Medical
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 sixteen known HA subtypes and nine known NA 	
			       	subtypes of influenza A viruses, with many different combinations of HA and NA 
			       	proteins possible. Each combination represents a different subtype of the virus. 
			       	Human illness has been documented from types H5, H7, and H9.  

Signs and                       The reported symptoms for avian influenza in humans have ranged from typical 
Symptoms:		        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. The fatality rate 
			        from H5N1 human illness in Asia is associated with a fatality rate above 50 	
			        percent. 
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:       	Standard Precautions:  Hand hygiene before and after all contact with patients 
			        or with items potentially contaminated with respiratory secretions.
			        Contact Precautions:  Use gloves, gown, eye protection, and dedicated 	
			        equipment (e.g. stethoscopes, disposable blood pressure cuffs, disposable 	
			        thermometers) for all patient contact.
			        Airborne Precautions:  Place the patient in an airborne isolation room. It should 
			        have monitored negative air pressure in relation to corridor, with 6 to 12 air 	
			        changes per hour (ACH), and exhaust air directly outside or have recirculated air 
			        filtered by a high efficiency particulate air (HEPA) filter.  Portable HEPA filters 
			        may be used instead to increase the number of ACH.  Use a fit-tested respirator, 
			        preferably a NIOSH-approved N-95 filtering respirator, when entering the room.

Lab Samples for               	Call the Delaware Public Health Laboratory (302-223-1520) for information 
Evaluation:		        about laboratory testing and to coordinate the submission of specimens for 	
		                analysis.  For viral cultures, acceptable specimens include nasal washes, 	
			        nasopharyngeal (NP) aspirates, NP and throat swabs, tracheal aspirates, and 
		                bronchoalveolar lavage. 
                                                    		
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 would probably work to 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. # 35-05-20/07/05/97