Health Advisory

Summary

• The Centers for Disease Control and Prevention (CDC) has reported a third human case of highly pathogenic avian influenza (HPAI) A(H5N1) virus infection following dairy cattle exposure, occurring in a Michigan dairy worker (fourth case overall).
• While to date, HPAI A(H5N1) has not been detected in people or dairy cattle in Virginia and CDC still considers the risk to the general U.S. public to be low, action is requested of healthcare providers to improve surveillance and reduce risk.

Suggested Actions

• Maintain a high index of suspicion for HPAI A(H5N1) among all patients with symptoms of acute respiratory illness and/or conjunctivitis and recent exposure to cattle, unpasteurized (raw) milk, or birds.
  • Immediately report all suspect cases of HPAI A(H5N1) to your local health department. The Fairfax County Health Department’s (FCHD) Communicable Disease/Epidemiology Unit can be reached at 703-246-2433 (normal business hours) or 703-409-8449 (evenings and weekends) to report the suspected case and for guidance on testing and infection control measures.
  • Implement Standard Precautions, plus Contact and Airborne Precautions, including the use of eye protection for all suspect HPAI A(H5N1) cases. See CDC’s full Interim Guidance for Infection Control.
  • Obtain nasopharyngeal (NP) and combined NP/oropharyngeal (OP) swabs in viral transport medium (VTM) and for suspect cases with conjunctivitis, a conjunctival swab in VTM for testing at the Virginia Division of Consolidated Laboratory Services (DCLS). Contact FCHD for further guidance on specimen collection and handling.
  • Initiate antiviral treatment with a neuraminidase inhibitor as soon as possible for any patient with suspected or confirmed infection with an avian influenza A virus. Antiviral treatment should not be delayed while waiting for laboratory test results.
• Health information for patients who keep backyard chickens can be found on this FCHD page. Patients can also be reminded to avoid direct contact with wild birds and not to eat or drink raw milk or products made with raw milk.
• The CDC has implemented heightened laboratory surveillance of influenza viruses this summer to better identify human cases of avian influenza A(H5N1). CDC is requesting that commercial laboratories forward all positive influenza specimens to public health laboratories for subtyping. Thus, healthcare providers are encouraged to test clinically compatible cases for influenza via molecular assays at commercial laboratories.

Additional Information

• Avian influenza is widespread in wild birds worldwide and is causing outbreaks in poultry and U.S. dairy cows. Situation updates can be found on CDC's website.
• The reported signs and symptoms of avian influenza infections in humans have ranged from no symptoms or mild illness [such as eye redness (conjunctivitis) or mild flu-like upper respiratory symptoms], to severe (such as pneumonia requiring hospitalization) and included fever (temperature of 100ºF [37.8ºC] or greater) or feeling feverish, cough, sore throat, runny or stuff nose, muscle or body aches, headaches, fatigue, and shortness of breath or difficulty breathing. Less common signs and symptoms include diarrhea, nausea, vomiting, or seizures.