Avian influenza primary prevention

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For more information about seasonal human influenza virus that is not associated with animal exposure, see Influenza

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

The best way to prevent infection with avian influenza A viruses is to avoid sources of exposure whenever possible. Most human infections with avian influenza A viruses have occurred following direct close or prolonged contact with sick or dead infected poultry. Chemoprophylaxis with influenza antiviral medications can be considered for all exposed persons. Decisions to initiate antiviral chemoprophylaxis should be based on clinical judgment, with consideration given to the type of exposure and to whether the exposed person is at high risk for complications from influenza.

Preventing Exposure

• The best way to prevent infection with avian influenza A viruses is to avoid sources of exposure. Most human infections with avian influenza A viruses have occurred following direct or close contact with infected poultry.
• People who work with poultry or who respond to avian influenza outbreaks are advised to follow recommended biosecurity and infection control practices.
• These include use of appropriate personal protective equipment and careful attention to hand hygiene.
• They should also be monitored for illness during and after responding to highly pathogenic strain outbreaks among poultry.
• Seasonal influenza vaccination will not prevent infection with avian influenza A viruses, but can reduce the risk of co-infection with human and avian influenza A viruses.

Safe Practices

There have been a number of practices that have changed in response to outbreaks of the H5N1 virus, including:

• vaccinating poultry against bird flu
• vaccinating poultry workers against human flu
• limiting travel in areas where H5N1 is found
• increasing farm hygiene
• reducing contact between livestock and wild birds
• reducing open-air wet markets
• limiting workers contact with cock fighting
• reducing purchases of live fowl
• improving veterinary vaccine availability and cost

Post-exposure Prophylaxis

Exposure to Birds Infected with Avian Influenza

• People who have had contact with infected birds may be given influenza antiviral drugs preventatively.
• An exposed person is defined as a person with contact in the past 10 days to infected sick or dead birds, or infected flocks. Infected refers to infection with avian influenza A viruses associated with severe human disease or which have the potential to cause severe human disease.

Monitoring of Exposed Persons

• Exposed persons should monitor themselves for new illness for 10 days after the last known exposure. The presence of fever and respiratory symptoms (e.g., cough, sore throat, shortness of breath, difficulty breathing) should be assessed daily during this period.

• Any exposed person who has a new fever or respiratory symptoms should be referred for prompt medical evaluation, antiviral treatment, and testing for avian influenza (A) virus infection.

Post-exposure Chemoprophylaxis of Exposed Persons

• When used to prevent seasonal influenza, antiviral drugs are 70% to 90% effective. The numbers for avian influenza are not known.
• Chemoprophylaxis with influenza antiviral medications can be considered for all exposed persons. Decisions to initiate antiviral chemoprophylaxis should be based on clinical judgment, with consideration given to the type of exposure and to whether the exposed person is at high risk for complications from influenza.

• If antiviral chemoprophylaxis is initiated, treatment dosing for the neuraminidase inhibitors oseltamivir or zanamivir (one dose twice daily) is recommended in these instances instead of the typical antiviral chemoprophylaxis regimen (once daily).
• If exposure was time-limited and not ongoing, five days of medication (one dose twice daily), from the last known exposure is recommended.

• Chemoprophylaxis is not routinely recommended for personnel involved in culling non-infected or likely non-infected bird populations as a control measure or personnel involved in handling sick birds or decontaminating affected environments (including animal disposal) who used proper personal protective equipment.