Warden Message

Avian Influenza A (H5N1) and Pandemic Influenza - July 17

This fact sheet alerts Americans to the Department of State's preparedness efforts with respect to a possible influenza pandemic. The Department of State emphasizes that in the event of a pandemic its ability to assist Americans traveling and residing abroad may be severely limited by restrictions on local and international movement imposed for public health reasons either by foreign governments and/or the United States. Furthermore American citizens should take note that the Department of State cannot provide Americans traveling or living abroad with medications or supplies even in the event of a pandemic.

Background - H5N1 Avian Influenza A

Countries continue to report cases of avian influenza A (H5N1) commonly referred to as "bird flu" in their domestic and wild bird populations. In addition countries are reporting H5N1 in other wild and domestic animal populations. A small number of confirmed cases of H5N1 among humans have been reported some of which have resulted in death. More information is available on the World Health Organization (WHO) website http://www.who.int/csr/disease/avian_influenza/country/en/. Please refer to this website for the most up to date information on the countries affected by H5N1 and the number of deaths.

The vast majority of the reported human cases have resulted from direct contact with H5N1-infected poultry. Although there is evidence to suggest very limited human-to-human transmission in family groups involving close exposure to a critically ill member there is no evidence that the virus can be easily or sustainably transmitted from human-to-human. The U.S. Department of Health and Human Services Centers for Disease Control and Prevention (DHHS/CDC) the WHO and the Department of State are nonetheless concerned about the potential for the virus to adapt or mutate into a strain that can be easily transmitted in a sustained manner among humans a characteristic that could result in a human influenza pandemic and are working closely with other partners toprepare for the possibility of pandemic influenza. Information on the U.S. Government's overall response and efforts is available at http://www.pandemicflu.gov/.

Travel and Avian Influenza A

The Department of State the DHHS/CDC and the WHO have not issued any health precautions travel alerts or warnings for H5N1 infected areas. However the DHHS/CDC advises travelers to H5N1 affected countries to avoid poultry farms contact with animals in live food markets and any surfaces that appear to be contaminated with feces or fluids from poultry or other animals and to eat only thoroughly cooked poultry products. American citizens traveling to or living in H5N1 affected countries should consider the potential risks and keep informed of the latest medical guidance and information in order to make
appropriate plans. Specific DHHS/CDC travel information relating to H5N1 including preventive measures is available at http://www.cdc.gov/flu/avian/index.htm and http://www.cdc.gov/travel. WHO guidance related to avian influenza is available at
http://www.who.int/csr/disease/avian_influenza/en/.

Additional general country information can be obtained from the Department of State's Consular Information Sheets at http://travel.state.gov/ and embassy and consulate
websites at http://www.travel.state.gov/travel/tips/embassies/embassies_1214.html. You may also call the Department of State's toll-free number 1-888-407-4747 or if calling from overseas 202-501-4444.

Prevention Response and Treatment - Take Charge of Your Plans

A vaccine for humans that is effective in preventing infection with the avian influenza A (H5N1) virus is not yet available. Based upon limited data the DHHS/CDC has suggested that the anti-viral medication Oseltamivir (brand name- Tamiflu) may be effective in treating avian influenza A. U.S. embassies and consulates do not have supplies of this drug for use by private American citizens abroad. The Department of State has pre-positioned
supplies of the drug Tamiflu at its embassies and consulates worldwide for eligible U.S. Government employees and their families serving abroad. Americans should also be aware of the potential health risk posed by counterfeit drugs including those represented as Tamiflu by scam artists who sell products on the internet or in countries with lax regulations governing the production and distribution of pharmaceuticals. For more information on counterfeit drugs please visit the Food and Drug Administrations (FDA) questions and answers for counterfeit drugs at http://www.fda.gov/oc/initiatives/counterfeit/qa.html.

In addition the Department of State has asked its embassies and consulates to consider preparedness measures that take into consideration the fact that travel into or out of a country may not be possible safe or medically advisable during a pandemic. Guidance on how private citizens can prepare to shelter in place including stocking food water and medical supplies is available at the http://www.pandemicflu.gov/ website. Embassy stocks cannot be made available to private American citizens abroad and we encourage people living in an area with outbreaks of H5N1 to prepare appropriately.

It is also likely that governments will respond to a pandemic by imposing public health measures that restrict domestic and international movement further limiting the U.S. government's ability to assist Americans in these countries. These measures can be implemented very quickly. Areas of known H5N1 outbreaks in poultry have been quarantined by governments within 24 hours restricting (if not preventing) movement into and out of the affected area.

Americans who are planning travel to a country that has reported the virus or who are concerned about avian influenza are advised to monitor the DHHS/CDC and the WHO
websites for the latest information.

CDC Contact Information

Public Inquiries:
English (888) 246-2675
Spanish (888) 246-2857
TTY (866) 874-2646
Mon-Fri 8am-11pm EST
Sat-Sun 10am-8pm EST

Address:
Centers for Disease Control and Prevention
1600 Clifton Rd.
Atlanta GA 30333
USA (404) 639-3311

Traveler's Website

http://www.cdc.gov/travel

WHO Liaison Office in Washington DC

Contact Information:
Telephone: (202) 974-3787
Facsimile: (202) 974-3789

Address:
WHO Liaison Office
1889 F Street N.W. Suite 369
Washington D.C. 20006 USA

Frequently Asked Questions about Avian Influenza A (H5N1) and Pandemic Influenza

Why isn't the U. S. Government providing Tamiflu to private Americans overseas?

The Department of State lacks the legal authority to provide any type of medication including Tamiflu to private American citizens. State Department physicians and medical staff have authorization to treat only those official employees and their families who are under Chief of Mission (the principal officer in charge of a diplomatic facility of the United States) authority.

What if I get sick when I am outside the U.S.? If I have a pre existing medical condition is there anything different I should do? How do I locate a local doctor when I am in another country?

Please see the Department's travel tips brochure on health issues including the importance of obtaining adequate medical insurance to cover overseas medical emergencies:
http://www.travel.state.gov/travel/tips/health/health_1185.html

If you have preexisting medical problems you should carry a letter from your physician describing the medical condition and any prescription medications including the generic name of prescribed drugs.

For a current list of doctors/hospitals in the country to which you are traveling please visit the embassy or consulate website which can be accessed through http://usembassy.state.gov/. The list is generally found under the Embassy or Consulate's link for Consular Services or American citizen services.

Will the U. S. government evacuate Americans from a foreign country in the event of a pandemic?

Current medical thinking suggests that sheltering in place may be the appropriate response to the start of an influenza pandemic in certain countries or regions. In this scenario people would be advised to exercise "social distancing" and avoid any form of public gathering where transmission of the disease could occur. Mass transit including air travel is a common venue for human-to-human transmission of viral infections due to the proximity of travelers to each other.

Whether the U.S. government evacuates anyone will depend on a variety of country-specific factors. Each U.S. embassy and consulate has been asked to develop a
contingency plan in the event of a pandemic and to identify events that might prompt them to send employees and/or their dependents out of the country assuming such
travel is possible. Should this decision be made the Department of State will communicate this to the private American community so that people can plan accordingly. As in any other crisis the Department of State will assess the availability of commercial transportation the ability of people to travel to the United States or a third country and other related factors in deciding on appropriate actions to assist official and private
Americans.

As a private American citizen living overseas what can I do today to help prepare myself and my family for a possible influenza pandemic?

Several simple measures can be taken now that will put you and your family in a better state of readiness should such a pandemic occur. These measures are outlined at
http://www.pandemicflu.gov/planguide/. If you are living overseas for work or education contact your sponsors and find out what plans they have regarding repatriation or
evacuation; they may also have advice for you about obtaining an influenza vaccination (if and when a vaccine becomes available) anti-viral medication and employing other suggested preventive measures as the need arises.

What precautions should I take if I live in or visit an area affected by H5N1 "bird flu"?

Avoid contact with live birds chickens ducks turkeys and geese and their feces feathers and pens if at all possible. Children in particular should be taught these precautions and small children may need to be supervised for their protection. Do not purchase or agree to adopt new pet birds from an area in which H5N1 influenza has been reported. Avoid poultry products from areas with H5N1-infected birds. Do not transport live or dead poultry even if it appears to be healthy.

All foods from poultry including eggs and poultry blood should be cooked thoroughly. Egg yolks should not be runny or liquid. Because influenza viruses are destroyed by heat the cooking temperature for poultry meat should be 74 C (165 F).

Avoid cross contamination of other foods by use of separate kitchen utensils and surfaces exposed to raw poultry. Wash hands with soap and water after any poultry
contact. For more information on food handling and safety please visit the United States Department of Agriculture (USDA) website at http://www.fsis.usda.gov/Fact_Sheets/index.asp.

Sanitary professionals health-care workers and others who must travel to H5N1-infected areas and work directly with infected birds poultry and humans should follow approved
precautions for reducing the risk for infection with H5N1 virus. See DHHS/CDC guidance at
http://cdc.gov/flu/avian/professional.

Can my domestic animals get bird flu?

There have been reports of H5N1 infection in domestic cats pigs tigers leopards ferrets and stone martens. The domestic cats are believed to have been infected by eating raw H5N1-infected birds. Although no human cases of avian influenza A have been associated with contact with infected cats you should keep your cats inside if there has been a verified outbreak of H5N1 in your area. In addition avoid contact with stray cats and inform your local veterinarian if your cat becomes sick after having had contact with birds. You should always follow strict hygiene rules when disposing of animal waste or caring for your pets.

At this time there is not enough information to determine if dogs can become infected with H5N1 virus. For more information about H5N1 infection in domestic animals see
the DHHS/CDC website at http://www.cdc.gov/flu/avian/gen-info/qa.htm

Current information about avian influenza A (H5N1) and pandemic influenza can be found at:

http://www.cdc.gov/flu/avian/gen-info/qa.htm

http://www.cdc.gov/travel

http://www.who.int/

http://www.pandemicflu.gov/

http://www.travel.state.gov/

National Strategy for Pandemic Influenza: Implementation Plan