Protection of individuals with high poultry contact in areas affected by avian influenza H5N1: Consolidation of pre-existing guidance

February 2008

This document consolidates pre-existing WHO guidance on protection of individuals engaged in activities involving high contact with poultry or wild birds confirmed or highly suspected of being infected with avian influenza H5N1 virus. High-contact activities include handling, collecting, transporting, culling, and disposal of birds, and cleaning/disinfection of contaminated areas.

All individuals involved in these activities should:

1. be registered with the animal health authority (or by the public health authority in collaboration with the animal health authority).
2. wear appropriate personal protective equipment (PPE) including protective clothing, heavy gloves and boots, goggles, and masks, and receive adequate training on putting on, taking off, and hygienic disposal/disinfection of PPE.
3. maintain diligence in personal hygiene, including frequent hand washing.
4. receive adequate instruction on disinfection/disposal of potentially contaminated personal clothing and other personal articles.
5. be monitored twice daily for fever (>38°C) and influenza-like illness (ILI)1 for 7 days after the last day of contact with poultry/contaminated environments. Any person experiencing fever or ILI should immediately report to health authorities for diagnostic testing and appropriate treatment 2 .

In case of a breach of PPE or in situations where full and appropriate personal protection was impossible, individuals might consider:

6. commencing a course of prophylactic oseltamivir (75mg once per day) on the date of first exposure, to be terminated 7-10 days after the last exposure. In this case, ongoing monitoring should include monitoring for adverse effects of chemoprophylaxis.

When possible, vaccination with seasonal influenza vaccine should be considered.

NOTE: such vaccination is not intended to protect against infection with avian H5 virus, but only to minimize other ILIs in exposed persons and facilitate identification of possible H5 infections.

Original recommendations with additional details can be found in:

WHO interim recommendations for the protection of persons involved in the mass slaughter of animals potentially infected with highly pathogenic avian influenza viruses,
26 January 2004,
WHO Western Pacific Region

WHO interim guidelines for health monitoring of persons involved in culling of animals potentially infected with highly pathogenic avian influenza viruses,
22 March 2004,
WHO Western Pacific Region

WHO Rapid Advice Guidelines on pharmacological management of humans infected with avian influenza A (H5N1) virus,
May 2006

1 Abrupt onset of fever and upper respiratory symptoms such as sore throat, cough, sneezing, and/or nasal discharge.
2 WHO Clinical management of human infection with avian influenza A (H5N1) virus,
Aug, 2007