Monday, 22 February 2016

Avian Influenza: Not Again!

AVIAN INFLUENZA: NOT AGAIN!

     It’s only a-day old kid that is yet to realize that Nigeria is currently bewildered by the reemergence of Avian Influenza popularly known as ‘Bird flu’. When Ebola virus was on board in the country some months ago, as an analyst and activist, in most of my commentaries I categorically stated that Nigeria would surely overcome the scourge if we could employ severe and sustainable measure just as we did during the era of avian influenza.

     To have used avian influenza as an instance as regards severe approach towards containing an epidemic signified that undoubtedly every needed step was taken when the country firstly experienced the disease (Bird flu) in 2006. To this end, the capital question that needs to be asked at this point is: why the reemergence, or why is the country experiencing the outbreak for a second time barely after nine years of its initial occurrence?

     The country was able to overcome the said pandemic infection during its previous outbreak, specifically in 2006, owing to the tactical and drastic approach employed by the government and other concerned bodies. This implies that the reemergence of the menace might not be unconnected to the fact that we went to sleep or on a recess; that is, apathy on the part of the concerned authorities and personnel regarding sustenance of the measure initially utilized. In view of this assertion, it’s high time we are awoke.

     Presently, survey indicates that seven outbreaks of highly pathogenic Avian Influenza have been discovered in Nigeria. Six of the A(H5N1) outbreaks were reported in the central and northern regions of the country, which affected states like Kano, Plateau, and the Federal Capital Territory (FCT); over 21 thousand birds were reportedly killed while over 17 thousand were destroyed in these six outbreaks. Another outbreak occurred in the southern region of Bayelsa, affecting 8-week old pullets; 850 poultry died whereas 2150 were destroyed in this very outbreak. Officials said that farm workers visit other farms in the affected areas, which has great implications for possible infection routes and biosecurity.

     Avian influenza is an infectious viral disease of birds particularly wild water fowls like ducks and geese among other such animals as pigs, whales and horses. Most avian influenza viruses don’t infect humans; however, some to include A(H5N1) and A(H7N9) have caused serious infections in people. It is noted that outbreaks of A1 in poultry may raise global public health concerns as a result of their effect on poultry populations, their potential to cause serious disease in people, and their pandemic potential.

     The majority of human cases of A(H5N1) and A(H7N9) infection have been associated with direct or indirect contact with infected live or dead poultry. There is no evidence that the virus can be spread to people through properly cooked food. It’s worthy to acknowledge that controlling the disease in animals is the first and basic step towards curtailing risks to humans. It often causes no apparent signs of illness among the infected animals.

     A1 viruses can sometimes spread to domestic poultry and cause large-scale outbreaks of serious disease. Some of these A1 viruses have also been reported to cross the species barrier and cause disease or subclinical infections in humans and other mammals. We need to note that A1 viruses are divided into two major classes based on their ability to cause disease in poultry namely, high pathogenicity and low pathogenicity.

      Highly pathogenic viruses usually result in high death rates, up to 100% mortality within forty-eight hours in some poultry species. On the other hand, lowly pathogenic viruses also cause outbreaks in poultry but are not generally associated with severe disease or attack.

     The case fatality rate for A(H5N1) and A(H7N9) virus infections in people is much higher compared to that of seasonal influenza infections. The A(H7N9) virus mostly affects people with underlying medical conditions. In many patients, the disease caused by the A(H5N1) virus follows an unusually aggressive clinical course with rapid deterioration and high fatality. Like most emerging disease, A(H5N1) influenza in humans is yet to be well understood.

     The incubation period for A(H5N1) Avian Influenza may be longer than that for normal seasonal influenza which is around two to three days. Current data for A(H5N1) infection indicate an incubation period  ranging from two to eight days or possibly as long as seventeen days. Whilst, present data for A(H7N9) infection indicate an incubation period ranging from two to eight days.

     Initial symptoms of Avian Influenza include high fever usually with a temperature higher than 38 degrees Celsius, and other influenza-like symptoms including cough and sore-throat. In some patients, signs such as diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums might also be noticed. One feature often seen in most patients is the development of lower respiratory tract in the early stage of the illness; also, a hoarse voice, respiratory distress, and a crackling sound when inhaling are commonly observed. Sputum production varies in individuals and sometimes bloody. Complications of A(H5N1) and A(H7N9) infections include hypoxemia, multiple organ dysfunction, as well as secondary bacterial and fungal infections.

     The fundamental risk factor for human infection, as stated earlier, appears to be direct or indirect exposure to infected live or dead poultry, or contaminated environments such as live bird markets. Indeed, controlling circulation of the A(H5N1) and A(H7N9) viruses in poultry is essential to reducing the risk of human contraction. There is no proof to suggest that the aforementioned viruses can be transmitted to humans through properly prepared poultry meals including meats and eggs.

     A few A(H5N1) human cases have been linked to consumption of dishes made of raw or contaminated poultry blood. More so, slaughtering, defeathering, handling carcasses of infected poultry and preparing poultry for consumption especially in household settings are likely to be risk factors. Most importantly, it’s imperative to comprehend that most humans have little or no immunity to A(H5N1) and A(H7N9) viruses.

      Strong evidence suggests that some antiviral drugs, notably Oseltamivir, can reduce the duration of viral replication as well as improve prospects of survival. In suspected cases, the aforesaid drug ought to be prescribed as soon as possible, ideally within 48 hours following symptom onset, to maximize its therapeutic benefits. Notwithstanding, given the significant mortality currently associated with A(H5N1) and A(H7N9) infection and evidence of prolonged viral replication in this disease, administration of the drug should also be considered necessary in patients presenting the symptom(s) later in the course of illness. Mind you; the use of corticosteroids is prohibited.

     In cases of severe infection with the viruses, clinicians may need to consider increasing the recommended daily dose and/or the duration of treatment. In severely ill A(H5N1) or A(H7N9) patients, or in carriers with severe gastrointestinal symptoms, drug absorption may be impaired; this possibility ought to be considered when managing these patients. Furthermore, most A(H5N1) and A(H7N9)  viruses are predicated to be resistant to adamantine antiviral drugs, which are usually recommended for use during treatment.

     According to World Health Organization (WHO), in view of the persistence of the prevalent avian influenza viruses in some poultry populations, control or eradication would require long-term commitments from affected countries as well as strong coordination between various animal and public health authorities.

     Acknowledging the unarguable fact that prevention is extremely better than cure, there’s a compelling need for the general public to be thoroughly educated on the prime causes and mode of transmission of the virus. Since human-to-human transmission is presently far-fetched or rarely possible, it’s imperative for us to apply adequate caution while dealing with the primary hosts of the dreaded virus such as fowls, ducks, pigs, whales, and horses, among others, particularly the fowls or poultry at large which are the closest to human beings; hence, the various poultry owners across the federation ought to be properly sensitized in respect to this obvious fact.

      The farmers in question must be meant to comprehend that there’s need for them or anyone else who intends to enter into their farms to be well kilted. There’s also a crucial need for the said farms and other related environments like poultry markets and what have you, to be adequately fumigated from time-to-time. Every poultry keeper, or livestock farmers in general should ensure that his/her farm is entitled to a qualified and reliable veterinary doctor and the medic ought to endeavour to regularly visit the farm. In the same vein, poultry consumers ought to be conscientized to endeavour to properly boil or cook any meat or egg before consumption. The media, ministries of Agriculture, various farmers’ unions, the civil society and the National Orientation Agency (NOA) have a very vital and cogent role to play in this aspect.

      Similarly, the concerned government authorities or agencies, but not limited to, ought to regularly make the Avian Influenza vaccine available in every nook and cranny of the country to enable the citizenry assess them easily; and such practice should be subsequently sustained even having overcome the scourge. No doubt, the above proposed measure if holistically adhered to would go a long way towards salvaging the country in its entirety from this unforeseen mess. Think about it!

 
Comr Fred Doc Nwaozor
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