DATE: 07/22/2024
TO: Healthcare Providers, Healthcare Facilities, Clinical Laboratories, and Local Health
Departments
FROM: New York State Department of Health (NYSDOH) Wadsworth Center and Division of
Epidemiology, Bureau of Communicable Disease Control (BCDC)
The purpose of this advisory is to provide guidance regarding surveillance for influenza (including
highly pathogenic avian influenza A(H5N1)) in patients with severe respiratory illness and the
submission of specimens to Wadsworth Center.
Summary
- In response to the ongoing and extensive global outbreak of highly pathogenic avian influenza
(HPAI) A(H5N1) in wild birds, poultry, and dairy cattle, the Centers for Disease Control and
Prevention (CDC) is encouraging year-round testing for influenza among persons with severe
respiratory illness. - NYSDOH and the CDC request that respiratory samples from persons hospitalized with
laboratory confirmed influenza, particularly patients receiving intensive care unit (ICU) level care,
be promptly forwarded to the Wadsworth Center Virology Laboratory for additional testing,
including subtyping, whole genome sequencing, and antiviral resistance testing. - Laboratories, hospitals, and clinical providers should recognize that adherence to
recommendations for influenza testing and sample submission are important steps for human
HPAI A(H5N1) surveillance in the United States (U.S.), especially during the summer when
influenza testing may not be routine and exposure to poultry, cattle, and swine may increase
during agricultural fair season. - If you suspect a patient has a novel influenza A virus infection based on an influenza A
positive laboratory result in combination with clinical history and exposures, immediately
contact the NYSDOH at 518-473-4439 or 1-866-881-2809 after hours and the local health
department (LHD)1 where the patient resides.
1 https://www.health.ny.gov/contact/contact_information/
Health Advisory: Influenza Testing among Persons with Severe Respiratory Illness
During Periods of Low Influenza Virus Circulation
Please distribute immediately to: Clinical Laboratories, Hospitals, Local Health Departments,
Physicians, Physician Assistants, Nurses, Nurse Practitioners, Facility Staff in The Departments of
Emergency Medicine, Infectious Disease, Infection Prevention and Control, Epidemiology,
Laboratory Medicine, Medical Directors, Directors of Nursing, and all patient care areas
Page 2 of 3
Background
Public health agencies in the U.S. and clinical partners continue to monitor and respond to the global
outbreak of HPAI A(H5N1). As of July 18, more than 100 million poultry have been affected in 48
states in the current U.S. outbreak, the largest domestic outbreak of avian influenza in poultry in
recorded history. Additionally, HPAI A(H5N1) has been detected in more than 163 U.S. dairy cattle
herds in 13 states and sporadically in other animals2
.
The currently circulating strain of HPAI A(H5N1) poses a low risk to the health of the general public.
However, to date, nine human cases of A(H5N1) infection associated with the outbreak in U.S. dairy
cows3 and poultry4 have been reported. While the number of human cases nationally remains small,
influenza viruses are known to be unpredictable and highly mutable with the potential for a rapid
change in tropism and transmission, which is a concern given the extent of spread in birds and novel
detections in dairy cows and other animals.
Please visit https://www.cdc.gov/bird-flu/situation-summary/index.html for the most up-to-date
information.
Recommended actions:
- Submit to Wadsworth Center year-round all positive influenza samples from hospitalized
patients requiring ICU care. - Conduct enhanced influenza surveillance during months when seasonal influenza
incidence is typically low (May through September).
- Continue ordering influenza testing and subtyping on patients with respiratory illness.
- NYSDOH recommends increased levels of clinical suspicion of influenza in patients with
respiratory illness who are at higher risk for contracting avian or novel influenza, such as those
with a history of exposure to dairy cattle, wild birds, poultry, or swine (pigs). - If you have a patient with conjunctival symptoms (with or without respiratory symptoms) and who
is at high risk for contracting avian or novel influenza, such as recent exposure to dairy cattle,
contact the local health department (LHD)5 where the patient resides for testing guidance. If
unable to reach the LHD where the patient resides, contact the NYSDOH Bureau of
Communicable Disease Control at 518-473-4439 during business hours or at 866-881-2809
after hours.
- Submit to Wadsworth Center all influenza positive samples detected in hospitalized
persons NOT requiring ICU care until December 31, 2024, for subtyping, sequencing,
and other specialized analyses, as well as potentially forwarding to CDC for their repository.
- In the event of an outbreak, please contact the NYSDOH at 518-473-4439 for guidance.
Specimen and shipping instructions - Specimens acceptable for influenza testing at Wadsworth Center include nasopharyngeal swabs
(NPs), oropharyngeal swabs (OPs), and nasal swabs (NSs) in viral transport media (VTM) or
universal transport media (UTM). - Flocked swabs are preferred. Sterile Dacron® or rayon swabs with plastic or metal handles may
also be used. Do NOT use cotton or calcium alginate swabs or swabs with wooden sticks. Place
the swab in liquid VTM or UTM. The swabs and media used for routine SARS-CoV-2 or influenza
(polymerase chain reaction (PCR)) testing can be used. Do NOT use saline or dry swabs. - Specimens MUST be kept cool until they reach Wadsworth Laboratory. Refrigerate OR store
specimens in cooler with frozen gel packs until ready to ship. Specimens should be shipped
2 https://www.cdc.gov/bird-flu/situation-summary/index.html
3 https://www.cdc.gov/media/releases/2024/p-0703-4th-human-case-h5.html
4 https://www.cdc.gov/media/releases/2024/p-0715-confirm-h5.html
5 https://www.health.ny.gov/contact/contact_information/
Page 3 of 3
overnight on frozen gel packs. - Specifics regarding influenza specimen collection and shipping to Wadsworth Center can be
found at: https://www.wadsworth.org/programs/id/virology/services/specimen-collection - A shipping manifest from an electronically submitted Remote Order OR an Infectious Disease
Requisition (IDR)6
form requesting influenza testing with subtyping should accompany all
specimens sent to Wadsworth. - For questions about shipping on holidays or weekends, please call 518-474-4177.
- Please ship specimens to:
David Axelrod Institute
Virology Laboratory
Wadsworth Center
New York State Dept. of Health
120 New Scotland Ave.
Albany, NY 12208
Infection Prevention Considerations
Standard, Contact, and Airborne precautions, including the use of eye protection, are
recommended for the collection of respiratory and other specimens and medical evaluation. - Patients with suspected HPAI A(H5N1) infection who present to a healthcare facility should be
placed in an airborne infection isolation room (AIIR). - If a patient presents to a healthcare facility at which an AIIR is not available, the patient should
be instructed to wear a facemask and should be placed in an examination room with the door
closed until discharge or transfer to a facility with an AIIR. - Additional infection prevention and control guidance for healthcare facilities with or without an
AIIR, including additional patient placement information and cleaning and disinfection steps, is
available7
.
NYSDOH appreciates your continued support in this effort to prevent and control influenza, and
the partnership with laboratories, hospitals, and providers to immediately identify and contain
potential human cases of novel influenza in the U.S.
Resources and Questions - Questions regarding submission of specimens to Wadsworth Center can be directed to
wcid@health.ny.gov. - Questions pertaining to enrollment to Wadsworth Center CLIMS for access to remote ordering and
access to electronic test reports can be directed to climsoutreach@health.ny.gov. - General questions about suspected A(H5N1) cases can be directed to the NYSDOH BCDC at 1-
866-881-2809 evenings, weekends, and holidays or by email at BCDC@health.ny.gov. - NYC based clinicians should contact the healthcare provider access line at 1-866-692-3641
- General questions about influenza infection control in hospitals, nursing homes, and diagnostic and
treatment centers can be sent to icp@health.ny.gov - Additional NYSDOH guidance for clinicians regarding Highly Pathogenic Avian Influenza A(H5N1)
is available at: https://commerce.health.state.ny.us/hpn/ctrldocs/alrtview/postings/NY_Advisory_-
_HPAI_Identification_of_Human_Infection_2024_1712853441619_0.0.pdf - General NYSDOH avian influenza information is available at:
https://www.health.ny.gov/diseases/communicable/influenza/avian/
6 https://www.wadsworth.org/programs/id/idr
7 https://www.cdc.gov/bird-flu/hcp/novel-flu-infection-control/?CDC_AAref_Val=https://www.cdc.gov/flu/avianflu/novel-flu-infection-control.htm