There are currently four drugs that treat influenza:
- amantadine
- rimantadine
- oseltamivir
- zanamivir
These drugs must be started within the first 48 hours of infection in order to help shorten the duration and lessen the severity of disease.
Individual flu strains can mutate and become resistant to the drugs. The Centers for Disease Control (CDC) analysis of the H5N1 strains from Asia have shown resistance to amantadine and rimantadine. This means that if the current H5N1 avian flu causes a pandemic, only oseltamivir and zanamivir can be used to treat it. Resistance patterns of influenza viruses are continuously monitored and updated as they change.
In the case of a pandemic, there will be several obstacles to drug therapy. The price of these medications is prohibitively high for many countries. In addition, the manufacturing processes are complex and time-consuming. Thus, we know that supplies will not be able to meet demands.
Is the annual flu vaccine effective against the H5N1 virus?
No. The annual flu vaccine only works against seasonal flu strains. Although a vaccine against the H5N1 virus is under development in several countries, any mutant flu virus could cause a pandemic. The vaccine needs to closely match the pandemic virus in order to work, so large-scale commercial production will not start until the new virus has emerged and a pandemic has been declared. This means that no vaccines are expected to be widely available until several months after the start of a pandemic.
Is there a pandemic flu now? Is one coming?
Currently, there is no pandemic flu. However, they have occurred naturally throughout history. In the past 100 years, there have been three:
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1918 - 1919: "Spanish flu": infected 20% of the world population. Ohio reported 1,113,797 cases and 8,602 deaths.
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1957 - 1958: "Asian flu": One or more outbreaks were reported in 71 of Ohio’s 88 counties with deaths in 63 counties. A flu vaccine was developed in 1957 to contain the outbreak.
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1968 - 1969: "Hong Kong flu": caused a mild flu pandemic, similar to seasonal flu.
Pandemics are largely unpredictable. History dictates that one will eventually occur again, but it is difficult to say when, what type of flu it will be, or how severe it will be. When one does occur, the virus could enter the United States via migratory birds, the poultry trade, or international travel.
What is special about the current outbreaks in poultry?
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The current outbreaks, which began in South-east Asia in mid-2003, are the largest and most severe on record. Never before in the history of this disease have so many countries been simultaneously affected resulting in the loss of so many birds.
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H5N1 appears to have expanded its host range, infecting and killing animals previously considered resistant to avian influenza viruses.
What is the difference between seasonal flu, avian flu and pandemic flu?
Seasonal flu: Seasonal flu is a respiratory illness that can be transmitted person to person. Flu is caused by many different types of viruses. In the fall and winter of every year, a common or seasonal flu virus infects people in the community. People have fever, chills, headaches, body aches, sore throat, shortness of breath, and they cough and sneeze. It can take 10 days for people to get over the flu. Most people have some immunity, and a vaccine is available.
Avian (or bird) flu: Avian flu is a contagious disease of animals caused by viruses that normally infect only birds and, less commonly, pigs. Avian influenza viruses are highly species-specific, but have, on rare occasions, crossed the species barrier to infect humans.
When human infection occurs, the symptoms are the same as the seasonal flu only much more severe. It is usually passed to humans through direct or close contact with birds (i.e. poultry farmers), although the H5N1 flu virus currently in Southeast Asia has passed from human to human in a few rare cases. There is no human immunity to avian flu, and no vaccine is available.
Pandemic flu: Pandemic flu can be caused by any type of flu virus that mutates into a highly infectious form. Because they are new mutations, people have little natural immunity; thus, disease spreads easily from person to person causing a global outbreak, or pandemic. There have been three flu pandemics in the past 100 years.
What is the difference between the flu and a common cold?
Common cold and the flu are both caused by viruses, and they are often confused. There is a lot of overlap in symptoms, however there are important differences. The cold is much more common, and the flu is much more serious.
Both can include
- sore throat, cough, sneezing
- headache and body aches
Cold
- minimal or no fever
- begin slowly
Flu
- fever and chills are the hallmark of the flu
- sudden onset, beginning with high fever, body aches, and loss of energy
- can develop marked cough and shortness of breath within several days of onset
A mild case of the flu is generally worse than a bad cold. Many people mistakenly believe that their, “Flu shot didn’t work,” because they mistake what is really a cold for the flu.
The flu shot does not prevent colds. There is no shot available to do so.
What is the Shaker Heights Public Health Department doing to prepare for a pandemic flu?
In collaboration with Cuyahoga County Board of Health, and in compliance with the Federal Emergency Management Agency’s (FEMA) recommended protocols, Shaker Heights has developed an emergency response plan for all stages of a pandemic flu. This plan includes procedures for surveillance, transmission limitation, vaccination, and antiviral distribution.
Why is the avian flu virus in the news called H5N1?
Flu viruses are named according to two different proteins on their surface: hemagglutinin and neuraminidase. Hemagglutinin helps the virus stick to cells and infect them. After invading cells, the virus replicates into many identical copies. Neuraminidase enables these new copies to exit the host cell.
Currently, there are 16 known variants of hemagglutinin and 9 known variants of neuraminidase. The avian flu currently under international scrutiny has hemagglutinin type 5 and neuraminidase type 1 (H5N1).
Emergency Preparedness
How can I know severe weather is coming?
The federal government operates the Emergency Alert System (EAS). In case of an emergency, EAS alerts interrupt regularly scheduled shows on broadcast media, cable television, pagers, Direct Broadcast Satellite, High Definition Television, and Video Dial Tone. EAS alerts account for the deaf and hard of hearing, as well as people who speak different languages.
To access this information during a power outage, it is best to have a battery operated (with plenty of extra batteries) or wind-up radio.
NOAA Weather Radio All Hazards (NRW) is another available emergency alert system run by the National Weather Service (NWS). It is a nationwide network of VHF radio stations that broadcast continuous “All Hazards” information, such as natural (earthquakes), environmental (chemical spills), and public safety (AMBER alerts) events. Standard am/fm radios can not receive these stations, but special radio receivers are available at many electronics, department, and sporting goods stores. For more information, please visit the National Weather Service's information page.
How can parents and teachers prepare children for a disaster?
The Department of Homeland Security provides an interactive web site to help educate children on emergency preparedness at http://www.ready.gov/.
There are also excellent links to resources for parents and teachers in the kids section of the website.
How do I prepare my business for a disaster?
The Department of Homeland Security provides comprehensive information on how to prepare your business at http://www.ready.gov/.
How do I protect my health after a power outage?
The following information is from the Ohio Emergency Operations Center:
Food Safety
Refrigerated and frozen foods can pose serious health risks after a power outage. Throw away any product if there is any doubt about its safety. Typically, food inside a refrigerator will stay cold for about four hours, depending on how warm your kitchen is and if the door remained closed. High-protein foods, such as dairy products, meat, fish and poultry, cannot be stored safely at room temperature. A freezer at least half-full should be able to keep foods frozen for about one day if the door remained closed.
Throw away any food products that are questionable or have obvious signs of spoilage; slime, mold or wilting. When in doubt, throw it out.
Water Safety
A person requires a half a gallon of water or other non-alcoholic liquids each day. Meeting this requirement after a water outage can be difficult. If you temporarily lost water service, it is important to boil your water vigorously for at least three minutes before using it, or use bottled water. Follow local water advisories issued after water service has been restored.
How do I protect myself from the summer heat?
With high heat and humidity, watch for signs of heat-related stress. Symptoms include heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea or fainting. People experiencing symptoms should be moved to a cool, shady or air-conditioned area and provided cool, non-alcoholic beverages.
Among those at highest risk for heat stroke or heat exhaustion are:
- Infants and children up to 4 years of age.
- People 65 and older.
- People who are overweight.
- People who overexert during work or exercise.
- People who are ill or on certain medications.
To help prevent heat-related stress, drink plenty of fluids and avoid alcohol and caffeine; they can add to dehydration and increase the effects of heat illness. Also, avoid outdoor activities during the hottest parts of the day. Friends, family and neighbors are urged to monitor the very young, the chronically ill and the elderly for signs of heat stress.
What do I do in case of a chemical, biological, radiation, or nuclear incident?
The Department of Homeland Security provides recommendations for these situations in the Be Informed section of their Ready America site. The Ready America site is just one part of the comprehensive emergency information they provide at http://www.ready.gov/.
What severe weather is most common in Ohio? How do I prepare?
The Ohio Committee for Severe Weather Awareness (OCSWA) prepares an outstanding annual emergency preparedness guide. It is easy to read and understand, and it addresses the following topics:
- Tornadoes – facts, safety tips, statistics, and loss prevention tips
- Thunderstorms/lightning – facts, and safety tips
- Floods – facts, safety tips, insurance facts, disaster assistance
- Insurance tips during rebuilding
- Health and safety concerns – power outages, flooding, and excessive heat
Of note is that even in the winter, flooding is Ohio’s most common severe weather threat.
Environmental
What is the safest way to dispose of medications?
See Public Works FAQs.
Meningitis
Can meningitis be treated?
Meningococcal meningitis can be treated with antibiotics. It is important, however, that treatment be started early in. Appropriate antibiotic treatment of most common types of bacterial meningitis should reduce the risk of dying from meningitis to below 15%, although the risk is higher among the elderly.
How do you catch it?
Meningococcal bacteria can be present in healthy individuals. In fact, less than 1% of people carrying the bacteria become sick as a result. No one knows why it becomes so dangerous and invasive in those few individuals. But we do know that when one active infection occurs, it is more likely that others may follow.
When an infection is present, meningococcal bacteria are spread through the exchange of respiratory and throat secretions (i.e., coughing, kissing) and through close personal contact. It is not as contagious as infections like the common cold or the flu. Thus, it is not spread by casual contact, by touching areas that have been touched by the person with the illness, or by breathing the air where a person with meningitis has been.
Those who are not at risk for the infection include those who have had only casual contact, or people who have only had contact with another high risk individual (in other words, no direct contact with the infected individual). Examples of casual contact include passing in the hall, being in a neighboring classroom, eating in the same area, or being on the same playground.
The concern with meningococcal disease is not that it is easy to catch, but that it becomes so severe, so quickly once the illness starts.
How is meningitis diagnosed?
The diagnosis is usually made by growing bacteria from a sample of spinal fluid. The spinal fluid is obtained by performing a spinal tap, in which a needle is inserted into the lower back where fluid in the spinal canal is readily accessible.
Identification of the type of bacteria responsible is important for selection of correct antibiotics. Early diagnosis and treatment are very important. If symptoms occur, the patient should see a doctor immediately.
If I come in close contact with a meningitis case, what is the preventive treatment?
The Shaker Heights Health Department recommends that any child or adult who has close personal contact with an infected individual receive preventive antibiotics. (See the FAQ How do you catch it?) These antibiotics are taken for a day or two. The incubation period—the time from exposure until development of symptoms—is 2 to 10 days, but most commonly 3 to 4 days.
What are the symptoms?
High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. These symptoms can develop over several hours, or they may take 1 to 2 days. Other symptoms may include nausea, vomiting, discomfort looking into bright lights, confusion, and sleepiness.
In newborns and small infants, the classic symptoms of fever, headache, and neck stiffness may be absent or difficult to detect, and the infant may only appear slow or inactive, be irritable, have vomiting, or be feeding poorly.
As the disease progresses, patients of any age may have seizures.
What is meningitis?
Meningitis is an infection of the fluid of a person's spinal cord and the fluid that surrounds the brain. Meningitis is usually caused by a viral or bacterial infection.
Knowing whether meningitis is caused by a virus or bacterium is important because the severity of illness and the treatment differ. Viral meningitis is generally less severe and resolves without specific treatment, while bacterial meningitis can be quite severe and may result in brain damage, hearing loss, learning disability, or death.
What is meningococcus?
Meningococcus is a bacterium that is commonly found in the respiratory tract of healthy individuals. It normally does not cause disease. When meningococcus does cause infection, the consequences can be severe, including infection of the blood (called meningococcemia) or of the fluid surrounding the brain (called meningococcal meningitis). Either of these infections can cause death.
What will happen in school if a child is diagnosed with meningitis?
The Shaker Heights Health Department recommends that any child or adult who has close personal contact with an infected individual receive preventive antibiotics. (See the FAQ How do you catch it?)
If infection occurs in a young child, we will recommend that all children in their classroom also receive preventive antibiotics. Young children tend to be very “touchy”, and not necessarily reliable reporters of physical contact.
If infection occurs in older children, routine use of preventive antibiotics for classmates is not recommended. It is presumed that older children are less likely to be touching and more likely to remember it if they have.
The incubation period—the time from exposure until development of symptoms—is 2 to 10 days, but most commonly 3 to 4 days.
Who needs the meningococcal meningitis vaccine?
The meningococcal vaccine is recommended, and frequently required, for students entering college.
The Advisory Committee on Immunization Practice has also recently recommended giving the vaccine to all 11 and 12 year old children, or unvaccinated teens at high school entry. Because these are only recommendations and not state of Ohio requirements, most insurance companies do not cover this immunization.
The meningococcal vaccine is not considered useful in early meningococcal outbreak management. An outbreak is defined as 2 or more cases occurring within 2 weeks in the same county or nearby communities. This is because they are not effective against all strains (or serogroups) of meningitis. Thus, the vaccine is only recommended for use in outbreaks when the meningococcal serogroup has been identified (which takes several days).
The meningococcal vaccine is available in the Shaker Heights Health Department for $95. For an appointment for any immunization, call 491-1480.
SERV
Is there liability protection offered for professionals?
No. SERV will never put our volunteers in a situation requiring liability protection. For professionals who want to do more, liability protection is offered through Citizen Corps and the Ohio Medical Reserve Corps. Please see the web site for more information.
What type of work is involved with being a SERV member?
SERV volunteers can anticipate work as early as this November when the city will conduct its annual emergency flu vaccination exercise. SERV volunteers will assist in greeting patients, distributing and compiling forms, directing traffic, and other general duties. The exercise represents the Department of Homeland Security’s efforts to conduct Point of Distribution training in anticipation of potential flu outbreaks. POD exercises help to prepare communities for rapid vaccination and outbreak control. All SERV members will be notified of the exact date and location of the POD exercise in early September.
What’s the difference between SERV and CERT?
SERV is a volunteer group specific to the city of Shaker Heights and requires only a minimal time commitment.
CERT is a partner of Citizen Corps and sponsored by the Department of Homeland Security. CERT members undergo training in basic disaster response skills, such as fire safety, light search and rescue, and disaster medical operations. They then serve a vital role in the community, educating their neighbors about disaster preparedness and assisting response teams in the event of an emergency.
Who’s qualified to be a SERV member?
SERV offers volunteer opportunities to all Shaker Heights residents and requires no special qualifications or training. SERV places greater emphasis on establishing a large volunteer pool than on creating a small group of highly trained volunteers. A large volunteer reserve is needed to supplement the efforts of trained professionals in order to alleviate the pressures of smaller, administrative tasks.
West Nile Virus
Besides mosquitoes, can you get West Nile virus directly from other insects or ticks?
Infected mosquitoes are the primary source of West Nile virus and caused the recent outbreaks in the United States. There is no evidence to suggest that ticks or other insects transmit West Nile virus.
Can you get West Nile virus directly from birds?
There is currently no evidence that West Nile virus can be spread directly from birds to people. However, dead birds can carry a variety of diseases and, therefore, should never be handled with bare hands. Use gloves to carefully place dead birds in double-plastic bags and then place in the outdoor trash.
I've gotten a mosquito bite. Should I be tested for West Nile virus?
No. Illnesses related to mosquito bites are still uncommon. However, you should see a doctor immediately if you develop symptoms such as high fever, confusion, muscle weakness, severe headaches, stiff neck, or if your eyes become sensitive to light. Patients with mild symptoms should recover completely, and do not require any specific medication or laboratory testing.
If I live in an area where birds or mosquitoes with West Nile virus have been reported, and I am bitten by a mosquito, am I likely to get sick?
Evidence indicates that the chance of human infection and illness resulting from West Nile virus is very low. Even in infected areas only about one percent of mosquitoes carry the virus. Of those bitten by an infected mosquito, less than one percent are likely to develop serious infection. People older than fifty, especially the elderly, are those most likely to get seriously ill if they become infected, and should, therefore, take the greatest care to prevent exposure to mosquito bites.
Is a woman's pregnancy at risk if she gets West Nile virus?
There is no documented evidence that a pregnant woman or her fetus are at increased risk due to infection with West Nile virus.
Is there a vaccine against West Nile virus?
A vaccine against West Nile virus for humans does not exist.
What should I do if I think I have West Nile encephalitis?
If you develop signs of encephalitis, with fever, muscle weakness, and confusion, you should seek medical care immediately.
