Outbreak Notice Guidelines and RecommendationsInterim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad This information is current as of today,
April 18, 2006, 11:24:54 AM
This notice initially released: March 24, 2005
Background
Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens. Human infections with H5N1 viruses are rare, but have also occurred in several countries since 2003. For a current list of countries reporting outbreaks of H5N1 infection among poultry and other birds and a list of countries reporting laboratory-confirmed human infections with H5N1 viruses, see the Centers for Disease Control and Prevention (CDC) website,
http://www.cdc.gov/flu/avian/outbreaks/current.htmSituation updates and cumulative reports can also be found on the World Health Organization (WHO) website at
http://www.who.int/csr/disease/avian_influenza/en/.
Most cases of H5N1 influenza in humans are thought to have occurred from direct contact with infected poultry in affected countries. Contact with sick or dead poultry as well as with poultry that have no apparent symptoms should be avoided. Contact with surfaces that may have been contaminated by poultry feces or secretions should also be avoided. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Therefore, uncooked poultry or poultry products, including blood, should not be consumed.
The public health threat of novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability for sustained spread from one human to another. Such transmission has not yet been observed. However, a few cases of probable person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person. For example, one case of probable person-to-person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004.
H5N1 infections in humans can cause serious disease and death. A vaccine to protect humans against influenza A (H5N1) is not yet available, but a candidate vaccine is undergoing human clinical trials in the United States. The H5N1 viruses currently infecting birds and some humans are resistant to amantadine and rimantadine, two antiviral medications commonly used to treat influenza. Most of the H5N1 viruses tested have been susceptible to the antiviral medications oseltamivir (Tamiflu®) and zanamivir (Relenza®), but resistance has been reported. The effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown. For more information about influenza antiviral drugs, see
http://www.cdc.gov/flu/avian/gen-info/avian-flu-humans.htm#antiviral.
The U.S. Department of State has decided to provide oseltamivir at its embassies and consulates for eligible U.S. government employees and their families serving abroad who become ill with avian influenza. For more information about this policy, see
http://travel.state.gov/travel/tips/health/health_1181.html. Other Americans living in affected areas or planning long-term travel to these areas may wish to discuss antiviral medication with their health-care providers.
CDC Recommendations
Surveillance and travel: The Centers for Disease Control and Prevention (CDC) continues to recommend surveillance, diagnostic evaluation, and infection control guidance for suspected H5N1 cases in travelers to the United States, as detailed in a health advisory update (
http://www.cdc.gov/flu/avian/professional/han020405.htm). CDC remains in communication with WHO and continues to closely monitor the H5N1 situation. Situational updates can be found on CDC's avian influenza (
http://www.cdc.gov/flu/avian/index.htm) and Travelers' Health websites (
http://www.cdc.gov/travel). Information also is available on the WHO website (
http://www.who.int/en/).
To reduce the risk of infection, Americans living in areas where outbreaks of H5N1 among poultry or human H5N1 cases have been reported should observe the following measures to help avoid illness:
Precautions: The following recommendations are directed to U.S. embassies and consulates, their personnel, and U.S. citizens living abroad in areas where avian influenza A (H5N1) outbreaks among poultry or wild birds have occurred or where human H5N1 cases have been reported. These recommendations may be revised as more information becomes available. Embassies and consulates should recommend the following precautions to U.S. expatriates living in an area with avian influenza:
Travelers should avoid all contact with poultry (e.g., chickens, ducks, geese, pigeons, turkeys, and quail) or any wild birds, and avoid settings where H5N1-infected poultry may be present, such as commercial or backyard poultry farms and live poultry markets. Do not eat uncooked or undercooked poultry or poultry products, including dishes made with uncooked poultry blood.
As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Clean your hands often, using either soap and water (or waterless, alcohol-based hand gels when soap is not available and hands are not visibly soiled) to remove potentially infectious materials from your skin and help prevent disease transmission.
CDC does not recommend the routine use of masks or other personal protective equipment while in public areas.
See
Seeking Health Care Abroad in Health Information for International Travel for more information about what to do if you become ill while abroad.
When Preparing Food
Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or the same knife for preparing raw meat and cooked or ready-to-eat foods.
Do not handle either raw or cooked foods without washing your hands in between.
Do not place cooked meat back on the same plate or surface it was on before it was cooked.
All foods from poultry, including eggs and poultry blood should be cooked thoroughly. Egg yolks should not be runny or liquid. Because influenza viruses are destroyed by heat, the cooking temperature for poultry meat should be 74°C (165°F)
Wash egg shells in soapy water before handling and cooking, and wash your hands afterwards.
Do not use raw or soft-boiled eggs in foods that will not be cooked.
After handling raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with soap and water.
If you believe you might have been exposed to avian influenza, take the following precautions:
Monitor your health for 10 days.
If you become ill with fever and develop a cough, sore throat, or difficulty breathing or if you develop any illness with fever during this 10-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following: 1) your symptoms, 2) where you traveled, and 3) if you have had direct poultry contact with poultry. The U.S. embassy or consulate also can provide names and addresses of local physicians.
Do not travel while ill, unless traveling locally for medical care. Limiting contact with others as much as possible can help prevent the spread of an infectious illness.
For more information about avian influenza, see
http://www.cdc.gov/flu/avian/index.htm.
Date: April 4, 2006
Content Source: National Center for Infectious Diseases, Division of Global Migration and Quarantine
http://www.cdc.gov/travel/other/avian_flu_ig_americans_abroad_032405.htm
