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Bird Flu (Avian Influenza)

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What Is Bird Flu?

Also called: avian flu, avian influenza, Influenza A (H5N1)

Bird flu-- also known as avian influenza -- is an infectious disease caused by specific types of viruses.  These viruses occur naturally in many species of birds, thus the term bird flu.

The terms "Avian Influenza" and "Bird Flu" refer to the same thing, and are used interchangeably.

Many wild bird species carry the virus in their intestines without becoming sick.  Sometimes these wild birds pass the bird flu viruses to domestic birds such as chickens, ducks, and turkeys.  When domestic birds catch these viruses, they get very sick and usually die.

Avian influenza is very contagious among domestic birds.  Because the virus is carried in the intestines, it is present in the birds' excrement.  As anyone who has ever visited a poultry farm knows, chickens and other fowl defecate very frequently.  When the other birds step in it (which they always seem to do!) or otherwise come into contact with the excrement, they acquire the virus and become sick.

The virus also is present in mucus and the respiratory secretions of infected animals.  The virus can be transmitted through contact with the secretions of infected animals.

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Bird Flu in Humans:

Avian influenza viruses usually do not infect humans, however there have been a small number of confirmed cases since 1997.  According to the U.S. Centers for Disease Control and Prevention (CDC), which tracks information about cases of this disease, most cases of avian influenza infection in humans are thought to have resulted from direct contact with infected poultry, or with surfaces contaminated by infected poultry.

So far, person-to-person transmission of this disease has been very rare.

Symptoms of bird flu in humans sometimes resemble those of more common kinds of seasonal flu: fever, cough, sore throat, and muscle aches.  Other cases have manifested as eye infections.

In more serious cases, some of which have resulted in death, symptoms have progressed to severe respiratory distress and pneumonia.

All viruses, including those that cause avian influenza, have the ability to mutate or change.  Scientists fear that the H5N1 virus eventually will develop characteristics that will allow it to be spread easily from person to person.  Since humans do not have a natural immunity to this virus, a worldwide outbreak (pandemic) could result.

So far there is no vaccination available against avian influenza, although scientists currently are working to develop such a vaccine.

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Risk to Aircrews:

Crews who fly international routes to countries where there are outbreaks of bird flu may be at risk for contracting bird flu if they visit outdoor markets or poultry farms on their layovers in affected countries, or if they purchase or handle poultry that is live, raw or not thoroughly cooked.

Crews should follow the advice of the CDC, that "travelers to countries with known outbreaks of Influenza A (H5N1) avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals."

Of particular concern are crews working on corporate and other private aircraft on trips to areas where there are bird flu outbreaks.  In most cases, Flight Attendants on privately owned aircraft are responsible for arranging for catering.  As well, many corporate flight attendants prepare food themselves for consumption aboard their aircraft.  At this point in time we would advise against shopping for, or purchasing, any kind of poultry in countries known to have had recent outbreaks of avian influenza, just to be on the safe side!

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Affected Locations:

Since late 2003, the particular strain of bird flu virus, known as the Avian Influenza A (H5N1) virus, has been causing outbreaks in poultry flocks - first in Asia, and more recently in various locations in Europe, Africa, and the Middle East.

Poultry outbreaks were reported in Malaysia and Laos during 2004.  During 2005 and 2006, outbreaks of H5N1 infection among poultry and/or wild birds have been confirmed in Afghanistan, Albania, Austria, Azerbaijan, Bosnia and Herzegovina, Bulgaria, Burkina Faso, Cambodia, Cameroon, China, Croatia, Czech Republic, Denmark, Djibouti, Egypt, France, Georgia, Germany, Greece, Hong Kong, Hungary, India, Indonesia, Iraq, Iran, Israel, Italy, Ivory Coast, Japan, Jordan, Kazakhstan, Laos, Malaysia, Mongolia, Myanmar (Burma), Niger, Nigeria, Pakistan, Poland, Romania, Russia, Serbia and Montenegro, Slovakia, Slovenia, South Korea, Spain, Sudan, Sweden, Switzerland, Thailand, Turkey, Ukraine, United Kingdom, and Vietnam.

From 2003 through the present time, human infections with H5N1 have occurred in the following countries: Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey, and Vietnam.

The number of humans who became infected during these outbreaks is still very small, however the death rate for humans positively diagnosed as being infected with the H5N1 virus is high -- around 50%.

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Medication Options for Avian Influenza:

While there is no vaccine to prevent avian influenza, certain antiviral drugs are available for the treatment of the disease.

Two such drugs are currently available:

• oseltamivir - brand name Tamiflu, an oral medication manufactured by Roche Laboratories
• zanamivir - brand name Relenza, an inhaled medication manufactured by Glaxo Wellcome

These drugs, known as neuraminidase inhibitors, do not cure or prevent avian influenza.  They can reduce the length and severity of the symptoms of the illness.

Tamiflu® and Relenza® are available only by prescription.  They are recommended for treatment of at-risk adults who are able to begin treatment within 48 hours of onset of symptoms.

If you are in, or have recently traveled to, a location where an outbreak of avian influenza is underway, and you experience symptoms of flu, you would do well to seek medical care as soon as possible, and to request a prescription for one of these drugs.

Crews who travel to areas where there are outbreaks of avian influenza, and especially those areas where human cases have been identified, should consider seeing their personal physician or their company's medical officer to discuss the risk prior to departure.

In late 2005 there were reports of a few humans with avian flu for whom administration of Tamiflu® had little benefit.  However, these appear to be exceptions.

Until such time as a vaccine becomes available, taking along a supply of Tamiflu® or Relenza® still may be a good idea, so that if crewmembers  become ill they can begin to take the medication without delay.

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How to Deal With Suspected Cases of Infectious Disease:

Guidelines for Air Transport Employees

In 2005, the International Air Transport Association (IATA) published a set of general guidelines for air transport employees:

• for cabin crews when facing a suspected case of communicable disease on board
• for passenger agents (check in and gate) when facing a suspected case of communicable disease at the departure airport
• for cleaning crews who have to clean an arriving aircraft with a suspected case of communicable disease
• for maintenance crews who have to do maintenance on an arriving aircraft with a suspected case of communicable disease
• for cargo and baggage handlers who have to handle cargo or baggage transported by an aircraft arriving from an affected area or carrying a suspected case of communicable disease.

We urge aviation personnel to familiarize themselves with this set of guidelines from IATA.

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News About Bird Flu (Avian Influenza):

Click here for recent news stories about Avian Influenza. - updated regularly!

Resources About Bird Flu (Avian Influenza):

Here are some trustworthy on-line sources of information related to the topic of Bird Flu (Avian Influenza).

Avian Influenza (Bird Flu): Implications for Human Disease - Center for Infectious Disease Research & Policy, October, 2006

Bird flu fears: Why prepare now for bird flu? - MayoClinic.com, October 2006

National Strategy for Pandemic Influenza: Implementation Plan - The White House, May 2006    [PDF format - 233 pages]

The Health Care Response to Pandemic Influenza - Position Paper, American College of Physicians, April 2006    [PDF format - 25 pages]

Reusability of Facemasks During an Influenza Pandemic: Facing the Flu - National Institute of Medicine, April 2006    [PDF format - 4 pages]

Information about Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus - Key Facts from the U.S. Centers for Disease Control & Prevention, January 2006    [PDF format]

Current WHO phase of pandemic alert - World Health Organization

Interactive Avian Flu Outbreak Map - FutureCrisis.com

Bird Flu Special Report - NewScientist.com, updated regularly

Pandemic influenza - Government of Canada

Pandemic flu - U.K. Dept. of Health, October 2005

Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad - Recommendations from the U.S. Centers for Disease Control & Prevention  [regularly updated]

Avian Influenza Situation Updates - World Health Organization, Communicable Disease Surveillance & Response  [regularly updated]

Avian Influenza - World Health Organization, Communicable Disease Surveillance & Response  [regularly updated]

Avian Influenza (Bird Flu) - U.S. Centers for Disease Control & Prevention  [regularly updated]

Ten things you need to know about pandemic influenza - World Health Organization

Protecting Yourself from Flu Pandemic - Mayo Clinic Consumer Health

Bird Flu (avian influenza) - information from MayoClinic.com

Joint position statement of the Infectious Diseases Society of America and Society for Healthcare Epidemiology of America on antiviral stockpiling for influenza preparedness - October, 2005    [PDF format]

Bird flu vaccines: Challenges of preventing a pandemic - MayoClinic.com, May, 2006

Questions & Answers: H5N1 Avian Flu Vaccine Trials - U.S. National Institute of Allergy & Infectious Diseases, May, 2006

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References:

In the interest of facilitating further research on the topic of Bird Flu (Avian Influenza), we have compiled a list journal articles and other references related to the topic.

Some of the items listed here were used as source material to prepare this information page about Bird Flu.

Click here to view references.

If you know of reference material about Avian Influenza that you think should be included on this list, please click here to submit the information.

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