Avian Flu May Pose a Threat
Nurses around the country prepare for a possible pandemic.

By Cathryn Domrose
March 14, 2005

Bird flu has Neil Pascoe, RN, BSN, CIC, plain scared. The 52-year-old nurse epidemiologist for the Texas Department of State Health Services in Austin says he doesn’t want to sound negative, but he believes there has never been a better chance for a public health crisis in his lifetime than the one posed by the avian influenza virus that has infected about five dozen people in three Asian countries and killed at least 42 of them.

“Most of what’s needed to create a pandemic is present,” Pascoe says. Just a small mutation could create a new and potentially lethal virus that spreads from person to person. Then, he says, “the flu will hit the fan.”

Although faced with such a disturbing prospect, nurses need not panic, say their epidemiology and infection control colleagues. But nurses do need to prepare themselves as best they can with information because regardless whether a pandemic develops this time, experts say, history tells us we will face pandemic influenza at some point.

U.S. and world health officials say a bird flu pandemic is not imminent, but they’re watching the situation in Southeast Asia with anxiety. Last week, the World Health Organization reported five new cases of bird flu in Vietnam, including one in a nurse who was caring for a patient with bird flu — the first case of a health care worker’s getting the disease. Some 60 people in Vietnam, Thailand, and Cambodia have contracted bird flu, almost all from direct contact with poultry.

As of early March, only one possible case of human-to-human spread of the virus — called H5N1 — was reported in Thailand last September. Investigators are looking into the case of the nurse in Vietnam who reportedly became ill in February. He was caring for a patient with avian influenza, but officials at his hospital say he most likely caught the virus from outside the facility.

The WHO and the Centers for Disease Control and Prevention report H5N1 has become entrenched among birds in parts of Asia and more human cases are likely. New research suggests H5 viruses are becoming more easily transferable to mammals and ducks infected with H5N1 are shedding the virus for longer periods without showing symptoms, raisingthe possibility of passing the virus to humans.

Epidemiologists are now watching for a mutation of the virus that allows person-to-person transmission. The most likely scenario, health officials say, is someone infected with a human flu virus also becoming infected with bird flu. The viruses could merge, unleashing a deadly illness as contagious as common flu upon a population with no ready antibodies. Scientists now believe some forms of human-bird viral combination were responsible for flu pandemics in the previous century.

Government health officials are preparing for clinical trials of an H5N1 vaccine this month. But any vaccine specific to a virus responsible for a pandemic would probably not be ready for at least six months after the first infections — and when it became ready for distribution, there would not be enough to vaccinate everyone, says Shelly McKeirnan, RN, MPH, epidemic response coordinator for the communicable disease, epidemiology, and immunization section of the public health department for Seattle and surrounding King County, Wash.

Some countries are stockpiling the antiviral drug oseltamivir, or Tamiflu, which has been shown to be effective against H5N1 in laboratory tests. But the drug is expensive; and other tests have shown the virus can mutate to make the drug less effective, according to press reports.

This leaves nurses with the basic weapons they have to combat any massive outbreak, from severe acute respiratory syndrome (SARS) to whooping cough — awareness, vigilance, infection control hygiene, and good emergency planning.

Nurses need to have increased awareness of what is happening with avian influenza, says Linda Chiarello, RN, MS, an infection control consultant with the CDC who is helping the organization develop a pandemic plan for health care facilities. Nurses should be reading avian flu reports on the CDC and WHO websites, she says.

The good news, say nurse epidemiologists, is that recent events, including SARS, have provided health care workers and public health departments with warnings and lessons about the ways to care for people during a massive outbreak. E-mail and websites give health care providers instant updates on disease outbreaks half-way around the world, notes Peggy Pass, RN, MS, CIC, infection control epidemiologist at Johns Hopkins Medical Institutions in Baltimore. “You can get a lot of information quickly,” she says, “which didn’t happen last time” during a flu pandemic.

McKeirnan believes public health departments are better prepared to deal with pandemics now than they were a few years ago. Many nurse epidemiologists say they feel their hospitals are prepared, too.

“We’ve been through bioterrorism,” says Lilly Guardia-La Bar, RN, CIC,
infection control clinical risk manager at Children’s Hospital in Oakland, Calif. “We have to be prepared.”

Editor’s Note: CE 341, “The Bird Flu (H5N1) — Influenza A: What Is It and Why Should We Care?” is available on nursingspectrum.com.

Cathryn Domrose is a senior staff writer for Nursing Spectrum.