Less than five years after the outbreak of COVID-19, the world remains vulnerable to another pandemic. Over the past five months, a mutated strain of the H5N1 influenza virus detected in dairy cattle poses a potential risk for a pandemic-causing virus. Yet governments and international organizations have done far too little to prepare for such a scenario, despite the lessons they should have learned from the global battle with COVID-19.
After the COVID-19 crisis revealed the shortcomings of the global public health response system, many assumed that governments and international organizations would strive to fix the most obvious problems. Given the catastrophic human and economic costs of the pandemic, countries had a strong incentive to start spending heavily on developing new generations of more protective influenza and coronavirus vaccines, as well as to greatly expand global manufacturing and distribution networks. But this has not happened. At current funding levels, it will likely take a decade or longer to develop more effective and longer-lasting vaccines. Although there are groups at work on new treatments and other antiviral initiatives, on the whole, global society does not appear to be much more prepared for a future coronavirus or influenza pandemic than it was five years ago.
The resurgence of H5N1 influenza in humans and animals has highlighted these failures. Although the virus was identified in the 1990s, over the last 20 years it has continued to mutate, reinventing itself over and over again. Today, it is infecting millions of birds, but it has also become more capable of spilling over into at least 40 species of mammals. It still cannot easily transmit between humans, but infections in dairy cattle, which have influenza receptors for both avian and human influenza viruses in their udders, demonstrate the risk for a new pandemic.
It is impossible to know when a new pandemic will arise, or which specific pathogen will be its cause. H5N1 is just one of the viruses that could mutate into something that will start a pandemic. But eventually, one will happen. It is therefore time to move away from vague recommendations and best practices to a far larger-scale program aimed at producing new and better vaccines, antiviral drugs and other countermeasures, and building the infrastructure at the scale needed to protect entire populations. Although such efforts will be costly, failing to take these steps could be catastrophic.
Although it has never caused a human pandemic, the H5N1 virus has been on the public health radar for decades. It was first identified in late 1996, when a new influenza virus, initially known as high pathogenic avian H5N1, began circulating in avian species in Asia. Influenza strains are classified by the characteristics of two proteins, hemagglutinin and neuraminidase, on the virion particles surface. The pathogen gained international attention for causing a 1997 outbreak in Hong Kong, killing six of the 18 people infected. To control the spread, Hong Kong was forced to cull millions of poultry from its markets and from the supplying farms.
In December 2003, H5N1 reemerged. For the next three years, wild birds spread the virus to domestic waterfowl and chickens in Asia, Africa, Europe, and the Middle East. It also infected a limited number of mammals, including tigers in Thai zoos, and eventually made its way to 148 humans in five Asian countries. Seventy-nine of those cases53 percentproved fatal. As the virus spread, public health officials grew concerned that the world was on the brink of a devastating pandemic. In 2005, at the height of that scare, one of us (Osterholm) wrote a Foreign Affairs article explaining how governments should prepare for such a scenario. The essay noted that the World Health Organizations (WHO) and various countries pandemic response plans were vague and did not offer a realistic blueprint for how to get a population through a potential one-to-three-year pandemic. The article recommended an initiative to provide vaccines for the entire world, with a well-defined schedule to ensure that it would be carried out in a timely way.
Fortunately, H5N1 did not cause a pandemic in 2005. But in late 2019, a different virus did. COVID-19 was a novel coronavirusso called because of the protein spikes on the virion surface that give it a corona-like appearancethat began infecting thousands of people in Wuhan, China. Soon, it spread across China, then the continent, and then the world. In its first year, COVID-19 infected hundreds of millions of people and killed at least three million.
Influenza pandemics are not a new phenomenon. From 2009 to 2010, an H1N1 viruspopularly known as swine flurapidly spread around the planet, killing an estimated 575,000 people. In the United States, the Centers for Disease Control and Prevention (CDC) estimated that 60.8 million people were infected, 273,300 hospitalized, and 12,469 died. This level of morbidity and mortality was tragic, but for a flu pandemic, relatively mild. After all, the 1918 flu pandemic, also H1N1, killed between 50 million and 100 million people worldwide, or at least 2.7 percent of the worlds population.
It might be tempting to conclude that the 2009 pandemic was less deadly than its 1918 counterpart because of 90 years of intervening medical progress, including improved vaccines. Unfortunately, that conclusion is incorrect. The 2009 virus was simply less virulent than the one that spread in 1918. Moreover, the most vulnerable grouppeople over 65already had H1N1 antibodies, thanks to previous infections with related viruses. As COVID-19 showed, the world is no better prepared for pandemics today than it was a century ago and, in some ways, is worse off. Today, there are three times as many people as in 1918. Hundreds of millions live close to poultry and pigs. Air travel can transport infected carriers anywhere in the world within hours. (There are more than a billion international border crossings annually.) And global supply chains have created far greater international interdependence. Humanity, in other words, has become an extraordinarily efficient biological mixing bowl as well as a highly productive viral mutation factory.
That does not mean an H5N1 pandemic is about to unfold. Both the WHO and the CDC assess the current risk of H5N1 in humans to be low. So far, there is no compelling evidence that the current virus is becoming better at attaching to the receptor sites for influenza in the human respiratory tract, the critical bar H5N1 must clear before it can cause a pandemic. To date, the primary outcome of humans becoming infected with H5N1 in the United Stateswhether by association with infected poultry flocks or working with infected dairy cowsis conjunctivitis. This is unsurprising since humans have receptor sites in the eye for bird viruses.
But nature can change fast. Viruses are constantly mutating and reassorting. Influenza reassortment can occur when a human, pig, or cow becomes infected simultaneously with two different viruses, presenting the opportunity for the pathogens to swap critical genetic segments and create new strains. Although the vast majority of these alterations either have little significance or make the new form less robust and adaptable, occasionally a mutation or reassortment will make a virus more transmissible, dangerous, or both. H5N1 could experience such a transformation at any point, turning the current consensus on its head. And H5N1 is just one of the influenza strains the epidemiology community is closely monitoring.
Officials should make no mistake: there will be more influenza and coronavirus pandemics, and any one of them could prove far more catastrophic than the COVID-19 pandemic. Whenever it occurs, it will almost certainly be a virus, primarily transmitted from person to person via the airborne route, a virus with wings, meaning the viral particles can be suspended in the air for long periods and distances. When such an outbreak transpires, rapid global transmission will happen before anyone realizes the world is in the earliest days of a years-long pandemic. Governments cannot wait to prepare until a virus is already spreading around the world. As the last five years have shown, even a moderately deadly disease can have enormous health, economic, social, and political consequences.
It is time for all nations to wake up to the danger and prepare for a new pandemic. At the top of the list should be a game-changing improvement in the medical countermeasures that governments put in place to fight influenza viruses and coronaviruses. Specifically, this means vaccines, drug treatments, and diagnostic tests. Improving the design and systems for manufacturing personal protective equipment quickly and in sufficient numbers will also be essential. Governments must begin investing heavily in vaccine research and development, including studies aimed at creating universal influenza and coronavirus vaccines: ones that provide protection against multiple strains of either virus, offer durable protection for extended periods, and can be manufactured quickly and distributed globally.
To be fully effective, improved vaccines must be safe and provide multiyear protection against most possible influenza strains. They must significantly reduce the likelihood of serious illness, hospitalization, and death, as well as prevent infection and transmission. Ideally, they should be produced and routinely administered to the general population before a pandemic virus emerges, and be readily available in low- and middle-income countries. Researchers are still a long way from creating such a vaccine, though current developments in the lab suggest it is possible. But at the current level of support for research and development, it could take a decade or more to achieve these game-changing vaccines. With significantly greater government support, this timeline almost certainly could be shortened.
The price tag for such measures will be high, and not all of the investment will pay dividends. But a new pandemic could prove far more deadly or costly than a new war, and governments rarely shy away from spending whatever is deemed necessary on new and better weapons. Biological security is just as important as military security, and the United States needs to accept the idea that it would be going to war against a microbial enemy potentially far more dangerous than any conceivable human foe.
Until these universal or near-universal vaccines are created, policymakers will need to work with currently available influenza and COVID-19 vaccines. These shots are good, but hardly great. For example, they limited illness and deaths caused by the 200910 H1N1 influenza and the COVID-19 pandemics, but the protection they provide against infection varies widely. Even now, the effectiveness of COVID-19 vaccines against symptomatic illness, disease severity, and hospitalization is largely determined by the viral variant then circulating and whether the infected person is immunocompromised. Similarly, the effectiveness of influenza vaccines against illness requiring medical care ranges from less than 20 percent to as high as 60 percent for any given flu season.
COVID-19 and flu vaccines also lack durability. In one recent study, the CDC found that COVID-19 inoculations provided approximately 54 percent protection against the need for medical care at an average of 52 days after vaccination. According to a different study, the vaccine loses almost all of its protective powers after a year. Current flu vaccine protection is even shorter, beginning to wane after only a month or two.
To keep up, health authorities generally recommend booster vaccines every year for influenza and even more often for COVID-19, with the antigenic component changing to match the most recent circulating strain. But when a reassorted or mutated virus with pandemic potential emerges, it is likely to be significantly different, causing vaccines to miss their targets. That, in part, was why H1N1 was able to spark a pandemic in 2009. The United States has tried to get out ahead of H5N1 by stockpiling 4.8 million vaccine doses, which were recently tested and found to be potentially effective against H5N1 by the Food and Drug Administration. But if a new H5N1 variant were to cause a pandemic, the changes to the viruss makeup could render the present vaccines largely or entirely ineffective.
Even if the vaccine in the current stockpile does prove effective, there are not enough doses to control an emerging H5N1 pandemic. The United States is home to 333 million people, each of whom would need two shots to be fully immunized, meaning the 4.8 million doses on hand would cover only about 0.7 percent of the population. The government would, of course, try to scale up production quickly, but doing so would be tricky. During the 2009 H1N1 pandemic, the first lot of vaccine was released on October 1, almost six months after the pandemic was declared. Only 11.2 million doses were available before peak incidence.
Other countries are no better equipped. In a 2019 report, the WHO and three academic centers estimated annual worldwide seasonal influenza vaccine production capacity to be 1.48 billion doses, with potential production capacity to be 4.15 billion doses. That means a maximum of two billion people25 percent of global populationcould be vaccinated in the first year of a pandemic.
The WHOs estimates rely on some optimistic assumptions. In the event of a pandemic, for example, the research assumes that there would be an adequate supply of egg-laying chickens, since fertilized chicken eggs are the vessels in which most influenza vaccines are grown. But since the natural reservoir for all influenza strains is avian, the virus could kill off or otherwise compromise large numbers of chickens. Even if it didnt, an H5N1 pandemic might erupt when manufacturers are in the middle of their normal, seasonal vaccine production, making it hard for them to rapidly switch. And a pandemic influenza vaccine strain may not grow as well in eggs and cells as do seasonal virus vaccines.
The 2019 WHO study also identified several potential bottlenecks. Manufacturers may not have sufficient facilities to put their vaccine into vials or syringes, and there may not be a sufficient and timely supply of those vials and syringes, or of reagentsthe chemicals to produce the vaccines. Shipping and administration of shots will be a significant challenge in many low- and middle-income countries. Manufacturers could lack the workforce protection needed to ensure continuous production. And producers may be short on adjuvants, compounds that enhance immune responses. Without them, twice as much antigen would be needed per dose.
Public health experts and government health officials are aware of the threat of another pandemic and have launched a variety of initiatives to mitigate it. The Coalition for Epidemic Preparedness Innovationsfocused on developing vaccines and treatments for infectious diseaseshas outlined a plan for delivering pandemic-beating vaccines within 100 days of a WHO declaration. CEPI has laid out five areas of innovation needed to make this a reality: creating a library of prototype vaccines for pathogens across multiple virus families, having clinical trials networks at the ready, speeding up identification of immune response markers, building global vaccine manufacturing capacity, and strengthening disease surveillance and global early-warning systems. These innovations, if realized, would greatly improve the worlds pandemic readiness. But with current funding levels, the projects 100-day target is hugely ambitious and unlikely to be realized over the next decade for either influenzas or coronaviruses. And as public health experts and governments rightly focus on shortening the time from the beginning of the pandemic until the first vaccine doses are available, just as important is how long it takes until everyone is vaccinated.
Nonetheless, some important steps forward have been made since the 2019 report. Improvements in mRNA technology, first used to make the most successful COVID-19 vaccines, could help speed up influenza vaccine production. Three Phase 3 trials are underway to evaluate the effectiveness of mRNA influenza vaccines. But no such vaccines are yet ready, and it is unclear when they will be.
In response to all these shortcomings, beginning in 2019, the Center for Infectious Disease Research and Policy at the University of Minnesota, which one of us (Osterholm) directs, has led an effort to coordinate research and development of new seasonal and universal influenza vaccines. Using a team of 147 multidisciplinary experts, CIDRAP launched the Influenza Vaccines Research and Development Roadmap to advance the scientific and policy knowledge needed to produce better vaccines and track progress. So far, the initiative has identified more than 420 projects that address at least one of these strategic goals, totaling over $1.4 billion, with U.S. government agencies funding approximately 85 percent of these research studies. This is a start toward more effective vaccines, but only a start. Recently, the Department of Health and Human Services Biomedical Advanced Research and Development Authority (BARDA) provided $176 million to Moderna to develop an mRNA-based pandemic influenza vaccine aimed at multiple strains of the virus. This effort should improve the speed with which a vaccine can be made available in an emerging influenza pandemic, but it is not expected to improve on the effectiveness of the current generation of mRNA vaccines.
BARDA has recently launched an initiative to develop better coronavirus vaccines and antiviral drugs, called Project NextGen. While it is to be hoped that this effort leads to better and quicker results, the $5 billion government investmenta tiny fraction of what the United States devotes to weapon systems procurementis only a minimal down payment on the research and development needed to accomplish this important goal. There is nothing currently in the legislative pipeline to suggest that Project NextGen will continue receiving vital government support.
Given these shortfalls, it will likely be a long time before scientists develop game-changing vaccines. In the interim, governments will have to dramatically increase the capacity to produce at pandemic scale the vaccines the world already has. This will mean high-income nations subsidizing their own pharmaceutical manufacturing capacity and helping middle- and low-income countries establish facilities and train workers to staff them.
At first glance, the costs may seem prohibitively high. But consider the stakes. If H5N1, or any other airborne virus that begins to spread in the human population, sparks a pandemic with a fatality rate even three to five percent higher than COVID, the world will be going to war against a terrifying microbial enemy. It would be far more deadly than any pandemic in living memory or any military conflict since World War II. Viewed from that perspective, adopting a military model of planning, procurement, and development is not just rational but essential. Yes, some of the pandemic preparedness projects the government funds may not pan out. Others may never go into use. But governments, and the people who vote them into power, have long accepted that aircraft carriers, fighter jets, and other weapons systems come with enormous price tags and take many years to finance, design, build, test, and commission. And they also accept that some of these arms may sit in storage until they are obsolete. Nations invest anyway, because in war, such weapons become indispensable. It is urgent that governments begin to think the same way about pandemic preparedness.
Of course, it is still possible that such a pandemic may never ariseor that it doesnt occur for many years. But hope is not a strategy. The United States and the rest of the high- and middle-income world need to start devoting the necessary resources to developing better vaccines, treatments, and other countermeasures immediately. Humanity will not get ahead of a pandemic-causing virus without such commitment.
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Every year, millions of migratory birds soar across continents, to seek the warmth of Indias wetlands and forests. Wardens of healthy ecosystems, migratory birds are also contributors to the global spread and evolution of avian influenza, or bird flu.
Wild aquatic birds are the primary and natural reservoirs for avian influenza A viruses (AIV). Most of these viruses exhibit low pathogenicity, causing only mild or asymptomatic infections.
Over time, however, the carriage and exchange of different virus strains along migration routes, transmission to domestic poultry, and reassortment that is, the mixing of different genetic material into new combinations of viruses between wild birds and poultry has led to the emergence of highly pathogenic avian influenza (HPAI) viruses with the ability to cause severe and highly contagious disease. Some of these can be fatal.
Once largely confined to birds, HPAI viruses have evolved into different clades, some causing mass epizootic think epidemic, but among animals outbreaks, and sporadic spillover human infections.
Characterised and named according to the combination pattern of two surface proteins, hemagglutinin (HA) and neuraminidase (NA), the AIV subtypes, H5, H7 and H9 have, in particular, proven their zoonotic capability by crossing species and infecting mammals.
Currently dominating world news for its infection of cattle herds in the US the first avian influenza spillover to cattle on record the HPAI A(H5N1) virus was first identified in farmed waterfowl in 1996 in China. After nearly a 30-year haul of reassortments and mutations, over 800 human infections in 23 countries with >50% mortality (most cases from 20032019), large and lethal infections in wild and farmed birds across continents (since 2020), and diverse spillover to over 40 species of mammals, the current 2.3.3.4b clade of HPAI A(H5N1) is still short of the adaptation or adaptations it needs to be capable of causing a human pandemic.
There is no evidence yet of sustained human-to-human transmission of HPAI A(H5N1). Thats reassuring but considering the geographical reach, the species promiscuity, and the notorious ability of AIV to reassert and revolve, it has to be said that this might change.
Since 2006, when Indias first avian influenza outbreak was reported in Navapur, Maharashtra in a poultry farm, the country has reported outbreaks in poultry every year in various states, leading to the culling of over 9 million birds, resulting in substantial economic losses.
As reported in a 2023 article in the Indian Journal of Medical Research, between 2006 and 2021, the largest number of HPAI (H5N1 and H5N8) virus outbreaks were reported from Maharashtra, West Bengal, Kerala and Odisha, with over 25 outbreaks in each state. Most recently, as avian influenza continued to spread globally, four Indian states Andhra Pradesh, Maharashtra, Jharkhand and Kerala recorded cases of avian influenza in poultry in May and June of this year.
With wild bird-poultry interface aplenty in its wetlands on central migratory flyways, and with a massive poultry sector that ranks third in the world for egg production, how much at risk is India for an avian influenza pandemic in humans?
The threat for India will be no different from the rest of the world, and that is unpredictable until we actually have sustained transmission and a large number of (human) cases, says Gagandeep Kang, noted Indian virologist.
Only two human cases of avian influenza have been reported in India thus far, the most recent one being in a four-year-old-child infected with avian influenza A(H9N2) in West Bengal in May 2024. That child was reported to have made a full recovery. In July 2021, the first case of a fatal avian HPAI A(H5N1) infection occurred in a boy under 18 years of age in Haryana. The source of infection was not ascertainable in either case, although both cases had family-owned poultry or butchery businesses.
Two is too small a sample size to scrutinise for epidemic or pandemic potential, says Gautam Menon, Professor of Physics and Biology atAshokaUniversity with expertise in epidemiological modelling of infectious diseases. There are too few cases for us to understand how the disease might affect people. Once there is evidence for a [novel] virus that moves easily between people, that could potentially lead to severe disease one can then bring in modelling to evaluate its pandemic potential. This is information that can only come once we begin to see a number of cases and even then, it may take time for us to fully understand its long-term impact, he explains, adding that tracking outbreaks and using genomic surveillance to identify whether a human infection has come from birds is essential.
With much of the global focus being on avian HPAI A(H5N1), the recent avian influenza A(H9N2) case in India has elicited relatively less concern. As Kang explains, H9N2 cases in humans are rare, with about 100 reported until recently. They do not result in mortality at the same rate as other AIV strains, but with any influenza virus, the concerns about transmission and virulence apply, and surveillance needs to be in place to detect potential changes in virus behaviour as early as possible. H9N2 is a low-pathogenicity AIV, but its severity in birds, where it causes about 10% mortality, does not predict how it will behave in humans now or in the future.
This unpredictability may apply to HPAI A(H5N1) as well, albeit conversely. Shahid Jameel, Indian virologist and Research Fellow at University of Oxford, explains, Transmission of avian flu viruses to humans is very inefficient due to the biology of these viruses and the types of cells that line the human upper and lower respiratory pathways. Human-to-human transmission of H5 viruses is even rarer. Whether an H5 virus that transmits more easily to and between humans will retain the cumulative human mortality rate of 4050% is not known. Most likely it will reduce in virulence but its anyones guess.
The measured case fatality rate of around 50% in humans infected with avian HPAI A(H5N1) is likely to be an over-estimate because milder cases may not be seen in the health care system, Kang clarifies. The real concern, Jameel stresses, is H5 AIV crossing the avian-to-mammalian species barrier and showing up in cattle, as in the US, which would have the potential to significantly speed up virus evolution. The potential for human transmission is getting more real, he cautions. Recent epidemiologic and genomic evidence revealing efficient cow-to-cow transmission in the US underscores the potential of avian HPAI A(H5N1) for adaptation and efficient transmission between humans.
Caution, vigilance, and surveillance remain key in the face of uncertainty. As Menon notes, Adequate sentinel surveillance, alertness to clusters of cases in birds and reports of mass bird deaths, the willingness to cull infected animals at scale, are key mitigating measures.
Noting Indias backyard poultry sector, which is seen as a challenge for surveillance, Kang opines, surveillance does not mean being in every backyard poultry farm to examine every transmission event this is impossible. One Health surveillance does mean being ready to detect a signal when it gets to a level of public health significance any cluster of human cases, any major illnesses or die-off of birds or animals, we should be able to investigate quickly.
Alertness and early detection were key lessons from the COVID-19 pandemic that brought with it a strengthening of health systems and lessons in pandemic preparedness. Sequencing was strengthened during COVID. Deploy it aggressively for field epidemiology and case characterisation, Jameel urges.
Early detection matters, so maintaining (not setting up and dismantling) surveillance is going to be critical for our preparedness, not just for bird flu but also for pandemic influenza preparedness, which may come from mutating known human strains as well as the emergence of new strains or reassortants, Kang observes.
Previously deployed successfully for COVID-19, wastewater surveillance can aid in the early detection of pathogens, offering crucial lead time for decision-making and preventive measures before human cases occur.
In a brainstorming session that the Department of Animal Husbandry & Dairying held last month, special emphasis was placed on developing SOPs for environmental surveillance using low-cost methods at sites like wet markets, water bodies, wastewater, slaughterhouses and poultry farms.
The session brought together different health ministries and departments to enhance surveillance, response mechanisms and vaccine development by leveraging the One Health approach. What matters is action on the ground, Jameel remarks, reflecting on the session, and adds that a clear chain of command integrating Indias various health departments for One Health will be vital as will sharing data widely across institutions.
As economies, particularly of low-income and middle-income countries, continue to recover from COVID-19, the notion of another pandemic is wearisome, to say the least. Communicating to the public that a bird flu pandemic is a possible but deeply uncertain prospect is a responsibility that health authorities must shoulder.At the time this article went to press, WHO had not updated its advice for India from June 2024 that read With the currently available evidence, WHO assesses the current public health risk to the general population posed by this virus as low.
It was likely to upset their core audience, but Colorado Public Radio nonetheless reported that H5N1 avian flu is showing up in the states domestic house cats. Its news that originated on the Colorado Veterinary Medical Associations website.
It stems from six feline Highly Pathogenic Avian Flu cases, including only one outside Northern Colorado. That area has been hard hit with poultry and cattle outbreaks of the bird flu.
The USDA has reported that five of the six feline cases have occurred in the northern counties of Adams, Larimer, and Morgan.
There have also been cases of bird flu in domestic cats in Texas.
Since 2022, the avian flu virus has been detected in numerous Colorado mammals, including red fox, mountain lion, bobcat, and black bear, as well as deer mouse, house mouse, dessert cottontail, prairie vole, raccoon and striped skunk.
According to Colorado officials, no human bird flu cases are linked to exposure to infected house cats, and the risk of H5N1 to the general public remains low.
The infected Colorado cats include two indoor-only pets and three indoor-outdoor cats known to hunt for mice or small birds outdoors. Mice testing positive for H5N1 is fairly common in Colorado.
Since 2022,the U.S. has reported 14 human cases of Avian flu in three states. Four were linked to exposure to dairy cows, occurring since March. Ten had exposure to poultry, reported between April 28, 2022, and July 25 this year2024.
Since the current round of bird flu began in early 2022, more than 100 million birds from commercial flocks have been lost in 48 states. Since March, the number of infected dairy herds has reached 190 in 13 states, with 63 infected herds in Colorado.
The CDCs flu surveillance systems report no indicators of unusual influenza activity in people, including avian influenza A(H5).
Still, the CDC wants to be prepared. It has 4.8 million doses of a possible vaccine ready for distribution. It intends to stop infections if necessary.
So far, that hasnt been necessary. The few human cases have not been severe. It is not yet known to be spreading person-to-person. An antiviral remains a better treatment than a vaccine.
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Brown skuas and south polar skuas, two gull-like species that nest in Antarctica, are sometimes called the pirates of the Southern seas. These migratory seabirds are fierce, competitive predators that hunt or scavenge anything, from eggs and adult birds to seafood, mammals or garbage.
Theyre really tough animals and theyre dying, says Antonio Quesada, director of the Spanish Polar Committee.
He gravely recounts why this seasons field work in the Antarctic was like no other: A lethal strain of avian flu, H5N1,breached this fragile ecosystemin February. Only a handful of specially trained researchers were allowed onshore in outbreak sites, garbed in hazmat suits to prevent contagion and spread.
The true scale of the event is still unknown, but reports were grim. In the Falkland Islands, H5N1killed 10,000 black-browed albatrossand ravageda gentoo penguin colony. Scientists discovered a mass skua die-off:50 carcasses littered a Beak Island nesting colony of 130.
Quesada has rarely seen a single dead skua in 20 years work in Antarctica. Theyre an indicator species. If theyre dying, what does it mean for other birds? he asks.
The threat posed by H5N1 extends far beyond the frozen South. Few people realize that the world is currently gripped in another serious pandemic or, to be exact,apanzootic, the animal equivalent. This virus has now infected more than 500 bird and mammal species.
Since it emerged in 2020 in Europe, this Highly Pathogenic Avian Influenza (HPAI) strain has blazed a trail of death across the planet, the largest outbreak in history. The virus is both lethal and unusually transmissible, jumping between birds, mammals and livestock with frightening agility.
Experts say the threat to humans is rising. Manycountries are increasing surveillance and developing or buying vaccines. Cases areticking up in the U.S.: Four people contracted the virus from cows and 10 others caught it from chickens.
Meanwhile, it continues to devastate wildlife, including many endangered animals, saysChris Walzer, executive director of health at the nonprofit Wildlife Conservation Society. As of March, H5N1 had leapt the species barrier to infectsome 485 types of birdandat least 48 mammal species, according to United Nations estimates. Many of these species had never been diagnosed with avian influenza before.
The disease has infiltrated even the most remote regions on six continents. When a polar bear in Alaska succumbed in 2023, it marked the first detected mammal death from avian flu in the Arctic. Thus far, only Australia and the Pacific Islands have been spared. And the virus is still on the move, spreading to new hosts as it evolves and picks up genes from other bird flu strains.
Victims have died in staggering numbers, especially animals that congregate in large groups like pinnipeds. The virus swept along South Americas Atlantic and Pacific coastlines,slaying more than 30,000 sea lionsin 2022-23. It then killed some17,000 Southern elephant seal pups on Argentinas Pennsula Valds the species largest die-off ever.
H5N1 has been carried worldwide by migrating birds. Butnew researchshows that this current strain (dubbed clade 2.3.4.4b) can now spread directly between mammals, with frightening implications. It seems that H5N1 viruses are becoming more evolutionarily flexible and adapting to mammals in new ways, the studys authors write, which could have global consequences for wildlife, humans, and/or livestock.
Walzer warns, H5N1 now presents an existential threat to the worlds biodiversity.
Its important to understand that this panzootic is a man-made problem, says Vincent Munster, who heads the Virus Ecology Section at the U.S. National Institute of Allergy and Infectious Diseases.
Avian flu is not uncommon in wild birds, particularly in its natural hosts:ducks, geese, gulls, terns, swansand other waterfowl. They carry a low pathogenic form, a mild virus that may be asymptomatic. It spreads seasonally, when multiple species congregate at migration stopover sites or cluster together to nest.
But when avian flu spills over into poultry, it can morph into a highly contagious, fatal virus.
The current panzootic began when this H5N1 strain jumped from domestic poultry back into wild birds which happened because of modern livestock production methods. Humans further facilitated spillover by destroying wetlands, which crowds migrating birds into small scraps of habitat, often with poultry farms nearby.
When farms encroach wetlands, it creates the perfect interface for this type of virus, Walzer says. Its a veritable petri dish of opportunity for avian flu to swap genes and mutate into potentially more virulent or transmissible strains. This environment allowed the virus to infect chickens, geese and ducks and jump back into the wild in a virulent form.
The emergence of Highly Pathogenic Avian Influenza is a direct result of commercial, large-scale poultry farming, Munster says. There are more than 34 billion chickens on Earth, according to Food and Agriculture Organization estimates.
The U.S. Delmarva Peninsula offers a prime example of farm-wetland overlap. Its both a migratory stopover and a wintering ground along the North American flyway on the nations Mid-Atlantic coast. Its also the site of a$4.4 billion poultry industry that raised 600 million chickens in 2023. H5N1 has hit there and across the globe. In Cambodia, for example, farmers that raise their ducks and geese in wetlands have also seen outbreaks.
The virus is now spreading among cows, infecting at least171 herds in 13 U.S. states. It thrives in udder cells, and RNA from H5N1 has been found in milk.
Another serious concern: H5N1 has not petered out between spring and fall migrations, like avian flu normally does. Its now endemic in Europe and North America. When that happened, Walzer says, people began worrying that its not going to go away anymore.
It has flared for four years straight now, with wild birds currently carriers, reservoir hosts and victims of the virus.
H5N1 isnt new. In 1996,a goose in Chinas Guangdong province may have been patient zerofor the current strain, which spread among the flock and passed to wild birds. The virus then morphed into asevere respiratory disease that infected 18 people and killed six in Hong Kong. That outbreak ended after 1.5 million chickens were slaughtered.
Next came a viral chatter phase. Viruses dont just break through species barriers. As they change, they make periodic forays into other species, sometimes over years. In most cases, these ventures are unsuccessful. Unless a virus can enter cells and replicate, it circulates harmlessly.
Flu virusesmutate rapidlyas they acquire genes from other viruses: mixing, matching, reassorting and adapting, says Colin Ross Parrish, a virologist at Cornell Universitys College of Veterinary Medicine. Each genetic mutation creates a new building block for evolution: Genetic sequences are cellular instructions. They help a virus evade immunity in a host, determine how it causes infection, how it spreads and much more.
Avian influenzaseight-section genomeoffers numerous opportunities to reassort its genetics, not unlike a Las Vegas slot machine and in 2003, it hit a viral jackpot. Avian flu mutated to successfully spill back from poultry into wild birds,launching the current panzootic.
Fast forward to 2020 when H5N1 appeared in its current form in European birds and then successfully infiltrated new species, including mammals. It quickly spread to Africa and the Middle East, as it was carried long distances along migratory flyways. Humans helped byselling and shipping infected poultryacross national borders.
The virus crossed the Atlantic, reaching U.S. and Canadian shores in late 2021. Soon,mallards and swans were dying in the U.S. Midwest, bald eagles died nationwide,seals perished in Maine, as did bobcats in Wisconsin and raccoons in Washington and Michigan, to name just a few of the many losses.
The virus then aggressively invaded South America, targeting birds and sea mammals.Genetic studies on dead seabirds, a dolphin and a sea lionin Peru shed light on H5N1s movement and adaptations. Researchers discovered that in the U.S., the Eurasian strain added genes; in this form, it expanded its repertoire of hosts and raged like wildfire through large seal and sea lion colonies.
H5N1 finally reached both poles. Outbreaks continue to arise nearly everywhere.
Proximity is a big factor in how viruses spread, as the world learned during the COVID pandemic. Sharing a home or gathering in large groups poses a huge H5N1 risk, says Amandine Gamble, an infectious disease ecology expert at Cornell Universitys College of Veterinary Medicine. To understand where birds go and how they spread H5N1, she is collecting genetic material from various species in the Falkland Islands and outfitting them with tracking devices to follow their movements.
Regardless of the location, the virus triggers a systemic infection in birds. They may become lethargic, sneezing, coughing, gasping for air or experiencing intestinal issues. The virus also invades the brain. Sick birds may become disoriented, uncoordinated, stumbling, swimming or walking in circles, trembling or jerking their necks before keeling over dead. Some suddenly die without showing any sign of illness.Survivors may pass the virus to others.
Mammals experience many of the same symptomsas birds, but postmortems have also revealed pneumonia and bleeding in the heart, liver and other organs. Autopsies of 55 mammals showed that the most commonly afflicted part of the brain was the frontal lobe, which explains the movement and cognitive symptoms.
The genie is out of the bottle, says Waltzer. He emphasizes that the length of the outbreak, as well as the amount of the virus in the environment, is unprecedented. The sheer global distribution of this virus, he notes, is underestimated everywhere as well as the breadth of ecosystems that are being impacted.
Researchers are deeply concerned by the effects of this red-alert virus: High pathogenicity H5N1 is a real, tangible threat to wildlife, of a magnitude and scale never seen before, says Marcela Uhart, who heads the Latin American program at the University of California Davis One Health Institute.
On a United Nations situation update map, swaths of the world seem untouched, but that is likely because some regions have little or no monitoring for avian influenza, Walzer notes. For example, experts suspect there is vast underreporting in Africa. Many countries have slim resources, so pathogen hunters target the deadliest human threats: malaria. Ebola, Lassa fever and other infectious diseases.
Many pathogens, including avian influenza, arezoonotic: They jump between wildlife, livestock and humans. In recent decades, zoonotic diseases haveemerged and spread at accelerating rates. They are frequently fatal and have no cure.
As humanity encroaches on wild areas, people, livestock and wildlife come into into unnatural proximity, exposing all to germs they have no immunity to like avian influenza and leave wild animals with ever-shrinking habitat. Add poaching for the illegal wildlife trade, bushmeat hunting, and rapidly changing climate, and its no surprise that many species are in serious danger of extinction.
H5N1 is the newest threat. The number of different species being infected is quite profound, says Emily Denstedt, a health program adviser with the Wildlife Conservation Society.
Wild birds are among the most affected animals. This is a major change: previous H5N1 strains primarily attacked poultry. At least485 bird species from 25 classifications have been infected, including puffins, pelicans peregrine falcons, owls, toucans, parrots, bald eagles, warblers, finches and many others.
However, seabirds are by far the hardest hit. H5N1 super-spreader events in the U.K. offer sobering examples of the carnage wrought by this virus, though theres no way to accurately count the casualties.
Nesting colonies are now notably emptier in many locations. In Scotland home to 60% of the worlds great skuas breeding numbers have plummetedby three-quarters since 2021. Some 16,000 gannets died and the population in Wales dipped to precarious lows not seen since the 1960s. Rangers discovered more than660 dead Arctic tern chicks in England.
During the spring of 2022 in Africa,thousands of birds perished, particularly along the East Atlantic Flyway migration route in Senegal and The Gambia.Later that year, South Africa lost at least 28 African penguins a tragedy for these endangered birds.
In the U.S., the virus struck Lake Michigans Caspian terns, killing 62%. In early 2023, pelicans littered Peruvian beaches; more than 40% of the population died. At least 20 critically endangered California condors perished in Arizona, endangering their perilous recovery from just 22 birds in 1987.
So far, seals and sea lions are the only mammals dying en masse. However, the sheer number of affected mammals is worrying, ranging from grizzly bears, lions, pika, cougars, cows and dolphins to domestic dogs and cats, racoons, foxes, sea otters and a zoo tiger.Six dead walruses were discovered in Svalbardin 2023, some 965 kilometers (600 miles) from the Arctic Circle.
Uhart explains the broader collateral damage: All species play a role in maintaining healthy ecosystems, and big losses reverberate throughout the entire community. She offers pinnipeds as an example. As top predators, seals, sea lions and walruses keep prey species in check. Without them, previously constrained species multiply, may expand their ranges and displace other animals.
We almost wiped out pinnipeds in the past, hunting them for their fur and their blubber, and they are only now recovering after years of protection, Uhart says. We cant let a disease put them at risk again.
There may be other, less obvious effects on wildlife. Birds that sicken and survive probably wont fledge young, Munster says, and birds that breed in large colonies may not thrive in smaller groups. Walzer notes that we humans and our monitoring systems are really bad at detecting these more subtle decreases in populations, And suddenly, theyre gone.
The ultimate extent of this global animal apocalypse will hinge on H5N1s vigor, endurance and adaptability and importantly, on preciselyhowit adapts.
Much depends on the ways species interact. Lifestyle impacts the dynamics of how [H5N1] spreads in animal populations, says Cornells Gamble. In close quarters, it passes between birds, but not all develop terrible disease. They may become silent spreaders.
Another important factor is how animals are exposed and where. H5N1 is a resilient organism: It replicates in the respiratory tracts of mammals and birds and in birds intestines. Animals can shed virus from infected cells after only six hours.
Its quite hardy and remains infectious in water.One study found that H5N1survived in bird fecesfor nearly a day in extreme heat (42 Celsius, 107 Fahrenheit), five days in balmy temperatures (24C, 75F) and for up to two months in the cold (4C, 39F). This strains resilience is still unknown.
Carnivores and scavengers can catch the virus by eating an infected bird carcass. But researchers have also confirmed that mammals now transmit the virus between themselves, in the wild, on farms and in zoos. It spread on amink fur farm in Spain(where tens of thousands lived in about 30 barns), among dairy cows in the U.S.,tigers in a Chinese zooand pinnipeds in Argentina. Scientists determined that the strain that killed elephant seals also infected terns which could spread it far and wide.
Quesada is deeply concerned about the coming breeding season in the Antarctic. Confirmation of the virus in elephant seals puts us on even higher alert, he says.
Risk to humans grows as the virus racks up an ever-longer list of mammal hosts. Fourteen people have been diagnosed this year in the U.S.; all worked with cattle or chickens. So far, theres no evidence that the virus can pass directly between humans. However, the World Health Organization (WHO) has cautioned public health officials to get ready for a potential spillover. Alert levels will jump if H5N1 becomes airborne, if it can be sneezed out and carried via aerosols or respiratory droplets, Uhart says.
A key question remains: As individuals develop immunity, will the virus fizzle out? And if so, when?
Predictions for wildlife arent good. In places where H5N1 has already invaded, Uhart says, it will take years, maybe decades or more, for some wild species to recover. In those locations, she says she believes it will likely remain, continue to adapt and evolve into new strains. She expects recurring deadly waves and for some species that are currently endangered, just one outbreak may mean extinction.
Munster likens this panzootic to the SARS pandemic but in wildlife, with no preemptive, therapeutic or prophylactic countermeasures, like social distancing, masking, vaccines and antivirals.
One strategy, vaccinating poultry against avian flu, could stop or limit the current H5N1 evolutionary pool, Walzer says.
For decades,experts have been waving a red flag, trying to gain traction for aOne Health strategy to prevent future pandemics. Its a holistic approach, inclusive of human, wildlife, livestock and ecosystem health. Importantly, it incorporates disease risk into decision-making. A One Health approachshifts the onus on officials to prevent diseasesbeforethey jump between species, rather than the current model reacting once a crisis hits. Studies show this to be themost effective and economicalpandemic strategy.
In December 2021, amid COVIDs mass human mortalities, the WHO and representatives from 194 nations agreed to negotiate a pandemic treaty. But countries have not yet reached an agreement, missing a May deadline to deliver the document at the 77thWorld Health Assembly.A recent editorialstated that negotiators are nowhere close to adopting text that will truly prevent consequential pathogen spillovers from wildlife.
With massive industrial livestock operations located within migratory flyways, We could have seen [this panzootic] coming, but our ability to actually intervene on a legislative and political level is not there unfortunately, Munster says. And [wildlife] is definitely paying the price.
Meanwhile, viral chatter continues to surge, invisible and unabated between domestic and wild species.
Citations:
Bouvier, N. and Palese, P. (2008). The biology of influenza viruses.Vaccine.https://doi.org/10.1016/j.vaccine.2008.07.039Campagna, C., et al. (2023). Catastrophic mortality of southern elephant seals caused by H5N1 avian influenza.Marine Mammals Science.https://doi.org/10.1111/mms.13101
Uhart, M., et al. (2024). Massive outbreak of Influenza A H5N1 in elephant seals at Pennsula Valds, Argentina: increased evidence for mammal-to-mammal transmission.bioRxiv. https://doi.org/10.1101/2024.05.31.596774
Evseev, D., Magor, K. E. (2019). Innate Immune Responses to Avian Influenza Viruses in Ducks and Chickens.MDPI.https://www.mdpi.com/2306-7381/6/1/5
Chen, H. (2009). H5N1 avian influenza in China.Science China Life Sciences. https://doi.org/10.1007/s11427-009-0068-6
Lycett, S, Duchatel, F. and Digard, P. (2019). A brief history of bird flu. Philosophical Transactions of the Royal Society B.https://doi.org/10.1098/rstb.2018.0257
Harvey, J., Mullinax, J., Runge, M., and Prosser, D. (2023). The changing dynamics of highly pathogenic avian influenza H5N1: Next steps for management & science in North America.Biological Conservation.https://doi.org/10.1016/j.biocon.2023.110041
Kilpatrick, A. Chmura, A., Gibbons, D., Fleischer, R., Marra, P. and Daszak, P. (2006). Predicting the global spread of H5N1 avian influenza.Proceedings of the National Academy of Sciences.https://doi.org/10.1073/pnas.060922710
Leguia, M., Garcia-Glaessner, A., Muoz-Saavedra, B., Juarez, D., Barrera, P., Calvo-Mac, C., Lescano, J. (2023). Highly pathogenic avian influenza A (H5N1) in marine mammals and seabirds in Peru.Nature Communications,14(1). doi:10.1038/s41467-023-41182-0
Duriez, O., Sassi, Y., Le Gall-Ladevze, C., Giraud, L., Straughan, R., Dauvern, L., Le Loch, G. (2023). Highly pathogenic avian influenza affects vultures movements and breeding output.Current Biology,33(17), 3766-3774.e3. doi:10.1016/j.cub.2023.07.061
Rohr, J. R., Barrett, C. B., Civitello, D. J., Craft, M. E., Delius, B., DeLeo, G. A., Tilman, D. (2019). Emerging human infectious diseases and the links to global food production.Nature Sustainability,2(6), 445-456. doi:10.1038/s41893-019-0293-3
Kurmi, B., Murugkar, H. V., Nagarajan, S., Tosh, C., Dubey, S. C., & Kumar, M. (2013). Survivability of highly pathogenic avian influenza H5N1 virus in poultry faeces at different temperatures.Indian Journal of Virology,24(2), 272-277. doi:10.1007/s13337-013-0135-2
Hu, T., Zhao, H., Zhang, Y., Zhang, W., Kong, Q., Zhang, Z., Zhang, F. (2016). Fatal influenza A (H5N1) virus infection in zoo-housed tigers in Yunnan province, China.Scientific Reports,6(1). doi:10.1038/srep25845
Bernstein, A. S., Ando, A. W., Loch-Temzelides, T., Vale, M. M., Li, B. V., Li, H., Dobson, A. P. (2022). The costs and benefits of primary prevention of zoonotic pandemics.Science Advances,8(5). doi:10.1126/sciadv.abl4183
Pfizer and BioNTech said Friday that their combined mRNA vaccine candidate against influenza and Covid-19 showed a lower immune response against one type of influenza, influenza B, in a Phase 3 trial, a setback for the vaccine.
The combination vaccine met its goal in generating an immune response against influenza A and against the SARS-CoV-2 virus, which causes Covid, the companies said in a statement.
They said, however, that they are are evaluating adjustments to the combination vaccine candidate aimed at improving immune responses against influenza B and will discuss next steps with health authorities.
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Travellers should consider getting vaccinated against mpox if they will be visting affected areas in Africa, new advice says.
The European Centre for Disease Prevention and Control (ECDC) has updated its recommendations in response to outbreaks of a new strain of the virus. Other continents, including Europe, can expect some cases too, it says.
ECDC says the risk of it spreading everywhere is low, despite the World Health Organization recently declaring the mpox situation a global emergency.
The disease - formerly known as monkeypox - can be passed on by close contact with anyone with the infection.
Those who have been vaccinated against mpox in the past might only need one-top up dose, rather than two shots.
Booster vaccine doses are typically recommended every two to 10 years if a person remains at continued risk for exposure.
Mpox has killed at least 450 people in the DRC in recent months, linked to a new type or Clade called 1b.
Mpox can be passed on from person to person through:
It causes flu-like symptoms, skin lesions and can be fatal for some.
Experts say there is still a lot to learn about 1b, but it may be spreading more easily, causing more serious disease.
Pamela Rendi-Wagner from the ECDC said: "As a result of the rapid spread of this outbreak in Africa, ECDC has increasd the level of risk for the general population in the EU/EEA and travellers to affected areas. Due to the close links between Europe and Africa we must be prepared for more imported Clade 1 cases."
Currently, there are no cases of Clade 1b mpox confirmed in the UK but experts say cases can spread if international action is not taken.
A case of mpox has also been detected in Sweden after a person became infected during a stay in an area of Africa where the disease is spreading.
The ECDC recommends that public health authorities plan and prepare for quick detection of any more cases that may reach Europe.
A previous mpox public health emergency, declared in 2022, was caused by a different, milder strain called Clade 2.
Despite having effective vaccines against mpox, too few doses are currently getting to where they are needed most.
How does the current COVID surge compare to previous waves?
Though the latest numbers suggest that COVID infections are continuing to rise nationwide, infections peaked locally in mid to late July and are now slowly falling. At their apex, waste water numbers in the Boston area were roughly one-third what they were in the last winter wave, which peaked around Jan. 1, said Dr. Shira Doron, chief infection control officer for the Tufts Medicine health system and hospital epidemiologist at Tufts Medical Center.
The good news is that COVID deaths are about a quarter of what they were in January, a decoupling of severe disease, compared to case numbers that Doron attributes to increasing levels of immunity over time.
People have had multiple vaccinations, multiple infections, and the disease is going to just get less and less severe over time, she said.
With autumn quickly approaching, the falling infection rate could easily reverse, Doron noted, which highlights the importance of keeping up to date with boosters.
Local infectious disease experts anticipate updated shots to arrive sometime in September. There will be two different varieties: a traditional vaccine and two vaccines created using the newer mRNA technologies. Both will confer added protection against the latest variants of the disease, but there are some differences.
Both Moderna and Pfizer have updated the formulations of their mRNA vaccines to combat the mutations that have allowed members of the FLiRT family, a subfamily of the Omicron variant, to better evade immune detection, said Dr. Sabrina A. Assoumou, associate professor of medicine at Boston University and infectious disease physician at Boston Medical Center.
But the Novavax booster relies on an older vaccine technology that takes longer to produce, and the process started before the latest surge. It was, however, updated to protect against the JN.1 strain of the virus, an immediate predecessor to the FLiRT variants, which contains many (though not all) of the mutations that have helped FLiRT to evade existing immunity.
Though slightly less effective, Novavax vaccines may appeal to individuals who are reluctant to embrace the relatively new mRNA technology, said Assoumou.
There are probably some people out there who, for whatever reason, did not want to get mRNA vaccines and its important to also let them know that the more traditional version of vaccines is also available, Assoumou said, adding that the safety of the mRNA shots is now well established. The most important message is get something, increase your immunity so that you have some protection, because we do know that immunity wanes. The goal of these vaccines is to prevent severe disease, hospitalization, and death. And all of these vaccines should do that.
The CDCs Advisory Committee on Immunization Practices recommends updated COVID-19 and flu vaccines for everyone age 6 months and up.
Last year, some experts recommended waiting until the approach of an anticipated peak of respiratory infections in the winter, and getting the COVID shot in tandem with an influenza booster, Doron said. But recommendations may differ this year if COVID rates are still high when the new boosters arrive in the clinic.
Assoumou recommends any individual who has not received a booster in four months get the shot as soon as it becomes available.
Cases are high right now, she said. I feel like we all know somebody who had COVID or is recovering from COVID. So I think that given that theres a lot of virus circulating in the community, I would say as soon as it is available to get vaccinated.
The CDC recommends that everyone 6 months and older in the US, with rare exceptions, get a seasonal influenza vaccine. The shot is particularly important for people at high risk of developing flu-related complications, including adults 65 and older, children younger than 2 years of age, and individuals with certain chronic conditions.
But this year, older adults, pregnant women, and the parents of small children also have a new vaccination to consider.
After decades of research, vaccines protecting against respiratory syncytial virus, or RSV, made their debut last year. The highly contagious virus usually causes mild symptoms. But in some cases, it can lead to life-threatening pneumonia and dangerous lung swelling, causing between 60,000 and 120,000 hospitalizations and 6,000 to 10,000 deaths every year among adults 65 and older.
Federal officials have gone back and forth over who should get the one-time shot. Though approved for use by all adults 60 and older, evidence has emerged in recent months suggesting the vaccine may be linked to a heightened risk of a rare nervous system condition called Guillain-Barr syndrome . In its June meeting, a CDC advisory committee said more research and safety analysis is needed.
On Aug. 6, the CDC issued revised guidance, recommending individuals age 75 and older receive the new one-time vaccination. But it stopped short of recommending the shot for all seniors below the age of 75, instead highlighting 11 risk factors that place people age 60 to 74 at increased risk for severe disease due to RSV, including those with chronic heart, lung, or liver disease; severe obesity; certain types of diabetes; and who reside in a nursing home.
In the absence of those risk factors, a provider may still determine that a person in that age range is at high risk and should get the shot, the CDC said.
The CDC also suggests pregnant women and the parents of newborn babies protect themselves from the virus. It recommends either maternal RSV vaccination during weeks 32 through 36 of pregnancy, or infant immunization with RSV monoclonal antibodies. That advice applies to all infants age 8 months and younger, born during or entering their first RSV season, and to infants and children ages 8 to19 months who are at increased risk for severe RSV disease and entering their second RSV season.
Late summer and early fall are the best time to get vaccinated, the CDC says.
Adam Piore can be reached at adam.piore@globe.com.
A sign announcing monkeypox vaccination is setup in Tropical Park by Miami-Dade County and Nomi Health on August 15, 2022. Image: Joe Raedle / Staff ( Getty Images ) In This Story
The stocks of two vaccine makers surged on Thursday after the World Health Organization (WHO) upgraded a Mpox (formerly known as monkeypox) outbreak in the Democratic Republic of Congo (DRC) to a public health emergency of international concern.
Medicare patients could save $1.5 billion on 10 prescription drugs
Shares of the Denmark-based vaccine maker Bavarian Nordic spiked 17% on Thursday in Copenhagen. And the stock of the U.S. pharma company Emergent BioSolutions (EBS) rose 6% on Thursday.
Bavarian Nordic and Emergent BioSolutions are the makers of the only two vaccines that the U.S. Centers for Disease Control and Prevention (CDC) recommends for Mpox.
The stock moves come just a day after the WHO determined an upsurge in Mpox cases in the DRC and other countries in Africa constitute an international public health emergency. This was the WHOs second public health emergency for Mpox in two years.
A new variant of Mpox, known as clade Ib, has emerged and appears to be more contagious than previous variants.
The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighbouring countries are very worrying, said WHO Director-General Tedros Adhanom Ghebreyesu in a statement. On top of outbreaks of other mpox clades in DRC and other countries in Africa, its clear that a coordinated international response is needed to stop these outbreaks and save lives.
This new variant has been found in DRC, Burundi, Kenya, Rwanda, and Uganda.
Swedens public health agency confirmed on Thursday its first case of the strain, marking the first occurrence of this strain outside of Africa.
Mpox is an viral disease that spreads between animals and people. It symptoms include fever, chills, muscle aches, and a rash that can look like pimples or blisters, according to the CDC.
Bavarian Nordics CEO Paul Chaplin told Bloomber on Wednesday that the company is able to meet the vaccine needs of this outbreak.
We have inventory and we have the capabilities. What were missing are the orders, said Chaplin
Media Advisory
Wednesday, August 14, 2024
Approach could have role in preventing malaria in pregnancy.
Two National Institutes of Health (NIH)-supported trials of an experimental malaria vaccine in healthy Malian adults found that all three tested regimens were safe. One of the trials enrolled 300 healthy women ages 18 to 38 years who anticipated becoming pregnant soon after immunization. That trial began with drug treatment to remove malaria parasites, followed by three injections spaced over a month of either saline placebo or the investigational vaccine at one of two dosages. Both dosages of the vaccine candidate conferred a significant degree of protection from parasite infection and clinical malaria that was sustained over a span of two years without the need for a booster dosea first for any malaria vaccine. In an exploratory analysis of women who conceived during the study, the vaccine significantly protected them from malaria in pregnancy. If confirmed through additional clinical trials, the approach modeled in this study could open improved ways to prevent malaria in pregnancy.
Spread by Anopheles mosquitoes, malaria parasites, including those of the species Plasmodium falciparum (Pf), can cause illness in people of any age. However, pregnant women, infants and very young children are especially vulnerable to life-threatening disease. Malarial parasitemia in pregnancy is estimated to cause up to 50,000 maternal deaths and 200,000 stillbirths in Africa each year.
The trials were co-led by investigators from the NIHs National Institute of Allergy and Infectious Diseases (NIAID) and the University of Sciences, Techniques and Technologies, Bamako (USTTB), Mali. The investigational vaccine used in both trials was PfSPZ Vaccine, a radiation-attenuated vaccine based on Pf sporozoites (a stage of the parasites lifecycle), manufactured by Sanaria Inc., Rockville, Maryland. Multiple previous clinical trials of PfSPZ Vaccine have shown it to be safe, including in malaria-endemic countries such as Mali. In results published in 2022, for example, an NIAID-sponsored, placebo-controlled trial of a three-dose regimen of PfSPZ Vaccine in Burkina Faso found that the vaccine had up to 46% efficacy that lasted at least 18 months.
In the first year of the current trial, 55 women became pregnant within 24 weeks of the third vaccine dose. Among these women, vaccine efficacy against parasitemia (whether before or during pregnancy) was 65% in those who received the lower dose vaccine and 86% in those who received the higher dose. Among 155 women who became pregnant across both study years, vaccine efficacy was 57% for those who received lower dose vaccine and 49% in those in the higher dosage group.
Women who received the investigational vaccine at either of the dosages conceived sooner than those who received placebo, although this finding did not reach the level of statistical significance, reported the investigators. The researchers speculate that the PfSPZ Vaccine might avert malaria-related early pregnancy losses since parasitemia risk during the periconception period was reduced by 65 to 86%.
Preconception immunization is a new strategy to reduce mortality for women with malaria in pregnancy, the researchers note. They plan to investigate the safety of PfSPZ Vaccine administered during pregnancy, then examine the efficacy of PfSPZ given preconception or during pregnancy in larger clinical trials. Existing measures are not protecting women from malaria in pregnancy, they added. A safe and effective vaccine is urgently needed, and our results indicate PfSPZ Vaccine might be a suitable candidate, they conclude.
The PfSPZ Vaccine Study Team was led by Alassane Dicko, M.D., of the Malaria Research and Training Center (MRTC), USTTB, Mali, Stephen L. Hoffman, M.D., of Sanaria Inc., and Patrick E. Duffy, M.D., of the NIAID Laboratory of Malaria Immunology and Vaccinology. Joint co-first authors were Halimatou Diawara, M.D., of MRTC, and Sara A. Healy, M.D., NIAID.
Additional information about the trials is available at clinicaltrials.gov using the identifiers NCT03510481 or NCT03989102.
H Diawara et al. Safety and efficacy of PfSPZ Vaccine against malaria in healthy adults and women anticipating pregnancy in Mali: two randomised, double-blind, placebo-controlled, phase 1 and 2 trials. Lancet Infectious Diseases DOI: 10.1016/ S1473-3099(24)00360-8(2024).
Patrick E. Duffy, M.D., Chief, Laboratory of Malaria Immunology and Vaccinology, NIAID, is available to comment.
To schedule interviews, please contact Anne A. Oplinger, (301) 402-1663, niaidnews@niaid.nih.gov.
NIAID conducts and supports researchat NIH, throughout the United States, and worldwideto study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID website.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
NIHTurning Discovery Into Health
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Reaching more children: When the VFC legislation was passed 30 years ago, it was a historic step in improving the lives of children. Despite these successes, there is continued need to reach children who lack insurance and children in families with lower incomes. Healthcare providers that serve VFC-eligible children are critical to the VFC program, providing children easy access to vaccination services.
There are still opportunities to increase vaccination coverage (the proportion of children vaccinated) with all recommended vaccines for VFC-eligible children. Combined coverage for 7 selected vaccines (the combined 7-vaccine series) was just over 61% for VFC-eligible children born in 2020. For individual vaccines, uptake was highest (around 90%) for first doses of vaccines and vaccines given earlier in life. Coverage was lowest for vaccines that require multiple doses, with additional doses recommended after 12 months of age. This suggests VFC-eligible children face challenges to receiving vaccines that require multiple doses as well as in their second year of life.
Healthcare providers can help reduce missed opportunities for vaccination by giving multiple childhood vaccines at well-child visits. Robust communication efforts to reach parents of those eligible for the VFC program will help them be aware of, have confidence in, and able to access recommended vaccines for their children.
Insurance status: Vaccinations were lower among uninsured children than for children insured by Medicaid. This is consistent with data on vaccinations among uninsured adolescents and adults. Uninsured children are more likely to live below the poverty level and are less likely to have seen a healthcare provider in the past year. They are also less likely to complete vaccine series that require multiple doses. Efforts to connect children to health insurance can contribute to increased vaccinations.
Reaching low-income households: VFC-eligible children living below the poverty level had lower vaccination coverage for rotavirus vaccine and the combined 7-vaccine series compared with VFC-eligible children living at or above the poverty level. Although the VFC program provides vaccine at no cost, there may be fees for an office visit or non-vaccine services received during the visit. Healthcare costs beyond vaccination cost may be potential barriers for low-income households in addition to other barriers affecting access to vaccinations. Making sure all children have an established medical home increases the potential to be up to date with recommended vaccines.
