Based on the latest World Health Organization (WHO) standards and recommendations, this 85-page document was developed as a joint project of the Ministry of Health of Ukraine, Gromashevsky Institute of Epidemiology and Infectious Diseases, Mechnikov Anti-plague Research Institute, PATH, the US Centers for Disease Control and Prevention (CDC), and WHO. The guidelines outlined in this report provide recommendations to help Ukrainian health care workers promptly identify, report, confirm, and classify potential cases of avian influenza in humans; analyse data; investigate and respond to cases and outbreaks; and improve other aspects of an early warning system for humans. They address the current and the next stages of pandemic preparedness (phases 3 and 4 of the World Health Organization [WHO] Pandemic Alert Period) and are designed primarily for health care personnel working at sanitary-epidemiological stations. In addition to general recommendations for the human avian influenza surveillance system as a whole, the guidelines include specific sections devoted to communication with the public as well as infection control in health facilities.

Communication aspects of recommendations for institutional surveillance for the occurrence of avian flu at health facilities and an early warning system, include the following:

• Defining and acting on “triggers” for investigation, active surveillance, and response - this section delineates the path of information flow in identified cases and the path and regimens for viral specimen testing in the national health system. The "triggers" are defined in section 13 for both health workers in clinical situations and for public health investigators. For public health investigators, they include reports of excessive wild bird or poultry deaths and rumours from news sources.
• Training health care providers in all oblasts to identify cases according to WHO case definitions and trigger criteria - these are outlined in the document with an accompanying investigation card form for reporting.
• Fostering coordination among veterinary services and other stakeholders - information is included on monitoring high-risk occupational groups (poultry handlers, farmers, healthcare workers,laboratory workers, and mortuary workers) who are to be registered and informed about clinical symptoms of influenza-like illness (ILI), instructed on self-monitoring for illness if they have been exposed to the virus, and provided with the contact details of a designated health care official or health facility.
• Nationwide public education and awareness about risk-reduction methods and reportable events - this may include social mobilisation for the delivery of community messages, particularly to the following groups at risk: villages with suspected H5N1 outbreaks; health care workers involved; poultry market handlers, cullers, farmworkers; veterinarians; hunters; dealers in wild/exotic birds; and zoo workers.

In Annex 1 of the document, the community education message content is given. There is a recommendation that some messages should be delivered by public health workers and medical professionals, particularly those on recognition of avian flu in animals and humans, transmission prevention, and when to seek treatment. The prevention of panic in the case of confirmed presence of the virus is emphasised. Communication methods listed are:

• Newspapers
• Television, radio
• Presentations at schools
• Meetings with health care personnel and trusted and respected religious and political leaders
• Individual consultation of residents seeking advice or recommendation

Dissemination methods include supporting presentations with printed leaflets and brochures for further reference. It is suggested that public health workers adapt the materials to address cultural beliefs about disease and the needs of specific populations. Five pages of messages in question and answer form are included in Annex 1.