Health Advisory: H5 Avian Influenza and Local Influenza (types A and B) Virus Updates

| May 16, 2022

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H5 Avian Influenza

  • Be aware:
    • On April 28, 2022, the CDC announced that a person in Colorado, who had direct exposure to poultry and was involved in the culling (depopulating) of poultry with presumptive H5N1 bird flu, tested positive for avian influenza. No other cases have been detected in the U.S. with currently circulating H5N1 strains.
    • Although highly pathogenic avian influenza is a highly contagious disease among birds and can cause significant mortality among poultry, the risk of it spreading to people is very low.
    • The H5N1 virus currently circulating in the US is genetically very different than the H5N1 virus that has been circulating in the past and is not an immediate concern for human health.
    • No humans with highly pathogenic avian influenza have been identified in Washington state.
    • Cases have been detected in birds in Washington state. The Washington State Department of Agriculture has detected H5N1 virus in surveillance specimens collected May 4, 2022, from a non-commercial backyard flock in Pacific County.
  • Advise patients that chicken, eggs, and other poultry and poultry products are safe to eat when properly handled and cooked. Follow these steps for safer food:
    • Wash hands and clean and sanitize work surfaces and equipment.
    • Do not wash poultry.
    • Separate raw and cooked meat to avoid cross-contamination.
    • Cook poultry thoroughly to an internal temperature of 165 degrees Fahrenheit.
    • Keep poultry stored at 40 F or below or, in the freezer at 0 F or below.

Other Influenzas (Types A and B)

  • Be aware, influenza activity is currently elevated in Kitsap County, and has been rising over the past two weeks. The Washington State Department of Health (DOH) has reported similar findings across the state. Influenza activity in Washington State is not thought to be related to H5N1 avian influenza.
  • Consider influenza in patients presenting with respiratory symptoms, particularly if they test negative for COVID-19. Consider testing for both concurrently and repeat rapid antigen testing for COVID the morning following an initial negative test if suspicion is high.
  • Teach patients how to care for themselves at home with mild to moderate illness and when to access emergency departments for care. Encourage patients to stay home from work, school, travel, shopping, social events, and public gatherings until at least 24 hours after their fever is gone (without the use of antipyretic medications).
  • Assess flu vaccination status for high-risk patients, including immunocompromised residents in congregate care settings and pregnant women. Know where to refer anyone unvaccinated.
  • Be aware that influenza-associated deaths and cases of novel influenza (human infection with an influenza A virus that is different from currently circulating human influenza H1 and H3 viruses) should be reported to Kitsap Public Health 24/7 by calling 360-728-2235 or using the Reportable Disease Fax Form and faxing to 360-813-1168 with any corresponding lab results.

Background

Avian Influenza

A person in Colorado tested positive for avian influenza A(H5N1) virus (H5 bird flu), Colorado Department of Public Health and Environment reported April 28, 2022. The U.S. Centers for Disease Control and Prevention (CDC) confirmed it is the first U.S. case of H5 bird flu. The person was involved in the culling of poultry with presumptive H5N1 bird flu. The person reported one symptom (fatigue) for a few days and has since resolved. The person is in isolation on oseltamivir treatment. While it is possible the detection of H5 bird flu in this specimen is a result of surface contamination of the nasal membrane, that can’t be determined at this point and the positive test result meets the criteria for an H5 case.

As of May 9, 2022, there have been only two human cases reported associated with this H5N1 clade. The first case was detected in the United Kingdom in December 2021 through routine monitoring of contacts to a flock that had recently tested positive for H5N1. That case was asymptomatic.

Infected birds shed H5N1 viruses in their saliva, mucous and feces. Starting in January 2022, U.S. Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) found highly pathogenic avian influenza A(H5N1) virus in U.S. wild birds. The virus was later found in U.S. commercial poultry and backyard bird flocks.

Bird testing and monitoring by the Washington State Departments of Agriculture and Fish and Wildlife are underway statewide. Avian Influenza | Washington State Department of Agriculture. The US Department of Agriculture has an online list of bird flu detections, USDA APHIS | 2022 Detections of Highly Pathogenic Avian Influenza.

Detection of H5 bird flu in one person involved in poultry culling does not change the health risk to the general public, which is low. People exposed to infected birds during work or recreation are at greater risk and should follow recommended precautions. For details, see CDC’s April 29, 2022 health advisory.

Resources

Influenza in Kitsap County

Influenza activity in Kitsap County is currently elevated and has been increasing over the past two weeks. In week ending April 30, 2022, twenty of 172 (12%) of specimens reported from three sentinel laboratories were positive for influenza (11 influenza A, 1 influenza B). This is above baseline, and is the highest level observed this season; however, it is still well below seasonal peaks in previous years. Data on Kitsap emergency department visits showed 1.3% of visits related to Influenza-like illness, which is elevated, and similar to what was observed at the end of December 2021.

As of May 9, 2022, there have no reported influenza-related deaths, and no reports of influenza outbreaks in long-term facilities.

Influenza in Washington State

DOH reports that influenza activity in Washington State is currently increasing. During week ending April 30, 2022, 2.6% of visits among Influenza-like illness Network participants were for influenza-like illness, above the baseline of 1.8%, and 4.1% of specimens submitted by Washington sentinel laboratories through the National Respiratory and Enteric Virus Surveillance System (NREVSS) were positive for influenza. The majority of specimens submitted this season have been typed as Influenza A.

As of April 30, 2022, there have been 13 influenza-associated deaths reported statewide; six of these have occurred in Western Washington.

Influenza is reportable to public health in Washington only in the following cases: (1) a novel or unsubtypable strain; (2) a laboratory-confirmed influenza-associated death; (3) outbreaks of influenza-like illness or lab-confirmed influenza in an institutional setting (e.g., long term care facility).

Additional data reported from clinical laboratories and sentinel providers, as well as patient visit data submitted through the DOH Rapid Health Information Network (RHINO), are monitored locally and nationally to describe influenza activity.

Resources

Influenza Testing

  • Influenza testing guidance, CDC
  • For help with questions or accessing resources, contact Kitsap Public Health at (360) 728‑2235.

Contacting the Health District

  • Call (360) 728-2235 and leave a message. Includes reporting notifiable conditions 24 hours a day, 7 days a week. Leave the patient’s name, date of birth and disease.
  • Fax (360) 813-1379.

Additional Resources