Stories are appearing almost daily regarding the outbreak of Avian influenza in various parts of the world. Two questions capture the essence of the problem and the concern of local citizens. First, is Nebraska prepared to respond to this new threat? And second, is all the attention really justified, or is the concern out of proportion to the risk?
Avian influenza is a concern not only because it has appeared this summer and fall in a variety of domestic and wild bird populations, but because it has continued to appear and reappear despite the best effort of governments in Asia to control it.
More than 200 million birds infected or suspected of being infected with the virus have been destroyed. This is significant because virtually every new strain of influenza that has emerged since 1917 — the year when the Spanish flu spanned the globe — appeared first in a bird population before it entered the human population, often with swine being an intermediate host.
An oft-cited book, “The Great Influenza” by John Berry, describes the history of the Spanish flu. In this book, he points out that the Spanish flu killed more Americans than either the Civil War or World War II. Influenza is like a dormant volcano – you never know exactly when it will erupt.
What will be the impact of Avian influenza if it is capable of moving from birds to humans? Conservative projections suggest that 20 percent of the population will become infected. This corresponds to 400,000 Nebraskans, resulting in 14,000 hospitalizations and 3,000 deaths.
There is little doubt that our private health care system will be stressed beyond its current capacity. The situation will be worsened by the loss of health care workers and first responders affected by the disease in the absence of a vaccine.
Nebraska has made great strides in public health and emergency preparedness over the past five years, not the least of which is the organization of regional public health districts encompassing the entire state. The state also has initiated surveillance programs for diseases such as influenza. The programs include monitoring increases in school absenteeism by our children, as well as monitoring influenza virus in domestic and wild bird populations by the Department of Agriculture.
Under the guidance of the Nebraska Emergency Management Agency (NEMA), state agencies and private companies have conducted training exercises for all types of situations including epidemic infectious disease. The entire University of Nebraska system has been a full participant in the NEMA planning exercises. The Nebraska Department of Health and Human Services used some of its federal allocation of bioterrorism preparedness funds to build a hospital biocontainment unit for patients with highly contagious diseases.
The evidence certainly suggests that Nebraska will mount an effective response should Avian influenza come to America, but there is a limit to what state government can do since such things as vaccine production are the purview of the federal government. Unfortunately, antiviral medications have not been produced in sufficient quantity to be stocked in advance within all states.
Federal agencies are taking steps to prevent the importation of infected birds into the U.S. If this effort is successful this year, then it may be another 12 months before the next challenge arises – sufficient time, if used wisely, for developing an effective vaccine and producing antiviral medications.
The danger could reappear on an annual basis because if Avian influenza remains in the wild bird population in Asia, the duck, geese and songbirds that pass through the central flyway in Nebraska will return in the fall from their shared summer feeding grounds in Alaska, where they will likely have been exposed to wild birds from Asia. Then again, the mountain may stop rumbling and Avian influenza may not be heard from again for another 20 years.
The issue undoubtedly warrants the attention it is receiving, and the public is justified in expecting the best from its government and their University of Nebraska in preparing for the challenges of the future.
Steven H. Hinrichs, M.D., is the Stokes-Shackelford Professor of Pathology and Microbiology at UNMC. He is director of the University of Nebraska Center for Biosecurity and the Nebraska Public Health Laboratory at UNMC.