The Public Health Agency of Canada continues to closely monitor
and report on occurrences of avian influenza A (H5N1), or "bird
flu", in humans and in birds.
Additional Countries Confirm H5N1 Infection in Birds
The countries of Bulgaria, Greece, Italy, and Slovenia have officially
notified the World Organization for Animal Health (OIE) of H5N1 avian
influenza infection among birds in their respective countries. The official
notification reports are available on the OIE
web site .
These countries have not reported any human cases of avian influenza
H5N1
Summary of H5N1 Avian Influenza Situation in Humans
At this time, human cases of avian influenza A (H5N1) have been reported
in Vietnam, Thailand, Cambodia, Indonesia, China, Turkey, and Iraq. Infection
in humans has occurred in three distinct periods or waves of activity,
since late-December 2003. The current wave of activity has been ongoing
since December 16, 2004 and sporadic cases continue to be reported in
all seven countries. For an updated account of human cases of H5N1by
region and time period, visit: Cumulative
Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported
to WHO.
Summary of H5N1 Avian Influenza Situation in Birds
Since mid-December 2003, several Asian countries have reported avian
influenza A (H5N1) activity in poultry and wild birds. In July of 2005,
the disease, which had previously been confined to Asia, was confirmed
in birds in an increasing number of European countries.
According to the World Organization for Animal Health and based on
criteria established in the Terrestrial Animal Health Code (2005 ), large
outbreaks of A (H5N1) among birds continue to persist in: Cambodia,
China, Indonesia, Thailand, Vietnam, Russia, Kazakhstan, and Mongolia.
More recently, the virus has been confirmed, in birds, in the countries
of Turkey, Romania, Croatia, Ukraine, Iraq, Nigeria, Bulgaria,
Greece, Italy, and Slovenia. For additional information about H5N1
and other avian influenza outbreaks among animals, visit the World
Organization for Animal Health Web site.
Source: World Health Organization, World Organization
for Animal Health, EU - Europa
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) virus 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 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.
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 A (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, Russia, Kazakhstan, Mongolia, Turkey, Romania, Croatia,
Ukraine, Iraq, Nigeria, Bulgaria, Greece, Italy, and Slovenia - where
avian influenza A (H5N1) outbreaks in fowl and/or humans are confirmed,
consider the following measures:
Get your annual flu-shot. 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 A (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.
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.
[Information for Travellers] [Information for Travel Medicine Professionals]
