0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:40
Influenza, Avian 835■No travel advisories at time of writing (check CDC website for up-
dates)
■Travelers to areas of bird or human disease advised to avoid contact
with domestic birds, avoid consuming undercooked poultry meat,
blood, or eggs. Practice frequent handwashing with soap and water
or alcohol-based hand rub.
■No licensed vaccine currently, but ongoing human trials in multiple
countriesHistory
Subtype of Influenza A (H5N1)
■Usually infects wild birds, but has caused large outbreaks of severe
disease in domestic poultry in a growing number of countries. Ini-
tially was in SE Asia, but recently also reported in birds in Europe,
India and Africa.
■First documented human case in 1997, re-emerged in 2003 coincid-
ing with extensive outbreaks in birds throughout Asia. Current virus
in human cases antigenically distinct from earlier cases.
Transmission – animal to human, environment to human and
human to human (nonsustained)
Most cases report handling or close contact with secretions of
infected poultry (sick or dying birds). Ingesting uncooked poul-
try meat or blood has also been associated and contaminated sur-
faces may transmit virus. Human-to-human transmission reported
in a family cluster with close contact. No airborne transmission yet
reported.
■Unlike seasonal influenza, attack rate is highest in children and
young adults.
■Incubation period up to 8 days
Signs & Symptoms
■Fever, lower respiratory symptoms, diarrhea may be present.
■May also present with encephalopathy without pulmonary disease
tests
■Blood: lymphopenia, elevated LFTs
During Early Febrile Stages:
■Limit testing based on appropriate clinical presentation and history
of travel to area with documented H5N1 in birds or humans.
Lab must be alerted to follow biosafety precautions. Send specimens
(throat and nasal) as quickly as possible.
Culture: Viral culture (require biosafety 3+facility)