FAQ from Guardian

Q&A: Bird flu
James Sturcke and Hélène Mulholland explain the background to the virus and how Britain is responding to the threat of a pandemic
James Sturcke and Hélène Mulholland
Wednesday October 26, 2005
Guardian Unlimited
What is avian flu?
Avian influenza, also known as bird flu, is a contagious viraldisease in animals, caused by a virus loosely related to human influenza. While all bird species and - less commonly - pigs are thought to be susceptible, domestic poultry flocks are especially vulnerable to infection, which can rapidly result in epidemics among their populations. Since bird flu was first recognised, in Italy, a century ago, there have been more than a dozen strains of virus. Some are almost harmless, while others result in death within hours. The H5N1 form of bird flu is the most dangerous. It is highly pathogenic and extremely contagious among birds, both by air and contact with faeces. Mortality is close to 100%, many birds dying on the same day as infection.
The latest bird flu outbreak, which started in 2003, has mostly affected Asia, where millions of birds have died after contracting the disease or have been destroyed in measures to prevent it spreading.
Since the end of 2003, cases have been recorded in Thailand, China, Indonesia, Cambodia, Vietnam, Laos, Malaysia, South Korea, Mongolia, Japan and Kazakhstan. In August, it was confirmed in Russia. Since then there have been confirmed outbreaks of H5N1 in Taiwan, Croatia, Turkey and Romania, as well as an H5 outbreak in Greece.
On October 21, British authoritiesconfirmed that a parrot from Surinam had died in quarantine in Essex after being infected with bird flu, which was later confirmed as the H5N1 strain.
If it just affects birds, why the panic?
Around120 people in Asia have been infected by the H5N1 strain, more than 60 of whom have died. Thus far, most human deaths have been in communities in which people live in close proximity to poultry.
World Health Organisation scientists believe it is likely that the virus is carried bymigrating birds. Although it does not easily infect humans, every time it does it increases the chance that the virus couldmutate into a form in which it could be passed from one infected human to another.
WHO says that would probably be how a flu pandemic, which is overdue, would start. Mass epidemics have occurred every 20 to 30 years, but it has been almost 40 years since the last one happened. On September 29, the WHO expert appointed to coordinate international response to a pandemic, David Nabarro, said a pandemic would cause anything from 5 million to 150 million human deaths.
The Department of Health‘scontingency plan says that between 21,000 and 700,000 deaths could be expected in Britain from a flu pandemic. One-quarter of the population could become infected, and another quarter would need to care for them.
What measures is the UK taking?
In common with other countries, the British government‘s plan to tackle bird flu is characterised by surveillance and containment. The Department for Environment, Food and Rural Affairs in Augustasked birdwatchers to help to provide an early warning against the arrival of the infection and hasissued guidelines accordingly. Scientists are also involved in examining bird droppings for signs of the influenza virus.
The EU sayscommunication between the public, vets and doctors is essential in alerting authorities to any outbreak of flu.
As in Turkey, when an outbreak is confirmed authorities slaughter poultry in an attempt to contain the spread of the virus. Were it to mutate into a form contagious among humans, authorities would begin a programme of mass treatment, using antiviral drugs and flu vaccines.
The British government is spending £200m onstockpiling antiviral drugs to treat one in four of the population and on 2m doses ofvaccines to protect medical and emergency staff in the event of the disease turning into a global pandemic.
Tamiflu, made by the Swiss pharmaceutical company Roche, is the antiviral drug favoured by most governments. It can be taken as a preventative treatment but there is no evidence it will stop people being infected. It might, however, relieve flu symptoms and help the body to fight the virus.
Tamiflu is only available in the UK on prescription and, with governments around the world ordering it, it has become very scarce. It might be possible to obtain online but since prices have increased the British government has warned that fakes are in circulation.
Another antiviral drug,Relenza, is available but it has to be inhaled and is harder to store over long periods.
Stockpiles of the vaccine against H5N1 could be a first line of defence for priority groups while scientists develop a vaccine against the exact strain responsible for the pandemic. The British government will buysufficient vaccine for the entire population should a pandemic begin and the strain of flu be identified but it would take some months to produce.
The government is briefing doctors on how to deal with any mass outbreak, and the Department of Health has made madeinformation available to the public, as has theWorld Health Organisation.
The EU has banned imports of poultry products from countries with bird flu outbreaks. Britain‘s health secretary, Patricia Hewitt, told the House of Commons on October 17 there was no danger to people of contacting bird flu by eating poultry. The Food Standards Agency says there isno evidence to suggest bird flu can be passed on by eating poultry or eggs but recommends ensuring they are properly cooked. The Australian government hasrecommended washing eggs before breaking them and washing hands afterwards.
What if the pandemic happens anyway?
TheDepartment of Health would have the main responsibility for coordinating the UK‘s emergency response, with the support of theHealth Protection Agency (HPA) - the UK-wide authority responsible for combating the spread of infectious disease. The DoH would establish a national operations room to support the local response to outbreaks and coordinate vaccine distribution to affected areas.
Devolved administrations in Wales, Scotland and Northern Ireland have been asked to coordinate the response in their regions. The HPA has also published an updated influenza pandemic contingency plan, which makes up part of the DoH‘s overall plan.
In the event of a pandemic, the HPA would set up a strategic emergency coordination centre. It would coordinate clinical surveillance, provide infection control advice, analyse flu strains and issue information to the public and healthcare professionals. It would also advise the DoH on the use of vaccines.
How would the response work on the ground?
Strategic health authorities would receive support through regional public health groups, which would coordinate the work of primary care trusts and hospitals in responding to cases.
All hospital and ambulance service trusts would be expected to put in place the necessary resources to care for people affected by a pandemic in their area, as well as offering help to other NHS trusts.
The Centre for Emergency Preparedness and Response would integrate pandemic planning with other emergency planning measures. Guardian Unlimited © Guardian Newspapers Limited 2005