Advice for Travelers: Precautions for Travel to Countries Reporting H5N1
Archive version: this notice no longer active
(Originally released February 6, 2004 and updated March 22, 2004)

The Centers for Disease Control and Prevention (CDC) within the Department of Health and Human Services has issued precautions for travel to countries that are reporting outbreaks of avian influenza A(H5N1), also known as H5N1, in humans and animals. The purpose of these precautions is to provide information for travelers on the status of H5N1 outbreaks, including where outbreaks are occurring, measures to take before travel, precautions to follow while abroad, and what to do if illness occurs during or after travel. Currently, CDC does not recommend that the general public avoid travel to any of the countries affected by H5N1.

In addition to animal cases, Vietnam and the Ministry of Health of Thailand have reported human cases of avian influenza A(H5N1). This website contains recent data on confirmed cases http://www.who.int/csr/disease/avian_influenza/country/en/.

Currently no definitive evidence has been found of human-to-human transmission; no H5N1 infections have been documented among health-care workers. While it is unusual for people to get influenza infections directly from animals, such transmission has been documented several times in recent years. The source of exposure in human cases of H5N1 influenza is under investigation although most human cases have been linked to direct contact with diseased birds.

Outbreaks of H5N1 infection have been detected in the poultry populations of Cambodia, China, Indonesia, Japan, South Korea, Laos, Thailand, and Vietnam and a single peregrine falcon in Hong Kong. On February 4, 2004, CDC issued an order for an immediate ban on the import of all birds (Class: Aves) from specified areas in Southeast Asia affected by the outbreak. On March 10, 2004, CDC, in coordination with the U.S. Department of Agriculture lifted the embargo of birds and bird products from Hong Kong. Visit the World Organization for Animal Health website at http://www.oie.int and CDC Influenza Branch website http://www.cdc.gov/flu/avian/outbreaks/embargo.htm for more information.

The co-circulation of human and highly pathogenic animal influenza viruses is of serious concern to the World Health Organization (WHO), CDC, and other health authorities worldwide, since an exchange of genes between the two viruses might occur if individuals were co-infected with both human and avian influenza viruses. This gene exchange could give rise to a new influenza virus to which humans would have little or no immunity and which could be transmitted from person to person.

CDC has issued the following recommendations for travel to countries reporting human or animal cases of H5N1:

Before you leave:

• Assemble a travel health kit containing basic first aid and medical supplies. Be sure to include a thermometer and alcohol-based hand sanitizer for hand hygiene.
• Educate yourself and others who may be traveling with you about influenza. Information about influenza is provided on CDC's influenza website: http://www.cdc.gov/flu/.
• Be sure you are up to date with all your vaccinations, and see your health-care provider at least 4–6 weeks before travel to get any additional medication or information you may need. CDC’s health recommendations for international travel are provided on CDC's Travelers’ Health website: http://www.cdc.gov/travel/.
• You may wish to check your health insurance plan or get additional insurance that covers medical evacuation in the event of illness. Information about medical evacuation services is provided on the U.S. Department of State website: http://www.travel.state.gov/medical.html.
• Identify in-country health-care resources in advance of your trip.

While you are in an area where avian influenza cases have been reported:

• At this time, CDC recommends that travelers to countries experiencing outbreaks of this disease in poultry should avoid areas with live poultry, such as live animal markets and poultry farms. Large amounts of the virus are known to be excreted in the droppings from infected birds.
• As with other infectious illnesses, one of the most important and appropriate preventive practices is careful and frequent hand hygiene. Cleaning your hands often using either soap and water or waterless alcohol-based hand sanitizers removes potentially infectious materials from your skin and helps prevent disease transmission.
• Influenza viruses are destroyed by heat; therefore, as a precaution, all foods from poultry, including eggs, should be thoroughly cooked.
• If you develop respiratory symptoms or any illness that requires prompt medical attention, a U.S. consular officer can assist in locating appropriate medical services and informing family or friends. See this website 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 further travel until you are free of symptoms.

Follow basic health habits outlined on this website to protect against flu:

http://www.cdc.gov/flu/protect/preventing.htm

After your return:

• Monitor your health for 10 days.
• If you become ill with fever or respiratory symptoms during this 10-day period, consult a health-care provider. Before your visit to a health-care setting, tell the provider about your symptoms and recent travel so that he or she can be aware you have traveled to an area reporting avian influenza.
• Information for health care providers wishing to test for or report cases of H5N1 and SARS can be found at this website http://www.cdc.gov/flu/han020302.htm.

For more information about current avian influenza outbreaks, see http://www.who.int/csr/don/en/ and http://www.cdc.gov/flu/avian/index.htm.

For information about previous avian influenza outbreaks, see http://www.cdc.gov/flu/about/avianflu.htm.

For information on influenza, see http://www.cdc.gov/flu/.