Avian and Pandemic Influenza, frequently asked questions

Why is there so much talk about influenza at the moment?

What is pandemic influenza?

How often do influenza pandemics occur?

When is the next pandemic due?

Why so much concern about the current situation?

Does human infection with H5N1 happen often?

How significant is the threat? Can people catch it from, for example, eating chicken?

How many confirmed human cases of avian flu are there?

What is the difference between ‘ordinary’ influenza and pandemic influenza?

Why is Shell making preparations for a influenza pandemic now?

How will we know a pandemic has started?

Can a pandemic be prevented at an early stage?

How will it spread to different countries?

Who will be at risk during a influenza pandemic?

How many people are likely to catch influenza during the pandemic?

How serious might it be?

How will an influenza pandemic impact on Shell business?

What is Shell doing now to prepare for a pandemic?

Are there currently any travel restrictions for Shell Staff?

Specifically what advice are you giving to Shell travelers?

Will people be prevented from traveling when a pandemic starts?

Are presently available vaccines useful in averting an influenza pandemic?

Where can I find Shell guidelines on current influenza vaccination?

Will existing antivirals be effective?

What is the Shell position on antiviral medication?

What can people do to reduce any risk of contracting bird flu?

What measures will Shell take if there is an influenza outbreak in a particular country?

Will you evacuate expatriate families and/or staff from a country if the WHO recommends that people

should not visit that country?

Will you continue to expatriate employees/families to a country if the WHO recommends that people

should not visit that country?

Will you evacuate expatriate employees and/or families in the event of a regional outbreak of the

influenza virus that is spreading between humans?

Will you medevac (provide medical evacuation to) an expatriate/family member?

Where can I find out more?

Since mid-December 2003, a growing number of Asian countries have reported outbreaks of avian influenza (“bird flu”) in chickens and ducks. This is a disease of birds caused by influenza viruses closely related to human influenza viruses. It is an important disease economically for poultry farmers because of losses in poultry flocks. Transmission to humans in close contact with poultry or other birds occurs rarely, and only with some strains, and therefore Shell or other travelers should follow the instructions on the Shell Health Service website ( http://sww-shs.shell.com/health) to minimize their risk of infection.  However, the potential for transformation of avian influenza into a form that both causes severe disease in humans and spreads easily from person to person is a great concern for world health.

For further information, the best source is the World Health Organisation website, http://www.who.int/csr/disease/avian_influenza/en/

Influenza that spreads rapidly to affect almost all countries and regions around the world. Influenza pandemics (i.e. global epidemics) occur when a new strain of influenza virus appears, to which most people have no immunity. Influenza pandemics generally affect more people, cause more severe illness and result in much more serious disruption to society than the ‘ordinary’ influenza that we see for example in the U.S. each winter.

Influenza pandemics have occurred every few decades. There were three influenza pandemics in the last century.

No one knows for sure. Intervals between previous pandemics have varied with no recognizable pattern. Also, a pandemic may not follow the usual seasonal pattern of ‘ordinary’ influenza and could occur at any time of the year.

The current rapid spread of highly lethal avian influenza, with outbreaks occurring at the same time in several countries, is historically unprecedented and of great concern for human health as well as for agriculture.

Particularly worrying, in terms of risks for human health, is the detection of a highly lethal strain, known as “H5N1”, as the cause of most of these outbreaks. H5N1 has demonstrated an ability to jump the species barrier, causing severe disease in humans who come into close contact with infected birds and poultry. A second and even greater concern is the possibility that the present situation could give rise to another influenza pandemic in humans. Scientists know that avian and human influenza viruses can exchange genes when a person is simultaneously infected with viruses from both species. This process of gene swapping inside the human body can give rise to a completely new subtype of the influenza virus to which few, if any, humans would have natural immunity. Moreover, existing vaccines, which are developed each year to match presently circulating strains and protect humans during seasonal epidemics, would not be effective against a completely new influenza virus.

If the new virus contains sufficient human genes, transmission directly from one person to another (instead of from birds to humans only) can occur. When this happens, the conditions for the start of a new influenza pandemic will have been met. Most alarming would be a situation in which person-to-person transmission resulted in successive generations of severe disease with high mortality.

Only very rarely. The first documented human infections with H5N1 occurred in Hong Kong in 1997. In that first outbreak, 18 persons were hospitalized and six of them died. The source of infection in all cases was traced to contact with diseased birds on farms and poultry markets. To date, the WHO has reported some 60 confirmed human deaths due to H5N1 in Asian countries despite millions of infected birds/poultry.

Exposure to infected poultry and their faeces or dust/soil contaminated with faeces can result in human infection. Those at risk are employees of affected poultry farms and others, like veterinarians, cullers and transporters, who visit poultry farms. However, based on existing information, WHO has concluded that processed poultry products (whole refrigerated or frozen carcasses and products derived from them) and eggs do not pose a risk to public health. . The virus is killed by heat, so poultry products should be thoroughly cooked, and people should avoid raw or lightly-cooked egg products.

The cumulative number of confirmed human cases and deaths caused by avian influenza A /(H5N1) and reported to WHO may be found on the following WHO site: http://www.who.int/csr/disease/avian_influenza/country/en/

‘Ordinary’ influenza is the influenza that circulates most of the time and produces the outbreaks we see every year. For most people this is an unpleasant though not life-threatening illness. The strains of virus causing this type of influenza change from year to year but can be fairly reliably predicted so that an appropriate vaccine can be prepared each year.

Pandemic influenza is caused when a new strain of influenza virus emerges which is markedly different from recently circulating strains. These changes cannot be predicted in the same way as the changes in ‘ordinary’ influenza viruses, so a vaccine specifically against the new strain cannot be developed in advance.

There is an outbreak of avian influenza in bird populations in S E Asia, spreading into Russia. The disease has also been identified in poultry workers and people who are thought to have been in close contact with infected birds.The World Health Organisation (WHO) is concerned that if the virus changes and develops the abilty to spread from human to human, a pandemic may develop.They have therefore advised governments and organizations to make preparations for a potential pandemic, and Shell is therefore following this advice.

The World Health Organization monitors influenza activity around the world and will announce the pre-pandemic stages and the start of a pandemic and will inform governments.

Efforts will be made internationally to try to control a pandemic at an early stage. However, influenza is highly infectious and because whole populations will be susceptible to the new virus, it is likely to continue to spread despite efforts to contain it.

Most likely through people catching the infection in an affected part of the world and developing symptoms after arriving in another country.

Everyone is potentially at risk of catching influenza during a influenza pandemic, as few, if anyone, will have immunity to the virus. Certain groups or age groups may be at greater risk than others; we will not know for certain who they will be until the virus starts circulating.

From past experience, around 25 - 50% of the population is likely to develop influenza, although it could be more.

We do not expect to see the same high mortality figures for pandemic influenza as for avian influenza; nevertheless, based on past experience and current medical and health standards and practices, it is possible that the fatality rate might be somewhere of the order of  between 4 and 20 per 1000 people who catch the disease.

Each pandemic is different and the impact on Shell businesses cannot be fully established until more is known about how a pandemic is evolving. Absence from work will depend largely on the age group most affected by the virus.

A quarter or more of the working population may have to take some 10 – 14 days off work at some stage during the pandemic. In addition to absence due to illness, some workers may need time off to care for family members or may have difficulty getting to work.

High sickness absence rates would result in reduced capacity for Shell businesses to operate normally and, if levels of sickness absence become intolerably high, could prevent their safe operation.

High levels of sickness absence in contractors, customers, public and emergency services would also have a significant impact on Shell operations.

Our overall approach is to align with WHO recommendations. Specifically, we have established a working group including Medical and other staff to guide and advise us. The Shell Health Services website http://sww-shs.shell.com/health already carries advice to Shell travelers on practical precautions and personal hygiene measures that can help minimize any risk. We have also drawn on the Group’s scenarios expertise to develop possible scenarios as a backdrop against which to develop country contingency plans that place priority on safety of operations and personnel, and take account of coordination with governments and other key stakeholders (e.g. partners, contractors, suppliers and customers).

There are currently no travel restrictions in relation to Avian influenza. Shell policy on travel restrictions is to align with WHO guidelines

Up-to-date details of which countries are currently affected, and further advice on public  health precautions and vaccination requirements  can  be found on the Shell Health Services website (http://sww-shs.shell.com/health/) under ‘Avian Influenza’ or at http://www.shell.com/us/help

Please note that in alignment with WHO guidance, Shell Health Services no longer advises vaccination of business travelers and transferees with normal influenza vaccine .

Please see current travel advice for more details.

When a pandemic starts, people are likely to be advised not to travel to affected areas or attend international gatherings such as large conferences and sports events. Later, depending on how the pandemic develops, it may be necessary to reduce the movement of people within a country to prevent or delay further spread of the disease. Such so-called ‘social distancing’ measures will be published on the SHS website and at www.shell.com/us/help and implemented when required.

Yes, but in a precisely targeted way. Current vaccines, when administered to high-risk groups, such as poultry cullers, protect against circulating human strains and thus reduce the risk that humans at high risk of exposure to the bird virus might become infected with human and avian viruses at the same time. Such dual infections give the avian and human viruses an opportunity to exchange genes, possibly resulting in a new influenza virus subtype with pandemic potential.

Annual vaccines are produced for routine use in protecting humans during seasonal epidemics of influenza. They offer no protection against infection with the H5N1 avian virus.

For these reasons, the WHO has issued guidelines for the vaccination, using the current influenza vaccine, of groups considered at high risk of exposure in countries experiencing outbreaks of highly pathogenic H5N1 avian influenza in poultry.

See http://sww-shs.shell.com/health/ go to vaccinations, specific and next influenza

It is assumed that ‘Tamiflu’ will be effective against the existing H5N1 virus, but mutations that create a novel virus may render Tamiflu less or ineffective. 

The WHO recently (12 August 2005) reported that results from initial clinical trials reconfirmed the feasibility of developing an H5N1-specific vaccine. However, this is only the first step towards developing a human vaccine.

Stocking antivirals will not be part of Shell business continuity plans. However, where a Shell company is the direct provider of primary or secondary medical care to employees and dependents (for example Nigeria, Brunei and Gabon), or where Shell could be considered the ‘de facto’ direct medical provider (for example on Shell-operated offshore installations and marine vessels), antivirals will be ordered as part of regular pharmaceutical supplies. Where a Shell company has contracted medical care from a third party health service provider, such as International SOS, that Shell company will endeavor to ensure the provider’s preparedness for a pandemic, including supplies of antivirals and antibiotics. In all other situations, Shell staff and dependants will need to rely on existing medical infrastructure or publicly available supplies in the countries where they live, and take personal responsibility for their own and their dependants’ health and health care.

A good deal: sensible behaviour and good personal hygiene can reduce risk. Good public hygiene practices such as hand washing etc, and not visiting poultry farms or markets – these and other recommendations are already on the Shell Health Services website.

Specific good respiratory hygiene measures include:

Covering your mouth and nose when you sneeze or cough.

Turning your face away from people when you cough.

After coughing, wash your hands.

If you blow your nose, use a paper tissue and carefully dispose of it in a rubbish bin.

Only use a paper tissue once before disposing of it in a rubbish bin.

Washing your hands often – especially after coming in from outside.

When washing your hands, use plenty of water and soap or rub your hands with hand alcohol.

If you touch surfaces such as handles, doorknobs and railings in crowded areas, always try and wash your hands before touching your face.

Trying to avoid touching your eyes, nose or mouth.

Maintaining good ventilation in both home and office environments.

Avoiding mass gatherings as far as you can.

Staying at home when you are sick. If you have a cough and a fever, it is best to rest at home, take medicines to relieve the symptoms and drink plenty of fluids. This will speed your recovery and help prevent the spread of infection.

A special influenza team will be set up as soon as limited human-to-human spread occurs in a country. This team will monitor developments on a daily basis and will be in close contact with the local health authorities as well as with other Shell companies in the region. It will provide regular updates to all staff on new developments. The team will also look into the need for specific preventive measures, ranging from for example the introduction of a temperature monitoring policy and ensuring proper daily cleaning with water and soap with a focus on hard surfaces (especially widely used areas like doorknobs, handrails and phone sets).

No, not necessarily. There is a difference between this and knowingly sending staff from a lower risk area to a higher risk area, especially when international authorities have issued travel advisories or restrictions. Any decision on relocation will take into account the advice issued by the local government and the WHO.

No, in such a situation we would limit expatriation to a minimum.

Any such decision would need to take into account the specifics of the situation, including the views of the Country Chair and the advice being provided by the local government and the WHO. It is likely that, in order to limit the risk of a further spread of the virus, the WHO will advise against movement of people to and from outbreak areas.

As in any case when an individual's clinical condition is deemed to require medical evacuation by a local medical provider, we will endeavour to medevac to the nearest centre of excellence. Most expatriate staff are enrolled in GEMS (Global Expatriate Medical Scheme) and we will follow medical evacuation policy as per arrangement with BUPA and ISOS. If a pandemic does unfold, all flights may be subject to international guidelines and national emergency laws. Shell experience with SARS suggests that this will most likely hamper the ability of medevac providers to offer evacuation services.

WHO General Influenza site :
http://www.who.int/csr/disease/influenza/en  

WHO Influenza Fact sheet :
http://www.who.int/mediacentre/factsheets/fs211/en/  

WHO Avian Influenza :
http://www.who.int/csr/disease/avian_influenza/en/    

WHO Avian Influenza Fact Sheet :
http://www.who.int/mediacentre/factsheets/fs211/en/  

WHO Avian Influenza - Frequently asked Questions :
http://www.who.int/csr/disease/avian_influenza/avian_faqs/en/  

CDC Avian Influenza site :
http://www.cdc.gov/flu/avian/index.htm