Warnings of a potential avian influenza pandemic have the nation and medical community on alert—but those who would be on the front lines appear to be taking the threat in stride.
One of the few concrete steps physicians can take at this time is to ensure that patients are vaccinated against conventional influenza strains, said Donald M. Poretz, M.D., vice president of the Infectious Diseases Society of America.
Such vaccination will address the immediate concern of influenza outbreaks in the United States and, according to World Health Organization guidelines, could be useful for preventing coinfection with H5N1 and a human influenza strain.
According to the WHO, doing so will decrease the opportunity for genetic reassortment of the avian H5N1 strain with genes from a human (H1 or H3) strain and thereby reduce the likelihood that a novel pandemic strain will emerge from the current situation in Asia.
If an avian influenza pandemic does occur, diagnosis could prove quite difficult, because the symptoms of H5N1 are similar to those of “regular flu,” said Doug Campos-Outcalt, M.D., chair of the department of family and community medicine at the University of Arizona, Phoenix, and former chair of the American Academy of Family Physicians' commission on clinical policy.
There doesn't appear to be—and there shouldn't be—major fear or panic in the United States regarding a pandemic at this point, he told this newspaper.
However, European Union (EU) public health experts have begun to rally after the confirmation by the WHO that, in addition to Asia, the H5N1 strain of the influenza virus has been isolated in poultry in Turkey and Romania, bringing the disease to Europe's doorstep. Among the steps taken by the EU was a ban on the importation of live birds, poultry meat, and other poultry products from Turkey and Romania, according to a statement posted on the EU Web site.
“We need to look at the information objectively, and not emotionally. I don't believe anyone can make a statement as to whether or not there will be a pandemic, but the likelihood is that there will be at some point, so one has to be prepared,” said Dr. Poretz, professor of medicine at Georgetown University in Washington.
Dr. Campos-Outcalt said that “everyone I know is fatalistic about it. Everyone knows it's coming, but it's difficult to prepare for.”
Beyond preventive hygiene measures, such as hand washing and covering one's mouth when coughing or sneezing, that are important for preventing transmission of any influenza virus, most preparations for a pandemic are “out of the hands of ordinary physicians,” said Dr. Campos-Outcalt.
When it comes to potential patient requests for antiviral medications such as oseltamivir, “I would encourage physicians to prescribe as recommended by the CDC and the manufacturer,” said Dr. Campos-Outcalt. The CDC's influenza page is located at www.cdc.gov/flu/
The watch-and-wait mode is an appropriate place for individual physicians to be right now, said Bill Hall, a spokesperson for the Department of Health and Human Services.
HHS is maintaining open lines of communication with public health departments, and through those departments is working to keep physicians informed of world events related to the spread of avian influenza—particularly the H5N1 strain that is rampant in Asia, has spread to numerous other areas, continues to mutate, and has jumped from birds to multiple other species.
While there is a sense of urgency, there is, at this point, no influenza strain that is causing a pandemic, thus there is no alert to physicians with regard to a pandemic, Mr. Hall said in an interview.
In fact, the only panic—as in people running through the streets with arms flailing—is occurring in the media, Mr. Hall said.
According to information from the WHO, IDSA, and various research projects, the H5N1 avian influenza strain does appear to have the potential for developing efficient person-to-person transmission capability, which it currently lacks, and which could be the bridge between the current situation and a future pandemic.
Should the virus obtain this capability, H5N1 could circle the globe within weeks or months, and could kill as many as 150 million people, according to a WHO estimate.
At press time, the WHO had confirmed 117 cases of human infection with H5N1 influenza, with cases in Vietnam, Thailand, Cambodia, and Indonesia. Human-to-human transmission has been documented in only two of those cases—both from a single household in Vietnam. The fatality rate among these cases is over 50%.
Infection in animals has been more widespread.
The virus's ability to mutate and infect additional species, including cats, leopards, tigers, and pigs, is another source of that urgency.