• Avian Influenza

    (Bird Flu, H5N1 Infection)

    Definition

    Avian influenza is a strain of influenza that primarily infects birds. It is often called the bird flu. In Asia and Africa, there have been cases of avian influenza that have infected humans.
    To date there have been few cases of human illness. However, many infected patients have died. There is also concern that the virus could become more efficient at infecting humans. Some health experts are concerned that this could eventually cause a pandemic of this disease. A pandemic is a worldwide outbreak. However, the virus is not currently increasing in severity.
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    Causes

    Viruses belonging to the A type of influenza viruses cause avian influenza. Sometimes a virus can mutate. These mutations can allow a bird virus to infect pigs or humans. Humans who have close contact with infected birds or pigs can then contract the virus. There is also concern that the virus can mutate to allow it to pass between humans.
    The virus is not contracted through eating well-cooked poultry, eggs, or pork products. It is currently passed through contact with an infected animal’s:
    • Saliva or blood
    • Nasal secretions
    • Droppings

    Risk Factors

    Risk factors include:
      Close contact with infected animals, such as:
      • Ducks
      • Geese
      • Chickens
      • Turkeys
      • Pigs
      Recent travel to an area known to have cases of avian influenza, such as:
      • Thailand
      • China
      • Vietnam
      • Cambodia
      • Indonesia
      • Laos
      • The Netherlands
      • Egypt

    Symptoms

    If you have any of these symptoms, do not assume it is due to avian flu. These symptoms may be caused by other conditions.
    In more severe cases, pneumonia (worsening fever and cough along with shortness of breath), problems with blood clotting, and organ failure (involving kidney, liver, lungs, and heart) can occur.

    Diagnosis

    Your doctor will ask about your symptoms and medical history. A physical exam will be done. The virus can be identified through a blood test.

    Treatment

    Talk with your doctor about the best plan for you. Research is still being done to find an antiviral agent that works against the virus. Some current agents are ineffective against the virus. Antiviral agents that appear effective against the avian flu include:
      Zanamivir (Relenza) Oseltamivir (Tamiflu)—This is the preferred medication to treat avian flu.
      • Oseltamivir (and perhaps zanamivir) may increase the risk of self-injury and confusion shortly after taking, especially in children. Children should be closely monitored for signs of unusual behavior.
    These medications do not cure the flu. They may help relieve symptoms and decrease the duration of the illness. They must be taken within 48 hours of the first symptoms.

    Prevention

    The overall risk of getting avian flu is small. If you are traveling to areas where there have been cases of avian flu, take these steps to reduce your risk:
    • Avoid traveling to areas where there are avian influenza outbreaks. For the latest travel information, visit the CDC's Traveler's Health page .
    • Avoid contact with potentially infected poultry or swine. This includes farms or open air markets.
    • Avoid eating raw or under-cooked eggs. Egg shells may be contaminated with bird droppings.
    • Raw poultry could be contaminated with bird droppings, saliva, or mucus. Cook poultry thoroughly. Carefully clean your hands. Clean all cooking surfaces, utensils, and cutting boards. Cooked poultry will not transmit the avian influenza virus.
    • Use excellent hand washing techniques if you might be in an area where exposure to the avian influenza virus is possible. Be sure that the person preparing your food washes his hands, as well.
    • Use a hand sanitizer if clean water is not available for washing.
    The Food and Drug Administration (FDA) has a vaccine to protect against H5N1 in adults aged 18-64. The government has this vaccine in case of an outbreak.

    RESOURCES

    Centers for Disease Control http://www.cdc.gov/

    Flu.gov http://www.flu.gov/

    World Health Organization http://www.who.int/

    CANADIAN RESOURCES

    Canadian Medical Association http://www.cma.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Avian influenza. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php . Updated August 2009. Accessed August 4, 2009.

    The avian flu vaccine. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated August 2009. Accessed August 24, 2009.

    Cohen J, Powderly WG. Infectious Diseases . 2nd ed. New York, NY: Elsevier; 2004.

    Cornelissen LA, de Vries RP, de Boer-Luijtze EA, Rigter A, Rottier PJ, de Haan CA. A single immunization with soluble recombinant trimeric hemagglutinin protects chickens against highly pathogenic avian influenza virus H5N1. PLoS One. 2010;5(5):e10645.

    Cumulative number of confirmed human cases of avian influenza A/(H5N1) reported to WHO. World Health Organization website. Available at: http://www.who.int/csr/disease/avian%5Finfluenza/country/cases%5Ftable%5F2011%5F01%5F20/en/index.html . Updated January 20, 2011. Accessed January 21, 2011.

    Kilany WH, Arafa A, Erfan AM, et al. Isolation of highly pathogenic avian influenza H5N1 from table eggs after vaccinal break in commercial layer flock. Avian Dis. 2010;54(3):1115-1119.

    New-style bird flu vaccine shows promise. Reuters UK website. Available at: http://uk.reuters.com/article/idUKN11302781.%5FCH%5F.242020080612 . Published June 12, 2008. Accessed August 4, 2009.

    Weir E, Wong T, Gemmill T. Avian influenza outbreak: update. CMAJ . 2004;170:785-786.

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