High pathogenic avian H5N1 influenza has not been found anywhere in the United States. However, it could be brought here at any time, making our disease tracking systems extremely important.

Infection control for suspect cases

All of the following precautions are necessary when assessing a suspect case of avian H5N1 influenza:

• Standard Precautions
  Always use these basic infection control practices in the care of all patients.
  
• Contact Precautions
  Use these additional precautions including gloves, gowns, and a private room when illness is easily transmitted by direct patient contact or by indirect contact with items in the patient's environment.
  
• Eye protection (i.e., goggles or face shields)
  Wear when within 3 feet of the patient.
  
• Airborne Precautions
  Use fit-tested respirators and airborne isolation rooms to provide protection against airborne transmission of infectious agents.

Isolation and infection control measures should be followed for 14 days following symptom onset.

• Interim Recommendations for Infection Control in Health-Care Facilities Caring for Patients with Known or Suspected Avian Influenza
  CDC guidance for protection of health-care workers involved in the care of patients in the United States with known or suspected avian influenza.

Antivirals

CDC has not issued guidance regarding treatment and prophylaxis of suspect avian influenza A (H5N1) cases and their contacts.

• This H5N1 strain appears to be resistant to amantadine (Symmetrel) and rimantadine (Flumadine).
  
• Zanamivir (Relenza) and oseltamivir (Tamiflu) are thought to be effective against the avian influenza A (H5N1) virus.
  
• Antiviral Agents for Influenza: Background Information for Clinicians
  CDC guidelines for use of antivirals for treating influenza. Does not address treatment of H5N1.
  
• Relenza (zanamivir)
  FDA Center for Drug Evaluation and Research (CDER) drug information page, including labels and review and approval process. 

• Tamiflu(oseltamivir phosphate)
  FDA Center for Drug Evaluation and Research (CDER) drug information page, including package inserts, labels, and MedWatch safety alert.

Prescribing antivirals in case of pandemic

DPH recommends only prescribing antiviral medications to patients who are ill and need them now, instead of encouraging personal stockpiling for pandemic, since:

• There aren’t enough antiviral drugs for everybody.
• Some people won’t need antivirals, and it is difficult to identify in advance those individuals who will need them most.
• To help ensure that antivirals are available for those most in need, public health workers and health care providers must be in a position to manage available supplies of these drugs. That won’t be possible if they are being stockpiled by private individuals.
• Indiscriminate use of antivirals may increase the possibility that the pandemic virus will become resistant to these drugs, potentially making them useless. Some strains of avian flu are already developing resistance to Tamiflu.
• Personal stockpiling may reduce available supplies of antivirals, making it harder to treat “regular” flu in the elderly, and others who face an immediate risk of serious illness and death from complications of the flu.
• The shelf life of Tamiflu is only five years, and no one knows how long it may be before a pandemic occurs.
• At $5 per pill, not everyone will be able to afford a personal stockpile.