Protective measures and options for public health response for avian influenza

Direct and unprotected exposure to possibly infected poultry or wild birds as well as mammals and their bodily fluids (including faeces and blood) are the most likely source of infection for humans. Wearing personal protective equipment (PPE) is therefore recommended to decrease the individual risk of infection.

In general, sick and dead wild birds or mammals should not be touched without proper precautionary measures such as wearing gloves, at the minimum.

In the EU/EEA, occupationally exposed people involved in control measures during an avian influenza outbreak, such as cullers, farmers and veterinarians with direct contact to infected animals and highly contaminated environments, are considered being at a higher level of risk. They should wear appropriately selected PPE.

Workers in close contact with potentially infected mammals such as minks, foxes or other wildlife (for e.g. at rehabilitation centres or in areas with high level of avian influenza outbreaks in wild birds), and other groups of people such as backyard farmers or wild bird hunters with possible exposure to infected poultry, wild birds or wild mammals (mainly carnivores) should use PPE and be made aware of avian influenza as well as the possible risks associated with direct and unprotected contact.

Recommended personal protective equipment (PPE)

• Well-fitting filtering face piece class-2 mask (FFP2) or respirator (see glossary here about the different mask types);
• Goggles;
• Disposable gloves or thicker rubber gloves that can be disinfected;
• Coverall or full body suit that can be disposed or washed and disinfected;
• Boots that can be cleaned and disinfected according to the national or local guidance.

In addition, other equipment such as an apron can be considered. PPE should be provided in different sizes as appropriate. Respirators have particular limitations for persons with different face shapes or facial hair. If respirators do not fit well, then the use of positive-pressure respirators should be explored. Staff should be trained to don (put on) and doff (put off) the PPE appropriately.

Data show that ocular conjunctival inoculation of seasonal and avian influenza viruses in ferrets can lead to productive and transmissible infection. Viruses can then be shed via direct contact or through aerosol. This underlines the importance of protecting the eyes and using goggles when in contact with infected animals, particularly related to occupational or culling activities where contaminated dust particles could enter the eye.

Please consult the videos on wearing a face mask and  washing of hands.

Protection measures for individuals

If people find multiple birds dead in the environment or close to housing areas with public access, local authorities need to be informed to take appropriate measures and dispose of the carcasses.

Single birds such as sparrows found dead can be removed by individuals who are not formally trained in animal disposal, by taking suitable protective precautions. This can be done without contacting local authorities, unless particular surveillance recommendations are in place.

A plastic bag can be used as a makeshift glove and placed over the dead bird to enclose and pick it up. The bag should be sealed, by which direct contact with the bird is prevented. Disposable gloves should be worn to protect the hands during the procedure. To take off the gloves, they should be turned inside out, to avoid contact with the contaminated surface. Both the gloves and the plastic bag can be placed inside a second bag for removal. Any contact with the contaminated environment or surfaces with bare hands should be avoided. The bag can then be disposed in the regular household waste. Hands should be washed with water and soap after the activity.

Dead birds can also be buried, but this might lead to cross-contamination of the equipment used. The bodies need to be buried deep and not in close proximity to water bodies to avoid scavengers  or contamination of the environment.

Follow-up of exposed people

People exposed to infected birds or mammals need to be followed up to identify whether they develop infection, and also to detect at the earliest possible stage if there is any evidence that transmission can occur between humans.

Therefore, workers who are occupationally exposed to infected animals, particularly during outbreaks (in poultry, mink or other animal farms), should be specifically monitored.

Active (e.g. through daily or frequent contact by health authorities to check for possible onset of symptoms) or passive (e.g. through daily self-assessment and reporting of health status) medical follow-up of exposed individuals should be in place for 10–14 days.

If people develop symptoms (e.g. fever, conjunctivitis, diarrhoea, respiratory, neurological, or other atypical symptoms), immediate testing should be performed. People should isolate at home if the symptoms do not require hospitalisation.

Contacts of confirmed cases also need to be tested and monitored to rule out further spread.

All exposed people should inform and consult a medical practitioner and subsequently get tested for avian influenza virus if they develop symptoms after exposure to potentially infected sick or dead animals.

Confirmed human cases should be isolated to prevent further transmission. ECDC has published a guidance on ‘Infection prevention and control practices in relation to respiratory virus infections in healthcare settings’, including high-threat pathogens.

Another guidance published by ECDC – ‘Guidance for wearing and removing personal protective equipment in healthcare settings for the care of patients with suspected or confirmed COVID-19’ – is also relevant for high-threat pathogens like avian influenza in humans.

Information about human exposure to infected birds, involvement in outbreaks, and suspected or confirmed human infection should also be shared with local occupational safety and health authorities.