Avian influenza A (H5N1) virus infection

The primary means of containing highly pathogenic avian influenza (HPAI) A(H5N1) virus in communities and decreasing the risk to human health is through H5N1 poultry immunisation or prompt culling of poultry with suspected or confirmed HPAI A(H5N1) virus infection and disinfection of the contaminated environment.

The most effective way to prevent HPAI A(H5N1) virus infection in humans is to minimise exposure by avoiding direct or close contact with sick or dead poultry (or other animals) in HPAI A(H5N1) virus-affected countries.

• The World Health Organization (WHO) recommends:[107]World Health Organization. ​Practical interim guidance to reduce the risk of infection in people exposed to avian influenza viruses. Aug 2024 [internet publication]. https://www.who.int/publications/i/item/B09116

  • Avoiding contact with animals (including wild animals) that are sick or dead from unknown causes

  • Reporting sick or unexpectedly dead animals to local authorities or a veterinarian

  • Following good food safety and personal hygiene practices, particularly hand washing

  • Properly handling and cooking poultry meat, eggs, and other animal products

  • Only slaughtering healthy animals for human consumption

  • Avoiding consuming raw or unpasteurised milk

  • Seeking health care if feeling unwell and reporting any possible exposure to sick animals

  • Wearing appropriate personal protective equipment when in direct or indirect contact with infected (or potentially infected) animals or their environment (e.g., occupational exposure).

• The US Centers for Disease Control and Prevention (CDC) recommends:[112]Centers for Disease Control and Prevention. Interim guidance on the use of antiviral medications for treatment of human infections with novel influenza A viruses associated with severe human disease. Sep 2024 [internet publication]. https://www.cdc.gov/bird-flu/hcp/novel-av-treatment-guidance ​

  • Avoiding unprotected (i.e., not using eye or respiratory protection) exposures to sick or dead animals including poultry, wild or domesticated birds, and other wild or domesticated animals, as well as animal faeces, litter, or materials contaminated by birds or other animals with suspected or confirmed HPAI A(H5N1) infection.

  • Wearing appropriate personal protective equipment (i.e., safety goggles, disposable gloves, boots or boot covers, approved particulate respirator, disposable fluid-resistant overalls, disposable head/hair cover) when in direct or close contact with sick or dead animals or potentially contaminated materials.

  • Cooking poultry, eggs, and beef to safe internal temperatures to kill bacteria and viruses. Avoiding consuming unpasteurised milk (and milk products) is recommended.

• The CDC offers specific guidance for employers to reduce the risk of infection in people working with or exposed to animals, such as poultry and dairy farmers and workers, and veterinarians and their staff.

  • CDC: interim guidance for employers to reduce exposure to avian influenza A viruses for people working with animals Opens in new window

• For people raising poultry or exotic birds in HPAI A(H5N1) virus-affected countries, efforts should be made to keep such birds away from wild waterfowl or other wild birds and their faeces, and away from water sources that are shared by wild waterfowl. Personal protective equipment should also be worn at all times when working in a potentially infected environment.[113]UK Health Security Agency. Avian influenza: guidance and algorithms for managing incidents in birds. Jan 2025 [internet publication]. https://www.gov.uk/government/publications/avian-influenza-guidance-and-algorithms-for-managing-incidents-in-birds

Vaccines

• Influenza A(H5N1) vaccines have been found to be safe and immunogenic in people when adjuvant is used.[114]Prieto-Lara E, Llanos-Mendez A. Safety and immunogenicity of prepandemic H5N1 influenza vaccines: a systematic review of the literature. Vaccine. 2010 Jun 11;28(26):4328-34. http://www.ncbi.nlm.nih.gov/pubmed/20403350?tool=bestpractice.com [115]Vesikari T, Forstén A, Herbinger KH, et al. Safety and immunogenicity of an MF59(®)-adjuvanted A/H5N1 pre-pandemic influenza vaccine in adults and the elderly. Vaccine. 2012 Feb 8;30(7):1388-96. http://www.ncbi.nlm.nih.gov/pubmed/22192847?tool=bestpractice.com [116]Langley JM, Risi G, Caldwell M, et al. Dose-sparing H5N1 A/Indonesia/05/2005 pre-pandemic influenza vaccine in adults and elderly adults: a phase III, placebo-controlled, randomized study. J Infect Dis. 2011 Jun 15;203(12):1729-38. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3100510 http://www.ncbi.nlm.nih.gov/pubmed/21606531?tool=bestpractice.com

• Various H5N1 vaccines are licensed around the world, including Europe and the US, for use in children and adults in pandemic situations. The US has a national stockpile that includes H5 vaccines that could be used if the virus begins transmitting easily from person to person.[117]US Food and Drug Administration. Influenza virus vaccine, H5N1 (for national stockpile). Feb 2018 [internet publication]. https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm094044.htm

• Information on the development and availability status of candidate vaccines is available from the WHO. WHO: zoonotic influenza – candidate vaccine viruses and potency testing reagents Opens in new window

• Healthcare workers worldwide are recommended to receive an annual seasonal influenza vaccine to decrease their risk of seasonal influenza and also to reduce the potential for nosocomial transmission of seasonal influenza viruses in the healthcare setting. Preventing seasonal influenza among people exposed to or infected with HPAI A(H5N1) virus may also decrease the theoretical risk of human co-infection with seasonal influenza A viruses and HPAI A(H5N1) virus and of viral genetic re-assortment (an event that could lead to the emergence of a potential pandemic influenza virus strain). However, seasonal influenza vaccination does not provide any protection against human infection with HPAI A(H5N1) virus infection.

Standard personal protective measures (e.g., home isolation, respiratory etiquette, hand hygiene) are recommended to slow the spread of infection; however, additional measures may also be recommended during pandemics, including:[118]Qualls N, Levitt A, Kanade N, et al; CDC Community Mitigation Guidelines Work Group. Community mitigation guidelines to prevent pandemic influenza - United States, 2017. MMWR Recomm Rep. 2017 Apr 21;66(1):1-34. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5837128 http://www.ncbi.nlm.nih.gov/pubmed/28426646?tool=bestpractice.com

• Voluntary home quarantine

• Use of face masks by people who are ill (or who are well)

• School, university, or child-care facility closures

• Social distancing measures (e.g., workplaces, mass gatherings)

• Environmental surface cleaning measures.

Post-exposure prophylaxis

• Antiviral post-exposure prophylaxis may be recommended for close contacts.

• See Treatment algorithm.