboratories and also 70,000 doses of Tamiflu will arrive in Baghdad today to be distributed in the north of the country.
The mortality rate stands at one confirmed death as a result of the H5N1, and seven other suspected cases of people who have been in contact with infected or dead birds in the north of the country.
Question: Can you be more specific about the GOARN and about the team that is going, does it include animal as well as public human health experts?
Dr. Michael Perdue: GOARN stands for Global Outbreak Alert and Response Network, which was established within the epidemic and pandemic response group many years ago. It is a network of experts outside of WHO that we bring in to help us. We have lists of experts in various areas. When we mount a GOARN response we send out a request for help. We did this for the Turkey outbreak, for which we got a very nice response because we had seen so many human cases in a relatively short period of time that we decided to mount that response. It worked out well because since we sent a lot of teams to other surrounding countries based on the response we got from the GOARN.
Our regional director this morning told us that there would be at least four epidemiologists, two laboratory experts and one data manager that will be identified and will leave Sunday.
Avian Flu outbreak in Nigeria
Dr. Michael Perdue, epidemiologist Global Influenza Program at WHO, Dr. Bruce Aylward, the coordinator of the Polio Eradication Initiative at WHO, and Fadela Chaib, WHO Spokesperson
Dr. Michael Perdue: We have recently been told that the H5N1 virus has arrived in Nigeria, the focus outbreak is apparently in the State of Kaduna, which is in the north central part of the country. There is also anecdotal evidence of outbreak in birds occurring in the State adjacent to it in Kano. Thus far we have no evidence of any human infections but it represents a fear that this virus is perhaps being carried by a migratory waterfowl. We don't know the genetic sequence of this yet but hope to soon, which will tell us exactly whether it is the same virus we have seen in Turkey and in the region surrounding the Black Sea area where we have seen a lot of outbreaks in the last six months. We are concerned with the fact that this particular strain of H5N1 has now moved through central Asia; Kazakhstan, Russia, Mongolia, Romania, Ukraine, Turkey, Iraq, and now down into Africa.
We don't know presently the risk of the virus infecting humans in Africa, but obviously we are concerned with the fact that birds have died and that the virus is there. The immediate issues are responding to WHO's office in Africa, in Nigeria, in any way that they need. We have a team immediately arranged to leave on Sunday organised by the WHO Office in Harare and we will be identifying team members from Headquarters to join this assessment team to Nigeria.
Question: It wasn't quite clear. Did you say Saturday or Sunday for the team going to the region?
Dr. Michael Perdue: Just this morning we heard that it would either be Saturday or Sunday. It will be this weekend. There are some clearance issues underway, but it will be very soon.
Question: How many people and what kinds of experts are you going to have on the team, and what are you actually doing on the ground? I would imagine that information and education plays a central role in this area. So if you could elaborate on what the government is doing, what you are doing immediately in order to try and control this outbreak.
Dr. Bruce Aylward: We have already had a lot of questions about the implications of this for polio, both in terms of our infrastructure on the ground and our activities. As you know, this is overlapping geographically and temporally with the major operation we have there with our polio campaign kicking off on Saturday covering the whole of the country, including the areas infected with Avian flu. But this actually is not the first time we have dealt with these two epidemics concurrently. In Indonesia last year, we were dealing with avian flu and a polio outbreak concurrently and we ran a joint operation in close collaboration with the EPR [Epidemic and Pandemic Alert Response] group, Mike Ryan's group. So this is the second time. And if there is any silver lining in what's happened in Nigeria it's actually that we are detecting disease, avian flu in birds, in the place where we have one of the strongest surveillance and operations infrastructures in Africa.
As people have watched the movement of Avian flu, there's been great concern about what happens when this gets into areas with a very weak infrastructure – Sub-Saharan Africa, South Asia – but in fact we have a much stronger infrastructure surveillance-wise there [compared to] many of the countries that have already been infected by the disease. There are about 450 people on the ground through the polio infrastructure alone, a combination of nationals and internationals. The Government has an avian flu response plan, which Mike alluded to, and that plan actually sits largely on the polio infrastructure. The immediate thing the Government is doing is launching a massive communications plan to raise community awareness as to the risk posed by infected sick or dead fowl. So that is the immediate thing with concentration very much on the Kaduna, Kano and Plateau states, which are just contiguous to Kaduna. As they are launching that mass media campaign they are looking at how they can use, if possible, this house-to-house polio campaign, which is being launched on Saturday to reinforce in these areas the appropriate behavior. The critical thing at this point in the Avian flu epidemic is to prevent human exposure to the virus to prevent human cases, if they have not already occurred, which is the major goal. We have tried to use all of the major activities that are on the ground to actually do that.
At the same time, we are orienting the whole polio surveillance system to actually be able to look for and investigate potential cases of human disease. So we are in the process now, with EPR, of orienting that team. Remember, what it does right now is it visits every major health facility in Nigeria at the national, State and sub-State level on a weekly basis. There is a system already going to the major facilities looking for paralyzed kids, and what we are looking to do right now is orient that, very quickly, to be able to look for severe, unexplained deaths or disease due to pneumonia so they can then be investigated.
The second major element of the work we are doing with Mike's group is to try and facilitate, if necessary, the collection of national and international transport and diagnostic specimens. This is always a major challenge in places where we may have avian flu. And we have a system already established to move polio specimens through that country and internationally into which we would put this.
The third major element of the collaboration is on the logistics of the operation. As Mike mentioned, they're putting in a team, which will be seven or eight people, within a couple of days. And we have on the ground a transport satellite communications security network right down to the sub-State level of Kano and Kaduna. So we actually have an infrastructure, it's not like going in right after the tsunami where the first thing we had to do is establish a logistics platform, and we have this on the ground in Nigeria.
The last major area we are working with Mike's group is on the risk communication within the health system making sure that primary providers understand the risks and are able to operate appropriately as we move into the investigation and response aspect of the Avian flu outbreak.
That is in a nutshell what we are doing. But it's a major collaborative effort on both parts sides to respond to both of these issues.
Question: Are you only having this immunization campaign in Nigeria, or is it elsewhere in Africa? And since Nigeria has avian flu it's now quite likely that other African countries have Avian flu. What you have outlined in terms of your polio surveillance system and the collaboration, will that also work in these other countries? Is this now unstoppable?
Dr. Bruce Aylward: It's definitely not unstoppable. In terms of our collaboration, we have a system that works on human disease, so we are really focusing on that element of it. The first signal should be disease in animals, and when that occurs we immediately orient our system to be able to look for disease in humans. There's been some discussion as to whether we should be looking for dead chickens, but that is not our area of expertise. We will keep focusing on our area of expertise and leave the agricultural people to be informing us on that side. The first trigger would be when we actually have animal disease. But we are, of course, through AFRO [WHO Regional Office for Africa] and others, alerting all the surrounding countries so that they're aware of this. We are also priming the system in Nigeria to be able to assist on avian flu. We will prime it in all the surrounding countries, obviously Niger, Benin, and Cameroon. The disease right now is smack in the middle of Nigeria; it is not in the bordering areas that we've detected, although that is still under investigation.
In terms of immunization activities, Nigeria is the only one taking off right now, but then a number of other countries follow in the first week of March, including Chad, Cameroon, Benin and Niger.
Dr. Michael Perdue: We are also working closely with FAO and OIE [World Organization for Animal Health], who also have people on the way. We coordinate with them from the beginning. We will try to make sense of the animal situation and the risk to humans in the surrounding area. We always depend on those organizations to give us the animal information.
The question as to whether it is unstoppable, I have worked with viruses for many years and I wouldn't make any predications about what they will or won't do. I will tell you a story in the United States where for many years we had migratory birds bringing flu viruses to the State of Minnesota and they would infect the free-range turkeys in the State. Each year we would get a different sub-type of virus showing up, and some years there would hardly be any virus there. The point is, not knowing exactly which birds, if these birds are carrying it around the world, which ones are carrying it and what their ecology is. It is very difficult to say that the virus might go away tomorrow, for example. It is very difficult to predict without knowing anything about the ecology of these migrating birds where the virus is going to show up next. It is problematic that we are seeing such an extension from China of apparently the same virus. On the other hand, it appears to be a single sub-strain that's being spread. In other words, we are not spreading all the viruses of South East Asia all over Asia and Europe. We're looking at what I think is probably limited species that are infected with what appears to be a single sub-strain of the Asian viruses, which is better news than thinking that all the birds are spreading the virus all over the world, that's not happening. In that sense, it's not as grim as perhaps it looks.
Question: I was wondering if you could give us some more details about the team going. Do you have a full green light from the authorities to go in, and are these experts just from WHO or is it also a GOARN [Global Outbreak Alert and Response Network] response?
Dr. Michael Perdue: We haven't activated the GOARN response yet. That may be depending upon what we hear about the human situation. Right now there is enough personnel in the African region to do the immediate response. We talked to our regional adviser this morning and he said the team would be leaving Sunday. Therefore, we assume we have country clearance. There are about seven people on board, logistics and laboratory people, from the region who will be heading out this weekend.
Question: [Translated from French] The measures taken to help for Iraq recently announced by the deputy director of WHO, we have not heard anything on that. What is the situation in this regard, most of all concerning the dispatch of the doses of Tamiflu?
Fadela Chaib: [Translated from French] In fact I received some information this morning from our Amman desk. They indicated that the samples that were sent from Sulamaniyah to Baghdad will very soon be sent to the Cairo and London laboratories and also 70,000 doses of Tamiflu will arrive in Baghdad today to be distributed in the north of the country.
The mortality rate stands at one confirmed death as a result of the H5N1, and seven other suspected cases of people who have been in contact with infected or dead birds in the north of the country.
Question: Can you be more specific about the GOARN and about the team that is going, does it include animal as well as public human health experts?
Dr. Michael Perdue: GOARN stands for Global Outbreak Alert and Response Network, which was established within the epidemic and pandemic response group many years ago. It is a network of experts outside of WHO that we bring in to help us. We have lists of experts in various areas. When we mount a GOARN response we send out a request for help. We did this for the Turkey outbreak, for which we got a very nice response because we had seen so many human cases in a relatively short period of time that we decided to mount that response. It worked out well because since we sent a lot of teams to other surrounding countries based on the response we got from the GOARN.
Our regional director this morning told us that there would be at least four epidemiologists, two laboratory experts and one data manager that will be identified and will leave Sunday.