Bureau of Consular Affairs

Transcription

1 U.S. U.S. Department of of State State Bureau of Consular Affairs AVIAN INFLUENZA FACT SHEET This Fact Sheet alerts Americans to the Department of State s preparedness efforts with respect to a possible avian influenza pandemic. The Department of State emphasizes that, in the event of a pandemic, its ability to assist Americans traveling and residing abroad may be severely limited due to restrictions on local and international movement imposed for public health reasons. Furthermore, American citizens should take note that the Department of State cannot provide Americans traveling or living abroad with medications, including in the event of a pandemic. Background H5N1 Avian Influenza A number of countries have reported cases of avian influenza, commonly referred to as bird flu in their domestic and wild bird populations. The H5N1 strain of influenza causes severe disease in domesticated fowl. In addition, there continues to be a number of confirmed cases of bird-to-human transmissions of avian influenza, many of which have resulted in death. Please visit the World Health Organization (WHO) website, for the most up to date information on the countries affected and the number of deaths. The vast majority of the known human cases have resulted from direct contact with poultry, and there is only limited evidence to suggest possible human-to-human transmission. However, the Centers for Disease Control and Prevention (CDC), the WHO, and the Department of State are nonetheless concerned about the potential for human-to-human transmission of this highly dangerous flu strain, and are working closely with other partners in an effort to monitor the outbreak. Concerns about the possibility of an avian influenza pandemic have prompted international and national efforts to institute pandemic preparedness measures. Information on the U.S. Government s overall response and efforts is available at Travel and Avian Influenza The Department of State, the CDC and the WHO have not issued any travel alerts or warnings for avian fluinfected areas. However, the CDC advises travelers to countries with documented H5N1 outbreaks to avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces or fluids from poultry or other animals. American citizens traveling to or living in countries where avian influenza is prevalent should consider the potential risks and keep informed of the latest medical guidance and information in order to make appropriate plans. Specific CDC travel information relating to avian influenza, including preventive measures, is available at WHO guidance related to avian influenza is available at Additional general country information can be obtained from the Department of State's Consular Information

2 Sheets at and Embassy and Consulate websites at You may also call the Department of State's toll-free number, , or if calling from overseas, Prevention, Response and Treatment Take Charge of Your Plans A specific vaccine for humans that is effective in preventing avian influenza is not yet readily available. Based upon limited data, the CDC has suggested that the anti-viral medication Oseltamivir (brand name- Tamiflu) may be effective in treating avian influenza. Using this input, the Department of State has decided to pre-position the drug Tamiflu at its Embassies and Consulates worldwide, for eligible U.S. Government employees and their families serving abroad who become ill with avian influenza. We emphasize that this medication cannot be made available to private U.S. citizens abroad. Because of this, and because Tamiflu may not be readily available overseas, the State Department encourages American citizens traveling or living abroad to consult with their private physician about whether to obtain Tamiflu prior to travel, for use in the event treatment becomes necessary, or whether Tamiflu is readily available in the country where they reside. Americans should also be aware of the potential health risk posed by counterfeit drugs, including those represented as Tamiflu, by internet scam artists or in countries with lax regulations governing the production and distribution of pharmaceuticals. In addition, the Department of State has asked its embassies and consulates to consider preparedness measures that take into consideration the fact that travel into or out of a country may not be possible, safe or medically advisable. Guidance on how private citizens can prepare for a stay in place response, including stockpiling food, water, and medical supplies, is available on the CDC and pandemicflu.gov websites. It is also likely that governments will respond to a pandemic by imposing public health measures that restrict domestic and international movement, further limiting the U.S. Government s ability to assist Americans in these countries. Americans who are planning travel to a country that has reported the virus or who are concerned about the Avian flu are advised to monitor the CDC and the WHO web sites for the latest information. CDC Contact Information Public Inquiries: English (888) Spanish (888) TTY (866) Mon-Fri 8am-11pm EST Sat-Sun 10am-8pm EST Address: The Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA USA (404)

3 WHO Liaison Office in Washington, DC Contact Information: Telephone: (202) Facsimile: (202) Address: WHO Liaison Office 1889 F Street, N.W., Suite 369 Washington, D.C USA March 2006

4 U.S. Department of State Bureau of Consular Affairs Why isn t the USG providing Tamiflu to private Americans overseas? The Department of State lacks the legal authority to provide any type of medication, including Tamiflu, to private American citizens. State Department physicians and medical staff have authorization to treat only those official employees, and their families, who are under Chief of Mission authority. Will you evacuate Americans in the event of a pandemic? Current medical thinking suggests that a stay in place response to a pandemic may be appropriate in certain countries or regions. In this scenario, people would be advised to exercise social distancing and avoid any form of public gathering where transmission of the disease could occur. People who are not comfortable with this scenario should consider these factors when making their plans. Whether the U.S. Government evacuates anyone will depend on a variety of factors specific to individual countries. Each U.S. Embassy has been asked to develop a contingency plan in the event of a pandemic, and to identify events that might prompt them to send employees and/or their dependents out of the country, assuming such travel is possible. Should the decision be made to send Embassy employees and/or their dependents out of a country, we will communicate this to the private American community so that people can plan accordingly. As in any other crisis, we will assess the availability of commercial transportation, the ability of people to travel to the United States or a third country, and other related factors in deciding on appropriate actions to assist Americans. Should I begin taking antiviral medications such as Tamiflu if I'm planning a visit to another country? No, the CDC specifically states at this time persons traveling to countries with Avian Influenza cases in birds, poultry or humans do not need to take Tamiflu prophylactically. If you become ill in any way while in the country, you should seek medical advice immediately. Travelers to any country that has reported cases of H5N1 among birds or humans should consider scheduling an appointment with their health care provider before traveling to discuss risks for potential exposure to H5N1. Only you and your health care provider can determine that risk and what the most appropriate precautions are for you. Is it safe to eat poultry and eggs in (country)? Proper cooking of poultry will destroy the virus. There have been no reported human cases of avian influenza contracted from consumption of well-cooked poultry or eggs. Both humans and animals have contracted avian influenza from eating undercooked poultry products. Best practices during handling of raw poultry meat and usual recommended cooking practices for poultry products should be followed to lower the risk of common bacterial diseases spread by poor handling and cooking techniques. Eggs from infected poultry could also be contaminated with the virus and therefore care should be taken in handling eggs or raw

5 egg products. Guidance on handling food to avoid spreading the virus is available on the websites for the Centers for Disease Control, the U.S. Department of Agriculture, and the World Health Organization. What are the travel recommendations regarding the H5N1 bird flu outbreak in Asia and parts of Europe? The U.S. Centers for Disease Control in Atlanta currently advises that travelers to countries with known outbreaks of influenza A (H5N1) avoid poultry farms, contact with animals in live food markets, and any surfaces that appear to be contaminated with feces from poultry or other animals. For more information about travel recommendations, visit the Centers for Disease Control website at Are children more susceptible? The World Health Organization and the Centers for Disease Control believe that children may be more susceptible due to their increased proximity socializing at schools and day care centers, as well as being more likely to come into contact with poultry or bird fecal matter during their play habits. It is unknown whether immunity differences in children have any significance, since we presume that the vast majority of humans have no immunity against the H5N1 virus. As a private American citizen living overseas, what can I do today to help prepare myself and my family for possible bird flu pandemic? Several simple measures can be taken now that will put you in a better state of readiness should such a pandemic occur. First of all, as suggested for reasons other than just bird flu, purchase enough nonperishable food, water, and personal supplies for your family to last 7 days. Store it in a place where you will not be tempted to break into it for everyday use; if you are asked to "shelter in place" or remain in quarantine, these supplies will be vital. Along with those supplies, buy several boxes of tissues (preferably a version with an "anti-viral layer") for use should someone come down with a respiratory virus. Also, purchase a personal thermometer or two. If you are living overseas due to work or education, contact your sponsor and find out what plans they may have regarding repatriation or evacuation; they may also have advice for you about procuring influenza immunization, avian influenza immunization (if and when available), anti-viral medication, and other suggested measures as they arise. Encourage regular handwashing among family members; discourage touching the eyes/nose/mouth. Personal hygiene measures to minimize the impact of sneezes and coughs will go a long way in lessening your risk of catching many viruses, not just the bird flu virus. Has a vaccine been developed against the virus yet? Yes, clinical trials of a Vietnam strain of H5N1 human vaccine have demonstrated safety and efficacy. Further work is required to determine the proper dosing and potential boosting of adjuvants. The US Department of Health and Human Services (HHS) has placed an initial order for this vaccine and stands ready to order more once it is available. It remains to be seen, however, whether this vaccine will be effective against other H5N1 strains currently circulating, let alone against a pandemic strain that has undergone genetic change from the currently circulating virus. Once a new pandemic virus has emerged,

6 large-scale production can begin of a more specific pandemic vaccine. Supplies sufficient to significantly impact a rolling pandemic may not be available for at least six months. Although the current global production capacity is inadequate for the expected vaccine needs, alternate and more efficient technologies for vaccine development are being vigorously pursued. Will getting a flu shot this year afford any protection against a future pandemic avian influenza virus? No. The annual influenza vaccine is targeted against specific influenza strains predicted from the previous year. Yearly seasonal flu shots are not even effective against next year's influenza strains, let alone against a future emerging pandemic strain. Of course medical authorities encourage everyone to have the seasonal vaccine every year to prevent flu. What precautions should I take if I live or visit in an area affected by bird flu? Avoid contact with live birds, chickens, ducks, turkeys and geese and their feces, feathers and pens if at all possible. Children, in particular, should be warned and precautions enforced. Pet birds should not be kept. If preparing poultry, cook it well done before eating. Avoid cross contamination of other foods by use of separate kitchen utensils and surfaces exposed to raw poultry. Wash hands with soap and water after any poultry contact. Be sure, if possible, that poultry does not live near your housing area. Do not transport live or dead poultry even if it appears to be healthy. Avoid poultry products from areas of infected birds. If you must travel to infected areas and work directly with infected birds, poultry or humans, hand washing and shoe and clothing cleaning should be an immediate priority. Be sure to wear gloves, a special N-95 mask, goggles and a disposable gown if you must be in contact with the birds/poultry in enclosed environments where aerosolization of the small virus particles may occur. Observe yourself for the development of any respiratory or gastrointestinal symptoms after the visit and check your temperature for a week afterwards, and contact a physician if you have any questions.

7 U.S. Department of State Bureau of Consular Affairs Medical Information for Americans Traveling Abroad If an American citizen becomes seriously ill or injured abroad, a U. S. consular officer can assist in locating appropriate medical services and informing family or friends. If necessary, a consular officer can also assist in the transfer of funds from the United States. However, payment of hospital and other expenses is the responsibility of the traveler. Before going abroad, learn what medical services your health insurance will cover overseas. If your health insurance policy provides coverage outside the United States, REMEMBER to carry both your insurance policy identity card as proof of such insurance and a claim form. Although many health insurance companies will pay "customary and reasonable" hospital costs abroad, very few will pay for your medical evacuation back to the United States. Medical evacuation can easily cost $10,000 and up, depending on your location and medical condition. THE SOCIAL SECURITY MEDICARE PROGRAM DOES NOT PROVIDE COVERAGE FOR HOSPITAL OR MEDICAL COSTS OUTSIDE THE U.S.A. Senior citizens may wish to contact the American Association of Retired Persons for information about foreign medical care coverage with Medicare supplement plans. To facilitate identification in case of an accident, complete the information page on the inside of your passport providing the name, address and telephone number of someone to be contacted in an emergency. A traveler going abroad with any preexisting medical problems should carry a letter from the attending physician, describing the medical condition and any prescription medications, including the generic name of prescribed drugs. Any medications being carried overseas should be left in their original containers and be clearly labeled. Travelers should check with the foreign embassy of the country they are visiting to make sure any required medications are not considered to be illegal narcotics. A listing of addresses and telephone numbers of U.S. embassies and consulates abroad is contained in Key Officers of Foreign Service Posts. This publication may be obtained through the Superintendent of Documents, U.S. Government Printing Office, Washington, DC Also available from the Government Printing Office is Health Information for International Travel by the Centers for Disease Control and Prevention (CDC). This contains a global rundown of disease and immunization advice and other health guidance, including risks in particular countries. The CDC maintains the international travelers hotline at FYI-TRIP ( ), an automated faxback service at CDC-FAXX ( ) and a home page on the Internet at

8 For information about outbreaks of infectious diseases abroad, consult the World Health Organization s (WHO) web site at The WHO also provides travel health information at For detailed information on physicians abroad, the authoritative reference is The Official ABMS Directory of Board Certified Medical Specialists published for the American Board of Medical Specialists and its certifying member boards. This publication should be available in your local library. U.S. embassies and consulates abroad maintain lists of hospitals and physicians. Major credit card companies also can provide the names of local doctors and hospitals abroad. Some countries require foreign visitors to have inoculations or medical tests before entering. Before traveling, check the latest entry requirements with the foreign embassy of the country to be visited. Several private organizations will provide medical information and insurance for overseas travelers. Most charge a fee for this service. The following is provided FOR INFORMATIONAL PURPOSES ONLY and in no way constitutes an endorsement, expressed or implied, by the Department of State. U.S.-based Companies ABLE JET Fort Pierce, FL AIR AMBULANCE / MED-EVAC ACADIAN AMBULANCE & AIR MED SERVICE, INC. Lafayette, LA ADVANCED AIR AMBULANCE Miami, FL / AIR AMBULANCE AMERICA Austin, TX / AIRMD AIR AMBULANCE SERVICES Clearwater, FL / AIRMED INTERNATIONAL LLC Birmingham, AL /

9 AIR AMBULANCE CARD LLC Birmingham, AL / AIR AMBULANCE NETWORK Sarasota, FL AIR AMBULANCE PROFESSIONALS Fort Lauderdale, FL / AIR AMBULANCE SPECIALISTS, Inc Englewood, CO info@airaasi.com AirEvac Phoenix, AZ AIR MEDIC - AIR AMBULANCE OF AMERICA Washington, PA AIRescue INTERNATIONAL Van Nuys, CA / AIR RESPONSE Orlando, FL / AIR STAR INTERNATIONAL Thermal, CA / AirStar1@aol.com AMERICAN AIR AMBULANCE Cincinnati, OH / AMERICAN CARE, INC. San Diego, CA /

10 AMERICAN JET AIR MEDICAL Houston, TX 888-I-FLY-AJI / CRITICAL AIR MEDICINE San Diego, CA / CRITICAL CARE MEDFLIGHT Lawrenceville, GA GLOBAL CARE / MEDPASS Alpharetta, GA INFLIGHT MEDICAL SERVICES INTERNATIONAL INC. Naples, FL / INTERNATIONAL SOS ASSISTANCE Philadelphia, PA / Also provides travel insurance services. LifeFlight New Orleans New Orleans, LA / Info@NewOrleansJets.com LIFE GUARD INTERNATIONAL, INC. Las Vegas, NV 866-SKY-LIFE ( ) lifeguardinternational@msn.com MedAire Tempe, AZ info@medaire.com MED ESCORT INTERNATIONAL INC. Allentown, PA /

11 MEDEX ASSISTANCE CORPORATION Baltimore, MD 888-MEDEX-00 / Also provides travel insurance services. MEDJET ASSISTANCE Birmingham, AL MEDWAY AIR AMBULANCE Lawrenceville, GA MERCY MEDICAL AIRLIFT Manassas, VA (Service area: Caribbean and part of Canada only. If necessary, will meet commercial incoming patients at JFK, Miami and other airports.) NATIONAL AIR AMBULANCE Ft. Lauderdale, FL / SMARTRAVEL Alexandria, VA / Provides a range of travel medicine services. TRAVEL CARE INTERNATIONAL, INC. Eagle River, WI / TRAVELERS EMERGENCY NETWORK Tierra Verde, FL 800-ASK-4-TEN ten@intrex.net Foreign-based Companies AEA INTERNATIONAL Singapore U.S. Phone: Service worldwide, also provides travel insurance services

12 AUSTRIAN AIR AMBULANCE Vienna, Austria EUROPASSISTANCE Johannesburg, South Africa GERMAN AIR RESCUE (DRF) Filderstadt, Germany TYROL AIR AMBULANCE Innsbruck, Austria TRAVEL INSURANCE COMPANIES U.S.-based Companies ACCESS AMERICA, INC. Richmond, VA AIGAssist American International Group, Inc. New York, NY ASA, INC. International Health Insurance Phoenix, AZ 888-ASA-8288 AXA ASSISTANCE Bethesda, MD CLEMENTS INTERNATIONAL Washington, DC / info@clements.com

13 CSA TRAVEL PROTECTION San Diego, CA GATEWAY Seabury & Smith Washington, DC / gateway.dc@seabury.com HEALTH CARE GLOBAL (also known as MEDHELP or WALLACH & COMPANY or HEALTHCARE ABROAD) Middleburg, VA / HIGHWAY TO HEALTH Fairfax, VA (Also provides destination-based travel health information for cities worldwide.) INTERNATIONAL MEDICAL GROUP (IMG) Indianapolis, IN / MultiNational Underwriters, Inc. Indianapolis, IN insurance@mnui.com MUTUAL OF OMAHA Tele-Trip Company Omaha, NE PETERSEN INTERNATIONAL UNDERWRITERS, INC. Valencia, CA piu@piu.org TRAVELEX Omaha, NE

14 TRAVEL GUARD Stevens Point, WI / TRAVEL BCISURED INTERNATIONAL E. Hartford, CT TRAVEL INSURANCE SERVICES InterMedical Division Walnut Creek, CA / UNIVERSAL SERVICE AND ASSISTANCE Alexandria, VA / WORLDWIDE ASSISTANCE Washington, DC ext. 417 Foreign-based Companies INTEGRA GLOBAL Hallein, Austria info@integraglobal.com EXECUTIVE MEDICAL SERVICES AMERICAN MEDICAL CENTERS Moscow, Russia Offices in Moscow, St. Petersburg, Kiev, Prague, Warsaw, Istanbul (7-095) (Moscow) HEALTH QUEST TRAVEL INC. Wexford, PA HQT@HealthQuestTravel.com WORLD CLINIC Burlington, MA

15 U.S. Department of State Bureau of Consular Affairs Relevant Resources U.S. Department of State Bureau of Consular Affairs After-Hours Emergencies For Embassy/Consulate websites: Centers for Disease Control Public Inquiries: English (888) Spanish (888) TTY (866) Mon-Fri 8 am 11pm EST Sat-Sun 10am 8 pm EST Traveler s Hotline: FYI-TRIP ( ) FAXback Service CDC-FAXX ( Address: The Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA USA (404) Homepage Travel information - Health Information for International Travel by the Centers for Disease Control and Prevention (CDC). World Health Organization Liaison Office in Washington, DC Telephone: (202) FAX: (202) Address: WHO Liaison Office 1889 F Street, N.W., Suite 369

16 Washington, DC USA WHO guidance - Outbreaks of infectious diseases abroad - Travel health information - General Information

17 Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO As of May 18, 2006 Country cases deaths cases deaths cases deaths cases de Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Thailand Turkey Viet Nam Total Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases.

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