Avian Influenza: An Analysis of an Emerging Global Health Issue

This report provides a comprehensive analysis of Avian Influenza as an emerging global health issue. It begins with an introduction to the disease, differentiating it from human pandemic influenza and highlighting the concern around various strains like H5N1 and H7N9. The report justifies the selection of Avian Influenza as an emerging health issue, focusing on its zoonotic potential, environmental changes, and global spread. It outlines and critiques approaches for mitigating the infection, including the 'one health' approach, stamping out, and vaccination strategies, while also examining the role of nurses in mitigation efforts. The report also develops and justifies new approaches or ideas for reducing the infection, such as partnerships between stakeholders and the implementation of the WHO's global influenza strategy. The report emphasizes the importance of ongoing research, the role of nurses, and the need for robust national plans to address and mitigate the impact of future outbreaks. It provides a detailed overview of the disease, its implications, and strategies for prevention and control.

Running head: Emerging global health issues
EMERGING GLOBAL HEALTH ISSUES
AVIAN INFLUENZA

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Introduction of Avian influenza
Avian influenza is different from human pandemic influenza. The disease within birds does
not infect humans easily. Since 2003, when the virus emerged, numerous deaths are caused
by H5N1 avian influenza. An H7N9 straining of the virus in rooster occurred that caused
deaths of many humans in China. The tendency of spreading avian influenza in Australia is
mainly from international tourists, as the virus is not present in the country. Ducks are the
usual hosts of these diseases and are perceived to have played a role in disseminating the
HPN1 virus in Asia, Europe and Africa. Several types of striding birds migrate to Australia;
however that are not the usual spreaders or host of avian influenza (Agriculture, 2019a).
It is normal for remote birds within Australia, or the seasonal birds come to the country
carrying the little pathogenic avian influenza. Formerly the country had occurrences for avian
influenza in marketable birds, and all of them were exterminated positively. However, the
currently emerged strains creating concern in Asia and the United States were not the cause
of the outbreaks. While the probability of the external HP HPAI virus inflowing and getting
recognised in Australia is little, it is an opportune notice that all the poultry vendors and
manufacturers apply right biosecurity actions for stopping avian influenza and other
widespread diseases within the birds (Agriculture, 2019b).
Justification for selecting Avian influenza as an emerging health issue
Currently identified avian flu virus does not spread easily from one person to another.
However, the constant flow of the viruses among birds and poultry is a matter of concern, as
they create severe illnesses within humans and can change to become more transmissible
between people. Hence, the Health Emergencies Programme of WHO observes avian
influenza cases in human constantly (WHO, 2019a). Avian and other viruses of zoonotic
influenza can infect humans. The subtypes of bird flu include A(H7N9), A(H9N2) and

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A(H5N1). In the words of Gao et al. (2013), emerging health concerns mainly take place due
to environmental changes, increased trade and mobility, intensified food production and
urban crowding. Global concern for avian influenza intensified when extremely pathogenic
influenza A subtype H5N1 occurred in January 2006 in Nigeria. The possible destruction
from the rise of an epidemic strain is Africa resulted in a sudden move of focus regarding
public health to epidemic preparedness. Primarily, humans become infected by straight
contact with contaminated environments or infected animals. These viruses cannot sustain
spread among humans. They cause a range of disease among humans, including cough and
fever sepsis with tremor, new mucus creation and fast development to acute pneumonia and
death. Besides, gastrointestinal symptoms, conjunctivitis, encephalopathy and encephalitis
are also seen in different extents based on the subtype. Most of the human cases of A(H7N9)
and A (H5N1) are related to indirect or direct interaction with contaminated deceased or live
poultry.
Directing the diseases within animal sources is essential to decrease the risk to humans.
Avian influenza with the vast still basin in water birds is not possible to eliminate. The
infection within humans will linger to take place. For reducing public health risk, it is crucial
to conduct great scrutiny in both human and animal populations by examining each social
contagion and risk-based epidemic planning. The type A viruses of influenza are of most
critical to human health because of their tendency of causing an influenza sickness. This virus
is categorised into subtypes considering the integration of various virus surface
neuraminidase and proteins hemagglutinin (WHO, 2019b). As stated by Wiwanitkit (2013),
influenza infection is a common respiratory pathogen. The emergence of new, unusual
influenza usually is a significant public health issue. The latest rare influenza virus is H7N9
bird flu, which is reported in 2013. The development of the new disease took place in China
and became the focus for a potential global pandemic. In this context, Krammer (2017) stated

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that with a projected case deadliness rate of up to 60%, it is essential to outline the current
digital technologies, which can be applied for enhancing disease checking and health result
for the virus. The primary reason behind the emergence of avian influenza is high interaction
between human beings, wild ducks and domestic poultry that is created by the high
population density and abundant chances for native birds to be open to remote ducks in some
Asian counties that increase the chance for avian influenza viruses to evolve reaffirm and
infect humans.
Thus, the growing percentage of avian influenza is caused by several reasons and hence, the
study chose this disease as an emerging health issue.
Outlining and criticising approaches for mitigating or reducing the infection
Different approaches are taken for addressing the concern of avian influenza. Zheng et al.
(2019) stated that the ‘one health approach’ is an effective method of preventing avian
influenza. According to the authors, the growingly fuzzy human-animal interconnection,
zoonotic contaminations are rising at an extraordinary rate. The inter-reliance between animal
health, human health and environmental condition is the thought behind the ''one health' that
means addressing the increasing concern of infectious viruses through collaboration among
experts from multiple disciplines. As the biggest agricultural nation of the world with a
substantial animal-human interface, China faces a significant number of evolving
communicable zoonotic diseases. Therefore, China seems to be the ideal background for the
application of one health program and resolving avian influenza and other infectious diseases
effectively. Okello et al. (2014) agree with the point that the environment, animal and human
are interlinked, and the one health policy improves a cooperative, transdisciplinary outlook
towards universal health. The exceptional political and financial response to H5N1 avian
influenza in the 21st century helped the expansion of worldwide inter-sectoral coalitions,

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producing an exceptional policy space for the governments, institutes and agencies to
cooperate in a large scale first. However, it could not be converted into a comprehensive
strategy for controlling avian influenza. It cannot be applied without wide institutional
changes, rights of the changes around the different interest groups, departments and
ministries with a post in controlling disease and adequate funding. Moreover, there is a need
for balancing national possession of change and global health programs for supporting the
operationalisation of one health.
Figure 1: One heath approach
(Source: Okello et al. 2014)

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Stamping out is another standard approach for preventing and mitigating avian influenza. It
involves identifying new cases, rescinding any identified infected herds after launching
movement actions for preventing and controlling future spread. It also traces both backward
and forwards to recognise threatening contact grounds. In 1997, the outbreak in Hong Kong
was controlled by stamping out the total marketable poultry population. In seven-week, the
markets and farms were cleaned and disinfected thoroughly, and new cages, plastics and
other equipment were introduced. However, the process is not always successful when
infection was already blowout (FAO, 2019). However, Uyeki & Cox (2013) commented that
the stamping out policy might not be suitable for some nations. Therefore, it applies only to
the counties wishing to recommence export and can implement strict biosecurity measures.
The OIE, however, continues to depend on the belief that stamping out is the process for
eliminating the avian influenza virus rapidly. However, it also believes that the operation
cannot be implemented in some nations for some reasons. Therefore, OIE has an unplanned
group, which has developed recommendations for the mass killing of animals at the time of
emergency and not complicating dumping of corpses. These processes differ considering the
available equipment, resources and infrastructure.
For such countries, where stamping out is not a good idea; vaccination can be applied. It is
proved to decline mortality, virus shedding and morbidity. It is a useful method for the
countries to comply with the rules of the OIE Terrestrial Manual. The vaccines are supervised
under the administration of formal veterinary services. The veterinaries must have the
required resources and equipment for ensuring that adequate and suitable surveillance is
conducted for avoiding potential problems as a result of vaccination. The suggested Code
Chapter enables the export of living birds from regions, zones or sections that have been
vaccinated, offers particulars of the vaccines and mentions the vaccination plans. The
Terrestrial Code also includes a section containing the typical requirements for a nation to

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conduct surveillance and supervision of animal health (Knobler et al. 2019). Kandeil et al.
(2018) supported the idea regarding the effectiveness of vaccines for preventing avian
influenza. Vaccination on the ground of commercial H5 vaccines is applied as a crucial
control approach in Egyptian poultry. Several factors are there that affect the efficiency of the
poultry vaccines. These include antigenic and genetic factors between the strains of
commercial vaccine and circulating viruses. As per the guidebook of vaccine analysis by the
World Organisation for Animal Health (OIE), a suitable poultry injection must protect
minimum 80% of immunised birds from demise and decrease the viral flaking after a trial
infection.
Role of nurses in mitigation
Nurses play a superior position in mitigating avian influenza, as evident in several cases. For
example, during the outbreak of the diseases in Hong Kong in 1997, the public health nurses
contributed notably to the management of the disease in partnership with the capacity-
development work. Thus, they have a more significant contribution to strengthening the
public health set-up by spreading public awareness about avian influenza and other infectious
diseases (Li et al. 2014). As stated by Swayne (2012), acute care nurses must take a
proactive role in the preparedness and plans for satisfying the demands of the health care
system. The nurses are in the central role as they are linked to planning for the possible
epidemic. With estimations of the effect, it is essential to ponder what would be the
consequence if 25-30% of physicians, support workers and nurses become sick to attend
work. It is one of the aspects that need to be taken into consideration while preparing for
managing an epidemic. It is imperative that the nurses contributed deliberately for
understanding the viruses, their consequences and ethical concerns the pandemic can carry.
Developing and justifying new approaches or ideas for reducing the infection

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Over the last years, several various control processes have been implemented for preventing
HPAI infection. Pramuwidyatama, Hogeveen & Saatkamp (2019) commented that the
national plan, including several measures, results in issue using budget allocation and
prioritisation. Although the government of different countries adopt mainly the vaccination-
based HPAI mitigation approach, the approach has low application viability. Therefore, for
the future, a partnership among the responsible stakeholders can improve the
practicability of the selected strategy. The stakeholders, who need to come together for
making the future mitigation of avian influenza useful include the government, farmers and
integrated companies.
Further, the World Health Organisation has developed a worldwide influenza strategy for
2019-2030. It offers a guideline for the WHO, partners and countries to approach avian
influenza universally by vigorous national programs ranging from investigation to
prevention and regulate of disease with the aim consolidating periodic prevention and
management as well as readiness for future epidemics. According to WHO, an outbreak of
any type can kill millions of people across the world and can have a destructing impact on
worldwide infrastructure and economies. Therefore, the goal of WHO’s strategy is decreasing
the encumbrance of seasonal influenza, minimising the threat of avian flu and mitigating the
effect of epidemic influenza. The approach is developed to reduce outbreak-related issues,
comprising the formulation of better international tools like antivirals, treatment and vaccines
and the creation of robust national plans for addressing national healthcare security planning
and enhancing health coverage abilities. Apart from that, the organisation is committed
explicitly to conduct new research for bringing innovation for discovering better-
preventing techniques and medicines for treating avian influenza and policies, which
individual nation can implement or addressing the disease before and after it appears

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adequately. The knowledge deficiency regarding the virus of bird flu and is hosts need to be
overcome for lowering morbidity and mortality rates (Hamilton & Villiger, 2019).
Besides, there is a need of more effective vaccines and antiviral drugs with broader, longer-
lasting and stronger immunity for countries struggling to obtain public confidence and
execute their efforts pertain to prevention, preparedness and control of influenza fully. Hence,
more investment and focus is required for discovering effective medicines and vaccines to
fight avian flu efficiently in future. Apart from that, enhancing the effort for preventing
seasonal avian influenza is also necessary. Thus, for ensuring the safety of human being from
bird flu in future, it is crucial adopting a collaborative approach, focusing more on research
and development and strengthening the surveillance system.
Concussion
Avian influenza is a zoonotic disease that infects human being for coming into contact with
poultry and wild waterfowls. The virus has been affecting people and birds of different
countries of the world severely. Therefore, governments have taken various initiatives and
approaches, including stamping out, vaccination, and so forth at times for preventing,
controlling and mitigating the disease. However, due to the knowledge gap about the various
hosts of avian influenza, extensive research is required for bringing innovation in the process
of controlling and preventing the virus. A collaborative approach between government,
framers and healthcare agencies can bring a positive difference in the way the disease is
restricted and controlled until now. The nurses also have a more significant contribution to
the mitigation of avian influenza by spreading awareness within the communities and
functioning proactively when the virus infects human beings.

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References
Agriculture (2019a). Department of Agriculture Avian Influenza or Bird Flu. Retrieved 14
September 2019, from
http://www.agriculture.gov.au/pests-diseases-weeds/animal/avian-influenza
Agriculture (2019b). Department of Agriculture Global Avian Influenza Outbreak Situation
Update. Retrieved 14 September 2019, from http://www.agriculture.gov.au/pests-
diseases-weeds/animal/avian-influenza/global-avian-influenza
Avian influenza. (2019). Retrieved 14 September 2019, from
https://www.who.int/westernpacific/emergencies/surveillance/avian-influenza
FAO (2019). Approaches to controlling, preventing and eliminating H5n1 highly pathogenic
avian influenza in endemic countries. Retrieved 14 September 2019, from
http://www.fao.org/3/i2150e/i2150e.pdf
Gao, R., Cao, B., Hu, Y., Feng, Z., Wang, D., Hu, W., & Xu, X. (2013). Human infection
with a novel avian-origin influenza A (H7N9) virus. New England Journal of
Medicine, 368(20), 1888-1897.
Hamilton, J., & Villiger, M. (2019). World Health Organization Releases Global Influenza
Strategy for 2019-2030. Retrieved 14 September 2019, from
https://globalbiodefense.com/2019/03/21/world-health-organization-releases-global-
influenza-strategy-for-2019-2030/
Kandeil, A., Sabir, J. S., Abdelaal, A., Mattar, E. H., El-Taweel, A. N., Sabir, M. J., ... & Ali,
M. A. (2018). Efficacy of commercial vaccines against newly emerging avian
influenza H5N8 virus in Egypt. Scientific reports, 8(1), 9697.

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Knobler, S., Mack, A., Mahmoud, A., & Lemon, S. (2019). Strategies for Controlling Avian
Influenza in Birds and Mammals. Retrieved 14 September 2019, from
https://www.ncbi.nlm.nih.gov/books/NBK22152/
Krammer, F. (2017). Stopping emerging influenza viruses at their origin. The Lancet
Infectious Diseases, 17(8), 784-786.
Li, Q., Zhou, L., Zhou, M., Chen, Z., Li, F., Wu, H., & Meng, L. (2014). Epidemiology of
human infections with avian influenza A (H7N9) virus in China. New England
Journal of Medicine, 370(6), 520-532.
Okello, A. L., Bardosh, K., Smith, J., & Welburn, S. C. (2014). One health: past successes
and future challenges in three African contexts. PLoS neglected tropical
diseases, 8(5), 2884.
Pramuwidyatama, M. G., Hogeveen, H., & Saatkamp, H. W. (2019). A systematic evaluation
of measures against highly pathogenic avian influenza (HPAI) in Indonesia. Frontiers
in veterinary science, 6, 33.
Swayne, D. E. (2012). Impact of vaccines and vaccination on global control of avian
influenza. Avian diseases, 56(4s1), 818-828.
Uyeki, T. M., & Cox, N. J. (2013). Global concerns regarding novel influenza A (H7N9)
virus infections. New England Journal of Medicine, 368(20), 1862-1864.
WHO (2019a). Retrieved 14 September 2019, from http://www.fao.org/3/i2150e/i2150e.pdf
WHO (2019b). Influenza (Avian and other zoonotic). Retrieved 14 September 2019, from
https://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-
zoonotic)

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Emerging global health issues
Wiwanitkit, V. (2013). H7N9 influenza: the emerging infectious disease. North American
Journal of medical sciences, 5(7), 395.
Zheng, Z., Lu, Y., Short, K. R., & Lu, J. (2019). One health insights to prevent the next
HxNy viral outbreak: learning from the epidemiology of H7N9. BMC infectious
diseases, 19(1), 138.