Preventing the Spread of Avian Flu in Okinawa

Subject:	Epidemiology
Pages:	12
Words:	3272
Reading time:	13 min
Study level:	Undergraduate

Introduction

Avian flu attacks happen intermittently throughout the globe. Avian flu is a communicable disease that is commonly associated with birds, though it frequently develops other strains that human beings are not immune to (Capua et al., 2002). This ailment has been very cumbersome to the poultry business because every time it occurs, lots of chicken, ducks and turkeys must be shattered to avoid more spread of the ailment.

Recently, there have been qualms over the spread of Avian Flu among the local nationals in Okinawa. So far, 238 cases of human infection by H5N1 have been established in 10 countries, with the largest numbers of infection being found in Indonesia, Thailand and Vietnam (Kurtz et al., 1996).

History of Avian Flu

The earliest case of avian influenza was established in the year 1878, in Italy (Li et al., 2004) The ailment, initially called Fowl Plague, incessantly caused enormous epidemics in poultry, counting two epidemics that occurred in 1924 and 1929, in the United States (Yuen et al., 1998).It was revealed that Fowl Plague was caused by an influenza virus in the year 1955.

In 1968, the last influenza pandemic was experienced in America (Li et al., 2004). It lasted throughout 1969 and led to deaths of approximately 34,000 people in America (Li et al., 2004). Following a long phase of dormancy, fears over the virus were rapidly revived in 1977, after a concise recurrence in Hong Kong. A man in Hong Kong was diagnosed with H5N1 for the first time, with several scientists predicting another international pandemic (Kurtz, et al., 1996). In 2003, few years after the H5N1 virus reappeared, the virus was experienced once more in some divisions of Asia and in the Netherlands (Koopmans et al., 2004). Conversely the epidemic was not remote throughout the phase and the H5N1 virus started to appear in many places during the year. Since then, there have been frequent flu virus attacks in many nations. Human epidemics and fatal cases have resulted chiefly from open contact with birds carrying the virus (Yuen et al., 1998). Even if the figure of persons infected with avian flu is fairly low compared to cyclic human flu, the proportion of persons who lose lives from HPAI H5N1 infection is extremely high, about 60% (Yuen et al., 1998). At present, many local officials are worried that HPAI H5N1 may possibly mutate into a structure that could be transmitted among human beings.

There are three types of influenza viruses: A, B, and C viruses (Liem & Lim, 2005). All these viruses are capable of affecting human beings. The following is a discussion of the types and subtypes of influenza.

Influenza Type A

The common hosts of Influenza type A are wild birds. However the virus can also infect chicken, persons, horses and other animals. The number of identified HA subtypes is 16 while the number of identified NA subtypes is 9 (Peiris et al., 1999). Various blends of HA and NA proteins can happen. Currently, the influenza A subtypes that affect people are H1N1, H1N2, and H3N2 (Tran et al., 2004). You can only find other subtypes in animals. For instance, H3N8 and H7N7 viruses cause infection in horses. Recently, H3N8 has been discovered to infect dogs (Webster et al., 1981).

Birds are usually infected by influenza type A solely. Birds are usually prone to infections caused by all known subtypes of influenza A viruses. Nevertheless, there are significant genetic disparities amid the influenza A subtypes that normally transmit the disease to birds and those that transmit the disease to both persons and birds. Influenza A H5, influenza A H7 and influenza A H9 are the three major subtypes of the avian influenza A viruses that commonly infect both persons and birds (Tweed et al., 2004). Let us look at each of these separately.

Influenza A H5

There are nine possible subtypes of H5. H5 viruses like HPAI H5N1 viruses, have been recognized amid people in Asia and Europe (Tweed et al., 2004). At times, they lead to rigorous sickness or demise.

Influenza A H7

There are nine possible subtypes of H7 (Puzelli et al., 2005). Humans are seldom affected by H7 infection though it can happen among people who touch the infected birds. Indicators of the disease in human beings may include upper respiratory and conjunctivitis. H7 viruses result to deadly infection when contracted by people (Fouchier et al., 2004).

Influenza A H9

There are nine possible subtypes of H9. This subtype seldom transmits diseases to people. Nevertheless, the subtype is recognized merely in a low pathogenic structure (Lin et al., 2000).

Influenza Type B

Viruses of influenza type B are typically found solely in people. Different from influenza A viruses, Influenza type B viruses lack subgroups. Although these viruses cause morbidity and transience amid people, they are known to have less rigorous epidemics compared to viruses of influenza A. Influenza type B viruses have only been reported to cause epidemics among people but not pandemics.

Influenza Type C

Viruses of influenza type C lead to mild sickness in people. They do not result to epidemics or pandemics and they lack subtype groupings.

Key Issues of Concern

Just like other viruses, the avian flu is continuously developing, acclimatizing to become more challenging to recent vaccines and mutating so as to be more competent at transmitting diseases to its hosts. This outstanding adaptability is the key reason as to why health specialists are taking tremendous measures to ascertain the spread of this ailment is minimized.

Although avian flu is known to affect birds, current subtypes of the virus, especially the well-known H5N1 strain, have been found to have critical effects on human beings (Stegeman et al., 2004). Since the avian flu viruses are continuously mutating, there is fear that a virus that could be transmitted among human beings may develop, which could lead to a very distressing end (Ungchusak et al., 2005).

Managing the virus is also not an easy task as most birds that are infected are usually wandering animals, frequently traveling to different nations unrestrained. People acquire H5N1 and other sorts of avian influenza via extended contact with the birds. The birds transmit the virus via waste products in their feces, which consequently are inhaled innocently by human beings.

The military officials have been identified as a group that is highly at risk of contacting the virus. In response, the local and military officials have come up with a strategic plan that can be applied in case an outbreak occurs. The plan is aimed at: ending, slowing or else restricting the spread of the outbreak to the United States; controlling the home spread of the infection and mitigating the ailment and distress; upholding infrastructure and reducing impact to the nation and the operation of the society.

Thus, a review of the steps that the local and military officials are taking in preventing avian flu is essential. So as to discuss this topic, I shall discuss the issues that should be addressed in emergency management by use of examples; the steps that the local and military officials in Okinawa are taking and make a conclusion that summarizes the key points discussed. I shall also give a final statement of opinion in the conclusion part.

There are three issues that must be considered while planning emergency management. These include preparedness and communication; surveillance and detection; and response and containment (Liem& Lim, 2005)

Issue #1: Preparedness and Communication

This should entail:

Planning for the virulent disease.
Communicating duties and roles.
Making and storing antiviral drugs, vaccines and other medical tools.
Instituting distribution tactics for antiviral drugs and vaccines
Promoting technological knowledge together with developing countermeasures.

All government ranks, divisions of society and persons should be well set and there duties communicated.

Issue #2: Surveillance and Detection

This is done through the national and international organizations that offer progressive situational alertness with the aim of giving the earliest possible warning signs of disease outbreak, so as to guard the residents (Koopmans, 2004). These organizations do the following:

Ensure fast disclosure of outbreaks and global transparence.
Make use of surveillance in controlling the outbreak.

Issue #3: Response and Containment

These comprise of activities that control the spread of the disease amid humans and lessen the economic, social and security impacts of the disease. They include:

Controlling outbreaks.
Maintaining the economy.
Ensuring effectual risk awareness.
Seeking state medical and public health flow capacity.

Strategies/Recommendations in Regard to Okiwan

Issue #1: Preparedness and Communications

Residents and non residents will be educated on the threats of the disease.
DoD shall carry out a medical necessities gap analysis and acquire essential material to improve military health system treatment competence before a duration of 18 months
DoD shall set up stores of H5N1 and other influenza subtypes vaccines so as to be able to provide sufficient vaccination to about 1.35 million people within 18 months
DoD, in synchronization with the Department of Health and Human Services (DHHS) and in partnership with the national, local and ethnic governments together with private segment cohorts, shall aid in the structuring of distribution strategies for medical stocks to make certain that delivery and allocation procedures have been designed
DoD shall provide military divisions, posts and stations with antiviral drugs and vaccine in line with the list of priorities planned in the DoD pandemic influenza guidelines in 18 months
The military officials’ shall institute a medical watch board that is accessible on the web, so as to offer the most recent information on the disease.
The officials shall endeavor to attain dependable sources of medical supply on stuff such as special protective tools

Since the disease will impact the personnel, it is vital that the local and military officials center planning efforts on the impending impact of an influenza endemic on its workers and the capacity to continue with crucial roles. Since pandemics spread rapidly the delivery of vaccines and antiviral drugs quickly presents significant logistical challenges, many of which may remain unresolved. Hence it is important to develop and practice countermeasures for pandemic influenza allocation strategies in each region and to build public and private collaborations so as to enhance the course of allocation.

Issue #2: Surveillance and Detection

The local and military officials’ shall constantly perform influenza surveillance in laboratories.
Policies shall be constructed so as to enable detection means in the lowest stage.
Information mechanisms that are capable of tracing outbreak of the ailment in recruited forces shall be put in place.
Intelligence: acumen obtained from the gathering, analysis, evaluation and interpretation of alien medical, bio-scientific, communicable disease, and ecological knowledge. The intelligence is of importance to tactical medical planning and actions for the preservation of promptness and the formation of evaluations of alien medical abilities in both military and civilian divisions
the continuing, systematic gathering of health information crucial to the assessment, preparation, and execution of public health exercise, integrated directly with the timely distribution of information as wanted by senior authority.
At present, DoD carries out medical surveillance and detection locally and overseas in coordination with the most suitable Federal subdivisions and agencies.
DoD will make sure that surveillance and detection resources are incorporated into interagency coverage etiquettes and measures. This incorporation will offer effective distribution of information and opportune caution to DoD civil authorities and forces in the occasion of an alleged pandemic influenza pandemic.

Issue #3: Response and Containment.

The local and military officials shall lay down policies that will be aimed at controlling the spread of the disease and lessening the economic, health, security, and communal impacts. Such policies may include: clinical policies regarding the diagnosis, cure, and management of patients who have contracted the disease or those exposed to the virus
The precedence of DoD health service support resources will be to guarantee adequate human resources, tools, pharmaceuticals, facilities and objects are set to offer the highest possible height of health support and safeguard universal operational efficiency of DoD forces, beneficiaries, service providers and dependents.
DoD will carry out suitable continuity of procedures and permanence of government guidelines and actions in the occasion of a pandemic influenza pandemic. Agencies and sectors will have precise plans to lessen the effects of non-attendance within their subsidiary commands and associations.
DoD will offer back ups to the civil authority reacting to a pandemic influenza once directed by the head of a nation or upon sanction by the Defense Secretary.
DoD may offer medical surge means to other State, local or Federal agencies after an appeal or direction by the head of a nation or upon sanction by the Defense Secretary.
DoD will offer transportation aid to civilian societies in backing the pandemic influenza vigilance and reaction efforts, when approved by the head of a nation, or ahead of approval by the Defense Secretary.
DoD will offer aid to civilian societies in support of pandemic influenza vigilance and reaction endeavors when approved by the head of a nation, or ahead of approval by the Defense Secretary.
Regular with appropriate laws, DoD will offer protection in aid of pharmaceutical or vaccine creation and allotment efforts, when approved by the head of a nation, or ahead of approval by the Defense Secretary.
When approved by the head of the nation, DoD may help U.S. civil authorities accountable for isolating or quarantining crowds of people so as to reduce the spread of sickness in the occasion of an influenza pandemic. Isolation is frequently used in public health so as to detach and limit the movement of sick people, avoiding the spread of the infectious illness. Persons in isolation may be looked after in hospitals, at their residence or at selected health care centers. Isolation is principally employed at an individual point, although it can be applied to crowds. It is usually voluntary, although it may be compulsory at times. On the contrary, quarantine refers to the disconnection and constraint of movement among healthy persons who are suspected of having been exposed to the pandemic viruses. Quarantine can be performed in the area of residence or at any other place. It can be deliberate or compulsory.
When approved by the head of the nation, DoD will offer aid to civil authorities in the occasion of a civil disorder. DoD will increase civilian rule enforcement endeavors to reinstate and preserve order in harmony with existing acts.
Mortuary Affairs means in DoD is very restricted. When approved by the head of the nation, or ahead of approval by the Defense Secretary, DoD can conduct exploration, recuperation, receiving, dispensation, and can direct emigration of vestiges of the dead.
As assets permit, DoD will offer communications tools support with related instruction to civil authorities as demanded in the occasion of a pandemic influenza occurrence.
DoD will direct all public affairs course of actions and communication for a pandemic influenza occurrence with inter-agency associates.
DoD will offer help in reaction to a pandemic influenza when approved by the head of the nation, or ahead of approval by the Defense Secretary. This help may include aid to containment actions and constancy operations.

In conclusion avian flu is a communicable disease that is commonly associated with birds, though it frequently develops other strains that human beings are not immune to. People acquire H5N1 and other sorts of avian influenza via extended exposure to the birds. The birds transmit the virus via waste products in their feces, which consequently are inhaled innocently by human beings. The earliest case of avian influenza was established in the year 1878, in Italy and the last influenza pandemic happened in 1968. It lasted throughout 1969 and led to deaths of approximately 34,000 people in America. Following a long phase of dormancy, fears over the virus were rapidly revived in 1977, after a concise recurrence in Hong Kong. A man in Hong Kong was diagnosed with H5N1 for the first time, with several scientists predicting another international pandemic. Although avian flu is known to affect birds, current subtypes of the virus, especially the well-known H5N1 strain, have been found to have critical effects on human beings (Stegeman et al., 2004). Since the avian flu viruses are continuously mutating, there is fear that a virus that could be transmitted among human beings may develop, which could lead to a very distressing end (Ungchusak et al., 2005).

Managing the virus is also not an easy task as most birds that are infected are usually wandering animals, frequently traveling to different nations unrestrained. The avian flu, just like other viruses, is continuously developing, acclimatizing to become more challenging to recent vaccines and mutating so as to be more competent at transmitting diseases to its hosts

Some plans for preparedness and communication include: residents and non residents will be educated on the threats of the disease; DoD shall carry out a medical necessities gap analysis and acquire essential material to improve military health system treatment competence before a duration of 18 months; DoD shall provide military divisions, posts and stations with antiviral drugs and vaccine in line with the list of priorities planned in the DoD pandemic influenza guidelines in 18 months; the military officials’ shall institute a medical watch board that will be accessible on the web, so as to offer the most recent information on the disease; the officials shall endeavor to attain dependable sources of medical supply on stuff such as special protective tools and DoD shall set up stores of H5N1 and other influenza subtypes vaccines so as to be able to provide sufficient vaccination to about 1.35 million people within 18 months.

Some plans for detection and surveillance include: the local and military officials’ shall constantly perform influenza surveillance in laboratories; policies shall be constructed so as to enable detection means in the lowest stage; information mechanisms that are capable of tracing outbreak of the ailment in recruited shall be put in place; acumen shall be obtained from the gathering, analysis, evaluation and interpretation of alien medical, bio-scientific, communicable disease, and ecological knowledge. The intelligence is of importance to tactical medical planning and actions for the preservation of promptness and the formation of evaluations of alien medical abilities in both military and civilian divisions; the continuing, systematic gathering of health information crucial to the assessment, preparation, and execution of public health exercise, integrated directly with the timely distribution of information as wanted by senior authority; and information mechanisms that are capable of tracing outbreak of the ailment in recruited forces have been put in place.

Finally, some plans for response and containment include: the local and military officials shall lay policies that will be aimed at controlling the spread of the disease and lessening the economic, health, security, and communal impacts; and when approved by the head of the nation, DoD shall help the U.S. civil authorities accountable for isolating or quarantining crowds of people so as to reduce the spread of sickness in the occasion of an influenza pandemic

For the aforementioned reasons, there is no need for Okiwan residents to remain worried since the local and military officials have laid down adequate strategies to prevent the spread of the disease to the local nationals.

References

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Fouchier, R.A., Schneeberger, P.M. & Rozendaal, F.W. (2004). Avian influenza A virus (H7N7) associated with human conjunctivitis and a fatal case of acute respiratory distress syndrome. Proc Natl Acad Sci USA, 101, 1356-61.

Koopmans, M., Wilbrink, B., Conyn, M. & Natrop, G. (2004). Transmission of H7N7 avian influenza A virus to human beings during a large outbreak in commercial poultry farms in the Netherlands. Lancet, 363 (9409), 587-93.

Kurtz, J., Manvell, R.J. & Banks, J. (1996). Avian influenza virus isolated from a woman with conjunctivitis. Lancet, 348 (9031), 901-2.

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Puzelli, S., Di Trani, L. & Fabiani, C. (2005). Serological analysis of serum samples from humans exposed to avian H7 influenza viruses in Italy between 1999 and 2003. J Infect Dis, 192(8), 1318-22.

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Tran, T.H., Nguyen, T.L. & Nguyen, T.D. (2004). Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med, 350, 1179-88.

Tweed, S.A., Skowronski, D.M. & David, S.T. (2004). Human illness from avian influenza H7N3, British Columbia. Emerg Infect Dis, 10(12), 2196-9.

Ungchusak, K., Auewarakul, P., Dowell, S.F. (2005). Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med, 352(4), 333-40.

Webster, R.G., Geraci, J. & Petursson, G. (1981). Conjunctivitis in human beings caused by influenza A virus of seals. N Engl J Med, 304(15), 911.

Yuen, K.Y., Chan, P.K. & Peiris, M. (1998). Clinical features and rapid viral diagnosis of human disease associated with avian influenza A H5N1 virus. Lancet, 351,467-471.