What is Avian Flu

Avian Flu is a new strain of the influenza virus (labelled H5N1).  It probably originated in domestic ducks, and has since spread to other kinds of poultry. Other species like cats, tigers have also been affected.  But to date, Avian influenza still mainly is a disease which is affecting only poultry on a large scale and indeed is not restricted anymore to the boundaries of South East Asia. Apart from infected poultry in South East Asian countries, new cases of poultry infected with the H5N1 strain have been detected in Russia near Moscow, Kazakhstan (near Siberia) and more recently in Turkey, Romania, and Greece.

Transmission of Avian influenza has been detected from bird to human, but still only on a small scale among people living in close proximity to infected birds or working with infected poultry. In the past three years, these clusters of cases in humans have only occurred in 4 South East Asian countries, respectively, Vietnam, Thailand, Cambodia and Indonesia. In total there have been 112 proven cases of Avian influenza (H5N1) so far in humans, of which 57 have died. Until now there is still no evidence of human-to-human transmission of this H5N1 strain.

Why  could it be a Threat?

1. It is a new virus, therefore we have no natural immunity to it (as we do for other current flu strains such as Asian or Hong Kong human influenza). 
2. The mortality rate is high, initially around 58%, and affecting a broad age range. 
3. There is no vaccine available currently, although trials are under way. 
4. 70% of cases so far can be attributed to exposure from dead or sick poultry. For the other 30% of cases the exposure is not known, but might be from human-to-human transmission.   If human-to-human transmission does start to occur in the same manner as ‘normal flu’ the infection can rapidly spread world-wide. 
5. The virus is highly unstable, and able to mutate rapidly.  If the virus changes to recombine with the human influenza virus, human-to-human transmission will occur and can initiate a pandemic.

Who is Currently at Risk?

Mainly people living or working in close proximity with infected birds or poultry are mostly at risk. Next people living or working with known human cases (such as nursing them) may also be at risk. But business travellers attending the above mentioned countries are not at risk of acquiring avian flu in the course of their normal duties.

Can it be Treated?

In the absence of an available vaccine, the following is available in case there has been an identified risk contact with or exposure to Avian influenza:

• Early detection is crucial   
• Isolation from other contacts 
• In case flu symptoms develop (see below) treatment with the anti-viral agent Oseltamivir (Tamiflu) should be started within 36 hours for the length of five days. 
• Otherwise Tamiflu should be used in those situations as prophylaxis for seven days. 
• Continuous prophylactic Tamiflu usage should definitely be considered in business people working in or near poultry farms in countries with Avian influenza.

What are the Symptoms?

The symptoms are similar to a severe case of influenza, i.e.:

• High temperature 
• Headache 
• Muscle aches 
• Cough, sore throat 
• Sweats

The incubation period is unknown, but probably about one week.

Travel Advice

A management plan has to be developed for the individual employee who may have been in contact with patients with flu or work in infested poultry farms. The logistics of prophylaxis and treatment of workers must be crystal clear.

• A policy for hygiene and protection against avian influenza must be installed, with specific advice on prevention, vaccination and treatment of (bird-)flu.
• An Emergency Response Committee has to advise on travel restrictions for individual workers.
• Vaccination against influenza is strongly advised. Although not providing protection against avian flu, it prevents a H5N1 human infection, thus avoiding cross-infection.
• Travel health kits are mandatory. They should include a thermometer, alcohol-based wipes, masks, surgical gloves (non-sterile) and protective glasses.
• Anti-viral treatment will prevent, or treat influenza, both human and avian. Oseltamivir (Tamiflu^®) is the drug of choice. It cannot be provided “over the counter” or kept in large quantities in store, but has to be prescribed to the individual worker.

The Travel Clinic is willing and able to assist in the design of an Avian Flu Policy, the vaccination against influenza and the prescription of  Tamiflu^®.