High Pathogenic Avian Influenza H7N8 Outbreak in Turkeys — Indiana, 2016

BACKGROUND:  On January 15, 2016, a turkey flock with high pathogenic avian influenza (AI) H7N8 infection was identified on a southern Indiana farm; the next day flocks on nine additional farms were diagnosed with low pathogenic AI H7N8. Because AI viruses can cause human infection, the Indiana State Department of Health (ISDH) implemented health monitoring procedures for exposed farmers and depopulation workers (responders). We assessed the effectiveness of procedures for identifying illness, providing medical evaluation and treatment, and facilitating rapid polymerase chain reaction (PCR) testing of ill responders.

METHODS:  ISDH developed health monitoring guidance based on the Public Health Monitoring Procedures for Avian Influenza Responders released in September 2015 by US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) and the Centers for Disease Control and Prevention (CDC). We measured the proportion of responders reporting illness, median number of days from onset to medical evaluation and from onset to antiviral treatment, and the proportion of ill responders tested for influenza by PCR. Following the response, barriers were identified in discussions with public health agencies.

RESULTS:  Approximately 500 persons from federal, state, and local agencies were involved in response efforts on and off the affected farms; 139 (28%) responders were monitored by ISDH for 10 days after their last exposure. The remaining responders were either state personnel without exposure or USDA/APHIS staff and contractors monitored in their state of residence. Of the 139 monitored, 14 (10%) reported having flu-like symptoms, with a median of 1 day from onset to medical evaluation. Of the 14 with symptoms, 12 (86%) had specimens tested at the ISDH Laboratories. None tested positive for influenza A or B by PCR; 1 of 12 (8%) tested positive for Coronavirus (OC43). None were treated with antiviral medications because symptoms were mild and test results were available within 24 hours. Barriers to health monitoring included delayed receipt of responder lists, inadequate self-monitoring and reporting of symptoms, and a lack of timely notification of public health agencies following identification of ill responders.

CONCLUSIONS: The H7N8 AI outbreak represented the first opportunity to use the USDA/APHIS health monitoring procedures during a coordinated response. We identified several barriers that are cause for concern. Delays in information sharing between animal response and public health agencies suggest insufficient attention to the human health risk. This presents a critical need for improved education and collaboration between animal and human health response teams prior to future outbreaks.