Public HealthInterventions for

Prevention and controlof avian influenza

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March 2006

© World Health Organization (2006)

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Publications of the World Health Organization enjoy copyright protection in accordance with theprovisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation,in part or in toto, of publications issued by the WHO Regional Office for South-East Asia, applicationshould be made to the Regional Office for South-East Asia, World Health House, Indraprastha Estate,New Delhi 110002, India.

The designations employed and the presentation of the material in this publication do not imply theexpression of any opinion whatsoever on the part of the Secretariat of the World Health Organizationconcerning the legal status of any country, territory, city or area or of its authorities, or concerning thedelimitation of its frontiers or boundaries.

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“The main health risk currently is to people who are in closecontact with infected poultry, such as families with backyard flocksand poultry workers in wet markets or live animal markets.Globally, the evidence demonstrates that there is no risk ofinfection when birds and eggs are well-cooked, as this kills thevirus. Poultry products are important sources of proteinthroughout the world.” LEE Jong-wook , M.D., Dr P.H., DirectorGeneral,World Health Organisation.

“In addition to drugs and vaccine, certain public healthinterventions must be included in the AI preparedness plans. Weshould help educate people to protect their own health, throughinformation and communication. We should develop educationalmessages that are easily understood by lay people, addressing theneed for improved hygiene, sanitation and food safety. Thesemessages should be translated into local languages, anddisseminated widely.”

Samlee Plianbangchang, M.D., Dr P.H., Regional Director, WorldHealth Organization, Regional Office for South East Asia.

We wish to acknowledge the collective and individual contributions to the developmentof this publication. Special thanks to Dr Roy Sparringa, National Agency for Drug andFood Control, Indonesia; Ms Napapan Nanthapong, Ministry of Public Health, Thailand;Jenny Bishop, WHO Regional Office for Western Pacific, Philippines; Mr SanjayChaudhary, Food Safety Expert, India; Dr Peter Karim Ben Embarek, WHO Geneva,Switzerland; Mr Alexander von Hildebrand, and the members of the Avian Influenza TaskForce in WHO Regional Office for South East Asia, India.

Acknowledgments

1. Introduction 1

2. What is Avian Influenza? 3

3. Direct and indirect factors facilitating the spread of Avian Influenza 5

3.1. Primary production farming systems in rural or urban settings 5

3.2. Unsafe transport 6

3.3. Live animal market (wet market) 8

3.4. Unsafe food preparation 12

4. What is biosecurity? 13

5. Taking action to enhance biosecurity all along the food chain 15

5.1. Secured primary production farming systems 15

5.2. Safe transport 17

5.3. Biosecurity in wet markets 18

5.4. Safety at Customers' and Consumers' end 21

6. Protection of human beings 23

7. Promoting Healthy Food Markets - Strategy and Plans 25

8. Key Public Health Messages 29

9. Sample questionnaire to assess practices in wet markets 31

10. Proposed steps to launch a National Healthy Food Markets Programme 33

11. Web Resources 37

This Manual has been developed to helpstrengthen the capacity of Member States inimplementing effective public healthinterventions to prevent and control thespread of Avian Influenza (AI) at source.

The Manual attempts to provide simple, yetvaluable, public health related measures thatwill not only improve and enhance biosecurity atcritical stages of the food supply chain(production, transportation, marketing andconsumption), but also ensure that the potentialtransmission of Avian Influenza virus fromanimals to humans is considerably reduced.

Biosecurity includes the management of allbiological and environmental health risksassociated with food. In the context of thisManual, biosecurity consists of a set ofmanagement practices which, when followed,collectively reduces the potential for thetransmission / spread of disease-causingorganisms - such as the Avian Influenza virus -onto and between sites, animals and humans.

Effective implementation of these simplepublic health measures would mean thatthe concept of healthy food markets couldbe established in practice and thatpotential heavy loss of human lives couldalso be avoided.

This Manual is addressed specifically topeople who handle poultry and itsproducts, whether at its stages ofproduction; transportation; handling andprocessing at live animal markets; or closerto homes, while preparing the food.

The document therefore, seeks to drawclose the attention al those handlingpoultry and its by-products, all along the food supply chain. Thatincludes, but is not restricted to,managers of poultry production units,transporters, marketplace managers,municipal authorities, health workers,food inspectors, veterinarians, vendors,food handlers and consumers.

1 Introduction

Outbreaks of Avian Influenza in poultry, whencaused by highly pathogenic viruses of the H5or H7 subtypes, are of great concern for theagricultural sector and can have considerableeconomic consequences. Such outbreaks arealso of concern to human health. WHO,therefore recommends, for certain AvianInfluenza viruses, a series of protectivemeasures aimed at preventing humaninfections in persons at high risk of exposure.

For several reasons, the highly pathogenicH5N1 virus the greatest concern atpresent. Of all Avian Influenza virusesknown to infect humans, H5N1 hascaused the greatest number of cases ofvery severe disease and the largest numberof deaths. Moreover, H5N1 has thepotential to trigger an influenza pandemic.The virus has also proved to be particularlydifficult to control in poultry populationsand is now considered endemic in parts ofSouth-East Asia1.

2.1 Affected species andnatural hosts

Chickens, ducks, geese, turkeys, guineafowl, quail, pigeons and numerous wild

birds may all be affected by influenzaviruses. Depending on the virus or on thehost, some birds will be resistant, others willget infected and may or may not showclinical signs.

Ducks are known to be resistant to theviruses and thus act as a "silentreservoir" that perpetuates transmission.In recent months, evidence has mountedthat at least some species of migratorybirds are directly spreading the virus, inits highly pathogenic form, H5N1, toparts of Central Asia and Europe. Inaddition to this, birds that surviveinfection may excrete the virus up to 10days, orally and in faeces, facilitatingfurther spread.

2.2 Humans at risk Though Avian Influenza virusesnormally infect only birds and,unusually, pigs, some strains of thevirus have also crossed the speciesbarrier since 1959 to infect humans on 10 occasions2. While most AvianInfluenza viruses affecting humans have caused mild respiratory symptoms

2 What is Avian Influenza?

1 http://www.who.int/csr/disease/avian_influenza/guidelines/firstoutbreak/en/print.html2 INFOSAN Draft Note 2, November 2005- Highly pathogenic H5N1 avian influenza outbreaks in poultry andin humans: Food Safety implications. http://www.who.int/foodsafety/fs_management/No_07_AI_Nov05_en.pdf

or conjunctivitis, the Highly PathogenicAvian Influenza (HPAI)3 resulted insevere disease outbreaks with highfatality rates in 1997, 2003, and in theongoing outbreak, caused by the strain H5N1, that began in South-East Asian countries in early 2004. The disease caused by H5N1 follows an unusually aggressive clinical course, with primary viralpneumonia and multi-organ failurebeing common. From December 2003to 1st of March 2006, 174 humancases have been reported, of which 94were fatal4.

The H5N1 virus has the potential tocause catastrophic human pandemics ifit mutates into a form that transmitsrapidly between humans. Allthoughseveral mutations in the virus have beendetected during 2005, the significanceof these mutations in terms of virulenceand transmissibility in humans, is notfully understood yet.

2.3 Characteristics of theAvian Influenza virus

The H5N1virus can survive in faeces for atleast 35 days at low temperature (4°C); at37°C, viruses could survive for six days instability tests on faecal samples (in studiesusing H5N1 viruses circulating during2004). Avian Influenza viruses can alsosurvive on other surfaces, such as thosewithin the poultry house environment, forseveral days. In general, low temperaturesmaintain the stability of the viruses.

Due to these survival properties, foodpreservation processes such as freezingand refrigeration will not reduce theconcentration or virulence of these virusesin contaminated meat. Normal cooking(temperatures at or above 70°C in all partsof the product) will inactivate the virus.

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3 A Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza (HPAI),FAO/OIE/WHO,November 2005; http://www.fao.org/ag/againfo/subjects/documents/ai/HPAIGlobalStrategy31Oct05.pdf4 Lab confirmed cases reported to WHO.http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_03_01/en/index.html

3.1. Primary productionfarming systems in rural orurban settings

Based on farm biosecurity and the systemused to market products, FAO has broadlydefined the following primary productionsectors5:

SSeeccttoorr 11:: Industrial integrated system withhigh level of biosecurity and birds/productsmarketed commercially (e.g. farms that arepart of an integrated broiler productionenterprise with clearly defined andimplemented standard operating proceduresfor biosecurity).

SSeeccttoorr 22:: Commercial poultry productionsystem with moderate to high biosecurityand birds/products usually marketedcommercially (e.g. farms with birds keptindoors continuously; strictly preventingcontact with other poultry or wildlife).

SSeeccttoorr 33:: Commercial poultry productionsystem with low to minimal biosecurityand birds/products usually enter livebird markets (e.g. a caged layer farmwith birds in open sheds; a farm with poultry spending time outside the

shed; a farm producing chickens andwaterfowl).

SSeeccttoorr 44:: Village, peri-urban or urbanbackyard production with minimalbiosecurity and birds/products consumedlocally. This sector includes low incomehouseholds wherein people live with poultryand other animals; and / or carry outunhygienic slaughtering within householdpremises.

The probability of infection is higher inproduction sectors 3 and 4 than insectors 1 and 2. However, if the virusdoes enter farms in sectors 1 and 2,infection may have a greater impact dueto the concentration of susceptible poultryin these farms.

More detailed information on primaryproduction farming systems in ruraland/or urban settings and therelationships to Avian Influenza can be found at the websites of the Food and Agriculture Organisation(http://www.fao.org/) and of the WorldOrganisation for Animal Health(http://www.oie.int/)

Direct and indirect factors facilitating thespread of the Avian Influenza virus

5 FAO Recommendations on the Prevention, Control and Eradication of Highly Pathogenic Avian Influenza (HPAI)in Asia September 2004 http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/27septrecomm.pdf

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High-risk farming practices6

Some of the salient high-risk farmingpractices prevalent in South-East Asia andpossibly contributing to the spread of AvianInfluenza are:

✦ Farming of multiple species ofanimals - e.g. raising ducks andchickens together wherein ducks are"silent natural carriers" of the virus andcan infect chickens; raising pigs andpoultry together wherein pigs can actas a "mixing vessel" for virus to adaptto a more lethal form for humans.

✦ Free-range poultry raising wherebypoultry move in a contaminatedenvironment to feed themselves.

✦ Free-ranging poultry in denselypopulated, rural or peri-urbansettings

✦ Use of untreated chicken faeces asfertilizer or livestock feed - The viruscan survive in manure for threemonths in cool temperatures6. Thedroppings of infected wild birds toocan infect poultry.

✦ Contaminated equipment, cages,vehicles, clothing and shoes - Poorhygiene, cleaning and disinfection.

✦ Poor ventilation of poultry sheds - Thevirus can spread by air if birds arekept closely together with poorventilation.

✦ Inappropriate disposal of dying anddead birds.

✦ Lack of adoption of `all - in, all - out'husbandry systems.

3.2 Unsafe transport

✦ Re-usage of dirty vehicles includingmotorcycles and cycles withoutremoval of faecal matter, cleaningand disinfection is risky. The H5N1virus can survive in faeces and othersurfaces for several weeks and hencecleaning and disinfectng of transport

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6 Let us stop the killer virus at source! - preventive measures to stop the spread of Bird Flu (Draft), WHO/FAO/OIENovember 2005. As from March 2006, final version available at: www.wpro.who.int/avian

AAllll-iinn,, aallll-oouutt

This refers to rearing chickens of thesame age. Once birds are sent to theabattoir or market, workers can cleanand disinfect the premises before thearrival of a new flock. Thus, the flock isprotected against the entry of new,possibly diseased, birds.

Tricycle used for transportation of poultry withoutremoval of faecal matter, cleaning or disinfection (A. Bhatiasevi, 2006)

vehicles is essential to prevent theAvian Influenza virus from spreading.This is crucial when moving to andfrom poultry farms and in and aroundwet markets.

✦ Re-usage of dirty cages fortransportation of poultry withoutcleaning and disinfection This is apotential hazard as Avian Influenzaviruses can be introduced into themarkets from contaminated crates.Therefore, material of the cage shouldbe such that it can be easily cleanedand disinfected e.g. plastic. Avoid woodas that cannot be cleaned effectively.

✦ Stacking of cages on top of the otherwithout waste trays underneath thecages - This is a potential hazard asthe faecal droppings of any infectedbirds can infect the other birds aswell as contaminate the cages andthe vehicle.

✦ Transportation of birds from one farmto another; or from one collectioncentre to another; or from the marketback to the farm / collection centre -The movement of birds, crates, orvehicles and personnel from acontaminated market can spread thevirus back to other farms, collectioncentres and markets.

✦ Caging of birds in excess ofcapacity or over stacking on a two-wheeler. This causes the birds toget distressed and defecate, whichcontaminates the feathers withfaeces.

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Continous re-usage of dirty wooden cages, litteredwith faecal matter, feathers and dirty water (WHO, 2006)

Some poultry broiler suppliers do not hesitate tostack up to 100 birds at one time on a two-wheeler(WHO, 2006)

3.3. Live animal market (wet market)

A live animal market or "wet market" is aplace where members of the public go tobuy small animals and birds that are:

✦ live and slaughtered there ✦ live and taken home to be slaughtered,

or ✦ already slaughtered and sold as meat.

3.3.1 `Wet markets whet viruses'The live animal markets or wet marketsprovide optimal conditions for the zoonotictransfer and evolution of infectious diseaseagents. Traditional Asian wet marketsprovide major contact points for people andlive animal mixing, making them importantpotential sources of viral amplification andinfection7. The traditional local demand for"warm meat" or freshly slaughtered meatsustains the wet markets.

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Examples of wet market scenes in Asia (WHO, 2006)

Wet markets can provide ideal conditions forzoonotic transfer and evolution of infectious diseaseagents (WHO, 2006)

7 Fielding R, Lam WWT, Ho EYY, Lam TH, Hedley AJ, Leung GM. Avian influenza risk perception, Hong Kong,University of Hong Kong, Special Administrative Region, China, Emerging Infectious Diseases, Vol. 11, No. 5, May 2005 677. http://www.cdc.gov/ncidod/EID/vol11no05/04-1225.htm

In the wet markets, the live animals, particularlypoultry are enclosed in small cages in numbersexceeding the capacity of cages. Although,direct hand-to-face contact is the most likelypath for infection of humans, the flapping by

distressed chickens inverted during inspection byshoppers raises fecal-dust aerosols and exposessellers, shoppers, and passers-by to any virusparticles on an infected bird. Highly denseurban populations maximize opportunities forinfection and transmission in any outbreak.

HPAI viruses have been isolated from livebird markets with, and without, evidence ofclinical disease8. Infection can spread fromthese markets to humans and to farms viathe movement of contaminated people,poultry, cages and transport equipment.Egg marketing practices can also lead tothe spread of AI viruses. Contaminated eggtrays that are recycled without disinfectioncan also spread the virus.

3.3.2 High- risk practices in the wet market9

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8 FAO Recommendations on the Prevention, Control and Eradication of Highly Pathogenic Avian Influenza (HPAI)in Asia September 2004 http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/27septrecomm.pdf9 FAO/OIE/WHO Consultation on avian influenza and human health: Risk reduction measures in producing, marketing andliving with animals in Asia, Kuala Lumpur, Malaysia, July 2005 See at: http://www.wpro.who.int/health_topics/food_safety/

Caging birds beyond capacity increases the mortalityrate and the risks transmission of Avian Influenza(WHO, 2006)

Slaughtering chickens in a wet market (WHO, 2006)

✦ Poor hygiene, cleaning and disinfectionof facility, equipment and personnelattire.

✦ Preference of `warm meat' i.e. freshmeat processed immediately afterslaughtering - The regional preferencefor warm meat has led to persistenceof wet markets10.

✦ Mixed slaughtering and selling zones.Animals including poultry arefrequently slaughtered at the selling /display premises, often in open,unprotected areas, which may releasecontaminated faeces or blood.

✦ Keeping multiple species togetherand in confined spaces.

✦ Stacking of cages on top of oneanother, without waste trays.

✦ Holding of poultry overnight andreturn of unsold birds to farms.

✦ Lack of pre-marketing health checksof poultry birds.

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10 A place where members of the public go to buy small animals and birds that are: (a) live and slaughtered there(b) live and taken home to be slaughtered, or (c) already slaughtered and sold as meat.)

Slaughtering, processing, selling and defecating livepoultry broilers - all in the same area (WHO, 2006)

Some bird species may be infected but do not showsymptoms.Allowing different species to mix is risky(A. Bhatiasevi, 2006)

Cages used without waste trays lead to faecal mattercontaminating the birds below as well as the floor(WHO, 2006)

✦ Risky operations while defeathering

✦ Lack of food safety awareness ofmarket stall owners.

✦ Lack of personal protective equipmentfor stall owners.

✦ Poor disposal of carcasses and otherhazardous wastes (liquid and solid).

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Stall owners and food handlers in a wet market lacking awareness about food safety and basic hygiene (WHO, 2006)

De-feathering without previous scalding not onlyhampers the operation per se, but also allowspotential virus contamination from feathers to meat(A. Bhatiasevi, 2006)

Unsafe disposal of feathers, carcasses and otherpotentially hazardous wastes (WHO, 2006)

3.4. Unsafe food preparationConsumers are the most vital link at the endof the food chain. All Avian Influenzapreventive and control measures followed bythe supply chain may be undone, on accountof improper handling of food, by theconsumer. Most common errors, having thepotential for increasing the risks oftransmission of Avian Influenza, are as under:

SSllaauugghhtteerriinngg aatt hhoommee –– Due topreference for ̀ warm' or ̀ fresh' meat oron account of religious beliefs or socialcustoms, many consumers, acrossregions, prefer slaughtering at home.This practice poses potential risks fortransmission of the Avian Influenza virusas well as other disease-causingpathogens, as the slaughtering may notbe as professionally carried out as byslaughtering experts in the wet markets. LLaacckk ooff hhyyggiieennee –– Poor consumerknowledge of personal and kitchenhygiene and sanitation may lead to thecontamination of work surfaces,equipment and utensils This mayindirectly help transmit the virus to notonly the food handler but also to otherpeople at home, particularly childrenand the immunocompromised oraged people. RRaaww aanndd ccooookkeedd ffoooodd ttooggeetthheerr ––Potential risk of Avian Influenzatransmission also stems frompossibilities of cross-contamination ofcooked food from raw meat if theconsumer is not careful in segregatingthem well. Besides, use of same

knives, utensils and chopping boardsfor cooked and raw food withoutthorough cleaning and sanitationoffers an indirect transmission routefor the Avian Influenza virus as well asfood pathogens. PPoooorrllyy ccooookkeedd –– Though there is noconcrete evidence of the transmissionof the Avian Influenza virus to humansthrough the food consumption mode,the possibility of the same cannot beignored as the AI virus is killed onlyafter thorough cooking wherein thecore temperature is above 70 °C. PPoooorr wwaassttee mmaannaaggeemmeenntt,, ssccaavveennggeerrss ––Improper disposal of hazardous wastelike meat trimmings, skin, feathers,blood, bones etc. outside the homes andin the open areas offers potential risksnot only to the ill-informed consumer butalso the people in the neighbourhood. Inaddition, such a practice attractsdomestic pets, street cats and otherscavengers and may result in the virus togo across species and also mutate inanimals like pigs, which act as mixingvessels for the Avian Influenza virus.

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Cat scavenging on a dead chicken in a wet market(WHO, 2006)

The Avian Influenza virus is best transmittedvia direct contact with sick and/or deadbirds. Most human cases of AI have beenrelated to such close contacts.

Biosecurity includes the management ofall biological and environmental healthrisks associated with food. In thecontext of this Manual, biosecurityconsists of a set of managementpractices which, when followed,collectively reduces the potential for thetransmission / spread of disease-causing organisms - such as the AvianInfluenza virus -onto and between sites,animals and humans.

Biosecurity comprises two main elements11

- bio-containment and bio-exclusion. Biocontainment refers to prevention of spreadof the virus from infected premises andbio-exclusion refers to measures to

exclude infectious agents from uninfectedones.

BBiioosseeccuurriittyy hhaass tthhrreeee mmaajjoorr ccoommppoonneennttss12:: IIssoollaattiioonn:: refers to the confinement oflive animals within a controlledenvironment. TTrraaffffiicc CCoonnttrrooll:: includes both thehuman traffic as well as the vehiculartraffic within the controlled environment.SSaanniittaattiioonn:: addresses the cleanlinessand disinfection of materials, peopleand equipment entering the controlledenvironment.

In simple words, biosecurity is the normalway to avoid unnecessary contact betweenanimals and microbes, infected animalsand healthy ones13. Biosecurity alsoapplies to public health measures that willreduce the contact between animals andhumans.

4 What is biosecurity?

11 FAO Recommendations on the Prevention, Control and Eradication of Highly Pathogenic AvianInfluenza (HPAI) in Asia September 2004. http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/27septrecomm.pdf 12 Poultry fact sheet no. 26, Cooperative Extension, University of California, March 1997.http://animalscience.ucdavis.edu/avian/pfs26.htm 13 Prevention and control of avian flu in small scale poultry, A guide for veterinary paraprofessionalsin Cambodia, FAO, 2005. http://www.fao.org/ag/againfo/subjects/documents/ai/AI-paravets-guide.pdf

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5.1. Secured primaryproduction farming systems14

While there is a need to reinforce biosecuritymeasures in sectors 1 and 2 farms, prioritymust be given to sectors 3 and 4 farms andassociated communities where humans livein close proximity to the animals beingraised by them or other communitymembers15. The key biosecurity measuresrecommended include the following:

✦ KKeeeepp tthhee wwiilldd bbiirrddss aawwaayy –– It isimportant to keep wild birds andducks, natural reservoirs of the virus,off farms. Many species can beinfected but will not show any signs ofdisease. They can excrete the virus for

30 days and contaminate feed, andshared water sources e.g. ponds.Therefore, poultry should be kept in aprotected place16: a fenced park,under the house protected by afishing net or better, a secured poultrypen. They must also have access toclean water and feed.EEnnssuurree AAllll-iinn,, aallll-oouutt ii..ee.. ensuring thatall birds from a shed / pen are sent tothe abattoir or market. Workersshould then clean and disinfect thepremises / shed / pen effectively (novisible feathers or faeces remaining)before the arrival of a new flock. Thispractice would contribute immensely

Taking action to enhance biosecurity allalong the food chain5

Fenced park Poultry pen Poultry kept under the House, behind a fishing net

14 Let us stop the killer virus at source! - Preventive measures to stop the spread of Bird Flu (Draft),WHO/FAO/OIE November 2005. www.wpro.who.int/avian 15 FAO/OIE/WHO Consultation on avian influenza and human health: Risk reduction measures inproducing, marketing and living with animals in Asia, Kuala Lumpur, Malaysia, 2005.http://www.wpro.who.int/health_topics/food_safety/ 16 Prevention and control of avian flu in small scale poultry. A guide for veterinary paraprofessionals inCambodia, FAO, 2005. http://www.fao.org/ag/againfo/subjects/documents/ai/AI-paravets-guide.pdf

in the containment of the avian flu.Unsold birds should not be returnedto the farm, but be slaughtered andsold as processed meat.

✦ AAvvooiidd mmuullttii-aaggee ppoouullttrryy ffaarrmmss17 aspartial sale of birds from commercialfarms presents a greater biosecurityrisk than the sale of the entire batchof birds as recommended under all-in, all-out production. This isprimarily because birds remaining inthe farm are exposed to catchers orother workers, who customarily movefrom farm to farm and can readilyspread infection if H5N1 virus iscirculating in the area.

✦ PPrrooppeerr vvaacccciinnaattiioonn of domesticpoultry, which ensures that thevaccine matches the circulating strainof virus, is considered to be a usefultool as part of an overall integratedstrategy for the control of H5N1. Itmust be implemented in accordancewith existing standards andprocedures for vaccination, includingin backyard flocks in rural and urbansettings. Poultry are usuallyvaccinated with a vaccine made frominactivated viruses which itself doesnot pose a food safety risk. Suchprocedures would ensure that noasymptomatic infected bird wouldenter the food chain. Therefore,

where there are appropriatemonitoring programmes in place,vaccinated poultry can enter the foodchain without particular risk to theconsumer.

✦ PPrreevveenntt movement of poultry fromone farm to another18 as H5N1infected birds, if any, on one farmmay transmit the virus to flocks on theother farm.

✦ CClleeaann and disinfect the premises andequipment on farms - Install adisinfectant pool at entrance to eachpoultry shed / pen and ensurevehicles entering the farm are notcontaminated.

✦ LLiimmiitt the access of visitors to areaswhere poultry are housed andprovide clean protective clothes,including boots, to people visiting thefarm. This is important as clothingand footwear are important means bywhich the virus can spread.

✦ OObbttaaiinn feed from a clean, dependablesource. Store feed properly so that it isbird-proof, insect-proof, and rodent-proof. Obtain water from a cleansource and ensure it is free fromcontamination. Drinking water, ifsourced from ponds or from a doubtfulsource, should be chlorinated.

✦ IInnssttrruucctt animal health workers toguard against spreading infection

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17 Poultry birds of different age are kept by farmers to spread their income and to avoid the financial risksassociated with having all birds entering the market on the same date 18 Costs and Benefits of regulatory Control in Wet Markets in Hong Kong , WHO (WPRO), Draft 02, 2004

accidentally from during their visits toother farms.

✦ EExxcclluuddee poultry from the home; alsoprohibit farm workers from rearingtheir own poultry at home.

✦ EEffffeeccttiivvee mmaannaaggeemmeenntt ooff hhaazzaarrddoouusswwaasstteess - Proper disposal of carcassesand other hazardous waste (liquidand solid) needs to be enforced.

● All dead birds and other contaminatedobjects (for instance: faeces, blood,feathers) must be destroyed properly19

as soon as possible throughout the day:◗ BBuurryyiinngg - Dig a hole (far from the

poultry sheds) put some quicklimeat the bottom and on the bordersof the hole; put all the birds andobjects in the hole; cover withquicklime; cover with earth.

◗ IInncciinneerraattiioonn,, if suitable incinerationfacility is available.

More detailed information on biosecuritymeasures for primary production farmingsystems in rural and/or urban settings to be found at http://www.fao.org/andhttp://www.oie.int/

5.2. Safe transport✦ AAvvooiidd ttrraannssppoorrttaattiioonn ooff ppeeooppllee aanndd lliivvee

aanniimmaallss ttooggeetthheerr,, eessppeecciiaallllyy ppoouullttrryy,,eennssuurriinngg aa sseeppaarraattee eenncclloossuurree ffoorr eeaacchh..

This will reduce the risks of potential AItransmission directly as well as indirectlythrough faecal depositions.

✦ UUssee oonnllyy cclleeaann aanndd ddiissiinnffeecctteedd ttrraannssppoorrttvveehhiicclleess for movement of poultry andeggs. Do not reuse dirty vehicles, litteredwith faecal matter, without propercleaning and disinfection, as the H5N1virus can survive in organic faecalmatter for several days. During vehiclecleaning and disinfection, the mainareas to concentrate are wheels, wheelarches, chassis and underbody, ifpossible; the trailer / area where poultryare transported; cages; sheeting orother covers on the vehicle

✦ DDoo nnoott ccaaggee bbiirrddss iinn eexxcceessss of thecage capacity. The H5N1 virus canspread by air if birds are kept closelytogether as well as from faecal matter,which may contaminate the bird'sfeathers, on account of less space.Preferably, cage capacity should notbe less than 300 cm2 per kg, with aheight of not less than 30 cm20.

✦ UUssee wwaassttee ttrraayyss - If birds with cagesare stacked on top of each other, usewaste trays underneath the cages forcollecting poultry droppings, whichcan then be safely disposed alongwith other hazardous waste byburying. The trays used should be ofthe same size as the cages.

17

19 Prevention and control of avian flu in small scale poultry, A guide for veterinary paraprofessionals inCambodia, FAO, 2005. http://www.fao.org/ag/againfo/subjects/documents/ai/AI-paravets-guide.pdf20Costs and Benefits of regulatory Control in Wet Markets in Hong Kong, WHO (WPRO), Draft 02, 2004

✦ AAvvooiidd ccoolllleeccttiinngg aanndd ttrraannssppoorrttiinnggbbiirrddss ffrroomm ddiiffffeerreenntt ffaarrmmss oorrccoolllleeccttiioonn cceennttrreess iinn tthhee ssaammeevveehhiiccllee and avoid transportation ofbirds from one farm / collectioncentre to another or from themarket back to the farm /collection center, as H5N1 infectedbirds from a farm or a market maytransmit the virus to other healthyflocks.

✦ DDoo nnoott ttrraannssppoorrtt ppoouullttrryy wwiitthh ootthheerrbbiirrddss aanndd aanniimmaallss,, as thisincreases the likelihood that AvianInfluenza viruses will enter otheranimal / bird populations, riskinginfection and reassortment with theother influenza viruses, leading to emergence of new strains ofinfluenza viruses.

✦ GGiivvee pprreeffeerreennccee ttoo nnoonn-wwooooddeenn //bbaammbboooo ccaaggeess:: Use cages made ofmaterials like plastic or non-toxicmetal that can be easily cleaned anddisinfected.

5.3 Biosecurity in wetmarkets

✦ SSeeggrreeggaattiioonn ooff ssppeecciieess - Whenintroducing poultry to the market,maintain the separation of species bykeeping separate species in differentcages.

✦ EEnnssuurree aallll-iinn,, aallll-oouutt ii..ee.. bringingin and taking out a flock at onetime. This would imply selling allbirds on site. Avoid returning

unsold birds to the farm, as theymay be infected and may carryback the virus. Prior arrangementsmust be made for birds that areunsold.

✦ SSllaauugghhtteerriinngg zzoonneess - Strictly ensure a separate area for poultryslaughtering, processing awayfrom the selling area. This willimprove biosecurity and reducethe likelihood that products orconsumers in other areas getcontaminated.

✦ PPrroocceessssiinngg eeqquuiippmmeenntt aanndd wwoorrkkssuurrffaacceess - Use non-toxic, imperviousand easily cleanable work surfaces(e.g. chopping boards, work tables).Avoid use of wooden surfaces,wooden knives as they cannot becleaned.

✦ PPrroocceessssiinngg - EEnnssuurree pprrooppeerrssccaallddiinngg ooff ppoouullttrryy bbeeffoorree ddee-ffeeaatthheerriinngg.. Use hot, potable waterfor scalding and change thescalding water frequently.

✦ CCuussttoommeerr oorriieennttaattiioonn - Do notallow or permit the customers to touch and inspect live poultrybefore purchase; ddiissccoouurraaggeesseelllliinngg lliivvee ppoouullttrryy ttoo ccuussttoommeerrss.

✦ CCoolldd CChhaaiinn ffaacciilliittiieess - Though thevirus survives low temperatures,adherence to the cold chain is vitalfrom the food safety perspective.Ensure chillers and chilled displaycabinets are used with back-uppower supply.

18

● HHyyggiieennee,, ssaanniittaattiioonn aanndd wwaasstteemmaannaaggeemmeenntt21::◗ CCoommppuullssoorryy rreesstt ddaayyss –– The live

animal markets in many areas mightbe working seven days a week.Having compulsory rest daysperiodically would facilitate emptying,cleaning and disinfecting the entiremarket regularly. This would improvehygiene and prevent build up ofpathogens and H5N1 virus load

◗ HHyyggiieenniicc ccaaggeess –– Cages holdingpoultry should not be placedbelow cages with other birds, to

prevent cross-contamination withfaeces. If unavoidable, place wastetrays under the cages. Ensureadequate ventilation and lowerstacking crates so as to helpreduce infection.

◗ CClleeaanniinngg ffaacciilliittiieess –– Set up aseparate area to clean anddisinfect cages. Cages should bemade of material easy to clean anddisinfect. Hand washing basins withsoap and potable water should beprovided where humans and birdscome into contact.

◗ CClleeaann aanndd ddiissiinnffeecctt pprreemmiisseess aannddeeqquuiippmmeenntt –– Following slaughteringoperations, clean and disinfectpremises (floors, walls, work tables,slabs, racks etc.) and equipment(knives, hooks, killing cones, de-featherer, scalder, chopping boardetc.) frequently.

19

Separate selling area observed in some wet markets(WHO, 2006)

Use of plastic cages: easy to clean and wash (WHO, 2006)

21 Let us stop the killer virus at source! - Preventive measures to stop the spread of Bird Flu (Draft),WHO/FAO/OIE November 2005. As from March 2006, final version available at: www.wpro.who.int/avian

◗ DDrraaiinnaaggee ssyysstteemm –– Ensure drainsare covered, sloped well andfacilitate flow of effluent in adirection opposite to the processflow (e.g. blood and scaldingwater from slaughtering areashould not flow towards theforward process flow areas likeselling area).

◗ PPeerrssoonnaall pprrootteeccttiivvee ggeeaarr –– Ensureworkers in slaughtering andselling operations wear clean,light coloured protected clothing,including clean aprons andrubber boots everyday and avoidusing the same clothes and bootsback home.

◗ PPeerrssoonnaall hhyyggiieennee –– Ensure theworkers handle live poultry andengage in slaughter only after athorough handwash with soapand potable water. Hands shouldbe washed frequently with soap and potable water andparticularly after change ofprocesses. Following slaughterand processing, the workersshould preferably take a bath atthe market personnel facilities orchange into clean clothes andshoes after washing hands, armsand feet thoroughly with soap andpotable water and drying withclean towel / cloth.

● EEffffeeccttiivvee mmaannaaggeemmeenntt ooff hhaazzaarrddoouusswwaassttee –– Proper disposal of carcasses,blood and other hazardous waste (liquidand solid) disposal needs to be enforced.

● All dead birds and other contaminatedobjects (for instance: blood, feathers)must be destroyed properly22 as soonas possible during the day throughproper burying or incineration, asmentioned earlier.

● DDiisseeaassee ddeetteeccttiioonn ◗ MMoonniittoorriinngg –– Poultry in the market

should be continuosly assessed forsickness. Collaborate to conductregular surveillance, sampling andanalysis along with marketassociations, local health authoritiesand veterinary authorities.

◗ NNoottiiffiiccaattiioonn –– Report diseased ordead birds immediately to health andveterinary authorities. Appropriateaction should then be taken by theauthorities.

◗ TTrraacceeaabbiilliittyy –– Support efforts toensure that the source of sick birds istraceable back along the productionand marketing chain.

● FFoooodd ssaaffeettyy ttrraaiinniinngg aanndd aawwaarreenneessss◗ Train the market community

associations, market stall owners,workers and local health authorities

20

22 Prevention and control of avian flu in small scale poultry, A guide for veterinary paraprofessionals inCambodia, FAO, 2005. http://www.fao.org/ag/againfo/subjects/documents/ai/AI-paravets-guide.pdf

in basic food safety aspects andmeasures to be taken for mitigatinginfection risks from Avian Influenza.

5.4 Consumption - Safety atCustomers' and Consumers'end

● AAvvooiidd bbuuyyiinngg lliivvee ppoouullttrryy// bbiirrddss aanndd tthheennssllaauugghhtteerriinngg aatt hhoommee aanndd//oorr iinn ffooooddsseerrvviiccee eessttaabblliisshhmmeennttss.. Slaughtering,de-feathering and degutting poultrybirds can be risky if infected. ◗ Where available, buy processed,

chilled and hygienically packedraw poultry meat from anestablished and reputed marketplace and preferably from anaccredited Hazard Analysis CriticalControl Point (HACCP) food safetysystems certified company.

● KKeeeepp CClleeaann –– When preparing food,follow good hygiene practice. Cleanand sanitize work surface, equipmentand utensils and wash handsfrequently.

● SSeeppaarraattee rraaww aanndd ccooookkeedd ffoooodd iitteemmss–– Separate raw from cooked meatand other cooked food items. Useseparate equipment and utensils such

as knives and chopping boards forraw foods.

● Cook thoroughly - To ensure thesafety of cooked meat, its juices mustrun clear and no parts of the meatshould be red or pink. Ensurethorough boiling / roasting / frying(ccoorree tteemmppeerraattuurree ooff ffoooodd sshhoouulldd bbeemmoorree tthhaann 7700 CC) as this kills the virusand other pathogens too. ◗ Eggs from infected birds can harbour

the virus both outside and within theshell and should therefore becooked well (with no "runny" yolks)before consumption. Raw eggsshould not be used in foods that willnot be further heat-treated as, forexample by cooking or baking.

● DDoo nnoott pprreeppaarree aanndd ccoonnssuummeessppeecciiaalliittyy rraaww ddiisshheess made from birdsor poultry raw meat and blood.

● KKeeeepp ffoooodd aatt ssaaffee tteemmppeerraattuurreess ––From the food safety perspective, eatcooked food immediately and do notleave cooked food at roomtemperature beyond 2 hours. Keepcooked food steaming hot (morethan 60°C) prior to serving.

21

6.1 How are people infected?Direct contact with an infected bird, poultry, orspaces and surfaces and objectscontaminated by their faeces, is presentlyconsidered the main route of humaninfection. As infected birds shed largequantities of virus in their faeces, opportunitiesfor exposure to infected droppings or toenvironments contaminated by the virus areabundant under such conditions. Exposure isconsidered most likely during slaughtering,defeathering, butchering, and preparation ofpoultry for cooking.

WWhhaatt pprreeccaauuttiioonnss sshhoouulldd bbee ttaakkeenn bbyyppeeooppllee iinnvvoollvveedd iinn tthhee ffoooodd cchhaaiinn??VVaacccciinnaattiioonn ffoorr ppuubblliicc hheeaalltthh ppuurrppoosseess::Health authorities may considervaccination against seasonal influenza forpersons at risk of occupational exposure tothe H5N1 virus. Vaccination againstseasonal influenza is a public healthmeasure aimed at reducing opportunitiesfor the virus to re-assort during co-infectionof a human with both avian and currentlycirculating human influenza viruses. Atleast some pandemic viruses are known tohave emerged following a re-assortmentevent. Vaccination against seasonalinfluenza will not protect people againstinfection with the H5N1 virus; no vaccineagainst H5N1 is presently available.

Persons who are in close contact with liveanimals including birds and poultry shouldwash their hands frequently with soap,particularly after change of a process.

Persons undertaking slaughtering andthose in selling operations should wearclean, light coloured protected clothing,including clean aprons and rubberboots everyday and avoid wearing thesame clothes and boots while returninghome.

Following slaughter and processing, theconcerned persons should preferably takea bath at the market personnel facilities orchange into clean clothes and shoes afterwashing hands, arms and feet thoroughlywith soap and potable water and dryingwith clean towel / cloth.

Food handlers /consumers should avoidbuying live animals (poultry) and thenslaughtering them at home / food serviceestablishments.

Food handlers / consumers involved infood processing / preparation should washtheir hands thoroughly with soap and warmwater. They should clean and disinfectequipment and surfaces in contact with themeat products.

6 Protection of human beings

24

All concerned persons at risk, bothenvironmentally and occupationally23,should be vaccinated with the currentWHO recommended influenza vaccine assoon as possible, to avoid simultaneousinfection by human influenza and AvianInfluenza. This, however, does notspecifically protect against H5N1.

HHooww ddoo yyoouu kknnooww iiff yyoouu aarree iinnffeecctteedd??24

Be aware of the early clinical symptoms ofH5N1 infection, but also know that manyother common diseases - of far less concern- will show similar early symptoms.

✦ Most patients infected with the H5N1virus show initial symptoms of fever(380 C or higher) followed byinfluenza-like respiratory symptoms,including cough, rhinorrhea, sorethroat, and (less frequently) shortnessof breath. Watery diarrhoea is oftenpresent in the early stages of illness,and may precede respiratory symptomsby up to one week. Gastrointestinal

symptoms (abdominal pain, vomiting)and headache may occur.

✦ Check for these signs (especiallyfever) each day during potentialexposure and for 14 days after lastexposure.

✦ Communicate any symptoms to adesignated local physician andprovide background information onhistory of exposure.

23 Persons at risk include poultry workers, poultry transport and slaughtering workers, cullers, veterinarians,food inspectors, local health authority personnel and other professional groups. 24 http://www.who.int/csr/disease/avian_influenza/guidelines/firstoutbreak/en/print.html

Children especially should be made aware of therisks involved in having close contact, or playing withbirds (WHO, 2006)

7.1 The impending needA recent OIE, WHO and FAO consultationon Avian Influenza and human health25

recognized the major role that wet marketshave played in the emergence of AvianInfluenza. In 1992, live poultry markets inUSA were considered the "missing link inthe epidemiology of influenza". In 1997,the wet markets were identified as thesource of H5N1 infections in chicken farmsin Hong Kong, wherein 20 % of the chickenin wet markets were found to be infected. In2005, it has been reported that 83% of thehuman H5N1 cases around the world havehad exposure to infected poultry.

A joint WHO/ FAO/OIE/World BankConference on Avian Influenza and HumanPandemic Influenza, held at Geneva(November 2005, stressed the need tocontain the Avian Influenza H5N1 at thesource i.e. at poultry farms and at liveanimal markets or "wet markets".Subsequently, experts have urged thecountries to develop integrated nationalplans across all sectors.

While the efforts of many agencies arerightly and predominantly aimed atcontaining the virus at the primary end ofthe food chain i.e. at the poultry farms,WHO, with its experience of developing"Healthy Marketplaces", needs to takeinitiatives at the intermediate i.e. themarketplaces, particularly the "wet market"and the tertiary ends of the food chain i.e.the food service establishments and foodprocessing industry, as well as theconsumers of poultry products.

Accordingly, this Manual outlines thestrategy and plans of action for evolvinghealthy market places with the emphasis on"wet markets".

7.2 Strategya) Obtain broad political commitment

at the local level and stakeholderparticipation26.

b) Assess the physical and operationalenvironment of the market settingsprioritize action and develop anaction plan.

25 OIE/FAO/WHO Consultation on Avian Influenza and Human Health: Risk reduction measures inproducing, marketing and living with animals in Asia, July 2005, Malaysia

26 Healthy marketplaces in the Western Pacific - Guiding Future Action - Applying a settings Approach to thepromotion of Health in Marketplaces, WHO (WPRO), 2004. To be purchased at:http://www.wpro.who.int/publications/pub_9290611707.htm

Promoting Healthy Food Markets - Strategy and Plans7

c) Develop communication plans andmaterials aimed at the general public

d) Adapt / develop a framework formonitoring and analysis of costs andbenefits27 of "Healthy Food Markets"

7.3 Implementing thestrategy

7.3.1 Obtain broad politicalcommitment and stakeholderparticipation

a) Familiarize stakeholders with theHealthy Food Markets concept andfood safety, and foster politicalcommitment of national, provincial andlocal authorities for supporting HealthyFood Markets Programme to ensuresupport with appropriate resources.

b) Establish a local / district / provincialHealthy Food Markets committee withrepresentation of all stakeholders forregular monitoring of implementationof action plans.

c) Identify priority health and safetyissues (current biosecurity level) of thelive animal markets and assess theirpotential contribution to the currentoutbreak of Avian Influenza.

d) Identify the salient markets thatrequire priority implementation andfacilitate the launch of a pilot"Healthy Food Market(s)".

7.3.2 Assess the Physical andOperational Environment of themarket settings, prioritize action anddevelop an action plan.

a) Jointly assess the current situation: design,construction and upkeep of the physicalenvironment of the marketplace in thecontext of hygiene and sanitation.Chapter 3.3 in this Manual provides hintsto help evaluate the market operations.

b) Jointly identify the gaps concerningmeasures, including infrastructure, aimedat protecting the health of consumers andthe market community. Adapt measuresoutlined under Chapter 5.3, 5.4. andChapter 6.0 in this Manual.

c) Prioritize the most urgent and feasibleactions and organize them in a timeframed plan, along with budgetaryneeds and identification of roles thateach segment of the marketcommunity should fulfill.

7.3.3 Develop Communication plans andmaterials aimed at the general public To raise awareness on the advantages of"Healthy Food Markets", some key messageshave been included in this Manual. These,and the more general "5 key food safetymessages"28 can be adapted to local needs,for different public segments, with referenceto Avian Influenza. For example:

26

27 Costs and Benefits of regulatory Control in Wet Markets in Hong Kong, WHO (WPRO), Draft 02, 200428 Five Keys to Safer Food: "First adapt, then act" WHO, SEARO, 2005.http://w3.whosea.org/en/Section23/Section1001/Section1110.htm and "Let us stop the killer virus atsource" - Preventive Measures to stop the spread of bird flu (Draft) WHO/FAO/OIE (2005). As from March2006, final version available at: www.wpro.who.int/avian

✦ Key food safety messages forconsumers, including those for safehandling and consumption of poultryand animal products.

✦ Key food safety messages for themarketing community with specificreference to measures for "wet markets".

✦ Key food safety messages for foodservice establishments with specificguidance in the context of handling,slaughtering processing / cookingand serving of poultry products.

7.3.4 Adapt / develop a framework formonitoring and analysis of costs andbenefits of "Healthy Food Markets"

a) To assess the viability to replicate thisinitiative in other settings, develop /

adapt a framework for monitoringand analysis of the actual costsincurred by the wet marketcommunity and other contributors(local, district, provincial, nationaland international stakeholders).Include all cost elements viz.infrastructure, market surveillance,research, training, etc.

b) Identify indicators to measure thebenefits of Healthy Food Markets viz.enhanced public health; treatment and control expenditures avoided;economic losses avoided; preventinga pandemic; public empowerment;etc.

c) Carry out an evaluation of the validityof Healthy Food Markets.

27

8 Key public health messages

Key public health messages for the general publicAAvvooiidd ssllaauugghhtteerriinngg lliivvee ppoouullttrryy aanndd bbiirrddss aatt hhoommee // ffoooodd sseerrvviiccee eessttaabblliisshhmmeennttss..

✦ Slaughtering, de-feathering and degutting poultry / birds can be risky if the poultry/ bird are infected.

✦ Buy processed, chilled and hygienically packed raw poultry meat from anestablished and reputed market place.

KKeeeepp CClleeaann ✦ When preparing food, practice good hygiene. Clean and sanitize the work surface,

equipment and utensils and wash hands frequently.

SSeeppaarraattee rraaww aanndd ccooookkeedd ✦ Separate raw meat from cooked meat and other cooked food. Use separate

equipment and utensils such as knives and chopping boards for raw foods.

CCooookk tthhoorroouugghhllyy ✦ For cooked meat and poultry to be safe, their juices must run clear and no parts

of the meat should be red or pink. ✦ Ensure thorough boiling / roasting / frying ((ccoorree tteemmppeerraattuurree ooff ffoooodd sshhoouulldd bbee

mmoorree tthhaann 77000CC)) as this kills the virus and other pathogens too.✦ DDoo nnoott pprreeppaarree aanndd ccoonnssuummee ssppeecciiaalliittyy rraaww ddiisshheess made from birds and poultry

raw meat and blood. ✦ Eggs can contain the virus both on the outside (shell) and the inside (whites and

yolk). Eggs from areas with Avian Influenza outbreaks in poultry should not beconsumed raw or partially cooked (runny yolk); uncooked eggs should not be usedin foods that will not be cooked, baked or heat-treated in other ways.

Key public health messages for the public in affected areas30

✦ Avoid contact with chickens, ducks or other birds unless necessary.✦ Keep children away from poultry and their waste or feathers.✦ Do not keep birds as pets.✦ If you touch poultry or poultry faeces from affected areas, or walk on soil

contaminated with faeces, wash hands with soap and water. Clean shoes outsidethe house. Seek medical help if you feel unwell.

30

Key public health messages for professional cullers(And ppeople hhandling ddiseased bbirds oor ddecontaminating ffarms)

✦ Wear protective clothing (mask, goggles, gown, rubber boots and gloves). Ifunavailable, cover mouth with a cloth and hands and shoes with plastic bags, tiedwith string. Wash or dispose clothing.

✦ Dispose of diseased birds properly by burying bird carcasses and faeces at adepth of at least 1metre. Avoid generating dust. Clean the area well withdetergent.

✦ All persons who have been in close contact with the infected animals should washtheir hands with soap and potable water and disinfect frequently.

Key messages for Local Health Authorities

✦ All persons exposed to infected chickens or to farms or to live animalmarkets under suspicion should be under close monitoring by local healthauthorities.

✦ It is recommended that persons at specific risk of inhaling possible infectedmaterial (e.g. cullers and farmers involved in mass culling at commercialfarms, workers at centralized live animal markets) receive prophylaxis withantivirals3.

✦ Such persons should also be vaccinated with influenza vaccine to avoidsimultaneous infection by human influenza and Avian Influenza and to minimizethe possibility of a re-assortment of the virus's genes.

✦ Persons at high risk for severe complications of influenza (e.g.immunocompromised, over 60 years old, or with known chronic heart or lungdisease) should not be allowed to work in the high risk areas (e.g. culling,slaughtering).

✦ There should be a serological surveillance of exposed animal workers andveterinarians.

Questionnaire tto aassess ppractices iin wwet mmarkets - PPage 11

Date: ______________________________ Period of time: _______________________________________

Country:____________________________ Location: _______________________________________

Name of Market: ____________________ Address of Market: ____________________________________

Category of market: (tick one box) Urban market Rural market Other - Describe_______

Category of market: (tick one box) Wholesale Retail Mixed wholesale and retail

Live animal section: (tick one box) Permanent/fixed location Not permanent/fixedlocation Mixture fixed/not Fixed

1. Origin of animals sold in Wildlifethe marketplace Animals from backyard/free-range farms(you may tick more than Animals raised in pens or cagesone box) Origins of some animals not known

2. Total number of animals Less than 10 10-100 101-200 More than 200 for sale in the market on the day of inspection(tick one box)

3. Kinds of live animals for Chicken Turkey Dog Civet cat ................sale in the entire market Duck Wild bird Cat Raccoon dog ................(you may tick more than Goose Pig Monkey Ferret-badger ................one box) Quail Rabbit Turtle ................ ................

Pigeon Rodent Reptile ................ ................

4. Manner of caging of Several animals share a cage/crate/penanimals (you may tick Different kinds of animals are caged separatelymore than one box) Different kinds of animals are caged together

Cages are stacked one on top of anotherAnimals are not caged

5. Types of cage material Steel/Wire Bamboo Wooden crate(you may tick more than Plastic Basket Sack one box) Other - Please describe ________________________________________

6. Slaughtering of animals Not done in the market(YOU MAY TICK MORE Done within animal stallsTHAN ONE BOX) Done in a common area

9 Sample questionnaire to assess practices inwet markets

(Draft WHO, FOS/WPRO, 2005)

32

Questionnaire tto aassess ppractices iin wwet mmarkets - PPage 22

7. No. of days animals may 1 day or less 2 days remain in the stalls 3-7 days More than 7 days(you may tick more than Other - Please describe ________________________________________one box)

8. Fate of animals not sold Returned to farm after each day at the end of a day or Returned to farm after 1 daylonger Killed and consumed by vendor or family(you may tick more than Other - Please state ___________________________________________one box)

9. Are animals arriving on Yes different days, mixed No together?

10.In relation to sick or Animals are accepted in the market for sale even if sick Yes No dead animals Animals are accepted in the market for sale even if dead Yes No (you must answer all) Animals that die while in the market are still sold Yes No

Animals that become sick while in the market are still sold Yes No

11.Are animals sampled On all animals Yes No locally for testing? On sick animals Yes No (you must answer all) On animals that die in the market Yes No

Other Yes No If yes please state:..........

12.Do veterinarians inspectanimals in the market?(tick one box)

13. How frequently is the Not cleaned Daily Weekly Monthly Other - Please state.. marketplace cleaned?(tick one box)

14.Are all animals Yes No removed during cleaning?

15.Are animal stall holders Not required to cleanrequired to clean their Yes Daily Yes Weekly Yes Monthly Yes Other - Please state … stalls and cages or pens?(tick one box)

16.Is a particular cleaning Yes No If Yes please describe what is requiredprogramme required and ……………………………………….enforced for animal stalls?

17.On the day of inspection Yes No If No, please describedoes it appear that the …………………………………. cleaning programme is effective

18.Location of live animal Separated structure from other sections Mixed with other sectionssection

No Weekly On arrival of animals onlyDaily Monthly Other - Please state

Note: AAnimal rrefers tto aall mmammals aand bbirds

Name, ffunction aand ssignature oof tthe pperson wwho aadministered tthis qquestionnaire:

(Extract from the report of the ExpertMission to Support Develop a NationalAction Plan to Prevent and Control theSpread of the Avian Influenza Virus inWet Markets, Jakarta, Indonesia, January2006)29

SSTTEEPP 11:: FFaammiilliiaarriizzee ssttaakkeehhoollddeerrss wwiitthh tthheeHHeeaalltthhyy FFoooodd MMaarrkkeettss ccoonncceepptt aanndd eennssuurreebbrrooaadd ppoolliittiiccaall ccoommmmiittmmeenntt aanndd aaccttiivveessttaakkeehhoollddeerr ppaarrttiicciippaattiioonn It is envisaged to first hold a two / three daymeeting / workshop of all stakeholders tofamiliarize them with the Healthy FoodMarkets concept and obtain theircommitment and active support indeveloping a National Healthy Food MarketProgramme (HFMP). The participation of allkey stakeholders is recommended. Actionsto be taken include:

✦ Constitution and empowerment of aNational Multisectoral HFM TaskForce for initiation, coordination andmonitoring of the HFMP and of CoreGroups for regular oversight ofrespective HFM Pilot Projects;

✦ Costing of national HFMP and pilotHFM projects and provision offunds from the private sector anddonors.

SSTTEEPP 22:: RRaaiissiinngg ppuubblliicc aawwaarreenneessss ffoorrpprreevveennttiinngg aanndd ccoonnttrroolllliinngg AAvviiaann IInnfflluueennzzaaBased on WHO's advice on prevention andcontrol of Avian Influenza, the HFMP taskforce to develop risk based messages inlocal / regional languages for differenttarget segments viz. consumers, live or wetanimal market personnel and authorities(national, provincial and local). The riskcommunication strategy to disseminateAvian Influenza prevention messages needsto be worked out by the Task Force, keepingin view the priorities and availability of funds.

SSTTEEPP 33:: CCaappaacciittyy bbuuiillddiinngg ooff WWeett MMaarrkkeettPPllaaccee SSttaakkeehhoollddeerrss iinn HHeeaalltthhyy FFoooodd MMaarrkkeettccoonncceeppttThe multisectoral HFMP Task Force, inclose association with donor agencies,should organize a `Training of Trainers'programme to familiarize stakeholdersincluding consumer representatives /consumer associations with Healthy FoodMarkets concept.

SSTTEEPP 44:: CCoonndduucctt llooccaall ppaarrttiicciippaattoorryyssiittuuaattiioonn aannaallyyssiiss ooff tthhee eexxiissttiinngg mmaarrkkeettccoonnddiittiioonnss aanndd iiddeennttiiffyy ggaappss..In order to plan activities in the identifiedHealthy Food Market Place Projects, the

Proposed steps to launch a NationalHealthy Food Markets Programme10

29 For more information contact Hildebranda@searo.who.int at WHO SEARO

respective core group of pilot projectsshould conduct a detailed situationalanalysis to identify the needs of the partners.The core group should conduct a surveyamong the `wet market' communitymembers, consumers and live animalsuppliers to identify health and safetyconcerns and possible solutions from theirpoint of view. Complete the list of concernsand solutions based on the elements formthe tables below. Based on the survey, thecore group is required to identify the gaps in

the physical and operational environment ofthe market setting.

SSTTEEPP 55:: PPrriioorriittiizzee tthhee aaccttiioonnss aanndd ddeevveellooppwwoorrkk ppllaannss wwiitthh bbuuddggeettss ffoorr rreessppeeccttiivvee ppiilloottpprroojjeeccttss.. Based on the identified gaps, the respectivecore groups to prioritize actions based onrisk and develop work plans in associationwith the HFMP task force. The keyprocesses involved in developing the workplan are depicted as under:

34

List aandprioritizeactivitiesbased oonidentified ggaps

Identify bbudget aandresources rrequiredfor pprioritizedactivities

Market AAssociation ✦✦ pooled ffunds✦✦ Fees ffor ffacilitiesDefine

objectives,measures aandtargets fforeachprioritizedactivity

Identify ssources aandmobilize ffunds fforbudgeted, pprioritizedactivities

Self-mmobilization bbymarket mmembers

Defineindicators fformonitoringand eevaluationof eeach aactivity

Develop aa ttimeschedule aand iidentifywho ddoes wwhat aandwhen ffor eeachprioritized aactivity

Government //Donors // LLoans

SSTTEEPP 66:: IImmpplleemmeenntt tthhee wwoorrkkppllaannss Keeping in view the priorities, the workplansshould be implemented by the empoweredcore groups for the respective pilot projectin a participatory way. Before and duringthe implementation process it is essentialthat the ownership of the stakeholders isensured. The wet market community andlive animal suppliers should be activelyinvolved throughout all stages of theplanning process, as many changes andimprovements in the market's physical andoperational environment will require theircooperation as well as resources.

Relocation decisions, if necessitated,should be taken only with the involvementof the market community.

SSTTEEPP 77:: MMoonniittoorr iimmpplleemmeennttaattiioonn aannddccoonndduucctt ppeerriiooddiicc eevvaalluuaattiioonnWith a view to make the Healthy FoodMarket projects successful and sustainable, itis imperative that regular monitoring andperiodic evaluation is undertaken. Therefore,

it is important that the HFMP task force andcore group together establish milestones tobe achieved in the short, medium and longrun. Consequently, it is also important thatappropriate and measurable indicators areidentified and incorporated in the workplans.

The marketplace managers need to beempowered to monitor the implementationof all controls and to take corrective actionas necessary. Corrective action needs to bedeveloped for each control in conjunctionwith the person undertaking the control.

SSTTEEPP 88:: DDrraaww ffrroomm lleessssoonnss lleeaarrnnttThe evaluation process comprisingcollation of data and analysis wouldreveal the milestones achieved and theshortfalls. It is important to find out whichactivities did not succeed and why so thatthe lessons learnt can be incorporatedinto the National Healthy Food MarketProgramme. This would facilitate timely,effective and efficient replication of theproject.

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1. World Health Organisation - WHOWHO | Influenza pandemic threat: current situationhttp://www.who.int/csr/disease/avian_influenza/pandemic/en/index.html

Avian Influenza: guidelines, recommandations, descriptionshttp://www.who.int/csr/disease/avian_influenza/guidelinestopics/en/index.html

Avian Influenza ("bird flu") and the significance of its transmission to humanshttp://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html

Avian Influenza Frequently Asked Questions FAQshttp://www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html

WHO guidelines for the use of seasonal influenza vaccine in humans at risk of AI infectionhttp://www.who.int/csr/disease/avian_influenza/guidelines/seasonal_vaccine/en/

WHO interim recommendations for the protection of persons involved in the massslaughter of animals potentially infected with highly pathogenic Avian Influenza viruseshttp://www.who.int/csr/disease/avian_influenza/guidelines/en/Avian%20Influenza.pdf

WHO recommendations relating to travellers coming from and going to countriesexperiencing outbreaks of highly pathogenic H5N1 Avian Influenza.http://www.who.int/csr/disease/avian_influenza/travel2005_11_3/en/index.html

Non-pharmaceutical interventions: their role in reducing transmission and spreadhttp://www.who.int/csr/disease/avian_influenza/pharmaintervention2005_11_3/en/index.html

Food Safety Issueshttp://www.who.int/csr/disease/avian_influenza/foodrisk2005_11_03/en/index.html

Tips that can help you avoid Avian Influenza, WHO Regional Office for South East Asiahttp://w3.whosea.org/EN/Section10/section1027/Section2208.htm

2. Food and Agriculture Organisation - FAOFAO: Animal Health Avian Influenzahttp://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/special_avian.html

FAO Information Ressourceshttp://www.fao.org/ag/againfo/subjects/en/health/diseasescards/avian_recomm.html

Web Resources11

AI Disease cardhttp://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/avian.html

FAO/OIE/WHO Consultation on Avian Influenza and human health: riskreduction measures in producing, marketing, and living with animals in Asia[Kuala Lumpur Report]http://www.fao.org/ag/againfo/subjects/documents/ai/concmalaysia.pdf

Prevention and Control of Avian Flu in Small-scale Poultry: A guide for veterinaryparaprofessionals in Vietnam.http://www.fao.org/ag/againfo/subjects/documents/ai/AIManual_VN2005(en).pdf

Prevention and Control of Avian Flu in Small-scale Poultry: A guide for veterinaryparaprofessionals in Cambodia. http://www.fao.org/ag/againfo/subjects/documents/ai/AI-paravets-guide.pdf

Avian Influenza - Safety Measureshttp://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/avian_safety.html

Economic and social impacts on Avian Influenza outbreakshttp://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/cd/documents/Economic-and-social-impacts-of-avian-influenza-Geneva.pdf

3. World Organisation for animal Health - OIE OIE : Avian Influenzahttp://www.oie.int/eng/AVIAN_INFLUENZA/home.htm

OIE Guidelines for control of the disease in Asiahttp://www.oie.int/eng/AVIAN_INFLUENZA/guidelines.htm

Zoning and compartmentalisationhttp://www.oie.int/eng/AVIAN_INFLUENZA/zoning_2005.pdf

AI Disease cardhttp://www.oie.int/eng/AVIAN_INFLUENZA/Disease%20card.pdf

4. OtherBiosecurity - General Information and guidelines - University of Minnesotahttp://www.ansci.umn.edu/poultry/resources/biosecurity.htm#general

"Avian Influenza risk perception" , Fielding R, Lam WWT, Ho EYY, Lam TH, Hedley AJ,Leung GM., Hong Kong, University of Hong Kong, Special Administrative Region, ChinaEmerging Infectious Diseases, Vol. 11, No. 5, May 2005http:// www.cdc.gov/eid

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