CDC Health Advisory Notices & Announcements

Update: Notice to Travelers about Avian Influenza A (H5N1)

According to a World Health Organization (WHO) report on August 5, 2005, the Ministry of Health in Vietnam has reported an additional three human cases of avian influenza A (H5N1) virus infection: one in the northern province of Ha Tay, one in the southern province of Tra Vinh, and one in Ho Chi Minh City, also in the south. The patients from Tra Vinh and Ho Chi Minh City died. These newly confirmed cases in Vietnam bring the total reported there since mid-December 2004 to 63 cases, 20 of which have been fatal.

During December 2003 to August 5, 2005, a total of 112 human cases of avian influenza A (H5N1) were reported in Vietnam (90), Thailand (17), Cambodia (4) and Indonesia (1), resulting in 57 deaths.

For more information about avian influenza A (H5N1) infections in humans, visit the WHO website (http://www.who.int/csr/disease/avian_influenza/en/) and the Centers for Disease Control and Prevention (CDC) website (http://www.cdc.gov/flu/avian/).

CDC is in communication with WHO and continues to closely monitor the H5N1 situation in Asia. CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1.

Most cases of H5N1 infection in humans are thought to have occurred from direct contact with infected poultry. Therefore, care should be taken to avoid contact, when feasible, with live, well-appearing, 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, consumption of uncooked poultry or poultry products, including blood, should be avoided.

To date, there has been no evidence of sustained person-to-person spread of influenza A (H5N1) virus; however, public health authorities continue to monitor for this possibility because the risk posed by avian influenza (H5N1) would be higher if such spread occurred. It is thought that a few cases of limited person-to-person spread of H5N1 viruses may have occurred. For example, one instance 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. No vaccine to protect humans against H5N1 infection is currently available, but an inactivated human H5N1 vaccine is undergoing human clinical trials in the United States. The H5N1 viruses currently infecting birds and some humans in Asia are resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. The H5N1 viruses are susceptible to the antiviral medications, oseltamavir and zanamavir, although the effectiveness of these drugs when used for treatment of H5N1 virus infection is unknown.

Outbreaks of H5N1 infection among poultry have been confirmed in Cambodia, China, Indonesia, Thailand, Vietnam, and, most recently, Kazakhstan and Russia during 2005.

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

Before any international travel

• Always educate yourself and others who may be traveling with you about any disease risks in areas you plan to visit (for information about H5N1, see this web page for more information: http://www.cdc.gov/flu/avian/).
• Be sure your vaccinations are up to date 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. CDC's health recommendations for international travel to Southeast Asia are provided on CDC's Travelers' Health website: http://www.cdc.gov/travel/seasia.htm.
• Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand rub for hand hygiene. See this page for other suggested items: http://www.cdc.gov/travel/other/travelers-health-kit.htm.
• Before you leave, find out how and where to get medical care in the country where you are traveling.
• 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 titled Medical Information for Americans Traveling Abroad, at http://travel.state.gov/travel/tips/health/health_1185.html.

During Travel

• Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places, such as poultry farms and bird markets, where live poultry are raised or kept, and avoid handling 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, using soap and water (or waterless alcohol-based hand rubs when soap is not available and hands are not visibly soiled), removes potentially infectious material from your skin and helps prevent disease transmission.
• Handwashing is especially important when preparing raw poultry for cooking (including during cooking classes).
• Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs and poultry blood, should be thoroughly cooked. See International Food Safety Authorities Network (INFOSAN) for guidelines about food safety and H5N1 at http://www.who.int/foodsafety/micro/avian/en/
• If you become sick with symptoms such as a fever, difficulty breathing, or cough or with 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. See this page for more information about what to do if you become ill while abroad: http://www.cdc.gov/travel/other/illness-abroad.htm. It is advisable that you defer travel until you are free of symptoms unless your travel is health-related.

After your return

• Monitor your health for 10 days.
• If you become ill with fever and develop a cough or difficulty breathing, or if you develop any illness 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 or contact with a known or suspected human case of influenza A (H5N1) in an H5N1-affected country. This way he or she can be aware you have traveled to an area reporting avian influenza.

For more information about H5N1 infections in humans, visit the World Health Organization (WHO) website and the CDC Avian Influenza site, http://www.cdc.gov/flu/avian/.

For information about CDC recommendations for enhanced surveillance, diagnostic evaluation, and infection control precautions for H5N1, see http://www.cdc.gov/flu/avian/professional/han081304.htm.

For more information about CDC's health recommendations for travel to Asia, see http://www.cdc.gov/travel/seasia.htm and http://www.cdc.gov/travel/eastasia.htm.

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