Imрlеmеntаtiоn оf Disеаsе Соntrоl аnd Prevention Роliсiеs

Imрlеmеntаtiоn оf Disеаsе Соntrоl аnd Prevention Роliсiеs

Summary of Avian Influenza A (H7N9) Virus

In 2013, the first outbreak of avian influenza in humans was identified in China. Thereafter, several such outbreaks transpired in that country. Since September 2016, there had been a spurt in the number of human infections with avian influenza A (H7N9)[CITATION She17 p 120 l 1033 ].

This increase generated considerable anxiety internationally. Exposure to avian influenza A(H7N9) virus among humans is primarily via contact with contaminated environments or infected poultry. This virus has been detected in animals and environments consistently. Despite reports that avian influenza infection among humans had spread to other patients in the same ward, the present virological and epidemiological evidence indicates that this virus is incapable of sustained transmission among humans[CITATION Wor171 l 1033 ]. Individuals, who develop severe acute respiratory symptoms at the time of travel in an area with avian influenza cases, should be examined for this disease medically.

During the past decade-and-a-half, the H5N1 and H7N9 avian influenza strains have transcended the species barrier and inflected humans. The advent of the H7N9 virus in China is a major threat of avian influenza to humans. The H5N1 had reportedly infected 650 humans since 2003; whereas, the H7N9 virus had infected more than 400 individuals in a year[CITATION Laz15 p 457 l 1033 ].

Implementation of disease control and prevention policies2

[CITATION Laz15 p 457 l 1033 ].

Geographical spread of influenza activity in Australia has been depicted below.Implementation of disease control and prevention policies2 1

[ CITATION Aus168 l 1033 ].

Thus, Avian Influenza A viruses have been described as highly pathogenic influenza (HPAI) or low pathogenicity avian influenza (LPAI), on the basis of the molecular features of the virus and the latter’s capacity to produce mortality and disease in chickens in laboratory settings[ CITATION Cen17 l 1033 ]. These forms of virus have produced severe illness in humans.

Moreover, in Victoria, there has been a 42% increase in confirmed influenza cases, as of 7 May 2017, in comparison to the same period in 2016, and 85% of these were of type A[ CITATION Vic171 l 1033 ]. Since the prevalence of influenza cases is high in Victoria, it is crucial to focus upon its prevention and control.

Steps of Investigation

The steps of investigation followed are: first, field investigation, involving a site visit by the health officers undertaken in collaboration with the institution and based on the situation. Second, establishing presence of an outbreak. Third, verifying the diagnosis, which is intimately connected to verifying the existence of an outbreak of the disease. This ensures correct identification of the disease, in addition to eliminating laboratory error as the cause for increase in reported cases of the disease. Fourth, construction of a working case definition, which can be updated and reviewed during the investigation. Initially, a sensitive case definition must be arrived at, as it will encompass most of the cases. Fifth, cases should be identified systematically and information should be recorded. Many outbreaks are intimated to the health authorities by the concerned citizens or healthcare providers[ CITATION Aus105 l 1033 ].

Sixth, conduct descriptive epidemiology. Moreover, an analytical epidemiological study could be required for testing several hypotheses. The primary epidemiological study designs are case control and cohort studies, vis-à-vis outbreak investigations. Seventh, development of hypotheses. These will depend upon the outbreak, and could address source of the infecting agent, mode of disease transmission, and exposures causing the ailment. These hypotheses should be amenable to testing. Eighth, implementation of control measures. It is necessary to conduct concurrent surveillance during the outbreak, as this facilitates identification of new cases, whilst updating the status of the existing cases. Whenever new cases continue to be identified and the nature of the illness undergoes change, it becomes necessary to consider the presence of a new organism or a different mode of disease transmission. Ninth, hypotheses should be re-evaluated, refined and reconsidered, as this permits an assessment of the actual outbreak condition. Tenth, findings should be communicated. Investigation details should be documented and should incorporate findings, investigation management and recommendations[ CITATION Aus105 l 1033 ]. Specifically, a summary report of the outbreak should be finalised and distributed among the stakeholders.

Prevention Strategies

Exposure to live poultry, specifically to live poultry markets (LPMs) has been recognised as the major risk factor of infection with the H7N9 virus. Several studies of the past had demonstrated that LPM exposure had a correlation with heightened risk of infection with this virus. In addition, the proportion of cases with LPM exposure history was higher than during the previous epidemics[ CITATION Zho17 l 1033 ]. To control this epidemic, several stringent market management measures had to be adopted, including market closures. Similarly, as health professionals, while controlling influenza, we should consider poultry market closures, on a temporary basis, to control risk of an epidemic.

After conducting a preliminary evaluation of the outbreak, the health department is tasked with measuring and describing morbidity. Upon arriving at a diagnosis of a reportable disease, physicians should report it to their local health department. The law obliges these reports to divulge information regarding when the incident had transpired; and the location, sex, age and race of the patient[CITATION Bis13 p 10-11 l 1033 ]. Thereafter, the health department consolidates and summarises this information by person, place and time.

As such, summarising the gathered information through investigation, our health department estimates the level and patterns of disease incidence in the area and identifies outbreaks of the disease. In order to compare the occurrence of a disease at different times or locations, our department has to convert the number of cases into rates. These rates correlate the number of incidents of the disease to the population size of the place where the disease had occurred (Victoria).These rates enable our department to identify groups in the community that have a heightened risk of disease. These high-risk groups can be further assessed and targeted for special intervention. Moreover, individuals should be familiarised with the information relating to these risk factors to decide about behaviours that affect health.

In addition, health authorities should adopt intervention methods for preventing influenza virus infection, which should have been employed previously, with success, for limiting transmission of the disease and reducing the number of cases[CITATION Poo131 p 221 l 1033 ]. These measures include, closure of live poultry markets, temporarily; dissemination of health information amongst the populace to familiarise them with the virus-related risks; and the promotion of personal hygiene practices. Moreover guidance to poultry slaughterers and sellers regarding proper equipment and operations, cleaning, and sanitation facilities, should be provided. Our health department will adopt the above measures to prevent influenza outbreak.

Furthermore, surveillance programmes have the capacity to identify escalations in occurrence and could prove to be early warning systems[CITATION Han10 p 1903 l 1033 ]. Thus, health professionals, while controlling influenza outbreak should undertake surveillance programmes to identify endemic warnings at an earlier stage.

In addition, it is difficult to manage communicable diseases within nations or jurisdictions, due to the rapidity and enormity of domestic and international travel. Effective international engagement is indispensable for diminishing global risks due to communicable diseases[ CITATION Aus1418 l 1033 ]. Similarly, our health department, will coordinate with several groups to help them to counter risks optimally and control the spread of influenza.

Health Communication

Victoria provides annual influenza immunisation service gratis for: individuals aged six months and over and with medical conditions that render them vulnerable to serious complications of influenza; Aboriginal and Torres Strait Islander residents; pregnant females; and people aged 65 years and over[ CITATION Sta171 l 1033 ].The above-mentioned people are considered the main risk group regarding influenza caused by the H7N9 virus in Victoria. Our health unit will communicate influenza outbreak information, mainly targeting high risk groups for the influenza attacks. We will prepare a report summarising the findings of our investigation, control measures of the epidemic and the precautions to be taken by poultry sellers, common people and other local health care organisations of Victoria.

As such, public communication makes it possible to address public concern emergent from the pandemic, as well involve the public in managing the impact of the disease. Regarding overseas travel by Australians, as well as those contemplating returning to Australia, the relevant information and risk warnings will be provided by the Australian Government Department of Foreign Affairs and Trade [ CITATION Aus1419 l 1033 ].

We will communicate with the public via the media and other means, as it moulds the public perception regarding risk and their engagement in measures that deal with the pandemic. By conveying accurate, consistent and the latest information regarding the status of the disease, we can facilitate understanding among the public about the real danger. During a pandemic, the primary source of information is the media. Wherever, priority requirements have been identified, we will provide exclusively designed and relevant information, including specialised media outlets to convey crucial information to the members of the remote Aboriginal and Torres Strait Islander communities. In this context, we have perceived that paid advertising could also be employed with benefit, especially when it is vitally important to mobilise the community rapidly in the face of a pandemic. Another strategy envisaged by us is to utilise print resources, which can be disseminated to stakeholders, who interact with the public, directly. These resources could consist of information for patients and could be distributed by health care workers. Thus, we will convey to the targeted public, information regarding the nature of the disease and the measures to be adopted to diminish the danger to themselves and their families.

List of References

Australian Government Department of Health. (2010). Chapter 7: Outbreak investigation. Retrieved May 22, 2017, from http://www.health.gov.au/internet/publications/publishing.nsf/Content/cda-cdna-norovirus.htm-l~cda-cdna-norovirus.htm-l-7

Australian Government Department of Health. (2014, April). Australian Health Management Plan for Pandemic Influenza. Retrieved May 23, 2017, from https://www.health.gov.au/internet/main/publishing.nsf/Content/519F9392797E2DDCCA257D47001B9948/$File/AHMPPI.pdf

Australian Government Department of Health. (2014, November 12). National Framework for Communicable Disease Control. Retrieved May 20, 2017, from http://www.health.gov.au/internet/main/publishing.nsf/Content/ohp-nat-frame-communic-disease-control.htm

Australian Government Department of Health. (2016). Australian Influenza Surveillance Report. Canberra, Commonwealth of Australia.

Bisen, P. S., & Raghuvanshi, R. (2013). Emerging Epidemics: Management and Control. Hoboken, NJ, USA: John Wiley & Sons.

Centers for Disease Control and Prevention. (2017, April 19). Influenza Type A Viruses. Retrieved May 24, 2017, from https://www.cdc.gov/flu/avianflu/influenza-a-virus-subtypes.ht

Hansbro, P. M., Warner, S., Tracey, J. P., Arzey, K. E., Selleck, P., O’Riley, K., . . . Hurt, A. C. (2010). Surveillance and Analysis of Avian Influenza Viruses, Australia. Emerging Infectious Diseases, 16(2), 1896-1904.

Lazarus, R., & Lim, P. L. (2015). Avian Influenza: Recent Epidemiology, Travel-Related Risk, and Management. Current Infectious Disease Reports, 17(1), 456-464.

Poovorawan, Y., Pyungporn, S., Prachayangprecha, S., & Makkoch, J. (2013). Global alert to avian influenza virus infection: From H5N1 to H7N9. Pathogens and Global Health, 107(5), 217-223.

Shen, Y., & Lu, H. (2017). Global concern regarding the fifth epidemic of human infection. BioScience Trends, 11(1), 120-121.

State of Victoria. (2017). Flu (influenza) – immunisation. Retrieved May 20, 2017, from Better Health Channel: https://www.betterhealth.vic.gov.au/health/healthyliving/flu-influenza-immunisation

Victoria State Government. (2017). Report No. 1: Week ending 7 May 2017. Retrieved May 20, 2017, from http://www.vidrl.org.au/wp-content/uploads/2013/09/2017-VicSPIN-report-1.pdf

World Health Organization. (2017, April 20). Human infection with avian influenza A(H7N9) virus – China. Retrieved May 20, 2017, from http://www.who.int/csr/don/20-april-2017-ah7n9-china/en/

Zhou, L., Ren, R., Yang, L., Bao, C., Wu, J., Wang, D., . . . Ni, D. (2017). Sudden increase in human infection with avian influenza A(H7N9) virus in China, September-December 2016. World Health Organization Western Pacific Region.