What You Need To Know About Bird Flu
by Nedaa Skeik, MD, Sabattus Street Internal Medicine, St. Mary’s Regional Medical Center, Lewiston, Maine. A member of the Sisters of Charity Health System

You’ve heard the stories on talk radio, you’ve seen the reports on the 6:00 pm news, and read countless articles in newspapers…but how much do you really know about the Avian flu, or bird flu?  What causes the virus, how can humans be infected, and what can be done to prevent widespread illness?  

Avian flu (subtype H5N1), besides birds, it can also infect humans, cats, and tigers. First reported human cases were in 1997 when 18 human cases were reported during a poultry outbreak in Hong Kong. So far, it has affected people in many countries in Asia, Africa, and Europe.

According to the World Health Organization (as updated at its website on May 26, 2007), H5N1 virus has already infected 307 humans and killed 186 of them. It has a mortality rate exceeding 50%.  The disease mainly affects domesticated poultry, including chickens, ducks, and turkeys. But it also affects migratory birds like wild ducks, geese, swans and hawks, which may be part of the reason it has spread to Europe and Africa.  The birds shed the virus in their saliva, nasal secretions, and feces. Infection can spread among birds by contact with infected birds or their excretions.

People can be infected by direct or close contact with infected poultry or surfaces contaminated with secretions and excretions from infected birds. Human exposure occurs most often during slaughtering, de-feathering, butchering, or preparation for cooking. Raw poultry or eggs can also transmit the disease. There are no reported cases through properly cooked poultry.

Other ways H5N1 can be transmitted include: drinking contaminated water, exposing mucus membranes in the nose and eyes to contaminated water, touching contaminated objects, and exposure to untreated poultry feces used as fertilizer.

Symptoms of H5N1 are typical flu-like symptoms: fever, cough, and sore throat, muscular pain, eye infections, pneumonia, diarrhea, and vomiting.  Laboratory tests may show elevated liver function and low blood cell counts. Complications include acute respiratory failure, heart and brain inflammation, multi-organ failure with kidney dysfunction, and sepsis.  Most human deaths have been related to respiratory failure.

Whenever possible, patients with suspected or proven influenza A (H5N1) infection should be hospitalized in isolation for clinical monitoring, appropriate lab tests, and antiviral therapy.

Although the risk of transmission from person to person appears low, quarantining of close contacts to patients for a week after the last exposure and monitoring for symptoms may help to reduce transmission rates.

Quarantine and culling of affected poultry is the best way to stop the disease. The use of inactivated H5N1 vaccines in chickens is an additional step, but should be done with caution.

In April, the U.S. Food and Drug Administration announced its approval of the first vaccine to prevent human infection with one strain of the avian flu. Progress in vaccine production for additional strains shows promise. If successful, vaccines would likely be the most important health tools to decrease morbidity, mortality, and economic effects of pandemic influenza.

For a pandemic to occur, three conditions must be met: a new influenza virus subtype must emerge, it must infect humans and cause serious disease, and finally it must spread easily among humans.

The first two conditions have already been met, and there are cases of suspected human-to-human transmission in Thailand and Indonesia. However, as of today, there is no evidence of easy human-to-human transmission that would be the key for a pandemic.

The emerging influenza virus H5N1, the threat of a flu pandemic seems to be real and inevitable, but no one can predict when it might happen.

According to a study by the Congressional Budget Office, the consequences of a severe pandemic could, in the United States, include 200 million people infected, 90 million clinically ill, and 2 million dead. The study estimated that 30% of all workers would become ill and 2.5 % would die, with 30 % of workers missing a mean of 3 weeks of work, resulting in a decrease in the gross domestic product of 5%. Furthermore, 18 to 45 million people would require outpatient care.  The economic cost in the United States alone would total approximately $675 billion. 

St. Mary’s Regional Medical Center and the Sisters of Charity Health System have assembled a Pandemic Influenza Task Force that worked with local, regional, and state officials in setting up protocols to keep residents safe and healthy should the H5N1 virus spread to Maine.

More information about avian flu can be found at http://www.cdc.gov/flu/avian.

Dr. Nedaa Skeik is an internal medicine physician at Sabattus Street Internal Medicine in Lewiston, Maine and is a member of the Pandemic Influenza Task Force at St. Mary’s Regional Medical Center in Lewiston. He is a graduate of Istanbul University, Cerrahpasa Faculty of Medicine, Istanbul, Turkey.  He performed his residency at New York Medical College, Metropolitan Hospital Center, New York, NY.

About St. Mary's Regional Medical Center St. Mary’s Regional Medical Center is a community hospital serving Maine’s greater Androscoggin County. From prevention to intervention, St. Mary’s and its staff takes pride in the care they provide every day. For more information about St. Mary’s please visit our website at www.stmarysmaine.com.