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avian influenza (Bird Flu)

Overview

Since 2003, over 220 human cases of avian influenza with over 120 fatalities have been reported from Eurasia and Africa to the World Health Organization¹ as well as the deaths of over 100 million birds. For the most recent statistics on the number of confirmed cases of avian influenza visit the World Health Organization’s Web site . Although the virus does not currently demonstrate efficient person-to-person transmission, it is possible that the virus may mutate or reassort allowing efficient person-to-person transmission. This scenario is particularly threatening, because of globalization and the virus’s highly pathogenic nature. Health organizations around the world are currently looking at ways to safeguard and prevent the possible spread of this disease. The World Health Organization (WHO) is continually monitoring the status of avian influenza outbreaks to determine whether person-to-person transmission of the virus has become more efficient. There is no evidence of improved efficiency of transmission at this time. Status reports are regularly updated and available on the WHO Web site.²

What is Avian Influenza?

Avian influenza is caused by type A strains of the influenza virus that primarily infects birds. To date, all outbreaks of the highly pathogenic form of avian influenza have been caused by the N5 and N7 subtypes. While the virus may be present in many wild birds, it can spread quickly and become particularly harmful to domestic fowl such as chickens, ducks, and turkeys. Domesticated birds may become infected after having direct contact with infected birds or contaminated surfaces. Direct contact means exposure to excretions such as saliva, feces or nasal secretions.

How can Humans Become Infected?

Contaminated poultry, in turn, may infect poultry farm workers and others who have contact with poultry feces. The disease is not easily spread from human to human. Health care workers and others who may be caring for infected patients are most at risk.

Disease causing bacteria and viruses can thrive in moist areas. Although viruses like other foodborne pathogens are killed by cooking, and no cases of avian flu have reportedly resulted from eating contaminated poultry, surfaces that touch raw poultry can remain infected for longer periods and must be thoroughly cleaned.

What are the Symptoms?

Those carrying the virus can reveal typical flu-like symptoms e.g. coughing, sneezing, sore throat, fever to more serious illnesses such as pneumonia or respiratory illness.

What are the Recommendations for Health Care Workers?

There have been recent reports of the development of an avian flu vaccine, however there are still limitations to its use. The best recommendations now are to be aware that this virus could spread and be prepared to encounter potentially infected patients.³ Annual influenza immunization is also possible, which can be coupled with immunization against pneumonia. Immunization against conventional influenza strains may prevent potential reassortment of the avian influenza virus into a new strain capable of more efficient person-to-person transmission. These vaccines should be administered to those who are high risk for death or spreading the disease.⁴

At this point in time, it is important to keep good hygiene habits in general, whether it is in a health care setting or in the home. Close attention should be given to proper hand hygiene and coughing etiquette. The U.S. Centers for Disease Control and Prevention has developed a poster for patients that can be downloaded and displayed in the dental office reception area or waiting room.⁵

What can the Dental Team do to be Prepared?

• Employ appropriate infection control procedures as outlined by the U.S. Centers for Disease Control and Prevention⁶ [See Avian Influenza (Centers for Disease Control and Prevention)]
• Stay informed
• Know the contact information for your local or state health department

Endnotes

1. http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_06_06/en/index.html (June 12, 2006)
2. http://www.who.int/csr/disease/avian_influenza/updates/en/ (July 12, 2005)
3. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr55e628a1.htm?s_cid=rr55e628a1_x (June 28, 2006)
4. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr54e713a1.htm (July 15, 2005)
5. http://www.cdc.gov/flu/professionals/flugallery/posters.htm (June 12, 2006)
6. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5217a1.htm (July 12, 2005)

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ADA News

• OSHA resources offer advice on preparing for flu pandemic (May 24, 2007)
• OSHA sees high risk for dentistry in flu pandemic (Feb. 13, 2007)
• Dental schools now offering disaster response CE  (April 03, 2006)
• HHS stockpiles vaccine for potential flu pandemic (Sept. 22, 2005)
• Influenza pandemic? Dentists urged to read reliable sources  (June 06, 2005)

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Additional Resources

• Avian Influenza (Centers for Disease Control and Prevention)
• Avian Influenza A (H5N1) Infection in Humans
  (New England Journal of Medicine—September 29, 2005)
• CDC: Interim Recommendations for Infection Control in Health-Care Facilities Caring for Patients with Known or Suspected Avian Influenza
• FDA and Pandemic Flu
• Influenza (National Institutes of Health)
• National Institute of Allergy and Infectious Diseases, National Institute of Health
  http://www2.niaid.nih.gov/newsroom/focuson/flu04/
• OSHA Guidance on Preparing Workplaces for an Influenza Pandemic NEW!
• PandemicFlu.gov (U.S. Government Web site)
• Report of Chief Policy Advisor: Influenza Pandemic | PDF file/61k
• Science in the News: Confirmed Cases of Avian Influenza in Europe
• Science in the News: Federal Agencies Issue Planning Checklist for
  Pandemic Influenza

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