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Worrying about avian flu isn't just for the birds, medical experts warn. But now that last fall's fears of a pandemic spreading through the U.S. human population haven't panned out, some health officials are fretting about a possible letdown in public preparedness.

"I'm concerned. The avian virus isn't getting much attention from the news media this year. But the threat hasn't changed," said Erin DeCarli, a health educator for the Virginia Department of Health in Roanoke. She was hired in July 2006 to get area businesses, schools and households ready to deal with a possible pandemic. "That's still my full-time job," she said.

But is her constituency letting down its guard? Maybe, say federal agencies, and they're trying to revive awareness.

"The public has become accustomed to news about outbreaks among poultry in Indonesia and other faraway places. That doesn't get their attention anymore," said Bill Hall, a spokesman for the U.S. Department of Health and Human Services.

Repeated alerts without apparent urgency can be perceived as nagging, Hall said. "People get tired of the government telling them about the next big disaster that's coming."

What's more, many highly publicized health threats over the years have abated without becoming widespread. Remember swine flu, SARS and mad cow disease?

Enthusiasm for pandemic planning soared a year ago. The Atlanta-based Centers for Disease Control and Prevention led a nationwide program, painting bird flu as imperiling "the economy and society."

That campaign rallied everyone from safety directors in the workplace to school nurses. The CDC pressed its case in a call to action, with specific measures to be taken for companies, their customers, schools and the overall community.

Companies and institutions responded with enthusiasm: naming pandemic coordinators and committees to install hand-cleaner dispensers at every turn. They lectured workers and students on hygiene and developed plans for operating through a mass illness with minimal staffing.

The potential danger of avian flu isn't in question. The virus, specifically labeled H5N1, affects a range of birds from waterfowl to domesticated poultry. The most lethal variety, known as "high path," hasn't been found in this country -- yet.

But the World Health Organization has tracked bird flu cases in 60 nations that have caused about 200 deaths, more than half of those in Vietnam and Indonesia. The victims are mainly people who work with poultry, either in farming or meat processing.

So far, the virus hasn't mutated in a way that allows for easy human-to-human transmission.

If -- or when -- it does, WHO estimates that up to 35 percent of the population could be infected, and the U.S. death toll could rise into the millions.

The worst pandemic happened in 1918 when a similar bird flu virus mutated to allow for human-to-human transmission. Ultimately, it killed an estimated 30 million to 50 million people worldwide over two years -- including 675,000 in this country.

Some area officials are busily reinforcing their avian flu safeguards. LaVern Davis, supervisor of health services for Roanoke County Public Schools, said that this fall her staff distributed a new and more powerful disinfectant that's being used in classrooms, lockers and buses.

But maintaining mass vigor to stay alert for avian flu, or any specific threat, may be too narrow a method, said Roger Glick, emergency management and safety officer for Carilion Clinic. Instead, Glick has broadened the 10,000-employee health care company's strategy to what he calls "an all-hazard approach."

Rather than checklists and employee drills aimed at a pandemic in particular, Carilion has reorganized its protective and reactionary procedures to concentrate on "common traits that can be used across a broad spectrum of threats."

For example, Glick says, the drill for responding to a partial electrical outage is similar to practicing for a pandemic outbreak in one major respect: "Both of these emergencies could mean you have to close part of the hospital, so you practice marshaling your people and your resources essentially the same way."

Thus planning to operate a business with a skeleton crew could apply to a range of crises from terrorist acts to floods.

Glick said it's easier to keep people "ready for anything" than for something specific that may seem unlikely or obscure. Glick finds Carilion employees receptive when he urges they practice for minimal staffing with the reminder that possible reasons might range from a train crash that creates a crush of patients at 2 a.m. on a holiday to the annual fall and winter nonavian influenza wave that keeps so many people in bed for days at a time.

If that sounds a little vague, consider that even the medical community can't prepare vaccine against avian flu in advance of an actual outbreak. That's because there are already several strains, and if one does hit the United States, it might be new and resistant to medicines currently available.

The inability to vaccinate is another factor that may well erode the public's responsiveness, says the HHS department's Hall.

"There's a tendency for some to say, 'Well, there's no shot so there's nothing I can do.' "