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Opinion of the Risk Watch and Anticipation Committee Sanitary
(COVARS)
June 8, 2023
On the HEALTH RISK of AVIAN INFLUENZA linked to
HIGHLY PATHOGENIC AVIAN INFLUENZA (HPAI)
Members of the Health Risk Monitoring and Anticipation Committee associated with this opinion:
Brigitte AUTRAN, President, Immunologist
Fabrice CARRAT, Epidemiologist
Yvanie CAILLE, Patient Association
Simon CAUCHEMEZ, Modeler
Julie CONTENTI, Emergency physician
Annabel DESGREES du LOU, Demographer
Didier FONTENILLE, Entomologist
Patrick GIRAUDOUX, Eco-epidemiologist,
Mélanie HEARD, Health Politist
Xavier de LAMBALLERIE, Virologist
Thierry LEFRANCOIS, Veterinarian,
Roger LE GRAND, Vaccines,
Xavier LESCURE, Infectiologist
Bruno LINA, Virologist
Véronique LOYER, Citizens' Representative
Denis MALVY, Infectiologist
Céline OFFERLE, Patient Association
Olivier SAINT-LARY, Generalist
Rémy SLAMA, Epidemiologist
The opinion was written by the Avian Flu pilot group coordinated by: Thierry LEFRANCOIS and Bruno LINA, and co-prepared by Denis MALVY, Simon CAUCHEMEZ, Annabelle DEGREES de LOU, Fabrice CARRAT, Véronique LOYER, Xavier LESCURE, Patrick GIRAUDOUX, Jocelyn RAUDE, with the support of Julie MEUNIER, Léa DRUET-FAIVRE and Brigitte AUTRAN.
This opinion was transmitted to the national authorities on June 8, 2023
Like the other opinions of the Committee for Monitoring and Anticipation of Health Risks, this opinion is intended to be made public.
...
EXECUTIVE SUMMARY
Avian influenza, due to Influenza A viruses, is a severe and highly contagious viral infection affecting
domestic and wild birds and can be transmitted to humans.
The highly pathogenic avian influenza (HPAI) outbreak of 2021-2022 has caused an unprecedented
crisis in France and worldwide, leading to the preventive slaughter of more than 21 million poultry in
France, with some mammal cases raising a major risk to human health. While the French situation
seemed quieter in March 2023, when the Ministry of Agriculture lowered the risk level from "high" to
"moderate", new outbreaks have occurred since then in farms in the south-west of France, bringing
back HPAI to the forefront of health risks. The threat of an endemization indeed raises health issues
for birds, mammals and humans who can contract avian influenza through close contact with a sick
animal, as well as socio-economic issues: in France in 2022, economic losses related to HPAI amounted
to more than one billion euros. Following the death of a child from an H5N1 Flu in Cambodia, the WHO
has estimated the situation as "worrying" in February 2023, calling for a vigilance increase in all
countries. (Part I-B)
Several factors make HPAI a particularly significant risk (Part I-C). First, HPAI cannot be eradicated
because of the immensity and diversity of its reservoir. Second, the rapid HPAI transmission between
birds and its severity causes high mortality in wild birds and increases the risk of IAHP becoming
endemic. It also increases the risk of transmission to and between mammals, particularly in the case
of the A (H5N1) virus. Climate change and the biodiversity crisis are altering the trajectories of wild
birds and their resistance to viruses, which could also be a source of new HPAI outbreaks. The loss of
seasonality in avian infection, the increase in the number of cases in farms, the diversification of the
affected wild species and the increase in mammal cases reinforce the public health risk for humans,
even though there have not yet been any confirmed cases of human-to-human transmission of avian
influenza.
In France, a passive surveillance of wild birds is orchestrated by the SAGIR network (Part II-A-1). The
farm surveillance allows the detection of cases leading to biosecurity and management countermeasures
in line with the recommendations of the ANSES. However, these measures are unevenly
followed by the poultry farmers and can raise socio-economic challenges that need to be taken into
account by the public authorities (Part II-A-2). Human surveillance is currently focused solely on
symptomatic cases, but the SAGA protocol, currently in development by health and veterinary
agencies, will set up active monitoring among professionals exposed to the risk of avian influenza
(poultry farmers, workers and veterinarians).
A strategy for vaccination of poultry against HPAI, has been authorised and recommended in 2022 at
the European level (Part II-A-3), and will shortly be finalised in France thus enabling preventive
vaccination in duck farms to begin in autumn 2023. Vaccination of poultry farmers and poultry
industry professionals against seasonal influenza is also now recommended in order to limit the risk
of recombination between avian and human viruses, which could create a risk of avian influenza.
Pandemic and pre-pandemic vaccines are currently being developed. While conventional antiviral
treatments are available in France, new anti-virals already authorised in some countries offer
numerous advantages for human cases of avian influenza (Part II-A-4) and should play a key role in an
avian influenza pandemic preparednesse and management, pending the deployment of an adapted
human vaccination strategy. Finally, research programmes on avian influenza (Part II-B) are underway.
The sustained HPAI circulation despite these countermeasures and the growing risk of an endemization
increase the health risks for the human population. It is therefore necessary to reinforce and
coordinate the multidisciplinary and multisectoral actions aimed at tackling this risk by focusing on
four key issues: vaccination, preventive measures to be applied in farms, animal and human
surveillance and research funding on avian influenza and HPAI.
The COVARS, adopting a "One Health" approach and incorporating the opinions of various agencies,
recommends to:
Implement a poultry vaccination strategy as soon as possible, based on the DIVA strategy and
supported by targeted communication, in addition to biosecurity measures, as part of an
overall farm management approach, in line with the recommendations of the ANSES and the
Council of the European Union.
Extend the recommendation to vaccinate against seasonal influenza to people at risk who
are in contact with birds potentially carrying the virus.
Adapt prevention and farm management counter-measures by actively researching
alternatives to preventive slaughter (including vaccination), improving the conditions for
euthanizing farm animals, and developing accompanying programmes for affected farmers.
Extend and strengthen human and financial resources for animal and human monitoring,
which must be harmonised at the national level, particularly in the French overseas territories.
Intensify the monitoring of wild species by the OFB (French Office for Biodiversity) and
promote the analysis of environmental DNA, adapted to epidemiological conditions, and the
participative surveillance.
Facilitate the collaboration between veterinary and human medicine in farms around
infected poultry, and allow human respiratory samples to be collected either by self-sampling
or by veterinarians with diagnosis to be carried out in the National Diagnostic Laboratories.
Build up and diversify strategic stocks of effective antivirals adapted to avian flu emergencies.
Build up strategic stocks of pre-pandemic vaccines.
Create a multi-disciplinary emergency unit that can be rapidly activated in the event of a
crisis, and composed of departmental laboratories and veterinarians dedicated to the poultry
industry, in order to strengthen local/national coordination.
Fund long-term research in animal and human health, virology/immunology, ecoepidemiology,
outbreak modelling, human and social sciences, as well as participatory studies,
to better protect animal species and human populations, gain a better understanding of
ecosystems, HPAI viruses and their consequences, and better assess the risks of a pandemic.
...
https://www.enseignementsup-recherc...aire-li-l-iahp-et-la-grippe-aviaire-28112.pdf
Opinion of the Risk Watch and Anticipation Committee Sanitary
(COVARS)
June 8, 2023
On the HEALTH RISK of AVIAN INFLUENZA linked to
HIGHLY PATHOGENIC AVIAN INFLUENZA (HPAI)
Members of the Health Risk Monitoring and Anticipation Committee associated with this opinion:
Brigitte AUTRAN, President, Immunologist
Fabrice CARRAT, Epidemiologist
Yvanie CAILLE, Patient Association
Simon CAUCHEMEZ, Modeler
Julie CONTENTI, Emergency physician
Annabel DESGREES du LOU, Demographer
Didier FONTENILLE, Entomologist
Patrick GIRAUDOUX, Eco-epidemiologist,
Mélanie HEARD, Health Politist
Xavier de LAMBALLERIE, Virologist
Thierry LEFRANCOIS, Veterinarian,
Roger LE GRAND, Vaccines,
Xavier LESCURE, Infectiologist
Bruno LINA, Virologist
Véronique LOYER, Citizens' Representative
Denis MALVY, Infectiologist
Céline OFFERLE, Patient Association
Olivier SAINT-LARY, Generalist
Rémy SLAMA, Epidemiologist
The opinion was written by the Avian Flu pilot group coordinated by: Thierry LEFRANCOIS and Bruno LINA, and co-prepared by Denis MALVY, Simon CAUCHEMEZ, Annabelle DEGREES de LOU, Fabrice CARRAT, Véronique LOYER, Xavier LESCURE, Patrick GIRAUDOUX, Jocelyn RAUDE, with the support of Julie MEUNIER, Léa DRUET-FAIVRE and Brigitte AUTRAN.
This opinion was transmitted to the national authorities on June 8, 2023
Like the other opinions of the Committee for Monitoring and Anticipation of Health Risks, this opinion is intended to be made public.
...
EXECUTIVE SUMMARY
Avian influenza, due to Influenza A viruses, is a severe and highly contagious viral infection affecting
domestic and wild birds and can be transmitted to humans.
The highly pathogenic avian influenza (HPAI) outbreak of 2021-2022 has caused an unprecedented
crisis in France and worldwide, leading to the preventive slaughter of more than 21 million poultry in
France, with some mammal cases raising a major risk to human health. While the French situation
seemed quieter in March 2023, when the Ministry of Agriculture lowered the risk level from "high" to
"moderate", new outbreaks have occurred since then in farms in the south-west of France, bringing
back HPAI to the forefront of health risks. The threat of an endemization indeed raises health issues
for birds, mammals and humans who can contract avian influenza through close contact with a sick
animal, as well as socio-economic issues: in France in 2022, economic losses related to HPAI amounted
to more than one billion euros. Following the death of a child from an H5N1 Flu in Cambodia, the WHO
has estimated the situation as "worrying" in February 2023, calling for a vigilance increase in all
countries. (Part I-B)
Several factors make HPAI a particularly significant risk (Part I-C). First, HPAI cannot be eradicated
because of the immensity and diversity of its reservoir. Second, the rapid HPAI transmission between
birds and its severity causes high mortality in wild birds and increases the risk of IAHP becoming
endemic. It also increases the risk of transmission to and between mammals, particularly in the case
of the A (H5N1) virus. Climate change and the biodiversity crisis are altering the trajectories of wild
birds and their resistance to viruses, which could also be a source of new HPAI outbreaks. The loss of
seasonality in avian infection, the increase in the number of cases in farms, the diversification of the
affected wild species and the increase in mammal cases reinforce the public health risk for humans,
even though there have not yet been any confirmed cases of human-to-human transmission of avian
influenza.
In France, a passive surveillance of wild birds is orchestrated by the SAGIR network (Part II-A-1). The
farm surveillance allows the detection of cases leading to biosecurity and management countermeasures
in line with the recommendations of the ANSES. However, these measures are unevenly
followed by the poultry farmers and can raise socio-economic challenges that need to be taken into
account by the public authorities (Part II-A-2). Human surveillance is currently focused solely on
symptomatic cases, but the SAGA protocol, currently in development by health and veterinary
agencies, will set up active monitoring among professionals exposed to the risk of avian influenza
(poultry farmers, workers and veterinarians).
A strategy for vaccination of poultry against HPAI, has been authorised and recommended in 2022 at
the European level (Part II-A-3), and will shortly be finalised in France thus enabling preventive
vaccination in duck farms to begin in autumn 2023. Vaccination of poultry farmers and poultry
industry professionals against seasonal influenza is also now recommended in order to limit the risk
of recombination between avian and human viruses, which could create a risk of avian influenza.
Pandemic and pre-pandemic vaccines are currently being developed. While conventional antiviral
treatments are available in France, new anti-virals already authorised in some countries offer
numerous advantages for human cases of avian influenza (Part II-A-4) and should play a key role in an
avian influenza pandemic preparednesse and management, pending the deployment of an adapted
human vaccination strategy. Finally, research programmes on avian influenza (Part II-B) are underway.
The sustained HPAI circulation despite these countermeasures and the growing risk of an endemization
increase the health risks for the human population. It is therefore necessary to reinforce and
coordinate the multidisciplinary and multisectoral actions aimed at tackling this risk by focusing on
four key issues: vaccination, preventive measures to be applied in farms, animal and human
surveillance and research funding on avian influenza and HPAI.
The COVARS, adopting a "One Health" approach and incorporating the opinions of various agencies,
recommends to:
Implement a poultry vaccination strategy as soon as possible, based on the DIVA strategy and
supported by targeted communication, in addition to biosecurity measures, as part of an
overall farm management approach, in line with the recommendations of the ANSES and the
Council of the European Union.
Extend the recommendation to vaccinate against seasonal influenza to people at risk who
are in contact with birds potentially carrying the virus.
Adapt prevention and farm management counter-measures by actively researching
alternatives to preventive slaughter (including vaccination), improving the conditions for
euthanizing farm animals, and developing accompanying programmes for affected farmers.
Extend and strengthen human and financial resources for animal and human monitoring,
which must be harmonised at the national level, particularly in the French overseas territories.
Intensify the monitoring of wild species by the OFB (French Office for Biodiversity) and
promote the analysis of environmental DNA, adapted to epidemiological conditions, and the
participative surveillance.
Facilitate the collaboration between veterinary and human medicine in farms around
infected poultry, and allow human respiratory samples to be collected either by self-sampling
or by veterinarians with diagnosis to be carried out in the National Diagnostic Laboratories.
Build up and diversify strategic stocks of effective antivirals adapted to avian flu emergencies.
Build up strategic stocks of pre-pandemic vaccines.
Create a multi-disciplinary emergency unit that can be rapidly activated in the event of a
crisis, and composed of departmental laboratories and veterinarians dedicated to the poultry
industry, in order to strengthen local/national coordination.
Fund long-term research in animal and human health, virology/immunology, ecoepidemiology,
outbreak modelling, human and social sciences, as well as participatory studies,
to better protect animal species and human populations, gain a better understanding of
ecosystems, HPAI viruses and their consequences, and better assess the risks of a pandemic.
...
https://www.enseignementsup-recherc...aire-li-l-iahp-et-la-grippe-aviaire-28112.pdf