H7N9 Project
Avian Influenza H7N9
Winnifred Brefo-kesse
Hlth 626
March 31, 2019
Professor Hughes
In February and March 2013, a novel influenza A (H7N9) virus emerged in China, causing an acute respiratory distress syndrome and occasionally multiple organ failure with high fatality rates in humans (Li et al., 2014). A total of 681 laboratory-confirmed cases and 275 deaths have been reported as of November 13th, 2015, with a fatality rate of 40% (http://www.who.int/influenza/human_animal_interface/HAI_Risk_Assessment/en/). H7N9 has been evolving and established amongst chickens in China over the past two years with occasional human infections (Lam et al., 2015; Su et al., 2015), thus posing a threat to public health. In the absence of an annually-updated effective vaccine, antiviral drugs constitute the first line of defense against H7N9 infections. H7N9 viruses already possess natural resistance to M2-ion channel blockers (amantadine and rimantadine) when it first emerged in 2013 (Gao et al., 2013). Therefore, neuraminidase inhibitors (NAIs), which include oseltamivir (TamifluH), zanamivir (RelenzaH) and peramivir constitute the main antiviral drugs against H7N9 infections (Hu et al., 2013; Wu et al., 2013). However, treatment with NAIs against H7N9 infections has resulted in the emergence of drug-resistant mutant viruses, as soon as 1~9 days after administration (Gao et al., 2013; Hu et al., 2013). Moreover, the first H7N9 isolate (A/Shanghai/1/2013(H7N9), SH-H7N9) was resistant to oseltamivir (Gao et al., 2013). Avian influenza A H7 viruses are a group of viruses that is mostly found amongst birds. The H7N9 virus is a subgroup of the H7 viruses and was recently discovered in China. There were three cases discovered in March of 2013 which ultimately increased in May by 132 cases. Of those cases, the 39 infected, died because of the virus (Peipei Song1, 2013). The clinical features described in the three patients with H7N9 virus infection, included fulminant pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), septic shock, multi-organ failure, rhabdomyolysis, and encephalopathy, are very troubling (Timothy M. Uyeki, 2013). As of now, this virus has reached stage two of three which is poultry passing the virus to humans. There is one more stage left which is human to human transmission which the Chinese health officials have confirmed it is not yet occurring. Creating an anti-virus takes a lot of time and until then public health officials should create new tactics in battling this epidemic.
Since there isn’t an anti-virus for the H7N9 virus, different health policies must be put in place to control the outbreak as well as preventative strategies from escalating. This virus was most found amongst poultry, so the Chinese health officials started the management of live poultry markets in urban areas, and free ranged poultry in rural areas. The Chinese health officials concluded that people could be infected through contact with virus-carrying birds or exposure to contaminated environments (Peipei Song1, 2013). China created public health responses to close down all affected markets, stopped the sale of birds, through disinfection, poultry culling, and prohibiting the entry of exotic live poultry that could benefit in preventing more people becoming infected with H7N9 virus (Peipei Song1, 2013). Ultimately closing all the markets permanently will be difficult and changing purchasing habits of live poultry will be challenging and might take a long time. Instead China has decided to enhance regulation of their poultry markets. Regulation includes in establishing quarantine areas at production sites, establish fixed locations for slaughtering and quarantine, implement regular spot checks, implement bio-safety level disinfection, and establish better traceability of frozen poultry (Peipei Song1, 2013).
Not only is there an exposure in urban areas, but there is a significant amount of exposure in rural areas as well. In urban areas people are exposed to the virus in live poultry markets, especially the poultry handlers. In rural areas most people raise their own poultry causing an environmental health concern. The Chinese conducted a study of 1,379 participants, half had contact with wild birds ("often" and "occasionally"); nearly 50% have a semi-closed or open yard that poultry could pass through, 51% kept poultry in their homes (Peipei Song1, 2013). Only a few residents had special poultry coops to maintain their poultry in a proper and feasible manner, and many others did not. People who did not have this luxury were forced to raise their poultry inside their homes for example, common rooms, and extra room or even a restroom (Peipei Song1, 2013). Researchers also found that since poultry was raised inside homes, poultry feces were discovered in the yards, the living rooms, restrooms, and worse, in the kitchens (Peipei Song1, 2013). This is a great environmental concern because family members including children, whom are more susceptible to the disease, are openly exposed to the H7N9 virus. Rx for survival did a piece on the H7N9 virus and stated the Chinese health officials noticed a trend of the virus occurring in young 6-7-year-old boys. This was because young boys were given the job to pluck the feathers off the dead poultry, thus openly exposing them to infected specimens.
Even though there isn’t an anti-virus Chinese health officials have stalked up millions of doses of Tamiflu and a new anti-influenza drug (peramivir sodium chloride injection) that has proven effective in fighting the H7N9 virus (Lin Mei, 2013). This anti-virus is only used to help cure patients who are already infected, not for the prevention of obtaining the virus. A statement about vaccine response had been made by WHO on May 2, 2013 (Lin Mei, 2013). USCDC and European center for disease prevention and control (ECDC) also issued guidelines of using antivirals. However, since the outbreak of H7N9 has been in a relatively short period of time, the existing policies about drug stockpiling and vaccine development to treat influenza A (H7N9) are still limited (Lin Mei, 2013). The U.S. Department of Agriculture (USDA) has set up a Situational Awareness Coordination Unit with a core team of subject matter experts and other USDA representatives, including the Animal and Plant Health Inspection Service (APHIS), the Agricultural Research Service (ARS), the Food Safety and Inspection Service, and the Foreign Agricultural Service (Emergence of Avian Influenza A(H7N9) Virus Causing Severe Human Illness , 2013).
The spectre of introduction of avian influenza in Zambia through migratory birds raises concerns for both human and animal health. Although avian influenza virus (AIV) surveillance has been on-going in wild waterfowl in Lochinvar national park (LNP) since 2006, little is known about the ecological drivers of AIV perpetuation in wild birds in Zambia. While several AIV subtypes have been isolated and characterized in Zambia, H10 viruses have not been studied. During routine AIV surveillance conducted in November 2014, of the 287 faecal samples collected from ducks, spur-winged geese and pelicans, four H10N1 viruses were isolated from ducks using embryonated eggs. In this study, the haemagglutinin (HA) and the neuraminidase (NA) genes of one of the isolates (designated A/duck/Zambia/36/2014 H10N1 (Dk-Zb14)) were amplified in a one-step reverse transcriptase polymerase chain reaction. Full length sequencing, phylogenetic and amino acid sequence analyses of the HA and NA genes was performed. The HA and NA gene phylogeny revealed that Dk-Zb14 belonged to the Eurasian-Avian lineage. The HA gene was closely related to that of A/Pekin duck/South Africa/AI1642/09 H10N7. In contrast, the NA gene was closely related to that of A/pelican/Zambia/13/09 H9N1 isolated in LNP. Dk-Zb14 had fewer glycosylation sites (3) than those reported for most AIVs. A glutamine to isoleucine substitution at the receptor biding site (position 226) was observed in the HA gene. The HA gene cleavage site had PEIMQGR?GLF amino acid motif, which is like previously described H10 isolates. Dk-Zb14 and Pel-Zb09 had ten amino acid differences within the NA gene. Additionally, the NA gene of Dk-Zb14 had a lysine at position 432 which formed a second neuraminic acid binding site. Surface glycoprotein phylogeny suggests interspecies transmission and maintenance of AIVs among wild and possibly domestic ducks within the Southern Africa ecosystem. These findings highlight the need for continued monitoring of AIVs in wild and domestic birds in the region. (Chambaro 2006)
The Journal of Thoracic Disease created a guideline on prevention and control of the H7N9 virus. Prevention measures include that health care providers should provide relevant training for the medical staff, and to improve their awareness and capacity in identifying, reporting, and managing the hospital acquired H7N9 infection and enable the early detection, early diagnosis, early isolation, and early report (Team, 2013). The health care providers should enhance their monitoring for hospital acquired infections by dealing with any suspects or cases with human H7N9 virus infection to be immediately reported as required and the patient should be properly managed (Team, 2013). The health care providers must standardize their disinfection, isolation and protection policies to provide sufficient, necessary and qualified disinfection and protection equipment to the medical staff, so as to ensure that all the disinfection, isolation, and personal protection measures are sufficiently and efficiently implemented (Team, 2013). The health care providers must properly clean and disinfect the medical equipment, contaminated items, item surface, and ground in accordance with the Technical Specifications for Implementing Disinfection in Hospitals (Team, 2013).
The bible verse that I will add to this research Paper is Mathew 7:7-11which states that ‘7 “Ask and it will be given to you; seek and you will find; knock and the door will be opened to you. 8 For everyone who asks receives; the one who seeks finds; and to the one who knocks, the door will be opened.
9 “Which of you, if your son asks for bread, will give him a stone? 10 Or if he asks for a fish, will give him a snake? 11 If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!
References
Ribavirin is effective against drug-resistant H7N9 influenza virus infections
1. Ribavirin is effective against drug-resistant H7N9 influenza virus infections. Yuhai Bi, Gary Wong, Yingxia Liu, Lei Liu, George F. Gao, Yi Shi
Protein Cell. 2016 Aug; 7(8): 611–614. Published online 2016 Jul 18. doi: 10.1007/s13238-016-0287-0
3. Timothy M. Uyeki, M. M. (2013). Global Concerns Regarding Novel Influenza A (H7N9) Virus Infections. The New England Journal of Medicine, 1862-1864.
4. Lin Mei, Q. T. (2013). Changes in and shortcomings of drug stockpiling, vaccine development and related policies during outbreaks of avian influenza A H5N1, H1N1, and H7N9 among humans. Drug Discoveries & Therapeutics, 95-100.
5. Editorial Team. Guideline on prevention and control of H7N9 avian influenza human infection. J Thorac Dis 2013;5(S2): S168-S172. doi: 10.3978/j.issn.2072-1439.2013.05.17
6. Chambaro, Herman Moses Characterisation of influenza A H10N1 virus isolated from ducks in Lochinvar National Park Zambia
7. NIV Bible