BIRD FLU

GENERAL RECOMMENDATIONS

This document will be updated on a monthly basis (or more often if necessary)

This document was updated and approved by the Director’s Committee of September 23, 2005

1 Inoculation against the flu before departure or on the field

2 On-site briefing by the coordinator

3 When to give the alert

4 What to do in case of Fever over 38°C with cough

5 Material and drugs available to the teams in Asia and Eastern Europe

1 Inoculation against the flu before departure or on the field for MDM staff (national and expatriated)

This will not prevent an infection by the virus of the bird flu but contributes to limit the emergence of a new human virus by reducing the opportunity of an infection to humans simultaneously to the bird virus and human virus.

The vaccine has to be made before departures to or on the field in Vietnam, Cambodia, Thailand, China, Indonesia, Myanmar, Malaysia, Mongolia, Nepal, Sri Lanka, Afghanistan, Pakistan, Uzbekistan, Russia, Belarus, Georgia, Moldavia (countries where bird flu affecting animals have been inventoried or neighboring countries or countries where we do not have information but that we think are affected).

2 Briefing about the bird flu

To be given to MDM members already on the ground (expatriated and national) or due to leave for the countries mentioned, even for a simple transit.

The briefing has to be ideally done by the coordinator present on the ground. If not possible by the Desk responsible for that mission.

The briefing has to include data on the bird flu, how to protect oneself and when to alert or notify.

2.1 What is bird flu?

The bird flu or flu of the chicken is an infection of birds due to a virus, a virus Influenza type A. This disease of birds, known for more than a 100 years, is spread all over the world. At present there are, in various countries, homes of épizooties (a sort of epidemic amongst animals) of bird flu; such homes were tracked down in Cambodia, in Vietnam, in Thailand, in China, in Malaysia and in Indonesia. Such épizooties have already happened in the past (in the USA 1983-1984, Hong-Kong 1997, Italy 1999-2001) killing millions of poultry.

There exists several sub types of virus Influenza A affecting birds, but so far those which created very murderous épizooties are H5 and H7. The current one is a H5N1.

Ducks are the natural reservoirs of these viruses. They carry the virus and pass it on but they are rarely sick from it. Domestic poultry, on the other hand, are very sensitive to it (especially chicken and turkey) and, it is amongst them, that we see the most mortal epidemics.

The virus is passed on from bird to bird but also from bird to other animals such as pigs and humans. Cases of this type are well documented in Thailand, Vietnam and Cambodia. In humans the disease appears in the form of fever, cough, muscular pains and very often diarrhea at the beginning. The contagion is made by air traffic (essentially) or by direct contact. Man to man transmission although rare is possible. The incubation (time delay between being infected and feeling sick) is from 1 to 3 days after the contaminating contact. It can go up to 7 days. The person is contagious since the day before the appearance of the first clinical signs.

2.2 How to protect oneself?

Ø Avoid contacts with poultry of all types including ducks, and avoid generally contacts with birds. Avoid also contacts with feathers, excrements of birds.

Ø Do not take a bird or a poultry as a pet

Ø Do not sleep near breeding of poultry

Ø Do not transport alive or dead poultry

Ø Do not prepare yourself poultry for food (cutting throat for example) from a zone of infestation.

Ø Take all the measures to make sure that the poultry or products stemming from poultry are correctly prepared and can be eaten without danger. The chickens must be cooked well (no pink juice, no pinkish meat). Well- cooked eggs (hard-boiled eggs) are not infectants. On the other hand, fresh eggs and its shells are potentially contaminating.

If you were nevertheless in touch with poultry in a zone of infestation (including have walked on ground soiled by excrements of poultry)

Ø Wash your hands with water and soap.

Ø Remove your shoes outside of your house, and wash them carefully and then wash your hands.

Ø Verify your temperature once a day during at least 7 days after contact. If the fever goes over 37.5°C consult a doctor.

3 When to give the alert to the local authorities

Ø When we learn that many poultry died in a breeding area

Ø When, in the medical services where you work, somebody is hospitalized for flu syndrome.

4 What to do in case a member of the MDM team has fever and cough

Medical consultation which will determine the need of testing or not, will establish a diagnosis (always think of malaria in countries where it is endemic!) and will decide on a hospitalization or not according to the severity (hospitalization if respiratory difficulties). The consulted doctor will notify the authorities in case of flu-like syndrome.

Notify the Desk in charge of the mission during office hours or the desk designated to do the outside-office-hours shift by calling 00 33 6 03 12 84 83

In case of flu-like syndrome and of non severe contact with treatment at home:

Ø Look for the other persons who could have been exposed at the same time and the persons in contact before the person became sick (the contaminated person is contagious before being sick)

- For all these persons, check the temperature until the 7th day after the last contact or exposure.

- For those exposed at the same time and apparently healthy (or actually healthy), if the exposure is of less than 48 hours, use an antiviral, Oseltamivir (Tamifluâ) 75mg 2 times a day during meals during 5 days. In other words the incubation period has to be short (less than 48 hours) to be able to treat the co infected. After 48 hours it is useless to treat the co infected.

Ø For the patient

- Specific anti viral treatment Oseltamivir 75mg by oral way, twice a day, during 5 days (during the meals)

- Surveillance: temperature twice a day until cured, consult again if the temperature increases; respiration, consult again if respiratory difficulty; appearance of other signs which did not exist at the beginning, consult again; state of spits, consult again if they become yellow or green

- The patient should wear a surgical mask when somebody enters his room or when he goes out of his room

- Limit the visits

Ø For the persons who take care of the patient (to bring the meals for example or for medical surveillance) or who visit him(her):

- Individual respiratory protection type FFP2 or if not possible FFP1

- Systematic hand-washing when going out of the room

- Temperature check-ups until the 7th day after the last contact

Visit limitation, hand-washing for the persons in contact and the wearing the mask must be maintained 7 days after the disappearance of the patient’s fever.

List of material which you should have at all times:

It includes enough drugs and material in case all MDM staff, national and expatriated, (including the families of the expatriates) is sick or co exposed

Clinical thermometer: 5 times the number of people

Surgical Mask: 5 times the number of people

Mask for respiratory protection FFP2 or FFP1: 15 times the number of people

Tamiflu ® 75 mg ( Oseltamivir): 10 tablets times the number of people

For reminder (but refer to the chapter “In case of non severe bird flu-like syndrome with treatment at home” for details)

The thermometers are for the sick, the co exposed and the people in contact

The surgical masks are for the sick patients

The masks for respiratory protection are for the people who take care of the sick and for those people visiting the sick

The Tamiflu ® tablets are for the sick patients (10 tablets for one treatment) and for the co exposed if the date of exposure is less than 48 hours.