March 2006 Health Tip

With all the news media currently available as to the potential threat of the Avian Flue, we felt that we may vary from our usual health hint for March and bring to you an update as to this new disease process written by Rolando Torres, Pharm.D., Community Pharmacy Resident and Maria Maniscalco, Pharm D., Faculty Adviser from NSU's College of Pharmacy. We hope you will find this interesting and informative.

Sincerely,

Robert S. Oller D.O.
CEO, Nova Southeastern University
Division of Clinical Operations

Avian Influenza (Bird Flu)
Rolando Torres, Pharm.D, Community Pharmacy Resident
Maria Maniscalco, Pharm.D., Faculty Advisor

Avian influenza virus, referred to as influenza Type A, is an infection caused by exposure to contaminated bird fluids and is very contagious among birds (i.e. chicken, turkeys and ducks). Infected birds get rid of influenza virus in their saliva, nasal secretions, and feces. Avian influenza viruses exist in a low and high form. The high form is responsible for affecting several organs and an increase risk of death.

The avian influenza has gained media attention since it is a strain of flu not treatable by typical medications. Hence, the media has tapped into the natural human fear of the unknown regarding potential death from this strain of the flu. The reality is, the avian flu has not been reported in the U.S. and the average adult should not worry about it. The Centers for Disease Control (www.cdc.gov) are tracking the reported strains of this flu and will notify all appropriate agencies should a case be reported in the US.

Human infection with avian influenza viruses

This risk is generally low; infection occurs mainly amongst birds and does not usually infect humans. Most of the avian influenza virus cases in humans have resulted from contact with infected poultry or surfaces contaminated with body fluids from infected birds. The spread from human to human is very rare. Properly cooked poultry or eggs cannot be a source of infection for avian influenza viruses, in other words there is NO risk to be infected with avian influenza by food.

Symptoms

• Typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches)
• Eye infection
• Pneumonia (lung infection that can be caused by different types of germs)
• Severe respiratory disease
• Life-threatening complications

Treatment

Prescription medicines approved in the United States for human influenza viruses, amantadine and rimantadine, are not an effective treatment for the avian influenza. Oseltamavir and zanamavir would probably work to treat avian influenza, but additional studies still need to be done to demonstrate their effectiveness. Presently, there is NO commercially available vaccine to protect humans against avian influenza virus.

Difference between seasonal influenza virus and avian influenza

• Seasonal influenza – Mild respiratory symptoms
• Avian influenza – Characterized by an unusual aggressive course with high fatality including viral pneumonia and organ failure

Prevention

Travelers to countries with known outbreaks should avoid poultry farms, contact with animals in live food markets, and surfaces that appear to be contaminated. There is a ban in place to control domestic and imported food products from countries affected by avian influenza.

Different types of Avian Influenza

There are different subtypes of influenza viruses Type A. All known subtypes of the viruses can be found in birds. There are three known Type A subtype influenza virus that circulate among humans (H1N1, H1N2 and pN2). Influenza A viruses are constantly changing therefore there is an increase the risk to adapt over time and spread amongst humans. Influenza A virus, known as “H5N1 virus”, subtype is very contagious and deadly to birds. Outbreak of the H5N1 virus occurs in Cambodia, China, Indonesia, Kazakhstan, Malaysia, Mongolia, Russia, Thailand, Turkey, Romania and Vietnam. Croatia confirmed H5N1 virus in wild birds. Human cases of H5N1 infection have been reported in China, Indonesia, Cambodia, Thailand and Vietnam. Within these countries, 134 cases have been reported so far, with 69 fatalities. All influenza viruses have the ability to mutate and scientists are concerned that H5N1 virus one day would be able to infect humans and spread easily from one person to another. If H5N1 viruses gain the capacity to spread easily from person to person, a pandemic flu (worldwide outbreak of disease) will occur. Experts are watching this situation closely.

Confirmed subtypes of avian influenza

H9N2 – Results in uncomplicated influenza-like illness. Two cases reported of infected children
  were reported in China and Hong Kong.
H7N2 – Reported in Virginia in 2002 at the Shenandoah Valley and in New York in 2003, where
  a patient was hospitalized with respiratory symptoms, recovered, and went home after a
  few weeks.
H7N3 – Reported in Canada in 2004, associated with mild eye infection.
H7N7 –  Infections amongst pigs and humans were reported in the Netherlands in 2003. Eighty-
   nine (89) people confirmed to have this type of virus. Seventy-eight (78) cases were eye infection only, five (5) were eye infection with influenza-like illness, two (2) cases of influenza-like illness and four (4) were classified as “other”. One death was reported. The majorities were thought to occur from direct contact with infected poultry. Since then, no other cases amongst humans have been reported.

Criteria to be met for a pandemic flu

• New influenza virus subtype must emerge
• Infection must involved humans and causes serious illness
• Must spread easily and without interruption among humans (keep in mind that a sustained transmission of H5N1 virus human-to-human has not occurred).

Here are some more resources for additional information about avian influenza:

National Institutes of Health; http://www3.niaid.nih.gov/news/newsreleases/2005/avianfluvax.htm; access November, 2005

World Health Organization; http://www.who.int/csr/disease/avian_influenza/en/; access November 2005

http://www.pandemicflu.gov; access on November 2005

Center for Disease Control and Prevention; http://www.cdc.gov/flu/pandemic/; http://www.cdc.gov/travel/other/avian_influenza_se_asia_2005.htm ; access December 2005