4 July 2006

Avian influenza - Advice for travellers to affected areas

Travellers to countries reporting animal and/or human cases of avian influenza (A/H5N1) are advised to check the NaTHNaC clinical updates for specific advice (see ‘Important Links’ below).

Currently there are no travel restrictions to countries reporting avian influenza. For country-specific travel and safety information, travellers should consult the Foreign and Commonwealth Office website. All travellers should have adequate travel health insurance.

During Travel

The risk of avian influenza to travellers is very low. Only rare cases of human infection with avian influenza have occurred, and there has been no sustained human to human transmission.

Previously recommended advice should continue to be exercised by those who are travelling to these regions:

• Avoid visiting live animal markets and poultry farms
• Avoid contact with surfaces contaminated with animal faeces
• Do not eat or handle undercooked or raw poultry, egg or duck dishes
• Do not attempt to bring any live poultry products back to the UK
• Do not pick up or touch dead or dying birds
• Exercise good personal hygiene with frequent hand washing

Advice for travellers to affected zones in EU countries where wild or domestic birds or animals have been found to be infected with H5N1 [1]

In countries where small numbers of wild birds have been confirmed to have H5N1 infection, special veterinary emergency rules will apply, usually within 3km or 10km protection zones.  People travelling to these zones should follow the general advice for avoiding contact with dead or diseased birds and poultry and also comply with any local hygiene enforcement restrictions and regulations for the period they are imposed.  These special veterinary measures are generally relaxed when control and prevention measures have been successfully applied in the area.

The European Centre for Disease Prevention and Control (ECDC) has recently reviewed the risk from swimming in water in Europe that is potentially contaminated by H5N1 [2]. They have concluded that there is “no additional risk to human health from the occasional presence of H5N1 in the environment [water] from wild birds. This is because of the poor adaptation of the virus to humans and the dilution effects in large bodies of water.” In addition, the decline in outbreaks of avian influenza in Europe makes it less likely that H5N1 will be in the water.

Osteltamivir (Tamiflu®)

It is not recommended that travellers take with them the neuraminidase inhibitor, oseltamivir (Tamiflu®) for either prevention or self-treatment of avian influenza. There are several reasons for this recommendation:

• There have been no cases of avian influenza in travellers, and no efficient transmission of infection from person to person. The risk to travellers from avian influenza remains very low.
• It is not UK health policy to recommend personal stockpiles of oseltamivir for travel or other use.
• High demand for oseltamivir by travellers could jeopardise current UK efforts to develop stores of the drug to be used as part of an overall plan of protecting UK residents in the event of an influenza pandemic. It could also jeopardise supplies needed by high-risk persons for normal seasonal influenza.
• It would be difficult for travellers to know the correct timing for initiating the drug, i.e. what constitutes a self-diagnosed case of avian influenza.
• Oseltamivir is a prescription only medicine intended for use under qualified medical supervision.

After Travel

If you become ill with fever and either cough or difficulty breathing within 14 days of your return to the UK, please consult your normal health care provider or call NHS Direct on 0845 46 47. Make sure you mention all your travel details.

References

1. Health Protection Agency. Avian influenza travel advice. 7 April 2006. [cited 7 April 2006] Available at http://www.hpa.org.uk/web/HPAweb&HPAweb

Standard/HPAweb_C/1195733851442

2. European Centre for Disease Prevention and Control. Avian influenza A/H5N1 in bathing and potable (drinking) water and risks to human health, version June 2006. [cited 30 June 2006] Available online at http://www.eurosurveillance.org/ew/ 2006/060608.asp#4

 

Additional Reading

Beigel JH, Farrar J, Han AM, et al. Avian influenza A (H5N1) infection in humans. N Engl J Med 2005;353:1374-85.

Moscona A. Neuraminidase inhibitors for influenza. N Engl J Med 2005;353:1363-73.

World Health Organization.  Epidemiology of WHO-confirmed human cases of avian influenza A(H5N1) infection.  Wkly Epidemiol Rec  2006;81:249-57.

Important Links

NaTHNaC clinical updates on avian influenza: www.NaTHNaC.org/pro/clinical_updates/

avian_influenza_index.htm

World Health Organization advice on avian influenza: www.who.int/csr/disease/avian_influenza/en/

Health Protection Agency frequently asked questions for those travelling to H5N1 infected areas

http://www.hpa.org.uk/webw/HPAweb&Page&HPAweb

AutoListName/Page/1202115534210?p=1202115534210

Algorithm for the management of returning travellers from countries affected by avian influenza presenting with febrile respiratory illness: recognition, investigation and initial management

Up to date information on the status of avian influenza in birds is available from the World Organisation for Animal Health at www.oie.int/eng/en_index.htm

Animal Health and Welfare page of the Department for Environment, Food and Rural Affairs (DEFRA) at www.defra.gov.uk/animalh/diseases/notifiable/disease/ai/

index.htm.

Information on the Department of Health Pandemic Influenza Plan: www.dh.gov.uk/PolicyAndGuidance/EmergencyPlanning/

PandemicFlu/fs/en