Avian Influenza Epidemiology

Training Workshop in Indonesia

Topic: Outbreak Investigation Worksheet Answers

Outbreak Investigation
Scenario There is increasing evidence that an outbreak of avian influenza is underway in flocks within your province. You are selected as a member of a team of animal health professionals who are investigating the health status of backyard flocks in your area. Question 1. Provide examples of types of evidence or findings that would be suggestive of an outbreak of avian influenza.

An outbreak occurs when new cases of AI occur at a higher rate than what is normally expected (relative to the usual disease frequency in the same area, among the specified population, in the same season) Thus, to have evidence of an outbreak one would need to know the expected occurrence of this disease within the specific province during this time of year. The number of diseased/dead birds in the flocks as reported would be greater than the expected number.
Your team evaluates 82 backyard flocks within the province. You and other team members examine birds within each flock and note if any birds are exhibiting clinical signs of respiratory disease (lethargic, coughing, open-mouth breathing, nasal discharge). Furthermore, samples (tracheal swabs) from birds in each flock are collected to determine the infection status of the flock. If one or more samples collected from one flock test positive by Real-Time PCR, then the entire flock is considered to be positive for avian influenza virus and is classified as Infected. If birds within the flock do not exhibit clinical signs of respiratory disease and all of the samples collected test negative by Real-Time PCR, then the entire flock is considered negative for avian influenza virus. Questions 1. Does the presence of clinical signs of respiratory disease in birds (as listed above) constitute a case definition for avian influenza?

The clinical signs as given above are included into a syndrome in the define a case portion of the investigation. This is a first step and provides the means to exclude cases of diseases other than AI.
2. Is it necessary to collect biological samples from birds in each flock? Why or why not?

Yes, in order to characterize the disease agent causing disease at this time.
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3. For the purposes of this preliminary investigation, the infection status of the flock was determined as described above. Is this an acceptable way to classify a flock as Infected? Why or why not?

Yes, because this is a preliminary step to characterize the situation in the province.
4. Describe how you would classify a flock as infected, i.e., what is your case definition?

This question is included to generate discussion specific for AI in Indonesia.

As part of the investigation, you and your team members determine if birds within a flock have contact with wild birds. Second, you determine if biosecurity measures are in place. Last, you determine if the birds have been vaccinated using an approved (legal) or non-approved (illegal) vaccine. Of the 82 flocks you evaluate, 45 of them are identified as positive for avian influenza virus and classified as Infected. A total of 45 flocks have contact with wild birds; 30 of which are classified as Infected. A total of 40 flocks appear to have good biosecurity and only 5 of these are classified as Infected. Last, you determine that 2 flocks out of a total of 22 who were vaccinated using a non-approved vaccine were classified as Infected. Questions 1. Calculate the proportion of flocks classified as infected.

45/82 * 100 = 54.9%

Is this a useful measure of disease occurrence? What does it tell you?

Yes, it may because it provides an overall measure of infection with avian influenza within the area and could be used as a rough comparison with other provinces or areas. BUT, it is important to know HOW the flocks were selected for investigation before making any conclusions. It would be useful to place all investigated flocks on a spot map also!
2. During your investigation, what methods/approaches could be used to determine if birds within the flock have contact with wild birds, if biosecurity measures are in place, and if birds have been vaccinated using an approved or non-approved vaccine.

This requires a combination of personal observation and questions to the owner. Be aware that questions do not always elicit the correct answer from owners as they often want to give you the answers that you want to here. For evaluation of biosecurity, you might need to complete a check list (or standard form) of items and then score the overall level of biosecurity.
3. What other potential risk factors would you include in your investigation? What data would you gather?

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The answers would vary but could include contact with wild birds, vaccine use.

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