Requested Actions
- Be aware two cases of persons being infected with Avian Influenza A Virus have occurred. One case was in 2022 after exposure to infected poultry and one case in March 2024 after an exposure to dairy cattle.
- Be aware of signs and symptoms of avian influenza A virus infection in humans.
- Be aware of recommended actions for patients considered to have recent exposure to avian influenza A viruses.
- Be aware, health care personnel should wear recommended personal protective equipment (PPE) when providing patient care. Visit Infection Control Within Healthcare Settings for Patients with Novel Influenza A Viruses.
- Be aware of signs or symptoms consistent with infection with avian influenza A virus for laboratory testing recommendations: Specimen Collection and Testing for Patients with Novel Influenza A Viruses with Potential to Cause Severe Disease in Humans.
- Be aware of treatment recommendations: Use of Antiviral Medications for Treatment of Human Infections with Novel Influenza A Viruses.
- Contact the Yakima Health District for any questions or concerns at (509) 249-6541.
Background
Avian influenza A viruses circulate among wild aquatic birds worldwide and can infect domestic poultry and other bird and animal species to cause disease referred to as avian influenza. Some avian influenza A viruses have caused rare, sporadic infections in people, resulting in human illness ranging from mild to severe respiratory disease.
People who are exposed to poultry, wild aquatic birds or other animals/mammals infected with avian influenza A viruses or associated contaminated environments may become infected with these viruses. People involved in poultry outbreak response activities and others with exposures to infected birds or contaminated material, surfaces, or water may be at risk of avian influenza A virus infection.
According to CDC’s interim recommendations, people should avoid unprotected exposures to sick or dead animals including wild birds, poultry, other domesticated birds, and other wild or domesticated animals (including cattle), as well as with animal carcasses, raw milk, feces (poop), litter, or materials contaminated by birds or other animals with confirmed or suspected HPAI A(H5N1)-virus infection. People should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized (raw) milk, or products made from raw milk such as cheeses, from animals with confirmed or suspected HPAI A(H5N1)-virus infection (avian influenza or bird flu). Specific recommendations for farmers; poultry, backyard flock, and livestock owners; and worker protection are also available.
Agencies will notify the Yakima Health District (YHD) when there is an infected animal. YHD will then attempt to contact the individuals exposed to the infected animal by making frequent phone calls over the course of 10 days. If the individuals develop symptoms, YHD will coordinate with their primary care provider for testing and treatment.
Summary Recommendations
The following are recommended actions for patients considered to have recent exposure to avian influenza A viruses.
If signs/symptoms compatible with avian influenza A virus infection are present:
- Isolate patient and follow infection control recommendations below. Symptomatic patients should be provided a surgical mask when presenting to healthcare facilities.
- Initiate empiric antiviral treatment as soon as possible.
- Contact the Yakima Health District at (509) 249-6541. If after business hours, call Yakima Health District’s emergency line: (509) 575-4040, option 2.
- Collect respiratory specimens from the patient to test for avian influenza A viruses at the state health department.
- Testing must be approved and coordinated through the Yakima Health District for State Public Health Lab testing.
If signs/symptoms compatible with avian influenza A virus infection are not present:
- Follow standard health care facility infection control practices/protocols.
- Investigate other potential causes of the patient’s signs and symptoms.
- Contact the Yakima Health District with any questions or concerns at (509) 249-6541.
Signs/Symptoms of avian influenza A virus infection in humans:
Signs/symptoms may include:
- uncomplicated upper respiratory tract signs and symptoms also referred to as influenza-like illness (ILI) [fever ≥100°F plus cough or sore throat],
- fever (temperature of 100ºF [37.8ºC] or greater) or
- feeling feverish,
- cough,
- sore throat,
- runny or stuffy nose,
- muscle or body aches,
- headaches,
- fatigue,
- eye redness (or conjunctivitis),
- shortness of breath or difficulty breathing.
Less common signs and symptoms are:
- diarrhea,
- nausea,
- vomiting, or
- seizures.
It is important to remember that infection with influenza viruses, including avian influenza A viruses, does not always cause fever. Fever may not occur in infected persons of any age, particularly in persons aged 65 years and older or people with immunosuppression. The absence of fever should not supersede clinical judgment when evaluating a patient for illness compatible with avian influenza A virus infection.
Infection Prevention and Control Recommendations
Standard Precautions, plus Contact and Airborne Precautions, including the use of eye protection, are recommended when evaluating patients for infection with avian influenza A viruses. If an airborne infection isolation room (AIIR) is not available, isolate the patient in a private room.
Health care personnel should wear recommended personal protective equipment (PPE) when providing patient care and collecting specimens. These recommendations are consistent with existing infection control guidance for care of patients who might be infected with a novel influenza A virus associated with severe disease.
For more information on recommended infection prevention and control measures, please visit Infection Control Within Healthcare Settings for Patients with Novel Influenza A Viruses.
Laboratory Testing Recommendations
Testing must be approved and coordinated through the Yakima Health District for State Public Health Lab testing. If signs or symptoms consistent with infection with avian influenza A virus are present in a patient with recent exposure to infected birds or contaminated environments should be tested. The preferred specimen types are nasopharyngeal swab and nasal swab combined with an oropharyngeal swab (e.g., two swabs combined into one viral transport media vial). If these specimens cannot be collected, a single nasal or oropharyngeal swab is acceptable. These should be collected for molecular testing (RT-PCR) for influenza viruses, including avian influenza A viruses.
For outpatients, upper respiratory tract specimens should be collected. If conjunctivitis is present, conjunctival swabs should be collected.
Patients who are severely ill should have both upper and lower respiratory tract specimens collected for influenza testing.
For information on specimen collection, infection prevention and control recommendations when collecting specimens, and influenza diagnostic testing, please visit Specimen Collection and Testing for Patients with Novel Influenza A Viruses with Potential to Cause Severe Disease in Humans.
Rapid influenza diagnostic tests are not a reliable indicator of avian influenza A virus infection, and the results should not be used to guide infection control or antiviral treatment decisions. Both commercially available rapid influenza diagnostic tests and most influenza molecular assays do not distinguish between infection with seasonal influenza A viruses and avian influenza A viruses.
If avian influenza A virus is suspected, the Yakima Health District will coordinate with the primary care provider and the state lab to get specimens forwarded.
Treatment Recommendations
Initiation of antiviral treatment with a neuraminidase inhibitor is recommended as soon as possible for any patient with suspected or confirmed infection with an avian influenza A virus. This includes patients who are confirmed cases, probable cases, or cases under investigation, even if more than 48 hours has elapsed since illness onset and regardless of illness severity (outpatients or hospitalized patients).
Treatment with oral or enterically administered oseltamivir (twice daily x 5 days) is recommended regardless of time since onset of symptoms. For more information on oseltamivir dosage, visit Influenza Antiviral Medications: Summary for Clinicians. If the patient has been sick for 2 days or less, oral baloxavir treatment is an option. Antiviral treatment should not be delayed while waiting for laboratory test results.
If molecular testing is negative for novel avian influenza A virus infection and other influenza viruses, but influenza virus infection is still suspected in a patient who is severely ill, antiviral treatment should be continued and additional respiratory specimens should be collected for repeat influenza testing.
For patients who are not hospitalized, if molecular testing is negative for avian influenza A virus and other influenza viruses, antiviral treatment can be discontinued.
For more information on treatment recommendations, please visit Use of Antiviral Medications for Treatment of Human Infections with Novel Influenza A Viruses.
Additional Resources