What You Should Do To Prepare For An Epidemic (DHHS)

How Would You Know If You Had Avian Flu?
A Bit of Context on the Bird Flu Threat
How To Protect Yourself

March 12, 2006 — Will there be an outbreak of avian flu that threatens humans? Many experts disagree on when or if a human pandemic will occur, but do say there is a chance that the virus could mutate, leading to widespread infection. In that case, the best thing you and your family can do right now is to prepare for that possibility.

If there is an avian flu pandemic, you'll want to minimize your chance of catching it by staying indoors; you might even be required to stay home if the government asks that people remain in quarantine or "shelter in place." Stocking up today on at least seven days' worth of essentials such as water, nonperishable food, emergency and medical supplies will help you get through an extended time at home if an outbreak happens. Once you've purchased these items, store them in a place where you will not be tempted to dip into them for everyday use. See the checklist below for guidelines on what and how much you need.

It may feel odd or uncomfortable to talk to family members and loved ones about the worst-case pandemic scenario. But if that scenario strikes, you'll all be much better off if you have a plan decided on and ready. Talk with your friends and family about how you'd respond to an epidemic. Figure out how you would care for them and what your first response and responsibilities would be; this is an especially important conversation to have with those with special care needs. Get involved with local groups and community efforts aimed at preparing for a pandemic. If your community has no program in place yet, find out how you and your neighbors can get one started.

The habits that can help keep you healthy in an outbreak are the same good health habits that can keep you from catching the common cold: maintain a balanced diet, exercise regularly and get sufficient rest. Particularly in a flu outbreak situation, it will be important to wash your hands thoroughly and often, reminding loved ones — especially children — to do the same. Be diligent about covering coughs and sneezes with tissues, teaching any children in your family to do the same. Also teach children to stay away from others as much as possible if they are sick and stay home from work or school if you are sick.

Know Your Emergency Contacts and Information Compile the phone numbers you'd need in case of the emergency, keeping the list somewhere safe and visible. Make sure everyone in your household knows where to find it. According to the Department of Health and Human Services, you should include information for:

Also, know your essential health information such as blood type, allergies, past or current medical conditions, and current medications and their dosages. Make a list of that essential information for all the members of your household. Keep that list safe and make sure everyone in your household knows where it is.

HHS has sample sheets that you can print out and fill in with all your essential contact and health information.

Food and nonperishable items, such as ready-to-eat canned meats, fruits, vegetables, and soups, protein or fruit bars, dry cereal or granola, peanut butter or nuts, dried fruit, crackers, canned juices, bottled water, canned or jarred baby food and formula, and pet food.

Medical and practical items, such as prescriptions drugs and medical supplies such as glucose and blood-pressure monitoring equipment, soap and water, or alcohol-based hand wash, medicines for fever, such as acetaminophen or ibuprofen, thermometer, anti-diarrheal medication, vitamins, fluids with electrolytes, cleansing agent/soap, flashlight, batteries, portable radio, manual can opener, garbage bags and tissues, toilet paper, and disposable diapers.

Seems to be picking up speed for killing Russian poultry. Likely caused by spring bird migration. Alaska and northwest states better take heed. Migrating birds from Asia are coming your way soon. - OB1

30,000 bird-flu deaths in south Russia in last 24 hours - ministry
16/03/2006 10:25

Source: http://en.rian.ru/russia/20060316/44383584.html

ROSTOV-ON-DON, March 16 (RIA Novosti, Sergei Rudkovsky) - More than 30,000 birds have died of bird flu in southern Russia over the last 24 hours, a local emergencies ministry official said Thursday.

"In Krasnodar Territory, 21,912 chickens have died over the last 24 hours, and the total number of dead birds has reached 350,288," the official said.

A further 10,818 birds have died over the last 242 hours in the North Caucasus republic of Daghestan, the official said, bringing the total including culled birds to 760,000.

A third wave of bird flu struck Russia starting February 3. The country's southern regions, where all cases in the country have so far been registered, are particularly vulnerable as a stopover for migrating birds. A vaccination program is currently underway in many of the country's regions.

No human deaths from bird flu have so far been registered in Russia.

Scientists Spot Potential Bird-Flu Pathway to Humans

03.16.06, 12:00 AM ET

THURSDAY, March 16 (HealthDay News) -- A newly developed molecular technology has identified certain mutations that the avian flu virus might undergo to unleash a human epidemic, researchers report.

The key is a mutation in the hemagglutinin molecule -- the "H" in the H5N1 designation of the bird flu virus -- that sits on the surface of the virus and is the primary target of the immune system's protective antibodies.

Besides giving insight into just how H5N1 might change, the finding could help scientists recognize important viral mutations early on and alert health officials to the potential for a pandemic.

"We looked at the structure of the H5 hemagglutinin from a recent bird flu isolate in Vietnam," said Ian A. Wilson, professor of molecular biology at the Scripps Research Institute, in La Jolla, Calif. That virus, which was found in a boy who died of bird flu in 2004, was similar to the one that caused the 1918-19 "Spanish flu" pandemic, which killed an estimated 20 million to 40 million worldwide, he said.

"Although this is an avian [bird] virus, similar to the 1918 virus, what we are really looking at is how a virus crosses the species barrier," Wilson said.

In principle, it's a substantial barrier. The bird flu virus attaches itself to cells in the intestinal tract, while the human flu virus attacks cells in the respiratory tract.

However, a previous study showed that only two mutations were needed to transform the bird virus to one that could infect humans, Wilson said.

"Biologists are concerned about being able to detect changes in the avian virus that might signal a transition to moving to a human host," added James C. Paulson, another professor of molecular biology at Scripps. "This method specifically looked at one change known to be a major difference between the avian virus and its counterpart in humans."

As reported in the March 17 issue of Science, the researchers used a technique called functional glycan microarray, which studies specific sugar molecules that allow the virus to attach itself to cells. There are a few known mutations that can convert other viruses with H2- and H3-type components from bird to human infections, but the new study showed that these mutations do not cause the H5 bird flu virus to switch to a preference for infecting human cells.

There was a slight change in the virus found in the Vietnamese boy. "This paper concludes that this change might be sufficient for the avian virus to get a foothold in the human population, but not sufficient for the virus to have full virulence in humans," Paulson said.

Human infection with the avian virus currently requires direct exposure to infected birds, he noted.

According to James Stevens, an assistant professor of molecular biology at Scripps, the new research has "identified a possible route that the virus could take [in the future] to become adapted to human beings."

There is some comfort in an indication that this change might not be easy for the virus, Paulson added.

The functional glycan microarray technique was developed at Scripps and is being used by some other laboratories, Paulson said. It could be very useful in the continuing effort to determine whether and how the H5N1 avian flu virus might become a major menace to humans, he said.

"We don't know how well-adapted these viruses need to be to get a human foothold," Wilson pointed out. "I suggest that there could be tests in the field for receptor binding."

The bulk of bird-flu infections have occurred in Asia, although the germ has been identified in birds in Africa, Europe and the Middle East. More than 100 people have been killed by H5N1, which so far has only been caught through direct contact with infected birds.

VHA Inc. Survey on Avian Flu Shows Some Hospitals Would Exhaust Supplies in Two Weeks; Money and Storage Space Prevent Hospitals from Building Inventory Levels

3/16/2006 8:00:00 AM EST
Source: http://www.genengnews.com/news/bnitem.aspx?name=1193378XSL_NEWSML_TO_NEWSML.xml

As fears about an avian flu pandemic rise globally, the question is: Are hospitals ready for the flood of patients this disease could generate? A February survey of U.S. hospitals indicates that while many have disaster plans in place, they may exhaust their inventory of critical supplies within a couple of weeks. Supply chain experts at VHA Inc. also believe that interruptions in Asian manufacturing centers due to avian flu could severely impact replenishment options here.

VHA, the national health alliance, surveyed 267 hospital leaders, including chief nursing officers, infection control personnel and emergency department directors, from member hospitals across the country to find out whether they are prepared for a major avian flu epidemic. Nearly two-thirds (62 percent) of the 267 respondents said their hospital has a disaster plan in place. However, when asked if they were prepared for this type of health crisis, 60 percent of respondents said, "No."

"An avian flu pandemic would place a heavy burden on hospitals from a supply and a staffing perspective," said Lillee Gelinas, R.N., M.S.N., vice president and chief nursing officer of VHA. "In an era of just-in-time inventory planning, hospitals often do not have large storehouses full of supplies. Under normal conditions this makes good business sense, but during a time of crisis it doesn't allow hospitals to access essential supplies when they are critically needed."

Survey respondents identified the following items as the most needed during an avian flu outbreak:

-- Anti-viral Medications
-- Masks
-- Gloves
-- Gowns
-- IV Supplies

Hospitals typically have about a 7-day supply of these items. Nearly 90 percent (86 percent) of respondents said their inventory would last 16 days or less, with 59 percent saying they had a 7-day supply of these products on hand. Twenty-eight percent of those surveyed said they have an 8- to 16-day supply and only 6 percent said they had enough of these supplies to last more than 30 days. However, the survey reported that 60 percent of the hospitals surveyed are not planning to change inventory levels in the face of a possible avian flu pandemic.

After viewing the results of this survey, VHA polled 20 of its largest members, and found that, on average, the larger health systems had about a 4-week supply of the key medical products.

The U.S. Department of Health and Human Services recommends that hospitals consider stockpiling enough consumable resources, such as masks and gloves, to last the duration of a pandemic wave, approximately six to eight weeks. It also recommends that hospitals do the following:

-- Anticipate the need for supplies and determine trigger points for ordering extra resources

-- Estimate the need for respiratory care equipment (including mechanical ventilators), and develop a strategy for acquiring additional equipment, if needed

-- Anticipate their need for antibiotics and determine how supplies can be maintained during a pandemic

Larry Dooley, vice president at Novation, VHA's supply contracting company, believes the likelihood of an avian flu pandemic in the U.S. is remote, but hospitals need to plan for this possibility. He believes U.S. hospitals are more likely to be impacted by an avian flu outbreak overseas before an outbreak actually occurs in the U.S.

"All of the supplies highlighted as necessary are made in places like China, Singapore and Malaysia. These are potential hotspots for avian flu and are more likely to see a pandemic first," Dooley said. "An outbreak there would impact manufacturing and transportation capabilities in those countries, which ultimately would impact U.S. hospitals' ability to take care of patients."

Dooley, who is an expert on medical supply distribution issues, said that most of the country's large medical distributors have an estimated 20- to 30-day cushion of key medical surgical supplies. However, he acknowledges that there appears to be a gap between the supplies that the nation would need and the supplies represented by distributors' stockpiles and hospitals' average inventory levels.

"We're not recommending that hospitals rush to stockpile medical supplies. That would place an undue stress on the supply chain and drive up prices for products," said Dooley. "Instead, hospitals need to take a critical look at their inventory levels."

Dooley also recommends that hospitals need to:

-- Determine whether they need to slowly begin making changes to prepare for the impact of avian flu or some other pandemic

-- Communicate their needs to their supply distribution partners

-- Network with other hospitals in their community or region

-- Develop a contingency plan for how they might share supplies or move supplies within a region on a rolling basis

Dooley concluded, "If we're hit by avian flu, and it spreads slowly, region by region, there might be enough flexibility in the supply chain to withstand that scenario."

VHA is in the business of helping hospitals with supply chain management and helping them establish networks with other hospitals so they can develop solutions to common operational and clinical challenges.

VHA Inc., based in Irving, Texas, is a national alliance that provides industry-leading supply chain management services and supports the formation of regional and national networks to help members improve their clinical and economic performance.

U.S. study defines two clear bird flu strains

20 Mar 2006 14:02:08 GMT

Source: Reuters - http://www.alertnet.org/thenews/newsdesk/N2012779.htm

(For release at 1:15 p.m. EST/1815 GMT)

ATLANTA, March 20 (Reuters) - The H5N1 strain of bird flu in humans has evolved into two separate strains, U.S. researchers reported on Monday, which could complicate developing a vaccine and preventing a pandemic. One strain, or clade, made people sick in Vietnam, Cambodia and Thailand in 2003 and 2004 and a second, a cousin of the first, caused the disease in people in Indonesia in 2004.

Two clades may share the same ancestor but are distinct -- as are different clades, or strains, of the AIDS virus, the team from the U.S. Centers for Disease Control and Prevention found. "Back in 2003 we only had one genetically distinct population of H5N1 with the potential to cause a human pandemic. Now we have two," said the CDC's Rebecca Garten, who helped conduct the study.

Speaking to the International Conference on Emerging Infectious Diseases in Atlanta, Garten said the pool of H5N1 candidates with the potential to cause a human influenza pandemic is getting more genetically diverse, which makes studying the virus more complex and heightens the need for increased surveillance. "As the virus continues its geographic expansion, it is also undergoing genetic diversity expansion," Garten said in a statement.

The H5N1 strain of bird flu has spread across Europe, Africa and parts of Asia and killed about 100 people worldwide and infected about 180 since it re-emerged in 2003. Although it is difficult to catch bird flu, people can become infected if they come into close contact with infected birds. Scientists fear the virus could mutate into a form that could pass easily between humans, triggering a pandemic in which millions could die.

All influenza viruses mutate easily, and H5N1 appears to be no exception. "Only time will tell whether the virus evolves or mutates in such a way that it can be transmitted from human to human efficiently," Garten said. The U.S. Health and Human Services Department has already recognized the two strains and approved the development of a second H5N1 vaccine based on the second clade.

Several companies are working on H5N1 vaccines experimentally, although current formulations are not expected to protect very well, if at all, against any pandemic strain. A vaccine against a pandemic flu strain would have to be formulated using the actual virus passing from person to person.

For their study, Garten and colleagues analyzed more than 300 H5N1 virus samples taken from both infected birds and people 2003 through the summer of 2005. The majority of the viruses, including all the human cases, belonged to genotype Z. Now there are two clades of the Z genotype. There were also small numbers of viruses in birds that were genotype V or W or recently identified genotype G.

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