Background: Since December 2003, infections of avian influenza A (H5N1) among poultry have been confirmed in Cambodia, China, Indonesia, Japan, South Korea, Laos, Thailand, and Vietnam.

As of February 20, 2004, the World Health Organization (WHO) reports the following human cases:

Testing of hospitalized patients for influenza A (H5N1) is indicated when both of the following exist: (1) radiographically confirmed pneumonia, acute respiratory distress syndrome (ARDS), or other severe respiratory illness for which an alternative diagnosis has not been established and (2) a history of travel within 10 days of symptom onset to an H5N1 affected country.

DC Department of Health Recommended Infection Control Precautions for influenza A (H5N1) as per Centers for Disease Control and Prevention, MMWR February 13, 2004:

• All patients with a febrile respiratory illness should be asked about their recent travel history and managed using Respiratory Hygiene/Cough Etiquette in Health Care Settings guidelines.
• Isolation precautions for all hospitalized patients who have or are under evaluation for influenza A (H5N1) are the same as those that should be used for severe acute respiratory syndrome (SARS), as follows:
  • Pay careful attention to hand hygiene before and after all patient contact.
  • Use gloves and gown for all patient contact.
  • Wear eye protection when within 3 feet of the patient.
  • Place the patient in an airborne isolation room (i.e., monitored negative air pressure in relation to surrounding areas with six to 12 air changes per hour).
  • When entering the patient's room, use a fit-tested respirator at least as protective as an N95 filtering-face piece respirator approved by the National Institute for Occupational Safety and Health.
• Outpatients or hospitalized patients discharged in <14 days should be isolated in the home setting on the basis of principles for home isolation of SARS patients.
• These precautions should be continued for 14 days after onset of symptoms until an alternative diagnosis is established or diagnostic test results indicate that the patient is not infected with influenza A virus.

As of February 12, avian influenza (H7N2) has been isolated from 2 farms in Delaware. Additional farms in a 6-mile radius of the affected farms are under state quarantine until further notice. To date, no humans have been infected and no other farms have been positive for avian influenza, but are being tested every 10 days for evidence of the virus. H7 is not typically infectious to humans; however, in 2003, the Netherlands reported human infections by H7N7. Infection by H7N2 is considered to be a very low possibility, but if transmission to humans does occur, it is expected in persons exposed to poultry infected with H7N2.

For more information about this event, please contact EHMSA at (202) 671-0733. Media inquiries should be directed to Briant Coleman at (202) 671-0701 or bcoleman@dchealth.com.