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Q:
What is avian influenza? Why does it cause a
human flu pandemic?
A：Avian
influenza, or so called “bird flu,” is a
disease caused by the avian influenza
viruses. The viruses naturally lie in
digestive tracts of birds and do not cause
obvious signs of infection. Avian influenza
viruses can be divided into highly
pathogenic avian influenza virus and low
pathogenic avian influenza virus. Birds
infected by highly pathogenic avian
influenza virus are characterized by their
untidy feathers, loss of appetite, failure
to lay eggs, and purple cockscombs. Poultry
infected by highly pathogenic influenza
virus have a lethality rate of 80% or
higher.
Currently the
H5N1 virus has crossed the species barrier
to infect human beings, and may cause a
lethal global pandemic after transforming
into a virus with person-to-person
transmission. As a result, the flu pandemic
is also called the Killer Flu or Super Flu,
which is most likely to be caused by H5N1.
Q: What is H5N1?
A: There are many different subtypes of type
influenza viruses. These subtypes differ
because of certain proteins on the surface
of the influenza A virus (hem agglutinin
[HA] and neuraminidase [NA] proteins). There
are 16 different HA subtypes and 9 different
NA subtype of flu A viruses, which can make
144 combinations of HA and NA proteins
possible. Each combination is a different
subtype. All known subtypes of flu A viruses
can be found in birds. A/H5N1, also called
the H5N1 virus, is a subtype of the
Influenza A virus that mainly occurs in
birds. It was first isolated from birds in
South Africa in 1961. H5N1 virus is very
contagious and fatal among birds; it has
also caused some human infections since
1997. However, there is no sufficient
information of efficient human-to-human
transmission of H5N1.
Q：What
features does avian influenza have?
A: Mutations in the virus can rapidly
develop. If avian and human influenza
viruses were to simultaneously infect a
person or an animal, the two viruses might
swap genes and generate a new virus that is
readily transmissible among human beings and
against which human beings will have no
natural immunity. The virus can survive
inside the body for ten days.
Q: How do chickens or ducks transmit avian
influenza to people?
A: The H5N1 virus in the excrements of
affected poultry may be spread via airborne
transmission. Chickens housed in batteries
will be easily infected through the
excrements.
Q: Why does the globe put so much emphasis
on avian influenza?
A: Modern global transportation and
communication systems have enabled viruses
to spread rapidly through poultry, poultry
products, trading approaches, migratory
birds, illegal import and sales of affected
birds, and travelers around the world. Once
a country is attacked by avian influenza,
there will be a serious impact on health and
livelihood of the citizens, social
stability, agriculture and economics. If
avian influenza unfortunately turns into a
human-to-human epidemic, a catastrophe may
fall to the mankind all over the world.
1. Threats on Lives
In 1918, the avian influenza outbreak in Spain caused more
than twenty million casualties. In 1957, the
outbreak in Asia murdered 4.5 million
people. In 1968, the third pandemic outbreak
in Hong Kong also destroyed millions of
lives. The World Health Organization (WHO)
has estimated that about two to seven
million people may lose their lives if a
global outbreak of avian influenza should
occur recently.
2. The Impact on Economics
Once the highly pathogenic avian influenza occurs, all the
poultry in the affected area will be killed.
This may lead to consumer panic and a
dramatic drop in poultry consumption, making
a great influence on food service industry,
channels, processing factories, poultry
industry, veterinarians, feedstuff industry,
consignees, and slaughterhouses. Poultry
products are not allowed to be exported.
Compensation for the killed poultry,
emergency disease control, stabilizing
prices of poultry, disinfection of poultry
farms, disposal of dead poultry, and
victims’ loans will result in economic loss
and depression in tourism industry. Given
that the virus becomes transmissible from
human to human, all the social or economic
activities will be forced to pause, and the
loss will be beyond measure.
3. Unprecedented Impact on the Medical System
The drastic growth of patients may cause a shortage of
medical staffs if the medical staffs
are not well-shielded and infected by the
patients. Great demands for antibiotics will
be overwhelming pressures on medical
professionals, and medical facilities will
be overloaded.
4. Emergence of Panic
Viewing from the human history, an unknown disease can
always bring fear to people. With the rapid
transmission and high mortality rates of the
diseases, the long time needed for recovery
will make the unknown diseases even more
mysterious. The physical and mental
pressures on people will eventually
accelerate the society to fall apart.
Q: What animals will be infected with avian
influenza?
A: Avian influenza viruses can infect a wide variety of birds and
poultry, and have been found transmissible
to human beings. Waterfowls such as water
birds or ducks may be carriers of avian
influenza viruses. Once chickens, turkeys,
or ostriches are infected, there may be a
wide range of deaths. According to the
current research, H5N1 has crossed the
species barrier and transmitted to pigs,
horses and felines (including cats, tigers,
and masked palm civets).
Q：Will
people get infected by buying a chicken
home?
A: There is a critical condition for being
infected by excretion of the poultry. The
virus density in the environment shall be
high. So far, no cases of avian influenza
infection have been reported in Taiwan. Even
though we buy a live chicken with viruses,
they can hardly be transmitted due to their
low density. There is no need to worry.
Q：Will
people get infected by eating poultry?
A: The possibility of virus transmission will be minimized after
the meat is fully cooked. If the meat is not
fully cooked, the viruses may invade human
bodies. Will viruses be transmitted to human
organs and tissues through digestive tracts?
How do viruses work in human bodies? Such
mechanisms have still been mysterious so
far.
Q：Will
people get infected by down jackets or down
quilts?
A: People will definitely not be infected by
down jackets or down quilts since products
made of down or feathers have often been
disinfected both physically and
chemically. Viruses can hardly survive or do
harm to human bodies.
Q: Is avian influenza curable?
A: Yes. The antiviral medications proved to treat influenza can be
divided into two types – M2 protein
inhibitors, such as Amantadine, and
neuraminidase inhibitors, such as
Oseltamivir (Tamiflu) and Relenza that are
used to treat Influenzas A and B
administered within 48 hours of the onset of
symptoms. They would also work to shorten
the duration of the flu, treat flu caused by
the H5N1 virus and help to relieve the
symptoms. Viruses becoming resistant to
antiviral are a concern; thus, medication
should only be taken under a physician’s
supervision.
Q：How
to prevent avian flu infection?
A：1. Do not touch poultry or its excrement.
Once we touch it by accident, we must wash
hands with soap immediately.
2. Do not eat raw poultry or poultry products (including
eggs or related products, such as duck
blood).
3. If not necessary or without
protection, do not go to live poultry
slaughterhouses, poultry farms, or live
poultry markets.
4. Those who work in the poultry industry
must be equipped with personal protection
accessories during the process, and get
cleaned and disinfected after work.
5. Develop good habits for personal
hygiene, balanced diets, proper exercise and
rest to keep a healthy body.
6. If people who have close contact with
birds or have been to the affected areas are
suffering from fever, sore throat, coughs,
or conjunctivitis, please wear a mask to
take medical treatment and sample
collection. Tell the doctor about your
contact history, work contents, and travel
experiences.
Q: How to prevent avian influenza infection
when traveling?
A：1. If not necessary or without protection,
please do not
go to the avian-flu-affected areas.
2. If typical symptoms of avian flu, such
as fever, cough, or sore throat, emerge,
trips should be postponed or canceled.
3. Do not have close contact with poultry
(including feeding) or their excrements. If
you touch it by accident, wash your hands
with soap immediately.
4. Pay attention to dietary hygiene and be sure not to
eat raw poultry or raw poultry products.
5. When returning to Taiwan, please fill
out the questionnaire regarding SARS and
other infectious diseases. If you have
symptoms of influenza, such as fever,
coughs, and sore throat, please wear a mask
to take medical treatment and sample
collection. Tell the doctor about your
contact history, work contents, and travel
experiences.
Q：What
should people who keep poultry do?
A: 1. Do not touch poultry, birds, or
their excrement, especially for the weak,
such as children or the elderly.
2. Wash hands with soap and clean water
after touching poultry or its excrement.
3. Workers in the poultry industry should
wear personal protection equipment during
the working process; take a shower and
perform disinfection after work.
4. Strengthen our resistance against diseases and live a
healthy lifestyle; for example, balanced
diets, proper
exercise, sufficient rest, and being a
non-smoker.
5. Maintain good personal and
environmental hygiene, such as keeping hands
clean, washing hands correctly, covering
your mouth and nose when sneezing, wrapping
up your sputum or mucus with a paper napkin
before throwing it into a trash can and
washing hands.
6. Perform temperature monitoring. Wear a
mask once you have any symptoms of flu and
take medical treatment and sample
collection. Tell the medical staff about the
contact history.
Q: What is the present global condition of
avian influenza in humans?
A: The first bird-to-human transmission of A/H5N1
virus was found during the influenza
outbreak in Hong Kong in 1997. Eighteen
people showed acute respiratory distress
syndrome, and six of them died.
In 1999 and 2003 respectively, two girls and
one boy suffered from A/H9N2 low pathogenic
avian influenza with slight symptoms. The
Netherlands reported outbreaks of influenza
A (H7N7) in 2003. Eighty-nine people were
confirmed to have H7N7 influenza virus
infection, and one veterinarian among them
died. The main symptom was conjunctivitis
and no obvious pneumonic and respiratory
syndromes were found. In February 2003,
H5N1-infected cases occurred among members
of a Hong Kong family (father and son) that
had returned from Fujian, China. The son
recovered, while the father died. In 2004,
two H7N3-infected cases with symptoms of
pneumonia and conjunctivitis were reported
in Canada.
Human-infected cases were reported during the large-scale
outbreak of H5N1 in Southeast Asia. From
2003 to September 15th, 2005, human-infected
cases of A/H5N1 had been found in Thailand,
Vietnam, Indonesia, and Cambodia. 114 people
in total were infected, and 59 of them died,
the mortality rate of which was
approximately 50%. Currently, the mortality
rate has decreased to 30% or so for the
experts have learned the best timing for
medication.
Q: What are the symptoms of avian influenza
in human beings?
A: Symptoms in early period of avian influenza are similar to
those of human influenza, including
headaches, myalgia, runny nose, coughs, sore
throat, and conjunctivitis (according to the
H7N7-infected patient in Netherlands).
Moreover, the H5N1-infected cases in Vietnam
also show the symptom of diarrhea. In the
later period, the patients may suffer from
high fever, pneumonia, multiple organ
failure, and even die.
Q：Avian
Flu and SARS, which is more dreadful?
A: The symptoms of avian influenza are similar to
those of SARS. Taiwan has experienced the
disease control methods for SARS, and Three
Main Strategies and Four Lines of Defense
for avian influenza have been proposed. Once
effective vaccines are successfully created,
and antiviral agents are sufficiently
prepared, the harm that avian influenza may
do on us will be minimized with real-time
monitoring and inspection. The World Health
Organization (WHO) has estimated that about
two to seven million people may lose their
lives if a global outbreak of avian
influenza should occur recently, which will
lead to a global economics crisis.
According to the prediction model proposed by CDC (Centers
for Disease Control and Prevention, US),
once the avian influenza viruses become
transmissible from human to human, there may
be up to 5.3 million people getting
infected. More than 70,000 people may need
hospitalization and about 14,000 people may
die. The social and economic impact of avian
influenza will be ten times greater than
that of SARS.
Q: How does avian influenza cause a pandemic
outbreak?
A: The avian influenza viruses that keep spreading among
birds are constantly changing forms, and new
strains of flu develop all the time. Some
influenza strains can even cross the species
barrier and jump from birds to human beings.
Several global flu pandemics have occurred
in the past, and if a new avian flu strain
acquired the ability to spread from person
to person, it would cause a widespread
health crisis. However, it is difficult
to predict when and how a pandemic outbreak
will occur.
Q: Will the influenza pandemic really occur?
A: In 1997, the first case of H5N1 infection from a bird to a
human was seen in Hong Kong during an
outbreak of avian influenza in poultry. The
virus caused severe illness in 18 people, 6
of who died, which had a mortality rate of
approximately 30 percent. From late 2003 to
September 15th, 2005 the World
Health Organization (WHO) had reported human
cases in Vietnam, Thailand, Cambodia, and
Indonesia. There were totally 114 people
infected 59 of who died; that is, the
mortality rate was more than 50 percent.
Mutations in the virus will develop with
time.
In recent years, outbreaks of influenza H5N1 have occurred
among poultry in 13 countries in Asia.
Taiwan is not an affected area; however, in
the area endangered by avian influenza, we
still need to keep high alert. The World
Health Organization and the experts agree
that new cases of influenza infection will
be reported sooner or later. There is no
evidence of efficient human-to-human
transmission; nevertheless, based on the
above-mentioned premise, the government and
citizens must cooperate to be prepared for
it.
Q: Is it true that there may be an outbreak
of avian influenza between next January to
March (2006)?
A: The H5N1 influenza virus has been endangering
the health and lives of both birds and human
beings since 1997, which has made hundreds
of millions of poultry and birds culled. The
number of the human infected cases is also
increasing. Until September 15th, 2005 the
World Health Organization had confirmed 114
infected cases and 59 deaths. H5N1 has made
avian influenza become a regional disease in
Southeast Asia. The constant change and
mutation of the viruses may lead to a
worldwide outbreak of avian influenza.
Taiwan is not an affected area; however,
migratory birds migrate to south every
September, and birds died of H5N1 infection
were sequentially reported in Qinghai,
Xinjiang, Siberia, Kazakhstan, and Mongolia.
Some worry that the virus carriers may
spread the viruses when traveling south.
Taiwan is a stopover site of migratory
birds. If proper precautions are not taken,
it is very likely that genes of human
influenza viruses will mix with those of
avian influenza viruses in the coming
influenza season.
Viewing from this, the critical phase of an avian influenza
outbreak probably lies between next January
and March. Therefore, the government and
civilians must cooperate to take precautions
for disease control.
Q: How much harm will an influenza outbreak
do on our health?
A: According to the prediction model proposed by CDC (Centers for
Disease Control and Prevention, US), once
the avian influenza viruses become
transmissible from human to human, there may
be up to 5.3 million people getting
infected. More than 70,000 people may need
hospitalization and 14,000 people may die.
The results are estimated based on the
population in Taiwan with an assumed
infection rate 25%.
Q：Why
don’t we need to panic about avian flu?
A: The panic feeling is mainly caused by ignorance and threats;
therefore, as long as people have full
understanding of the disease, and the
government has the ability to detect the
disease in time and enforce disease control
measures, people will be confident enough
and panic no more.
The government has accomplished some
standard operation procedures and projects
based on the parameters for disease control,
such as period of communicability,
incubation period, mechanisms,
and morbidity rate. Related information is
posted on the website of Centers for Disease
Control. (http://flu.cdc.gov.tw)
The authorities concerned are also commanded
to take measures to advance our disease
control system with international
cooperation.
Q: How does the flu outbreak spread? Who
will get infected easily?
A: The flu outbreak is resulted from person-to-person
transmission, droplet transmission, and
airborne transmission. According to the
experiences from SARS, the virus may be
spread in a hospital through businessmen,
travelers, and patients. If doctors do not
detect the situation in time, the medical
staff will get infected sooner or later.
Therefore, people in a medical system or an
organization with intense population may get
infected more easily.
Q: What are the symptoms of novel influenza?
The novel influenza is essentially a name designated by the
government to distinguish it from the
seasonal strain of influenza. In other
words, when people with flu-like symptoms
are identified as having contracted A-type
influenza but not the H1 or H3 subtype, they
are regarded as suspected cases of novel
influenza and shall be given antiviral drugs
and preventive therapies. They need to
undergo an examination to determine whether
or not they have indeed contracted novel
influenza, and if found positive, they shall
be classified as H5 or H7 cases and will be
treated accordingly. Symptoms in early
period of the novel influenza are similar to
those of human influenza, including
headaches, muscle aches, runny nose, coughs,
sore throat, and conjunctivitis (according
to the H7N7-infected patient in
Netherlands). Moreover, the H5N1-infected
cases in Vietnam also show the symptom of
diarrhea. In the later period, the patients
may suffer from high fever, pneumonia,
multiple organ failure, and even die.
Q: What’s the difference between “Common
Flu” and “Super Flu”?
A：The
“Common Flu” occurs every year and
everywhere. An epidemic by definition means
an infectious disease that develops and
spreads rapidly in a community. The "Common
Flu,” a seasonal disease resulted from
antigenic variation in the influenza virus,
has an infection rate of 10%. The peak of
seasonal influenza in Taiwan usually occurs
every December to March. Most patients can
recover in two to seven days and generate
antibodies. However, it will cause
complications such as bronchitis, pneumonia,
and so forth to the elderly, children, and
those suffering from diabetes or
cardiovascular and pulmonary diseases. The
mortality rate is less than 0.1%. "Super
Flu," a disease that simultaneously breaks
out in many countries and spreads rapidly
worldwide with the flow of population, will
occur every ten to fifty years and appear
anytime in a year. The reason of its
occurrence lies in the great antigenic
variation in influenza viruses that makes
people unable to be protected by antibodies.
It has an infection rate reaching 20-50%,
and can result in severe symptoms at any
age. "Super Flu" is usually accompanied by
many infected cases and more severe
symptoms, causing a high mortality rate.
Q: Why is vaccination against "Common Flu"
emphasized this year?
A: Every vaccine has its own specialty. The vaccines against
influenza were created especially against H1
and H3 influenza viruses, but genes of
viruses are constantly changing. In recent
years, human cases of SARS or H5N1 avian
influenza have been found every winter and
spring, which may even influence safety of
the nation. Consequently, with the high
vaccination rate of Common Flu, precautions
will be taken effectively.
Furthermore, the situation of H5N1 avian influenza among the
poultry farms in many Asian countries has
become more and more serious. A new strain
of the H5N1 avian influenza virus may emerge
when people are infected by both common
influenza and avian influenza, which may
bring about an influenza pandemic if people
are not protected with the antibodies.
Therefore, it is necessary to emphasize
vaccines against "Common Influenza."
Q: What are the action plans and policies on
influenza pandemic prevention in Taiwan?
Taiwan’s influenza preparedness consists of
the following three main strategies and four
lines of defense:
1. Three Main Strategies
★
Strategy I: Block Transmission
Stockpile protection equipment for safety of the staff for
disease control. Establish a quarantine area
in case of an influenza pandemic. Propose
related programs to regulate activities of
schools and organizations according to the
distribution of the clinical cases.
★Strategy
II：Antiviral
Agents
Presently, the antiviral agent has proven effective in the
treatment and prevention of seasonal
influenza. Hence it is expected to be
effective in the treatment and post-exposure
prevention of avian flu and pandemic flu. It
could help prevent the spread of the virus,
or reduce the morbidity and mortality rates.
A target to stockpile sufficient antiviral
agents for at least 10% of the population in
Taiwan has been set to achieve.
★Strategy
III：Novel
Influenza Vaccine
The annual flu vaccination plan has effectively reduced
severe illnesses and deaths caused by
seasonal influenza. Similarly, during flu
pandemic periods, sufficient quantities of
effective vaccines are expected to be
obtained through sourcing or domestic
research and manufacturing in order to
maintain vital social functions and to
protect the health of high-risk groups.
2. The Four Lines of Defense
★First
Line: Containment Abroad
It is now necessary for Taiwan to actively participate in
international prevention plans with the US,
Japan, Hong Kong, Singapore, the UK, and
Australia to share epidemic prevention
information, establish close cooperation
channels, and prevent the flu infection in
Thailand and Vietnam from spreading out. To
respond to the appeal of the US, Japan, and
the WHO, our government has donated 600,000
doses of antiviral agents to Vietnam to help
the disease control. In addition, latest
information and related protection should be
provided to the Taiwan-based manufacturers.
★Second
Line: Quarantine Inspections on National
Borders
Close monitoring and processing of inbound travelers is to
be carried out in accordance with the
international epidemic situation. Potential
cases detected will be treated promptly to
prevent an outbreak within the country.
★Third
Line: Community Prevention
The government should join with civil groups to provide
correct information on prevention and to
strengthen the level of community
cooperation and management of the poultry
industry with disease control efforts.
★Fourth
Line: Maintain a Sound Healthcare System
The Infectious Disease Prevention and Treatment Network have
been established to handle epidemic
prevention contingencies in line with
national needs. With the examination
network, any flu-infected patient would be
detected in no time to avoid nosocomial
infection.
Q: Why does the World Health Organization
approve of the avian influenza control
measures in Taiwan?
A: Owing to the avian influenza outbreaks in Mainland China and
Southeast Asia, the government in Taiwan had
been alert to the threats and elevated the
disease control system to the level of
national security, which was approved by the
officials of the World Health Organization.
On August 19th, 2005 President Chen
Shui-bian held the Conference on the
Precautionary Policies for Avian Influenza
and arouses people's concerns for avian
influenza affection. Taiwan is also
qualified to provide assistance on disease
control via the teamwork of officials and
civilians.
Q: Is it possible to avoid an influenza
pandemic?
A: No. The H5N1 influenza virus has been
endangering the health and lives of both
birds and human beings since 1997, which has
made hundreds of millions of poultry and
birds culled. The number of the human
infected cases is also increasing. Until
September 15th, 2005 the World
Health Organization had confirmed 114
infected cases and 59 deaths. H5N1 has made
avian influenza become a regional disease in
Southeast Asia. The constant change and
mutation of the viruses may lead to a
worldwide outbreak of avian influenza.
Q: Do people need to buy antiviral drugs?
No. Since anti-viral drugs are prescription drugs, the disease
must be properly diagnosed by a medical
specialist prior to writing and releasing a
prescription by the same doctor. Recent
studies show that early detection of
suspected cases can effectively hinder an
epidemic widespread. Administering of
anti-viral drugs within 2 days after the
symptoms appear can produce favorable
curative effects. Conversely, aimless and
extensive prophylactic medicines shall
adversely result in drug resistance.
Q：Do
people need to buy masks?
A: Yes. Anyone who shows symptoms of
respiratory tract problems should wear
masks, so as not to transmit to others
whatever illness the person might have. Both
the government and medical administration
should stockpile surgical masks in case of a
large-scale epidemic outbreak.
Q：Where
to get further information on avian flu?
A：Centers
for Disease Control http://flu.cdc.gov.tw
or Council of Agriculture http://www.coa.gov.tw
Q: How do we deal with pigeons kept on the
top floor, wild pigeons in the park, and
pigeons for sale on the streets?
A: Contact the Bureau of Environmental
Protection to give a fine ticket if the
pigeons kept in a private house are not
enclosed by a mesh to prevent feathers and
excrements from spreading around. Call the
District Offices to inform the Bureau of
Urban Development to demolish the
illegally-built dovecots. If the pigeons are
kept in the public space on the top floor,
the apartment building management committee
can denounce the situation based on the
Apartment Building Regulations. Due to the
limited manpower of the Disease Control
Center, all the other authorities concerned
must strictly work on disease control
measures. Request the Public Health Bureau
to dissuade the pigeon keeps and ask the
police to ban the pigeon sales.
Q：Are
over-easy eggs edible now?
A：It's
not necessary to worry too much since Taiwan
is not an avian-flu-affected area. However,
considering the hygiene factor, we’d better
have eggs well done.
Q: Will people get infected by buying
chickens or eggs with excrement?
A: If you still feel worried, packaged eggs
are also a choice. Hands must be washed
properly after touching eggs or poultry.
Q: Can we make masks with egg white or egg
yolk?
A: If you still feel worried, stop using
eggs temporarily.
Q：Will
people get infected by feeding pigeons or go
bird-watching?
A：Watching
birds with a telescope at a long distance is
recommended. Minimize the chances of getting
close to birds.
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