Pandemic Influenza

Frequently Asked Questions About Pandemic Influenza and Avian Flu

What is the difference between seasonal flu, bird flu and pandemic influenza?

Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. At this time the H5N1 virus cannot easily be transmitted from person to person. There is no human immunity to this virus and no vaccine is available.

Pandemic influenza is a worldwide outbreak of severe flu caused by a virus that is new to humans. Pandemics occur when a new or markedly changed virus develops. Because the virus is new or very different from any virus seen before, there is no natural immunity (defenses) in the human population, and the disease can spread easily from person to person. In a pandemic, many people may get sick at the same time, and many may die.

What is the most important thing to do about pandemic influenza?

Be Informed. Be Prepared.

What is the difference between avian flu and bird flu?

None. “Avian” is Latin for “bird.”

Are we in the midst of an influenza pandemic?

No, there is no pandemic influenza in the world today.

How is a pandemic different from regular flu season?

Pandemic influenza is caused by an influenza virus that is new to people. Seasonal flu is caused by viruses that already exist among people. We have vaccines that help protect against the seasonal flu. No one would have defenses (immunity) to a new influenza virus. Currently there is no vaccine to protect us from a pandemic influenza strain.

How long will the pandemic last?

Past pandemics have spread across the world in two and sometimes three waves. In the last major pandemic, which occurred in 1918, each wave lasted six to eight weeks. The waves might be separated by several months. Not all parts of the world or of a single country are expected to be severely affected at the same time.

What are the symptoms we can expect during a pandemic flu?

In a pandemic, infected individuals will show the same symptoms that appear during the regular flu season, such as sudden onset of a fever of 101°F or higher that lasts for several days, muscle aches and pains, coughing, and shortness of breath. A runny nose is a symptom of a common cold, not influenza.

How long does it take for a person to show symptoms of influenza after they are exposed? How long do influenza symptoms last?

After a person is exposed to influenza, it can take two to four days for a person to show symptoms. Symptoms may last seven to 14 days.

If someone has influenza, for how long are they contagious?

In general, a person can transmit influenza starting one day before their symptoms appear, and up to five days after they first showed symptoms. In some cases, the contagious period may be even longer.

Why is pandemic influenza so serious?

Pandemic influenza can cause widespread illness and death. The influenza virus, in a pandemic situation, will infect many people in a short time. In a very severe pandemic, many people might die. The demand for healthcare services will increase during a pandemic influenza outbreak, and the number of healthcare workers available will decrease due to illness. Many essential services will be strained, and everyday life may be severely disrupted for a period of months.

Can pandemic influenza be stopped?

Scientists are confident that an outbreak of pandemic influenza will occur again. Influenza viruses are always changing: new influenza viruses that spread easily emerge, or old ones can re-emerge. Once a fully contagious virus emerges, its global spread is considered inevitable. Countries might delay arrival of the virus through measures such as border closures and travel restrictions, but they probably cannot stop it.

Where will the pandemic influenza come from?

Many experts believe that the pandemic influenza of 1918 started in the United States. However, a number of new influenza viruses have originated in Asia. The speed and amount of international travel will make it very easy for a new virus to spread across the world. Cases of human infection with the avian flu virus have been reported in several countries, including Cambodia, China, Indonesia, Iraq, Thailand, Turkey and Vietnam.

More on the history of influenza:
Timeline of Human Flu Pandemics
Pandemics and Pandemic Threats since 1900
The Great Pandemic of 1918: State by State
The American Experience, Influenza 1918

Why do the current bird flu outbreaks pose a risk of causing a pandemic influenza outbreak in humans?

Cases of human infection with the avian flu virus have been reported in several countries, including Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. In each case of human infection, the person had close contact with infected poultry. Experts from around the world are watching the spread of this virus across the world very closely, and are preparing for the possibility that the virus that has infected people in Asia, Eurasia and the Near East may change into a strain that can be easily transmitted from person to person. More information on monitoring outbreaks.

When will pandemic flu get to Rhode Island?

No one can predict when a pandemic will occur, or how fast it will spread across the world. More information on global surveillance activities.

What’s the worst-case scenario for an influenza pandemic in Rhode Island?

In Rhode Island, it is estimated that up to 30% of the Rhode Island population might become sick in a few weeks. In a very severe pandemic, many infected people might die. The demand for healthcare services will significantly increase, and the number of healthcare workers may be reduced at any given time. Many essential services will be strained, and everyday life may be severely disrupted.

Will the anti-viral Tamiflu® be available to me when pandemic flu gets to Rhode Island?

No one can be sure that Tamiflu® will be effective against a pandemic influenza virus. Although the federal government keeps a certain amount of medical supplies and antivirals on hand, no country has enough antivirals to protect all its citizens. Some antivirals may be helpful in an influenza pandemic. If these drugs become available, they would be given to priority groups based on the guidance from the U.S. Department of Health and Human Services that is current at that time. Flu Drugs

Is it a good idea to get a supply of Tamiflu® now “just in case?”

No one can be sure that Tamiflu® will be effective against a pandemic influenza virus. Tamiflu® is in short supply throughout the world. Tamiflu®, as is the case with many other medications, can have unwanted side effects if it is not used correctly, or may become useless if stored incorrectly. Medicines like Tamiflu® are also very expensive, and you may end up spending a lot of money on a medicine that you might never need. It is important that a healthcare professional determines who needs Tamiflu®. In many cases, Tamiflu® may not be the appropriate medication, and may do more harm than good. Incorrect use of any medicine, such as an antibiotic or antiviral may cause the virus to become resistant to these drugs, which would make it more difficult to treat. Influenza (Flu) Antiviral Drugs and Related Information

When will a vaccine against pandemic influenza be available?

Currently there is no Avian Influenza Vaccines available for an influenza pandemic. The exact pandemic influenza virus cannot be identified before a pandemic, and current vaccine-making techniques require six to eight months to manufacture influenza vaccine. Questions and Answers: H5N1 Avian Flu Vaccine Trials The federal government’s goal is to have enough vaccine for everyone, but supplies will probably be limited in the early stages of a pandemic. Researchers are working on ways to make vaccine more quickly, and the U.S. is working to recruit more companies that can produce vaccine. If vaccine becomes available, it will be distributed according to the guidance from the U.S. Department of Health and Human Services that is current at that time.

How can I protect my family and myself?

Get a flu shot every year. Eligible people should also get a pneumonia shot as advised by their doctor. Practice good health habits, including eating a balanced diet and getting sufficient rest. Covering your coughs and sneezes, washing your hands frequently, or using alcohol-based hand gels can help keep you and others healthy. Discuss individual health concerns with your healthcare provider.

As you plan, it is important to think about the challenges that you might face, particularly if a pandemic is severe. It may take time to find the answers to these challenges. Below are some situations that could be caused by a severe pandemic and possible ways to address them. A checklist and fill-in sheets for family health information and emergency contact information have been prepared to help guide your planning and preparation. Pandemic Influenza Planning: Guide for Individuals and Families

Will people be quarantined or isolated?

At some point we may advise people who are sick with pandemic influenza to voluntarily stay home to avoid making other people sick. People with influenza feel very ill, so they will probably want to stay home anyway. If travelers who are sick with pandemic influenza arrive in Rhode Island in the earliest stages of a pandemic, we may have to ask them to stay isolated (away from other people) until they are no longer contagious.

Should I stop eating poultry?

People cannot get avian influenza from properly cooked poultry or eggs. The U.S. bans imports of poultry from areas where avian flu is present in flocks.

Can I get bird flu from eating at an Asian restaurant?

You cannot get avian influenza from meals that contain properly cooked poultry or eggs in Asian restaurants or in any other place, and you cannot get bird flu from being in contact with healthy people of any nationality.

If I just stay home during an influenza pandemic, will I be safe?

Influenza is primarily spread from person to person. It is not possible to get infected if you are not in contact with sick people or freshly contaminated surfaces. One of the ways to slow the spread of influenza is to avoid large groups of people like entertainment events, crowded shopping centers, etc. However, most people will have to be in contact with other people to do everyday activities such as shopping, going to work, etc. Frequent hand-washing and good etiquette when coughing or sneezing can help keep you and others healthy and reduce the spread of disease.

What emergency supplies should I keep at home?

An emergency kit is a good idea for many types of emergencies. Some important things to keep on hand are: An extra supply of any medication you use regularly; extra food and water; thermometers; pain relievers; decongestants; soup or other comfort foods; lots of fluids; pet food and any other supplies that you and the members of your household may need for at least 3 days. If you cannot leave your home, your kit will provide essential needs to help protect your family’s health and your own. Here is more information on preparing for emergencies. This emergency preparedness information is also available in English, Spanish, Portuguese, Chinese, French, Cambodian, Hmong and Laotian.

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These are some questions that people might have, if a pandemic of influenza ever got to Rhode Island.

How can my family prepare?

A checklist and fill-in sheets for family health information and emergency contact information have been prepared to help guide your planning and preparation. Pandemic Influenza Planning: Guide for Individuals and Families

What can the public do to reduce their risk of pandemic influenza during an outbreak?

First, do not feed waterfowl – it is against the law! When someone feeds these birds, large flocks congregate, resulting in overcrowding and making it easier for diseases to spread among the flock. The large amounts of waste can also impact water quality, resulting in beach closures and shellfish bans.

Stay informed. Follow instructions from public health officials, who will communicate often through the statewide and local television stations, newspapers, and radio stations. Look for updated information on the Department of Health Web site. Health officials will be in contact with community leaders to coordinate services and public health messages throughout the state. Stay away from sick individuals as much as possible. If you are sick, stay away from others as much as you can.

Why is family preparedness and community preparedness so important?

A pandemic is a world-wide event. Many, many cities and towns in the United States will have a very large number of sick people at the same time. Very little help from the outside will be available. Neighborhoods, communities, cities and towns must prepare to care for their residents without much outside help.

What steps should we take if a family member is infected with the pandemic influenza virus?

As you take care of a sick person, take normal precautions to prevent the spread of infection – wash your hands often or use alcohol-based sanitizing gels. Keep the sick person away from people who are healthy and have the sick person over their cough to reduce the spread of disease. If someone is seriously sick, consult with your healthcare provider.

Someone in my family has been ill, do I need to clean my house to avoid getting sick?

The influenza virus cannot stay alive for very long outside of a living organism. Freshly contaminated surfaces can be cleaned with Lysol or another disinfectant household cleaner. Washing hands regularly, or using alcohol-based sanitizing gels, is very important and can help you and others stay healthy.

Do I need to wear a mask?

Right now there is no recommendation for the general public to wear masks during an influenza pandemic. If CDC recommends masks for the general population we will inform the public.

How can communities prepare?

The U.S. Department of Health and Human Services has developed preparation checklists for many groups such as businesses, schools, health care organizations and community organizations.

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What is the State of Rhode Island doing to prepare for an influenza pandemic?

Governor Donald L. Carcieri has appointed a Pandemic Flu Working Group to prepare Rhode Island for a pandemic influenza outbreak. State agencies, municipalities, hospitals, healthcare providers, businesses, industries and community leaders, and community representatives from all sectors are working together to minimize the effect of an influenza pandemic on everyday life.

Will a state of emergency be declared when pandemic influenza arrives in Rhode Island?

An emergency declaration is one of the options we have. However, resources across the country will be used in their own communities, and we will have to look at resources within the state to support each other. More on state and local planning.

Where can I get more information?

The federal government and many international health authorities have reliable Web sites that constantly update their information. You can find many of these links here.

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When would businesses or industries activate their pandemic influenza plans?

The decision to activate your plan should be based on information from the Department of Health’s website and the media. We will communicate directly with key infrastructure providers.

How can we prevent employees from infecting each other?

Employers should use the concept of social distancing at work. If possible, teams should split into different work locations to minimize the risk of spreading infection. Cancel non-essential training sessions. Avoid face-to-face meetings, and use telephone conferencing. If face-to-face meetings are absolutely necessary, try to use a large room and seat individuals at least three feet apart.

Manage shift changes in a way to prevent employees from being together in small areas. Clear the building of one shift before the second shift enters. This helps reduce the number of people meeting in the hallway, locker rooms, etc. and provides an opportunity to ventilate the work site during the shift change (open windows).

In offices, ask staff to bring their lunch to work and eat at their desk – to avoid crowded restaurants. In cafeterias, use staggered lunch times to avoid large numbers of people congregating.

How does pandemic influenza spread? Do businesses and factories need to turn off their HVAC systems? Should they wipe every surface with a disinfectant every night?

Office cleaning should be stepped up during pandemic influenza. Disinfectants should be applied to all common area surfaces: counters, railings, sinks, toilet bowls.

HVAC systems should continue running, increasing the amount of outside air and reducing the amount of recirculated air. There is no medical indication for cleaning air filters more frequently than usual during pandemic influenza. Since the spread of influenza is still primarily by droplets, the filters will not make a difference. Additionally, most industrial HVAC filters will not filter virus-sized organisms.

What types of planning should employers consider?

There is a checklist for business and industrial planning that can be used by businesses for protecting employees' health and safety as well as limiting the negative impact to the economy and society. Businesses and industries need to identify their most essential operations, and the minimum number of staff needed to keep these operations running. Companies that provide critical infrastructure services, such as media, power and telecommunications, also have a special responsibility to plan for continued operation in a crisis and should plan accordingly. As with any catastrophe, having a contingency plan is essential.

All businesses needs to plan for loss of people and expertise (cross-training for essential functions), and the loss of services from suppliers. Critical infrastructure companies /essential service providers should stockpile three days of food/water/other supplies. They should stockpile cleaning supplies - contract maintenance workers may not be available.

How should I prepare my employees?

Employee education is critical. A checklist and fill-in sheets for family health information and emergency contact information have been prepared to help guide your planning and preparation. Pandemic Influenza Planning: Guide for Individuals and Families

The Department of Health has prepared a simple flyer, available for downloading and printing, which will help employees understand the situation and reduce some of their anxiety.

Most employees want to know specifically how pandemic flu will affect their job. They want to know what your policies will be if the business closes (either because too many staff are sick or because supplies are not available to continue operation). Will they be able to work from home? Will they get paid if they get sick? They need to know what the policy will be if several members of their family get sick and they must stay home.

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Is my pet bird in danger of catching bird flu?

A pet bird would have to come in contact with a wild or domesticated bird with avian flu to become infected. There is no reported avian flu in the United States at this time. But even after bird flu is identified in the United States, the risk is small for caged birds.

Can I get bird flu from my pet bird?

A pet bird would have to come in contact with a wild or domesticated bird with avian flu to become infected. Most human cases probably came from direct contact with infected birds or their droppings. Follow good health habits when cleaning your bird’s cage, and wash your hands frequently.

I have chickens as pets. How can I protect them from bird flu? Am I in danger of getting bird flu from my neighbors’ chickens?

In the United States there is no need at present to remove a flock of chickens because of concerns regarding avian influenza. The U.S. Department of Agriculture monitors potential infection of poultry and poultry products by avian influenza viruses and other infectious disease agents. Avoid contact with any surfaces that have been in contact with uncooked poultry or that appear to be contaminated with feces from any animal. Rhode Island’s Department of Environmental Management (DEM) is monitoring poultry farms in the state, and will issue advisories as necessary.

The Department of the Interior is monitoring wild birds across the nation. When bird flu reaches the United States, some experts have suggested that chicken yards and similar areas for containing a small flock of birds should have a solid roof and be enclosed with chicken or rabbit wire so that the pet birds will avoid contact with any wild birds, including their droppings.

There are several sources of additional information on protecting poultry and protecting people exposed to animals:

Biosecurity for Birds: Avian Influenza (Animal and Plant Health Inspection Service-Learn how to protect your poultry from avian influenza Biosecurity for the Birds: Avian Influenza (AI).

Biosecurity Tips : 6 Ways to Prevent Poultry Disease (Animal and Plant Health Inspection Service) Biosecurity Tips: 6 Ways To Prevent Poultry Disease.

Avian Influenza (Animal and Plant Health Inspection Service- The threat Avian Influenza poses to U.S. poultry.)
Avian Influenza (AI)

Animal Health : Avian Influenza (Food and Agriculture Organization- A list of resources on avian influenza.)
Animal Health: Avian Influenza

Embargo of Birds from Specific Countries (Centers for Disease Control and Prevention- Countries are prohibited from exporting birds and bird products to the United States.) Embargo of Birds from Specified Countries

Protecting Poultry Workers at Risk (Occupational Safety and Health Administration-Discover how employers can provide a safe environment for their poultry workers.) Avian Influenza: Protecting Poultry Workers at Risk

Interim Guidance for Protection of Persons Involved in U.S. Avian Influenza Outbreak Disease Control and Eradication Activities (Centers for Disease Control and Prevention- Protection methods for people involved in activities that could result in exposure to avian influenza, such as culling operations, carcass disposal, and cleaning and disinfection of premises.) Interim Guidance for Protection of Persons Involved in U.S. Avian Influenza Outbreak Disease Control and Eradication Activities

I go duck hunting every fall. Should I cancel this year’s trip?

Water fowl hunters should always follow simple precautions, such as wearing rubber gloves when handling birds, washing hands and instruments thoroughly when done, and cooking meat thoroughly (to an internal temperature of 165 oF. The meat-smoking process does not reach this temperature.

There are several sources of safety information for fowl hunters. We suggest you check now and nearer to the time of your trip:

Safety Guidelines for Handling Wild Birds (USGS National Wildlife Health Center - Gives advice for the general public, hunters, and field biologists.) Safety Guidelines for Handling Wild Birds

What Hunters Should Know About Avian Influenza (Alaska State Department of Fish and Game - the safe preparation and cooking of game animals and the susceptibility of other animals to avian influenza.)What Hunters Should Know About Avian Influenza

A fact sheet prepared for hunters by the State of Washington. Avian Influenza

Quick facts about Bird Flu before your next hunting trip from the California Department of Fish and Game What Hunters Should Know About Avian Influenza (Bird Flu) (PDF)

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What are the travel recommendations regarding the H5N1 bird flu outbreak?

The U.S. Centers for Disease Control (CDC) currently advises travelers to countries with known outbreaks of avian influenza A of the H5N1 strain to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals.

Human cases of avian influenza infection have been reported in several countries, including Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam. In each case of human infection, however, the person had close contact with infected birds. CDC does encourage international travelers to visit the Center’s Travelers' Health website to educate themselves and others about any disease risks and CDC health recommendations for international travel in areas they plan to visit.

What can I do during travel to Asia or other areas where avian flu is present, to minimize the risk of getting avian flu?

Avoid contact with chickens and ducks (including droppings and blood). Follow good health habits, such as frequent hand-washing. Avoid “live markets”, bird farms, poultry-related materials such as feathers, “lucky chicken feet”, and partially cooked poultry. To avoid carrying the disease to American poultry, you should also stay away from farms with poultry, feed stores, and live bird markets for 7 to 10 days after returning from your trip.

What steps can I take before I travel areas where avian flu is present?

Check the CDC’s web site for travel advisories. Be sure all of your shots are up-to-date and make sure that your health insurance provides coverage for you in other countries. Contact the U.S. Consulate at your destination to learn of available healthcare options.

What can I do after I travel to areas where avian flu is present?

To this date, no travelers have become ill with avian flu during their travels. However, if you have any illness within 10 days of coming back from a region where avian flu is present, see your healthcare provider. Tell your healthcare provider about your travel.

Which countries have identified bird flu in wild birds or domestic flocks?

According to the World Health Organization, the avian flu in wild and/or domestic birds has spread from Southeast Asia to South Asia and Pacific countries, to Africa and the Near East and to several countries in Europe. Forty-three countries have reported infected birds as of April 19, 2006.

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As an Emergency Medical Technician, do I need to wear a mask or other personal protective equipment (PPE) when treating a person infected with avian flu?

The Centers for Disease Control and Prevention (CDC) recommends that healthcare workers wear personal protective equipment (PPE) –including N-95 masks, gloves and gowns— when taking care of a patient with avian influenza who has been placed in respiratory isolation. This equipment must be fitted to each healthcare worker in order to be effective, and conditions of use are very strict in order for the equipment to be protective. Here are recommendations on the use of PPE for health care personnel. See also the Rhode Island Department of Health’s Protocols and Standing Orders.

These recommendations, however, are under review.

As an Emergency Medical Technician, do I need to wear a mask or other personal protective equipment (PPE) when treating a person infected with pandemic influenza?

The Department of Homeland Security recommends surgical masks and eye protection during care of patients with pandemic flu. CDC recommends healthcare providers use of the N-95 mask only when a procedure has high likelihood of aerosolized matter, such as a bronchoscopy/intubation. The CDC recommendations, however, are under review.

The N-95 mask is difficult to use for several reasons: Fit testing requires medical screening first; the big thick masks are hard to breathe through and not everyone would physically tolerate them; they are not useable with facial hair. These recommendations could change but the science of flu viruses that exists still says that they spread by large droplets, so any mouth/nose/eye protection should be effective.

If it is available, will first responders get the vaccine for pandemic influenza?

Yes, according to guidance from the U.S. Department of Health and Human Services, first responders and other healthcare personnel are some of the priority groups that will receive the vaccine against pandemic influenza when it becomes available.

Will masks and other personal protective equipment (PPE) be available to first responders in case of an influenza pandemic?

Yes. This equipment is already required on all ambulances and emergency departments in Rhode Island.

Will personal protective equipment (PPE) protect me against avian influenza or another virus that might cause an influenza pandemic?

All properly worn personal protective equipment should protect the wearer. However, it is never possible to assure safety with 100 % certainty.

Is infection rate in an influenza pandemic expected to be higher for EMS personnel and other health care providers than it is for the general population?

Healthcare personnel will have increased chance of contact with the pandemic influenza virus; that is why personal protective equipment must be used according to established protocols. Healthcare and EMS personnel must also take precautions such as frequent and thorough hand washing, using alcohol-based antibacterial hand gel, and good respiratory hygiene.

Are there any precautions that first responders should take when responding to emergencies at poultry farms?

Regular precautions are sufficient; there are no problems reported in Rhode Island poultry farms at this time.

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4/20/06

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