FDA grants enforcement discretion for use of conjunctival swabs to test for bird flu in humans

The Food and Drug Administration last week granted enforcement discretion for the use of conjunctival swabs by laboratories as part of human testing for H5N1 bird flu, as two human cases only showed symptoms of conjunctivitis before confirmation. For patients that meet the Centers for Disease Control and Prevention's epidemiologic criteria and either clinical or public health response criteria for testing, local laboratories must submit the conjunctival swabs along with nasal swab samples to state laboratories. Conjunctival swabs must be collected and transported using the same media as the paired nasal swabs used with the current kit authorized by the CDC.   
 
Yesterday, a third confirmed human case of H5N1 bird flu — a second dairy farm worker in Michigan — was announced by the CDC. The individual worked on a farm separate from where last week’s confirmed case was employed. Unlike the previous two cases where only conjunctivitis was reported, this individual also reported upper respiratory tract symptoms including cough without fever, making them the first human case of H5 bird flu in the U.S. to report more typical symptoms of acute respiratory illness associated with flu infection, including type A (H5N1) viruses.