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 Frequently Asked Questions on Bird Flu (H5N1) Epidemic.

      A guide for the lay public and the media 

New Delhi , 30 January 2004:

1. What is avian influenza (bird flu)?

Avian refers to birds and influenza is commonly known as flu. That is why the disease is also termed as bird flu. It is a contagious disease that commonly occurs in birds and sometimes in humans and pigs. The disease can occur in any bird though domestic poultry flocks are more susceptible to be affected by epidemics. At present an epidemic of bird flu is occurring in a number of countries in Asia

The disease may occur in a mild form or a severe form. In the mild form, it occurs in the form of ruffled feathers or reduced production of eggs. Bird flu may start as a mild illness but after some months, due to changes in the virus, the disease may become serious and rapidly kills nearly all the affected birds. This has been seen in many countries in the past where the disease remained mild for several months and then became serious, leading to the death of a large number of birds

In the severe form (which is of greater concern) the disease is rapidly fatal. Almost all the affected birds die in this form of the disease. In the fatal form of the disease, the affected birds can die on the same day when they first develop the symptoms. It is called Highly Pathogenic Avian Influenza (HPAI). The present disease is severe occurring in epidemic form which is affecting the domesticated poultry (chicken, turkey, and eggs from infected birds) and human beings in some countries.

2. What causes the bird flu?

            Bird flu is caused by influenza virus type A. There are about 15 different sub types of the virus though bird flu is caused by subtypes H5 or H7 strain. These sub types cause a severe disease in birds especially chicken and turkeys. Occasionally the infection jumps from infected birds or their infected material (bird droppings) to human beings. Even though there are large epidemics of the disease in birds, there are very few human beings in some countries who have suffered from the infection. Most countries are confirming the occurrence of H5 N1 influenza A. Some countries (e.g. Pakistan ) are reporting a different strain as the cause of bird flu in the current epidemic.  

3. How does bird flu spread amongst the birds and in human beings?

            Within a country, the disease spreads easily from farm to farm. Even small quantities of bird droppings carry a large load of the virus. These are carried through contaminated equipment, bird feeds, cages, clothing and shoes of workers in the farm. The infection can occur through the inhalation of the material infected with virus. The risk of transfer of infection from wild birds to domestic poultry is maximal when domestic birds roam freely or use a common source of water supply. Unsanitary, overcrowded markets can be another source of spread.

From infected poultry the infection can affect the human beings who come in contact with the infected material like the droppings or the virus sticking to the hair or other parts of the body of the infected animal and inhale it.

4. How can the disease spread from one country to another?

            The spread of this disease from one country to another can occur as a result of bird trade or through migratory birds infected with the virus. Although they suffer from infection, migratory birds may not bet sick or have only a mild illness. They can carry the disease to long distances.

Migratory water fowl- the wild ducks, carry the virus but do not suffer from disease. Epidemics of bird flu occur when domesticated birds like chicken or turkey come in contact with wild ducks carrying the virus.

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5. Is the current epidemic of bird flu the first time occurrence of the disease like SARS?

            This is not a new disease. The first epidemic was reported from Italy more than 100 years back. Since then the disease has been reported often from many countries. In recent years, the epidemic in Hong Kong (1997) was of concern since it affected human beings but it was controlled by killing a large number of birds rapidly (in a few days) from the infected farms.

6. Can the spread of bird flu occur from one human being to another?

            At present there is no indication for spread of severe form of bird flu from one human being to the other. However, this is a possibility and it can happen in future. The influenza virus type A and its various subtypes can in the presence of another influenza virus merge with it through mixing and re-assortment. This can lead to the appearance of a new virus with characteristics that are different from the parent viruses. Since the population has no immunity to the new virus subtype, it can appear as a serious life threatening disease. Human beings and pigs serve like mixing vessels where the mixing of type A influenza virus acquired from the birds with human influenza (also called flu virus) can occur. This can lead to human to human transmission of a severe disease in future. The past pandemics (1918, 1957 and 1968) of flu have occurred as a result of re-assortment and mixing of various influenza viruses. The only effective way to prevent this is by destroying the infected birds rapidly.

7. Why is there so much concern about bird flu in the countries in Asia ?

            There are several countries from where large epidemics of bird flu are being reported. These countries have reported the infection over a short period of time (since December 2003). Some of these countries include Indonesia , Thailand , Viet Nam , Cambodia , Hong Kong , Pakistan , Japan , Korea and Taiwan . The list of affected countries is increasing. There is worry because the number of cases in birds and in human beings is increasing.     

The current epidemic is caused by highly pathogenic avian influenza (HPAI). There is evidence that this strain can jump the species and cause severe disease in human beings. At present there is no immunity to bird flu in human beings. The mortality in affected human beings is much higher than SARS even though the number of affected human cases currently is small. Although bird flu in human beings is reported from Thailand and Viet Nam , there are fears that the virus may jump from birds to human beings in larger numbers in future. According to current information, the infection does not spread from an infected human to another but this remains a possibility. If this occurs then a large epidemic (pandemic) of bird flu may occur in humans that can prove to be devastating.

            The current epidemic can be devastating for the poultry industry and the farmers. Large number of affected and exposed birds has to be killed and destroyed rapidly over a few days to prevent the spread of the epidemic. This has an adverse economic impact and deprives families of nutritious diet.

8. How can the epidemic be controlled in birds?

            The most important measure is rapid destruction of infected and exposed birds. This should be accompanied by proper disposal of the carcasses of birds. The affected farms should be carefully disinfected. The rapid destruction of infected and exposed birds was effective in controlling the epidemic that occurred in Hong Kong in 1997 and the epidemic in Netherlands in 2003.  In the current epidemic, Japan and Korea appear to have controlled the epidemic quickly and safely by undertaking the above mentioned measures. The disinfection can be done by formalin or iodine. The virus is killed by heat but survives at cool temperatures. It can survive for one month or longer at 0 C . Just one gram of infected material can kill millions of birds.

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9. Can the spread of bird flu in poultry be prevented through vaccination?

            A vaccine for use in birds is available. But while it may reduce the severity of the disease, affected birds will continue to shed virus and pass the infection.  A milder form of the disease in the birds might actually serve to make the flu endemic.

10. How is bird flu suspected in human beings?

            Bird flu in human beings resembles an acute respiratory infection like SARS which can be caused by any flu (influenza) or flu like illness caused by other viruses. Bird flu in human beings is recognized when the patient has fever 38 C or more, cough, sore throat, sore eyes, muscle aches, pneumonia, acute respiratory distress (breathing difficulty), or renal problems. All the above signs may not be present in the same patient. In addition, there should be history of the affected person visiting an infected poultry farm or a market where poultry is reported to be infected or a laboratory worker who had processed samples of patients or birds with the disease.

11. How can the diagnosis of bird flu in human beings be confirmed?

            Like SARS, the diagnosis of bird flu can be confirmed in only a few laboratories in the world that are well equipped to do it. This is done by the finding of the virus from the patient's samples or by blood tests that can be done only in selected laboratories. The information about these laboratories is provided by the national government and support is provided by WHO to the governments to make arrangements in selected laboratories to confirm the diagnosis of bird flu in human beings.

12. What should I do if there is a person in my house suffering from bird flu?

            The suspected patient of bird flu is treated much the same way as any other flu. If the patient develops fast breathing or breathing difficulty or has reduced urine then it is important to take the patient to the hospital immediately for admission and treatment. According to current information, the risk of getting the infection directly from a person who is sick with bird flu is small. However more than one family member can suffer from the disease if they have been exposed to the infection while going to a poultry farm, going to a market where animals are sold or while handling a sick bird. To protect yourself from getting the disease wash your hands thoroughly especially when handling poultry. In contrast to SARS, the risk of getting the disease from one person to another directly is small. The real  risk of getting the disease through inhalation of the infected material..

13. Is there any special age or sex predilection for bird flu?

            The answer to this question is not final since there have been very few cases of bird flu in humans till now remains relatively small. More information will be required to be certain. The current information suggests that it occurs more in children and younger people than in older people. There is no sex predilection.

14. How soon can bird flu appear in humans after exposure to the disease in birds ?

            Bird flu can appear within 1-5 days after contact with the infected material. This is termed as incubation period for the disease.

15. Who is at risk of getting bird flu?

            In the affected countries, people who work in the poultry farms are at risk. There are markets where birds and eggs are sold. Those who are selling birds and eggs are at risk of getting the disease. Staff members who visit the affected country to investigate the epidemic can come in contact with the droppings of birds during their field visits (while visiting markets where animals are sold or poultry farms or laboratories where handling of infected material takes place). They are at greater risk of getting the disease. Veterinarians and people working in laboratories with the type A influenza virus are more likely to get the infection. Until there is evidence for human to human transmission, the disease will most likely remain confined to those who come in contact with sick birds or their droppings.

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16. Can bird flu be prevented by medicines?

            There are no medicines known that can prevent bird flu. Antibiotics are not advised.  There are antiviral drugs available but their efficacy in the current strain of bird flu influenza is not proven. One class of antiviral drugs is being evaluated while another class has not been found to be effective in the epidemic in Viet Nam . Personal protection measures and ensuring food safety are the best ways to protect against bird flu.

17.   Is there a vaccine to prevent bird flu?

            Like SARS there is at present no specific vaccine to prevent bird flu in human beings. Currently available vaccines will not protect against the H5N1 strain of the virus. A vaccine was produced against the bird flu that occurred in Hong Kong in 1997 but this cannot be recommended to control the present epidemic since the virus has changed its character through mutation. Therefore at present there is no vaccine for prevention of bird flu. The technology for producing this vaccine exists. According to the current information it will take about 1year for the specific vaccine against bird flu to be available in the market. Since influenza viruses tend to undergo frequent and permanent changes, the viruses are continuously monitored and the composition of the vaccine is different from year to year to protect against the circulating viruses. Influenza vaccine for the other common flu viruses is available but it will not protect against the bird flu.

18.   Is there any role for human influenza vaccine in control of bird flu in human?

            As mentioned already, there is no specific vaccine to prevent bird flu although influenza vaccine for the country where you live in is available. Influenza vaccine is recommended for people at risk. While it may not prevent H5N1, it will help to prevent re-assortment and mixing up of the genetic material between influenza (flu) viruses and reduce the risk of human to human transmission. It may also prevent the occurrence of severe forms of the disease. The people who should be considered for influenza vaccine first are those persons who are likely to come in contact with the infected material. These include WHO staff who visit the field in the affected countries, laboratory workers who come in contact with the infected material, people working in the poultry farms and people in the markets where poultry is sold.

19. What are the precautions at personal level to avoid getting bird flu?

            During an epidemic, avoid going to markets where birds are sold, and do not visit poultry farms during the epidemic. This infection affects predominantly the respiratory tract (breathing passages) in humans and it is acquired by inhalation of the virus. There is a greater risk of getting bird flu while handling the infected bird or infected eggs than eating these foods. If the food is well cooked, there is hardly any risk of getting bird flu. Frequent and thorough hand washing is to be observed to avoid getting the disease during processing and cooking of possibly infected poultry. Remember that this virus can survive for long periods of time when the temperature is cold. It can survive for long at freezing temperatures. Therefore frozen food may have the virus on them. Thorough and frequent hand washing especially by food handlers at home and in restaurants should become a routine practice to help wash out the virus from the hands picked up from infected or frozen food.

20. I work on a poultry farm and have the responsibility for destruction of sick birds. I hear that there is an epidemic of bird flu. What should I do to protect myself from getting the disease?

            Since you handle possibly infected birds you should take preventive steps to get the infection. Cover your shoes well by shoe covers so that your shoes do not carry the contaminated droppings.  You should wear a gown, a face mask and goggles to prevent inhalation of the contaminated material. You should practice thorough and frequent hands washing to protect yourself from inhaling the infected material from contaminated hands. These precautions should also be observed by all those who handle the poultry in the farms, market places, at home and laboratory personnel who handle possibly contaminated material from the poultry and infected human beings.

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21. I have chickens in my house and a couple of other birds as pets. What is your advice to me for the protection against bird flu?

            The risk of getting bird flu from birds at home is small unless the disease spreads from poultry farms to homes. However, you should observe all precautions to protect yourself and the family from getting the disease. You should practice thorough hand washing after handling the birds or their droppings. Watch your birds, if they are getting sick. In such an event currently there is no option except to kill them. Ensure that they are killed as soon as the disease is suspected. Suspect the occurrence of bird flu if the bird in your house has ruffled feathers or there is slowing down in laying of the eggs.

            At present there is no risk of transmission of the disease from another infected person since human to human transmission of the disease is rare.

22. What is your advice on eating chicken meat/eggs  imported from countries where bird flu is occurring? Should my government not impose a ban on the import of meat?

            There is minimal risk from consuming the infected eggs or infected meat provided it is well cooked. The danger is greater if the human beings inhale the infected material or come in contact with their droppings.

            There is no evidence that bird flu is a food borne disease. The disease is not likely to occur from eating contaminated food. However it is important to be sure that meat or meat products that you eat are properly cooked in a hygienic way. This would also help in protection against other infections that are food borne. The consumption of raw poultry, eggs and pork is not advised because of the additional risk of salmonella and campylobacter infections. The advice on food hygiene should always be followed. This includes thorough hand washing, thorough cooking of poultry products and prevention of cross contamination. The decisions on the bans on imports are made by the government after due consideration of all the factors. The intention of this decision is to minimize the risk of release of the virus particles in the country to infect the wild and domestic poultry.

23. What is your advice about the disposal of infected birds?

            The birds that are infected should be disposed off carefully. They should either be burnt or buried. The persons who are responsible for disposing of the birds or possibly infected eggs should observe all precautions to avoid coming in contact with them or their droppings. They should observe the recommended infection control measures and wash their hands frequently and thoroughly.

24. Are there any travel restrictions imposed to prevent the spread of bird flu?

            WHO is not recommending any restrictions on travel to the affected countries. This is because the reported cases acquire the infection through direct contact with infected poultry on the farms or in live bird markets. There is no evidence for human to human transmission of the infection. The current infection is spreading through trade of domesticated birds or through the natural flight route of infected birds. Isolation of affected countries is not necessary since it will merely create unwarranted panic and adversely affect the trade and economy.

25. What is your advice on screening of the passengers coming from other countries?

WHO does not advise routine screening of passengers for the symptoms of bird flu. Unlike the SARS epidemic, the current form of bird flu is not known to be transmitted from person to person. Another reason why screening is not advised is because influenza is known to spread before the first symptoms appear. Therefore screening of passengers will not help in controlling the spread of the disease.  It is advised that travellers should avoid visiting markets where chicken and birds are sold and not go to poultry farms in the affected countries that they are visiting.

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26. Environmentalists  object to the killing of birds and animals. What is your guidance to them on control of bird flu?

            The concern of environmentalists about the wanton killing of birds and animals is normally justified. At present many countries are in the midst of an epidemic of bird flu that is also infecting humans. This disease at present is not being transmitted from an infected human being to an uninfected human being but if this does happen then we may face a pandemic of influenza which can be devastating. Past experience shows that prompt culling of birds is the only effective way to control the epidemic. Therefore doing this when it is required can avert a major disaster and it is justified. This issue should be taken up with the environmentalists and they should be convinced about the need for such an action.

27. The farmers and others involved in poultry industry are worried about  heavy economic losses. They may not fully cooperate in the rapid culling of birds. What is being done to address this problem?

            It is quite natural for the farmers and traders to be worried since poultry is bread and butter for them. Many governments have started to address this problem by engaging the farmers and traders in a dialogue. The issue of compensating them for the losses incurred is being addressed by the governments. This would help to reduce the economic burden resulting from large scale culling of infected and exposed birds.

29. What is your advice to the countries on prevention of spread of bird flu in the animals?

            Avoid selling of raw vegetable near the areas where these might come in contact with droppings of birds in cages or with drains that might carry the infected material. The slaughter of birds should be done in a hygienic way.            The persons responsible for handling of raw poultry products should observe infection control and hygienic measures and cleanliness to prevent them from getting infected. The government should consider the separation of sale of live birds and animals from ready to eat foods prepared from meat and meat products.

30. What is being done by the national governments and international agencies to control the epidemic of bird flu?

            There is widespread concern abut the spread of bird flu and the possibility of a pandemic of flu. At the international level, WHO, FAO (Food and Agriculture Organization) and OIE (International Organization for Animal Health) are exchanging up to date information, doing regular consultations and advising the national governments. They are assisting in resource mobilization.

            The governments are strengthening the inter-sectoral collaboration between the ministries of health, agriculture, forestry, animal husbandry, trade, transport, etc. to undertake a coordinated action in controlling the epidemic of bird flu.

31. What is the role of WHO in controlling the bird flu epidemic ?

            WHO's objective is to reduce the risk to humans from bird flu to prevent it from recombining with human influenza virus in which case it will not only spread rapidly but may also become more severe. To avert an influenza pandemic, it is helping to support countries so that every one in contact with affected poultry is adequately protected. WHO is taking the lead helping to lead the development of a vaccine against bird flu. It is advising the national authorities to increase their surveillance of affected poultry stocks and strengthening surveillance of human beings. Control of bird flu requires effective coordination with ministry of agriculture, ministry of trade and animal husbandry and WHO is trying to bring about this coordination.

For any clarification or information, journalists may contact: Mrs Harsaran Bir Kaur Pandey, Information Officer, WHO Regional Office for South-East Asia Region, New Delhi, Phone # 23370971 (Direct) or Board # 23370804 (Extn: 26401/26424)