[Federal Register Volume 69, Number 30 (Friday, February 13, 2004)]
[Rules and Regulations]
[Pages 7165-7166]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 04-3137]



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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

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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