Preparing to go to China

December 19, 2006 5:08 AM

I'm going to China next year to study for 12 months. I am concerned about getting sick over there, particularly, contracting Avian Influenza (bird flu). My question is, how concerned should I be?

I will be staying mostly in Hang Zhou, an ubranised area, as that is where the host uni will be, however I intend to do some travelling and sightseeing especially to rural areas.

My doctor told me I should be the anti-virus Tamiflu after arrival since it would be much cheaper than purchasing it here in Australia. Doe you know if it is as accessible and of the same quality?

What could I do as "prevention"? Eat only from clean-looking restaurants, avoid all poultry...?

posted by gttommy to travel & transportation (12 comments total)

I would say not to be overly concerned.

In the whole world in the last few years there have been only around 200 odd cases of avian flu, about 100 deaths and not a single instance of patient-to-patient transmission.

That said you should of course take the same precautions you would otherwise take when eating and drinking water in developing countries.

I would be more worried about hepatitis, cholera and TB than avian flu. But simple precautions that are easily found if you engage your google-fu will see you through.

So... relax! :)
posted by TheOtherGuy at 5:17 AM on December 19, 2006

Not at all.

I do, however, recommend that you get your hepatitis vaccinations. Enjoy the food.
posted by geekyguy at 5:37 AM on December 19, 2006

I know that you can get Tamiflu in Hong Kong, but I don't think it's readily available on the mainland. Actually, you'll be close to Shanghai (3 hours by train, I think) that I'm sure you'll be able to get it if you really want it there.

But why are you so worried about Avian flu? It's not an epidemic by any means. You're much, much more likely to die in a car wreck in any part of SE Asia you travel in than Avian flu.

Get the full range of inoculations before you arrive. Then don't worry about it anymore. Don't slaughter any ducks while you're there. Resist the overwhelming urge to drink chicken blood. You'll be fine.

Don't avoid street food, you're just hurting yourself if you miss out on that!

Hangzhou is such a cool city, you'll have a blast! Check out JZ Bar on West Lake, it's a fantastic place to hang out.
posted by bluejayk at 5:39 AM on December 19, 2006

There have been a total of 21 reported human cases of bird flu in China in the past 4 years [source], while China has a population of 1,313,973,713 [source]. So I think your chances of getting bird flu are pretty slim ( approximately 1:62,570,177).

The World Health Organization doesn't recommend any special precautions other than perhaps avoiding visiting poultry cages at farmers markets and poking dead birds with sticks.
posted by falconred at 6:10 AM on December 19, 2006

Almost all the fatalities due to avian flu in China have been poultry farmers, their families or others in direct daily contact with poultry through their work.
I worked in rural development right out in the sticks and lived in Beijing all through the SARS crisis, and have yet to get much worse than a heavy cold after a decade in China.
Sensible precautions certainly, but don't worry over-much.
posted by Abiezer at 6:14 AM on December 19, 2006

You can't get bird flu from eating chicken meat. The virus is not in the meat (it's not like prion-insane-virus, BSE). It's only transmissible from coming into contact with infected "live" or maybe (this is a guess, and even if it were a testable theory to look for, there haven't been enough cases yet) from a very recently dead bird.

So eat well, my friend.

Get tamiflu if you can. You just carry it around until you have the flu, btw, so it's not like you take it regularly or without symptoms. Also, it hasn't been shown to be effective against bird flu. It's just a "good idea" thing to take -- no guarantees. But hey, it could help.

My real fear with bird flu is not contracting it (at least not where I am and with my non poultry-farming job). It's the fact that if you are overseas when an outbreak does occur, you might be quarantined in that country for a long time. If the virus really is 50% lethal or even 25-30% lethal, I am quite sure that moving between countries will become restricted to basically essential government transit only. This could mean that your stay would be extended for quite a while.... This probably won't happen, but it's a possibility. I mean, if you were Australia (poster's home country?) or the US (mine), you probably wouldn't want thousands of scary asian bird-lovers storming your borders. There would be tremendous public pressure not to let people in. And you could be caught in this net of xenophobia.
posted by zpousman at 6:49 AM on December 19, 2006

Also, you should do a search at youtube for the bird flu dance / music video. It's awesome. If that's what bird flu is like, then please bird flu, teach a white boy to dance!
posted by zpousman at 6:51 AM on December 19, 2006

I spent two weeks in China last autumn and had a lot of problems with pollution (streaming nose, horrible cough) - lasting some time after I came back and serious enough that I would think several times before going again. I was on the tourist route - Shanghai, Xi'an, Yangtze, Beijing. You may be able to find pollution stats on Hang Zhou. It wasn't just the urban areas, as rural areas use anthracite. In River Town, Peter Hessler lists all the illnesses he had whilst in China - pollution-induced asthma was one, as far as I remember. (And it's a wonderful book, if you haven't come across it.)
posted by paduasoy at 12:33 PM on December 19, 2006

and not a single instance of patient-to-patient transmission

False; there have been several small clusters of proven person-to-person transmission. See these reports from the New England Journal of Medicine about three clusters in Indonesia, one cluster in Thailand, and this report on multiple family clusters in Turkey. The New York Times did a good article on the likely under-reporting of multiple human-to-human clusters in various countries, including the ones previously mentioned plus Azerbaijan and Iraq.

But why are you so worried about Avian flu? It's not an epidemic by any means.

The WHO disagrees, and so do unknown numbers of dead animals (birds, cats, even some unfortunate tigers in the Jakarta Zoo), millions of culled chickens, and thousands of culled dogs. It is certainly a full-fledged epidemic there. It is just not that common in humans...yet. But with a >50% case fatality rate (>70% in kids and young people), you can understand why scientists, businesses, and governments are terrified that this is going to turn into a horrendous pandemic situation. H5N1 is a novel virus to humans; no one has immunity. A pandemic situation with even a moderated less-deadly version of the current main strain would be a catastrophe -- and not just because of the disease, but rather the cascading social and political problems the disease could cause, even for those not actually infected.

You can't get bird flu from eating chicken meat.

You can if it's undercooked or the kitchen isn't sanitary. The virus is present in the dead uncooked chicken and its juices/blood, which is exactly how a number of victims are thought to have caught the disease: preparing and cooking a sick chicken for dinner.

Also, [Tamiflu] hasn't been shown to be effective against bird flu.

Yes it has; in fact, it's currently the standard treatment protocol in hospitals for confirmed H5N1 cases. Quick use of a "Tamiflu blanket" (prophylactic usage for people thought to have been exposed -- massive doses of the drug were flown in from international warehouses under WHO auspices) is why it is thought the Turkey clusters did not spiral out of control last year. But it's feared that the virus is starting to become resistant to Tamiflu. See these two articles in the NEJM.

Do not buy your Tamiflu in China; it is much more likely to be counterfeit there. Cheaper yes, but also probably bunk. See this article on counterfeit Tamiflu being shipped in to the US from China.

As for other preventative measures, note that cats and dogs are known carriers of H5N1 (along with birds and humans, of course).

Finally, of specific note to you, please read the U.S. State Department's warning very recently sent to Americans overseas in several countries, but first noticed in a posting to Hong Kong and Macau. U.S. citizens are advised to have 12 weeks of food and water for shelter-in-place, and it is mentioned that the U.S. will probably not be able to provide emergency re-patriation in the event of an outbreak, nor will embassy/consulate supplies be given to citizens in the area.

Finally-finally, I should self-link to a MeFi post I made about the Qinghai Lake situation in China last June, as an example of how the Chinese government may or may not respond in the face of another outbreak, i.e. quarantines, bullshit press releases, and possible military involvement. If they get that bad when it's (supposedly) just birds dying in large numbers, how do you think they're going to react when it's people?

Would I go to China for a year right now? Um, no. But if you really want to go, please take ample amounts of (legit) Tamiflu with you, have the State Department's requested 12 weeks of food and water stockpiled (discreetly) in your apartment, and have one of those open-ended plane tickets so you can get home quickly if things start looking bad. Read Effect Measure (one of the "higher end sciencey" flu blogs by two psuedonymous medical bigwigs) and monitor Declan Butler's reporting at "Nature" and Helen Branswell in the Canadian Press and canada.com. Keep your eyes open.

Good luck!
posted by Asparagirl at 12:43 PM on December 19, 2006

Asparagirl, with all due respect to the studies you cite and the serious nature of avian flu, you are making it sound like spending a year in Hangzhou would be a high-risk thing to do and it just isn't.
gttommy - if you are of even moderate constitution, my advice is get your shots and get over here.
To my mind, the benefits of beginning the study of the language and culture of what is going to be the most important nation over the next three decades at the earliest opportunity far outweigh any excess health risks compared to back home in Australia. If you don't, the thousands of other foreign students who come here every year (and return home unscathed by and large) will have a head start on you in this regard.
posted by Abiezer at 4:08 PM on December 19, 2006

The chances of getting infected seems negligable, so I will still go to China next year.

Thanks everyone for the insights, especially Asparagirl for the alarming information! I'll make sure to do some more research into this matter come closer to my departure date.
posted by gttommy at 5:07 AM on December 20, 2006

Good luck, gttommy! And to re-emphasize, one of the main problems about pandemic flu isn't the flu itself -- although obviously that's really bad, especially if you're under 30 and thus in the prime age group for fatalities. The problem may rather be the social/political/economic effects. You could get stuck in a martial law situation and there would almost definitely be military quarantines. There might be no easy way to leave the country if the airlines are ordered to stop international travel, and there's no certainty that your home country's borders would still be open once you tried to get there. New Zealand, for example, has made it clear in its government pandemic plans (available online) for quite a while now that they will seal themselves off during a pandemic.

I strongly suggest you look at China's history during the SARS epidemic (just four years ago) as a possible tip as to how the government might react in a major flu pandemic. Check out China Syndrome: The True Story of the 21st Century's First Great Epidemic, which was written by the editor of Time Magazine Asia, who was there during the outbreak, simultaneously trying to protect his family, report the story, and expose the PRC's cover-up.

I do honestly hope that you have a great trip, though!
posted by Asparagirl at 12:50 PM on December 20, 2006