Bird Flu: Is Your Dental Practice Prepared?

By Genni Burkhart, Editor

Less than two months before the fifth anniversary of COVID-19's declaration as a global pandemic, the U.S. reported its first human death from avian influenza(H5N1),¹ also known as "bird flu." This viral infection, found in wild birds, is responsible for the nationwide outbreaks in dairy cows and poultry dating back to 2022.

Fortunately, there have been no documented cases of human-to-human transmission² of avian flu so far. Most human exposures have occurred among dairy and poultry workers handling infected animals, prompting the Centers for Disease Control and Prevention (CDC) to classify the public health risk as low. Currently, the CDC is closely monitoring H5 bird flu³ infections through its national surveillance system for any mutations that could impact the risk level.

Given the potential for the H5N1 virus to mutate into an epidemic, it's a good time for dental practices to revisit and strengthen infection control protocols and stay informed on the situation.

A Brief History

The first case of the bird flu, described as the "Fowl Plague," was recorded in 1878 in northern Italy as a contagious and deadly poultry disease. However, the fowl plague wasn't discovered as a type A influenza virus until 1955.⁴

In 1971, influenza viruses were classified based on the antigenic properties of their structural and surface proteins. By 1980, scientists were using this system to classify influenza viruses regardless of the originating species, the same classification system used today.⁴

The term "Fowl Plague" was renamed avian influenza at the First International Symposium on Avian Influenza,⁵ held in 1981.

What are the Risks?

Since the start of 2024, the U.S. has confirmed 66 cases of bird flu,⁶ mostly mild and primarily affecting dairy and poultry workers. However, a few severe cases across North America have raised concern, including a hospitalization in Missouri, a critical case involving a 13-year-old in British Columbia, and a death in Louisiana, the latter two having underlying health conditions that predisposed them to more serious complications.

While the virus has shown a high mortality rate⁶ internationally, experts suggest this may be an overestimate due to underreporting of mild cases or cases not being reported at all. Despite hospitalization and one death, the CDC maintains that the overall risk to the public remains low.

While most human cases have been mild and low risk, infectious disease experts agree that could quickly change. In a recent article in Scientific American,⁷ Michael Osterholm, chair of public health and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, states, "When it comes to bird flu, we seem to live in two separate universes: one where we have a state like California, which has just declared a state of emergency⁸ over bird flu, and then you have the CDC saying it’s low-risk, and they’re both right." Osterholm goes on to explain, "it's much like walking safely along a long, flat field and then suddenly coming upon the edge of a cliff with a mile-high drop. Once one gets past that edge, that’s what a pandemic is. So it’s accurate to say the risk is low right now, but that could change in a heartbeat."

Preparing Your Dental Practice for Bird Flu Risks

Dental practices can minimize potential risks associated with bird flu by implementing the CDC's recommended safety measures.⁹ These steps prioritize the health of staff and patients.

1. Conduct a Hazard Assessment

• Evaluate exposure levels in your practice.
• Identify potential risks and areas for improvement.

2. Implement Engineering Controls

• Ensure proper ventilation systems with clean-to-dirty airflow.
• Maintain regular cleaning of HVAC systems to prevent debris buildup.
• Use air filters or exhaust systems to reduce airborne particles.

3. Establish Administrative Controls

• Monitor staff for flu-like symptoms and maintain health records.
• Encourage seasonal flu vaccinations to reduce overall illness risk.
• Develop clear protocols for managing sick employees.

4. Utilize Personal Protective Equipment (PPE)

• Provide masks, gloves, and eye protection as needed. 
• Be mindful of any possible supply chain issues that could cause problems in stocking PPE.
• Review with staff proper PPE usage to maximize effectiveness.

Proactive measures like these ensure a safer environment for your dental team and patients.

It’s Not a Pandemic, Yet

With flu season upon us,¹⁰ it's even more crucial to practice strict infection control measures. Bird flu symptoms—such as cough, fever, body aches, shortness of breath, fatigue, and headaches—can also resemble seasonal flu and COVID-19 symptoms, making it all the more important to be cautious. Fortunately, most practitioners see infection control as a top priority, given the close, hands-on nature of the work. While the COVID-19 pandemic is behind us, the risk of exposure to dangerous viruses hasn’t disappeared.

Perhaps the recent (re)emergence of human bird flu cases drives home just how crucial the CDC's role is in tracking viruses and spotting mutations that make them more contagious. Time and time again, history has shown¹¹ the devastating impact of viruses when they're ignored, overlooked, or left unchecked.

Author: With over 15 years as a published journalist, editor, and writer, Genni Burkhart's career has spanned politics, healthcare, law, business finance, technology, and news. She resides in Northern Colorado, where she works as the editor-in-chief of the Incisor at DOCS Education.

References:

1. Louisiana Department of Health. (2022, April 13). Louisiana reports first human case and death from avian influenza H5N1. Louisiana Department of Health. https://ldh.la.gov/news/H5N1-death
2. Centers for Disease Control and Prevention. (2023, November 3). Avian influenza: Current situation summary. U.S. Department of Health and Human Services. https://www.cdc.gov/bird-flu/situation-summary/index.html
3. Centers for Disease Control and Prevention. (2023, September 15). Monitoring for avian influenza viruses in humans. U.S. Department of Health and Human Services. https://www.cdc.gov/bird-flu/h5-monitoring/index.html
4. Centers for Disease Control and Prevention. (2023, August 30). Avian influenza: Timeline of events. U.S. Department of Health and Human Services. https://www.cdc.gov/bird-flu/avian-timeline/index.html
5. Easterday, B. C. (2003). Historical perspective of the avian influenza symposium. Avian Diseases, 47(s3), 3–5. https://www.jstor.org/stable/3298792
6. Centers for Disease Control and Prevention. (2023, November 3). Avian influenza: Interim recommendations for prevention of HPAI in humans. U.S. Department of Health and Human Services. https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html
7. Scientific American. (2022, April 28). First human bird flu death in U.S. reported: How worried should we be? https://www.scientificamerican.com/article/first-human-bird-flu-death-in-u-s-reported-how-worried-should-we-be/
8. Office of Governor Gavin Newsom. (2024, December 18). Governor Newsom takes proactive action to strengthen robust state response to bird flu. State of California. https://www.gov.ca.gov/2024/12/18/governor-newsom-takes-proactive-action-to-strengthen-robust-state-response-to-bird-flu/
9. Centers for Disease Control and Prevention. (2023, September 15). Worker protection: PPE recommendations for preventing avian influenza exposure. U.S. Department of Health and Human Services. https://www.cdc.gov/bird-flu/prevention/worker-protection-ppe.html#:~:text=Use%20a%20ventilation%20system%20that,velocity%20airflow%20upon%20building%20occupants
10. Centers for Disease Control and Prevention. (2024, January 5). FluView: Weekly U.S. influenza surveillance report (Week 52). U.S. Department of Health and Human Services. https://www.cdc.gov/fluview/surveillance/2024-week-52.html
11. Science Museum. (n.d.). The bubonic plague: The first pandemic. https://www.sciencemuseum.org.uk/objects-and-stories/medicine/bubonic-plague-first-pandemic