The H5N1 bird flu virus has been spreading among dairy cows in multiple U.S. states. This virus has been found at high levels in the milk of infected dairy cows. It has also been found in the lungs, muscle, and udder tissue of infected dairy cows. This virus has also been found in poultry flocks. The virus is also found in wild birds and in some mammals, including cats. Different animals may show different symptoms. The virus is often fatal in poultry. Cows may experience mild symptoms, including coughing, sneezing, runny eyes or nose, or lack of appetite.

Although H5N1 bird flu usually does not infect people, there have been some cases of human infection. Symptoms in people can range from no symptoms to mild or severe symptoms, including death. Confirmed cases found in the United States to date have generally been mild. If you work with animals or materials that could be infected or contaminated with H5N1 bird ?u, your employer should take steps to reduce your exposure. This includes providing personal protective equipment (PPE) for your use in certain situations and training on how to use it safely.

CDC has identified work tasks and settings that may expose you to H5N1 bird flu. These tasks and settings range from low to high exposures. The type of personal protective equipment you should wear depends on the exposure level.

Example work tasks and exposure levels include:

High exposure: work in milking parlors on farms with animals known to be infected with H5N1 bird flu (affected farms) or with sick or dead animals on affected farms
Medium exposures: work with healthy non-lactating animals on farms affected by H5N1, or near affected farms
Low exposures: work that does not involve direct contact with animals, or only includes animal contact in areas without any animals affected by H5N1
Talk with your supervisor or your employer´s health and safety committee to understand your exposure levels and how to best apply these recommendations.

How it spreads
This virus could spread from animals to people in several ways:

If you touch something contaminated with the virus and touch your eyes, nose, or mouth
If a liquid which contains live virus splashes into your eyes (like raw cow´s milk from an infected cow, for example)
If you eat, drink, or inhale droplets contaminated with virus
If you handle sick or dead animals infected with the virus
Symptoms can include:

Eye redness (conjunctivitis)
Mild flu-like upper respiratory symptoms
Fever (temperature of 100°F [37.8°C] or greater) or feeling feverish
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue
Shortness of breath or difficulty breathing
Pneumonia requiring hospitalization
Less common signs and symptoms include diarrhea, nausea, vomiting, or seizures.

Prevention steps and strategies
When you are performing work in medium and high exposure settings you should use PPE. If you are not wearing (PPE) during these work tasks, avoid direct or close physical contact with:

Any animals that are or might be sick, including birds, dairy cows, and other livestock, including
Feces, urine, or litter from these animals
Raw (unpasteurized) milk from these animals
Any animals that have died, including birds and livestock
Internal organs or udders from lactating dairy cows
Surfaces and water (for example, ponds, waterers, buckets, pans, troughs) on farms with potentially infected animals that might be contaminated with animal waste or waste milk
Wear PPE
In medium and high exposure settings, wear PPE when in contact with or around dairy cows, raw milk, other animals, or surfaces and other items that might be contaminated. You may need more PPE than what you use for your normal duties. The type of PPE you need will depend on:

Your work tasks;
If there are confirmed or suspected cases of H5N1 bird flu in your farm or area.
Workers who have a high exposure level will require more PPE than those with medium exposure levels.

Your employer should provide the recommended PPE at no cost. Ask your supervisor if you have questions about what type of PPE to wear or when or how to use it. Putting on and removing PPE should occur during work hours.

Protect Yourself From H5N1 Bird Flu
Before putting on PPE
Leave clean personal clothing and items, food, and drinks in clean areas provided by your employer.
Follow directions from your employer for entering and leaving the worksite.
Use separate designated areas to put on ("clean") and remove PPE ("dirty").
Wash your hands for 20 seconds with soap and water or, if not available, use an alcohol-based hand sanitizer.
While wearing PPE
Avoid touching yourself above your chest, especially your eyes, mouth, or nose, especially after touching any contaminated material
Do not eat, drink, touch your phone, smoke, vape, chew gum, dip tobacco, or use the bathroom
Work in pairs and pay close attention to your surroundings for hazards such as animal movement
Protect yourself from heat stress
Learn the symptoms and risk factors, first aid, and prevention for heat-related illness.
Work with a buddy and observe each other for signs of heat-related illness.
Take frequent breaks to rest and hydrate in a cool clean area after removing dirty PPE. This is important because removing PPE to take a drink while you are still working could exposure you to virus that could make you sick.
Stay hydrated and avoid alcohol and drinks with high caffeine or sugar.
Understand how certain medicines may increase the risk of heat-related injury and talk to a healthcare worker for help.
Removing PPE
Remove PPE before entering any clean areas including restrooms, breakrooms, and administrative areas
Set aside reusable PPE for cleaning and disinfection and throw away disposable PPE according to your employer´s guidance
After removing PPE
Clean and disinfect reusable PPE based on guidance from your employer.
If possible, shower at the end of the work shift and put on clean clothing. If there are no showers at work, clean up as much as possible, put on clean clothing, and shower immediately when you are home.
Leave all contaminated clothing and equipment at work to be cleaned.
Observe your health daily, even if you followed all instructions for wearing PPE. If you get any new symptoms of illness while working with confirmed or potentially infected animals or confirmed or potentially contaminated byproducts or surfaces and during the 10 days after your last exposure:

Stay home and stay away from others as much as possible until you know whether you have H5N1 bird flu.
Tell your supervisor and medical provider, and they will help you contact your state/local health department.
Your health department will help you determine what to do next and may test you for H5N1 bird flu.
If you have H5N1 bird flu, stay home and away from others until you feel better.
A medical provider may prescribe medication that is used to prevent and treat flu (antiviral medication). It is important to follow the directions for taking the medication.