CDPH Recommendations for Protecting Dairy Employees from H5N1 Highly Pathogenic Avian Influenza (HPAI)

Bryan Little, Farm Employers Labor Service

April 19, 2024

The California Department of Public Heath has issued the following recommendations for protection of dairy employees over the signature of Kristin J. Commings, Chief of CDPH's Occupational Health Branch:

Employers should take measures to protect workers from avian influenza virus infection if livestock become sick and you suspect or know it to be due to avian influenza infection.

• Respiratory protection and other personal protective equipment (PPE) should be provided to and worn by dairy workers who enter the hospital pen or go into any buildings that currently or previously housed sick or dead animals, carcasses, feces, or litter from potentially infected animals until the buildings have been decontaminated.
• Respirators must be at least as effective as an N95 respirator. Impermeable gloves, indirectly vented goggles (or full-face respirators), boots or boot covers, disposable fluid-resistant coveralls, and disposable head or hair cover should also be provided and worn to prevent infection, particularly for workers who have direct contact with ill cows or their milk. When working in enclosed areas, the Cal/OSHA Aerosol Transmissible Diseases - Zoonotic standard requires that workers wear elastomeric facepiece respirators or powered air purifying respirators (PAPRs) equipped with P100 or HEPA filters.
• Workers must be included in a respiratory protection program that includes medical clearance, training, and fit testing of their respirators. See Cal/OSHA’s publication: Respiratory Protection in the Workplace.
• Consumption of raw milk should be prohibited in the workplace and discouraged outside the workplace.
• If workers are known to have exposures to livestock infected with avian influenza virus, advise them that they will be contacted by their local public health department. Public health officials will monitor an exposed worker for symptoms of illness for several days following the worker’s last possible exposure. Public health officials will also arrange for testing, in collaboration with the farm’s occupational health provider, if an exposed worker develops symptoms suggestive of influenza.
• The most common symptoms of avian influenza in humans include eye redness (conjunctivitis), fever, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue, and shortness of breath or difficulty breathing. If a dairy worker develops any of these symptoms after exposure to avian influenza virus infected animals, they should promptly notify their employer and the local health department (LHD). The local health department will advise the dairy worker on seeking medical evaluation, avian influenza testing, and antiviral treatment. Testing, evaluation, and preventive treatment recommended by CDC, CDPH, or the local health officer for exposed employees must be provided at no cost to the employee and during the employee's working hours.