Updated July 2009                                    

Avian influenza - Advice for travellers to affected areas

Currently there are no travel restrictions to countries reporting avian influenza. For country-specific travel and safety information, travellers should consult the NaTHNaC Country Information Pages and the Foreign and Commonwealth Office website. All travellers should have adequate travel health insurance.

Periodically NaTHNaC will post News items about both human and avian cases of avian influenza. These should be checked for the latest information.

During travel

To date there have been no cases of avian influenza in international travellers. In addition, only rare cases of human infection with avian influenza have occurred in risk countries, and there has been no sustained human to human transmission.

The following precautions should be practised by those who are travelling to these regions:

• Avoid visiting live animal markets and poultry farms
• Avoid contact with surfaces contaminated with animal faeces
• Do not eat or handle undercooked or raw poultry, egg or duck dishes
• Do not attempt to bring any live poultry products back to the UK
• Do not pick up or touch dead or dying birds
• Exercise good personal hygiene with frequent hand washing

Advice for travellers to affected zones in EU countries where wild or domestic birds or animals have been found to be infected with H5N1 [1]

In countries where small numbers of wild birds have been confirmed to have H5N1 infection, special veterinary emergency rules will apply, usually within 3km or 10km protection zones.  People travelling to these zones should follow the general advice for avoiding contact with dead or diseased birds and poultry and also comply with any local hygiene enforcement restrictions and regulations for the period they are imposed.  These special veterinary measures are generally relaxed when control and prevention measures have been successfully applied in the area.

In 2006 the European Centre for Disease Prevention and Control (ECDC) reviewed the risk from swimming in water in Europe that is potentially contaminated by H5N1 [2]. They concluded that there is “no additional risk to human health from the occasional presence of H5N1 in the environment [water] from wild birds. This is because of the poor adaptation of the virus to humans and the dilution effects in large bodies of water.” In addition, the decline in outbreaks of avian influenza in Europe makes it less likely that H5N1 will be in the water.

Osteltamivir (Tamiflu®)

It is not recommended that travellers take with them the neuraminidase inhibitor, oseltamivir (Tamiflu®) for either prevention or self-treatment of avian influenza. There are several reasons for this recommendation:

• There have been no cases of avian influenza in travellers, and no efficient transmission of infection from person to person. The risk to travellers from avian influenza is very low.
• It is not UK health policy to recommend personal stockpiles of oseltamivir for travel or other use.
• High demand for oseltamivir by travellers could jeopardise current UK efforts to develop stores of the drug that are being used as part of the overall plan of protecting UK residents in the current influenza pandemic of H1N1 2009. It could also jeopardise supplies needed by high-risk persons for normal seasonal influenza.
• It would be difficult for travellers to know the correct timing for initiating the drug, i.e. what constitutes a self-diagnosed case of avian influenza.
• Oseltamivir is a prescription only medicine intended for use under qualified medical supervision.

After travel

Travellers who become ill with fever and either cough or difficulty breathing within 14 days of returning to the UK should consult their normal health care provider or call NHS Direct on 0845 46 47.

References

1. Health Protection Agency. Avian influenza travel advice. 31 December 2008. [Accessed 13 July 2009] Available at http://www.hpa.org.uk/webw/HPAweb&HPAwebStandard/HPA

web_C/1195733807095?p=11604956170922.

2. European Centre for Disease Prevention and Control. Avian influenza A/H5N1 in bathing and potable (drinking) water and risks to human health, version June 2006. [Accessed 13 July 2009] Available online at http://www.ecdc.europa.eu/documents/pdf/H5N1_Bathing_

water_060609.pdf

Additional reading

Crusat M, de Jong MD. Neuraminidase inhibitors and their role in avian and pandemic influenza. Antivir Ther. 2007;12(4 Pt B): 593-602

Melidou A, Gioula G, Exindari M et al. Influenza A (H5N1): an overview of the current situation. Euro Surveill 2009;14(20): May 21. Available at http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=

19216

World Health Organization.  Update: WHO-confirmed human cases of avian influenza A (H5N1) infection November 2003-May 2008. Wkly Epidemiol Rec  2008;83:415-420. http://www.who.int/wer/2008/wer8346.pdf

Important links

NaTHNaC News items on avian influenza

NaTHNaC Outbreak Surveillance Search

World Health Organization advice on avian influenza

Health Protection Agency frequently asked questions on avian influenza

HPA algorithm for the management of returning travellers from countries affected by avian influenza

World Organisation for Animal Health

Animal Health and Welfare page of the Department for Environment, Food and Rural Affairs (DEFRA)

Department of Health Pandemic Influenza Plan