Awareness of avian influenza ("bird flu") among attendees of a primary healthcare clinic in Riyadh.

To the Editor: Avian influenza A (H5N1) viruses usually affect wild birds, but now are infecting and causing serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have occurred during 2003–2006 in Cambodia, China, Indonesia, Iraq, Thailand, Turkey and Vietnam, with many cases resulting in death.1

The influenza A strain (H5N1) involved in the latest outbreak is not new. It was first isolated in South Africa in the 1960s and has since caused epidemics in poultry. However, in the spring of 1997 it caused the death of many thousands of chickens in Hong Kong, and increasingly intensive surveillance was started after a human case was recognized in June 1997.2,3,4

The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. However, confirmed cases of human infection from several subtypes of avian influenza infection have been reported since 1997.5

Countries that have experienced confirmed outbreaks of H5N1 infection among poultry and other birds in 2005–2006 include Azerbaijan, Bulgaria, Cambodia, China (including Hong Kong SAR), Croatia, Germany, Greece, Indonesia, Iran, Italy, Kazakhstan, Mongolia, Nigeria, Romania, Russia, Thailand, Turkey, Ukraine, and Vietnam.1 Most cases of avian influenza infection in humans have resulted from contact with infected poultry (e.g. domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretions from infected birds. The Centers for Disease Control And Prevention (CDC) remains in communication with the World Health Organization (WHO) and continues to closely monitor the H5N1 situation in countries reporting human cases and bird outbreaks. The threat of a pandemic arising from novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability to spread from one human to another. Such transmission has not yet been observed. However, a few cases of limited person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person.1,6,7

The present study was undertaken to assess the awareness among people in Riyadh, Saudi Arabia about avian influenza A (bird flu). A cross sectional study was carried out at primary health care clinics (PHCC), King Khalid University Hospital in Riyadh, Saudi Arabia, during December 2005. An arabic questionnaire was distributed to all attendees older than 12 years of age of both sexes in the waiting rooms of PHCC. A total of 516 participants completed the questionnaires.

The questionnaires included socio-demographic data and questions designed to elicit awareness about avian influenza A. The questionnaire was tested in a pilot study and some verbal modifications were made before implementing the study. The data were analyzed using the Statistical Package For Social Sciences (SPSS), software version 10.

A total of 516 people of both genders participated in the study. Females were 54.3%, while males were 45.7% of the participants. Most (84.1%) were in the age group 20 to <60 years. Most (96.3%) were aware of avian influenza news. Only 39.1% of participants were aware of the mode of transmission of avian influenza to humans. Sixty-one percent were worried and to some extent had a fear of avian influenza. Only 27.5% of participants were aware of measures that prevent transmission of avian influenza to humans.

The present study showed that 96.3% of 516 participants were aware of avian influenza, which might indicate how well people are alerted to mass media news. But only 39.1% of participants were knowledgeable about the mode of transmission of avian influenza, while 61% were worried about avian influenza infection of humans, and only 27.5% were aware of human preventive measures, which might indicate the need for scientific health education for the public.

While there is currently no evidence that H5N1 virus has reassorted its genetic segments with human influenza A viruses, the possibility that it might has led the WHO and CDC to launch a number of preventive initiatives and issue guidelines and recommendations for both public health practitioners and individuals. 8,9,10,11,12

The recent growth in momentum for action against avian influenza has been flanked by a rise in anxiety about the pandemic risk. These fears are perpetuated by politicians’ misplaced instincts to withhold information instead of talking openly about the disease. And, worryingly, experience shows that widespread fear can lead to social and economic consequences as serious as the disease itself.13,14,15 Preparedness planning continues among international public health and veterinary authorities to combat avian influenza, particularly the H5N1 strain and the possibility of pandemic human influenza, 16,17,18,19,20,21,22,23 but public assurance is difficult to muster when uncertainties abound and available scientific information is incomplete.13

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1. Persons visiting areas with reports of outbreaks of H5N1 among poultry or of human H5N1 cases can reduce their risk of infection by avoiding all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. They should avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or secretions. As with other infectious illnesses, one of the most important preventive practices is careful and frequent hand washing. And, as influenza viruses are destroyed by heat, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked1 as a precaution.

Good communication means responding to public concerns.13 Both primary care and public health professionals must work to improve population health.24 It is important that scientific health education programs be planned to improve knowledge of avian influenza in the community and minimize anxiety and fear.