Live Poultry Markets in Bangkok Metropolitan, Thailand: A Survey of H5 & H7 Prevalence in Bird and Worker s vaccination and knowledge

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1 Live Poultry Markets in Bangkok Metropolitan, Thailand: A Survey of H5 & H7 Prevalence in Bird and Worker s vaccination and knowledge Prabda Praphasiri, DrPH, PhD 29 August 2016 Thailand MOPH U.S. CDC Collaboration A joint activity of the Thailand Ministry of Public Health and the U.S. Centers for Disease Control and Prevention

2 The top 10 disease surveillance of Bangkok and Thailand in Bangkok Thailand Disease Patient (person) Rate /100, Diarrhea 20, Influenza 15, Pyrexia (Fever of Unkown 7, Origin) 4. Pneumonia 4, Dengue (Total) 3, Hand-Foot Mouth- Disease 2, Sexually transmitted infection (Total) 1, Foodborne disease 1, Conjunctivitis 1, Chickenpox 1, Note: Data from the Bureau of Epidemiology at June 7, Disease Patient Rate /100,000 (person) 1. Diarrhea 483, Pyrexia (Fever of Unkown 163, Origin) 3. Pneumonia 89, Foodborne disease 52, Conjunctivitis 52, Influenza 50, Chickenpox 24, Dengue (Total) 18, Sexually transmitted infection (Total) 16, Hand-Foot Mouth- Disease 13, Note: Data from the Bureau of Epidemiology at June 7, 2016.

3 The proportion of ILI patients on all outpatient Influenza situation in Bangkok per week Number of patient (person) 2000 Med Bangkok 2015 Bangkok % Week Data from the Bureau of Epidemiology at June 7, 2016.

4 Why Bangkok is at Risk of AI transmission Sprawling cross-road area with 10 millions population High density of the inhabitants and high turnover rates of both human and animal population First entry point for foreigners and tourists traveling into Thailand, including poultry imported for domestic trading

5 Location of Live Bird Market in Bangkok

6 Types and places of poultry purchased at Live Poultry Market in Bangkok District Types of Poultry Places of Poultry (Provinces or countries) Bang Rak Chickens Nakhon Pathom, Bangkok Samphan thawong Chickens Nakhon Pathom, Nakhon Nayok, Bangkok Rat Burana Chickens Phetchaburi Khlong Toei Chickens, Ducks, Geese Nakhon Pathom, Phetchaburi, Ratchaburi, Chachoengsao, Ang Thong, Chon Buri Pom Prap Sattru Chickens, Ducks, Samut Sakhon Phai Geese Bangkok Noi Pet birds a Bangkok Min Buri Pet birds a Bangkok, Samut Prakan, Chachoengsao, Phetchaburi Thawi Watthana Pet birds a Bangkok, Ang Thong, Samut Sakhon, Chachoengsao, Nakhon Pathom, Kanchanaburi, Netherlands, Belgium, Australia, Philippines Chatuchak Pet birds a 18 provinces

Live Bird Market at JJ market in Bangkok Bangkok, Nakhon Nayok, Chachoengsao, Samut Prakan, Phetchaburi, Phra Nakhon Si Ayutthaya, Saraburi, Nakhon

7 Live Bird Market at JJ market in Bangkok Bangkok, Nakhon Nayok, Chachoengsao, Samut Prakan, Phetchaburi, Phra Nakhon Si Ayutthaya, Saraburi, Nakhon Ratchasima, Chon Buri, Pathum Thani, Chiang Mai, Suphan Buri, Buri Ram, Kalasin, Roi Et, Prachin Buri, Songkhla, Yala, Pattani, Narathiwat, Netherlands

8 Thailand avian influenza situation in human Cumulative number of human confirm Avian influenza 25 case, 17 death in Thailand since * - Distribute in 18 province of Thailand (18/77; 23%) No confirm Avian influenza case and death in Thailand since 2007 until now * 8

9 Risk of AI transmission in Bangkok Cumulative number of human There was reported confirm AI case in human in Bangkok 2005 Previous study found AI (H5N1) in live bird market, central part of Thailand Lack of the data amount of shop in Bangkok Most well known market such as Chatuchak live bird market receive live bird from other province Unknown vaccine coverage among live bird vendors in Bangkok 9

The organization responsibility to detect avian

Bird type Wild bird Farm bird Organization

of national park, wildlife and plants conservation

started 2004* 2004** Zoo bird Zoological park

10 The organization responsibility to detect avian influenza by type of bird in Thailand since 2004 Bird type Wild bird Farm bird Organization responsibility for surveillance disease Department of national park, wildlife and plants conservation (DNP) Department of livestock development (DLD) Year started 2004* 2004** Zoo bird Zoological park organization 2004*** Live bird in live bird market No surveillance system - 10

11 Why surveillance in LBMs is important to detect disease? LBMs play a crucial role in the maintenance, amplification and dissemination of avian influenza viruses Considered high risk locations for potential zoonotic transmission of influenza viruses to humans Control measures in LBMs and along the market chain have been found to be effective for reducing the spread of H5N1 viruses 11

12 Objectives To determine knowledge about avian influenza among bird To determine vaccine coverage among bird vendors in Bangkok, November 2013 To identify H7N9 and other avian influenza viruses in live poultry, environmental samples and live poultry serum in live poultry markets in Bangkok ( ) 12

Study area 50 districts were listed by Bangkok metropolitan during July 2013 9 of 50

13 Study area 50 districts were listed by Bangkok metropolitan during July of 50 districts have live bird market and survey number of shop by BMA veterinary officer during July

14 Cross-sectional survey Sampling method Bird & environment (convenience sampling) 20 bird (if number of bird < 20, collected all) oropharyngeal swab serum 50 districts 9 districts 9 live bird markets 2 environment fresh feces water 76 live bird shops Preliminary survey by BMA Selected all Selected all 1 vendor (purposive sampling using shop management criteria)

15 Data collection Human : purposive sampling incline to high knowledge of shop management criteria - 1 st owner - 2 nd worker - 3 rd other person in shop Data collection Questionnaire was developed and reviewed by content experts Train field worker collected sample from live bird shop and interview method Structure interview questionnaire to obtain data» > Demographic data» > General shop information» > Animal-human contact» > Vaccine and illness history in the past 1 year» > Knowledge about avian influenza 15

16 Poultry sample collection Specimen from bird: convenience sampling Oropharyngeal swab : 20 avian; 4 samples (pool) Serum : 20 avian ;20 samples (only food bird) Environmental sample convenience sampling Water : 4 samples (from 4 container) Feces : 5 area; 1 sample (pool) 16

17 laboratory Pathogen detection : Influenza virus A ( H5 and H7) Laboratory institute : National Institute of Animal Health(NIAH), Department of Livestock Development Laboratory detection technique : Reverse-Transcription PCR (RT-PCR). hemagglutination(ha) assay Hemagglutination-inhibition (HI) assay 17

18 RESULTS 18

19 No. of shop collected specimen and interviewee in live bird shop, Bangkok, November live bird shops 4 Shops allowed to collected specimen only 71 Shops allowed to collected Specimen and interviewed 1 Shops allowed Interviewed only 19

20 Distribution of live bird shop were collected data by district, Bangkok, November 2013 District Total number of eligible shops Number of shops provided samples Number of interviewee Pom Prap Sattru Phai Rat Burana Bangkok Noi Bang Rak Min Buri Sampan thawong Thawi Watthana Klong Toei Chatuchak Total

21 Map distribution of live bird shop were collected data by district, Bangkok, November 2013

22 Shop type and shop staff of live bird shop in Bangkok, November 2013 (n=76) 32% 68% consumption pet participant Type of shop No. (%) of Consumption bird shop (n=25) No. (%) of Pet bird shop (n=51) p-value* Answer questionnaire 23 (92.0) 49 (96.1) Giving specimen 25 (100) 50 (98.0) * Chi-square test 22

23 Years of operation and number of bird in live bird shop by type of shop in Bangkok, November 2013 (n=72) Year of operation, no. of bird Type of shop No. (%) of Consumption bird shop (n=24) No. (%) of Pet bird shop (n=49) p-value* years 0.001** (8.7) 17 (34.7) (17.4) 19 (38.8) > (65.2) 11 (22.4) unknown 2 (8.7) 2 (4.1) No. of birds < 50 7 (30.4) 26 (53.1) (45.8) 11 (22.4) > (20.8) 12 (24.5) * Chi-square test **68 shops with known years of operation 23

24 % Percentage of Shop have Trading and transport permission license by type of shop in Bangkok, November 2013 (n=72) consumption pet 0 trading license transport license License 24

25 Frequency of shop open by type of shop in Bangkok, November 2013 (n=72) Frequency of shop open Type of shop No. (%) of Consumption bird shop (n=23) No. (%) of Pet bird shop (n=49) p-value* Shop open everyday 20 (87.0) 31 (63.3) not everyday 3(13.0) 18 (36.7) * Chi-square test 25

26 No. of vendors No. of vendors Distribution of vendors by age in live bird shop in Bangkok, November 2013 (n=72) years Distribution of vendors by education level in live bird shop in Bangkok, November 2013 (n=72) primary school high school diploma Bachelor upper bachelor Education level not study 26

27 Influenza and vaccine history of shop staff by type of shop in Bangkok, November 2013 (n=154) Variable Flu patient history diagnosed by physician Type of shop No. (%) of Consumption bird shop (n=70) No. (%) Pet bird shop (n=84) p-value* 1 (1.4) 3 (3.6) ILI history 1 (1.4) 5 (6.0) Vaccine coverage 13 (18.6) 22 (26.2) Vaccine coverage and 95% CI among Consumption bird vendor = 18.6 ( ) Pet bird vendor = 26.2 ( ) Vaccine coverage among vendors = 22.7 ( ) * Chi-square test 27

28 Knowledge among live bird vendors in live bird shop,bangkok, November 2013 (n=72) Knowledge variable 1) Avian influenza could transmit by touching, blood, feces, saliva and nasal secretion of birds 2) Avian influenza could transmit by consuming well-cooked birds 3) Slaughtering sick/dead birds could get avian influenza infection 4) Slaughter and birds shop owners should meet physician in case of having fever and cough symptoms 5) In case of having fever and cough symptoms, patients should provide history of contacting sick/dead birds No. (%) of correct answering by Type of shop Consumption bird vendor (n=23) Pet bird vendor (n=49) p-value* 16(69.6) 37(75.5) (52.2) 31(63.3) (43.5) 35(71.4) < (78.3) 42(85.7) (73.9) 43(87.8) * Chi-square test 28

29 Knowledge among live bird vendors in live bird shop, Bangkok, November 2013 (n=72) Knowledge variable No. (%) of correct answering by Type of shop Consumption bird vendor (n=23) Pet bird vendor (n=49) p-value* 6) There were not necessary to washing hands after touching birds, if the birds were not sick. 13(56.5) 38(77.6) ) Consuming well-cooked birds could not prevent consumers from avian influenza infection 15(65.2) 32(65.3) ) Children played around contaminated areas with feces of birds had the risk of avian influenza infection 9) In case there were massive deaths of birds, it was not necessary to notify the veterinarians to investigate the event. 12(52.2) 37(75.5) (52.2) 36(73.5) ) Avian influenza infection in human may be severe cases and dead if he was received late treatment 15(65.2) 43(87.8) * Chi-square test 29

30 Shop characteristic and attitude in shop staff by shop with history of vaccination in Bangkok, November 2013 (n=154) Shop characteristic and attitude Shop with history of vaccination No. (%) of Vaccinated history (n=22) No. (%) Unvaccinated history (n=50) p-value* Shop type consumption 6 (27.3) 17 (34.0) pet 16 (72.7)) 33 (66.0) Occupation status owner 18 (81.8) 40 (80.0) worker 3 (13.6) 9 (18.0) other 1 (4.5) 1 (2.0) concerned about avian influenza outbreak concerned about avian influenza infection 10 (45.5) 10 (20.0) (31.8) 15 (30.0) * Chi-square test

31 Attitude among live bird vendors in live bird shop,bangkok, November 2013 (n=72) Attitude variable 1) You concerned about avian influenza outbreak 2) You concerned about avian influenza infection 3) You would be able to protect yourself from avian influenza infection in case of slaughtering the birds 4) In case there were prevention and control measures for avian influenza in your area, you thought that these measures would work and could prevent the outbreak * Chi-square test No. (%) of answering agree by Type of shop Consumption bird vendor (n=23) Pet bird vendor (n=49) p- value* 10(43.5) 10(20.4) (30.4) 12(24.5) (65.2) 29(59.2) (47.8) 26(53.1)

32 Practice among live bird vendors in live bird shop,bangkok, November 2013 (n=72) Practice variable No. (%) of vendors by Type of shop Consumption bird vendor (n=23) Pet bird vendor (n=49) p-value* Bird movement movement 1 (4.3) 13 (16.5) no movement 22 (95.1) 36 (73.5) Cage cleaning frequency everyday 17 (73.9) 26 (53.1) not everyday 5 (26.1) 23 (46.9) Using disinfectant using 12 (52.2) 40 (81.6) not using 11 (47.8) 9 (18.4) * Chi-square test 32

33 Practice among live bird vendors in live bird shop,bangkok, November 2013 (n=72) Practice variable 1) There was disease screening before admitting the birds to the shop 2) There was a place for quarantine the birds 3) Bird was vaccinate before admitted to the shop 4) In case there were sick birds in the shop, you took care them appropriately No. (%) of vendors by Type of shop Consumption bird vendor (n=23) Pet bird vendor (n=49) p-value* 10 (43.5) 7 (14.3) (0.0) 10 (20.4) (4.3) 14 (60.9) (21.7) 41(83.7) <0.001 * Chi-square test 33

34 % Source provide avian influenza information among live bird vendors Bangkok, November 2013 (n=72) Source 34

35 Total number of specimen collected by type of shop in Bangkok, November 2013 (n=75) Specimen collection technique Oropharyngeal swab Type of shop Consumption bird shop (n=25) Pet bird shop (n=50) Total Serum Fresh feces Drinking water Waste water All specimens were negative for Influenza A virus subtype H5 and H7. 35

36 Total number of specimen collected by type of shop in Bangkok, Specimen collection technique year Oropharyngeal swab 834 1, Serum Fresh feces 410 1, Drinking water and Waste water 36

37 Discussion (1) No sample were positive for avian influenza A virus. However, influenza A virus subtypes H4N6, H4N9 and H10N3 was found in an active surveillance among avian species in a live bird market in Bangkok, in 2010 Having Trading license was different between two types of shops Consumption shop have higher proportion of having license than pet shop 37

38 Discussion (2) Vaccine coverage (20%) in shop staff is the same previous study in high risk group (> 65 years) conducted during (1) Should have high vaccine coverage ( > 70% ) in high risk group (2) 1) Owusu JT1 et al, Seasonal influenza vaccine coverage among high-risk populations in Thailand, Jan 29;33(5): doi: /j.vaccine Epub 2014 Nov 7. 2) 38

39 Discussion (3) The study found knowledge of human AI in both group similarly but look lower in consumption bird vendor like previous study done in rural Thailand before public education campaigns (1) Knowledge In topic Slaughtering sick/dead birds could get avian influenza infection was significant different and low in consumption shop - This should concern because of the shop have slaughter bird inside the shop have more high risk 1) Olsen SJ, Laosiritaworn Y, Pattanasin S, Prapasiri P, Dowell SF. Poultry-handling Practices during Avian Influenza Outbreak, Thailand. Emerging Infectious Diseases [Internet] October[cited 2015 Feb];11(10): Available from 39

40 Discussion (4) Percentage of attitude about concern avian influenza outbreak and infection of both groups are not high (<70%). This may come from they can protect themselves and avian influenza outbreak inhuman was not occur in Thailand since 2009(1) 1) berh5n1cases.pdf 40

41 Discussion (5) Poor practice in some topic was different and increase risk of expose avian influenza (1-2) Pet bird :movement their bird to their home when they cannot sold them Cost of bird Consumption bird : using disinfectant was low Consumption bird vendors know disease screening history than pet bird owner this may come from consumption bird have law to screen disease before movement or sold. 1) 2) 2http:// 41

42 Discussion (6) Television is the most effective source to disseminate avian influenza information as previous study in Thailand(1) and china (2). The consumption shop or more than 10 years operation shop or shop having trading license likely to provide adequate specimen however this study have some confounder to be find out 1) Olsen SJ, Laosiritaworn Y, Pattanasin S, Prapasiri P, Dowell SF. Poultry-handling Practices during Avian Influenza Outbreak, Thailand. Emerging Infectious Diseases [Internet] October[cited 2015 Feb];11(10): Available from 2) Nijuan Xiang et al, Knowledge, attitudes and practices (KAP) relating to avian influenza in urban and rural areas of China, BMC Infect Dis Feb 21;10:34. doi: /

43 Discussion (7) 54% H9N2 found in environment showing the possibility infection by daily life activity Possibility assortment with other virus

44 26 July 2006 at a.m.

46 26 July 2006 at p.m.

47 30 July 2006 at 8.00 a.m.

48 Conclusion and Recommendation In Thailand, live poultry purchasing habits, poultry handling and living conditions increase the risk of exposure to avian influenza virus contaminated environments Although no virus was found, it is critical to maintain the level of biosecurity to prevent introduction of the virus - Control of poultry movement - Cleaning markets or shops - Quarantine areas at production locations - Designate fixed locations for slaughtering - Provide health education for shop owners and workers - Shop owners and workers receive influenza vaccination annually - Continue active surveillance programs in poultry, humans and the environment 48

49 THANK YOU FOR YOUR ATTENTION One health Bangkok team

Avian Influenza (Bird Flu) Fact Sheet

Avian Influenza (Bird Flu) Fact Sheet What is an avian influenza A (H5N1) virus? Influenza A (H5N1) virus also called H5N1 virus is an influenza A virus subtype that occurs mainly in birds. It was first isolated from birds (terns) in South