Pandemic means " A disease prevalent throughout an entire country, continent or whole world." It also means "A disease that is easily transmissible by humans or animals."

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Current situation - World Health Organization raises Pandemic Level to Level 6. From WHO news conference 11 June 2009: "On the basis of available evidence and these expert assessments of the evidence, the scientific criteria for an influenza pandemic have been met. I have therefore decided to raise the level of influenza pandemic alert from Phase 5 to Phase 6.

The world is now at the start of the 2009 influenza pandemic." The transcripts of the Press Conference can be read or videos watched at the WHO site: http://www.who.int/mediacentre/influenzaAH1N1_presstranscript_20090611.pdf It is important to note that this does not indicate an increase in the severity, just that the criteria for Phase 6 regarding the spread of the Novel H1N1 Influenza have been met. This puts in to place additional steps by WHO and Nations' plans for control and prevention in such a widespread situation of pandemic.

Avian influenza is flu infection in birds. The virus that causes the bird infectin can change (mutate) to infect humans. Such mutation could start a deadly worldwide epidemic.

Bird flu; H5N1

The first avian influenza virus to infect humans occurred in Hong Kong in 1997. The epidemic was linked to chickens and classified as avian influenza A (H5N1).

Human cases of avian influenza A (H5N1) have since been reported in Asia, Africa, Europe, Indonesia, Vietnman, the Pacific, and the near East. Hundreds of people have become sick with this virus. Slightly more than 60% of those who became ill have died.

The more the avian flu virus spreads, the greater the chances of a worldwide outbreak in humans. There is a tremendous concern that H5N1 poses an enormous pandemic threat.

The following people have a higher risk for developing the bird flu:

• Farmers and others who work with poultry
• Travelers visiting affected countries
• Those who touch an infected bird
• Those who eat raw or undercooked poultry meat, eggs, or blood from infected birds

Health care workers and household contacts of patients with avian influenza may also be at an increased risk of the bird flu.

The avian flu virus (H5N1) has been shown to survive in the environment for long periods of time. Infection may be spread simply by touching contaminated surfaces. Birds who were infected with this flu can continue to release the virus in their feces and saliva for as long as 10 days.

Symptoms of avian flu infection in humans depend on the strain of virus.

Infection with the H5N1 virus in humans causes typical flu-like symptoms, which might include:

• Cough (dry or productive)
• Diarrhea
• Difficulty breathing
• Fever greater than 100.4°F (38°C)
• Headache
• Malaise
• Muscle aches
• Runny nose
• Sore throat

If you think you have been exposed to avian influenza, call your health care provider before your visit. This will give the staff a chance to take proper precautions that will protect them and other patients during your office visit.

Tests to identify the avian flu exist but are not widely available. A test for diagnosing strains of bird flu in people suspected of having the virus gives preliminary results within 4 hours. Older tests took 2 to 3 days.

Your doctor might also perform the following tests:

• Auscultation(to detect abnormal breath sounds)
• Chest x-ray
• Nasopharyngeal culture
• White blood cell differential

Other tests may be done to look at the functions of your heart, kidneys, and liver.

Different types of avian flu virus may cause different symptoms. Therefore, treatment may vary.

In general, treatment with the antiviral medication oseltamivir (Tamiflu) or zanamivir (Relenza) may make the disease less severe if you start taking the medicine within 48 hours after your symptoms start.

Oseltamivir may also be prescribed for persons who live in the same house as those diagnosed with avian flu.

The virus that causes human avian flu appears to be resistant to the antiviral medicines amantadine and rimantadine. Therefore these medications should not be used if an H5N1 outbreak occurs.

People with severe infection may need to be placed on a breathing machine. Experts recommend that persons diagnosed with avian flu be put in isolation.

Doctors recommend that people get an influenza (flu) shot to reduce the chance of an avian flu virus mixing with a human flu virus, which would create a new virus that may easily spread.

The U.S. Food and Drug Administration has approved a vaccine to protect humans from the avian flu. Experts say the vaccine could be used if the current H5N1 virus starts spreading between people.

The outlook depends on the severity of infection and the type of avian influenza virus that caused it. Death is possible.

• Acute respiratory distress
• Organ failure
• Pneumonia
• Sepsis

Call your health care provider if you develop flu-like symptoms within 10 days of handling infected birds or traveling to an area with a known avian flu outbreak.

At this time, the U.S. Centers for Disease Control and Prevention (CDC) has no recommendations against travel to the countries affected by H5N1 .

However, travelers should avoid visits to live-bird markets in areas with an avian flu outbreak. People who work with birds who might be infected should use protective clothing and special breathing masks. Avoiding undercooked or uncooked meat reduces the risk of exposure to avian flu and other foodborne diseases.

Current information regarding avian flu is available at www.cdc.gov/flu/avian/outbreaks/current.htm.

Treanor JJ. Influenza viruses, including avian influence and swine influenza. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 165.

US Food and Drug Administration. FDA Approves First U.S. Vaccine for Humans Against the Avian Influenza Virus H5N1. Rockville, MD: National Press Office; April 17, 2007. Release P07-68

Levin S. Zoonoses. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 349.

Hayden FG. Influenza. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 387.

Ferri FF. Avian influenza. In: Ferri FF, ed. Ferri's Clinical Advisor 2010. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2009:section 1.

Review Date: 02/01/2011

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Mosquitoes are typically smaller than a shirt button, but they can pose big health risks. More than 200 species are found throughout North America, some of which can transmit West Nile virus and other viruses that cause encephalitis, or swelling of the brain.

According to the Centers for Disease Control and Prevention, more than 19,500 cases of West Nile have been reported in the United States, including more than 750 deaths, since the virus was first identified in New York in 1999. Serious symptoms of West Nile virus can include high fever, headache, neck stiffness, disorientation, convulsions, vision loss and paralysis; and the disease can even be fatal.

Furthermore, mosquitoes cause major health problems internationally by carrying and transmitting infectious agents that cause diseases such as malaria, elephantiasis, and yellow and dengue fevers.

"Not only are mosquitoes dangerous, but they're also annoying, ranking among the most frequently encountered pests in American homes," says Frank Meek, entomologist and Technical Director for Orkin, Inc. "It is important to protect yourself and your family against mosquitoes, especially in summer and early fall, when populations are most prevalent."

Fortunately, 90 percent of Americans realize that mosquitoes are capable of spreading disease and adversely impacting health, according to a recent survey released by Orkin, Inc. Armed with this knowledge, homeowners should proactively follow these tips to help protect against mosquito populations thriving in and around their homes:

• When outdoors, apply an EPA-approved insect repellant on clothing and exposed skin.

• During prime mosquito-biting hours of dusk to dawn, wear long sleeves and pants in addition to repellant, or consider staying indoors.

• Make sure screens on windows and doors fit tightly and have no holes.

• Remember, mosquitoes only need a thimbleful of water to breed and survive, so eliminate breeding sites by emptying standing water from objects around the home, including flowerpots, buckets, tire swings and children's wading pools. Change the water in pet dishes and birdbaths regularly.

Controlling mosquito populations can be difficult, but professional help is available through Orkin, the only national pest control provider offering treatment services against these dangerous pests.