Bird Flu Alarm

Understanding Avian Influenza

Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad

Interim Guidance about Avian Influenza A (H5N1) for U.S. Citizens Living Abroad

This information is current as of today, February 12, 2006, 03:51:10 PM


Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens. Countries that have experienced outbreaks of H5N1 infection among poultry and other birds in 2005-2006 include Cambodia, China (including Hong Kong SAR), Croatia, Indonesia, Kazakhstan, Mongolia, Nigeria, Romania, Russia, Thailand, Turkey, Ukraine, and Vietnam. Poultry outbreaks were also reported in Japan, Laos, and Malaysia during 2004. Human infections with H5N1 viruses are rare, but have occurred during 2003 - 2006 in Cambodia, China, Indonesia, Iraq, Thailand, Turkey, and Vietnam.

Most cases of H5N1 infection in humans are thought to have occurred from direct contact with infected poultry in the affected countries. When possible, care should be taken to avoid contact with poultry that has no apparent symptoms, as well as with sick or dead poultry and any surfaces that may have been contaminated by poultry or their feces or secretions. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Therefore, uncooked poultry or poultry products, including blood, should not be consumed.

The threat of novel influenza subtypes such as influenza A (H5N1) will be greatly increased if the virus gains the ability for sustained spread from one human to another. Such transmission has not yet been observed. However, a few cases of probable person-to-person spread of H5N1 viruses have been reported, with no instances of transmission continuing beyond one person. For example, one case of probable person-to-person transmission associated with close contact between an ill child and her mother is thought to have occurred in Thailand in September 2004.

H5N1 infections in humans can cause serious disease and death. A vaccine to protect humans against influenza A (H5N1) is not yet available, but a candidate vaccine is undergoing human clinical trials. The H5N1 viruses currently infecting birds and some humans are resistant to amantadine and rimantadine, two antiviral medications commonly used to treat influenza. The H5N1 viruses are susceptible to the antiviral medications oseltamivir and zanamivir, but the effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown. For more information about influenza antiviral drugs, see

Situation Update

The World Health Organization (WHO) maintains situation updates and cumulative reports of human cases of avian influenza A (H5N1). Please visit the WHO links for additional information, as well as links to previous situation updates and cumulative reports.

On August 3, 2005, the U.S. Department of State issued a statement on its decision to provide the drug oseltamivir (Tamiflu®) at its embassies and consulates for eligible U.S. government employees and their families serving in the Southeast Asia region. For more information about this policy, see Other Americans living in affected areas or planning long-term travel to these areas may wish to discuss antiviral medication with their health-care providers.

CDC Recommendations

Surveillance and Travel: The Centers for Disease Control and Prevention (CDC) continues to recommend surveillance, diagnostic evaluation, and infection control guidance for suspected H5N1 cases in travelers to the United States, as detailed in a health advisory update on February 4, 2005 ( CDC remains in communication with WHO and continues to closely monitor the H5N1 situation. Situational updates can be found on CDC's avian influenza ( and Travelers' Health websites ( Information also is available on the WHO website (

To reduce the risk of infection, Americans living in areas where outbreaks of H5N1 among poultry or human H5N1 cases have been reported should observe the following measures to help avoid illness:

Precautions: The following recommendations are directed to U.S. embassies and consulates, their personnel, and U.S. citizens living abroad in areas where avian influenza A (H5N1) outbreaks among poultry or human H5N1 cases have been reported. These recommendations may be revised as more information becomes available. Embassies and consulates should recommend the following precautions to U.S. expatriates living in an area with avian influenza:

Travelers should avoid all contact with poultry (e.g., chickens, ducks, geese, pigeons, turkeys, and quail) or any wild birds, and avoid settings where H5N1-infected poultry may be present, such as commercial or backyard poultry farms and live poultry markets. Do not eat uncooked or undercooked poultry or poultry products, including dishes made with uncooked poultry blood.

As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Clean your hands often, using either soap and water (or waterless, alcohol-based hand gels when soap is not available and hands are not visibly soiled) to remove potentially infectious materials from your skin and help prevent disease transmission.

CDC does not recommend the routine use of masks or other personal protective equipment while in public areas.

See Seeking Health Care Abroad in Health Information for International Travel for more information about what to do if you become ill while abroad.

When Preparing Food

Separate raw meat from cooked or ready-to-eat foods. Do not use the same chopping board or the same knife for preparing raw meat and cooked or ready-to-eat foods.

Do not handle either raw or cooked foods without washing your hands in between.

Do not place cooked meat back on the same plate or surface it was on before it was cooked.

All foods from poultry, including eggs and poultry blood, should be cooked thoroughly. Egg yolks should not be runny or liquid. Because influenza viruses are destroyed by heat, the cooking temperature for poultry meat should reach 70°C (158°F).

Wash egg shells in soapy water before handling and cooking, and wash your hands afterwards.

Do not use raw or soft-boiled eggs in foods that will not be cooked.

After handling raw poultry or eggs, wash your hands and all surfaces and utensils thoroughly with soap and water.

If you believe you might have been exposed to avian influenza, take the following precautions:

Monitor your health for 10 days.

If you become ill with fever and develop a cough , sore throat, or difficulty breathing or if you develop any illness with fever during this 10-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following: 1) your symptoms, 2) where you traveled, and 3) if you have had direct poultry contact with poultry. The U.S. embassy or consulate also can provide names and addresses of local physicians.

Do not travel while ill, unless traveling locally for medical care. Limiting contact with others as much as possible can help prevent the spread of an infectious illness.

For more information about avian influenza, see