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Avian flu continues to spread in the U.S. and to date there have been four human deaths in the nation. Humans can get this variation of the flu from birds or mammals. The Centers for Disease Control and Prevention (CDC) recommends antiviral medication for infection, which a physician can prescribe, and to notify your local public health department. CDC is currently working on a vaccine.
According to the World Health Organization (WHO), H5N1, an RNA virus (in which the genetic information is stored in the from of RNA as opposed to DNA), was first found in humans in 1997 during a poultry outbreak in Hong Kong. Since 2003, this virus has spread in bird populations from Asia to Europe and Africa, and to the Americas in 2021. It has become endemic in poultry populations in many countries and has recently been found in dairy cows.
Outbreaks have resulted in millions of poultry infections, several hundred human cases and many human deaths worldwide. Between 2003 and March 2024, WHO has recorded 888 confirmed cases leading to 463 deaths. Human cases have been reported mostly from countries in Asia but also in Africa, the Americas and Europe. The Department of Agriculture says it has not only been found in livestock and wild birds but also in wild terrestrial and marine mammals.
While research shows discrepancies in the numbers, as of June 2024 the CDC reports a total of four human deaths from H5N1 in the U.S. since 2022. Three of those deaths were following exposure to dairy cows (reported between April 1, 2024 and May 29, 2024), onedeath was following exposure to poultry (reported in April 2022). Other reports have the number of deaths as high as seven. Human cases have been reported in Colorado, Michigan and Texas.
Mallory Schmitt, epidemiologist and public information officer with San Benito County Environmental Health, told BenitoLink her agency is preparing for H5N1 but said it is not considered highly infectious or pathogenic to humans at this point (the use of highly pathogenic only refers to chicken pathology or the ability for the virus to cause disease in chickens). She said there have been no confirmed human cases in the county and no confirmed cases in wild animals in the county in 2023 or 2024. She added they are working with the agriculture commissioner to ensure safety on poultry and dairy farms. In December 2023 a commercial poultry farm outside of Hollister city limits had waterfowl infections and 5,000 ducks and geese were euthanized. Schmitt said, once birds become infected all animals are culled to prevent further spread.
CDC recommendsthat anyone exposed to H5N1-infected birds, cattle or other animals be monitored for symptoms consistent with the virus starting the first day of exposureday 0 and continuing until 10 days after the last exposure. Monitoring exposed individuals can help to rapidly identify human cases, provide appropriate treatment, prevent onward spread, and help understand the scope of human risk. Between February 2022 and May 2024, at least 9,500 people with potential exposure to HPAI in the United States have been monitored. The median number of days from exposure to illness is 6.5 days according to UC Davis.
As respiratory diseases including COVID-19, SARS, MERS and RSV have been more prominent in the 25 years, highly pathogenic avian influenza (HPAI) A(H5N1) virus, is the latest one to raise public health concerns. H5N1 is an influenza virus while COVID-19 and SARS are corona viruses.
CDC states that exposures includecontact with infected birds (including poultry, wild birds, and backyard birds), livestock (including dairy cows) or other animals; carcasses of birds, livestock, or other animals; feces or litter; raw cow milk; surfaces and water that might be contaminated with animal excretions. UC Davis recommends wearing gloves, goggles and face masks while working with poultry.
UC Davis treats infected individuals in isolation rooms. Care beyond antivirals can include fluid replacement therapy, fever reducing medication, dialysis, supplemental oxygen therapy and the use of a ventilator.
CDC currently recommends treatment as soon as possible with flu antiviral drugs for peoplewith suspected or confirmed H5N1 infection. Antiviral treatment works best when started as soon as symptoms begin. It recommends that people who become ill after being in close contact with infected or potentially infected animals contact the state or local health department and a health care provider right away.
Looking ahead
In Viral Mutation Rates, a paper for the Journal of Virology, Nebot, Mansky et al., state influenza viruses have a relatively high mutation rate that is characteristic ofRNA viruses. The WHO website states the following regarding a potential pandemic:
There will be pandemics in future, but when, where and how they spread is difficult to predict. They can have significant health, economic and social consequences. An influenza pandemic will occur when an influenza virus emerges with the ability to cause sustained human-to-human transmission and the human population has little to no immunity against the virus. With the growth of global travel, a pandemic can spread rapidly.
Whether currently circulating avian, swine and other influenza viruses will result in a future pandemic is unknown. However, the diversity of zoonotic [disease passing from another animal to a human] influenza viruses that have caused human infections necessitates strengthened surveillance in both animal and human populations, thorough investigation of every zoonotic infection and pandemic preparedness planning.
WHOs Pandemic Influenza Preparedness Frameworkimplements a global approach to prepare for the next influenza pandemic.
Vaccines against H5N1 have been given to endangered California condors with success, but according to the CDC there is currently no vaccine for humans, though they are working on it.
CDC has developed H5 candidate vaccine viruses (CVVs) that are nearly identical or, in many cases, identical to the hemagglutinin (HA) protein of recently detected clade 2.3.4.4b avian influenza A(H5N1) viruses in humans, birds and other mammals. These H5 CVVs could be used to produce a vaccine for people, if needed, and preliminary analysis show that they are expected to provide good protection against avian influenza A(H5N1) viruses currently circulating inbirds and other animals.
Updates on CDC knowledge and response to H5N1 can be found here.
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When the COVID-19 booster targeting the XBB 1.5 variant was made available late last summer, the variant was the most dominant in the United States. Within weeks of the booster's introduction, variant JN.1 began to rise and replaced XBB as the dominant virus strain by the end of 2023.
A new study in Clinical Infectious Diseases looks at outcomes among more than 3 million adult Singaporeans who received the XBB booster amid JN.1 virus circulation and finds protection against both infection and serious outcomes.
The study was conducted from November 26, 2023 to January 13, 2024, and assessed COVID-19associated emergency department (ED) visits and hospitalizations, stratified by vaccination status or prior infection. Outcomes among those vaccinated 8 to 120 days prior to infection were compared to people last boosted at least 1 year prior to their XBB dose.
In total, during Singapore's JN.1 outbreak, 28,160 SARS-CoV-2 infections were recorded, including 2,926 hospitalizations and 3,747 ED visits, and the cases were driven by increasing circulation of the JN.1 variant (more than 90% of sequenced viruses).
By the end of the study period, 20.8% (696,344 of 3,340,800) received a bivalent (two-strain) booster; while 3.2% (107,966 of 3,340,800) received an XBB 1.5 booster.
An XBB booster was associated with a 41% reduced risk of JN.1 infection (adjusted hazard ratio [aHR], 0.59). COVID-19associated ED visits were reduced 50% among those with XBB boosters (aHR, 0.50), while hospitalizations were 42% lower (aHR, 0.58).
There was no statistically significant reduction of risk for JN.1 infections, ED visits, or hospitalizations in people vaccinated with a bivalent booster within 8 to 365 days after the shot.
For Singaporeans with prior COVID-19 infections, compared to adults with no history of COVID-19 infection, those infected less than 1 year prior during XBB-predominant transmission had a 35% lower risk of COVID-19associated ED visits (aHR, 0.65) and a numerically lower risk of hospitalization that was not statistically significant.
Those with COVID-19 infections recorded more than 1 year prior had an increased risk of JN.1 infection and COVID-19associated ED visits and hospitalizations.
Our results highlight the benefit of updated booster doses in maintaining relative protection, even during a wave of transmission driven by the emerging SARS-CoV-2 JN.1 variant
"Our results highlight the benefit of updated booster doses in maintaining relative protection, even during a wave of transmission driven by the emerging SARS-CoV-2 JN.1 variant," the authors wrote. "Regular annual boosting remains important in preserving healthcare systems' resilience during COVID-19 endemicity."
In a recent study published in the journal Nature Human Behaviour, researchers used a large, binational cohort (total n = 4,731,778) to investigate the short- and long-term associations between SARS-CoV-2 infections and subsequent adverse neuropsychiatric outcomes. They used exposure-driven propensity score matching to compare their samples outcomes against the general population and individuals with a non-SARS-CoV-2 respiratory infection.
Study: Short- and long-term neuropsychiatric outcomes in long COVID in South Korea and Japan. Image Credit:Kateryna Kon/ Shutterstock
Study findings revealed that COVID-19 survivors were at significantly heightened risk of developing cognitive deficits, insomnia, encephalitis, and at least four other neuropsychiatric sequelae. Specific conditions included Guillain-Barr syndrome (aHR, 4.63), cognitive deficit (aHR, 2.67), insomnia (aHR, 2.40), anxiety disorder (aHR, 2.23), encephalitis (aHR, 2.15), ischaemic stroke (aHR, 2.00), mood disorder (aHR, 1.93), and nerve/nerve root/plexus disorder (aHR, 1.47). Encouragingly, vaccination was observed to attenuate the neuropsychiatric effects of the infection. These results are particularly interesting to clinicians and healthcare policymakers as they imply that the early management of COVID-19 may help their patients short- and long-term mental health.
The severe acute respiratory syndrome coronavirus 2 (SARSCoV2) caused coronavirus disease 2019 (COVID-19) pandemic remains one of the worst disease events in recorded human history, infecting approximately 700 million individuals and claiming more than 7 million lives in the three years since its discovery. Unfortunately for its survivors, the condition has been observed to induce long-term physical and psychological ailments that persist well past the diseases primary infection.
This colloquially termed long-COVID has been loosely defined as a multisystemic illness of persistent or newly developed COVID-19 symptoms or comorbidities that remains present for three or more months following recovery from the primary SARS-CoV-2 infection. Alarmingly, the number of long-COVID patients is estimated to be between 18% and 70% of COVID-19 survivors, with recorded numbers (more than 65 million confirmed patients) assumed to be but a fraction of its undocumented global prevalence. Long-COVID thus represents one of the most oppressive healthcare concerns of the modern age.
Long-COVID is a recently described and, therefore, relatively poorly understood disease. A growing body of research demonstrates the association between long-COVID and neuropsychiatric conditions such as depression, insomnia, anxiety, and cognitive dysfunction, with durations often exceeding six months. Unfortunately, previous studies aiming to evaluate psychiatric risks in COVID-19 survivors versus the general populace suffer from small sample sizes, limited follow-up durations, and, most notably, highly biased hospital-derived cohorts. The outcomes of such studies are confounding, thereby damping Long-COVID management and mitigation efforts.
The present binational (South Korea and Japan) study aims to assess the relative risk of adverse neuropsychiatric outcomes in COVID-19 survivors versus the general populace. It also compares this risk between the former cohort and survivors of another respiratory infection (ARI). For this study, primary exposure comprised the onset of laboratory-confirmed COVID-19 (or ARI), while the primary outcome consisted of diagnosing one of 13 groups of neuropsychiatric disorders.
The study dataset was divided between discovery and validation. The discovery dataset was obtained from the K-COV-N cohort, a population-based, nationally representative summation of the South Korean National Health Information Database (n = 10,027,506). The validation dataset was derived from the Japanese claims-based cohort (JMDC; n = 12,218,680). Both datasets included patient-level age (>20 years), sex, income, medical history, region of residence, and insurance claims data. All participant outcomes were recorded using the World Health Organizations (WHOs) International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes.
The study methodology used exposure-driven propensity score matching to establish baseline-corrected comparisons between COVID-19 survivors and the general populace or ARI. This served the dual purpose of evaluating the robustness of observations and generalizing study findings across the large binational sample cohort.
Statistical analyses included the computation of Cox proportional hazards regression models (adjusted hazards ratios [aHR]) to estimate short-term, long-term, and overall neuropsychiatric risk between included sample subgroups (SARS-CoV-2 infection and ARI), thereby inducing reverse causation. Covariates were accounted for by including Charlson comorbidity indices, smoking status, physical activity levels, alcohol consumption, and body mass indices (BMIs) of included participants.
The discovery and validation cohorts initially comprised 10,027,506 and 12,218,680 participants, respectively. Exclusion of individuals with incomplete health records, a previous history of neuropsychiatric disorders, COVID-19 and ARI coinfections, and multiple confirmed COVID-19 reinfections resulted in a final sample size of 4,731,778 participants. The mean age of study participants was found to be 48.4 years, with 50.1% of individuals being male.
Exposure-driven propensity score matching results suggested a 1:4 ratio for COVID-19 versus the general population (discovery/South Korean sample), 1:2 for COVID-19 versus the general population (validation/Japanese sample), and 1:1 across both COVID-19 versus ARI (discovery and validation) comparisons.
Short-term (<30 days following infection recovery) risk assessments revealed that COVID-19 survivors had a substantially elevated risk of neuropsychiatric events (aHR = 2.35) compared to the general populace, with some conditions, particularly encephalitis (aHr = 12.34), Guillain-Barr syndrome (aHR = 11.89) and insomnia (aHR = 5.36) presenting alarmingly increased risk. These findings were consistent (albeit attenuated) with those observed in SARS-CoV-2 infection versus ARI comparisons, with the former presenting an aHR of 1.36 compared to the latter.
Long-term risk assessments similarly revealed that COVID-19 survivors were significantly more likely to retain neuropsychiatric disorders for longer than 30 days when compared to the general populace and ARI (aHR = 1.71 and 1.60, respectively).
Guillain-Barr syndrome had the highest hazard ratio post-COVID-19 diagnosis (aHR, 4.63; 95% CI, 1.6612.98), followed by cognitive deficit (aHR, 2.67; 95% CI, 1.395.15), insomnia (aHR, 2.40; 95% CI, 2.152.69), anxiety disorder (aHR, 2.23; 95% CI, 2.082.40), encephalitis (aHR, 2.15; 95% CI, 1.183.94), ischaemic stroke (aHR, 2.00; 95% CI, 1.642.44), mood disorder (aHR, 1.93; 95% CI, 1.772.09) and nerve/nerve root/ plexus disorder (aHR, 1.47; 95% CI, 1.361.59).
Time attenuation evaluations revealed that while South Korean individuals returned to near general populace risk levels in 12 months following initial infection recovery, the same was not valid for the Japanese cohort. Encouragingly, the patient-level risk of neuropsychiatric events was strongly associated with infection severity and vaccination status risks were lower in mild SARS-CoV-2 infections and when multiple vaccinations were received.
The present study establishes the link between COVID-19 infections and a subsequently heightened risk of neuropsychiatric sequelae development in South Korean and Japanese natives. Furthermore, it is the first to compare this risk between COVID-19 survivors, the general population, and other respiratory infections. While time attenuation results highlight Japanese individuals as having persistent risk even after 12 months of COVID-19 recovery, insights into the associations between infection severity/vaccination status and risk can better equip clinicians and healthcare policymakers to manage their patients and this silent global pandemic.
All Americans ages 6 months and older should receive one of the new Covid-19 vaccines when they become available this fall, the Centers for Disease Control and Prevention said on Thursday.
The recommendation comes as the nation faces a summer wave of Covid, with the number of infections rising in at least 39 states and territories.
Most Americans have acquired immunity against the coronavirus from repeat infections or vaccine doses, or both. The vaccines now offer an incremental boost, remaining effective for only a few months as immunity wanes and the virus continues to evolve.
Still, across every age group, a vast majority of Americans who were hospitalized for Covid did not receive one of the shots offered last fall, according to data presented at a meeting on Thursday of the C.D.C.s Advisory Committee on Immunization Practices.
Dr. Mandy Cohen, the agencys director, accepted the unanimous advice of the panel on Thursday to recommend another round of immunizations.
Professionals and the public in general do not understand how much this virus has mutated, said Carol Hayes, the committees liaison to the American College of Nurse-Midwives. You need this years vaccine to be protected against this years strain of the virus.
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FLORENCE, Italy (AP) Tadej Pogacar was infected with COVID-19 during his Tour de France preparations, the two-time champion revealed Thursday two days before the race starts in Italy.
The Slovenian is aiming for the rare Tour and Giro dItalia double after dominating the Italian race last month.
Pogacar, who won the Tour in 2020 and 2021, said that the virus only prevented him from training for one day.
Its not as serious anymore. Especially if your body already had the virus before and I had it once or twice, Pogaar said, adding that he caught the virus about 10 days ago. It wasnt too bad, just like a cold. It passed really fast.
I stopped for one day and then (did) some rollers inside, he added. Then when I wasnt sick anymore, I was riding outside.
Pogacar has been dominant this season, winning four of the five races hes entered and collecting 14 victories in 31 days of racing including Strade Bianche and Liege-Bastogne-Liege.
The last rider to win the Giro and the Tour in the same year was Marco Pantani in 1998.
After back-to-back Tour titles, Pogacar then finished runner-up to Jonas Vingegaard the last two years.
Vingegaard was hospitalized for nearly two weeks in April following a high-speed crash in the Tour of the Basque Country. He sustained a broken collarbone and ribs and a collapsed lung and has not raced since.
Im just happy to be here at the start line of the Tour de France I think thats a victory in itself, Vingegaard said. I did a lot of work, a lot of good work, and Im not in a bad shape. But it was such a bad crash that everything from here is a bonus.
AP cycling: https://apnews.com/hub/cycling
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For many people who have already had COVID, a reinfection is often milder than an earlier case. But those 65 and older, pregnant or immunocompromised remain at higher risk of serious complications from COVID.
Health officials have told Americans to expect a yearly update to COVID vaccines, just like annual flu shots are updated to protect against the latest flu strains.
Our top recommendation for protecting yourself and your loved ones from respiratory illness is to get vaccinated, said Dr. Mandy Cohen, director of the CDC, said in a press release. Make a plan now for you and your family to get both updated flu and COVID vaccines this fall, ahead of the respiratory virus season.
But many Americans are not following the CDCs advice. Only about 22% of U.S. adults and 14% of children were up to date in their COVID shots, according to the CDC.
Its even lower in Georgia with only about 8% of adults and less than 2% of children up to date, according to CDC.
While the general recommendation is for everyone six months and older to get an updated COVID shot, doctors and public health experts say it is especially important for older adults and others people at high risk for severe illness.
Age remains the strongest risk factor for severe COVID outcomes, with risk of severe outcomes increasing markedly with increasing age, according to CDC researchers. Compared to adults between 18 and 29, the risk of death from COVID is 25 times higher in those between the ages of 50 and 64 years, 60 times higher in those ages 65 and 74 years. It is 340 times higher in those ages 85 and older.
The latest recommendations come at a time when cases are growing or likely growing in 39 states including Georgia, according to the CDC, signaling that a summer bump is underway. The CDC no longer tracks COVID case numbers but estimates the trend of the virus spread based on emergency room visits.
Levels of virus found in wastewater samples, often an early signal of rising COVID cases, have also been rising in Georgia according to CDC surveillance. But its not clear if that means cases will continue to surge.
And while the rise is not too surprising now that people are traveling and gathering indoors where its cooler, health experts and doctors expect this seasons illnesses to be milder than some past versions of the virus. But the latest iterations of the ever-evolving coronavirus seem to be more contagious.
Symptoms from the latest variants circulating are familiar and include sore throat, runny nose, coughing, head and body aches, fever, fatigue, and in more severe cases, shortness of breath.
Earlier this month, the Food and Drug Administration following the guidance of its own panel of expert advisers told vaccine manufacturers to target the JN.1 (omicron) version of the virus. But a week later, the FDA told manufacturers that if they could still switch, a better target might be an even newer variant called KP.2.
Data reporter Stephanie Lamm and The Associated Press contributed to this story
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Posted: June 27, 2024 Last Updated: June 28, 2024
Early on in the pandemic, in 2021, Hugh Potter ate dinner and watched TV next to his wife while she coughed violently from COVID-19, yet he never even sniffled.
It's been thought that some people may not have gotten COVID because they were careful to avoid exposure. Alternatively, some people may have been infected but showed no symptoms. Another possibility is that some people have a genetic advantage that makes them a super-dodger.
"Bloody lucky," Potter, 68, said. "Where I work, I think almost everyone has had it." A few didn't believe thePickering, Ont., resident has escaped it since the early years of the pandemic.
Now, experts peering into the genes of such rare people have gained some surprising insights.
WATCH | Scientists have leads on why some people never get COVID:
Last week, scientists writing in the journal Nature described high activity of a specific gene in people who didn't get infected. And in a complementary research project, Potter provided DNA from saliva samples to researchers at McGill University Health Centre looking for those with a golden armour against the virus.
Researchers hope by better understanding early immune responses, it could help with developing nasal spray forms of vaccines for the coronavirus, similar to the existing FluMist to prevent influenza.
As much as people may wish to forget the pandemic emergency, the virus is still with us and kills about 20 people a week in Canada. The World Health Organization reported more than 2,600 new fatalities in April, bringing total confirmed cases to over 775 million including more than seven million deaths globally.
To gain some leads into what makes people super-dodgers, in March 2021, investigators with the UK COVID-19 Human Challenge study administered a low dose of the original form of SARS-CoV-2 through the nose to 36 healthy adult volunteers and then closely tracked how long it took their immune cells to kick into gear. None were previously exposed to the virus or vaccinated.
The 16 participants with detailed monitoring of their blood and nose fell into three groups:
Christopher Chiu, a professor of infectious diseases at Imperial College London, and his co-authors saw high levels of activity in a gene called HLA-DQA2. They think the gene helps flag invaders to the immune system so it can quickly destroy the virus.
For medical researchers, the study offers a step-by-step look at what happens in the immune responses to the virus in both the nose and blood and their interaction.
Immunologists who weren't involved in the U.K. study say they're not sure why or how that specific gene offers protection.
"If you had asked me to bet money on the genes involved in the protection, they're not the ones I would have chosen," said professor Dawn Bowdish, who holds the Canada Research Chair in Aging and Immunity at McMaster University in Hamilton.
The realtor's motto of location, location, location applies, Bowdish said, because our nose, blood and lungs all differ in the type and timing of immune responses.
For instance, the vaccines we get in the arm are designed to trigger our immune system to mount a response as part of adaptive immunity.
HLA genes take up the trigger and present it to fighter cells of the immune system.
While the particular HLA in the study was better at blocking infection in COVID, it isn't necessarily better overall since it is also associated with some diseases like lupus and rheumatoid arthritis, said Dr. Lynora Saxinger, an infectious diseases specialist at the University of Alberta.
In people who got a sustained infection in the study, it took their immune systems a while to concentrate efforts in the nasal mucosa lining areas like the nose, Saxinger said. In contrast, findings from those who mounted the fastest immune response could invigorate the field of nasal vaccines.
Teams of researchers at McMaster and the University of Ottawa are among those aiming to design nasal spray or puffer forms of inhaled vaccines to not only prevent the risk of severe illness requiring hospitalization and death from COVID as current vaccines do but to block infection altogether.
Bowdish said scientists used to think turning on immune cells in the nose would be enough to kill the virus. But in the new study from England, cells involved in recruiting immune reactions in the mouth, nose and lungs were all important.
"We are hoping to move to a world where we use inhaled vaccines or nasal vaccines, and this gives us some hints about what specific immune genes we want those vaccines to turn on to help protect us," Bowdish said.
WATCH | Vulnerability from age still holds:
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Saxinger called the opportunity to block infection "really big," adding understanding how to clear the virus early is also important to prevent asymptomatic spread.
The pandemic landscape of variants and immunity from vaccinations is now very different than when the volunteers were exposed in the study. Some people come down with COVID repeatedly as variants evolve to dodge immune defences. And COVID illness continues to push some older, vulnerable individuals over the edge when hospitalized, doctors say.
Next, the British researchers plan to test the potential of several nasal spray vaccines against the family of coronaviruses that includes SARS-CoV-2, MERS and four seasonal common cold viruses in other human challenge trials.
"There might be some kind of common features that that would allow you to consider preventative or very early treatment," Saxinger said.
Amina Zafar covers medical sciences and health topics, including infectious diseases, for CBC News. She holds an undergraduate degree in environmental science and a master's in journalism.
