A Simple Guide to SARS and Related Influenza diseases (A Simple Guide to Medical Conditions)

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For example, provincial or territorial Chief Medical Officers of Health can quarantine people within their jurisdiction to limit spread of disease. Partnerships among all levels of government allow Canada to increase its capacity to prepare and respond to public health events. Local authorities are responsible for providing public health services in Canada.


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During a domestic infectious disease outbreak, local public health officials are the front-line public health responders, working with other health care providers. Their role includes monitoring and detection of health events and carrying out outbreak investigation to identify the source, including laboratory testing if available, isolation and treatment of the sick, and follow-up with close contacts of the sick. Outbreaks are also often detected by provincial and territorial public health authorities.

If an outbreak spreads beyond local boundaries or has serious human health implications, the province or territory will assume leadership in coordinating the management of the response. Provincial and territorial public health authorities also establish standards and guidelines and provide assistance to local authorities, including laboratory services. Before an outbreak even occurs, the Agency is involved in the routine detection, monitoring and analysis of national and international trends and spread of infectious disease threats. As diseases and patterns can change, ongoing review is critical.

In , the Agency together with provinces and territories assessed and ranked the top 60 infectious disease threats in Canada according to a set of criteria, including how common, severe, and easily spread the disease is and whether public health interventions are available and needed. The Agency led the development of national standards for detection and reporting of these infectious diseases, including case definitions and protocols for reporting to allow Canada-wide comparison.

When there is an international effort to control or eliminate a disease e.

Respiratory Tract Infections: Influenza Virus – Respiratory Medicine - Lecturio

While local public health authorities may detect unusual clusters of disease or illness in their communities, the linkage of information at the national level may detect geographically dispersed but related cases e. The Agency has also developed mechanisms to monitor other information sources, such as global media and newswires, which can help detect health issues abroad that may potentially have an impact on the health of Canadians. When the Agency detects a potential threat abroad through unofficial information sources, it verifies the information with the WHO and other official government channels.

Likewise, Canada contributes to the global picture of disease. For example, we are part of an extensive network that monitors the ever-evolving influenza viruses and their spread around the world. In managing domestic outbreaks, the federal government may take on an advisory role in addition to monitoring and communicating with provinces and territories.

For example, the federal government may link with national and international experts to provide advice to health care providers on public health measures, laboratory testing and clinical management as well as providing information to the general public and at-risk groups. When outbreaks involve more than one province or territory, the federal government takes on a leadership role to coordinate the response. At times, outbreaks that are geographically localised can be large i. Provinces and territories may then request federal assistance to support or lead the investigation and response.

The federal government is also involved when there is potential for spread of the disease into or out of Canada. Infectious disease outbreaks are only one type of event that can have an impact on the health of Canadians. Local authorities prepare and respond to emergencies using local resources and emergency management systems. When an emergency exceeds local capacity or if it becomes larger in scope, provinces and territories, as well as the federal government may become involved to coordinate and assist, as needed.

The SARS outbreak, while comparatively small in terms of total number of cases, presented a formidable challenge to public health in Canada. In a few short months the global community combined efforts to identify, contain and eradicate a newly emerged virus in human populations.

Federal response was required due to the need for coordination and collaboration with multiple Canadian and international partners from diverse disciplines in dealing with this novel disease. The situation was especially challenging given that knowledge was initially limited and constantly evolving, there was no specific treatment and public health measures had to be adjusted based on knowledge collected over time.

In keeping with the recommendations of this committee chaired by Dr. David Naylor, the federal government created the Public Health Agency of Canada in to provide leadership and action on public health matters such as national disease outbreaks and emergencies. David Butler Jones, to be the leading federal voice for public health in Canada. The Public Health Agency of Canada Act , which came into force in , gave the Agency the statutory footing required to fulfill its role on behalf of the Minister of Health.

To accomplish this, the Agency is focused on promoting health, preventing chronic diseases and injuries, and responding to public health emergencies and infectious disease outbreaks. Laboratory liaison technical officers have been placed in several provincial laboratories to increase their capacity. The Agency has also bolstered the number of training positions across Canada, including field epidemiologists disease investigators and other scientists.

The Agency has further developed the Skills Online program, based on a defined set of essential public health skills core competencies which has helped over 4, public health practitioners nationwide increase their skills, knowledge and abilities in public health since its creation in by Health Canada. The program consists of 10 internet-based modules aimed at public health practitioners at all levels, including modules on surveillance, epidemiology and outbreak management. Applying the knowledge and skills from these modules helps to achieve sound, evidence-based public health decision-making and planning.

The Agency is also involved in the design and development of electronic information systems to support the investigation, monitoring and reporting of public health events across the country. One such system, the Canadian Network for Public Health Intelligence CNPHI , is a secure, web-based system now utilised by one hundred percent of local health authorities, all provinces and territories, and the Agency.

This system enables communication across public health jurisdictions, including timely dissemination of information about emerging or evolving public health events such as the posting of public health alerts. In addition, the Agency has provided technical input for the development of a pan-Canadian electronic tool Panorama that allows health authorities to collect, share and analyze a wide range of health information to manage public health issues, including outbreaks and vaccine coverage.

An informed and engaged public is important in managing public health threats. Since SARS, the Agency and Health Canada developed and adopted a Strategic Risk Communications Framework to guide their work in developing effective communications for the general public and specific groups such as health professionals and vulnerable populations. This framework advocates facilitating dialogue to enable authorities and stakeholders to make well-informed decisions for effective, responsible and ethical risk management i.

This approach to communicating risk issues has already been extensively applied to areas including pandemic influenza planning and response. The Agency is also working with risk communication networks, both nationally and internationally, to provide training and produce consistent approaches and messages.

Many organizations are involved in managing public health events. On a federal level, the Agency is part of the Health Portfolio. Health Canada, another key component of the Health Portfolio, has a special role in managing events such as outbreaks involving First Nation and Inuit communities. Health Canada also regulates pharmaceuticals, vaccines and other health products.

The Agency collaborates with several other federal partners including the Canadian Food Inspection Agency CFIA to manage foodborne and select animal disease outbreaks such as avian influenza. Finally, Public Safety Canada coordinates multi-department response to emergencies including counter-terrorism issues. In the ensuing weeks, a large scale depopulation of poultry in the BC lower mainland was carried out by the Canadian Food Inspection Agency as a standard measure to stop the spread of the virus to other birds and prevent the infection from entering the human population.

Local, provincial and federal health authorities put in place measures to further reduce the risk of human infection with the avian virus and to prevent possible double infection of humans with both the avian virus and human seasonal influenza viruses mixing of animal and human virus infections which has the potential to generate a new pandemic virus. These measures included providing workers involved in poultry depopulation with personal protective equipment e. In addition, health authorities actively monitored for illness among workers involved in poultry depopulation, farm workers and their household contacts.

Two individuals with exposure to infected poultry were identified as having mild avian influenza A H7N3 virus infection. Both individuals received treatment with antiviral medication and their symptoms resolved fully.

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This avian influenza A H7N3 outbreak in Canada, and the avian influenza A H5N1 outbreak in other regions of the world, further led to the development of a collaborative federal, provincial, territorial and non-governmental organization project to survey influenza A infections in wild birds across Canada. This survey provides a better understanding of the character, presence and relevance of these viruses in bird populations and will aid in more rapid diagnosis of virus strains in the event of an outbreak. Likewise the survey's multi-agency collaborative effort is building and maintaining important linkages between field, laboratory, regulatory and communications partners within Canada to better enable a rapid and integrated response to avian influenza virus outbreaks and related emerging disease issues.

Canada's experience in responding to domestic avian influenza outbreaks has provided us a greater understanding of the risks and challenges of early intervention and effective measures for animal and human disease prevention and control. To improve collaboration in public health response to outbreaks and other public health events across Canada, including the development of agreements and protocols, the Agency supported the formation of the Pan-Canadian Public Health Network.

Headed by the Public Health Network Council co-chaired by the federal Chief Public Health Officer and a provincial or territorial Chief Medical Officer of Health , this federal, provincial and territorial network is a mechanism for providing technical advice and evidence-based best practice protocols to Deputy Ministers upon request in order to improve the daily operations of public health in Canada. Canadian public health and other experts support the work of the Pan-Canadian Public Health Network in the areas of communicable disease control, emergency preparedness and response, public health laboratories, surveillance and information, chronic disease and injury prevention and control, and health promotion.

In September , federal, provincial and territorial Ministers of Health approved two key agreements memoranda of understanding developed via the network on information sharing and on mutual aid during public health emergencies. This system sets out how jurisdictions and organizations connect and interact effectively with each other before, during and after a public health event or emergency.

SARS: Causes, symptoms, and prevention

General approaches to emergency management are adopted by governments to prepare for and respond to any natural and man-made hazards. Broadly speaking, these approaches address pre-event activities which aim to prepare for and mitigate a hazard, activities during an event to respond to the emergency and post-event activities which aim to facilitate recovery and evaluate lessons-learned learnt. First published in and updated in , the plan is designed to coordinate federal, provincial, territorial, and local jurisdictions in their preparation and response to an influenza pandemic in Canada.

Before a pandemic occurs, the pre-event stage involves monitoring public health intelligence to detect potential threats such as avian influenza viruses and other novel influenza viruses which may cause illness in human. Depopulation of infected birds has been used as one measure to prevent the spread of new influenza viruses potentially capable of infecting humans , thereby reducing the risk of a pandemic. Preparedness includes developing plans, training responders and testing these plans through exercises, securing vaccine supply, building medical stockpiles e. Prior to an event, it is also important to clarify and formalize roles and responsibilities amongst governments and stakeholders.

During a pandemic, public health response activities are aimed at mitigating impact on the population by minimizing severe health outcomes, including death, and secondly, by reducing social disruption and economic impact. These activities may include isolation of the sick, treatment with anti-influenza medication, conducting immunization programs, laboratory analyses, triage and provision of additional medical capacity e. After the event, recovery involves organizing activities to restore community life and health services e.

Evaluating the effectiveness of the public health response is a key after-event activity to inform planning and preparedness activities. After SARS, recognizing the rapid and serious global impact of infectious disease and other public health hazards, there was international impetus to strengthen disease detection and reporting capabilities. The regulations are a framework for detecting, reporting and managing public health risks in the international context.

The regulations require signatory countries, including Canada, to report to the WHO public health events that have the potential to cross borders and threaten people worldwide, and to strengthen their core capacity for public health surveillance and response. As described above, managing a public health threat involves a series of activities that starts with detection of the threat, followed by an assessment of the associated risks and the implementation of appropriate response or management activities. Another novel SARS-like or pandemic disease outbreak will likely occur again. When that happens, it is likely that informed front-line health care providers will be the first to detect the disease in Canada.

The Agency is collaborating with public health partners to implement measures such as rapid communication to the front-line, training tools and guidelines to ensure that emergency room physicians and other front-line health providers are advised of what to look for when a patient presents to their clinic and know what to do in terms of infection control, testing and notifying appropriate authorities. The Agency has worked closely with provinces and territories to develop and maintain systems and tools to detect and report respiratory diseases and unusual activity.

Following SARS, the Agency worked with provinces and territories to develop a surveillance protocol and case report form to rapidly identify and report severe respiratory illnesses of unknown cause. In addition, a Respiratory Illness Outbreak Response Plan was developed and implemented to assist in coordinating the investigation and control of severe respiratory illness outbreaks. Outbreaks may also be detected through laboratory testing and analyses. The Agency coordinates PulseNet Canada , a network of microbiologists who conduct genetic fingerprinting of disease-causing bacteria such as E.

A web-based database and discussion board enables the laboratories to compare information from cases that may be geographically far apart but share the same genetic pattern, allowing the Agency to investigate and respond to an outbreak before it becomes a wider problem.

Since SARS, this National Microbiology Laboratory NML has further developed state-of-the-art technology to rapidly analyze genetic sequences of viruses and enhanced vaccine research capacity. On July 29, , the Ontario Ministry of Health notified the Agency of a listeriosis outbreak in the province. The source of the listeria was unknown at that time. On August 13, the National Microbiology Laboratory notified laboratories across Canada using PulseNet, an electronic communication tool, that genetic fingerprinting showed a clustering of cases with a similar strain in more than one province.

The Agency issued a public health alert to inform local, provincial and territorial public health officials of the potential multi-provincial foodborne illness outbreak and to request information on cases. Additional cases of listeriosis were identified in British Columbia, Quebec and Saskatchewan. The Agency took the lead in coordinating the investigation, as per the Foodborne Illness Outbreak Response Protocol FIORP , a national reference to guide the provincial, territorial and federal response to outbreaks involving more than one jurisdiction.

Most of the ill individuals were residents of long-term care facilities or were hospitalized during their likely exposure period and reported consumption of ready-to-eat meat. The Agency and its provincial, territorial, and federal partners collaborated to determine that Maple Leaf Foods ready-to-eat meat was the cause of the outbreak.

Such a change could mark the start of a pandemic a global outbreak in humans. Much of the scientific evidence suggests that domestic poultry provide a favourable environment for the entry, spread and shift to high virulence of influenza viruses, which were mostly mild and confined to waterfowl in the past. The dramatic growth in domestic poultry production is part of the explanation. More than half of the domestic bird population is in medium- to large-scale intensive poultry holdings where fairly strict hygiene, prevention and containment biosecurity measures are in place; however, a sizeable part of the poultry population remains with the smallholder sector run by an estimated million farmers, each keeping birds, mainly ducks, chicken, geese, turkeys and quail.

Backyard or village poultry is characterised by scavenging birds and open coops, and is exposed to viruses carried by wild birds.


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  • Seasonal seeding of influenza viruses into backyard poultry systems by migrating waterfowl allows regular addition of new viruses to the diverse domestic poultry virus pool and may explain some of the geospatial features of regional virus distribution. However, the rapid spread of certain virus types suggests dissemination mechanisms within the poultry sub-sector itself, such as live poultry movements or transports involving infected materials such as unclean cages or dirty egg crates. The risks from live bird or 'wet' markets appear the most obvious and have in the past been incriminated as a critical risk.

    Densely populated livestock areas are vulnerable to the introduction and spread of infectious diseases, and this is compounded by the presence of forest reserves and open water bodies in the production area, movement of animals, contamination of lorries, feed and other supplies, and hygiene on farms, the processing chain and markets. The widespread infections of commercial poultry flocks in many countries of Asia is not a total surprise. The region is known to form an influenza epicentre where birds, other animals and humans live closely together in conditions where viruses have the greatest opportunity to pass from one species to another.

    A number of conditions make transmission to humans of a variety of disease agents more likely, including poor sanitation of chicken stalls in retail outlets, the proximity of markets to living areas, the absence of central slaughtering facilities, and, the practice of slaughtering chickens at the retail outlets without veterinary inspection. More in general, avian influenza outbreaks can be considered as part of the process of global change. Traffic and trade dynamics create conditions for viruses, bacteria and parasites to hitch-hike around the world, affecting people, animals and ecosystems.

    Climate change alters the distribution and abundance of insect vectors, and influences bird migration and livestock concentrations. Urbanization, income rise and dietary changes create an increase in the demand for animal production. Outbreaks of avian influenza, SARS, foot-and-mouth disease, classical swine fever and Rift Valley Fever are all believed to reflect instabilities in the production environment and perhaps in agro-ecology in general.

    Learning from SARS: Preparing for the Next Disease Outbreak: Workshop Summary.

    FAO is studying the linkages between disease occurrence in animals and diseases of animal origin in humans and environmental change, in order to better advice on the health implications of production changes in the future. Avian influenza is most often spread by contact between infected birds and healthy birds. It may also be spread indirectly through contact with contaminated equipment and materials.

    The avian influenza virus is found in secretions from the nares nostrils , mouth, and eyes of infected birds and is also excreted in their droppings. Contact with contaminated droppings is the most common means of bird-to-bird transmission, although airborne secretions are another important means of transmission, especially within poultry houses. Wild duck droppings can introduce low pathogenic LPAI into domestic flocks raised on range or in open flight pens. How highly pathogenic avian influenza HPAI is initially introduced into poultry flocks remains unclear.

    However, the spread of avian influenza between poultry facilities almost always results from the movement of infected birds or contaminated people and equipment including clothing, boots, and vehicles. Avian influenza virus can also be found on the outer surfaces of egg shells but rarely inside ; therefore, egg transfer is a potential means of avian influenza transmission.

    Airborne transmission of avian influenza virus from farm to farm is not likely. H5N1 HPAI can be spread from birds to people as a result of direct contact with infected birds, such as during home slaughter and plucking of infected poultry. Public health concerns centre around the potential for the virus to mutate or combine with other influenza viruses to a form that could easily spread from person to person.

    If that happens, there is a risk that the virus could rapidly spread worldwide and cause large numbers of humans to become ill or die a pandemic. The transmission of avian influenza refers to the passing of the disease from one animal to another and in very limited cases from an animal to a human. The spread of avian influenza refers to the wide diffusion geographically or throughout production and market systems of the disease among a large number of animals.

    Transmission From what we know today, the avian influenza virus can be transmitted through contact among and with poultry and their droppings, feathers, intestines and blood. The greatest risk of infection for humans appears to be through the handling and slaughtering of live infected poultry. Spread Unlike some diseases, avian influenza is not an air-borne disease.

    Most current evidence suggests that the virus spreads mainly through the movements of poultry, poultry products, people and the vehicles they use for transport. Most outbreaks of avian influenza can be linked to movements of poultry, poultry manure, poultry by-products and accidental transfer of infected material such as bird droppings, bedding straw or soil on vehicles, equipment, cages or egg flats, clothes and shoes. Worldwide, unregulated movement of poultry is the most important way that the disease is spread.

    Live animal or 'wet' markets may have played a major part in sustaining the virus in Southeast Asia, They were identified as the source of the H5N1 infection in chicken farms in Hong Kong in when approximately 20 percent of the chickens in live poultry markets were found to be infected.

    The same situation occurred in Viet Nam, where the circulation of H5N1 in geese in live bird markets in Hanoi had been documented three years before the outbreaks on chicken farms. There is also a huge international trade in poultry - both legal and illegal.

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    The legal trade involves millions of hatching eggs and poultry being shipped to destinations worldwide; information on the extent of the unregulated and illegal poultry trade is scarce but interceptions in recent years indicate lapses in border controls despite the risk. The widespread illegal trade in ornamental, sporting and caged birds has also transported H5N1-infected birds over large distances. One of the most likely sources of infection in captive birds in Asia is again in 'wet' markets, where domestic and wild-caught birds are kept in close proximity, posing a risk of cross-contamination.

    Poultry droppings could be dangerous for other animals and for people because infected poultry excrete the H5N1 virus and other potentially dangerous pathogens in their droppings. It is impossible to avoid other chickens coming into contact with droppings from infected chickens in the same flock, but you can protect different species by keeping them in separate enclosures.

    Wild ducks often introduce low pathogenic avian influenza into domestic flocks raised on range or in open flight pens through faecal contamination. Low pathogenic avian influenza naturally occurs in wild birds and can spread to domestic birds. In most cases it causes no signs of infection or only minor sickness in birds.

    You can protect your birds by using screens or nets to keep them separated from wild birds and their droppings. If your birds come into contact with wild birds, be sure to watch for signs of highly pathogenic avian influenza in them such as breathing problems, watery diarrhoea, swelling around the head, neck and eyes, and a drop in egg production or malformed eggs.

    A loss of appetite might also occur in birds. Poultry droppings are also widely used in agriculture and aquaculture as fertiliser and food for other animals such as pigs and fish. However, untreated droppings can be a significant way of passing on the disease. Even the collection and transport of untreated or non-composted poultry manure could be a highly effective way of spreading the virus. People can come into contact with poultry droppings in two ways: directly through their skin and indirectly through clothing or equipment. Always try to wear gloves, boots and other protective clothing if you are going to be in places where poultry are kept or have been kept recently such as enclosures, coops, sheds or other buildings.

    When you leave, take your gloves, boots and protective clothes off and wash your hands thoroughly with soap or scour them vigorously with ash if no soap is available , disinfecting them afterwards if possible. It is even more important to wash and disinfect thoroughly if you have not been wearing gloves or other forms of protection. It depends on the amount of virus contained in the droppings, temperature and moisture content. Generally speaking however, the virus dies more quickly in higher temperatures and the drier the droppings are. Yes, the possibility of HPAI H5N1 breaking out always exists but the likelihood of it happening varies from country to country.

    This largely depends on the level of biosecurity in place on farms and in commercial poultry production facilities, on the safeguards in place to monitor disease in poultry flocks, and on the level of compliance with import and export controls. Everyone, including pet owners, should be aware of the potential of the H5N1 avian influenza virus to cause disease and death, as well as how it can be transmitted. If H5N1 HPAI is identified in your country, the competent authorities will issue instructions on the precautions to take, but there is no reason to abandon cats, dogs, or other pets because of concerns about contracting or spreading the virus.

    Although H5N1 can cause serious disease in people, the virus is "hard to catch". Transmission from birds to human remains difficult, usually involving prolonged and close contact, and so far the virus has not been shown to spread from person to person. In the last years there have been at least three major pandemics of human influenza A, which killed many people around the world.

    The origins of these deadly virus strains remain uncertain, but at least two are thought to have arisen when avian influenza and human influenza viruses came together, possibly in pigs, and reassorted their genetic material. Continued outbreaks of H5N1 increase the chances of this happening again, especially as the current strain of H5N1 is exceptional in that it can though rarely does pass directly from poultry to humans.

    Almost always, human infections have occurred in people who have been closely associated with poultry. Given the substantial number and distribution of outbreaks in domestic poultry and waterfowl, there have been relatively few cases in people WHO statistics up to 29 November indicate confirmed infections, with fatalities , indicating that the transmission of the virus from poultry to people remains inefficient.

    We do not know for certain, but direct contact with infected poultry, or surfaces and objects contaminated by their droppings is presently considered the main route for infection of humans by the avian H5N1 virus. To date, most human cases have occurred in rural or urban fringe areas where many households keep small poultry flocks, which often roam freely, sometimes entering homes or sharing outdoor areas where children play.

    As infected birds shed large quantities of virus in their droppings, opportunities for exposure to infected droppings or to environments contaminated by the virus are abundant under such conditions. Moreover, because many households depend on poultry for income and food, families sometimes sell or slaughter and consume birds when signs of illness appear in a flock, rather than disposing of the birds safely, and this practice has proved difficult to change. Exposure is considered most likely during slaughter, plucking and butchering. There is no evidence that properly cooked poultry or eggs can be a source of infection.

    Yes, but even though the H5N1 virus may have the potential to change into a virus that can easily pass from person to person, there is no evidence that this has happened. An influenza pandemic is a rare event and has occurred only three times over the last years in with around 50 million deaths, in with almost two million deaths, and in with about one million deaths.

    It is impossible to calculate the risk of a human pandemic. The H5N1 avian influenza virus meets two out of three conditions necessary to cause a human pandemic. It can infect humans and it causes serious illness, but critically it does not spread easily and sustainably between humans. If this virus subtype changes to spread easily and sustainably between humans it may have the capacity to cause a pandemic, but we cannot predict if, when or where this will happen. Nor can we predict whether the virus would retain its ability to cause serious disease.

    But we can take precautions to protect humans and we can take action where avian influenza is identified in poultry. The specific actions to be taken with regard to controlling marketing, imposing movement restrictions or quarantine measures, culling and vaccinating vary according to local circumstances and from country to country. There is no one solution for all situations, and a balance must be established among effective, feasible and socially acceptable control measures that safeguard the short- and long-term livelihoods of farmers and the health of the population.

    In general however, a number of basic measures are common to all situations: infected birds and those in contact with them must be humanely and safely culled to halt spread of the disease, levels of prevention and containment biosecurity must immediately be raised appropriate to the level of risk, and surveillance must be increased and widened to permit earlier detection and reporting of disease.

    Report sick or dead birds to the local veterinary or public health authorities. If this is not possible, tell your neighbours or community leaders. It is important that all signs of illness or sudden and unexplained deaths in poultry and wild birds are reported to the authorities so that they can deal with them safely and help stop the virus spreading. Keep all birds separate from people and living areas.

    Close contact with infected birds can put you and your family at risk. Keep wild birds away from poultry and keep different types of bird apart. Screens, fencing or nets cvan be used to separate species and help prevent transmission. Wash your hands often to kill and remove the virus. You should always do so after handling birds, cooking or preparing poultry products, and before eating. Eat well-cooked poultry products.

    Do not eat sick or dead chickens and do not give or sell them to others. Keep chicken from infected flocks out of the food chain and do not feed them to other animals. Seek immediate treatment from your doctor if you have fever after being in contact with sick or dead poultry. Why is there so much concern about the current outbreaks?

    I have heard avian influenza will kill millions of people - is this true? Is it safe to eat poultry and poultry products? Can I get avian influenza from handling wild birds? Should people avoid travelling to countries affected by HPAI? What can travellers do to avoid bringing the disease back to their country? There is concern that the virus may change reassort or mutate to emerge as a new virus that is easily transmissible between people and capable of causing disease in people, birds and other animals.

    Influenza A viruses occur worldwide in a wide range of animals, including humans. The high pathogenic H5N1 avian influenza strain involved in most of the outbreaks during the last 18 months has shown the ability to jump the species barrier occasionally and cause severe disease, with high fatality, in humans.

    It has not shown the capacity to transmit between humans. Avian and human influenza viruses can exchange genetic material when a person or other animal susceptible to infection is simultaneously infected with these viruses. This could create a completely new subtype of the influenza virus to which few, if any, humans would have immunity and which might be able to spread between humans. Avian influenza is primarily a disease of birds.

    It is caused by influenza viruses closely related to human influenza viruses. Transmission to humans in close contact with poultry or other birds occurs rarely and only with some strains of avian influenza. There is potential for mutation of avian influenza viruses to new forms of virus that could cause severe disease in humans. It is also possible that a previously unknown deadly virus with the capacity to spread easily from person to person could appear.

    However, there has been a limited number of cases in which there has been evidence to suggest person-to-person transmission and to date there is no evidence that the highly pathogenic avian influenza virus has adapted to spread easily in humans. Currently, no. There is no vaccine to protect people against H5N1 influenza infection or disease, although research is under way to find a safe and effective vaccine for human use.

    There is however evidence that most, but not all, H5N1 viruses respond to antiviral drugs if taken immediately or soon after infection has started. Yes, but certain precautions should always be followed to ensure that the meat and animal products we eat come from healthy animals. Poultry and other birds that have been ill and died should not be eaten nor given as feed to other animals. Only consume meat or products from healthy birds. In areas free of the disease, poultry and poultry products can be prepared and consumed as usual following good hygienic practices and proper cooking , with no fear of being infected by the H5N1 virus.

    In areas experiencing outbreaks of HPAI, poultry and poultry products can also be safely consumed provided they are properly cooked and properly handled during food preparation. Consumers need to be sure that all parts of the poultry are fully cooked no "pink" parts and that eggs are properly cooked no "runny" yolks ; this kills not only the virus but also other important disease-causing microbes. In areas affected by the H5N1 virus, certain customary practices such as drinking raw blood or raw embryonating eggs should be discouraged if not prohibited.

    It is always a good idea to wash the outer surface of eggs with water and some soap to remove any dirt or faecal matter before storing or using. Also, remember that raw eggs used as an ingredient in sauces, cakes or other foodstuffs are always a potential source of disease-carrying microbes. Consumers should also be aware of the risk of cross-contamination.

    When preparing food, juices from raw poultry and poultry products should never be allowed to touch or mix with items eaten raw. When handling raw poultry or raw poultry products, persons involved in food preparation should wash their hands thoroughly and clean and disinfect surfaces in contact with the poultry products. It is sufficient to use soap and hot water. Avian influenza is not transmitted through cooked food. To date, no evidence indicates that anyone has become infected following the consumption of properly cooked poultry or poultry products.

    The probability of humans being infected with avian influenza directly from birds is extremely low even though there have been cases of villagers in Azerbaijan who reportedly contracted the disease after plucking feathers from dead infected swans. To be on the safe side, children should not pick up or handle feathers or dead birds. If they come into contact with birds in an area not affected by HPAI, it is always wise for them to wash their hands properly.

    All hunters should avoid indiscriminate killing or poaching of wild birds, not just because of the risks associated with avian influenza but as a matter of common sense and respect for legislation governing hunting. When hunting, they need to be careful about good hygiene, particularly if hunting in areas currently infected by HPAI. In addition, however, there are a number of good practices to follow which can help limit any potential increase in the risk of helping spread the virus: Hunters' associations should inform their members about how to recognise the presence of avian influenza in wild birds, bearing in mind that most wildlife do not show external clinical signs of the disease; one important indicator of the possible presence of avian influenza is multiple deaths of birds in or close to the same location.

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    Dead birds should not be handled without proper protection such as gloves or plastic bags or other forms of hand protection. All hunters should report any suspicious or large numbers of deaths of birds to veterinary authorities or local equivalent ; these authorities will arrange for the transport of the carcasses to laboratories for analysis. However, to minimise any risk it is advisable to carry out general hygiene precautions when handling wild birds, such as wearing disposable protective gloves when picking up and handling carcases and washing hands, nails and forearms thoroughly with soap and water after handling the carcass.

    Do not touch any dead animals. Report the finding to the local veterinary or public health authorities who will take the appropriate step to remove the bird and arrange for an autopsy to determine the cause of death. Feeding garden birds is completely safe provided simple common sense rules are followed. These include avoiding touching carcasses of wild birds and washing hands after filling or cleaning bird feeders. Both measures are advisable not just in the case of H5N1 but because birds can carry other potentially dangerous pathogens. If in doubt, consult your nearest vet.

    The risk of being infected by wild birds is extremely low. However, it is advisable to avoid sites where there have been known cases of HPAI and - as always - it is important to use common sense and proper hygiene. Avoid touching wild birds, their droppings or water near them, and wash your hands before eating or smoking and after any contact with animals.

    Never pick up sick or dead animals. There is no reason not to travel affected countries but, once there, it is unwise to visit poultry farms, bird markets and other places where live poultry are kept. If in doubt, consult your embassy or consulate of the country to be visited to find out if the local authorities have placed any restrictions on travel.

    While out of the country: Avoid visiting areas where you may come into contact with live birds, such as poultry farms, live bird markets or any other area where birds congregate. If you are in contact with live birds infected with the avian influenza virus, the virus may persist on clothing, footwear and in hair. Take appropriate personal hygiene measures including thorough hand washing and showering, wash clothing, and clean and disinfect footwear to ensure they are free of soil and manure. Before returning: Find out from your country's veterinary authorities if any birds or poultry products you intend bringing back are eligible for import.

    On arrival, declare all such birds or poultry products. On returning home: Avoid visiting poultry farms upon return from a country affected by HPAI until you have bathed and changed clothes and footwear. What part do wild birds play in the spread of avian influenza? Can wild birds transmit avian influenza to humans? If wild birds are at least partly responsible for transmitting H5N1 avian influenza, is culling part of the solution? Should wetlands be drained to deter wild birds that congregate near or on water? What kinds of wild birds carry avian influenza viruses?

    Do migratory birds carry the virus from one country to another? Can other wild animals be infected with avian influenza? What should I do if I find sick or dead wild birds? We do not know the whole story. Wild waterfowl, e. There is evidence that suggests that wild migratory birds can transmit avian influenza to domestic poultry, however there is no direct evidence as to their role in H5N1 yet and active monitoring of the wild bird population will soon give us more evidence on these uncertainties. It is unlikely that wild birds play a major role in spreading avian influenza.

    The spreading, or wider distribution of the disease, takes place within flocks or sizeable numbers of poultry and is influenced more by production and marketing practices. The risks to human health from wild birds carrying avian influenza is extremely low. Apart from a few cases of villagers in Azerbaijan who reportedly contracted the disease after plucking feathers from dead infected swans, there have been no confirmed cases of transmission from wild birds to humans.

    Attempts to control the spread of H5N1 by culling large numbers of wild birds are not recommended because: they are costly they are unlikely to be effective they may disperse infected birds over a wider area they may kill or cause disturbance to non-target species they require resources to be diverted from more effective ways of combating the virus, such as improving biosecurity and clamping down on illegal or unregulated movements of poultry.

    No existing culling technique can kill sufficient numbers of wild birds as quickly as possible to avoid repopulation by birds from elsewhere, and these newcomers either come into contact with existing pockets of infection or bring it in themselves. Most killing techniques involve severe disturbance e. It is difficult to monitor and control these survivors.

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