An introduction to avian and pandemic influenza

There are many types of influenza viruses, which cause illness in a variety of birds and mammals. New strains are constantly evolving, causing seasonal influenza epidemics in humans. This article provides information about influenza and influenza viruses, and the three influenza pandemics of the twentieth century. Pandemic influenza is differentiated from avian influenza, which is a viral disease that primarily infects birds. The current outbreak of avian influenza H5N1 in poultry flocks across the world is unprecedented in its spread. Human infection with avian influenza is rare and for most strains the symptoms are usually mild. A notable exception is HN51, where almost 60 per cent of the currently recorded 251 human cases have died. While the risk of a pandemic occurring in the current circumstances is unknown, there is a high level of concern worldwide.     

北京市顺义区禽流感高危职业人群知信行调查

目的了解北京市顺义区禽流感高危职业人群人禽流感知识、职业防护意识和防护行为现状,为制定该类人群禽流感职业防护策略提供依据。方法采用分层整群随机抽样方法抽取顺义区禽流感高危险职业从业人员191名,进行禽流感有关知识、信念和行为的问卷调查。结果被调查对象对人禽流感及其传染源的知晓率分别为99.0%和83.8%;认为人群对禽流感普遍易感的为45.5%;认为禽流感临床表现有发热和流涕、咳嗽、咽痛症状的分别有79.1%和52.9%的。认为应穿防护服、戴防护口罩、戴防护帽子、戴防护手套、穿防护鞋、戴防护镜、工作后应消毒或洗浴的比率分别为97.9%,99.0%,91.6%,96.3%,99.0%,67.0%,94.2%;工作中能够采用上述7种防护措施者分别为85.3%,67.5%,78.0%,81.2%,84.3%,16.8%,68.1%。结论顺义区禽流感高危职业人群具有一定的人禽流感基础知识和较高的职业防护意识,采取措施的比例与较高的职业防护意识仍有一定的差距,应加强人群职业防护的宣传教育。     

深圳市宝安区禽流感高危职业人群知信行调查

目的了解深圳市宝安区禽流感高危职业人群人禽流感知识、职业防护意识和防护行为现状,为针对该类人群制定相应防治策略提供科学依据。方法采用整群抽样方法抽取宝安区禽流感高危险职业从业人员158名,进行禽流感有关知识、信念和行为的问卷调查。结果大部分人了解禽流感病的临床症状,79.75%认为密切接触病禽会传播禽流感,60.76%认为密切接触禽流感病人会传播禽流感,71.52%认为禽类煮熟食用可以预防禽流感,对密切接触、空气飞沫及蚊虫叮咬等3种传播途径的知晓率分别为77.85%,73.42%,67.09%;工作中穿工作服、戴防护手套、戴防护口罩、洗手的比率分别为77.22%,77.22%,57.59%,70.89%;普遍认为禽流感可怕,对政府实施的集中屠宰生鲜上市政策支持率仅为13.29%。结论宝安区禽流感高危职业人群具有一定的禽流感知识,禽流感防护行为与意识依然欠缺,应加强该类人群的健康教育。     

The avian influenza pandemic: Discourses of risk,contagion and preparation in Australia

This paper examines the construction of avian influenza in Australian media and federal government policy, with a focus placed on discourses of contagion, preparedness and risk. The threat of an infectious disease outbreak, such as avian influenza, on social life is surrounded by a range of collective narratives which attempt to make it explicable. These narratives socially define the disease and provide explanations for its existence. The paper demonstrates that central to these narratives are depictions of the source of the outbreak and suggestions of appropriate responses to the threat. Methodologically, a narrative analysis of print media and government documents was conducted. This showed that conceptually both government and media discourses could be understood in terms of risk, contagion and blame. Furthermore, it was found that narratives linking the risk of avian influenza with globalised interconnectedness and contagion by the developing world underpin discourses of causation and frame the reactions to and preparation for a potential outbreak.     

禽类及非禽类从业人员禽流感认知状况调查

目的 了解广东省东莞市禽类从业人员和非禽类从业人员人禽流感知识、态度和行为状况,为制定人禽流感防控措施提供依据.方法 对259名禽类和129名非禽类从业人员进行人禽流感知识、态度、行为调查.结果 禽类和非禽类从业人员人禽流感相关知识总知晓率分别为34.03%和29.75%.农贸市场及批发市场销售的家禽95.83%有检疫证明,但散养家禽禽流感疫苗接种率仅为62.69%.禽类从业人员每天穿工作服、戴手套、戴口罩人数所占比例分别为19.79%,32.81%和29.17%.禽类和非禽类从业人员对病死禽能采取正确处理措施的分别占25.87%和21.71%;接触病死禽后能每次洗手的分别占81.85%和92.25%;对"家禽实行定点屠宰,禁售活禽"的赞成率分别为20.08%和31.78%;对"定期对市场进行清洗消毒、宰杀当天所有活禽"的支持率分别为33.98%和54.26%.结论 东莞市禽类从业人员存在人禽流感防治知识缺乏、个人防护不足、对病死禽处理措施欠妥、散养家禽禽流感疫苗接种率偏低等现象.应加强宣传教育和管理措施.     

Preparedness for highly pathogenic avian influenza pandemic in Africa

Global concerns about an impending influenza pandemic escalated when highly pathogenic influenza A subtype H5N1 appeared in Nigeria in January 2006. The potential devastation from emergence of a pandemic strain in Africa has led to a sudden shift of public health focus to pandemic preparedness. Preparedness and control activities must work within the already strained capacity of health infrastructure in Africa to respond to immense existing public health problems. Massive attention and resources directed toward influenza could distort priorities and damage critical public health programs. Responses to concerns about pandemic influenza should strengthen human and veterinary surveillance and laboratory capacity to help address a variety of health threats. Experiences in Asia should provide bases for reassessing strategies for Africa and elsewhere. Fowl depopulation strategies will need to be adapted for Africa. Additionally, the role of avian vaccines should be comprehensively evaluated and clearly defined.     

Seasonal influenza vaccination in the Americas: Progress and challenges during the COVID-19 pandemic

BackgroundVaccination is one of the most effective measures to prevent influenza illness and its complications; influenza vaccination remained important during the COVID-19 pandemic to prevent additional burden on health systems strained by COVID-19 demand.ObjectivesWe describe policies, coverage, and progress of seasonal influenza vaccination programs in the Americas during 2019–2021 and discuss challenges in monitoring and maintaining influenza vaccination coverage among target groups during the COVID-19 pandemic.MethodsWe used data on influenza vaccination policies and vaccination coverage reported by countries/territories via the electronic Joint Reporting Form on Immunization (eJRF) for 2019–2021. We also summarized country vaccination strategies shared with PAHO.ResultsAs of 2021, 39 (89 %) out of 44 reporting countries/territories in the Americas had policies for seasonal influenza vaccination. Countries/territories adapted health services and immunization delivery strategies using innovative approaches, such as new vaccination sites and expanded schedules, to ensure continuation of influenza vaccination during the COVID-19 pandemic. However, among countries/territories that reported data to eJRF in both 2019 and 2021, median coverage decreased; the percentage point decrease was 21 % (IQR = 0–38 %; n = 13) for healthcare workers, 10 % (IQR = -1.5–38 %; n = 12) for older adults, 21 % (IQR = 5–31 %; n = 13) for pregnant women, 13 % (IQR = 4.8–20.8 %; n = 8) for persons with chronic diseases, and 9 % (IQR = 3–27 %; n = 15) for children.ConclusionsCountries/territories in the Americas successfully adapted influenza vaccination delivery to continue vaccination services during the COVID-19 pandemic; however, reported influenza vaccination coverage decreased from 2019 to 2021. Reversing declines in vaccination will necessitate strategic approaches that prioritize sustainable vaccination programs across the life course. Efforts should be made to improve the completeness and quality of administrative coverage data. Lessons learned from COVID-19 vaccination, such as the rapid development of electronic vaccination registries and digital certificates, might facilitate advances in coverage estimation.     

Seasonal influenza vaccination knowledge, risk perception, health beliefs and vaccination behaviours of nurses

The relationship between knowledge, risk perceptions, health belief towards seasonal influenza and vaccination and the vaccination behaviours of nurses was explored. Qualified nurses attending continuing professional education courses at a large London university between 18 April and 18 October 2010 were surveyed (522/672; response rate 77·7%). Of these, 82·6% worked in hospitals; 37·0% reported receiving seasonal influenza vaccination in the previous season and 44·9% reported never being vaccinated during the last 5 years. All respondents were categorized using two-step cluster analyses into never, occasionally, and continuously vaccinated groups. Nurses vaccinated the season before had higher scores of knowledge and risk perception compared to the unvaccinated (P<0·001). Nurses never vaccinated had the lowest scores of knowledge and risk perception compared to other groups (P<0·001). Nurses' seasonal influenza vaccination behaviours are complex. Knowledge and risk perception predict uptake of vaccination in nurses.     

Patient knowledge and attitudes about avian influenza in an internal medicine clinic

BACKGROUND: Avian influenza is an emerging threat to public health, but little is known about how the public perceives this threat. The objective of this study was to describe beliefs, attitudes and knowledge regarding avian influenza among patients in an internal medicine clinic. STUDY DESIGN: Cross-sectional survey. METHODS: Four hundred adult patients in an internal medicine clinic received the survey between April and June 2006. RESULTS: The most common sources of information about avian influenza were local and national television news (74%), cable news (51%) and newspapers (50%). The mean percentage of correct answers to seven questions regarding knowledge of avian influenza was 49%. Multivariable linear regression using the percentage of correct answers to these questions as the primary outcome showed that: (1) college education, Internet and cable news as sources; (2) income greater than $75,000; and (3) receiving an influenza vaccine in the last influenza season were positively associated with knowledge. Having a viral upper respiratory infection on the day of the survey was negatively associated with knowledge. However, greater knowledge was not associated with more positive attitudes regarding possible public health interventions in a pandemic setting. Although 42% of patients were worried about avian influenza, only 22% trusted the Government to contain its spread. Most patients were willing to wear a mask (82%), be quarantined (78%) or undergo mandatory vaccination (55%). CONCLUSION: Knowledge about avian influenza was poor in this mainly college-educated sample, but most patients had positive attitudes towards public health control measures that would be used in a pandemic scenario. Further studies are needed to inform education strategies and pandemic influenza planning.     

Precautionary behavior in response to perceived threat of pandemic influenza

Faced with an epidemic of an infectious disease, persons may take precautionary actions to try to reduce their risk. Such actions include avoiding situations that persons perceive to be risky, which can have negative health and economic effects. Therefore, we conducted a population-based survey of persons' precautionary actions in response to a hypothetical influenza pandemic. For the 5 European and 3 Asian regions that had been affected by severe acute respiratory syndrome, the pattern of reported precautionary action was broadly similar across the regions; approximately 75% of respondents reported that they would avoid public transportation and 20%-30% would try to stay indoors. Some regional differences were noted; Europeans were more likely than Asians to avoid places of entertainment, and Asians were more likely to avoid seeing physicians. This international survey provides insight into what might be expected during an influenza pandemic.     

The role of the WHO Regional Office for Europe in response to seasonal, avian, and pandemic influenza

Between 2005 and 2011, the WHO Regional Office for Europe assisted the member states of the WHO European Region to prepare and respond to outbreaks of avian influenza H5N1, the 2009 pandemic, and to enhance their capacities for the prevention and control of seasonal influenza. It did this through conducting a combination of regional and subregional meetings and trainings, establishing a regional network for influenza surveillance, providing operational guidance for implementing influenza surveillance and strengthening the capacities of National Influenza Centers, and through assistance at the country-level where needed. In all, close to 60 country-missions or country-level activities were conducted. These activities were conducted in close coordination with WHO headquarters, WHO European Region Country Offices, the European Commission, the European Centre for Disease Prevention and Control, and with other partner organizations, and were in line with the implementation of the International Health Regulations (2005). The results of activities as well as guidance documents were disseminated to a wide audience through publication on the WHO Regional Office for Europe Influenza website, on the EuroFlu website, and through peer-reviewed publications.     

Seasonal and pandemic influenza during pregnancy and risk of fetal death: A Norwegian registry-based cohort study

Previous studies of fetal death with maternal influenza have been inconsistent. We explored the effect of maternal influenza-like illness (ILI) in pregnancy on the risk of fetal death, distinguishing between diagnoses during regular influenza seasons and the 2009/2010 pandemic and between trimesters of ILI. We used birth records from the Medical Birth Registry of Norway to identify fetal deaths after the first trimester in singleton pregnancies (2006–2013). The Norwegian Directorate of Health provided dates of clinical influenza diagnoses by primary-health-care providers, whereas dates of laboratory-confirmed influenza A (H1N1) diagnoses were provided by the Norwegian Surveillance System for Communicable Diseases. We obtained dates and types of influenza vaccinations from the Norwegian Immunisation Registry. Cox proportional-hazards regression models were fitted to estimate hazard ratios (HRs) of fetal death, with associated 95% confidence intervals (CIs), comparing women with and without an ILI diagnosis in pregnancy. There were 2510 fetal deaths among 417,406 eligible pregnancies. ILI during regular seasons was not associated with increased risk of fetal death: adjusted HR?=?0.90 (95% CI 0.64–1.27). In contrast, ILI during the pandemic was associated with substantially increased risk of fetal death, with an adjusted HR of 1.75 (95% CI 1.21–2.54). The risk was highest following first-trimester ILI (adjusted HR?=?2.28 [95% CI 1.45–3.59]). ILI during the pandemic—but not during regular seasons—was associated with increased risk of fetal death in the second and third trimester. The estimated effect was strongest with ILI in first trimester.

     

Globalised disease control and response distortion: a case study of avian influenza pandemic preparedness in Zambia

The past decade and a half has witnessed an increased and justified interest in global pandemic preparedness, owing to the unprecedented global spread of infectious disease threats, such as Severe Acute Respiratory Syndrome (SARS), H5N1 avian influenza and H1N1 Influenza. The repercussions of human and animal mortalities, and economic losses, have justified the need for globalised disease control responses through global pandemic preparedness. However, the blurring of the distinction between national and global preparedness has implications for the appropriateness of local disease control responses, particularly for poor resource countries reliant on donor aid to support their own preparedness. Examining the case of avian and pandemic preparedness in Zambia, this article explains how international funding led to a distortion of the pandemic response in this developing country. Despite the gains made under the global call for pandemic preparedness, the resulting avian and pandemic influenza response was inappropriate when weighed against Zambia's risk of an H5N1 incursion and the country's wider trade, agricultural and health priorities. We conclude that pandemic preparedness policy processes should take into consideration both the local policy context and realistic risk assessments of the local likelihood and potential impact of disease to ensure both the appropriateness and the sustainability of disease control measures instituted.     

成都市五类重点人群流感大流行认知及行为态度现状调查研究

目的:了解成都市重点人群对流感的认知和行为态度情况;方法:采用问卷现场调查的方法收集相关资料,利用SPSS15.0对数据进行处理和分析;结果:不同人群对流感核心知识的知晓存在一定差异,不同人群对流感的行为和态度也不尽相同。除了门诊医生(23%)外,大部分学生、建筑工人、门诊病人等人群(超过70%)对政府应对流感的工作信心不够。结论:五个重点人群对流感知识和健康的态度行为有一定认知,但还需进一步加强宣传,对流感的态度行为还需进一步加强倡导,政府应加强与社会公众的交流与沟通。     

Avian and pandemic influenza: an overview

Influenza A/H5N1 (avian influenza) has now caused 258 human infections (as of November 13, 2006), with an approximate 50% mortality rate. Because the virus is novel in terms of antigenic type and causes infection and illness, and because humans have no pre-existing immunity, the conditions for a possible pandemic exist. Additionally, wild migratory birds appear to be spreading the virus across ever larger geographic areas, and newer clade 2 influenza A/H5N1 viruses have begun to emerge. The US Congressional Budget Office has formally modeled the likely consequences of pandemic influenza and estimates that up to 2 million of the US population might die, with up to 40% of all workers ill for as long as 3 or more weeks. This brief overview will review basic virologic, immunologic and epidemiologic information relevant to understanding and preparing for this threat. In particular, the role of avian influenza vaccines will be reviewed.     

Personal protective equipment and antiviral drug use during hospitalization for suspected avian or pandemic influenza

For pandemic influenza planning, realistic estimates of personal protective equipment (PPE) and antiviral medication required for hospital healthcare workers (HCWs) are vital. In this simulation study, a patient with suspected avian or pandemic influenza (API) sought treatment at 9 Australian hospital emergency departments where patient-staff interactions during the first 6 hours of hospitalization were observed. Based on World Health Organization definitions and guidelines, the mean number of "close contacts" of the API patient was 12.3 (range 6-17; 85% HCWs); mean "exposures" were 19.3 (range 15-26). Overall, 20-25 PPE sets were required per patient, with variable HCW compliance for wearing these items (93% N95 masks, 77% gowns, 83% gloves, and 73% eye protection). Up to 41% of HCW close contacts would have qualified for postexposure antiviral prophylaxis. These data indicate that many current national stockpiles of PPE and antiviral medication are likely inadequate for a pandemic.     

Concerns and preparedness for an avian influenza pandemic: a comparison between community hospital and tertiary hospital healthcare workers

Little is known about differences in levels of concerns or preparedness for an avian influenza (AI) pandemic among healthcare workers (HCWs) in different types of hospitals. We compared these concerns and preparedness between 326 HCWs of two community hospitals (CHs) and 908 HCWs from a tertiary hospital (TH) using a self-administered questionnaire between March-June 2006. Response rates were 84.2% and 80.0% from the CHs and TH. Most HCWs (71.6%) felt prepared for an AI outbreak and had significant concerns. They perceive an AI pandemic having adverse impacts on their personal life and work, such as people avoiding them (57.1%). A greater percentage of TH compared to CH HCWs expressed concerns such as feeling their jobs put them at great AI exposure (78.3% vs 67.5%, p=0.012). TH HCWs were more likely to report participating in readiness preparation activities, such as training for infection control (90.0% vs 82.2%, p=0.014) and feel that they (74.1% vs 64.7%, p=0.045) and their hospital (86.8% vs 71.8%, p=0.000) were prepared for an outbreak. Healthcare institutions need to include personal, psychological and family concerns on the agenda and increase participation in readiness preparation activities among HCWs to help prepare for such future crises.     

济南市家禽从业人员人禽流感防治相关知识知晓率调查

摘要：目的　了解济南市家禽从业人员对人禽流感相关知识知晓情况、职业防护及行为态度状况。方法　
对家禽从业人员进行问卷调查,利用ＳＡＳ９．１３ 软件进行数据分析,率的检验采用卡方检验和Ｆｉｓｈｅｒ精确
检验。结果　共调查济南市家禽从业人员１４１ 名,人禽流感传染源知晓率为３９．７２％,传播途径知晓率为
１６．３１％,人患禽流感后症状知晓率为３６．８８％,人禽流感相关知识知晓率与文化程度有关。调查对象接触
家禽或污染的器物后, 有洗手习惯的占８９．３６％, 工作时坚持更换工作服的占７３．７６％, 戴口罩的占
６４．５４％,对使用的生产器具,能够做到定期消毒的占８４．４０％,以上防护行为执行情况在规模化屠宰场明
显好于个体养殖、活禽交易、屠宰等从业人员。调查对象每年接种流感疫苗的占９．９３％,流感疫苗接种率
与年龄有关。人禽流感相关知识获得途径,主要是电视、报纸、宣传单、宣传画等。结论　应该对济南市
禽类从业人员进行全面的、针对性人禽流感防控知识健康教育及职业培训。
关键词：人禽流感;家禽从业人员;防治知识;知晓率
中图分类号：Ｒ１８４．３９　　文献标识码：Ａ　　文章编号：１００９ ６６３９ （２０１４）０１ ００７２ ０４