Influenza is a contagious respiratory disease that can be prevented by immunization. It is caused by a virus that attacks the nose, throat, and lungs. Influenza symptoms come quickly in the form of fever, dry cough, sore throat, headache, extreme tiredness, nasal congestion, and body aches. These symptoms can be severe and put you in bed for a number of days.  Influenza is not the “stomach flu” (diarrhea and vomiting) and is not the same as a bad cold. A cold generally stays up in the head while the flu brings body aches, fever, and extreme fatigue. 

Influenza is a serious disease. People die of the flu every year, and many are hospitalized with serious complications. The very young and very old, plus those with chronic health conditions, are most likely to be hospitalized or die of the flu. 

The first case of flu is often identified in Washington in October or November. Widespread flu activity appears 6-10 weeks after the first case. You need a flu shot each year to get the latest protection. Flu vaccination usually begins in September and October in Washington and continues through March or April. Your flu shot takes 1-2 weeks to take effect. 

 Who should get the seasonal flu vaccine: 

 People who are at high risk of developing serious complications like pneumonia if they get sick with the flu including: 

• People who have certain medical conditions like asthma, diabetes, and chronic lung disease. 
• Pregnant women. 
• People 65 years and older. 

People who live with or care for others who are high risk of developing serious complications including: 

• Household contacts and caregivers of people with certain medical conditions including asthma, diabetes, and chronic lung disease. 

Remember, influenza is a serious disease that causes misery, hospitalizations, and even death each year in the U.S. The flu season in Washington begins in October and often peaks in March or even April. Flu vaccination will protect you for the season, as well as people you come in contact with. Flu shots that aren't used this season are simply wasted since the vaccine has to be reformulated every year to match the circulating strains. Plus, providers with vaccine left over lose money and may not order as many doses next year. 

As last year's shortage showed, our nation's flu vaccine supply system is fragile. It depended on just two major vendors, one of which was not able to deliver vaccine last year. It would help if every eligible person got a flu shot every year. Getting a flu shot every year will not only protect you and the people around you but will also help strengthen the nation's annual flu supply system.

If you are at high risk for complications of the flu, or if you live with and care for someone who is, you are especially encouraged to seek a flu shot. Looking for the Flu Shot? Watch for announcements of flu vaccine offered at your local grocery store or pharmacy. Contact your health care providers or contact your local pharmacy!

What about the nasal vaccine, FluMist? 

FluMist, the intranasal flu vaccine, is a viable option for healthy individuals ages 2 to 49 years old. 

Healthy people ages 2-49 may be eligible for the FluMist nasal influenza vaccine. See FluMistQuadrivalent.com for more information. 

Cover your mouth and nose. Cough or sneeze into your elbow or with a tissue. Dispose of tissue in the nearest waste receptacle. If you cough or sneeze into your hands, you risk the spreading disease when you touch surface that others come in contact with. 

Wash your hands often with soap and water. The key is to wash thoroughly with warm water, and to wash frequently. When hand washing is not possible, use antiseptic hand gels that contain alcohol. 

Stay home if you are sick. If you are sick with flu-like illness, stay home for at least 24 hours after your fever is gone, except to get medical care or other necessities. (Your fever should be gone without the use of a fever-reducing medicine). Keep away from others as much as possible to prevent spreading illness. 

Hand hygiene is a term used to cover both the topic of the traditional hand washing using soap and water, and cleaning hands with alcohol based hand sanitizers.  Proper hand hygiene may eliminate nearly half of all cases of foodborne illness and significantly reduce the spread of the common cold and flu.  Proper hand hygiene (CDC) is especially important in slowing and stopping the spread of disease outbreaks such as pertussis (whooping cough) or if we have a pandemic. 
 
Washing your hands with Soap and Water 
Comprehensive guide to properly washing your hands with soap and water. 

Cleaning your hands with Alcohol Hand Sanitizers 
Information about cleaning your hands with alcohol-based hand sanitizers. 

Cleaning and Sanitizing Surfaces
Information about cleaning surfaces in your home and office. 

Guidelines for Hand Hygiene in Healthcare Settings (CDC) recommendations of the healthcare infection control practices advisory committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task force 

Suds Up Against Germs Infographics: 

• How To Effectively Wash Your Hands 
• Which Soap is Best? - Choosing a Hand Cleaner
• Why You Should Wash Your Hands
• Common Ways Germs Are Spread 
• Suds Up Against Germs
• Suds Up Against Germs
• Suds Up Against Germs
• Sanitize Against Germs 

• Flu Guide for Families (CDC) 
• For School and Child Care (CDC) 
• For Health Care Providers (CDC) 
• For Heath Care Facilities (CDC) 
• For Long Term Care Facilities (CDC) 
• Online Videos about the Flu (CDC) 
• COVID-19, Influenza, RSV Factsheet for Long Term Care Facilities (TC)

Avian influenza is an infection caused by avian (bird) influenza (flu) viruses. These influenza viruses occur naturally among birds. Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them. However, avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Human infections with bird flu viruses have most often occurred after close or lengthy unprotected contact (i.e., not wearing gloves or respiratory protection or eye protection) with infected birds or places that sick birds or their saliva, mucous and feces have touched.

Human infections with bird flu viruses can happen when virus gets into a person’s eyes, nose or mouth, or is inhaled. This can happen when virus is in the air (in droplets or possibly dust) and a person breathes it in, or possibly when a person touches something that has virus on it and then touches their mouth, eyes or nose. The spread of bird flu viruses from one infected person to a close contact is very rare, and when it has happened, it has not led to continued spread among people. Five subtypes of bird flu viruses have infected people to cause respiratory illness (H5, H6, H7, H9, and H10 viruses). Among these, H5N1 and H7N9 viruses have caused the majority of infections in people. More information about bird flu in humans is available at Bird Flu Virus Infections in Humans (CDC).

Poultry Monitoring 

The Washington State Department of Agriculture (WSDA) currently has two programs designed to monitor for bird flu. They are testing samples of fresh eggs grown in the state for antibodies to the virus. They also have a program in conjunction with the Washington Animal Disease Diagnostic Laboratory that tests domestic poultry for bird flu virus. Persons owning poultry that died of an unknown cause can inquire about bird flu testing by calling the WSDA at 360-902-1881 or 360-902-1878.

Wild Bird Monitoring 

Several agencies are conducting surveillance for bird flu among wild birds, especially migratory waterfowl. Surveillance is being strengthened in certain parts of the country such as Alaska because it is believed that migratory birds like ducks and geese could carry bird flu there from Asia and Russia.

What will my symptoms be if I have "Bird Flu"?

The reported symptoms of bird flu in humans have ranged from typical influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), pneumonia, acute respiratory distress, viral pneumonia, and other severe and life-threatening complications.

If I think I have the flu, should I be tested for Bird Flu?

Only if you have a recently returned from travel to an area where bird flu is present. Depending on your symptoms, dates of travel, and activities, additional testing might be recommended. Let your healthcare provider know about your travel history and if you had contact with poultry or bird markets.

I live near a chicken farm or have farmers spreading chicken manure next door, am I safe?

This does not present a risk. At the present time, the H5N1 strain of bird flu that has spread through poultry farms in southeast Asia and into eastern Europe is not present in the U.S. Transmission from birds to people require close contact with birds, such as handling, butchering or exposure to a lot of bird droppings. Animals that die of diseases have to be disposed of properly.

I have a bird feeder and a bird bath in my yard. Is that safe?

Maintaining a clean bird feeder or birdbath is generally safe, unless these are attracting rodents or raccoons. It is always best to wear protective gloves when handling or cleaning these items to avoid contact with bird droppings or contaminated water in a birdbath. Always wash your hands with soap and water after doing these chores.

Is Avian Flu a risk for pet birds kept indoors?

The likelihood of getting a pet bird that is already infected with avian flu is very low. It is illegal in the U.S. to import pet birds from regions that are infected with bird flu. In addition, if you’re concerned and already own a pet bird, keep it inside to avoid exposure to wild or migratory birds. If you are buying a new bird, especially of an exotic variety, be sure it has been legally imported. Smuggled birds from affected areas could possibly be infected with the bird flu virus. Information about federal embargoes on bird importation can be found at information about bird flu (CDC).

Can my other pets get Bird Flu?

There is no evidence that bird flu is a risk to dogs. There is evidence from the Asian outbreak that the bird flu virus might affect cats fed raw poultry, but there is currently no cause for concern because the virus is not present in the U.S.

What do I do if I find a dead bird?

You may dispose of the dead bird by double bagging in plastic bags and discarding in your household garbage. Use gloves or a shovel to avoid touching the bird or any other dead animal with your bare hands.

I have a small flock of chickens in my backyard. Are there any special precautions I should take to keep them from getting bird flu?

You should practice good sanitation and preventive measures, such as reducing exposure to wild birds, to guard against a variety of diseases. Excellent information on “backyard biosecurity for the birds” is available. For more information, see Avian Influenza (Al).  If birds in your flock die unexpectedly, you can report this to the Washington State Department of Agriculture at 360-902-1881 or 360-902-1878; testing for bird flu may be recommended as part of the state’s monitoring program.

Why is it necessary to kill all the birds in an affected flock?

Like all other living things, viruses continue to change and evolve. It is possible that the viruses that cause mild avian influenza could evolve into a more pathogenic form. This is apparently what happened in Pennsylvania in 1983 and 1984, when a low-pathogenic strain turned into a highly pathogenic strain. Flocks are destroyed to prevent the virus from evolving and spreading.

What is done to protect people in the case of an AI outbreak in a flock?

The people involved in destroying flocks wear gloves, masks and protective clothing. Anyone who develops respiratory symptoms reports to a doctor to be checked out. People who have no reason to be on a farm involved in the outbreak are kept away.

Is it safe to eat chickens, other fowl and eggs?

Yes, eating properly cooked poultry, as well as eggs, is safe. The U.S. government has banned imported poultry from countries affected by bird flu. At the present time, H5N1 avian flu is not present in the U.S. For protection against many types of food borne diseases, such as Salmonella, all poultry should be cooked to 165º F or hotter. Cooking also destroys flu viruses.

Influenza A H5N1 is causing widespread outbreaks among wild and domestic birds in Asia and Eastern Europe. At this time, person-to-person transmission appears to be rare, but travelers from affected areas with serious respiratory illness could be infected with H5N1.

To rapidly detect and control imported Influenza A H5N1, we are asking healthcare providers to immediately notify their local health department of any patient who has:

• Traveled to areas reporting avian or human H5N1 within 10 days of onset, AND
•  Has severe respiratory disease, including pneumonia or acute respiratory distress syndrome (ARDS), for which no alternative cause is established, OR
• Milder illness with fever (>100.4°F [38°C]) and respiratory symptoms (cough, sore throat or shortness of breath) following contact with live birds or persons with suspected or confirmed influenza A H5N1 during travel.

Infection control for patients with suspected or confirmed H5N1 should include standard and droplet precautions. Airborne precautions should be used for procedures that may aerosolize respiratory secretions.

We encourage providers to obtain travel histories from patients with severe respiratory illness. Avian H5N1 has been reported in Cambodia, China, Croatia, Indonesia, Kazakhstan, Kuwait, Mongolia, Russia, Thailand, Turkey and Vietnam and in birds smuggled to Taiwan, Belgium and the United Kingdom. Updated information on H5N1 activity is available on the H1N1 (WHO) and H1N1 Influenza (CDC) websites.

Laboratory Diagnosis of Suspected H5N1 Influenza 

Your local health department will facilitate diagnostic testing at the Washington State Department of Health Public Health Laboratories (PHL). Please do not submit specimens to a commercial laboratory, which may cause a delay in confirming the diagnosis. The PHL performs H antigen subtyping of influenza by polymerase chain reaction assay. H5N1 is considered to have pandemic potential and specimens identified as influenza A H5 or another novel subtype will go to CDC for further identification and viral isolation under enhanced biosafety level 3 conditions.

To maximize the detection of influenza, specimens should be collected within three days of symptom onset. Collect serum for antibody testing and at least one of the following:

1. Oropharyngeal swab, nasopharyngeal swab or aspirate
2. Bronchoalveolar lavage, tracheal aspirate or pleural fluid as appropriate

• All testing should be performed using appropriate infection control precautions.
• No specimens will be accepted at the Washington State Public Health Laboratories (PHL) without notification and approval of your local health department.
• 360-786-5470 - All messages left on the 24-hour reporting line are retrieved hourly during business hours. 

Oropharyngeal swab specimen collection*

1. All testing should be performed using appropriate infection control precautions.
2. Place the swab immediately into a sterile vial containing 2 mL of viral transport media. Break off or bend the end of the applicator shaft to close the vial tightly.
3. Label the vial with the patient’s name, specimen source and date obtained.

Nasopharyngeal swab specimen collection*

1. Use only sterile Dacron or rayon swabs with wire shafts. Insert the swab into the nostril parallel to the palate until resistance is met by contact with the nasopharynx. Leave the swab in for a few seconds. If possible, do the other nostril with the same swab.
2. Place the swab immediately into sterile vials containing 2 mL of viral transport media. Break off or bend the end of the applicator shaft to close the vial tightly.
3. Label the vial with the patient’s name, specimen source and date obtained.

Nasopharyngeal aspirate specimen collection*

1. Have the patient sit with head tilted slightly backward.
2. Instill 1-1.5 mL of nonbacteriostatic saline into one nostril.
3. Flush a plastic catheter with 2-3 mL of nonbacteriostatic saline.
4. Insert the catheter into the nostril parallel to the palate until resistance is met by contact with the nasopharynx. Aspirate the nasopharyngeal contents. If possible, repeat with the other nostril.
5. Instill the aspirate into sterile vials, and label the vials with the patient’s name, specimen source and date obtained.

*Multiple naso- or oropharyngeal specimens can be combined in a single viral medium transport tube.

Bronchoalveolar lavage, tracheal aspirate or pleural fluid specimen collection

1. During lavage or aspirate, use a double-tube system.
2. Centrifuge half of the specimen and fix the cell pellet in formalin. Place the remaining unspun fluid in sterile vials with external caps and internal O-ring seal, then seal tightly with the available cap and secure with adhesive tape.
3. Label each specimen with the patient’s name, specimen source and date obtained.

Blood Specimen Collection

1. Antibody testing requires both acute (<7 days of onset) and convalescent (2-4 weeks after onset) serum specimens.
2. Collect 5-10 cc of whole blood in a serum separator tube. Allow the blood to clot, centrifuge briefly, and collect all the sera in vials with external caps and internal O-ring seals. If no O-ring vials are available, seal the existing cap with adhesive tape.
3. The minimum amount of serum needed for testing is 200 μl.
4. For pediatric patients, a minimum of 1 cc of whole blood is needed. Ideally, collect 1 cc in a serum separator and 1 cc in an EDTA tube. If only 1 cc can be collected, collect in a serum separator.
5. Label each specimen with the patient’s name and date obtained.

Storage: All respiratory and blood specimens should be refrigerated at 4°C until ready for transport. Transport on ice packs.

Each specimen must be accompanied by a completed PHL Viral Examination Form which includes:

• Patient Name
• Specimen collection date
• Date of symptom onset
• Source of specimen
• Test requested
• Submitter name, mailing address.

Packaging: Pack and label specimens as Diagnostic Specimens or Clinical Specimens.  Pack and label viral isolates as Infectious Substances, UN 2814.  Pack and ship according to United States Department of Transportation and United States Postal Service regulations. Specimens that leak in transit or do not have appropriate identification of the patient on the tube will be rejected.  Specimens without collection date, submitter name and address or requested test will be delayed for reporting until the missing information is received.

Transport: Every attempt should be made to transport specimens to the PHL on ice packs within 24 hours of collection.