Infectious Diseases s1

Senior Form Biology – Infectious Diseases Infectious Diseases Teacher’s Version NOS/STSE Features 1. Both collaboration and competition are common among scientists. . 2. Scientific investigations are competitive in nature: competition occurs with other research groups, with time and for resources. 3. Scientists aim to be objective, however observations are theory-laden. 4. Scientific knowledge is tentative. It changes due to new evidence and new ways of looking at existing evidence. 5. Scientists must report truthfully. 6. Scientists should not readily submit to authority.

Who is Peter? Peter, one of the key scientists fighting against SARS during the 2003 SARS outbreak, always has a burning passion for making new scientific discoveries and doing scientific investigations to serve the community. He has been appointed to chair the committee against Avian Influenza (Bird flu) which is made up of a group of doctors and government officials from the Health Department. One day, Peter finished a marathon meeting with the committee members and went back to his office. An old photograph fell from the shelf which caught Peter’s attention. It was his best friend Mary, who had died in the battle against SARS. Mary was a good doctor and an infectious diseases specialist. She was infected during the SARS outbreak. With the photo of his best friend, many memories of SARS and many reflections came to Peter’s mind……….

Table of Contents Introduction (i) Activity 1: Knowing our enemies P.1 Activity 2: Have you bought enough “weapons”? P.3 Activity 3: Unfolding the mystery of how scientists work P.5 Activity 4: What happened at Amoy Gardens? P.7 Activity 5: Are we well organized to fight against any invader? P.8 Activity 6: A coming killer? – Bird flu P.9 Appendix 1: Simulating the spreads of germ P.12 Appendix 2: Reference for activity 6 - Q1 P.13 Appendix 3: Lesson plan P.15

Introduction

Rationale This teaching package aims to help students to learn about viruses and several key features about the nature of science and how to make informed decisions, through a range of creative and authentic activities (revision exercises, flash animations, videos of interviews with scientists, PowerPoint presentations, an investigation game, discussions, internet searches and a simulation exercise) linked by memories and reflections of Peter, a supposedly famous virologist in Hong Kong who is also one of the key scientists fighting SARS during the 2003 SARS outbreak.

Level of study Number of lessons Form 4 – Form 6 6 lessons (each 35-40 minutes)

Contents

1. Revision of the general structure of virus, lytic cycle for virus reproduction, modes of transmission of diseases and the preventive measures for guarding against infectious diseases. 2. Making informed decisions based on proper scientific justification, illustrated by the “vinegar” and “Tamiflu” incidents. 3. Some key features of the nature of science learnt from the SARS virus hunt. 4. Investigation of the transmission of SARS virus in Amoy Gardens. 5. Activity to simulate the spread of germs and evaluation of some hygiene measures. 6. Roles and contributions of some important health organizations set up locally and internationally for maintaining public health. 7. Bird flu animation for understanding how it can lead to a flu pandemic. 8. Preventive measures for reducing the risks of a bird flu pandemic.

Teaching package includes

1. Worksheets (Teacher’s Version and Student’s Version) 2. Four Teaching PowerPoints

Activity 1 Knowing our enemies “In Chinese, there’s a saying “知己知彼, 百戰百勝”, which means we can certainly defeat our enemies if we know them in detail.” - Peter

If you agree with what Peter said, first we must understand the structure (the weapons and defences) of our enemies before we fight against them. Try to label the parts A, B and C with a simple description of each.

A: Envelope (made of protein from the virus DNA or RNA) B: Genetic material (double or single stranded nucleic acid, DNA or RNA) C: Viral protein (antigen for attachment to a host cell).

Let’s see whether your understanding of viruses and flu are good. Here are some statements about these matters. For each one, put a tick to show whether you think it is true or false. If you are not sure, put a tick in the “not sure” box and discuss with your classmates.

Statements True False Not sure 1. Viruses have cellular structure. √ 2. Viruses are living organisms. √ 3. Viruses are parasites, which mean they can only reproduce √ using the mechanisms and resources of living cells. 4. Viruses usually cause some symptoms of disease in their host. √ 5. For most viruses the virus DNA or RNA takes control of the √ cells and then replicates and codes for new viral proteins in a process called the “lytic cycle”. 6. In the “lysogenic cycle”, the host cell is not destroyed by the √ virus. 7. Vaccination is effective in preventing human flu. √ 8. Vaccination is effective in preventing humans from infection by √ bird flu. 9. Hygiene behaviors are pointless if there is a large scale flu √ outbreak occurs as the flu virus spreads very quickly.

One of the reason why bird flu virus is so dangerous to humans is that reassortment of its genetic material can occur with human flu viruses. This process happens in the “lytic cycle” of virus replication. On the left is a simplified lytic cycle, use a few words to describe the events in A, B, C and D. (You will learn more about genetic reassortment in the last activity in this unit.) A: Viral DNA injected into host cell_____ B: Viral DNA replicates______C: New virus coats are formed and enclose new DNA/RNA D: Host cell bursts releasing virus particles This description of the lytic cycle is highly simplified. Many viruses undergo modifications of the sequence shown.

Alert! The faces of our “enemies” under the electron microscope:

Electron micrograph of the SARS Coronavirus. Electron micrograph of a cluster of influenza You will learn about how the SARS scientists hunted (flu) viruses, each about 100 nanometers and investigated this virus in activity 3 and 4. (nm=billionths of a meter) long.

You are going to explore the battle between humans and these two viruses in the following activities……

Reference: Electronic micrographs of viruses http://www.ucmp.berkeley.edu/alllife/virus.html - Source of electron micrographs of the SARS coronavirus and flu virus.

Activity 2 Have you bought enough “weapons”? “ Having been a HK citizen for more than 20 years, I have witnessed many irrational behaviors in this interesting city. Panic buying of vinegar and Tamiflu are two more examples. To make our society rational, learning to make informed decisions is the key. Beware, taking Tamiflu incorrectly may make it a weapon for our enemy the flu virus, instead of for us!” - Peter

The photo on the left shows some people’s panic buying of vinegar and “banlangen” in Guangzhou during the early stage of the SARS outbreak in 2003

Q1 a) What is the everyday use of vinegar in food preservation? What is the scientific principle behind it? - Vinegar is commonly used in pickling, a process of preparing food by soaking and storing in concentrated salt, acid (vinegar), or both. The resulting food, called a pickle, can be kept for months. - The principle behind pickling: the water potential of the acidic and salty solution is low, which draws water out from micro-organisms by osmosis, killing them. Additionally, the vinegar solution greatly increases the acidity of the solution so that the protein coat of the micro-organisms is denatured.

Q1 b) Vinegar has also been a kind of ‘folk medicine’ used in China to prevent the spread of viruses such as SARS. What scientific principle might lie behind it? The Chinese people mix vinegar with water and then boil the mixture until the vapor is present throughout the house. The principle might be that the acidity of vinegar vapor can denature the protein coat of the virus. This process might be able to create an environment which destroys the SARS virus. Q1 c) What similar, more modern, principle was recommended in Hong Kong to prevent the spread of SARS virus? People were invited to clean surfaces with 1:99 dilution of chlorine bleach or alcohol, which had a similar disinfectant effect.

Read the newspaper article below and answer the questions

Wenweipo 2005-10-23

ｔｔ Fear for bird flu raises price of anti-viral drug ‘Tamiflu’ by four times Under the threat of a bird flu outbreak, Hong Kong people stockpile the anti-viral drug ‘Tamiflu’. Travellers also come to the city to buy it. Though the drug can only be sold by prescription, most pharmacies cannot offer it due to shortage of supply. Some pharmacies sell the drug illegally without a doctor’s prescription and mark the price up from $180 to $800. More than 10 pharmacies in Tsim Sha Tsui had already run of Tamiflu yesterday. The owner of Kam Po Pharmacy told us that the drug supply had run out more than a week ago, ‘with the government keeping all the drugs to itself, there is no stock left for pharmacies.’ Another pharmacy claimed they had stocked only a few boxes of Tamiflu before the bird flu panic and they were rarely sold. Recently he noticed increased selling of the drug, ‘we get a few enquiries everyday from both local people and foreigners. They buy them for emergency use without a medical prescription’. Some pharmacies have raised the price of a box of 10 capsules to $800 and yet they are selling well.

Prescribed medicine

Tamiflu is listed in the Appendix 3 under the ‘Pharmacy and Poisons Ordinance’. Patients must have prescription from a doctor and are allowed to use the drug only with supervision of pharmacists. Since it is one of the limited drugs effective for treating flu, abuse of it will result in drug-resistance. The authority will inspect pharmacies more frequently for illegal sales. Offenders will be prosecuted and subject to a maximum penalty of $100,000 and imprisonment of two years.

Quick facts for flu killer - Tamiflu ▲Action: Attacks the viruses that cause flu, soothes flu symptoms ▲Appearance: Grey or light yellow capsule ▲Administration: Oral ▲Dosage: Twice a day in the morning and the evening for consecutive 5 days ▲Shelf life: up to 3 or 4 years after manufacture ▲Side effects: Nausea, vomiting ▲Caution: Patients under other medication or with kidney failure should take special care when using it **Abuse of this drug may result in drug-resistance

Q2 Peter said “Beware, taking Tamiflu incorrectly make it a weapon for our enemy the flu virus, instead of for us!” Explain what he said with reference to the newspaper article and your prior scientific knowledge. The newspaper article mentioned the misuse of Tamiflu can lead to the flu virus becoming resistant to the drug. Organisms are said to be drug-resistant when drugs meant to act on them have a reduced effect. Q3 Do you think the behaviors of “panic buying of vinegar” or “panic buying of Tamiflu” are rational? What would you do if one day all the people around you “panic” when something happens? Being rational or irrational depends on whether the people understand what they are doing or whether they hold a sound justification to support their behaviors. For example, if a person rushes to buy white vinegar without knowing anything about vinegar, his behavior is still ‘irrational’ though actually there may be enough scientific justification to support the use of vinegar. (Any discussion of what is rational and what is irrational is acceptable)

Activity 3 How did the SARS scientists work? “Being one of the SARS scientists, I feel proud to be able to contribute my knowledge to save human lives. When I was young, I always asked myself these questions: What is the nature of scientific theory? In what ways does a scientist work with other experts? What attitude should a good scientist have? ” - Peter

In this activity, your teacher will show you three PowerPoint presentations of some interviews with scientists about how science and scientists work. Complete the relevant summary table below after each discussion.

Part 1

Both collaboration and competition are common among scientists.

Scientific investigations are competitive in nature: competition occurs with other research groups, with time and for resources. Notes: Teacher can accept other ideas, but ensure these points come out. Part 2

Scientists aim to be objective, however observations are theory-laden.

Scientific knowledge is tentative. It changes due to new evidence and new ways of looking at existing evidence.

Notes: Teacher can accept other ideas, but ensure these points come out. Part 3

Scientists must report truthfully.

Scientists should not readily submit to authority.

Notes: Teacher can accept other ideas, but ensure these points come out.

Extension Activity 1: DNA sequencing animation http://www.koshlandscience.org/exhibitdna/seq01.jsp

- A flash animation for exploring DNA sequencing, designed by the National Academy of Sciences in the U.S.

Extension Activity 2: Simulation of DNA sequencing to identify SARS http://www.koshlandscience.org/exhibitdna/inf01.jsp

- A flash simulation showing the latest DNA sequencing technology to identify the SARS virus as a strain of coronavirus. Notes: the concepts in this animation are not easy. It is a good idea to use the animation with guidance from your teachers.

- This is a good example of how the advancement of technology has contributed to the advancement in science. The identification of the cause of SARS provides an example of the great speed that modern DNA sequencing has brought to the detection of infectious diseases. In this case, a new tool that uses the wealth of available DNA sequence information was used to identify the SARS disease agent as a type (strain) of coronavirus in just 24 hours. This information guided public health researchers to the source of the SARS virus in wild animals. This DNA technique can be used rapidly to detect and identify new outbreaks, whether they stem from natural sources or criminal activities, thereby saving many lives.

Extension Activity 3: Knowing the Human Genome Project http://www.ornl.gov/sci/techresources/Human_Genome/home.shtml

- Completed in 2003, the Human Genome Project (HGP) was a 13-year project coordinated by the U.S. Department of Energy and the National Institutes of Health. Project goals were to identify all of the approximately 20,000-25,000 genes in human DNA, and to determine the sequences of the 3 billion chemical base pairs that make up human DNA. This is a good example of collaboration among scientists all over the world.

Activity 4 What happened at Amoy Gardens? “ During the battle discovering the origin and transmission of the SARS virus in Amoy Gardens, I felt like I had become a detective tackling the hottest case in town. People from all over the world were examining this case. I needed to exhaust all my resources and intelligence to close the case, since the answer was the key to saving the lives of six million people.” - Peter

Your teacher will show you a presentation to guide you to investigate the transmission of SARS in Amoy Gardens. Be ready!

Q1 What are the usual ways in which any disease causing agent can spread?

- Carrier organisms – e.g. mosquitoes, fleas, rats, cockroaches. - Air and water: by droplets or dust. - Direct transfer of body fluids – e.g. sweat, blood, saliva and semen. - Surfaces on which body fluids have dried: door handles, lift buttons etc.

Q2 Design an investigation plan to identify how SARS spread in Amoy Gardens.

Notes: Refer to the PowerPoint slides for suggested step-wise investigation and analysis procedures for this part.

References:

World Health Organization SARS information site http://www.who.int/csr/sars/en/

Department of Health, HKSAR http://www.info.gov.hk/dh/

Activity 5 (Homework) Are we well organized to fight against any invader? “Once the full force of the world is united, any invader cannot stay here for long. Finally, SARS was defeated” - but can it be the same for all diseases? - Peter

International organizations, local governments and research laboratories have set up dedicated bodies to fight against infectious diseases. Do you know much about them? Let’s search their websites and learn about how they help us to fight disease.

Notes: Teachers may divide the class into five groups. Each group is assigned one organization and presents their findings after searching the internet at home. Organizations How do they help? Department of Health web page on Educate the general public about the SARS Atypical Pneumonia virus, report the latest news and statistics about SARS, provide proper guidelines to the Website: general public about hygiene measures for http://www.info.gov.hk/info/sars/eindex.htm preventing SARS to general public and all (last visited on 11-6- 2007) sectors and maintain close surveillance for the disease in Hong Kong. World Health Organization (WHO) WHO’s general objective: “attainment by all Severe Acute Respiratory Syndrome people of the highest possible level of health” - (SARS) unites scientific forces all over the world to investigate SARS, publish international health Website: http://www.who.int/csr/sars/en/ regulations, set up a global outbreak alert and (last visited on 11-6- 2007) response network and conduct research about SARS, maintain surveillance for the disease at a worldwide level. Centers for Disease Control and The principal agency in the United States for Prevention, USA Severe Acute protecting the health and safety of all Respiratory Syndrome (SARS) Americans and for providing essential human services, CDC is globally recognized for Website: http://www.cdc.gov/ncidod/sars/ conducting research and investigations about (last visited on 11-6- 2007) SARS. The University of Hong Kong Corona Provide latest news, information, knowledge virus Pneumonia (CVP) and guidelines for preventing SARS to Website: university staff and students, set up a task http://www.hku.hk/uhs/he/flu/pneumonia.htm force to conduct research and deliver talks to (last visited on 11-6- 2007) educate the public about the disease. They are supported by the Faculties of Medicine of CUHK Campus (SARS) Task Force CUHK and HKU.

Website: http://www.cuhk.edu.hk/sars/ (last visited on 11-6- 2007) Suggested development activity: Check for relevant websites for bird flu.

Remarks: The information on the internet changes every second, you may have to search for the correct path if those suggested above have vanished. Activity 6 A coming killer? – Bird flu “No one will ever forget how the killer flu took away more than 25 million human lives in 1918. No one can afford the consequence of underestimating the power of a possible bird flu outbreak. The flu viruses are mutating all the time, the chances of H5N1 flu developing into a type able to pass from human to human is uncertain. However, if it happens, no city in the world can escape without heavy loss of life and the use of expensive resources. ” - Peter

Do you know about the 1918 flu pandemic(流感大流行)?

The 1918 "Spanish" flu pandemic is estimated to have infected up to one billion people - half the world's population at the time. The virus killed more people than any other single outbreak of disease, surpassing even the Black Death of the Middle Ages. Although it probably originated in the Far East, it was dubbed "Spanish" flu because the press in Spain were the first to report extensively on its impact. It is thought that the virus may have played a role in ending the Great War (1914-1918) as soldiers were too sick to fight, and by that stage more men on both sides died of ‘flu than were killed by weapons.

According to the latest research by the scientists Emergency hospital during 1918 influenza epidemic, from U.S. Centers for Disease Control and Camp Funston, Kansas USA (source: National Prevention, the 1918 flu virus did come from birds. Museum of Health and Medicine, AFIP) Q1 Part 1: Based on your existing knowledge about viruses and diseases, discuss with your classmates why a bird flu outbreak could potentially take away so many human lives (such as the 1918 Spanish flu did)? Part 2: After discussion in part 1, your teacher will show you an interactive animation to let you learn more about bird flu, try to enrich your answers to above question from your understanding of the animation. Notes: Teachers can refer to appendix 2 for reference 1. Flu viruses spread efficiently among birds. 2. Some types of bird flu viruses quickly cause disease and can cause death. 3. Birds are free to fly off and can easily contact humans and farm flocks which have close contacts with humans. 4. The bird flu virus could mutate to pass from human to human by the process of genetic reassortment ( explained in the next question ) 5. Flu symptoms do not appear immediately, thus increasing difficulty in identifying infected people, but infected people may infect others before they feel ill themselves 6. People may be travelling and live close together. This greatly increases the possible

spread of flu among humans.

Q2 What is genetic reassortment? Why is it a critical process to cause bird flu to be transmitted between humans? (Review genetic reassortment in the animation if needed)

Genetic reassortment – is the mixing of genetic material of two similar viruses that are infecting the same cell. It is through such a process in which the bird flu virus can mutate to be able to be transmitted among humans.

When human influenza and bird influenza viruses exist together in the same animal, the two viruses may exchange their genes by reassortment and produce a new virus. The resulting new virus would carry genes coming from both human and bird influenza viruses, thereby increasing the risk of human to human transmission.

Q3 Can science and technology save us? Try to brainstorm some reasons why our situation might be much better or much worse than 1918 outbreak if a similar bird flu pandemic begins.

Reasons why our situation might be better: - Better medical knowledge in flu vaccines, anti-viral drugs and medicines to control flu symptoms. - Better information system can give us warnings of outbreaks, rapid medical distribution and precise data analysis to make predictions. - Better methods for diagnosing infected birds, killing infected birds and disposing of infected birds safely. - Technology of DNA sequencing - Technology of helping respiratory symptoms, respirators, air humidifiers etc - Better understanding of avoiding infection of transmissible diseases

Reasons why our situation might be worse: - Easier travel around the globe by air and land - Many more people living closely together in cities

(Accept all reasonable suggestions & discuss)

Q4 Imagine you are a health advisor to the Department of Health of Hong Kong SAR Government and discuss with your classmates how to reduce the risks of bird flu. Your advice will become guidelines to the general public.

Suggested ways to reduce the risk of bird flu:

Vaccinations Existing vaccines are only effective against human influenza and provide no protection against bird flu. There are currently no bird flu vaccines for human use on the market. However, it is still desirable for people having a high risk of infection by bird flu (e.g. people who work at poultry farms or markets) to receive influenza vaccination. The reason is to reduce the chance of genetic exchange between human and bird flu viruses which might occur when there is a infection by

P. 11 © 2007 The University of Hong Kong – Faculty of Education. All rights reserved. Senior Form Biology – Infectious Diseases both viruses (co-infection). It can also reduce the number of people who need medical treatment if a bird flu pandemic occurs. Antiviral agents Commonly used antiviral agents include amantadine and the neuraminidase inhibitors (oseltamivir and zanamivir). These drugs have important roles in the treatment and prevention of influenza and possibly in containing a pandemic at the early stages. Therefore the medical profession and the public should use these agents carefully. Stockpiling of these drugs is the responsibility of health authorities and not of individuals. Indiscriminate use of these drugs will increase the likelihood of drug resistance among the viruses.

Preventive measures against human influenza - Observe good personal hygiene Keep hands clean and wash hands properly. Cover mouth and nose while coughing or sneezing. Dispose of tissue paper with sputum or respiratory secretions into covered rubbish bins and wash hands afterwards. - Observe good environmental hygiene Maintain good indoor ventilation. Avoid crowded places with poor ventilation during community outbreaks. - Use a face mask properly Wear a face mask if you have symptoms of respiratory infection, or if you need to take care of influenza patients. - Adopt a healthy lifestyle Have adequate rest and a balanced diet. Do regular exercise and do not smoke. - Consult a doctor if you have influenza symptoms Stay at home if you have symptoms of influenza such as fever, cough, running nose, extreme tiredness, joint/muscle pain etc. Consult a doctor and stay at home if you have symptoms of influenza such as fever, cough, running nose, extreme tiredness, joint/muscle pain etc. If you must go to work or to other social gatherings during the illness, wear a mask and observe good hygiene measures.

Preventive measures for bird influenza - Avoid contact with live poultry Avoid close contact with live poultry. Wear gloves when handling their droppings, and wash hands thoroughly with liquid soap and water after contacts. - Wash and cook poultry and eggs thoroughly before eating There is currently no evidence that bird ‘flu is transmitted through eating poultry, eggs, and their food products. However, poultry and eggs should still be cooked thoroughly before eating.

Additional information about bird flu in Hong Kong: Department of Health, HKSAR ( http://www.info.gov.hk/info/flu/eng/index.htm)

Extension activity: Watching the film “Influenza 1918” http://www.pbs.org/wgbh/amex/influenza/index.html - Background and information about the movie “Influenza 1918” Notes: Teachers may divide the students into two groups. Tell students they are going to see a film about a public health crisis. Ask one group to jot down all the things that

caused the rapid spread of the disease. Ask the other group to note how local or national officials tried to slow the spread of the illness and what the time sequence was. Appendix 1: Simulating the spread of germs

Simulating the spread of germs

Remarks: This simulation should be kept secret from the students until they are checked later for “infection”! Background Information: This simulation will make use of a product called “Glo Germ”, which is used in liquid and powder form that contains safe ingredients about the same size as bacteria, basically 5 microns in size. It is invisible in normal circumstances. However, it become visible when illuminated with ultra-violet light. It is used internationally in hospitals, universities, colleges, government, and commercial companies to simulate the spread of germs, teaching students and workers how quickly and widely germs can be spread. (Reference: http://www.glogerm.com )

Procedures: Teachers put some invisible Glo Germ powder in several places which will be touched by the students before or during the lessons such as doors, tables and chairs. Students are not told about the germ powders and carry out some activities that can trigger the spread of germ powders, such as group discussions and circulation of materials/papers etc. during the lessons. Suggestion: Teacher may consider circulat ing a photo of virus es during the lesson to trigger the spread of ‘germs”! Students are only told at the end of the lesson the purpose of the simulation activity and the existence of the invisible germ powders in class. Students are lined up a few at a time, and a UV “money verifying” light is used to illuminate the students’ bodies for tracing the spread of the germs. The distribution of “germs” on hands, clothing and faces is noted.

Possible variations:

1. Do the common hygiene measures help? Repeat the simulation by asking the students to try their best to avoid getting “infected” during the lessons by all measures they can take, see how many “infected bodies” can be reduced and whether their measures are effective or not.

2. Does wearing a mask help? If some students are told to wear masks, as a later activity, after they know about the powder, it can be shown whether wearing masks might be a problem, or of value in defense against micro-organism transmission.

3. What differences will there be if the students’ hands are not dry? It is a well known good practice to dry one’s hands after washing them, will wet hands really speed up the spread of germs? Why is a hot air is dryer better than a cloth towel,

P. 13 © 2007 The University of Hong Kong – Faculty of Education. All rights reserved. Senior Form Biology – Infectious Diseases are paper towels better or worse than cloth or hot air? Appendix 2: Reference to activity 6 Q.1

URL of the Bird flu animation for activity Q.1 http://www.biotechnologyonline.gov.au/human/birdflu.cfm - Source of the bird flu animation, by Australian Government Biotechnology Agency.

Notes: You can refer to the table below for the scripts of the animations.

Scripts of the Bird ‘Flu animation

Scene 1. Introduction

Humans are not the only ones to suffer from Influenza (flu). Influenzas, are caused by a group of viruses. There is an influenza virus which causes flu in birds, whose formal name is “Aves”, hence “bird” flu.

Scene 2. Global killer

Global killer: There are three known types of influenza in humans: A, B and C. Type A influenza is the most frightening of these, with outbreaks in 1918, 1957 and 1968 causing large numbers of deaths.

Scene 3. Watch out for the spikes on the virus

Watch out for the spikes: The spikes are two surface proteins which characterize the influenza A virus.

They are: Haemagglutinin (HA) and Neuraminidase (NA).

There are fifteen HA protein subtypes and nine NA protein subtypes. An influenza virus has one of each and it is the different combinations of these that can make it deadly. The most striking feature of a flu virus is a layer of spikes coming from its surface.

Scene 4. The control centre inside the virus

The control centre: Inside the influenza virus are eight RNA strands. Each codes for one or two of ten different proteins which make up the virus.

There are 15 different versions of the RNA coding for HA and 9 versions of the RNA coding for NA.

Scene 5. Cunning adaptors (Genetic reassortment simulation)

The influenza virus can swap its genes with other influenza viruses leading to new strains that our immune system has not come across. This is called genetic reassortment.

H1N1: called the Spanish Flu, this strain killed more than 25 million worldwide in 1918 and 1919.

H3N2: caused the so called “Hong Kong” flu pandemic in 1968.

H5N1: In 1997, the new strain H5N1 was reported. It has been transmitted from sick birds to people, and kills both. Will this cause the next pandemic?

Scene 6. What’s around the corner?

What sparks these pandemics? Many scientists believe it is only a matter of time until the next influenza pandemic occurs.

Work through the recent outbreak of bird flu in Asia to see what it will take to spark the next human pandemic.

Bird influenza virus infects domestic poultry such as: chickens, turkeys, pheasants, partridges, quail, pigeons, ducks, geese, guinea fowl and ostriches; as well as wild birds such as migratory waterfowl, sea birds, ducks and waders.

Bird influenza viruses usually only infect birds.

Scene 7 to 8. Where does your bird live?

Many people in Asia are poor, living with animals either under their houses or close by. Pigs are common. If a pig or a human got infected with both bird influenza and human influenza at the same time, the viruses RNA could reassort leading to a new strain that humans have not come across and do not have immunity to. This is a matter of chance (probability) and time.

In addition, animals are farmed and taken to local markets to sell for eating or breeding. It makes the local markets hotspots for contact with humans.

Scene 9. What are the chances? (Genetic reassortment simulation)

No one knows exactly how the H5N1 strain could change to make it easy for it to spread from person to person. Unfortunately, we’re unlikely to have natural immunity, and this could lead to the next pandemic.

Scene 10. Ending

The chances of this H5N1 flu developing into a strain capable of passing from human to human are uncertain. However, the number of cases of humans with H5N1 influenza infection continues to rise.

Appendix 3: Lesson Plan Activity 1: Knowing our enemies Time Intended Learning Outcomes Teaching Flow Materials Remarks Acquire the following knowledge:  Teachers go through the background of the teaching  Activity 1  Prior knowledge of general package with students. Emphasis should be put on the worksheets. structure of a virus, lytic  the general structure of a virus storyline and the role of Peter, one of the key scientists in cycle of virus reproduction the SARS battle. The whole package is linked by the and some common  the lytic cycle for virus reproduction memories and reflections of Peter. understanding about disease is assumed.  simple concepts about virus and flu  Teachers ask students if they have noticed the recent news about bird flu. Start the activity by asking one student to (The following remark is read Peter’s words aloud. Explain that knowledge of also important for the viruses is the foundation to all virus related investigations other activities.) and research.

 Students are asked to complete all the exercises in activity  Teachers should refer to the 35 min 1. Teachers should note that there is a column “not sure” in standard textbooks or refer the second exercise, this design aims at encouraging the students to them, or to the students to discuss any uncertainty with classmates. internet, to supplement the scientific concepts involved  Transition to activity 2: See the “real face”/electron in this package which is not micrographs of the SARS coronavirus and the flu virus, intended to be exhaustive which are the two key viruses they have to investigate in but stimulatory in all subsequent activities. knowledge building.

Activity 2: Have you bought enough weapons? Time Intended Learning Outcomes Teaching Flow Materials Remarks  Understand that everyday use of vinegar has  Teachers start this activity by asking one student to read  Activity 2  Teacher can prompt for more some scientific principles behind it. aloud Peter’s words. Ask whether the students can worksheets. examples of “irrational remember the reports of “panic buying of vinegar” during behaviors” apart from buying  Understand the layman’s use of vinegar to the SARS outbreak. vinegar and “Tamiflu”, such as prevent the spread of SARS and the possible lining up for IPO(Initial public scientific principle behind it. Q1: “Panic buying of vinegar” offering) forms and buying stocks  Students are asked to complete question 1a and 1b. without analysis.(e.g. PCCW  Be aware that the misuse of the drug Teachers write some students’ answers on the board and some years ago and the Link “Tamiflu” can lead to drug resistance of the discuss. Teachers should make the students aware that REIT more recently) flu virus. even “folk medicine”, like white vinegar, can have valid scientific justification to support its usage. * Teachers  Teacher may ask the students to  Develop the sense of making rational and should go around during student discussion time to choose collect a few newspaper clippings informed decisions based on proper scientific good answers which might be used to develop the about “Tamiflu” as a preparation evidence and justification. discussion and thus avoid crazy or unhelpful answers. for this activity. 35 min Q2: “Panic buying of Tamiflu”  Prior knowledge of vinegar is  Students are asked to read the newspaper clipping provided assumed. The fact that white and complete question 2. Teachers write some students’ vinegar is the mixture of water answers on the board and discuss, linking to Peter’s words and ethanoic acid can be at the beginning of this activity: “Beware, taking Tamiflu mentioned to the students if incorrectly way may make it a weapon for our enemy the forgotten. flu virus instead of for us.” See * above.

Q3: Making informed decisions based on scientific justification  Students are asked to complete question 3. Teachers write some students’ answers on the board and discuss. Teachers should let the students be aware of the point that it is not the behavior itself makes it ‘rational’ or ‘irrational’, it is the existence of proper justification behind a behavior that makes it ‘rational’.

Activity 3: How did the SARS scientists work? Time Intended Learning Outcomes Teaching Flow Materials Remarks Through the three thoughtfully designed  Students are given the worksheets for activity 3. Teachers  PowerPoint Important notes for using the PowerPoint slide shows, students are guided to use Peter’s words as the set and ask some students to Slides for PowerPoint presentations: develop the following concepts of Nature of attempt the questions with proper feedback. Following activity 3: Science(NOS): are the three PowerPoint slide shows. (Part 1, Part 2  Teachers should not give or and Part 3) leak any explicit clue of the  Both collaboration and competition are  Teachers should pay attention to the “Remarks” column NOS points to the students common among scientists. of this page and the detailed teachers’ remarks inside the  Activity 3 before they appear naturally. PowerPoint files. worksheets. The sequence of the slide shows  Scientific investigations are often competitive should be strictly followed so in nature: Competition occurs with other Part 1 presentation: that the pedagogical flow of the research groups, with time and for resources.  NOS points: collaboration and competition of scientists shows can be preserved. All of these are done for the purpose of  Scientists aim to be objective. However Part 2 presentation: guiding students to discover and observations are theory-laden which may  NOS points: observations are theory-laden, scientific then build the knowledge 70 min restrict new vision. knowledge is tentative. themselves instead of “being told” by the teacher.  Scientific knowledge is tentative. It changes Part 3 presentation: due to new evidence and/or new ways of  NOS points: scientists must report truthfully and should  Teachers should give enough looking at existing evidence. not submit to authority time to students to discuss the post-video questions before  Scientists must report truthfully.  Students complete the summary tables after each jumping to the next section. The presentation. Teachers collect and later return, going over summary tables should be used  Scientists should not submit readily to misconceptions found in the worksheets. for assessing students’ authority. understanding. If significant numbers have not “got it” they  Extension activity: Playing the DNA sequencing should be helped in the next Extension activity: simulation suggested at the end of the activity.  Know the basic concepts of DNA sequencing. lesson.

Activity 4: What happened at Amoy Gardens? Time Intended Learning Outcomes Teaching Flow Materials Remarks ReR Acquire the following knowledge:  Students are given the worksheets for activity 4 and  PowerPoint ( Refer to the notes: “Important teachers start the activity by examining Peter’s words with Slide for notes for using the PowerPoint  how diseases are transmitted students. Students are asked to recall their memory of the activity 4. presentations” in the Remarks news reported on TV about Amoy Gardens during the column of Activity 3)  how to reduce the risk of spreading the disease SARS outbreak.  Activity 4 or being infected by viruses worksheets.  Prior knowledge of how diseases are transmitted and Simulate the spread of germs by “Glo germ” “What happened at Amoy Gardens” presentation: basic preventive measures for powders and evaluate the effectiveness of hygiene  Teachers start the investigation with students by running viral infection is assumed. measures such as wearing a mask and drying the slide show. Worksheets are provided for the students to 35 min hands thoroughly after washing. write down their investigation plan. It is suggested that the part on investigation can be run by group discussion Learn the following concept of NOS through instead of individual work, as investigation is always ‘Investigating Amoy Gardens’: collaborative among experts from different fields instead of one person’s work. Remind them of TV series such as  Careful analysis and logical arguments are CSI (Crime Scene International)! important in scientific investigations. “Simulating the spread of germs” experiment:  (Please refer to the experiment details in the Teachers’ Version of worksheets.)

Activity 5: Are we well organized to fight against any invader? (Homework) Time Intended Learning Outcomes Teaching Flow Materials Remarks  Be aware of the roles and contributions of the  Students are asked to complete the homework.  Activity 5  Teachers should check health bodies locally and globally in worksheets. whether the URLs provided maintaining and promoting public health both  Teachers may divide the students into groups. Each group are still valid before the locally and internationally is assigned with one organization and presents their lessons since the information Homework - findings in front of class (say, 3 min) after completing the on internet is not static and  Practice skills for searching useful information homework. often changes. on internet by looking for corresponding websites for bird flu.

Activity 6: A coming killer? – Bird Flu Time Intended Learning Outcomes Teaching Flow Materials Remarks ReR  Acquire an understanding of why bird flu virus  Teachers start the activity by asking the students to read Peter’s  Flash file for  Teachers are encouraged can potentially take away so many human lives. warning that the coming bird flu may bring another disaster to understanding to read the reference humans, as proven by the 1918 bird flu pandemic. Students are bird ‘flu materials published the  Understand how genetic reassortment occurs then asked to read the small article about 1918 flu pandemic. Faculty of Medicine, between the bird flu virus and human flu virus.  Activity 6 HKU as background Q1: Why Bird flu kills? worksheets. information before  Part 1: Teachers ask the students to brainstorm the reasons that  Appreciate the advance of modern technology teaching this activity. account for the danger of bird flu based on their existing and medical knowledge to better safeguard knowledge. They write down the important points from the human lives from flu pandemic.  Students are asked to brainstorm. Part 2: After running the animation, students should collect some newspaper have learnt some precise reasons for the same question. Students clippings about the latest  Be aware of the preventive measures we can are asked to enrich/refine their answers based on the new reports of bird flu in the take to fight against bird flu. knowledge and to organize their ideas into a logical written media before running paragraph. activity 6. Q2: What is genetic reassorment?  Students are encouraged 35 min  Teachers show the part about genetic reassortment in the animation again to the students. Students are then asked to write to play the bird flu down the answers in their own words on the worksheets. animation at home after class for more detailed Q3: Can Science save us? examination of the  Teachers first ask the students to compare the technology in 1918 contents. and nowadays in general. Then direct the students to the field of medical knowledge and information systems if the students are  Basically all the not able to brainstorm some relevant points. questions can be run as group discussion or Q4: What preventive measures can we take? individual classwork  Teachers divide the students in groups to discuss what preventive depending on the time measures they might take to prevent a bird flu pandemic. management of the Guidelines for discussion based on the provided answers can be teachers. given if the students are not able to organize their answers logically. (e.g. Human flu and bird flu preventive measures should be addressed separately.)