Frequently Asked Questions about Avian Influenza A (H5N1) and Pandemic Influenza


What is the difference between seasonal, avian (or bird) and pandemic influenza?

Seasonal (or common) influenza is a respiratory illness, caused by influenza Type A and Type B viruses, that occurs every year on a seasonal basis and can be transmitted from person to person.  Because the seasonal influenza virus changes rapidly and frequently, seasonal vaccine contents have to be changed each year.  Fortunately, most people have some immunity to seasonal influenza viruses, and a vaccine can help protect against some strains.

Avian influenza (or bird flu) is caused only by influenza Type A viruses.  These viruses occur naturally among wild birds. Low pathogenic avian influenza is common in birds and causes few signs of illness. A highly pathogenic avian influenza (H5N1) is deadly to domestic fowl.  It has been transmitted from birds to humans on a limited basis, and when a human is infected, the resulting illness is often fatal.  Humans have virtually no immunity to highly pathogenic H5N1 avian influenza.

Pandemic influenza is a virulent human influenza caused by a mutated influenza Type A virus that spreads easily from human to human in a sustainable manner, for which there is little natural immunity. A pandemic is a global outbreak of serious illness. Currently, a pandemic influenza virus has not yet emerged, but scientists are concerned that avian influenza could evolve into a virus that is easily spread from human to human in a sustainable manner and could cause a pandemic.

Where can I find up-to-date medical and planning information on avian influenza Type A (H5N1) and pandemic influenza?

Information about avian and pandemic influenza can be found at:

How can I prepare for a pandemic?

The U.S. Department of Health and Human Services has developed plans for individuals and groups to protect themselves against infection during a pandemic. They include simple techniques such as washing your hands, practicing cough etiquette, staying home when you or family members are sick, limiting contact with others and avoiding public gathering places. In addition, guidance suggests that individuals who need to enter crowded areas should consider using a face mask for protection against others who are coughing and to limit the wearers’ ability to cough on others.  However, there are no definitive studies regarding the effectiveness of face masks in preventing the transmission of the influenza virus.   For complete information on these planning tools, please visit http://www.pandemicflu.gov/plan/tools.html.

If you work or study overseas, contact your sponsors for information about their pandemic readiness plan.  Ask them if they will send you home (telework, etc.) at the onset of a pandemic.  Will they provide you with antiviral medications, medical care and/or a pandemic vaccine, if available?  Have they stored 2 to 12 weeks of food and water for your use in a pandemic or do you need to obtain these provisions yourself?

Are Tamiflu® and Relenza® effective in treating or preventing human cases of avian influenza?

Although we don’t know how effective antiviral medications such as Tamiflu® (oseltamivir) and Relenza® (zanamivir) would be in treating a pandemic influenza virus, both of these medications are approved for preventing and treating acute uncomplicated seasonal influenza.  Approved doses, and dosing instructions for children, are different for each drug, so the individual package inserts should be checked for this information. Evidence indicates that the sooner these antivirals are administered, the better the outcome. You should be aware that antiviral drugs are not a substitute for vaccines.  The U.S Department of Health and Human Services/Food and Drug Administration’s (HHS/FDA) web site has more information on antiviral medications at http://www.fda.gov/cder/drug/antivirals/influenza/default.htm.

How can I obtain antiviral medications?

American citizens overseas can find out if antiviral medications are available where they live and whether or not they need a prescription.  Due to legal restrictions and a lack of sufficient resources, the U.S. Department of State is not in a position to provide private American citizens traveling or living abroad with medications or supplies, or medical treatment, in the event of a pandemic. Influenza antiviral medications can be obtained by prescription from a healthcare provider in the United States.  If adequate medical treatment or antiviral medications such as Tamiflu® or Relenza® are not readily available at your overseas location or travel destination(s), you should consider discussing with your personal physician the advisability of obtaining an advance supply of appropriate medication for your trip or period of stay overseas.  You can obtain more information at http://wwwn.cdc.gov/travel/contentDiseases.aspx#influ.  Expired medications must not be taken.
 
It is important for overseas travelers and residents to consider the local availability of medical diagnosis and treatment, including hospital care and medication, in the event of a pandemic.

How do I find a local doctor when I am traveling?

For a current list of doctors/hospitals in the country to which you are traveling, please access the list of Embassies and Consulates.  A medical practitioner list can be found under Consular Services or American Citizen Services.
 
What if I have a pre-existing medical condition?

Please see the U.S. Department of State's Tips for Traveling Abroad for information on health issues, including the importance of carrying needed medicine and obtaining adequate medical insurance to cover overseas medical emergencies.

Individuals with chronic medical conditions identified by the WHO and CDC may be at higher risk of suffering complications from influenza and should consider returning to the United States early at the onset of a pandemic or postponing travel during a pandemic.  Those at high risk may include pregnant women; adults and children who have chronic pulmonary (including asthma), cardiovascular (except hypertension), renal, hepatic, hematological or metabolic disorders (including diabetes mellitus); adults and children who have suppressed immune systems (caused by medication or by HIV); and adults and children who have any neurological condition (e.g., cognitive dysfunction, spinal cord injuries, seizure or other neuromuscular disorders) that can compromise respiratory function.  In the event of an actual pandemic, additional groups might be at particular risk of becoming ill with severe influenza.

Americans who are traveling or living overseas are advised to monitor HHS/CDC and the WHO websites for the latest information.  Additional country information can be obtained from the U.S. Department of State's Country Specific Information and Embassy and Consulate web pages. You may also call the U.S. Department of State's toll-free number, 1-888-407-4747, or if calling from overseas, 1-202-501-4444.

Will the U. S. Government evacuate Americans from a foreign country?

The U.S. Government will not evacuate private American citizens in the event of a pandemic.  If a severe pandemic occurs, the U.S. Government will permit its non-emergency employees and dependents to return to the United States via commercial means, if available.  It will also recommend that private American citizens consider departing via commercial means while they can.   Private Americans’ decision to depart or to remain in country will be based on many factors including (but not limited to) personal/family situation, underlying medical conditions, access to medical care, safety, the severity and global pattern of spread of the pandemic, etc.  A pandemic could result in temporary disruptions of travel because of quarantines, border closures or a lack of equipment or crews.  All Americans abroad should make preparations to remain in country to ensure that they have access to adequate supplies of food, water and medication in a worst-case scenario, should they be unable or unwilling to leave when a pandemic strikes.  Refer to the U.S. Department of State’s Remain in Country in a Pandemic flyer and to http://www.pandemicflu.gov/plan/index.html for complete planning guidance. 

In the event of a pandemic, Americans who are traveling or living overseas are advised to monitor HHS/CDC and the WHO websites for the latest information.  Additional country information can be obtained from the U.S. Department of State's Country Specific Information and Embassy and Consulate web pages. You may also call the U.S. Department of State's toll-free number, 1-888-407-4747, or if calling from overseas, 1-202-501-4444.

What will happen if I can’t return to the United States? 

If a pandemic causes border closures, quarantines or other temporary disruptions in commercial transportation, remaining in country to wait out the pandemic might be the only available option.  At that point, U.S. Government assistance to private American citizens would be limited to traditional consular protection, i.e., communicating with family and friends, monitoring quarantine/detention conditions as permitted by local health authorities, arranging for transfers of funds or granting temporary subsistence loans, and providing information regarding the availability of medical care (to be paid for by the individual).  Due to legal restrictions and a lack of sufficient resources, the U.S. Department of State is not in a position to provide private American citizens traveling or living abroad with medications or supplies, or medical treatment, in the event of a pandemic.  This includes food and water.

What if foreign health officials quarantine me overseas?

 The U.S. Department of State cannot demand the immediate release of private Americans who have been detained or quarantined abroad in accordance with local public health and legal authorities.  Every effort will be made to assist American citizens, but U.S. Government offices overseas may need to scale back operations because of reduced staffing.  Once the pandemic subsides and travel resumes, the U.S. Department of State can once again provide full consular services to American citizens, including routine repatriation assistance.  

Why can’t I get a pandemic vaccine?

The avian influenza Type A (H5N1) virus is continually evolving and cannot yet easily pass from human to human in a sustainable manner. A vaccine for humans that effectively prevents infection with this virus is not yet readily available, because a specific pandemic vaccine cannot be developed until a pandemic begins and the virus causing it is identified.  We cannot know how the virus might evolve and how seriously it might affect humans. Experts anticipate a four- to six-month lag between identification of the pandemic influenza virus and commercial development and distribution of an effective vaccine. 

What should I do if avian influenza breaks out in poultry where I am living or visiting?

Avoid contact with live birds, chickens, ducks, turkeys and geese and their feces, feathers, live bird markets, wet markets and bird pens if at all possible. Children, in particular, should be taught these precautions, and small children might need to be supervised for their protection.  Do not purchase or agree to adopt new pet birds from an area in which avian influenza has been reported.  Avoid poultry products from areas with avian influenza-infected birds.  Do not transport live poultry, even if the birds appear to be healthy, or dead poultry.  Importing birds or unprocessed bird products into the United States from areas affected by H5N1 is not permitted.

Even if you assume that the poultry is safe to eat, all poultry products, including eggs and poultry blood, should be cooked thoroughly. Egg yolks should be firm, not runny.  Cook poultry to an internal temperature of 165 degrees Fahrenheit (74 degrees Celsius) to kill any viruses or bacteria.  Avoid cross contamination of other foods by keeping kitchen utensils and surfaces that are exposed to raw poultry separate from utensils and surfaces used for cooked poultry products and other foods.  Wash your hands with soap and water after any poultry contact. For more information on food handling and safety, please visit the U.S. Department of Agriculture (USDA) web site at http://www.fsis.usda.gov/Fact_Sheets/index.asp.

Sanitation professionals, healthcare workers and others who must travel to areas infected by avian influenza and work directly with infected birds, poultry and humans should follow approved precautions for reducing the risk for infection with H5N1 virus.  See HHS/CDC guidance at http://www.cdc.gov/flu/avian/professional/.

 
Can avian influenza infect my pets?

There have been reports of H5N1 infection in domestic cats, pigs, tigers, leopards, ferrets and stone martens, among other animals.  Domestic cats and dogs are believed to have been infected by eating raw, H5N1-infected birds. Although no human cases of avian influenza Type A have been associated with contact with infected cats, you should keep your cats inside if there has been a verified outbreak of H5N1 in your area. In addition, avoid contact with stray cats, and inform your local veterinarian if your cat becomes sick after having had contact with birds. You should always follow strict hygiene rules when disposing of animal waste or caring for your pets.

For more information about H5N1 infection in pets, see the HHS/CDC web site at http://www.cdc.gov/flu/avian/gen-info/qa.htm.