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    Avian influenza

    Bird flu; H5N1

    Avian influenza is flu infection in birds. The virus that causes the disease in birds can change (mutate) so it can spread to humans.

    Causes

    The first avian influenza in humans was reported in Hong Kong in 1997. It was called avian influenza (H5N1). The outbreak was linked to chickens.

    Since then there have been human cases of avian influenza A (H5N1) in Asia, Africa, Europe, Indonesia, Vietnam, the Pacific, and the near East. Hundreds of people have become sick with this virus. Up to half of the people who get this virus die from the illness.

    The chance of a worldwide outbreak in humans goes up the more the avian flu virus spreads.

    Your risk of getting the bird flu virus is higher if:

    • You work with poultry (such as farmers)
    • You travel to countries where the virus is present
    • You touch an infected bird
    • You eat raw or undercooked poultry meat, eggs, or blood from infected birds

    Health care workers and people who live in the same house as people with bird flu may also be at higher risk of infection.

    The avian flu virus (H5N1) lives in the environment for long periods of time. Infection may be spread just by touching surfaces that have he virus on them. Birds who were infected with this flu can give off the virus in their feces and saliva for as long as 10 days.

    Symptoms

    Symptoms of avian flu infection in humans depend on the strain of virus.

    The H5N1 virus in humans causes typical flu-like symptoms, such as:

    • Cough
    • Diarrhea
    • Trouble breathing
    • Fever greater than 100.4°F (38°C)
    • Headache
    • General ill feeling (malaise)
    • Muscle aches
    • Runny nose
    • Sore throat

    Exams and Tests

    If you think you have been exposed to the virus, call your health care provider before your visit. This will give the staff a chance to take steps to protect themselves and other patients during your office visit.

    There are tests for the avian flu but they are not widely available. One type of test can give results in about 4 hours.

    Your doctor might also do the following tests:

    • Auscultation (to detect abnormal breath sounds)
    • Chest x-ray 
    • Nasopharyngeal virus detection by reverse transcription-polymerase chain reaction (RT-PCR)
    • Nasopharyngeal culture
    • Throat virus detection by RT-PCR
    • White blood cell differential

    Other tests may be done to look at how well your heart, kidneys, and liver are working.

    Treatment

    Treatment varies based on your symptoms.

    In general, treatment with the antiviral medication oseltamivir (Tamiflu) or zanamivir (Relenza) may make the disease less severe. You need to start taking the medicine within 48 hours after your symptoms start for it to work.

    Oseltamivir may also be prescribed for persons who live in the same house people with avian flu. This may prevent them from getting the illness.

    The virus that causes human avian flu is resistant to the antiviral medicines amantadine and rimantadine. These medicines should not be used in the case of an H5N1 outbreak occurs.

    People with severe infection may need to be placed on a breathing machine. People infected with the virus also should be kept separate from non-infected people.

    Doctors recommend that people get an influenza (flu) shot This may cut down the chance that the avian flu virus will mix with a human flu virus. This might create a new virus that may easily spread.

    The U.S. Food and Drug Administration has approved a vaccine to protect humans from the avian flu. This vaccine could be used if the current H5N1 virus starts spreading between people. The U.S. Federal Government keeps a stockpile of H5N1 vaccine.

    Outlook (Prognosis)

    The outlook depends on the type of avian flu virus and how bad the infection is. The disease can be fatal.

    Possible Complications

    • Acute respiratory failure
    • Organ failure
    • Pneumonia
    • Sepsis

    When to Contact a Medical Professional

    Call your health care provider if you develop flu-like symptoms within 10 days of handling infected birds or being in an area with a known avian flu outbreak.

    Prevention

    At this time, the U.S. Centers for Disease Control and Prevention (CDC) Does not recommend against travel to countries affected by H5N1 .

    If traveling to an area that has H5N1 outbreak:

    • Avoid visits to live-bird markets
    • Use protective clothing and special breathing masks if you work with birds.
    • Avoid undercooked or uncooked meat reduces the risk of exposure to avian flu and other foodborne diseases

    Current information regarding avian flu is available at http://www.dc.gov/flu/avianflu/

    References

    US Food and Drug Administration. FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1. Rockville, MD: National Press Office; April 17, 2007. Release P07-68

    Levin S. Zoonoses. In: Goldman L, Schafer AI, eds.Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2001:chap 336.

    Hayden FG. Influenza. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 372

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            Review Date: 2/4/2013

            Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.

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