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Avian Influenza A (H5N1) is highly pathogenic. It first came to the attention of

ID: 3202427 • Letter: A

Question

Avian Influenza A (H5N1) is highly pathogenic. It first came to the attention of the world in November 2003. The virus has been constantly evolving. From being 100% in wild birds (such as geese) it first evolved to infect domestic poultry. Later it evolved to infect humans. Most cases of infection have been traced to human contact with infected poultry. While the virus currently does not yet transmit efficiently from person to person, some cases of person to person transmission have occurred.[1]

Use Table 4 (below) for the following calculations. Remember that case-fatality rates are calculated with a multiplier of 100 (as percentages).

Table 4: Cumulative Number of Confirmed Human Cases and Deaths from Avian Influenza A (H5N1) Reported to WHO, 2003- November 21, 2016

Country

2003-2009

2010-2014

2015

2016[2]

Total

Cases

Deaths

Cases

Deaths

Cases

Deaths

Cases

Deaths

Cases

Deaths

Azerbaijan

8

5

8

5

Bangladesh

1

0

6

1

1

0

8

1

Cambodia

9

7

47

30

56

37

Canada

1

1

1

1

China

38

25

9

5

6

1

53

31

Djibouti

1

0

1

0

Egypt

90

27

120

50

136

39

10

3

356

119

Indonesia

162

134

35

31

2

2

199

167

Iraq

3

2

3

2

Lao People’s Democratic Republic

2

2

2

2

Myanmar

1

0

1

0

Nigeria

1

1

1

1

Pakistan

3

1

3

1

Thailand

25

17

25

17

Turkey

12

4

12

4

Viet Nam

112

57

15

7

127

64

Total

468

282

233

125

145

42

10

3

856

452

Calculate the total case-fatality rate for avian influenza in the world (all countries combined and all years combined). (Show all steps.)

Please calculate the case-fatality rates for avian influenza for each of the following: 2003-2009, 2010-2014, 2015, and for 2016 (up until November 21st). After calculating these rates, place them in table 5 below.

Describe how the case-fatality rate for avian influenza has changed over time.

Calculate the case-fatality rates for avian influenza for each country where it has occurred for all years combined. After calculating these rates, place them in table 6 below.

Which countries has had the highest case-fatality rate for this disease? Which countries has had the lowest?

Not including countries with fewer than 8 total cases, which country has had the highest case-fatality rate and which the lowest?

Explain why it is necessary to maintain surveillance of this particular disease.

Table 5: Case-Fatality of Avian Influenza over Time

Date

2003-2009

2010-14

2015

2016

Case-Fatality Rate

Table 6: Case-Fatality Rates of Avian Influenza by Country

Country

Case-Fatality Rate

Country

Case-Fatality Rate

Azerbaijan

Iraq

Bangladesh

Laos

Cambodia

Myanmar

Canada

Nigeria

China

Pakistan

Djibouti

Thailand

Egypt

Turkey

Indonesia

Viet Nam

Country

2003-2009

2010-2014

2015

2016[2]

Total

Cases

Deaths

Cases

Deaths

Cases

Deaths

Cases

Deaths

Cases

Deaths

Azerbaijan

8

5

8

5

Bangladesh

1

0

6

1

1

0

8

1

Cambodia

9

7

47

30

56

37

Canada

1

1

1

1

China

38

25

9

5

6

1

53

31

Djibouti

1

0

1

0

Egypt

90

27

120

50

136

39

10

3

356

119

Indonesia

162

134

35

31

2

2

199

167

Iraq

3

2

3

2

Lao People’s Democratic Republic

2

2

2

2

Myanmar

1

0

1

0

Nigeria

1

1

1

1

Pakistan

3

1

3

1

Thailand

25

17

25

17

Turkey

12

4

12

4

Viet Nam

112

57

15

7

127

64

Total

468

282

233

125

145

42

10

3

856

452

Explanation / Answer

a) the total case-fatality rate for avian influenza in the world = (number of people died / total number of cases)*100

= (452/856)*100 = 52.8%

b) Similar to previous part

c) The case-fatality rate for avian influenza has decreased overtime. It decreased drastically in 2015, which was a positive sign but it increased again in 2016.

d) This can be done in the similar manner as part (a) and (b).

Date 2003-09 2010-14 2015 2016 Case-Fatality Rate (282/468)*100 = 60.25% (125/233)*100 = 53.64% (42/145)*100 = 28.96% (3/10)*100 = 30%
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