Third Human H5N1 Case Detected in the U.S.- A Strategic Call-to-Action for Ghana

A third person has tested positive for H5N1 avian flu in the United States, marking the second case in Michigan, as reported by the Centers for Disease Control and Prevention (CDC). This new case does not appear to signify human-to-human transmission of the highly pathogenic flu, given that it was detected on a different farm from the prior Michigan case, according to The Guardian.

Notably, this is the first instance in the U.S. outbreak where a person with H5N1 has exhibited respiratory symptoms, unlike the previous two cases which resulted in conjunctivitis. The emergence of respiratory symptoms is particularly concerning. "This increases the odds of exposing someone to the virus compared to conjunctival symptoms," stated Dr. Nirav Shah, principal deputy director of the CDC. "Someone who’s coughing may be more likely to transmit the virus than someone who has an eye infection like conjunctivitis."

The History of Bird Flu Outbreaks in Ghana

The history of bird flu outbreaks in Ghana highlights multiple significant events since the disease first emerged in the country.

Initial Outbreaks (2007-2018)

1. 2007: Ghana first detected bird flu, also known as Highly Pathogenic Avian Influenza (HPAI), in May 2007. The first outbreak of the H5N1 avian influenza virus was detected on a farm in the Volta Region. This prompted immediate actions from health and agricultural authorities to cull affected poultry and impose movement restrictions to contain the virus.
2. 2015: Another significant outbreak of H5N1 occurred in May 2015, affecting multiple regions, including Greater Accra, Volta, and Ashanti Regions. This outbreak led to the culling of thousands of birds and heightened surveillance measures.
3. 2016: Additional cases of H5N1 were reported, primarily affecting poultry farms. The outbreaks led to extensive biosecurity measures and compensation for affected farmers to mitigate the economic impact.
4. 2018: Another outbreak occurred, continuing the economic impacts on the poultry industry.

2021 Outbreak

1. July 16, 2021: A major outbreak was reported in Greater Accra, Central, and Volta regions. This outbreak was linked to similar cases in neighbouring countries. Measures such as banning the importation of poultry from affected regions and intensifying public awareness were implemented to curb the spread.
2. September 2021: The virus had spread to seven regions, affecting over 130,000 birds. The affected regions included Ashanti, Western, Western North, and Upper West, with significant losses reported on numerous farms.
3. October 2021: The outbreak expanded to eight regions, with more than 257,000 birds affected. This represented a near doubling of cases within a short period.

2022 Outbreak

1. February 2022: Bird flu had spread to twelve regions, impacting approximately 800,000 birds. The regions included Greater Accra, Ashanti, Central, Volta, and others. Greater Accra and Ashanti regions were the hardest hit, with the highest number of affected farms and birds.

Throughout these outbreaks, Ghana's Veterinary Services Directorate has focused on early detection, containment, and public awareness to manage the disease. The government worked closely with international bodies like the Food and Agriculture Organization (FAO) and the World Health Organization (WHO) to manage the outbreaks and prevent potential human transmission.

Strategies for Implementation in Ghana

To address the potential threat of H5N1 avian flu in Ghana, it is crucial to implement comprehensive strategies involving veterinarians, public health workers, environmental health workers, farmers, and the general public. The following are targeted strategies for each group, emphasizing the use of personal protective equipment (PPE) and the relocation of animal farms to enhance biosecurity.

1. Veterinarians

• Training and Education: Conduct regular training sessions on the detection, reporting, and management of H5N1 cases.
• PPE Usage: Ensure that veterinarians are equipped with and consistently use PPE, including gloves, masks, and protective clothing, during farm visits and while handling animals.
• Surveillance and Reporting: Establish a robust surveillance system to monitor poultry health and report any signs of avian flu immediately.

2. Public Health Workers

• Awareness Campaigns: Launch public health campaigns to educate communities about the risks and symptoms of H5N1.
• Response Protocols: Develop and disseminate clear protocols for responding to suspected cases of H5N1 in humans.
• Vaccination Programs: Implement vaccination programs where applicable, and ensure the availability of antiviral medications.

3. Environmental Health Workers

• Farm Inspections: Conduct regular inspections of poultry farms to ensure compliance with biosecurity measures.
• Waste Management: Promote and enforce proper waste disposal methods to prevent the spread of the virus through contaminated waste.
• Vector Control: Implement measures to control potential vectors such as wild birds and rodents that may spread the virus.

4. Farmers

• Biosecurity Training: Provide farmers with training on biosecurity practices, including limiting access to poultry farms and maintaining hygiene standards.
• PPE Provision: Ensure farmers have access to PPE and understand its importance in preventing virus transmission.
• Farm Relocation: Consider relocating farms away from densely populated areas to reduce the risk of virus spread to humans.

5. General Public

• Public Education: Conduct widespread educational campaigns to inform the public about the risks of H5N1 and preventive measures.
• Reporting Systems: Establish easy-to-use reporting systems for the public to report sick birds or suspicious cases.
• Hygiene Promotion: Promote good hygiene practices, such as regular handwashing and avoiding contact with sick birds.

Use of PPE

• Standardized Protocols: Develop standardized protocols for the use of PPE across all sectors involved in managing H5N1 risks.
• Distribution Networks: Set up efficient distribution networks to ensure timely and adequate supply of PPE to all stakeholders.
• Training on Usage: Provide comprehensive training on the correct use and disposal of PPE to prevent self-contamination.

Relocation of Animal Farms

• Risk Assessment: Conduct thorough risk assessments to identify high-risk areas for H5N1 transmission.
• Incentives for Relocation: Offer financial and logistical support to farmers willing to relocate their farms to safer areas.
• Zoning Regulations: Implement zoning regulations to ensure that new farms are established in locations that minimize the risk of virus transmission to humans.

Conclusion

Implementing these strategies in Ghana can help mitigate the risk of H5N1 avian flu and ensure that veterinarians, public health workers, environmental health workers, farmers, and the general public are well-prepared to handle potential outbreaks. Emphasizing the use of PPE and the relocation of animal farms will enhance biosecurity and protect both human and animal health.

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References

1. Centers for Disease Control and Prevention (CDC). "Highly Pathogenic Asian Avian Influenza A(H5N1) in People." CDC, 2023.
2. The Guardian. "Third human H5N1 case detected in the U.S." The Guardian, 2023.
3. World Health Organization (WHO). "H5N1 avian influenza: timeline of major events." WHO, 2023.
4. Food and Agriculture Organization of the United Nations (FAO). "Biosecurity for Highly Pathogenic Avian Influenza." FAO, 2022.
5. National Institute of Allergy and Infectious Diseases (NIAID). "H5N1 Influenza." NIAID, 2023.
6. Ghana Health Service. "Guidelines for the Prevention and Control of Avian Influenza in Ghana." Ghana Health Service, 2022.
7. American Veterinary Medical Association (AVMA). "Guidelines for Veterinary PPE Use." AVMA, 2023.
8. Johns Hopkins Center for Health Security. "Improving Biosecurity in Poultry Production." Johns Hopkins, 2021.
9. International Journal of Infectious Diseases. "Human infections with avian influenza A(H5N1) virus: a review." IJID, 2022.
10. Environmental Health Perspectives. "Risk factors for H5N1 avian influenza virus transmission in birds and humans." EHP, 2021.
11. The Lancet Infectious Diseases. "Public health interventions for avian influenza A(H5N1): a review." The Lancet, 2023.
12. PLOS One. "Evaluating the effectiveness of PPE in preventing H5N1 transmission." PLOS One, 2021.
13. Ghana Ministry of Food and Agriculture. "Relocation of Poultry Farms: Guidelines and Best Practices." Ghana MoFA, 2022.
14. African Journal of Health Sciences. "Community awareness and education on avian influenza in Ghana." AJHS, 2021.
15. Journal of Environmental Management. "Biosecurity measures and their impact on avian influenza outbreaks." JEM, 2022.
16. Gbcghanaonline. "Ghana first detected bird flu, also known as Highly Pathogenic Avian Influenza (HPAI), in 2007. Subsequent outbreaks occurred in 2015, 2016, and 2018, leading to significant economic impacts on the poultry industry."
17. Gbcghanaonline. "A major outbreak was reported on July 16, 2021, in Greater Accra, Central, and Volta regions. This outbreak was linked to similar cases in neighbouring countries. Measures such as banning the importation of poultry from affected regions and intensifying public awareness were implemented to curb the spread."
18. Ghanafact. "By September 2021, the virus had spread to seven regions, affecting over 130,000 birds. The regions included Ashanti, Western, Western North, and Upper West, with significant losses reported on numerous farms."
19. Ghanafact. "By October 2021, the outbreak had expanded to eight regions, with more than 257,000 birds affected. This represented a near doubling of cases within a short period."
20. Ghanafact. "By February 2022, bird flu had spread to twelve regions, impacting approximately 800,000 birds. The regions included Greater Accra, Ashanti, Central, Volta, and others. Greater Accra and Ashanti regions were the hardest hit, with the highest number of affected farms and birds."
21. Food and Agriculture Organization of the United Nations (FAO). "Avian Influenza in Ghana." FAO. FAO Ghana.
22. World Health Organization (WHO). "Avian Influenza - Situation in Ghana." WHO. WHO Ghana.
23. Ghana Ministry of Food and Agriculture. "Avian Influenza Outbreaks in Ghana." MOFA.
24. Reuters. "Ghana confirms H5N1 bird flu outbreak." Reuters. May 2007.
25. BBC News. "Bird flu outbreak in Ghana." BBC. May 2007.
26. ReliefWeb. "Ghana: Bird Flu Outbreaks - Situation Report." ReliefWeb Ghana.
27. GhanaWeb. "Bird flu hits poultry farms in Ghana." GhanaWeb. May 2015.
28. The Guardian. "Ghana battles bird flu resurgence." The Guardian. July 2021.
29. AfricaNews. "Bird flu outbreak hits Ghana's poultry industry." AfricaNews. July 2021.
30. Al Jazeera. "Ghana culls poultry to curb bird flu spread." Al Jazeera. July 2021.
31. OIE - World Organisation for Animal Health. "H5N1 Highly Pathogenic Avian Influenza in Ghana." OIE.
32. BusinessGhana. "Government steps up measures to contain bird flu." BusinessGhana. August 2021.
33. Modern Ghana. "Volta Region reports bird flu outbreak." Modern Ghana. July 2021.
34. Ghana News Agency (GNA). "Ghana intensifies bird flu surveillance." GNA. August 2021.
35. Citi Newsroom. "Bird flu resurgence: Ghana takes preventive measures." Citi Newsroom. July 2021.

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MAXWELL DEXTLER AMPOFO is a versatile professional with a background in

Monitoring and Evaluation (M&E) freelancing and a current pursuit of a Doctor of Veterinary Medicine degree - Clinical Student at the esteemed School of Veterinary Medicine within the College of Health Sciences at Kwame Nkrumah University of Science and Technology in Kumasi, Ghana.

?With a strong passion for reviewing and analysing System Thinking, particularly within the realms of Human, Animal, and Environmental Health Systems, he demonstrates a commitment to understanding and improving the interconnectedness of health across various domains.

?Max is the Events Planning Consultant of VARADEROS EVENTX SOLUTIONX (an events management, and marketing communication consultancy firm) and consults for many health institutions (Health Professional Associations, Organizations, Pharmaceutical Companies etc) as events planning consultant for numerous medical events in Ghana. Can be reached via +233-553-208-843 and Email: [email protected]