Avian Influenza Health Emergency Alert Response Team Denton County Health Department

Covered Topics What is avian influenza? Avian influenza and humans Symptoms of avian influenza Avian influenza treatment Avian influenza and Pandemic influenza Prevention of Avian or Pandemic Influenza Home Care for Avian or Pandemic Influenza Denton County Preparedness Personal Preparedness

Avian influenza “Bird flu” Occurs naturally in birds Wild birds carry the viruses in their intestines, but don’t usually get sick. Can make chickens, ducks, and turkeys very sick and kill them. It is very contagious to birds

Avian Influenza A H5N1 virus A type of influenza that occurs mainly in birds Outbreaks have occurred in poultry in Asian countries. Humans have gotten sick in many Eastern Asian countries. This is the type of flu that many scientists are watching for a possible worldwide outbreak

Spread of Avian Influenza Migratory birds pass it on to each other. Infected birds shed the virus and susceptible birds become infected. Poultry become infected by the migratory birds or by other poultry. Humans become infected by infected poultry or contaminated surfaces. If avian flu becomes contagious between people, it will be spread like other flu viruses. Flu viruses are spread when contaminated droplets exit the mouth or nose of an infected person and the virus comes in contact with others.

Bird flu human infection Avian influenza (bird flu) viruses usually do not make humans sick. Avian influenza does not spread easily from bird to humans. Avian Influenza H5N1 is the kind of bird flu that has made some people sick in Asia. As of October 2005, the World Health Organization (WHO) reports 117 confirmed cases of H5N1 bird flu in humans. Sixty of those 117 people died. Most people got sick because of contact with sick poultry (chickens, ducks, turkeys) or by touching contaminated surfaces. There is no evidence that H5N1 can spread from person to person. Since 2002, more than 100 human cases of avian influenza have occurred in Eastern Asia; however, this is a small number compared to the large number of birds affected and the many opportunities for human exposure.

Avian Influenza Symptoms in Humans Symptoms may vary depending on the type Typical flu like symptoms Fever Headache Muscle aches Cough Sore throat Eye Infections Pneumonia Acute respiratory distress

Treatment for Avian Influenza The same medication used for regular seasonal flu may work for bird flu infections in humans. Check with a physician about specific treatment plans. Two drugs, oseltamirvir (commercially known as Tamiflu) and zanamivir (commercially known as Relenza) can reduce the severity and duration of the illness caused by seasonal influenza. For human cases of H5N1, the drugs may increase a person’s chance of survival, if administered early, but data is limited. The H5N1 virus is expected to be susceptible to the neuraminidase inhibitors. M2 inhibitors, amantadine and rimantadine, could be used against pandemic influenza, but drug resistance can develop rapidly and could limit their effectiveness. Antibiotics may be used for secondary bacterial infections that often times develop.

U.S. Outbreak Risk The current risk in the United States is low. The H5N1 virus has not been found in the U.S. and there have been no human cases. It is possible for travelers to countries in Asia to become infected. The Centers for Disease Control and Prevention (CDC) recommends that travelers to countries in Asia with known outbreaks of H5N1 influenza avoid poultry farms, contact with animals in live food markets, and any surface that appears to be contaminated with poultry or animal feces.

Before you travel to an affected area… Visit CDC's Travelers' Health website on Southeast Asia at http://www.cdc.gov/travel/seasia.htm 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. For other information about avian influenza, see this website: http://www.cdc.gov/flu/avian/index.htm. 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. See the Travelers Health Kit page in Health Information for International Travel for other suggested items. Identify in-country health-care resources in advance of your trip. Check your health insurance plan or get additional insurance that covers medical evacuation in case you become sick. Information about medical evacuation services is provided on the U.S. Department of State web page Medical Information for Americans Traveling Abroad, at http://travel.state.gov/travel/tips/health/health_1185.html.

During travel to an affected area… Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or secretions. As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often with soap and water removes potentially infectious material from your skin and helps prevent disease transmission. Waterless alcohol-based hand gels may be used when soap is not available and hands are not visibly soiled. Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked. If you become sick with symptoms such as a fever, difficulty breathing, or cough, or with any illness that requires prompt medical attention, a U.S. consular officer can assist you in locating medical services and informing your family or friends. Inform your health care provider of any possible exposures to avian influenza. You should defer further travel until you are free of symptoms, unless your travel is health-related.

After you return from an affected area… Monitor your health for 10 days. If you become ill with fever and develop a cough, sore throat, or difficulty breathing or if you develop any illness with fever 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 ill, unless you are seeking medical care. Limiting contact with others as much as possible can help prevent the spread of an infectious illness.

Nations With Confirmed Cases H5N1 Avian Influenza (July 7, 2006) Source: U.S. Department of Health and Human Services Pandemic Influenza website, www.pandemicflu.gov

National Avian Influenza Surveillance Information Birds Tested by State in the 2006 Sampling Season Surveillence News: Test results for 11801 samples have been entered into HEDDS as of August 25, 2006 Highly pathogenic H5N1 avian influenza virus has NOT been detected in these samples Information courtesy of National HPAI Early Detection Data System (HEDDS)

Pandemic vs. Avian Influenza Avian influenza is only referring to influenza strains that usually affect birds. Avian influenza viruses can mutate to become infectious to humans (as in the case with H5N1) Avian influenza has not yet shown the ability to be contagious in humans. If Avian influenza develops that ability, it could turn into pandemic influenza. An influenza pandemic is caused by humans becoming infected by a new strain of influenza that they have little or no immunity for. Since their immune systems do not have the capacity to fight off infection, people often become sicker, quicker. If Avian influenza becomes contagious, it could easily turn into pandemic influenza.

Past Influenza Pandemics 3 in the last century “Spanish influenza” 1918 40-50 million people died worldwide One of the deadliest outbreaks in human history “Asian influenza” 1957 2 million people died worldwide “Hong Kong influenza” 1968 1 million people died worldwide

What if Avian Influenza starts to make Americans sick? Use good hygiene practices. If you have contact with a sick person or animal, birds included, wash your hands. Clean any surfaces where poultry has been. If you or one of your family members feels sick and has a fever, keep that family member home. If you or one of your family members gets bird flu, you will be asked to stay at home and the health department will call you everyday to check your temperature and symptoms. If you are too sick to stay at home, go to your nearest hospital.

What if Avian Influenza starts to make Americans sick? (continued) To control the spread of the bird flu from person to person People may be asked to stay at home. Large events where people would gather (such as concerts or festivals) may be cancelled. Movement from home out to the public (such as going shopping) may be restricted. Schools may be closed Quarantine and Isolation

Preventing Pandemic Flu Practice healthy habits to keep you and others from getting and passing on the virus. Clean your hands often with soap and water or alcohol based hand sanitizer Cover your mouth and nose with tissue when you cough or sneeze and clean your hands afterward. Put used tissues in a trashcan. Cough or sneeze into your upper sleeve if you don’t have a tissue. Keep your hands away from eyes, nose and mouth to prevent germs from getting into your body.

Practice Correct Handwashing 1. Wet hands with warm running water. 2. Add soap, then rub hands together to make a soapy lather. Make sure to wash the front and back of your hands, nails and nail beds, wrists, and between fingers. 3. Wash hands for 20 seconds or the length of singing “Happy Birthday”. 4. Rinse hands with warm running water with your hands pointed down. 5. Dry hands thoroughly with a clean towel and use that towel to turn off the water and open the door.

Preventing the Spread of Pandemic Flu A person with signs of flu should: Stay home from work, school and errands and avoid contact with others. Consider wearing a surgical mask when around others.

When a Household Member Is Sick Keep everyone’s personal items separate and avoid sharing personal items. Disinfect door knobs, switches, handles, toys and other commonly touched surfaces. Wash clothes with detergent and very hot water. Wash your hands after handling dirty laundry. Wear disposable gloves when in contact with or cleaning up body fluids. One person should be the caregiver. He or she may benefit by wearing a mask when giving care. Disinfectant: 1 gallon water ¼ cup bleach Mix up a fresh batch everytime you use it.

Care for Someone with Flu A person recovering from flu should have: Rest and plenty of liquids No alcohol or tobacco Medication to relieve flue symptoms In some cases, a health care professional may prescribe antiviral medications to treat the flu. Antibiotics don’t cure it.

Monitor Pandemic Flu Symptoms Keep a care log with date, time, fever, symptoms, medicine given and dosage. Update every 4 hours or when symptoms change. Call a health care provider again if the person has: High fever Shaking chills Coughing that produces thick mucus Dehydration If existing conditions (such as heart disease or diabetes) become worse If you cannot reach a health care provider, call 9-1-1 if the person has any signs below: Irritability and/or confusion Difficulty breathing or chest pain with breathing Bluish skin Stiff neck Inability to move an arm or leg First time seizure

What is Denton County doing to prepare for Avian or Pandemic influenza? Continuous surveillance Pandemic influenza plans are in place to be implemented if the need arises. Exercising mass dispensing clinic operations Communicable Disease Response Team (CDRT) meetings bi-monthly

What can I do to prepare for Pandemic Flu? Make a plan NOW for a flu pandemic. Figure out what you will do if members of your household have to stay home from work or school or stay separated from others for a period of time. Prepare an emergency “Stay Kit” and “Go Kit”. Prepare a Pandemic Flu caregiving supplies kit.

Pandemic Flu Caregiving Supplies Thermometer Soap Box of disposable gloves Acetaminophen Ibuprophen Bleach Alcohol-based hand sanitizer Paper towels Tissues Surgical masks

For Additional Information www.pandemic.dentoncounty.com

References American Red Cross, www.redcross.org Centers for Disease Control and Prevention (CDC), www.cdc.gov Denton County Health Department, www.dentoncounty.com/heart or www.pandemic.dentoncounty.com National Geographic Society, www.nationalgeographic.com World Health Organization (WHO), www.who.int