By Prathiba Raju & Abhijeet Singh
New Delhi: After witnessing the horrors, devastation, and large-scale human suffering caused by a once-in-a-generation global pandemic, it seemed like things were getting back on track and the Indian healthcare ecosystem is in recovery mode. However, the recent bird flu cases in India serve as a reminder of the persistent threat posed by zoonotic disease developments. From the episodes of Nipah virus outbreaks to the recent bird flu cases underscore the need for robust surveillance and preventive measures to manage zoonotic diseases effectively, informed experts.
Last week the World Health Organisation (WHO) confirmed the first ever death of a human being due to bird flu in Mexico, while in India the issue started hitting the headlines after the world health body confirmed the second-ever case in the country and the first since 2019 of a human infection attributed to the avian influenza A (H9N2) virus, commonly referred to as bird flu, in a four-year-old child from West Bengal.
Understanding the gravitas of the problem and to dissect its overlooked aspects ET HealthWorld spoke to several experts
Providing the basic description of the problem Dr Mohan Kumar Singh, Senior Consultant Internal Medicine, Marengo Asia Hospital, Gurugram said, “So far we know that H9N2 is a subtype of avian influenza virus, commonly found in birds. While it primarily infects birds, it can occasionally infect humans, including children. This is the second such case in our country, as confirmed by WHO. The virus can spread through two different ways: direct contact with infected animals or indirect contact with polluted settings and environment.”
On being asked about the prevention and precautions from the disease Dr Singh suggested, “To prevent H9N2 infection, it is essential to limit exposure to live poultry and bird markets since these types of environments can act as hotspots for viral transmission. Maintaining good hygiene by washing hands frequently, especially after handling birds or their environments, is crucial. Wearing protective gear, such as gloves and masks, when working with birds can reduce direct contact with potential viral sources. Furthermore, getting the yearly flu shot can provide some cross-protection against H9N2, even if there isn’t a specialized vaccination for it.” Talking about its management the expert suggested, “Antiviral drugs like zanamivir (Relenza) or oseltamivir (Tamiflu) must be used as soon as possible if you are infected in order to lessen the frequency and severity of your symptoms. Supportive care is equally important, focusing on staying well-hydrated, getting a good amount of rest, and using fever reducers to manage symptoms effectively. Seek immediate medical attention, in case of breathing difficulties as it may require hospitalisation.”
Voicing his stance on the problem another expert Dr Nasiruddin G, Consultant-Internal Medicine, Fortis Hospital, said,” The WHO confirmed a 4-year-old in India tested positive for H9N2 bird flu, the second such case in the country. This strain typically causes mild illness, but this child did require hospitalisation. The infection likely occurred through contact with poultry, as the child had no reported close contacts with other cases. H9N2 rarely spreads between people, but health officials monitor these cases because flu viruses can mutate.”
“As a precaution, people in India, especially those around poultry farms, should practice good hygiene, avoid close contact with sick birds, and cook poultry products thoroughly,” Dr Nasiruddin added.
Dr Praveen Gupta, Principal Director and Chief of Neurology, Fortis Hospital voiced similar views and urged for extensive monitoring at various hotspots. He said, “The recent report of a bird flu case in India is alarming and necessitates immediate action. Forest officials and wildlife personnel must adopt stringent safety protocols, such as wearing gloves and protective gear when handling dead birds.”
“Alongside, there should be an increase in monitoring and preventive measures to swiftly identify and contain new cases. This includes setting up checkpoints for wildlife health, increasing testing in areas with previous outbreaks, and educating the public about the signs of bird flu and the importance of avoiding contact with wild birds. Proactive steps in surveillance and hygiene can help to mitigate the spread of this potentially dangerous virus.” Dr Gupta added.
Commenting over the potential diagnostic strategies to detect the rare disease Dr Manish Mannan, HOD – Paediatrics and Neonatology, Paras Health, Gurugram said,” Diagnosing H9N2 requires a combination of clinical suspicion and laboratory testing. If a child presents with symptoms suggestive of bird flu and has a history of bird exposure, a respiratory sample (swab or wash) will be collected and tested for the specific influenza virus strain. Early diagnosis is crucial for prompt treatment and isolation to prevent further spread.
Adding to the management aspect Dr Mannan said, “The infection primarily involves supportive care to manage symptoms like fever and dehydration. Antiviral medications are typically used to shorten the illness duration and reduce the risk of complications. In severe cases, additional supportive measures like oxygen therapy or respiratory assistance might be needed.
Sharing her opinion on how to mitigate the risk in the initial stages Dr Neha Rastogi Panda, Consultant-Infectious Diseases, Fortis Gurugram suggested to, “Ensure that poultry reaches an internal temperature of 165°F (74°C) to kill any virus; avoid live bird markets: If possible, opt for poultry from reputable sources.”
Mentioning that the disease is mild in humans, and treatment is similar to that of other influenza viruses, including antiviral medications like Tamiflu, Dr Sushila Kataria, Senior Director, Internal Medicine, Medanta,said, “H9N2 bird flu is a type of influenza A virus primarily found in birds. Human transmission is possible due to the same, usually occurring through close contact with infected birds. This includes individuals handling poultry, such as those working in hatcheries, who are at a higher risk of infection. H9N2 bird flu is not highly transmissible and does not have the potential to become a pandemic, as its R0 (basic reproduction number) is very low. Therefore, there is no cause for widespread concern. But, people with comorbid conditions, children, and the elderly with low immunity are more susceptible to infections and should take extra precautions. By adhering to these preventive measures, the risk of transmission can be significantly reduced.”
Elaborating over the epidemiology of bird flu Dr Akshay Budhraja, Senior Consultant & HOD- Respiratory & Sleep Medicine, Aakash Healthcare, New Delhi stated, “H9N2 is a subtype of avian influenza which spreads through direct contact with infectious animals mainly birds.The pathogencity is very low and the virus rarely infects humans. Sporadic cases of infection with avian virus are seen around the world mainly in Asia, Europe, Africa and the Middle east. While its symptoms are similar to that of flu: cough, fever, sore throat, headache, bodyache and rarely leads to severe lung infection.
Experts voiced the unpredictable nature of infectious diseases and the continuous threat they pose, even as the world recovers from COVID-19. Informed that the rapid mutation rates of viruses like avian influenza demand a robust and proactive approach to public health. The global health community must remain vigilant and adaptable, ready to respond swiftly to emerging threats to prevent another crisis on the scale of COVID-19.
