Following are questions regarding "practical pointers" to keep in mind about bird flu, along with responses from Dr. William Schaffner. Schaffner is chair of Vanderbilt University School of Medicine's department of preventive medicine, and an infectious disease consultant for the World Health Organization and the Centers for Disease Control.
Q: For people who have compromised immune systems because of leukemia or other diseases -- what can we do? Should we leave town if a case is reported locally? Keep our kids out of school? -- Carolyn, Atlanta
A: A large percentage of the U.S. population has a medical condition that puts them at increased risk of the complications of influenza. This includes persons with compromised immune systems (leukemia, HIV infection, steroid therapy, etc.) as well as those with chronic lung or heart disease -- not to mention young children (6 to 23 months of age) and persons of advanced age. All these groups are at increased risk of developing the complications of influenza.
There are two basic strategies to protect oneself against infection. The first is to get yourself into the best health status that you can. Make sure that your weight is appropriate, that your illness is well-treated by your physician and that you follow your medical regimen closely. Stop smoking if you do so -- and send smokers in your family out on the porch if they insist on lighting up. Get into the habit of washing hands frequently.
It is not practical or useful to "head for the hills" if pandemic influenza involves your community. However, staying at home and minimizing social interactions with crowds is prudent. Thus, avoid concerts, movies, shopping at the mall and, perhaps for a time, even religious services. This likely will reduce your chance of coming into contact with someone who is spreading the influenza virus. Consider using a surgical mask. Please realize that there are scant data to show that masks actually offer protection in the community (use in hospitals by health care workers is another story). Indeed, some public health authorities are wary of recommending masks because they fear that some persons with flu-like symptoms will put on masks and go out into the community and contribute to the spread of the virus. Obviously, masks should be used sensibly.
Your local health department and local school board will close public schools if the circumstances indicate. I would advise against keeping your child at home based just on your own decision.
I anticipate that persons who have compromised immune systems and other similar conditions will be extra careful in following the advisories from national and local public health authorities that will help them avoid infection.
Second, in addition to the above, vaccine to protect against the pandemic virus will be offered. Persons at risk of serious complications of influenza will be near the very top of the priority list for getting the vaccine. The times and locations for vaccination will be announced by the news media. Stay tuned.
What type of either house or commercial disinfectant products help to avoid the spreading of the bird flu? -- Abraham, Novato, Calif.
A: The World Health Organization recommends that for hands, bird flu can be killed by washing thoroughly with warm soap and water. If no water is available, use a 70% alcohol rub or gel, then wash hands when you are able. For surfaces, wipe clean with a disinfectant such as Lysol or one with sodium hypochlorite, then wash with soapy water. [World Health Organization]
How soon after being infected do bird flu symptoms start? -- Nada, of Nigeria
A: Please be aware that there is NO bird flu in the United States (indeed, the entire Western Hemisphere) at this time. As with "ordinary" influenza, symptoms begin 1 to2 days after a person has been exposed to the virus.
Note that the infected person usually starts to produce virus in their respiratory secretions and saliva before they become sick themselves. Thus, while persons still are feeling perfectly healthy, they can transmit the virus to other persons. This period of viral "shedding" before the onset of illness can be as long as 24 hours. This characteristic of influenza contributes to its rapid spread - and makes its containment difficult.
If you are infected with bird flu and survive -- does that mean you are then immune to getting it again? Are any of us immune to it already? -- Paul, Brookline, Mass.
A: None of us is immune to bird flu at present. If the virus arrives in the U.S. and if it acquires the capacity to be transmitted easily from person-to-person (two big "ifs"), those persons who become infected will be immune after they recover.