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Swine Flu | Avian Flu

Swine Flu FAQs

About the Flu

What actions can I take to limit exposure?

I don't have any flu symptoms, but think I may have been exposed to Swine Flu - what should I do?

Do not take Tamiflu if you do not have any symptoms. Taking Tamiflu prophylactically could be a danger to your personal health, as well as the larger public health effort against Swine Flu. Monitor your health for 10 days and contact a medical professional if you do experience flu symptoms.

If I have flu-like symptoms, how long will it take to diagnose me?

Dr. Walter “Ben” Koppel, MEDEX Medical Director, urges anyone with flu-like symptoms to consider themselves as having the flu until proven otherwise. The laboratory test for the swine flu takes a few days to obtain results. Even if the test is negative, patients should still be treated as if they have the disease.

Can I conduct my own testing? Is there a kit?

Actual identification of the type of influenza virus is not essential for treatment. Treatment for all viral respiratory conditions is the same – antiviral, fluids, fever medication, supportive care and isolation. All testing would take time and can be expensive. Any self diagnosis test kits may not be effective in properly diagnosing the Swine Flu.

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Travel

Is it safe to travel to risk-prone areas?

Any unnecessary travel to risk-prone areas should be postponed or cancelled. If travel is needed, you should always check the CDC, WHO and your government’s public health authority websites for any travel advisories that may be issued for the country in question. Also, contacting MEDEX Assistance is always a smart way to obtain accurate and unbiased information. For tips on traveling to a risk-prone area, make sure you read and follow appropriate health precautions.

• People who have direct contact with pigs
• People with compromised immune systems or any other condition that can compromise respiratory function or the handling of respiratory secretions. These conditions include difficulty breathing or swallowing; brain injury or disease; spinal cord injuries; seizure disorders, and other nerve or muscle disorders.)
• Adults of any age and children six-months and older with chronic heart or lung conditions, including asthma
• Adults of any age and children six-months and older and adults who require regular medical care or were in a hospital during the previous year because of a metabolic disease such as diabetes, chronic kidney disease, or a weakened immune system (including those immune system problems caused by medicines or by infection with human immunodeficiency virus [HIV/AIDS]);
• People 65 years and older
• Children from six-months to 18 years of age who are on long-term aspirin therapy
• Women who are pregnant
• All children 6 to 23 months of age

Should I seek treatment locally or return home?

If you have flu symptoms, MEDEX Assistance advises travelers to seek treatment immediately and locally for the following reasons:

• Local medical professionals are most familiar with Swine Flu and are therefore more likely to have the latest information and treatment options available to you
• Local treatment avoids potential spread of Swine Flu (and the common flu too)
• There may be travel restrictions for anyone who displays flu symptoms

How is the Mexican health care system?

Mexico City has reliable medical care, through physicians and hospitals. So far, metropolitan Mexico City medical resources are not reporting that they are overwhelmed by Swine Flu cases. Certainly public hospital will likely be the first to see any surge in patients requiring admission to the hospital for severe flu symptoms. Mexico City has several private, acute care hospitals with appropriate physicians to attend flu patients. For expatriates and families, their first line of medical defense should be their personal physicians; internist, gynecologist and pediatrician. If a family does not have a personal physician, a fellow employee maybe able to recommend their practitioner and MEDEX can make referral to physicians.

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Medication

Will the common flu vaccine help me avoid Swine Flu?

The common flu vaccine may not be effective against Swine Flu. However, MEDEX Assistance does advise travelers going to risk-prone areas to get the common flu vaccine to serve as a differentiator if flu symptoms present (see “Additional Recommendations from MEDEX Assistance” on page 11 for more information).

Will gamma globulin protect me?

An injection of gamma globulin, or blood proteins, is sometimes given in an attempt to boost a patient’s immunity against disease. However, this is not an effective prophylactic measure. Because the swine flu is a new strain of flu virus, no one has any antibodies yet to help develop the gamma globulin.

What if I start experiencing flu symptoms & want to purchase Tamiflu?

Purchasing Tamiflu overseas may be difficult for a number of reasons. First, some local officials have already stopped purchase of the drug by foreign physicians to combat stockpiling. If you do try to purchase the drug overseas, make sure you are working with a reputable medical facility or pharmacy. With a shortage of Tamiflu, counterfeit supplies may be a problem. MEDEX Assistance can direct you to a reputable provider, but cannot guarantee availability.

I'm traveling to a risk-prone area -- will my physician write me a prescription for Tamiflu?

• Your physician may determine that you are not at high risk for contracting the disease
• There is a short supply of Tamiflu worldwide. Medical professionals and public health officials are discouraging widespread prescriptions which could limit supply when and where it is needed most.
• Taking Tamiflu prophylactically is not recommended. Tamiflu is a prescription drug because it should be administered by a medical professional when symptoms are verified. Individuals obtaining Tamiflu and self-administering the drug is dangerous
• Widespread and/or incorrect usage of Tamiflu could result in a mutation of the Swine Flu virus, rendering Tamiflu completely useless.
• Your physician may advise that you seek care locally if you experience flu symptoms (see answer below to “Should I seek care locally or return home?”).

If I do bring Tamiflu with me, what should I do during travel?

Follow typical travel tips for traveling with prescription drugs, including the following

• Carry all medications in your carry-on luggage
• To minimize the suspicion of customs officials, carry medications in their original labeled containers (not mixed in other containers)
• Carry your original, written prescriptions and, in a separate place, write down the name (including the generic name), strength and dose of your medications, with your doctor's name and contact information

Also, be sure to keep the Tamiflu in a secure location in hotel rooms, such as the hotel room safe or your luggage.

Store Tamiflu as directed by the manufacturer:

• Capsules: Store at 77°F (25°C); excursions permitted from 59° to 86°F (15° to 30° C)
• Tamiflu Suspension: Stored under refrigeration from 36° to 46°F (2° to 8°C) Do not freeze

Can MEDEX provide me with Tamiflu?

Worldwide, national governments are in control of the stocks of Tamiflu and Relenza and are using them to treat confirmed cases. It is not currently available at pharmacies and hospitals in Mexico City. MEDEX is continuing the inquiry of Tamiflu availability in Mexico. Also, MEDEX is unable to assist you in importing Tamiflu to any country, as it is under strict control by the government.

What if I start experiencing flu symptoms & I have Tamiflu in my possession already?

MEDEX Assistance advises travelers who are experiencing flu symptoms in a risk-prone area to still seek medical care immediately – even if they brought Tamiflu with them. If a physician in your home country prescribed Tamiflu prior to your travels, try to contact your physician for specific instructions. You may also see a local medical professional who can provide advice. MEDEX Assistance can assist you in finding a local medical professional. Keep in mind that Tamiflu should be administered by a medical professional within 48 hours from the first sign of flu symptoms. Also, remember that Tamiflu has not been confirmed as a reliable treatment for Swine Flu. If you do have Swine Flu, local medical professionals will be most up-to-date on additional/ alternative treatments that may be available.

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MEDEX

How can I contact MEDEX from Mexico?

There are several ways to contact MEDEX’s 24/7 Emergency Response Center from Mexico.

• Toll Free: 00 1 800 101 0061
• Phone: 00 1 410 453 6330
• Fax: 00 1 410 453 6331
• Email: Operations@medexglobal.com

Can MEDEX help me identify the best hosptals and clinics to go to?

Yes, MEDEX clients can call our Emergency Response Center to hospital information. Clients with access to the MEDEX Member Center can log in online and find this information in the MEDEX 360ºm Global Medical Monitor portion of the site

What should I do in case of an emergency because of the influenza?

MEDEX can help you locate preferred providers and assist with direct billing. It’s important to remember that when epidemic concerns exist, many local hospitals and doctors may still expect patients to pay cash upfront for services. With a higher influx of patients, cash payment is preferred and more expedient; this could be true for hospitals with which MEDEX already has billing arrangements.

Is MEDEX ready to support me for a medical evacuation?

MEDEX can always assist with evacuation if it is permissible by both the Mexican and US governments. The evacuation will be reviewed by our medical team and would take place only if it is medically necessary.

What should I do if I’m in Mexico and want to get home? Or if I have travelers in Mexico?

Any kind of travel during this epidemic is limited to government and airline rules and regulations. If you become sick, MEDEX will monitor your care, as we would during a non-epidemic situation.

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Avian Flu FAQs

About the Flu

What is it?

The Avian flu gets its name because it is typically transmitted between, affects, infects, and can be fatal to birds.  "Avian flu," or "bird flu," is a collective name for a variety of viruses that occur naturally among birds.  Generally carried by wild birds, the bird flu is extremely contagious among bird populations and can make domesticated birds (including chickens, ducks and turkeys) fatally ill. 

Although the Avian flu does not typically infect humans, there have been numerous cases of human infections reported since 1997.  Almost all of these cases were caused by the H5N1 strain of virus.  The causes of the infections are the result of direct contact with infected poultry or through direct contact with contaminated surfaces at venues such as live bird markets.  Confirmed reports of the spread of avian flu viruses from one ill person to another remain rare. The World Health Organization (WHO) has recently confirmed one case of human-to-human transmission of the H5N1 virus, in which the virus mutated and was passed to a third person. Officials confirm that the virus died with the third person and did not transmit to others.

How do I keep from getting it?

If a human becomes infected with avian flu today, it is mostly likely from close contact with infected birds.  Therefore, any unnecessary contact with birds and bird products, including uncooked poultry, should be avoided.  Careful and frequent hand washing is one of the most important preventative practices to avoid the avian flu and other diseases.

Is there a cure?

At this time, a cure for avian flu has not yet been developed.  However, antiviral treatments have proven somewhat effective in treating the disease.  Scientists around the world are currently conducting studies to find a cure for humans infected with the disease.  They are also investigating vaccine options to prevent the spread of the disease.

What are the symptoms?

Symptoms of avian flu in humans are similar to the symptoms of the common flu:  Fever higher than 100°F (38°C) associated with a sore throat; difficulty breathing and other respiratory symptoms such as a dry or hacking cough; a feeling of exhaustion; severe muscle aches; and thin mucus, such as a runny nose.  Because these symptoms are similar to the common flu, avian flu cannot be diagnosed based on symptoms alone, but requires a laboratory test.  Swab samples are taken from the throat or the nose and tested on a molecular level. The incubation period for avian flu may be as long as seven days, so symptoms may not develop until a week after exposure.

What do I do if I think I have it?

If you think you may have Avian Flu, contact your healthcare provider immediately.  Be sure to tell them your symptoms, whether you have had direct contact with poultry, and where you have recently traveled.  Antiviral treatments are only successful if they are administered within two days of initial symptoms.

Won't I be protected if I received my seasonal flu shot?

The flu can come from any one of a number of viruses.  Each year, the U.S. Food and Drug Administration predetermines the particular flu virus for which a vaccine will be developed.  Due to the varying types of viruses, the vaccine for the common flu of that year will not prevent the spread of the Avian Flu.

How does it spread?

Avian flu is spread through direct contact with infected birds, either living or dead.  Most specifically, the virus is found in their saliva, nasal secretions, and feces.  Surfaces that have been exposed to any of these bird products may also be contaminated. Health officials believe that nearly all people who have contracted the Avian Flu have done so through close contact with infected birds.

Is there a vaccine?

To be most effective, a vaccine must be created based upon the virus causing the pandemic. As a pandemic is not yet occurring, vaccine manufacturers do not know for which virus to develop a vaccine.  Currently, there are not any vaccines ready for commercial production, and none are expected to be widely available until several months after the start of a pandemic. 

What is the status of vaccine development and production?

Experimental vaccines are being tested to determine which formulations will be the most effective.  Once a virus has emerged as a pandemic, vaccination production for that strain of flu can begin.  It is difficult to create a vaccine because the virus is likely to mutate, possibly making that particular vaccine ineffective.

Should I wear a surgical mask or gloves to prevent exposure to the avian flu?

Surgical masks and gloves are not recommended for routine use in preventing influenza exposure.  However, in the event of a pandemic, they can be helpful in limiting exposure to the disease.

Who is most vulnerable to bird flu?

As with the common flu, the populations most at risk would be young children and the elderly.  Also at risk are people who have direct contact with poultry, birds and their excretions and secretions, people with compromised immune systems, anyone with chronic heart or lung conditions, and women who are pregnant.  

Can I still eat chicken?

Yes.  Chicken that is cooked to a temperature of 158° F (70° C) is safe for consumption.  Cooked eggs are also safe to consume.  If handling raw poultry or eggs, take precaution.  Keep raw meat separate from cooked meat, and wash your hands and all surfaces and utensils afterwards.

If mammals can contract it, should I be concerned about my dog and cat?

While it is possible for domestic cats to contract the avian flu virus, there have been very few reports around the world.  Any reported incidents of pets contracting the disease are directly related to occurrences of the animal consuming an infected bird.  There is no evidence that cats have spread the virus to humans.  There is very limited information on dogs being affected by the avian flu, however, the CDC, USDA, and several veterinary organizations are working to gain more knowledge in this area.

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Global Situation

How many people have died from it?

As of June, 2009, 433 people have been diagnosed with avian flu, 262 people have died from the disease.

If there has not yet been any documented human-to-human transmission, why all the concern about a pandemic? 

There is a possibility that the H5N1 strain will mutate into a virus that affects humans.  In humans, the H5N1 virus is aggressive, with rapid deterioration and high fatality, with primary viral pneumonia and multi-organ failure common.  If the virus mutates into a form that is highly infectious for humans, it will spread easily between people and could create a global outbreak.

What countries have human cases?

Countries that have confirmed human cases of Avian Flu include:

What countries have non-human cases?

Countries with confirmed non-human cases of the avian flu include:

Do migratory birds spread the disease?

Yes, migratory birds have been known to spread the disease among bird populations.

Are any travel restrictions to avian flu countries recommended?

At this time, neither the CDC, WHO, nor MEDEX recommends travel restrictions to countries affected by the avian flu. 

Why is the death rate so high?

The death rate for individuals affected by avian flu is so high because humans have no natural immunity toward the disease.  Vaccinations, once developed, will help humans develop immunity towards the disease and should therefore lower the death rate.

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Pandemic Information

What is a pandemic?

A pandemic is a global disease outbreak, identifiable by meeting three conditions:  1) it affects humans and causes illness; 2) there is little or no human immunity; and 3) it spreads easily and consistently among humans.  There have been three influenza pandemics in the 20th century.  Worldwide, 40 million people died in 1918, 2 million people died in 1957, and 700,000 people died in 1968.  The sharp decline in the death rate is due primarily to advances in hygiene and medicine. 

How should I prepare for a pandemic?

You can prepare for a pandemic by staying informed about the situation.   Take appropriate steps to prevent transmission of the disease, such as washing your hands frequently, limiting your exposure to birds and people who may be infected, and seeing a physician as soon as you suspect symptoms.   

What changes are needed for H5N1 to become a pandemic virus?

H5N1 may become a pandemic virus in one of two ways.  It can gradually mutate into a form that infects humans, or it can exchange genes with an influenza strain that already infects humans, creating a new virus.  The World Health Organization, the World Organization for Animal Health, and the Food and Agriculture Organization are currently monitoring the global movement of the H5N1 and other influenza strains.

What are the warning signals that a pandemic is about to start?

Early warning signs of an upcoming pandemic begin with clusters of patients exhibiting the same symptoms.  When these patients are closely related, there is a possibility of human-to-human transmission.  Each reported avian flu case is researched to confirm the diagnosis, identify the source of that particular outbreak, and determine the occurrence of human-to-human transmission. 

Can a pandemic be prevented?

Typically, if identified and contained within the first 30 days of an outbreak, a pandemic may be prevented.  However, it may take some countries up to 30 days to confirm the diagnosis and determine the cause of the transmission of the disease.  In many instances, the 30-day timeframe has been surpassed before an official statement has been declared by the local government, bringing to question the world's ability to contain a pandemic.

Is the world adequately prepared for a pandemic?

The World Health Organization has urged all countries to develop pandemic preparedness plans, however only approximately 40 have actually done so.  While many countries are stockpiling antiviral drugs, the manufacturers are unable to keep up with the current demand for the medication.  If a pandemic is in the immediate future, most developing countries will have little or no access to vaccines and antiviral drugs.

If there is an outbreak of pandemic flu, is there any way to protect myself?

As with any other flu virus, the best way to protect yourself against avian flu is through frequent hand washing.  One of the most preventable methods of transference is by covering the nose and mouth when coughing or sneezing.  Anyone with a cough and a fever of over 100°F (38°C) should seek medical attention. 

Should I ask my doctor for Tamiflu now so that I can take it if there is ever a pandemic?

Stockpiling Tamiflu or any other antiviral medication is not recommended for individuals.  Antiviral medications including Tamiflu and Relenza have not yet been proven effective against the H5N1 influenza strain and are in short supply.  By stockpiling, individuals would be taking these medications away from the people who could most benefit from them, not only during a pandemic, but also during regular flu season.  Governments are currently creating their own stockpiles for the event of a pandemic.

Is a bird flu pandemic imminent?

The timing and severity of a pandemic cannot be predicted.  Many scientists believe that it is only a matter of time before the avian flu, or some other disease, reaches pandemic proportions.  

What is the government doing to prepare for bird flu?

Governments around the world are taking steps to prepare for an avian flu outbreak.  In the United States, preparing for a pandemic is a collaborative effort between federal, state, and local officials.  The U.S. Department of Health and Human Services is working with the World Health Organization and other nations to contain outbreaks, developing a national stockpile of antiviral medication, and supporting the manufacture of possible vaccines.  In addition, they are working with other federal agencies to prepare for the impact that a pandemic may have on local and national infrastructure.

The steps that other countries are taking to prepare for the Avian Flu range from little or no preparations to full pandemic response plans.  Indonesia has promised free medication to victims; Australia has thermal imaging screeners ready to deploy to airports within hours should a pandemic outbreak occur; and Greece, having prepared for biological concerns during the 2004 Summer Olympics, has a set contingency plan in place.  To find out more information about specific countries, check with that country's government website.

Are there specific items I should keep on hand in the case of a pandemic?

In the event of a pandemic, you may wish to have antibacterial hand gel or soap available.  Gloves and masks may help limit your exposure, but are not necessarily an effective precautionary step.

What is the shelf life of Tamiflu?

According to the manufacturer, Roche, the shelf life of Tamiflu is 5 years.

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Businesses and the Avian Flu

How will a pandemic affect my business?

If a pandemic develops, many people will be unable to go to work.  Others may stay home to care for family, or be too scared to leave their house.  Businesses will experience absenteeism, and can therefore expect a drop in productivity.  You can expect disruptions in transportation, trade, payment systems, and major utilities.  The World Bank estimates that a flu pandemic would cost $800 billion in a single year.  

What if there is an outbreak in a location where I have travelers?

If you have travelers where there is an outbreak, they should immediately begin to monitor their health for symptoms.  Remind them to wash their hands frequently, to cover their nose and mouth when they cough or sneeze, and to limit their exposure to live birds and people who are ill.  If your company wishes for those travelers to return to their home countries, you should be aware of any travel restrictions that may be placed upon them, such as being quarantined upon their return home. Contact MEDEX for assistance in this matter.

How can I prepare my business for a pandemic?

Your business can prepare by developing a business continuity plan.  With almost a quarter of the population expected to be infected, your business should be prepared for the drop in demand, as well as the rise in absenteeism.  The plan should include information about continuing operations without key individuals being present.  It is possible for a flu pandemic to last longer than a year, so making sure that your business is properly prepared is essential to economic survival.  Fortunately, many companies specialize in developing business continuity plans.  For more information on business planning, please click here.

Are there specific items that I should have my international travelers take with them on their trips?

To limit flu exposure, international travelers may wish to have antibacterial hand gel with them.  This can help limit exposure not just to avian flu, but other viruses as well.

How can I prepare my employees?

You can prepare your employees by making sure that they know and understand basic avian flu facts.  There are many locations throughout the world that are not yet affected by the virus, and others where the virus has not yet affected humans.   Protecting themselves against the avian flu is no different than protecting themselves against the common flu virus - frequent hand washing, and limited exposure to possible sources of infection.  In locations affected by avian flu, it is best for travelers to avoid live bird markets and other locations with poultry and fowl.

What absenteeism rate should I expect?

The Centers for Disease Control and Prevention estimate that up to 35% of the workforce could be affected by the avian flu at any given time.  The Ontario (Canada) Ministry of Health projects a 35% illness rate and a 40-50% absence rate.

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