May 31, 2006

Avian Flu: University of Michigan Recommendations for Travelers

Michigan faculty, staff and students traveling overseas are asked urged to stay informed about avian influenza and to take steps to reduce risk of exposure to this disease. As of May 31, 2006, human cases have been reported in parts of Azerbaijan, Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Thailand, Turkey, and Viet Nam. At present, travelers to areas affected by avian influenza in birds are not considered to be at elevated risk of infections unless they are directly exposed to infected birds.

In order to help communications with the University if conditions worsen and increase the risks of travel, members of the Michigan community are urged to register their travel plans and contact information on the University's Travel and Information Web (http://www.umich.edu/~itoc/). This site also has links to up-to-date information from the Centers for Disease Control and Prevention and the World Health Organization.

Avian influenza A (H5N1) viruses usually affect wild birds but have infected and caused serious disease among poultry, such as chickens, ducks, and turkeys. Most cases of H5N1 influenza in humans are thought to have occurred from direct contact with infected poultry. Travelers are advised to avoid contact with high-risk environments in affected countries, such as live animal markets, poultry farms, and any free-ranging or caged poultry. Contact with sick or dead wild birds or poultry, as well as with poultry that have no apparent symptoms should be avoided. Contact with surfaces that may have been contaminated by poultry feces or secretions should also be avoided. Uncooked poultry or poultry products, including blood, should not be consumed.

While the CDC has not recommended that the general public avoid travel to any of the countries affected by H5N1, persons visiting areas with reports of outbreaks of H5N1 among poultry or of human H5N1 cases can reduce their risk of infection by taking the following steps:

Before any international travel to an area affected by H5N1 avian influenza

• The CDC's Travelers' Health website (http://www.cdc.gov/travel) has information about disease risks and health recommendations for specific regions. For other information, see CDC's Avian Influenza website: http://www.cdc.gov/flu/avian/index.htm.
• Be sure you are up to date with all routine vaccinations. See your health-care provider 4-6 weeks before travel to get additional vaccination medications or information you may need.
• Assemble a travel health kit containing basic first aid and medical supplies, including a thermometer and alcohol-based hand gel for hand hygiene.
• Identify in-country health-care resources in advance of your trip.
• Check your health insurance plan or get additional insurance that covers medical evacuation in case you become sick. Information about medical evacuation services is provided on the U.S. Department of State web page Medical Information for Americans Traveling Abroad, at http://travel.state.gov/travel/tips/health/health_1185.html.

During travel to an affected area

• Avoid all direct contact with poultry, including touching well-appearing, sick, or dead chickens and ducks. Avoid places such as poultry farms and bird markets where live poultry are raised or kept, and avoid handling surfaces contaminated with poultry feces or secretions.
• As with other infectious illnesses, one of the most important preventive practices is careful and frequent handwashing. Cleaning your hands often with soap and water removes potentially infectious material from your skin and helps prevent disease transmission. Waterless alcohol-based hand gels may be used when soap is not available and hands are not visibly soiled.
• All foods from poultry, including eggs and poultry blood should be cooked thoroughly. Egg yolks should not be runny or liquid. Heat destroys influenza viruses-cooking temperature for poultry meat should be 74°C (165°F)
• If you become sick with fever accompanied by a cough, sore throat, or difficulty breathing or if you develop any illness that requires prompt medical attention, a U.S. consular officer can help you in locate medical services and informing your family or friends. Inform your health-care provider of any possible exposures to avian influenza. Notify your emergency contacts in the US. You may email umitoc@umich.edu to facilitate emergency contacts. Defer further travel until you are free of symptoms, unless traveling locally for medical care.

Note: Some countries have instituted health monitoring techniques, such as temperature screenings, at ports of entry of travelers arriving from areas affected by avian influenza.

After your return

• Monitor your health for 10 days.
• If you become ill with a fever plus a cough, sore throat, or trouble breathing during this 10-day period, consult a health-care provider. Before you visit a health-care setting, tell the provider the following: 1) your symptoms, 2) where you traveled, and 3) if you have had direct contact with poultry or close contact with a severely ill person. This way, he or she can be aware that you have traveled to an area reporting avian influenza.
• Do not travel while ill, unless you are seeking medical care. Limiting contact with others as much as possible can help prevent the spread of an infectious illness.

(adopted from recommendations from the CDC and WHO)