Dealing with Avian Influenza: hysteria does not help

The President recently made an alarming statement that if Avian Influenza, or bird flu, reached our shores, infected Americans would be quarantined and, if necessary, military troops would be used to enforce this. Naturally, this has scared people, even panicked them, and quite unnecessarily.

Avian Influenza is a flu infection of birds. The germ responsible is a virus, related to the virus which causes standard human influenza. It is genetically known as Avian Influenza A (H5N1). Infected wild migratory waterfowl are thought to be spreading the virus from location to location around the world, and when it gets into commercial poultry farms the birds get sick, many die and the industry suffers tremendous financial losses.

It is rare in humans and resembles standard influenza. Infection causes a high fever, cough, muscle aches, headache, shortness of breath or difficulty breathing and, unfortunately, in some cases, death. It is difficult to diagnose, requiring specialized laboratories to perform the necessary tests. This virus is spread by direct contact with infected birds; you cannot get the illness by eating properly cooked chicken nor by eating cooked eggs.

Avian Influenza is notable for two reasons: it is ruining the poultry industry in Asia and it has the potential to jump species, which could lead to a worldwide flu pandemic. However, the problem has been brewing for several years now and humans have been infected in just four countries: Vietnam, Cambodia, Thailand and Indonesia. There was a similar outbreak in Hong Kong in 1977, stopped by killing every chicken in the colony.

In two years there have been just over 120 cases — fewer cases than we see of traditional flu in the USA in a single day during the height of our normal flu season — and nearly every single case has occurred in poultry workers, those related to poultry workers or those taking care of ill poultry workers.

There is no vaccine commercially available, although work is aggressively being done now to develop one. There is no definitive treatment, either. Two antiviral medications, Tamiflu® and Relenza®, may reduce the duration or intensity of the illness.

Unfortunately, since the President’s speech, there has been a run on Tamiflu and people are hoarding it. At the end of October, Roche, the manufacturer of Tamiflu, stopped shipments to the USA because people were stockpiling the medication unnecessarily and there was not enough for patients who truly needed it. This sad behavior is reminiscent of the panic over Cipro supplies during the anthrax scare when pharmacies ran out of this antibiotic and sick patients could not get hold of a single dose.

Overwhelmingly, people do not need Tamiflu, and it is not reasonable for them to demand it of their doctors. It does not cure or prevent influenza or avian influenza. Furthermore, it appears that resistance to this drug has already begun, with a case in Vietnam.

Governments, just like people, can overreact. Culling all the chickens in a country is not likely to stop the spread of the germ, as migratory birds can spread it. Furthermore, as influenza vaccines are made in chicken eggs, if we kill all the chickens it will be rather difficult to make lifesaving vaccines against regular flu and bird flu.

Let’s be concerned about Avian Influenza but not overreact. Yes, there is a chance the germ will jump species and infect humans. That would not be good. But let us not be taken in by the “chicken littles” who cry that the sky is now falling.

Let us be sensible. Until a vaccine is available, avoid people who are coughing, avoid crowds if possible, wash hands well and often, and get vaccinated against the standard flu. Sleep well, eat properly and enjoy life. Pay attention to the news, but be alert to reports that are incendiary (and sell copy) rather than objective and helpful.

Tourists are highly unlikely to be infected with Avian Influenza when traveling to Asia, so there is no reason at this time not to travel for fear of this illness.

—Travel & Health is written by Alan M. Spira, M.D., DTM&H, FRSTM