Laidback Al
New member
<TABLE cellSpacing=0 cellPadding=2 width="100%" border=0><TBODY><TR><TD>Avian Flu Epidemic Nothing To Fear Now [ 2008-3-14 ]
Indira Aryal
Although the risk of Avian Influenza (AI), popularly known as bird flu has been averted this year, the fear of the fatal flu could recur next year. With a view to cope with the possible threat of AI in the coming days, the government has introduced a number of programmes from this year.
Until last year, we were in confusion. Thank god! It did not happen to us. But now we are already prepared to tackle with the risks of AI and we have devised a number of programmes to minimize the risks," said Dr. Manas K. Banerjee, Regional Director and Project Coordinator of Avian Influenza Control Project.
Since 2003, the world has been witnessing the unusual behavior of the avian influenza virus H5N1, which is widely circulating in poultry. It has proved to be capable of crossing the species barrier and producing a severe form of influenza in humans with high mortality rate.
The impact that an influenza pandemic may have on Nepal is difficult to predict. In Nepal, it is likely that the population would have a different care-seeking behavior and the proportion of people seeking out-patient care would be lower than in the developed countries," said Dr. Banerjee.
If a novel virus entered Nepal, a major epidemic is possible, he said. Information will then be required to monitor the impact and effectiveness of interventions. If information is to be collected on the number of cases and fatalities and the results of public health and clinical interventions in an overstretched health care system, it is necessary to plan ahead.
The absorptive capacity of the health care system in the country is low at present with only 16,000 beds in the 84 public health hospital system and 4,015 periphery health facilities, manned mostly by health assistants. In such a scenario, health facilities would be soon found to be overwhelmed by the sheer number of both out patient visits and in patient care, health staff themselves would also fall ill with a consequent reduction in those able to care for the sick and medical supplies would quickly be exhausted," Dr. Banerjee said.
He said that Nepal is among the risk prone countries because of the open border with India as lots of cases were found in some of the areas of India and the migratory birds is another factor. The disease would spread through birds and there should be vigil on the migratory birds.
Dr. Baikuntha Parajuli, program director at the Directorate of Animal Health under the Department of Livestock Services, said the virus H5N1 would spread to human beings from birds and at least 60 per cent of the people who had contracted the virus have died worldwide.
The symptoms of the disease in chickens are they start dying suddenly with swelling on the head, lose appetite and thirst evident. The eggs they produce also become wrinkled and the shell is not hard facilitating the spread of bird flu.
Dr. Parajuli said the symptoms in human beings are seen from 18 to 72 hours and the patient suffer from fever and pain in the neck. He said the virus easily passes on to people suffering from chronic diseases, respiratory problems and specially the chicken and bird sellers.
Re-usage of dirty vehicles, dirty cages and crates and unsafe transportation system, live animal markets are the optimal conditions for zoonotic disease transfer and other infections. Lack of safety awareness among market stall owners and poor disposal of hazardous wastes are other causes of communicating the virus," he said.
Dr. Banerjee added that the five development regions will each have a referral hospital capable of dealing with the most severe cases requiring respiratory support and isolation. The first thing is to create a public information environment conducive to behavior change and reduced public panic and mistrust through a consistent, timely and accurate flow of information on avian influenza," he added.
A World Health Organisation (WHO) report estimates that the effects in Nepal could be catastrophic. Over 6 million people in Nepal could be ill and more than 100,000 die in a period of 8-16 weeks.
A communication operation plan has been formed to prevent and reduce the negative social impact and threat to human health from the occurrence of poultry outbreaks of AI and minimize the social disruption and impact of an influenza epidemic through advocacy, behavior change communication, and social mobilization. Advocacy, social mobilization and behavior change communication activities will be simultaneously implemented to ensure each of the objectives is successfully met, Dr. Banerjee said.
According to the plan, epidemiologists will be recruited for the central unit and the five regional directorates. Three additional regional teams have been planned: one each at BPK Institute of
Health Science in the eastern region, Nepalgunj Medical College in the western region and Epidemiology and Disease Control Division (EDCD), Teku. The Immunization preventable Diseases (IPD) network will be expanded with five new field offices located at the regional directorates by 2008.
Cases suspected to be human avian influenza because of exposure history or with unusually severe respiratory illness will be tested with the necessary protection for the staff, immediately isolated and reported to the corresponding regional team which will perform thorough field investigation of the case to rule out contact with sick animals or other related cases.
Only the five epidemiology laboratory combined MoHP/IPD regional teams, the BPKIHS and Nepalgunj Medical College teams, and the central team formed by EDCD/ National Public Health Laboratory (NPHL) and Teku hospital will be specially equipped and trained to ensure bio-safety and conduct investigation of suspected human avian influenza cases.
All health workers at the village level and all public and private health facilities will be alerted to report any unusual clinical presentation of acute respiratory infection or other acute disease suggested to be infectious in origin occurring in people in contact with poultry or health workers or other populations at risk as deemed necessary. The case definition and the corresponding reporting mechanisms will be developed and disseminated widely throughout the healthcare network.
Although they do not provide a definitive diagnosis of the presence of human avian influenza, rapid diagnostic kits have an important role to play in the surveillance and investigation of this disease. These kits can provide an important early clue to the presence of avian influenza in someone with a compatible illness, thereby allowing early interventions to be initiated.
Besides, at least 1000 animal health workers and 300 health workers would be vaccinated against seasonal influenza every year, regional strategic stock pile of antiviral to protect the animal health workers and the human health staff of Rapid Response Team and hospitals responding to the cases.
A modern quarantine system coordinated by the Ministry of Health and Population (MoHP) will be in place, including by Tribhuvan International Airport, seven cross points in the India-Nepal Border and one cross-point in the China-Nepal border, by 2010. A mechanism will be developed to acquire and deploy pandemic influenza vaccines if available and a legal and regulatory framework to allow containment and response to human-to-human transmission of avian influenza.
The national referral center will be Sukraraj Tropical and Infectious Diseases Hospital in Teku, Kathmandu while the interim referral center will be established at Tribhuvan University Teaching Hospital (TUTH) during the first two years of the project.
However, because the timing of influenza pandemic is unpredictable, it is unwise to procure large quantities of these medications, which may then not be used. A small stockpile of medications to support the isolation wards of the referral centers will be deployed. Those may be used for the regular load of patients as expiry periods approach and in the same manner the stock pile will be replenished so as to ensure availability when required.
The experts said that early precaution should be adopted to avert the danger of the deadly flu and for this the government should formulate stringent laws to regulate quarantine system. Besides, the hygiene in the production center and retail meat shops is a must to minimize the risk. If we strictly followed the regulations, and government as well as the people cooperate as we anticipate there is nothing to fear," Dr. Banerjee added.
http://www.gorkhapatra.org.np/content.php?nid=38156
</TD></TR><TR><TD>
</TD></TR></TBODY></TABLE>
Indira Aryal
Although the risk of Avian Influenza (AI), popularly known as bird flu has been averted this year, the fear of the fatal flu could recur next year. With a view to cope with the possible threat of AI in the coming days, the government has introduced a number of programmes from this year.
Until last year, we were in confusion. Thank god! It did not happen to us. But now we are already prepared to tackle with the risks of AI and we have devised a number of programmes to minimize the risks," said Dr. Manas K. Banerjee, Regional Director and Project Coordinator of Avian Influenza Control Project.
Since 2003, the world has been witnessing the unusual behavior of the avian influenza virus H5N1, which is widely circulating in poultry. It has proved to be capable of crossing the species barrier and producing a severe form of influenza in humans with high mortality rate.
The impact that an influenza pandemic may have on Nepal is difficult to predict. In Nepal, it is likely that the population would have a different care-seeking behavior and the proportion of people seeking out-patient care would be lower than in the developed countries," said Dr. Banerjee.
If a novel virus entered Nepal, a major epidemic is possible, he said. Information will then be required to monitor the impact and effectiveness of interventions. If information is to be collected on the number of cases and fatalities and the results of public health and clinical interventions in an overstretched health care system, it is necessary to plan ahead.
The absorptive capacity of the health care system in the country is low at present with only 16,000 beds in the 84 public health hospital system and 4,015 periphery health facilities, manned mostly by health assistants. In such a scenario, health facilities would be soon found to be overwhelmed by the sheer number of both out patient visits and in patient care, health staff themselves would also fall ill with a consequent reduction in those able to care for the sick and medical supplies would quickly be exhausted," Dr. Banerjee said.
He said that Nepal is among the risk prone countries because of the open border with India as lots of cases were found in some of the areas of India and the migratory birds is another factor. The disease would spread through birds and there should be vigil on the migratory birds.
Dr. Baikuntha Parajuli, program director at the Directorate of Animal Health under the Department of Livestock Services, said the virus H5N1 would spread to human beings from birds and at least 60 per cent of the people who had contracted the virus have died worldwide.
The symptoms of the disease in chickens are they start dying suddenly with swelling on the head, lose appetite and thirst evident. The eggs they produce also become wrinkled and the shell is not hard facilitating the spread of bird flu.
Dr. Parajuli said the symptoms in human beings are seen from 18 to 72 hours and the patient suffer from fever and pain in the neck. He said the virus easily passes on to people suffering from chronic diseases, respiratory problems and specially the chicken and bird sellers.
Re-usage of dirty vehicles, dirty cages and crates and unsafe transportation system, live animal markets are the optimal conditions for zoonotic disease transfer and other infections. Lack of safety awareness among market stall owners and poor disposal of hazardous wastes are other causes of communicating the virus," he said.
Dr. Banerjee added that the five development regions will each have a referral hospital capable of dealing with the most severe cases requiring respiratory support and isolation. The first thing is to create a public information environment conducive to behavior change and reduced public panic and mistrust through a consistent, timely and accurate flow of information on avian influenza," he added.
A World Health Organisation (WHO) report estimates that the effects in Nepal could be catastrophic. Over 6 million people in Nepal could be ill and more than 100,000 die in a period of 8-16 weeks.
A communication operation plan has been formed to prevent and reduce the negative social impact and threat to human health from the occurrence of poultry outbreaks of AI and minimize the social disruption and impact of an influenza epidemic through advocacy, behavior change communication, and social mobilization. Advocacy, social mobilization and behavior change communication activities will be simultaneously implemented to ensure each of the objectives is successfully met, Dr. Banerjee said.
According to the plan, epidemiologists will be recruited for the central unit and the five regional directorates. Three additional regional teams have been planned: one each at BPK Institute of
Health Science in the eastern region, Nepalgunj Medical College in the western region and Epidemiology and Disease Control Division (EDCD), Teku. The Immunization preventable Diseases (IPD) network will be expanded with five new field offices located at the regional directorates by 2008.
Cases suspected to be human avian influenza because of exposure history or with unusually severe respiratory illness will be tested with the necessary protection for the staff, immediately isolated and reported to the corresponding regional team which will perform thorough field investigation of the case to rule out contact with sick animals or other related cases.
Only the five epidemiology laboratory combined MoHP/IPD regional teams, the BPKIHS and Nepalgunj Medical College teams, and the central team formed by EDCD/ National Public Health Laboratory (NPHL) and Teku hospital will be specially equipped and trained to ensure bio-safety and conduct investigation of suspected human avian influenza cases.
All health workers at the village level and all public and private health facilities will be alerted to report any unusual clinical presentation of acute respiratory infection or other acute disease suggested to be infectious in origin occurring in people in contact with poultry or health workers or other populations at risk as deemed necessary. The case definition and the corresponding reporting mechanisms will be developed and disseminated widely throughout the healthcare network.
Although they do not provide a definitive diagnosis of the presence of human avian influenza, rapid diagnostic kits have an important role to play in the surveillance and investigation of this disease. These kits can provide an important early clue to the presence of avian influenza in someone with a compatible illness, thereby allowing early interventions to be initiated.
Besides, at least 1000 animal health workers and 300 health workers would be vaccinated against seasonal influenza every year, regional strategic stock pile of antiviral to protect the animal health workers and the human health staff of Rapid Response Team and hospitals responding to the cases.
A modern quarantine system coordinated by the Ministry of Health and Population (MoHP) will be in place, including by Tribhuvan International Airport, seven cross points in the India-Nepal Border and one cross-point in the China-Nepal border, by 2010. A mechanism will be developed to acquire and deploy pandemic influenza vaccines if available and a legal and regulatory framework to allow containment and response to human-to-human transmission of avian influenza.
The national referral center will be Sukraraj Tropical and Infectious Diseases Hospital in Teku, Kathmandu while the interim referral center will be established at Tribhuvan University Teaching Hospital (TUTH) during the first two years of the project.
However, because the timing of influenza pandemic is unpredictable, it is unwise to procure large quantities of these medications, which may then not be used. A small stockpile of medications to support the isolation wards of the referral centers will be deployed. Those may be used for the regular load of patients as expiry periods approach and in the same manner the stock pile will be replenished so as to ensure availability when required.
The experts said that early precaution should be adopted to avert the danger of the deadly flu and for this the government should formulate stringent laws to regulate quarantine system. Besides, the hygiene in the production center and retail meat shops is a must to minimize the risk. If we strictly followed the regulations, and government as well as the people cooperate as we anticipate there is nothing to fear," Dr. Banerjee added.
http://www.gorkhapatra.org.np/content.php?nid=38156
</TD></TR><TR><TD>
</TD></TR></TBODY></TABLE>