Preparing for a pandemic: concern over a possible avian flu pandemic is moving states, communities and the federal government to action.

• Author: Winterfeld, Amy

Pandemic. It's a word of horrific implications. In the past, millions of people have died from flu viruses that swept through a less populated, less well-traveled world than the one we know today. So the idea that the avian flu, a bird virus that has killed some 100 people in Asia, may be the precursor of the next pandemic has started a national dialogue about how prepared we are and where responsibility lies.

And much of it lies with the states.

"It is states and communities that will be on the front lines," says Health and Human Services Secretary Mike Leavitt. "While the federal government is stockpiling antivirals, success will be determined by whether state and local officials can put pills in people's hands everywhere they are needed within a short time.

"Actions at the state and local level will define victory."

Preparation seems wise. The H5N1 strain of the avian flu virus has infected 173 people in Asia, including the Near East. As of mid-March, 98 of them have died, according to the World Health Organization.

In poultry or wild birds, the virus has spread into Europe and Africa. Human-to-human transmission of the virus is rare--but there are a handful of cases, the result, apparently, of close and prolonged contact. Most infections in humans are believed to occur from direct contact with infected poultry or contaminated surfaces.

But fears that the virus could eventually mutate and be easily passed between humans, as viruses have in the last hundred years, make avian flu big news.

THE FACTS

Avian flu is an infection caused by a bird virus. All avian flu strains originate in migratory waterfowl, which carry the virus in their intestines usually without becoming sick. The virus is very contagious and can sicken domesticated birds, including chickens, ducks and turkeys, and kill them in large numbers.

The flu strain that's concerning health officials today is the Avian influenza A (H5N1) virus. In late 2003 and early 2004, outbreaks in poultry resulted in the death or destruction of more than 100 million birds in eight Asian countries (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand and Vietnam).

In 2005, the H5N1 strain was detected in domestic poultry in Turkey and Romania and in wild birds in Croatia. Active outbreaks have continued in 2006, mostly following wild bird migratory routes into Europe. In early March a dead cat in Germany tested positive for H5N1, probably the result of eating infected birds.

THE FEARS

A flu pandemic occurs when a new type of virus emerges for which there is little or no immunity in humans. It causes serious illness and spreads easily person to person worldwide.

At least three human influenza pandemics have occurred in the 20th century. In the most deadly of these, the 1918 Spanish Flu, a virus that probably began in the United States killed an estimated 20 million to 50 million people worldwide. The virus evolved into a virulent form easily transmitted between humans and circulated on the crowded battlefields of World War I. In 1957, a...