Bird flu has led to the deaths of hundreds of millions of wild and domestic birds and
to a small number of human deaths. Right now, however, bird flu remains difficult for
humans to contract. Most people who have developed symptoms have had close
contact with sick birds, though in a few cases, bird flu has passed from one person to
another.

Health officials are concerned that a major bird flu outbreak could occur in humans if
the virus \u2014 H5N1 \u2014 mutates into a form that can spread more easily from person to
person. The grimmest scenario would be a global outbreak to rival the flu pandemic
of 1918 and 1919, which claimed millions of lives worldwide. For now, researchers
are trying to develop a vaccine that would protect people in the event of a bird flu
pandemic.

According to the Centers for Disease Control and Prevention (CDC), about 36,000
people die of influenza in the United States each winter. And three or four times every
century, a flu pandemic sweeps the globe, claiming millions of lives. That the flu can
cause so much misery is a result of its ability to change quickly and unexpectedly, to
outwit "best guess" vaccines, and to take the immune system by storm.

Influenza viruses are divided into three types (strains) of viruses \u2014 influenza A, B
and C. Type A is responsible for the deadly influenza pandemics. Type B can lead to
smaller, more localized outbreaks. Less common and more stable than other strains,
type C has milder symptoms. Either types A or B can cause the flu that circulates
almost every winter. Types B and C are usually found only in humans, whereas type
A infects both people and animals, including birds, pigs, horses, whales and seals.

Numerous influenza A subtypes exist, and they can combine to form even more
subtypes, some of which affect only certain animals. At least 15 flu subtypes affect
birds, the most virulent of which is H5N1. Until recently, avian subtypes have rarely
been found in humans or in animals other than pigs.

Type A influenza viruses are further divided into strains, which are constantly
evolving. And it is exactly this \u2014 the ability of influenza viruses to change their
genetic makeup and to swap genes \u2014 that makes them so unpredictable and

Avian viruses generally don't affect humans, but in 1997, an outbreak of bird flu in
Hong Kong infected 18 people, six of whom died. Since then, human cases of bird flu
have been reported in Asia, Europe and the Middle East. Most were traced to contact
with infected poultry or surfaces contaminated by sick birds.

Often, flu viruses that cross the species barrier originate in areas where people live in close proximity to chickens and pigs. That's because pigs are susceptible to infection with both avian and human viruses and so are an ideal "mixing bowl" for genes.

But at least some bird flu viruses don't need a third party. Instead, they shuffle and
rearrange their genetic material directly in humans. That seems to be the case in most
instances of human-acquired bird flu. People become sick after direct contact with
infected birds or bird-contaminated surfaces, not from contact with other animals.

these birds or with contaminated water, feed or soil. Bird flu spreads quickly within a
domestic flock and is inadvertently transported from farm to farm on equipment, cages, and
workers' shoes and clothing. Heat destroys the virus, but it can survive for extended periods
in cool temperatures.

crowded and unsanitary conditions, are hotbeds of infection and spread the disease into the
wider community. At any point along the way, humans may pick up the virus through close
contact with sick birds or contaminated surfaces. An ailing bird can shed the virus in its
feathers as well as in droppings, and some people have contracted bird flu simply by
touching an infected bird.

H5N1 mutates quickly and is able to incorporate large blocks of genetic code from
viruses that infect other species, a process called reassortment. For that reason, H5N1
has particular potential to combine with a human flu virus, creating a new viral strain
that spreads rapidly from person to person. The emergence of such a virus would
mark the beginning of a potentially devastating pandemic. The ability of H5N1 to
evolve rapidly was demonstrated in October 2006 when a new strain, called H5N1
Fujian-like, appeared in China and spread quickly throughout much of Southeast
Asia. The new strain is immune to the vaccines normally given to birds to prevent

The greatest risk factor for bird flu seems to be contact with sick birds or with
surfaces contaminated by their feathers, saliva or droppings. The World Health
Organization (WHO) has confirmed a handful of cases of limited human-to-human
transmission of bird flu. But unless the virus begins to spread more easily among
people, infected birds or associated material presents the greatest hazard.

The pattern of human transmission remains mysterious. Young children seem
especially vulnerable to the virus, although some experts note that children are more
likely to have contact with sick birds or to play on ground contaminated with
droppings. What's more, people of all ages have contracted and died of bird flu. At
this point, too few people have been infected to know all the possible risk factors for

See your doctor immediately if you develop flu symptoms, including a fever, cough
and body aches, and have recently traveled to a part of the world where bird flu
occurs. Be sure to let your doctor know when and where you traveled and whether
you visited any farms or open-air markets.

Doctors have rapid tests to identify the flu virus, but until recently, the tests couldn't
distinguish between avian flu and other influenza A viruses. For that reason,
specimens from anyone with a suspected case of bird flu were sent to state health labs
or the Centers for Disease Control and Prevention (CDC) for analysis. However, in
September 2007, researchers in Singapore announced a new rapid test that detects
bird flu by taking a swab of your throat, then analyzing the collected droplets using a
hand-held device. This test or similar ones may become commercially available in the
future.

Most people with bird flu have signs and symptoms of conventional influenza. Some
also develop life-threatening complications such as viral pneumonia and acute
respiratory distress syndrome, which causes the air sacs in your lungs to fill with