IDAHO HEALTH ALERT NETWORK
GUIDANCE FOR PROVIDERS

Recognition, Testing, and Management of Avian Influenza in People Potentially Exposed to Infected Dairy Cattle or Other Animals
JUNE 18, 2024

Eastern Idaho clinicians are encouraged to consider avian influenza infection in patients who present with influenza-like illness including isolated conjunctivitis or other symptoms of acute respiratory infection and have had recent close contact with animals known or suspected to have avian influenza A virus infection. Contact Eastern Idaho Public Health at 208-533-3152 for assistance with influenza testing by the Idaho Bureau of Laboratories and provision of oseltamivir, if needed.

Background

Highly pathogenic avian influenza (HPAI) A(H5N1) in dairy cows has been reported from eleven states and several counties in Idaho, including Canyon County, Owyhee County, and Payette County. Avian influenza A(H5N1) has also been detected in backyard flocks and a cat in Idaho.

Three avian influenza A(H5N1) infections in dairy workers associated with the national outbreak have been detected, one in Texas and two in Michigan. Two infected workers had mild conjunctivitis and one had mild respiratory symptoms. Five symptomatic people in Idaho with possible exposure to avian influenza A(H5N1) have been tested and influenza A(H5N1) was not detected. Ill people with possible exposure to avian influenza A(H5N1) have sought care at Idaho emergency departments, urgent care clinics, and primary providers’ offices.

Symptoms and Recommendations for Clinicians

Previously reported symptoms of this strain of avian influenza A(H5N1) range from mild to severe and include:

• Mild flu-like illness (cough, sore throat, fever or feeling feverish, rhinorrhea, fatigue, myalgia, arthralgia, headache) or conjunctivitis (red eye, discharge from eye)
• Moderate to severe illness: shortness of breath or difficulty breathing, altered mental status, seizures
• Complications: pneumonia, respiratory failure, acute respiratory distress syndrome, multi-organ failure, meningoencephalitis
• Less commonly, diarrhea, nausea, or vomiting

If a patient with recent exposure has compatible signs and symptoms:

1. Isolate the patient and follow infection prevention recommendations below.
2. Collect respiratory specimens for influenza testing by the Idaho Bureau of Laboratories (IBL). Contact EIPH immediately to facilitate testing at IBL. Specimens should be collected following the information below (Specimens to Collect) 

• EIPH has a courier that can facilitate transportation on Tuesday and Thursdays to the State Lab
• If unable to perform testing at your facility, please contact EIPH for additional testing locations.
  

3. Initiate antiviral treatment as soon as possible. EIPH may be able to assist with free antiviral medications.

Infection prevention

Promptly screen and triage symptomatic patients. Upon entry to the facility, place a facemask on symptomatic patients and place in a single-patient airborne infection isolation room (or if unavailable, a single room with door closed pending transfer). 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. For more information on ways to minimize potential exposures, see interim guidance at https://www.cdc.gov/flu/avianflu/novel-flu-infection-control.htm. Contact the state Healthcare-Associated Infections Program at 208-334-5871 if you have questions.

Antiviral treatment

Treatment with oral or enterically administered oseltamivir (twice daily x 5 days) is recommended regardless of time since onset of symptoms. 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.
See interim guidance at https://www.cdc.gov/flu/avianflu/novel-av-treatment-guidance.htm for details.

Specimens to collect

• 
  • Conjunctival swabs if conjunctivitis is present
  • Upper respiratory tract specimens (nasopharyngeal swab, or nasal aspirate/wash preferred)
  • In addition, lower respiratory tract specimens (endotracheal aspirate or bronchoalveolar lavage fluid) if the patient is severely ill

See interim guidance at https://www.cdc.gov/flu/avianflu/severe-potential.htm for details. Contact the Idaho Bureau of Laboratories at 208-334-0555 if you have questions.

Additional resources
CDC: H5N1 Bird Flu: Current Situation Summary. https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm
USDA: Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock. https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/livestock
USDA: Detections of Highly Pathogenic Avian Influenza in Mammals [other than livestock]. https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/mammals
USDA: Detections of Highly Pathogenic Avian Influenza in Wild Birds https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/wild-birds
ISDA. Avian influenza in Idaho [domestic avian species]. https://agri.idaho.gov/animals/animal-disease/avian-influenza/avian-influenza-resources/