Travel advice to prevent BIRD FLU.

Australians travelling to areas affected by avian influenza

should reduce their risk of infection by avoiding poultry

farms and live bird markets. They should also ensure that

they wash their hands thoroughly after handling uncooked

poultry products such as eggs, and that they ensure that

poultry is cooked thoroughly before eating.

What is the public health response for BIRD FLU?

Outbreaks of different strains of avian influenza have

occurred previously in Australia. However, there have been

no recent reports of avian influenza in Australian birds and

there are no reports of Australian people with H5N1 virus

infection. There is surveillance for the illegal importation

of birds or bird products at Australian borders.

Human infection with avian influenza must be notified to

the local public health unit. Should suspected human cases

occur in NSW, the local public health unit would work

with the patient, the treating doctors, and the laboratory to

confirm the diagnosis. Suspected cases would be isolated

from others to prevent further infections. Close contacts of

these cases who may have been exposed to the virus will

be given information about the risk of infection. Should

these people also develop symptoms, they would also be

isolated and tested for avian influenza.

How BIRD FLU is treated?

Specific anti-influenza drugs are likely to be effective

against avian influenza in humans and are used to treat

people with the H5N1 strain.

How BIRD FLUE is diagnosed?

Avian influenza virus infection can be diagnosed using

specimens of blood, or from swabs of the nose and throat.

Testing is done at a specialised laboratory.

How BIRD FLU is prevented?

A human vaccine is not available for the new avian influenza

strain. Existing vaccines for normal human influenza will

not provide protection against avian influenza, including the

H5N1 strain. Scientists worldwide are currently working

to develop a suitable vaccine for this strain.

Who is at risk of BIRD FLU?

Most people are not at risk of this disease. People at risk

of becoming infected with H5N1 are those who come into

contact with sick birds or their secretions or droppings while

living or travelling in areas where the virus is circulating, or

(possibly) people who have had close contact with a person

with the human form of the disease in the affected areas.

In the absence of a vaccine, the best method of prevention

is to ensure that all people who are working with infected

birds are supplied with appropriate personal protective

equipment, such as masks, goggles, gloves and protective

clothing, and, if necessary, anti-influenza medication.

What are the symptoms of BIRD FLU?

Different strains of avian influenza can lead to different

symptoms in people. All strains can cause symptoms typical

of human influenza (fever, cough, tiredness, muscle aches,

sore throat, shortness of breath, runny nose, headache). In

some cases the H5N1 strain has caused a severe pneumonia

and, in a small number of cases, encephalitis (inflammation

of the brain) or diarrhoea. The most common symptom

of humans infected with H7 strains of avian influenza

is conjunctivitis (inflammation of the lining of the eye).

Symptoms generally appear between two to four days

following exposure.

What is avian influenza (bird flu)?

Avian influenza is an infectious disease of birds, caused by a

number of different strains of avian influenza virus. Usually

the virus circulates in wild bird populations causing no

disease or only mild disease. Infection of domestic poultry,

such as chickens, can cause severe disease in these birds.

There are a number of different strains of avian influenza,

only a few of which can cause disease in humans.

A new type of avian influenza, called influenza A H5N1

(hereafter referred to as H5N1), was first recognised in 1997

in Hong Kong. This strain reappeared in late 2003 and has

rapidly spread to many Asian, Middle-Eastern, European

and African countries, causing severe infection in wild birds

and domestic poultry flocks. There is no evidence that avian

influenza is currently infecting birds in Australia.

This virus has also infected a number of people in Asia, the

Middle East and Africa who had close contact with infected

poultry or poultry droppings.

At this stage, humans infected with the H5N1 virus do not

easily transmit the infection to others. Exposure to infected

poultry, or their infected secretions or droppings, or dust or

soil contaminated with their secretions or droppings, can

result in human infection. Eating cooked poultry products

including chicken or eggs does not result in infection.

A large-scale, worldwide influenza epidemic is called a

pandemic. Pandemics occur when a new virus emerges to

which people have little or no immunity. Previous influenza

pandemics occurred in 1918-19, 1957-58 and 1968-69. In

the 1918-19 pandemic, between 20 and 40 million people

died. Many scientists are concerned that the recent H5N1

outbreak in birds could mutate to produce a new strain of

influenza virus that is easily spread among people, resulting

in a pandemic.

RESTRICTION OF ACTIVITY IF SWINE FLU DETECTED.

As there is no evidence that treatment with antiviral medication reduces a person’s contagious
state, it must be assumed that persons remain contagious for 7 days after the onset of
symptoms regardless of whether or not they are treated with antiviral medication. The
following restrictions on activity shall be implemented when there is a suspected or confirmed
case of influenza.

1. To the extent possible, maintain individuals with suspected or confirmed influenza on
droplet precautions in their bedroom for 7 days from the onset of symptoms.
2. At a minimum, restrict individuals(s) with suspected or confirmed influenza to the
affected unit/residence.
3. To the extent possible, individuals with suspected or confirmed influenza are to dine in
their rooms.
4. If dining in the common area, individuals(s) with suspected or confirmed influenza are to
dine separately from those who are well/not exposed, with the well individuals dining
first followed by the individuals(s) with suspected or confirmed influenza.
5. When in common areas, promote spatial separation of at least 6 feet whenever possible
between individuals(s) with suspected or confirmed influenza and other individuals.
6. Bedrooms, bathrooms, dining and common areas and “high touch” areas such as
doorknobs, telephones, faucet handles, remote controls, etc. should be thoroughly
cleaned frequently with a product that is effective against influenza. It is important that
staff use any product according to the manufacturer’s recommendations, paying
particular attention to any “sit time” that is required.
7. To the extent possible in large facilities, cohort individuals with suspected influenza with
other individuals with suspected influenza; cohort individuals confirmed to have
influenza with other individuals with confirmed influenza.
8. All individuals in a residence (or in a large facility, in the area, wing or unit) who have
suspected or confirmed influenza or who have been exposed to influenza are not to
attend day program, to interact with individuals or staff from other residences or units,
or go to activities outside of the residence.
9. Individuals must remain out of day program for a minimum of 7 days after the last
known exposure. Individuals may return to day program after 7 days provided the
following criteria are met:
a. the individual has completed at least 5 days of prophylactic medication; AND
b. the individual is asymptomatic and has been afebrile for at least 48 hours; AND
c. there is no evidence of on-going transmission in the residence, area, wing or unit.
(NOTE: if the primary care provider determines that a person cannot/should not
receive prophylactic medication, conditions b and c above must be met prior to
the person returning to program.
10. During the period of possible contagion, staff must be restricted from floating into or out
of the residence, area, wing or unit. In addition, staff that have been exposed must be
restricted from doing overtime or extra service in other programs, residences, areas,
wings or units for at least 7 days after the last known exposure. Staff restrictions may
be lifted after the following criteria are met:
a. the staff person has completed at least 5 days of prophylactic medication; AND
b. the staff person is asymptomatic and has been afebrile for at least 48 hours; AND
c. there is no evidence of on-going transmission in the residence, area, wing or unit
11. Restrict visitors to the residence to the extent possible until the contagious period is
over.
12. Restrict the use of respite in any residence with an individual with influenza. Restrict
the use of respite to individuals who are free of respiratory symptoms or a known
exposure to influenza.
13. Restrict admissions, discharges or transfers of individuals during the period of
infectivity. In the event that an individual must be re-located, the following measures
should be followed:
a. Carefully screen individuals to be relocated for symptoms of, and exposure to,
influenza.
b. If discharging/transferring an individual with respiratory symptoms or a known
exposure to influenza, notify the receiving facility.
c. Individuals admitted with respiratory symptoms or known exposure to
influenza are to be placed on droplet precautions.
d. Individuals admitted without respiratory symptoms or known exposure may be
admitted to the residence and treated as any other individual in the residence
without influenza.

DIAGNOSIS OF SWINE FLU.

Appropriate treatment of patients with respiratory illness depends on accurate and timely
diagnosis. Clinicians should consider the possibility of swine influenza virus infections in any
person presenting with febrile respiratory illness.

If swine flu is suspected, clinicians should obtain a recent travel history to affected areas
(including New York City) and test anyone meeting the case definition for swine flu:

1. A person with an acute respiratory illness who was a close contact to a confirmed case of
swine influenza A (H1N1) virus infection while the case was ill OR
2. A person with an acute respiratory illness with a recent history of contact with an animal with
confirmed or suspected swine influenza A (H1N1) virus infection OR
3. A person with an acute respiratory illness who has traveled to an area where there are
confirmed or probable cases of swine influenza A (H1N1) **INCLUDING TRAVEL TO NEW
YORK CITY

Definitions of Respiratory Illness from the NYS DOH:

1. Acute respiratory illness: Recent onset of at least two of the following:
-> rhinorrhea or nasal congestion
-> sore throat
-> cough
-> fever or feverishness
2. Influenza-like illness: fever >37.8°C (100°F) plus cough or sore throat.

Patients who meet the suspect case definition should be tested for influenza.

WHAT ARE THE SYMPTOMS OF SWINE FLU?

Some of the symptoms are the sudden onset of fever, cough or shortness of breath. Other symptoms can include headache, sore throat, tiredness, aching muscles, chills, sneezing, runny nose or loss of appetite.

WHAT CAN I DO TO PROTECT MYSELF AND OTHERS AGAINST FLU?

The best thing you can do to protect yourself is to follow good hygiene practices. These will help to slow the spread of the virus and will be the single most effective thing you can do to protect yourself and others from infection.

When you cough or sneeze it is especially important to follow the rules of good hygiene to prevent the spread of germs:

->Always carry tissues.
->Use clean tissues to cover your mouth and nose when you cough and sneeze.
->Bin the tissues after one use.
->Wash your hands with soap and hot water or a sanitiser gel often.

IS THERE A VACCINATION I CAN HAVE?

Not at this stage. This type of flu is not the same as seasonal flu: it involves a completely new type of virus. A vaccine can only be developed when the specific strain has been identified, and it would then take several months to produce.

The UK governments have agreements in place with manufacturers so that we can get stocks as soon as possible after a vaccine has been developed.

HOW DOES SWINE FLU SPREAD?

Flu viruses are made up of tiny particles that can be spread through the droplets that come out of your nose and mouth when you cough or sneeze.

When you cough or sneeze without covering your nose and mouth with a tissue, those droplets can spread and others will be at risk of breathing them in.

If you cough or sneeze into your hand, those droplets and the germs in them are then easily spread from your hand to any hard surfaces that you touch, and they can live on those surfaces for some time. Everyday items such as door handles, computer keyboards, mobile and ordinary phones and the TV remote control are all common surfaces where flu viruses can be found.
If other people touch these surfaces and then touch their faces, the germs can enter their systems and they can become infected. That’s how all cold and flu viruses, including swine flu, are passed on from person to person.

WHAT IS SWINE FLU ?

Swine flu is a respiratory disease and has some elements of a virus found in pigs. There is no evidence of this disease circulating in pigs in the UK and scientists are investigating its origins.
Swine flu has been confirmed in a number of countries and it is spreading from human to human, which could lead to what is referred to as a pandemic flu outbreak.

Pandemic flu is different from ordinary flu because it’s a new flu virus that appears in humans and spreads very quickly from person to person worldwide. The World Health Organization (WHO) is closely monitoring cases of swine flu globally to see whether this virus develops into a pandemic.
Because it’s a new virus, no one will have immunity to it and everyone could be at risk of catching it. This includes healthy adults as well as older people, young children and those with existing medical conditions.