Avian (bird) flu: H5N1 – Highly pathogenic

 (Survival Manual/6. Medical/b) Disease/Avian flu H5N1)

Definition
H5N1 Bird flu is caused by a type of influenza virus that rarely infects humans. But when bird flu does strike humans, it’s often deadly, more than half the people (60%) who become infected with H5N1 die of the disease.

In recent years, outbreaks of bird flu have occurred in Asia, Africa and parts of Europe. Most people who have developed symptoms of bird flu have had close contact with sick birds. In a few cases, bird flu has passed from one person to another. As of the end of 2010, H5N1 has not been detected in North or South America.

Health officials worry that a global outbreak could occur, with potentially catastrophic consequences,  if a bird flu virus mutates into a form that transmits more easily from person to person. Researchers are working on vaccines to help protect people from bird flu.

Symptoms
Signs and symptoms of bird flu typically begin within two to five days of infection. In most cases, they resemble those of conventional influenza, including:
•  Cough
•  Fever
•  Sore throat
•  Muscle aches

Some people also experience nausea, vomiting or diarrhea. And in a few cases, a mild eye infection (conjunctivitis) is the only indication of the disease.

There are no known ‘mild’ occurrences of  the Avian flu H5N1 disease.

 When to seek medical advice
See your doctor immediately if you develop a fever, cough and body aches, and have recently traveled to a part of the world where bird flu occurs. Be sure to let your doctor know if you visited any farms or open-air markets.

Causes
Bird flu occurs naturally in wild waterfowl and can spread into domestic poultry, such as chickens, turkeys, ducks and geese. The disease is transmitted via contact with an infected bird’s feces, or secretions from its nose, mouth or eyes.

Open-air markets, where eggs and birds are sold in crowded and unsanitary conditions, are hotbeds of infection and can spread the disease into the wider community.

According to the Food and Drug Administration, bird flu cannot be transmitted by eating properly cooked poultry meat or eggs from infected birds. Poultry meat is safe to eat if it’s been cooked to an internal temperature of 165 F (74 C). Eggs should be cooked until the yolk and white are firm.

At present, the best defense from H5N1 is to not touch or come within about 6 feet of dead sick or dead poultry. If you are likely to come near a source of the disease wear respiratory protection or a higher level face mask..

Risk factors
The greatest risk factor for bird flu seems to be contact with sick birds or with surfaces contaminated by their feathers, saliva or droppings. The World Health Organization (WHO) has confirmed a handful of cases of limited human-to-human transmission of bird flu. But unless the virus begins to spread more easily among people, infected birds or associated material presents the greatest hazard.

The pattern of human transmission remains mysterious. Young children seem especially vulnerable to the virus, although some experts note that children are more likely to have contact with sick birds or to play on ground contaminated with droppings. What’s more, people of all ages have contracted and died of bird flu. At this point, too few people have been infected to know all the possible risk factors for bird flu.

 Can a person become infected with avian influenza A (H5N1) virus by cleaning a bird feeder?
There is no evidence of H5N1 having caused disease in birds or people in the United States. At the present time, there is no risk of becoming infected with H5N1 virus from bird feeders. Generally, perching birds (Passeriformes) are the predominate type of birds at feeders. While there are documented cases of H5N1 causing death in some Passeriformes (e.g., house sparrow, Eurasian tree-sparrow, house finch), in both free-ranging and experimental settings, none occurred in the U.S. and most of the wild birds that are traditionally associated with avian influenza viruses are waterfowl and shore birds.
Pasted from <http://www.medicinenet.com/bird_flu/page4.htm>

Complications
People with bird flu may develop life-threatening complications, including:
•  Pneumonia
•  Collapsed lung
•  Respiratory failure
•  Kidney dysfunction
•  Heart problems

Although bird flu kills more than half the people it infects, the number of fatalities is still low because so few people have had bird flu. According to the World Health Organization, a few hundred people have died of bird flu since 2003.

In contrast, the Centers for Disease Control and Prevention estimates that seasonal influenza is responsible for tens of thousands of deaths each year in the United States alone.

Tests and diagnosis
Samples of fluids from your nose or throat can be tested for the presence of a flu virus. In the past, these types of tests could take hours or even weeks to complete. When more-rapid tests became available, they couldn’t distinguish between bird flu and other types of influenza. The Food and Drug Administration recently approved a type of test that can identify bird flu viruses in less than an hour.

Imaging tests
X-rays may be useful in assessing the condition of your lungs, which can help determine the proper diagnosis and the best treatment options for your signs and symptoms.

Treatments and drugs
Many influenza viruses have become resistant to the effects of a category of antiviral drugs that includes amantadine and rimantadine. Health officials recommend the use of oseltamivir (Tamiflu) and possibly zanamivir (Relenza) instead.

These drugs must be taken within two days after the appearance of symptoms, something that may prove logistically difficult on a worldwide scale, even if there were enough to go around. Because they’re in short supply, it’s not entirely clear how flu drugs would be allocated if there were a widespread epidemic.

Doctors recommend that people get an influenza (flu) shot to reduce the chance of an avian flu virus mixing with a human flu virus, which would create a new virus that may easily spread.
Pasted from <http://health.nytimes.com/health/guides/disease/avian-influenza/overview.html>

Self-Care at Home
Influenza is a respiratory infection. These are some of the recommended self-care techniques to help relieve viral flu symptoms:
•  Rest in bed. Avoid physical exertion. Avoid using alcohol and tobacco.
•  Drink plenty of fluids such as water, fruit juices, and clear soups. Water should not be the
sole or main liquid consumed for prolonged periods because it does not contain adequate electrolytes (sodium and potassium, for example) that the body requires. Commercially  available products such as sports drinks can be useful in this regard. For children, ORS (Oral Rehydration Solution) packets are another good way to replenish the body fluids.
•  Treat fever and aches with over-the-counter medications such as acetaminophen (Tylenol is a
common brand), ibuprofen (Advil or Motrin are examples), and naproxen (Aleve or Naprosyn can
be purchased at most drug stores). Aspirin is not recommended in children or teenagers because of an increased risk of severe liver disease called Reye’s syndrome.
Always follow package directions. Do not combine medicines with the same ingredients. For example, many sinus preparations already contain acetaminophen and should not be taken together with Tylenol.
•  Cough suppressants, antihistamines, and decongestants should be used only according to package directions. Many of these products have limited effectiveness and may have side effects. The FDA has recommended against the use of these products in children and infants.
•  Steam inhalations may be useful in opening up a blocked nose and thus make breathing easier.
•  Avoid touching hard surfaces where flu viruses may remain alive: handrails, telephones, doors,faucets, and counters. Wash your hands often, especially after being in public places or at work.
•  Cough or sneeze into a soft tissue or handkerchief. Carefully dispose of tissues after using them and wash your hands.
•  Stay away from people who have the flu if possible. If you experience flu symptoms, you should consider staying at home and not going to work or to crowded places in which you might spread the virus.
Pasted from <http://www.emedicinehealth.com/bird_flu/page5_em.htm>

Items to have on hand at home
•  Imodium is a trade name for Loperamide. It can be purchased generically for relatively little cost, at such places as warehouse stores. The generic (house brands) are just fine.
•  Stock up on Acetominophen (Tylenol) and Ibuprofen (Motrin) as well – for treating fevers. These two antipyretics can be taken together or on an alternating 4 hour schedule (take each every 4 hours but split them, for example at 8 AM take acetaminophen, at 10 AM take ibuprofen, etc. This makes it easier to monitor the patient and get them to drink fluids, if they’re up every 2 hours they will have to drink some fluids).
•  Either have a traditional glass thermometer for each person, or a digital thermometer with lots of disposable sleeves. The thermometers are a couple of bucks at most drug stores. The sleeves are a buck or so per hundred. Don’t cross-contaminate your patients.

Influenzas tend to kill most of their victims in two ways: dehydration and lung congestion.
Even the Avian flu, which is respiratory usually starts with stomach flu symptoms. Stomach flus usually induce diarrhea which rapidly dehydrates the victim. To fight this, you need to stock up on both anti-diarrhea medicines (such as Imodium AD–an anti-spasmodic) and electrolyte solutions such as Pedialyte. (The latter is available in bulk though large chain “warehouse” stores.) The various sports type drinks (such as Gatorade) can be used as oral rehydration solutions (ORSs) too. However, I prefer to dilute them about 50% with water, they have a lot of glucose in them which will exacerbate diarrhea symptoms.

Homemade Oral Rehydration Solution
If commercial oral hydration solutions are not available, I have read that you can make an emergency solution as follows:

  • 1/2 teaspoon of salt
  • 2 tablespoons honey, sugar, or rice powder
  • 1/4 teaspoon potassium chloride (table salt substitute)
  • 1/2 teaspoon trisodium citrate (can be replaced by baking soda)
  • 1 quart of clean water

 Bird flu vaccine
The Food and Drug Administration has approved one vaccine to prevent infection with one strain of H5N1 bird flu virus. This vaccine isn’t available to the public, but the U.S. government is stockpiling it and will distribute it in the event of an outbreak. It’s intended to help protect adults ages 18 to 64 and could be used early in such an outbreak to provide limited protection until another vaccine — designed to protect against the specific form of the virus causing the outbreak — is developed and produced.

Researchers continue to work on other types of bird flu vaccines. One of the stumbling blocks is that most vaccines need chicken eggs for their development and production. Bird flu viruses are lethal to chicken eggs.

Recommendations for travelers
If you’re traveling to Southeast Asia or to any region with bird flu outbreaks, consider these public health recommendations:
•  Avoid domesticated birds. If possible, avoid rural areas, small farms and open-air markets.
•  Wash your hands. This is one of the simplest and best ways to prevent infections of all kinds. When you’re traveling, alcohol-based hand sanitizers containing at least 60 percent alcohol are an excellent choice. They are effective, easy to use, don’t require water and they’re safe for children.
•  Ask about a flu shot. Before traveling, ask your doctor about a flu shot. It won’t protect you specifically from bird flu, but it may help reduce the risk of simultaneous infection with bird and human flu viruses.

Poultry and egg products
Because heat destroys avian viruses, WHO officials don’t consider cooked poultry a health threat. Even so, it’s best to take precautions when handling and preparing poultry, which is often contaminated with salmonella or other harmful bacteria.
•  Avoid cross-contamination. Carefully wash cutting boards, utensils and all surfaces that have come into contact with raw poultry in hot, soapy water.
•  Cook thoroughly. Cook chicken until the juices run clear, and it reaches a minimum internal temperature of 165 F (74 C).
Steer clear of raw eggs. Because eggshells are often contaminated with bird droppings, avoid mayonnaise, hollandaise sauce, ice cream, and any other foods containing raw or undercooked eggs.

Can I get avian influenza from eating or preparing poultry or eggs?
You cannot get avian influenza from properly handled and cooked poultry and eggs. There currently is no scientific evidence that people have been infected with bird flu by eating safely handled and properly cooked poultry or eggs.

Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry or surfaces contaminated with secretions and excretions from infected birds.
Even if poultry and eggs were to be contaminated with the virus, proper cooking would kill it.
In fact, recent studies have shown that the cooking methods that are already recommended by the U.S. Department of Agriculture (USDA) and the Food and Drug Administration (FDA) for poultry and eggs to prevent other infections will destroy influenza viruses as well.

So to stay safe, the advice is the same for protecting against any infection from poultry:
• Wash your hands with soap and warm water for at least 20 seconds before and after handling raw poultry and eggs.
• Clean cutting boards and other utensils with soap and hot water to keep raw poultry from contaminating other foods.
• Use a food thermometer to make sure you cook poultry to a temperature of at least 165 degrees Fahrenheit Consumers may wish to cook poultry to a higher temperature for personal preference.
• Cook eggs until whites and yolks are firm.
The U.S. government carefully controls domestic and imported food products, and in 2004 issued a ban on importation of poultry from countries affected by avian influenza viruses, including the H5N1 strain. This ban still is in place.

Grocery Industry Prepares for Bird Flu
Sunday February 18, 2010
http://www.hpj.com/archives/2007/feb07/feb26/Groceryindustrypreparesforp.cfm
[A news article that provides thinking on how a major flu pandemic might be treated in the USA. Mr Larry]
OMAHA, Neb.
(AP) — Stocking up on food is as simple as a trip to the grocery store, a veritable land of plenty for Americans.
“It’s so easy when you have three grocery stores in your vicinity,” said Becky Jones of Omaha, who stocks up once a week for her family of three. “You think: how could you possibly not get what you needed?”
But will fresh fruits and vegetables, meat, bread, milk and other household staples still be available if the U.S. is hit with an anticipated bird flu pandemic? If state and federal officials urge people to stay away from public places, like restaurants and fast-food establishments, will they be able to get the
groceries they need to prepare food in their homes?
For Jones, the prospect of not having access to food is frightening. She said most people, herself included, only have food on hand for three or four days.
Unlike other critical infrastructure sectors like water, energy and health care, the food industry isn’t getting much help from state and federal governments when it comes to disaster planning. That
puts the burden on individual supermarket chains and wholesalers to deal with a potentially large number of sick workers that could affect store operations and disrupt the food supply.
“The industry is actively thinking through contingency plans, so if it should happen, our members would be well prepared to deal with it,” said Tim Hammonds, president of the Food Marketing Institute, an advocate for grocery wholesalers and retail supermarkets nationwide.

The U.S. Department of Health and Human Services estimates a third of the population could fall ill if the H5N1 strain of the bird flu mutates into a form that spreads easily from person to person. It’s not clear if that will ever happen and no human cases of bird flu have ever been traced to eating properly cooked poultry or eggs.

But if a pandemic emerges, the Department of Homeland Security projects worker absenteeism to reach 40 percent or more over a prolonged period. Hammonds said retail food stores would have to contend with worker shortages and disruptions in the supply chain.

The food and agriculture industry is listed among 13 critical-infrastructure sectors that the Department of Homeland Security says must remain functional during a pandemic.  “Having those critical facilities open — like power, water, food — becomes very important” during a national disaster such as a pandemic, said Keith Hanson, an outreach coordinator for Nebraska’s Center for Biopreparedness
Education.

Hanson works with local businesses, helping test their preparedness plans. He will speak about the importance of that testing at the Public Health Preparedness Summit in Washington, an annual conference designed to help public health workers prepare for emergencies. This year’s meeting started Friday and ends Feb. 23. Hanson said continued operations of power and water utilities are of the utmost importance, but grocery stores rank highly too. That’s because people today keep less food on hand, opting instead to make weekly trips to the grocery store.

Americans are also dining out more than they have in the past. Money spent on food prepared outside the home rose from 34 percent of total food costs in 1974 to about 50 percent in 2004, according to a report by the U.S. Department of Agriculture.

The Food Marketing Institute’s Hammonds said a widespread pandemic will likely cause food consumption to shift away from restaurants and fast-food establishments and toward in-home eating, causing a greater demand for groceries. “That means stores would need to be prepared for an increase in volume,” he said.

Hy-Vee, a West Des Moines, Iowa-based supermarket chain that operates more than 200 stores in the Midwest, does not have a disaster plan developed in the event of avian flu. But company spokeswoman Chris Friesleben said the company keeps abreast of the illness through the Food Marketing Institute.

“The food supply is essential to the well-being of the community,” said Hammonds. “We’ve been through a lot about what we need to do as a supermarket.” That includes urging wholesalers and retailers to talk with their suppliers about alternative sources for their products and to anticipate what products will be in high demand in a pandemic situation, such as medicines and food staples.

Stephanie Childs, a spokeswoman for Omaha-based ConAgra Foods Inc., said a company task force was formed more than a year ago to develop an operating plan in the event of a national disaster. The plan specifically addresses bird flu, examines areas that could be affected and how the company could respond, she said.

ConAgra is one of the nation’s largest food companies, with brand names that include ACT II popcorn, Banquet, Chef Boyardee, Marie Callender’s, Egg Beaters and Orville Redenbacher’s.

The company employs about 27,000 people, but Homeland Security projections indicate that number could fall to 16,200 during a pandemic.

Childs said such worker shortages and difficulties with suppliers getting their products to ConAgra plants were among the potential problems the company identified. She did not disclose how the company would address those issues.

The federal government and public health agencies are urging people to stock up on nonperishable food, like canned goods and dried fruit, to ensure they have to food to eat during a pandemic.

Jones, the Omaha woman, said that’s a proactive approach, but was worried that people with limited incomes may not be able to afford a large stockpile of food. She stopped short of calling for the government to oversee the food industry’s pandemic planning, but said, “If they see a crisis that is on the horizon, they do have to give us some type of warning.

Critical infrastructure
The U.S. government has identified 13 sectors and four resources that must remain operational during a bird flu pandemic. They are:

Critical infrastructure
•    food and agriculture
•    national monuments and icons
•    banking and finance
•    chemical and hazardous materials
•    defense industrial base
•    water
•    public health and health care
•    energy
•    emergency services
•    information technology
•    telecommunications
•    postal and shipping
•    transportation

Key resources
•    government facilities
•    dams
•    commercial facilities
•   nuclear power plants
Source: U.S. Department of  Homeland Security

 

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