What You Can Do; What the Government Is Doing
By Daniel J. DeNoon
WebMD Feature
Reviewed by Louise Chang, MD
WebMD answers 10 common questions about bird flu.
1. Is a bird flu pandemic imminent?
Short answer: probably not. But there are many unknowns involved, making accurate prediction impossible.
Sooner or later, pandemic flu will happen. Flu pandemics sweep the globe from time to time as new flu bugs emerge. These bugs cause global epidemics --pandemics -- because humans have little or no immunity to these viruses. Sometimes, as in the war-torn world of 1918, it's a terrible plague. Sometimes, as in 1957 and 1968, it's relatively mild.
Bird flu is still a bird disease. The H5N1 bird flu in Asia does not spread well from person to person. It's a leading contender to be the next pandemic flu bug because it has caused an unprecedented epidemic in poultry and wild birds across Asia and Eastern Europe. But nobody knows for sure whether this will be the flu that causes the next human pandemic.
Bird flu could become a human flu in two ways.
If a person were infected with a human flu and the bird flu at the same time, the two viruses could swap genes -- reassort -- and a human version of bird
flu could emerge. This is what happened in the last two flu pandemics in 1957 and 1968.
Bird flu could also evolve into a form adapted to humans, as was the case in the 1918 flu pandemic. There's evidence the H5N1 bird flu virus has begun this process, but scientists say it isn't yet very far along. Nevertheless, a few H5N1 viruses isolated from humans have acquired some key 1918-like mutations.
At a World Health Organization news conference in May 2005, Klaus Stöhr, PhD, DVM, project leader for the WHO's Global Influenza Program, was asked whether a bird flu pandemic is imminent.
"With this virus we have had very many surprises; we have had a very steep learning curve," Stöhr said. "We are seeing that it is changing very rapidly.
We have also seen that it is not reassorting as everybody thought 18 months ago. So we do not know if a pandemic can occur next week or next year, or perhaps if another virus is going to cause a pandemic. We should simply continue with our pandemic preparedness."
2. Is there a cure for bird flu?
No. There's no cure for any kind of flu.
The H5N1 bird flu bug has been particularly deadly for people unlucky enough to catch it from poultry. But if the bug learns to spread among humans, it almost certainly won't be as deadly as it is now, says Ira Longini, PhD, professor of biostatistics at Emory University's Rollins School of Public Health in Atlanta.
"Avian H5N1 looks like a [very high] case fatality in humans. But this has never been true of any human strain," Longini told WebMD. "There has never been any human influenza virus that has behaved that way in recorded or even unrecorded history. The case fatality of even highly virulent flu strains are a couple of deaths per 10,000 people."
3. What can I do about bird flu?
If a bird flu pandemic occurs, there's a very good way to minimize the chance of getting infected: Wash your hands. Frequent hand washing is the best way to avoid a viral infection -- including the flu. Remember to use soap and warm water, and to scrub all parts of the hand. The rule of thumb, as it were, is to scrub the hands and fingers until you finish singing the alphabet song to yourself.
Should a flu pandemic break out, pay attention to news reports, and follow public health advisories. Panic is the least helpful response to any emergency.
It's easy to come up with very scary worst-case scenarios for a bird flu pandemic. The worst case is rarely the actual case, but it's wise to be prepared for an emergency.
It's definitely a good idea to provide your household with the items in the government-recommended checklist. How much of these supplies should you have?
In any given community, an outbreak is expected to last six to eight weeks. This would be followed by at least two new pandemic waves.
Do you need a protective face mask? That's one item notably missing from the government checklist.
Flu most often spreads from large droplets coughed or sneezed from a sick person. These large droplets don't travel more than 3 feet. People are most likely to spread flu viruses in the first two days of illness, although they first become infectious up to a day earlier.
If a sick person can tolerate it, a normal surgical mask (tie on) or procedure mask (ear loops) would make them less likely to spread infection. The CDC advises offering these masks to a person infected with flu-related cough. If a mask isn't available, coughing or sneezing into a tissue would work almost as well.
The World Health Organization says that face masks aren't likely to significantly affect the spread of a pandemic virus. They don't advise them -- but as people are going to use them anyway, they don't advise against them, either.
Flu expert John Treanor, MD, tells WebMD that wearing a facemask would help a little bit: It would stop you from touching your mouth, eyes, or nose. That would help, because a major mode of flu transmission is from touching people or surfaces contaminated with flu virus and then touching your face.
But no expert really expects facemasks to prevent the spread of pandemic flu virus in a community. Everybody wore one in 1918; it was still a terrible pandemic.
The most effective facemasks for protecting uninfected people, Treanor says, would be the N95-rated masks. These disposable masks are relatively cheap -- although more expensive than surgical masks -- but likely will be in short supply if a pandemic arrives. They should offer "some protection," Treanor says, but "no one thinks they will be completely effective." N95 masks aren't necessary for infected people.
Those caring for sick people during a flu pandemic should wear a facemask, according to WHO and CDC recommendations. The best way to limit the spread of flu isn't a facemask. It's following these simple hygiene rules:
* Wash your hands often using soap and water. You can also use an alcohol-based hand sanitizer.
* When you cough or sneeze, use a tissue to cover your mouth and nose. Discard used tissues in a wastebasket.
* Don't have a tissue? Cough or sneeze into your upper sleeve.
* Clean your hands after coughing or sneezing. Use soap and water or an alcohol hand sanitizer.
* Stay at home if you are sick.
Even if you get sick during a flu pandemic, you're less likely to get severely ill if you're healthy. If you're worried about getting the flu:
* Eat a balanced diet with plenty of vegetables, whole grains, and low-fat dairy products.
* Drink a lot of water. If you drink alcohol, be moderate.
* Regular exercise is essential for good health.
* Get a full night's sleep every night.
4. What can the government do about bird flu?
The U.S. has a pandemic flu preparedness plan. This includes plans for deciding which people most urgently need scarce hospital beds and medicines, deploying response teams, increasing hospital capacity, and, when necessary, enforcing patient isolation and quarantine.
The government will try to delay the arrival of a flu pandemic by isolating ill travelers arriving from affected areas. This is not expected to prevent a pandemic from sweeping the country.
In the event of a flu pandemic, the first thing that will happen is that schools will close. Public gatherings will be discouraged or forbidden. People will be urged to work from home.
It's expected that about 40% of children and 20% of working adults will get the flu during a pandemic. Overall, about a third of the population is expected to get ill. At least half of infected people are expected to seek medical care.
The government is stockpiling antiviral medicines. How large this stockpile will be depends on how soon a pandemic hits. Eventually, the U.S. hopes to stockpile enough flu drugs to treat 25% of the U.S. population.
The government will deploy its stockpiled bird-flu vaccine, but it's not clear this will be effective. A truly effective vaccine should start to appear about six months after the pandemic begins. It will take two vaccinations, weeks apart, for a person to become protected.
Vaccines will be distributed to people in order of priority, in two tiers, with group A having the highest priority in each tier. This list, from the U.S. Department of Health and Human Services, does not include the 1.5 million members of the military considered essential to ongoing operations and military medicine.
Tier 1, Group A:
* The approximately 40,000 people essential to vaccine manufacture.
* Medical workers with direct patient contact
Tier 1, Group B:
* People with two medical conditions that put them at high risk of flu complications
* People with a past history of flu hospitalization
Tier 1, Group C:
* Pregnant women
* Household contacts of people with immune-system problems (such as transplants or AIDS) that prevent them from being vaccinated
* Household contacts of children under 6 months of age
Tier 1, Group D:
* Emergency response workers critical to pandemic response
* Key government leaders
Tier 2, Group A:
* Healthy people aged 65 and older
* People aged 6 months to 64 years with one medical condition that puts them at high risk of flu complications
* Healthy children aged 6 to 23 months
Tier 2, Group B:
* Emergency responders not critical to pandemic response
* Public safety workers (firefighters, police, 911 dispatchers, correctional facility staff)
* Utility workers essential for maintaining power, water, and sewage systems
* Transportation workers transporting fuel, water, food, and medical supplies
* Transportation workers providing public ground transportation
* Telecommunications and internet technology workers essential for network operation and maintenance
Tier 3:
* Other key government health decision-makers
* Funeral directors and embalmers
Tier 4:
* Healthy people aged 2 to 64 years not included in the above categories.
5. What good are antiviral drugs?
Antiviral drugs taken within 48 hours of the first symptoms -- such as a sudden fever -- make the illness less severe. The sooner after infection these drugs are taken, the better.
The H5N1 bird flu is resistant to an older and less potent class of flu drugs, which includes Symmetrel and Flumadine. These drugs won't work and would not be used in bird flu pandemic.
Newer and more effective flu drugs, Tamiflu and Relenza, can still work against H5N1 viruses. However, several bird flu viruses isolated from infected humans have already become resistant to Tamiflu.
Relenza is sprayed in the nose. It is extremely effective at neutralizing flu viruses. But people who get bird flu from poultry tend to get infections deep in their respiratory tracts. It's not at all clear that Relenza could reach such deep-seated infections.
Could flu drugs protect people from getting the flu? Yes and no.
People who are stockpiling Tamiflu likely will take the drugs at the wrong time, in the wrong way. That's likely to offer little protection -- and to spur the virus to become even more resistant to Tamiflu.
But in a community experiencing a flu pandemic, Tamiflu and Relenza could be quite effective, says flu expert Anne Moscona, MD, professor of pediatrics and microbiology and immunology, and vice chairwoman of pediatrics research at Weill Medical College of Cornell University in New York.
The drugs could be used to protect people with known exposure to someone infected with pandemic flu virus.
"Nobody says these drugs are going to protect everybody," Moscona tells WebMD. "But in an epidemic, a drug that prevents as little as 50% of transmission, even that has a role."
Vaccines, not antiviral drugs, are the key to stopping the flu. An experimental H5N1 vaccine has been made -- a major scientific achievement. New ways of using it already are in the works.
But the first batch of this prototype vaccine likely will not be a good match for whatever bird flu virus eventually emerges to cause a pandemic. New batches of vaccine will have to be made. That process would take more than a year before most people can be immunized. And it will take two shots, weeks
apart, before a person is protected. Meanwhile, experts suspect that modern transportation would carry flu around the world.
Since a vaccine won't immediately be available, flu drugs will be a major line of defense. But there won't be enough of the drugs to go around unless the next pandemic waits several years to strike.
6. Should individuals stock up on flu drugs?
No. Several flu experts tell WebMD that they are not stocking up on flu drugs, and they strongly recommend that individuals follow their lead.
Why? First of all, the drugs are in short supply. In the event of a pandemic, public health workers will need all the flu drugs they can get in order to treat people actually exposed to the virus. The drugs won't do nearly as much good sitting in people's medicine cabinets.
And even if you had the drugs on hand, when would you take them? Without a flu test, it's hard to know whether your symptoms are the flu or another respiratory infection. And the pills only work against the flu.
7. Can you get bird flu from eating chicken or other poultry?
No, not if the meat is fully cooked. Cooking kills flu viruses in poultry, meat, and eggs.
The bird flu virus can survive on raw meat from infected poultry. Proper hygiene -- hand washing and the disinfecting of all surfaces that come in contact with the meat -- is essential.
8. How do you catch bird flu?
People have caught bird flu from handling infected poultry and from surfaces contaminated with poultry feces. There are a few suspected cases of human-to-human bird flu transmission. This happened only after prolonged face-to-face contact. But bird flu has not learned how to spread easily from person to person.
9. Is there more than one type of bird flu?
Yes. The H5N1 bird flu gets a lot of attention because it is so widespread in Asia, and because many of the people unlucky enough to catch it from poultry have died.
Other bird flu bugs have spread to humans. One is the H7N7 bird flu that in 2003 infected a number of people in the Netherlands. This virus usually caused pinkeye in infected people. However, one unlucky veterinarian died from the virus. Fortunately, Dutch authorities stamped out the virus before it learned to spread widely in humans.
Bird flus have, in the past, infected U.S. poultry. So far, all of these bugs have been eradicated before spreading among humans.
10. Who is most vulnerable to bird flu?
Flu is usually most dangerous to infants, pregnant women, the elderly, and people with immune suppression (such as transplant patients or people with AIDS). It's also dangerous to people who have previously been hospitalized for flu or pneumonia.
But much depends on whether there's any immunity to the flu in some populations. For example, the 1918 flu was more deadly to young adults than to those over 40. It's thought that a similar virus may have circulated more than 40 years before, giving some protection to those who had caught it as youths.
By Daniel J. DeNoon
WebMD Feature
Reviewed by Louise Chang, MD
WebMD answers 10 common questions about bird flu.
1. Is a bird flu pandemic imminent?
Short answer: probably not. But there are many unknowns involved, making accurate prediction impossible.
Sooner or later, pandemic flu will happen. Flu pandemics sweep the globe from time to time as new flu bugs emerge. These bugs cause global epidemics --pandemics -- because humans have little or no immunity to these viruses. Sometimes, as in the war-torn world of 1918, it's a terrible plague. Sometimes, as in 1957 and 1968, it's relatively mild.
Bird flu is still a bird disease. The H5N1 bird flu in Asia does not spread well from person to person. It's a leading contender to be the next pandemic flu bug because it has caused an unprecedented epidemic in poultry and wild birds across Asia and Eastern Europe. But nobody knows for sure whether this will be the flu that causes the next human pandemic.
Bird flu could become a human flu in two ways.
If a person were infected with a human flu and the bird flu at the same time, the two viruses could swap genes -- reassort -- and a human version of bird
flu could emerge. This is what happened in the last two flu pandemics in 1957 and 1968.
Bird flu could also evolve into a form adapted to humans, as was the case in the 1918 flu pandemic. There's evidence the H5N1 bird flu virus has begun this process, but scientists say it isn't yet very far along. Nevertheless, a few H5N1 viruses isolated from humans have acquired some key 1918-like mutations.
At a World Health Organization news conference in May 2005, Klaus Stöhr, PhD, DVM, project leader for the WHO's Global Influenza Program, was asked whether a bird flu pandemic is imminent.
"With this virus we have had very many surprises; we have had a very steep learning curve," Stöhr said. "We are seeing that it is changing very rapidly.
We have also seen that it is not reassorting as everybody thought 18 months ago. So we do not know if a pandemic can occur next week or next year, or perhaps if another virus is going to cause a pandemic. We should simply continue with our pandemic preparedness."
2. Is there a cure for bird flu?
No. There's no cure for any kind of flu.
The H5N1 bird flu bug has been particularly deadly for people unlucky enough to catch it from poultry. But if the bug learns to spread among humans, it almost certainly won't be as deadly as it is now, says Ira Longini, PhD, professor of biostatistics at Emory University's Rollins School of Public Health in Atlanta.
"Avian H5N1 looks like a [very high] case fatality in humans. But this has never been true of any human strain," Longini told WebMD. "There has never been any human influenza virus that has behaved that way in recorded or even unrecorded history. The case fatality of even highly virulent flu strains are a couple of deaths per 10,000 people."
3. What can I do about bird flu?
If a bird flu pandemic occurs, there's a very good way to minimize the chance of getting infected: Wash your hands. Frequent hand washing is the best way to avoid a viral infection -- including the flu. Remember to use soap and warm water, and to scrub all parts of the hand. The rule of thumb, as it were, is to scrub the hands and fingers until you finish singing the alphabet song to yourself.
Should a flu pandemic break out, pay attention to news reports, and follow public health advisories. Panic is the least helpful response to any emergency.
It's easy to come up with very scary worst-case scenarios for a bird flu pandemic. The worst case is rarely the actual case, but it's wise to be prepared for an emergency.
It's definitely a good idea to provide your household with the items in the government-recommended checklist. How much of these supplies should you have?
In any given community, an outbreak is expected to last six to eight weeks. This would be followed by at least two new pandemic waves.
Do you need a protective face mask? That's one item notably missing from the government checklist.
Flu most often spreads from large droplets coughed or sneezed from a sick person. These large droplets don't travel more than 3 feet. People are most likely to spread flu viruses in the first two days of illness, although they first become infectious up to a day earlier.
If a sick person can tolerate it, a normal surgical mask (tie on) or procedure mask (ear loops) would make them less likely to spread infection. The CDC advises offering these masks to a person infected with flu-related cough. If a mask isn't available, coughing or sneezing into a tissue would work almost as well.
The World Health Organization says that face masks aren't likely to significantly affect the spread of a pandemic virus. They don't advise them -- but as people are going to use them anyway, they don't advise against them, either.
Flu expert John Treanor, MD, tells WebMD that wearing a facemask would help a little bit: It would stop you from touching your mouth, eyes, or nose. That would help, because a major mode of flu transmission is from touching people or surfaces contaminated with flu virus and then touching your face.
But no expert really expects facemasks to prevent the spread of pandemic flu virus in a community. Everybody wore one in 1918; it was still a terrible pandemic.
The most effective facemasks for protecting uninfected people, Treanor says, would be the N95-rated masks. These disposable masks are relatively cheap -- although more expensive than surgical masks -- but likely will be in short supply if a pandemic arrives. They should offer "some protection," Treanor says, but "no one thinks they will be completely effective." N95 masks aren't necessary for infected people.
Those caring for sick people during a flu pandemic should wear a facemask, according to WHO and CDC recommendations. The best way to limit the spread of flu isn't a facemask. It's following these simple hygiene rules:
* Wash your hands often using soap and water. You can also use an alcohol-based hand sanitizer.
* When you cough or sneeze, use a tissue to cover your mouth and nose. Discard used tissues in a wastebasket.
* Don't have a tissue? Cough or sneeze into your upper sleeve.
* Clean your hands after coughing or sneezing. Use soap and water or an alcohol hand sanitizer.
* Stay at home if you are sick.
Even if you get sick during a flu pandemic, you're less likely to get severely ill if you're healthy. If you're worried about getting the flu:
* Eat a balanced diet with plenty of vegetables, whole grains, and low-fat dairy products.
* Drink a lot of water. If you drink alcohol, be moderate.
* Regular exercise is essential for good health.
* Get a full night's sleep every night.
4. What can the government do about bird flu?
The U.S. has a pandemic flu preparedness plan. This includes plans for deciding which people most urgently need scarce hospital beds and medicines, deploying response teams, increasing hospital capacity, and, when necessary, enforcing patient isolation and quarantine.
The government will try to delay the arrival of a flu pandemic by isolating ill travelers arriving from affected areas. This is not expected to prevent a pandemic from sweeping the country.
In the event of a flu pandemic, the first thing that will happen is that schools will close. Public gatherings will be discouraged or forbidden. People will be urged to work from home.
It's expected that about 40% of children and 20% of working adults will get the flu during a pandemic. Overall, about a third of the population is expected to get ill. At least half of infected people are expected to seek medical care.
The government is stockpiling antiviral medicines. How large this stockpile will be depends on how soon a pandemic hits. Eventually, the U.S. hopes to stockpile enough flu drugs to treat 25% of the U.S. population.
The government will deploy its stockpiled bird-flu vaccine, but it's not clear this will be effective. A truly effective vaccine should start to appear about six months after the pandemic begins. It will take two vaccinations, weeks apart, for a person to become protected.
Vaccines will be distributed to people in order of priority, in two tiers, with group A having the highest priority in each tier. This list, from the U.S. Department of Health and Human Services, does not include the 1.5 million members of the military considered essential to ongoing operations and military medicine.
Tier 1, Group A:
* The approximately 40,000 people essential to vaccine manufacture.
* Medical workers with direct patient contact
Tier 1, Group B:
* People with two medical conditions that put them at high risk of flu complications
* People with a past history of flu hospitalization
Tier 1, Group C:
* Pregnant women
* Household contacts of people with immune-system problems (such as transplants or AIDS) that prevent them from being vaccinated
* Household contacts of children under 6 months of age
Tier 1, Group D:
* Emergency response workers critical to pandemic response
* Key government leaders
Tier 2, Group A:
* Healthy people aged 65 and older
* People aged 6 months to 64 years with one medical condition that puts them at high risk of flu complications
* Healthy children aged 6 to 23 months
Tier 2, Group B:
* Emergency responders not critical to pandemic response
* Public safety workers (firefighters, police, 911 dispatchers, correctional facility staff)
* Utility workers essential for maintaining power, water, and sewage systems
* Transportation workers transporting fuel, water, food, and medical supplies
* Transportation workers providing public ground transportation
* Telecommunications and internet technology workers essential for network operation and maintenance
Tier 3:
* Other key government health decision-makers
* Funeral directors and embalmers
Tier 4:
* Healthy people aged 2 to 64 years not included in the above categories.
5. What good are antiviral drugs?
Antiviral drugs taken within 48 hours of the first symptoms -- such as a sudden fever -- make the illness less severe. The sooner after infection these drugs are taken, the better.
The H5N1 bird flu is resistant to an older and less potent class of flu drugs, which includes Symmetrel and Flumadine. These drugs won't work and would not be used in bird flu pandemic.
Newer and more effective flu drugs, Tamiflu and Relenza, can still work against H5N1 viruses. However, several bird flu viruses isolated from infected humans have already become resistant to Tamiflu.
Relenza is sprayed in the nose. It is extremely effective at neutralizing flu viruses. But people who get bird flu from poultry tend to get infections deep in their respiratory tracts. It's not at all clear that Relenza could reach such deep-seated infections.
Could flu drugs protect people from getting the flu? Yes and no.
People who are stockpiling Tamiflu likely will take the drugs at the wrong time, in the wrong way. That's likely to offer little protection -- and to spur the virus to become even more resistant to Tamiflu.
But in a community experiencing a flu pandemic, Tamiflu and Relenza could be quite effective, says flu expert Anne Moscona, MD, professor of pediatrics and microbiology and immunology, and vice chairwoman of pediatrics research at Weill Medical College of Cornell University in New York.
The drugs could be used to protect people with known exposure to someone infected with pandemic flu virus.
"Nobody says these drugs are going to protect everybody," Moscona tells WebMD. "But in an epidemic, a drug that prevents as little as 50% of transmission, even that has a role."
Vaccines, not antiviral drugs, are the key to stopping the flu. An experimental H5N1 vaccine has been made -- a major scientific achievement. New ways of using it already are in the works.
But the first batch of this prototype vaccine likely will not be a good match for whatever bird flu virus eventually emerges to cause a pandemic. New batches of vaccine will have to be made. That process would take more than a year before most people can be immunized. And it will take two shots, weeks
apart, before a person is protected. Meanwhile, experts suspect that modern transportation would carry flu around the world.
Since a vaccine won't immediately be available, flu drugs will be a major line of defense. But there won't be enough of the drugs to go around unless the next pandemic waits several years to strike.
6. Should individuals stock up on flu drugs?
No. Several flu experts tell WebMD that they are not stocking up on flu drugs, and they strongly recommend that individuals follow their lead.
Why? First of all, the drugs are in short supply. In the event of a pandemic, public health workers will need all the flu drugs they can get in order to treat people actually exposed to the virus. The drugs won't do nearly as much good sitting in people's medicine cabinets.
And even if you had the drugs on hand, when would you take them? Without a flu test, it's hard to know whether your symptoms are the flu or another respiratory infection. And the pills only work against the flu.
7. Can you get bird flu from eating chicken or other poultry?
No, not if the meat is fully cooked. Cooking kills flu viruses in poultry, meat, and eggs.
The bird flu virus can survive on raw meat from infected poultry. Proper hygiene -- hand washing and the disinfecting of all surfaces that come in contact with the meat -- is essential.
8. How do you catch bird flu?
People have caught bird flu from handling infected poultry and from surfaces contaminated with poultry feces. There are a few suspected cases of human-to-human bird flu transmission. This happened only after prolonged face-to-face contact. But bird flu has not learned how to spread easily from person to person.
9. Is there more than one type of bird flu?
Yes. The H5N1 bird flu gets a lot of attention because it is so widespread in Asia, and because many of the people unlucky enough to catch it from poultry have died.
Other bird flu bugs have spread to humans. One is the H7N7 bird flu that in 2003 infected a number of people in the Netherlands. This virus usually caused pinkeye in infected people. However, one unlucky veterinarian died from the virus. Fortunately, Dutch authorities stamped out the virus before it learned to spread widely in humans.
Bird flus have, in the past, infected U.S. poultry. So far, all of these bugs have been eradicated before spreading among humans.
10. Who is most vulnerable to bird flu?
Flu is usually most dangerous to infants, pregnant women, the elderly, and people with immune suppression (such as transplant patients or people with AIDS). It's also dangerous to people who have previously been hospitalized for flu or pneumonia.
But much depends on whether there's any immunity to the flu in some populations. For example, the 1918 flu was more deadly to young adults than to those over 40. It's thought that a similar virus may have circulated more than 40 years before, giving some protection to those who had caught it as youths.
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