A Course on Avian Influenza: An Emerging Infectious Disease

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A Course onAvian Influenza An Emerging
Infectious Disease

• University of Minnesota
• Summer Public Health Institute

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Ecology of Influenza
Genetic Reservoirs
H3, H7
H1, H2, H3
Intermixing
H5N1
Commercial, LBMs Others
H10
H1-12 H14-15
H1-2, 4-7, H9-13, 15-16
Other Aquatic Birds?
H1, H3, H4, H7, H13
H1, H3
Source D. Swayne and D. Senne
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Avian Influenza Emerging Zoonosis
Translocation
Encroachment Introduction Spill over Spill
back
Human encroachment Ex situ contact Ecological
manipulation
Wild Aquatic birds
Domestic Poultry, Swine
Humans
Global travel Urbanization Biomedical manipulation
Agricultural Extensive Poultry Production
Technology and Industry
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The Problem

• Animal and human influenza experts with an
  incomplete understanding of the ecology and
  epidemiology of the viruses, the disease in
  different species, how pandemic influenza viruses
  emerge, the socio-economic context in which
  transmission occurs, and the impact of AI on
  public health, commerce, food systems, and
  international trade cannot/will not
• Contribute most effectively to pandemic planning,
  preparedness, response
• Understand how their role and actions impact on
  human and animal health, well-being, and disease
  control
• Communicate risk appropriately and effectively to
  different key audiences-- the public, poultry and
  swine industry management and workers, backyard
  flock and swine farm owners
• Understand important research gaps that need to
  be addressed

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The Need..

• To reach a shared understanding across
  disciplines
• Human experts who understand ecology,
  epidemiology, pandemic virus emergence, animal
  health concerns impacting industry, role of live
  bird markets to ethnic communities, challenges in
  the prevention and control of animal influenza
  viruses
• Animal experts who have an understanding of
  seasonal and pandemic influenza, role of animal
  viruses in emergency of pandemic viruses,
  surveillance and effective disease control,
  interventions to minimize human exposure to
  animal viruses, pandemic preparedness planning
• A cadre of informed experts who can craft and
  deliver accurate, appropriate, effective risk
  communication messages
• An educational environment where multiple
  disciplines and perspectives are involved for
  optimum learning across sectors and for the
  development of shared understanding

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Recruitment of Participants with Diverse
Professional Backgrounds

• DVM/MPH students in Public Health Institute
• Graduated veterinarians post doctoral fellows
  Continuing education
• State and county public health personnel working
  with influenza programs, pandemic preparedness
• Hospital emergency department physicians and
  nurses
• State and county animal disease personnel
• Food industry professionals/personnel
• MPH students
• Other

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Course Objectives

• After completing the course, participants will be
  able to discuss
• The basic structure of influenza viruses the
  standard naming nomenclature key
  molecular/genetic characteristics including
  genetic shift and drift
• The epidemiology of and differences and
  relationships between the influenza viruses of
  humans, wild birds, poultry and swine
• Differences between seasonal, pandemic, avian,
  and swine influenza
• The importance and role of swine influenza to the
  swine industry and the role of pigs as mixing
  vessels
• Prevention and control of seasonal human
  influenza
• How pandemic viruses emerge, the phases of
  pandemic alerts, and pandemic influenza
  preparedness

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Course Objectives

• After completing the course, participants will be
  able to discuss/identify
• The importance to and impact of avian influenza
  infections on poultry and the poultry industry
• Human and avian influenza surveillance strategies
  and the use of diagnostic tests
• Important risk factors for transmission of and
  strategies for preventing, controlling avian and
  swine influenza viruses on the farm the special
  role of live bird markets
• How highly pathogenic H5N1 has emerged and
  spread, is threatening human health, animal
  health and international trade, might become a
  pandemic virus

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Course Objectives

• After completing the course, participants will be
  able to discuss/identify
• Hazards of influenza viruses that are associated
  with food systems
• How qualitative risk assessments for human and/or
  animal exposure to avian influenza viruses are
  conducted
• Issues involved with effectively communicating
  avian influenza risks to media, stakeholders,
  scientific, and lay audiences
• Selected current issues and controversies
  surrounding the transmission, prevention and
  control of human, avian, and swine influenza

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Course Organization

• Lectures and discussion
• Field Trip
• Local live bird markets
• MN Veterinary Diagnostic Laboratory
• State Public Health laboratory
• Team projects, presentations
• Individual reports
• 1 credit
• Graded as Satisfactory/Non-satisfactory
• 60 class participation, presentation 40 paper

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Course Overview

• Ecology, transmission, disease, pathophysiology,
  surveillance, prevention and control of
• Seasonal human influenza virus
• Pandemic influenza viruses
• Avian influenza viruses poultry and wild birds
• Swine influenza viruses-- relationship to human
  and bird influenzas
• Live Bird Markets
• Diagnostic tests
• Global issues and trade implications
• Risk assessment, management, communication

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Class Schedule
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Faculty

• Human
• Kristin Ehresmann/Dr. Richard Danila, Influenza
  Program, Minnesota
• Dr. Michael Osterholm, Professor SPH, Director
  CIDRAP
• Dr. Marguerite Pappaioanou, Professor, SPH
• John Besser, Susan Fuller, MN Public Health
  Laboratory
• Avian
• Dr. Dave Halvorson, Professor, Department of
  Veterinary Biosciences, Extension veterinarian
• Dr. Andre Ziegler, Assistant Clinical Prof., Vet.
  Pop. Med. VDL
• Dr. Dale Lauer, MN BD. Animal Health Director,
  MN Poultry Lab
• Dr. Heidi Kassenborg, Dr. Nikki Neeser, Dairy,
  Food, Meat Inspection, MN Dept. Agriculture
• Ron Joki, Veterinary Diagnostic Laboratory
• Live Bird Market Manager
• Swine
• Dr. Marie Gramer, Assist. Clinical Spec., Vet.
  Pop. Med. VDL
• Risk assessment, management, communication
• Dr. William Hueston

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Field Trip

• Live Bird Market and Diagnostic Laboratories
• Group A LBM, Veterinary Diagnostic Lab
• Group B MN Public Health Lab, LBM
• Group C MN Public Health Lab, Veterinary DX Lab
• Veterinary Diagnostic Laboratory
• Tour of the facility
• Avian influenza diagnostic tests
• Swine influenza diagnostic tests
• Minnesota Public Health Laboratory
• Tour of the facility
• Human influenza diagnostic tests

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Class Projects

• Class participants sign up for one of four given
  scenarios on Day 1
• Teams of 5-8 class members
• Team members represent a different perspective
  different than their own background (e.g., state
  epidemiologist, state veterinarian, industry
  representative, hospital administrator) in
  solving the scenario
• Presentation of scenario / recommendations on Day
  4 20 minutes for presentation
• Individual reports from students (3-5 double
  spaced typed pages) due 7 days after last class

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Scenarios

• Pandemic Influenza Preparedness
• Surveillance early detection and response human
  and/or animal
• Preventing and controlling avian influenza in
  birds (at the source)
• Preventing transmission of avian influenza across
  country borders-- protect trade, travel and
  commerce during avian influenza outbreaks
• Risk communication challenge

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Feedback on Class

• Helped individuals have better understanding of
  breadth of disease and different perspectives
• Some have commented that the course helped them
  do their jobs better
• Requirement to take on a role in addressing the
  scenario from a different perspective than their
  own (e.g., emergency room nurse representing the
  perspective of the state veterinarian)
  challenging some have appreciated it, some have
  not, meets the objective of the course

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Learn LotsHave FunThis is one very
interesting disease of huge public and animal
health importance!!!
Final Message to Class During Introduction--