Community health nursing involves helping people and society to establish an environment that supports health through health promotion, prevention, and support (Diem and Moyer 2004 p.7). Avian influenza, which is normally spread by birds, is a fatal disease, as it kills infected people very quickly; besides, the treatment is quite expensive. In this case, proper community health nursing is highly recommended if an outbreak is reported in order to control further spreading, and modify care of people who are more vulnerable. To achieve good community health, the public should be educated about the flu, its causes, its transmission routes, and the control mechanism.
In the case of avian flu occurrence, it must be reported promptly to the authority in charge in order to put up measures of preventing further transmission, and care of infected persons. In addition, the government can reduce the cases of avian flu through surveillance, diagnosis, communication, and vaccination. Moreover, the community health nurse should also modify the care of persons with respiratory diseases, as they are a more vulnerable group.
An outbreak of avian flu results in disruption of travel affects the economy and can lead to diplomatic misunderstandings. Generally, there is no known treatment for avian flu; and worse enough, the flu has become resistant to the available vaccines. Due to this, quarantine and isolation are preferred as effective means to contain the spread of the outbreak.
The outbreak of Avian Influenza
Avian flu is caused by viruses found in birds the most dangerous strain being the H5N1 virus. This flu mostly occurs in the winter seasons, since the viruses can survive for extended periods in cold temperatures, but could still occur in any other season (Basavanthappa, 2008, p.669). The first occurrence of avian flu in humans was in China in 1997 where18 people were infected and six of them died. In the subsequent cases of the flu, the death rate is estimated to be 25% (American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons and Caroline, 2010, p 35 2). Moreover, since the first occurrence in 2002, the H5N1 virus has continued to change its antigen and increase in its geographic prevalence (Heymann, Alcamo and Sfakianos, 2006, p.57).
Avian influenza has dominated the Asian continent with few occurrences in Africa and Europe. The first strain of human infection of bird flu was reported in Asia. In Africa, most outbreaks are reported in the northern part of the continent bordering the Asian continent i.e. Egypt. The movement of this flu since 2003 in different countries continues to rise due to increased market globalization and cross-border traveling. The graph below indicates the international trends of avian flu in three continents since 2003 and up to 2010. It is based on the data, provided by the World Health Organization and other agencies that study the spread of avian influenza. In this map, we have identified those areas where the instances of these diseases have been reported. Furthermore, we have also shown its hypothetical route.
The spread of the avian influenza1
This picture points out those areas where medical workers have registered the cases of Avian Influenza A(H5N1). It is known for a fact that this epidemic broke out in Chain, particularly in the province of Fujian in 2003 (WHO, 2010b, unpaged). In 2004 it spread over neighboring countries such as Indonesia, Thailand, Vietnam, Lao People’s Democratic Republic and so forth (WHO, 2010b, unpaged). This route is marked in deep blue color. However, medical workers do not know how this virus was transmitted to the Middle East, namely to Iraq, Afghanistan and such African countries like Egypt and Nigeria. In part, it can be explained by the movement of people or the migration of birds.
Epidemiological indicators and epidemiology data analysis
Epidemiological indicators include frequency of occurrence, distribution (time and place) and other deterministic factors. Avian flu has been reported to cause many deaths in many parts of the world including Asia, Africa, Europe, and America (Dudley, 2008). These three types of viruses are known to cause Avian influenza, namely; type A, B, and C. Type A virus is the only known type that infects birds and has other subtypes that have been identified to infect humans which include N5, N1, N2 and N8. These viruses are further classified as either low or high pathogenic; for instance, H5N1 is an example of a highly pathogenic virus. High pathogenic viruses cause severe diseases compared to low pathogenic viruses (Heymann, Alcamo, Sfakianos, 2006, p.57)
The first outbreak of H5N1 occurred in Hong Kong in 1997, and was later detected in 2002, thus necessitating the culling of a large number of chickens. However, this did not stop the occurrence of the flu in the subsequent years; for instance, in 2003, there were four deaths reported, caused by this virus. Since then, cases of H5N1 virus have been detected in Thailand, Vietnam, China, Indonesia, Japan to name but a few (Webber, 2009, p.259) Once these viruses enter the body of humans, they have the ability to mutate to stages that can be transferable from human to human, and whenever this stage is reached, a global epidemic is inevitable. Some mode of transmission is human to human and contact with infected poultry and their products. Young children are at a higher risk of catching bird flu; this is attributed to kids playing with infected birds or on grounds infested viruses that cause avian flu (Basavanthappa, 2008, p.669). According to the American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons and Caroline (2010, p. 35) the main and common symptoms of avian flu are “fever, sore throat, cough, and other respiratory diseases.” However, the symptoms vary from one person to another depending on what strain and subtype of virus caused the flu.
After analyzing the epidemiological data of avian flue, some risk factors were identified – rearing of mixed species, marketing of infected birds, and keeping of the birds in open fields. Besides identifying risks factors, analysis of epidemiology data assists in having improved interventions targets and the patterns of occurrence of avian flu. This data is used to trace the source of the flock where it originated from, and once established, it is very important in the control of the flu. Moreover, regional analysis helps to identify the common strain of virus and patterns of occurrence in that region.
Effects on the community
Avian flu has serious consequences on the economy of a nation; for instance, the “ban of export of poultry products since 1997 has caused a loss of approximately U.S. $50 billion” (Dudley, 2008). Generally, the damage of one country’s economy could have a ripple effect on other nations since the world economy is interlinked. In addition, a farmer lost their poultry through culling meant to control the outbreak. As a result, most farmers and employees lost their means of earning an income, creating unemployment. During the outbreak of avian flu, there is controlled movement and traveling from or to those areas, affecting people’s schedules, as well as tourism. In addition, movement and transportation control also affect the economy as the transport and logistics industry suffers losses. Moreover, there are changes in poultry production due to government policies and biosecurity regulations.
The period also witnesses a complete ban on people’s interaction in public places, schools are closed down and businesses. In addition, the cost of vaccines and treatment becomes very high and strains the families and the government as the demand is usually high. Generally, an outbreak of avian flu can cause diplomatic strains between nations because of the tighter travel regulations (through travel bans) and lack of cooperation in fighting the flu. For instance, countries would result in crossing borders or denying access to people from a nation with an outbreak, the result of which would be political tension.
Avian flu outbreak brings personal insecurity because of anxiety and stress in the community; for instance, farmers and farmworkers in poultry farming lose their jobs and the fear of being infected is one of the causes. Detention of people suspected to be infected with avian flu and lack of vaccines are some causes of social unrest. These measures are always taken due to the fact that the flu kills a lot of people who are infected; for example, it is estimated that half of the people infected die. In this case, there is a risk of tearing up the social knit as ill people fight for scarce medication.
Routes of transmission
One route of transmission is through direct infection through the passing of virus from infected birds to human beings, with children reported to be more susceptible. Primarily, the migration of infected wild birds from place to place results in the transmission of the virus to domesticated birds and later to humans. These wild birds drop viruses through saliva, droppings, or secretions, whereas domesticated birds pick up this virus from water sources, feeds, or soil.
The viruses are also transmitted from one farm to another through the movement of tools or workers. Avian flu is transmitted to humans through inhaling infected droplets or direct contact with contaminated places. However, transmission can also occur in health facilities to health care workers and other patients treating infected people; thus to avoid this method of transmission, it is required that health care workers to have safety equipment and have isolated wards for avian flu patients.
Although improper handling and disposal of birds that died of avian flu also transmit the flu, up until now, there is no scientific evidence to prove that consumption of cooked poultry products can transmit avian flu.
Protocol of reporting an outbreak
If a case of avian flu is detected in the local health clinic, the matter should be reported to the health officer in charge of that health facility who should report immediately the case to the local health department. The cases should be reported to CDC (Center for Disease Control and prevention) for evaluation of the magnitude of the spread. The state government is then expected to relay the information to other countries through diplomats’ representatives. The information should also be relayed to the world for safety precautions and surveillance of visitors from a country with an avian flu outbreak.
Modification of care
People already suffering from respiratory diseases like asthma are more vulnerable during avian flu outbreaks and they are much more sensitive to the changes in air quality. Community nurses should take into account extra risks and modify the care given to these patients. In particular, people with upper respiratory disease should be placed under antiviral therapy and supportive care. Supportive care, which includes intravenous rehydration, mechanical ventilation, vasopressor therapy, and renal replacement therapy, should be given to patients that are at a high risk of infection. The health care providers should provide frequent air changes per hour (6 to 12). N95 respirators can be reused in the care of TB patients, but they should not be reused after being worn by another patient because it greatly increases the risks of infection.
Special precautions should be undertaken for each member of the community, however, people, suffering from respiratory diseases have to be extra careful. These measures include wearing masks, washing of hands and vaccination. Immunization of older patients with chronic respiratory disease would very effective way of lowering the risks of infection. In addition, monitoring and surveillance of people will help the detection of any infections. Thus, people with respiratory diseases should be advised to avoid public areas and if they have to, they should wear protective masks. In some cases, people should be advised to stay indoors, for example, if the area is covered with smog. In this case, the task of the community nurse is to raise people’s awareness about the health risks, which they may face by going outside. Secondly, he/she has to instruct these people as to how they should behave.
Community health nursing helps in managing of the spread of communicable diseases like avian flu. This flu is contagious and has fatal consequences if it is not detected early. It is caused by viruses and the most common is the H5N1 strain. Primarily, the virus found in birds’ intestines is transmitted to humans through contact with infected objects. The effects of avian flu on a community include loss of income, cause of stress and anxiety, and diplomatic misunderstandings. Avian flu is a respiratory disease and people with other respiratory diseases are more vulnerable if they get affected. Therefore, for sake of public health quarantine, regulation of movement from areas with avian outbreaks can reduce the spread of the flu. In addition, an outbreak can tear apart the social setting of a community as they fight for scarce medication. Moreover, strains of avian flu tend to create resistance to vaccines and taking influenza shots cannot immunize someone from avian flu.
American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons and Caroline, N. (2010). Nancy Caroline’s Emergency Care in the streets. Ontario: Jones & Bartlett Learning.
Basavanthappa. (2008). Community Health Nursing. Delhi: Jaypee Brothers Publishers.
Diem, E. & Moyer, A. (2004). Community Health nursing projects: making a difference. NY: Lippincott Williams & Wilkins publishers.
Dudley, J. (2008). Public health and epidemiological considerations for avian influenza risk mapping and risk assessment. Ecology and Society, vol. 13, No. 2, pp 21.
Heymann, D., Alcamo, E. & Sfakianos, J. (2006). Avian Flu. NY: Infobase Publishing. Web.
Webber, R. (2009). Communicable disease epidemiology and control: a global perspective. London: CABI.
World Health Organization (2010). Affected areas with confirmed cases of H5N1 avian influenza since 2003. Web.
World Health Organization (2010b). Confirmed Human Cases of Avian Influenza A(H5N1). Web.
- This graphical illustration relies on the map, provided by the World Health Organization (2010, unpaged).