Every Traveler Should Know About Avian Influenza:
by Karin Leperi
Including an Exclusive Interview with U.S.
Senate Majority Leader, Bill Frist
Everyone is talking about Avian Influenza
these days, especially travelers. Also known as bird flu or fowl plague,
many experts and specialists now use the “P” word squared
(pandemic and pandemonium) when describing the possible outcomes of
this mutating virus.
Senator Bill Frist
What is Avian Influenza?
A contagious viral infection, avian influenza can affect
all species of birds, including migratory and domestic flock. However,
water fowl in particular, have been identified as possible carriers
of the more highly pathogenic of avian influenza, H5N1 variant, causing
both human and animal illness that often results in death. This strain
can be transmitted from birds to people; however, it has yet to be
spread from human to human. With no vaccines presently available and
no known human immunity, health officials are understandably worried.
Not since the days of the Bubonic Plaque when more
than 25 million people perished from a plague no one understood,
and more recently, the 1918 Spanish Flu which claimed between 50-100
million lives worldwide, have individuals been so fearful of the
potential for an epidemic spreading with no immediate cure. That
has left many a potential traveler in a quandary as to whether to
travel, and if so, what to do to minimize one’s risk to this
erratic variant. This is especially true for those traveling to
areas directly linked to recent human deaths involving the H5Nl
virus. Though initial cases were originally confined to Asia, they
now include Europe, Asia, and Africa.
Facts and Fears
As of today, over 204 laboratory cases of avian influenza
in humans have been confirmed by the World Health Organization (WHO);
over half of these, 113 to be exact, ended in death. Over 40 countries
have now reported positive cases of the potent H5N1 strain.
“Experts warn that a global, cataclysmic pandemic
is not a question of “if,” but “when,” said
Senator Bill Frist, Senate Majority Leader in a Senate statement
last September 28, 2005. “Like an earthquake, it could hit
at anytime. And when it does, it could take the lives of tens of
millions of people – including half a million people right
here in the United States. The threat is real.”
Now, public health officials are concerned that with
more countries reporting the virus, opportunities for human transmission
increase, especially with the spread of HN51 from migratory wild
birds to domesticated flocks. Most human deaths attributed to this
strain involve individuals who were working in close proximity with
backyard and caged birds.
In February of this year, chief veterinary officers
from more than 50 countries in Europe, Asia, and the Middle East,
met in Paris to coordinate responses to the migratory spread of
avian influenza. Meanwhile, French health officials began an unprecedented
vaccination of more than 700,000 domestic ducks and geese on farms
in the southwest of France. This comes on the heels of some 20 countries
now banning French imports of poultry and foie gras.
World Organization for Animal Health (OIE) director-general
Bernard Vallat rang an alarm when he warned that the situation was
beginning to transform from “epidemic to pandemic.”
"The probability of this strain appearing in Australia is very
high. The possibility is also very high for the United States and
Canada," OIE Director General Bernard Vallat told a French
parliamentary commission on the disease.
With numerous migratory paths that traverse both
American coasts as well as the heartland, the U.S. is substantially
increasing surveillance and testing of migratory flocks for bird
flu. This is particularly true in Alaska, considered to be a confluence
area of numerous migratory paths leading to the mainland.
Though rumors have the Asian strain of avian influenza
as spreading from person to person, this is more myth than fact.
In a January 2006 briefing with industry, The Animal and Plant Health
Inspection Service of the U.S. Department of Agriculture, released
H5N1 AI has been spreading across poultry populations
in several Southeast Asian countries since 1997, and in Russia and
eastern European countries during recent months. There have also
been documented cases of the virus affecting humans who have been
in direct contact with sick birds. While there is worldwide concern
that the H5N1 virus might mutate, cross the species barrier and
touch off a human influenza pandemic, there have been no cases of
significant human to human transmission of the disease at this time.
So far, the spread of the H5N1 virus from person to person has been
rare and has not continued beyond one person.
In an interview with the U.S. Senate Majority Leader
Bill Frist, Talking Travel’s correspondent, Karin Leperi, asked
the Senator the following questions:
What precautions can travelers take against
contracting or being exposed to avian influenza?
Senator Frist: All Americans
should be aware if they are traveling to or living in countries with
documented H5N1 cases in animals or humans. To reduce the risk of
infection, travelers should avoid poultry farms, direct contact with
live animals in food markets, direct contact with sick or dead poultry,
and eating uncooked poultry or poultry products.
Humans have no natural immunity to avian influenza.
And currently, we lack our best defenses: effective vaccines and
antivirals. However, there are additional steps travelers can take
to reduce the risk of infection such as making sure you are up to
date with all routine vaccinations, assembling a travel health kit
with basic first aid and medical supplies, and identifying in-country
health care resources before traveling. All of these tips and more
can be found on the
Do American travelers need to stop traveling
to countries where avian influenza has been identified in humans?
Senator Frist: No. The US
State Department, CDC, and WHO have not issued any travel alerts
or warnings at this time. All travelers should be aware of the risk
of infection and take the steps above to reduce such risk.
Are there any particular concerns regarding
shared borders with Canada and Mexico? Considering how common travel
is between our countries, what is being done for coordinated responses
should avian influenza present in humans?
Senator Frist: Avian influenza
knows no borders, so it's important that we monitor all travel.
On an international level, the CDC and WHO continue to work together
to detect and identify outbreaks, so that we are able to effectively
contain, reduce the spread of, and respond to H5N1 cases.
Domestically, just last month, the US Department of
Agriculture, US Department of Health and Human Services, and US
Department of the Interior announced a $29 million interagency plan
to expand detection efforts of avian flu in migratory birds. Specifically,
scientists are prioritizing their focus on Alaska given wild bird
About Senator Bill Frist
Senator Bill Frist, U.S. Senator from Tennessee, became
the U.S. Senate Majority Leader in 2003. Frequently mentioned as a
potential candidate for the 2008 Republican presidential nomination,
he is the only licensed physician serving in the Senate, certified
in both general surgery and heart surgery.
What You Should Know About Avian
For itinerant travelers, the spread of the highly
pathogenic avian influenza strain, HN51, is a real concern. And
based on expert scientific analysis, the probability that this virus
will spread globally by 2006, is a distinct probability.
However, the transmutation of HN51 from an avian-based
illness to one where humans infect humans, has not occurred beyond
one person. Furthermore, it is a known fact that those at greatest
risk to contacting this virulent strain are people who work and
live around water fowl and poultry. With special precautions, an
individual can minimize their risk. A traveler’s checklist
(adapted from World Health Organization Guidelines) includes the
A Traveler’s Checklist
for Avian Influenza
1. Avoid contact with chickens, ducks, poultry, water
fowl, and migratory birds. (Yes, this means staying away from open
markets with birds!)
2. Avoid contact with birds, feathers, faeces, and other waste.
3. Do not keep birds as pets.
4. Wash hands with soap and water after any contact.
5. Do not sleep near poultry.
6. Eat chicken that has been prepared hygienically and cooked thoroughly.
(That means no pink juices. For my friend Joan, that means avoiding
the delicacy of chicken feet unless well-cooked.)
7. Eggs may carry the bird flu virus inside or on their shells.
Do not eat anything prepared with raw egg such as ceaser salad.
Do not eat any “runny” yolks. Any eggs consumed should
be cooked thoroughly, such as hard-boiled eggs.
Though CDC has not recommended that the general public
avoid travel to any HN51 infected countries, following the guidelines
above, can definitely minimize a traveler’s risk to this potentially
deadly virus. Nevertheless, if your travels take you to areas with
reports of outbreaks of H5N1 among poultry or of human H5N1 cases,
you can reduce risk of infection by observing the following measures
compiled by the CDC (Centers for Disease Control and Prevention):
Before any international travel to an area
affected by H5N1 avian influenza:
• Visit CDC's Travelers' Health website at
to educate yourself and others who may be traveling with you about
any disease risks and CDC health recommendations for international
travel in areas you plan to visit. For other information about avian
influenza, see CDC's Avian Influenza website: http://www.cdc.gov/flu/avian/index.htm.
• Be sure you are up to date with all your routine vaccinations,
and see your doctor or health-care provider, ideally 4–6 weeks
before travel, to get any additional vaccination medications or
information you may need.
• Assemble a travel health kit containing basic first aid
and medical supplies. Be sure to include a thermometer and alcohol-based
hand gel for hand hygiene. See the Travelers Health Kit page in
Health Information for International Travel for other suggested
• Identify in-country health-care resources in advance of
• Check your health insurance plan or get additional insurance
that covers medical evacuation in case you become sick. Information
about medical evacuation services is provided on the U.S. Department
of State web page Medical Information for Americans Traveling Abroad,
During travel to an affected area
• Avoid all direct contact with poultry, including touching
well-appearing, sick, or dead chickens and ducks. Avoid places such
as poultry farms and bird markets where live poultry are raised
or kept, and avoid handling surfaces contaminated with poultry feces
• As with other infectious illnesses, one of the most important
preventive practices is careful and frequent handwashing. Cleaning
your hands often with soap and water removes potentially infectious
material from your skin and helps prevent disease transmission.
Waterless alcohol-based hand gels may be used when soap is not available
and hands are not visibly soiled.
• 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 be 74°C (165°F)
• If you become sick with symptoms such as a fever accompanied
by a cough, sore throat, or difficulty breathing or if you develop
any illness that requires prompt medical attention, a U.S. consular
officer can assist you in locating medical services and informing
your family or friends. Inform your health-care provider of any
possible exposures to avian influenza. See Seeking Health Care Abroad
in Health Information for International Travel for more information
about what to do if you become ill while abroad. You should defer
further travel until you are free of symptoms, unless traveling
locally for medical care.
Note: Some countries have instituted
health monitoring techniques, such as temperature screenings, at
ports of entry of travelers arriving from areas affected by avian
influenza. Please consult the Embassy of your travel destination
country if you have any questions.
After your return
• Monitor your health for 10 days.
• If you become ill with a fever plus a cough, sore throat,
or trouble breathing during this 10-day period, consult a health-care
provider. Before you visit a health-care setting, tell the provider
the following: (a) your symptoms, (b) where you traveled, and (c)
if you have had direct contact with poultry or close contact with
a severely ill person. This way, he or she can be aware that you
have traveled to an area reporting avian influenza.
• Do not travel while ill, unless you are seeking medical
care. Limiting contact with others as much as possible can help
prevent the spread of an infectious illness.
For More about Avian Influenza,
visit the following websites:
also our previous editorials