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Dealing With Bird Flu Outbreak

Dealing With Bird Flu Outbreak

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08/08/2013

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Dealing with bird flu outbreak
Dr.Kedar KarkiBackground:
The current situation of avian influenza or bird flu is quite unprecedented andalarming. It raises particular concern regarding the potential threat of aninfluenza pandemic which many medical historians believe is imminent. Thedevastating effects of the 1919 pandemic and the 40 million lives it claimed arestark reminders of what could be looming on our doorsteps. The last centurysaw three pandemics, the last one occurring in 1968. Looking back, it could befound that an outbreak caused by the highly pathogenic H5N1 strain of theavian influenza virus was reported in Scotland in the 1950s; human casesoccurred for the first time in Hong Kong in 1997.The outbreak which began in China in late 2003 is unparalleled in terms of thenumber of countries affected. More than 65 countries across Asia, Europe,Africa, and the Middle East have reported infection in poultry or wild birds. Thespread across continents is seems to be attributed to migratory birds, butrecent events have pointed to the movement of live bird and poultry products.Human cases have been reported from 14 countries, seven of which are in Asia.The situation remains highly dynamic with recent outbreaks in poultry inBangladesh, China, India, Indonesia, Myanmar, Thailand, and Vietnam, Nepal.The concern is not focused on bird flu per se, but on the potential risk of itigniting an influenza pandemic.The H5N1 virus has the tendency and the capacity to change through re-assortment through mixing with other circulating seasonal influenza virusstrains. In fact, influenza can be categorized into three broad types from thepublic health risk perspective: seasonal influenza or common flu; avianinfluenza, in particular H5N1 among birds or poultry; and finally, pandemicinfluenza. Till today nobody has any idea about if, and when, the pandemic willoccur and whether it will be caused by the currently circulating H5N1 virus oranother virus. Bird flu now appears to be firmly entrenched in much of Asia.Moreover, there is a close interface between animals and humans as well ashumans who share a common dwelling with animals including poultry, puttingthem at risk. Bird flu primarily lurks in the animal sector in most countries,especially among backyard poultry. Situation which Nepal is facing today inpast this disease use to occur during cold winter season but this year even itsoutbreak is occurring even in hot humid summer rainy season this is the mainconcern for the authourity.Even after the ban imposed for movement of poultryand sale of poultry product like meat the disease is flaring up. Due to themovement and sale restriction till date 95% of meat shops those were dealingexclusively poultry meat are now closed and depopulation of birds frominfected farms farmers have to incur a loss of about 60 million in currentmarket price.
 
Transmission from poultry to humans is uncommon but it has occurred amongadults and children exposed to sick or dying chicken. Relatively few deaths of human infection have occurred to date but mortality at 61 per cent worldwideis very high. There are a few examples of human cases occurring in clusters. In2004, Thailand reported a case when a mother fell ill after providing care toher sick daughter in hospital; she had otherwise no exposure to sick or dyingchicken. Then, in 2006, several members of one family developed avianinfluenza in Karo, Indonesia after being exposed to a sick family member athome. There have been a few clusters reported in Vietnam too. Althoughtransmission of avian influenza from human to human is rare, preparedness ispivotal in view of the dynamic nature of the situation. At least two of the threepandemics that occurred in the last century originated from Asia and this is asobering thought. Will the next pandemic virus also emerge from Asia? It isanybody’s guess.
Control measures and precautions
A prerequisite for preventing the pandemic is containing the virus at the sourceitself - in this case, in the animal sector. The most important control measuresinclude practicing bio-security, culling of poultry combined with quick andadequate compensation to farmers. The control measures in the human sectorinclude prevention of exposure to infected poultry and reducing case fatalityrates. The precautions that people must take in an outbreak area are fairlystraightforward: knowing how to steer clear of getting infected by avoidingexposure to and contact with sick and dying chicken, and not de-featheringpoultry at home. In the event that one develops an influenza-like illness,prompt consultation at a health facility is recommended with suitable anti-virals taken within 48 hours. Consuming chicken is safe as long as it is cookedthoroughly at a high temperature since the virus cannot survive at boilingtemperature.
Lessons learnt from past:
Avian influenza outbreaks have brought to light several dimensions. Thecultural and economic spin-offs from a traditional way of life, especially inAsia, have been brought under the spotlight. The political commitment tointer-Sectoral collaboration, particularly between the agriculture and healthsectors, has led to rapid and successful containment of the outbreaks in manycountries including India. The high case fatality rates documented in theoutbreaks, especially in Indonesia nearly 85 per cent recently, is of immenseconcern. In order to understand why, and what can be done to reduce this,research is a priority. The communication messages needed to alter riskbehavior and improve case management to reduce death from avian influenzapose key challenges. To prevent avian influenza and to rapidly contain itsspread. Table-top exercises and mock simulation drills are being suggested tohelp fine-tune the response mechanism. The rapid containment strategiesinclude early and strategic use of anti-virals and public health measures such associal distancing, school closure, restricting gatherings and cough etiquette.

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