Information for Health Care Providers

Screening patients for H5N1

Influenza A H5N1 is causing widespread outbreaks among wild and domestic birds in Asia and Eastern Europe. At this time, person-to-person transmission appears to be rare, but travelers from affected areas with serious respiratory illness could be infected with H5N1.

To rapidly detect and control imported Influenza A H5N1, we are asking healthcare providers to immediately notify their local health department of any patient who has:

• Traveled to areas reporting avian or human H5N1 within 10 days of onset, AND
•  Has severe respiratory disease, including pneumonia or acute respiratory distress syndrome (ARDS), for which no alternative cause is established, OR
• Milder illness with fever (>100.4°F [38°C]) and respiratory symptoms (cough, sore throat or shortness of breath) following contact with live birds or persons with suspected or confirmed influenza A H5N1 during travel.

Infection control for patients with suspected or confirmed H5N1 should include standard and droplet precautions. Airborne precautions should be used for procedures that may aerosolize respiratory secretions.

We encourage providers to obtain travel histories from patients with severe respiratory illness. Avian H5N1 has been reported in Cambodia, China, Croatia, Indonesia, Kazakhstan, Kuwait, Mongolia, Russia, Thailand, Turkey and Vietnam and in birds smuggled to Taiwan, Belgium and the United Kingdom. Updated information on H5N1 activity is available on the WHO and Centers for Disease Control and Prevention (CDC) websites:

• WHO: www.who.int/csr/disease/avian_influenza/en/
• CDC: www.cdc.gov/flu/avian/index.htm

Laboratory diagnosis of suspected H5N1 Influenza

Your local health department will facilitate diagnostic testing at the Washington State Department of Health Public Health Laboratories (PHL). Please do not submit specimens to a commercial laboratory, which may cause a delay in confirming the diagnosis. The PHL performs H antigen subtyping of influenza by polymerase chain reaction assay. H5N1 is considered to have pandemic potential and specimens identified as influenza A H5 or another novel subtype will go to CDC for further identification and viral isolation under enhanced biosafety level 3 conditions.

To maximize the detection of influenza, specimens should be collected within three days of symptom onset. Collect serum for antibody testing and at least one of the following:

1. Oropharyngeal swab, nasopharyngeal swab or aspirate
2. Bronchoalveolar lavage, tracheal aspirate or pleural fluid as appropriate

• All testing should be performed using appropriate infection control precautions.
• No specimens will be accepted at the Washington State Public Health Laboratories (PHL) without notification and approval of your local health department.
• For Thurston and Mason Counties, contact Dr. Diana T. Yu at 360-867-2501.

For detailed instructions for collecting each specimen, see H5N1 Collection.