|
Limiting Exposure to the Avian Flu
MICHAEL P. ZIMRING, M.D., Director
Center for Wilderness & Travel Medicine
Mercy Medical Center, Baltimore, Maryland
Imagine you are on vacation in Bangkok and develop a slight fever. You have a sore throat and achy muscles and all you want to do is get home. Nobody wants to be sick – especially when they are far away from home.
But should you come home? You realize that, during your trip, you visited a poultry market and now you wonder, “What if I have avian flu?” A human avian flu outbreak can have significant effects on the way we travel. International health regulations, airline rules, and your personal care may all be influenced. However, you can limit your exposure to diseases such as the avian flu by following these tips:
- Visit a travel clinic four to six weeks before your departure. Be sure to receive your flu vaccination and other necessary immunizations.
- While traveling, avoid poultry farms and markets where respiratory secretions and fecal contamination can be passed on to you.
- Hand washing is essential. I recommend carrying an alcohol based-soap with you.
- If you are in close proximity to birds, especially if you are in a country known for avian flu incidents, you may wish to consider using gloves and a mask, such as the ones found in a MEDEX traveler’s kit.
If you develop flu-like symptoms, you should seek local medical care. MEDEX can help you find a local medical facility offering quality healthcare. While the chances of contracting avian influenza are slim, it is best to make sure that you don’t bring the virus home. Limiting the number of people exposed to the virus will help control the disease and reduce the opportunities the virus has to mutate into a more dangerous pathogen.
If you become sick while traveling and are unsure of whether or not you should continue traveling, contact MEDEX. We will help you seek necessary medical attention and, depending on which MEDEX program you have, you may be able to easily change your flight options for a trip delay due to illness.
Every few years, there is an international incident to remind us of the dangers of traveling when sick– SARS jumped from Asia to Canada in 2003 and, in May of this year, a man with tuberculosis traveled around Europe and then returned to the United States. In both cases, travelers unnecessarily exposed other plane passengers, airline employees, and other people they encountered to their illnesses. We have to learn from such incidents. It is imperative that we be able to contain any potential avian flu outbreaks to one region of the world. All precautions should be taken to avoid diseases like the Avian Flu.
RISK COMMUNICATION: Start thinking in phases - risk communication phases (April 2007)
Posted: This article was re-published from the Apr. 19, 2007 CIDRAP Source Weekly Briefing
Dr. Peter Sandman
CIDRAP
You have a few crucial moments for talking about pandemic preparedness with your management and leadership teams.
Use them well.
This article was republished from CIDRAP Business Source and permission has expired. If you would like to read the entire article and find other pandemic planning resources, you may do so by signing up for a 14-day trial to the CIDRAP Business Source.
Pandemic Preparedness: Highlights From A Recent National Summit - CIDRAP (February 2007)
Posted: Wednesday, February 28, 2007
David Mair, Director of Client Relations
MEDEX Global Group, Inc.
What happened to the Avian Flu concerns?
That was one of several questions addressed the Second National Summit on Business Preparedness for Pandemic Influenza hosted in February by the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota.
During the summer of 2006, newspapers routinely carried front page stories about an outbreak of H5N1 influenza. Several American television networks telecast made-for-TV movies about an outbreak and its impact. More recently, though, it appears that the news has fallen from the mainstream media. But even as this was occurring, coverage of the pandemic potential increased dramatically in the business and financial press. Dr. Peter Sandman, a consultant to CIDRAP, explained this phenomenon as a result of the mainstream media’s inability to sustain such a story over a long period of time, also referred to as “pandemic fatigue.” This is, he indicated, in stark contrast to the business press’ capability of analyzing the impact of the same story from multiple angles with a more focused audience. The hope is that each sector of the business world will be ready for a pandemic, when and if one should occur, and the first step in pandemic preparations is to understand how it could affect you.
What seems clear from the messages delivered by public health, governmental, and private sector leaders at the CIDRAP Summit is that the threat of a pandemic influenza outbreak presents significant risk to businesses and individuals around the world. The timing of such an outbreak; the specific disease strain; the location of the initial outbreak; the nature of its spread and its severity are uncertain. What is more certain, however, is that organizations that fail to understand the implications or prepare for these variables will face difficult times during a pandemic.
The experts at the CIDRAP Summit addressed several common questions regarding the Avian Flu and its potential to develop into a pandemic:
1. Why is there such a strong belief there will be an influenza pandemic?
Since the 16 th century, there have been approximately three influenza pandemics each century, and it has been more than 50 years since we have last had a pandemic. In short, it seems that if the patterns of history remain the same, the world is due for a pandemic event.
2. Why do experts feel that the H5N1 virus will be the likely cause of the next pandemic?
There are several reasons why there is concern over the H5N1 virus:
- The virus has been circulating among poultry since 2003 and shows no loss of persistence in nature or virulence when transmitted to humans. In fact, the fatality rate among human cases has increased from 43% in 2005 to 61% today.
- The close proximity of poultry, other animals and humans in Asia creates a viral melting pot, enabling the virus to quickly transmit from host to host.
- An increasing number of bird cases are being reported in new locations, including recent outbreaks in the United Kingdom, Russia and parts of Africa.
- As Gregory Poland, MD, of the Mayo Clinic in Rochester, Minnesota, commented, H5N1 is “a teeming mass of constantly mutating viruses” now counted at 1600, instead of one single influenza strain.
- Mammals unknowingly fed ill poultry have contracted the disease and died.
According to the Centers for Disease Control and Prevention, three criteria must be fulfilled for a pandemic to occur:
- Humans must have little or no immunity to the disease;
- The disease must infect humans and cause harm;
- It must spread easily from human to human.
To date, this third criteria, the capacity to be spread easily between humans, is the only one keeping the current Avian Influenza situation from being declared a pandemic event.
3. How will a pandemic affect people throughout the world?
Dr. Margaret Chan, Director-General of the World Health Organization; Dr. Julie Gerberding of the Centers for Disease Control and Prevention, and other speakers addressed this question. There is no doubt among the experts that international spread will be widespread and rapid. The WHO expects a 20% illness rate among the population in many countries. They anticipate markedly higher attack and fatality rates in underdeveloped countries where co-infection with HIV, TB, malaria and other diseases exist unchecked. Although there are 27 trials underway around the world, few believe that a vaccine will be available during the first wave of a pandemic, antiviral medications (e.g., Tamiflu) will not be available in sufficient supplies, and hospital and medical care resources will be inadequate to meet demand.
4. What are the social concerns and how will they affect businesses?
Pandemics in the last two centuries have been accompanied by significant social disruption. What may make the next pandemic outbreak unique in the human experience is the global environment in which it will occur. For example, today’s transportation capabilities create unprecedented international mobility. We learned from the SARS outbreak only a few years ago how quickly a disease can spread from a single hotel in China to Canada, disrupting the country from one coast to the other. Many nations include in their respective response plans to close schools and suspend large gatherings in order to promote social distancing and slow the spread of a pandemic. The loss of school and child care facilities will result in increased absenteeism among workers unable to leave children, whether they are ill or not. Global news networks and the accelerated information flow of the Internet will push information from one corner of the world to another, and the accuracy of information will challenge decision-makers and individuals alike.
5. What is the current state of business preparedness?
A report by Deloitte & Touche released at the Summit spoke in part to the disconnect in business awareness. A survey of Chief Risk Officers showed that 74% rated human resource functions as likely to be very or severely affected by a pandemic outbreak. Approximately half of the Chief Risk Officers and Chief Financial Officers anticipated supply chains to be very or severely affected; however, only 6% of responding CFOs were confident their suppliers’ pandemic response plans were likely to be sufficient. Human Resources officers reported being prepared with their departmental plans for benefits and pay adaptations but believed an insufficient amount of funds were being set aside to address concerns. Conclusions offered from the survey results included a sense that corporate plans continue to be underfunded, operationally directed, disconnected interdepartmentally, and of low priority at the executive and directors levels.
Common Vaccinations that Could Save Your Life During a Pandemic
Posted: Monday, November 20, 2006
Dr. Walter B. Koppel, Medical Director
MEDEX Assistance Corporation, United States
Dr. Charlie Easmon, Medical Director
Number One Health, United Kingdom
With potential for a flu pandemic to occur within the next decade, a little planning now could save your life. In the New England Journal of Medicine, John F. Brundage examines relations between historical influenza pandemics and the related deaths caused by secondary bacterial infections (“Interactions Between Influenza and Bacterial Respiratory Pathogens”, May 2006). His review suggests that since many influenza related deaths are caused by pneumonia, meningitis, and Haemophilus, vaccinations against these diseases could prove beneficial in the event of a pandemic.
With a few vaccinations, you can limit your exposure to these diseases. If a pandemic should occur, such preparations could make a difference. It is precisely this thinking that has led pandemic researchers to now focus on ways of reducing the risk of influenza-bacterial interactions. Physicians around the globe have begun to carefully consider the following vaccinations as countermeasures against a potential pandemic.
Pneumococcal vaccine
The pneumococcal vaccine costs about $50 and is routine for people over the age of 65, people who are HIV-positive, and anyone else who is immunosuppressed. Regardless, healthy adults may be able to benefit from this vaccination, especially if you are traveling to a location in which a local flu pandemic is likely to occur.
Meningitis and Haemophilus vaccines
All adults can benefit from the meningitis (ACWY) vaccine and the Haemophilus (HIB) vaccine. Routine for British citizens, the necessity of these immunizations is debated among U.S. physicians. However, receiving these vaccinations during a WHO pre-pandemic phase means that you will have less to worry about should a pandemic occur. While the meningitis vaccine needs to be boosted every three years, the pneumococcal and the HIB vaccines are one-dose vaccinations.
If you plan on traveling to an area that has a higher risk for influenza, you may wish to consider these vaccines and discuss them with your physician. Health care workers may also wish to inoculate themselves against these diseases. The benefits of receiving them far outweigh the risks, and they could save your life in the event of a flu pandemic.
A Scientific Summary of the History of Avian Influenza
by
Dr. Muhammad Salman, MBBS; FCPS (Microbiology)
Consultant Microbiologist Public Health Laboratories Division
National Institute of Health, Islamabad, Pakistan
Avian influenza, or "bird flu", is a contagious disease of animals caused by viruses that normally infect only birds and, less commonly, pigs and other species. Pathogenicity of avian influenza viruses vary greatly and ranges from non-pathogenic to highly pathogenic types. Avian influenza viruses are widely distributed in wild birds like water fowls, geese and ducks, which serve as the natural reservoir of the virus.
Influenza infection in humans is an acute viral disease of respiratory tract. It is caused by Influenza A or B virus that attacks the upper respiratory tract and, rarely, the lungs. The infection spreads via airborne transmission or through direct contact with infected secretions. The patients can transmit the infection three to five days from clinical onset in adults and up to seven days in children.
Viral Characteristics
Influenza A viruses are sero-typed on the basis of two surface glycoproteins: haemagglutinin (H) and neuraminidase (N) antigens. A total of 16 H and 9 N types have been reported so far. Thus a large number of antigenic types of the virus exist. Most of the pathogenic avian influenza viruses isolated belong to H5 or H7 type. The Influenza A virus genome consists of 8 single stranded negative-sense RNA segments.
Because point mutations in genes encode the haemagglutinins or neuraminidase, the virus has a tremendous ability of antigenic variation by antigenic drift.. Rarely, antigenic shift can occur by the re-assortment of viral genes of two different influenza subtypes infecting the same host, such as avian influenza virus and human influenza virus simultaneously infecting pigs. Antigenic shift can also occur through direct transmission of avian viruses to humans with subsequent adoption to the new host (adoptive mutation). This process of gene-exchange (re-assortment) could produce new influenza viruses containing many different combinations of genes. The phenomenon was well established for Influenza pandemics of 1916-1918, 1938 and 1958.
The Spread of H5N1
Among influenza virus subtypes, H5N1 is particularly alarming for several reasons. H5N1 mutates rapidly with a recognized propensity to acquire genes from viruses infecting other animal species. It has the ability to cause severe disease in humans and has caused the largest number of cases of severe illness and death in humans during the recent years.
Domestic poultry, including chickens and turkeys, are particularly susceptible to epidemics of rapidly fatal influenza. Direct or indirect contact of domestic flocks with wild migratory waterfowl has been implicated as a frequent cause of epidemics. Live bird markets have also played an important role in the spread of epidemics. Birds that survive infection excrete virus for at least 10 days, orally and in feces, thus facilitating further spread at live poultry markets and by migratory birds. The quarantining of infected farms and destruction of infected or potentially exposed flocks are standard control measures. The first documented infection of humans with an avian influenza virus occurred in Hong Kong in 1997, when the H5N1 strain caused severe respiratory disease in 18 humans, resulting in six deaths. Genetic studies reveals that the virus had jumped directly from birds to humans, alarming public health authorities as the first instance that an avian influenza virus was transmitted directly to humans without first re-assorting in a mixing vessel, like a pig.
Preparing for a Pandemic
Combating avian influenza and Pandemic Influenza would be a difficult task in the absence of a broad and collaborative framework that provides human resources, training and supervision, as well as strengthens health services and logistics with regard to antiviral, vaccines and laboratory supplies. Governments should adopt multi-pronged strategies to control avian influenza at source in animals through active surveillance and culling of the infected flocks for the short- and medium terms and simultaneously preparing for pandemic influenza. All countries should develop a comprehensive pandemic preparedness plan having all of the internationally recommended components, e.g. clinical health services, emergency response, antiviral medicines, vaccines, surveillance, quarantine and containments and risk communication and health education.
Keeping in view the epidemiology, natural history, and management issues of influenza A (H5N1) disease in humans, there is an urgent need for more coordination in areas of clinical health services, epidemiology and lab based surveillance among institutions to limit the infection among birds.
References:
Beigel JH, Farrar J, Han MA, Hayden GF, Hyer R, De Jon DM et al. Avian Influenza A (H5N1) Infection in Humans. Review Article. N Engl J Med 2005; 353;13:1374-85
Osterholm TM. Preparing for next Pandemic. N Engl J Med 2005; 352;18:1839-42
Peiris JS, Yu WC, Leung CW et al. Re-emergence of fatal human influenza A subtype H5N1 disease.
Lancet 2004;363:617-9
Avian influenza (bird flu): an introduction. DCD Newsletter 2005;7:1-2
Preparing for the anticipated pandemic. DCE Newsletter 2005;7:6
Pandemic Flu update. CDC, August 2006
PHASE 3: What does it mean?
"A Phase Three (3) Pandemic Alert, is not cause for panic. It does mean that the potential for an outbreak is serious, and people and organizations should prepare a plan."
-- Dr. Walter B. Koppel, MD, MPH
Medical Director, MEDEX Assistance Corporation
Phase Three means that there has been increased distribution of a disease, with little or no human-to-human transmission. At this point, the World Health Organization (WHO) has confirmed only one case of human-to-human transmission of the H5N1 virus, in which the virus mutated and was passed to a third person. Officials confirm that the virus died with the third person and did not transmit to others.
Why the high concern?
Influenza viruses have the inherent characteristic of being able to mutate. We see this annually with seasonal human flu virus strains. H5N1, however, is a new strain to which people have no immunity. In addition, H5N1 has proven to have a high mortality
rate in humans, currently 63 percent to date in 2006.
If the virus continues to spread in humans and mutates
to a fully contagious virus, a worldwide pandemic
is likely. In this situation, all countries will be
affected and a large number of deaths will occur.
Of particular concern is the high incidence of previously
healthy and fairly young persons who have already
been hospitalized and who have died as a result of
contracting the H5N1 virus. If an Avian Flu pandemic
becomes reality, widespread illness will affect all
countries and in most areas, medical supplies will
be inadequate.
What can be done to limit the impact of Avian
Flu?
The key is prevention and preparation. Only with
the combined effort of public health officials, world
governments, private organizations and individuals,
can immense economic and social disruption be avoided.
Please reference the following resources for information
on what is being done and what you should do:
|
