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
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.
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.
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