Avian Influenza (Bird Flu) Treatment & Management

Updated: Feb 12, 2020
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Michael Stuart Bronze, MD  more...
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Treatment

Medical Care

The mainstay of treatment is the administration of antiviral medication.

Supportive care such as oxygen therapy, intravenous fluids and parenteral nutrition may be needed.

Severe cases may require ventilatory support with intubation and low-volume (high-frequency) ventilation.

Antiviral therapy should be tailored to the patient's age and the antiviral resistance profile of the virus from the area of exposure. Therapy should be initiated even when the presentation is late.

Antibiotics may be needed to treat bacterial pneumonia but are not empirically necessary.

Steroids have not been shown to be beneficial, except perhaps in the setting of sepsis with adrenal insufficiency. [14]

Baloxavir acid (BXA) and its prodrug baloxavir marboxil (BXM) have shown promise in the treatment of H7N9 influenza in vitro and in vivo. In a mouse model, BXM administration provided complete protection from a lethal A/Anhui/1/2013 (H7N9) challenge, and this treatment proved effective even after delayed treatment (up to 48 hours following infection) and at higher virus doses, supporting investigation in humans. [15]

An important consideration is that of infection control and prevention of transmission to other patients and health care workers. Droplet precautions should be used, including eye protection. No evidence shows that airborne spread is possible, but, if fine aerosols are expected because of specific procedures, a particulate respirator should be properly fitted and used.

Adults and children older than 12 years require one week of infection-control precautions, from the initial onset of symptoms. Children younger than 12 years may shed high titers of human influenza virus for up to 21 days after the illness onset, and the World Health Organization (WHO) recommends the same duration for avian influenza precautions. [14]

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Consultations

Consultation with an infectious disease expert is recommended.

Intensive care specialists need to be involved to manage severe disease.

Ultimately, the WHO and/or CDC should be contacted; the CDC can safely perform testing for suspected avian influenza strains.

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Prevention

No vaccine is currently available to the public for routine immunization, although two adjuvanted influenza A (H5N1) monovalent vaccines have been approved by the FDA for H5N1 influenza A.

The AS03 adjuvant vaccine (GlaxoSmithKline) is a 2-component monovalent vaccine. It is supplied as a vial of inactivated, split-virion, A/H5N1 influenza antigen suspension and a vial of AS03 adjuvant emulsion that must be combined before IM administration. Each 0.5-mL dose contains 3.75 mcg hemagglutinin (HA) of the influenza virus strain A/Indonesia/05/2005 (H5N1). [16]

The MF59 adjuvant (Audenz; Seqirus Inc) is a ready-to-use emulsion. Each 0.5-mL dose contains 7.5 mcg HA of the H5N1 influenza virus strain A/turkey/Turkey/1/2005. [17]

Each vaccine is approved for patients aged 6 months or older and is administered as a 2-dose series given at least 21 days apart.

Prophylactic antivirals are not indicated for patients who plan to travel to areas where avian influenza has been reported. Travelers who plan to travel to areas of the world affected by avian influenza outbreaks in birds and/or humans are advised to avoid close contact with poultry, especially diseased or dead birds, and to consume only adequately cooked meat. If contact with birds in enclosed spaces is unavoidable, an N-95 respirator mask (or equivalent), gloves, and goggles should be used to minimize contact with droplets or particulates. PandemicFlu.gov details more specific travel recommendations.

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