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Precautions against Avian influenza
Avian influenza A (H5N1) or "bird flu" is a serious viral infection that occurs primarily in poultry, migratory waterfowl, and-less commonly-pigs. Although it is unusual for humans to acquire influenza virus infections from birds, human infections and deaths caused by the H5N1 virus have occurred. Humans have no immunity to this virus, and a human avian flu vaccine is not yet available, although vaccine trials are underway. Once a "bird flu" vaccine becomes available, 2 doses will be needed, given 1 month apart.
Where Are People At Risk for Avian Influenza?
Anywhere there are cases of H5N1 avian influenza occurring in birds, there is a risk that humans can also become ill if exposed to this virus. During 2005 and/or 2006, H5N1 outbreaks or occurrences among poultry and/or other birds have been reported in the following countries: Afghanistan, Albania, Austria, Azerbaijan, Bosnia and Herzegovina, Burkina Faso, Bulgaria, Burma (Myanmar), Cambodia, Cameroon, China, Cote d'Ivoire, Croatia, Czech Republic, Denmark, Djibouti, Egypt, France, Germany, Georgia, Greece, Hong Kong, Hungary, India, Indonesia, Iran, Iraq, Israel, Italy, Jordan, Kazakhstan, Laos, Malaysia, Mongolia, Niger, Nigeria, Pakistan, Poland, Romania, Russia, Serbia and Montenegro, Slovakia, Slovenia, Spain, Sudan, Sweden (H5), Switzerland, Thailand, Turkey, Ukraine, United Kingdom, and Viet Nam.
Human cases and deaths have occurred in Thailand, Viet Nam, Indonesia, Cambodia, China, Turkey, Iraq, Azerbaijan, Egypt, and Djibouti. For a current list of affected countries, see: www.oie.int/downld/avian influenza/a_ai-asia.htm and www.wpro.who.int/health_topics/avian_influenza/. For cumulative human cases by country, see: www.who.int/csr/disease/avian_influenza/country/en/.
How do People Get Infected?
The H5N1 virus is spread by domestic ducks, poultry, and wild migratory birds. Most human cases are thought to have resulted from direct contact with sick or infected poultry (e.g., in live animal markets or poultry farms) or with their droppings, respiratory secretions, or eye secretions, or through contact with contaminated surfaces. It is possible that humans can be exposed by eating undercooked, infected poultry or eggs or duck blood. Theoretically, the virus may also be transmitted through inhalation of dried, airborne poultry feces. Human-to-human transmission is extremely rare.
The current H5N1 virus, which is adapted to birds, may have an incubation period of 1 week, but if it is able to adapt to humans and becomes a pandemic strain, the incubation period is likely to be 2 days (similar to seasonal influenza).
What are the symptoms of Avian Influenza?
Initially avian (H5N1) influenza may appear like a severe case of regular, seasonal influenza with typical flu-like symptoms (fever, chills, cough, runny nose, sore throat, muscle aches, headaches), but the person then deteriorates rapidly, suddenly developing severe pneumonia and respiratory distress about 3-5 days into the illness. Other symptoms might include eye inflammation, severe diarrhea, encephalitis (brain inflammation), seizures, or coma.
How to Prevent Avian Influenza?
If you plan to travel to an area where H5N1 avian influenza has been detected in domestic poultry or humans, take the following precautions:
- Check for any travel restrictions.
- Identify an in-country health care resource before travel.
- Get a regular flu vaccination if you have not had one this year. Flu vaccine won't protect you against avian influenza but may decrease the chance of confusing regular flu with avian influenza if you do become sick.
- Have a pre-packed travel kit ready to take with you. Include an oral thermometer with probe covers and a temperature chart to keep track of your temperature, first aid/medical supplies, alcohol-based wipes/hand sanitizer, household disinfectant, and masks, such as 2- or 3-ply surgical, N95, etc. (See "B" below for information on an anti viral drug for treatment of avian influenza that your medical provider may advise that you carry as well.)
- Do not embark on travel if you have a fever.
- If you will be traveling in or remaining in an area where many human cases are occurring, take and record your temperature 3-5 times daily.
- Avoid all contact with all poultry, waterfowl, and other birds.
- Avoid live animal markets ("wet markets") and poultry farms.
- Avoid any surfaces that may be contaminated with bird droppings.
- Thoroughly cook poultry and eggs before eating; heat destroys influenza viruses. Eggs and poultry should be cooked to at least 165° F (74°C) using a food thermometer.
- Practice food safety habits at all times: wash hands, surfaces, and knives in hot soapy water after handling raw poultry; keep uncooked poultry separate from cooked foods; keep uncooked poultry refrigerated or frozen; and do not eat products with raw or lightly cooked eggs (e.g., eggnog, cookie dough). These tips can also help prevent exposure to bacteria or salmonella in foods.
- Frequent, thorough hand washing is vital. Carry and use alcohol hand sanitizers or towelettes. Be especially vigilant after shaking hands, before eating, and after using the toilet.
- Practice good respiratory hygiene. When possible, change seats in an airplane to avoid travelers with respiratory symptoms. Carry and use masks as directed by your health care provider.
- If you are in an epidemic situation, try to reduce meetings and interactions with others as much as possible.
In some situations, your medical provider may ask you to include an anti viral drug called oseltamivir (Tamiflu) in your medical kit. If oseltamivir is unavailable, zanamivir (Relenza) is another option, but it is in extremely short supply and may not generally be available.
- Oseltamivir and zanamivir are the only available therapy for treatment of avian influenza in travelers. Use as directed by your physician.
- Due to the limited availability of anti viral worldwide, carrying anti viral for standby treatment or prevention of avian influenza is not currently supported by official public health recommendations.
Can H5N1 Infection Be treated?
As noted above, oseltamivir (Tamiflu) or zanamivir (Relenza) are the only available therapy for treatment of avian influenza. Ask your health care provider if you should carry one of these drugs with you and how and when to use it.
What to do whey You fall Sick?
If you become sick with a fever or any flu-like symptoms during travel or for 10 days after travel to an H5N1-infected area, (i.e., where cases are occurring in domestic poultry or humans), seek medical care. Inform your physician of your symptoms and travel itinerary, including possible exposure.
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