Health investigation following an outbreak of highly pathogenic Avian Influenza A (H5N1) in Poultry in Nabi Chit, Lebanon, 2016: a teaching case-study
Zeina E. Farah1,&, Nada Ghosn1, Walid Ammar1, Yousef Khader2
1Epidemiological Surveillance Program, Ministry of Public Health, Lebanon, 2Jordan University of Science and Technology, Jordan
Zeina E. Farah, Epidemiological Surveillance Program, Ministry of Public Health, Lebanon
In Lebanon, no cases of influenza A (H5N1) were reported among poultry or humans before 2016. In April 2016, the Ministry of Agriculture confirmed the incursion of H5N1 in two poultry farms in Nabi Chit village in Lebanon. The disease led to the death of 20,000 domestic birds.
This case study is based on the actions taken by the Ministry of Public Health during this outbreak to prevent the spread of the disease to humans. It simulates an outbreak investigation including laboratory confirmation, active case and exposed finding, descriptive epidemiology and implementation of preventive and control measures.
This case study is designed for the training of basic level field epidemiology trainees or any other health care workers working in public health-related fields. It can be administered in 3-4 hours. Used as adjunct training material, the case study provides the trainees with competencies in investigating an outbreak in preparation for the actual real-life experience of such outbreaks.
How to use this case study
General instructions: this case study should be used as adjunct training material for novice epidemiology trainees to reinforce the concepts taught in prior lectures. The case study is ideally taught by a facilitator in groups of about 8 participants. Participants are to take turns reading the case study, usually a paragraph per student. The facilitator guides the discussion on possible responses to questions. The facilitator may make use of flip charts to illustrate certain points. Additional instructor’s notes for facilitation are coupled with each question in the instructor’s guide to aid facilitation.
this case study was developed for novice field epidemiology students. These participants are commonly health care workers working in the county departments of health whose background may be as medical doctors, nurses, environmental health officers or laboratory scientists who work in public health-related fields. Most have a health science or biology background.
before using this case study, participants should have received lectures on disease surveillance and outbreak investigation.
Flash drive, flip charts and markers.
Level of training and associated public health activity:
Novice – Outbreak investigation
Case study material
- Download the case study student guide
- Request the case study facilitator guide
The authors declare no competing interests.
Authors would like to thank the Eastern Mediterranean Public Health Network (EMPHNET) for their technical support. We also acknowledge officers at the epidemiological surveillance program and communicable diseases department at the Ministry of Public Health who conducted the outbreak investigation on which this case study is based.
We also wish to thank the Ministry of Agriculture, the National Influenza Center and the World Health Organization for their collaboration.
Annex 1: case study H5N1-Lebanon- table 2
- World Health Organization. Frequently Asked Questions: H5N1 Influenza. 2012. Accessed on 20 December 2018.
- Centers for Disease Control and Prevention. Highly pathogenic Asian avian influenza A (H5N1) virus. 2015. Accessed on 20 December 2018.
- Food and Agriculture Organization of the United Nations. Highly pathogenic avian influenza (H5N1 HPAI) spread in the Middle East: risk assessment. Rome. EMPRES Watch. September 2016; 36.
- Asmar, Fadi. Lebanon; country pasture forage resource profile, 2011. Accessed on 20 December 2018.
- World Health Organization. Early detection, assessment and response to acute public health events: implementation of early warning and response with a focus on event-based surveillance. 2014 WHO/HSE/GCR/LYO/2014.4. Google Scholar
- Farah ZE, Khatib O, Hamadeh S et al. Containment of Highly Pathogenic Avian Influenza A(H5N1) Virus, Lebanon, 201 Emerg Infect Dis. 2018 Feb;24(2):374-376. PubMed | Google Scholar