The Avian Influenza Virus (Bird Flu) A Pandemic in the Making

Is the world today looking at another pandemic due to the avian influenza virus?  The increasing cases of the avian influenza virus, the global spreading of the disease and the fact that many scientists believe that it is not a matter of if but when we will experience it, is making this a global question.  What is making some believe this is highly probable?

To answer that question we first need to examine what the avian influenza is, and some of its history.

Avian Influenza, also known as bird flu is an illness that is caused by avian influenza viruses.  These viruses occur naturally amongst wild birds and are carried in their intestines.  These viruses are very contagious and normally will not make wild birds sick however; they can be extremely dangerous to domestic birds such as Turkeys, Chickens, and Ducks making them extremely sick and can lead to death.

The Avian Flu was first recorded in Italy more than 100 years ago in 1878.  As the cause of a large amount of deaths in Poultry it became known as “Fowl Plague”.  This disease was recorded in the United States in 1924-25, and then again in 1929.  In 1955, it was determined that the virus causing Fowl Plague was one of the influenza viruses. The official designation for the bird flu is Influenza-A H5N1.  This strain was originally first isolated in birds from South Africa in 1961.

Originally thought only to infect birds this flu received unprecedented publicity in 1997 when for the first time the virus was transmitted to humans.  During this period 18 people were hospitalized and 6 died.  Authorities in an attempt to control the outbreak killed approximately 1.5 million chickens.  This was in an attempt to remove the source of the virus.

Since 1997 there have been confirmed cases of humans infected with the virus.  Two children from Hong Kong were infected that year but both children recovered.

In 2003 two members of a Hong Kong family were infected after traveling to China.  One person died.  The cause was never determined on where or how those two people were infected.  Later back in China another family member died of a respiratory illness but no testing was done at that time.

Also in 2003 the Netherlands reported more than 80 cases of avian influenza-A among poultry workers and their families.  One patient died.  At that time there seemed to be some evidence of human to human transmissions.  These outbreaks tapered off in the spring of 2004 but then re-emerged in the summer.

As of Sept 19, 2005 there have been 114 confirmed human cases of bird flu with 59 of them being fatal.  Human cases of the disease have been reported in Vietnam, Thailand, Cambodia, and Indonesia.  Sustained person to person transmission has not occurred but there is another report of suspected human to human transmission from Thailand in fall of 2004.  The virus recently has shown the ability to jump from species to species with cats, pigs, tigers and leopards becoming infected.  Areas affected by H5N1 avian influenza in poultry include: Cambodia, China, Hong Kong, Indonesia, Japan, Laos, Malaysia, South Korea, Thailand, Vietnam, Russia, Kazakhstan and Mongolia.

So now what does this all have to do with a possible influenza pandemic?

First an influenza pandemic occurs when a new virus appears that the human population has no immunity from.  This results in a large scale outbreak worldwide with an enormous amount of deaths and illness.  Because of global transportation, over crowding and urbanization these epidemics would take hold very quickly on a global scale.

This is why the recent findings in regards to the bird flu virus are particularly concerning.  The reassortment (this is the changing of genetic material between two types of virus making a third) of avian influenza genomes is very likely to occur since these viruses have demonstrated a capacity to infect multiple species, as is now the case in Asia.  This then leads to the greater chance of human exposure and infection.  This new virus has new genetics which would then be immune to current vaccines.  As shown the world has faced pandemic possibilities for several years in regards to the avian influenza virus and with the recent developments it does only seem a matter of time before we are faced with a flu pandemic of gigantic proportions.  No one knows for sure if or when a pandemic would occur, it could be within weeks or years, but all the conditions are in place, save one – sustained proof of a virus that is being transmitted from human to human.

Take a look to history on past influenza pandemic’s.  This may give a better understanding when we use the word gigantic proportions.  These previous pandemics have led to high levels of illness, death, social disruption, and economic loss.  The potential devastation of the avian flu virus is greater than these former pandemics.

There have been 3 such influenza pandemics in the 20^th century.

In 1918-1919 when more than 500,000 died in the United States alone, along with approximately 50 million people worldwide.  In 1957-1958 the Asian flu caused 70,000 deaths first reported in China late in February 1957 and it spread to the U.S by June of 1957.  The Hong Kong flu in 1968 and 1969 caused some 34,000 deaths in the United States alone.

So what would happen if we faced a pandemic today, from the avian flu virus?  Most agree we could stand a very little chance of containment for several reasons.  First the world will have just weeks to accomplish that feat.  Scientists estimate that 300,000 to one million people would immediately be in need of the anti-viral.  At this time there are limited stocks.  Because of production limitations the current time frame is four to six months to produce a certain quantity of vaccine.  This may not be fast enough.   The fact is that for containment the world would need to carry out a massive inoculation campaign within a two to three week time frame for any type of chance to contain the virus.

There is also the chance that current vaccines for the avian flu would have little or no effect on a pandemic virus.  This is because the vaccine needs to match the pandemic virus which may not be the case.  The world then would need a new vaccine.  So a vaccine developed in Thailand may not protect you from another virus in another part of the world.   This would take several months to develop and by that time millions may die.

Then there is the distribution issue.  There is no guarantee of distribution priorities.  This could mean that poorer nations may not get the vaccine at all, because richer countries would get the majority. 

So what is our government and others doing to effectively deal with this possible nightmare?  What can you do as an individual?

On February 4, 2004 there was an order for an immediate ban on the import of all birds ) from the following areas in Southeast Asia: Cambodia; Indonesia; Japan; Laos; People's Republic of China, including Hong Kong, SAR; South Korea; Thailand; and Vietnam.   Hong Kong was removed from the ban list because of imposed vaccination, inspection, and surveillance programs for poultry farms, live poultry markets, and pet bird dealers; Also since there have been no additional cases of Influenza A (H5N1) in birds in Hong Kong since the positive peregrine falcon which was the reason for their inclusion on the list.

The World Health Organization has helped lead efforts to develop a national plan to cover aspects of responding to a pandemic require enhanced surveillance and early detection.  Improving our public health infrastructure to be able to administer programs effectively is also a priority.

There has also been contract for egg surge capacity worth about $10 million awarded.  This was done to assist with the making of vaccines.  Since vaccines can provide a safe, effective and efficient means to prevent illness, disability and death from infectious diseases, research is a high priority with health organizations.  The National Institutes of Health is another organization that is assisting with the testing of new vaccines.

The only downfall is they do take time to develop and as in any new strain of the virus there would not be enough at the time of the outbreak.  This fact is making the reporting and early detection a priority.

The World Health Organizations Center For Disease Control, Association of Public Health Laboratories, Council of State and Territorial Epidemiologists, Vietnamese Ministry of Health just to name a few are proactively monitoring world influenza reports.  There is a network of 112 National Influenza Centers that are monitoring activity and isolating influenza viruses in all continents.  They then report immediately the finding of any new or unusual influenza viruses found.  They have also implemented new notification methods for public health emergencies that would be of international concern.

In America at this time the risk is very low for a pandemic from the avian flu virus.  This does not mean the government is doing nothing.  The French drug maker Sanofi-Aventis won a $100 million contract to supply the United States a vaccine against H5N1. 

The United States has also awarded a $2.8 million contract to Britain's GlaxoSmithKline for 84,300 courses of an antiviral.  Although not a vaccine, this antiviral Tamiflu®, has shown the ability to protect against human infection. The purchases are part of a US plan to buy vaccine for 20 million people and anti-viral for another 20 million.  In the past four years the Department of Health and Human Services has invested a large amount in protecting against the flu including increases for CDC influenza funding ($17.2 million to $41.6 million, 242%) and creation of Strategic Reserves/Stockpiles ($0 to $80 million).

It also looks like an effective vaccine may finally have emerged to counter the avian flu virus.   Just recently in tests, preliminary results obtained from 115 of the vaccine recipients showed a strong enough immune response to ward off the virus.  These tests have been taking place for several months.

Also in the United Kingdom the risk at this time is very low but could be subject to change very suddenly.  Precautions are being taken since the virus is spreading.  The government has ordered around 14.6 million courses of the drug Tamiflu - enough to treat around a quarter of the UK's population.  They have devised a distribution system that would make the anti-viral available to health workers, people who would be essential to the continuing of the government, and people at high risk first.   The UK Health Protection Agency estimates that in the event of a flu pandemic there could be a possible 50,000 deaths in Wales and England alone.  Because of its planning The World Health Organization has said that the UK is at the forefront of preparations internationally for a pandemic influenza outbreak.

Now you’re asking what can I do to help myself in case of an influenza outbreak?

Still the most effective way to deal with influenza in general is still by vaccination each year.  At this time there are no vaccines on the market to combat the avian flu virus.  But as seen above it is very close to a answer.  Other flu vaccines are available and should be considered to prevent help prevent an outbreak.

There are two types of vaccines.  The first is a flu shot.  This is inactivated vaccine (containing a killed virus) given usually in the arm.  It has been approved for use in persons older than 6 months, healthy people, and also people with a chronic health condition.  The second type is a nasal spray flu vaccine.  This is a vaccine made with live and weakened viruses that do not cause the flu.  It is approved for use in healthy people over 5 years of age up to 49 years.

Anyone who wants to reduce their chances of getting influenza can be vaccinated.  There are people who are at high risk to suffer serious complications if they were to contract influenza or people who care for such individuals.  These people should be vaccinated each year.  This group includes, persons 65 years of age or older.  People who live in nursing homes, or other long term care facilities.  Adults and children 6 months and older who have chronic heart or lung conditions, this is including asthma.  Adults and children 6 months and older who needed regular medical care or were in a hospital during the previous year because of a metabolic disease (like diabetes), chronic kidney disease, or weakened immune system, including immune system problems caused by infection with human immunodeficiency virus. [HIV/AIDS] Any Children 6 months to 18 years of age who are on long-term aspirin therapy.  This is because children given aspirin while they have influenza are at risk of Reye syndrome.  Any women who will be pregnant during the influenza season and all children 6 to 23 months of age should also be vaccinated yearly.

People with any condition that can compromise respiratory function meaning, a condition that makes it hard to breathe or swallow, such as brain injury or disease, spinal cord injuries, seizure disorders, or other nerve or muscle disorders.

Other measures to prepare and deal with an outbreak would include.  Avoid close contact with people who are sick.  If possible, stay home from work or keep your child from school when sick.  Cover your mouth and nose with tissue when coughing or sneezing.  Wash your hands often.  Avoid touching your eyes, nose or mouth. 

Keeping surfaces clean also plays a significant role in the preventing the spread of the virus.  Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against influenza viruses if used in proper concentration for sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands.

Not wanting to sound like a doomsday prophet but in the end the following is known.  The threat is real.  Bird flu is spreading at an alarming rate.  There is the potential for a catastrophic flu pandemic.  Since 1997 we have seen the virus go from affecting just birds, to affecting other animals and now an increasing amount of human infections.  This is showing that the virus is changing and not for the better.  The world is becoming united to stopping this deadly virus and saving an apocalyptic nightmare.  Do we know when or where a flu pandemic may start?  No, we don’t due to the fact at this time there is no absolute proof of human to human transmittal of the virus we can not guess.  This is a prerequisite of a pandemic; it has to be spread human to human.

By monitoring, reporting and working together on vaccines we are at the present time staying ahead of a possible flu pandemic which could devastate the global community.  There is promise as seen by this month’s discovery of a workable vaccine for the avian flu virus.  Even with this new threat as individuals we do need to take precautions to keep from contracting any of the other forms of influenza.  By continued research, individual effort and the joint effort of the global community we may avoid a flu pandemic that would have the potential to kill millions.

For more information on the avian flu virus some good resources are.  Centers for Disease Control and Prevention, World Health Organization, Department of Health and Human Services, the World Organization for Animal Health and the New England Journal of Medicine.