Avian influenza surveillance in hospitalized patients
Highly pathogenic avian influenza (HPAI) H5N1 continues to circulate in Canada and internationally among wild and domestic birds, and there have also been detections in wild and domestic mammals that have had exposure to infected birds, including domestic cats and dogs.
Recently, HPAI has also been detected among livestock, causing illness and decreased milk production in dairy cattle. HPAI has been detected in unpasteurized milk from infected cows, and there has been evidence of transmission of the same virus to an occupationally exposed individual, resulting in mild illness and conjunctivitis.
Currently, the risk to the general population is low, with the greatest risk being occupational exposures to infected poultry, livestock, and other animals. Due to this evolving risk, Dr. Kieran Moore, Chief Medical Officer of Health, announced enhanced surveillance for avian influenza amongst hospitalized patients from April 15 to Sept. 15, 2024. HCPs are asked to maintain a heightened index of suspicion for patients with severe influenza (i.e. hospitalization) as part of the enhanced surveillance. This includes:
- Screening of hospitalized patients:
- obtain a history from individuals with severe influenza/influenza-like symptoms regarding potential exposures to infected birds or mammals, or to contaminated environmental surfaces in the 14 days prior to illness onset.
- This includes occupational/recreational close contact exposure to poultry, wild game, livestock, or other mammals; or consumption of raw/unpasteurized dairy products or undercooked meat from infected cattle.
- If there is a relevant exposure history, notify the hospital IPAC and HPEPH. Hospital IPAC will advise further on IPAC precautions.
- Further information for health professionals is available from the Public Health Agency of Canada.
- Screening of all patients with influenza-like symptoms in the community or emergency department is NOT recommended, as risk to public is low.
- Laboratory surveillance:
- For patients in hospital with influenza A (non-H3/non-H1, if known) should be forwarded to Public health Ontario Lab (PHOL) for sub-typing.
- For more information on laboratory testing, see test information from PHOL.
- Patients without relevant exposure history for HPAI do NOT require additional IPAC measures while this surveillance testing is completed.
- Any ill patient (hospitalized or not) who presents with a history of potential exposure to an infected bird or animal should be reported to HPEPH for further evaluation, and sub-typing if patient is influenza A positive.
Suspected avian flu cases can be reported to HPEPH ICD Intake Line, 613-966-5500, ext. 349.
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