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Influenza, Avian Influenza, Pandemic Influenza FAQ

These are being continually updated as more information comes to hand, and are available at www.moh.govt.nz/pandemicinfluenza.

Frequently Asked Questions

Influenza, Avian Influenza (Bird Flu) and Pandemic Influenza

What is Influenza?

Influenza (the flu) is a highly infectious illness caused by a virus. It is much more serious than a common cold and will leave you ill for up to 10 days. Symptoms of the flu start suddenly and include: a high fever, headache, muscle aches and pains, fatigue, cough, sore throat, or a runny nose. Influenza can be a mild or severe illness depending on the type of influenza virus causing it, and the age and general health of the person affected. It may take up to three days to show symptoms when you catch the flu.

Anyone can get influenza — being fit, active and healthy does not protect you from getting this virus.

Anyone can die from influenza — it kills at least 100 New Zealanders every year, including some young, fit people.

Can I do anything to prevent myself getting it?

Every year you can ask your doctor to vaccinate you against the flu. As the influenza virus changes frequently, new vaccine against the new virus is made every year. To get your immunity to the new virus you will need to get the new vaccine.

The flu is very easily spread by sick people who cough and sneeze. To reduce the chances of getting the flu there are also things you can do, such as ensuring good health hygiene habits. If you have the flu, you should stay home from work, avoid public places and close contact with others. If you have the flu, you should always cough and sneeze into a disposable tissue and wash your hands afterwards.

What is Avian Influenza (Bird Flu)?

There are many types of influenza virus, some of which infect other animals including birds. The viruses that infect birds are avian influenza viruses. Very rarely, an avian influenza virus can also infect people. One of these viruses - H5N1- has infected some people who
have caught it from having close contact with infected birds .

Avian influenza can cause severe flu-like symptoms in people and may result in death. It has not been shown for sure that anyone has caught avian influenza from another person. If this has happened it has been very rare.

There are currently no commercially available vaccines that will protect people against disease caused by H5N1.


Is Avian Influenza transmissible to humans?

Yes, very rarely, an avian influenza virus can also infect people. The current avian influenza virus – H5N1 – has infected some people who have caught it from having close contact with infected birds.

Since December 2003, widespread outbreaks of H5N1 in birds in Asian countries have been associated with human cases and deaths in Asia.

For more information on avian influenza and the significance of its transmission to humans, see the World Health Organization website http://www.who.int/mediacentre/factsheets/avian_influenza/en/index.html

What are Avian Influenza symptoms in humans?

The exact symptoms, incubation period and duration of avian influenza in people are not known, because there have not been enough cases. Generally the symptoms are similar to those for people infected with human influenza virus, although the severity of the illness may differ. Symptoms generally appear three to seven days after exposure and can last up to seven days.

Why are health authorities concerned about Avian Influenza?

The World Health Organization is worried that an avian influenza virus might change so that it has the ability to easily spread from person to person, or mix with a human influenza virus resulting in a new strain of influenza virus that can do this. This could trigger an influenza pandemic.

What is an influenza pandemic?

An influenza pandemic occurs when a new strain of influenza virus emerges, spreading around the world and infecting many people in a very short time.

An influenza virus capable of causing a pandemic is one that people have no natural immunity to and can easily spread from person to person. It may cause severe disease. An influenza pandemic could cause many deaths and could occur at any time. It could happen at any time of the year, not just winter.

What are the symptoms of an influenza pandemic?

The symptoms of pandemic influenza are the same as seasonal influenza. This includes: The sudden start of a high fever, headache, muscle aches and pains, fatigue, cough, sore throat, or a runny nose. The virus can cause a mild or severe illness depending on the type of influenza virus and the age and general health of the person affected. It may take up to three days to show symptoms.

How likely is an influenza pandemic?

It is certain an influenza pandemic will happen one day. There are many bird flu viruses circulating in some countries at present. One of these, the H5N1, could become a pandemic influenza virus at any time if it changes so it can be easily spread from human to human.

How often do pandemics occur?

There were three influenza pandemics last century, in 1918, 1956-57 and 1968.

What caused them?

All three pandemics last century were caused by different types of bird flu viruses.

Could migratory birds "import"avian influenza virus to New Zealand?

Migratory waterfowl (such as ducks and geese) are carriers of the avian influenza virus. It generally does not make them sick, but they excrete the virus. The virus they leave in fields or water can then infect domestic birds.

Fortunately New Zealand is not on the regular migratory pathways of any waterfowl. The small number which do reach New Zealand mostly originate from southern Australia.

Other migratory birds such as shorebirds including the bar-tailed godwit, lesser knot, ruddy turnstone, Pacific golden plover etc, visit estuaries along the Asian coastline, Philippines and Australia on their annual migrations south from arctic Russia . They are not "waterfowl" and are not regarded as a high risk for introducing avian viruses into New Zealand.

The Ministry of Agriculture and Forestry (MAF) is currently undertaking surveillance in wild birds to assess the influenza status of waterfowl and shore birds. It is not known why some strains of influenza become virulent in some species under certain circumstances while others do not, but it is thought that inter-species mixing (i.e. quails, geese, ducks and chickens) and high population densities, such as occur in intensive poultry farming and bird markets in China and other Asian countries, may favour interspecies transmission of the viruses.

Avian influenza in New Zealand is notifiable . If you have concerns or questions about avian influenza in New Zealand birds, please contact the MAF Emergency Pest and Disease Hotline on 0800 809 966.

How can avian influenza be controlled in birds?

The most important control measures are surveillance, identification and rapid destruction (culling) of all infected or exposed birds, proper disposal of carcasses, and the quarantining and rigorous disinfection of farms.

Restrictions on the movement of live poultry, both within and between countries, are another important control measure.

I have chickens. How will I know if my flock has got avian influenza?

The disease can be variable, depending on species, age, virus type and other factors like concurrent bacterial infections. The main symptoms to look for in poultry are:

- Sudden and unexplained deaths

- Rapid spread of disease throughout the flock

- Depression and loss of appetite

- Drop in egg production

- Nervous signs

- Swelling and blue combs and wattles

- Coughing, sneezing and diarrhoea.

Mortality from Highly Pathogenic Avian Influenza (HPAI) is usually very high, with deaths up to 100 percent over just a few days. Less virulent forms of the virus, Low Pathogenic Avian Influenza (LPAI) may show as mild respiratory disease, depression and drop in egg production in laying birds.

Please call the MAF Emergency Pest and Disease Hotline on 0800 809 966 if you suspect your birds may be infected with avian influenza.


What could happen in an influenza pandemic

Who will decide if the world is having a pandemic?

The World Health Organization (WHO) will determine when a virus such as the avian flu virus is spreading from human to human in sufficient numbers to constitute a pandemic.

Many governments and the WHO have intensive surveillance programme to track the spread of avian flu. This programme will provide global early warning of human infections so Governments can begin implementing "pandemic alert"phases designed to track the progress of the disease spread nationally.

Can a pandemic be averted?

No one knows for sure. Influenza viruses are highly unstable and difficult to predict. However, health authorities such as the World Health Organization remain optimistic that if the right actions are taken quickly, an influenza pandemic can be averted. For more information, see the WHO website http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/index.html#isthere

Who will be in charge if there is a pandemic in New Zealand?

The Government will ensure there is an appropriate response from all agencies involved. The Ministry of Health will take the lead in all national health-related matters.

Will New Zealand stop travellers from coming into the country in an effort to stop the spread of disease?

The details of how New Zealand would manage its borders in the event of a pandemic are still being worked through. Because we are an island nation, active management of the border - ranging from partial restrictions to full closure - needs to be considered among the range of options as we plan our response. Other countries are also considering this issue.

Any final decision on border management will be made by the Government with input from a range of government departments.

What could happen in New Zealand if there is a pandemic?

A pandemic could mean so many people are sick that it will affect workplaces, schools, hospitals and many other services.
Some workplaces and schools may close. Normal health and other services may not be available for several weeks. You may be asked to care for yourself and others at home.
There would be public announcements on TV, the radio and through other media channels that there is an influenza pandemic and information about what to do and where to go for help.

How many people could get sick or die if a pandemic virus reaches New Zealand?

This is difficult to say because it depends on many factors, such as the severity of the pandemic and who it affects most.
However research published in the New Zealand Medical Journal earlier this year suggested a flu pandemic could result in the deaths of up to 3700 New Zealanders, with as many as 20,000 people requiring hospital care and just over one million people needing to see a health professional.

How will the New Zealand health system cope with a pandemic?

There is no doubt that in a severe pandemic, hospitals and primary care practitioners such as GPs will find it difficult to deal with large numbers of people with the flu. The Ministry of Health is considering and planning for other possible options such as community assessment centres for people with the flu. People may also be asked to look after each other at home and given information about how best to do so.

In a pandemic, what is likely to happen to elective services offered by hospitals?

Individual District Health Boards will decide whether they are able to continue offering elective services.

Can health professionals be required to turn up to work if there is a pandemic?

No one can be required to attend work. One of the important factors to consider when developing pandemic plans is how to keep essential services operating when staff might be away. In a pandemic, many people, including health professionals, are likely to become sick.

How will New Zealanders get treatment or health advice in a pandemic?

This will depend on the severity of the pandemic and how many people it affects. If you are sick you may be asked to phone your local doctor or nurse for advice, rather than visiting a waiting room and potentially spreading germs. The Ministry of Health is also investigating the possibility of setting up community assessment centres, where people who are sick with influenza go to be assessed.

You will also be able to ring the national free 24-hour health advice number, Healthline (0800 611 116). This line is staffed by registered nurses.

Many people may be asked to care for themselves and their family members at home.

How will I know what to do in a pandemic?

There would be public announcements on TV, the radio and through other media channels, and regular updates using a variety of communications channels.

What should people do at home to deal with an influenza pandemic?

Stay home if you are sick and keep away from other people -- avoid visitors and visiting others.

Wash and dry your hands before handling food, after coughing, sneezing, using the bathroom, wiping or nose-blowing (whether your nose or your child's), and when looking after sick people.

Keep coughs and sneezes covered. Tissues are best. Put the tissue in a rubbish bin.

Give plenty to drink to people who have a fever and/or diarrhoea.

Include paracetamol (for fever) in your home emergency survival kit.

Getting ready for a pandemic

What should people do now to prepare for an influenza pandemic?

Have a plan and talk to friends and family about their plans. Write a list of the things you need to remember.

Talk to your family and friends about hygiene – hand washing, and safe coughing and sneezing.

Make sure you have an emergency ``B-ready kit’’ (see the Civil Defence advertisement in the back of the Yellow Pages).

Include paracetamol (for fever) in your home emergency ``B-ready kit’’

What is New Zealand doing to prepare for an influenza pandemic?

New Zealand has been planning for this for some years. The Ministry of Health has a national pandemic plan which is continually being updated in line with WHO recommendations. (see: link) District Health Boards have local plans too.

All other Government agencies are also planning for a pandemic. An intersectoral group is considering non-health issues that are directly affected by a pandemic, such as school closures, border management and the maintenance of critical infrastructure, including supply of food and water and law and order.

The New Zealand Government, following the advice of the WHO, is stockpiling anti-viral medicine (Tamiflu) suitable for use against influenza viruses. By the end of 2005 there will be enough anti-viral medicine to treat about 21 percent of the population.

The Ministry of Health has set up a Pandemic Influenza Technical Advisory Group (PITAG), which advises the Ministry on the international situation and provides recommendations on the appropriate nature of New Zealand's responses.

There is also a Pandemic Influenza Reference Committee (PIRC) , with members from across the health sector.

What work is being done with primary care practitioners such as GPs and nurses on avian flu and preparing for a pandemic?

Primary health care is a fundamental component of pandemic planning at a District Health Board (DHB) level, and DHBs are working in their communities to make sure this is achieved through their emergency plans. Many DHBs employ general practitioners to liaise with other GPs on primary care issues.

Nationally the Ministry of Health is working on pandemic planning with primary care leaders, such as the Royal New Zealand College of General Practitioners and the College of Practice Nurses. National GP organisations have met and identified how they are will continue to contribute to the ongoing pandemic planning processes, and the College of GPs has been nominated as the lead agency for this.

There are GPs and nurses on various pandemic influenza advisory groups to the Ministry.

Information packs advising on infection control measures to minimise the spread of flu among health workers and the public are being prepared for distribution to primary care practitioners.

Anti-viral medication

How effective is the anti-viral medicine Tamiflu against bird flu?

Tamiflu is one of two medicines that are effective against the strains of avian influenza circulating in birds in Asia. The WHO have advised all health authorities to stockpile anti-viral medicines to prepare for a pandemic. New Zealand has followed that advice.

Will Tamiflu cure people sick with the bird flu virus, H5N1?

We don't know for sure. When people have seasonal influenza, rather than killing the virus, Tamiflu reduces symptoms and may shorten the duration of illness by a day and a half. If otherwise healthy people who are ill with influenza take it, they are less likely to develop complications of influenza. Those complications are usually treated with antibiotics.

Does Tamiflu prevent people from getting influenza?

Yes it does, but it is not the best means of preventing influenza. Vaccination is the best protection against influenza, which is why people are encouraged to immunise against seasonal influenza every year.

For more information on how Tamiflu works against influenza, see the Tamiflu datasheet on the Medsafe website

How does Tamiflu work?

It is a medicine that only works against influenza viruses A and B. It does not work against other viruses or bacteria that can cause illness similar to influenza or that can cause respiratory infection. If taken within 48 hours of becoming ill it stops the virus from bursting out of infected cells, infecting new cells and possibly other people.

Can Tamiflu be given to children?

Yes, it can be used to treat influenza in children aged over 1 year of age, and is licensed for this group in New Zealand.

Who will get the Tamiflu the Government is stockpiling?

Clearly, in an influenza pandemic, there will be a need to use Tamiflu in the most effective way. Details of how it will be prioritised and used can only be confirmed once we know the exact nature of the pandemic. At this stage, we can say it is likely that Tamiflu might be used for post-exposure prophylaxis for some priority groups (giving Tamiflu to, eg doctors and nurses treating people with pandemic flu), and for treating some people who are sick . It may also be used to "ringfence" an outbreak in its very early stages. However it is very important to reiterate that the policy is not yet finalised.

Tamiflu will be only part of New Zealand's overall response to a pandemic.

What is post-exposure prophylaxis?

Post-exposure prophylaxis is what happens when you take a medicine or get a vaccination after being exposed to a virus, BEFORE you get symptoms. This can stop you getting symptoms or becoming sick. Examples of post-exposure prophylaxis used routinely now include when protecting against possible rabies or HIV infection.

I'm worried about bird flu and an influenza pandemic. Is Tamiflu available, should I wish to add it to my first aid kit?

This is something you will need to discuss with your doctor. Tamiflu is a prescription-only medicine in New Zealand and is not subsidised by the Government.

Whether it is prescribed by a GP to a patient or not, at the patient's request, is at the discretion of the GP. The issues that would have to be covered in a consultation would then be the specific indications for the use of the medicine and the importance of timely administration, emphasising that the best way to prevent influenza is by vaccination.

The Ministry of Health cannot restrict the prescribing of a registered medicine which is not Government funded. With a prescription, Tamiflu can be purchased at community pharmacies, but some pharmacies may have to order in stock.

It is worth noting that any community prescriptions for Tamiflu will not come from the Government's national stockpile.
For more information see the Ministry's information on Tamiflu on www.moh.govt.nz/pandemicinfluenza

Will masks help protect me and my family from the influenza virus?

A surgical mask, if put on someone who is sick, will help reduce the spread of infection, because it will hold the virus in the coughs and sneezes close to that person. People who are not sick and who are very close to the person who is coughing and sneezing - closer than 1 metre - may get some protection by covering their own nose and mouth with a mask. Again, this is because the mask will catch the virus in the cough and sneeze droplets.

Vaccines

Is there a vaccine available for the bird flu virus?

There are no commercial supplies of vaccine against the bird flu virus H5N1 although many countries are trying to develop one. The Ministry
of Health is working to make sure New Zealand gets access as quickly as possible to a vaccine once it is developed and
available.

When a vaccine becomes available, how long will it be before New Zealand can get it?

From the onset of an influenza pandemic it may take up to six months for a vaccine to be developed and made in sufficient quantities for all New Zealanders.

Who will get the vaccine?

The Ministry of Health is working to get access to enough vaccine to cover all New Zealanders.


ENDS

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