Timely Topics

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/.

Avian influenza virus detected in Oahu wastewater

On Wednesday 11/13/2024, the Department of Health announced they had detected H5 virus from a wastewater processing plant on Oahu. This testing is a part of routine testing of wastewater facilities across the US by the CDC. Due to the type of testing performed, the presence of the avian influenza virus was detected, but no sequencing has yet been conducted to confirm whether this is the highly pathogenic strain of avian influenza also known as HPAI, H5N1.

During the outbreak of highly pathogenic avian influenza within the United States over the past 2 years, Hawaii has been the only state in the US without a confirmed case of H5N1 in humans or animals. H5N1 can spread rapidly between birds, and has been found more rarely in mammals such as humans, cows, and pigs. There is no evidence of sustained human-to-human transmission of H5N1 in the United States.

There are no reports of human or animal H5N1 cases in Hawaii and the overall risk of H5N1 to humans and animals within the state remains low.

The Hawaii Department of Agriculture (HDOA) already maintains strict bird import laws that require permits, inspections, health certificates, identification requirements and in some cases, isolation periods prior to importation into Hawaii. Due to recent widespread outbreaks of highly pathogenic avian influenza on the mainland, HDOA has further restricted the importation of birds from areas experiencing outbreaks and has required pre-entry avian influenza test protocols. In addition, HDOA has placed an embargo on importing birds through the mail.

While the Department of Health continues to investigate the source of the H5 virus detected, veterinarians and the public should continue to be vigilant for illness or mass die-offs in poultry or waterfowl flocks.

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

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.