Risk Perceptions for Avian Influenza Virus Infection among Poultry Workers, China

To determine risk for avian influenza virus infection, we conducted serologic surveillance for H5 and H9 subtypes among poultry workers in Beijing, China, 2009–2010, and assessed workers’ understanding of avian influenza. We found that poultry workers had considerable risk for infection with H9 subtypes. Increasing their knowledge could prevent future infections.

In terms of knowledge of avian influenza, 181 (87.4%) of workers recognized the transmission route through the respiratory tract, 113 (54.6%) recognized the transmission route through the gastrointestinal tract, and 117 (56.5%) recognized the transmission route through the mucosa. Nearly half of the participants ignored the latter 2 major transmission routes. In terms of knowledge of poultry housing practices, 135 (65.2%) and 160 (77.3%) of the workers had the correct understanding that chickens and ducks should not be raised with pigs in the same backyards and that poultry should not have contact with wild birds. Furthermore, 181 (87.4%) of the participants knew that eating and selling dead birds was against health regulations, and 167 (80.7%) knew that improving vaccination coverage and quality is an effective strategy for preventing AIV infection. Significant discrepancies were observed among groups with different educational levels in knowledge of avian influenza (except for those who understood that infection occurred through the respiratory tract and mucosa) (p<0.05) ( Table 1). Workers with a high level of education (senior high school, university or college, and above) had more correct answers to the corresponding questions. Significant differences were also found between groups of different ages and occupations regarding knowledge of avoiding mixed housing practices (p<0.05). Most (79.0%-95.0%) young persons, 18-35 years of age, knew that poultry should not be kept in mixed housing with pigs nor kept in contact with other species of birds. Also concerning the above 2 risks, chicken keepers had more accurate knowledge than duck keepers (Table 1). No significant differences were found between men and women in terms of general knowledge (p>0.05).  Regarding attitudes toward avian influenza, 116 (56.0%) of 207 surveyed workers did not consider that AIVs pose a public health threat. They also rarely showed concern for the consequences resulting from avian influenza.
Analysis of practices concerning avian influenza prevention among 207 poultry workers is shown in Table 2.
Although 184 (88.9%) respondents said they wore specific work clothing, wearing personal protective equipment was not a routine practice among poultry workers: only 112 (54.1%) wore gloves, and 95 (45.9%) wore masks. We also found that 165 (79.7%) participants routinely washed their hands after work and that 174 (84.1%) workers regularly used disinfectant. Significant differences were found between chicken keepers and duck keepers; the former were more likely to follow good hygiene practices than were the latter (p<0.01) ( Table 2).

Conclusions
Transmission of AIVs from poultry to humans probably results from contact with infected poultry or contaminated materials (6)(7)(8)(9). Workers in the poultry industry are at high risk for AIV infection. We found that 4.6% of poultry workers in Beijing had antibodies against influenza virus subtype H9. These findings indicate that viruses of subtype H9 may have previously infected a considerable number of persons in China, thus highlighting the potential public health risk for H9 AIV. None of the poultry workers in our study had positive test results for H5. Similarly, previous serologic surveillance studies in China showed that the prevalence of antibodies against H5 strains was significantly lower than that for antibodies against H9 (10,11).
In assessing the KAPs about avian influenza in poultry workers, we found that knowledge of avian influenza needs to be increased among poultry workers, especially among workers who are older, less educated, and duck keepers, and that the use of protective measures against AIVs should be enhanced among poultry workers, especially those on duck farms. Improving the KAPs of poultry workers could provide an effective means of preventing AIV infection in humans.  *OR, odds ratio; -, indicates that OR of variable itself is not calculated; boldface indicates that p value is significant. †Low education indicates junior high school, elementary school and below; high education indicates senior high school, university or college and above. ‡ORs are calculated as follows: for different age groups, we calculated 2 ORs-OR1 = odds (<36 y)/odds (36-45 y), OR2 = odds (<36 y)/odds (>45 y); for different education groups, OR = odds (low)/odds (high); for different job groups, OR = odds (chicken keepers)/odds (duck keepers).