Avian Influenza

TO ALL AMERICAN CITIZENS IN MALTA: 

As the press devotes more attention to Avian Influenza, Americans overseas may have a growing number of AI-related concerns. The following guidance was provided by the United States  Department of State Office of Medical Services and may be useful to you. It outlines the risks and practical protective measures related to bird droppings, dead birds, and house cats.

Bird Droppings

Birds infected with AI excrete the virus in their droppings, where the virus can survive for long periods, especially when temperatures are near or below freezing. Although there is minimal risk of humans becoming infected by AI from bird droppings (the majority of human cases have resulted from extensive contact with live poultry), as a precautionary measure, the following guidelines may be followed when removing bird droppings, even in regions where there have been no documented cases of AI. Bird droppings can contain infectious agents other than AI, and so these guidelines represent good practice in any case. (Note: these guidelines apply to the removal of thin coatings of droppings. Thick amounts of droppings – i.e., those that would require removal using a shovel – should be removed only by trained sanitation workers.)

-- wear gloves that are either disposable or easily cleanable (e.g., light-weight vinyl or nitrile gloves, or heavy duty dishwashing rubber gloves;

-- spray the droppings with water or a disinfecting solution made from 3 tablespoons of household bleach per gallon of water. Allow time for the bird droppings to soften;

-- surgical masks should be worn if removal will aerosolize the droppings; i.e., cause the droppings to turn to airborne dust;

-- remove the droppings with a disposable or cleanable utensil;

-- if dust is observed as the droppings are disturbed, stop and wet the droppings again before continuing the clean up;

-- place the droppings, tainted debris, and tools into a plastic bag and seal the bag;

-- clean re-usable utensils with water and detergent or preferably a disinfectant solution as described above;

-- clean the exterior of footwear with detergent and water or the disinfectant solution;

-- rinse reusable gloves with detergent and water or disinfectant solution prior to removing. Disposable contaminated gloves should be placed in a sealed bag for appropriate trash disposal;

-- place reusable gloves in a clean plastic bag and wash them in water containing detergent or disinfectant;

-- thoroughly wash your hands with soap and water for 15-20 seconds.

Dead Birds

The AI virus remains in the tissues of infected dead birds for some time. Therefore, contact with dead birds should be avoided and local veterinary or agricultural authorities should be notified to collect the bird carcass for disposal or testing. If contact with a bird carcass is unavoidable (for example, a cat brings a dead bird into the house), follow the guidance below:

-- wear gloves and, if possible, remove the carcass with a shovel or other disposable or cleanable utensil. Under no circumstances should the bird be touched with bare hands.

-- place the carcass in a plastic bag and seal it. Place this bag in another bag or a cardboard box.

-- if disposing of the carcass in the absence of other instructions, bury it in a location where it is unlikely to be disturbed by other animals.

-- thoroughly wash your hands with soap and water for 15-20 seconds.

House Cats

A few domestic cats, in addition to pigs, tigers, leopards, ferrets, and stone martens (a weasel-like mammal), have been infected with AI. The cats are believed to have been infected by eating uncooked diseased birds. Although no human cases of AI have been associated with contact with AI-infected cats, the following measures are recommended if there has been a verified AI infection in birds within the region:

-- keep domestic cats inside the house to avoid exposure to potentially infected birds;

-- avoid all contact with stray cats and keep them outside the house;

-- inform local veterinary authorities if your cat is sick and has possibly been in contact with birds;

-- strictly follow normal cat care hygiene rules. When cleaning cat litter boxes, wear gloves and thoroughly wash your hands with soap and water immediately afterward.

Families are encouraged to refer to the U.S. government’s one-stop web site on avian and pandemic influenza ( www.PandemicFlu.gov) with particular attention to the individual planning checklist, and the WHO website (www.who.int/en/) while doing their emergency planning.

How to Prepare for “Sheltering-In-Place”

Health professionals are concerned that the continued spread of a highly pathogenic avian influenza (H5N1) virus among animals in Asia, Africa, the Middle East and Europe has the potential to significantly threaten human health.  If a virus such as H5N1 mutates and spreads easily from one person to another, avian influenza may break out globally.  While there are no reports of sustained human-to-human transmission of avian influenza, the U.S. government and international health agencies are preparing for a possible pandemic. 

Depending on the severity of a pandemic, commercial airlines might drastically curtail or even cease operations.  Travel restrictions could also impede people from returning to the United States or fleeing to other countries.  For these reasons, it may make more sense to “shelter-in-place” (i.e., stay home and practice “social distancing” to avoid contagion) for an appropriate period of time.

United States Residents: The Department of Health and Human Services suggests that US residents prepare two weeks of emergency supplies (food, water, medicines, etc.) in order to shelter-in-place during an influenza pandemic.

American Citizens Abroad:  Due to varying conditions overseas, Americans abroad should evaluate their situation and prepare emergency supplies accordingly (non-perishable food, potable water, medicines, etc.) for the possibility of sheltering-in-place for at least two and up to twelve weeks.  Water purification techniques such as boiling, filtering and/or adding chlorine to locally available rainwater, swimming pools, lakes, rivers and wells may replace the need to store large quantities of water.

What can you do on a daily basis?  Cover your cough.  Wash your hands regularly with soap and water for at least 20 seconds to eradicate viruses and bacteria or apply a hand sanitizer with a minimum of 60% alcohol content when soap and water are not available.  Stay home if you are sick. Vaccinate yourself against seasonal flu.

Travel: American citizens living in or traveling to countries with human or animal cases of H5N1 virus should consider the potential risks.  Keep informed of the latest medical guidance and practical information and plan accordingly.  Consult www.travel.state.gov for the latest tips on international travel.

On-Line Resources: Detailed information about suggested preparations, as well as planning checklists, are available on the U.S. government’s one-stop web site on pandemic influenza (www.pandemicflu.gov), also the World Health Organization (www.who.int/en/) and the Centers for Disease Control (www.cdc.gov) websites.

Useful Links

For further information, consult the following websites:

http://www.avma.org/public_health/influenza/avian_faq.asp
http://www.fao.org/ag/againfo/subjects/en/health/diseases-cards/avian_cats.html
http://www.nwhc.usgs.gov/publications/wildlife_health_bulletins/WHB_05_03.jsp
http://www.oie.int/eng/en_index.htm