[Federal Register: February 13, 2004 (Volume 69, Number 30)]
[Rules and Regulations]
[Page 7165-7166]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr13fe04-17]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
42 CFR Part 71
Foreign Quarantine
AGENCY: Centers for Disease Control and Prevention(CDC), Department of
Health and Human Services (HHS).
ACTION: Notice of embargo of birds (Class: Aves) from specified
Southeast Asian countries.
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SUMMARY: An outbreak of avian influenza more commonly known as bird
flu, is affecting bird populations in countries throughout Southeast
Asia. The outbreak is caused by the H5N1 subtype of influenza A. Human
cases also have been reported. Effective immediately and until further
notice, CDC is banning the importation of all birds (Class Aves) from
the following Southeast Asian countries: Cambodia; Indonesia; Japan;
Laos; People's Republic of China, including Hong Kong SAR; South Korea;
Thailand; and Vietnam. Exceptions exist for certain categories of birds
and processed bird products. This order complements a similar action
taken by the U.S. Department of Agriculture (USDA). This order may be
amended as necessary as the situation develops, for example, to add or
remove countries.
DATES: This embargo is effective on February 4, 2004, and will remain
in effect until further notice.
FOR FURTHER INFORMATION CONTACT: Paul Arguin, National Center for
Infectious Diseases, Centers for Disease Control and Prevention,
Mailstop C-14, 1600 Clifton Rd., Atlanta, GA 30030, telephone 404-498-
1600.
SUPPLEMENTARY INFORMATION:
Background
H5N1 avian influenza is a subtype of the type A influenza virus.
Wild birds are the natural hosts of the virus, which circulates among
birds worldwide. It is very contagious among birds and can be deadly to
birds, particularly domesticated birds like chickens. Infected birds
shed virus in saliva, nasal secretions, and feces. Avian influenza
viruses spread among susceptible birds when they have contact with
contaminated excretions.
Since mid-December, outbreaks of influenza A (H5N1), infection have
been detected in the poultry populations of Cambodia, China, Hong Kong
(in a single peregrine falcon), Indonesia, Japan, Korea, Laos,
Thailand, and Vietnam. The virus does not typically infect humans, but
in recent months, Vietnam has reported hospitalized cases of serious
respiratory illness, primarily among children, most of whom have died.
Thirteen of these patients were confirmed as having avian influenza A
(H5N1), and nine of the confirmed cases have been fatal. The Ministry
of Health of Thailand announced four confirmed cases of avian influenza
A (H5N1) in humans; all four of the patients have died. It is believed
that most cases of H5N1 infection in humans have resulted from contact
with infected poultry or contaminated surfaces.
The incubation period for influenza is one to four days, with an
average of two days. Uncomplicated influenza illness is characterized
by the abrupt onset of constitutional and respiratory signs and
symptoms (e.g., fever, myalgia, headache, severe malaise, nonproductive
cough, sore throat, and rhinitis). Among children, otitis media,
nausea, and vomiting are also commonly reported characteristics of
influenza illness.
Influenza illness typically resolves after a limited number of days
for the majority of persons, although cough and malaise can persist for
more than two weeks. Among certain persons influenza can exacerbate
underlying medical conditions (e.g., pulmonary or cardiac disease),
lead to secondary bacterial pneumonia or primary influenza viral
pneumonia, or occur as part of a co-infection with other viral or
bacterial pathogens. Young children with influenza infection can have
initial symptoms mimicking bacterial sepsis with high fevers, and less
than or equal to 20% of children hospitalized with influenza can have
febrile seizures. Influenza infection has also been associated with
encephalopathy, transverse myelitis, Reye syndrome, myositis,
myocarditis, and pericarditis. Influenza-related deaths can result from
pneumonia as well as from exacerbations of cardiopulmonary conditions
and other chronic diseases.
Public Health Risks
So far, H5N1 viruses have not been capable of efficient human-to-
human transmission. The co-circulation of human and highly pathogenic
animal influenza viruses is of serious concern to the World Health
Organization (WHO), CDC, and other health authorities worldwide, since
an exchange of genes between the two viruses might occur if individuals
were co-infected with both human and avian influenza viruses. This gene
exchange could give rise to a new influenza virus to which humans would
have little or no immunity and which could be transmitted efficiently
from person to person. If an avian influenza virus were able to infect
people and gain the ability to spread easily from person to person, an
``influenza pandemic'' could begin. A pandemic is an outbreak of an
infectious disease that rapidly spreads worldwide resulting in large
amounts of morbidity and mortality. Three such pandemics occurred
during the 20th century and resulted in many more deaths and
hospitalizations than occur during a typical influenza season because
the human population did not have underlying immunity to the newly
circulating virus.
There is no current vaccine specifically formulated to provide
immunity against H5N1 subtype of influenza. In addition, of the four
antiviral agents currently licensed in the United States for treatment
of influenza, genetic sequencing of influenza A (H5N1) virus samples
from human cases in Vietnam shows antiviral resistance to two of them
(amantadine and rimantadine). The remaining two antivirals (oseltamavir
and zanamavir) should still be effective against this strain of H5N1.
The principal measures to control an outbreak of H5N1 in birds are
the culling (killing) of sick and exposed birds and the restriction of
movement of potentially exposed birds to unaffected areas. So far over
45 million birds have been culled. According to the U.S. Fish and
Wildlife Service, the United States imports over 20,000 live birds from
countries affected by the outbreak of avian influenza.
Introduction of influenza A (H5N1) infected birds into the United
States could lead to outbreaks of disease in the human population, a
significant public health threat. Banning the importation of all avian
species from affected countries is an effective means of limiting this
threat. CDC is therefore taking this action to reduce the chance of
introduction or spread of influenza A (H5N1) into the United States.
This order complements a similar action taken by the U.S. Department of
Agriculture.
Because there is no current evidence suggesting that birds infected
with influenza A (H5N1) have been imported and are causing disease in
the United States, this order does not include restrictions upon the
domestic movement of birds already in the United States.
Immediate Action
Therefore, pursuant to 42 CFR 71.32(b) and in accordance with this
order, no person may import or attempt
[[Page 7166]]
to import any birds (Class: Aves), whether dead or alive, or any
products derived from birds (including hatching eggs), from the
following Southeast Asian countries:
Cambodia;
Indonesia;
Japan;
Laos;
People's Republic of China, including Hong Kong SAR;
South Korea;
Thailand; and
Vietnam.
This prohibition is effective immediately and until further notice.
This prohibition does not include pet birds which originated in the
United States (as defined in 9 CFR 93.100), provided that the
importation of such birds complies with USDA requirements, which
includes a 30-day quarantine in a USDA facility. This prohibition also
does not apply to any person who imports or attempts to import products
derived from birds if, as determined by federal officials, such
products have been properly processed to render them noninfectious so
that they pose no risk of transmitting or carrying the influenza A
(H5N1) virus and which comply with USDA requirements. This order may be
amended as necessary as the situation develops, for example, to add or
remove countries.
Dated: February 5, 2004.
Julie Louise Gerberding,
Director, Centers for Disease Control and Prevention.
[FR Doc. 04-3137 Filed 2-12-04; 8:45 am]
BILLING CODE 4160-17-P