QUESTIONS AND ANSWERS ON AVIAN INFLUENZA IN TURKEY
(World Health Organization-Regional Office for Europe - Updated 18 Jaunuary 2006)

Q: What is the risk of human infection with avian influenza?
A: Avian influenza remains primarily an animal disease that only very rarely affects humans. The small number of human cases, despite the tens of millions of poultry infected, over vast geographical areas, for more than two years, supports this conclusion.
However, the epidemiology of the outbreak needs to be carefully studied before any instances of human to human transmission can be ruled out.

Q: What are the causes of human infection with avian influenza in Turkey? Have there been any reports on human to human transmission so far?
A: All available evidence to date indicates that patients have been infected through direct contact with diseased birds. There is no evidence to date of any instances of human to human transmission.

Q: Should we expect more human cases of avian influenza in Turkey?
A: Although the awareness of avian influenza is high in Turkey, we can expect to see more human cases, most likely be linked directly to H5 outbreaks in animals, as has been observed in the current reported cases.

Q: Where are the laboratory testing conducted?
A:  Samples taken from patients suspected of having been infected with avian influenza are sent to a national influenza laboratory for preliminary testing. Final testing is conducted by WHO's Collaborating Centre at the MRC National Institute for Medical Research in London, and includes the sequencing on the virus and monitoring of its eventual mutations or changes.

Q: Is the virus detected in people in Turkey the same type as the one detected in birds?
A:  The completed sequencing of a virus from one of the first two fatal cases in the Turkish outbreak indicates that this virus is very similar to current avian H5N1 viruses isolated from birds in Turkey. It is also very similar to viruses recently found circulating in Russia, Romania, Western China and Mongolia.

Q: Is the avian influenza virus detected in Turkey expected to change?
A: One change in the HA (hemaglutinin) gene in one sample has been detected. The significance of the change is unclear; it is impossible to draw substantial conclusions from genetic changes alone. Because influenza viruses evolve constantly, genetic changes must be matched with epidemiological and clinical properties before we can conclusively determine their significance. We will need to look at other viruses from Turkey and consider the disease pattern in the country, before we can determine the importance of this change.

Q: Have any changes in the epidemiology of the disease been registered so far?
A: From the investigation in Turkey so far, there have been no significant changes in the epidemiology of the disease, i.e. we have not seen substantial evidence of increased transmission, human to human transmission, or severity.

Q: What actions has WHO taken in response to the outbreaks in Turkey?
A:  At the invitation of the Turkish government, a team of experts from the WHO European Office, the European Centre for Disease Prevention and Control (ECDC) and the European Commission arrived in Ankara, Turkey, on 5 January. The team has expertise in epidemiology, infection control, logistics, virology, and communications. The experts are assisting local authorities with their epidemiological investigation of the situation. The team is also attempt to identify the risk factors for H5 transmission, and making recommendations to improve both infection control procedures, as well as the treatment of hospitalized patients.

Q: What are the initial findings?
A: The initial investigation has found no evidence the virus has increased its transmissibility or is spreading from person to person. Most people under investigation are children, and almost all have a clear contact with diseased poultry.

Q: Why are we seeing such large numbers of suspected human cases in Turkey?
A: The confirmed cases were said to have had contact with sick or dead poultry. One possible contributing factor is the common practice in this region to bring poultry into the home during the winter season. The winter temperatures have dropped to under 20 degrees Celsius during the last weeks of December and many households have brought the livestock in their houses. This has most likely contributed to a more close contact between diseases animal and people.

Q: Has WHO issued any travel restrictions to the affected areas in Turkey?
A:WHO does not recommend travel restrictions to Turkey or other countries experiencing outbreaks of highly pathogenic H5N1 avian influenza in birds, including countries which have reported associated cases of human infection. More information for travellers coming from and going to countries experiencing outbreaks of highly pathogenic H5N1 avian influenza available at http://www.who.int/csr/disease/avian_influenza/travel2005_11_3/en/index.html

Q: Are other countries on the region at risk of avian influenza outbreaks in birds?
A: Other countries in the Black Sea region have reported bird flu outbreaks, as they are on the route of migratory birds, which may play a role in the spread of the virus.

Q: What is the current WHO global pandemic alert phase?
A: The WHO global pandemic alert remains unchanged, at level three. To move to phase four, we would need to see evidence of sustained transmissibility of the virus among people.

Q: Where can I find situation updates on avian influenza in Turkey?
A: Updates on avian influenza in Turkey can be found on the following WHO/Europe web page:
http://www.euro.who.int/eprise/main/WHO/Progs/INF/situation/20051101_1
Global updates on avian influenza can be found on the following WHO/headquarters web page:
http://www.who.int/csr/disease/avian_influenza/updates/en/index.html