Warden Notice 10/05 (21 November 2005)

AVIAN FLU

Summary
•  The risks to humans from avian flu are low, but it is possible that current outbreaks in birds could at some point develop into a human flu pandemic which would be much more serious

•  The risk of avian flu to British nationals visiting countries affected by avian flu is believed to be very low. There is no reason not to travel to these countries

•  The risk of avian flu to British nationals living overseas in countries affected by avian flu is also currently very low; but they should take personal responsibility for their own safety in the event of a future pandemic, including considering their access to adequate healthcare

•  All those visiting or living in countries affected by avian flu should follow sensible precautions

Introduction

The World Health Organisation (WHO) warns that recent outbreaks of bird flu, also known as avian influenza, could lead to the possibility of a human flu pandemic. This factsheet explains why there is international concern about this. It describes sensible precautions for travellers and residents in affected areas, both in respect of avian influenza, and in respect of a possible future human flu pandemic. And it sets out the measures taken by the Foreign & Commonwealth Office and its diplomatic posts abroad (Embassies, Consulates and High Commissions) in response to these concerns.

Current situation

There have been a series of outbreaks of a virulent form of avian influenza , known as the H5N1 (or A/H5N1) strain, starting in South-East Asia at the end of 2003. Vietnam , Cambodia , China , Indonesia , Japan , Laos , Malaysia , South Korea , North Korea , Pakistan , Thailand , Mongolia , Russia , Kazakhstan , Turkey , Romania and Croatia have all suffered confirmed outbreaks in poultry or wild birds. (The case involving imported birds in quarantine in the UK in October 2005 does not affect the UK 's AI-free status.)

Avian influenza is largely a disease of birds. Despite large outbreaks in poultry, only about 120 people have so far caught the disease. Of these, about half have died. All human cases have occurred in Vietnam , Thailand , Cambodia , and Indonesia . Almost all are thought to have caught the disease from infected poultry. There has been no sustained human-to-human transmission: the virus does not pass easily between people.

Medical experts warn that the avian influenza virus could combine with influenza viruses already circulating in the human population or adapt into a form which could be transmitted readily between people. It is impossible to predict when this might happen. But if it did, it could trigger a global human flu pandemic .

It is important to distinguish between avian flu, the current disease affecting mainly birds, and pandemic flu, which would affect mainly humans and is at this stage only a possibility.

Precautions against avian flu

There are no specific restrictions for travellers to any of the countries affected by avian influenza, as the risk is believed to be very low. But if you plan on travelling to areas where outbreaks have been reported, you should seek expert medical advice before departure, check on latest travel advice and take the following precautions:

•  Avoid visiting live animal markets, poultry farms and other places where you might come into contact with wild, domestic or caged birds

•  Avoid contact with surfaces contaminated with animal faeces or fluids

•  Not eat or handle poultry, egg or duck dishes, if any of these are undercooked or raw

•  Wash hands regularly

•  Not attempt to bring any live poultry products back to the UK

Most human cases are thought to have acquired their infection following exposure to dead or diseased birds. Evidence suggest that particularly risky exposure occurs during the slaughter, plucking and preparation of poultry for cooking.

You should not eat dishes made with fresh duck blood or any other raw or inadequately cooked poultry or egg products. Normal cooking destroys the avian influenza virus. No cases of avian influenza have been linked to the consumption of properly cooked poultry and egg products.

Medical interventions for avian flu and pandemic flu

There is at present no vaccine against avian flu or against any future pandemic flu strain. The normal seasonal flu vaccination protects against currently circulating human influenza strains, but is unlikely to offer any protection against avian flu strains or against a new pandemic flu strain. The use of seasonal flu vaccination, by minimising numbers of cases of seasonal flu, would reduce opportunities for avian strains to mix with human strains, and may allow people with avian or pandemic flu to be more easily identified.

Anti-viral drugs, such as oseltamivir (Tamiflu ®), may be effective in reducing the severity and duration of an influenza illness, but this has not been proven in a pandemic situation and their effect may be limited if the virus develops resistance to the drugs. Further medical information is provided on the Department of Health website www.dh.gov.uk

FCO precautions

The FCO and its posts overseas are working to prepare for a possible pandemic in line with Department of Health guidelines. As a precaution, the FCO intends to pre-position the anti-viral drug oseltamivir (Tamiflu ®) for staff at its posts overseas. The drugs would be prescribed and used under medical supervision to treat FCO staff should they become unwell in the event of a pandemic. It is hoped that this would enable FCO staff at posts overseas to continue to work and provide consular assistance to British nationals overseas. It also fulfils the FCO's duty of care to its staff, in line with the actions of many other organisations and companies with operations overseas.

The FCO is also offering the normal seasonal flu vaccination to its staff worldwide as an occupational health measure aimed at reducing sickness absence in the flu season and maintaining business continuity overseas. It offers no protection against avian or pandemic flu.

The FCO is also considering as part of its pandemic contingency planning the possibility of withdrawing some staff from posts overseas in certain circumstances.

Advice for British nationals travelling overseas

Travellers to areas affected by avian influenza should consult their usual healthcare provider for travel medical advice and further guidance. As the risks from avian influenza are considered small, the UK 's Health Protection Agency does not at present advise tourists visiting affected areas to carry anti-viral drugs. There have been no cases of avian flu in travellers.

Advice for British nationals living overseas

British nationals resident overseas should be prepared to take personal responsibility for their own health in a pandemic situation, including access to adequate healthcare. Availability of anti-viral drugs is currently limited in many countries, including the UK . If a human pandemic occurred, such medicines could be particularly difficult to obtain. As a precautionary measure, those living in or near an avian influenza-affected country for an extended period might consider, with their healthcare adviser, whether they would have access to anti-virals for treatment in case of a pandemic. In a pandemic you should seek medical advice before using anti-viral drugs. British diplomatic missions overseas cannot provide medicine or medical treatment to British nationals, but may be able to advise on local availability of medicines, and provide details of healthcare providers.

A flu pandemic could spread extremely quickly and with little warning. Some countries might close their borders, international transport could be severely disrupted or halted, and travel could become medically inadvisable. In these circumstances, and because of the likely numbers involved and risks of infection, British diplomatic missions could find it difficult to help British nationals. British nationals should consider in advance the potential risks, monitor medical guidance and travel advice on the FCO website and make appropriate preparations. They should ensure that travel documents such as passports and visas are up to date and in order.

Further information

The latest information on avian flu and pandemic flu, including prevention and treatment measures and other Frequently Asked Questions, can be found on the following websites:

•  Department of Health www.dh.gov.uk

•  Health Protection Agency www.hpa.gov.uk

•  National Travel Health Network and Centre www.nathnag.org

•  World Health Organisation www.who.int

Information and Travel Advice on specific countries can be found on the FCO website www.fco.gov.uk

William John Neil
HM Consul