Rapid Assessment of H7N9 Avian Influenza: 200+ Cases in Two Months - Essay Sample

Introduction

Rapid Assessment after onset: Influenza A is a subtype H7N9 virus that was first reported in China in 2013. Majority of the reported avian influenza cases of human infection. Most of the cases were reported to result in severe respiratory cases. In two months following the reports of the avian influenza first case, more than 200 people had been infected, which was usually a high rate of infection. A fourth of the patients died, with sixth recovering, and the rest were announced as critically ill. The World Health Organization has described Avian influenza as 'a dangerous virus for human beings, as of July 28, 130 cases had been reported, and resulted in deaths of 402.

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Research regarding the transmission and background of the disease is underway. It has been proven that many of the human-related cases of avian influenza appear to be linked to the bird market in China. As of June 2014, there had no evidential prove to show human-to-human transmission of the disease. However, a study group that was carried by one of the world's recognized experts on avian influenza reported numerous instances of the individual-to-individual infections were noted. It has also been indicated that the avian influenza virus is not a threat to poultry, which makes surveillance of the disease much more difficult.

There has been a notable prevalence of the H7N8 diseases older people infected patients. While numerous behavioural, environmental and biological explanations for this disease patterns have been proposed, as of today, the reason remains unknown. There is no vaccine of the disease that has been identified. However, neuraminidase inhibitors is an influenza drug that used to contain the infection. Various arms of the cooperating agencies in this task force were responsible for different components of the response plan, such as the identification and isolation of cases, including the creation of quarantine wards set up in nearby hospitals. Other duties included the training of health and response workers, contact tracing, and getting samples from suspect cases to UVRI for laboratory confirmation. The Ministry of Health was primarily responsible for dispensing information3.

Preventive measures and control of patients and contacts: As a way of preventing the illness from spreading, suspected cases were isolated, and in a hospital, quarantine wards were established, and personal safeguard gears were offered for health workers and task force members working on-site. Education was the key in preventing further spread of the outbreak, particularly in regard to methods of transmission, identification of suspect cases, and proper handling of dead bodies. Scientists from the China Centers for Disease Control and Prevention worked along scientists at the China Virus Research Institute to confirm suspect and probable influenza cases through laboratory testing. Medecins Frontieres and the Red Cross Society worked with medical personnel hospitals to provide supportive treatment patients and necessary supplies. Laboratory testing at The Chinese Virus Research Institute (UVRI) was done to obtain confirmation for suspect cases. Through interviews with patients and family members, contact tracing and follow-up were possible. The recommended observation period of contacts and suspect cases for Avian influenza is 21 days, which is at the tail end of the incubation period prior to the infection; however, in this case, the observation period was greater than 21 days.9 It was stated that over 400 patients who came in contact with Avian influenza and were admitted and monitored were all successfully discharged.9 In addition, the last suspect case was monitored for double the recommended incubation period, for a total of 42 days, before the outbreak was determined to be over, and the region was declared free of Avian influenza4.

Surveillance/early warning system: Avian influenza usually spread in birds but can be commonly prevalent in humans - it is an infectious disease. Humans can be infected if they come into close contact with contaminated environments or infected poultry. However, the recently recognized avian flu virus cannot transmit from one individual to another. It is not known how the viruses circulate in poultry. The avian viruses cause severe illness in humans and are capable of mutating to become highly contagious between persons. Therefore, the Health Emergency Program - an affiliate of the World Health Organization - is closely monitoring human cases of the avian flu on an ongoing basis4.

Preventive measures and control of patients and contacts: People who do not visit the bird markets are not prone to contracting or developing avian flu. The people at high risk are the animal control workers; poultry farm workers, ornithologists, and wildlife biologists who handle birds. It is recommendable for the organizations dealing with live birds to have avian flu response plan to contain the spread of the infection. Poultry flock biosecurity is another critical prevention mechanism for the disease. It is advisable to isolate flocks from outside birds particularly wild birds. Vehicles used for flocking should be continuously disinfected and avoid sharing between farms. All measures should be taken to ensure birds from slaughterhouses are not returned to farms. Through interviews with patients and family members, contact tracing and follow-up were possible. The recommended observation period of contacts and suspect cases for avian influenza is 21 days, which is at the tail end of the incubation period prior to infection. In addition, the last suspect case was monitored for double the recommended incubation period, for a total of 42 days, before the outbreak was determined to be over, and the region was declared free of avian influenza4. Taskforce members working on-site was also key in preventing further spread of the outbreak, particularly in regard to methods of transmission, identification of suspect cases, and proper handling of dead bodies.

With effective infection prevention and control and usage of personal protective equipment, the chances of avian influenza infection can be reduced. It is recommendable for people to protect their nose, eyes, hands and mouth to prevent the spread of the disease. These are considered the commonest ways of spreading the virus. Effective protective equipment includes gloves, coveralls, boot covers, hair cover and headcover. It is recommended to dispose of the PPE. An unvented and N-95 vented safety goggles are considered as appropriate for protection against avian influenza. A powered purifying air respirator with helmet or hood and face shield is an alternative option4. Another way to prevent the spread of the virus is through reporting of the isolated case.

Epidemic Measures/control outbreaks: Both active and passive surveillance assisted in the control measures for containing this influenza outbreak. Passive surveillance detected the first few cases, which initiated active surveillance efforts by the Taiwan Avian Influenza Task Force. Per the World Health Organization, there were 53 suspect cases, 24 probable cases, 11 laboratories confirmed cases, 17 probable deaths and four laboratory-confirmed deaths. This resulted in a case-fatality rate (CFR) of 36.36% among laboratory-confirmed cases and of 70.8% among probable cases. Wildlife samples were collected from bats, and primates and samples were taken from livestock in an attempt to determine the reservoir5.

Culling is preventing control can be used to decrease the threats posed by the virus. This can be done by killing all the infected birds. The FAO manual document on HPAI control highly recommends for zoning strategy, which can be achieved through identification of the infected areas where dead or sick birds have tested positive for avian influenza. All poultry in the IA zone can be effectively culled while the area 2 to 6 km from the outer boundaries of the IA is deemed as restricted areas, and thus should be under heavy surveillance. Control and prevention programs should take into account local comprehension of poultry-people relations (Selim et al., 2017). Previously, programs that were focusing on the placed-based, singular understanding of avian influenza transmission have not been effective5. The birds existed in the context of markets, farms, roads and slaughterhouse and people were the primary transmitters of the flue.

Management of dead bodies: Per regulations from the Ministry of Health, all people who have died of avian influenza were required to be handled with strong protective gears and immediately buried, with the avoidance of the traditional feasts and preparations of the body by family members for the funerals6. The burial of all suspicious deaths needed to be under the supervision of trained Taiwan health workers. These regulations were put in place because the traditional funeral practices and handling of the dead have been known to facilitate the spread of avian influenza because it increases the likelihood of contact with infected or contaminated body fluids5, 6.

Lessons and limitations: Various factors influence the epidemiological study on the course of the avian influenza outbreak where the hemorrhagic epidemic was observed. On course of the virus outbreak in rural areas, investigation of the virus showed that the avian influenza was transmitted to humans from birds. Contrary to this, in the urban areas, the transmission of the virus among the communities greatly impacted the avian influenza epidemic. Effective surveillance is fundamental to help in contai...