Avian influenza is a “flu infection that occurs in birds, but birds can mutate or change the virus that causes avian influenza and spread it to humans” (Centers for Disease Control and Prevention, 2013). Today, researchers have identified two types of avian influenza viruses (H5N1 and H7N9) that affect humans. The H7N9 mutates faster in birds than the H5N1. Hence, H7N1 spreads fast and more easily to humans.
Avian Influenza outbreak
The World Health Organization (WHO) reported the first outbreak of avian influenza (H5N1) in the year 2003 that caused deaths to humans in the Asian region, specifically China. In the US, there were different cases of avian influenza viruses that affected poultry between 2003 and 2004, and one person in 2003.
In April 2013, the WHO reported an outbreak of human infections that had a new avian influenza (H7N9) virus in China (Li et al., 2013). This was the first case ever of H7N9. Scientists found this virus in poultry too. The recent outbreak in China affected over 130 people. Most of the people who the virus affected had contact with poultry. As a result, the assumption that scientists developed was that “many infected people got the infection after exposure to affected birds or contaminated places” (Centers for Disease Control and Prevention, 2013).
The outbreak in China claimed 44 lives. It also led to harsh cases of respiratory conditions and mild cases of illness. The Centers for Disease Control and Prevention (CDC) reported that close contacts of “confirmed H7N9 patients were followed to determine whether any human-to-human spread of H7N9 was occurring, but there was no evidence of sustained person-to-person spread of the H7N9 virus” (Centers for Disease Control and Prevention, 2013). Apart from the reported cases in China, there were no other cases of H7N9 in humans or birds elsewhere.
The CDC notes that avian influenza virus changes easily. This would make it easy to spread among people and create a possible global pandemic outbreak of avian influenza.
The Epidemiological Indicators of Avian Influenza
The direct source of avian influenza virus is difficult to ascertain, but scientists have traced the virus to poultry and wild birds. The main origin of avian influenza has been China and other countries in the Asian region, such as Thailand, Vietnam, Azerbaijan, and Indonesia. In addition, the WHO reported cases of H5N1 in Africa, Europe, and the Near East.
In 2003, the WHO reported cases of H5N1 in China. The infection spread to other countries like the US through flirts.
In March 2013, the WHO confirmed the first case of H7N9 in China. The infection resulted in rapid cases of “acute respiratory conditions, pneumonia, and other fatal outcomes” (Li et al., 2013). There were cases in the Eastern areas of China, Shanghai, and Anhui. By April 2013, the virus had spread to surrounding provinces like Jiangsu, Zhejiang, Beijing, and Henan.
There were no cases of H7N9 reported outside China.
The Epidemiological Data on the Avian Influenza Outbreak
The WHO noted that the average rate of mortality from H5N1 was roughly 60%. Most cases affected children and adults below 40 years old. Several cases of deaths were common in people below 20 years.
The H7N9 affected more than 130 people in China and killed 44 people in 2013. Majorities of the affected people had contact with poultry (dead or alive) or visited markets.
Various governments have strived to control the spread of H7N9. As a result, the rate of mortality has remained low.
The Route of Transmission of the Avian Influenza
According to Declan Butler, “scientists do not yet fully understand how the H7N9 avian influenza virus is spreading in China, or why the pattern of sporadic human cases looks like it does” (Butler, 2013). However, analysis of past cases in the affected geographies may provide some explanations.
The immediate source of the virus is domestic poultry. Contact with domestic poultry and wild birds could be responsible for the spread of the virus. Swine may contribute to the spread of the virus through turkeys as they come close. The virus is highly contagious once it affects poultry, and it can spread from bird to bird fast. It can spread through contact, feeding, contaminated feeding equipment, and service crews among others.
There are also cases of airborne transmission among birds. Humans get the virus from birds and spread it through contact.
There are no reported cases of human-to-human transmission in the case of H7N9 as Butler notes (Butler, 2013).
A graphic representation of the avian influenza international pattern of movement or possible movement
This map indicates that Eastern China is the main source of H7N9 avian influenza outbreaks. Eastern China has some of the busiest airline routes. The map indicates that the virus can easily spread from China to other parts of the world through the movement of people.
Researchers noted, “risk modeling and mapping were approaches to devise targeted surveillance of H7N9 spread” (Butler, 2013). Data collected from such surveillance could be useful in farming and international trade.
How avian influenza outbreak could affect a community
Avian influenza is a highly contagious infection. It results in “rapidly progressive pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), and fatal outcomes” (Li et al., 2013). The WHO has reported an average mortality rate of 60% from avian influenza.
The rapid spread of the virus can affect the whole community fast. This could lead to a possible avian influenza pandemic coupled with several deaths in the community.
The appropriate protocol for reporting the possible SARS outbreak
Nurses should immediately report all possible and confirmed cases of SARS to their local health offices by following the right procedure. However, physicians must have the latest protocols on SARS because its data change rapidly.
- The CDC provides clear CDC SARS screening procedures to confirm cases of suspected SARS
- There is a CDC SARS report form that physicians must complete before reporting the case
- All reported cases must have their X-ray reports attached to them
- It is advisable to fax information collected as soon as possible to the relevant contact number
- Laboratory reports are important for epidemiological surveillance
- Collect all the required specimens for testing
- It is advisable to take standard precautions and protect the face and eyes
- Airborne precaution is necessary within the hospital. Use the recommended mask (N-95) and a room with negative pressure for all confirmed cases
- Nurses must take contact precautions by using gloves and gowns
- The same precaution should also apply to outpatients
- Patients must not mingle with the rest of the population
- Nurses should only use droplets and minimize contacts
- Physicians must assure patients about their conditions and provide surgical masks to all suspected cases of SARS.
It is also important to educate the community about the outbreak of SARS. Physicians should inform patients about suitable strategies for home isolation, effective hand hygiene, and safeguarding the respiratory system of care providers at home. It is necessary for SARS patients to stay at home for ten days and wait for the resolution of symptoms.
All members of the household with SARS should practice high standards of hygiene and avoid contact with the body fluids of the patient. If such contacts occur, family members should wash their hands thoroughly.
SARS patients may also use masks at home when they come in close contact with other healthy persons. This would prevent the spread of viruses through droplets. Gloves must be properly disposed after use. It is not advisable to reuse any gloves.
Patients must not share utensils, towels, bedding, and clothing with other members of the family. It is advisable to use such items after thorough cleaning.
Modification of Care for Asthma Patients
Most people who have asthma must observe the quality of air they breathe. People who suffer from allergic asthma cannot survive in environments with poor quality of air for long. Dust mites, mold spores, pollen dusts, and other particles found in air contribute to poor quality of air. Hence, it is important for physicians to modify care for asthma patients in such environments. Modification of care for asthma patients should involve the following (MacNaughton, 2013).
- The physician should adjust the quality of care based on an individual patient’s sensitivity to poor quality of air. Patients should track their allergic reactions to poor quality of air.
- Modification should help patients to determine when they breathe poor air quality. Patients should know how to tell exactly when the air quality is bad for their health. Generally, air quality is poor during summer, but different forms of air pollution can even take place during winter. Patients must know that bad weather may worsen their conditions.
- Modification strategies should depend on the quality of the air. Physicians must advise their patients to plan their activities well based on the weather. In most cases, patients should stay indoors and close their windows and doors. Patients should perform most of their activities outside in a good air quality, particularly in the morning. Changes in routines and outdoor activities may help patients to avoid breathing much poor quality air.
- Patients must have their quick-relief medications as close as possible. In poor air quality, patients may experience symptoms rapidly. Quick-relief medications like inhalers can help in controlling asthma condition before it goes out of control. It is advisable to have enough supply of inhalers in such environments with poor quality of air.
- Patients must recognize that some normal masks may not filter small particles in the air. Hence, patients should avoid bad air if possible.
- Patients should drive, walk, and bike only when the quality of the air has improved.
Overall, the physician should advise their patients to reduce cases of exposure as much as possible. They should use medications and other inhalers. Moreover, patients need to control the quality of air they inhale through air filtering systems and stay indoors. Patients must also avoid air pollution at their personal levels.
References
Butler, D. (2013). Mapping the H7N9 avian flu outbreaks. Web.
Centers for Disease Control and Prevention. (2013). Avian Influenza A (H7N9) Virus. Web.
Li, Q., Zhou, L., Zhou, M., Chen, Z., Li, F., Wu, H.,…Feng, Z. (2013). Preliminary Report: Epidemiology of the Avian Influenza A (H7N9) Outbreak in China. The New England Journal of Medicine. Web.
MacNaughton, K. (2013). Tips for Preventing Poor Air Quality from Interfering with Asthma Control. Web.