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Isolation precautions in health care facilities


* Patients should be treated with a combination of standard, contact, droplet, and airborne isolation precautions.+


* Patients should be housed alone in a negative-pressure room, if available, or in a single room with the door closed.


* If a single room is not available, patients should be housed in designated multibed rooms or wards. The beds should be at least 1 m apart and preferably separated by a physical barrier.


* High-efficiency masks (NIOSH-certified N-95 or equivalent), long-sleeved cuffed gowns, face shield or eye goggles, and gloves are recommended for health care workers.


* When feasible, limit the number of health care workers with direct contact with patients and limit access to the environment of patients. If possible, these health care workers should not look after other patients.


* Restrict visitors to a minimum and give them proper personal protective equipment and instructions in its use.


Health care worker exposures


* Those caring for infected patients should monitor temperature twice daily and report any febrile event. If unwell for any reason, health care workers should not be involved in direct patient care. Health care workers with fever (temperature higher than 38[degrees]C) and patient contact should undergo appropriate diagnostic testing. If an alternative cause is not identified, they should be treated immediately with oseltamivir on the assumption of influenza infection.


* Those who have had a possible exposure to infectious aerosols, secretions, or other body fluids or excretions because of a lapse in aseptic technique should be considered for postexposure chemoprophy-laxis with oseltamivir at a suggested dose of 75 mg once daily for 7 to 10 days.


* Health care workers involved in high-risk procedures (such as aerosol-generating procedures) should consider the need for pre-exposure prophylaxis.


Precautions for household and close contacts


* Household contacts should use appropriate hand hygiene, should not share utensils, should avoid face-to-face contact with patients with suspected or proven cases, and should consider donning high-efficiency masks and eye protection.+


* Contacts who have shared a defined setting (household, extended family, hospital or other residential institution, or military service) with a patient with proven or suspected avian influenza A (H5N1) infection should monitor their own temperature twice daily and check for symptoms for 7 days after their last exposure.


* In such persons, postexposure prophylaxis with oseltamivir at a suggested dose for adults of 75 mg once daily for 7 to 10 days is advisable.


* Household or close contacts should receive empirical antiviral treatment and undergo diagnostic testing if fever (temperature higher than 38[degrees]C) and cough, shortness of breath, diarrhea, or other systemic symptoms develop.


Precautions for travelers 1


* Travelers to areas with avian influenza activity should be immunized with the available trivalent human vaccine, preferably at least 2 weeks before traveling.


* Travelers should avoid all direct contact with poultry, including chickens, ducks, or geese that appear to be well, and farms or live-animal markets with poultry, and should avoid touching surfaces contaminated with poultry feces or secretions.


* Travelers should reduce possible exposure by practicing good hand hygiene with frequent handwashing or use of alcohol gels and by not ingesting undercooked eggs or foods from poultry.


* Handwashing is important when handling raw poultry for cooking (such as during cooking classes).


* Travelers should be advised to consult a health care provider if they become ill with fever and respiratory symptoms within 10 days of returning from an affected area.




1. Centers for Disease Control and Prevention. Update: notice to travelers about avian influenza A (H5N1). 2005. [Editor's note: Link removed from site; see]. [Context Link]


2. World Health Organization. WHO interim guidelines on clinical management of humans infected by influenza A(H5N1). 2004. [Context Link]


*These summaries do not present formal World Health Organization (WHO) guidelines, although they contain content from WHO documents. 2 The guidelines are adapted in part from the Centers for Disease Control and Prevention. 1 NIOSH denotes National Institute for Occupational Safety and Health, and N-95 a nonoilproof respirator with at least 95% efficiency in filtering particles with a mean diameter of more than 3 micrometers. [Context Link]


+The duration of viral shedding in children younger than 12 years of age who have human influenza can last up to 21 days and also may be protracted in children and adults with avian influenza A (H5N1), so that infection-control precautions should be maintained for at least 7 days after the resolution of fever or possibly up to 21 days. [Context Link]