Avian Flu and Pandemic Flu

The spread of avian influenza continues. To date, the virus has resulted in 201 human deaths and affected wild birds and poultry populations in 60 countries (Figure 1) throughout Asia, Europe, the Middle East and Africa (Figure 2). Poultry deaths due to culling and disease stand at about 300 million. The disease is believed to be present in most East Asian countries, as well as in Egypt and Nigeria. Recent Outbreaks. Increasing numbers of outbreaks of Highly Pathogenic Avian Influenza (HPAI) sub-type H5N1 have been reported in the first half of 2007, reflecting what has become an annual cyclical re-occurrence of the disease in animals between December and April since its first large-scale emergence at the end of 2003. Since the beginning of 2007, new outbreaks have been reported in Afghanistan, Bangladesh, Cambodia, China, Czech Republic, France, Germany, Ghana, Hong Kong, Hungary, India, Indonesia, Japan, Kuwait, Lao PDR, Malaysia, Myanmar, Pakistan, the Republic of Korea, Russia, Saudi Arabia, Thailand, Togo, Turkey, the United Kingdom, and Vietnam. It is expected that more outbreaks will follow, although their geographical distribution is largely unpredictable. Human Cases. While there are definitely seasonal peaks and troughs in human infections, there have been cases recorded every month since November 2004. Human infections with the H5N1 virus continue to be extremely rare, though the number of cases has been increasing every year. To date, the World Health Organization (WHO) confirmed 329 people in 12 countries have been infected with the virus, of which 201 fatalities, representing a case fatality ratio of over 60 percent. Most human cases have occurred in East Asia, where Indonesia recently overtook Vietnam as the country with the largest number of human infections (107) and continued to register the highest death toll (86).	Figure 1. Human Deaths from H5N1 and Countries Affected (both cumulative)

Table 1. Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

2 October 2007

Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases. All dates refer to onset of illness.

In Africa, Egypt has reported the largest number of human cases of H5N1 infection (38), most of whom were women. The most recent additions to the list of countries reporting H5N1 in humans were Nigeria, which confirmed its first human infection and death in January, and Lao PDR, confirming its first human cases in February and March. To date, close exposure to diseased poultry remains the primary risk factor for infection, despite reports of a number of cluster cases, where human-to-human transmission has not been excluded. Recent reports from Egypt that the virus had become resistant to Tamiflu, did not reflect a mutation of the virus to a more virulent form.

A recent analysis of demographic data published by the WHO in the agency's online journal the Weekly Epidemiological Review [1] shows that the virus affects predominantly young people born after 1968 (Figure 2). According to the study, the median age of laboratory confirmed human H5N1 influenza cases (up to November 24^th 2006) was 18 years old, with 52 per cent of cases younger than 20 years old and 89 per cent under age 40. Men and women made up virtually an equal number of cases. The death rate was highest among cases aged 10 to 19; 76 percent of cases in that group died. Cases aged 50 and over had the lowest death rate (40 percent) followed by children under age five (44 percent) and children aged five to nine (49 percent). In addition, the review found that the median interval from illness onset to hospitalization was four days, and the median duration from onset of symptoms to death was nine days. The relatively small number of cases precludes the drawing of definite conclusions, although the analysis seems to suggest that the higher number of cases among young people is not solely due to the age structure of the populations of affected countries.

World Bank Contributions to the Global Fight against Avian and Human Influenzas (AHI)

The World Bank is working closely with developing countries, donors, the UN System Influenza Coordinator (UNSIC, David Nabarro) and the international technical agencies—the World Health Organization (WHO), the Food and Agriculture Organization (FAO) and the World Organization for Animal Health (OIE)—in providing an integrated approach at the national, regional and international levels to the fight against HPAI and in preparing for a possible pandemic.  While the international technical agencies are positioned to help address scientific and technical issues, the Bank has ongoing health and rural development programs in most developing countries, and has a comparative advantage in fostering a cross-sectoral approach to fighting avian flu. 

Support for Integrated Country Programs. The Bank is currently working in more than 50 developing countries in all regions, providing advice on preparation of AHI projects for financing under its $500 million Global Program for Avian Influenza (GPAI), which was endorsed by the Board in January 2006.  By end-June 2007, $377 million has been approved for 40 projects in 41 countries (Table 2).  Most of this financing was from IBRD/IDA, which provided $299 million to fully-developed integrated country programs in 24 countries.  Significant funding came from Bank-administered trust funds, including the Policy and Human Resources Development Fund (PHRD) provided by Japan, and the newly-established multidonor Avian and Human Influenza Facility (AHIF). AHIF received pledges of $83 million from 9 donors, of which the European Commission is the largest. Twenty-five projects have already been approved for AHIF financing, totaling more than $58 million, including for integrated country programs in Egypt, Indonesia, Vietnam, and West Bank and Gaza.  More than 20 countries have projects under preparation for financing from AHIF and IBRD/IDA.