While the risk of HPAI to the general public is currently low, people who work with wild birds, poultry, cattle, and other farm animals should take steps to reduce their risk of exposure to HPAI and other diseases that affect both animals and people.

Resources for People Who Work with Poultry and Livestock:

• CalOSHA: What Are Employers Required to Do to Protect Workers
• CDC: Information for Workers Exposed to H5N1 Bird Flu English Spanish
• CDC: Interim Guidance for Employers to Reduce the Risk of Novel Influenza A Exposure for People Working with or Exposed to Animals English
• CDC How to Prevent Avian Flu Viruses in People English
• CDFA Biosecurity for Backyard Birds – Simple Tips to Keep Your Small Poultry Flock Healthy English
• USDA Information for Small Ruminant (Sheep and Goat) and Camelid Stakeholders English

What to Do if You See a Sick or Dead Bird:

• If you see a bird that appears sick or that is dead, do not touch it. If you must touch it, wear a mask and gloves. Wash your hands thoroughly with soap and warm water afterwards.
• To report sick or dead wild birds, call the California Department of Fish and Wildlife (CDFW) at 916-358-2790 or visit the CDFW Mortality Reporting website.
• To report sick or dead pet birds or commercial flocks, call the California Department of Food and Agriculture at 866-922-2473. There may be a fee assessed for pet birds and commercial flocks.

A wide range of land and marine mammals have been reported with HPAI A(H5N1) virus infection in multiple countries, typically resulting in signs of disease and death. HPAI A(H5N1) virus infection has been reported in wild mammals such as foxes, bears, seals, and sea lions, and in domesticated animals, including pets such as cats and dogs, farmed mink and foxes, and livestock such as goats and cows.

National:

Click here to visit the Centers for Disease Control and Prevention's (CDC's) website for a summary of current HPAI surveillance in the United States.

Click here to visit the United States Department of Agriculture website for information about current HPAI surveillance in wildlife and domestic animals.

California:

Click here to visit the California Department of Public Health's website for information about current HPAI surveillance in California.

For information about location of animal avian influenza detections in California, visit the California Department of Food and Agriculture's Avian Influenza Updates website.

Enhanced Surveillance:

County of Monterey Health Department is conducting enhanced influenza surveillance.  Acute care hospitals should submit the following specimens to the County of Monterey Health Department's Public Health Laboratory for additional testing:

• All influenza A positive patients (inpatient and outpatient who report one of the following exposures in the 10 days prior to symptom onset:
  • Close contact with wild birds, wild animals, domestic poultry, cattle and/or other farm animals; or
  • Close contact with a cat that tested positive for influenza A at a veterinary laboratory; or
  • Close contact with a person who was recently diagnosed with influenza A(H5); or
  • Consumption of raw dairy products.
• All influenza A & B positive patients with severe illness requiring ICU admission.
• All influenza A & B positive patients who expire.
• Influenza A & B negative patients who present with 1) influenza-like illness and/or conjunctivitis and 2) report working on a farm where avian influenza A(H5) has been confirmed.

For more information about summertime enhanced influenza surveillance, please contact the Health Department's Epidemiology & Surveillance Unit at 831-755-4698.

Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Avian Influenza:

• Consider avian influenza A infection in a patient with:
  1. Signs and Symptoms consistent with acute respiratory tract infection or conjunctivitis,
  2. Exposure in the lat 10 days to animals or people with suspected or confirmed avian influenza A infection.
• If a case is suspected, immediately mask the patient and place them in an airborne infection isolation room (AIIR) with the door closed, white in the AIIR, the patient's mask may be removed.
• If an AIIR is not available, place the patient in a single-patient room with the door closed and have the patient remain masked.
• Use personal protective equipment that includes:
  1. Respiratory protection (fit-tested N95 respirator or higher level protection)
  2. Eye protection (goggles or face shield)
  3. Gown and gloves
• Use diligent hand hygiene before and after contact with the patient.
• Limit room entry to essential personnel.  Limit transport of patient outside their room.
• If an non-AIIR is used, after the patient leaves, the room should not be reused and unprotected individuals should not enter until sufficient time has elapsed for enough air changes to remove potential infectious particles, per CDC guidance.  For example, in a patient-care area with 6 air exchanges per hour, the time to removal of airborne contaminants with 99.9% efficiency is 69 minutes.

Testing for Suspected Avian Influenza:

• Contact the County of Monterey Health Department's Communicable Disease Unit immediately if you suspect your patient has avian influenza by calling 831-755-4521 during business hours or 831-755-5100 outside of normal business hours.
  
• Specimens should ideally be collected within 24–72 hours of symptom onset and no later than 10 days after symptom onset.
• Respiratory specimens should be collected from people experiencing any symptoms potentially associated with avian influenza A. 
  1. Collect a nasopharyngeal swab AND if feasible, also collect separate nasal and oropharyngeal swabs combined in a single transport media vial. 
  2. A conjunctival swab should also be collected from anyone experiencing conjunctivitis. A conjunctival swab MUST be paired with a nasopharyngeal swab even if the person does not have respiratory symptoms.
  3. Specimens should be collected using swabs with synthetic tips (e.g., polyester or Dacron®) and an aluminum or plastic shaft.
  4. Swabs with cotton tips and wooden shafts are NOT recommended.
  5. Specimens collected with swabs made of calcium alginate are NOT acceptable. 
• Swabs should be placed in specimen collection vials containing 2–3ml of viral transport media (VTM) or universal transport media (UTM).
• Specimens should be refrigerated or frozen after collection. Refrigerated specimens should be transported to the public health lab on cold packs. Frozen specimens should be transported on dry ice.

See below for additional infection control recommendations.

Other Resources for Healthcare Providers:

• California Department of Public Health (CDPH) CAHAN: IHealth Update: Updated Guidance on Recommended Specimens for Human Avian Influenza A(H5N1) Testing - April 2, 2025
• California Department of Public Health (CDPH) CAHAN: IHealth Update: Evaluation and Testing for Human Avian Influenza A(H5N1) Infection - December 16, 2024
• Centers for Disease Control and Prevention's (CDC's): IInterim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease
• California Department of Public Health (CDPH): Avian Influenza Information for Healthcare Professionals
• County of Monterey Health Department: Public Health Laboratory's Interim Guidance on Testing and Specimen Collection for Highly Pathogenic Avian Influenza A(H5N1) - April 12, 2024

• CDPH: Testing and Management of Cats for Influenza: Guidance for Veterninarians- February 10, 2025

• CDC: Considerations for Veterinarians Evaluating and Handling Cats Potentially Exposed to HPAI A(H5N1) Virus- April 12, 2024