Recommendations

Consider Avian Influenza Infection

• Healthcare providers should consider the possibility of avian influenza A (H5N1) virus infection in a patient with signs and symptoms consistent with acute respiratory tract infection or conjunctivitis and history of exposure in the last 10 days to animals suspected or confirmed to have avian influenza A (e.g., dairy, poultry or slaughterhouse workers).

• ​If you encounter patients working with ill animals, please encourage them to use personal protective equipment (PPE) and suggest they get a seasonal flu vaccine.
  

Specimen Collection and Testing

• Healthcare providers who suspect avian influenza A virus infection should immediately reach out to their local health department (LHD). The LHD can help determine if testing is warranted and coordinate testing at a public health laboratory.

• Testing of clinical specimens for avian influenza A virus can only be performed at a public health laboratory. Testing at a clinical or commercial laboratory cannot rule out avian influenza A virus infection.  

• Specimens should ideally be collected within 24–72 hours of symptom onset and no later than 10 days after symptom onset.     

• ​Respiratory specimens (e.g., nasopharyngeal swabs, nasal swabs, throat swabs, or dual nasopharyngeal/throat swabs) should be collected from people experiencing any symptoms potentially associated with avian influenza A.

• ​​A conjunctival swab should also be collected from anyone experiencing conjunctivitis. A conjunctival swab MUST be paired with a nasopharyngeal swab even if the person does not have respiratory symptoms.

• Specimens should be collected using swabs with synthetic tips (e.g., polyester or Dacron®) and an aluminum or plastic shaft.

• ​Swabs with cotton tips and wooden shafts are NOT recommended.

• Specimens collected with swabs made of calcium alginate are NOT acceptable. 

• Swabs should be placed in specimen collection vials containing 2–3ml of viral transport media (VTM) or universal transport media (UTM).

• ​Specimens should be refrigerated or frozen after collection. Refrigerated specimens should be transported to the public health lab on cold packs. Frozen specimens should be transported on dry ice.

• For further information about laboratory testing for avian influenza A, please refer to the CDPH Viral and Rickettsial Diseases Labotoratory (VRDL) website or call the VRDL at 510-307-8585. 

Treatment

• Healthcare providers who suspect avian influenza A virus infection should refer to the CDC's Interim Guidance on the Use of Antiviral Medications for Treatment of Human Infections with Novel Influenza A Viruses Associated with Severe Human Disease.

Antiviral treatment is recommended as soon as possible for patients with suspected or confirmed avian influenza A virus infection. Close contacts of symptomatic confirmed cases should be offered antiviral medications according to risk of exposure.  Antiviral treatment should not be delayed while waiting for laboratory test results.

The standard treatment dose of oseltamivir is 75 mg twice daily for 5 days. Dosage adjustment is needed in adult patients with renal impairment. Oseltamivir is not recommended for people with end-stage renal disease (ESRD) who are not receiving dialysis.

PPE and Infection Control

Standard, contact, and airborne precautions are required for patients presenting for medical care or evaluation who have illness consistent with influenza and recent exposure to potentially infected animals. For additional guidance on infection control precautions for patients who might be infected with novel or avian influenza virus, please refer to infection control guidance within healthcare settings when caring for patients with novel influenza A viruses. 

For more California-specific information on infection control requirements in health care settings, please see the Cal/OSHA website on H5N1 and California's Aerosol Tran​smissible Diseases standard.​