What is avian flu and how do we protect people from it in the UK? – UK Department of Health and Security

Avian influenza (avian flu) is an infectious disease affecting birds caused by the influenza A virus. Birds are hosts to a variety of influenza virus subtypes, especially waterfowl and coastal birds. All birds are susceptible to avian influenza, and the virus can rapidly cause serious mortality in flocks, although some bird species show more severe clinical signs than others.

Influenza viruses found in birds are not well adapted to infecting humans, and human infections by avian influenza viruses are rare. However, some subtypes, such as A(H5N1) or A(H7N9), are associated with human disease, usually in people who have been directly exposed to infected birds or animals.

Over the past few years, one particular virus, influenza A (H5N1), has come to dominate bird infections in the Western Hemisphere. Animal outbreaks have occurred among mink and marine mammals worldwide. In recent months, the disease has spread among dairy cattle in the United States, and there have been human cases in people working on farms with infected cows. A(H5N1) and A(H5N5) have been detected in both wild and captive-bred birds in the UK this season.

Human symptoms and risk levels

Symptoms of avian influenza in humans vary. Current human infections in the United States are so mild that conjunctivitis (red, sore, and discharged eyes) is common. However, the infection can be serious. For example, there have been a number of individuals in Cambodia and, more recently, individuals in Canada who have experienced severe illness.

Almost all cases of A(H5N1) virus infection in humans are associated with close contact with infected live or dead birds, mammals, or contaminated environments. Influenza A(H5N1) continues to infect new mammals (from foxes, otters, and seals to cattle) and spread among them, increasing the opportunity for the virus to evolve.

The concern is that these changes in the virus could make it easier for it to spread between people at some point. We are therefore alert to and continually review any evidence of changes in risk levels. However, latest evidence suggests that the current risk to the UK population from avian influenza viruses is very low.

Measures to protect humans from avian influenza

UKHSA works with the Animal and Plant Health Agency (APHA), the Department for the Environment, Food and Rural Affairs (Defra), the Food Standards Agency (FSA) and public health authorities in Scotland, Wales and Northern Ireland to monitor the risks of: Human health from new influenza viruses.

Our work contributes to initiatives such as the WHO Global Influenza Surveillance and Response System, helping the world detect and respond to new influenza viruses with pandemic potential.

Our surveillance and diagnostic expertise, combined with our genome sequencing capabilities, is critical to the early detection, assessment and response to emerging health and biosecurity threats, such as avian influenza.

We typically see more avian influenza found in wild birds in the fall and winter, and an increased risk to poultry and other captive birds associated with migratory patterns in waterfowl and environmental conditions that are more favorable for virus survival.

Enhanced Surveillance Program

To increase scientific understanding of the threat of avian influenza to humans, UKHSA runs the Zoonotic Influenza Surveillance Program in humans.

The purpose of this program is to detect potential animal-to-human transmission in people exposed to infected birds (e.g. poultry keepers, people involved in the slaughter of birds in infected commercial and domestic establishments) to better understand whether bird-to-human transmission occurs. The goal is to make it possible. If so, how often does it happen?

Individuals participating in the program will have samples collected via virological nose and throat swabs. The samples are then processed in the UKHSA testing laboratory, with positive samples sent to the WHO-designated National Influenza Reference Laboratory at the Colindale building for genomic analysis. Over 200 participants were recruited, some of whom participated more than once.

If a positive test is returned, the individual will be managed according to UKHSA guidelines. As part of the public health response to the positive findings, our health protection team is tracing all individuals who have been in contact with confirmed human cases of avian influenza.

NHS Surveillance

Alongside this asymptomatic avian influenza surveillance programme, we are working with the NHS to ensure that patients admitted to intensive care with severe acute respiratory infection or with influenza-like illness can be tested for respiratory viruses, including influenza.

UKHSA Public Health Laboratories and Influenza Reference Laboratories carry out additional testing on samples that test positive for influenza A but where normal seasonal influenza is not detected to ensure that the detection is not due to avian influenza.

Monitoring these samples is an important mechanism for early detection of avian influenza and new influenza viruses. For example, in November 2023, a new human case of A(H1N2)v influenza was identified in this way.

People who develop avian influenza infection can become seriously ill, so intensive care units are a good place for disease surveillance. This work fits into a wider surveillance program alongside existing contact management processes where people exposed to birds with avian influenza are monitored by UKHSA health protection teams.

vaccination

The standard seasonal flu vaccine is not expected to protect against avian influenza. However, it is still important for people who are eligible to get the seasonal flu vaccine to protect them from serious illness caused by the flu that circulates each winter.

As part of a long-standing preparedness plan, the government recently purchased more than 5 million doses of human H5 influenza vaccine in case they are needed in a pandemic scenario.

How to avoid exposure

If possible, avoid touching or handling wild birds or their droppings. Keep your distance from wild birds as much as possible and aim to keep a distance of at least 2 meters if possible. If you decide you must handle wild birds, there are several steps you can follow to reduce your risk. Please see the advice posted here.

In England, the public is encouraged to report the discovery of dead wild birds using the online reporting system or by calling the Defra helpline on 03459 33 55 77. Reporting dead wild birds helps Defra and APHA understand the risk of avian influenza and other diseases to different groups of wild bird species and supports UKHSA's understanding of the risk to humans. Further information on APHA surveillance for avian influenza in wild birds can be found in the guideline Avian influenza: Infections of wild birds and wild mammals – GOV.UK (www.gov.uk).

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