Volume 13, Number 10–October 2007
Dispatch
Multifocal Avian Influenza (H5N1) Outbreak
Ran D. Balicer,*† Shmuel Reznikovich,† Elyakum Berman,‡ Michael Pirak,‡ Amnon Inbar,‡ Shimon Pokamunski,‡ and Itamar Grotto*†
*Ben-Gurion University of the Negev, Beer-Sheva, Israel; †Israeli Ministry of Health, Jerusalem, Israel; and ‡Veterinary Services of the Israeli Ministry of Agriculture and Rural Development, Beit Dagan, Israel
Suggested citation for this article
Abstract
During March 2006, an outbreak of highly pathogenic avian influenza (H5N1) occurred in multiple poultry farms in Israel. The epidemiologic investigation and review of outbreak mitigation efforts uncovered gaps in planning for and containing the outbreak, thus affording valuable lessons applicable to other countries in similar settings.
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The Israeli public proved quite attentive to risk communication efforts as shown by the results of a national telephone survey conducted at the peak of the outbreak by the Israeli Center for Disease Control. Among a random sample of Israelis >21 years of age, 34 (62%) of 552 interviewees who were aware of the outbreak and generally consumed poultry products did not reduce poultry consumption at all due to the outbreak. In contrast, a recent preevent survey in the United States has shown that 40% of respondents would stop eating poultry products altogether if the H5N1 virus was detected. (12). This outbreak was also not associated with a massive increase in "worried well" hospital admissions. Only 24 patients (21 adults and 3 children) came to local hospitals due to self-defined or general practitioner-defined suspected avian flu during March 2006. Five of these 24 persons (4 adults and 1 child) indeed met the case definition of suspected case and were hospitalized, but none had laboratory-confirmed H5N1 infection. These results are probably derived, at least in part, from the effective frontline risk communication efforts of the district health officers who offered guidance to local general practitioners and the anxious public at the outbreak scene.
Conclusions
Preparedness planning for avian influenza should account for the unique challenges associated with a simultaneous multifocal outbreak, including personnel recruitment and allocation; coordination of all parties involved in outbreak mitigation and investigation; simultaneous culling and disposal in multiple sites; and coordinated central and local risk communication efforts. Outbreak containment, even in these settings, could be achieved without the use of vaccines, which should be kept as a measure of last resort. Case definition and antiviral prophylactic policies may be revised ad hoc according to the unfolding events and in response to the medical and psychological needs of each population. The lessons learned and described in our study may serve to refine preparedness plans elsewhere in view of the increasing global dissemination of this virus.
