GUIDELINES AND RECOMMENDATIONS
Interim Guidance about Avian Influenza for Americans Living Abroad
(Released February 18, 2004)

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Since December 2003, outbreaks of highly pathogenic avian influenza – mostly influenza A (H5N1) – among chickens and ducks have been reported in several countries in Asia. Human cases also have been reported. No evidence for sustained person-to-person transmission of influenza A (H5N1) has been identified; however, influenza A viruses can change rapidly, and therefore the situation in these countries is being monitored carefully. The Centers for Disease Control and Prevention (CDC), the World Health Organization (WHO), and national authorities in Asia are working to assess the outbreak, provide support, and assist with control efforts.

At this time, WHO and CDC do not recommend that the general public avoid travel to countries with reported avian flu cases in birds and humans. CDC will provide updates on its avian flu website (http://www.cdc.gov/flu/avian/index.htm) and Traveler’s Health website (http://www.cdc.gov/travel) as further information becomes available. Information also is available on the WHO website (http://www.who.int/en/).

Background

Avian influenza viruses usually do not infect humans. The ability of avian viruses to spread from person to person appears limited. Rare person-to-person infection was noted in the influenza A (H5N1) outbreak in Hong Kong in 1997 and in the Netherlands in 2003, but these secondary cases did not result in sustained chains of transmission or communitywide outbreaks. These previous experiences with avian influenza viruses suggest that limited person-to-person transmission of the current H5N1 viruses could occur.

Infected birds shed virus in saliva, nasal secretions and feces. Avian influenza viruses spread among susceptible birds when they have contact with contaminated nasal, respiratory, and fecal material from infected birds; however, fecal-to-oral transmission is the most common mode of spread.

All influenza viruses can change, and therefore it is possible that an avian influenza virus could change so that it could infect humans and spread easily from person to person. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population.

Recommendations for Americans Living Abroad

The following recommendations are directed to embassies and Americans living abroad in areas where avian influenza cases have been reported. These recommendations are based on experience to date and may be revised as more information becomes available. Embassies should recommend the following precautions to U.S. expatriates living in an area with avian influenza:

• As with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand washing. Cleaning your hands often using either soap and water or waterless, alcohol-based hand rubs removes potentially infectious materials from your skin and helps prevent disease transmission.
• To minimize the possibility of infection, observe precautions to safeguard your health. This includes avoiding settings where avian influenza is most likely to be transmitted, such as bird markets and poultry yards.
• Influenza viruses are destroyed by adequate heating; therefore, as a precaution, all foods from poultry, including eggs, should be thoroughly cooked.
• CDC does not recommend the routine use of masks or other personal protective equipment while in public areas.

At this time, there is no U.S. Department of State (DOS) travel warning related to influenza. For a list of DOS travel warnings, see the DOS website (http://travel.state.gov/travel_warnings.html).