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Guidelines and Recommendations: Interim Guidance about Avian Influenza (H5N1) for U.S. Citizens Living Abroad

Current Situation

Highly pathogenic avian influenza A virus (also called “H5N1,” “bird flu,” or “avian flu”) has caused serious disease in poultry and wild birds on multiple continents. Humans rarely get sick with H5N1 viruses, but since 2003, more than 500 people in parts of Asia, Africa, Eastern Europe, and the Middle East have become ill and about 60% of these people have died. You can find the most up-to-date information by using the links below:

  • The [[forward label=([World Organization for Animal Health (OIE)]) link=([http://www.oie.int/downld/avian%20influenza/A_AI-Asia.htm])]] lists the countries reporting outbreaks of H5N1 among poultry and wild birds.
  • Confirmed human cases of H5N1 virus are listed, by country, on the [[forward label=([World Health Organization (WHO) Avian Influenza website]) link=([http://www.who.int/csr/disease/avian_influenza/country/en/])]].
  • The Centers for Disease Control and Prevention (CDC) Avian Influenza website also gives information on avian flu.

Most people become infected with H5N1 through direct contact with sick or dead birds (poultry or wild birds) carrying the H5N1 virus. Direct contact could happen during activities such as—

  • Visiting live bird or poultry markets
  • Preparing or consuming uncooked or undercooked bird products (such as meat, eggs, or blood)

A few people have become infected through close contact with another person who is sick with bird flu, but this is very rare and H5N1 has not continued to spread past one person. CDC expects that outbreaks of H5N1 virus will continue among birds in Asia, parts of Europe, the Middle East and Africa. Because of this, people getting sick with H5N1 from direct contact with infected birds may also continue in countries where poultry flocks are infected.

Advice for U.S. Citizens Living in H5N1-Affected Areas

Citizens living in H5N1-affected countries should stay up-to-date on the H5N1 situation in their local area and follow all recommendations to protect their health. Recommendations may be revised or changed as more information becomes available.

Monitor the worldwide situation

  • CDC Travelers’ Health
  • CDC Avian Influenza
  • [[forward label=([World Health Organization Avian Influenza]) link=([http://www.who.int/csr/disease/avian_influenza/en/])]]
  • [[forward label=([World Organization for Animal Health]) link=([http://www.oie.int/downld/AVIAN%20INFLUENZA/A_AI-Asia.htm])]]

Monitor the local situation

  • If H5N1 virus has been found in the country where you live, monitor the announcements of the country’s Ministry of Health and local government.
  • Follow local public health guidelines, including any movement restrictions and prevention recommendations.

Be prepared

If H5N1 virus causes an outbreak among birds in your area, be aware that local officials may decide to limit the movement of birds or people to contain the spread of disease. It is a good idea to prepare for the possibility of these movement restrictions.

  • Have an extra supply of water, nonperishable food, medications and other necessities in your home. Some helpful tips can be found on the [[forward label=([Pandemic Flu Planning Checklist for Individuals and Families]) link=([http://www.pandemicflu.gov/planguide/checklist.html])]]. Even though right now there is no pandemic, the steps to plan for restricted movements are the same.
  • Identify medical care resources in your local area. Make sure to plan how you would receive health care if you become sick.
  • Review your plans from time to time and update as needed based on new information or recommendations.

Practice healthy habits to help stop the spread of germs

  • Wash your hands often with soap and clean water. This removes germs from your skin and helps prevent diseases from spreading.
    • Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap is not available and hands are not visibly dirty.
    • Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in a waste basket.
    • If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
    • Wash your hands after coughing or sneezing.
    • Follow all local health recommendations. For example, you may be asked to put on a surgical mask to protect others.

Be careful with birds

  • Avoid all contact with birds, including poultry (such as chickens and ducks) and wild birds.
  • Avoid touching surfaces that have bird droppings or other bird fluids on them.
  • Avoid places where there may be H5N1 virus-infected poultry, such as commercial or backyard poultry farms and live poultry markets.
  • Teach children not to touch sick or dead birds. If there have been outbreaks of H5N1 in birds within your region, be especially watchful of small children when they go outside.
  • If possible, ask trained workers to dispose of any dead birds and bird droppings that you may see. Contact local health authorities or government officials to find out if trained workers are available.
  • If you cannot avoid coming in contact with a dead bird (for example, a cat brings a dead bird into the house), follow these guidelines to protect yourself:
    • Do not touch the bird with your bare hands. To protect your hands when picking up a dead bird, follow the steps below:
      1. Take two plastic bags and place one inside the other
      2. Put both your hands inside the bags
      3. Pick up the dead bird, using the bags as a protective barrier
      4. Pull the bags up and around the dead bird
      5. Tie the bags
      6. Unless otherwise instructed, place the bags in a trash bin
    • You can also use a shovel to pick up a dead bird. If possible, wear disposable gloves.
    • For additional protection, wear safety goggles or glasses and a surgical mask to protect your nose, mouth and eyes from splashes.
    • Immediately clean hands with soap and water (or an alcohol-based hand gel if soap and water are not available).
    • Avoid touching your face, rubbing your eyes, eating, drinking, or smoking before washing your hands.

Protect your pets

Other animals can also become infected with H5N1 viruses, including cats. As the virus evolves, other animals, such as dogs, may also be at risk for infection. Evidence suggests that cats may become infected through eating raw infected birds. If dogs are susceptible to H5N1, infection might occur in the same way.

  • There is no evidence to suggest that cats or dogs can spread H5N1 virus to humans.
  • Follow these recommendations if H5N1 infection has been found in birds within the region where you live:
    • Keep your pets inside the house to avoid exposure to birds that may be sick.
    • Do not feed your pet raw meat or poultry.
    • Avoid all contact with stray cats and do not allow them to come inside the house.
    • Inform local veterinary authorities if your pet is sick and may have been in contact with birds.
    • Follow all normal hygiene rules for pet care to avoid contracting diseases transmitted by pets.
    • Wear gloves to clean cat litter boxes and thoroughly wash your hands with soap and water right afterward.

Be careful when preparing food

  • Eat only bird meat or products that have been cooked.
  • Do not eat dishes containing uncooked (raw) or undercooked bird meat or products (such as eggs and poultry blood).
  • Wash your hands with soap and warm water before and after handling raw meat and eggs.
  • Keep raw meat and its juices away from other foods to prevent spreading any germs.
  • Use soap and hot water to wash cutting boards and other kitchen tools that have touched raw meat.
  • If bird meat and eggs are contaminated with the virus, safe cooking will kill it.
    • Use a food thermometer to make sure you cook meat to a temperature of at least 165˚F (74˚C).
    • Cook eggs until whites and yolks are firm.
  • Use these websites for more information about food preparation safety:
    • The U.S. Food and Drug Administration’s [[forward label=([Questions and Answers on Avian Influenza ("Bird Flu") and Food Safety]) link=([http://www.fda.gov/Food/ResourcesForYou/Consumers/ucm085550.htm])]] page.
    • The Partnership for Food Safety Education (PFSE)
    • The Federal Government’s Consumer Advice pages for [[forward label=([Eggs]) link=([http://www.foodsafety.gov/%7Efsg/eggs.html])]] and [[forward label=([Meat & Poultry]) link=([http://www.foodsafety.gov/%7Efsg/meat.html])]].

If you think you might have been in contact with sick or dead birds —

  • Monitor your health closely for 7 days after your possible contact with birds infected with H5N1.
  • If you become ill with a fever, cough, sore throat, or have trouble breathing, go to a doctor right away. This is especially important if you think you may have been exposed to birds infected with avian influenza in the past 7 days.
  • Before you visit a health-care setting, tell the doctor the following:
    1. your symptoms,
    2. 2) where you traveled, and
    3. 3) if you have had direct contact with poultry or close contact with a very sick person.
  • The U.S. embassy or consulate can provide names and addresses of local doctors. To contact the U.S. Embassy or consulate in the country where you are visiting, call Overseas Citizens Services at:
    • 1-888-407-4747 if calling from the U.S. or Canada,
    • 00 1 202-501-4444 if calling from overseas, or
    • Find your local US Embassy at [[forward label=([Websites of U.S. Embassies, Consulates, and Diplomatic Missions]) link=([http://www.usembassy.gov/])]].
  • Do not travel when you are sick, unless you are traveling locally for medical care.
  • Limit contact with others as much as possible. This can help prevent the spread of an infectious illness.
  • See Seeking Health Care Abroad in CDC Health Information for International Travel 2008 for more information about what to do if you become sick while abroad.

Concerns about an Influenza Pandemic

All influenza (or flu) viruses can change, and experts are concerned that the H5N1 virus could change and begin to spread easily from one person to another person (known as “sustained human-to-human transmission”). If this were to happen, an influenza pandemic (worldwide outbreak of disease) could begin. Because no sustained human-to-human transmission of H5N1 virus has been reported anywhere in the world, WHO reports that the current worldwide pandemic alert is in [[forward label=([Phase 3]) link=([http://www.who.int/csr/disease/avian_influenza/phase/en/index.html])]]. CDC remains in close communication with WHO and continues to monitor the H5N1 virus situation in countries reporting bird outbreaks and human cases.

In the event of a pandemic, the U.S. Department of State will be able to provide oseltamivir (Tamiflu) only for U.S. government employees and their families serving abroad. The U.S. Department of State does not have the legal authority to provide private American citizens living or traveling abroad with antiviral medications, even during a pandemic. If you are a private U.S. citizen living outside the United States, talk to your doctor about what medications to have on hand in case a pandemic occurs. For more information, please visit [[forward label=([http://www.travel.state.gov]) link=([http://www.travel.state.gov])]].

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

Additional Information

For more information, please see the Questions and Answers About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus page.

For more information about influenza, see the Influenza chapter in CDC Health Information for International Travel 2010.

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 [[forward label=([Avian Influenza Low Pathogenic H5N1 vs. Highly Pathogenic H5N1 Latest Update]) link=([http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?navid=SEARCH$q=Avian+Influenza+Low+Pathogenic+H5N1+vs.+Highly+Pathogenic+H5N1$site=usda$Go_button.x=9$Go_button.y=9])]].

For additional guidance on handling dead birds, see the CDC’s Interim Guidance for States Conducting Avian Mortality Surveillance for West Nile Virus (WNV) and/or Highly Pathogenic H5N1 Avian Influenza Virus. [[image id=362 template=6]] (39 KB, 3 pages)

 
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