Transmission electron micrograph of avian influenza H5N1 virus
Avian Influenza (Bird Flu)
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For Clinicians
What is Avian Influenza (Bird Flu)
At this time avian influenza (H5N1), also known as bird flu, is a disease of wild birds and domesticated poultry like farm chickens, ducks, and turkeys. Although millions of birds have been infected, only a very small number of people have been infected. Because all influenza viruses have the ability to change there is concern that the H5N1 virus could mutate and be spread easily and widely by humans. If that happens, it is possible that a pandemic or widespread outbreak of disease could occur. World health organizations and the San Francisco Department of Public Health are monitoring the situation and making plans to control avian influenza. Download frequently asked questions above.
What is Pandemic Influenza (Pandemic Flu)
A pandemic influenza occurs when a new influenza virus: 1) develops and there is little or no immunity (protection due to previous infection or vaccination) in the human population; 2) it is easily passed from human to human; 3) is found in many countries; and, 4) causes serious illness in humans. Presently avian influenza (H5N1) is not a pandemic influenza because it is mostly a disease of birds and is not easily passed between humans. Click to link to the Pandemic Influenza home page.
Situational Update
Avian influenza has not been found in the United States.
Avian flu has been detected in wild birds and domestic poultry in East Asia and the Pacific, South Asia, Europe and Eurasia, Africa, the Near East, and Canada. Click for up to date information on animal cases of avian influenza. Since 2003, rare cases of human infection with this strain of avian flu virus have occurred in Asia and Eastern Europe. There have been 334 confirmed cases of illness, including 205 deaths in people. More information on human cases of avian influenza.
How Avian Influenza is Spread to Humans
The current risk to Americans is low. Avian influenza is not easily passed from birds to humans. People may get avian influenza by touching an infected bird, fluid or surfaces contaminated with fluids from infected birds and then touching their eyes, nose, or mouth. People who could be at risk in the US are those who travel to countries with outbreaks of avian influenza and have close contact with live or improperly cooked poultry while there.
Human Symptoms
Individuals with avian influenza (H5N1) usually develop symptoms within 10 days of contact with infected birds, became very ill, and required hospitalization. Symptoms are usually severe and include high fever, muscle aches, cough, mucus production and shortness of breath. Abdominal pain and diarrhea can also occur.
Vaccine and Treatments
A vaccine for humans is being developed but at present there is no vaccine. It is expected that if avian influenza becomes easily passed between humans a vaccine could be available within 4-6 months. There is now a vaccine for birds which is being used on domestic poultry in areas that have infected birds.
The H5N1 virus currently infecting birds has caused human illness and death is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, may treat flu caused by the H5N1 virus, though studies still need to be done to evaluate their effectiveness in treating avian influenza.
The San Francisco Department of Public Health strongly discourages the personal stockpiling of antivirals for pandemic influenza. Personal stockpiling will decrease availability to those who need the medications most. To date it is unclear if Tamiflu or other antivirals are effective in treating avian influenza. During an emergency the health department will distribute appropriate medications as available to infected individuals and their close contacts.
Traveling to Areas Affected by Avian Influenza
Before traveling to a country affected by H5N1 avian influenza:
- Check to see if any travel advisories have been issued by the US State Department or CDC.
- Get a flu vaccine before traveling, preferably at least 2 weeks prior to leaving. Make sure you are up to date on all your vaccinations.
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Avoid direct contact with poultry, wild birds, farms, or live-animal markets. Avoid touching surfaces contaminated with poultry feces (droppings) or fluids.
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Wash your hands frequently or use alcohol hand sanitizers. Avoid touching your eyes, nose, and mouth. Wash your hands if you are handling raw poultry for cooking.
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Do not eat undercooked eggs or poultry (pink meat).
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Monitor your health and see a doctor if you develop symptoms (see above) within 10 days of having close contact with birds. Let your doctor know about your travels, sympotms, and contact with birds.
Control measures at the San Francisco Department of Public Health
The San Francisco Department of Public Health is closely monitoring avian influenza H5N1 and is preparing for the possibility of spread to our region. We are working to ensure that our hospitals and clinicians are educated about pandemic flu and know how to care for infected patients. We provide updates to the clinical community on the status of avian flu, consultation to clinicians who suspect avian flu, infection control recommendations, and facilitate laboratory testing. We have created an Avian/Pandemic Flu Task Force for all city agencies to ensure that all city departments and agencies have well-developed and coordinated plans to address a pandemic influenza situation.
Where to Find Information During an Infectious Disease Emergency
During an Avian Influenza outbreak, San Francisco specific emergency information can be found at:
Useful Avian Influenza Links
Clinicians with additional questions please e-mail:avianflu.dph@sfdph.org. Responses will be made via e-mail, by phone, or incorporated into the web page. Please include contact information.
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