• How is avian influenza transmitted?
• What is the relationship between avian influenza and a pandemic?
• Is there a test for avian influenza?
• What is the treatment for avian influenza?
• Is there a vaccine for avian influenza?
• What can I do to protect myself?
• How will the potential impact on human health be assessed in an avian influenza outbreak?
• Where can I obtain more information on avian influenza?

The exact mode of transmission from birds to people is not known. However, most human cases of the HPAI H5N1 virus have been traced to direct contact with infected poultry or their droppings.

High risk activities include plucking, preparing or playing with diseased birds, consuming duck's blood or possibly undercooked poultry and handling birds involved in cock-fighting. Mass culling of poultry has not been implicated in transmission of the HPAI H5N1 virus.

While sustained human to human transmission of HPAI H5N1 has not been reported as yet, it is possible that this strain could mutate to one which can be transmitted by humans. This type of mutation could occur in humans or pigs, which are susceptible to both avian and human forms of influenza. Because of farming practices and close contact between animals and humans, these potential events are most likely to occur first in China or Southeast Asia.

The diagnosis of AI may be made by :

• Viral culture;
• Direct Detection Methods: Reverse transcription PCR (RT-PCR) assays and immunofluorescence assays; and
• Serology: (antibody detection), serologic testing can be used for retrospective diagnosis of infection but is rarely useful for patient management, peak antibody response occurs four to seven weeks after infection.

Both throat and nasal pharyngeal swabs should be collected with appropriate precautions. Only patients who have symptoms compatible with influenza-like-illness (ILI) and a history of travel within 14-days of symptom onset to a country with documented HPAI H5N1 and exposure to poultry (or possibly persons with ILI), should be tested. The World Health Organization (WHO) website carries an up-to-date list of affected countries.

The HPAI H5N1 virus is susceptible to both oseltamivir and zanamivir. The optimal dose and duration of therapy is uncertain; for oseltamivir it has been suggested that higher than normal doses for prolonged periods (eight days instead of five) are needed, based on recent isolated strains. Treatment must be initiated as soon as possible in the course of the illness. Zanamivir has not been studied for treatment in humans, and the virus is resistant to amantadine and rimantadine.

Health care workers caring for infected patients should wear appropriate personal protective equipment (see below under Personal Protective Equipment) and monitor their own health, including temperature. Any lapse in precautions resulting in potential exposure to aerosols, secretions, or body fluids should trigger consideration of post-exposure prophylaxis of oseltamivir at 75mg per day for seven to 10 days. The same recommendations are applicable for household or close contacts of infected patients.

There is no commercially available human vaccine against avian influenza; however early studies of inactivated and live attenuated intranasal vaccines appear promising.

In general :

• Practice meticulous infection control, such as hand hygiene techniques, at all times
• Get your annual influenza immunization

If traveling to an area with AI activity :

• avoid all direct contact with poultry, including chickens, ducks or geese that appear to be well and avoid farms or live-animal markets with poultry; avoid touching surfaces contaminated with poultry feces or secretions
• avoid ingesting undercooked eggs or poultry
• practice meticulous hand hygiene techniques when handling poultry for cooking
• consult a health care provider if you have fever and respiratory illness within 14- days of returning from an affected area.

Upon being informed that a suspected avian influenza outbreak in domestic poultry population has been detected, response activities will be undertaken by various agencies to determine the public health risk and impact, if any. The various agencies involved in determining public health risk include the Canadian Food Inspection Agency (lead agency in an AI outbreak), Health Canada, Ministry of Health and Long-Term Care, Ministry of Labour and local public health units.

Information on this website was taken from a review article in the New England Journal of Medicine :

Current Concepts - Avian influenza A (H5N1) Infection in Humans. The Writing Committee of the World Health Organization (WHO) Consultation in Human Influenza A/H5; NEJM 353; 13:1374-85.

Personal Protective Equipment (PPE), includes :

• alcohol-based hand rub (60 per cent to 90 per cent alcohol)
• surgical procedure masks
• eye goggles or face shields
• disposable gowns
• non-latex gloves
• N95 masks (if perform/exposed to high risk respiratory procedures)
• Surgical mask for patient if patient is not in an airborne infection isolation room

Visit the Avian Influenza Links page for a list of other sites offering additional resources

CritiCall Ontario provides a 24 hour call centre for hospitals to contact on-call specialists; arrange for appropriate hospital bed access and facilitate urgent triage for patients
1-800-668-4357

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