By Hiba Fatima and Leah Watson
We all remember the
2009 swine flu epidemic that caused 14,000 deaths worldwide. Despite only
causing cold-like symptoms, the mass panic that surrounded this epidemic was
notable, and to an extent, justified. It brought attention to our health
system’s ability to cope with an epidemic and shed light on other countries’
healthcare infrastructure. After the epidemic was over, many of our
governmental organizations turned their attention to bolstering preparedness
for such epidemics. The widespread concern was not if it would happen again, but rather when. This series of events put the spotlight on vaccinations,
influenza and the health issues that surround them.
Influenza is the
most common cause of any respiratory illness as well as the most prevalent, it
accounts for 2.7% of global DALYs, 3.9% of death worldwide. The influenza
vaccine is very helpful in stopping the spread of influenza in the United
States and is renewed every year because the virus undergoes recombination and
becomes a new subtype. The pathogenicity of influenza is usually undermined in
the United States while in the developing world it is taken much more
seriously. This is because the neglect of influenza can very often lead to
death. Influenza A and B are the most prevalent, and Influenza A is most
commonly responsible for pandemics. This is partly due to its ability to infect
and stay in avian and swine species which act as reservoirs for the disease.
This gives the virus many opportunities to jump to a human host. Since
influenza is an airborne disease, people who work in pig and poultry farms are
especially affected, just by being in close contact. Additionally, children
ages 5-9 are disproportionately affected compared to the rest of the
population. Other high-risk groups for influenza include the elderly living in
assisted living institutions, pregnant women and healthcare workers. In many
industrialized countries, influenza poses an economic burden as well, many
people lose days of work or school and it causes a significant strain on the
healthcare system.
Live animal markets
are notorious for the spread of influenza from the animals to humans. Prolonged
exposure to the hosts causes a high susceptibility to contracting influenza,
especially avian and swine influenza. This is exacerbated by the fact that
influenza is airborne, making it very easy to spread in a small and confined
population. As Dr. Gray mentioned, pigs are the easiest mode of transportation
for influenza virus to get to humans. Another point of concern is that the
virus undergoes recombination within the animal host and emerges as a novel virus.
So by the time it gets to a human host, it is completely new and we have no way
of fighting or preventing it.
Source:
http://wncn.com/2015/10/07/threat-of-avian-flu-cancels-nc-state-fair-poultry-shows/
North Carolina is
currently anticipating a potential avian flu epidemic, as Dr. Gray described in
his lecture, due to a highly pathogenic avian influenza strain, H5N2, that has
already been found in 21 states. Prevention measures are already being taken,
such as the cancellation of large poultry-focused events described in the WNCN
news headline from October 7th this year (above). The Charlotte Observer
reports an $18 billion poultry industry in North Carolina, which may be in
jeopardy depending on the progress of the epidemic. Though no cases have yet
been reported, a task force has already been formed to ensure effective culling
of affected flocks found to be carrying the influenza strain. More than 44
million birds have been killed so far in an attempt to keep this influenza
strain under control, and more are projected to be culled as the migration
season approaches. This threat may initially seem irrelevant to us humans,
until we consider the proximity of vulnerable animals to agricultural workers.
While the species barrier between birds and humans may be harder to cross than
the species barrier between pigs and humans, close contact with infected birds
increases likelihood of passing on the virus from poultry to human.
There’s an
additional layer to the issue. With the threat of the potential influenza A
epidemic looming over North Carolina, the scientific community is faced with
the challenge of promoting public health measures despite pushback from
industries who may face economic damage. The balance of economic and public
health issues pervades the issue of global influenza. As Dr. Gray mentioned in
class, live animal markets in China have been a foundation of local economies
and traditions for thousands of years, and threatening to remove these is
unlikely to result in immediate compliance. Similarly, as mentioned, Dr. Gray’s
article “Variant Influenza A (H3N2) Virus: Looking Through a Glass, Darkly”,
farmers are unlikely to comply with studies on zoonotic influenza transmission
if they perceive the success of their businesses to be at risk.
This brings us to
areas of pandemic influenza that are hotly contended. How, then, do we propose
to unite the efforts of these two sides of the equation? Is legislation the
only option - in essence, using the power of the law to initiate compliance
among economic stakeholders? Might there be areas of overlap in which both
sides can cooperate? These are questions that both the scientific community and
those with commercial interests will need to answer, and soon. As migration
season for many bird species is rapidly approaching, united strategies will be
key to effective prevention of an impending epidemic.
We cannot
underestimate the importance of pandemic influenza, and the urgency with which
we must handle it. Although we may have only had to deal with inconvenient
symptoms like sneezing or a runny nose, this does not mean that influenza isn’t
a serious illness; its strains can become deadly when left unchecked,
particularly when cultivated in animal reservoirs for extended periods of time.
United efforts such as OneHealth here at Duke have made huge headway in
bridging the gap between different areas of study of influenza, including
medicine, veterinary medicine, and environmental health, and this has greatly
helped us to understand different contributors to influenza pandemics. However,
true prevention of an epidemic requires further open collaboration among the
government, economic stakeholders, the public, and the scientific community,
and it is only when we take a multi-perspectival look at the issue that we’ll
be able to deal with it this year and in years to come.
