How should patients be evaluated for avian influenza (H5N1)?

Updated: Apr 23, 2019
  • Author: Hien H Nguyen, MD, MS; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

If avian influenza is suspected, cultures should not be ordered without guidance from a public health laboratory. Many laboratories are not equipped to deal with the isolation needed to safely contain avian influenza (biosafety category 3+ containment, which is higher than that used for HIV). If a sample is accidentally handled, the laboratory may have to be shut down for decontamination.

Samples from patients with suspected avian influenza should be sent to a dedicated central reference laboratory, such as that at the CDC. The CDC laboratory can perform antiviral sensitivity testing, as well as subtyping of the virus.

The best specimens are material collected with oropharyngeal swabs, material from bronchoalveolar washes, or tracheal aspirates. Specimens from nasopharyngeal swabs are acceptable, but they may contain a low quantity of the virus. The CDC recommends obtaining multiple respiratory specimens from different sites on at least 2 consecutive days, as soon as possible after illness onset—ideally, within the first 7 days. [35]

Pneumatic tubing is not recommended for transport; hand transport using a leakproof specimen bag is preferred. The specimen should be clearly labeled as “suspected AI,” and the person who transports the specimen should use appropriate protective equipment. [35]


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