Date : 30 November 2005
QUESTIONS & ANSWERS
AVIAN (BIRD) FLU
1. What is Avian (bird - flu) influenza?
Like in man, birds can also develop flu - caused by avian Influenza viruses. Wild birds are the natural host (carrier) to this virus and due to the contagiousness of this virus; it circulates freely among birds worldwide.
There are different viruses (Influenza A,B,C) but only Influenza A & B cause serious disease. Influenza A again being further subdivided into 16 subtypes (H1-H16, N1-N9). Infection from this virus is normally highly species specific and very rarely crossed the species barrier to infect humans.
Though the viruses cause minimal disease in wild birds, infection in
domesticated fowls can lead to severe disease. It usually presents in two forms. One with low virulence (does not kill the fowl typically fowl appears with ruffled feathers and reduced egg production) and the other with high virulence (kills the fowl usually within 48 hours). Only viruses of H5 & H7 are known to cause highly virulent form of the disease.
2. What is special about the current outbreak?
The current outbreak among birds/fowls is being caused by a highly virulent strain (H5N1) of avian influenza virus. It began in mid 2003 in South East Asia and is quickly becoming the largest and most severe on record. It has simultaneously spread to many countries and has resulted in the loss of >150 million birds and fowls. Despite active culling of infected fowls, the disease continues to spread in poultry.
Especially worrying is the widespread persistence of H5N1 in poultry population. This poses a risk of direct infection when the virus passes from poultry to humans, which unfortunately has already occurred.
As this is a new strain, the human body has no previous immunity against this virus. The disease manifesting in those inflicted with the virus has been severe with 50% mortality.
Of greater concern is the possibility of the virus mutating and acquiring the capability of sustains human to human transmission. The risk that the H5N1 virus will acquire this ability is further aided by the emergence of the flu season in the Northern Hemisphere where co- infection with the human and avian influenza virus will allow for transfer exchange of genetic material between the two viruses permitting for the emergency of a fully transmissible pandemic influenza
virus.
3. How does the bird flu spread?
Wild waterfowl are considered to be the natural reservoir of the avian influenza A virus. These viruses do no harm to these birds. From these migratory birds, virus is shed from droppings, saliva, nasal secretions and other body fluids, invariably infecting the domesticated fowl.
Though the virus does not typically infect humans, it is believed that most reported cases have resulted from direct contact with infected poultry, uncooked poultry products, contaminated surfaces with droppings, and secretions of
infected birds.
4. What are the risks to humans from bird flu?
Currently, the risk is only to those who have close contact or consumed disease poultry and/or poultry products. The virus does not typically infect humans.
Almost all documented cases have been from direct spread of avian flu infection form diseased poultry to humans, principally through close contact. There have only been reports of two probable cases of human to human spread of infection being documented thus far.
There is no current evidence to indicate that the H5N1 avian influenza virus has transformed to allow it to cause widespread sustain human to human transmission, a prerequisite to go on to cause global pandemic.
However, as the H5N1 avian influenza virus is a new strain and has not been exposed before to humans, we have no natural immunity to it. Those that have been infected thus far with this strain have shown severe disease.
5. What are the symptoms of bird flu in humans?
The symptoms of bird flu in humans range from typical flu like symptoms such has fever, sore throat, cough, body ache, eye
congestion, viral pneumonia and respiratory distress. There has also been a recent reported case of encephalitis (inflammation of the brain) in a child. Severe form of the disease can lead to multi organ failure and death.
6. What preventive measures can I take? Is it safe to eat poultry and poultry products?
All cases of human infection have occurred among those that had a history of closed contact with infected poultry. Infection occurs through contact with secretions and faces of infected fowl and consumption of diseased poultry and poultry products.
In endemic areas, as a precaution, it is best to avoid poultry farms and life market where poultry is sold or where avian flu is prevalent. Avoid contact with wild birds. Personal hygiene is of paramount importance and frequent washing of hands with soap and water thoroughly is a good practice. Eat balance healthy meals and have adequate amount of exercise and rest to build a good immune system.
In areas where there is no prevalence of avian flu, it is safe to consume poultry or poultry products prepared in the usual manner with no fear of acquiring infection with the H5N1 virus.
In areas experiencing outbreaks, poultry and poultry products can also be safely consumed provided these items are properly cooked and properly handle during food processing. Precautions advocated
are:
· Do not eat uncooked or undercooked poultry products, including dishes made with uncooked poultry blood.
· When preparing food, separate raw meat from cooked or ready to eat food. Do not use the same knife or cutting board when preparing raw meat and cooked or ready to eat food.
· Do not handle raw poultry and cooked food without washing your hands in between.
· Do not place cooked poultry on the same plate or surface it was on
before it was cooked.
· All foods from poultry including eggs and poultry blood should be cooked thoroughly. Egg yolk should not be runny or liquid. As influenza viruses are killed by heat, cooking temperatures should be 70 °C or more.
· Wash shells of eggs with soapy water before handling and cooking and wash your hands after that.
· Do not use raw or soft boiled eggs in food that will not be cooked.
· After handling raw poultry and eggs, wash all surfaces and utensils thoroughly with soap and water.
7. Which are the Countries with bird flu out breaks?
The countries that have reported outbreaks in their poultry are:
· Korea
· Viet Nam
· Japan
· Thailand
· Cambodia
· Laos
· Indonesia
· China
· Malaysia
· Russia
· Kazakhstan
· Mongolia
· Turkey
· Romania
8. Can I be protected against bird flu?
There is currently no vaccine available against the H5N1 influenza strain. Influenza vaccine against the H5N1 virus is expected to be developed in the near future.
There are two oral antiviral drugs that can combat the disease. To be effective, these have to be taken within the first 48 hours on onset of disease. It can also be taken as prophylaxis in individual with high risk occupations.
Prevention is still the best option currently.
9. What to do if exposed to bird flu?
If you think you have been exposed to avian flu, do the following:
· Monitor your health for 10 days
· If you become ill with fever and develop a cough, sore throat or difficulty in breathing or if you develop any illness with fever during this 10 day period, consult a doctor.
· Do not travel while ill. This is to prevent spread of disease.
10. Shall I restrict my travel?
Currently there is no restriction to travel. There is also no requirement requiring the wearing of face mask in endemic areas. The current spread of bird flu is through direct contact. Washing hands often with soap and water will protect against infection.
PREPARED BY:
Medical Services Department
November
2005
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