Medical health officer update – December 2024

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December 02, 2024

Please read for important information regarding avian influenza.

Fraser Health in British Columbia is currently experiencing another resurgence of Highly Pathogenic Avian Influenza (HPAI) among birds and in the United States, HPAI has been detected in dairy cattle.

The most affected sites are commercial poultry farms in areas around Abbotsford and Chilliwack. However, all commercial poultry farms and all backyard bird flocks are susceptible to this virus. To date, there have been no documented cases of HPAI in Canadian dairy cattle.

What is the human health risk

HPAI is a type of Influenza A. It causes bird flu but can also spread to humans and other mammals. The currently circulating strain in North America is H5N1. Increased HPAI activity among birds and mammals increases the potential for human exposure.

An individual in British Columbia has tested positive for avian influenza. This is the first detection of avian influenza due to the H5 virus in a person in B.C. No further cases have been identified at this time. A joint investigation was undertaken by experts from public health, animal health and environmental health to identify the source of exposure. For the most recent update on human Avian Influenza case in Fraser Health, please refer to the update from the Provincial Health Officer.

Who is at increased risk for HPAI?

  1. Commercial Poultry or Cattle Farm workers: Individuals with insufficient Personal Protective Equipment (PPE) and very close exposure to a flock, herd or group of sick or dead animals infected with HPAI may be at risk of infection (e.g., farm family member or worker who handled sick animals).
  2. Animal Handling and Disposal workers: People involved in handling sick animals or exposed to affected environments (including animal disposal) as part of outbreak control efforts (e.g., cullers) without consistent use of PPE. Avian influenza can spread through contact with the feces or saliva of infected animals, or the infected animals themselves.
  3. Hobby Farms/Petting Zoos workers and visitors: Workers and visitors at hobby farms or petting zoos could be at risk of infection if they come in contact with sick livestock (or feces/saliva of the same).
  4. Household or Family Contacts: Close contacts of a confirmed human HPAI patient may rarely acquire infection during the expected period of communicability, particularly if the patient is quite sick. However, human to human transmission of Avian Influenza remains rare.

What are signs and symptoms of human HPAI infection?

Symptoms may range from no symptoms or mild illness to severe influenza-like illness and can be non-specific. Common signs and symptoms include:

  • Fever or feverishness, malaise, fatigue, myalgia, arthralgia.
  • Cough, rhinorrhea, headache, sore throat.
  • Conjunctivitis symptoms including redness to sclera, eyelid/conjunctival inflammation, excessive tearing, pruritus, eye pain/burning, discharge, photosensitivity.
  • Gastrointestinal symptoms including abdominal pain, nausea, diarrhea, vomiting.
  • Respiratory complications including shortness of breath, chest pain, pneumonia, respiratory failure and death.

How to test for HPAI?

  • Clinicians should have a low threshold for HPAI virus testing of individuals with clinically compatible symptoms (see above) who report sick bird, cattle or other exposures of concern within the ten days prior to onset.
  • Nasopharyngeal (NP) and throat swab should be collected as close to the onset of illness as possible. For both NP and throat swabs, a red-top swab in Universal Transport Media is required.
  • If conjunctivitis is present in the patient, consider obtaining conjunctival swab as well. Please use blue-top swab with Universal Transport Media for eye swabs.
  • When testing is indicated it should be done preferably within five days of symptom onset. However, clinicians should have a low threshold for testing beyond this period as detection can occur up to three weeks, particularly in children and immunocompromised individuals.
  • The BCCDC PHL eLab Handbook provides testing information, including ordering procedures, process information, specimen collection instructions and handling and transport instructions.
  • The BCCDC Public Health Lab Virology requisition has a specific checkbox for Avian Influenza Testing.
  • When testing, please specify exposure source to avian influenza virus. The BCCDC Medical Microbiologist on-call should be notified of the case and testing request at 604-661-7033.
  • Samples can be tested for influenza A at the local hospital lab or PHL.

What constitutes an exposure to HPAI?

Close exposure to birds, cattle, other animals or humans with confirmed HPAI virus infection. Exposures include, but are not limited to:

  • Being in the same close airspace, touching or handling infected animals.
  • Consuming under - or uncooked poultry or egg products from an affected farm.
  • Direct contact with contaminated surfaces.
  • Being exposed to manure or litter containing high concentration of virus or being in a contaminated air space or environment.
  • Visiting a live poultry market with confirmed bird infections or associated with a case of human infection.
  • Consumption of or exposure to unpasteurized milk from a farm with confirmed infections.

What PPE is required in health care setting for HPAI?

During assessment, testing and care or procedures, clinicians should implement appropriate protective measures. In addition to routine practices, patients under investigation and patients with probable or confirmed avian influenza should be placed on airborne, droplet, and contact precautions. Refer to the PICNET guidance for more information.

What does Fraser Health Public Health do to manage HPAI?

  • Fraser Health Communicable Diseases teams follows up with commercial livestock operations that the Canadian Food Inspections Agency (CFIA) identifies as affected by HPAI. All the individuals identified by the poultry farm owners as working on the farm are contacted, their personal risks assessed, and post-exposure prophylaxis offered when indicated.
  • We also follow individuals who have backyard flocks affected by HPAI or are otherwise identified as exposed to infected birds or wildlife.
  • When there is a suspect, probable, or confirmed human case, we also follow with the case and contacts as per BCCDC guidelines.

How to reduce the risk of HPAI for humans?

  1. Influenza vaccine: Getting the seasonal influenza vaccine reduces the risk of coinfections and genetic re-assortment. It is strongly recommended for people working with live poultry.
  2. Treatment: If avian influenza infection is suspected, antiviral treatment with Oseltamivir should be provided without delay. Waiting for lab confirmation is not recommended.
  3. Post-exposure Prophylaxis: Fraser Health Communicable Diseases team and the Medical Health Officers are available for consultation to clinicians for individuals under consideration for post-exposure prophylaxis for Avian Influenza.
  4. Biosecurity: Poultry farmers and workers should follow strict Biosecurity Standards when working with live poultry. This i) minimizes exposures to potentially infected animals, ii) mitigates the risk of acquiring infection, and iii) helps monitor to ensure timely identification of human cases.
  5. Practice food safety: while there are no documented cases of humans contracting avian influenza from pasteurized milk, cooked meat, or cooked egg products, it is not advised to consume unpasteurized milk. Pasteurization kills potentially harmful bacteria and viruses (including avian influenza). Follow good hand hygiene practices, including after touching uncooked poultry.
  6. Always avoid touching sick or dead animals, including birds.

Can pets get HPAI?

Pet owners should monitor their pets closely to ensure they do not come into contact with sick or dead birds and animals. They should not be fed any raw meat or other products from game birds, poultry, or other animals infected with avian influenza.

If pets develop signs of illness after exposure to sick or dead animals, owners should consult with their veterinarian. For more information on precautions for pets see the CFIA's guidance on pets and avian flu.

Resources for more information:


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