Strengthening the Prevention and Control of Avian Influenza H5N1: Directive from the Ho Chi Minh City Department of Health.
How does the Department of Health of Ho Chi Minh City require strengthening the prevention and control of avian influenza H5N1?
On February 24, 2023, the Department of Health received Official Dispatch No. 586/PAS-KSBT from the Pasteur Institute of Ho Chi Minh City regarding the enhancement of surveillance for severe pneumonia caused by viruses. According to information shared by the World Health Organization (WHO) and the international health focal point in Vietnam, in Prey Veng Province, Cambodia (which borders Vietnam), two cases were initially recorded to have tested positive for the highly pathogenic avian influenza A(H5N1) virus, including one case of a pediatric fatality and several suspected cases.
Faced with the complex developments of the H5N1 avian influenza epidemic, on February 25, 2023, the Ho Chi Minh City Department of Health issued Official Dispatch 1277/SYT-NVY for 2023 to agencies and units to strengthen the prevention and control of influenza A(H5N1).
In Official Dispatch 1277/SYT-NVY, the Ho Chi Minh City Department of Health directed the City Center for Disease Control as follows:
- Implement strict surveillance measures for those entering/arriving/staying from regions with influenza A(H5N1) outbreaks and cooperate with Animal Quarantine Stations to monitor poultry and waterfowl entering Vietnam through border gates.
- Monitor and detect early cases, clusters of cases, and outbreaks of influenza and unexplained respiratory illnesses in the community and healthcare facilities to conduct epidemiological investigations, collect samples for testing, and send them to the Pasteur Institute of Ho Chi Minh City to determine the cause and quickly implement measures to prevent and control the epidemic, limiting wide-scale spread.
- Communicate to the public about measures to detect, prevent, and control avian influenza at border gates and in the community.
- Serve as the focal point and cooperate with the Livestock Production and Animal Health Sub-department to strengthen the organization and supervision of the implementation of avian influenza prevention and control tasks in districts, towns, and Thu Duc City according to the provisions of Joint Circular 16/2013/TTLT-BYT-BNN&PTNT dated May 27, 2013, of the Minister of Health and the Minister of Agriculture and Rural Development.
- Organize training for district, town, and Thu Duc City medical centers on the surveillance and control of influenza A(H5N1) in the community.
Simultaneously, in Official Dispatch 1277/SYT-NVY, the Ho Chi Minh City Department of Health directed district, town, and Thu Duc City medical centers as follows:
- Cooperate with the Health Department to advise district, town, and Thu Duc City People's Committees to direct local departments, agencies, and organizations to implement measures to prevent and control influenza A(H5N1) following the directives of the City People's Committee and the guidance of related provincial departments and authorities.
- Enhance surveillance to early detect cases of severe viral pneumonia at healthcare facilities and in the community; pay particular attention to cases with a history of travel to/arrival from endemic areas, and report immediately to the City Center for Disease Control to promptly implement measures to prevent and control the epidemic.
- Implement communication measures for the prevention and control of avian influenza in the managed area.
Furthermore, in Official Dispatch 1277/SYT-NVY, the Ho Chi Minh City Department of Health also directed healthcare facilities as follows:
- Strictly implement the "Guidelines for diagnosis, treatment, and prevention of influenza A(H5N1) in humans" according to Decision No. 30/2008/QD-BYT dated August 19, 2008, of the Ministry of Health.
- Enhance surveillance and early detection of cases with atypical pneumonia, especially those with a history of exposure to sick or dead poultry; consult with the Hospital for Tropical Diseases for prompt diagnosis, isolation, and treatment to minimize fatalities. Submit urgent reports to the City Center for Disease Control for epidemiological investigation and sample collection for surveillance.
- Assign the Hospital for Tropical Diseases to ensure personnel, equipment, medical supplies, and drugs to receive, isolate, and treat suspected or confirmed cases of influenza A(H5N1) according to regulations. Organize retraining on the diagnosis, treatment, and prevention of influenza A(H5N1) for healthcare facilities.
- Assign district, town, and Thu Duc City Health Departments to disseminate this document's content to private multi-specialty and specialty clinics in the area for awareness and implementation.
How has the Department of Health of Ho Chi Minh City requested to strengthen the prevention and control of the avian influenza H5N1 epidemic? (Image from the Internet)
What are the clinical symptoms of chickens infected with avian influenza H5N1?
Based on section 5.1.2 of sub-section 5.1 of Section 5 National Standard TCVN 8400-26:2014 which stipulates the clinical symptoms of avian influenza H5N1 as follows:
Procedure
5.1. Clinical Diagnosis
...
5.1.2. Clinical Symptoms
5.1.2.1. Peracute Form
- Poultry die quickly and suddenly.- No clinical signs of pathology are present.
5.1.2.2. Highly Pathogenic Form
- High fever of 40°C or higher- Ruffled feathers, lethargy, anorexia, reduced egg production- Swollen head and face, edema around the eyes, and swelling and hemorrhage in the comb and wattles.- Conjunctivitis and possible eye hemorrhage- Petechial hemorrhages between the toes and hocks- Respiratory symptoms, with excessive salivation from the beak- Nervous symptoms, twisted necks, drooping wings- Green and white diarrhea- Ducks and geese mainly exhibit nervous symptoms, twisted necks, lack of coordination, mild tremors, and fatigue.
5.1.2.3. Low Pathogenic Form
In chickens: Fatigue, mild respiratory symptoms, wheezing, and mild coughing. In rare cases, the low pathogenic form may exhibit symptoms of the highly pathogenic form such as cyanosis of the comb and wattles, reduced egg production, and a mortality rate exceeding 50%. In ducks and geese: No clinical signs are present.
...
According to the aforementioned standard, the clinical symptoms of H5N1 chicken influenza are categorized into three levels: peracute form, highly pathogenic form, and low pathogenic form.
In the peracute form, poultry die quickly and suddenly without displaying clinical signs of pathology.
In the highly pathogenic form, chickens typically have a high fever of 40°C or higher; their feathers are ruffled, they are lethargic, stop eating, and their egg production decreases; their head and face swell, there is edema around the eyes, and swelling and hemorrhaging in the comb and wattles; their eyes may have conjunctivitis and possible hemorrhage; there are petechial hemorrhages between the toes and hocks.
Additionally, chickens show respiratory symptoms with excessive salivation from the beak; nervous symptoms, twisted necks, drooping wings; and they often discharge green and white diarrhea.
In the low pathogenic form, chickens typically exhibit fatigue, mild respiratory symptoms, wheezing, and mild coughing. In rare cases, this form may also show symptoms of the highly pathogenic form such as cyanosis of the comb and wattles, reduced egg production, and a mortality rate that can exceed 50%.
How is Avian Influenza regulated?
According to Section 1, Appendix 09 issued together with Circular 07/2016/TT-BNNPTNT, avian influenza is described as follows:
+ Avian Influenza (AI) is an infectious disease that affects birds (both poultry and wild birds) and mammals (including humans); caused by influenza A viruses belonging to the Orthomyxoviridae family, containing RNA, and coated with a lipid envelope. The envelope has two types of antigens: H (Hemagglutinin) and N (Neuraminidase).
The H antigen has 16 subtypes numbered from H1 to H16, and the N antigen has 09 subtypes numbered from N1 to N9. Depending on the virus strain, the subtype designations H and N are assigned to that strain. In Vietnam, high pathogenic avian influenza virus strains H5N1 and H5N6 have been identified.
In poultry farming, chickens are usually heavily affected, while ducks often carry the virus without displaying clinical symptoms and are the main source of spreading the virus into the environment. Some strains of avian influenza viruses do not cause disease in poultry but can transmit to humans and cause fatalities (influenza A/H7N9 virus).
+ Virus Resistance: The virus typically remains viable longer in the air under low humidity and in manure under low temperature, high humidity conditions. The virus can live up to 35 days in poultry houses at low temperatures and up to 3 months in infected poultry manure.
The virus is easily destroyed at 70°C within 5 minutes. In refrigerators and freezers, the virus can survive for several months. Common disinfectants such as: 2% sodium hydroxide, 3% formaldehyde, 5% cresol, 3% chloramine B, 1% iodine, 20% halamid, 70° - 90° alcohol, lime powder or 10% lime water, concentrated soap water, can effectively kill the virus.
Some strains of avian influenza viruses do not cause disease in poultry but can transmit to humans and cause fatalities.
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