Bird Flu Information

Q. What is bird flu?

Bird – or Avian – flu, often mis-spelled as bird flue or avian flue, is caused by a virus that usually infects birds (particularly poultry) but occasionally crosses the species barrier and infects humans – recently predominantly in the Far East, although it also happens elsewhere. It is not correct to refer to it as “avian bird flu” as many internet searches suggest.

Q. Does it affect people?

Until recently, avianflu was thought to affect people rarely and usually cause only mild disease such as conjunctivitis. Since 1997, however, one strain of the avian virus – H5N1 – has been associated with a very high death rate when people have been affected.

Q. Is there a vaccine for avian flu virus?

Vaccines against the H5N1 avian virus currently occurring in SE Asia are under development. These are not the same as a pandemic vaccine – if a pandemic were to emerge from this virus the virus may have changed to such an extent that this vaccine may not be appropriate.

Q. Why are we concerned about avian flu?

The birdflu that is affecting poultry flocks and avian health in Asia at the present time has increased experts’ concern and has now been found in birds in some parts of Europe. The avian viruses including H5N1 which is causing these outbreaks has affected some humans causing serious illness, and a high proportion have died. Scientists fear that this virus may change with time to make it a more serious threat for humans and start another pandemic.

The following table summarises the main differences between ordinary flu and pandemic flu:

Ordinary flu

Pandemic flu

Ordinary flu occurs every year normally during Northern-hemisphere winter months.

Pandemic flu occurs roughly every thirty years and can take place in any Season.

Ordinary flu: Usually affects 10-15% of the population and is thought to kill between 500,000 to 1 million persons worldwide annually.

Pandemic flu: It affects many more people than ordinary flu – a quarter or more of the population – and is associated with much higher rates of illness and death. For example, the worst flu pandemic last century – the 1918 ‘Spanish Flu’, caused up to 40 million deaths worldwide.

Ordinary flu: Most people recover from ordinary flu within one or two weeks without requiring medical treatment.

Pandemic flu: Usually associated with a higher severity of illness and consequently a higher risk of death, represents a much more serious infection than ordinary flu.

Ordinary flu: Deaths are generally confined to ‘at risk’ groups including:

- Elderly people over 65 years of age

- People with existing medical conditions such as lung diseases, diabetes, cancer, kidney or heart problems

People whose immune systems are compromised due to HIV/AIDS or because they have a transplant for example

- The very young

Pandemic flu: People of all age groups may be at risk of infection with pandemicflu, not just ‘at risk’ groups. In fact studies have shown that groups normally ‘at risk’ with ordinary flu are less susceptible during pandemic flu. This is because healthy individuals’ immune systems are likely to put up much more of a fight which itself can exhaust the individual’s immune system to a point of giving up the fight altogether.

Ordinary flu: The vaccine against ordinary flu is effective because the virus strain in circulation each winter can be fairly reliably predicted.

Pandemic flu: A vaccine against pandemic flu will not be available at the start of a pandemic. This is because the virus strain will be completely new. It will be different from viruses that circulated the previous winter, and not predictable in the same way.

Ordinary flu: Annual vaccination, when the correct virus strain is fairly reliably predicted, and antiviral drugs are available for those at risk of becoming seriously ill.

Pandemic flu: Antiviral drugs may be in limited supply, their use depending on evidence of their efficacy which will only emerge once the pandemic is under way.

Q. Is there a treatment for avian flu?

One or more antiviral drugs are usually helpful in treating avian flu. But they have to be started within 48 hours of the avian flu symptoms starting. They can also be taken by, for example, poultry workers and cullers exposed to infected birds, or their droppings, to prevent then getting avian flu.

Q. What is the best line of defense in an influenza pandemic?

Vaccines are the best line of defense in reducing illness and deaths during normal seasonal influenza. The vaccine has to change each year as the viruses circulating change. This can be done because the changes can be fairly reliably predicted. Vaccines can also play an important role in responding to an influenza pandemic but because the virus will be entirely new and not predictable in the same way, a specific vaccine cannot be made in advance. Preparatory work is being undertaken to be in the best possible position to produce vaccine against a pandemic strain when the situation arises, but they are unlikely to be available in the early stages.

Q. What do vaccines do?

Vaccines are biological agents that stimulate the body to produce antibodies or other immunity. Influenza vaccines produce antibodies against strains closely related to the strains of the virus contained in the vaccine. On exposure to avian viruses, the antibodies help prevent infection and reduce the severity of the illness. Normal flu vaccines contain parts of three viruses thought most likely to be circulating during the forthcoming winter.

Q. How effective are influenza vaccines?

This depends on how well the vaccine matches the strains of virus currently causing illness. Even with the best match influenza vaccines are not 100% effective in preventing illness. But they can be expected to reduce the most serious illness complications, the need for hospital care, and deaths.

Q. Will a vaccine be available to prevent illness in a pandemic?

Until the virus has been identified, it is not possible to prepare a vaccine against a pandemic strain of influenza virus. Once the virus is identified, the vaccine will take about four to six months to produce. Therefore, depending on the gap between the two waves of infection a vaccine should be available for the second wave of infection.

Q. How long will the vaccine take to produce?

The vaccine will take at least 4-6 months to produce.

Q. Why can’t we use currently available flu vaccine?

Currently available flu vaccines only protect against the currently circulating ordinary flu. The virus causing a pandemic will be so different from the strains in the vaccine that they are very unlikely to provide any significant immunity in a pandemic situation. New vaccine must be developed to match the new pandemic strain.

Q. Can any vaccine left from previous years be used?

No. It will only provide protection against old strains of influenza virus, not against a new strain.

Q. Can’t we anticipate what viruses might cause a pandemic and make a vaccine available?

There is no vaccine ready to protect against pandemic flu. The virus that causes pandemic flu will be new and a vaccine to protect against it cannot be made until the virus has been identified. Before a pandemic starts it is difficult, if not impossible, to predict what strain will cause it and even then, predictions may prove wrong, or the predicted virus may have changed enough for a pre-prepared vaccine to be ineffective. ‘Ordinary’ flu vaccines will not provide protection and having had a flu ‘jab’ in the recent past does not protect someone.

Q. Can we be sure the Government will be able to obtain enough vaccine for our needs?

The Governments are discussing their needs with manufacturers, but it is very unlikely enough vaccine can be produced for everyone to be immunised before the first wave of illness due to the pandemic strain.

Q. Does this mean that the vaccine will be rationed?

Priority will be given to certain groups first. Healthcare workers and other essential service key workers will need to take precedence over other groups, as it will be important to maintain health and other essential services. Those groups most at risk of serious illness will then receive the vaccine as supplies increase.

Q. Who makes the decision on priority groups?

Each Country will deploy it’s own way of prioritising who should receive vaccinations. It is likely that the following priority will be recommended:

- healthcare workers most at risk

- essential service workers

- clinical ‘high-risk’ groups

- closed communities such as nursing homes

- general population.

These would be kept under review during a pandemic and modified if necessary.

Q. Will the whole population be vaccinated?

Whilst the overall aim will be to vaccinate the entire population, this will not be possible in the early stages of a pandemic. A tiered approach will be taken to vaccination as vaccine becomes available. An important part of the response is to optimise the use of vaccine and other resources in limited supply.

Q. Who purchases the vaccine?

The local Government is responsible for purchasing and supplying a pandemic vaccine on behalf of the whole of the Country. They will liaise with each local state/province for the supply of vaccines to these regions.

Q. Are there any other ways to prevent influenza?

Antiviral agents can be used to prevent influenza, for example in the early stages of a pandemic. But, again, until the virus starts circulating it is not possible to know how effective antivirals will be, or the best way to use them.

Q. How will vaccine be equitably distributed?

Vaccine will most likely be distributed on a per capita basis, according to the groups being immunised.

Q. Who will do the vaccinations?

The precise vaccine formulation, dose and dose schedule will not be known until nearer the time, so detailed arrangements for immunisation are not yet established. Mass community immunisation plans are currently being developed and will examine the possibility of immunisation by people other than doctors/nurses such as medical students and pharmacists.

Q. What are antiviral drugs?

Antiviral drugs are special medicines for the treatment of certain viral infections. Two types of antiviral drugs are available against influenza. They will have an important role in the prevention and treatment of pandemic influenza, especially during the time before vaccine becomes generally available.

Q. Do Countries have contingency stockpiles of antiviral drugs and other essential pharmaceuticals?

Most Countries are building up a stockpile of antiviral drugs against the contingency of an influenza pandemic.

Q. Do antivirals have side effects?

The antivirals which are likely to be of most use in a pandemic are generally well tolerated, but on occasion can cause nausea and vomiting.

Q. Will they be recommended for all groups of the population?

During a pandemic, antivirals will have to be used in the most effective way, taking into account emerging evidence about the pandemic and the effectiveness of the drugs as well as their availability. Some groups of people will, therefore, take priority over others.

Q. Are there any other countermeasures available?

Since vaccines and antiviral drugs are likely to be in limited supply, especially at the onset of a pandemic, other public health and ’social’ interventions may be the only available countermeasures to limit or slow the spread of the disease.

Measures such as hand washing, and limiting non-essential travel and mass gatherings of people may slow the spread of the virus to reduce the impact and ‘buy’ valuable time.

Q. What contingency plans do Countries have for an influenza pandemic?

Plans will provide the overall framework for an integrated Country-wide response, escalating as the pandemic threat increases and then as the pandemic evolves. At its simplest it covers actions to be taken before, during and after the pandemic.

Plans concentrate on the central response, but contains information for al organisations involved in preparing for and responding to an influenza pandemic in order to provide a coherent approach with each part knowing its role in relation to others.

The plan is also intended to be flexible so that our response can be adapted as a pandemic evolves and knowledge about the new virus, its impact and the effectiveness of available countermeasures emerges.

Q. What would we do if pandemic flu arrives?

If the pandemic started outside your Country, the government would already have put its contingency plan into action and started preparing for the pandemic in your Country. A graduated series of public health measures would be implemented to reduce the impact, and help control the pandemic.

Q. What are the objectives of the plan?

The overall aim of the plan is to minimise the impact of the pandemic on the local population in particular to:

- reduce illness and save lives

- provide health care for the sick

- ensure that essential services can continue, and

- ensure the public, health professionals and the media have up to date, comprehensive information at al stages.

The plan also aims to reduce the disruption a pandemic may cause to peoples’ daily lives.

Q. What are key elements of the pandemic plan?

The key elements of pandemic planning incorporate:

- establishing ‘command and control’ structure to lead and co-ordinate the

- response

- communications

- monitoring the pandemic (surveillance)

- public health response

- health service response

- civil contingencies response

- preparatory work to support the response

- international collaboration.

Q. What control measures are envisaged?

The following control measures are envisaged:

- Vaccination of identified high-risk groups as and when vaccine becomes available

- Use of antiviral drugs

- Appropriate advice about the use of healthcare services

- Appropriate treatment of cases according to nationally agreed principles

- Other ’social’ measures to reduce person to person spread.

Q. What preparations are being made by Governments?

Publishing the plan is an important step in preparing for a pandemic. But improving our preparedness is ongoing work, putting into place the actions described in the plan.

Q. What will happen at the end of a pandemic?

The Health Authorities will review the data about the pandemic as it affects your Country and the effectiveness of its response and will make recommendations for future modification of pandemic influenza contingency plans.

Q. Can anyone get pandemic flu?

Anyone could get sick from pandemic flu. This is a new virus, to which no one is immune. However, about half of those who are infected can expect to have no symptoms – called asymptomatic infection.

Q. What are the symptoms?

Symptoms are similar to (although usually more severe than) other types of flu – sudden onset of fever, cough, headache, extreme tiredness and aching muscles, respiratory symptoms such as a sore throat.

Q. Could the virus infect all age groups?

It is expected that all age groups, would be affected as no-one will have immunity to the new virus.

Q. Is pandemic flu more serious than seasonal flu?

An influenza pandemic is usually very different from seasonal influenza. It causes more severe illness and affects more people. It is expected that during a pandemic of influenza 25% of the population could fall ill (compared with up to 10% in a normal winter) and that the illness will be more serious. In the space of a few months, the pandemic could lead to several million deaths worldwide.

Q. How can I protect myself and my family?

During a pandemic, the advice is similar to that for ‘ordinary’ flu.

Q. Are we at risk right now?

Pandemics are unpredictable in their timing, so we cannot be sure, although experts say that the warning signs have increased.

Q. Is there treatment available?

As a new pandemic has not materialised yet there is no vaccine and it could take several months after the start of a pandemic before one could be manufactured on any scale. Antiviral drugs are available, which limit the symptoms and as a result lessen the chances of serious complications. They possibly also reduce spread of the disease. They will need to be used in the most effective way, according to expert advice.

Q. How will we know what to do?

There will be regular updates on the television telling us what is happening and what to do. People with mild to moderate symptoms will be advised to stay at home.

Q. How can I reduce my risk and protect myself and my family?

You can reduce, but not eliminate, the risk of catching or spreading influenza during a pandemic by:

- covering your nose and mouth when coughing or sneezing, using a tissue when possible

- disposing of dirty tissues promptly and carefully � bag and bin them

- avoiding non-essential travel and large crowds whenever possible

- maintaining good basic hygiene, for example washing your hands frequently with soap and water to reduce the spread of the virus from your hands to your face, or to other people.

- cleaning hard surfaces (e.g. kitchen worktops, door handles) frequently, using a normal cleaning product

- making sure your children follow this advice.

If you do catch flu:

- stay at home and rest

- take medicines such as aspirin, ibuprofen or paracetemol to relieve the symptoms (following the instructions with the medicines). Children under 16 must not be given aspirin or ready made flu remedies containing aspirin

- drink plenty of fluids.

Q. Why won’t antibiotics work?

Influenza is a virus, so antibiotics will not work unless influenza has led to a bacterial illness that requires treatment.

Q. Can I still travel abroad?

In the event of a pandemic international travel, particularly to and from areas already affected, is likely to be discouraged in an attempt to slow, or delay, international spread of the virus.

Q. Should I have the ordinary flu jab?

Yes. If you are due an ‘ordinary’ flu jab you should have it.
Courtesy: birdflu-manual.com