Warden Messages - December 2005

Avian Flu Fact Sheet

This Fact Sheet alerts Americans to the most recent occurrences of Influenza A H5N1 (avian influenza strain). A number of countries are reporting cases of avian influenza, commonly referred to as “bird flu” in their domestic and wild bird populations. The H5N1 strain of influenza causes severe disease in domesticated fowl. In addition, there are confirmed cases of bird-to-human transmissions of avian influenza in the South East Asia region, many of which have resulted in death. Please visit the WHO website, <http://www.who.int/csr/disease/avian_influenza/country/en/> for the most up to date information on the countries affected and the number of deaths.
The vast majority of the known human cases have resulted from direct contact with poultry, and there is only limited evidence to suggest possible human-to-human transmission. The Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and the Department are concerned about the potential for human-to-human transmission of this highly dangerous flu strain, and are working closely with other partners in an effort to monitor the outbreak.
Concerns about the possibility of an avian influenza pandemic have prompted international and national efforts to institute pandemic preparedness measures. In keeping with the CDC and the WHO guidance, the Department of State is working with its embassies and consulates worldwide to prepare in the event of a pandemic. American citizens traveling to or living in countries where avian influenza is prevalent should consider the potential risks and keep informed of the latest medical guidance and information in order to make appropriate plans.
The Department, the CDC and the WHO have not issued any travel alerts or warnings for avian flu-infected areas. However, the CDC advises travelers to countries in Asia with documented H5N1 outbreaks to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces or fluids from poultry or other animals. In addition, the Department has asked its embassies and consulates to consider preparedness measures that take into consideration the fact that travel into or out of a country may not be possible, safe or medically advisable. Specific CDC travel information relating to avian influenza, including preventive measures is available at <http://www.cdc.gov/flu/avian/index.htm>. WHO guidance related to avian influenza is available at <http://www.who.int/csr/disease/avian_influenza/en/>.
A specific vaccine for humans that is effective against avian influenza has not yet been developed. Based upon limited data, the CDC has suggested that the anti-viral medication Oseltamivir (brand name-Tamiflu) may be effective in preventing or treating avian influenza. Using this input, the Department of State has decided to pre-position the drug Tamiflu at its Embassies and Consulates worldwide, for eligible U.S. Government employees and their families serving abroad. Tamiflu may not be readily available overseas and the State Department encourages American citizens traveling or living abroad that are interested in obtaining this medication to consult with their physician. There is no provision for the U.S. government to provide American citizens traveling or living abroad with medications, including in the event of a pandemic.
Americans who are planning travel to a country that has reported the virus or who are concerned about the Avian flu are advised to monitor the CDC and the WHO web sites for the latest information.
Additional country information can be obtained from the Department of State's Consular Information Sheets at <http://travel.state.gov/> and from the Department of State's toll-free number, 1-888-407-4747, or if calling from overseas, 202-501-4444.

CDC Contact Information:
Public Inquiries:
English (888) 246-2675
Spanish (888) 246-2857
TTY (866) 874-2646
Mon-Fri 8am-11pm EST
Sat-Sun 10am-8pm EST
Address:
The Centers for Disease Control and Prevention
1600 Clifton Rd.
Atlanta, GA 30333
USA (404) 639-3311

WHO Liaison Office in Washington, DC
Contact Information:
Telephone: (202) 331-9081
Facsimile: (202) 331-9097
Address:
WHO Liaison Office
1775 K Street, N.W., Suite 430
Washington, D.C. 20006 USA

*Frequently Asked Questions*

What are the travel recommendations regarding the H5N1 bird flu outbreak in Asia?
The U.S. Centers for Disease Control in Atlanta currently advises that travelers to countries in Asia 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. For more information about travel recommendations, visit the Centers for Disease Control website at http://www.cdc.gov/travel/seasia.htm#country <http://www.cdc.gov/travel/seasia.htm>.

Should I begin taking antiviral medications such as Tamiflu if I'm planning a visit to a country with reported cases of H5N1?

Travelers to any country that has reported cases of H5N1 among birds or humans should consider scheduling an appointment with their health care provider before traveling to discuss risks for potential exposure to H5N1. Risk of exposure and the decision to take a drug like Tamiflu, which, as yet, has no proven role for preventing human H5N1 infections, must be determined on a case-by-case basis. Only you and your health care provider can determine that risk and what the most appropriate precautions are for you.
Why isn’t the U.S. Government providing Tamiflu to private Americans overseas?
The Department of State lacks the legal authority to provide any type of medication, including Tamiflu, to private American citizens. State Department physicians and medical staff have an obligation to treat only those official employees, and their families, who are under Chief of Mission authority.

If I live in an area where diagnostic tests for AI are not available and I become sick with flu like symptoms, should I fly out?

If you develop influenza symptoms and are in a country known to have H5N1 among birds and/or humans, it is important to get immediate medical care. For this reason, you should visit your local doctor for treatment.

Do High Efficiency Particulate Air (HEPA) filters on airplanes offer protection?

Yes, if they are true HEPA filters, but many planes are not equipped with them. Airplanes are a common venue for human-to-human transmission of viral infections due to proximity of travelers and recycling of air within the cabin. You should not travel if you are ill or have a fever. If a neighbor is coughing or appears ill near you, move and tell the flight attendant. This is particularly important if you are flying from a country that has documented avian influenza cases in humans.

Will you evacuate Americans in the event of a pandemic?

Current medical thinking suggests that a “stay in place” response to a pandemic may be appropriate in certain countries or regions. In this scenario, people would be advised to exercise “social distancing” and avoid any form of public gathering where transmission of the disease could occur. Airplanes are a common venue for human-to-human transmission of viral infections due to proximity of travelers and recycling of air within the cabin. People who are not comfortable with this scenario should consider these factors when making their plans.
Whether the U.S. Government evacuates anyone will depend on a variety of factors specific to individual countries. Each U.S. Embassy has been asked to develop a contingency plan in the event of a pandemic, and to identify events that might prompt them to send employees and/or their dependents out of the country, assuming such travel is possible. Should the decision be made to send Embassy employees and/or their dependents out of a country, we will communicate this to the private American community so that people can plan accordingly. As in any other crisis, we will assess the availability of commercial transportation, the ability of people to travel to the United States or a third country, and other related factors in deciding on appropriate actions to assist Americans.

Is it safe to eat poultry and eggs?

Proper cooking of poultry will destroy the virus. There have been no reported human cases of avian influenza contracted from consumption of well-cooked poultry or eggs. Both humans and animals have contracted avian influenza from eating undercooked poultry products. Best practices during handling of raw poultry meat and usual recommended cooking practices for poultry products should be followed to lower the risk of common bacterial diseases spread by poor handling and cooking techniques. Eggs from infected poultry could also be contaminated with the virus and therefore care should be taken in handling eggs or raw egg products. Guidance on handling food to avoid spreading the virus is available on the websites for the Centers for Disease Control, the U.S. Department of Agriculture, and the World Health Organization.

Are children more susceptible?

The World Health Organization and the Centers for Disease Control believe that children may be more susceptible due to their increased proximity socializing at schools and day care centers, as well as being more likely to come into contact with poultry or bird fecal matter during their play habits. It is unknown whether immunity differences in children have any significance, since we presume that the vast majority of humans have no immunity against the H5N1 virus.