If a bird flu pandemic hits the United States, travelers should expect more scrutiny from customs officials worldwide, public health officials say.
Depending on the U.S. airport, you may be asked to undergo testing if you appear sick. But beyond those steps, most public health agencies and travel industry groups and agencies are taking a wait-and-see approach. Implementation of additional protective measures depends on whether the virus, called H5N1, shows up in the United States.
As of June 1, more than 218 human cases of avian influenza have been confirmed worldwide, including in Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey and Vietnam, according to the World Health Organization; 127 have died from the disease.
The virus primarily has affected poultry flocks in the Middle East, Europe, Africa and Asia. More than 200 million chickens have died of the disease or been killed to stem its spread, the United Nations reports. So far, bird flu has not been transmitted person to person, but a recent outbreak in a group of family members in Indonesia has scientists more worried than ever that the virus could mutate to a form that spreads easily among people.
Customs officers already are trained to deal with infectious disease threats, says Leah Yoon, a spokeswoman for U.S. Customs and Border Protection.
"If a customs officer notices that you are looking sick, he will get in touch with the federal Centers for Disease Control and Prevention," she says. It's up to the health officials to decide the next step.
Travelers should be honest in completing their customs declarations forms, she says. "A lot of times, travelers forget about where they have been or what they have been in contact with."
Customs officials are on heightened alert, Yoon says, to prevent travelers from smuggling in birds.
Late last year, Honolulu International Airport began a monitoring program in which officials test people who appear to be sick if they agree to it.
"If an individual is very sick on an incoming flight, the flight crew will alert the on-call nurse at the airport to provide assistance to the passenger," says Janice Okubo, a spokeswoman for Hawaii's State Department of Health.
"If the passenger agrees, a sample will be taken from their nose with a swab. The sample will be sent to the state laboratory for testing. Results will determine if the passenger has the flu and what type of flu."
Passengers suspected of having avian flu are detained at the airport for six to eight hours until test results are available. If it is not suspected, the traveler is free to leave and can get test results in two to three days.
Since November, 21 travelers have been tested for bird flu. Four tested positive for seasonal influenza, but none for avian flu, Okubo says.
Symptoms of bird flu in humans can include a fever, cough and sore throat, as well as eye infections and respiratory problems, according to the CDC. Prescription medicines used to treat other human influenza strains are expected to work, but additional studies are needed, the agency says.
Honolulu's program, an expansion of routine flu surveillance conducted by all states, was undertaken because of the large number of Asian visitors to the islands, Okubo says.
The Honolulu airport also has one of the 18 CDC quarantine stations at U.S. ports of entry; there is one at Dulles International Airport in Virginia as well. But the CDC has no plans to begin flu testing at the other quarantine stations, says Jennifer Marcone, a CDC spokeswoman.
"Most international airports are providing leaflets to the public about the dangers of bird flu," says Dr. David Nabarro, the United Nations system influenza coordinator.
This month, the U.N. plans to launch an Internet site where travel agencies booking tours can look for updates on the avian flu situation, Nabarro says. "Reputable companies will all be participating in this because they want to be sure they have the most up-to-date advice."
Already, large tour companies are arming their guests with information, says Maggie Buttweiler, a spokeswoman for Carlson Wagonlit Travel, a network of about 700 travel agencies nationwide. The company points travelers to the CDC Web pages on avian flu, www.cdc.gov/flu/avian/index.htm, and urges them to follow the recommendations.
The International Council of Cruise Lines, an industry group made up of most U.S.-based cruise lines, is working with the CDC and its member lines to be sure the cruise ship operators have the latest bird flu information, says council spokeswoman Christine Fischer.
The council encourages cruise lines visiting countries where outbreaks have occurred to remind passengers to take precautions, such as washing hands often and avoiding poultry farms.
Travelers to those countries also are asked not to handle dead birds or move live birds across borders, Nabarro says.
But "there is no case for people to stop eating poultry," he adds. "If I am in Vietnam, where there is bird flu, that doesn't mean I should not eat properly cooked poultry in a tourist hotel in Hanoi or Ho Chi Minh City. If the poultry is properly cooked, that poultry is safe to eat."
Meanwhile, wildlife experts are keeping a close eye on Alaska, where the disease, if it appears in this country, would be likely to show up first.
"It's not correct to say biologists 'definitely' expect it to show up in Alaska in the next few weeks," says Matt Robus, director of wildlife conservation for the Alaska Department of Fish and Game.
Alaska is under scrutiny because Asian bird flyways and North American migratory bird flyways intersect in Alaska, Robus says.
Kathleen Doheny is a freelance writer for the Los Angeles Times.