What You Should Know About the Avian Flu

"Stay informed and don't panic."

This advice comes from Joseph DiCorpo, M.M.Sc., Sc.D., P.A., Assist America's Chief Medical Consultant, regarding the avian flu, a subject that has put the entire planet on edge.

"We seem to be getting a little ahead of ourselves," he says. "Where the world is with respect to avian flu right now warrants informed concern-but not wild-eyed anxiety. Mass irrational fear and clouded judgment can create more problems than the avian flu itself may end up causing." Most experts-and even the media of late-seem to be echoing DiCorpo's opinion. After the initial reporting frenzy, most media outlets have toned down their sensationalist coverage to focus on hard facts.

DiCorpo adds, "Obviously this is not something to be taken lightly or ignored. We have to be careful and vigilant about monitoring the situation and staying proactive about something that could have a profound effect on world health, travel and commerce. But now is not the time to be running to your doctor in mid-America, asking for Tamiflu. We are just not at that point, and hopefully we will never get there."

So what is important to know and consider?

The Avian Flu

Avian influenza is a contagious disease that normally only affects birds, but which on rare occasions crosses species barriers to infect humans and other animals. Flu virus infections can be low pathogenic, with mild symptoms, or high pathogenic, causing dramatic symptoms and a high mortality rate.

In the current scenario, the ratio of infected birds to affected humans is extremely low: 140 million to 118. However, the H5N1 strain (as it is known) is particularly virulent once it takes hold, with a 50% mortality rate.

Stages of a Pandemic

The World Health Organization classifies influenza pandemics into six phases:

Phase 1-No new flu viruses have been detected in humans. Low risk of infection.

Phase 2-No new flu viruses detected in humans, but an animal influenza poses substantial human risk.

Phase 3-Human infections with a new subtype, but little or no human-to-human spread.

Phase 4-Small clusters of infection with limited, localized human-to-human transmission. Virus not well adapted to humans.

Phase 5-Larger clusters but human-to-human spread still localized; virus is becoming better adapted to humans, but may not be fully transmissible yet.
Phase 6-Increased and sustained transmission in the general population.

So far, we have reached Phase 3. The coming weeks, months and years will determine whether the virus adapts and spreads up the phase cycle or is contained or eradicated.

The Good and the Bad

The Bad News	The Good News
Since 2004, there have been 130 cases of avian flu in humans, with 67 deaths.	Incidences have been primarily confined to Asia, and in nearly every case the victims had direct contact with infected birds. Human to human transmission has been very rare, and when it has occurred it resulted from extremely close personal contact and has not spread beyond one person.
The avian flu has "migrated" from Asia into parts of Europe.	The fact that it has migrated geographically does not affect its transmissibility to humans.
UN coordinator David Nabarro estimated that if an avian flu pandemic broke out there could be as many as 150 million deaths.	He later retracted the comment, calling it "imprecise." The World Health Organization puts the figure at anywhere between 2 and 7.4 million.
Scientists have recently decoded the 1918 flu virus that killed more than 50 million people and have found that it mutated to enable human to human transmission.	The current avian flu has not mutated for human to human transmission. Even if it does, world conditions have improved so significantly since 1918 that the mortality rate would be hugely lower. Modern governments possess antibiotics, antivirals, vaccines and equipment that were not even known of in 1918. Countries will be able to use resources, such as the military, that were unavailable or severely incapacitated amidst the fighting of World War I, to enforce quarantines and distribute supplies.
The avian flu has a 50% mortality rate, while the 1918 flu only killed 1 in 100.	The statistics are based on bird-to-human cases. Current avian flu may not become a human virus (a 1976 swine flu panic never materialized in humans, nor did significant numbers of West Nile, SARS, anthrax, etc., cases), and even if it does, its lethal capacity will be greatly diminished by having to mutate or combine with other viruses.
If the avian flu pandemic occurs, global economies will be sent reeling. The UK alone could see as much as an 8% decrease in Gross National Product. Tourism and its associated industries would be hard-hit in Europe, Asia and around the world.	Governments are taking a sophisticated and proactive stance to prevent an avian flu pandemic. Compromised bird flocks are being destroyed quickly and countries are working together to identify and quarantine victims immediately. For every business that is affected negatively by the notion of avian flu, there is another that is bolstered by it-pharmaceuticals, at-home entertainment, industrialized food production, etc.
Air travel makes the virus capable of traveling swiftly to different countries and continents; if the pandemic occurs medical facilities will be overwhelmed and there may be shortages of personnel who provide essential community services.	The World Health Organization has a network of 112 influenza monitors that fosters rapid detection and isolation of unusual influenza cases; airlines have been educated about how to handle and quarantine suspected infected passengers, particularly on routes from destinations that have confirmed cases, and the CDC has set up quarantine stations at 18 U.S. airports to monitor and respond to potential outbreaks.-these are just some of the measures taken to avoid pandemic and its associated problems.

How to Protect Yourself

Some general guidelines are:

Stay current on news developments about the avian flu.
Do not consume uncooked poultry or poultry products, including blood.
Avoid contact with wild birds and domesticated poultry (chickens, ducks, turkeys, geese, pigeons, quail) and their excretions.
Avoid settings where infected poultry may be present, such as commercial or backyard poultry farms and live poultry markets.
Wash your hands frequently with soap and water, or with waterless, alcohol-based hand sanitizing rubs when soap is not available.
Be vigilant when preparing food:

Separate raw meat from all other foods; do not use the same chopping board or knife for raw meat as for other foods.
Wash your hands between handling raw meat and other foods.
Do not place cooked meat back on the same plate or surface it was on before it was cooked.
Wash egg shells in soapy water before handling and cooking, and wash your hands afterwards.
Do not use raw or soft-boiled eggs in foods that will not be cooked.
Cook all poultry-based foods thoroughly, including eggs and blood. Egg yolks should not be runny or liquid. Cooking temperature for poultry meat should reach 158 degrees F to destroy influenza viruses.
Wash your hands, surfaces and utensils thoroughly with soap and water after handling raw poultry or eggs.

The CDC does not recommend use of masks or other personal protective equipment while in public areas

If you must travel to an area that has been affected by the avian flu, the CDC recommends the following:

Visit CDC's Travelers' Health webpage www.cdc.gov to educate yourself and others who may be traveling with you about any disease risks and CDC health recommendations for international travel in areas you plan to visit.
Be sure you are up to date with all your vaccinations, and see your doctor or health-care provider, ideally 4-6 weeks before travel, to get any additional vaccination medications or information you may need.
Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand gel for hand hygiene.
Identify in-country health-care resources in advance of your trip.

If you think you have been exposed to avian influenza:

Monitor your health for 10 days. The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.
If you become ill with fever and develop a cough or difficulty breathing or if you develop any illness during this 10-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following: 1) your symptoms, 2) where you traveled, and 3) if you have had direct contact with poultry. This way, he or she can be aware that you have traveled to an area reporting avian influenza.
Do not travel while sick, and limit contact with others as much as possible to help prevent the spread of any infectious illness.

Information for this article was adapted from Newsweek, USA Today, and the websites of the CDC and WHO.