KARUNA MEDICAL COLLEGE-Bird Flu H5N1

What is avian or bird flu?
Scientists are concerned that the H5N1strain of bird or avian flu could spread across the globe and become the next flu pandemic, sickening and killing scores of people.

The H5N1 bird flu virus is spread when wild birds pass the virus along to birds such as chickens or ducks that are being raised for human consumption. While the wild birds do not seem to be affected by the virus, the livestock that contract the virus get very sick and many die.

Typically, avian or bird flu is not passed from birds to humans. However, in the past ten years, there have been hundreds of cases of bird flu in humans, and scientists believe that, if it continues to spread, there could be a flu pandemic. Most cases of H5N1 infection are thought to have occurred as a result of direct or close contact with sick or infected poultry.  That's because there is no natural immunity from bird flu in humans. Your body cannot develop antibodies, and, typically, hospitalization is required. Because of this, anyone is at risk for avian or bird flu, and that's one thing that raises the concern about a flu pandemic.



                                                              What is a flu pandemic?
While a flu pandemic is rare, it happens when a new flu virus spreads to people all over the world. With a flu pandemic, flu vaccine is typically unavailable in the early weeks, and then there is not enough flu vaccine to distribute to the population. With a flu pandemic, hospitals are unlikely to be able to support the scores of patients of all ages who present with serious flu complications. The economy may come to a grinding halt as scores fall ill from a flu virus strain that mystifies experts.

Flu symptoms with a flu pandemic are much more severe than the standard seasonal flu, and greater numbers of humans are at risk as the flu quickly spreads. As more people of all ages fall ill, travel may be restricted, offices and schools may close, and large public gatherings can be banned because these gatherings could become breeding grounds for more cases of an incurable flu.


                       There were three outbreaks of a flu pandemic in the 20th Century:

The Spanish flu in 1918-1919 killed 500,000 people in the U.S. and as many as 50 million people worldwide.
The Asian flu in 1957-1958 killed 70,000 Americans.
The Hong Kong flu in 1968-1969 caused 34,000 U.S. deaths. This strain is still around. The recent "Fujian flu" is a variant of the Hong Kong flu virus.
The swine flu (H1N1) in 2009-2010 sickened up to 89 million people and caused as many as 18,000 deaths.
Since there have been four flu pandemics in the past 100 years, scientists are convinced that another flu pandemic is inevitable and that any part of the population is vulnerable. The problem is that it is very difficult to tell the difference between a pandemic flu outbreak and a seasonal flu outbreak.

Officials claim that testing to determine the type of flu outbreak could take weeks. Major research is being done that will hopefully speed up the process of influenza testing so that if a flu pandemic is imminent, experts will be able to do everything they can to stop this potentially life-threatening illness.

                                                       What is the flu, anyway?
Influenza -- commonly called "flu" -- is a contagious viral infection that infects the nose, throat and lungs and normally occurs in late fall and winter months. Unlike a common cold, the flu virus has the potential to cause serious flu complications. Each year, the flu kills around 36,000 Americans and puts any age group at risk for flu complications.

Spreading through the upper respiratory tract and sometimes invading the lungs, the flu virus can make you very ill for a week or two -- even longer if you get flu complications such as pneumonia or have a chronic medical condition.

                       Aside from avian or bird flu, what are the other types of flu?
The flu virus is categorized into three types: A, B, and C. Type A flu viruses are responsible for major epidemics. That's because these viruses mutate every few years and are difficult to isolate and eliminate. In addition, the human body cannot develop complete immunity to the type A flu viruses.

Type B flu is a less common form of influenza. Although it normally has a milder effect on the body, it has been responsible for major outbreaks every three to five years. Type C flu is less common. While type C flu virus causes illness, the symptoms of type C flu are the mildest.

                                                       How is the flu virus spread?
The flu virus is typically spread from person to person through coughs and sneezes -- that is through "droplets" from the respiratory system. The flu normally enters through the nose and settles inside the respiratory tract.

                                                       What are the symptoms of the flu?
Unlike a common cold, the flu hits hard and fast with symptoms of fever (usually high), headache, extreme fatigue, dry cough, sore throat, runny or stuffy nose, muscle aches, and stomach symptoms, which are more common in children than in adults.

                                                  Who's at greatest risk for catching the flu?
Influenza occurs most commonly in school-age children. Still, the most severe cases of the flu typically occur in infants, older adults, and in those with weak or compromised immune systems.

                                                  Should I take antibiotics to fight the flu?
Antibiotics can't cure the flu; they treat bacterial infections and the flu is a viral infection. Sometimes, flu complications, such as pneumonia, bronchitis, and sinus and ear infections, occur. If these flu complications are bacterial infections, then antibiotics might be necessary.

There are "antiviral" drugs available that help treat the signs and symptoms of flu if they are taken within the first 48 hours of flu symptoms. The CDC recommends oseltamivir (Tamiflu) and zanamivir (Relenza). Both are effective against both influenza A and B viruses.

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KARUNA MEDICAL COLLEGE-Ebola

EBOLA

Q. How deadly is Ebola?

A. The Ebola strain in the current outbreak is the most lethal of the five known strains of the virus. It is called Ebola Zaire and usually kills up to 9 out of 10 infected people. But the high death rate might be due to a lack of modern medical care, Adalja says. “It’s hard to say exactly what the [death] rate would be in a modern hospital with all of its intensive care units.”

The CDC said in July the Ebola death rate in the West African outbreak is about 6 in 10, rather than 9 in 10. That shows that early treatment efforts have been effective, says Stephan Monroe, deputy director of the National Center for Emerging and Zoonotic Infectious Diseases at the CDC.

On July 31, the CDC issued a travel advisory recommending against non-essential travel to Guinea, Liberia, and Sierra Leone.

Q. What are the symptoms?

A. At first, the symptoms are like a bad case of the flu: high fever, muscle aches, HEADACHE, sore throat, and weakness. They are followed quickly by vomiting, diarrhea, and internal and external bleeding, which can spread the virus. The kidneys and liver begin to fail.

Ebola Zaire kills people quickly, typically 7 to 14 days after symptoms appear, Adalja says.

A person can have the virus but not show any symptoms for as long as 3 weeks, he says. People who SURVIVE can still have the virus in their system for weeks afterward.

The virus has been detected in semen up to 7 weeks after recovery, according to the WHO. But this is very rare, says Thomas Geisbert, PhD, a professor of microbiology and immunology at the University of Texas Medical Branch. Geisbert has been studying the Ebola virus since 1988.

Q. How does the virus spread?

A. Ebola isn’t as contagious as more common viruses, such as colds, influenza, or measles, Adalja says. It spreads to people by close contact with skin and bodily fluids from infected animals, such as fruit bats and monkeys. Then it spreads from person to person the same way.

“The key message is to minimize bodily fluid exposures,” Adalja says.

Q. What precautions should people take if they’re concerned they might come in contact with someone infected with Ebola?

A. “Ebola is very hard to catch,” Adalja emphasizes. Infected people are contagious only after symptoms appear, by which time close contacts, such as health care workers and family members, would use “universal precautions.” That's an INFECTION CONTROL approach in which all blood and certain body fluids are treated as if they are infectious for diseases that can be borne in them, Adalja says.

Even though the virus can be transmitted by kissing or sex, people with Ebola symptoms are so sick that they’re not typically taking part in those behaviors, he says.

Q. Is there a cure or a vaccine to protect against it?

A. No, but scientists are working on both. The National Institutes of HEALTH is taking part in human testing of an experimental Ebola vaccine, which began in early September. Testing for that vaccine is also taking place in the U.K. and Mali.

The agency expects to have results of that trial by the end of 2014. The NIH is also testing several other potential vaccines.

There is no specific treatment for Ebola. The only treatments available are supportive kinds, such as IV fluids and medications to level out BLOOD PRESSURE, a breathing machine, and transfusions, Adalja says.

An experimental treatment called ZMapp was given to Brantly and Writebol, among others. But HEALTH officials don't know if ZMapp aided in their recovery. A trial of ZMapp in 18 Ebola-infected rhesus monkeys prompted recovery in all 18, researchers reported. No ZMapp is available for now, and officials are trying to ramp up production.

Sacra received a different treatment, called TKM-Ebola. He also received a blood transfusion from Brantly, a friend. HEALTH officials don't know if any of these treatments helped with his recovery.

Duncan and Mukpo both received an experimental drug named brincidofovir. The drug is being tested for effectiveness against cytomegalovirus and adenovirus, but test-tube experiments done at the CDC and National Institutes of HEALTH reveal it showed effectiveness against Ebola, according to its manufacturer, Chimerix Inc.

Mukpo and Pham also received blood transfusions from Brantly.

Q. Why do some people SURVIVE the virus?

A. That’s hard to say. Adalja thinks several things might play a role, such as a person's age and genetic makeup, and whether they have other medical conditions. Those aren't proven reasons, though.

Q. How can the outbreak be stopped?

A. Simple steps to control infection, such as gowns, gloves, and eye protection, can help halt the spread of Ebola, Adalja says. Public HEALTH officials will have to wait 6 weeks after the last case is reported before declaring the outbreak over, he says.

Keys to stopping Ebola include identifying patients; providing treatment, preventing the spread, and protecting HEALTH care workers, including following patients’ contacts and monitoring them for symptoms; and preventing future cases through education and urging people to avoid close contact with sick people or bodies, Frieden has said.

But, he said, turning the tide in Western Africa is “not going to be quick or easy. Even in a best-case scenario, it would take 3 to 6 months or more.”

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