Category: Flu Virus

By Julie Steenhuysen and Leah Douglas

July 2 (Reuters)-The U.S. government has awarded $176 million to ModernaMRNA.Oto advance development of its bird flu vaccine, the company said on Tuesday, as concerns rise over a multi-state outbreak of H5N1 virus in dairy cows and infections of three dairy workers since March.

Funds from the U.S. Biomedical Advanced Research and Development Authority will be used to complete late-stage development and testing of a pre-pandemic mRNA-based vaccine against H5N1 avian influenza.

U.S. officials said on a press call that late-stage testing would begin in 2025, pending results expected in the coming weeks of Moderna's phase 1 trial. The late-stage trial would likely focus on safety and immune response.

The contract includes options to accelerate the development timeline if needed, based on an increase in human cases, the severity of cases or human-to-human transmission of the virus.

It is too early to tell how many doses Moderna will be able to manufacture, said Robert Johnson, director of the medical countermeasures program at HHS, on the call.

In March, U.S. officials reported the first outbreak of the H5N1 virus in dairy cattle, which has since infected more than 130 herds in 12 states.

Scientists are concerned that exposure to the virus in poultry and dairy operations could increase the risk that the virus will mutate and gain the ability to spread easily among people,touching off a pandemic.

The risk to the general public from bird flu remains low, and vaccination is not currently recommended for any segment of the population, Dawn O'Connell, assistant secretary for preparedness and response at the U.S. Department of Health and Human Services, said on a call with reporters.

However, robust discussions are occurring within government agencies about whether vaccinating farm workers would be helpful, said Nirav Shah, principal deputy director of the U.S. Centers for Disease Control and Prevention, adding that no final decisions have been made.

The government expects to have more announcements on H5N1 vaccines in the near future, OConnell said. In a previous briefing, OConnell said her agency was also negotiating with PfizerPFE.Nfor an mRNA vaccine against H5N1.

Both the Moderna and Pfizer vaccines use messenger RNA, the technology used in their COVID-19 vaccines.

mRNA vaccine technology offers advantages in efficacy, speed of development and production, scalability, and reliability in addressing infectious disease outbreaks, as demonstrated during the COVID-19 pandemic, Moderna CEO Stephane Bancel said in a statement.

Manufacturing of conventional flu vaccines using cell or egg-based technology can take four to six months.

U.S. officials previously announced they were moving bulk vaccine from CSL SeqirusCSL.AXthat closely matches the current virus into finished shots that could provide 4.8 million doses if needed.

Some of those doses could be available as early as this month, O'Connell said. Those shots could potentially be used toinoculate farm workers and others at risk of exposureto the virus.

Lab experiments from the U.S. Food and Drug Administration continue to confirm that pasteurization inactivates the bird flu virus in dairy products, said Don Prater, director of the agency's Center for Food Safety and Applied Nutrition.

The FDA isconducting ongoing testsof retail dairy products for traces of avian flu and has cautioned against consuming raw milk.

(Reporting by Julie Steenhuysen in Chicago and Leah Douglas in Washington; Additional reporting by Bhanvi Satija, Christy Santhosh in Bengaluru; Editing by Bill Berkrot)

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Bird flu concern prompts U.S. to award Moderna $176 million for vaccine development - Successful Farming

Raw milk can harbor live bird flu virus, according to the results of a new study. The results come ... [+] amid a survey showing that many Americans underestimate the health risks of consuming raw milk.

An alarming 14% of raw milk samples taken from four states with dairy herd outbreaks contained infectious H5N1 bird flu, according to new testing results released by the FDA.

The researchers took 275 milk samples from bulk storage tanks on farms in states where dairy cattle are confirmed to be infected by H5N1. The virus was actually detected in 57.5% of the samples, with further testing showing that a quarter of these contained infectious virus. However, the FDA was keen to stress that the study was not specifically designed to assess the prevalence of the virus in milk and that the numbers might not be more widely representative.

"The goal of this study was to determine what range of viral load might be present in raw milk samples from farms that routinely send product for pasteurization, not to determine state-wide or national H5N1 virus prevalence in the overall milk supply," said a spokesperson for the FDA.

The results were published in a preprint paper, which has not yet been peer reviewed by external experts for scientific rigor. However, the paper has sparked a significant response from experts around the world, reiterating the dangers of consuming raw milk.

The researchers also artificially spiked milk with infectious H5N1 virus, before heat treating it in a process designed to mimic pasteurization, which the standard commercial milk supply goes through before sale, finding that the process was very effective at inactivating the virus. "These findings demonstrate that the milk supply is safe," the researchers stated.

The consumption of raw milk, which has not undergone filtration or heat treatment to remove pathogens, has been responsible for several outbreaks of illness including with bacteria such as campylobacter and comes with significant health risks, according to the CDC. Although there are no documented cases yet of humans getting H5N1 by drinking infected raw milk, there is evidence that mice have been infected via drinking cows milk.

However, all of the milk sampled for the FDA study was destined to be pasteurized.

"The samples in this study were taken from milk producers participating in the Pasteurized Milk Ordinance (PMO) regulatory program and thus their milk was bound for pasteurization and not destined for sale to consumers as raw milk in states where this is permitted," said a spokesperson for the FDA.

The new results come amid a new survey released today which shows that less than half of U.S. adults know that drinking raw milk is more unsafe than drinking milk that has been pasteurized.

The survey, run by researchers at the Annenberg Public Policy Center at the University of Pennsylvania from June 7-10, asked more than 1,000 U.S. adults their beliefs about raw milk, finding that only 47% of respondents knew that raw milk was less safe to drink. A further 30% were not sure, 15% thought it was just as safe and 9% of respondents thought it was safer.

It is important that anyone planning to consume raw milk be aware that doing so can make you sick and that pasteurization reduces the risk of milk-borne illnesses, said Patrick E. Jamieson, director of the Annenberg Health and Risk Communication Institute at the Annenberg Public Policy Center at the University of Pennsylvania.

The survey also found that 20% of respondents weren't sure how effective pasteurization is at killing viruses and bacteria and 4% thought it was "not too effective" or "not at all effective." Adults who were 65 or older and/or college educated were more likely to understand the benefits of pasteurization and also correctly believe that pasteurization does not destroy nutrients in milk.

Some beliefs about raw milk were also different depending on political affiliation, with 57% of Democrats believing that drinking raw milk is more unsafe than drinking pasteurized milk, compared to 37% of Republicans.

"The difference in views of raw milk that we see between Democrats and Republicans is difficult to disentangle from the difference between rural and urban dwellers, said Kathleen Hall Jamieson, director of the Annenberg Public Policy Center. Those in rural areas are both more likely to identify as Republicans and to consume raw milk.

This article was updated on 3rd July at 4pm EST to include comments from the FDA regarding the study.

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FDA Study Finds Infectious H5N1 Bird Flu Virus In 14% Of Raw Milk Samples - Forbes

Federal officials suspect that live bird markets in San Francisco may be the source of bird flu virus in area wastewater samples.

Days after health monitors reported the discovery of suspected avian flu viral particles in wastewater treatment plants, federal officials announced that they were looking at poultry markets near the treatment facilities.

Last month, San Francisco Public Health Department officials reported that state investigators had detected H5N1 the avian flu subtype making its way through U.S. cattle, domestic poultry and wild birds in two chickens at a live market in May. They also noted they had discovered the virus in city wastewater samples collected during that period.

Two new hits of the virus were recorded from wastewater samples collected June 18 and June 26 by WastewaterSCAN, an infectious-disease monitoring network run by researchers at Stanford, Emory University and Verily, Alphabet Inc.s life sciences organization.

Nirav Shah, principal deputy director of the U.S. Centers for Disease Control and Prevention, said that although the source of the virus in those samples has not been determined, live poultry markets were a potential culprit.

Hits of the virus were also discovered in wastewater samples from the Bay Area cities of Palo Alto and Richmond. It is unclear if those cities host live bird markets, stores where customers can take a live bird home or have it processed on-site for food.

Steve Lyle, a spokesman for the states Department of Food and Agriculture, said live bird markets undergo regular testing for avian influenza.

He said that aside from the May 9 detection in San Francisco, there have been no other positives in Live Bird Markets throughout the state during this present outbreak of highly-pathogenic avian flu.

San Franciscos health department referred all questions to the state.

Even if the state or city had missed a few infected birds, John Korslund, a retired U.S. Department of Agriculture veterinarian epidemiologist, seemed incredulous that a few birds could cause a positive hit in the citys wastewater.

Unless youve got huge amounts of infected birds in which case you ought to have some dead birds, too itd take a lot of bird poop to become detectable in a citys wastewater system, he said.

But the question still remains: Has anyone done sequencing? he said. It makes me want to tear my hair out.

He said genetic sequencing would help health officials determine the origin of viral particles whether they came from dairy milk, or from wild birds. Some epidemiologists have voiced concerns about the spread of H5N1 among dairy cows, because the animals could act as a vessel in which bird and human viruses could interact.

However, Alexandria Boehm, professor of civil and environmental engineering at Stanford University and principal investigator and program director for WastewaterSCAN, said her organization is not yet able to reliably sequence H5 influenza in wastewater. We are working on it, but the methods are not good enough for prime time yet.

A review of businesses around San Franciscos southeast wastewater treatment facility indicates a dairy processing plant as well as a warehouse store for a member-supported community of people that feed raw or cooked fresh food diets to their pets.

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Live poultry markets may be source of bird flu virus in San Francisco wastewater - Los Angeles Times

Bird flu

Colorado dairy worker recovers as officials work toward vaccines and offer farmers financial aid

The US announced its fourth human case of bird flu, in a Colorado dairy worker, on Wednesday, as officials work to expand the availability of potential vaccines and commercial tests and open up financial assistance for affected farmers.

The dairy worker was in close contact with cows that had tested positive for H5N1, a highly pathogenic bird flu, and the worker reported only eye symptoms, according to the Centers for Disease Control and Prevention (CDC).

The person took antiviral medication and has recovered, the CDC said. The agency is sequencing a sample of the virus to see if it has developed any concerning mutations.

More than 780 people have been monitored for symptoms and at least 53 have been tested for H5N1 this year, the CDC reports. The vast majority of those tests have been performed in Michigan.

Colorado has the highest number of affected herds, according to the US Department of Agriculture (USDA). A cat in Colorado has also tested positive after no known contact with poultry or dairy operations.

Prior to this years outbreak in dairy cattle, the only previous US case in humans was detected in Colorado in 2022, after an incarcerated person was exposed to the virus while culling a flock of infected poultry.

The new case followed an announcement the day before from US officials about plans to build up the supply of H5N1 vaccines and expand the availability of tests.

The US is partnering with the vaccine maker Moderna to help develop and manufacture mRNA bird flu vaccines if needed, said Dawn OConnell, assistant secretary for preparedness and response (ASPR). Trials for safety and efficacy in people would probably begin next year, she said.

While the $176m contract focuses on H5N1 vaccines, it could also be used on developing or procuring vaccines targeting other strains of influenza or emerging infectious diseases, McConnell said.

The US has also ordered 4.8m doses of another type of H5N1 vaccine, which are expected to come off the production line in the middle of July, faster than we had initially anticipated, McConnell said.

These vaccines would still need to be approved by the Food and Drug Administration (FDA) before they could be given to people.

The risk to humans from bird flu remained low, officials said, and H5N1 vaccines are not recommended for anyone at this point.

Officials also floated the possibility of using influenza antivirals to prevent transmission of the H5N1 virus among people, if it mutates to become more effective at human-to-human spread.

The vaccines tend to be better at preventing severe disease rather than transmission, said Nirav Shah, principal deputy director of the CDC, adding that more widespread distribution of antivirals could help with the latter.

Expanding test availability could mean those at risk for contracting H5N1 could go to a commercial lab to get tested, which could make testing more accessible and faster.

Right now, the US has about 750,000 tests for H5N1, and another 1.2m expected in the next two to three months, all of which are conducted in public health laboratories. The CDC is working to share its test designs with commercial companies, and on 10 June the agency opened a call for companies to propose new H5N1 test designs.

On Monday, the USDA opened up a financial assistance program to dairy producers with herds affected by H5N1. While infected cows usually survive, their milk production often plummets, and disposing of H5N1-infected milk means lost income.

The new program allows any dairy farmers with H5N1-positive cows to apply for federal assistance, similar to programs that exist for poultry farmers who lose flocks. Experts hope it will encourage producers to test their herds and help contain the spread of bird flu.

Six states have also enrolled in the USDAs voluntary dairy herd status pilot program, and 24 herds are enrolled in the agencys financial support programs to enhance biosecurity and testing on farms.

Bird flu vaccines for cows are also being studied, but that process takes time, said Eric Deeble, acting senior adviser for the USDAs H5N1 response. It will take a while for any vaccine to become available, and in the interim, were going to continue to stress biosecurity for example, limiting the number of people on farms, or cleaning and disinfecting equipment and clothing. Studies so far indicate that people are moving the virus between farms via shared workers, cows, vehicles and equipment.

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US reports fourth case of bird flu in humans - The Guardian

MISSOULA H5N1 also known as bird flu has been slowly infecting new animals across the country, including dairy cows.

A recent development has been that some people who work on dairy farms have also been infected.

While no dairy herds in Montana have been infected by the bird flu that doesnt mean the virus hasnt been showing up in other animal populations in the state.

That is something that is raising alarms within the scientific community.

I think we've had close to 20 flocks here in Montana since 2022 that's impacted about 150,000 birds in the state, said Montana State Veterinarian Tahnee Szymanski.

In addition to the threat to poultry populations, bird flu has been found in wild birds, lynx, barn cats and even grizzly bears. However, Szymanski noted that transmission from wild animals is currently not a large concern. It's really interesting because they're using the genetic sequencing of the virus to show that it's not wild birds that are continuing to spread this particular variant that's in dairy cattle," Szymanski told MTN. "It's actually we're moving cattle around or we're moving the virus around on people, equipment, or whatever.

So what is being done to counteract this virus? MTN visited Rocky Mountain Laboratories in Hamilton where researchers have been studying H5N.

Zach Volheim/MTN News

Influenza. As I've mentioned, it may have mentioned is really kind of a shapeshifter of the virus. It's got a lot of tricks that it can pull," explained Rocky Mountain Laboratories Associate Director for Scientific Management Marshall Bloom.

The evidence so far is that the virus does not appear to be highly transmissible in humans, and scientists are trying to study why that is. Bloom explained there are five key points that they are looking into.

Those are why and how this virus infects certain animals, how can it be detected, how long it lasts on transmissible surfaces, how can they improve vaccines and what kind of countermeasures such as anti-viral drugs can be used to slow the virus.

While researchers are concerned about the virus being detected in humans, the concerns for a larger outbreak are still rather minimal at this point.

The risk to people right now is low. Our food supply is safe. Our commercial milk supply is safe," Szymanski told MTN. But we just want to be we want to be careful with that added Szymanski.

Currently, the overall threat of bird flu spreading between animals and people in Montana is rather low, but precautions are still being taken to make sure that remains the case.

More local news from KPAX

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What are the risks of bird flu in Montana? - KPAX News

A fourth person has tested positive for bird flu in the outbreak linked to dairy cows, this time in Colorado.

The Centers for Disease Control and Prevention said Wednesday that the patient, a dairy worker at a farm where cows had also tested positive for the virus, had eye symptoms and has recovered after getting the antiviral drug Tamiflu.

The case mirrors the course of illness seen in two earlier cases in this outbreak, in Texas and Michigan dairy workers. The only symptoms either developed was pink eye. A third patient, also in Michigan, did develop upper respiratory symptoms, including sore throat, cough and congestion.

All of the patients have recovered, and none were connected to one another.

Based on the information available at this time, this infection does not change CDCs current H5N1 bird flu human health risk assessment for the U.S. general public, which the agency considers to be low, the agency said in a news release Wednesday.

There is no evidence, the CDC said, of increased flu-like illnesses that would indicate that the virus a strain called H5N1 is spreading widely in people.

Since the outbreak was first detected in March, more than 780 people exposed to sick cows have been monitored, and 53 have been tested for the virus, the CDC said Tuesday in a briefing with reporters.

Federal health officials said that 4.8 million doses of a vaccine for this particular flu strain could be available in the coming weeks. Drugmaker Moderna is also in the early stages of an mRNA vaccine for bird flu.

As of Wednesday, 139 herds in 12 states had been affected, according to the Department of Agriculture.

TheCDC recommendsthat anyone in contact with dairy cattle wear protective equipment, including safety glasses, waterproof aprons and boots that can be sanitized. Health officials also strongly warn against drinking unpasteurized raw milk. Pasteurization has been shown to neutralize the virus in milk samples.

Erika Edwards is a health and medical news writer and reporter for NBC News and "TODAY."

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4th case of bird flu linked to dairy cows detected in Colorado - NBC News

FILE PHOTO: A dairy cow calls out in Chino, California, April 25, 2012. Photo by Alex Gallardo/Reuters

Afourth farm workerhas been infected with bird flu in the growing outbreak linked to dairy cows, health officials reported Wednesday.

The worker had direct contact with infected dairy cows on a northeast Colorado farm, state and federal health officials said. The man developedpink eye, or conjunctivitis, received antiviral treatment and has recovered.

READ MORE: How bird flu puts workers on farms and in food processing plants at higher risk

Three previous casesof human infection linked to cows have been reported in dairy workers in Texas and Michigan since March. Two of those workers also developed pink eye, while one had mild respiratory symptoms, In 2022, the first U.S. case of bird flu was detected in a Colorado farm worker exposed to infected poultry.

The Centers for Disease Control and Prevention said the new infection "does not change" the agency's assessment that the risk to the general public remains low. Surveillance systems tracking flu in the U.S. have shown no unusual activity, officials said. However, people with prolonged contact with to infected birds or other animals, including livestock, or to their environments, are at higher risk of infection.

The Colorado man was being monitored when he developed symptoms because of his work with dairy cows, according to the CDC. Tests at the state level were inconclusive, but samples sent to CDC tested positive. Full results of genetic analysis of the sample are pending.

As of Wednesday, more than 135 dairy herds in a dozen states had reported infections with the H5N1 virus thatoriginated in poultry,according to the Agriculture Department.

Left: FILE PHOTO: A dairy cow calls out in Chino, California, April 25, 2012. Photo by Alex Gallardo/Reuters

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Colorado dairy worker infected with bird flu in 4th human case linked to U.S. outbreak - PBS NewsHour

As the H5N1 bird flu outbreak in dairy cows enters its fourth month, the Centers for Disease Control and Prevention is taking steps to ramp up the nations capacity to test for the virus in people.

In a call with reporters Tuesday, Nirav Shah, the CDCs principal deputy director, emphasized that the risk to the general public remains low at this time. But given that the virus is showing no signs of slowing its push deeper into the U.S. cattle population threatening to create lasting risks to dairy workers and giving it more chances to evolve in ways that make it better at spreading to and among humans the agency is looking to increase the number and types of tests that can effectively detect H5N1 infections in people.

We need to stay prepared for the possibility of an expansion of the H5N1 outbreak in humans, Shah said.

Currently, the CDCs bird flu test is the only one the Food and Drug Administration has authorized for use. Shah said the agency has distributed 750,000 of these tests to local public public health labs, and is expecting 1.2 million more to come online in the next two to three months.

But should the virus begin to spread easily among humans, testing needs may quickly outpace existing public health laboratory capacity. Which is why the CDC is also working with commercial labs to build additional tests. So far, the agency has given eight companies licenses for its tests, Shah said. Three additional licenses are pending and another four companies are in the process of applying for licenses.

The effort appears to be aimed at avoiding mistakes the federal government made in the early months of the Covid-19 pandemic, when testing failures including a slow recruitment of commercial labs to the response allowed the coronavirus to spread undetected.

The CDC and local health departments have tried to boost bird flu testing among farmworkers including with financial incentives but uptake has been slow. Since the outbreak was recognized in March, the U.S. has tested only 53 people for novel influenza strains, which would include H5N1, according to the CDCs latest figures. Three people one farmworker in Texas and two in Michigan tested positive for the virus. Two experienced only minor symptoms, namely conjunctivitis, or pink eye. The third had more traditional flu-like respiratory symptoms, and all three recovered.

Many dairy workers are immigrants, who live in rural areas with little access to transportation and no sick leave, making it difficult to travel to health care providers for testing and treatment. While acknowledging these challenges, public health experts have criticized the lack of testing, which is making it difficult to know how many farmworkers have been infected. Insufficient surveillance could also mean public health agencies might miss signs of human-to-human spread of the H5N1 virus.

The labs granted CDC licenses will still have to have their versions of the CDC test cleared for use by the FDA before they can be rolled out. Part of that approval process is proving the tests work. And to conduct such validation studies, labs and diagnostics manufacturers need control materials samples that carry enough of the virus that they will light up a test as positive. That gets more complicated with a flu virus like H5N1, which is highly pathogenic, and therefore requires additional biosafety controls to work with in a lab.

To streamline the test validation process, the CDC is working to develop a non-virulent form of the control material, which it plans to provide to diagnostics manufacturers and commercial testing labs, although Shah did not provide a timeline for when they would become available.

The agency is also entreating the diagnostics industry to develop additional kinds of H5N1 tests, to broaden the nations portfolio of viral detection capabilities. On June 10, CDC put out a call for innovative testing solutions that can be easily ramped up to handle at least a million samples by the end of this year. The agency is now reviewing those applications, Shah said, with a goal of awarding funding to the winning companies by the end of August.

On Tuesday, the federal government also announced plans to support the development of messenger RNA-based pandemic influenza vaccines, including those that target H5 and H7 avian influenza viruses. BARDA, the Biomedical Advanced Research Development Authority, awarded Moderna $176 million to accelerate clinical testing of its pandemic vaccines, which are expected to enter a Phase 3 trial sometime next year. The U.S. government already has vaccine contracts and stockpiles of H5 vaccines made using other platforms by other manufacturers, including CSL Seqirus and Sanofi.

Dawn OConnell, assistant secretary for preparedness and response at the Department for Health and Human Services, said at the press briefing that nearly 5 million doses of H5 vaccine stored in bulk in the National Pre-Pandemic Influenza Vaccine Stockpile are now in the process of being put into vials, in case its needed. Our expectation is that those first doses will begin coming off the line in the middle of this month, OConnell said. We remain extraordinarily watchful regarding the situation that were all tracking regarding dairy cows and working very closely with our other public health partners trying to understand if and when we should move these vaccines from the lines and out into deployment.

As of Tuesday, the Department of Agriculture has reported infections in 137 dairy herds in 12 states. That tally doesnt include four additional infected herds reported by state authorities this week, including one each in Iowa and Minnesota and two in Colorado. With 27 outbreaks in Colorado most of which have occurred in the last month that state has now seen nearly one-quarter of its dairy herds infected with the virus.

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CDC looks to expand capacity to test for H5N1 bird flu in people - STAT

AMA Update covers a range of health care topics affecting the lives of physicians, residents, medical students and patients. From private practice and health system leaders to scientists and public health officials, hear from the experts inmedicineon COVID-19, medical education, advocacy issues, burnout, vaccines and more.

Featured topic and speakers

What is dengue fever? Is dengue fever deadly? How long does dengue fever last? Can dengue fever kill you? Is dengue fever in Florida? Also, a bird flu 2024 update.

Our guest is AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH. AMA Chief Experience Officer Todd Unger hosts.

Unger: Hello, and welcome to the AMA Update video and podcast. Today, we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine, and Public Health Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Good to see you again, Andrea.

Garcia: Good to see you, too.

Unger: Well, the last couple of weeks we've talked a lot about how climate change is driving extreme temperatures and the health impact of all of this heat. But this week, we've got something new that's driving concern and headlines, and that is dengue fever. Andrea, tell us what's going on there.

Garcia: Well, Todd, last week, we saw the CDC issue a health advisory, or a HAN, to physicians, public health authorities and the public, warning of an increased risk for dengue virus infections in the U.S. this year. This is really coming in response to an alarming number of cases we've seen abroad already in the first six months of 2024.

Countries in the Americas have reported more than 9.7 million dengue cases. That's twice as many as we saw in all of 2023. And in the U.S., Puerto Rico has declared a public health emergency this past spring because they've reported more dengue cases in the first five months of 2024 than all of last year. And those were during the dry season when dengue cases are typically at their lowest.

Unger: Andrea, have we seen any cases like this in the continental U.S.?

Garcia: Well, the CDC has said there's currently no evidence of a dengue outbreak in the continental U.S. We do see travel-related cases here. And since January, 745 dengue cases have been identified among U.S. travelers who became infected abroad.

That's higher than expected for this time of year, given that dengue cases typically increase during the warmest months, and we know those are yet to come. Public health officials are expecting to see the virus in more temperate regions, including the southern-most portions of the United States. The mosquito responsible for dengue is found in several states, including Texas, Florida and California. So far this year, Florida has already reported 10 cases from local spread and that is across four different counties.

Unger: So in effect, although we're not talking about necessarily the heat, this is an outcome of climate change, so to speak. Andrea, in terms of how it spreads, we know that dengue fever is spread through mosquitoes. But take us through a little bit more in detail about the mechanism there.

Garcia: So dengue is spread by the bite of an infected Aedes species mosquito, primarily Aedes aegypti, but it can also be spread by the Aedes albopictus mosquito.

Travelers infected abroad can then bring the virus back to their communities, where local mosquitoes bite them and then transmit the disease to others. According to the WHO, dengue is one of the world's most neglected tropical diseases. Three out of four cases are mild or asymptomatic, and that makes the illness really difficult to track.

Unger: And when you say Aedes, I don't think you mean the decade. That's A-E-D-E-S, for those of you who have not heard that term before. Andrea, talk to us about the seriousness of the cases that we're seeing right now.

Garcia: So most cases aren't serious, but there can be severe cases that lead to internal bleeding, organ failure or even death. Infections usually begin after an incubation period of about five to seven days, starts with a fever, and then it's accompanied by other symptoms, including nausea, vomiting, rash, muscle aches, joint and bone pain, pain behind the eyes, headache, or low white blood cell counts.

Unlike other diseases, where fever reduction is a sign that someone's getting better, for dengue, this is when the critical phase begins, and it typically lasts for 24 to 48 hours. There are several warning signs that indicate progression to severe disease. Those include abdominal pain or tenderness, persistent vomiting, bleeding from the nose or gums, and lethargy or restlessness.

Severe disease develops in about one out of 20 people with symptomatic dengue. And infants, pregnant people, adults over 65 years of age, and people with certain medical conditions are at an increased risk.

Unger: All right. Andrea, do we know what is driving this dramatic increase, you have to say, in the number of cases?

Garcia: Well, as you briefly mentioned, this is likely yet another byproduct of climate change. Soaring global temperatures have really accelerated the life cycles and expanded the ranges of mosquitoes that are responsible for dengue, helping spread that virus to roughly one in every 800 people on the planet in the last six months alone.

But it's not just rising temperatures. Climate-induced droughts can prompt people to stockpile water, which creates more mosquito habitats, and then it also escalates hurricanes and floods that produce standing water while simultaneously forcing people from their homes and increasing their exposure to mosquitoes. There was a Washington Post article that noted that, without drastic action to control the virus and slow climate change, research is suggesting that some two billion additional people across the globe could be at risk for dengue in the next 50 years.

Unger: Well those are pretty incredible numbers. And as you outlined before, in terms of symptoms, especially the more serious side, not good. Is there any kind of treatment available?

Garcia: Unfortunately, there are no antiviral medications approved to treat dengue and no vaccines for adults or people without a previous dengue infection. The only vaccine approved for use here in the U.S. is for children aged 9 to 16 years old who have had a previous dengue infection and who live in frequent or continued continuous dengue transmission area.

So think like American Samoa, Puerto Rico, U.S. Virgin Islands. But the supply of that vaccine is expected to run out after August of 2026. That's because the manufacturer is going to stop making it due to low demand. In May, the WHO expanded the use of a second vaccine, but that manufacturer withdrew its application from the FDA last summer because of data collection issues.

There's a third vaccine being developed by the NIH. It's still in clinical trials, and it won't be available in the U.S. for at least a few years. I think it's also worth noting that this disease is complicated because it's caused by four distinct but closely related dengue viruses. Infection with one dengue virus generally produces lifelong protection against infection from that specific virus but only partial and short-term protection against the others. And there's evidence that suggests the risk of severe complications may increase with sequential infections from a different type.

Unger: So Andrea, what should physicians be doing in response to this latest development?

Garcia: So the CDC is urging physicians to be on the lookout for dengue among people who have a fever and who've been in areas with dengue transmission within the last 14 days of the start of their illness. This disease is easy to miss, and since dengue hasn't been a problem here, awareness among physicians is likely low.

If physicians do suspect dengue, they need to order the appropriate diagnostic tests for acute dengue infection and of course report those cases to public health authorities. We can also do our part by using EPA-approved repellents, wearing loose-fitting long-sleeve pants and shirts to prevent getting bitten by mosquitoes in the first place. The CDC also suggests using air conditioning and window screens when possible and dumping and draining containers outside that hold water. And if you do develop symptoms, be sure to seek medical care.

Unger: All right. That is a great update on that and all good information, especially as we head into the hotter months. Andrea, let's switch gears a bit and do a quick check in on bird flu. Anything new happening there?

Garcia: Well we do continue to see rising cases. Last week we reported that we had been seeing 118 herds in 12 U.S. states with bird flu. This week, that number has grown to 132 herds. I think something worth talking about briefly are those agricultural fairs as we head into the holiday weekend.

Millions of people in the U.S. attend fairs each year, especially around the fourth and throughout the summer months. The CDC's recommendations around fairs previously focused on reducing the risk of spreading swine-origin flu viruses between pigs and people. Those recommendations have now been expanded to include cattle. The best thing people can do is avoid animal exposures at these fairs and remember to wash your hands frequently.

Unger: All right. There was also a new study that I read about that was promising news for containing the virus. Andrea, can you tell us a little bit more about that?

Garcia: Well, one of the big questions that scientists have been wrestling with is how this virus spreads from one animal to another. And there was a detailed article in The New York Times around a small experiment that was carried out in Kansas and Germany, which has offered some new information. Now, I think it's important to note these findings haven't been posted online or published in a peer-reviewed journal yet.

But what that experiment found is that the virus is mainly infectious via contaminated milking machines. And this certainly poses logistical problems for dairy farmers. But it would mean the virus is easier to contain than if it were spread through respiratory droplets.

According to a scientist involved in the study, this offers hope that the outbreak could theoretically be halted before it evolves into a form that can spread readily between humans. There are certainly caveats, though. These results are from two experiments that involved a very small number of cows.

The scientists also studied an early strain of the virus, and we know that virus has been mutating as it has moved from animal to animal. And researchers can't say whether a more recent strain would behave more like a respiratory disease. Certainly, though, Todd, this is something we'll continue to pay attention to.

Unger: Well, that's something we'll continue to watch carefully in the coming weeks. Andrea, that's all we have time for this week. I want to say thanks again for being here and sharing this important information.

I do want to add that we also have a lot of vaccine updates following the CDC's Advisory Committee on Immunization Practices meeting last week, but we'll be diving into more details on that on Monday with the AMA's ACIP liaison, Dr. Sandra Fryhofer. So make sure to tune in for that.

If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. And due to the Fourth of July holiday, this is going to be our last episode until Monday. Of course, you can always find all our videos and podcasts at ama-assn.org/podcasts.

Please enjoy your Fourth of July holiday. Stay safe out there. Take care.

Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.

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Here is the original post:

2024 dengue fever outbreak, dengue symptoms, a new study on bird flu in cows and state fair safety - American Medical Association

Ever since scientists discovered influenza infecting American cows earlier this year, they have been puzzling over how it spreads from one animal to another. An experiment carried out in Kansas and Germany has shed some light on the mystery.

Scientists failed to find evidence that the virus can spread as a respiratory infection. Juergen Richt, a virologist at Kansas State University who helped lead the research, said that the results suggested that the virus is mainly infectious via contaminated milking machines.

In an interview, Dr. Richt said that the results offered hope that the outbreak could be halted before the virus evolved into a form that could spread readily between humans.

I think this is good news that we can most likely control it easier than people thought, Dr. Richt said. Hopefully we can now kick this thing in the behind and knock it out.

The findings have yet to be posted online or published in a peer-reviewed science journal.

Seema Lakdawala, a virologist at Emory University who is researching the virus on dairy farms and was not involved in the new study, cautioned that breaking the transmission chain would require serious changes to how farmers milk their cows.

Its really great that these results are coming out, she said. But this is a real logistical problem.

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The rest is here:

How Does Bird Flu Spread in Cows? Experiment Yields Some 'Good News.' - The New York Times