Outbreak Notice
Human Infection with Avian Influenza A (H5N1) Virus: Advice for Travelers
This information is current as of today, October 18, 2007 at 03:57

Updated: February 02, 2007

Current Situation

Visit the official U.S. government website for pandemic influenza

Highly pathogenic avian influenza A (H5N1) (hereafter referred to as “H5N1”) virus has caused serious disease among wild birds and poultry on multiple continents. For a current list of countries reporting outbreaks of H5N1 among poultry and/or wild birds, view updates from the World Organization for Animal Health (OIE). Human infections with H5N1 viruses are still rare, but have occurred in countries in Asia, Africa, Eastern Europe, and the Middle East between 2003—2007. Most cases of H5N1 virus infection in humans are thought to have occurred from direct contact with infected poultry, but in one instance, human cases are thought to have been acquired through close contact with wild swans. Rare occurrences of probable spread (or ‘transmission’) from human to human have been reported. So far, however, this type of transmission has not been sustained. Transmission of H5N1 viruses to two persons through consumption of uncooked duck blood may also have occurred in Vietnam in 2005. Total numbers of confirmed human cases of H5N1 virus by country are available on the World Health Organization (WHO) Avian Influenza website. An assessment of the current situation can be found on the Centers for Disease Control and Prevention (CDC) Avian Influenza website.Outbreaks of H5N1 virus among bird populations in Asia, parts of Europe, the Middle East and Africa are not expected to diminish significantly in the short term. Consequently, it is expected that human infections resulting from direct contact with infected poultry will continue to occur in countries where poultry flocks are infected. Because no sustained human-to-human transmission of H5N1 virus has been documented anywhere in the world, the current phase of alert, based on the WHO global influenza preparedness plan, remains at Phase 3 (Pandemic Alert). If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. CDC remains in close communication with WHO and continues to monitor the H5N1 virus situation in countries reporting bird outbreaks and human cases.

For more information about pandemic influenza, please see the official U.S. government website for pandemic influenza.

CDC Recommendations

CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1 viruses. Persons visiting H5N1-affected areas can reduce their risk of infection by observing the following measures.

Before travel to an area affected by H5N1 virus, follow these routine precautions

• Visit CDC’s Travelers’ Health Website to educate yourself and others who may be traveling with you about any disease risks and CDC health recommendations for international travel in areas you plan to visit.
• Be sure you are up-to-date with all your routine vaccinations, including seasonal influenza vaccine, and see your doctor or health-care provider, ideally 4–6 weeks before travel, to get any additional vaccinations, medications or information you may need.
• Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand gel (containing at least 60% alcohol) for hand hygiene. See Travelers’ Health Kit in Health Information for International Travel for other suggested items.

• Identify in-country health-care resources in advance of your trip.
• Check your health insurance plan or get additional insurance that covers medical evacuation in case you become sick. Information about medical evacuation services is provided on the U.S. Department of State web page, Medical Information for Americans Traveling Abroad.

During travel to an H5N1-affected area

• Avoid all direct contact with birds, including domestic poultry (such as chickens and ducks) and wild birds.
• Avoid places such as poultry farms and bird markets where live birds are raised or kept.
• Avoid touching surfaces contaminated with poultry feces or secretions.
• As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often with soap and water removes potentially infectious material from your skin and helps prevent disease transmission. Waterless alcohol-based hand gels (containing at least 60% alcohol) may be used when soap is not available and hands are not visibly soiled.
• 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 be 74°C (165°F).
• If you become sick with symptoms such as a fever plus a cough, sore throat or have trouble breathing, or if you develop any illness that requires prompt medical attention, a U.S. consular officer can assist you in locating medical services and informing your family or friends. Inform the health-care provider of any possible exposures to avian influenza, such as exposures to ill or dead birds. See Seeking Health Care Abroad in Health Information for International Travel for more information about what to do if you become ill while abroad. You should defer further travel until you are free of symptoms, unless traveling locally for medical care.
  • To help stop the spread of germs,
    • Cover your mouth and nose with a tissue when you cough or sneeze.
    • If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.
    • Put your used tissue in the waste basket.
    • Clean your hands after coughing or sneezing by washing them with soap and water (or by using an alcohol-based hand cleaner with at least 60% alcohol when soap and water are not available).
    • You may be asked to put on a surgical mask to protect others.

Note: Some countries have instituted health monitoring techniques, such as temperature screenings, at ports of entry for travelers arriving from areas affected by the H5N1 virus. Please consult the embassy of your travel destination country if you have any questions.

After your return from an H5N1-affected area

• Closely monitor your health for 10 days.
• If you become ill with a fever plus a cough, sore throat or have trouble breathing 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 contact with poultry or close contact with a severely ill person. This way, he or she can be aware that you have traveled to an area reporting H5N1.
• Do not travel while ill, unless you are seeking local medical care. Limiting contact with others as much as possible can help prevent the spread of an infectious illness.

Additional Information

For more information, including information about vaccine development for H5N1 influenza, please see the Questions and Answers About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus page.

For more information about avian influenza, see CDC’s Avian Influenza Web site.

For more information about commonly used avian influenza terms, see the U.S. Department of Agriculture’s Avian Influenza Low Pathogenic H5N1 vs. Highly Pathogenic H5N1 Latest Update.

Visit the official U.S. government website for pandemic influenza.

Content Source:
Division of Global Migration and Quarantine
National Center for Preparedness, Detection, and Control of Infectious Diseases