Questions and Answers on Bird Flu

A bird flu virus spreading through Asia and now reported in part of Turkey, has world health authorities warning of a worldwide pandemic unseen since world War I.

Some questions and answers on the bird flu :

Q: What is bird flu?

A: The term "bird flu" describes one of several influenza viruses that birds can carry. But several types can also infect humans. These are different in makeup from the usual human flus.

Q: What are the symptoms of bird flu in humans?

A: They can include typical flu-like symptoms, like fever, cough, sore throat and muscle aches, as well as eye infections, pneumonia and severe respiratory illness. At this point, it is believed to have killed at least 60 people, the majority in Vietnam, since 2002.

Q: How do humans get bird flu?

A: Right now, authorities believe there have been cases of humans contracting bird flue primarily from contact with excretions from infected birds. Common victims are people who handle poultry on farms or at live markets. There is one known case of it spreading from one person to another.

Q: Why is bird flu receiving so much attention?

A: A particular type of bird flu, known as H5N1, is seen as a candidate to cause a flu pandemic if it mutates into a form capable of spreading easily from person to person.

Because people have not developed immunity to H5N1, unlike the usual strains of human flue, it could have more severe effects on a greater number of people. However, it is also possible that the mutation could create a relatively mild human flu.

Q: Is bird flu the only possible source of a flu pandemic?

A: No. A pandemic could break out should any dramatically different new flu virus emerge. The last century saw three; in 1918, 1957 and 1968.

The 1918 pandemic, caused by a bird flu that jumped to humans, killed at least 40 million people; the later outbreaks killed far fewer but still caused widespread disruption.

Fear of a pandemic is also heightened because it has been 37 years since the last one, and some scientists argue that new flu strains capable of causing a pandemic emerge every 30 years or so.

Estimate of the death toll from a new pandemic vary wildly, and depend on the level of organized response to an outbreak. However the World Health Organization consider the most likely scenario to be a toll between 2 million and 7.4 million people.

Q: How can doctors detect bird flu?

A: With a blood test of a person suspected of having it.

Q: Is there a vaccine for bird flu?

A: Yes, French vaccine maker Sanofi-Pasteur has begun production of a vaccine against H5N1. But researchers have not settled on how large a dose will ensure protection.

If bird flu began spreading widely, scientists would have to check whether that vaccine still would provide protection or a new one would be needed. Other manufacturers are working to produce experimental bird-flue vaccines as well.

Q: Is it part of my flu shot this year?

A: No. the yearly flu shot is composed of vaccines for several varieties of human flu that are expected to be in circulation this winter. Officials expect at least 71 million doses to be available.

Q: So how do I get vaccinated for bird flu?

A: At the moment, the public can't. It is likely the government would control distribution in the event of an outbreak in an effort to manage its spread.

Q: How is bird flu treated?

A: Two drugs that fight regular flu. Tamiflu and Relenza, are considered to be effective in treating flu caused by H5N1 if administered quickly. They also may help prevent infection. The government plans to stockpile tens of millions of Tamiflue pills, and a smaller supply of the inhaled drug Relenza.

Q: Where is bird flu now?

A: Outbreaks of the H5N1 strain have occurred in poultry in several countries in Asia, and is now moving across Eurasia. More than 150 million of birds died from the disease or have been slaughtered to contain its spread.

Source : Centres for Disease Control and Prevention.

New Guidelines for NZ Doctors Managing Procedural Pain in Children, Including Suggestions for Parents

Doctors now have new guidelines for treating and managing children experiencing procedure-related pain. The guidelines also give parents some handy suggestions on how they can support their child during medical procedures, such as during immunisation injections, tube insertions, wound dressing and foreign body removal.

The guidelines for the management of procedure-related pain in children and adolescents, and the statement for neonates have been launched 17th October in Sydney by the Paediatrics & Child Health Division of The Royal Australasian College of Physisians. 17th October is Global Day Against Pain and the theme for this year is pain in children, the beginning of the International Global year Against Pain.

"Pain in children is often poorly managed and many children continue to suffer unnecessarily. Children who experience extreme procedural pain can develop post-traumatic stress disorder. Up to 25 per cent of adults experience significant fear of needles, hospital and dental care and have an avoidant attitude to health care.

Of the 10 per cent of adults with needle phobia, most date their phobia from experiences in the first 10 years of life," Dr Angela Mackenzie, Chair of the Working Group, said.

"Pain in newborn babies is often unrecongnised and under treated. Newborn babies do feel pain. If a procedure is painful in adults it should be considered painful in newborns, even it they are preterm. Compared with older age groups, newborns may experience a greater sensitivity to pain and are more susceptible to the long-term effects of painful stimulation."

For Parents :

"Parents have the potential to play an important role in the preparation of children for medical procedures by providing information about what to expect - giving older children a chance to ask any questions and younger children the opportunity to act out the procedure with a toy medical kit. Parents may be helping themselves understand what to expect in the process. Siblings may also be helpful to distract a child especially before and after a procedure," Dr. Mackenzie said.

"Suggestions for parents include talking about activities or subjects that are not related to the procedure such as birthday parties, pets and favourite activities. Parents can also use distraction to help their child such as blowing bubbles, playing games, playing their favourite song or reading aloud."

Another way parents can assist their children is through learning some basic breathing techniques and teaching the technique to their child. Parents may also develop their own ideas and coping strategies to support their child during painful medical procedures.

For Doctors :

"The aim is to prevent pain and distress as much as possible and ensure this is taken into account when planning the procedure. In practice it is important to find out if a child's expectations of a procedure are realistic and if not, correct them will before the procedure," Associate professor Neil Wigg, President of Paediatrics & Child Health Division said.

Important sections of the guidelines include :

Adopting a child-centred approach (listening to the needs of the child and family) rather than procedure-focused "get-it-over-with" approach.

Make the child and their family active participants and members of the team, rather than passive recipients. Use parents for positive assistance, not negative restraint.

Ensure all procedures undertaken are necessary i.e. the benefit outweighs any negative impact caused by the procedure.

Perform procedures in a child friendly environment, away from the bed where possible.

Optimise waiting time; too little time increases distress but too much time increases anxiety. Time required for preparation is age and child-specific.

Consider exposure and discussion on procedures; such as handling equipment, practicing procedure e.g. on a doll.

Give child choices (e.g. whether to sit or lie, which hand to use) but not absolute control such as when to start procedure.

Consider the child's expectations of the procedure.

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