AVIAN INFLUENZA

Influenza caused by avian (bird) influenza Type A viruses (mainly H5N1 strain). It is endemic in the poultry population in Eurasia and can occasionally be transmitted to humans through direct contact with sick birds (inhalation of infectious droplets). Disease can be mild or severe and has limited potential to spread from person to person but there is risk of mutations giving rise to a very infectious virus which
could cause widespread epidemics. Avian flu is a notifiable disease

Cause

  • Avian (bird) influenza Type A viruses

Clinical features

  • Conjuctivitis
  • Flu symptoms: fever, cough, sore throat, muscle aches
  • Gastrointestinal (diarrhoea) and neurological symptoms
  • In some cases, severe acute respiratory syndrome (SARS)

Investigations

  • Blood and respiratory specimens, nose swab: lab test for influenza and rule out bacterial infection
    • Testing must be in a special laboratory

Management

If patient requires hospitalisation

  • Hospitalise patient under appropriate infection control precautions
  • Administer oxygen as required. Avoid nebulisers and high air flow oxygen masks
  • Give paracetamol or ibuprofen for fever prn
  • Give oseltamivir phosphate in patients ≥ 1 year who have been symptomatic for no more than two days. Treat for 5 days as below:Adults and children ≥ 13 years: 75 mg twice dailyChild > 1 year and < 15 kg: 30 mg twice dailyChild 15– 23 kg: 45 mg twice daily

    Child 23–40 kg body weight: 60 mg twice daily

    Child > 40 kg body weight: 75 mg twice daily

  • If a case does not require hospitalisation
  • Educate the patient and his/her family on:
    • Personal hygiene and infection control measures
    • Hand-washing, use of a paper or surgical mask by the ill person
    • Restriction of social contacts
    • Seek prompt medical care if the condition worsens

Prophylactic use of oseltamivir

  • Indicated in persons 13 years and above who have come into contact with affected birds/patients
  • Close contact: 75 mg once daily for at least 7 days
  • Community contacts: 75 mg once daily up to 6 weeks
  • Protection lasts only during the period of chemoprophylaxis

Discharge policy

  • Infection control precautions for adult patients should remain in place for 7 days after resolution of fever and for 21 days in children younger than 12 years
  • Children should not attend school during this period

Control and Prevention of Nosocomial Spread of Influenza A (H5N1)

Health workers should observe the following to prevent the spread of avian influenza in the health care facilities:

  • Observe droplet and contact precautions. In addition, get negative pressure room if available
  • Isolate the patient to a single room
  • Place beds more than 1 metre apart and preferably separated by a physical barrier (e.g. curtain, partition)
  • Appropriate personal protective equipment (APPE) in all those entering patients’ rooms. APPE includes high efficiency mask, gown, face shield or goggles, and gloves
  • Limit the number of health care workers (HCWs) and other hospital employees who have direct contact with the patient(s). These HCWs should:
    • Be properly trained in infection control precautions
    • Monitor their own temperature twice daily and report any febrile event to hospital authorities
  • A HCW who has a fever (>380C) and who has had direct patient contact should be treated immediately
  • Restrict the number of visitors, provide them with APPE, and instruct them in its use