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By Dr Eddy Bajrovic, Medical Director, Travelvax Australia.

Avian or ‘bird’ flu has been a hot topic lately.
A second seasonal wave of the A(H7N9) strain is occurring in China resulting in 96 cases and 19 deaths to date this month for a total of 57 deaths from 252 cases in the past year. In addition, a new strain called A(H10N8 ) has killed 1 of the 2 people infected in just the past month.
But, these two strains are relative newcomers. Since 1997, the A(H5N1) strain of avian influenza has been diagnosed in various parts of the world.
H5N1 has been remarkable for its relatively low number of infections (648), but high death rate (384). The majority of fatal cases have been in Indonesia (163), Egypt (63), and Vietnam (62), according to WHO figures.
Other avian influenza subtypes, including H7N7 and H9N2, have also infected people.
All those letters and numbers can be confusing.
Although none of the strains of avian influenza cross easily from birds to people, it’s clear that a significant proportion of cases result in severe illness or death.
Worryingly, several H7N9 cases have also been diagnosed among travellers infected in China who became ill after arriving home. A young Canadian woman died after visiting family and friends in Beijing recently.
Callers to Travelvax Australia’s travel health advisory phone service (1300 360 164) have been asking about bird flu, as have patients visiting our clinics. So, let’s look more closely at avian flu, what these viruses mean for travellers, and how to reduce the risk of illness.

What is the avian influenza A(H7N9) virus?

A H7 is the designation given to the group of influenza viruses that usually circulate among birds. While H7 viruses have occasionally infected people in the past, China’s H7N9 is the first to result in human infections.

What are its symptoms?

The typical symptoms have been fever, cough, shortness of breath, and for some unlucky patients, severe pneumonia.

Why are humans being infected?

Scientists are unsure why bird flu is crossing the species barrier: The source of bird flu remains unclear. However, genetic analysis has revealed that certain avian flu viruses are being transmitted from birds (mainly poultry) to people more readily than other strains.

How do people get infected with the A(H7N9) virus?

Also unclear is how the viruses are being passed on to humans. We only know that some of those people infected had contact with animals or were in, or near, the markets where live birds (mainly chickens, ducks, and pigeons) were housed or sold. It’s not known if other animals are a source of the infection or if person-to-person transmission is taking place.

Is it safe for me to travel to China?

The WHO has not recommended any restrictions on travel to China at this time. For Australian’s visiting China, Travelvax Australia believes the risk from bird flu continues to remain low, although the latest surge in cases is cause for concern. Anyone visiting China – especially those staying with friends and family in a province experiencing outbreaks – should certainly be alert to the rising risk of bird flu and take the precautions listed below to avoid infection.

Should I avoid eating poultry and other meat in China?

You can’t get bird flu by eating food that’s been properly stored and prepared, and then thoroughly cooked so it’s served to you piping hot – including poultry and game birds, or beef and pork. However, leave dishes that incorporate raw meat or are blood-based off your menu.

Is it safe to visit live markets and farms?

In light of the new wave of bird flu infections, Travelvax Australia recommends that travellers avoid live animal markets and avoid direct contact with live birds and areas contaminated by their droppings. In particular, avoid touching sick or dead animals, or eating food made from an animal that had been sick or had died from unknown causes.

Is there a vaccine for any of the bird flus?

No. There is no vaccine to prevent A(H7N9) or any other bird flu, however the process to develop several possible vaccines is now well advanced. This research will be used to create one or more vaccines to target a particular strain of bird flu if a widespread epidemic or pandemic occurs. Travelling or not, being immunised against seasonal flu is always a good idea and experts say it may offer some ‘cross-protection’ against avian strains. At least it will protect you against seasonal flu you might encounter on planes and in crowded places if you’re travelling into the northern winter in coming weeks.

Can bird flu be treated?

Antiviral drugs called neuraminidase inhibitors are effective at reducing the symptoms of seasonal influenza virus and influenza A(H5N1) virus infection if taken within 24-48 hours of the first symptoms. These drugs include oseltamivir (Tamiflu) and zanamivir (Relenza) which have been in use in Australia for many years. Further testing needs to be done to determine these drugs are effective in the treatment of H7N9 infection. Encouragingly, recent WHO research has revealed no signs of resistance to these and other neuraminidase inhibitors at this time. 

How can I avoid getting sick?

There is agreement that, as with all forms of flu, basic hygienic practices are important in picking up germs or spreading them. These include:
REGULAR HAND HYGIENE: Wash your hands carefully, thoroughly and regularly with soap and water, especially AFTER using the toilet and BEFORE you eat, prepare, or handle food. Alcohol-based sanitisers containing 60% alcohol are convenient but should be used in conjunction with, rather than instead of, soap and water. Good hand hygiene will also help to prevent viruses like Hepatitis A and the bugs that cause travellers’ diarrhoea.
KEEP YOUR DISTANCE: Reducing your exposure to others if they, or you, are unwell. Move away from anyone who is sneezing or who has a persistent cough – whether in a plane, an airport, public transport – any public setting. For people visiting family or friends in China, distancing yourself from flu may be difficult.
DON’T SPREAD THE NEWS: Do your bit to reduce spreading infection: When coughing or sneezing, cover your mouth and nose with a tissue, your sleeve or the crook of your elbow. Bin each tissue after a single use. If you’ve sneezed or coughed into your hands, remember to wash them.

WHEN YOU RETURN HOME…

If you been in an area where bird flu cases have been reported and you develop illness with an accompanying fever in the 10 days after travel, call your doctor immediately. Tell the receptionist about your travel history – especially if you suspect you have flu – when you make your appointment. The clinic can then take precautions to isolate from other patients when you come in.
Read more about avian influenza (WHO)

For more advice on bird flu or other travel health issues, call Travelvax Australia’s obligation free travel health advisory service on 1300 360 164 (toll-free for landlines). You can also make an appointment for a pre-travel medical consultation at a clinic to receive vaccines, any medication required, accessories, and personalised advice tailored to your itinerary and your medical history.

 

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