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Avian Influenza A (H7N9) Virus was first noted in March 2013 in China. It was originally observed in poultry but human cases followed. In the spring of 2013, 132 human H7N9 infections were reported, with 44 leading to death. On February 12, 2014, the first case outside of China was reported. The case was located in Malaysia in a patient from an H7N9 exposed area of China. This traveler served as the vector for transmitting the virus from China to Malaysia. (Center for Disease Control, 2015).

Most human cases seem to be linked to prolonged direct contact with contaminated living or dead poultry. People who are exposed to poultry or poultry markets in affected geographic areas are at risk. When possible, poultry exposure in those areas should be avoided. Proper hand hygiene should occur. Health care workers treating H7N9 may also be at an elevated risk, though human-to-human contact is rare at this point. Infected patients should be isolated with contact and droplet precaution orders. Personal protective equipment should be worn and excellent hand hygiene should be practiced by exposed health care workers. Most of the human cases have resulted in severe respiratory illness, with one-third of those cases leading to death. The illness does not typically spread person-to-person, however there is some limited evidence of a few rare cases that may have been caused by person-to-person contact. It is also possible that the virus will mutate, leading to easier human to human transmission. (World Health Organization 2014).

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The major concern at this time regarding H7N9 is the possibility for a pandemic if the virus mutates in such a way that human-to-human infection becomes more likely. If this were to occur, local health systems could be flooded with patients in need of severe respiratory support.
It is possible that there could be so many patients in need that hospitals would not be able to accommodate them all. Lack of treatment could lead to a higher death ratio than the current one-third. It might become necessary to close schools and local businesses for a period of time in order to minimize transmission. (CDC 2015).

Locally, if a human outbreak were to occur, the incidents would be reported to local and state health departments, Monroe County Health Department and the Indiana State Department of Health respectively, as well as the Center for Disease Control. Health officials should also report the outbreak to community leaders such as school administrators and city and county officials, so that those leaders could take appropriate steps to minimize further spread of the infection by taking steps such as providing community education or closing schools. Suspicious bird deaths should be reported to the Indiana State Board of Animal Health and the Department of Natural Resources, so it can be determined if they are related to avian influenza.

To prevent an outbreak in the local community, the public should be educated on the need to to avoid contact with contaminated poultry, the need to use proper hand hygiene when handling poultry (even if the poultry is not known to be contaminated), and the need to take extra precautions when traveling to areas of the world where H7N9 outbreaks have occured. Patients
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should be educated about the need to cover their mouth and nose when coughing or sneezing so as to reduce the spray of droplets. Contact and droplet precautions such as gowns, masks and gloves should be used when treating humans infected with the virus. (WHO, 2014).

Health care workers should be trained to identify and report H7N9, as well as trained on the proper contact and droplet precautions to take. Taking the above steps will help to prevent and reduce the transmission of H7N9 Avian Influenza A Virus. (WHO, 2014).

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References

Center for Disease Control. 2015. Avian Influenza A (H7N9) Virus. Retrieved from http://www.cdc.gov/flu/avianflu/h7n9-virus.htm

World Health Organization. 2014. Avian Influenza A (H7N9) Virus. Retrieved from http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/