Public Health Recommendations for Bird Flu

At least one Canadian group formed after SARS hit Toronto is working with the World Health Organization (WHO), Centers for Disease Control and Prevention (CDCP) and other organizations to help boost public safety.

That group is the Public Health Agency of Canada (PHAC), which was formed in 2004. It acts independently but is responsible to Canada's health minister. PHAC is in the midst of creating a pandemic plan for Canada, said Aggie Adamczyk, media relations officer with the agency.

The plan is not being formulated just for the Avian Flu but for any disease that could reach pandemic proportions, although PHAC is monitoring the Bird Flu situation. The agency recommends "good respiratory etiquette," she said, which includes using a tissue or sleeve when a sneeze comes upon you. Plenty of hand washing is also a PHAC suggestion.

Where the regular Influenza A symptoms include aching muscles, sore nose, high fever and coughing, people wary of the Bird Flu should be on the watch for symptoms pinpointed in a 1997 Hong Kong outbreak. In that outbreak, people "developed symptoms of fever, sore throat, cough and, in several of the fatal cases, severe respiratory distress secondary to viral pneumonia. Previously healthy adults and children, and some with chronic medical conditions, were affected," according to WHO Web information.

As with the WHO, PHAC isn't rushing to recommend the use of SARS-style face masks to ward off the Avian Flu, Adamczyk said, although that could change depending on the course the H5N1 virus takes. "It's a little bit early (for masks or antiviral drugs) at this point," she said. Even so, global health officials need to be ready for whatever new infectious disease comes their way, she said. "No one really knows if it will be Avian Flu or something like SARS. You have to be ready for (any disease)," Adamczyk said.

It is possible to create a vaccine for a pandemic flu, although making it ahead of time is risky because the flu could mutate, limiting the vaccine's effectiveness. The amount of vaccine that would be needed for a pandemic could also prove to be a problem, although research is underway to find technologies to streamline the vaccine production process.

In the event of a pandemic, public health officials could ask people to remain in their homes and refrain from gathering in public places. Other viral outbreaks have led to similar scenarios in North America in the past.

The WHO recommends the following to public health groups dealing with cases of Avian Flu:

* Co-ordinate services: Agricultural, veterinary and health services (along with other sector services deemed as appropriate) should exchange lab information and other data.

* Vaccination for public health reasons: Health authorities may consider vaccination against more common, seasonal influenza for persons at risk of occupational exposure to the H5N1 virus. Vaccination against seasonal influenza is a public health measure aimed at slashing the progression of HN51 along with the seasonal flu. Even so, vaccination against seasonal influenza will not protect people against infection with the H5N1 virus.

* Protection of persons at risk of occupational exposure: This is aimed at helping protect people who work on farms or other businesses wherein contact with fowl is common. Such people should wear personal protective equipment as follows:

• Protective clothing, preferably coveralls plus an impermeable apron or surgical gown with long-cuffed sleeves plus an impermeable apron.

• Heavy-duty rubber work gloves that can be disinfected.

• Standard well-fitted surgical masks should be used if high-efficiency respiratory masks are not available. Masks should be fit-tested and training in their use should be provided.

• Goggles.

• Rubber or polyurethane boots that can be disinfected or protective foot covers that can be discarded.

Tamiflu should be made available to people who work in at-risk conditions, the WHO recommends. In addition, people in such occupations should be aware of the early clinical signs of H5N1 infection and check for them daily (as well as for two weeks after the last exposure to potentially-dangerous conditions), with the caveat that many of those signs are also apparent in more common diseases.

The following symptoms should be reported to a doctor, according to the WHO: "Most patients infected with the H5N1 virus show initial symptoms of fever (38 C or higher) followed by influenza-like respiratory symptoms, including cough, rhinorrhea, sore throat, and (less frequently) shortness of breath. Watery diarrhea is often present in the early stages of illness, and may precede respiratory symptoms by up to one week. Gastrointestinal symptoms (abdominal pain, vomiting) may occur and headache has also been reported. To date, one report has described two patients who presented with an encephalopathic illness and diarrhea without apparent respiratory symptoms."

People suspected of carrying the virus should be put in isolation and virus samples should be sent to WHO laboratories, the group said.

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To learn more about the potential impact of an influenza pandemic I recommend the following books:

1. America's Forgotten Pandemic : The Influenza of 1918 : A fine, galloping account of the influenza pandemic that killed some 25 million people in less than a year. In some ways it was a page out of the Middle Ages bound in the twentieth century. No plague ever killed so many people in so short a time. Alfred Crosby has systematically covered the effect of influenza upon the armed forces, major cities, and American territories. Over and above this he has depicted the spread and impact of the disease over a good part of the world. The scariest aspect of this tale is that it is not fiction. It has already happened, and scientists not only foresee the repeat of such an apocalyptic scourge as possible, but they express surprise that it hasn't already repeated its destruction... yet.

2. The Monster at Our Door: The Global Threat of Avian Flu : Avian influenza is a viral asteroid on a collision course with humanity. In 1918, a pandemic strain of influenza killed at least 40 million people in three months. Now, leading researchers believe, another world catastrophe is imminent. A virus of astonishing lethality, known as H5N1, has become entrenched in the poultry and wild bird populations of East Asia. It kills two out of every three people it infects. The World Health Organization warns that it is on the verge of mutating into a super-contagious pandemic form that could visit several billion homes within two years. In this urgent and extraordinarily frightening book, Mike Davis reconstructs the scientific and political history of a viral apocalypse in the making, exposing the central roles of agribusiness and the fast-food industries, abetted by corrupt governments, in creating the ecological conditions for the emergence of this new plague. He also details the scandalous failure of the Bush administration, obsessed with hypothetical "bio-terrorism," to safeguard Americans from the greatest biological threat since HIV/AIDS.

3. Flu : The Story Of The Great Influenza Pandemic : Feeling tired, achy, and congested? You'll hope not after reading science writer Gina Kolata's engrossing Flu, a fascinating look at the 1918 epidemic that wiped out around 40 million people in less than a year and afflicted more than one of every four Americans. Could such a deadly flu appear again? Many scientists fear it could, hence their quick response to the 1997 outbreak of chicken flu in Hong Kong, which led to the slaughter of 1.2 million birds and, Kolata argues, averted another worldwide disaster. Clearly explaining both the science and the social toll of the pandemic, Kolata writes an admirable history and soberly spells out how the U.S. government is preparedAor unpreparedAfor a similar public health threat today.