|Home | About | Journals | Submit | Contact Us | Français|
Experience from a local H7N2 avian influenza (AI) event in poultry, the international emergence of AI, and the projected spread of AI to other countries made AI an important issue for the communities in the Delmarva Peninsula (which encompasses parts of Delaware, Maryland, and Virginia), where agriculture—particularly poultry production—is a major industry. The identification of the H7N2 AI strain in poultry on Maryland's Eastern Shore in spring 2004 resulted in flock depopulation to keep the strain from spreading. The impact of this strain on Delmarva's $1.9 billion poultry industry could have been devastating.1
The practice of flock depopulation, which addresses the issue of infectious disease, was developed to minimize exposure and thus reduce the risk of disease for people exposed to AI-infected poultry. The Worcester County Health Department (WorCHD) in Worcester County, Maryland, recognized the need to increase its capacity and preparedness to manage an AI outbreak by developing agreements, procedures, and educational materials and identifying resources relevant to such an event.
This need led WorCHD to develop an operational response plan initially based on the Centers for Disease Control and Prevention's (CDC's) and Occupational Safety and Health Administration's (OSHA's) guidelines2,3 with additional guidance from a regional task force of interested stakeholders, including representatives of the Delmarva poultry industry and other agencies and health departments. The response plan has been updated based on more recent guidance.4
The Delmarva Avian Influenza Joint Task Force (Task Force) convened in December 2004 under the leadership of the Worcester County Health Officer. Members of the Task Force represented three states, private industry, and state agencies. Membership initially included: Allen Family Foods, Delaware Department of Agriculture, Delaware Division of Public Health, Lasher Poultry Diagnostic Lab at the University of Delaware, Delmarva Poultry Industry, Inc., Maryland Department of Agriculture (MDA), Maryland Department of Health and Mental Hygiene, Mountaire Farms, Perdue Farms, Somerset County Health Department, Tyson Foods, Virginia Department of Health, Wicomico County Health Department, and WorCHD. Membership has expanded since the inception of the Task Force.
As the lead agency for the Task Force, WorCHD initiated, facilitated, and hosted all Task Force meetings, and staff recorded the meeting proceedings. Other agencies and businesses partnered in the planning and actively participated in meetings, and some members also served on subcommittees. WorCHD valued the input of all members and routinely solicited input from the various partner agencies in the process.
In October 2005, the Task Force published “Interim Guidance for Implementation of CDC and OSHA Avian Influenza Recommendations.”5 The document was a culmination of work by Task Force members during a 10-month period. It included guidelines for training, infection control, personal protective equipment, decontamination, vaccine and antiviral drugs, surveillance, and evaluation of ill workers. It defined the roles and responsibilities of the various agencies, and stressed the critical role each plays in the prevention of disease spread. Appendices to the document included a Training Checklist for Workers Exposed (in English and Spanish), Declination of Human Influenza Vaccine form, AI Exposure Symptom Questionnaire, and templates for communications with medical providers. Other documents have also been added, including a Question and Answer sheet for Poultry Growers (available in English and Spanish) and an AI Education Brochure and Education Plan, both of which were drafted in February 2006. The document was produced in English, Spanish, and Korean and is available on the websites of WorCHD and MDA. A plan has been drafted to distribute this educational material to poultry farmers in Delmarva.
The Task Force represents a new partnership among public health, agriculture, and the poultry industry, and encompasses agency representation from Maryland, Delaware, and Virginia. This new partnership and the plan are unique, as measured by the response WorCHD has witnessed from other state and federal agencies that have contacted it for the guidelines. WorCHD believes this work is the first time in this country that operational guidance has been developed to outline the roles of public health, agriculture, and the poultry industry in the context of AI. The Task Force sees other applications for this partnership beyond AI.
The strength of the interstate partnership was evidenced when WorCHD participated in an emergency preparedness tabletop exercise—a chemical event—in June 2005 in Sussex County, Delaware. WorCHD attributes its invitation to the Task Force's efforts, even though the department's activities were limited to a biological event. After the exercise, one poultry executive stated he would contact WorCHD first in any similar event. Within the state of Maryland, the intrastate portion of the partnership was evident when the Health Officer of WorCHD participated in a tabletop drill sponsored by MDA in December 2005. And staff members of WorCHD continue to be invited to additional trainings and exercises in the Delmarva region, both as participants and speakers.
The emergency presented by the presence of the H7N2 AI strain in poultry on Maryland's Eastern Shore in spring 2004 required a rapid response by WorCHD and the other stakeholders. One of the lessons learned was that when any local health department is faced with an AI emergency, the department should be prepared to collaborate with multiple partners. Also, a response plan must address the health protection of all workers involved in the poultry industry. To address these issues, the medical departments of the poultry companies were important assets in planning.
In addition, public health departments must have a plan for disseminating health information to both medical providers and the public in the area affected. Preparing an accurate, easy-to-understand script is essential in managing an AI event. Ongoing surveillance of the health of local poultry is also critical for identifying and containing a potential AI outbreak. The agreement and cooperation of all stakeholders in following the Task Force's Interim Guidance Recommendations are essential in managing any future outbreaks. Finally, unexpected benefits of AI planning may have an impact on planning for other potential incidents that may affect the planning partners.
In March 2006, work began on an Emergency Communications Plan that involved preparing press releases and message maps to be used in the case of various potential AI events. These have been approved and will be adapted by the states of Maryland and Delaware in the case of an actual AI event. The Task Force will also expand its focus to develop local AI operational response plans, media messages, and outreach and education for populations other than commercial poultry, such as hunters, waterfowl processors, and zoo workers.
WorCHD did not have the funds specific to this project but was able to accomplish the objectives through the use of its general budget, and partner agencies provided in-kind support. WorCHD is confident that the collaboration will continue as the Task Force identifies future concerns related to AI or other issues concerning our agricultural community, particularly poultry production. This is supported by the acknowledgement that any disease affecting the poultry industry would have a dynamic impact on the local economy.
The authors acknowledge the contributions of the member organizations of the Delmarva Avian Influenza Joint Task Force: Allen Family Foods, Delaware Department of Agriculture, Delaware Division of Public Health, Lasher Poultry Diagnostic Lab at the University of Delaware, Delmarva Poultry Industry, Inc., Maryland Department of Agriculture, Maryland Department of Health and Mental Hygiene, Mountaire Farms, Perdue Farms, Somerset County Health Department, Tyson Foods, Virginia Department of Health, Wicomico County Health Department, and the Worcester County Health Department. The Task Force has expanded and now includes the Maryland Department of Natural Resources, and the Delaware Department of Natural Resources and Environmental Control.