Bird Flu and the Alpha-1 Community

Medical Advisory from Robert A. Sandhaus, MD, PhD, FCCP Medical Director, AlphaNet

This special insert is intended to answer some of the concerns
Alphas have expressed regarding bird flu, what can be done to
decrease the risks of infection, and what the future may hold
with these types of infections.

Introduction

Bird Flu is an influenza virus (flu) that infects birds and has, rarely, been transmitted to humans. There is no doubt that “bird flu” is coming to North America. It has already come to Asia and Europe. There is tremendous uncertainty, however, about what the risks might be to humans. The form of influenza virus that causes the current epidemic infection in birds, known as the Influenza A H5N1 strain, is not easily transferred to humans. Worldwide, of the approximately 200 cases of human disease due to this virus, virtually all have been in individuals who had intense, prolonged exposure to sick birds. Unfortunately, about half of those infected individuals died. Thus far, there are very few documented cases of transmission from an infected person to another person and even then the virus has never been passed beyond that one person.

The major concerns regarding this virus are:

1. Will I get infected if I am exposed to a sick bird?
2. What is the risk that the virus may mutate or change into a form that could pass from person to person?
3. If I am at risk, what can I do to prevent or treat an infection with this virus?

In general, mutations that lead to changes in the virus that make it more infectious to humans happen in infected humans. The best way to prevent the virus from succeeding at human-to- human transmission is to keep the number of infected humans as low as possible. Surveillance programs are in place around the world to identify changes in the virus. Unfortunately, there is currently no vaccine or specific therapy that is uniformly effective against bird flu, although some existing anti-viral agents have shown activity in the test tube.

Is the Alpha-1 community at special risk?

When birds are infected, they excrete the virus in their feces. The feces dry and turn to dust. When infection has occurred in humans, the mode of infection has been by inhalation of feces from infected birds. Children working as bird handlers seem to be particularly susceptible to infection. Symptoms of infectionare very similar to any type of flu: fever, chills, body/muscle aches, cough, and sore throat. Those people who die of bird flu infection usually die from lung complications such as pneumonia and respiratory failure.

From these data it can be suspected that individuals with underlying chronic disease, especially lung disease, are at greater risk of serious complications and death if they become infected. The same is true for any flu that infects humans. There is no reason to believe that individuals with Alpha-1 are at greater risk of catching this virus than other individuals.

Specifics about plasma-derived products

There may be concerns about the plasma-derived products that are used to treat lung disease in Alpha-1. Since these products are derived from the pooled plasma donations of literally thousands of individual donors, many wonder whether a donor with bird flu might contaminate these products at some point.

This is very unlikely for several reasons. First, donors are evaluated before each plasma donation for fever and symptoms of illness. If any of these are present, the donor is rejected. Second, the procedures used to inactivate and eliminate viruses during the processing and packaging of all of these plasma products have been well documented to eliminate influenza viruses of all types. Thus, there is virtually no risk of bird flu infection transmission by these products.

Each manufacturer of these products has provided a statement regarding bird flu and product safety and these can be found on the AlphaNet website in the News section.

Measures to reduce the chances of infection

Logically, one should not spend a lot of time around sick birds! The types of birds that are kept as pets are not thought to be susceptible to bird flu. In general, the birds at greatest risk are domestic poultry and migratory waterfowl. The migrating birds will bring this virus to North America.

It is important to get your annual influenza vaccine. This will not protect you against getting the bird flu, but it makes it less likely that the bird flu will acquire the ability to directly infect humans, since this ability depends on genetic rearrangement between the bird flu and human flu.

If, in the future, you learn of a bird flu infection in your neighborhood, the current recommendation is for all who can to stay at home for two to three weeks. This is intended to stop the spread of infection and limit the likelihood that the bird flu will “learn” to spread from human to human. In order for such a plan to work, individuals will need to have a supply of basic necessities such as food and medications to last for two to three weeks. It is not necessary to stock up on these things now. There should be plenty of warning when the bird flu begins to show up in areas of North America.

As mentioned, there is some expectation that anti-influenza medications, such as Relenza®and Tamiflu®, may have some effectiveness against the bird flu virus. In general, Alphas tend to use Tamiflu®, since it is not recommended that Relenza® be used in individuals with lung disease (Relenza®is an inhaled medication while Tamiflu®is taken by mouth).

Tamiflu® has two uses:

1. It can be taken prophylactically by individuals who have been exposed to the flu virus to prevent infection.
2. It can be taken when someone is infected to shorten the duration and intensity of the infection.

 

It is important to note that when considering the use of Tamiflu® in someone who has the flu, it only works if Tamiflu® is started within the first 48 hours of an infection. Anyone considering taking an antiviral medication like Tamiflu® should consult his/her physician. These medications require a prescription and have known side effects that must be considered before using.

The Future

Work is moving forward to develop an immunization active against the bird flu. At present, it is impossible to predict whether bird flu will become the next major epidemic facing humankind or will simply be a tiny chapter in a future history of medicine. Airplanes have made the world such a small place that we can no longer be reassured that an infection that starts around the world will take months or years to find its way to North America. Keep an eye on the newspapers, TV news, and the Internet, and be in touch with your AlphaNet Coordinator. Stay informed. We promise to keep you up to date.