How do people become infected? Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretions and excretions from infected birds. The spread of avian influenza viruses from an ill person to another person has been reported very rarely.

What are the symptoms of avian influenza in humans? Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye infection, pneumonia, severe respiratory diseases (such as acute respiratory distress syndrome), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which specific virus subtype and strain has caused the infection.

Is there a risk to be infected by eating poultry? There is no evidence that properly cooked poultry or eggs can be a source of infection by avian influenza viruses. For more information about avian influenza and food safety issues, World Health Organization website may be visited.

Bird flu in Asia: As of February 19, 2006, bird flu has killed at least 91 people -- mostly in Asia since 2003, according to World Health Organization. Sick birds have directly infected most victims, but scientists fear the H5N1 virus could change to a form easily passed between humans and spark a pandemic.

Situation in Bangladesh: Although Bangladesh continues to be a low prevalence area, but high prevalence countries surround it, as bird flu has already entered in India. India reported its first case of the deadly H5N1 strain of bird flu after chickens were found to have died from the virus. At least 30,000 chickens have died in Navapur, a major poultry-farming region of Maharashtra state, of which Mumbai, the country's commercial hub, is the capital (The Washington Post, 2006).

We however must not adopt a complacent attitude in this respect as our country has all the determinants for an outbreak. The healthcare system is inadequate and over-strained and living is crowded, especially is Dhaka city. If the bird flu enters Bangladesh, it may spread like fire. We still have time to be thoroughly watchful, only if we can raise a strong and effective role of Public Health Administration

Policy implications: It is important to increase awareness of the population and health care staff about the characteristic symptoms and the need to seek prompt medical attention. All ports and borders of Bangladesh need to have strict scrutiny and a plan to boost screening -- bar travelers with bird flu symptoms, require health declaration of visitors from affected countries. The border security personnel need to be extra vigilant to prevent smuggling of live birds or poultry products from neighbouring countries. An awareness building campaign needs to be started through media. We need to explore the possibilities of importing vaccines in huge quantity to vaccinate poultry birds.

According to the studies by the World Health Organisation, backyard farming was the source of avian influenza outbreaks in many cases. Due to space constraints, backyard poultry owners could not install bio security measures to prevent cross infection. It is therefore necessary for us to ban such activities to reduce possible infection among poultry, which might eventually cause human infection. No government could bear to ignore the threat of avian influenza. Instead, all are racing against time to prevent any occurrence of human infection cases.

Above all, we need to plan policies to prevent spread of bird flu. We need to wrestle with this disease. "Try, not to smell where the bird flu is going!"

Prevention in schools

• Schools must not keep poultry in their premises and refrain from keeping live birds where possible.
• Establish barriers to prevent children from touching live bird;
• Avoid organising activities that may expose children to live birds.
• Do not touch poultry and their excreta (wash hands with soap immediately after contact with live birds or surfaces contaminated by bird droppings). Schools should call the government hotline at 1823 for advice on handling sick, wounded or dead birds found on their premises. The Agriculture, Fisheries and Conservation Department will collect the birds for laboratory examination, where necessary.
• Cover nose and mouth when sneezing or coughing and wash hands with soap afterward;
• Cleanse used toys and furniture properly.
• Maintain good ventilation.
• Keep sufficient stock of face masks in the school for staff/students who may need one.
• If any students/staff develop respiratory symptoms, they should consult their doctor promptly, wear a surgical mask, and take rest at home and refrain from going to school as advised by their doctor.

Schools should also visit the web site of the Centre for Health Protection of the Department of Health (http://www.chp.gov.hk) for more information on the prevention of avian influenza.

Prevention in public places

• Step up hygienic practices like washing hands and keeping the environment clean and maintain good ventilation.
• Cover nose and mouth while sneezing or coughing. Dispose sputum or secretions wrapped in tissue paper into rubbish bins with lids and wash hands as soon as possible.
• Avoid crowded or poorly ventilated places.
• Wear a mask when caring for the sick, and when visiting hospitals and clinics.
• Watch out for the latest situation of the influenza pandemic and further announcements from the government.
• Pay attention to and comply with guidelines issued by the government with respect to prevention of avian flu, traveling and port health control.
• Ban import of birds (including pet birds ) and bird products from H5N1-affected countries in Asia and Europe.
• Ban import of birds from areas where H5N1 has been documented.

As a general rule, the public should observe wildlife, including wild birds (seasonal birds) from a distance. This protects you from possible exposure to pathogens and minimises disturbance to the animals. If there is contact with wildlife do not rub eyes, eat, drink, or smoke before washing hands with soap and water. Do not pick up diseased or dead wildlife. Contact with the appropiate natural resource agency if a sick or dead animal is found.

Shakeel Mahmood is Senior Administrative Officer, Health Systems and Infectious Diseases Division, ICDDR, B