1. Put a mask on the patient (surgical is fine). 
2. Get a thorough history (including travel history, occupation, other ill close contacts) and respiratory specimens (nasopharyngeal, throat swab, nasal wash). 
3. Instruct the lab to save all specimens. 
4. Do a rapid test for flu, if possible; otherwise, prep the specimens for overnight shipment to a Laboratory Response Network laboratory maintaining the cold chain. 
5. Call the local or regional health department for assistance. 
6. Determine all staff, visitors, guests, or others potentially exposed during clinic or emergency department triage. 
7. Further intervention and/or evaluation would depend on the situation. 

• Guidance for Monitoring of Avian Influenza (AI) Responders  
  This guidance is for local and regional health departments in Texas that are monitoring individuals who have been involved with an avian influenza outbreak response.  
• AI Monitoring Calls Checklist  
  This is a checklist that may be used by regional and local public health departments that are monitoring individuals who have been involved with an avian influenza outbreak response. 
• AI Demobilized Responder Symptom Tracking Form  
  This form should be completed by the regional or local health department for any monitored individuals who were involved with an avian influenza outbreak.
• AI Responder Notification of Travel Form  
  This form should be completed by the regional or local health department for any individual who was involved with an avian influenza outbreak response who intends to travel within the 10-day monitoring period. 

Avian Influenza Initial Notification of PUI Testing at LRN  
The form should be completed for any person who develops avian influenza symptoms and had a positive initial laboratory testing for influenza. 

Protocol for Laboratory Testing of Symptomatic Responders who Participated in an Avian Influenza Outbreak Response  

This guidance should be used when a symptomatic responder who participated in an avian influenza outbreak response will be tested at a Texas public health laboratory. The guidance covers specimen collection, packaging, and shipping, and recommended laboratory testing.

For complete and detailed infection control guidance please see the CDC’s “Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease”.

Key Points

• Healthcare providers (HCPs), including Public Health and staff at healthcare facilities (HCFs), should use standard, contact, and airborne precautions when dealing with a suspected or confirmed case of infection with avian influenza, including a person symptomatic for avian influenza.  
• Personal protective equipment (PPE) that should be used by HCPs/HCFs includes gown, gloves, goggles, face shield, and N95 respirator or higher.
• HCP must be fit-tested N95 masks.
• When the patient arrives at the HCF, the patient should be placed in airborne isolation (i.e., a negative pressure room or airborne isolation infection room [AIIR]).
• When outside of the AIIR, patients should wear a facemask to contain secretions.
• Public health and the patient’s provider should notify the accepting HCF before the person symptomatic for avian influenza arrives at the facility. 

Guidance for Emergency Medical Services (EMS) Personnel when Responding to and/or Transporting a Person Who May be Infected with Avian Influenza Virus  

• Avian Influenza Initial Case Investigation Form Instructions 
• Avian Influenza Case Investigation Form