AVIAN FLU FAQs
Q. Is avian influenza a big concern for DPH? Are you worried about avian influenza in Delaware? Are you worried about a flu pandemic?
Avian flu is a top priority for DPH as it is for our Governor, elected officials, and government agencies. Thankfully, there have been no human or bird cases of the H5N1 strain in the U.S. and there is only one possible case of the disease spreading through human to human contact. At this time our concern centers around getting accurate information to our public and planning for the impact on Delaware of a worldwide pandemic.
Q. Are you concerned about the new cases identified in Romania and Turkey?
Absolutely, we are paying close attention to all reported cases of H5N1 in birds and humans around the world that are identified and reported through an extensive worldwide system of epidemiologic surveillance.
Q. Is Delaware prepared? Do you have a plan to respond?
Preparedness involves the capability of identifying a threat (in this case a disease), monitoring it, controlling it’s spread, and working with others to reasonably respond in a coordinated manner to such threats and the impact on Delaware. With that said, there is no perfect essence of preparedness. From our perspective, preparedness is an ongoing process. Delaware has a pandemic flu plan. With regard to preparing for a pandemic of influenza, we are prepared to identify avian influenza and other infectious diseases in human and animals. Physicians and hospitals are required by law to report influenza to the Division of Public Health (DPH). DPH routinely monitors disease occurrence statewide. Our laboratory has testing capabilities to identify avian influenza strains. Our staff includes specialists in the area of disease investigation. This allows us to monitor and control spread of disease by finding the source of infection and those exposed. Our Laboratory has rapid access to CDC laboratories, other state laboratories and is part of a worldwide network of surveillance that shares information on outbreaks of disease and the latest techniques to detect them.
Depending on how extensive a pandemic is, the entire nation’s health system may be challenged. To prepare for that challenge, DPH works with hospitals in Delaware and other key health stakeholders to prepare for a possible pandemic and other threats.
*Resources such as vaccine and anti-virals are unknowns.
Q. Is H5N1 influenza a big deal? It sounds like you look at it as just another flu season.
The people in our communities are too valuable for Public Health to let down its guard. Anything that poses a threat to the health of Delawareans is relevant to us. It's important for us to keep abreast of the changes in this disease, and to use each day as an opportunity to become more prepared. And we need to stay focused on the facts. This year’s influenza season may be mild or severe but there is absolutely no indication that the H5N1 strain has or will have anything to do with this season’s influenza cycle. Remember, H5N1 has not made the leap from man to man and remains largely confined to birds.
Q. What is considered human-to-human close contact/exposure to H5N1?
Exposure would require close enough contact to expose a person to body fluids or body surfaces that contain the virus. Sneezing and coughing propels virus into the air in microscopic particles so that close contact may not be necessary for infection. Indeed, some respiratory viruses can remain infectious on surfaces such as doorknobs for up to 2 days so that close personal contact would not be necessary. In short, influenza is as infectious as the common cold.
Q. What is the risk of people getting avian flu in the U.S./Delaware? How far/fast do you think avian flu will spread in the U.S./Delaware?
There is extremely little risk at this time of US human infection with H5N1 unless an individual traveled to an area where H5N1 is present in birds and then came in contact with infected birds, their droppings, etc. The strain of flu that has affected commercial poultry in the U.S. is H7N2. This strain carries little infectivity to human or risk of severe disease. Moreover, the risk of transmission is a function of duration, intensity, and frequency of contact. No one knows how long it will take the disease to become transmissible person-to-person.
Q. What would public health do if a Delawarean was diagnosed with avian influenza? What measures would be taken if Delaware residents were infected?
DPH would do what it is trained and experienced to do – identify the source of infection, track it, and try to control spread. Public Health officials would follow the same protocol and procedures that it would with any serious infections disease. There are principles and practices that our Division applies daily in its line of work to protect the public’s health. If the avian influenza strain is identified as a pandemic strain, we would follow the Pandemic Influenza Plan protocols.
The steps in a disease investigation have been established for decades. We use our knowledge of how the disease is transmitted and how long it takes to cause visible symptoms to determine who is at risk. That should give us a manageable number of people to start contacting and assessing. DPH would then work to control the source of the disease and prevent others from being infected. The goal of this activity would be to contain the virus so that it does not become widespread in Delaware. This may be possible if the virus is not efficiently spread from person-to-person. These are the methods DPH used to investigate and monitor a suspect case of anthrax in 2001 and other diseases that are reported each year.
Q. Does Delaware have a pandemic flu plan? What is the status of a state pandemic flu plan?
Yes, Delaware has a Pandemic Influenza Plan and DPH is moving forward to evaluate it. We will keep revising and adding to it, to improve it in every way possible. While the plan outlines roles and procedures, it leaves room for us to make choices based on medical assessment and findings of health investigations.
Q. How has the Delmarva Poultry and Health Task Force helped you with flu planning?
DPH is an active participant in the task force. We are able to make recommendations on how to protect the health of agricultural workers so that they don't become a bridge between poultry flu strains and typical human influenza. By working with the Department of Agriculture and the poultry industry, we've created a multi-faceted and coordinated plan.
Q. When would people be quarantined? What do you think about President Bush's plan to use the military to enforce quarantine? Doesn't quarantine violate people's rights?
Right now, the illness doesn’t appear to spread from person to person, so quarantining people is not needed. In the U.S., widespread quarantine has not been imposed since the 1918 flu pandemic. However, small groups and individuals are routinely quarantined for a few days of less by the federal government coming off flights or cruise ships where a contagious disease was reported. Therefore, quarantine is a way to safely monitor people who may have been exposed to a contagious communicable disease. Quarantine can be as simple as staying at home and can be done on a voluntary basis.
Q. If Delaware had the first person infected with H5N1 in North America, would federal agencies be involved? Who and how?
Our planning assumption is that if Delaware had a person infected with H5N1, then the Department of Health and Human Services (DHHS) and Centers for Disease Control and Prevention (CDC) would be immediately involved as a result of reporting this information. It is likely that the U.S. Department of Agriculture (USDA) would be involved because H5N1 can infect poultry. However, Delaware would still implement and carry out its Pandemic Influenza Plan.
Q. If Delaware had a person infected with H5N1 who contracted the disease from birds in Asia, would we quarantine their family, other contacts in the U.S.?
The first step Delaware would take is to activate its usual public health response to a communicable disease in an effort to identify the disease, track it and control spread. If this were to be the first case reported or one where there had not yet been regional spread of the disease, yes, DPH would quarantine the exposed family. Other contacts may be quarantined or isolated depending on exposure or evidence of symptoms. There is no way now to predict the number of people affected. A lot would depend on intensity, frequent, and duration of contact with the infectious agent.
Q. When and where would people be quarantined? When would you limit the movement of an entire community?
Quarantine is used to separate healthy people who may have been exposed from the rest of the community. This would typically be done at home.
If there were just a few cases in Delaware, mandatory quarantine of a limited number of exposed people would be appropriate to prevent those few cases from starting a full blown epidemic.
When cases become widespread in the community or spread regionally, the effectiveness of quarantine is markedly reduced. Under these circumstances, public health officials might recommend voluntary quarantine and isolation by remaining at home. Public Health officials might also suspend mass gatherings or other activities where there might be large scale exposure, such as schools. This would only occur if there were both a high rate of infection to an agent with high serious morbidity or mortality. Again, there are many scenarios where the H5N1 might not change into such an agent.
Q. Would an infected person walking through a busy office building/public place/airport be considered close contact? Would we quarantine everyone on the whole floor/in the whole area?
The risk of transmission is a function of duration, intensity, frequency of contact, and how efficient the virus is spread. All have to be considered and for the H5N1 agent, this is unknown since there is no efficient human to human spread. There are scenarios where the virus in not highly infectious or dangerous and there are those where it might be. While walking through a busy office is not intense, frequent or of high duration, we would evaluate this question based on what we know about how efficient the virus appears to be spreading and how long it would remain alive on surfaces such as doorknobs, desks, and computers.
Q. What is our current surge capacity and where would we gain it? (Christiana expands, all hospitals expand)
Current surge capacity consists of the following:
- During an emergency, each hospital has plans in place to expand their capabilities to increase the number of patients they can evaluate and treat.
- Each hospital has been requested to coordinate with the long term care facilities in their area for additional bed space if needed.
- As part of DPH emergency response plans, we are able to set up an Acute Care Center to evaluate and treat an additional 400 patients above the additional surge the hospital facilities can handle.
Q. Would that surge capacity be equipped to care for avian flu patients?
Acute Care Centers (ACC) can potentially care for some flu patients; however those needing ventilation or other mechanical treatments would need to be treated at a hospitals.
While efforts are underway here and in all counties to plan for hospital surge capacity, in a scenario involving a highly infectious agent that has a high attack rate and causes serious symptoms and death in a high percent of those infected, hospitals and existing surge capacity will be overcome.
Q. Is there a shot for human avian flu?
Efforts are underway to develop an effective one for H5N1 virus. The U.S. has put in an order for several million doses of this experimental vaccine. However, governments face the dilemma that this vaccine might not be effective against a new strain of this virus when and if it makes the leap from man to man. We face the same dilemma with antiviral medications. When and if we experience a flu pandemic, we hope a vaccine will be ready in time. There is intense research activity to develop better and faster ways to manufacture flu vaccine.
Q. Should people get Tamiflu just in case? Would you recommend people buy Tamiflu? Does Tamiflu protect people from Avian flu?
There is no need for anyone to take Tamiflu right now. Additionally, stockpiling the medication may lead to expiration of the medication, which has only a 5-year shelf life. This disease does not appear right now to be spread by person-to-person contact.
Q. Would you recommend that Delawareans wear breathing masks when in public? Should travelers use breathing masks outside the United States?
In the case of a pandemic, we would not discourage any activity that limits the spread of the virus no matter how ineffective as long as these activities are safe. At this time, in the absence of a pandemic, there is no need to take action actions of precautions against H5N1.
Q. Where can people get factual information on Avian Flu?
Information on Avian Flu can be found on the website for the Centers for Disease Control and Prevention (CDC), the World Health Organization’s website, the Division of Public Health website. The CDCs website also contains information in Spanish. Individuals are also encouraged to contract their primary care physician for information or concerns. For those without insurance, contact with Community Health Centers or Federally Qualified Health Centers in the state would be a valuable source of information.
Q. What is avian influenza (bird flu)?
Bird flu is an infection caused by avian (bird) influenza (flu) viruses. These flu viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, bird flu is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.
Q. Do bird flu viruses infect humans?
Bird flu viruses do not usually infect humans, but several cases of human infection with bird flu viruses have occurred since 1997.
Q. How are bird flu viruses different from human flu viruses?
There are many different subtypes of type A influenza viruses. These subtypes differ because of certain proteins on the surface of the influenza A virus (hemagglutinin [HA] and neuraminidase [NA] proteins). There are 16 different HA subtypes and 9 different NA subtypes of flu A viruses. Many different combinations of HA and NA proteins are possible. Each combination is a different subtype. All known subtypes of flu A viruses can be found in birds. However, when we talk about “bird flu” viruses, we are referring to influenza A subtypes chiefly found in birds. They do not usually infect humans, even though we know they can. When we talk about “human flu viruses” we are referring to those subtypes that occur widely in humans. There are only three known A subtypes of human flu viruses (H1N1, H1N2, and H3N2); it is likely that some genetic parts of current human influenza A viruses came from birds originally. Influenza A viruses are constantly changing, and they might adapt over time to infect and spread among humans.
Q. What are the symptoms of bird flu in humans?
Symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of bird flu may depend on which virus caused the infection.
Q. How does bird flu spread?
Infected birds shed flu virus in their saliva, nasal secretions, and feces. Susceptible birds become infected when they have contact with contaminated excretions or surfaces that are contaminated with excretions. It is believed that most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces. The spread of avian influenza viruses from one ill person to another has been reported very rarely, and transmission has not been observed to continue beyond one person.
Q. How is bird flu in humans treated?
Studies done in laboratories suggest that the prescription medicines approved for human flu viruses should work in preventing bird flu infection in humans. However, flu viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to prove the effectiveness of these medicines
Q. What is the risk to humans from bird flu?
The risk from bird flu is generally low to most people because the viruses occur mainly among birds and do not usually infect humans. However, during an outbreak of bird flu among poultry (domesticated chicken, ducks, turkeys), there is a possible risk to people who have contact with infected birds or surfaces that have been contaminated with excretions from infected birds. The current outbreak of avian influenza A (H5N1) among poultry in Asia and Europe (see below) is an example of a bird flu outbreak that has caused human infections and deaths. In such situations, people should avoid contact with infected birds or contaminated surfaces, and should be careful when handling and cooking poultry. For more information about avian influenza and food safety issues, visit the World Health Organization website. In rare instances, limited human-to-human spread of H5N1 virus has occurred, and transmission has not been observed to continue beyond one person.
Q. What is an avian influenza A (H5N1) virus?
Influenza A (H5N1) virus – also called “H5N1 virus” – is an influenza A virus subtype that occurs mainly in birds. It was first isolated from birds (terns) in South Africa in 1961. Like all bird flu viruses, H5N1 virus circulates among birds worldwide, is very contagious among birds, and can be deadly.
Q. What is the H5N1 bird flu that has been reported in Asia and Europe?
Outbreaks of influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreak. By March 2004, the outbreak was reported to be under control. Beginning in late June 2004, however, new outbreaks of influenza H5N1 among poultry were reported by several countries in Asia (Cambodia, China [ Tibet ], Indonesia, Kazakhastan, Malaysia, Mongolia, Russia [ Siberia ], Thailand, and Vietnam). It is believed that these outbreaks are ongoing. Most recently, influenza H5N1 has been reported among poultry in Turkey and Romania. Human infections of influenza A (H5N1) have been reported in Cambodia, Indonesia, Thailand, and Vietnam.
Q. What is the risk to humans from the H5N1 virus in Asia and Europe?
The H5N1 virus does not usually infect humans. In 1997. However, the first case of spread from a bird to a human was seen during an outbreak of bird flu in poultry in Hong Kong, Special Administrative Region. The virus caused severe respiratory illness in 18 people, 6 of whom died. Since that time, there have been other cases of H5N1 infection among humans. Recent human cases of H5N1 infection that have occurred in Cambodia, Thailand, and Vietnam have coincided with large H5N1 outbreaks in poultry. The World Health Organization (WHO) also has reported human cases in Indonesia. Most of these cases have occurred from contact with infected poultry or contaminated surfaces; however, it is thought that a few cases of human-to-human spread of H5N1 have occurred.
So far, spread of H5N1 virus from person to person has been rare and has not continued beyond one person. However, because all influenza viruses have the ability to change, scientists are concerned that the H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population. If the H5N1 virus were able to infect people and spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.
Q. How is infection with H5N1 virus in humans treated?
The H5N1 virus currently infecting birds in Asia that has caused human illness and death is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat flu caused by the H5N1 virus, but additional studies still need to be done to prove their effectiveness.
Q. Is there a vaccine to protect humans from H5N1 virus?
There currently is no commercially available vaccine to protect humans against the H5N1 virus that is being seen in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine to protect humans against H5N1 virus began in April 2005, and a series of clinical trials is underway. For more information about the H5N1 vaccine development process, visit the National Institutes of Health website.
Q. What is the risk to people in the United States from the H5N1 bird flu outbreak in Asia and Europe?
The current risk to Americans from the H5N1 bird flu outbreak in Asia is low. The strain of H5N1 virus found in Asia and Europe has not been found in the United States. There have been no human cases of H5N1 flu in the United States. It is possible that travelers returning from affected countries in Asia could be infected if they were exposed to the virus. Since February 2004, medical and public health personnel have been watching closely to find any such cases.
Q. What does CDC recommend regarding the H5N1 bird flu outbreak?
In February 2004, CDC provided U.S. health departments with recommendations for enhanced surveillance (“detection”) in the U.S. of avian influenza A (H5N1). Follow-up messages, distributed via the Health Alert Network, were sent to the health departments on August 12, 2004, and February 4, 2005; both alerts reminded health departments about how to detect (domestic surveillance), diagnose, and prevent the spread of avian influenza A (H5N1). The alerts also recommended measures for laboratory testing for H5N1 virus. CDC currently advises 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. CDC does not recommend any travel restrictions to affected countries at this time. For more information, visit Travelers' Health.
Q. What is CDC doing to prepare for a possible H5N1 flu pandemic?
CDC is taking part in a number of pandemic prevention and preparedness activities, including:
Providing leadership to the National Pandemic Influenza Preparedness and Response Task Force, created in May 2005 by the Secretary of the U.S. Department of Health and Human Services.
- Working with the Association of Public Health Laboratories on training workshops for state laboratories on the use of special laboratory (molecular) techniques to identify H5 viruses.
- Working with the Council of State and Territorial Epidemiologists and others to help states with their pandemic planning efforts.
- Working with other agencies such as the Department of Defense and the Veterans Administration on antiviral stockpile issues.
- Working with the World Health Organization (WHO) and Vietnamese Ministry of Health to investigate influenza H5N1 in Vietnam and to provide help in laboratory diagnostics and training to local authorities.
- Performing laboratory testing of H5N1 viruses.
- Starting a $5.5 million initiative to improve influenza surveillance in Asia.
- Holding or taking part in training sessions to improve local capacities to conduct surveillance for possible human cases of H5N1 and to detect influenza A H5 viruses by using laboratory techniques.
- Developing and distributing reagents kits to detect the currently circulating influenza A H5N1 viruses.
- Working together with WHO and the National Institutes of Health (NIH) on safety testing of vaccine seed candidates and to develop additional vaccine virus seed candidates for influenza A (H5N1) and other subtypes of influenza A virus.
Important links for more information on avian flu:
- Centers for Disease Control and Prevention - http://www.cdc.gov/flu/avian/
- World Health Organization - http://www.who.int/csr/en/
- Department of Health and Human Services - http://www.flu.gov/types/h5n1/
- United States Department of Agriculture - http://www.aphis.usda.gov/lpa/issues/avian_influenza/index.html
- National Institutes of Health – www.nih.gov