Protective measures and H5N1-seroprevalence among personnel tasked with bird collection during an outbreak of avian influenza A/H5N1 in wild birds, Ruegen, Germany, 2006.
BACKGROUND
In Germany, the first outbreak of highly pathogenic avian influenza A/H5N1 occurred among wild birds on the island of Ruegen between February and April 2006. The aim of this study was to investigate the use of recommended protective measures and to measure H5N1-seroprevalence among personnel tasked with bird collection.


METHODS
Inclusion criteria of our study were participation in collecting wild birds on Ruegen between February and March 2006. Study participants were asked to complete a questionnaire, and to provide blood samples. For evaluation of the use of protective measures, we developed a personal protective equipment (PPE)-score ranging between 0 and 9, where 9 corresponds to a consistent and complete use of PPE. Sera were tested by plaque neutralization (PN) and microneutralization (MN) assays. Reactive sera were reanalyzed in the World Health Organization-Collaborating Centre (WHO-CC) using MN assay.


RESULTS
Of the eligible personnel, consisting of firemen, government workers and veterinarians, 61% (97/154) participated in the study. Of those, 13% reported having always worn all PPE-devices during bird collection (PPE-score: 9). Adherence differed between firemen (mean PPE-score: 6.6) and government workers (mean PPE-score: 4.5; p = 0.006). The proportion of personnel always adherent to wearing PPE was lowest for masks (19%). Of the participants, 18% had received seasonal influenza vaccination prior to the outbreak. There were no reports of influenza-like illness. Five sera initially H5-reactive by PN assay were negative by WHO-CC confirmatory testing.


CONCLUSIONS
Gaps and variability in adherence demonstrate the risk of exposure to avian influenza under conditions of wild bird collection, and justify serological testing and regular training of task personnel.
Cai
Wei
W
Department for Infectious Disease Epidemiology, Robert Koch Institute, DGZ Ring 1, Berlin, Germany. caiw@rki.de
Schweiger
Brunhilde
B
Buchholz
Udo
U
Buda
Silke
S
Littmann
Martina
M
Heusler
Jörg
J
Haas
Walter
W
D000293:Adolescent; D000328:Adult; D000818:Animals; D000914:Antibodies, Viral / Q000097:blood; D001717:Birds / Q000821:virology*; D004196:Disease Outbreaks / Q000662:veterinary*; D005260:Female; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype; D005585:Influenza in Birds / Q000453:epidemiology*; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016273:Occupational Exposure; D011482:Protective Devices / Q000706:statistics & numerical data; D016036:Seroepidemiologic Studies; D055815:Young Adult; D015047:Zoonoses / Q000453:epidemiology
D000914:Antibodies, Viral