HDOA HPAI Guidance for Veterinary Clinics

Submitted by Raquel Wong, DVM, Hawaii Dept of Ag Animal Industry Division

Avian clients should not be turned away simply because HPAI is in the environment. Clinics and mobile veterinarians are encouraged to continue treating birds with extra attention focused on biosecurity and the signs of HPAI should they need to report suspected cases to animal health officials.

What are the signs of HPAI?

  • Decreased water consumption
  • Extreme depression
  • Very quiet
  • Difficulty breathing
  • Decrease in feed or water intake
  • Swelling or purple discoloration of head, eyelids, comb, wattle, and hocks
  • Decrease in egg production
  • Sudden unexplained death

What if a client calls with sick birds?

Veterinary clinics should develop a set of questions for their clients to determine the HPAI risk of the pet bird and then develop their own procedures appropriate to the risk. Some starter questions to consider:

  • Is the avian species a wild bird?
    • Veterinarians should not let wild waterfowl, gulls or other susceptible HPAI wild species into their facility.
  • Are all birds sick or just one? What is the overall health of the flock?
    • If one bird is sick or dead and all the others appear healthy it may not be HPAI. However, if a flock is experiencing daily mortality or there are a number of dead birds it should be reported to the Animal Industry Division, Hawaii Department of Agriculture at 808-483-7100 (Monday – Friday 7:45 AM – 4:30 PM).  After hours or weekends to 808-837-8092.  Or email HDOAIC@hawaii.gov.
  • Does the bird have access to the outside in a free ranging type of situation (vs. being in a contained/controlled housing away from environmental elements)
    • If yes, how long does the bird spend time outside? Is the time spent outside supervised?
  • Does the client live by a body of water or agricultural field?
  • Does the client feed wild birds or wild animals?
  • Does the client engage in sport hunting of wild birds?
  • Does the client work or volunteer with any avian species?

Answering yes to any of these questions should prompt additional precautionary procedures to be utilized and have AI on your list of differential diagnoses.

How should clinics handle routine avian appointments?

Avian patient physical contact should be limited, and staff should always wear the appropriate PPE and wash their hands before and after handling birds. Additional biosecurity guidance includes:

  • Make an exam room at the clinic for avian appointments only.
  • See avian appointments at the end of the day.
  • Limit staff contact with avian species, especially those that have pet birds at home.
  • Emergency surgeries only for avian species.
  • Hospitalized avian species should be kept away from routine avian appointments.
  • All medical equipment and laundry used for avian appointments should be washed and disinfected appropriately.
  • Disinfect exam rooms following label directions on preparation and contact time to ensure it kills potential HPAI virus. Look for a disinfectant with an EPA registered product with label claim for Avian Influenza
  • Proper PPE should be used including gowns, foot coverings, masks, gloves, and eye protection.
  • Educate staff and clients about how HPAI is spread and how to reduce the spread of the disease.

How should mobile veterinarians handle client visits?

  • Wear clean clothing and boots.
  • If possible, limit ambulatory visits to facilities with poultry to one site per day.
  • Wash your vehicle immediately prior to and when leaving a site with poultry.
  • Use disposable coveralls, boots, and gloves, +/- masks. If possible and agreeable to the client, leave them at the client’s site.

Considerations for clinic staff biosecurity

  • Does the facility have a written biosecurity plan and procedures?
  • Do employees and volunteers receive biosecurity training?
  • Do employees and volunteers change into dedicated work clothing onsite? Is work-provided clothing laundered onsite, or is it taken home with employees?
  • What personal protective equipment (such as boots, gloves, coveralls, and masks) do you provide?
  • Are staff allowed to keep poultry or pet birds at home? Do staff engage in sport hunting of wild birds?
  • If the attending veterinarian is an offsite contractor, do they treat birds at other locations? What precautions do they take when visiting your facility?
  • Are there protocols (such as showering, changing clothes, or avoiding bird contact for 72 hours) for people who visit captive wild bird facilities or poultry premises?

What if you suspect a bird in your care has HPAI?

  • Call the Animal Industry Division, Hawaii Department of Agriculture at 808-483-7100 (Monday – Friday 7:45 AM – 4:30 PM).  After hours or weekends to 808-837-8092.  Or email HDOAIC@hawaii.gov.

Resources to share with your clients

H5N1 Avian Influenza virus confirmed on Oahu

On Friday 11/15/2024, the Hawaii Department of Agriculture announced they had confirmed multiple bird deaths due to H5N1 from a backyard flock in Central Oahu near the Wahiawa wastewater treatment plant. HDOA pathologists performed necropsies on the dead birds, and confirmatory tests for H5N1 were performed at NVSL and Hawaii Department of Health. Affected birds from this site included ducks, a goose, and a zebra dove.

HDOA has issued a quarantine order on this site, which requires all birds on the property to be depopulated and the premises cleaned and disinfected.

Human illness from H5N1 is uncommon, and people in Hawaii are still unlikely to get sick from avian influenza at this time. 

Veterinarians and the public should continue to be vigilant for illness or mass die-offs in poultry or waterfowl flocks, and report any multiple or unusual illnesses or deaths to HDOA Animal Industry Division at 808-483-7102 or 808-837-8092.

Symptoms of avian influenza in poultry and other birds include:

  • Sudden death without any prior symptoms of illness
  • Lack of energy and appetite
  • A drop in egg production or soft-shelled, misshapen eggs
  • Swelling of the eyelids, comb, wattles and shanks
  • Purple discoloration of the wattles, comb and legs
  • Gasping for air (difficulty breathing)
  • Nasal discharge, coughing, sneezing
  • Twisting of the head and neck (torticollis)
  • Stumbling or falling down
  • Diarrhea

Specialized BHI swabs for AI PCR testing of poulty and waterfowl are available from HDOA. In poultry, collect oropharyngeal swabs; in waterfowl, collect cloacal swabs. Swabs can be pooled and stored in the BHI media refrigerated for up to 1 week prior to submission to the Halawa Veterinary Laboratory. Please see these instructions and contact Dr. Raquel Wong at the HDOA Animal Industry Division (808-483-7100) to obtain the appropriate media and swabs.

Talking points for the public:

  • The risk of H5N1 to humans and animals in Hawaii is currently low.
  • Do not touch sick or dead birds without appropriate personal protective equipment such as gloves, facemasks, protective gowns and footwear.
  • Poultry or other bird owners should increase biosecurity for their flocks.
  • Multiple sick or dead birds should be reported to the HDOA Animal Industry Division.

Read the full HDOA Press Release from 11/15/2024 here.

More information can be found in these resources:
Hawaii Department of Agriculture (HDOA)
Hawaii Department of Health (DOH)
Centers for Disease Control and Prevention (CDC)
United States Department of Agriculture (USDA)

Updated 11/23/2024: Check out HDOA’s HPAI Guidance for Veterinary Clinics

HPAI Possible Exposure at Mililani Pet Fair

DOH NOTIFIES PUBLIC OF POTENTIAL EXPOSURE TO AVIAN INFLUENZA AT MILILANI PET FAIR HELD NOV. 2

November 17, 2024                                                                                                    24-147

Investigation by the Hawaiʻi Department of Health (DOH) and Hawaiʻi Department of Agriculture (HDOA) of confirmed H5N1 avian influenza in a backyard flock of various birds in Central Oʻahu has identified a potential exposure to members of the public who attended the Mililani Pet Fair held on Nov. 2, 2024.

While certain birds from the infected flock were present at the fair, the first signs of infection in the flock did not occur until several days after the fair. As the birds were not showing signs of infection at the time of the fair, the likelihood of spreading H5N1 to humans is low. However, out of an abundance of caution, DOH recommends that individuals who attended the fair and touched a duck or goose monitor for influenza-like illness (ILI) and conjunctivitis (“pink eye”) symptoms.

Individuals who attended the fair and have not developed symptoms can be reassured. Symptoms of avian influenza in humans usually develop within two to five days of exposure but can take up to 10 days to develop in some cases. Symptoms that are associated with bird flu infection in humans are typical mild and may include the following:

  • Fever
  • Cough
  • Sore throat
  • Conjunctivitis (“pink eye”)

Avian influenza in humans can be treated with antiviral medications.

The DOH advises anyone who attended the fair, touched a duck or goose at the fair, and is currently experiencing ongoing symptoms to isolate at home. Please contact your primary care provider for evaluation and testing, as well as the DOH Disease Reporting Line at 808-586-4586 for further guidance (calls answered 24/7). Please also call the DOH Disease Reporting Line if you’ve experienced symptoms that have since been resolved. Health care providers can submit specimen samples to Hawaiʻi’s State Laboratory Division (SLD) for bird flu testing.

If other animals had contact with a duck or goose at the fair and are exhibiting signs of illness, owners should contact their veterinarians. The likelihood of transmission is low; however, HDOA veterinarians have advised local private veterinarians of the situation and asked them to report any possible cases of infection.

To report multiple or unusual illnesses in poultry, livestock, or other wild birds or animals, contact HDOA’s Animal Industry Division at 808-483-7102, Monday to Friday from 7:45 a.m. to 4:30 p.m. or 808-837-8092 during non-business hours and holidays.

For more information about avian influenza, visit the DOH website: https://health.hawaii.gov/docd/disease_listing/avian-influenza/

AVMA Updates – Summer 2024

The AVMA House of Delegates approved revisions to the policy that provides ethical guidance for all veterinarians, restructuring it to improve clarity and usability. Among the changes, the policy now features a Code of Conduct with three sections: provide competent medical care, prioritize patient welfare in balance with client needs and public safety, and uphold standards of professionalism.
Read more

Two new surveys find lack of support for midlevel practitioner. Both the American Association of Veterinary State Boards and the Veterinary Management Groups said they support better utilization of credentialed veterinary technicians as part of the answer to workforce issues.
Read more

Revised CPR standards issued for dogs and cats. The first update to the life-saving RECOVER guidelines since 2012 emphasizes speed and standard techniques. Changes include a streamlined CPR algorithm and new drug dosing charts. 
Read more


AVMA MENTORSHIP

Any AVMA member with less than 10 years of professional experience can now get free professional mentoring through MentorVet Connect, brought to you by the AVMA. Learn more.

AVMA Updates

AVMA Vitals

The AVMA has made monthly need-to-know updates available on the following topics:

  • Better integrating veterinary technicians’ robust skill set into practice
  • Highly pathogenic avian influenza found in Texas, Kansas dairy cattle
  • HHS, senators ask DEA to use marijuana restrictions
  • ACVIM issues updated guidance on canine leptospirosis
  • Number of NAVLE test takers increases; Overall scores drop
  • More veterinary colleges in line for accreditation evaluations
  • Education Department to forgive loans for some borrowers; recertification deadline extended
  • Find veterinary clinic trials
  • Two new resources support equine practitioners
  • Pet food safety resources protect patients and clients
  • Managing toxicosis cases: Tips from the experts
  • Curiosity can lead to discovery: Embracing neurodiversity
  • Discover your advocacy path
  • Stay in the know–and qualify to earn rewards
  • Help for veterinarians and animals affected by wildfires
  • AVMA Convention 2024
  • Test yourself: Animal Welfare Assessment Contest

View the full AVMA Vitals update here.

AVMA Expands Mentorship Program

Any AVMA member with less than 10 years of professional experience can now get free professional mentoring through MentorVet Connect, brought to you by the AVMA. Learn more.

Pono Pet Parents

Submitted by Michelle Barbieri, DVM

The HVMA is providing a landing page for resources for veterinarians, technicians, and pet owners called Pono Pet Parents. This information campaign currently focuses on cats, but the hope is that in the future, it can be expanded to dogs and more. Cat owners can learn about how to raise their beloved pets in a thoughtful way that strengthens their bond with their cats, keeps them happy and healthy, and benefits wild animals and our island home.

Resources are grouped by the following sections:

  • Ensure my cat has a happy home for life
  • Keep my cat safe indoors
  • Create an enriching home environment
  • Spay/neuter and microchip
  • Dispose of litter in the garbage
  • Learn about the unique Hawai’i environment I’m protecting

Pet owners can then take the Pono Cat Pledge, which includes a commitment to these activities. These pages are the result of a combined effort of humane society representatives on Oahu and Kauai, and local, state and federal conservation groups hoping to realize the shared goals of responsible pet ownership and wildlife and ecosystem health.

Please share this resource with your clients and colleagues. And if you have any feedback or want to help get involved with future steps in this information campaign, contact Michelle Barbieri.

Honolulu Street Dog Coalition Update

The Honolulu Street Dog Coalition is a state chapter of the national Street Dog Coalition, which is a nonprofit organization aimed to provide free veterinary care and related services to pets of people affected by homelessness. The Honolulu Street Dog Coalition clinics is led by Aleisha Swartz, DVM and Jerrisa Ching, DVM, and has partnered with the Hawaii H.O.M.E. Project to serve Oahu communities.

The organization is always looking for donations to support the community, supplies, and resources. If you would like to donate, please click the link here. We are also looking for veterinarian and veterinary staff volunteers to help the clinics. If you want to learn more about how to volunteer, please email info@thestreetdogcoalition.org.

American Heartworm Society Survey

APEX, NC —The American Heartworm Society (AHS) is urging veterinarians to participate in the 2022 AHS Heartworm Incidence Survey.

The AHS maps, dating back to 2001, are generated every three years and are widely used by veterinarians, animal shelters, animal rescue organizations and media to educate the pet-owning public about the threat of heartworm disease. The maps, which are built using data submitted by thousands of veterinary practices and animal shelters, also provide vital insights for veterinary professionals about trends in heartworm incidence and the spread of heartworms into new areas of the country.

“Each veterinary practice that submits data enables the AHS to create a more comprehensive and useful map,” states AHS President Jenni Rizzo, DVM. “We urge every practice—large or small—to take a few short minutes to submit their information.”

The deadline to submit survey data on heartwormsociety.org/2022survey is March 15, 2023. The new 2022 AHS map will be made available in April as part of Heartworm Awareness Month.