What is bird flue?

Interestingly bird flu is a disease that affect birds, especially poultry. Bird flu is caused by variety of influenza viruses (also known as Avian viruses). Till a decade back these viruses were infecting no more than birds, however in last few years bird flue viruses have, on rare occasions, crossed the species barriers and infected human beings. The reason of concern is not that it has jumped or acquired the acumen of infecting human beings but the real concern is high death rates almost 50%. And what if this virus starts spreading like normal flu virus which infect millions on our planet every year?

What type of viruses cause bird flu?

As stated earlier these are Influenza viruses, classified by the severity of the disease they cause to the birds, and are classified as two broad types-

Low Pathogenic/Mild form- commonly causes only mild symptoms like ruffled feathers, a drop in egg production and may easily go undetected
High Pathogenic/Severe form- which is far more striking. It spreads rapidly in birds, affecting multiple internal organs and mortality rate can approach 100% within 48 hours.

What else do we know about these viruses?

As Known, various strains of H5 and H7 subtypes of influenza A virus infect poultry flocks in their low pathogenic/mild form. If allowed to spread in poultry populations, the viruses can mutate(change form), usually within a few months, into the highly pathogenic/Severe form. This is why the presence of an H5 or H7 virus in poultry is always cause of concern, even when the initial signs of infection are mild.
Out of these H5N1strain has caused the largest number of cases of severe disease and death in humans.

What is the global incident of outbreaks among human beings, and how severe were they?

Bird flue was initially reported in Hong Kong in 1997, in 18 humans, of whom 6 died
Initially laboratory-confirmed human cases have been reported in few countries including Cambodia, Indonesia, Thailand, Viet Nam, China and Hong-Kong.
However H5N1 strains were isolated from poultry in many countries including Nigeria,Greece,Solvenia,Romania,Bulgaria,Austria,Iran,Germany,Hungary,Italy,Switzerland,Denmark,Egypt,France and India.
An outbreak of highly pathogenic H7N7 avian influenza, which began in the Netherlands in February 2003, caused the death of one veterinarian two months later, and mild illness in 83 other humans.
Since mid 2003,169 human cases confirmed in four Asian countries, of whom 91 died.

What it is the worst scenario it can cause?

To answer this let me explain the fact that, an epidemic needs three things:
1. A new virus strain:
2. Its ability to infect human beings: and
3. Ability to spread from human to human.

Bird flue virus meets above two criteria, not the third as of now. The fear is that it will acquire the third and pass from human to human like common cold viruses. This may lead to a pandemic .i.e. an epidemic that can cover entire population of our dear planet, for which inhabitants of our planet are inadequately prepared.

Since when the virus started infecting humans? What is the mortality rate?

Infection to human beings is not very old phenomenon; first case was detected nine years ago. On a rough scale mortality is considered to be 50% for human beings. This means, statically only one infected person out of two will survive.

What is mode of transmission?

Direct contact with infected poultry (at the time of slaughter, de-feathering, preparation of poultry for cooking) or by stuff polluted by their faeces.
To date, most human cases have occurred in rural or semi urban areas where households keep small poultry flocks, which often roam freely, sometimes entering homes or sharing outdoor areas where children play.
Be cautious as children and young adults are more susceptible to bird flu virus.

How safe is it to consume chicken in these circumstances?

It depends on where you live. If you reside in-
1. Areas free of the disease-
Poultry and poultry products can be prepared and consumed as usual, with no fear of acquiring infection with the bird flu virus.
2. In areas experiencing outbreaks-
Poultry and poultry products (including eggs) can be consumed provided these are properly cooked The H5N1 virus is sensitive to heat. Normal temperatures used for cooking (70oC in all parts of the food) will kill the virus. You need to be sure that all parts of the poultry are fully cooked and that eggs too, are properly cooked (no soft yolks). However avoid unnecessary contacts with live, sick and dead birds. Do not touch feathers and liquid waste of poultry, as these may have virus in large quantity. Remember, children are especially susceptible. Therefore, prevent their coming in contact with poultry.
Juices from raw poultry and poultry products should never be allowed, during food preparation. When handling raw poultry or raw poultry products do not touch or mix items which are eaten raw.
Raw eggs should not be used in recipes that will not be further heat-treated as, for example by cooking or baking.
Bird flu viruses are not transmitted through cooked food. The good news is that, no evidence indicates that anyone has become infected following the consumption of properly cooked poultry or poultry products, even when these foods were contaminated with the bird flue virus.
If you see a sick or dying chicken, report immediately to the local concerned authorities

What precautions shall I take while cooking poultry for my family?

Keep clean
Wash your hands before handling food and often during food preparation.
Wash and sanitize all surfaces and equipment used for food preparation.
Protect kitchen areas and food from animals and Birds.
Separate raw meat, poultry and seafood from other foods.
Use separate equipment and utensils such as knives and cutting boards for handling raw foods.
Store food in containers to avoid contact between raw and prepared foods. Cook thoroughly
Cook food thoroughly, especially poultry and eggs.
Bring foods like soups and stews to boiling to make sure that they have reached 70C. For meat and poultry, make sure that juices are clear, not pink. Ideally, use a thermometer
Reheat cooked food thoroughly

Keep food at safe temperatures
Do not leave cooked food at room temperature for more than 2 hours.
Refrigerate promptly all cooked and perishable food (preferably below 5C).
Keep cooked food piping hot (more than 60C) prior to serving.
Do not store food too long even in the refrigerator.
Do not thaw frozen food at room temperature.
Use safe water and raw materials
Use safe water or treat it to make it safe (preferably by filtering and boiling)
Select fresh and wholesome foods.
Choose foods processed for safety.
Do not use food beyond its expiry date.
How about other birds like ducks, sparrows, parrots etc.?
They are vulnerable to the strains of bird flu viruses and are required to be isolated from wild/infected birds.

My family is vegetarian, how about us?

Vegetarians can also get infected if they come in close contact with infected birds or its excreta. Otherwise only if bird flu virus decides to jump from human to human, would become a cause of concern for you. Fortunately till now the virus has not decided to behave like that. What is the available treatment? If someone in my family gets infected?
There are no available vaccines as of now however many countries and companies are working to devise one.
Two drugs, Oseltamivir (commercially known as Tamiflu) and Zanamivir (commercially known as Relenza) can reduce the severity and duration of illness caused by seasonal influenza (flu). For bird flu patients, the drugs may improve prospects of survival, if administered early (within 48 hours of onset of symptoms), but clinical data are limited. Antiviral resistance to Oseltamivir has been clinically negligible so far but may be detected during widespread use during a pandemic.
Along with this antibiotics are also required to prevent any secondary infection by bacteria, so that chance of survival of your family member improves.
It would be wise to protect your family through preventive measure at this point of time when no definite cure is available.

How would I know if someone in my family is infected by bird flu? What are the symptoms?

Currently, bird flu is to be suspected when flu-like symptoms i.e.
1. Fever,
2. Cold,
3. Body ache
4. Running nose and/or eyes, combined with
5. Loss of appetite.

Appear in suspect. You should be more cautious if the person has recently come in contact with poultry in a bird-flu affected area. I know it is difficult to differentiate between bird flu and flu. However you should seek immediate medical assistance as soon as these symptoms appear, so as to rule out any possibilities if so ever. Most of the patients judge bird flu as normal/seasonal flu and miss on the time line. Remember available drugs can improve the chances of survival if administered within 48 hours of onset of symptoms.

Why the world is so worried? It seems the virus does not spread rapidly among human beings?

You are very right! However Unlike normal seasonal flu, where infection causes only mild illness in most people, the disease called bird flu follows an unusually aggressive path, with rapid fall in health and more number of deaths. Thousands if not millions of people suffer from seasonal flu every year but hardly anyone dies of it. If you consider present outbreak of the bird flu, more than half of those infected with the virus have died. Most cases have occurred in previously healthy children and young adults.
What we fear is that the virus if given enough opportunities will change into a form that is highly infectious for humans and spreads easily from person to person. Such a change could mark the start of a global outbreak (a pandemic).Wherein the entire system will come under immense stress. Unfortunately our world is not prepared to handle such a pandemic.

How would I know if there is pandemic? What should I do in these circumstances?

You would know as media is quite fast these days, still if you miss on this you would know by the shortage of appropriate medicine and Nanomasks. In these circumstances you should-
1.Try not to PANIC.
2. Follow the instructions of national public health authorities.
3. Make a plan for emergency supplies; prepare a roster of people who should be contacted and develop a contingency plan for your business.
4.Remember, a pandemic is likely to cause social disruption and strict measures such as social distancing and travel restrictions may be imposed by national authorities. Follow these. 5. On your end - avoid bringing poultry at home. This is extremely dangerous and requires complete respiratory protection in the form of mask, hand washing and proper disposal of feathers etc. It is strongly advised NOT to do it at home.
6. The feathers and other body parts of the chicken could be contaminated with bird flu virus. Handling the chicken increases the possibility of getting the virus into your nose, eyes or mouth and causing disease.
7. Start wearing Nanomasks during your visits to infected patients (although avoid it).
8. During pandemic even vegetables and fruits may get contaminated with manure which may be rich in virus. Hence-
 Wash the vegetables properly, rinse in clean water for 15minutes and wash again under running water.
 Wash your hands thoroughly after-wards.
 Wherever possible, cook vegetables properly. Steaming kills all viruses.
9. Take preventive medication as per physicians advice.
10. Take measures to enhance your immune system (discussed later). What supplies shall I keep beforehand?
1. Nanomasks or any other good quality mask, even a cloth or tissue paper mask can be used in emergency.
2. Buy medications like Tamiflu and/of Relenza along with antibiotics beforehand bearing long expiry date.
3. Good disinfectants like soap, Lysol, sodium hypochlorite etc. What if one of my family member gets infected? How can I take his/her care?

Do not panic. Remember there is no evidence till now of human to human transmission of this virus. However-
 Wear a mask to protect yourself from the virus.
 Clean all surfaces that come in contact with the hands or secretions of the patient with soap, Lysol, sodium hypochlorite or any other disinfectant.
 Do not allow the patient to go out. Restrict the number of people attending him.
 Follow the advice of medical personnel.

How can I boost my immune system so as avoid infection from viruses? As per Johnson et al. 1992; Grimble 1997; Shankar et al. 1998; Ravaglia et al. 2000
1.Nutritional supplements-The most consistent nutrients linked to immune dysfunction have been low levels of vitamins A, C, E, and B6, copper, iron, and zinc. Hence it is advisable to take supplements of these on prior consultation of your physician. Especially vitamin C has long been associated with sound performance of immune system. Vitamin C is naturally found in all citrus fruits.
2.Exercise-As per Shinkai et al. 1997 moderate exercise has beneficial effect on the immune system hence it should be on everyones health agenda. However heavy exercise demonstrates opposite effect.
3. Meditation vs. Emotional Stress- emotional Stress plays a significant role in degrading your immune systems. Many articles and books have been published on this now accepted idea (Pert 1999) .Try not to panic in these situations as I will further deteriorate the condition.
Herbal Supplement- there are quite a few herbal traditional medication in Indian and Chinese traditional therapeutics like Chavanprash(ayurveda) and extracts or preparation of Ganoderma lucidum

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