Avian Influenza: Not Again

By Comr Fred Doc Nwaozor 

It’s only a-day old kid that is yet to realize that Nigeria is current­ly bewildered by the re-emer­gence 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 measures 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 re-emergence, 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 re-emergence of the menace might not be unconnected with 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 in the 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 visited 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 includ­ing 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 of 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 made to comprehend that there’s need for them or anyone else who intends to enter into their farms to be well kitted. 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 ought to regularly make the Avian Influenza vaccine available in ev­ery nook and cranny of the country to enable the citizenry access them easily; and such practice should be subsequently sustained even having overcome the scourge. No doubt, the above proposed measures if holisti­cally adhered to would go a long way towards salvaging the country in its entirety from this unforeseen mess. Think about it!

*Nwaozor wrote in from Owerri