BIRD FLU

Influenza viruses that primarily affect birds are called avian influenza viruses or popularly known as bird flu viruses. Of the three bird flu virus types (A to C), only influenza A can infect birds. The virus multiplies in the intestines of certain birds, usually waterfowl, and is later shed. Infected birds, on the other hand, shed the virus from other sites including saliva, nasal secretions, and feces. Wild birds are the natural hosts of all influenza A subtypes but they typically do not get sick when infected. Certain avian influenza A virus subtypes, however, can cause extensive disease and death among some domesticated birds. One very pathogenic bird flu virus of importance is the H5N1 strain which has been the causative subtype for the recently reported bird flu outbreaks in Asia.

From 1997 to early 2005, several outbreaks of avian influenza A among humans have been reported in several countries all over Asia. The recent outbreak reported in Vietnam was caused by the avian H5N1 strain. Outbreaks caused by this particular strain are closely monitored due to its unique capacity to cross species barriers and infect the human population.

Transmission from birds to humans can occur:

Directly from birds or from avian-contaminated environments (bird droppings, contaminated dust and soil, contaminated equipment, feeds, or cages in affected farms);
Through an intermediate host, like pigs (direct contact and respiratory droplets).

Symptoms of avian influenza among humans may include: Fever cough sore throat muscle pains and eye infections. Complications, however, may be sudden and severe leading to pneumonia, acute respiratory distress, encephalitis, and other severe and lifethreatening conditions.

 Generally,

the diagnosis is made on clinical grounds. A thorough history of exposure is sought. Suspicion of a possible avian flu outbreak is raised when there is an unexplained high number of mortality among domestic fowl (chickens, ducks).

The most important precautionary measure for now is prevention of human exposure to the avian flu, hence the need to quickly detect any outbreaks among poultry. In the Philippines, 14 wetlands and 2 dams which serve as sanctuaries for migratory ducks have already been identified as critical areas for surveillance. Residents and wildlife bureau workers in the perimeter of these areas together with poultry workers have also been identified as target risk groups. Finally, a key preventive measure which cannot be overemphasized is frequent hand washing.

The current influenza vaccine will not protect against disease caused by the H5N1 strain but this vaccine will protect against currently circulating human strains and subsequently reduce the risk for high risk individuals to be infected with human and avian viruses at the same time. As the influenza virus is capable of antigenic exchange (mutations), vaccines are prepared annually to match the predicted circulating strains of human influenza A and B. Vaccination in young adults is 70-90% effective. This efficacy, however, although significantly diminished among the elderly, still reduces the number of confinements and mortality. In the Philippines, the influenza vaccine employed is the Southern hemisphere formulation, which is generally made available starting February of each year.

Severe acute respiratory syndrome (SARS) is a life-threatening viral respiratory illness caused by a coronavirus known as SARS-associated coronavirus (SARS-CoV). SARS is associated with a flu-likesyndrome, which may progress intopneumonia, respiratory failure, and sometimes death. The SARS virus is believed to have originated in the Guangdong Province in southern China and has subsequently spread around the world. China and its surrounding countries have witnessed the greatest numbers of SARS-related cases and death.

The SARS virus is a previously unrecognized coronavirus called SARS-associated coronavirus (SARS-CoV). The SARS virus is spread by close person-to-person contact, either through the air or by touching something that is contaminated with the SARS virus. Preliminary SARS research studies suggest that the SARS virus may survive in the environment for several days. The length of time that the SARS virus survives likely depends on a number of factors. These factors could include the type of material or body fluid containing the virus and various environmental conditions such as temperature or humidity.

Exposure Pathway The main pathway of human exposure is close contact with respiratory droplets containing the SARS virus. The major route of transmission is therefore close person-to-person contact. At this point it appears a patient must be symptomatic to spread the virus. In most circumstances the spread of SARS can be attributed to short-range contact with infected respiratory droplets, however, transmission through sewage, feces, food, water and air are other possibilities.

It was recently concluded inadequate plumbing likely played a role in the spread of SARS in Hong Kong during early 2003 so the fecal droplet route is considered another mode of transmission.

How is SARS Transmitted?

Spread of SARS to uninfected individuals can occur by:Deposition of respiratory droplets onto the mucous membranes of the mouth, nose, or eyes, which were released by an infected individual through airborne transmission after a cough or sneeze. (Droplets are able to travel about 3 feet) Contact with surfaces or objects contaminated with SARS infected droplets and the sequential contact with the individuals mouth, nose, or eyes.

SARS is spread by close person-to-person contact. Close contact includes having lived with or cared for an individual with SARS or having had direct contact with the body fluids or respiratory secretions of an individual infected with SARS. Examples of close contact: Kissing Hugging Sharing drinking or eating utensils Directly touching a SARS patient Talking to a SARS patient within three feet

2-10 DAYS but may be long as 13 days based on cohort analysis of cases from Hongkong and Canada.

Symptoms

The symptoms of SARS usually begin two to seven days after a person becomes infected. They include: high temperature (fever) of 38C (100.4F) or above fatigue (extreme tiredness) headaches chills muscle pain loss of appetite

Diarrhea Between three and seven days after the onset of these symptoms, the infection will begin to affect the respiratory system (the lungs and airways). This will cause additional symptoms, such as: a dry cough breathing difficulties an increasing lack of oxygen in the blood, which can be fatal in the most severe cases