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In this summary


Risk assessment

  • The risk of influenza A(H5N1) infection to UK residents within the UK is very low
  • The risk of influenza A(H5N1) infection to UK residents who are travelling to Egypt, or other affected areas is very low but may be higher in those with exposure to specific risk factors within the region, such as poultry
  • The level of risk of influenza A(H5N1) infection in those who arrive in the UK from affected areas and meet the case definition is low but warrants testing
  • The probability that a cluster of cases of severe respiratory illness in the UK is due to influenza A(H5N1) is very low, but warrants testing. A history of travel to affected areas would increase the likelihood of influenza A(H5N1)
  • If there is good compliance with guidance on infection control measures, the risk to healthcare workers caring for cases of influenza A(H5N1) in the UK is very low. However, severe respiratory illness in healthcare workers caring for cases of influenza A(H5N1) warrants testing
  • The risk to contacts of confirmed cases of influenza A(H5N1) infection is low but warrants follow up in the 7 days following exposure and urgent investigation of any new febrile or respiratory illness

Advice for travellers

  • No specific restrictions to travel are advised. However, to help reduce the risk of infection NaTHNaC advise that travellers:
    • avoid close or direct contact with live poultry
    • avoid visiting live bird and animal markets (including ‘wet’ markets) and poultry farms
    • avoid contact with surfaces contaminated with animal faeces
    • avoid untreated bird feathers and other animal and bird waste
    • do not eat or handle undercooked or raw poultry, egg or duck dishes
    • do not pick up or touch dead or dying birds
    • do not attempt to bring any poultry products back to the UK
    • maintain good personal hygiene with regular hand washing with soap and use of alcohol-based hand rubs
  • Travellers to affected areas should be alert to the development of signs and symptoms of influenza for 7 days following their return. It is most likely that anyone developing a mild respiratory tract illness during this time is suffering from seasonal influenza or other commonly circulating respiratory infection. However, if they become concerned about the severity of their symptoms, they should seek appropriate medical advice and inform the treating clinician of their travel history

Advice for clinicians and health professionals

  • Clinicians should retain a high level of suspicion of influenza A(H5N1) when managing patients with confirmed or suspected influenza A and a history of travel to affected areas in the 7 days before the onset of symptoms
  • Guidance on the public health management of possible cases and their contacts is available on the PHE website. Contact the local health protection team to discuss possible cases and testing criteria
  • The local PHE Public Health Laboratory can provide advice on arranging testing for influenza A due to H5/H7
  • Guidance for the initial management of possible cases of avian influenza in primary care is available on the PHE website

Case definition for possible cases of A(H5N1)


  • Fever ≥38°C and lower respiratory tract symptoms (cough or shortness of breath) or chest X-ray (CXR) findings of consolidation or acute respiratory distress syndrome (ARDS)


  • Other severe illness suggestive of an infectious process


Exposure within 7 days of the onset of symptoms, consisting of:

  • Close contact (within 1 meter) with live, dying or dead domestic poultry or wild birds, including live bird markets, in an area of the world affected by avian influenza A(H5N1), or with any confirmed A(H5N1) infected animal*
  • Close contact (providing care/touching/speaking distance within 1 meter) with human case(s) of severe unexplained respiratory illness, unexplained illness resulting in death from listed areas*

* Countries with outbreaks within the past 12 months listed at: Update on avian influenza in animals (types H5 and H7)

full guideline from…

Public Health England. Risk assessment of avian influenza A(H5N1). March 2015 (updated January 2019).
First included: September 2015, updated January 2019.