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CDC Health Information for International Travel 2008

Outbreak Notice
Human Infection with Avian Influenza A (H5N1) Virus: Advice for Travelers
This information is current as of today, January 08, 2009 at 23:47

Updated: November 03, 2008

Current Situation

Highly pathogenic avian influenza A virus (also called “H5N1,” “bird flu,” or “avian flu”) has caused serious disease in poultry and wild birds on multiple continents. Humans rarely get sick with H5N1 viruses, but since 2003, close to 400 people in parts of Asia, Africa, Eastern Europe, and the Middle East have become ill and about 63% of these people have died. You can find the most up-to-date information by using the links below:

Most people have become infected with H5N1 through direct contact with sick or dead birds (poultry or wild birds) carrying the H5N1 virus. Direct contact could happen during activities such as―

  • Visiting live bird or poultry markets
  • Preparing or consuming uncooked or undercooked bird products (such as meat, eggs, or blood)

A few people have become infected through close contact with another person who is sick with bird flu, but this is very rare and H5N1 has not continued to spread past one person. CDC expects that outbreaks of H5N1 virus to continue among birds in Asia, parts of Europe, the Middle East and Africa. Because of this, people getting sick with H5N1 from direct contact with infected birds may also continue in countries where birds are infected.

Advice for Travelers

At this time, CDC is not recommending that the general public avoid travel to any of the countries affected by H5N1 viruses. If you are planning travel to an area affected by H5N1, follow these steps to reduce your risk of getting sick:

Before Your Trip

  • Visit CDC's Travelers’ Health Website to learn about any disease risks and health recommendations for areas you plan to visit.
  • See a travel medicine specialist or a doctor familiar with travel medicine at least 4–6 weeks before you leave to answer your questions and make specific recommendations for you.
  • Be sure you are up-to-date with all your routine vaccinations, including a seasonal influenza vaccine. Get any travel-related vaccines that your doctor recommends for you.
  • Pack a travel health kit that contains basic first aid and medical supplies. See the Pack Smart page for suggested items.
  • Know where health-care resources are located in your destination before you leave. For more information, visit Doctors/Hospitals Abroad from the U.S. Department of State.
  • Learn more about preparing for your trip at Your Survival Guide to Safe and Healthy Travel.

During your visit to an area affected by H5N1

Be careful with birds
  • Avoid all direct contact with birds, including poultry (such as chickens and ducks) and wild birds.
  • Avoid touching surfaces that have bird droppings (feces) or other bird fluids on them.
  • Avoid places such as poultry farms and bird markets where live birds are raised or kept.
  • Eat only bird meat or products that have been thoroughly cooked.
    • Egg yolks should not be runny or liquid.
    • Do not eat dishes that contain uncooked (raw) or undercooked bird meat or products (such as eggs and poultry blood).
    • Because influenza viruses are destroyed by heat, the cooking temperature for bird meat should be165°F (74°C).
Practice healthy habits to help stop the spread of germs
  • Wash your hands often with soap and clean water. This removes germs from your skin and helps prevent diseases from spreading.
    • Use waterless alcohol-based hand gels (containing at least 60% alcohol) when soap and clean water are not available and hands are not visibly dirty.
  • Cover your mouth and nose with a tissue when you cough or sneeze, and put your used tissue in a waste basket.
  • If you don't have a tissue, cough or sneeze into your upper sleeve, not your hands.
  • Wash your hands after coughing or sneezing.
  • Follow all local health recommendations. For example, you may be asked to put on a surgical mask to protect others.
Seek medical care if you feel sick
  • If you become sick with a fever plus a cough and sore throat, or have trouble breathing, seek medical care right away. Tell the doctor if you have had contact with sick or dead birds.
  • If you need to find local medical care, a U.S. consular officer can help you locate medical services and will inform your family or friends in the United States of your illness. To contact the U.S. Embassy or consulate in the country where you are visiting:
  • See the information on the page “Know What To Do if You Become Sick or Injured on Your Trip” to help you. You should avoid further travel until you are free of symptoms, unless you are traveling locally for medical care.
A note about health screening
Some countries monitor the health of people arriving from areas affected by the H5N1 virus, usually in airports. This could include asking passengers to fill out a questionnaire or have their temperature taken.

After your return from an H5N1-affected area

  • Closely monitor your health for 7 days.
  • If you become sick with a fever plus a cough, sore throat, or have trouble breathing during this 7-day period, see a doctor. When you make the appointment, tell the doctor the following—
    1. your symptoms,
    2. where you traveled, and
    3. if you have had direct contact with birds or close contact with a very sick person.
  • Do not travel when you are sick, unless you are traveling locally to get medical care. By limiting contact with others as much as possible, you can help prevent other from getting sick.

Concerns about an Influenza Pandemic

All influenza (or flu) viruses can change, and experts are concerned that the H5N1 virus could change and begin to spread easily from one person to another person (known as “sustained human-to-human transmission”). If this were to happen, an influenza pandemic (worldwide outbreak of disease) could begin. Because no sustained human-to-human transmission of H5N1 virus has been reported anywhere in the world, WHO reports that the current worldwide pandemic alert is in Phase 3. CDC remains in close communication with WHO and continues to monitor the H5N1 virus situation in countries reporting bird outbreaks and human cases.

For more information about pandemic influenza, please see the official U.S. government website for pandemic influenza.

Additional Information

For more information, including information about vaccine development for H5N1 influenza, please see the Questions and Answers About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus page.

For more information about avian influenza, see CDC’s Avian Influenza Web site.

For more information about commonly used avian influenza terms, see the U.S. Department of Agriculture’s Avian Influenza Low Pathogenic H5N1 vs. Highly Pathogenic H5N1 Latest Update.

Visit the official U.S. government website for pandemic influenza.

  • Page last updated: November 03, 2008
  • Content source:
    Division of Global Migration and Quarantine
    National Center for Preparedness, Detection, and Control of Infectious Diseases
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