Avian Influenza (Bird Flu)

Bird flu, or avian influenza, is a viral infection spread from bird to bird. Currently, a
particularly deadly strain of bird flu H5N1 continues to spread among poultry in
Egypt and in certain parts of Asia.
Technically, H5N1 is a highly pathogenic avian influenza (HPAI) virus. It's deadly to
most birds. And it's deadly to humans and to other mammals that catch the virus from
birds. Since the first human case in 1997, H5N1 has killed nearly 60% of the people
who have been infected.
Many species of wild bird – particularly migratory waterfowl, and, especially,
ducks seem able to carry bird flu without coming to any apparent harm, but
infection with avian influenza causes other species, including domestic chickens,
turkeys and geese, to become seriously ill.
Some people have caught H5N1 from cleaning or plucking infected birds. In China,
there have been reports of infection via inhalation of aerosolized materials in live bird
markets. It's also possible that some people were infected after swimming or bathing
in water contaminated with the droppings of infected birds. And some infections have
occurred in people who handle fighting cocks.
In poultry, the sickness caused by bird flu comes in two different types, one mild,
widespread and barely noticeable, the other uncommon, deadly and very difficult
to overlook.
The incubation period of avian influenza ranges from 1 to 7 days. It is worth
mentioning that the recent Bird Flu outbreaks in South East Asia and some
European countries (like Turkey), as well as Iraq, are basically attributed to the
direct contact with domestic, migratory and water birds.

Pandemic Prevalence
Avian influenza (H5N1) has epidemically prevailed among birds and poultry in
many countries around the world, including Hong Kong, Vietnam, Cambodia,
Thailand, Indonesia, and recently China, Russia and Kazakhstan. It is for this
reason that millions of birds and poultry have been culled, in an endeavor to put
end to the pandemic prevalence, and prevent it from transmission to humans,
considering that human-to-human infection has not yet been proven.
Causes
The avian influenza A encompasses numerous subclasses and strains (15 strains so
far), undergoing several genetic mutations and leading up to the appearance of
several avian epidemics in South East Asia, the Americas, and, recently, Russia.
These viral strains have been reduced to one stain (H5N1), which can affect
several mammals, including humans.
All bird species are prone to the H5N1 infection, but at varying degrees. At
present, several spots around the world are hit by H5N1 outbreaks, leading up to
the death and culling of millions of birds.
Besides, a number of humans, those in contact with infected birds, have been
detected to be carriers of the virus. The contact with the live infected birds, either
direct or indirect, is considered the main cause of infection.
The virus could be transmitted through the birds' mouth secretions and excretion.
Human infection could also cause by the contamination of the tools or clothes of
the workers at poultry farms with the virus included in the birds' secretions and
wastes. The virus can live for relatively long time in low-temperature
environments.

Incubation Period
1-7 days.

Ways of Transmission

 The contact with the live infected birds, either direct or indirect, is
considered the main cause of infection. The virus could be transmitted
through the birds' mouth secretions and excretion.
 The virus can live for relatively long time in low-temperature environments.
 Human infection could also cause by the contamination of the tools or
clothes of the workers at poultry farms with the virus included in the birds'
secretions and wastes.

Symptoms of Avian Influenza (H5N1)

The symptoms of avian influenza include: high temperature (38° C, or more),
throat pains, cough, dyspnea (caused by viral inflammation in the lungs). Other
digestive disorders could occur, such as vomiting and diarrhea. These symptoms
usually continue for 3-7 days, and may end up with death.

Diagnosis
Taking blood and respiratory samples to be examined for avian influenza (H5N1).
The result would be positive on the occurrence of one (at least) of the following
results:

 The farm is positive to the virus.

 The PCR is positive to H5N1.
  The IFA is positive to the antiviral.
 Higher by for times of the specific antiviral.

Remdies
Treatment could be conducted by treating the major symptoms, which are:
pneumonia, fever, and secondary inflammations.

 Taking samples for the laboratory testing of avian influenza and other
inflammations.
 Giving antivirals to the patient. Antivirals could be used for treatment, as
well as prevention of those in contact with patients, and those who are
vulnerable to infection.
 Tamiflu (Oseltamivir) is recommended (tablets, 75mg, twice a day, for 5
days), whereas amantadine and rimantadine are not recommended, since the
virus already has resistance against them. Likewise, ribavirin is unfavorable.
The Tamiflu treatment begins on the first or second day of the appearance of
symptoms (36 hours after the symptom appearance).

 Using broad spectrum antibiotics for the treatment of secondary bacterial

infections.
 Avoiding sodium aspirin for people under 18 years old, and using, instead,
paracetamol (Panadol) and ibuprofen when need be.
 Assigning an isolated room with negative pressure for the patient. And if not
possible, patients could be put together in one room, with cloth separators
between them.
 In case the patient is unwilling to receive medicament at the hospital, he
(and his family) should be well aware of the disease, and ways of
transmission, as well as adopting the means of personal protection (washing
hands, using a facemask, and avoiding social visits). It is highly
recommended, also, to ask for medical help in case of the occurrence of any
complications.

II) Towards those in Contact with Patients:

 Following up those in direct contact with patients for 7 days. It is

recommended to measure temperature twice a day.
 Immediately applying the therapeutic plan in case the temperature goes
higher than 38° C, or when breathing becomes difficult.

III) Towards the Health Workers in Contact with Patients:

  Using protective clothes (surgical facemasks, gloves, aprons, etc.)
 Washing hands well, by using a disinfectant or water and soap.
 Giving antivirals for prevention.
 Measuring temperature twice a day.
 Immediately applying the therapeutic plan in case the temperature goes
higher than 38° C, or when breathing becomes difficult.

Preventive Measures:
The preventive measures are intended to reduce the infection sources in poultry
farms, and prevent the infection transmission to other farms, and to humans
accordingly. In this spirit, the following precautionary measures are highly
recommended:

1. Raising the health awareness for those working in the field of aviculture, and
providing them with the necessary information, tips and preventive
measures.
2. Giving the anti-avian influenza drug (Tamiflu, 75ML, one dose a day, for 7
days; in addition to the antivirals necessary for human influenza, as
recommended by the WHO) to the most vulnerable persons (poultry
workers, laboratory workers dealing with avian influenza, and health
workers in contact with patients infected with H5N1)
3. Enforcing the instructions and regulations of infection control in hospitals
and laboratories.
4. Coordinating between the relevant authorities (e.g. the Ministry of
Agriculture, the Ministry of Health, the Ministry of Commerce & Industry
and the Ministry of Rural and Municipal Affairs), so as to take the proper
action with the aim to prevent the disease from entering the Kingdom, and
raise the level of surveillance and early detection of the potential sources of
the disease.