Avian influenza A(H5N1): Prevention and risks

Where avian influenza A(H5N1) is found

The avian influenza A(H5N1) virus is commonly found in birds in several countries in Africa and Asia, and more recently has spread to Europe, North America (Canada, the United States, and Mexico) and parts of Central and South America.

Wild birds in Canada and throughout the world are natural carriers of avian influenza viruses. Although some wild birds may get sick and die, others can be infected and still appear healthy. All bird species are thought to be susceptible to infection, however domestic poultry, such as chickens and turkeys, are more likely to become severely ill and die.

While avian influenza is primarily a disease of birds, it can also infect mammals, especially those who hunt, scavenge or otherwise consume infected birds. Foxes, skunks, mink, bears, cats, otters, and marine mammals are some animals that have been infected.

How avian influenza A(H5N1) spreads

Birds spread avian influenza viruses through their feces and secretions (mucus, saliva). Human infections can happen when the virus gets into a person's mouth, nose or eyes, or is inhaled. This can happen when the virus is in the air in droplets, or possibly through dust or feathers, and a person breathes it in. It can also happen when a person touches something that has virus on it and then touches their mouth, nose or eyes.

Human infections with avian influenza viruses have occurred most often after close contact with infected birds or highly contaminated environments, such as poultry farms or live bird markets.

Although the virus spreads easily between birds, it is not well adapted to mammals, including humans. There have been some reports of possible limited human-to-human transmission in other parts of the world, but there has been no evidence of ongoing transmission between people.

You cannot get infected with avian influenza virus by eating thoroughly cooked poultry and eggs.

Preventing avian influenza A(H5N1) infections

Minimizing contact with secretions (mucus, saliva), blood, or feces from infected birds and mammals is key to preventing avian influenza A(H5N1) infections.

The risk of infection is low for the general public, however basic precautions are always recommended to prevent transmission of zoonotic diseases (diseases that transmit from animals to people), including avian influenza:

Keep a distance from wild birds and other wild animals, and don't touch, feed, or handle them
If contact is unavoidable, wear gloves or use a doubled plastic bag and avoid contact with blood, body fluids and feces. Remove gloves if worn, and wash your hands thoroughly with soap and water. If soap and water aren't available, use a hand sanitizer containing at least 60% alcohol
Always wash your hands after being in an area where birds and other wildlife are living or nesting, such as in parks or zoos

Children should be monitored to ensure proper handwashing
Pets should be kept away from birds and wildlife and their feces

People who have close contact with poultry, wild birds, or other wildlife that are suspected or confirmed to be infected with avian influenza A(H5N1) should take additional precautions during handling or when working in heavily contaminated environments:

Wear masks and eye protection to protect your eyes, nose and mouth from contaminated dust, feathers, secretions and feces
Wear other protective clothing, such as gloves, boots and coveralls
Prior to cleaning up contaminated areas, mist dry areas with low pressure water to prevent fecal matter, dust and feathers from being stirred up into the air
Change clothing and footwear, and wash hands thoroughly with soap and water before moving onto other activities
Follow any additional occupational health guidelines, as directed by your occupational health provider

There is no evidence to suggest that fully cooked wild game meat, organs or wild bird eggs are a source of avian influenza infection for people. However, because exposure to avian influenza can occur when handling wild birds and some wild mammals, it is recommended that hunters and trappers take precautions when de-feathering, cleaning and preparing wild game, along with following other safe food handling procedures.

Thoroughly cooking meat, organs and eggs harvested from wildlife will kill the avian influenza virus and other potential pathogens, such as Salmonella.

The annual seasonal influenza vaccine ("flu shot") does not provide protection against avian influenza. However, if you are involved in the food production system or agricultural settings, getting a seasonal flu shot each year can help reduce the spread of human influenza viruses between people and between people and animals.

Risks of getting avian influenza A(H5N1)

The risk of infection is low for the general public who has limited contact with infected animals; those with close contact to infected animals are at increased risk, and should take appropriate precautions.

Human infection with avian influenza A(H5N1) is rare.

Since 1997, there have been over 800 human cases of avian influenza A(H5N1) reported worldwide, mostly occurring in Africa and Asia. The number of human cases has decreased substantially since 2015. This decrease may be attributed to the use of poultry vaccinations, prevention and control initiatives, and potentially changes in the virus.

The predominant avian influenza A(H5N1) viruses now circulating globally among birds are different from earlier A(H5N1) viruses. Avian influenza viruses continually change, which can affect how easily the virus spreads from birds to other animals, including humans, and also how severe illness is.

While historically, the risk of infection was highest for those travelling to areas in Asia and Africa, avian influenza A(H5N1) has recently spread throughout Europe and North America and has been detected in parts of Central and South America. In 2022, the virus became widespread across Canada through the migration of wild birds, and has affected many poultry farms and many different species of wild birds and other wildlife.

Few human cases associated with the 2021-2023 avian influenza A(H5N1) outbreak have been detected. The number of A(H5N1) human cases reported worldwide is tracked and reported in the Human Emerging Respiratory Pathogen Bulletin.

There has only been one human case of A(H5N1) ever reported in Canada. A Canadian resident died of avian influenza A(H5N1) in early 2014 after returning from a trip to China, where they were likely infected.

Avian influenza is not a food safety concern. There is no evidence that eating fully cooked commercial poultry or eggs could transmit avian influenza to humans.

Safe food handling practices such as handwashing and keeping poultry, meat, eggs and egg products separate from other food products to avoid cross contamination should be followed

Who is most at risk

Some examples of activities that may increase your risk of exposure and infection include:

Working with infected poultry (e.g., chickens, turkeys, ducks) such as on a commercial poultry farm or with small/backyard flocks
Hunting, de-feathering, field dressing and butchering infected wild birds and wild mammals
Working with wild birds for activities such as research, conservation, or rehabilitation
Working with wild mammals, especially those that commonly eat wild birds (e.g., foxes, skunks, mink, some marine mammals)
Visiting live bird markets

What to do if you have been exposed

Early recognition of exposure to an animal infected with avian influenza and initiation of treatment, if deemed necessary, are important steps to provide protection against infection.

Antiviral medications may be considered after exposure to animals infected with avian influenza, as antivirals may help prevent infection or reduce symptoms often associated with an infection. Speak with your health care provider or local public health authority for assessment of your exposure risk, instructions to follow, and further information about antiviral treatment options.

Recommendations for travellers

Avian influenza A(H5N1) is a concern in many countries, including Canada. If you plan to travel to another country where avian influenza A(H5N1) is a concern, see your health care provider or visit a travel health clinic at least 6 weeks before you leave.

When travelling to an affected area:

Avoid high-risk areas (such as poultry farms and live animal markets)
Avoid close contact with birds and wild mammals, including:

chickens
ducks and other waterfowl
wild birds
wild mammals that commonly ingest wild birds (e.g. foxes, skunks, mink, some marine mammals)

Avoid surfaces that may have animal droppings or secretions on them
Make sure that all foods made with poultry, game meat and eggs, are cooked well
Wash your hands immediately after touching potentially contaminated environments and/or animals:

use soap and water for at least 20 seconds
if soap and water aren't available, use an alcohol-based hand sanitizer with at least 60% alcohol content

If you develop flu-like symptoms after travelling or living in an area where avian influenza is a concern:

Upon arrival in Canada, tell a border services officer
Contact a health care professional immediately and tell them about your symptoms and where you have been travelling or living, and follow their instructions

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