Avian Influenza, also known as the Bird Flu, is an influenza A virus caused by avian, which means bird. These viruses occur naturally in some birds. Wild birds in all areas of the world get the viral infections in their intestines, but do not usually become ill from them. The avian influenza is quite contagious among birds and can even kill domesticated species such as chickens, turkeys, and ducks. These birds become infected when exposed to secretions or feces from infected birds or from coming into contact with surfaces that those infected birds have come into contact with (cdc.gov). Birds, just like people, get the flu. Most bird flu viruses can only infect other birds. However, bird flu can pose health risks to people. The first case of a bird flu virus infecting a person directly, H5N1, was in Hong Kong in 1997. Since then, the bird flu virus has spread to birds in countries in Asia, Africa and Europe. Human infection is very rare, but the virus that causes the infection in birds might change, or mutate, to more easily infect humans.
This could lead to a pandemic. During an outbreak of bird flu, people who have had contact with infected birds can become sick. It may also be possible to catch the bird flu by eating poultry that is not well cooked or through contact with a person who has it. Once infected with the Bird Flu symptoms occur approximately two to eight days after exposure. Infected people experience typical flu – like symptoms including fever, cough, sore throat, and muscle aches. This can progress to pneumonia and even respiratory failure. The Bird Flu can cause a very aggressive form of pneumonia, called ARDS, that is often fatal. The risk to humans from this disease is typically low. However, several subtypes of the avian influenza infection have been reported in humans since 1997. Most of these cases have been caused by contact with infected birds or surfaces that have become contaminated from secretions or excretions from the infected birds. Some precautions to take would be to inform travelers to avoid visits to live bird markets in areas with an avian flu outbreak. Also people who work with birds who might be infected should use protective clothing and special breathing masks. And also it is important to avoid undercooked or uncooked meat .
Describe the epidemiological indicators associated with the identified disease.
Human cases of avian influenza have been reported in Asia, Europe, Africa, Indonesia, Vietnam, and the Philippines (nytimes.com). In 2004, an investigation in Thailand concluded that human spread of the virus was limited to a family as a result of close contact between an infected child and her mother. Transmission was not discovered to go beyond on person (cdc.gov). Also in 2004 in Japan, there have been reports of respiratory symptoms in the majority of known cases of the avian influenza, with one death of a child as a result of the disease. In 2005, Vietnamese investigations implicated the transmission of the avian influenza to two people from ingesting the uncooked blood from a duck. In Azerbaijan in 2006, several teenagers were found to have become infected by removing feathers from an infected bird. In Indonesia in 2006, 8 members of one family were infected from human to human contact and 7 of them died. The first member is believed to have been infected by contaminated fowl then infected the other members of the family. No infections outside that family were reported (cdc.gov).
Analyze the epidemiological data on the outbreak.
According to the CDC, Indonesia and Vietnam have reported the highest number of human cases. Overall mortality in those cases is 60%. Nearly all clusters reported have occurred between blood related members of a family living under the same roof (cdc.gov). According to the Food and Agriculture Organization, most outbreaks start with contact of domestic poultry with water birds. Scientific evidence suggests that a genetic mutation emerged in the eastern U.S. in 1983-1987 (fao.org). Prior to that, strains were non-pathogenic or only mildly pathogenic to the poultry. Once avian influenza is established in domestic poultry, it becomes highly contagious. Infected birds excrete high concentrations of the virus in feces and discharges from eyes and nose. Once a bird is infected, it spreads throughout the flock and then occasionally to humans (fao.org).
Discuss the route of transmission of the disease causing the outbreak.
Currently, the main route of infection of the avian influenza is from direct contact with infected poultry, or contact with surfaces or objects that have become contaminated by secretions or feces of infected birds (who.org). The reported highest risk factor for human infection has been linked to direct contact with sick or dead birds, or visiting a live poultry market (cdc.gov). As stated above, humans can become infected after coming into contact with contaminated birds or from surfaces that sick birds have come into contact with. Studies have shown an association between human infections and direct or household contact with diseased poultry (medscape.com). This transmission may be from inhalation or deposition of infected excretions into mucous membranes. Another route is either from the preparation or consumption of infected poultry (medscape.com). The study has also linked lack of indoor water sources to infections in humans. This may be from lack of hand washing, bathing, or drinking water that has become contaminated with feces or fluids from sick poultry.
Create a graphic representation of the outbreak’s international pattern of movement or possible movement.
Discuss how the outbreak could affect your community.
An outbreak could cause multiple deaths as well as put a strain on the economy. Resources would be exhausted in the treatment of the disease and poultry farmers would be impacted by the reduction in marketing of their product. Resources would also be necessary for preparedness and surveillance in the event of an outbreak. Globally, there would be an impact on travel, tourism, and investments due to a pandemic.
B. Imagine that you are a community health nurse. You suspect that a family that has just returned from travel overseas has contracted SARS. Soon, several other community members present the same symptoms. Testing occurs in your health clinic and the presence of SARS is confirmed.
1. Explain the appropriate protocol for reporting the possible outbreak. According to the CDC, “A SARS outbreak will generate a need for rapid analysis of the status of patients and transmission in the healthcare facility and reporting of this information to the public health officials and to the public, press, and political leaders” (cdc.gov). The first objective is to communicate regularly with the health department including all SARS related activities. The next objective is to “communicate with facility staff and the public” including daily updates to infection control staff members and administrative members regarding SARS activity in the facility and in the community (cdc.gov).
C. The news has just announced that the air quality index is poor. As the community health nurse, you are concerned about your clients who have asthma and other respiratory diseases.
1. Discuss how you would modify their care to address the increased risk due to poor air quality. I would first educate my patients about air quality, how it is measured, and how it can trigger asthma attacks and decreased lung function. Ozone and other forms of air pollution can worsen asthma and increase hospital visits for those who have asthma. I would advise my patients to pay attention to the Air Quality Index which was created by the Environmental Protection Agency to monitor air quality (kidshealth.org). I would advise them that when air is poor, they should avoid triggers. This would include closing windows in their home and vehicles and allowing the air conditioner to recycle the inside air. They can also improve the indoor air by using ozone reducing air filters. They should avoid areas of heavy traffic and plan all outdoor activities to take place early in the day. They should know what to do in the event of an asthma attack and be prepared for such an incident. They should also have extra medication on hand during these times.
Avian influenza: food safety issues. World Health Organization. Retrieved 8/11/2012 from http://who.int/foodsafety
Avian influenza overview. The New York Times. Retrieved 8/11/2012 from http://health.nytimes.com
Epidemiology of avian influenza. Food & Agriculture Organizations of the United Nations. Retrieved 8/11/2012 from http://fao.org
(n.a.) (2004). Severe acute respiratory syndrome. Centers for disease control and prevention. Retrieved 8/11/2012 from http://www.cdc.gov
Ozone, air quality, and asthma. Kids Health. Retrieved 8/11/2012 from http://www.kidshealth.org
Risk factors for human infection with avian influenza. Medscape. Retrieved 8/11/2012 from http://medscape.com