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People travelling abroad issued advice on bird flu

BMJ 2006; 332 doi: (Published 09 March 2006) Cite this as: BMJ 2006;332:570
  1. Michael Day
  1. London

    England has joined other European countries in advising people on how to avoid the H5N1 strain of avian influenza, as the virus continues its spread eastwards.

    Liam Donaldson, the chief medical officer for England, said that although H5N1 infections had not yet been reported in the UK it was “important that travellers from the UK have clear factual information to assist them.” A leaflet made available last week in general practices, health centres, and air and sea ports in England tells people travelling abroad not to visit bird or poultry farms and markets, to avoid close contact with live or dead poultry, not to eat raw or poorly cooked poultry and to wash hands often with soap and water.

    Human cases of H5N1 have so far been seen only in Turkey, Iraq, and east Asia. However, infections in birds have been found in Austria, France, Germany, Greece, Hungary, Italy, Slovakia, Slovenia, and now Poland.

    France has already warned its citizens not to handle dead birds and to avoid feeding ducks or pigeons, and the government has set up a telephone helpline and a website to offer advice and information. Switzerland has ordered poultry to be kept indoors, a precaution being taken by other European countries. Germany has stepped up measures to stop the spread of bird flu by ordering a ban on pets roaming free, after a dead cat was found to be infected with H5N1.

    The World Health Organization has not yet recommended travel restrictions to areas that have had outbreaks of H5N1 bird flu in birds or humans. However, it echoes advice from the UK government in advising travellers to avoid contact with live animal markets and poultry farms and with any free ranging or caged poultry. It notes that “direct contact with infected poultry, or surfaces and objects contaminated by their droppings, is considered the main route of human infection.”

    It says that risk of exposure is considered highest during the slaughter, defeathering, butchering, and preparation of poultry for cooking but that there is “no evidence that properly cooked poultry or poultry products can be a source of infection.”

    Peter Openshaw, professor of experimental medicine at Imperial College London and an expert in respiratory viral infections, said the precautions were sensible, but he stressed that the risk of infection to people was very low. He said, “The fact is that only around 200 people in the whole of the Far East have developed H5N1 influenza so far. It doesn't seem very good at infecting humans.”

    As the BMJ went to press the International Society for Infectious Diseases warned that Indonesia was currently the “hot spot” for human cases of bird flu. At present 27 cases (20 of which have been fatal) have been confirmed in the country by an external WHO collaborating laboratory. Last weekend China confirmed its ninth death from bird flu. A 32 year old man died in the south of the country, close to the Hong Kong border, prompting Hong Kong's Centre for Health Protection to predict that new cases in humans in Hong Kong were likely.

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