Lately there have been human deaths reported in Nigeria and Egypt from "bird flu," or "highly pathogenic avian influenza H5N1." This page summarizes some of the useful references on avian influenza and pandemic preparedness, along with practical summaries of main points.
General Background
Fact 1: This is not a human epidemic. Avian influenza A (H5N1) is a disease of birds that rarely passes to humans. The total number of confirmed human cases worldwide over the past two years [2005-2006] is 213. Considering the hundreds of millions of humans in contact with birds (including poultry) in China and other Asian countries where the virus has been most active, this is a very low number. As long as the virus does not begin spreading efficiently in humans, you are probably at more risk from snake bites and bee stings, and certainly at more risk (in Africa) from malaria and automobile accidents, than you are from bird flu. (Wasps and bees cause 30-120 deaths yearly in the United States alone, according to eMedicine, which would be a higher risk than from bird flu even in Asia where nearly all human cases have occurred.)
Influenza A (H5N1) Virus
Fact 2: To date there have been very few confirmed cases of person-to-person transmission. So for now, bird flu is something caught from birds, not from other people. Unless you keep chickens yourself, the main points are how to be especially careful while preparing and cooking birds and chickens. Eating well-cooked chicken is not risky, but preparing the uncooked meat could expose you to the virus if the chicken is infected just as it can expose you to Salmonella and other illnesses. Note that these are nothing new, just the standard precautions that should always be followed in cooking, not anything new, but it’s probably a good time to make sure to follow the guidelines.
Fact 3: The reason health officials worldwide are concerned about bird flu is that it could mutate to become contagious among humans, and because it could be a more virulent (more dangerous) form of influenza than the usual strains. The current strain, basically limited to birds, has been unusually virulent in the few humans who have been infected. No one knows whether the virus will mutate in a way to pass efficiently between humans, nor whether if it does it will still have the same virulence. This is not something that has happened yet.
How is the virus transmitted? (WHO)
"Presently, sound evidence on exact modes of human transmission of highly pathogenic avian influenza viruses is lacking. It is believed that multiple modes of transmission exist (large droplet, small particle aerosol, hand-contamination and self-inoculation, and possibly oral contamination), but their relative importance in sporadic ... infections is uncertain." (Remember, at this point, sustained human-to-human transmission does not occur. But the routes mentioned are applicable to influenza in general.)
"When assessing possible cases, the level of clinical suspicion should be heightened for persons showing influenza-like illness, especially with fever and symptoms in the lower respiratory tract, who have a history of close contact with birds in an area where confirmed outbreaks of highly pathogenic H5N1 avian influenza are occurring." Not all cases have history of contact with birds, though.
Common laboratory abnormalities include leukopenia (mainly lymphopenia), mild-to-moderate thrombocytopenia, elevated aminotransferases, and with some instances of disseminated intravascular coagulation. (WHO Clinical Features)
Initial symptoms: high fever and influenza-like symptoms. Diarrhoea, vomiting, abdominal pain, chest pain, and bleeding from the nose and gums have also been reported as early symptoms in some patients. (see reference for more reported symptoms)
Early lower-respiratory involvement, "Many patients have symptoms in the lower respiratory tract when they first seek treatment."
Respiratory distress, a hoarse voice, and a crackling sound when inhaling are commonly seen.
Sputum production is variable and sometimes bloody.
Rapid clinical deterioration: acute respiratory distress often within 4-6 days.
Multiorgan dysfunction, may have disseminated intravascular coagulation (DIC)
Symptoms of Avian Influenza in Humans (CDC)
"The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications."
Some antiviral drugs, notably oseltamivir (Tamiflu), may reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset.
In suspected cases, oseltamivir should be prescribed as soon as possible (ideally, within 48 hours following symptom onset). Consider giving the drug to those presenting later than 48 hours though the benefits are not yet known.
The recommended dose of oseltamivir for the treatment of influenza in adults and adolescents 13 years of age and older is 150 mg per day, given as 75 mg twice a day for five days. Oseltamivir is not indicated for the treatment of children younger than one year of age. See product information at the manufacturer’s web site.
"...clinicians should consider increasing the duration of treatment to seven to ten days in patients who are not showing a clinical response.
In cases of severe infection with the H5N1 virus, consider increasing the daily dose or the duration of treatment, keeping in mind that doses above 300 mg per day are associated with increased side effects.
In severely ill H5N1 patients or in H5N1 patients with severe gastrointestinal symptoms, drug absorption may be impaired. This possibility should be considered when managing these patients.
General Preparedness Measures
Hygiene
"Strengthening personal hygiene practices to reduce human to human transmission will help stop or slow the spread of a pandemic virus." WHO
"Special attention should be paid to personal behaviour in community settings as well as the household." WHO
"Public education, including public health messages, is an important part of national and local planning for pandemic influenza." WHO
Standard, important family and community measures include (WHO)
"Cover your mouth and nose with a tissue when coughing or sneezing.
"Wash your hands often, especially: before, during, and after you prepare food; before you eat; after you use the toilet; after handling animals or animal waste; when your hands are dirty; and more frequently when someone in your home is sick.
"Avoid touching your eyes, nose or mouth. Infections are often spread when a person touches something that is contaminated with microorganisms and then touches his or her eyes, nose, or mouth."
"Special attention should be given to teaching staff, children, and their parents on how to limit the spread of infection." WHO
"Cleaning and disinfection of household surfaces likely to be contaminated by infectious secretions appears worthwhile." WHO
"Presently, there is no evidence to support the efficacy of widespread disinfection of the environment or air." WHO
"A large number of confirmed human cases are believed to have acquired their infection during the slaughtering or subsequent handling of diseased or dead birds prior to cooking. For this reason, such practices involving obviously diseased or dead birds must be stopped." (emphasis added)
In outbreak areas, in the absence of effective monitoring for the presence of infection, " it is recommended that home-slaughtering be avoided." Chickens may be infected even though they do not appear sick.
Sanitation: "The transmission of human influenza is commonly by aerosols (droplets and small particles in air) carrying the virus that enter the body through the nose or throat. Thus, other means of excreta disposal where aerosol formation is unlikely, such as latrines, probably represent an extremely low risk of virus transmission. The widespread use of untreated poultry faeces as fertilizer is, however, a possible risk factor."
Water: "... the little evidence available ... suggests that the potential risk of human infection from water contaminated with the H5N1 avian influenza virus is small." However, disinfection of public water (e.g. by chlorination) is recommended and if not present, households may boil or add bleach to drinking water.
"Use dedicated equipment such as stethoscopes, disposable blood pressure cuffs, disposable thermometers, etc."
"Wear [goggles or face shields] when within 3 feet of the patient."
Photo by Ryan Schultz, Quiplash! at Flickr. (Note that this is a surgical mask, not a respirator.)
"Use a fit-tested respirator, at least as protective as a ... (NIOSH)-approved N-95 filtering facepiece (i.e., disposable) respirator, when entering the room."
Health-care workers involved in the care of patients with documented or suspected avian influenza should be vaccinated with the most recent seasonal human influenza vaccine.
"Place the patient in an airborne isolation room (AIR). Such rooms should have monitored negative air pressure in relation to corridor, with 6 to 12 air changes per hour (ACH), and exhaust air directly outside or have recirculated air filtered by a high efficiency particulate air (HEPA) filter." Obviously, this will not be possible in most of our developing world settings.
Emphasize respiratory hygiene and cough etiquette: cover mouth when coughing or sneezing; use tissues; dispose of tissues properly; hand washing.
Provide tissues and no-touch receptacles for used tissue disposal.
Provide conveniently located dispensers of alcohol-based hand rub; where sinks are available, ensure that supplies for hand washing (i.e., soap, disposable towels) are consistently available.
Offer masks to persons who are coughing. Either procedure masks (i.e., with ear loops) or surgical masks (i.e., with ties) may be used to contain respiratory secretions (respirators such as N-95 or above are not necessary for this purpose).
When space and chair availability permit, encourage coughing persons to sit at least three feet away from others in common waiting areas.
Advise healthcare personnel to wear a surgical or procedure mask in addition to Standard Precautions, when examining a patient with symptoms of a respiratory infection, particularly if fever is present.
Avian Influenza: Resources for Health Professionals (CDC). Includes: Key Facts for Clinicians; Overview; Training; Outbreaks; Professional Guidance; Infection Control; Vaccination; Treatment; Health Education; Travel Advice; Prevention; Other Resources & References.
Lately there have been human deaths reported in Nigeria and Egypt from "bird flu," or "highly pathogenic avian influenza H5N1." This page summarizes some of the useful references on avian influenza and pandemic preparedness, along with practical summaries of main points.
Some antiviral drugs, notably oseltamivir (Tamiflu), may reduce the duration of viral replication and improve prospects of survival, provided they are administered within 48 hours following symptom onset. 
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