Avian Influenza, also called bird flu or H5N1 is an infection that naturally occurs among birds. Avian Influenza is carried in wild birds in their intestines but usually do not get sick. On the contrary domesticated birds: turkey, chickens, and ducks pick up the very contagious virus and get very sick. The virus is fatal.
Birds that are susceptible to the virus become infected by being in contact with contaminated secretions or excretions.
Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus. (CDC) 2010.
The spread of avian influenza A viruses from one ill person to another has been reported very rarely, and has been limited, inefficient and not sustained. However, because of the possibility that avian influenza A viruses could change and gain the ability to spread easily between people, monitoring for human infection and person-to-person transmission is extremely important for public health. (CDC) 2010.
Avian Influenza Outbreak

Outbreaks
The most recent reported outbreak was January 2015. The outbreak is still ongoing but has not yet spread to humans.
The most recent outbreak in North America with transmission to humans was in Canada in 2004. Health Canada reported two cases of laboratory-confirmed influenza A (H7): one in a person involved in culling operations, and the other in a poultry worker who had close contact with poultry. Both patients developed conjunctivitis (eye infection) and mild illness. Their illnesses resolved after treatment with the antiviral medication oseltamivir. (CDC) 2010
The largest outbreak of the bird flu was in China in 2013. 139 people were affected by the outbreak. Confirmed cases occurred in 12 areas of China. Nine persons were poultry workers, and of 131 persons with available data, 82% had a history of exposure to live animals, including chickens (82%). Most patients were hospitalized with severe lower respiratory tract illness (NEJM) 2014
While some mild illnesses in human H7N9 cases have been seen, most patients have had severe respiratory illness, with about one-third resulting in death. (CDC) 2015

Epidemiological Determinants
Most of these infections are believed to result from exposure to infected poultry or contaminated environments, as H7N9 viruses have also been found in poultry in China.
No evidence of sustained person-to-person spread of H7N9 has been found, though some evidence points to limited person-to-person spread in rare circumstances. (CDC) 2015
The avian influenza A viruses may be passes from animal to humans. This happens from direct contact with infected birds or through an intermediate host such as a pig. This was seen in the 1998 H1N1 outbreak in U.S. pigs.
The largest risk factor of contracting this illness is direct contact with an infected animal.
Handling sick or dead poultry poses the biggest risk of infection.
Any direct contact with poultry or birds in the 2 weeks before the onset of illness, chronic medical conditions excluding hypertension, and exposure to an environment with poultry, including visiting a live poultry market, as risk factors associated with H7N9 virus infection.
Avian flu infections in humans are thought to be from bird-to-human transmission.
Up until June 2006, less than a dozen cases were recorded by WHO.
A few isolated cases of suspected human to human transmission exist. With the latest such case in June 2006 (among members of a family in Sumatra). No pandemic strain of H5N1 has yet been found. (Mcneil 2006)
This also worry that other animals may be able to act as a bridge between birds and humans. Animals such as cats and dogs, but with no definite proof.
From the first confirmed case through 2012, the number confirmed human cases of H5N1 reported to WHO stands at 583, with 344 fatalities, or a 59% fatality rate. (Mcneil 2015)

Effecting your community.
An outbreak such as this could have effect on your local economy. If infected poultry has to be culled in mass quantities this effects the price of chicken, turkey, etc. With the current January 2015 outbreak they are assessing how it will affect Thanksgiving. This virus can cost companies such as Tyson, millions of dollars. Small businesses such as petting zoos’ also suffer.
Outbreaks such as these cause panic and fear. This illness is most threating to the very young, elderly, and immune compromised. This can affect your local hospitals by requiring additional training, etc for the staff.
ER’s and Urgent cares would have to be put on alert. Schools would have to be notified. Any field trips involving live animals would have to be cancelled. Children who lived and/or worked with poultry would have to be notified of risks and education involving hand washing, etc. Reporting.
The first step in reporting would be contacting your local health department. State health departments are encouraged to initiate a public health investigation with animal health partners and should notify CDC promptly. There would need to be coordination of specimen collection.
Use of airborne precautions is recommended for the collection of respiratory specimens.
The chain of reporting is as follows: Nurse would call local health department, local would call state health department, and State health department would call the CDC.

The Plan.
The most important outbreak prevention would be contacting any poultry farms in the community. Next would be reaching out to any petting zoos’, live animal markets, and animal auctions. Anywhere live poultry is. After coordinating with the Health Dept and CDC, it would be necessary to contact local urgent cares and ER’s to inform them to be on the lookout for symptoms of Avian Influenza.

Preventing an Outbreak
As with everything proper hand washing technique is always a good place to start. Correct use of personal protection equipment is also very important. Minimizing handling live poultry, discussing the need to avoid cross contamination with local poultry farms, and restricting outside access to infected farms will help stop the spread.

References 1. Lee CW, Swayne DE, Linares JA, et al. H5N2 avian influenza outbreak in Texas in 2004: the first highly pathogenic strain in the United States in 20 years? J Virol. 2005 Sep;79(17):11412-21. 2. Skowronski DM, Tweed SA, Petric M, et al. Human illness and isolation of low-pathogenicity avian influenza virus of the H7N3 subtype in British Columbia, Canada. J Infect Dis. 2006 Mar 15;193(6):899-900. 3. CDC. Update: Influenza Activity --- United States and Worldwide, 2003—04 Season, and Composition of the 2004—05 Influenza Vaccine. MMWR 2004; 53(25). 4. Donald G. McNeil Jr. (June 4, 2006). "Human Flu Transfers May Exceed Reports". New York Times. 5. N Engl J Med 2014; 370:520-532 February 6, 2014DOI: 10.1056/NEJMoa1304617
Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa1304617 6. Li Q et al, 2013. Epidemiology of human infections with avian influenza A (H7N9) in China