Guidance

Reminder for health professionals on recognising possible human cases of Avian Influenza and accessing testing

Published 18 November 2021

Applies to England

General practitioners
Emergency departments
Acute hubs
Infectious diseases
Microbiology departments

Dear colleague

Reminder for health professionals on recognising possible human cases of avian influenza and accessing testing

With increasing foreign travel and people entering England from other countries, health professionals may receive enquiries from recent travellers about acute respiratory illness. In some instances, countries of travel may have previously reported human cases of avian influenza viruses that have been associated with severe human disease. In 2021, there have been increased numbers of human cases of avian influenza A(H5N6) in China compared to historical levels, as well as the first detection in Lao PDR.

Health professionals should refer to published guidance for the investigation of possible human cases of avian influenza viruses that have been associated with severe human disease. The exposure criteria are outlined in the guidance; it is important is to determine if the individual has been within 1 metre of poultry or wild birds, in an affected country, in the 10 days prior to onset of symptoms.

In particular, be aware of persons with:

• fever ≥ 38°C OR acute respiratory infection symptoms OR other severe / life-threatening illness suggestive of an infectious process

AND

• on questioning, report exposures to birds (including poultry) in affected countries

If an individual with this clinical presentation reports such an exposure, they should be assessed for avian influenza in addition to coronavirus (COVID-19) and other respiratory infections.

The guidance also includes information relating to persons with exposures to confirmed human cases

If an individual meets the clinical and exposure criteria outlined in the guidance, the following steps should be taken:

• ensure appropriate isolation and infection prevention and control measures including correct use of specific PPE (as described in guidance document)

• discuss the possible case with the Duty Microbiologist/Virologist at nearest UKHSA Public Health Laboratory (PHL) – see outline of laboratory investigations

• if the PHL Duty Microbiologist / Virologist agrees that testing is indicated, follow the laboratory investigations algorithm and inform the relevant HPT

• treat and investigate as clinically indicated; following agreement with the PHL that testing is indicated, start oseltamivir treatment if not already done so (do not wait for results of avian influenza diagnostic tests)

For persons who meet the possible case definition, testing should always be submitted via the UKHSA PHL Duty Microbiologist / Virologist as this is the established testing pathway for avian influenza subtypes; health professionals are advised not to rely on other routes to exclude avian influenza infection.

Avian influenza A(H5N6) is one of the infections classified as a high consequence infectious disease (HCID). HCIDs are rare in the UK but when they have occurred previously, they have been typically associated with recent travel to an area where they are known to be endemic or where an outbreak is occurring.

As international travel continues to increase, health professionals should take a thorough travel history from all patients and ask about exposures that may increase the risk of different airborne or contact HCID infections, for example contact with animals or their urine or droppings, bites from ticks and contact with unwell people. Further details on the other diseases considered HCIDs, links to key guidance documents and how to access specialist advice can be found in our High consequence infectious diseases (HCID) guidance.

Health professionals wishing to determine the HCID risk in any particular country, can view an A to Z list of countries and their respective HCID risk.

Best wishes

Susan Hopkins

Chief Medical Advisor, UK Health Security Agency