Emergency Medical Services
AVIAN INFLUENZA

Agent Information:              The “avian influenza virus” refers to influenza A viruses found chiefly in birds, 
				but infections with certain strains can occur in humans. Many different 	
				subtypes of type A influenza viruses exist.  These subtypes are identified by 
				specific proteins on the surface of the influenza A virus (hemagglutinin [HA] 
				and neuraminidase [NA] proteins).  There are 16 known HA subtypes and 9 
				known NA subtypes of influenza A viruses, with many different combinations 
				of HA and NA proteins. Each combination represents a different subtype of 
				the virus. Human illness is documented from types H5, H7, and H9.  
  
Signs and Symptoms:          	Reported symptoms for avian influenza in humans range from typical 	
				influenza-like symptoms (fever, cough, sore throat, and muscle aches) to eye 
				infections (conjunctivitis), pneumonia, acute respiratory distress, viral 	
				pneumonia, and other severe life-threatening complications.

Transmission:                   Direct contact with infected poultry or contaminated surfaces. Avian strains 
				which infect humans may acquire the ability to be spread from person to 	
				person. Person-to-person transmission of H5N1 in Asia is suspected on rare 
				occasions but not proven.  Person-to-person transmission occurs by droplet, 
				aerosol and fomite transmission.
	
Protective Measures:           	Follow appropriate Body Substance Isolation (BSI) precautions, with use of 
                               	Personal Protective Equipment (PPE). 
			      	Standard Precautions: Hand washing before and after all patient contacts 
			       	and contact with patient care equipment.  
			       	Contact Precautions: Use of gloves, gown and eye protection.  
			       	Airborne Precautions:  Initiate droplet precautions for persons with flu-like 
			       	illness or confirmed H5 infection, including wearing masks (fit tested NIOSH 
			       	approved N-95 respirator) when in contact with patient.  
	
Decontamination for 		Thoroughly clean all patient care equipment and contaminated surfaces of  
PPE and equipment:            	ambulance with hospital-approved disinfectant. Linen management, same as 
				with other patients. Frequent disinfect EMS radio, pens, etc.

Prophylaxis:                    Four different influenza antiviral drugs (amantadine, rimantadine, oseltamivir, 
				and zanamivir) are approved by the U.S. Food and Drug Administration (FDA) 
				for the treatment of influenza; three are approved for prophylaxis. The 	
				Centers for Disease Control and Prevention (CDC) recommends that neither 
				amantadine nor rimantadine be used for treatment or prevention of influenza 
				A viruses. All four have activity against influenza A viruses. However, 	
				sometimes influenza strains can become resistant to these drugs, and 	
				therefore the drugs may not be effective. 
		
Treatment:                      There is no vaccine currently available. The H5N1 virus that has caused 	
				human illness and death in Asia is resistant to amantadine and rimantadine, 
				two antiviral medications commonly used for influenza. Two other antiviral 
				medications, oseltamavir and zanamavir, might treat influenza caused by 
				H5N1, but additional studies are needed to demonstrate 	their effectiveness. 

Reporting:                      Report any suspect cases immediately to the Division of Public Health, 	
		            	Epidemiology Branch: 1-888-295-5156 (24/7 coverage). For additional 	
				information, view the CDC website:  http://www.cdc.gov/flu/avian/.
 
 
 
 
24/7 Emergency Contact Number:  1-888-295-5156
Revised: 05/2007     Doc. # 35-05-20/07/05/99