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Avian flu concerns demand our vigilance

Bird flu keeps worldwide health organizations on high alert. The most recent human cases occurred in northern Iraq and included a young girl's death. In Hong Kong, health officials expect more infected birds and remain vigilant checking poultry and banning poultry imports from countries whose flocks have been infected. Fortunately, three recent suspect human Hong Kong cases tested negative for avian flu typed influenza A H5N1.

The last Hong Kong human case was in 2003. Infected birds have been identified recently in Nigeria. Last week, Greece and Italy identified infected fowl and the Greek health ministry noted that one ill 29-year-old hunter who handles wild ducks was being quarantined and tested for bird flu.

Thus far, identified human cases remain in Asia, Iraq and Turkey. Human disease has been due to direct contact with poultry. No infected birds have been identified in the United States or the Western Hemisphere. It is possible the Pacific bird migration could bring infected birds into Alaska from Siberia. However, infectivity risk is low in Alaska because birds and poultry have less contact than in Asia.

Currently, health experts debate the pandemic's potential. At present, the disease is spread from poultry to humans. Cases remain isolated. Until the virus mutates allowing person-to-person transmission, there will be no major spread of disease. Predicting the potential pandemic's significance can best be characterized as speculative. The disease may not materialize in spite of expensive preparation, but neglecting strong public health measures could prove catastrophic. This was the case with Spanish flu in 1918.

Many U.S. Spanish flu deaths occurred because of inaction, refusal to inform the public, and the lack of treatment modalities. An overwhelmed health care system collapsed in its efforts to address a highly contagious, acute, deadly viral pneumonia. There were examples where candor and quarantine by officials saved some American communities, such as in Colorado, from the ravages of deadly 1918 flu. Modern medical care could prevent a similar outbreak. Antibiotics, antiviral medications, immunizations, diagnostic, and management modalities are light-years ahead of earlier treatment.

Experts emphasize that without person-to-person transmission there can be no pandemic. One scientist suggests that the fear of avian flu is spreading faster than the disease. The virus may or may not mutate to a more transmissible form. Scientists that underplay the severity of bird flu suggest that only serious cases are diagnosed. One Stockholm physician declares that milder human cases have not been counted because the people affected do not seek treatment. That means a much lower death rate than feared.

However, debate aside, acute viral pneumonias were lethal in 1918 and could prove deadly today. It would be unwise to miscalculate avian flu's potential risk. Preparation must continue as infected birds and human cases expand to more countries.

Three major initiatives to combat a possible pandemic include a potential vaccine for prevention. Pennsylvania researchers have had significant success in animal trials with a rapidly produced vaccine. Quickly produced vaccine could prove a powerful tool against mutating viruses. Human trials should begin shortly.

The second effort involves stockpiling of antiviral drugs deemed effective against bird flu. Treatment must begin within 48 hours of flu symptoms to be effective. The logistics of providing large populations with the drug can prove challenging. Thus far, public health professionals have been highly successful containing the contagious and lethal Ebola virus through effective response teams. The repeat of such actions should be effective in a potential bird flu pandemic.

Finally, individuals can reduce their threat of disease. When traveling in countries with infected poultry, avoid direct contact with living or dead domestic fowl or wild birds. Practice good hand hygiene. Maintain current information on local policies that may include interventions such as quarantine or border closures. There is no evidence that properly cooked poultry will transmit the virus. Prepare such foods well.

Although a vaccine against avian flu is not available, influenza shots are highly recommended in appropriate risk groups. Travel with a health kit including a thermometer and other first aid items such as mild analgesics and antidiarrheal medication. Those whosuspect exposure to bird flu should seek appropriate treatment. Health experts will continue to debate bird flu pandemic risks and the potential severity of such an outbreak. Of course the best-case scenario, agreed upon by all public health officials, would be continued limited transmission and no pandemic.

Dr. Marc J. Yacht is director of the Pasco County Health Department.