Risk of Bird Flu for International Travelers
The first outbreak of the ]]>bird flu]]> (H5N1) in humans occurred in 1997. Eighteen people in Hong Kong were infected; six died. In an effort to stop the spread of the virus, the Chinese government responded by destroying the poultry population—1.5 million birds. Since 1997, the bird flu has infected people in over 15 countries in Asia, Europe, the Near East, the Pacific, and Africa, and it remains a highly contagious and deadly virus among birds. There is a fear that the bird flu could mutate and spread more easily to humans. The fear of a pandemic is further heightened by the fact that migratory birds can continue to spread the virus to other countries.
What should you do if you have plans to travel abroad? The first step is to find out the facts.
How Contagious Is the Bird Flu?
The bird flu is caused by the type A strain of the influenza virus. In the wild, influenza A is easily spread among birds, but they usually do not get sick from the virus. Domestic birds, like chickens, are more susceptible, though. Among poultry populations, a highly dangerous form of the flu can cause severe sickness and death within 48 hours.
While the bird flu has infected tens of millions of poultry, H5N1 remains rare among humans. The World Health Organization (WHO) reports that, between 2003 and May of 2009, there have been 436 confirmed cases, with more than half of these people dying from the virus. Those at the greatest risk of infection are people who have direct contact with sick or dead birds or with surfaces contaminated by the virus. While there is the potential for the virus to mutate and become more contagious, at this time, the bird flu does not spread easily from birds to people, nor does it spread easily between people.
How Does the Bird Flu Affect Humans?
Symptoms can range from mild to severe. A person with the virus may have an eye infection, flu-like symptoms (eg, fever, chills, ]]>cough]]> , ]]>sore throat]]> ), and gastrointestinal problems ( ]]>diarrhea]]> , vomiting). In severe cases, H5N1 can quickly progress to respiratory distress, ]]>pneumonia]]> , organ failure, and death.
What Is Being Done to Combat the Bird Flu?
The H5N1 is resistant to two commonly used antiviral medications, ]]>amantadine]]> and ]]>rimantadine]]> (Flumadine). Because of this, the WHO and the US Centers for Disease Control and Prevention (CDC) recommend ]]>oseltamivir]]> (Tamiflu) for the treatment and prevention of H5N1. However, there have been cases where the virus is resistant to this medication.
In April 2007, the US Food and Drug Administration (FDA) approved the first US vaccine to protect against a strain of the virus. Not available to the general public, the vaccine was purchased by the government for the Strategic National Stockpile; health officials will distribute the vaccine if a crisis arises. Meanwhile, other government agencies and private companies are working towards developing a more advanced vaccine to protect against H5N1.
For example, the company Novartis has developed a vaccine called Aflunov that uses an adjuvant, a substance that triggers the immune system to have a stronger response. In investigational studies, Aflunov has shown to offer protection against several H5N1 strains. Another company, BioSante Pharmaceuticals, is currently conducting tests on two vaccines—one for ]]>swine flu]]> and one for bird flu—that use its new adjuvant BioVant, designed to make the vaccines more effective.
Are There Travel Restrictions?
If you are traveling to a country that has reported cases of the bird flu in the past, you do not necessarily need to change your plans. The CDC does recommend that you get the latest information on your destination and continue to check for updates. In the event of an outbreak, the local government, in an effort to contain the virus, is likely to place restrictions on where people can go. You can be prepared by having a supply of necessities (eg, canned food, water, medicine) and knowing where to go for medical care.
How Can You Reduce Your Risk?
To reduce your chance of being infected with the bird flu, follow these guidelines from the CDC and the WHO:
- Avoid direct or indirect contact with wild and domestic birds, including feathers, feces, undercooked meat and egg products.
- Make sure all poultry foods—including eggs—are thoroughly cooked. The heat from the cooking destroys the bird flu virus.
- Do not consume blood from poultry (eg, duck blood).
- Wash egg shells in soapy water before handling and cooking.
- Beware of cross contamination. Raw poultry juices should never be near food preparation areas. Do not use the same utensils, cutting boards, or dishes for raw and cooked foods, and keep these types of food separate. Thoroughly clean any items that come into contact with poultry.
- Wash your hands frequently or use an alcohol-based instant hand sanitizer.
- Do not visit poultry farms or live food markets where poultry is sold.
Keep in mind that you are more at risk if you handle poultry, such as:
- Plucking birds
- Preparing birds for cooking
- Handling fighting cocks
- Petting birds
In addition to these tips, make sure that all of your immunizations are up-to-date before you travel. Keep in mind, though, that none of these immunizations will protect your from bird flu. Also, research what medical facilities exist and what resources are available. The US Department of State ( http://www.usembassy.gov/ ) has a list of all of the US embassies; from there, you can find information on foreign hospitals and doctors.
What Should You Do If You Become Ill While Traveling?
If you do become ill while abroad, contact the US consulate in the country you are in and an officer can help you locate medical care. In addition, follow these tips:
- Find out what your health insurance will cover when you are traveling. Keep in mind that ]]>Medicare]]> does not pay for coverage outside of the US.
- If you have a health condition, obtain a letter from your doctor that explains your condition and your medication.
- Always carry your health insurance card and any other identification or proof of insurance coverage.
- Keep identification information with you at all times while traveling. Make sure pertinent health information, such as medication allergies, is included.
Centers for Disease Control and Prevention (CDC)
US Department of State
World Health Organization (WHO)
Canadian Lung Association
Public Health Agency of Canada
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Last reviewed August 2009 by ]]>Richard Glickman-Simon, MD]]>
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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