Health Care Professionals

Bird Flu (Avian Influenza) Information for Health Care Professionals

Page originally published 2/21/2025.

The risk to the general public remains low. However, people with job-related or recreational close and prolonged exposures to infected birds, cows, or other animals are at higher risk of infection. Health care providers should consider avian influenza A in persons with:

Acute respiratory symptoms and/or conjunctivitis and recent exposure to animals or humans suspected or confirmed to have avian influenza A, or
Recent consumption of raw dairy products.

On this page:

Actions Requested
Recommendations
- Consider Avian Influenza
- Specimen Collection and Testing
- Treatment
Infection Prevention and Control
Resources

Actions Requested

Expedite subtyping of influenza A-positive specimens from hospitalized patients, particularly those in an intensive care unit (ICU)
Consider avian influenza (H5N1) in persons with acute respiratory symptoms and/or conjunctivitis with relevant exposure history as outlined in Highly Pathogenic Avian Influenza A(H5N1) Virus in Animals: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations.
Treat suspected or confirmed cases of avian influenza (H5N1) with antivirals as clinically indicated.
Utilize appropriate personal protective equipment (PPE) and infection prevention and control measures recommended for seasonal influenza. For severe cases who are confirmed or suspected of novel influenza A, contact and airborne precautions are recommended.
Report cases of suspected or confirmed cases of avian influenza (H5N1) to the County Epidemiology Unit by calling 619-692 8499 (Monday-Friday 8 AM-5 PM).
Submit Influenza A-positive lab specimens for which subtyping is negative to the San Diego Public Health Lab for retesting, following the testing guidelines provided by SDPHL using the Influenza Test Requisition Form.

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Recommendations

Consider Avian Influenza Infection

Health care providers should consider the possibility of avian influenza A virus infection in a patient with:

Signs and symptoms consistent with acute respiratory tract infection and/or conjunctivitis; and
A history of exposure in the last 10 days to animals or humans suspected or confirmed to have avian influenza A, or who have had exposure to raw milk.

If you encounter patients who work with infected animals, please encourage them to use personal protective equipment (PPE) and suggest they receive the seasonal influenza vaccine during influenza season.

Any time a provider has a patient with compatible exposure history and symptoms, healthcare providers should immediately contact the County of San Diego Epidemiology Unit at (619) 692-8499 (Monday-Friday 8:00 a.m. – 5:00 p.m.) or (858) 565-5255 (after hours and holidays).

Polymerase chain reaction (PCR) testing for H5N1 influenza is available at the County of San Diego Public Health Lab (PHL).
Testing for other potential causes of acute respiratory illness should also be considered depending upon the local epidemiology of circulating respiratory pathogens, including SARS-CoV-2.

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Specimen Collection and Testing

If a person develops symptoms that could be consistent with avian influenza infection within 10 days of exposure, they should be tested.

Specimens should ideally be collected within 24–72 hours of symptom onset and no later than 10 days after symptom onset. 
- Swabs with cotton tips and wooden shafts are NOT recommended. 
- Specimens collected with swabs made of calcium alginate are NOT acceptable. 
Swabs should be placed in specimen collection vials containing 2–3ml of viral transport media (VTM) or universal transport media (UTM). 
Specimens should be refrigerated or frozen after collection.

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Treatment

Healthcare providers who suspect influenza A (H5N1) virus infection should refer to the CDC's Interim Guidance on the Use of Antiviral Medications for Treatment of Human Infections with Novel Influenza A Viruses Associated with Severe Human Disease and the CDC Emergency Use Instructions for Oseltamivir. 
Antiviral treatment is recommended as soon as possible for patients with suspected or confirmed influenza A (H5N1) virus infection. 
- Antiviral treatment should not be delayed while waiting for laboratory test results.

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Infection Prevention and Control

If a case is suspected, immediately mask the phe patient and place them in an airborne infection isolation room (AIIR) with the door closed. While in an AIIR, the patient’s mask may be removed.
- If an AIIR is not available, place the patient in a single-patient room with the door closed and have the patient remain masked.
Use PPE that includes respiratory protection (fit-tested N95 respirator or higher level of protection), eye protection (goggles or face shield), and gown and gloves.
Use diligent hand hygiene before and after contact with the patient.
Limit room entry to essential personnel. Limit transport of patient outside their room.

For additional infection control recommendations, see CDC Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease.

For applicable Cal/OSHA requirements in healthcare settings, please see California’s Aerosol Transmissible Diseases standard. 

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