CDC Issues Advisory Regarding Highly Pathogenic Avian Influenza A H5 Viruses

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On June 2, 2015, the Centers for Disease Control and Prevention (CDC) issued a health advisory with recommendations for human health investigations and response to highly pathogenic avian influenza A (H5N2), (H5N8), and (H5N1) viruses.

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Advisory Background

More than 200 findings of birds infected with highly pathogenic avian influenza (HPAI) A H5 viruses have been confirmed by the U.S. Department of Agriculture between Dec. 15, 2014-May 29, 2015. The majority of the infections have occurred in poultry, and surveillance indicates that more than 40 million birds in 20 states may have been affected.

The CDC confirms that these HPAI H5 viruses are not known to have caused disease in humans; however, their appearance in North American birds may increase the likelihood of human infection in the United States.

It’s important to note that the CDC considers the general public to be at low risk from the newly identified HPAI H5 viruses. However, those individuals who have close or prolonged contact with infected birds or contaminated environments may be at greater risk of infection.

Previous human infections with other avian viruses have most often occurred after unprotected direct physical contact with infected birds or surfaces contaminated by avian influenza viruses, being in close proximity to infected birds, or visiting a live poultry market. There have been no occurrences of human infection from eating properly cooked poultry or poultry products, the CDC says.

Until more is known about the newly identified viruses, the CDC’s public health recommendations are largely consistent with influenza viruses associated with severe disease in humans, for example different HPAI H5N1 viruses that have caused human infections with high mortality in other countries.

More information on the origin of the recently-identified HPAI H5 viruses in the United States, their clinical presentation in birds, and their suspected clinical presentation in humans can be found here.

Recommendations for Clinicians

The CDC suggests that clinicians should consider the possibility of HPAI H4 virus infection in persons showing signs or symptoms of respiratory illness who have relevant exposure history. This would include contact with potentially-infected birds, contact with feces or parts of potentially-infected birds, or prolonged exposure to potentially infected birds in a confined space.

Further, the advisory says that:

  • People should avoid unprotected exposure to sick or dead birds, bird feces, litter, or materials contaminated with suspected or confirmed HPAI H5 viruses.
  • People exposed to HPAI H5-infected birds (including people wearing PPE) should be monitored for signs and symptoms consistent with influenza beginning after their first exposure and for 10 days after their last exposure.

Infection control guidance as well as information on surveillance and testing of persons under investigation for avian HPAI H5 virus infection is available through the CDC. Clinicians can also refer to the CDC’s influenza antiviral medications summary for clinicians.

At this time, the CDC says that no human vaccines for HPAI (H5N1), (H5N2), or (H5N8) are available in the United States. There are now efforts underway to develop vaccines for these viruses.