what is bird flu
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WHAT IS BIRD FLU ?
Avian influenza is flu infection in birds. The disease is of concern to humans, who
have no immunity against it. The virus that causes this infection in birds can
mutate (change) to easily infect humans. Such mutation can start a deadly
worldwide epidemic.
What Is The Avian Influenza A (H5N1) Virus That Has Been Reported In
Africa, Asia, Europe, And The Near East?
Influenza A (H5N1) virusalso called "H5N1 virus"is an influenza A virus
subtype that occurs mainly in birds, is highly contagious among birds, and can be
deadly to them.
Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in
Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and
Vietnam) during late 2003 and early 2004. At that time, more than 100 million
birds in the affected countries either died from the disease or were killed in order
to try to control the outbreaks. By March 2004, the outbreak was reported to be
under control.
Beginning in June 2004, however, new outbreaks of influenza H5N1 among
poultry and wild birds were reported in Asia. Since that time, the virus has spread
geographically. Reports of H5N1 infection in wild birds in Europe began in mid-
2005. In early 2006, influenza A H5N1 infection in wild birds and poultry were
reported in Africa and the Near East.
Human cases of influenza A (H5N1) infection have been reported in Azerbaijan,
Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Kuwait, Lao People's
Democratic Republic, Nigeria, Thailand, Turkey, and Vietnam.
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Causes, incidence, and risk factors
Historically, avian influenza viruses infected pigs and mixed with pig influenza
viruses. The viruses exchanged genetic information, which led to the formation of
a new virus. This new virus could then infect humans and easily spread from
person to person. Previous flu pandemics (worldwide epidemics) have started
this way.
The first avian influenza virus to infect humans directly occurred in Hong Kong in
1997, during an avian flu epidemic on the island. This outbreak was linked to
chickens and classified as avian influenza A (H5N1).
Since the Hong Kong outbreak, the bird flu virus has spread across Asia, and in
October 2005 was discovered in poultry in Turkey and Romania. So far,
hundreds of people have been infected by H5N1. Many people have died.
The wider the area over which the avian flu virus spreads, the greater the
chances of a worldwide outbreak. There is tremendous concern that H5N1 poses
an enormous pandemic threat.
Farmers and other people working with poultry, as well as travelers visiting
affected countries, have a higher risk for getting the bird flu. Handling an infected
bird can cause infection. People who eat raw or undercooked poultry meat are
also at an increased risk for avian influenza. Highly infective avian flu viruses,
such as H5N1, have been shown to survive in the environment for long periods
of time, and infection may be spread simply by touching contaminated surfaces.
Birds who recover from the flu can continue to shed the virus in their feces andsaliva for as long as 10 days.
Health care workers and household contacts of patients with avian influenza may
also be at an increased risk of the bird flu.
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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.
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What are the Symptoms of Bird Flu?
The incubation period of H5N1 Bird Flu virus varies from 2 to 10 days. That
is, symptoms appear 2 to 10 days after the virus has first entered a body. A
person can be contagious without showing symptoms. An adult is still contagious
until 7 days after fever stops and must remain isolated. Children 12 and under
are still very contagious for 21 days from the beginning of illness. Keep the
patient quarantined during this time.
Symptoms of Bird Flu
eople infected with Bird Flu may have some or all of the:ollowing symptoms
Mild cold, sore throat, cough and shortness of breath.
Fever greater than 38 degrees Celsius
Diarrhea, vomiting and abdominal pain.
Mild to severe respiratory distress. needing ventilation within days.
In very severe cases large amounts of mucous accumulate in the lungs
limiting breathing. Patients can drown in their own mucous within 10 to 20
days. This may also involve secondary bacterial infection.
Laboratory tests have shown an early onset of lymphopenia, which is an
abnormally low number of lymphocytes in the blood.
Complications also included renal failure and multi organ failure.
Other symptoms have also occurred through H5N1 bird flu infection
leading to many incorrectly diagnosed patients including encephalitis,
dengue, gastrointestinal disorders and cholera.
A very common symptom of the 1918 Spanish flu was the cytokine storm
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?ow is avian influenza detected in humansAvian influenza cannot be diagnosed by symptoms alone, so a laboratory test is
required. Avian influenza is usually diagnosed by collecting a swab from the nose
or throat during the first few days of illness. This swab is then sent to a
laboratory, where they will either look for avian influenza virus using a molecular
test, or they will try to grow the virus. Growing avian influenza viruses should only
be done in laboratories with high levels of protection. If it is late in the illness, it
may be difficult to find an avian influenza virus directly using these methods. If
this is the case, it may still be possible to diagnose avian influenza by looking for
evidence of the body's response to the virus. This is not always an option
because it requires two blood specimens (one taken during the first few days of
illness and another taken some weeks later), and it can take several weeks to
verify the results.
What are the implications of avian influenza to human health?
Two main risks for human health from avian influenza are 1) the risk of direct
infection when the virus passes from the infected bird to humans, sometimes
resulting in severe disease; and 2) the risk that the virusif given enough
opportunitieswill change into a form that is highly infectious for humans and
spreads easily from person to person.
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Transmission and host range
Influenza A virus, the virus that causes Avian flu. Transmission electron
micrograph of negatively stained virus particles in late passage. (Source: Dr. Erskine
Palmer, Centers for Disease Control and Prevention Public Health Image Library)
Infected birds transmit H5N1 through their saliva, nasal secretions, feces and
blood. Other animals may become infected with the virus through direct contact
with these bodily fluids or through contact with surfaces contaminated with them.
H5N1 remains infectious after over 30 days at 0 C ( 32.0 F) (over one month at
freezing temperature) or 6 days at 37 C ( 98.6 F) (one week at human body
temperature) so at ordinary temperatures it lasts in the environment for weeks. In
Arctic temperatures, it doesn't degrade at all.
Because migratory birds are among the carriers of the highly pathogenic H5N1
virus, it is spreading to all parts of the world. H5N1 is different from all previously
known highly pathogenic avian flu viruses in its ability to be spread by animals
other than poultry.
In October 2004, researchers discovered that H5N1 is far more dangerous than
was previously believed. Waterfowl were revealed to be directly spreading the
highly pathogenic strain of H5N1 to chickens, crows, pigeons, and other birds,
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and the virus was increasing its ability to infect mammals as well. From this point
on, avian flu experts increasingly referred to containment as a strategy that can
delay, but not ultimately prevent, a future avian flu pandemic.
"Since 1997, studies of influenza A (H5N1) indicate that these viruses continue to
evolve, with changes in antigen city and internal gene constellations; an
expanded host range in avian species and the ability to infect felids; enhanced
pathogen city in experimentally infected mice and ferrets, in which they cause
systemic infections; and increased environmental stability."
The New York Times, in an article on transmission of H5N1 through smuggled
birds, reports Wade Hagemeijer of Wetlands International stating, "We believe it
is spread by both bird migration and trade, but that trade, particularly illegal trade,
is more important".
On August 22, 2007, a 28-year-old Indonesian chicken trader was the 2nd
person to die of bird flu on the island of Bali, after 4 days of hospitalization,
raising the death toll due to the disease in Indonesia to 84. Tests in 2 local
laboratories were positive for the H5N1 strain of the disease. 194 people the
majority of them in Indonesia -- have died since 2003, according to the WorldHealth Organization.
The H5N1 bird flu virus can also pass through a pregnant woman's placenta to
infect the fetus, researchers reported on Thursday 27 Sep 2007. They also found
evidence of what doctors had long suspected -- that the virus not only affects the
lungs, but also passes throughout the body into the gastrointestinal tract, the
brain, liver, and blood cells.
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SYMPTOMS TO THE ANIMAL
Wild fowl act as natural asymptomatic carriers of Influenza A viruses. Prior to the
current H5N1 epizootic, strains of Influenza A virus had been demonstrated to be
transmitted from wild fowl to only birds, pigs, horses, seals, whales and humans;
and only between humans and pigs and between humans and domestic fowl;
and not other pathways such as domestic fowl to horse.
Wild aquatic birds are the natural hosts for a large variety of influenza A viruses.Occasionally viruses are transmitted from these birds to other species and may
then cause devastating outbreaks in domestic poultry or give rise to human
influenza pandemics.
H5N1 has been shown to be transmitted to tigers, leopards, and domestic cats
that were fed uncooked domestic fowl (chickens) with the virus. H3N8 viruses
from horses have crossed over and caused outbreaks in dogs. Laboratory mice
have been infected successfully with a variety of avian flu genotypes.
Influenza A viruses spread in the air and in manure and survives longer in cold
weather. It can also be transmitted by contaminated feed, water, equipment and
clothing; however, there is no evidence that the virus can survive in well-cooked
meat. Symptoms in animals vary, but virulent strains can cause death within a
few days.
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Effect on human society
Main article: Social impact of H5N1
H5N1 has had a huge effect on humansociety, especially the financial, political,
social, and personal responses to both actual and predicted deaths in birds,
humans, and otheranimals.
Billions ofU.S. dollars are being raised and spent to research H5N1 and prepare
for a potential avian influenza pandemic. Over ten billion dollars have been lost
and over two hundred million birds have been killed to try to contain H5N1.
People have reacted by buying less chicken causing poultry sales and prices to
fall. Many individuals have stockpiled supplies for a possible flu pandemic. One
of the best known experts on H5N1, Dr. Robert Webster, told ABC News he had
a three month supply of food and water in his house as he prepared for what he
considered a reasonably likely occurrence of a major pandemic.
International health officials and other experts have pointed out that many
unknown questions still hover around the disease
Dr. David Nabarro, Chief Avian Flu Coordinator for the United Nations, and
former Chief of Crisis Response for the World Health Organization has described
himself as "quite scared" about the potential of H5N1's potential impact on
humans. Nabarro has been accused of being alarmist before and on his first day
in his role for the United Nations he proclaimed the avian flu could kill 150 million
people. In an interview with the International Herald Tribune, Nabarro compares
avian flu to AIDS in Africa, warning that underestimations led to innappropriate
focus for research and intervention.
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However it has been pointed out that media often focuses on "worst case" and
"what if?" scenarios, which often promotes a climate of fear and "a fertile ground
for speculation and rumours". Availability of reliable information is tanatamount
according to WHO public health official Robert Brown. Brown downplays the
significance of bird flu compared to other global public health issues:
In terms of death statistics so far, human avian influenza is not a huge public
health issue. As Brown put it, there are 40 million people living with HIV around
the world. More people die of traffic accidents in Vietnam than of avian flu. But a
mix of fear, disaster and the unknown makes avian flu a topic of concern. Other
factors add to this -- that avian flu marks the arrival of a new emerging infection
has a large impact on the poultry industry, a high mortality rate, and the potentialto cross national boundaries.
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Treatment and prevention for humans
Flu
Treatment
Different types of avian flu virus may cause different symptoms. Therefore,
treatment may vary.
In general, treatment with the antiviral medication oseltamivir (Tamiflu) or
zanamivir (Relenza) may make the disease less severe -- if you start taking the
medicine within 48 hours after your symptoms start.
Oseltamivir may also be prescribed for persons who live in the same house as
those diagnosed with avian flu.
The virus that causes human avian flu appears to be resistant to the antiviral
medicines amantadine and rimantadine. Therefore these medications cannot be
used if an H5N1 outbreak occurs.
People with severe infection may need to be placed on a breathing machine.
Experts recommend that persons diagnosed with avian flu be put in isolation.
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.
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The U.S. Food and Drug Administration has approved a vaccine to protect
humans from the avian flu. Experts say the vaccine could be used if the current
H5N1 virus starts spreading between people.
Prevention
Flu-like Symptoms With a Few Differences:
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In general, bird flu symptoms in humans are similar to regular flu symptoms. High
fever, muscle aches, cough, and sore throat are common. Humans ill with avian
flu subtype H5N1 rarely have conjunctivitis, a common symptom in people
infected with other subtypes of avian flu.
Most people have suffered respiratory distress, but a couple of young children
did not show any signs of respiratory distress, but had diarrhea and symptoms of
encephalitis.
Surveillance:Keeping track of where bird flu cases break out in poultry, other
animals and in humans is mostly the role of country governments. The World
Health Organization provides surveillance support. The WHO seeks to confirmbird flu cases and deaths and may use computer mapping (Geographic
Information Systems) to help local officials plan containment strategies. The
pitfalls of surveillance lie in unreliable data or untimely reporting of diseases.
Laboratory Competence: Bird flu symptoms alone are not enough to
determine if an illness can be attributed to bird flu. Rapid antigen tests are not as
sensitive in detecting influenza as laboratory tests that isolate the genetic
material of the virus (RNA) for identification. Prevention of bird flu measures
involve proper identification of the disease-causing agent. A weakness in
laboratory readiness in many countries is that tests may be too expensive to
perform regularly.
Participation and Communication: Individual Pandemic Preparation
Planning should help slow or prevent the spread of a pandemic flu. The fewer
human cases there are, the less likely it is that a new avian flu virus in humans
will emerge and become very contagious. Pandemic stockpilingfor 12 weeks has
been recommended. Community participation in planning and decision making is
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necessary for the success of emergency measures, such as the culling of
animals. Ignorance, mistrust and poverty can lead to breakdowns in
communication and participation. See why backyard chickens in a developed
country are not likely to cause avian flu in humans.
Government Policies: Government policies affect important prevention
measures such as: timely reporting of diseases, solid surveillance programs,
laboratory preparation, community participation, the ability to plan for
emergencies and enforce emergency measures, the ability to stockpile poultry
vaccines, antibiotics, and antiviral drugs and deliver them, and the level of
access to healthcare.
Personal Hygiene and Healthcare: Frequently wash hands with soap and
water and avoid contact with sick animals and people. Maintain general health by
updating routine vaccinations, getting a seasonal flu shot, eating right and
exercising. Receive medical care if bird flu symptoms are detected. Treatment
with antiviral drugs can reduce the severity of the flu if taken within 24-48 hours
of the onset of symptoms. Nevertheless, antiviral drugs, such as Tami flu, have
not been very successful in preventing death from avian flu so far. More studies
are needed to determine the effectiveness of antiviral drugs in treating avian flu.
Food Safety: Follow the tips to cooking poultry safely. Well cooked poultry and
eggs are perfectly safe to eat. Avoid cross contamination of raw meat with
cooked meat. Always disinfect cutting boards with 4 teaspoons of chlorine bleach
to one gallon of water before re-using them. Do not eat uncooked blood from
poultry.
It's not clear how people could become infected with the H5N1 avian flu virus via
the gastrointestinal tract, but it does seem some people contracted the virus in
Vietnam after drinking blood from poultry. Blood from infected animals contains
high levels of avian flu virus.
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Follow Best Practices for Poultry Farmers: Poultry farmers should
cooperate with their country's governments in the effort to contain bird flu. In the
US, farmers should be familiar with Insecurity for the Birds to protect poultry from
diseases introduced from outside the farm and participate in the voluntary USDA
reporting program. Learn how to spot bird flu among your flock. Report
suspicious deaths to the USDA. Protect those who must be in direct contact with
poultry. Wear gloves, rubber boots, and properly fitted face masks.
Rapid Response to Human Outbreaks: Rapid response to human outbreaks
of bird flu will reduce human deaths and the possibility of human-to-human
transmission. The outcome of rapid response will also reduce the possibility that
the bird flu virus will mutate or result in resentment to create a very contagious
novel virus in humans. The correct use of antiviral drugs and seasonal flu
vaccines play a role in the response to human outbreaks of bird flu
Preparations for pandemic
Cumulate Human Cases of and Deaths from H5N1
As ofApril 11, 2007
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Notes:
Source WHOConfirmed Human Cases of H5N1
"The incidence of human cases peaked, in each of the three years in
which cases have occurred, during the period roughly corresponding to
winter and spring in the northern hemisphere. If this pattern continues, an
upsurge in cases could be anticipated starting in late 2006 or early 2007."Avian influenza epidemiology of human H5N1 cases reported to WHO
The regression curve for deaths is y= a + ek x, and is shown extended
through the end of April, 2007.
"The United States is collaborating closely with eight international organizations,
including the World Health Organization (WHO), the Food and Agriculture
Organization of the United Nations (FAO), the World Organization for Animal
Health (OIE), and 88 foreign governments to address the situation through
planning, greater monitoring, and full transparency in reporting and investigating
avian influenza occurrences. The United States and these international partners
have led global efforts to encourage countries to heighten surveillance for
outbreaks in poultry and significant numbers of deaths in migratory birds and to
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rapidly introduce containment measures. The U.S. Agency for International
Development (USAID) and the U.S. Department of State, the U.S. Department of
Health and Human Services (HHS), and Agriculture (USDA) are coordinating
future international response measures on behalf of the White House with
departments and agencies across the federal government".
Together steps are being taken to "minimize the risk of further spread in animal
populations", "reduce the risk of human infections", and "further support
pandemic planning and preparedness".
Ongoing detailed mutually coordinated onsite surveillance and analysis of human
and animal H5N1 avian flu outbreaks are being conducted and reported by the
USGS National Wildlife Health Center, the Centers for Disease Control and
Prevention, the World Health Organization, the European Commission, and
others.
Infectivity
Highly pathogenic H5N1
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Countries with poultry or wild birds killed by H5N1.
Countries with humans, poultry and wild birds killed by H5N1.
H5N1 is easily transmissible between birds facilitating a potentialglobal spread of
H5N1. While H5N1 undergoes mutation and reassortment, creating variations
which can infect species not previously known to carry the virus, not all of these
variant forms can infect humans. H5N1 as an avian virus preferentially binds to a
type ofgalactose receptors that populate the avian respiratory tract from the
nose to the lungs and are virtually absent in humans, occurring only in and
around the alveoli, structures deep in the lungs where oxygen is passed to the
blood. Therefore, the virus is not easily expelled by coughing and sneezing, the
usual route of transmission.
H5N1 is mainly spread by domestic poultry, both through the movements of
infected birds and poultry products and through the use of infected poultry
manure as fertilizer or feed. Humans with H5N1 have typically caught it from
chickens, which were in turn infected by other poultry or waterfowl. Migrating
waterfowl (wild ducks, geese and swans) carry H5N1, often without becoming
sick. Many species of birds and mammals can be infected with HPAI A(H5N1),
but the role of animals other than poultry and waterfowl as disease-spreading
hosts is unknown.
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According to a report by the World Health Organization, H5N1 may be spread
indirectly. The report stated that the virus may sometimes stick to surfaces or get
kicked up in fertilizer dust to infect people.
How is avian influenza in humans treated?
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Studies done in laboratories suggest that the prescription medicines approved for
human influenza viruses should work in treating avian influenza infection in
humans. However, influenza viruses can become resistant to these drugs, so
these medications may not always work. Additional studies are needed to
determine the effectiveness of these medicines.
Does seasonal influenza vaccine protect against avian influenza infection
in people?
No. Seasonal influenza vaccine does not provide protection against avian
influenza.