BIRD FLU AND YOU

A QUICK GUIDE TO PROTECTING YOURSELF AND YOUR FAMILY FROM BIR

Prepared by: Robert Armstrong, PhD1 and Stephen Prior, PhD2 with Natalie Tedder, BS3, Mary Beth Hill-Harmon, MSPH4, 

What is the flu? 

Influenza, also called the flu, is caused by a virus. The virus is an

organism too small to be seen by the naked eye, but looks like the

picture shown on the right. The virus is shaped like a ball with two

types of “spikes”, an “H” spike and an “N” spike, sticking out of the

ball’s surface. (The H stands for hemagglutinin; the N stands for

neuraminidase. These are both special types of proteins. Unlike the

protein you eat, these proteins are not good for you.) A flu virus can

have one of 15 different H proteins and one of 9 different N

proteins. Scientists name the flu viruses by indicating which H

protein is present and which N protein is present. (For example, the

virus that caused the 2003-2004 flu was named H3N2.) These

“spikes” help the flu virus attach to the cells in your body. Once attached, the virus puts its genetic material into your

cells and uses your cells to help make more virus particles. It is this process that makes you ill. 

Seasonal Flu

Every year, a flu virus infects people around the world. This flu is a yearly, or seasonal, event. In the United States, the

flu season begins in late December and ends in March, killing about 36,000 people (approximately 250,000-500,000

worldwide). Typically, the seasonal flu is most dangerous for the very young, the very sick, and the very old. 

Bird (Pandemic) Flu

Occasionally, a new virus appears that does not follow the normal seasonal cycle. Pandemic flu will affect people

worldwide and can appear at the same time as seasonal flu. Pandemic flu, however, will cause many more deaths

than seasonal flu. (In the 20th century, three pandemics occurred. The pandemic of 1918 killed approximately 40

million people worldwide; 500,000 in the U.S.) Currently, there is a flu virus in birds, called H5N1, that is of extreme

concern to health officials. In Asia, H5N1 has already killed large numbers of chickens, ducks and geese that farmers

raise for food. The virus can pass between farmers’ birds and wild birds, causing it to spread worldwide. The virus

can change slightly (mutate) and be able to pass from birds directly to humans. (There have been several cases

reported in Asia.) The final step to a pandemic is a further change (mutation) in the virus that allows it to pass easily

from human to human. There have been a few reported cases of the virus being passed from human to human, but

as of now, it is a rare event. Many scientists feel that it is just a matter of time, however, before the virus changes

(mutates) and easily passes from human to human; thus, causing a pandemic. 

Seasonal Flu Pandemic Flu

Occurs every year Occurs infrequently; there were three 

in the last century

Occurs during the winter; in the U.S. flu season Occurs at any time of the year

begins in December and ends in March

Most people recover within one or two weeks Some people will not recover 

without requiring medical treatment even with medical treatment 

The very young, the very old and People of every age may 

the very sick are most at risk of be at risk of serious illness

serious illness

Newspaper and radio/TV reports have also used the following names for the disease caused by the H5N1 virus:

■ Highly pathogenic avian influenza (HPAI) ■ Avian Influenza (flu)

■ H5N1 ■ Chicken flu 

■ Bird flu ■ Chicken Ebola

■ Bird flu virus ■ Fowl Plague

What does the word “pandemic” mean?

A pandemic is an outbreak of a disease that covers a wide geographic area and affects large numbers of people.

The H5N1 flu virus (bird flu) could become a pandemic flu.

Why is a pandemic flu deadlier than the seasonal flu?

■ Pandemic flu is caused by a new virus or one to which humans have not been exposed in a very long time

(probably not within the lifetime of anyone currently living).

■ Pandemic flu spreads rapidly and is seen worldwide.

■ Pandemic flu infects large numbers of people of all ages and causes serious illness and deaths.

How long would an H5N1 pandemic last?

An H5N1 pandemic would probably come in waves. In each wave about 1/4 of the population could be infected.

People who become ill in the first wave could also become sick in later waves. Each wave could last about 8-12

weeks, and the period between waves could vary between 8-20 weeks. Most likely, an H5N1 pandemic would have

at least three waves and could last for over 12 months.

When will the next flu pandemic occur?

No one knows for sure. The period between flu pandemics does not follow any regular pattern. Many scientists think

the H5N1 virus is showing signs of becoming a pandemic flu virus, though they are not certain when an H5N1

pandemic might start. Before it reaches the U.S. there will be national and international media reports of the initial

cases of pandemic flu. If a pandemic reaches the U.S., an announcement will be made on television, in newspapers,

on the Internet or the radio.

What will happen if a flu pandemic occurs in the U.S.?

A flu pandemic would spread across the U.S. within weeks and could cause:

■ Disease in large numbers of people (up to 25% of the population).

■ Potential deaths in all age groups.

■ Significant pressure and disruption to all health services.

■ Potential disruption to all aspects of daily life.

■ Possible emergency measures that will affect the entire nation.

(See “What You Can Do” for tips on staying healthy during a flu pandemic.)

FREQUENTLY ASKED QUESTIONS

Can my pets (cats, dogs) contract H5N1? Can I contract

H5N1 from them?

See diagram.

Can I get H5N1 from eating infected poultry or eggs?

In general, scientists do not think you can get H5N1 from

eating infected poultry or eggs. To avoid any possibility of

getting sick, follow safe cooking practices: Cook chicken or

eggs at temperatures above 70oC (158oF); keep raw and

cooked foods apart; wash your hands when handling raw

foods; clean all cutting boards, counter tops and utensils; 

do not eat raw, undercooked poultry or poultry products, 

or raw runny eggs.

Can I get H5N1 from working with/around poultry? What if I

work on a farm?

Exposure to infected poultry and their droppings or dust

contaminated with poultry droppings has been associated with

human infection; however, this is a rare occurrence. The

Centers for Disease Control and Prevention (CDC) and World

Health Organization (WHO) have developed recommendations

for people working with poultry. 

Is H5N1 the same as SARS?

No. H5N1 is a completely different virus from the one that

causes Severe Acute Respiratory Syndrome (SARS).

Is it safe to visit other countries that have reported cases

of H5N1 infection?

To date, the World Health Organization (WHO) has not advised

any travel restrictions. When visiting affected countries, avoid

farms and live poultry and birds, and adopt good hygiene

practices. The CDC provides updated information for travelers.

For further details, visit their website: www.cdc.gov/travel

Are there any supplements, herbs or natural food products

I can take to help protect me from H5N1?

To date, dietary supplements and herbal remedies have not

been evaluated or approved by the Food and Drug

Administration (FDA) for H5N1. Because supplements and

over-the-counter products can interfere with prescription

medicines, consult your healthcare provider before using such

products.

Will my annual flu shot (vaccination) protect me against

H5N1?

No. Your yearly flu vaccination will not provide any protection

against H5N1.

What should I do if I am pregnant during the pandemic?

Make sure you get your seasonal flu shot, even though it will

not protect you from H5N1 it will still protect your from the

seasonal flu. Keep all appointments with your doctor. At the

first onset of flu symptoms, go see your doctor.

Should I stockpile food and water? If so, for how many

days?

Experts recommend stockpiling 3 days worth of non-perishable

food and stockpiling 3 gallons of water for each person in your

household, per day. This is a standard approach for any

emergency that might limit your ability to leave your home.

Will I need to be quarantined?

If pandemic flu occurs in the United States, it is likely that

authorities will ask people to voluntarily restrict their travel and

other day-to-day activities. For those who are infected with

H5N1, mandatory (enforced) movement and activity restrictions

may be imposed to limit the spread of H5N1. (See “Social

Distancing and Movement & Activity Restrictions”.)

Who should I contact if I think I’m infected with H5N1?

If you believe you are infected or have been ill for longer than

10 days or have a fever above 104°F, contact your healthcare

provider.

Can I go to my doctor/healthcare provider and be tested

for H5N1?

To date, there is no routine test for H5N1.

Am I at a greater risk for being infected with H5N1 if my

immune system is already weakened due to HIV, cancer

treatment or other health problems?

People with weakened immune systems are at greater risk of

H5N1 related complications and, if infected, may be capable of

spreading the virus for longer periods of time.

Are there any devices or products that will boost my

immune system and provide protection for H5N1?

If a pandemic occurs, it is highly likely that many people will be

offering to sell you a variety of products that they will claim are

designed to protect you from H5N1. In nearly all cases, such

products will be of little to no value and just cost you money.

Follow the advice of public health officials and your personal

doctor.

Can H5N1 live on everyday surfaces like clothes,

telephones, door handles, toys, grocery carts, etc.? 

Some reports suggest H5N1 can live for several days on a

variety of everyday surfaces. Follow the suggestions noted in

“Cleaning and Sterilizing” for treating your working and living

areas. Washing clothes in hot water will kill any H5N1 particles

that could be on them. Wearing disposable gloves, or using

paper towels or napkins as a barrier, will reduce your chances

of getting H5N1. Wash your hands frequently during the day

and avoid touching your mouth, nose, or eyes. 

What You Need to Know W

The Symptoms:

H5N1 symptoms are the same as seasonal flu:

■ Fever

■ Body ache

■ Cough

■ Fatigue

At first, based only on symptoms, you cannot tell the

difference between H5N1 and seasonal flu (unlike

seasonal or pandemic flu, a common cold does not

normally include body ache). 

Human H5N1 cases reported to date have usually

started very suddenly with:

■ fever (from 102°-104°) lasting 3-4 days

■ headache

■ severe muscle aches

■ general weakness/extreme fatigue

These symptoms are accompanied by:

■ dry cough

■ sore throat

■ runny or stuffy nose

Stomach or intestinal symptoms, for example nausea,

vomiting, and diarrhea, are much more common in

children than adults.

You should see a healthcare provider or go to an

emergency room immediately if you or your child have

any of the following:

■ Severe or prolonged (10 days or more) symptoms

■ Difficulty breathing; rapid/painful breathing

■ Bluish skin

■ Dizziness or fainting

■ Return of fever or cough after symptoms have

improved

■ Dehydration (feeling of dry mouth or excessive thirst)

■ Cough with yellow mucus or saliva

■ Confusion

■ Severe or persistent vomiting

■ Worsening of an existing serious medical condition

(e.g., heart or lung disease, diabetes, HIV, cancer)

Treatments for H5N1:

Antiviral Drugs:

H5N1 can be treated with antiviral drugs, which

require a doctor’s prescription. (Antibiotics are not

effective against H5N1.) Limited supplies of an antiviral

drug called Oseltamivir (Tamiflu®) are being stockpiled,

but its effectiveness in a pandemic will not be known 

until H5N1 is more widespread in humans.

Antiviral drugs for treatment of H5N1 have several

limitations:

■ Treatment must begin no later than two days after

symptoms start. Full treatment lasts for five days.

■ Over time, the drugs may become ineffective against

H5N1 as it mutates.

■ There may not be enough drugs to treat everyone.

Vaccine:

■ The vaccine against seasonal flu will not protect against

H5N1.

■ Scientists have developed an H5N1 vaccine that is

likely to provide protection. However, many problems

need to be resolved before it is ready for general use.

To date, there is no solid estimate as to when a vaccine

will be available for general use.

Announcements from WHO and

Government Organizations:

The WHO (World Health Organization) will inform

governments when a pandemic starts and the CDC

(Centers for Disease Control and Prevention) will provide

information to the media and make announcements on

television, radio, in print, and via the Internet when the

United States is going to be affected.

The CDC website can be found at: www.cdc.gov

The WHO website can be found at: www.who.int

FOUR SIMP

PROTECT Y

Cleaning and Sterilizing:

H5N1 is killed by alcohol and bleach. Clea

dishwashing liquid, laundry detergent, han

The table gives you directions on how to p

Sterilizing Agents 

Household (Laundry) Bleach: 

Dilute 3/4 cup of bleach 

into one gallon of water. 

Rubbing Alcohol: 

(e.g. 70% isopropyl alcohol or 

60% ethyl alcohol) 

Do not dilute; use straight from bottle

Items with lower alcohol concentration

such as whiskey, vodka and rum, 

will not be effective. 

Personal Protective Equipment

■ According to the World Health Organizat

(PPE) may reduce, but not eliminate the 

■ Certain individuals, such as those expos

and healthcare workers, should wear PP

your employer.

■ Family members or other people who ca

disposable latex or plastic gloves. H5N1 

people. The preferred type of mask is an 

local hardware stores or through medica

(see photo). Surgical masks and gloves 

■ Discard masks after 4-6 hours of use. D

in a sealed plastic bag and throw away w

replace basic sanitary measures such as 

preventing the spread of H5N1.

■ If asked to wear a mask, be sure to wea

• Securing ties behind head or placing e

• Fitting the flexible band at top of the m

• Fitting the mask snugly to your face a

■ Wash your hands immediately after remo

■ While there is some debate about wheth

cause harm.

Social Distancing and Move

Contact with an infected person increases 

will help prevent the spread of H5N1. The 

activity restrictions (MAR).

Social Distancing:

The goal of social distancing is to increase 

that will increase social distancing include:

■ Avoiding crowded places (including mov

■ Working from home.

■ Changing work schedules and patterns 

Movement and Activity Restrictions (M

MAR reduces contact between people by 

gather. Restrictions could be placed on yo

community. Public health authorities may i

■ Authorities think you may be infected be

you may show no symptoms.

■ Authorities think you may be infected be

contact with a known infected person or 

showing symptoms.

In each of these cases, an adult would mo

10 days (14 days for a child of 12 and you

remember that early in the illness you m

symptoms but can pass H5N1 to other p

Historically, MAR has included quarantines

of a pandemic, enforced quarantines may 

widespread voluntary home quarantine (als

shielding” or “snow days”) will likely be rec

authorities will ask for wide-scale voluntary 

declare “snow days.”

In addition to wide-scale voluntary actions

may take the following measures on a com

■ Temporary closing of schools, universitie

and places of worship.

■ Limiting mass transportation (including s

and airports).

Remember, during a pandemic, limit your c

continue to communicate (phone, Internet, 

family.

H E A L T H P O L I C Y C E N T E R

N A T I O N A L S E C U R I T Y

Keep blea

Do 

This diagram shows how humans and animals interact to catch and spread H5N1. For

example, it can pass to a farmer’s chickens, then pass to humans. Likewise, it can pass to

a farmer’s pigs and then pass to humans. In a pandemic flu, the virus will change (mutate)

so that it can also easily pass from one human to another.

■ There is evidence that cats can catch H5N1, but it is not certain that they can pass it to

humans.

■ There is no known case of dogs catching or spreading H5N1.

■ Pet birds can catch H5N1 and spread it to humans. However, there should be no concern

if bird owners keep their birds in clean conditions, away from wild birds, and continue to

wash their hands after handling birds or coming into contact with bird droppings.

The facts, recommendations and advice expressed or implied on this poster are those of

the contributors and do not necessarily reflect the views of the Department of Defense, 

the National Defense University or any other agency of the Federal Government. If you are

in any doubt about what actions to take you should obtain professional healthcare advice.

1 Senior Fellow, Center for Technology and National Se

2 Director, National Security Health Policy Center, The P

3 Research Assistant, National Security Health Policy C

4 Research Associate, Center for Technology and Natio

5 Analyst, Joint Warfighting Division, ANSER, Arlington

COVER YOUR COUGH A

■ Cover your mouth and nose wit

■ Put your tissue in the trash can

■ If you do not have a tissue, cou

sleeve, not your hands

WASH YOUR HANDS

■ Wash hands with warm, soapy 

OR use a hand sanitizer after:

• Coughing or sneezing • 

• Caring for a sick person • 

KEEP LIVING AND WOR

■ Clean areas with household det

(dishwashing liquid, laundry det

hand soap).

■ Sanitize surfaces with bleach o

KEEP YOUR DISTANCE

■ Avoid crowds

■ Limit your travel

■ Travel to and from work during 

■ Work from home, if possible

There are many common sense, non-m

Following these procedures can signif

© 2005 by NSHPC. All rights reserved. No part of this poster may be used or reproduced outside the United States Government in any manner whatsoever without written permission of the authors.