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Introduction ⬇

Asian highly pathogenic avian influenza, called HPAI (H5N1), also known as “bird flu,” is an infectious disease of birds caused by influenza A viruses. Bird flu viruses typically do not infect humans; however, in 1997, several cases of human infection were reported. Since 2003, the most human Asian HPAI cases have been reported from Indonesia, Vietnam, and Egypt. The first report in North America was in in Canada in 2014 after a person traveled to China. There are 16 different hemagglutinin (H) and 9 different neuraminidase (N) protein subtypes of influenza A virus, with many different combinations possible. These viruses are constantly changing, and over time, it has become apparent that they can infect and spread among humans. Influenza H5N1 virus has now been associated with human infection and death. Person-to-person spread is inefficient and, therefore, rare; however, because viruses have the ability to change, this may be a concern in the future.

Procedure ⬆ ⬇

  1. Blood specimen: Obtain 5–10 mL of blood in a serum separator tube.

  2. Nasal specimen: Instill 1–1.5 mL of nonbacteriostatic saline into one nostril and subsequently aspirate with a plastic catheter or tubing. A nasal swab can also be used to obtain a specimen by swabbing both nostrils and placing into a sterile vial.

  3. Sputum specimen: Have patient rinse mouth with water and then expectorate deep-cough sputum into a sterile screw-cap sputum container.

  4. Label specimen with the patient’s name, date, and test(s) ordered and place specimen in biohazard bag and transport to laboratory.

Procedural Alert

Growing the virus in culture is the gold standard for influenza diagnostics. If influenza A H5N1 is suspected, the virus should be cultured under biosafety level 3 (BSL-3) conditions with enhancements for positive identification of subtype.

Clinical Implications ⬆ ⬇

A positive test is consistent with infection; however, identification of the viral subtype is necessary to confirm avian influenza.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain necessity, purpose, and procedure of testing. Assess for and document signs and symptoms of infection (fever, cough, sore throat, and muscular weakness). Note recent travel history to areas known to have avian flu outbreaks or possible exposure to migratory waterfowl, especially wild ducks or domestic poultry, such as chickens or turkeys.

  2. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Review test results; report and record findings. Modify the nursing care plan as needed. Counsel the patient as appropriate.

  2. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal

Negative by hemagglutination inhibition (HAI), IFA staining, or RT-PCR