Term Paper: Avian Flu Avian Influenza: If H5N1

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Avian Flu

Avian Influenza: If H5N1 is the Virus to Fear, Is America Prepared for a Potential Outbreak?

The effects of a bird flu pandemic would dwarf even the devastation caused by Hurricane Katrina. -- Marty Evans, Chairwoman for the Red Cross, 2005

Explanation of the Problem

The introduction of innovations in telecommunications and transportation over the past century or so has made the world a much smaller place, and what happens in other countries can have an enormous impact on the United States today. The events of September 11, 2001 also made the point absolutely clear that Americans are not immune from being attacked on the home front, and many observers are becoming increasingly concerned about the potential threat represented by biological, chemical and nuclear weapons as well. In this environment, any type of virulent pathogen represents a threat to the nation's health and well-being, and H5N1, otherwise known as avian influenza, appears to represent just such a threat. In fact, a recent report from Fabian (2006) suggests that if such an epidemic were to affect the United States, virtually everyone in the country would experience the loss of at least one person in their lives. The potential threat to the citizens of the United States began with events in China and Southeast Asia where migratory waterfowl managed to pick up the H5N1 flu virus from lake waters they have visited on their migration journeys (Fabian, 2006).

As the result of aggressive economic development in these regions, many of the natural wetlands that these birds visit have been eliminated; consequently, the waterfowl have turned to landing in farm areas for water and food. In these concentrated regions of Asia, these wild birds ultimately come into contact with local poultry and the close interactions that result between waterfowl and poultry has caused the virus to be communicated from the migratory birds into poultry flocks; the result of these interactions has been numerous outbreaks of bird flu in poultry populations (Fabian, 2006).

To date, more than 135 humans are known to have contracted the disease, almost always from chicken blood or droppings (Fabian, 2006). The extent of the problem continues to elude many observers that might question the threat represented by the number of dead birds (approximately 150 million thus far) compared to the relatively small number of people (about 70) who have died from the virus (Fabian, 2006). In reality, the potential threat is very real and continues to grow; should the H5N1 virus mutate and become communicable between humans, the potential for a worldwide outbreak would become even greater. This is not the first such pandemic threat in recent years, and during the 20th century, there were three such outbreaks:

1918-1919 -- the Spanish flu, 1957-1958 -- the Asian flu, and 1968-1969 -- the Hong Kong flu.

The World Health Organization (WHO) defines a pandemic as the confluence of three events:

There must develop a novel virus that the world has never seen before (and to which humanity has absolutely no immunity).

That virus must demonstrate an ability to sicken or kill people.

The virus must become transmissible among humans.

According to Fabian (2006), "The first two of these conditions have now been met. It is therefore little wonder that the public health community is alarmed" (2006, p. 47).

Justification for Using an Interdisciplinary Approach

Complex problems require complex solutions, and the knowledge needed to address the potential health threat represented by the H5N1 virus must be utilized from multiple viewpoints as determined by various disciplines in order to fully understand the scope of this issue (Repko, 2005).

Identification of Relevant Disciplines

The disciplines to be used for analysis of the country's current readiness for an H5N1 epidemic in this study were biology, psychology, and economics, and a further discussion of these respective viewpoints is provided below.

Respective Viewpoints of Relevant Disciplines


The perspective of biologists concerning the H5N1 virus is focused on how the pathogen operates at the molecular level to determine its potential for mutation and the biological impact of a potential pandemic.


A primordial dread characterizes most people's views about potential biological threats because of the unknowns involved. Indeed, most Americans have become accustomed to thinking the inoculations they have received throughout their lives makes them virtually immune to any such biological agent, and the psychological impact of an avian flu epidemic in the United States could reasonably be expected to be pronounced and long-lasting.


Perhaps the best way to mobilize scarce resources in advance of a potential threat is to emphasize how much money is at stake. In the case of potential outbreak of the H5N1 virus, the economic consequences would be enormous and from this perspective, it just makes good business sense to plan ahead for a worst case scenario.


To address the issues discussed in the explanation of the problem above, a critical review of the relevant and peer-reviewed literature was deemed the best approach. In this regard, Wood and Ellis (2003) identified the following as important outcomes of a well conducted literature review:

It helps describe a topic of interest and refine either research questions or directions in which to look;

It presents a clear description and evaluation of the theories and concepts that have informed research into the topic of interest;

It clarifies the relationship to previous research and highlights where new research may contribute by identifying research possibilities which have been overlooked so far in the literature;

It provides insights into the topic of interest that are both methodological and substantive;

It demonstrates powers of critical analysis by, for instance, exposing taken for granted assumptions underpinning previous research and identifying the possibilities of replacing them with alternative assumptions;

It justifies any new research through a coherent critique of what has gone before and demonstrates why new research is both timely and important.

Purpose of the Study

The purpose of this paper is to create awareness among the general American population and to inform people of the potential threat represented by the H5N1 without resorting to alarmist rhetoric or unfounded claims.


General History of the Problem.

It is clear from the events following Hurricane Katrina that the nation's ability to adequately respond to widespread threats to the public welfare remains a work in progress. In spite of billions of dollars spent on homeland security initiatives following the terrorist attacks of September 11, 2001, there are some glaring gaps in readiness. These issues may come back to haunt the United States in the near future if some observers are right and the potential threat represented by the H5N1 virus. While there have been a number of influenza pandemics in human history, there are some disturbing qualities to the recent outbreak that have many observers concerned that the nation remains unprepared. The general history of the problem began in 2003 when an epidemic of a viral respiratory disease called bird flu (avian influenza) first began to devastate poultry farms in many Asian countries; by the end of 2004, the virus had infected poultry in Cambodia, China, Indonesia, Japan, Kazakhstan, Laos, Malaysia, Mongolia, North Korea, Romania, Russia, South Korea, Thailand, Turkey, Ukraine, and Vietnam (Ford, 2006). To date, millions of birds have been destroyed by the disease or by authorities that slaughtered them in an attempt to restrict the spread of the virus (Ford, 2006).

The deadly disease known as bird flu or avian influenza is caused by the H5N1 strain of type A influenza virus; the H5N1 strain was first isolated from terns in South Africa in 1961 and is now regarded as being common in waterfowl such as wild ducks; unfortunately, these wild fowl subsequently infect domesticated birds such as chickens, and the disease is virulent among this population (Ford, 2006). According to this authority, "The H5N1 virus was first found to have the capability of infecting humans in 1997, when an outbreak of bird flu in Hong Kong poultry caused severe illness in 18 persons, 6 of whom died" (Ford, 2006, p. 17). The notion of a type of influenza being transmitted from birds to humans appears disturbing to many people; however, this is an age-old problem facing mankind. According to Fabian, genetic research suggests that in fact, all flu strains have originated from birds (Fabian, 2006).

By the end of 2005, the epidemic of avian influenza had resulted in human cases of the disease in Cambodia, China, Indonesia, Thailand, Turkey, and Vietnam. Vietnam was the worst hit, with 93 cases. Of those, 42 died; citing statistics from the World Health Organization, Ford reports that the total number of cases by the end of 2005 was more than 140, with approximately half of these resulting in death (2006). Although sustained communicability of the H5N1 virus from person to person has not been observed, health officials remain cognizant that the H5N1 virus has the potential to mutate rapidly or even combine genetically with a human influenza virus to yield a virulent new strain that could easily spread… [END OF PREVIEW]

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