Please try to answer the following on Bird Flu
1. What is avian flu?
2. What are the agent, host, and environmental factors?
3. Why is it of importance now?
4. What is the current magnitude of problem in the region?
5. What are the strategies for surveillance in Malaysia?
6. What are the steps to investigate and control the disease in Malaysia?
7. What preventive strategies can be adopted?
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1.Avian influenza (AI) is a contagious viral infection caused by the influenza virus type "A", which can affect several species of poultry (chickens, turkeys, quails, guinea fowl, etc.), as well as pet birds and wild birds.
2. The natural hosts of the virus are ducks, shorebirds, and other species of wild aquatic birds. In the natural hosts, influenza infections cause almost no disease signs and the infection is established mostly in the intestinal tract. The virus is excreted with the feces into the water promoting a cycle of fecal-oral transmission. Poultry feed may sometimes be exposed to droppings from wild birds. Owners and managers of multiple farms and farm workers who are employed on several farms and others having access to poultry premises could transmit the virus on their boots, clothing, or on the tires of their vehicles. Casual visitors and relatives provide a threat of transmission as well. Equipment used by any person visiting a poultry farm also provides a vector for transmitting the virus.
3. It is important now because human infection with avian influenza viruses have been reported since 1997. More recently, more than 200 confirmed cases of human infection with avian influenza A (H5N1) viruses have been reported since 2004. The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms e.g., fever, cough, sore throat, and muscle aches, conjunctivitis, pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.
4. The avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe, the Near East, and Africa is not expected to diminish significantly in the short term. It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry and/or wild birds will continue to occur. So far, the spread of H5N1 virus from person-to-person has been rare. No evidence for genetic association between human and avian influenza A virus genes has been found; however, this epizootic continues to pose an important public health threat.
5.
i.Development of an outbreak case definition that includes details regarding specific symptoms, incubation period, exposures and locations of concern in addition to laboratory test results that are associated with confirmed cases.
ii.Dissemination of the outbreak case definition to all relevant stakeholders including the public health outbreak investigators, occupational health authorities responsible for persons involved in controlling the outbreak and other stakeholders who might be involved in case detection (e.g. local physicians or hospitals).
iii.Identification of potential human cases and contacts and administration of the outbreak questionnaire to collect epidemiological information and implement the appropriate investigation and public health measures.
iv.Ongoing timely reporting on any human cases and control measures put in place, through the normal reporting channels.
v.Notification
vi.Notification of asymptomatic individuals linked to the outbreak -up).
vii.An assessment for evidence of human influenza strains currently circulating in or near the affected area(s).
viii.Consideration of any special studies (e.g., serosurveys for evidence of asymptomatic infection) that might require data or laboratory specimen collection during or following the outbreak.
6. For clinical case description and managing of possible cases.
a.Patients with the following criteria should be treated as suspected cases of avian influenza:
•Recent (< 7 days) history of direct exposure* to diseased or dying poultry or birds (* direct exposure: direct contact or close proximity e.g. within 3 feet or contact with case.
-Fever > 38ºC
-Respiratory symptoms (e.g. cough, sore throat, shortness of breath)
-Chest radiograph may show pneumonic infiltrates, which are often patchy (rather than lobar) in distribution. Chest X-rays, however, maybe normal initially.
b.All patients with suspected avian influenza should be referred to the designated to GOVERNMENT HOSPITAL
No private hospital /clinics are allowed to treat a suspected case of avian influenza.
c.The A&E Department of the receiving hospital should be notified after which a designated ambulance from that hospital is sent to pick up the patient.
d.While awaiting transfer, the patient should be stabilized and isolated in a single waiting / examination room or area. He/she should be provided with a surgical mask (if not contraindicated).
e.The attending doctor and other healthcare personnel (kept to smallest possible number to minimize possible exposure) should don personal protective equipment (PPE) at all times while attending to the patient. The PPEs include; 3-ply surgical mask, gloves, water- proof gown and face shield (if splashes are expected). If intubations or other invasive procedures are performed, a N-95 respirator mask should be used instead.
f.All healthcare workers involved should comply with strict infection control. Adequate hand washing must be performed after all procedures. If hand washing is not immediately possible, alcohol hand rubs maybe used. (However, alcohol hand rubs should not be a substitute for hand washing in cases of visible hand soiling.)
g.All objects in direct contact with the patient and spillages should be decontaminated as in the SARS protocol.
h.Notification of possible cases will be done by the receiving government hospital, however the referring hospital /clinic should inform the State Operations Room concerning the case.
i.The referring hospital/ clinic must provide contact numbers (telephone or fax numbers) for further clarification and information.
7.
-Keep poultry in closed poultry houses.
-Keep wild birds and their feces away from poultry and poultry feed
-Seal poultry house attics and cover ventilation openings with screens
-Thoroughly and routinely clean all equipment, vehicles, including service vehicles, clothing and footwear before and after coming into contact with poultry
-Ensure proper hygiene practices for all persons coming into contact with poultry
-Maintain high sanitation standards in and around poultry houses
-Isolate or avoid introducing new birds into existing poultry flocks if their health status is unknown
-Limit access to poultry houses, including farm workers, feed suppliers, poultry veterinarians, catching crews, sawdust and shavings suppliers, agricultural service personnel and casual visitors
-Avoid using water in poultry houses contaminated with feces from wild birds
-Ensure thorough cleaning and disinfection for all cages transporting birds
-Maintain a log of all visitors coming into contact with poultry
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