What 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 this statement:


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.

Government Response

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 CDC's website.

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 migratory pathways.

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 Flu

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 following:

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 http://www.cdc.gov/travel 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 items.
• Identify in-country health-care resources in advance of your trip.
• 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, at http://travel.state.gov/travel/tips/health/health_1185.html.
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 or secretions.
• 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:




See also our previous editorials