Human Health Issues related to Avian Influenza in Canada

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Appendix C: Sample Avian Influenza (H7N3) Outbreak Laboratory Testing Recommendations for Investigation of Human Cases Associated with Domestic Avian Influenza Outbreaks

[based on BC Avian Influenza (H7N3) Outbreak Laboratory Recommendations, 2004]

These sample recommendations are intended to serve as a starting point for jurisdictions dealing with an outbreak of avian influenza and planning an investigation of possible human cases which may arise from the domestic outbreak in birds. Other jurisdictions, not directly affected by the outbreak, are encouraged to refer to the sections of the Canadian Pandemic Influenza Plan that correspond to the pandemic phase (e.g., Canadian Phase 1.0 or 2.0) as indicated by the epidemiological findings from the outbreak.

Recommendations from the Respiratory Infections Surveillance Committee, 2004 (RISC^[27]):

1. Persons with a history of exposure to infected poultry, potentially infected poultry or contaminated surfaces who develop a fever, conjunctivitis or respiratory symptoms should have a respiratory sample (e.g., nasopharyngeal swab or aspirate) collected and forwarded to the provincial laboratory.

2. Conjunctival swabs in addition to NP (nasopharyngeal) swabs should be collected on all symptomatic individuals even if eye-related symptoms are absent at the time of presentation.^[28]

3. Swab or nasal wash samples should not be taken immediately after exposure. Waiting at least 12 hours is recommended to avoid positive tests due to contamination of mucous membranes as opposed to infection of mucous membranes.

4. Optimally, an acute- (within 1 week of illness onset) and convalescent-phase (2 weeks after collection of acute specimen) serum sample should be collected and stored locally in case testing for antibody to the avian influenza virus should be needed.

5. When only convalescent sera is available, control sera can be used as a baseline to assess titre rise. Details on testing are available from the National Microbiology Laboratory (NML).

6. Due to its higher reported sensitivity, microneutralization techniques are recommended over hemagglutin inhibition techniques. Specifics on use of microneutralization testing are available from the NML.

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