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Health advisory: H5N1 Bird Flu - Updated Status and Provider Recommendations

December 10, 2024

To:

From:

All healthcare providers

Sarah L. Rudman, MD, MPH
Deputy Health Officer


Krishna Surasi, MD, MPH
Assistant Public Health Officer

Healthcare providers should be aware of the possibility of infection with H5N1 in symptomatic persons. This is most likely in people who have had exposure to animals confirmed or suspected to have H5N1.

Recommendations for Healthcare Providers
 

Providers who suspect H5N1 infection should:

  1. Isolate the patient: Implement standard, contact, and airborne precautions, and use eye protection.
  2. Immediately report to Public Health
    1. Office hours, Monday through Friday, 8 a.m. to 5 p.m.: (408) 885-4214
    2. After hours, page the on-call Health Officer: (408) 998-3438
  3. Initiate treatment: Empiric antiviral treatment should be started as soon as possible for all patients with possible H5N1 infection.
  4. Collect specimens: Specimens should be collected in persons with recent exposure (within 10 days) to animals and/or materials suspected or confirmed to be infected with H5N1 AND signs and symptoms consistent with acute or lower respiratory tract infection and/or conjunctivitis and/or gastrointestinal symptoms. Multiple specimen types must be collected and vary depending on symptoms. 

For more information, visit SCCPHD H5N1 bird flu information for clinicians.

Situation status 
 

To date, there have been no reported human H5N1 bird flu cases among residents of Santa Clara County, and there have been no confirmed infections among cattle or commercial poultry in the county. However, H5 remains detectable in a majority of wastewater samples from all areas of the county without a specifically determined source.

Raw Milk Recalls
 

In two separate instances, on November 21 and November 26, 2024, the county's Public Health Laboratory identified H5 in samples of raw milk produced by Raw Farm LLC, purchased at retail outlets in Santa Clara County. The County immediately notified the California Department of Public Health. The raw milk was voluntarily recalled in both instances by the company, and the state has warned the public to not consume any raw milk or cream products from Raw Farm LLC. See December 3 broad voluntary recall.

Raw Milk Implications for Human Risk
 

While there have been no confirmed cases of people getting infected with H5N1 due to consumption of raw milk, the virus has been found at high levels in raw milk of infected dairy cows, and exposure to raw milk has been implicated in H5N1 infections among dairy workers and in animal models. 

There have been cases in the United States among people with no history of exposure to animals suspected or confirmed to be infected with H5N1, including one case in Alameda County. An additional case is under investigation in Marin County.

While most U.S. cases of H5N1 have been mild, concurrent infection with H5N1 and seasonal flu increases the risk of gene reassortment, leading to changes that make H5N1 more transmissible to humans or enable it to spread from human-to-human.

References:                                                        

  1. H5N1 bird flu | Providers | County of Santa Clara
  2. CDPH Health Update: Evaluation and Testing for Human Avian Influenza A (H5N1) Infection 
  3. State Secures Broad Voluntary Recall of Raw Milk and Cream to Protect Consumers