Category: 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

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.

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)

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.

2024 HVMA Conference Registration Now Open

This year we are moving our annual conference to the Hawaii Convention Center! Labs will be offered on Nov 6-7, 2024, and a full slate of lectures will fill Nov 8-10, 2024. Lecture topics include behavior, cardiology, anesthesia, soft tissue surgery, exotics, and more! 

Registration is now open for attendees and exhibitors. Remember to log in to your HVMA online account to receive the discounted registration rates for active members. Accommodations will be across the street from the convention center at the Ala Moana Hotel.

Check out our conference page where you can find lab details and our conference schedule. Please join us for great RACE-approved CE, our lively exhibit hall, food, and fellowship, and get to know your local vet community! 

In Remembrance: Lester Naito

Dr. Naito with Tomi, a chihuahua-terrier.
Photo by Craig T. Kojima

Lester Naito graduated from Oklahoma State University in 1959 and opened his 1st clinic in 1963, Animal Clinic Waimalu, followed by Animal Clinic Mililani, Moanalua, Waipahu, and Kapolei. These clinics are now VCA Animal Hospitals.

Dr. Naito studied for two years as a pre-med major at Marquette University in Milwaukee. He chose to further his education at OSU because the pre-veterinary requirements closely matched his pre-med course work.

He and his wife Grace have 4 kids, Steven, Joanne, Scott and Leslie.

I will always be grateful to Doctor Lester Naito for giving me the opportunity to gain experience and grow in the profession as a beginning veterinarian.  By example, he kept his optimism even during difficult circumstance.  His foresight and support were instrumental in developing my own professional vision .   Through the years his life touched many of us as employees, pet owners and friends.  Les will be missed.
– Dr. Isaac Maeda

Hawaii State Board of Veterinary Medicine Updates

New temporary permits are now in effect!

The Hawaii Board of Veterinary Medicine has recently increased its bank of test questions, and has reduce the waiting period to retest following a failed attempt to pass the Hawaii state veterinary examination from 90 days to 60 days. While the HVMA had petitioned for a shorter (30 day) waiting period, we are grateful for this small improvement.

In upcoming legislative sessions, the HVMA will be looking into revising the veterinary practice law to allow temporary permittees to continue practicing veterinary medicine during this waiting period following a failed attempt to pass the State veterinary examination.

Currently, Hawaii Revised Statutes (“HRS”) section 471-8(c)(5), titled “Examinations; qualifications of applicants” states in relevant part:
“(c)(5) The temporary permit shall be valid until the results of the Hawaii state board examination taken by the permittee are known; provided, that failure of the Hawaii state board exam, the National Board Examination, or Clinical Competency Test shall immediately terminate the temporary permit;”

If you have suggestions or inquiries regarding licensure or regulation of veterinary medicine in Hawaii, please contact the Hawaii State Board of Veterinary Medicine at veterinary@dcca.hawaii.gov or (808) 586-2705.

CDC Importation Rabies Rule Update

The Centers for Disease Control and Prevention (CDC) has issued its final rule that it hopes will reduce public health risks of the dog-maintained rabies virus variant (DMRVV) associated with the importation of dogs into the United States. The final rule addresses the importation of cats as part of overall changes to the regulations affecting both dogs and cats, but the final rule does not require that imported cats be accompanied by proof of rabies vaccination and does not substantively change how cats are imported into the United States.

In this final rule, CDC aligns U.S. import requirements for dogs with the importation requirements of other DMRVV-free countries by requiring proof of rabies vaccination and adequate serologic test results from a CDC-approved laboratory. Requirements that need to be met for dogs to be imported include: a microchip, six-month minimum age requirement for admission, and importer submission of a CDC import form. The rule also requires airlines to confirm documentation, provide safe housing for animals, and assist public health officials in determining the cause of an animal’s illness or death.

The final rule was published in the Federal Register on May 13 and is effective August 1, 2024.

AVMA article: https://www.avma.org/news/dog-import-requirements-strengthened-prevent-canine-rabies-return

Here are some resources released by the CDC:

https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/dogs.html

https://www.cdc.gov/importation/bringing-an-animal-into-the-united-states/dogs-entering-us-after-august-1.html