Human Health Issues related to Avian Influenza in Canada

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Appendix G: Sample Farmer Information Letter

Dear Poultry Farmer -
Please also share this information with your family, crew, co-workers & employees -

Avian Influenza - Important Health Information for Poultry Farmers, their Families and Employees

I. What is avian influenza?

Influenza (‘flu") viruses that infect birds are called avian influenza viruses. These viruses are related to but different from human influenza viruses. Some avian influenza viruses are called "highly pathogenic" because they can cause severe outbreaks of "bird flu" or "chicken flu" in poultry that can spread quickly between flocks.

II. What is the cause of avian influenza outbreaks in BC in 2004?

A "highly pathogenic" avian influenza virus is currently causing illness in poultry flocks in the Fraser Valley. This virus belongs to the H7 subtype of influenza virus and is called H7N3. H7 subtypes of avian influenza have caused serious outbreaks in poultry before. In the Netherlands, an outbreak of a "highly pathogenic" H7N7 avian influenza virus led to the depopulation of 30 million birds during the spring and summer 2003.

It is likely that wild waterfowl such as ducks or geese are the original source of outbreaks of avian influenza in poultry. Waterfowl are known to be infected with many different avian influenza viruses and they can shed these viruses in their feces even if they are not ill. Commercial and domestic farms may be contaminated as waterfowl migrate. The spread of the avian influenza virus from farm-to-farm thereafter may occur in many different ways including contaminated vehicles, equipment or surfaces (such as boots or clothing) or by infected people.

III. Can avian influenza viruses cause infections in humans?

Only a few avian influenza viruses have been known to cause illness in people. This likely occurs by direct contamination of the eyes, nose or mouth or by contaminated hands, or by breathing in virus released into the air of a confined space. Such infections have been reported with "highly pathogenic" H5 and H7 subtypes of avian influenza viruses. H5 avian influenza viruses have caused widespread poultry outbreaks in Asia and people have died from severe illness as a result of close contact with infected birds.

Human illness due to H7 occurred in the Netherlands in 2003 in people who had close contact with infected birds. In some cases, infected people also passed it on to their household or other close personal contacts. Most people who got avian influenza due to H7 in the Netherlands had mild illness, but one person died. The H7 strain of avian influenza affecting birds in the Fraser Valley has also caused mild illness, such as red eyes, cough, sore throat and runny nose in people who have had close contact with infected birds.

IV. Why is it so important to prevent avian influenza infections in people?

It is very important to prevent infections due to avian influenza viruses in people, even if it seems like it is only a mild illness. The reason for this is because influenza viruses are very changeable. Sudden mutations in the virus can lead to severe illness, even if the virus only caused mild symptoms initially. Also, if a person is infected with an avian influenza virus and with a human influenza virus at the same time, the two viruses can mix and exchange information so that the bird virus can learn how to spread easily from person to person. When these changes occur, there is a risk that large scale outbreaks (or "pandemics") of severe disease in people could get started. For this reason it is very important to prevent any infection due to avian influenza virus in people. Poultry farm operators, their families or their employees are of greatest concern to us, because they might have close unprotected contact with infected birds and can then be the link between poultry outbreaks and outbreaks in people.

Avian Influenza - Protect Your Farm and Your Family

1. Follow strict hygiene measures after contact with poultry, manure or contaminated surfaces. Wash your hands frequently with soap and water for at least 30 seconds and avoid touching your eyes, nose or mouth with your hands.

2. Reduce the amount of time you spend in close contact with potentially infected poultry or manure. By close contact, we mean minimize direct handling or sharing the same confined airspace as the birds or manure. Elderly people, children, & persons with chronic or immune-compromising conditions should avoid any contact with potentially infected poultry or manure. Persons with flu-like symptoms should avoid contact so as to minimize the chance that human and bird influenza viruses could mix.

3. When in close contact with potentially infected poultry or manure, wear protective equipment:

• Disposable gloves or heavy duty rubber work gloves that can be disinfected should be worn. Remove gloves promptly after use and before touching non-contaminated items or surfaces and wash your hands immediately with soap and water for at least 30 seconds.
• Protective clothing, preferably disposable and impermeable outer garments or coveralls should be worn.
• Open wounds or sores should be covered.
• Disposable head or hair cover should be worn.
• Disposable protective shoe covers are preferred but if not available, wear rubber or polyurethane boots that can be cleaned & disinfected.
• Disposable masks (N-95, fit-tested) should be worn. Safety goggles should be worn to protect the eyes.
• After use, disposable personal protective equipment should be double-sealed in plastic bags and discarded as directed by the Canadian Food Inspection Agency.
• Non-disposable equipment or apparel should be cleaned of any soil, manure or other organic matter and then disinfected before being introduced into a non-contaminated environment. Utmost caution should be followed during the cleaning or disinfecting procedure including wearing of gloves, outer garment and goggles to prevent splash of infected material.

4. Farmers, families, crews, employees or visitors should restrict their movement between avian influenza infected and non-infected farms. Shoes or other potentially contaminated clothing worn near or in barns with infected (confirmed or where there has been unusual bird illness or die-off) poultry, manure or products should ideally not be worn off that immediate site, and if so, only after thorough cleaning and disinfection. Farmers, employees or crews from infected farms should not visit, travel to or from or work on non-infected farms and any visitors to infected farms should be restricted until the farm is officially cleared. A process for cleaning & disinfecting shoes of unexpected visitors should be in place for when they leave the premises.

5. During this outbreak, poultry farm workers, their families and employees who may have close contact with any poultry should receive this year's influenza vaccine as soon as possible. This is to prevent infection with human influenza viruses that are still known to be circulating in BC as of April 2004. This vaccine is free to you and can be obtained through the local health unit for this outbreak. This vaccine is available free of charge. To find out how to obtain the vaccine, phone Public Health at 1-866-854-5255.

6. Farmers or other persons with close contact with known avian influenza infected poultry or manure (or on a poultry farm in the control zone where there have been unusual illness or die-off amongst birds) should receive a drug called Tamiflu® during their exposure to prevent infection with avian influenza. This drug is available free of charge during this outbreak if you present this letter and a prescription from your doctor. Phone Public Health at 1-866-854-5255 to find out how to obtain this medication. The drug should be continued until the poultry have been removed, barns have been cleaned and manure has been covered for compost or else removed. Other people on poultry farms in the control area who do not have close contact with infected or ill birds or possibly contaminated manure should watch closely for flu-like symptoms in themselves and seek immediate medical care should they occur. If you are uncertain about your own risk or possible exposure, please contact Public Health at 1-866-854-5255 for advice.

7. Watch for red, itchy or burning eyes or flu-like symptoms (i.e., cough, runny nose, sore throat, feverishness or aches) starting within one week of exposure to poultry, manure or contaminated surfaces or contact with other ill persons who may have had this kind of exposure. If these symptoms develop seek medical care immediately and notify the health care provider of your possible exposure before arriving at his/her office so he/she can take proper precautions. Take this letter with you and request that he/she contact the local Medical Health Officer for detailed information on testing and early treatment with Tamiflu®. You should also report your symptoms to Public Health at 1-866-854-5255 directly. You will receive instructions on how to limit the risk to your household or other close personal contacts. Except for visiting your physician, stay home and minimize contact with others until you are advised by Public Health that you can resume normal activities (usually until 24 hours after symptoms have completely cleared).

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