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Welcome to "Ask the State Department" -- an online interactive forum where you can submit questions to State Department officials.

Senior Policy Advisor for the Avian Influenza Action Group, Dr. Daniel Singer answered questions on the U.S. Government's efforts to coordinate with other nations on preparedness, prevention, and containment of Avian and Pandemic Flu.

Dr. Daniel Singer, Acting Deputy Coordinator and Senior Medical Policy Advisor for the Avian Influenza Action Group
Dr. Daniel Singer, Acting Deputy Coordinator and Senior Medical Policy Advisor for the Avian Influenza Action Group
Biography


Karin from Washington , DC writes:

I am curious to know what is being done, if anything, to prepare for a possible Avian Flu pandemic in the Caribbean and Central America ?  What steps must be taken to truly prepare a region with so few resources?

Dr. Daniel Singer:

At the moment, there is no known H5N1 (the avian flu thought to be most likely to cause a pandemic) anywhere in the Americas .  Most of the support for pandemic planning in the Caribbean and Central America is being coordinated through the Pan-American Health Organization (PAHO), the regional body of the World Health Organization (WHO).  Next week PAHO is sponsoring a conference on avian and pandemic influenza preparedness in Barbados for the Caribbean Community (CARICOM).

The U.S. Government is supporting these efforts.  The U.S. has given more than $20 million dollars to WHO for pandemic preparedness, including approximately $2 million directly to PAHO.  Recently the Department of State also hosted a group of visiting veterinary and human health experts from Central and South America and the Caribbean .  The group met with U.S.  influenza experts and visited the Centers for Disease Control and Prevention in Atlanta and a U.S. Quarantine Station.


Heather from Washington , DC writes:

Did the experts rush to panic over the Avian Flu? It seems as if the experts were driving home the message that this could wipe us at and we all rushed out to buy Tamiflu, and nothing happened.

Dr. Daniel Singer:

Pandemics are similar to earthquakes in that they inevitable, but predicting their timing, location, and severity is very difficult.  Historically there have been roughly three pandemics per century.  Over the last several decades our increasing understanding of influenza viruses has led us to realize that pandemics occur when viruses which were present in other animals suddenly spread among humans.  Experts are worried because the H5N1 influenza virus is spreading among birds, and it is clear that it can infect humans and make them very sick.  This virus has been known since the 1960s, but it did not seem to cause human disease until 1997 when 18 people became ill and six died in Hong Kong .  Since 2003 we have seen the H5N1 virus spread rapidly among birds in Asia, Europe, the Middle East, and Africa .  Along the way it has caused more than two hundred people to get sick and over half of them have died.  Although we cannot be 100% sure that the H5N1 virus will cause the next pandemic, experts believe that the situation is very worrying, and that the right elements continue to exist which could result in a severe pandemic. 


Laura from Canada writes:

What type of cross-border monitoring is in place or being introduced to track the evolution of triple reassortant (human, swine, avian) H3N2 influenza?  What action is being taken to prevent this reassortant from occurring with more virulent strains of avian influenza? Can you quantify the level of this risk? Are there recommendations or standards in place for industry to mitigate this risk?

Dr. Daniel Singer:

In the U.S. , poultry are monitored for evidence of influenza infection through blood tests which include direct isolation of parts of the virus.  If needed, additional tests are done to determine the exact type of influenza virus (the H and N type). H5 and H7 viruses are the most worrisome types, and require immediate control measures.  H3N2 is a common cause of influenza in humans, but is not an especially problematic virus in birds.  As you are aware, there is the risk that this virus could combine (reassort) with more dangerous viruses such as H5N1 to produce a virus which would spread easily and cause severe disease.  Since there is no H5N1 virus in the western hemisphere, the chance of this happening in North America is very low.  When worrisome viruses are isolated from birds or other animals (in the U.S. or abroad) control measures are put in place which can include culling, vaccination, additional biosecurity at farms, and enhanced surveillance for influenza in flocks.   Protocols for such measures are developed by the World Organization for Animal Health (known as the "OIE").


Younghyun from South Korea writes:

Dear Dr. Daniel A. Singer,

In order to defend our global community from all fatal factors that stem from formidable natural catastrophes such as Bird flu, what efforts can your administration do to make our global community well prepared?

Dr. Daniel Singer:

The United States believes that global cooperation is critical to dealing with the threat of avian influenza.  President Bush signaled the importance he attaches to this by launching the International Partnership on Avian and Pandemic Influenza (IPAPI) at the United Nations General Assembly in September 2005.  IPAPI has now met twice, October 6-7, 2005 in Washington , D.C. and June 6-7, 2006 in Vienna .  These meetings provide opportunities for senior officials from all interested countries to discuss strategies and to generate the political and financial support necessary to combat the virus and prepare for a possible pandemic.  Over the last two years, the United States has pledged a total of $362 million to assist other countries and international organizations in preparing for avian and pandemic influenza.  This money is used for establishing surveillance capability in countries at risk, strengthening the international animal health infrastructure, supporting a coordinated response by nations to contain outbreaks of influenza with pandemic potential, and coordinating public communication efforts.


Naomi from New York writes:

How has our government coordinated with other nations on this issue? Have other nations that are not always in agreement with the U.S. ( China , e.g.) been cooperative on the avian flu issue?

Dr. Daniel Singer:

The United States was one of the first countries to recognize the serious threat of avian influenza.  The International Partnership on Avian and Pandemic Influenza (IPAPI) was launched by the U.S. with the support of a group of countries which shared the view that international cooperation was critical if we were to be successful in combating the virus and preparing for a pandemic.  The first IPAPI meeting was attended by 88 countries and many international organizations.  Subsequent meetings have had even more participation.  One critical element to international cooperation is an agreement to be transparent in reporting outbreaks to international health authorities and to share samples of virus within the international laboratory network.  Some countries have been more transparent than others in admitting that they have the disease, and some countries have been unaware they have the disease because they lack the ability to monitor for cases.  The U.S. continues to work through IPAPI and other venues to support countries in developing their disease detection capability and to push for international pressure on those countries which do not recognize the importance of collaboration on the issue of avian and pandemic influenza.


Ruth from Baltimore writes:

Tamiflu seems expensive. What is being done to make it available to less developed nations?

Dr. Daniel Singer:

Until recently, Tamiflu was licensed to only one company to manufacture, and supplies were extremely limited.  In the last several months, that manufacturer has increased its own production, and has worked with other companies to ensure that even more will be available.  Many countries have developed stockpiles for their own population, but the drug is not universally available, especially in developing nations.  In recognition of this, the company which makes Tamiflu has donated enough drug to treat 5 million people to the World Health Organization (WHO).  The WHO will use this stockpile of Tamiflu to assist countries which are experiencing outbreaks of pandemic influenza and do not possess enough of the drug to respond on their own.  In addition, the United States and Japan have both donated a portion of their own stockpiles to support international efforts at response and containment of a spreading pandemic virus.


John from Phoenix writes:

How much should we fear from birds being imported illegally across U.S. borders?

Dr. Daniel Singer:

The health risk to an individual from a smuggled bird or bird product is low, but the possibility that such an incident could introduce the H5N1 virus into the United States is very significant.  U.S. Customs and Border Protection officials are working with the USDA Animal and Plant Health Inspection Service to detect smuggling operations and develop travel advisories which alert international travelers to the risk from illegal trafficking in birds.  The Department of State is collaborating with other countries to develop agreements on combating illegal trafficking of all animals. 


Anne from Nebraska writes:

If caught early enough, can bird flu be cured?  Also, when will we have enough vaccine ready for the entire U.S. population?

Dr. Daniel Singer:

Human cases of "bird flu" are not always fatal.  Many people fully recover.  When treated early with appropriate medicines (including Tamiflu and other antivirals), people can have shorter periods of illness and less severe complications.  The only way to prevent bird flu (or any influenza) is through vaccination.  Although we have developed some preliminary vaccines against the H5N1 virus, it is impossible to create a vaccine against a pandemic virus until the pandemic begins.  Because of this, it will be important to make lots of vaccine quickly.  Currently all influenza vaccines are made in a process which uses eggs.  This process is time-consuming and not suited to rapid increases in production.  Another process for making influenza vaccine is being developed called "cell-based" vaccine production.  Earlier this year, the Department of Health and Human Services gave $1 billion to five companies for the development of cell-based vaccine technology.  Once this method is fully operational, we will be much better able to provide vaccine for the entire U.S. population in a timely manner.


Tom from Idaho writes:

How worried should I be about birds migrating from the north into the U.S. ?  Have there been any proven cases in the U.S. so far?

Dr. Daniel Singer:

Based on the known migratory patterns of birds, there is a real risk that migrating birds could carry the H5N1 virus into the U.S.   The Department of Interior is currently working with counterparts in Canada and officials in Alaska to monitor these birds during their transit.  Additional surveys are being planned for other areas.  There have been no cases of the virus among the thousands of birds tested so far.  Nevertheless, it is important to be aware of the risk, stay away from wild birds, and to keep pet birds separated from wild birds.


Paul from Pittsburg writes:

How can I tell the difference between the symptoms of bird flu versus regular flu?

Dr. Daniel Singer:

In its early stages, the symptoms of influenza caused by the H5N1 virus (bird flu) are identical to regular flu.  Also, regular flu can sometimes cause severe illness and death just like bird flu.  The difference is that bird flu is more likely to be fatal and it affects more young healthy people, while regular flu is generally severe only in the elderly and those with other health problems.

There is no bird flu currently in the United States , so the most important way to determine whether you could have bird flu is to know whether you've traveled to areas where the virus exists.  A laboratory test is the only way to absolutely determine what type of virus is causing flu symptoms.


Jennifer from Oklahoma writes:

As a rural health worker, I often have to answer questions about bird flu.  Probably the most frequently asked question relates to whether it is possible to determine which birds are infected by looking at them.  Are there symptoms in affected birds that people can observe?

Dr. Daniel Singer:

The H5N1 influenza which most people call "bird flu" is very severe in poultry - there are usually no symptoms/signs other than sudden death.  In other birds, there can be various signs of respiratory or intestinal problems: swollen wattles, coarse breathing, spots of blood under the skin, etc.  Unfortunately, many of these symptoms occur in other bird diseases as well, and other birds (including some ducks and migratory birds) have no signs of disease at all.


Lee from Malaysia writes:

How many documented cases of bird flu have been the result of person to person transmission?  Is there a pattern and/or trend toward more person to person transmission of the virus?

Dr. Daniel Singer:

Currently, there is only once case for which we have absolute genetic evidence of person to person transmission, however there are several other cases from a few countries where the timing and circumstances of the illness make it likely that the individual was infected by another person.  As the virus has spread to more areas and there have been more cases of avian influenza in humans, researchers have found more instances which may be the result of person to person transmission.  However, there is no pattern or genetic change in the virus which would suggest it has mutated into a form which is causing more person to person transmission. 


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