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Outbreak Report: H5N6 (AVIAN FLU), CHINA

Jade Patel, Benjamin Maher, Alyssa Schmidt, Chandlyr Mickan, Emergency Management, Health, and Hazards Team

Week of Monday November 8, 2021


Influenza A Particle[1]


H5N6 (Avian Influenza A) is a contagious strain of bird flu that can be transmitted to humans from infected animals, especially poultry. Although this zoonotic virus cannot transmit between humans, it can cause severe illness and has a high fatality rate.[2] Those infected are most likely to have had direct contact with live virus particles. Identifying infected individuals early and preventing increased cases will likely inhibit the virus’ ability to mutate, decreasing the possibility of a strain that can transmit between humans. More cases are likely to occur in the future due to a lack of treatment options and vaccinations. A national outbreak is unlikely because the virus cannot transmit between humans. Although the number of H5N6 cases remains low, citizens should follow public health advice to prevent further cases.


Description of Pathogen

H5N6, one of the viruses commonly known as bird flu, is a contagious virus that infects humans and animals, notably birds. The H5N6 virus is a cross-species infection that can transmit between animals and humans and through virus particles in contaminated sites.[3] H5N6 can be fatal for humans and has killed more than half of those infected.[4] The H5N6 strain is likely more fatal to humans than other types of bird flu as it does not have an effective treatment. However, the World Health Organization (WHO) reported that an outbreak is unlikely since H5N6 does not transmit between humans.[5] There is no evidence to suggest that viral outbreaks are seasonal.[6] Individuals infected by H5N6 exhibit common flu-like symptoms including fever, cough, respiratory complications, diarrhea, vomiting, and chest pain.[7] Complications of H5N6 include pneumonia, hypoxemic respiratory failure, multi-organ dysfunction, septic shock, and secondary bacterial and fungal infections.[8] 48 cases of H5N6 have been reported since 2014, 24 of which occurred in 2021.[9] The lack of appropriate treatment very likely makes this increase in cases concerning.


People with underlying health conditions such as diabetes, cancer, and kidney failure are likely to face more severe symptoms and long-term health consequences if they are infected with the H5N6 virus and other strains of influenza.[10] A study of flu survivors with previous health conditions found a 78.2% rate of abnormalities in CT scans administered 18 months after infection, along with restrictive ventilation dysfunction.[11] All strains of bird flu can cause lung damage and pulmonary dysfunction.[12] Although the virus does not transmit between humans, traveling birds can spread the virus for up to 10 days after infection.[13] If the virus mutates and can transmit between humans, it would likely be one of the most severe outbreaks of bird flu due to a lack of effective treatment and vaccinations. Infected individuals should be isolated as a precaution to decrease the likelihood of the virus mutating and being able to transmit between humans. Governments should encourage research and collaboration between government research facilities and private organizations on a vaccine for H5N6 virus to prevent future outbreaks.


The virus strains that infect humans can develop resistance to amantadine and rimantadine (Flumadine) that are the two most accessible antiviral medications.[14] Infected individuals should take antiviral medication like oseltamivir (Tamiflu) or zanamivir (Relenza) within 48 hours of exhibiting symptoms.[15] Healthcare providers would very likely struggle to provide the appropriate treatment for the H5N6 virus in the event of an outbreak. The lack of medication available to treat this strain would likely result in the overwhelming of hospitals, impacting their ability to treat infected individuals. Although vaccines can prevent outbreaks, isolating infected individuals will likely prevent the emergence of new strains. Basic sanitation and safety practices such as washing hands and using caution while visiting food markets should be encouraged to limit outbreaks. The virus is likely to transmit in poultry farms, unsanitized areas that house poultry, or crowded animal facilities.


Location


Impacted Province, October 2021[16]


H5N6 cases were identified in Hunan Province, China in October 2021, but cases across mainland China have been monitored since 2014.[17] Currently, the threat of the virus remains in Hunan but is unlikely to spread nationally unless the virus mutates and is able to transmit among humans.


Response Challenges

The major challenge in responding to the virus is the absence of a vaccine and the virus’ resistance to antiviral drugs. China’s healthcare system can likely withstand a small H5N6 outbreak, as low numbers of cases are unlikely to strain its medical resources. The transmission of the virus outside Hunan Province would likely increase pressure on the national healthcare system due to an increase in patients and lack of effective treatment. Public health services should monitor the spread of the virus and relay information transparently in order to prevent misinformation or widespread panic.


Travel Warnings

There is no current vaccination publicly available for H5N6.[18] Individuals traveling domestically or internationally to China should be cautious while visiting infected areas like the Hunan Province. Travelers in the Hunan Province should avoid visiting poultry farms and markets, meat manufacturing companies, and areas that may have been exposed to infected animals. Travelers should maintain proper food safety and hygiene practices such as thoroughly cooking meat and washing hands with soap before eating. Travelers should wear masks and follow the public health guidance when travelling through infected regions. In line with public health measures, travelers returning from affected regions should report to local health services if they experience respiratory symptoms such as cough, sore throat, or pneumonia.[19] Travel restrictions are unlikely to be implemented as the virus does not spread between humans. However, people should avoid high risk environments and follow public health guidance.


Political Effects/ Effects on Terrorism

The current outbreak of H5N6 is unlikely to cause political instability because of the low number of cases. Public compliance and preventative measures can likely contain the H5N6 virus. An increase in H5N6 cases will likely result in poultry farms being depopulated, resulting in meat shortages. Reduced availability of poultry will likely increase food inflation and the need for alternative meats. Government spending will likely increase to provide food to the vulnerable population. A national outbreak could likely result in China having to import poultry. Poultry farmers will likely need financial support from governments, as their income will decrease. However, terrorist groups such as the Eastern Turkistan Islamic Movement (ETIM) are unlikely to leverage this food inflation to radicalize the population by offering financial aid and food supplies to the vulnerable population.


Recommendations for Agencies, Organizations, and Companies

Agencies, organizations, and companies (AOC’s) associated with poultry should continue to monitor cases and mutants of H5N6. Health guidelines such as washing hands, routinely sanitizing places containing poultry, and avoiding contact with infected animals should be followed to reduce the risk of transmission to poultry farmers and residents in the infected areas.[20] Common practices such as avoiding touching the eyes, nose, or mouth when in high risk environments are also encouraged.[21] Poultry farmers should be given instructions on safe practices to reduce infections and be provided personal protection equipment (PPE). If cases continue to rise, it is recommended that individuals check for symptoms and consult with a medical professional about further testing to increase early detection. Containment measures such as quarantines should be reviewed to reduce human contact with poultry until there are minimal cases of the H5N6 virus.


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[1]Influenza virus by Kat Masback licensed under Creative Commons

[2] WHO calls for surveillance to explain rise in human cases of H5N6 bird flu, BNO News, October 2021, https://bnonews.com/index.php/2021/10/who-calls-for-surveillance-to-explain-rise-in-human-cases-of-h5n6-bird-flu/

[3] H5N6 influenza virus infection, the newest influenza, Science Direct, June 2015, https://www.sciencedirect.com/science/article/pii/S2221169115000672

[4] WHO calls for surveillance to explain rise in human cases of H5N6 bird flu, BNO News, October 2021, https://bnonews.com/index.php/2021/10/who-calls-for-surveillance-to-explain-rise-in-human-cases-of-h5n6-bird-flu/

[5] Influenza (Avian and other zoonotic), WHO, November 2018, https://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)

[6] Ibid

[7] Ibid

[8] Ibid

[9] WHO calls for surveillance to explain rise in human cases of H5N6 bird flu, BNO News, October 2021, https://bnonews.com/index.php/2021/10/who-calls-for-surveillance-to-explain-rise-in-human-cases-of-h5n6-bird-flu/

[10] What Are Flu Complications?, Web MD, August 2021, https://www.webmd.com/cold-and-flu/flu-complications

[11] Long-term clinical prognosis of human infections with avian influenza A(H7N9) viruses in China after hospitalization, The Lancet, 2020, https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30026-2/fulltext

[12] Ibid

[13] Bird Flu, Healthline, November 2021, https://www.healthline.com/health/avian-influenza#risk-factors

[14] Ibid

[15] Ibid

[16] China reports H5N6 avian flu case in Hunan Province, by Jade Patel, via MapChart

[17] China reports H5N6 avian flu case in Hunan Province, Outbreak News Today, October 2021, http://outbreaknewstoday.com/china-reports-h5n6-avian-flu-case-in-hunan-province-51098/

[18] Bird Flu, Medline Plus, September 2021, https://medlineplus.gov/birdflu.html#:~:text=There%20is%20currently%20no%20vaccine,easily%20from%20person%20to%20person.

[19] Influenza (Avian and other zoonotic), WHO, November 2018, https://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)

[20] Ibid

[21] Ibid


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