FINAL PART OF AVIAN INFLUENZA H7N9 PROJECT

PART 4 AND IS THE FINAL PART OF THIS PROJECT

Avian Influenza H7N9 Project Assignment Instructions

Overview

Vaccines are an invaluable tool in the public health effort to prevent morbidity and mortality from infectious diseases. The public health practitioner must understand basics of immunology to respond properly to the legitimate concerns of the public. Furthermore, one must understand how vaccines are developed and proper course of action to administer them. In an immunological health crisis, public health officials must be able to develop and implement a vaccination campaign.

Instructions

Review the following background resources which contain descriptions of the origins of a novel avian influenza threat that began in the winter of 2013 AND the fictional scenario based in Zambia suggesting a potential for development of a more serious epidemic situation.

Background Resources

1. Cheng M. Health and Wellness: Evidence suggests new bird flu spread among people. USA Today. August 7, 2013: http://www.usatoday.com/story/news/health/2013/08/06/bird-flu-spread/2625877/.

2. Department of Health and Human Services. NIH begins testing H7N9 avian influenza vaccine candidate. National Institutes of Health: Turning Discovery to Health. September 18, 2013. http://www.nih.gov/news/health/sep2013/niaid-18.htm

3. World Health Organization. Background and summary of human infection with influenza A(H7N9) virus as of 5 April 2013. http://www.who.int/influenza/human_animal_interface/latest_update_h7n9/en/index.html Published April 5, 2013. Accessed September 28, 2013.

4. Centers for Disease Control and Prevention. Emergence of avian influenza A (H7N9) virus causing severe human illnessChina, February-April 2013. MMWR. May 10, 2013; 62(18):366371. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6218a6.htm?s_cid=mm6218a6_w

5. World Health Organization. Global Alert and Response (GAR): Human infection with influenza A(H7N9) virus in China. Geneva, Switzerland: World Health Organization; 2013. Available at http://www.who.int/csr/don/2013_04_01/en/index.html

Fictional Zambia Scenario

In mid-December, a cluster of 7 cases of a severe flu-like illness was identified in a rural village in Zambia. The index case was a 12-year-old child who died at home on the 4th day of the illness. The other cases include the girls mother, a younger brother, and 4 classmates at the small school at the edge of the village. Each of the secondary cases was exposed to the index case and developed symptoms of influenza within 25 days of exposure. Presenting symptoms for all cases included fever over 101 F, dry cough, sore throat, headache, and myalgia. All of the affected individuals sought care at the village health center and were attended by a community health worker (CHW). The CHW became concerned about the brother of the index case on the sixth day of illness when the child developed hemoptysis and increasing respiratory distress. He was referred to Mtendere Mission Hospital in the Southern Providence of Zambia near the border with Zimbabwe, where he subsequently died a week later.

Viral cultures from the boys nasopharynx were submitted to CIDRZ laboratory in Lusaka, Zambia at the time of admission. Samples were forwarded to the National Institute for Communicable Diseases (NICD) in South Africa as well as the Centers for Disease Control and Prevention (CDC) in the United States. Both laboratories isolated an influenza A (H7N9) strain similar to the Chinese strain of H7N9 originally isolated in August 2013.

The remaining 5 cases have recovered significantly since being diagnosed. The average duration of most symptoms for the survivors was approximately 8 days; however, profound fatigue persisted beyond 2 weeks. Neither of these cases required a referral for hospitalization, thus viral cultures were not submitted.

Investigation of potential sources of the infection suggested a possible link to imported chickens. The father of the index case had purchased several birds from a Chinese vendor using a micro loan a few weeks prior to the outbreak. The index case was responsible for cleaning the chicken coup outside the familys home. The girls mother and brother had no history of exposure to the chicken coup. The other children at school also denied history of exposure to chickens. The familys flock has been destroyed by government authorities because of the possible association of the index case and chickens. Laboratory officials are now reporting influenza A (H7N9) virus in at least one chicken. Confirmatory studies are underway.

Part 1 Situation Assessment Assignment

You will write a 5-page research-based paper in current AMA format focusing on the potential of avian influenza A (H7N9) to expand into a local epidemic or spread beyond to pandemic proportions. The paper must include at least 5 peer-reviewed references in addition to the five background resource, the course textbooks, and the Bible. A biblical perspective on the response must be considered and referenced appropriately.

Part 2 Vaccine Development Assignment

You will write a 5-page research-based paper in current AMA format that focuses on the progress in the development of avian influenza A (H7N9) vaccine. The paper must include at least 5 references. All references must be peer-reviewed, scientific papers published since August 2013; however, peer-reviewed, scientific papers on related influenza vaccines from an earlier date may be used if a definitive correlation to the scenario presentation can be drawn. The purpose of this portion of the project will be to analyze the vaccine situation and determine a likely timeline for development and distribution of a vaccine should a crisis situation arise.

Part 3 Mass Vaccination Campaign Assignment

You will assume a pandemic of avian influenza is imminent if the outbreak cannot be confined to the geographic area identified in the fictional scenario. You must design a culturally appropriate campaign and write a 5-page paper in current AMA format describing the vaccination campaign using a newly available vaccine believed to have a 90% efficacy. All aspects of the campaign from vaccine acquisition, shipment, storage, distribution, and documentation must be addressed. Diagrammatic models may be appropriate to fully communicate the plan. The paper must be cited, but references are restricted to World Health Organization, UNICEF, National Institutes of Health, Centers for Disease Control and Prevention, The Medical Journal of Zambia, and Zambian governmental documents related to vaccination strategies.

Part 4 Implementation Assignment

In this final installment of the Avian Influenza (H7N9) Project, you will edit previous installments of the project (Parts 13) based on instructor feedback and combine them to produce a single document. This document will also include 1 additional section devoted to implementation barriers. In this section, you will address the barriers to a vaccination program in Zambia. These barriers include, but are not limited to, financial, geopolitical, ideological, and logistical considerations. Potential immunologic issues related to the vaccine usage in a mass campaign must also be addressed. As always, current AMA format will be used and proper citation is essential. The instructor will be looking for a 20-page paper, as this document will contain new information in addition to materials unified from the documents created in the previous related assignments.

Note: Your assignment will be checked for originality via the Turnitin plagiarism tool.

AMA FORMAT, NO AI, NO SIMILARTIES INTEXT CITATION WITH NUMBER SUPERSCRIPTS