title: Exposure of uninfected poultry farms to HPAI (H7N7) virus by professionals during outbreak control activities.
abstract: With an extensive data set on visits made to control the H7N7 avian influenza epidemic in The Netherlands in 2003 we investigate the potential role of the persons involved in the control activities as vectors for disease transmission. We hypothesized that people can spread the virus on the same day mechanically, or till 10 days if they have become infected themselves. Taken into account was the estimated time of introduction of the virus into a poultry flock back-calculated from mortality data. We identified 19 visits from a person that went on the same day from an infected (source) farm to a (target) farm that was before infection and a further 197 visits were made to (target) farms that remained uninfected. Of the 19 visits, eight were made within 3 days before an infection started on the target farm. If we assume that these eight visits were the primary reason the visited farms became infected, then we can calculate an upper estimate for the probability of transmission by a person per visit of 0.037. In addition we identified visits were a person first visited an infected source farm and up to 10 days after visited a target farm that either remained uninfected or was before infection. Most visits to infected source farms were made just after infection. Animals on these farms were likely not yet symptomatic, thus escaping diagnosis. Such events may be difficult to prevent, although awareness of this possibility is already a major step towards prevention. Most of these visits involved tracing and screening and were made by a relatively small number of trained veterinarians. This makes it possible to focus training efforts specifically on these persons and make sure they stringently use the personal protective equipment and strictly follow the hygiene protocol, to protect them and prevent them from spreading the disease.
authors.affiliation: Department of Farm Animal Health, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands. dennis.te.beest@rivm.nl 
authors.forename: D E
authors.initials: DE
authors.lastname: te Beest
authors.forename: J A
authors.initials: JA
authors.lastname: Stegeman
authors.forename: Y M
authors.initials: YM
authors.lastname: Mulder
authors.forename: M
authors.initials: M
authors.lastname: van Boven
authors.forename: M P G
authors.initials: MP
authors.lastname: Koopmans
mesh_terms: D000822:Animal Husbandry; D000818:Animals; D003140:Communicable Disease Control; D004196:Disease Outbreaks / Q000662:veterinary*; D006801:Humans; D053126:Influenza A Virus, H7N7 Subtype; D005585:Influenza in Birds / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D009426:Netherlands / Q000453:epidemiology; D011200:Poultry