Hawaiʻi Department of Health FAQs on Avian Influenza, H5N1

The Hawaiʻi Department of Health released a list of FAQs on Avian Influenza or H5N1 following confirmation of the virus at a Wahiawā bird sanctuary on on Nov. 15; and a subsequent confirmation of avian flu in a wild duck on Oʻahu earlier this week.

How did this begin?

DOH first received a report of H5 detection in wastewater from the municipal Wahiawā wastewater treatment plant on Nov. 12, 2024. The positive sample had been collected on Nov. 7, and was tested as part of routine wastewater testing conducted by CDCʻs National Wastewater Surveillance System. The detection was made in wastewater as it exited the sewer pipes and before being treated at the wastewater treatment facility. The methods used for routine wastewater testing can only detect one part of the influenza virus, the H5 antigen. The test tells us that H5 influenza is present in the wastewater, but cannot tell us whether the virus detected was H5N1, specifically.

Has there been any detection in any other wastewater treatment plant in Hawaiʻi?

Other than the Wahiawā plant, there have been no detections reported to DOH as of Nov. 25, 2024.

What is “bird flu”?

Avian influenza (bird flu) viruses occur naturally in wild birds. Avian influenza A viruses have been isolated from more than 100 different species of wild birds around the world, including ducks, geese, terns, plovers and sandpipers. These viruses are very contagious among birds and have the potential to cause severe illness among poultry, other animal species and even among humans exposed to the virus. It has the potential to affect common Hawai‘i backyard birds like mynah, bulbuls and zebra doves.

Avian Influenza Type A Viruses | Bird Flu | CDC

Am I at risk from H5N1?

Although the health risk from bird flu viruses is low, the following may place individuals at increased risk of infection:

• Unprotected close or direct contact with sick or dead animals, including wild birds, poultry, other domesticated birds and other wild or domesticated animals.
• Handling the feces, bedding (litter), or materials that have been touched by, or close to, birds or other animals on a farm with suspected or confirmed H5N1 infection.
• Consuming raw, unpasteurized milk or other dairy products.

How do I know I’ve been infected?

Symptoms of avian influenza in humans usually develop within two to five days of exposure but can take up to 10 days to develop in some cases. Symptoms that are associated with bird flu infection in humans are typically mild and may include fever, cough, sore throat or conjunctivitis (“pink eye”). Avian influenza in humans can be treated with antiviral drugs, prescribed by health care providers.

If you have symptoms and a known exposure within the past ten days, contact your primary care provider for evaluation and testing, as well as the DOH Disease Reporting Line at 808-586-4586 for further guidance (calls answered 24/7). Also, call if you’ve experienced symptoms that have since been resolved. Health care providers can submit specimen samples to Hawaiʻi’s State Laboratory Division (SLD) for bird flu testing.

What if I have become infected with bird flu?

It is recommended that infected individuals should stay at home and away from others, including household members, except for when seeking medical evaluation. If you need to leave home or are not able to fully isolate from others, wear a mask and increase your hand hygiene (soap and water for at least 20 seconds) to prevent the spread of the virus.

Treatment for bird flu infections in humans is available. A health care provider might prescribe an antiviral medication for you that is used for treatment of seasonal flu. These drugs can also be used to treat an avian influenza virus infection. It is important to start antiviral treatment as soon as possible and to follow the directions for taking all of the medication that is prescribed.

Is there an H5N1 vaccine for humans?

The Centers for Disease Control and Prevention (CDC) has done the preliminary scientific work that would enable it to produce vaccines, if needed, to protect against the strain of avian flu currently circulating on the U.S. mainland (clade 2.3.4.4b). However, there is no vaccine currently in production. Regular seasonal flu vaccines do not provide protection against avian influenza A viruses, but getting the seasonal flu vaccine lowers the chance of a person becoming infected with seasonal flu and H5N1 at the same time. That’s important because it makes it harder for the virus to undergo reassortment, which could make avian flu better adapted to spread in people. 

Should I remove or turn in dead or sick birds?

If you need to remove a dead wild bird on your property, wear disposable gloves or turn a plastic bag inside out and use it to pick up the carcass. Double-bag the carcass and throw it out with the regular trash. Wash your hands and disinfect your clothing and shoes after handling a dead wild bird. Be mindful of any health symptoms that may develop afterward. For more information, visit: https://www.aphis.usda.gov/sites/default/files/fs-hpai-dead-wild-bird.508.pdf

What is the risk right now?

For the moment, the risk to the general public remains low. There have been a small number of human cases reported in the continental US, mostly among people working closely with infected animals. Human illnesses in the US have been mild and self-resolving, primarily conjunctivitis or mild respiratory symptoms.

Why is this a public health concern in Hawaiʻi?

Influenza viruses undergo genetic reassortment, or change, as they spread between different animal species and humans. There is a risk that the H5N1 or other avian influenza viruses might change to spread more easily among humans, potentially leading to a pandemic. Therefore, it’s extremely important to adopt avian influenza prevention practices, monitor for animal and human infections and detect the development of any person-to-person spread as early as possible.

Who is at greatest risk from the virus?

H5N1, even in its current form, can have a much greater impact on agricultural operations. For poultry farms, when infected birds are found, the whole flock needs to be culled to contain the infection and keep it from spreading to other birds. These measures are of course incredibly disruptive to farm operations and livelihood.

It is important to protect people who work closely with animals that are susceptible to infection, such as poultry farm workers. These are the people at highest risk of getting infected. DOH, HDOA and USDA have been working closely together over the past few months to plan for such a scenario. HDOA also is working with the University of Hawai‘i College of Tropical Agriculture and Human Resilience to assist in outreach to poultry farms.

Is it safe to eat eggs from local farms?

Yes, it is safe to eat eggs from Oʻahu farms. There have been no reports of sick birds on any commercial farm in Hawaiʻi. The likelihood that eggs from infected poultry are found in the retail market is low and proper storage and preparation reduce further risk.

What is DOH doing to protect the general public?

DOH, in partnership with HDOA, the US Department of Agriculture and the Centers for Disease Control and Prevention, is reinforcing longstanding efforts to detect avian influenza disease in birds, cattle and humans in Hawaiʻi. This includes:

• Monitoring wastewater, human influenza infections detected in the laboratory, and emergency department visits for influenza as tracked on the Hawaiʻi Respiratory Disease Activity Summary dashboard;
• Participation in the National Poultry Improvement Plan with routine sampling of chickens at the state’s largest poultry farm;
• Participation in US Geological Survey (USGS) collection and testing of wild bird specimens;
• Testing of any lactating cows being brought into the state;
• Working with federal, state and county agencies to provide updated information to the public in a timely manner.

Do we need to get rid of all those feral chickens?

At this point, the best defense against the avian flu is to avoid interacting with feral chickens and wild birds as much as possible. Generally, if the chickens appear healthy and are behaving normally, the risk is probably lower. However, if you find several dead or dying birds in a particular area, please report it as soon as possible to DOH and HDOA. From a medical perspective, it is not clear that a mass culling of feral chickens would appreciably reduce the risk to humans.

For more information: