Avian Influenza

The following is a condensed compendium of information resources concerning Avian Influenza (November 2005):

1) EDUCATION

To be generally acquainted with the subject and for up-to-date information:

The following materials are recommended reading. They are in ascending order of depth of content. Most of these are from WHO:

These materials will give you a feel of the potential severity of the situation that we may face in the event that the last precondition for a WW pandemic is fulfilled. This risk of this happening increases with each human and porcine infection that is reported. Currently, we are at WHO Pandemic alert Status Phase 3 (out of 6 phases).

In addition, for those who reside in countries where avian influenza is endemic, here is advice from WHO:

2) PREPAREDNESS PLANS

Be familiar with your National Preparedness Plans so that you will fully understand what your government will do in the event that there is an outbreak of influenza in your country. Here is an example of the Singapore Plan for reference. In Asia it is one of the best in terms of the detail that it goes into. Some of the country plans in Asia are clearly inadequate to address a human influenza pandemic:

The International SOS Pandemic Preparedness Plans is a very good starting point and extremely comprehensive. It is available through the SOS website and is updated on a regular basis. Here is the latest version that is available:

3) OTHER RECOMMENDATIONS/MEASURES

Influenza Vaccinations

  • The Singapore MOH Advisory gives good advice on this matter, and includes some simple precautions for travel.
  • Over and above this it is recommended that all people located in endemic countries and especially those frequently visiting hospitals receive influenza vaccinations.
  • All people visiting/travelling to H5N1 virus endemic countries should also be vaccinated.
    • Note: current endemic countries are the following (subject to updates): Human cases - Cambodia, Indonesia, Thailand and Vietnam.
    • Note that the Seasonal Influenza vaccination is usually in a tri-valent form - check whether northern or southern hemisphere version is applicable. It will not protect against avian flu, nor any mutated influenza of avian origin. These vaccines are being developed and will not be available till probably 6 months after a pandemic outbreak.
    • Read: the reasons behind the recommendation for vaccination

Travel and Meetings

  • There are currently no Travel restrictions at the moment.
  • It is best not to encourage large meetings to be located in endemic countries.

Stockpiling of Antivirals

  • There are 2 known effective anti-virals against the influenza virus and many pros and cons as well as ethical and logistical issues surrounding this practice.

This is an issue of potentially severe impact and warrants close attention. The following are a number of points that warrant re-emphasis (abstracted from the WHO literature):

  • The world may be on the brink of another pandemic.
    • Only 1 precondition remains to be fulfilled for this to happen. The probability of mutation to highly infectious human to human transmission increases daily.
  • All countries will be affected.
  • Medical supplies will be inadequate.
    • Govts and medical facilities are unlikely to be able to cope fully.
  • Large numbers of deaths will occur.
    • Current fatality rate is >50% (this is likely to decrease in a pandemic)
  • Economic and social disruption will be great.
  • Every country must be prepared.