May 03, 2024
Dear Colleague:
On April 1, 2024, Texas reported, and CDC confirmed, that a person in the United States tested positive for highly pathogenic avian influenza (HPAI) A(H5N1) virus after exposure to infected dairy cattle. The patient reported eye redness, consistent with conjunctivitis, as their only symptom. In light of this, VDH is asking clinicians to maintain a low threshold for H5N1 testing if a patient presents with any relevant symptom(s) and exposure history. To date, HPAI A(H5N1) virus has not been detected in people, dairy cattle, or other domestic animals in Virginia.
According to CDC, the current risk of H5N1 bird flu infections in people remains low. There is no current evidence of human-to-human HPAI A(H5N1) transmission. However, people with exposure to infected birds, cattle, or other animals are at higher risk and should take appropriate precautions. Genetic analyses of the virus from the Texas patient show no evidence of increased transmission risk or antiviral drug resistance. Two H5N1 candidate vaccines are available if the human health risk assessment changes and vaccines are needed.
VDH is recommending that clinicians have a low threshold to request H5N1 testing in any person showing signs or symptoms of acute respiratory illness (including conjunctivitis) who has a relevant exposure history to cattle, unpasteurized (raw) milk, birds, other animals, or their feces, including exposure to animals with no apparent signs of infection. If an H5N1 bird flu infection is suspected, please immediately notify your local health department, who can coordinate testing with the Virginia Division of Consolidated Laboratory Services (DCLS). Specimen collection guidance can be found on the DCLS website.
The following is recommended for any person with signs and symptoms compatible with avian influenza A(H5N1):
- Isolate the patient and follow infection control recommendations, including using PPE.
- Initiate empiric antiviral treatment as soon as possible. Do not delay treatment while awaiting laboratory results.
- Notify your local health department immediately to arrange testing for influenza A(H5N1) virus.
- Collect specimens from the patient to test for influenza A(H5N1) virus at the state health department laboratory.
- Patient with respiratory symptoms: collect one nasopharyngeal (NP) swab AND one combined nasopharyngeal/oropharyngeal (NP/OP) swab
- Patient with conjunctivitis symptoms (with or without respiratory symptoms): collect one NP swab AND one conjunctival swab
- Encourage patients to isolate at home away from their household members and not go to work or school until it is determined whether they have avian influenza A(H5N1) virus infection.
VDH is coordinating closely with the Virginia Department of Agriculture and Consumer Services (VDACS) and will ensure that local public health officials, the public, and healthcare providers have up to date information on this situation as it evolves.
Thank you again for your continued partnership in keeping Virginians safe from all respiratory illnesses. To learn more about H5N1 bird flu, please visit the following websites:
- VDH Website: https://www.vdh.virginia.gov/epidemiology/influenza-flu-in-virginia/novel-variant-and-pandemic-influenza/
- CDC Website: https://www.cdc.gov/flu/avianflu/hpai/hpai-interim-recommendations.html
- VDACS Website: https://www.vdacs.virginia.gov/animals-avian-influenza.shtml
Sincerely,
Karen Shelton, MD
State Health Commissioner