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Introduction: The purpose of this study was to determine the perceived likelihood of emergency nurses reporting to work during an avian influenza outbreak, to consider options if nurses decided not to report work, and to explore Protection Motivation Theory constructs as predictors of reporting to work., Methods: A descriptive, nonexperimental, cross-sectional survey of emergency nurses within the United States., Results: A total of 332 nurses (46%) responded. Most emergency nurses (84%) reported they would report to work (1 in 6 would not). The likelihood of reporting to work differed by education level, nurses' avian influenza information sources, and nurses who had family living with them. Of the nurses who decided not to report to work, the majority were willing to provide health information (90%), administer vaccinations (82%), and triage (74%) neighbors/friends from home. One third of nurses had not attended a disaster-preparedness drill within the past year. Only 20% identified formal training while on the job as a source of avian influenza information. A third of emergency nurses would be worried about getting an avian influenza vaccination because of potential adverse effects. Protection Motivation Theory accounted for almost 40% of the variance of likelihood to report to work, with response costs being the largest predictor., Discussion: Disaster drills, avian influenza job training, and vaccination education are necessary to prepare emergency nurses for an outbreak. The findings support emergency nurses' willingness to work from home if they are unable to report to work. This finding is new and may have implications for disaster planning, staffing, and ED operations., (Copyright © 2014 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.)

Highly pathogenic avian influenza (HPAI) H5N1 is an infectious disease of fowl that can cause rapid and pervasive mortality resulting in complete flock loss. It has also been shown to cause death in humans. Although H5N1 HPAI virus (HPAIV) has not been identified in the United States, there are concerns about whether an infected flock could remain undetected long enough to pose a risk to consumers. This paper considers exposure from an Asian lineage H5N1 HPAIV-infected chicken flock given that no other flocks have been identified as H5N1 HPAIV positive (the index flock). A state-transition model is used to evaluate the probability of an infected flock remaining undetected until slaughter. This model describes three possible states within the flock: susceptible, infected, and dead, and the transition probabilities that predict movements between the possible states. Assuming a 20,000-bird house with 1 bird initially infected, the probability that an H5N1 HPAIV-infected flock would be detected before slaughter is approximately 94%. This is because H5N1 HPAIV spreads rapidly through a flock, and bird mortality quickly reaches high levels. It is assumed that approximately 2% or greater bird mortality due to H5N1 HPAIV would result in on-farm identification of the flock as infected. The only infected flock likely to reach slaughter undetected is one that was infected within approximately 3.5 days of shipment. In this situation, there is not enough time for high mortality to present. These results suggest that the probability of an infected undetected flock going to slaughter is low, yet such an event could occur if a flock is infected at the most opportune time.

In the United States, some 1.7 million agar gel immuno diffusion (AGID) tests for avian influenza (AI) are conducted yearly by various poultry groups, governmental sectors, and private industry. In addition to the AGID test, additional testing includes virus isolations, enzyme-linked immunosorbent assays, real-time reverse transcriptase polymerase chain reactions, and hemagglutination inhibition (HI) tests. HI and neuraminidase inhibition tests are conducted on positive AGID samples to determine the subtype. Directigen, a type of antigen capture test, is used in the field in some cases. If monitoring and surveillance activities give rise to a suspicious test result, the accredited veterinarian and official State laboratory are required to report these to the governmental authorities. A thorough investigation in collaboration with the National Veterinary Services Laboratories (a World Organization for Animal Health--AI reference laboratory), State and Federal veterinarians, and others is conducted. Testing conducted as part of the National Poultry Improvement Plan (NPIP) effectively monitors the status of breeder and multiplier flocks. A new commercial poultry program is being added and will expand NPIP AI testing to all commercial flocks. Private poultry companies conduct additional tests; and in the poultry-producing States, there are active state-wide programs to monitor poultry health. All components of the live-bird market system (source flocks, haulers, dealers, and markets) are tested under the Low Pathogenicity AI Live-Bird Market Program.

Case Description: A 3-month-old red-lored Amazon parrot (Amazona autumnalis autumnalis) was evaluated for severe lethargy., Clinical Findings: Avian influenza virus hemagglutinin subtype H5N2 with low pathogenicity was characterized by virus isolation, real-time reverse transcriptase PCR assay, chicken intravenous pathogenicity index, and reference sera. The virus was also determined to be closely related to a virus lineage that had been reported only in Mexico and Central America., Treatment and Outcome: The chick was admitted to the hospital and placed in quarantine. Supportive care treatment was administered. Although detection of H5 avian influenza virus in birds in the United States typically results in euthanasia of infected birds, an alternative strategy with strict quarantine measures and repeated diagnostic testing was used. The chick recovered from the initial clinical signs after 4 days and was released from quarantine 9 weeks after initial evaluation after 2 consecutive negative virus isolation and real-time reverse transcriptase PCR assay results., Clinical Relevance: To the authors' knowledge, this is the first report of H5N2 avian influenza A virus isolated from a psittacine bird and represents the first introduction of this virus into the United States, most likely by illegal importation of psittacine birds. Avian influenza A virus should be considered as a differential diagnosis for clinical signs of gastrointestinal tract disease in psittacine birds, especially in birds with an unknown history of origin. Although infection with avian influenza virus subtype H5 is reportable, destruction of birds is not always required.

Since 1993, 14 cases of avian influenza from four different states in the U.S.A. have been diagnosed by virus isolation from eight avian species. Only 11 of the 14 avian influenza virus (AIV) primary isolations would have been successful if only the standard protocol for AIV isolation, i.e., inoculation of specific-pathogen-free embryonating chicken eggs (ECEs) by the chorioallantoic sac (CAS) route, had been followed. Primary isolation attempts were negative for AIV in three cases in which ECEs were inoculated by the CAS route; AIV could not be detected by hemagglutinating activity, agar gel immunodiffusion test or negative stain electron microscopy. However, in these three cases, primary isolations of AIV were achieved by inoculation of ECEs into either the yolk sac or onto the chorioallantoic membrane.