Information for Workers Exposed to H5N1 Bird Flu

Overview

This H5N1 bird flu virus has been found at high levels in the milk of infected dairy cows. It has also been found in the lungs, muscle, and udder tissue of infected dairy cows. This virus has been spreading among dairy cows in multiple U.S. states and has also been found in poultry flocks. It is widespread in wild birds and has been found in some mammals, including cats. Symptoms in animals vary, with high death rates in poultry but often mild symptoms in cows, including coughing, sneezing, runny eyes or nose, or lack of appetite.

Although H5N1 bird flu usually does not infect people, there have been some infrequent cases of human infection. Confirmed cases detected in the United States to date have all been mild. However, symptoms in people can range from no or mild to severe, including death. If you work with animals or materials that could be infected or contaminated with H5N1 bird flu, you can take steps to reduce your risk of getting sick. Consult your supervisor or your employer's health and safety committee to determine how best to apply these recommendations.

How it spreads

This virus could spread from animals to people in several ways:

• If you touch something contaminated with the virus and touch your eyes, nose, or mouth
• If a liquid contaminated with live virus splashes into your eyes (like raw cow's milk from an infected cow, for example)
• If you eat, drink, or inhale droplets contaminated with virus
• If you handle sick or dead barn cats or other animals infected with the virus

Symptoms can include:

• Eye redness (conjunctivitis)
• Mild flu-like upper respiratory symptoms
• Pneumonia requiring hospitalization
• Fever (temperature of 100°F [37.8°C] or greater) or feeling feverish*
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue
• Shortness of breath or difficulty breathing

Less common signs and symptoms include diarrhea, nausea, vomiting, or seizures.

*Fever may not always be present

Prevention steps and strategies

When you are not wearing personal protective equipment (PPE), avoid direct or close physical contact with:

• Any animals that are or might be sick, including birds, dairy cows, and other livestock
  • Feces, urine, or litter from these animals
  • Raw (unpasteurized) milk from these animals
• Any animals that have died, including birds and livestock
• Viscera or udders from lactating dairy cows
• Surfaces and water (for example, ponds, waterers, buckets, pans, troughs) on farms with potentially infected animals that might be contaminated with animal waste or waste milk

Wear PPE

Wear PPE when in contact with or around dairy cows, raw milk, other animals, or surfaces and other items that might be contaminated. You may need more PPE than what you use for your normal duties. Your employer should provide the recommended PPE at no cost. Ask your supervisor if you have questions about what type of PPE to wear or when or how to use it. Putting on and removing PPE should occur during work hours.

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Before putting on PPE

• Leave food and clean personal clothing and items, food, and drinks in clean areas provided by your employer.
• Follow directions from your employer for entering and leaving the worksite.
• Use separate designated areas to put on ("clean") and remove PPE ("dirty").
• Wash your hands for 20 seconds with soap and water or, if not available, use an alcohol-based hand sanitizer.

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While wearing PPE

• Avoid touching yourself above your chest, especially your eyes, mouth, or nose, after touching any contaminated material
• Do not eat, drink, touch your phone, smoke, vape, chew gum, dip tobacco, or use the bathroom
• Work in pairs and pay closer attention to your surroundings for hazards such as animal movement
• Protect yourself from heat stress
  • Learn the symptoms and risk factors, first aid, and prevention for heat-related illness.
  • Work with a buddy and observe each other for signs of heat-related illness.
  • Take frequent breaks to rest and hydrate in a cool clean area after removing dirty PPE. This is important because removing PPE to take a drink while you are still working could exposure you to virus that could make you sick.
  • Stay hydrated and avoid alcohol and drinks with high caffeine or sugar.
  • Understand how certain medicines may increase the risk of heat-related injury and talk to a healthcare worker for help.

Removing PPE

• Remove PPE before entering any clean areas including restrooms, breakrooms, and administrative areas
• Set aside reusable PPE for cleaning and disinfection and throw away disposable PPE according to your employer's guidance

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After removing PPE

• Clean and disinfect reusable PPE based on guidance from your employer.
• If possible, shower at the end of the work shift and put on clean clothing. If there are no showers at work, clean up as much as possible, put on clean clothing, and go straight from work to shower.
• Leave all contaminated clothing and equipment at work to be cleaned.

Observe your health daily, even if you followed all instructions for PPE. If you get any new symptoms of illness while working with confirmed or potentially infected animals or confirmed or potentially contaminated byproducts or surfaces and during the 10 days after your last exposure:

• Stay home and stay away from others as much as possible until you know whether you have H5N1 bird flu. If you have H5N1 bird flu, stay home and away from others until you feel better.
• Tell your supervisor and medical provider, and they will help you contact your state/local health department.
• Your health department will help you determine what to do next and may test you for H5N1 bird flu.
• A medical provider may prescribe medication that is used for treatment of flu (antiviral medication). It is important to follow the directions for taking the medication.

Know your rights

Federal law entitles you to a safe workplace. Your employer must keep your workplace free of known health and safety hazards. You have the right to speak up about hazards without fear of retaliation. See the Occupational Safety and Health Administration's Worker Rights and Protections page for more information.