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Operation Outbreak Hamlet’S Story Operation Outbreak Hamlet’s Story Activity details Age or grade level Activity time This activity is intended for middle and high 45 minutes school teachers to teach public health using the The Junior Disease Detectives, Operation: Handouts Outbreak graphic novel in their classrooms. • Chains of Infection: Story Map Outlines • Story Map Learning objectives At the end of this activity, students should be able to Materials • The Junior Disease Detectives, Operation: • Define zoonotic influenza virus. Outbreak graphic novel • Explain how some influenza viruses in (https://www.cdc.gov/flu/graphicnovel) animals have the potential to cause disease • Internet access in humans, and how some influenza viruses in humans can infect animals. Introduction • Define variant virus and explain how it is a hen an outbreak occurs, disease detectives specific kind of zoonotic influenza virus in W humans; also explain risk factors for variant try to identify what the infectious agent is, how it virus infections in humans. is being transmitted, and who or what is transmitting it by mapping the chain of • Differentiate between direct and indirect infection. The chain of infection provides a transmission and explain the different detailed account of how an infectious agent modes of transmission through which interacts with its host(s) and environment. More influenza viruses can spread between specifically, it shows the sequence of events. It hosts, such as humans and animals. starts when the infectious agent leaves its • Define novel influenza virus and explain reservoir host — the natural habitat (animal or how zoonotic and novel influenza A virus environment). This is where the infectious agent infections on rare occasions can cause normally lives, grows, and multiplies. Note: pandemics among humans. reservoir species may not appear ill, and this is true of some avian influenza (bird flu) viruses in Problem-based skill wild waterfowl. Likewise, pigs infected with Identifying trends influenza do not always display signs of illness. So animals that appear healthy can still carry National standards and spread disease. The infectious agent HS-EPHS1-1: Describe how epidemiologic leaves the reservoir host through a portal of thinking is used to provide an evidence-based exit. It is then transported by some mode of explanation concerning causes and correlations transmission and can enter a susceptible host of health and disease. through an appropriate portal of entry. https://www.cdc.gov/careerpaths/k12teacherroadmap/pdfs/ephs- competencies.pdf Note: different schools of thought exist NGSS Science & Engineering Practice: regarding modes of transmission. This document teaches modes of transmission Developing and using models; Crosscutting Concept: Systems and system models based on CDC’s existing scientific literature on http://www.nextgenscience.org/get-to-know influenza transmission as well as “Principles of Hamlet’s Story I Page 2 Epidemiology in Public Health Practice”. See become contaminated with influenza virus. the resources section for links to relevant Soon after, if another (susceptible) person information. touches that same doorknob while influenza virus is still present and viable and then touches An infectious agent may be transmitted from its his or her eyes, nose, or mouth, he or she could natural reservoir (host or environment) to a become indirectly infected with influenza. susceptible host in different ways. The mode of Experts currently believe that the influenza virus transmission can be direct or indirect. can “live” on some surfaces for up to 48 hours. Direct transmission occurs when the Vector-borne transmission is another form of infectious agent is transferred from its reservoir indirect transmission involving vectors, such as to a susceptible host without an intermediate mosquitoes, fleas, or ticks. Malaria and Lyme step. This can occur by direct contact (e.g., disease are examples of vector-borne diseases. physical contact between an infected host and Influenza is not spread through vectors. a susceptible host) or droplet spread (i.e., droplets containing an infectious agent that are In some outbreaks, the infectious agent can be produced through coughing, sneezing, talking, transmitted from animals to human hosts, or possibly even breathing). For example, when causing human disease. Similarly, infectious a person coughs or sneezes, droplets are agents can be transmitted from humans to produced that range in size from large to very animal hosts, causing animal disease. The term small. Very small droplets are characterized as zoonotic disease or zoonosis is used to “aerosols.” Experts believe that most influenza describe these infections spread between virus transmission occurs via large droplets and animals and humans. For example, certain that these droplets travel generally short influenza A viruses that normally circulate distances (i.e., up to about 6 feet) from an among birds or among pigs can be transmitted infected host. Less is known about the ability of to human hosts, causing human disease. When influenza viruses to spread via aerosols, which an influenza A virus that normally circulates is a topic that scientists continue to research. among birds infects a human, it is called an Large droplets tend to infect the upper avian influenza A virus infection. When an respiratory tract (e.g., the nose and nasal influenza A virus that normally circulates among passages), whereas aerosols have the potential pigs infects a human, it is called a variant to enter the lower respiratory tract (e.g., the influenza A virus infection. Both are considered trachea, bronchi, and lungs). novel influenza A virus infections because a person is infected with an influenza A virus that Indirect transmission occurs when an is different from the seasonal influenza A infectious agent is transferred from its reservoir viruses that normally circulate in humans. to an inanimate object or surface (i.e., fomite) and then from that inanimate object or fomite to Although animals can occasionally transmit a susceptible host. For example, if an influenza- influenza viruses to people, people also can infected pig eats out of a food trough shared by transmit human influenza viruses to animals. other pigs, it is possible that respiratory Pigs are often called mixing vessels because secretions from the infected pig could they are susceptible to influenza viruses from contaminate the food trough with influenza multiple animal species, including humans. It is virus. Subsequently, other uninfected pigs who possible for two or more influenza A viruses eat out of that same food trough could become from different species to infect a pig at the infected with influenza virus through indirect same time. When this happens, it is possible for transmission. the genes of these different influenza viruses to mix and create a new influenza A virus. This act Switching to a human example of indirect of multiple viruses infecting and mixing within a transmission: if an influenza-infected person single host is called reassortment. sneezes or coughs into his or her hands, and then touches a doorknob, the doorknob can Hamlet’s Story I Page 3 Reassortment is one way that antigenic shift Transmission of Influenza Viruses from Animals can occur. This abrupt, major change in the to People molecular make-up of the influenza virus can (https://www.cdc.gov/flu/about/viruses/transmis result in an influenza A virus that is novel or sion.htm) different from influenza A viruses currently circulating in people. People generally do not Information on Avian Influenza-Bird Flu Basics have any pre-existing antibodies to protect (https://www.cdc.gov/flu/avianflu/bird-flu- against novel influenza A viruses. If such novel basics.htm) influenza A viruses gain the ability to spread efficiently between people (i.e., easily transmit Graphic - Flu Can Spread Between Pigs and from person to person and forming long chains People of transmission), it could result in a pandemic (https://www.cdc.gov/flu/pdf/swineflu/transmissi (i.e., the global spread of a new influenza virus). on-between-pigs-people.pdf) In the case of the last four flu pandemics, the pandemic influenza A viruses had at least some Graphic - How Infected Backyard Poultry Could genes derived from influenza A viruses that Spread Bird Flu to People normally circulate among birds or pigs in (https://www.cdc.gov/flu/pdf/avianflu/avian-flu- addition to genes of influenza viruses that transmission.pdf) normally circulate among people. Information on Swine Influenza/Variant In this activity, students will explore chains of Influenza Virus infection among birds, pigs, or humans, as well (https://www.cdc.gov/flu/swineflu/) as among these three populations. Students will learn how disease infections among other CDC One Health website species can have a dramatic impact on the (https://www.cdc.gov/onehealth) health and well-being of people in their own community. USDA One Health website (https://www.usda.gov/topics/animals/one- Did you know? health) Health experts believe the 2009 H1N1 influenza pandemic was caused by gene reassortments Activity instructions between influenza A viruses from North Explain American pigs, Eurasian pigs (i.e., pigs In ecology, we study the interactions that originally from Europe or Asia), birds and organisms have with each other, other humans, making it a quadruple reassortant organisms, and their environment. Similarly, in virus. epidemiology, we study the ecology of infectious agents (for example, viruses, Resources
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