Avian Influenza
Q & A for UNICEF Staff Members
September 2005
What is avian influenza?
Avian (bird) influenza (flu) is a viral infection caused by strains of influenza that occur normally among
birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them.
However, bird flu is very contagious among birds and can make some domesticated birds, including
chickens, ducks, and turkeys, very sick and kill them.
Can bird flu viruses infect humans?
Bird flu viruses do not usually infect humans, but several cases of human infection caused by different
kinds of bird flu viruses have occurred since 1997. Occasionally the virus jumps from infected birds or
their infected material (bird’s droppings) to human beings. However, even though there are large
epidemics of the disease amongst birds, there are very few human beings who have suffered from the
infection.
Why is there so much attention being paid to avian influenza?
This virus first infected people in 1997 in Hong Kong. In late 2003 and early 2004, outbreaks of
influenza H5N1 were reported among poultry in eight countries in Asia (Cambodia, China, Indonesia,
Japan, Laos, South Korea, Thailand, and Vietnam) resulting in more than 100 million bird deaths in the
affected countries either from the disease or from culling to try to control the outbreak.
More than 110 human infections associated with these outbreaks have been reported in Cambodia,
Indonesia, Thailand, and Vietnam.
Most recently, H5 infections among birds have been reported from Russia, Kazakhstan, Mongolia and
China although the infections have not been firmly verified in all locations.
Among the children that have contracted avian influenza, a large proportion has died. UN Country Teams
must be strongly engaged in control and prevention efforts.
http://www.wpro.who.int/health_topics/avian_influenza/
http://www.who.int/csr/disease/avian_influenza/en/
How is avian influenza spread?
Among birds, infected birds are thought to contaminate the environment by shedding virus in their feces.
However, some avian viruses appear to also be spread among birds by respiratory transmission.
The exact way that people get infected by avian influenza viruses is not clear, but most cases appear to
involve direct contact between the person and the infected bird.
For more information on animal transmission see:
http://www.oie.int/eng/AVIAN_INFLUENZA/Disease%20card.pdf
What are the symptoms of bird flu in humans?
Symptoms of bird flu in humans have ranged from typical flu-like symptoms (fever, cough, sore throat
and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory
distress), and other severe and life-threatening complications. The symptoms of bird flu may depend on
which virus caused the infection.
What is being done to stop bird flu?
The UN and national governments are working together to address the problem of avian influenza. There
are several main activities under way.
1. Efforts to control the infection among poultry.
2. Efforts to reduce the possibility that humans will be exposed to and infected by avian influenza,
and
3. Efforts to prepare for wide-spread infection in humans if the avian virus control efforts fail and
the virus should gain the ability to spread easily among people.
The WHO has appointed Dr. Margaret Chan as Chief of Pandemic Influenza to coordinate WHO's
efforts. Previously as director of the Hong Kong, China, health department, she directed its response
to two major disease outbreaks that threatened the world's health and economy, avian influenza and
SARS.
a) Animal Control: Since the virus predominately infects birds, the most important first step in
stopping bird flu is to identify and arrest the spread of the virus in birds. Affected national
agricultural and veterinarian departments are working closely with FAO, the Organization for
Animal Health (OIE), WHO, the World Bank and others to quickly set-up and strengthen
monitoring systems that rapidly identify sick birds and destroy them. Combinations of
surveillance, quarantine, destruction of sick birds and vaccination of poultry are some of the steps
being taken to stop the virus from spreading.
b) Human health controls: WHO is coordinating the UN portion of international response in this
area. Because avian influenza and pandemic influenza both pose threats to people, WHO is
working with governments and other partners to improve monitoring of influenza viruses and
infections in people, on increasing the availability of antiviral drugs and reducing the time needed
to make bird flu vaccines, and development of contingency plans.
Why are people worried about avian influenza?
The H5N1 virus does not usually infect humans. In 1997, however, the first case of spread from a bird to
a human was seen during an outbreak of bird flu in poultry in Hong Kong. The virus caused severe
respiratory illness in 18 people, 6 of whom died.
Since that time, there have been other cases of H5N1 infection among humans. Most recently, human
cases of H5N1 infection have occurred in Thailand, Vietnam and Cambodia during large H5N1 outbreaks
in poultry. The death rate for these reported cases has been about 50 percent. Most of these cases occurred
from contact with infected poultry or contaminated surfaces; however, it is thought that a few cases of
human-to-human spread of H5N1 have occurred.
So far, spread of H5N1 virus from person to person has been rare and spread has not continued beyond
one person. However, because all influenza viruses have the ability to change, scientists are concerned
that the H5N1 virus could one day be able to infect humans and spread easily from one person to another.
Because these viruses do not commonly infect humans, there is little or no immune protection against
them in the human population.
If the H5N1 virus were able to infect people and spread easily from person to person, an “influenza
pandemic” (worldwide outbreak of disease) could begin. No one can predict when a pandemic might
occur. However, experts from around the world are watching the H5N1 situation in Asia very closely.
There were pandemics of new flu strains before, most recently in 1968.
Is it certain that avian influenza virus will cause a global pandemic?
No, this is not at all certain. First, not everyone who comes in contact with the virus will develop
influenza. Typically, influenza infects between 15-40% of those who come into contact with the virus. In
addition, the current avian influenza virus would probably have to change so that person-to-person
transmission was efficient. Even in that case, a global pandemic is not certain.
In addition, although not proven, it is believed that the anti-viral drug oseltamavir (Tamiflu) can prevent
infection in people in contact with the virus and treat people who are infected.
What is the treatment for bird flu in humans?
The current H5N1 viruses appear to be sensitive to two other antiviral medications, oseltamavir and
zanamavir, that have direct effect on influenza viruses. Many (but not all) of the current viruses appear to
be resistant to two different antiviral drugs. Although oseltamivir and zanamivir should be effective when
used early, there is still very little direct experience with these drugs when used to treat people ill with the
H5N1 virus.
Is there a vaccine to protect humans from H5N1 virus?
No. There is currently no commercially available vaccine to protect humans against the H5N1 virus.
Vaccine development efforts are under way. However, research studies are being carried out in several
countries in this regard.
What can I do to protect my family and myself?
Most people are at low risk for getting infected by an avian influenza virus. The UN staff and their
dependents are at no special risk of acquiring avian influenza, except animal health experts, professionally
exposed staff (mostly agriculture and health workers) who are visiting facilities and laboratories where
influenza diagnostics are attempted, and medical personnel visiting hospitals where human cases are
being treated.
Currently, the most important steps are to avoid touching dead or ill birds directly or surfaces potentially
contaminated by secretions or faeces from these birds without adequate protection. If such contact is
made, then you should wash your hands and body surfaces exposed to the bird with soap and water.
Where possible it also wise to avoid poultry raising areas and never eat uncooked or undercooked poultry.
The anti-viral drug oseltamivir (Tamiflu) is effective in preventing disease if taken soon after exposure
(prophylaxis) and is effective at lessening the severity of disease in those infected. It is not prescribed
unless a person has probably been exposed to avian influenza. The UN plans to stockpile some Tamiflu
in all countries for UN staff..
(Please see at end of this document a note entitled “Recommendations for avoiding avian influenza”)
How can I tell if a bird has avian influenza?
Signs of avian influenza are extremely variable. In some flocks the only evidence of the infection is
seroconversion i.e., the birds develop a detectable antibody. Avian influenza can also be manifest as
respiratory, enteric, reproductive or nervous system disease. Decreased food consumption and drops in
egg production are among some of the earliest and most predictable signs of disease.
Signs including coughing, sneezing, ruffled feathers, swollen heads, nervous signs like depression, and
diarrhea may occur together or singly. In some cases, birds die rapidly without clinical signs of disease.
For more information in this regard:
http://www.vetmed.ucdavis.edu/vetext/INF-PO_AvianInfluenzaFS.html
Why are governments having trouble stopping bird flue in birds?
This task is difficult for several reasons:
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The ways that these viruses spread between domestic and wild birds is not fully clear, making it
more difficult to develop fully effective control strategies
Because many people in countries currently affected by H5N1 raise poultry in their houses and
yards, and depend upon these birds for food, outbreaks and deaths among poultry in these small
flocks can be reported late and can be very hard to monitor and control
In many countries, national systems meant to monitor animal health are often weak and underfunded. They often do not reach the small-scale producers and illnesses can they spread without
early detection.
Migratory birds share water, sometimes food and can thus be infected with the new virus. Before
they become very ill, they can fly on with the virus and spread it through droppings in water and
through contact with other domestic birds elsewhere.
What is UNICEF doing to prepare for avian influenza?
UNICEF is working with the entire UN system to ensure that all necessary preparations are in place to
respond to the threat of avian influenza. UNICEF is part of global and regional UN taskforces for the
control of avian influenza.
UN Country Teams will strive for a co-ordinated, efficient response to prevention and protection.
Given our expertise in community mobilization and communications, UNICEF may have a key role to
play with other partners to help people understand control and treatment measures.
UNICEF may be called on for a number of responses:
 Work with FAO and national governments to help quickly inform farmers and small-scale poultry
producers of a) the threat of avian influenza and b) the important of monitoring and control
measures.
 Support to ministries of health, WHO and others to quickly disseminate enhanced public health
messages about the virus and vital prevention messages.
 Work with ministries of health, WHO and others to strengthen national capacity to respond to any
large-scale outbreaks.
 Potential support to procurement and shipping of treatment for UN staff and dependents.
What is UNICEF doing to protect and assist staff?
UNICEF will continue to work closely with the UN medical service and UN Country Teams to protect
UNICEF staff from avian influenza. A global contingency plan is being developed and guidelines for
staff protection and measures such as the procurement and forward placing of the anti-viral drug
oseltamivir (Tamiflu).
Similarly, measures including the identification of medical staff and facilities and other necessary medical
supplies to treat any UNICEF covered person who contracts avian influenza are underway.
Who will UNICEF’s avian influenza response plan cover?
UNICEF will provide medical assistance to all staff, their families and contracted workers. Given the
potential serious implications of infection, all household members will be considered.
How will I know if avian influenza has reached my country?
The WHO will monitor the situation and notify governments and through the UN system, all local UN
Country Teams. The UNICEF country office will provide information to UNICEF staff.
What will happen if avian influenza reaches my country?
The UNICEF country office will provide details on how to access medical services according to a
previously established contingency plan. UNICEF will provide updated information regularly as the
situation changes.
Who will be provided medical support?
All staff members will be provided information on how to reduce their risk and the risk of their
dependents of contracting avian influenza (see other parts of this Q&A). Appropriate medical advice and
available treatment will be provided to every staff member and dependent who falls ill, including
provision of oseltamivir where possible. Because the global supply of oseltamivir is still limited, it will be
distributed in accordance with a recommended medically-based priority list of countries; countries at
highest risk will receive the drug first. The priority list will be revised periodically to ensure that it
reflects the most recent available information.
Where can I get more information on avian influenza?
There are numerous WebPages on avian influenza with numerous links that are updated regularly. A few
examples of information include the following:
 WHO:
http://www.who.int/csr/disease/avian_influenza/en/
 Centers for Disease Control and Prevention (CDC)
http://www.cdc.gov/flu/avian/gen-info/facts.htm
 World Organization for Animal Health (OIE):
http://www.oie.int/eng/AVIAN_INFLUENZA/home.htm
Recommendations for avoiding avian influenza
The following recommendations are directed to UN staff and dependents travelling or living in areas
where avian influenza A (H5N1) outbreaks among poultry or human H5N1 cases have been reported.
These recommendations may be revised as more information becomes available.

To minimize the possibility of infection, observe precautions to safeguard your health.
Specifically, travelers should avoid touching live or dead poultry (e.g., chickens, ducks, geese,
pigeons, quail) or any wild birds or their feces, and avoid settings where H5N1-infected poultry
may be present, such as commercial or backyard poultry farms and live poultry markets.
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Do not eat uncooked or undercooked poultry or poultry products, including dishes made with
uncooked poultry blood.
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As with other infectious illnesses, one of the most important preventive practices is careful and
frequent hand washing. Cleaning your hands often, using either soap and water (or waterless,
alcohol-based hand rubs when soap is not available and hands are not visibly soiled), removes
potentially infectious materials from your skin and helps prevent disease transmission.
When preparing food:
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Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or the
same knife for preparing raw meat and cooked or ready-to-eat foods.
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Do not handle either raw or cooked foods without washing your hands in between.
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Do not place cooked meat back on the same plate or surface it was on before it was cooked.
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All foods from poultry, including eggs and poultry blood, should be cooked thoroughly. Egg
yolks should not be runny or liquid. Because influenza viruses are destroyed by heat, the cooking
temperature for poultry meat should reach 70°C (158° F).
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Wash egg shells in soapy water before handling and cooking, and wash your hands afterwards.
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Do not use raw or soft-boiled eggs in foods that will not be cooked.

After handling raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with
soap and water.
If you believe you might have been exposed to avian influenza, take the following precautions:

Monitor your health for 10 days.

If you become ill with fever and develop a cough or difficulty breathing, or if you develop any
illness during this 10-day period, consult a health-care provider. Before you visit a health-care
setting, tell the provider the following: 1) your symptoms 2) if you have had direct poultry
contact, and 3) where you traveled.
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Do not travel while sick, and limit contact with others as much as possible to help prevent the
spread of any infectious illness.