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Avian Influenza ("Bird Flu")
Avian influenza (sometimes called "bird flu") refers to influenza A viruses found in wild and domestic birds. Birds transmit the viruses to other birds via infected respiratory secretions and droppings. Avian influenza strains are divided into to two categories based on virus properties and the severity of disease seen in infected birds:

Low Pathogenic Avian Influenza (LPAI) infection in birds causes no or mild disease. Indicators of LPAI in a flock include ruffled feathers and a decrease in egg production. Because the symptoms are mild, LPAI in a flock may not be detected. An example of a well-known LPAI is influenza A H7N9 identified in flocks in China.

High Pathogenic Avian Influenza (HPAI) infection in birds can cause severe disease that is often fatal, especially in poultry populations (chickens, turkeys, phesants). The disease is often identified when disease or deaths in a flock or bird population prompts testing. The most well-known HPAI strain is influenza A H5N1 that has been seen in flocks in Asia and Europe. Of note, the H5N1 virus recently identified in birds in the United States is different than the Asian H5N1 virus that has been identified in birds and, rarely, humans in contact with birds for the last decade in Asia, Europe, and Africa.

Both LPAI and HPAI strains have been identified in birds throughout the world.

Avian Influenza in People

Rarely, influenza in birds can be transmitted to humans. Both LPAI and HPAI strains have been identified in humans. The vast majority of people that have been found with to be sick with an avian influenza virus have close contact with infected birds. Avian influenza viruses do not transmit readily from person to person. Only a small handful of person to person avian influenza transmissions have ever been identified in people with extremely close contact with another case. However, epidemiologists around the world keep close watch on these infections in case an avian influenza virus mutates and develops the ability to transmit readily between human hosts. People have little or no immunity against the influenza viruses that circulate among birds, so avian influenza that can be transmitted readily from person to person could potentially cause an influenza pandemic.

High Pathogenic H5 Avian Influenza in the United States

Recently, several high pathogenic influenza A H5 strains have been identified in birds in the United States, including in Minnesota and South Dakota. These identifications followed an increase in testing after HPAI A H5N2 was identified in chickens and turkeys on a poultry farm in British Columbia, Canada.

On April 9th, the North Dakota Board of Animal Health announced samples from a commercial turkey flock in Dickey County had perliminarily tested positive for avian influenza A H5. HPIA A H5N2 was then confirmed. A Second outbreank in commerical turkeys was confirmed on April 24th. No elevated human health risk for the general population associated with these birds has been identified. Transmission of avian influenza to humans is not common, and H5N2 avian influenza transmitting to a human has never been documented. It is possible a very small number of sporadic cases in people who have had direct contact with sick birds associated with this or other avian influenza outbreaks happening in the United States may be identified. Because of this, health care providers are advised to look out for avian influenza infection in humans who are in contact with sick birds (see recommendation below). However, it is important that the public understands that this recommendation is designed to identify a very low probability scenario.

Background: In December of 2014 the state of Washington reported identifying HPAI A H5N8 in a grayfalcon that had died after eating a wild duck. This was followed by several additional identifications of HPAI in the western United States: H5N2, H5N1, and more H5N8 have been identified in states that include California, Idaho, Oregon, Utah, Nevada and Washington. All of these states that can be found within the Pacific Flyway, a path followed by migratory birds. In late February, a large die-off of turkeys on a turkey farm in Pope County, Minnesota promted testing. It was determined that the birds were infected with H5N2. This is the first recent HPAI to be identified in the Mississippi Flyway, a migratory flyway that does include airspace over parts of North Dakota. Soon after, Missouri and Arkansas also annouced H5N2 had been identified at Turkey farms in their states. In mid March, Kansas became the first state in the Central Flyway to report avian influenza, this time in a backyard flock of chickens and ducks. Soon after, Wyoming reported its first Central Flyway case, this time finding H5N2 in a wild goose. This was followed by H5N2 identifications in South Dakota (commercial turkey farm), Montana (backyard flock), North Dakota (commercial turkey farm), Wisconsin (commercial turkey farm, backyard flock, wild bird), Iowa (commercial chicken farms), Kentucky (wild bird) and Nebraska (commercial egg laying opperation). Indiana announced in May that they had identified H5N8 in a backyard block. This is the first identification of H5N8 outside the west coast.

Recommendation for Health Care Providers: Recommendations for North Dakota Providers are outlined here. Currently, the Centers for Disease Control and Prevention (CDC) recommends that avian influenza be considered by health care professionals as a possible diagnosis in people with influenza-like illness (ILI) that have had recent contact with sick or dead birds, especially in areas where the virus has been identified. The North Dakota Public Health Laboratory can test for avian influenza. Rapid and commercial influenza tests (including RT-PCR) may not be able to identify influenza in people infected with influenza A H5 viruses. For this reason, these tests should not be relied to preliminarily identify avian influenza strains in people. Additionally, people who have been exposed to birds that have tested positive for avian influenza A H5 virus should be monitored for ILI for 10 days. Influenza antiviral prophylaxis should be also be considered for people with an identified exposure. Please contact that North Dakota department of health for dosing information. Extensive CDC guidance on identification and testing for avian influenza for public health and health care professionals can be found here. Possible infection with an avian influenza virus is immediately reportable via phone call to the North Dakota Department of Health Division of Disease control (701-328-2378)

Avian Influenza Resources
red bullet Avian Influenza Guidance Sheet for Clinicians
red bullet H7N9 Web Page
red bullet NDDoH Avian Flu Factsheet ((pdf)
red bullet CDC Avian Influenza
red bullet ND G&F Avian Influenza Brochure (pdf)
red bullet ND Board of Animal Health Avian Influenza Information
red bullet NDND Board of Animal Health Standard Poultry Biosecurity Plan
red bullet North America Waterfowl Flyways(image)
red bullet US Department of Agriculture - APHIS Avian Influenza Brochure(pdf)
red bullet US Fish and Wildlife Services
red bullet NDSU Veterinary Diagnostic Laboratory
red bullet Pandemic Flu