Travel Health Advisory
Updated: August 15, 2005
The Public Health Agency of Canada continues to closely monitor occurrences of avian influenza A (H5N1), or “bird flu”, in birds and in humans in Asia and in birds in Eastern Europe.
Human Cases
Human cases of avian influenza A (H5N1) have been reported in Vietnam, Thailand, Cambodia, and most recently Indonesia. The spread in humans has occurred in three distinct periods or waves of activity, since late-December 2003, when human cases were first reported.
Summary of Human Cases since December 2003
Indonesia: 1 human case of avian influenza A (H5N1) infection, including 1 death.
Vietnam: 90 human cases of avian influenza A (H5N1) infection, including 40 deaths.
Cambodia: 4 human cases of avian influenza A (H5N1) infection, all of which have been fatal.
Thailand: 17 human cases of avian influenza A (H5N1) infection, including 12 deaths. Note: the last reported case in Thailand occurred in October of 2004.
Note: Any significant change in this outbreak situation (i.e. geographic region, a large increase in case numbers, etc.) will result in the release of an updated advisory; however, minor situational changes will be updated periodically.
Outbreak in Poultry
Since mid-December 2003, several Asian countries have reported avian influenza A (H5N1) outbreaks in poultry; the disease has also been reported in wild birds and pigs. According to the World Organization for Animal Health and based on criteria established in the Terrestrial Animal Health Code (2005), H5N1 infection in birds continues to persist in Cambodia, China, Indonesia, Thailand, Vietnam, and Laos. Outbreaks in birds have also recently been confirmed in the previously unaffected countries of Russia and Kazakhstan.
Source: World Health Organization, World Organization for Animal Health
Information on Avian Influenza A (H5N1)
Avian influenza A (H5N1) is a contagious viral infection that is thought to affect all species of birds; although rare, infection in humans can occur. The first documented infection of humans with the avian influenza A (H5N1) v irus occurred in Hong Kong in 1997, when the strain caused severe respiratory disease in 18 humans, six of whom died. The infection in humans coincided with an epidemic of H5N1 in Hong Kong's domestic poultry population.
Investigation into human cases of H5N1 suggests that direct contact with infected poultry has been the primary, if not the exclusive, means of infection; although, in a small number of instances a link to direct contact with infected poultry was not identifiable. In a few cases it would appear that human-to-human transmission may have occurred. However, such cases involved extended close personal contact with an infected individual (i.e. providing bedside care for an infected relative) and no further transmission occurred.
At this time, there is no vaccine that protects against the avian influenza A (H5N1) virus. While the current seasonal flu shot does not protect against the H5N1 virus, immunization with it may be of benefit for travellers to geographic regions where human cases of H5N1 are being reported. Individuals who are immunized with the seasonal influenza vaccine are less likely to contract seasonal influenza; this in turn reduces the likelihood of an immunized individual becoming infected with both human and avian forms of influenza at the same time. Should a person be infected with both viruses at the same time, there is a possibility that the two viruses could “mix” and mutate into a new virus that could spread efficiently and against which humans would have no immunity.
Several anti-viral drugs are available for the prevention and treatment of seasonal influenza in Canada. Although, none of the anti-viral drugs have been shown to prevent H5N1, studies done through the WHO Global Influenza Surveillance Network have shown that the anti-viral Oseltamivir may be effective in the treatment of A (H5N1).
Recommendations
As a precautionary measure, the Public Health Agency of Canada recommends that it would be prudent that travellers to Cambodia, China, Indonesia, Thailand, Vietnam, Laos, Russia, and Kazakhstan, where avian influenza A (H5N1) outbreaks in fowl are confirmed, consider the following measures:
Avoid unnecessary contact with domestic poultry and wild birds. This includes poultry farms as well as markets where live and slaughtered animals such as chickens and ducks are sold, as these animals have been found to be carriers of the avian influenza A (H5N1) virus. Evidence suggests that the risk of infection is greatest in persons having direct contact with live and/or dead poultry including surfaces contaminated with their feces or secretions. Travellers should be aware that it is possible for the avian influenza A (H5N1) virus to stick to hair and clothing, and may be inhaled.
Ensure that poultry prepared for consumption is thoroughly cooked (juice runs clear and no visible pink meat) to eliminate the risk of infection. Internal temperatures for whole chicken and parts should reach 82°C-85°C. While to date there is no evidence that the virus is transmitted through contaminated food, it is always advisable to avoid undercooked or raw poultry dishes, including eggs and egg products.
Follow normal precautions regarding food storage, handling and preparation. Travellers are advised to maintain high standards of hygiene, including thorough hand washing, particularly after having contacted eggs or undercooked fowl and egg products and to avoid cross contamination with other food products. Using hot, soapy water and lathering for at least 20 seconds is the single most important procedure for preventing infections. This is because disease-causing micro-organisms can frequently be found on the hands. Alternatively, travellers can use waterless, alcohol-based antiseptic hand rinses. If there is visible soiling, hands should be washed with soap and water before using waterless antiseptic hand rinses. If soap and water are unavailable, cleanse hands first with detergent-containing towelettes to remove visible soil.
Canadian Food Inspection Agency recommendations to prevent the introduction of avian flu into Canada's animal population:
Ensure all birds and poultry products you wish to bring into Canada are eligible for entry and declare all animal products upon arrival.
Travellers who have visited a farm while in an affected country should ensure that clothing and footwear worn on the farm are free from soil and manure before entering Canada. Clothing should be laundered and footwear should be disinfected after arrival. More information is available at the Canadian Food Inspection Agency.
As a reminder…
The Public Health Agency of Canada routinely recommends that Canadian international travellers seek the advice of their personal physician or travel clinic prior to international travel, regardless of destination, for an individual risk assessment to determine their individual health risks and their need for vaccination, preventative medication, and personal protective measures.
Travellers to geographic destinations where human cases of H5N1 are being reported are advised to specifically discuss the topics of seasonal influenza vaccination and anti-viral drugs, as part of an individual risk assessment with their personal physician or travel clinic.
The Public Health Agency of Canada recommends, as well, that travellers who become sick or feel unwell on their return to Canada should seek a medical assessment with their personal physician. Travellers should inform their physician, without being asked, that they have been travelling or living outside of Canada, and where they have been.
Additional Information
Information on Avian Influenza from the Public Health Agency of Canada
FAQ on Avian Influenza
Archived travel health advisories on avian influenza
Information on Influenza from the Public Health Agency of Canada
Advisory Committee Statements
Committee to Advise on Tropical Medicine and Travel (CATMAT) Statement on Travel, Influenza, and Prevention
National Advisory Committee on Immunization (NACI) Statement on Influenza Vaccination for the 2004-2005 Season
Other related information from the Public Health Agency of Canada
FluWatch weekly report summarizes influenza surveillance activities in Canada and abroad.
Antivirals
External Sources of Information
For additional information on Avian Influenza A (H5N1) f rom the World Health Organization (WHO) visit the WHO Avian Influenza Disease Page
For an updated account of human cases of H5N1by region and time period, visit the following: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO
For international reports of the flu, visit the World Health Organization influenza web site
For international reports of infected animals by country, visit the World Organization for Animal Health
Updated: August 15, 2005
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