Kuş gribi ve halk sağlığı

Kayda değer medikal gelişmeler bir yana, son zamanlardaki olaylar bulaşıcı hastalıkların önemlerinden bir şey kaybetmediğini göstermektedir. Gerçekten, tüm dünyayı saracak epidemi tehdidi artmaktadır. Yüksek bulaşıcılıkları ve insandan insana hızlı geçişleri nedeniyle pandemi potansiyeli olan yeni influenza virüslerinin ortaya çıkması bu anlamda özellikle dikkat çekici ve uyarıcıdır. Son on yılda, avian influenza virüsünün yüksek patojeniteli suşları H5N1 alt tipi de aralarında olmak üzere, kuşlardan insanlara türler arası geçiş göstererek ölümcül bir hastalığa neden olmuştur. Şu anda, bir pandeminin oluşmasında gerekli üç genel şarttan ikisi gerçekleşmiştir ki bunlar, yeni bir virüs tipinin ortaya çıkması ve bunun insanlarda ciddi hastalığa neden olabilmesidir. Virüs insandan insana geçiş özelliğini kazandığında bunu izleyen influenza pandemisi oluşabilecektir. Bu derlemede önceki epidemilerin tarihsel ve karakteristik özellikleri ışığında influenzanın biyolojik ve epidemiyolojik yönlerine ve bunun yanında influenza patogenezi, tedavisi ve kontrol olanaklarına ilişkin günümüz anlayışı adına atılması gerekli somut adımlara yer verilmiştir.

Anahtar Kelimeler:

Halk sağlığı, Virulens, İnfluenza A virüsü, H5N1 alttipi

Bird flu and public health

Despite significant medical progress, recent events have shown that infectious diseases have not lost importance. Indeed, the threat of worldwide epidemics has increased. Due to their high infectious ness and rapid person-to-person transmissibility, the emergence of new influenza viruses with pandemic potential poses an especially alarming situation in this regard. During the last decade highly pathogenic strains of avian influenza virus, including the H5N1 subtype, crossed the species barriers from birds to humans and caused fatal disease. At present, two out of three general conditions for the onset of a pandemic have been met; namely, the emergence of a new virus and its ability to replicate in humans causing serious illness. Should the virus achieve efficient human-to-human transmission, the next influenza pandemic might occur. However, the subsequent risk for generating a pandemic human strain is unknown. This review addresses these biological and epidemiological aspects of influenza in the context of history and characteristics of previous epidemics, as well as concrete actions that can be undertaken considering current understanding of influenza pathogenesis, treatment, and control possibilities.

Keywords:

Public Health, Virulence, Influenza A Virus, H5N1 Subtype,

PDF

___

1. D.R Kurt, JK. Meece, JS. Henkel, S K. Shukla. Birds, Migration and Emerging Zoonoses: West Nile Virus, Lyme Disease, Influenza A and Enteropathogens Clin Med Res. 2003; 1 (1): 5–12.
2. Mermel LA. Pandemic avian influenza. Lancet Infect Dis. 2005; 5 (11):666-7.
3. Murphy FA. Emerging zoonoses. Emerg Infect Dis. 1998; 4:429–35.
4. Normile D. Avian influenza. Are wild birds to blame? Science. 2005; 21; 310 (5747): 426-8.
5. Macfarlane JT, Lim WS. Bird flu and pandemic flu. BMJ. 2005; 29; 331 (7523):975-6. Epub 2005 ;24.
6. Nichol ST, Arikawa J, Kawaoka Y. Emerging viral diseases. Proc Natl Acad Sci USA. 2000; 97:12411–2.
7. Daszak P, Cunningham AA, Hyatt AD. Emerging infectious diseases of wildlife—threats to biodiversity and human health. Science. 2000; 287:443–9.
8. Fereidouni SR, Aghakhan M, Werner O, Starick E, Bozorghmehrifard MH. Isolation and identification of avian influenza viruses from migratory birds in Iran. Vet Rec. 2005; 22;157 (17):526.
9. Normile D. Avian influenza. Europe scrambles to control deadly H5N1 Strain. Science. 2005; 21; 310 (5747): 417.
10. de la Barrera CA, Reyes-Teran G.Influenza: forecast for a pandemic. Arch Med Res. 2005; 36 (6):628-36.
11. Perdue ML, Swayne DE. Public health risk from avian influenza viruses. Avian Dis. 2005; 49 (3):317-27.
12. Horimoto T, Kawaoka Y.Influenza: lessons from past pandemics, warnings from current incidents. Nat Rev Microbiol. 2005; 3 (8):591-600.
13. Anonymous H5N1 avian influenza virus reaches Europe. Vet Rec. 2005; 22; 157 (17):494.
14. Sheldon T. Bird flu poses no immediate threat to Europe, leading virologist claims.BMJ. 2005; 29;331 (7523):981.
15. Watson R. European centre plays down threat from avian influenza. BMJ. 2005 (22); 331 (7522): 922.
16. Liu J, Xiao H, Lei F, Zhu Q, Qin K, Zhang XW, Zhang XL, Zhao D, Wang G, Feng Y, Ma J, Liu W, Wang J, Gao GF. Highly pathogenic H5N1 influenza virus infection in migratory birds. Science. 2005 (19); 309 (5738):1206.
17. Hanson BA, Swayne DE, Senne DA, Lobpries DS, Hurst J, Stallknecht DE.J Avian influenza viruses and paramyxoviruses in wintering and resident ducks in Texas. Wildl Dis. 2005; 41 (3):624-8.
18. List of NIAID emerging and re-emerging diseases. National Institute of Allergy and Infectious Diseases; 2002. http://www.niaid.nih.gov/dmid/eid/erd.htm.
19. Gross M. Bird flu fears heading west. Curr Biol. 2005; 20;15 (18): R740-1.
20. World Health Organization. Avian influenza, Indonesia--update. Wkly Epidemiol Rec. 2005; 7;80 (40):341-2.
21. Maines TR, Lu XH, Erb SM, Edwards L, Guarner J, Greer PW, Nguyen DC, Szretter KJ, Chen LM, Thawatsupha P, Chittaganpitch M, Waicharoen S, Nguyen DT, Nguyen T, Nguyen HH, Kim JH, Hoang LT, Kang C, Phuong LS, Lim W, Zaki S, Donis RO, Cox NJ, Katz JM, Tumpey TM. Avian influenza (H5N1) viruses isolated from humans in Asia in 2004 exhibit increased virulence in mammals. J Virol. 2005; 79 (18):11788-800.
22. Rahamat-Langendoen JC, van Vliet JA, Suijkerbuijk AW. Recognition of the threats caused by infectious diseases in The Netherlands in 2002 and 2003 by the weekly meetings of the early warning committee. Ned Tijdschr Geneeskd. 2005 (1); 149 (40):2238-42.
23. Hollenbeck JE. An Avian Connection as a Catalyst to the 1918-1919 Influenza Pandemic. Int J Med Sci. 2005; 2 (2):87-90.
24. Day M. Experts disagree over WHO should get avian influenza vaccine. BMJ. 2005 (29); 331 (7523):986.
25. Longini IM Jr, Nizam A, Xu S, Ungchusak K, Hanshaoworakul W, Cummings DA, Halloran ME. Containing pandemic influenza at the source. Science. 2005 (12); 309 (5737):1083-7.
26. Guo YJ, Wen LY, Zhang Y, Wan M, Guo JF, Li Z, Shu YL. Do pigs play a role in human infection with avian influenza A H9N2 viruses Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi. 2005; 19 (2):106-9.
27. Matthews L, Woolhouse M. New approaches to quantifying the spread of infection. Nat Rev Microbiol. 2005; 3 (7):529-36.
28. Williams JV. The clinical presentation and outcomes of children infected with newly identified respiratory tract viruses. Infect Dis Clin North Am. 2005; 19 (3):569-84.
29. Kwon YK, Joh SJ, Kim MC, Lee YJ, Choi JG, Lee EK, Wee SH, Sung HW, Kwon JH, Kang MI, Kim JH. Highly Pathogenic Avian Influenza in Magpies (Pica pica sericea) in South Korea. J Wildl Dis. 2005 ; 41 (3):618-23.
30. Mannelli A, Ferre N, Marangon S. Analysis of the 1999-2000 highly pathogenic avian influenza (H7N1) epidemic in the main poultry-production area in northern Italy. Prev Vet Med. 2005: 19.
31. Bremer V. Field Epidemiology Training Programmes in Germany and Europe. FETP and EPIET. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2005; 48 (9):1049-54.
32. Lipatov AC, Smirnov IuA, Kaverin NV, Webster RG. Evolution of avian influenza viruses H5N1 (1997-2004) in southern and south-eastern Asia.Vopr Virusol. 2005; 50 (4):11-7.
33. Li C, Yu K, Tian G, Yu D, Liu L, Jing B, Ping J, Chen H. Evolution of H9N2 influenza viruses from domestic poultry in Mainland China.Virology. 2005 (15); 340 (1):70-83.
34. Gani R.Potential Impact of Antiviral Drug Use during Influenza Pandemic. Emerg Infect Dis. 2005; 11 (9):1355-62.
35. Lee CW, Suarez DL.Avian influenza virus: prospects for prevention and control by vaccination. Anim Health Res Rev. 2005; 6 (1):1-15.
36. Le QM, Kiso M, Someya K, Sakai YT, Nguyen TH, Nguyen KH, Pham ND, Ngyen HH, Yamada S, Muramoto Y, Horimoto T, Takada A, Goto H, Suzuki T, Suzuki Y, Kawaoka Y. Avian flu: isolation of drug-resistant H5N1 virus. Nature. 2005 (20); 437 (7062):1108.
37. Winter G.Global virus alert. How SARS highlighted the risk of viral pandemics. Nurs Stand. 2005 (13-19); 19 (44):24-6.
38. Makarov VV, Vorob'ev AA, Bondarenko VM, Boev BV. Highly pathogenic avian influenza virus inducing influenza pneumonia in humans. Zh Mikrobiol Epidemiol Immunobiol. 2005; (3):105-9.
39. Chia SE, Koh D, Fones C, Qian F, Ng V, Tan BH, Wong KS, Chew WM, Tang HK, Ng W, Muttakin Z, Emmanuel S, Fong NP, Koh G, Lim MK. Appropriate use of personal protective equipment among healthcare workers in public sector hospitals and primary healthcare polyclinics during the SARS outbreak in Singapore. Occup Environ Med. 2005; 62 (7):473-7.
40. Cyranoski D. Avian flu special: masking our ignorance. Nature. 2005 26; 435 (7041):408.
41. Derrick JL, Gomersall CD. Protecting healthcare staff from severe acute respiratory syndrome: filtration capacity of multiple surgical masks. J Hosp Infect. 2005; 59 (4):365-8.
42. Haas WH. Principles of epidemic emergency preparedness planning: the example of the German Influenza Pandemic Preparedness Plan. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2005; 48 (9):1020-7.
43. Elbers AR, Koch G, Bouma A. Performance of clinical signs in poultry for the detection of outbreaks during the avian influenza A (H7N7) epidemic in The Netherlands in 2003. Avian Pathol. 2005; 34 (3):181-7.
44. Matsui S. Protecting human and ecological health under viral threats in Asia. Water Sci Technol. 2005; 51 (8):91-7.
45. Sims LD, Domenech J, Benigno C, Kahn S, Kamata A, Lubroth J, Martin V, Roeder P. Origin and evolution of highly pathogenic H5N1 avian influenza in Asia. Vet Rec. 2005 (6); 157 (6):159-64.