During two years in the 20th century, a deadly strain of influenza , known as the "Spanish flu," spread across the globe, killing anywhere from hundreds of thousands to millions of people. It's been many decades since that outbreak. According to some experts, the world is overdue for another.
Though it seems to have stabilized at the moment, some experts believe that bird flu, or avian flu, might one day be such a pandemic. It's an example of a strain of the flu virus called influenza A -- a virus that has jumped from one species (birds) to another (us, and a few other unlucky hosts, including a group of tigers in a zoo).
Although bird flu has infected more than 868 people -- 457 of whome died from the virus -- and killed millions of domesticated birds in 19 countries, infection in people is still rare and the human toll has been small so far. According to the U.S. Centers for Disease Control and Prevention, however, the disease still poses a major public health threat.
"So far, the spread of the viruses from person-to-person has been very rare, limited and unsustained," the CDC has noted, adding that if the viruses gain the ability for efficient and sustained transmission among humans, "an influenza pandemic could result, with potentially high rates of illness and death worldwide."
What is bird flu?
Federal health agencies put it simply: Bird flu is an infection caused by avian (bird) viruses. Wild birds around the globe carry these viruses in their intestines, but are rarely sickened by them. For domestic birds like chicken, turkeys, and ducks, however, bird flu can be a killer.
Just like humans, birds can come down with the flu. The illness varies widely in intensity, from mild to deadly. A particularly vicious avian flu virus hit domestic chickens and ducks in several Asian countries in late 2003 and early 2004. Millions of birds have either died from the flu or had to be destroyed to stop the spread of the disease.
Because many families in many parts of the world keep small flocks of chickens and ducks, the outbreak has been both an economic disaster and a threat to human health. As predicted by a number of scientists, the virus soon spread outside Asia.
What are the symptoms of bird flu in humans?
Some symptoms of bird flu in humans are similar to those caused by typical flu: fever, cough, sore throat, and muscle aches. Other symptoms include eye infections, pneumonia, severe respiratory diseases, and life-threatening conditions such as acute respiratory distress.
How does bird flu spread?
The virus is found in the saliva, nasal discharge, and feces of infected birds. Most cases in humans seem to have resulted from contact with infected poultry or surfaces contaminated by bird feces. It's also possible for the virus to spread by drinking contaminated water and getting contaminated bird secretions or feces in your eyes or nose, either from touching them or breathing in contaminated particles.
Why are experts so concerned about bird flu?
Bird flu has two of the key qualities of a global threat: It's both deadly and (among birds) extremely common. Despite concerted efforts to quell it, it's still showing up in poultry. It also spreads faster and more widely than any previous bird flu outbreak, and it can be deadly. The only thing keeping it in check at the moment is that it doesn't spread easily from birds to humans or from humans to humans. Although there have been a few documented instances of transmissions occurring between family members in Indonesia and Thailand, confirmed cases of people catching the bird flu from another person are extremely rare.
Unfortunately, flu viruses have a way of finding new victims. If a bird flu virus mingles with one of the human flu virus strains, the two viruses could swap genetic material. In theory, the bird flu could pick up genes that make it as contagious as a strain of flu bug that strikes seasonally. One other way the virus could become more likely to infect people could be through gradual genetic changes over time. The virus has shown that it can infect animals that usually do not get the flu, such as cats. And in Germany and Austria, domestic cats have been infected with the virus.
If the virus does start spreading quickly to people, it could turn into a major killer. Humans have very little natural immunity to the bird flu. To make matters worse, viral resistance may render two common antiviral flu medications -- amantadine and rimantidine -- ineffective against the bird flu. Two other medications, oseltamivir and zanamivir, may still be effective against bird flu in its present form, according to the Centers for Disease Control and Prevention.
What's the risk to people in the United States?
The agency still considers the overall risk to the public to be low. However, since early 2022, the CDC reports, more than 49 million birds in 46 states have either died as a result of bird flu virus infection or have been culled (killed) due to exposure to infected birds. The CDC has tracked the health of more than 5,190 people exposed to the bird flu, with only one case of infection reported so far. The agency cautions people in contact with sick or dead birds to use personal protective equipment (including gloves and an N-95 face mask, to avoid touching their nose, mouth or eyes, to wash their hands with soap and water after exposure and to change out of their clothes.
What can be done to control bird flu?
Bird flu has become so entrenched in Asia that it may never disappear. At this point, experts can only hope to contain it and, if possible, prevent a human epidemic. Asian countries are searching for outbreaks of bird flu in chickens and ducks and are destroying any affected flocks. But because many of the outbreaks occur on small family farms scattered throughout the countryside, not all outbreaks are reported or discovered by authorities, according to the World Health Organization.
In the United States, health officials have put together pandemic bird flu prevention measures. The Food and Drug Administration (FDA) has approved the first U.S. vaccine against bird flu. While there has only been one reported cases of human bird flu in the United States, the vaccine could provide limited early protection against widespread infection. Having a vaccine readily available in case there is an outbreak will buy time for health officials who could then develop a vaccine tailor-made to the specific strain of bird flu that develops in the United States.
What can I do to protect myself?
At this point, the World Health Organization has not yet advised travelers to avoid any countries because of bird flu, and the risk of getting it is low.
But if you do travel to any of the more than 50 countries that has reported a bird flu outbreak in poultry or wild birds (including Thailand, Japan, Korea, India, Nigeria, Russia, and Zimbabwe), avoid poultry farms, contact with animals in live food markets, or surfaces that appear to be contaminated by feces from poultry or other animals. The CDC also advises travelers to clean their hands frequently with soap and water or an alcohol-based hand cleaner. In addition, travelers to affected countries should only eat poultry products -- such as chicken or eggs -- that have been thoroughly cooked. Heat destroys influenza virus.
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