Recognition, Testing, and Management of Avian Influenza in People Potentially Exposed to Infected Dairy Cattle or Other Animals

AVIAN INFLUENZA ADVISORY FOR HEALTHCARE PROVIDERS

June 20, 2024

Central Idaho clinicians are encouraged to consider avian influenza infection in patients who present with influenza-like illness including isolated conjunctivitis or other symptoms of acute respiratory infection and have had recent close contact with animals known or suspected to have avian influenza A virus infection. Contact Central District Health at 208-327-8625 for assistance with influenza testing by the Idaho Bureau of Laboratories and provision of oseltamivir, if needed.

Background

Highly pathogenic avian influenza (HPAI) A(H5N1) in dairy cows has been reported from twelve states and several counties in Idaho, including counties bordering our district. Avian influenza A(H5N1) has also been detected in backyard flocks and a cat in Idaho.

Three avian influenza A(H5N1) infections in dairy workers associated with the national outbreak have been detected, one in Texas and two in Michigan. Two infected workers had mild conjunctivitis and one had mild respiratory symptoms. Seven symptomatic people in Idaho with possible exposure to avian influenza A(H5N1) have been tested and influenza A(H5N1) was not detected. Ill people with possible exposure to avian influenza A(H5N1) have sought care at Idaho emergency departments, urgent care clinics, and primary care providers’ offices.

Symptoms and Recommendations for Clinicians

Previously reported symptoms of this strain of avian influenza A(H5N1) range from mild to severe and include:

• Mild flu-like illness (cough, sore throat, fever or feeling feverish, rhinorrhea, fatigue, myalgia, arthralgia, headache) or conjunctivitis (red eye, discharge from eye)
• Moderate to severe illness: shortness of breath or difficulty breathing, altered mental status, seizures
• Complications: pneumonia, respiratory failure, acute respiratory distress syndrome, multi-organ failure, meningoencephalitis
• Less commonly, diarrhea, nausea, or vomiting

If a patient with recent exposure has compatible signs and symptoms:

1. Isolate the patient and follow infection prevention recommendations below.
2. Notify Central District Health immediately for assistance with antivirals and testing. Call 208-327-8625 between the hours of 8:00 am and 5:00pm.
3. Initiate empiric antiviral treatment as soon as possible. Central District Health may be able to assist with free medications.
4. Collect respiratory specimens for influenza testing by the Idaho Bureau of Laboratories. See specimens to collect below.

Infection prevention

Promptly screen and triage symptomatic patients. Upon entry to the facility, place a facemask on symptomatic patients and place in a single-patient airborne infection isolation room (or if unavailable, a single room with door closed pending transfer). Standard Precautions, plus Contact and Airborne Precautions, including the use of eye protection, are recommended when evaluating patients for infection with avian influenza A viruses. For more information on ways to minimize potential exposures, see interim guidance at https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/hpai/hpai-interim-recommendations.html.. Contact the state Healthcare-Associated Infections Program at 208-334-5871 if you have questions.

Antiviral treatment

Treatment with oral or enterically administered oseltamivir (twice daily x 5 days) is recommended regardless of time since onset of symptoms. If the patient has been sick for 2 days or less, oral baloxavir treatment is an option. Antiviral treatment should not be delayed while waiting for laboratory test results.

See interim guidance at https://www.cdc.gov/bird-flu/hcp/clinicians-evaluating-patients/?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/clinicians-evaluating-patients.htm for details.

Specimens to collect

• Conjunctival swabs if conjunctivitis is present
• Upper respiratory tract specimens (nasopharyngeal swab, or nasal aspirate/wash preferred)
• In addition, lower respiratory tract specimens (endotracheal aspirate or bronchoalveolar lavage fluid) if the patient is severely ill

See interim guidance at https://www.cdc.gov/bird-flu/php/severe-potential/?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/severe-potential.htm for details. Contact the Idaho Bureau of Laboratories at 208-334-0555 if you have questions.

Additional resources

CDC: H5N1 Bird Flu: Current Situation Summary. https://www.cdc.gov/bird-flu/situation-summary/?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm

USDA: Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock. https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/livestock

USDA: Detections of Highly Pathogenic Avian Influenza in Mammals [other than livestock]. https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/mammals

USDA: Detections of Highly Pathogenic Avian Influenza in Wild Birds https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/wild-birds

ISDA. Avian influenza in Idaho [domestic avian species]. https://agri.idaho.gov/animals/animal-disease/avian-influenza/avian-influenza-resources/