Category: Flu Virus

CAMBRIDGE - Moderna announced Monday that its combination COVID and flu vaccine showed positive results in a late-stage trial.

The Cambridge, Massachusetts-based biotech company said the mRNA-1083 vaccine produced a higher immune response in older adults than the separate shots that were co-administered in the study.

"Combination vaccines have the potential to reduce the burden of respiratory viruses on health systems and pharmacies, as well as offer people more convenient vaccination options that could improve compliance and provide stronger protection from seasonal illnesses," Moderna CEO Stephane Bancel said in a statement Monday. "Moderna is the only company with a positive Phase 3 flu and COVID combination vaccine.

The Phase 3 trial involved two groups of about 4,000 adults each. One group consisted of adults between the 50 and 64 years old and the other was just for those above 65. In the older group, the combination vaccine was compared to a higher dose flu shot.

"In both age cohorts, mRNA-1083 also elicited statistically significantly higher immune responses against three influenza virus strains (H1N1, H3N2, and B/Victoria) and against SARS-CoV-2," Moderna reported.

The company said the trial showed the new combination vaccine has "an acceptable tolerability and safety profile." The most commonly reported side effects were injection site pain, fatigue, muscle pain and headaches.

Back in early 2022, Moderna said it was planning to have a combination COVID and flu vaccine ready by the fall of 2023. Many months later, it's still not clear when the public will have access to the shot.

Moderna said it "will engage with regulators on next steps" for its combination vaccine. In aletter to shareholders at the start of the year, Bancel said the intention is to have the combination vaccine ready as early as 2025.

Speaking to CBS News last fall as Moderna prepared to begin the late-stage trial, Montclair State University public health professor Dr. Stephanie Navarro Silvera said a combination vaccine would be more appealing for people who don't like getting multiple shots.

"Let's face it, nobody wants to get a shot more than once," she said. "So if we can combine two vaccines into one ... that's going to be a win in terms of public health."

Moderna's competitors are also working on a combination shot. Pfizer and BioNTech said last October that it was preparing a Phase 3 trial after getting "positive topline results" in earlier studies. And Novavax's website says a COVID and seasonal influenza vaccine is in the Phase 2 trial stage.

Neal J. Riley is a digital producer for CBS Boston. He has been with WBZ-TV since 2014. His work has appeared in The Boston Globe and The San Francisco Chronicle. Neal is a graduate of Boston University.

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Moderna says its combination COVID and flu vaccine tested better than separate shots - CBS Boston

The World Health Organization (WHO) has confirmed that a four-year-old child in West Bengal, India, has been infected with the H9N2 bird flu virus.

The child was admitted to a local hospital's pediatric intensive care unit in February, suffering from severe respiratory issues, high fever, and abdominal cramps. After receiving the diagnosis and treatment, the child was discharged three months later.

The WHO reported that the child had been exposed to poultry at home and in the surrounding area. No other family members or contacts have reported respiratory symptoms. Details on the child's vaccination status and antiviral treatment were not available at the time of reporting.

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This case marks the second instance of human infection with the H9N2 strain of bird flu in India, following the first reported case in 2019. While H9N2 typically causes mild illness, the WHO warned that sporadic human cases may continue to occur, given the virus's prevalence in poultry across various regions.

ALL ABOUT THE H9N2 BIRD FLU STRAIN

The H9N2 strain is a subtype of the avian influenza virus, commonly found in birds. This is the second case of H9N2 in India.

"While it primarily infects birds, it can occasionally infect humans, including children," said Dr Saibal Chakravorty, Senior Consultant, Internal Medicine, Metro Hospital, Noida.

Direct contact with infectious animals or indirect interaction with contaminated environments are the two ways that the virus spreads.

Common symptoms of H9N2 are familiar to other viral infections. Individuals may experience fever, cough, sore throat, runny or stuffy nose, and headache. Other symptoms could include muscle aches, fatigue, and conjunctivitis.

In some cases, severe symptoms like difficulty breathing and pneumonia can occur.

It can occasionally lead to more severe illness, especially in individuals with weakened immune systems or underlying health conditions.

"In comparison to other strains of avian influenza, such H5N1 and H7N9, H9N2 is typically less infectious and results in a milder illness in humans. It is well established that H5N1 and H7N9 can cause serious respiratory illnesses and increase an infected person's mortality rate," said Dr Chakravorty.

H9N2 is less hazardous to public health due to its comparatively lower pathogenicity, but regular observation is still necessary because of its global distribution and human infection potential.

TREATMENT FOR H9N2 BIRD FLU

Multiple techniques are used to manage and treat H9N2 avian influenza.

Antiviral medications like zanamivir (Relenza) and oseltamivir (Tamiflu) can be helpful, especially if used early in the course of the illness.

It's also critical to provide supportive care, which includes relaxation, adequate hydration, and treatment of fever and respiratory problems.

In severe circumstances, the patient may need to be admitted to the hospital for intensive care and respiratory support in order to obtain the essential medical attention to adequately manage the infection.

"Generally, H9N2 is less dangerous than other more virulent strains of avian influenza; but, because of its ability to disseminate and infect people, especially those who have close contact with birds, continuous surveillance and preventive measures are necessary," underscored Dr Chakravorty.

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Daphne Clarance

Published On:

Jun 12, 2024

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WHO confirms second human case of H9N2 bird flu in India: All about this strain - India Today

Bird flu

Scientists are on alert for signs the virus is adapting to spread more easily among humans, after the WHO announced the death from April

Guardian staff and agencies

The World Health Organization (WHO) has said a mans death in Mexico was caused by a strain of bird flu called H5N2 that has never before been found in a human.

The WHO said Wednesday it wasnt clear how the person became infected. Although the source of exposure to the virus in this case is currently unknown, A(H5N2) viruses have been reported in poultry in Mexico, it said in a statement.

Scientists are on alert for changes in the virus that could signal that bird flu is adapting to spread more easily among humans.

But the UN agency said Wednesday said the current risk of the bird flu virus to the general population in Mexico is low.

The 59-year-old man, who had been hospitalised in Mexico City, died on 24 April after developing a fever, shortness of breath, diarrhoea, nausea and general discomfort, the WHO said.

Mexicos health ministry added in a statement on Wednesday that there had so far been no evidence of person-to-person transmission of bird flu in the case of the man who died, and that he had several prior health conditions. All people who had contact with him have tested negative, it said.

In March, Mexicos government reported an outbreak of A(H5N2) in an isolated family unit in the countrys western Michoacan state, but said at the time it did not represent a risk to distant commercial farms, nor to human health.

After the April death, Mexican authorities confirmed the presence of the virus and reported the case to the WHO, the agency said.

There had been three poultry outbreaks of H5N2 in nearby parts of Mexico in March, but authorities havent been able to find a connection.

Scientists said the case in Mexico is unrelated to the outbreak of a different strain of bird flu H5N1 in the United States that has so far infected three dairy farm workers.

Other bird flu varieties have killed people across the world in previous years, including 18 people in China during an outbreak of H5N6 in 2021, according to a timeline of bird flu outbreaks from the US Centers for Disease Control and Prevention.

Andrew Pekosz, an influenza expert at Johns Hopkins University said that since 1997, H5 viruses have continuously shown a propensity to infect mammals more than any other avian influenza virus.

So it continues to ring that warning bell that we should be very vigilant about monitoring for these infections, because every spillover is an opportunity for that virus to try to accumulate those mutations that make it better infect humans, he said.

Cases of bird flu have now been identified in mammals such as seals, raccoons, bears and cattle, primarily due to contact with infected birds.

Australia reported its first human case of A(H5N1) infection in May, noting there were no signs of transmission. It has however found more poultry cases of H7 bird flu on farms in the state of Victoria.

With Reuters and Associated Press

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Mexico man dies from first human case of bird flu strain H5N2 - The Guardian

REUTERS The ongoing U.S. outbreak of avian flu in dairy cattle reached Minnesota last week as the state announced its first infected herd.

Glacier FarmMedia ROTTERDAM Many major crop-producing regions, Canada among them, now have a pathway to market gene-edited crops

More than 80 dairy herds have been infected with the virus across 11 states since late March, and three dairy workers have tested positive for the virus.

The Minnesota Board of Animal Health said the farmer of the affected herd reported more than 40 cows with signs of fever. The animals were tested and the U.S. Department of Agricultures National Veterinary Services Laboratories confirmed the positive test.

We knew it was only a matter of time before this detection would reach our doorstep, said Brian Hoefs, the state veterinarian, in a statement. Its important for dairy farmers to follow the example of this herd and test sick cows.

The other states with infected herds include Idaho, Colorado, South Dakota, Kansas, New Mexico, Texas, Michigan, Ohio, Iowa and North Carolina.

Dairy cows with avian flu have died or been slaughtered by farmers after not recovering, Reuters reported. The U.S. Department of Agriculture said most cows recover.

A 59-year-old man with underlying health conditions died in a Mexico City hospital on April 24 from complications due to contracting A[H5N2] strain of bird flu, according to the World Health Organization. The man reportedly had not been exposed to poultry or other animals.

The bird flu virus strain that infected a Texas dairy farm worker in March was lethal to ferrets in experiments designed to mimic the disease in humans, the U.S. Centers for Disease Control and Prevention reported. Seasonal flu, by contrast, makes ferrets sick but does not kill them, the CDC said.

Ferrets are considered the best small mammal for studying influenza virus infection and transmission and are commonly used as a tool to inform public health risk assessments of emerging influenza viruses, according to the CDC.

The strain of avian influenza virus found in Texas spread easily among healthy ferrets when they were placed in direct contact with infected ferrets, the researchers found.

The virus was less efficient than other influenza strains at spread by respiratory droplets, however.

This suggests viruses like this one would need to undergo changes to spread efficiently by droplets through the air, such as from coughs and sneezes, the CDC said.

Bird flu has been found in seals in the United Kingdom, Denmark and Germany.

The EU recently signed a contract to secure more than 40 million doses of a preventive avian flu vaccine for 15 countries. The first shipments will go to Finland.

The deal secures up to 665,000 doses from vaccine manufacturer CSL Seqirus and includes an option for a further 40 million vaccines for a maximum of four years.

There were no active cases in humans or in cattle in the EU as of early June, according to the European Centre for Disease Prevention and Control.

Transmission to humans remains a rare event and no sustained transmission between humans has been observed so far, it said in a weekly report for June 1-7.

The risk of zoonotic influenza transmission to the general public in EU/EEA countries is considered to be low.

The World Health Organization recently said the child with H5N1 bird flu reported by Australia last month had traveled to Kolkata, India, and the family said they did not have any known exposure to infected people or animals while there.

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Bird flu spreads in North America, globally - The Western Producer

The strain of H5N1 bird flu isolated from a dairy worker in Texas was 100 percent fatal in ferrets used to model influenza illnesses in humans. However, the virus appeared inefficient at spreading via respiratory droplets, according to newly released study results from the Centers for Disease Control and Prevention.

"This suggests that A/Texas/37/2024-like viruses would need to undergo changes to spread efficiently by droplets through the air, such as from coughs and sneezes," the CDC said in its data summary. The agency went on to note that "efficient respiratory droplet spread, like what is seen with seasonal influenza viruses, is needed for sustained person-to-person spread to happen."

In the CDC's study, researchers infected six ferrets with A/Texas/37/2024. The CDC's data summary did not specify how the ferrets were infected in this study, but in other recent ferret H5N1 studies, the animals were infected by putting the virus in their noses. Ars has reached out to the agency for clarity on the inoculation route in the latest study and will update the story with any additional information provided.

All six of the infected ferrets developed severe disease and died. To test how well the virus could spread among the ferrets, the CDC scientists set up experiments to test transmission through direct contact and respiratory droplets. For the direct transmission test, three healthy ferrets were placed in the same enclosures with three experimentally infected ferrets. All three healthy ferrets became infected.

For the respiratory transmission test, three healthy ferrets were placed in enclosures next to enclosures containing the experimentally infected animals. The infected and uninfected ferrets shared air, but did not have direct contact with each other. Of the three healthy ferrets, only one contracted the H5N1 virus (33 percent). Additionally, that one respiratory transmission event seemed to have a one- to two-day delay compared with what's seen in the same test with seasonal influenza viruses. This suggests further that the virus is inefficient at respiratory transmission.

The CDC called the overall results "not surprising." Previous ferret experiments with H5N1 isolatescollected prior to the current bird flu outbreak among US dairy cowshave also found that H5N1 is often lethal to ferrets. Likewise, H5N1 isolates collected from Spain and Chile during the current global outbreak also found that the virus was inefficient at spreading via respiratory droplets among ferretswith rates ranging from 0 percent to 37.5 percent.

For now, the findings don't affect the CDC's overall risk assessment for the general public, which is low. However, it does reinforce the risk to those who have contact with infected animals, particularly dairy and poultry farm workers.

To date, there have been four human cases of H5N1 in the US since the current global bird flu outbreak began in 2022one in a poultry farm worker in 2022 and three in dairy farm workers, all reported between the beginning of April and the end of May this year. So far, the cases have been mild, the CDC noted, but given the results in ferrets, "it is possible that there will be serious illnesses among people," the agency concluded.

As of June 9, the US Department of Agriculture has confirmed H5N1 in 85 dairy herds and one alpaca farm across 10 states.

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Bird flu virus from Texas human case kills 100% of ferrets in CDC study - Ars Technica

The World Health Organisation (WHO) said a case of human infection with bird flu caused by the H9N2 virus was detected in a four-year-old child in West Bengal.

The patient was admitted to the pediatric intensive care unit (ICU) of a local hospital due to persistent severe respiratory issues, high fever and abdominal cramps in February, and was discharged three months later after diagnosis and treatment.

The patient had exposure to poultry at home and in his surroundings, and there were no known persons reporting symptoms of respiratory illness among his family and other contacts.

This is the second human infection of H9N2 bird flu from India, with the first in 2019.

While the H9N2 virus typically tends to cause mild illness, the WHO said that further sporadic human cases could occur as this virus is one of the most prevalent avian influenza viruses circulating in poultry in different regions.

Bird flu (Avian Influenza)

Bird flu (Avian Influenza) is a contagious viral disease affecting several species of food producing birds (chickens, turkeys, quails, guinea fowl, etc), as well as pet birds and wild birds.

Occasionally mammals, including humans, may contract Avian Influenza, says World Organisation For Animal Health (OIE).

Avian Influenza has captured the attention of the international community over the years, with outbreaks in poultry having serious consequences on both livelihoods and international trade in many countries.

India notified the first outbreak of Avian Influenza in 2006. Since then, outbreaks have been reported in many states. The disease spreads mainly by migratory birds coming into India during winter months, SeptemberOctober to FebruaryMarch.

Human infection with Avian Influenza

Although most Avian Influenza viruses do not infect humans, some, such as Avian Influenza H5N1, H7N9 and H9N2, are well known to the public because of their implication in serious and sometimes fatal infections in people.

H5N1, for example, a highly pathogenic AI virus, was initially diagnosed in humans in Hong Kong in 1997. The virus then re-emerged in 2003 and 2004, and spread from Asia to Europe and Africa causing several hundred human cases and deaths, as well as destruction of hundreds of millions of poultry.

This Asiatic form of H5N1 triggered concern from scientists and authorities and remains under close surveillance due to its feared pandemic potential if a mutation allows it to be transmitted from human to human.

Nowadays, due to ongoing circulation of various strains (H5N1, H5N2, H5N8, H7N8, etc), outbreaks of Avian Influenza continue to be a global public health concern.

From January 1, 2003 to December 21, 2023, a total of 248 cases of human infection with Avian Influenza A(H5N1) virus were reported from four countries within the Western Pacific Region. Of these cases, 139 were fatal.

As of January 31, 2024, a total of 90 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 35 deaths were reported to WHO in the Western Pacific Region since 2014. The last case was reported from China on November 25, 2023.

As of January 31, 2024, a total of three laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death were reported to WHO in the Western Pacific Region.

Highly Pathogenic Avian Influenza

During 2020, Highly Pathogenic Avian Influenza (HPAI) A(H5N1) clade 2.3.4.4b viruses arose from previously circulating influenza A(H5Nx) viruses and spread predominantly via migratory birds to many parts of Africa, Asia and Europe.

The epizootic (a disease event in an animal population akin to an epidemic in humans) has led to unprecedented numbers of deaths in wild birds and caused outbreaks in domestic poultry.

In late 2021, these viruses crossed to North America and subsequently South America in October 2022.

Globally, there have been increased detections of A(H5N1) viruses in non-avian species including wild and domestic (including companion and farmed) terrestrial and marine mammals and, more recently in goats and dairy cattle in the US.

Avian Influenza A(H5N1) viruses, especially those of clade 2.3.4.4b, continue to diversify genetically and spread geographically.

Since 2022, a broader range of wild bird species has been infected globally which has had deleterious ecological consequences and caused mass die-offs in some species. The situation with wild mammals is also worrying, with some species suffering significant mortality events.

HPAI is an extremely contagious, multi-organ systemic disease of poultry leading to high mortality, and caused by some H5 and H7 subtypes of type A influenza virus.

HPAI viruses pose a threat to wild birds and poultry globally. HPAI H5N1 viruses are of even greater concern because of their frequent spillover into mammals.

Since the beginning of 2021, as many as 28 detections of A(H5N1) in humans have been reported to WHO, including a case who had exposure to dairy cattle presumed to be infected with A(H5N1) virus.

Although human infections with HPAI A(H5N1) virus are rare, having unprotected exposure to any infected animal or to an environment in which infected birds or other animals are or have been present can pose a risk of infection.

Therefore, people with work or recreational exposures to A(H5N1) virus-infected animals may be at increased risk of infection and should follow recommended precautions.

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WHO confirms human case of bird flu in West Bengal - Onmanorama

This article is republished from The Conversation under a Creative Commons license.

Recent outbreaks of bird fluin US dairy herds, poultry farms in Australia, and elsewhere, and isolated cases in humanshave raised the issue of food safety.

So can the virus transfer from infected farm animals to contaminate milk, meat, or eggs? How likely is this? And what do we need to think about to minimize our risk when shopping for or preparing food?

Bird flu (or avian influenza) is a bird disease caused by specific types of influenza virus. But the virus can also infect cows. In the US, to date, more than 80 dairy herds in at least nine states have been infected with the H5N1 version of the virus.

Investigations are under way to confirm how this happened. But we do know that infected birds can shed the virus in their saliva, nasal secretions, and feces. So bird flu can potentially contaminate animal-derived food products during processing and manufacturing.

Indeed, fragments of bird flu genetic material (RNA) were found in cows milk from the dairy herds associated with infected US farmers.

However, the spread of bird flu among cattle, and possibly to humans, is likely to have been caused through contact with contaminated milking equipment, not the milk itself.

The test used to detect the virus in milkwhich uses PCR technology similar to lab-based Covid testsis also highly sensitive. This means it can detect very low levels of the bird flu RNA. But the test does not distinguish between live or inactivated virus, just that the RNA is present. So from this test alone, we cannot tell if the virus found in milk is infectious (and capable of infecting humans).

Does that mean milk is safe to drink and wont transmit bird flu? Yes and no.

In Australia, where bird flu has not been reported in dairy cattle, the answer is yes. It is safe to drink milk and milk products made from Australian milk. In the US, the answer depends on whether the milk is pasteurized. We know pasteurization is a common and reliable method of destroying concerning microbes, including influenza virus. Like most viruses, influenza virus (including bird flu virus) is inactivated by heat.

Although there is little direct research on whether pasteurization inactivates H5N1 in milk, we can extrapolate from what we know about heat inactivation of H5N1 in chicken and eggs. So we can be confident there is no risk of bird flu transmission via pasteurized milk or milk products.

However, its another matter for unpasteurized or raw US milk or milk products. A recent study showed that mice fed raw milk contaminated with bird flu developed signs of illness. So to be on the safe side, it would be advisable to avoid raw milk products.

Bird flu has caused sporadic outbreaks in wild birds and domestic poultry worldwide, including in Australia. In recent weeks, there have been three reported outbreaks in Victorian poultry farms (two with H7N3 bird flu, one with H7N9). There has been one reported outbreak in Western Australia (H9N2).

The strains of bird flu identified in the Victorian and Western Australia outbreaks can cause human infection, although these are rare and typically result from close contact with infected live birds or contaminated environments. Therefore, the chance of bird flu transmission in chicken meat is remote.

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With So Much Bird Flu Around, Are Eggs, Chicken, and Milk Still Safe to Consume? - WIRED

The World Health Organisation has confirmed a case of human infection with the H9N2 bird flu virus in a four-year-old child from West Bengal, India. The child, who was hospitalised with severe respiratory issues, high fever, and abdominal cramps, has now been discharged after receiving treatment.

The WHO stated that the patient had been in contact with poultry at home and in the vicinity, with no reports of respiratory illness symptoms among family members or other contacts. Details regarding vaccination status and antiviral treatment were not disclosed at the time of the report.

This marks the second recorded case of H9N2 bird flu infection in humans in India. The first one was recorded in 2019. While the virus typically leads to mild illness, the WHO cautioned that sporadic human cases could still arise, as H9N2 is among the most prevalent avian influenza viruses found in poultry across various regions.

As of the latest update, there has been no immediate response from the Indian health ministry regarding this incident.

About H9N2 virus

- H9N2 is a subtype of the avian influenza virus, commonly found in birds, and it is the second case of H9N2 in India. - The virus spreads through direct contact with infectious animals or indirect interaction with contaminated environments. - Common symptoms of H9N2 include:

- Severe symptoms like difficulty breathing and pneumonia can also occur. - It can lead to more severe illness, especially in individuals with weakened immune systems or underlying health conditions. - H9N2 is less infectious and results in a milder illness than other avian influenza strains such as H5N1 and H7N9.

Treatment

- Treatment for H9N2 bird flu includes anti-viral medications like zanamivir (Relenza) and oseltamivir (Tamiflu) if used early in the illness, as well as supportive care like relaxation, hydration, and treatment of fever and respiratory problems. - In severe cases, hospitalisation for intensive care and respiratory support may be required to manage the infection effectively. - Due to H9N2's global distribution and potential for human infection, continuous surveillance and preventive measures are necessary.

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WHO confirms second human case of H9N2 bird flu virus; Check symptoms and treatment here - Business Today

Updated at 12:05 p.m. ET on June 7, 2024

Our most recent flu pandemic2009s H1N1 swine fluwas, in absolute terms, a public-health crisis. By scientists best estimates, roughly 200,000 to 300,000 people around the world died; countless more fell sick. Kids, younger adults, and pregnant people were hit especially hard.

That said, it could have been far worse. Of the known flu pandemics, 2009s took the fewest lives; during the H1N1 pandemic that preceded it, which began in 1918, a flu virus infected an estimated 500 million people worldwide, at least 50 million of whom died. Even some recent seasonal flus have killed more people than swine flu did. With swine flu, we got lucky, Seema Lakdawala, a virologist at Emory University, told me. H5N1 avian flu, which has been transmitting wildly among animals, has not yet spread in earnest among humans. Should that change, though, the worlds next flu pandemic might not afford us the same break.

Read: Cows have almost certainly infected more than two people with bird flu

Swine flu caught scientists by surprise. At the time, many researchers were dead certain that an H5N1, erupting out of somewhere in Asia, would be the next Big Bad Flu. Their focus was on birds; hardly anyone was watching the pigs. But the virus, a descendant of the devastating flu strain that caused the 1918 pandemic, found its way into swine and rapidly gained the ability to hack into human airway cells. It was also great at traveling airbornefeatures that made it well positioned to wreak global havoc, Lakdawala said. By the time experts caught on to swine flus true threat, we were already seeing a ton of human cases, Nahid Bhadelia, the founding director of the Boston University Center on Emerging Infectious Diseases, told me. Researchers had to scramble to catch up. But testing was intermittent, and reporting of cases was inconsistent, making it difficult for scientists to get a handle on the viruss spread. Months passed before the rollout of a new vaccine began, and uptake was meager. Even in well-resourced countries such as the U.S., few protections hindered the viruss initial onslaught.

But the worst never came to passfor reasons that experts still dont understand. Certainly, compared with the 1918 pandemic, or even those in the 1950s and 60s, modern medicine was better equipped to test for and treat flu; although vaccine uptake has never been perfect, the availability of any shots increased protection overall, Sam Scarpino, an infectious-disease modeler and the director of AI and life sciences at Northeastern University, told me. Subtler effects may have played a role too. Other H1N1 viruses had been circulating globally since the late 1970s, potentially affording much of the population a degree of immunity, Troy Sutton, a virologist at Pennsylvania State University, told me. Older people, especially, may have harbored an extra dose of defense, from additional exposure to H1N1 strains from the first half of the 20th century. (After the 1918 pandemic, versions of that virus stuck around, and continued to percolate through the population for decades.) Those bonus safeguards might help explain why younger people were so severely affected in 2009, Lakdawala told me.

Some of those same factors could end up playing a role in an H5N1 epidemic. But 2009 represents an imperfect templateespecially when so much about this new avian flu remains unclear. True human-to-human spread of H5N1 is still a distant possibility: For that, the virus would almost certainly need to undergo some major evolutionary alterations to its genome, potentially even transforming into something almost unrecognizable. All of this muddies any predictions about how a future outbreak might unfold.

Still, experts are keeping a close eye on a few factors that could raise H5N1s risks. For instance, no versions of H5N1 flu have ever gained a sustained foothold in people, which means theres very little immunity in the community, Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told me.

Exposure to other flu strains could offer limited protection. Lakdawala and Sutton have been running experiments in ferrets, which transmit and fall ill with flu much like people do. Their preliminary results suggest that animals with previous exposures to seasonal-flu strains experience milder disease when theyre next hit with this particular H5N1. That said, ferrets with zero prior flu experiencewhich would be the case for some very young kidsfare poorly, worse than they do with the H1N1 of 2009, and thats scary, Lakdawala told me.

Its too early to say how those results would translate into people, for whom data are sparse. Since this H5N1 virus was first detected in the 1990s, scientists have recorded hundreds of human cases, nearly half of whom have died. (Avian flus that spill intermittently into people often have this kind of nasty track record: This week, the WHO reported that another kind of bird flu, designated H5N2, killed a man in Mexico in late April. It was the flu subtypes first recorded instance in a human; no evidence suggests yet that this virus has the ability to spread among people, either.) Experts caution strongly against reading too much into the stats: No one can be certain how many people the virus has actually infected, making it impossible to estimate a true fatality rate. The virus has also shape-shifted over decadesand the versions of it that killed those people did not seem capable of spreading among them. As Sutton pointed out, past experiments suggest that the mutations that could make H5 viruses more transmissible might also make them a bit less deadly. Thats not a guarantee, however: The 1918 flu, for instance, transmitted really well in humans and caused very severe disease, Sutton said.

Read: Americas infectious-disease barometer is off

Scientists also cant extrapolate much from the fact that recent H5N1 infections among dairy workers in the U.S. have been documented as mild. Many people who work on farms are relatively young and healthy, Bhadelia noted; plus, their exposures have, presumably, been through virus-laden raw milk. The virus could affect a different community in more dramatic ways, and the nature of the disease could shift if the virus entered the body via another route. And mildness in the short term isnt always a comfort, Scarpino said: As with COVID, the disease could still have chronic consequences for someones health.

The world is in some ways better prepared for H5N1 than it was in 2009. Scientists have had eyes on this particular avian flu for decades; in the past few years alone, theyve watched it hopscotch into dozens of animal species, and tracked the genetic tweaks its made. Already, U.S. experts are testing for the pathogen in wastewater, and federal regulators have taken action to halt its spread in poultry and livestock. H5 vaccines are stockpiled, and more are on the waya pipeline that may be speedier than ever before, thanks to the recent addition of mRNA tech.

Read: The bird-flu host we should worry about

But this close to the worst days of the COVID-19 pandemic, Osterholm and others worry that halting any outbreak will be harder than it otherwise would have been. We could see many, many individuals refusing to get a vaccine, he said. (That may be especially true if two doses are required for protection.) Bhadelia echoed that concern, adding that shes already seeing a deluge of misinformation on social media. And Scarpino noted that, after the raging debates over COVID-era school closures, legislators may refuse to entertain the option againeven though children are some of the best conduits for flu viruses. Stopping a pandemic requires trust, coordination, and public buy-in. On that front alone, Osterholm said, without a doubt, I think were less prepared.

The world has a track record of not taking flu seriouslyeven, sometimes, when it sparks a pandemic. In the months following the initial outbreaks of swine flu, the outbreak was mocked as a nothingburger; public-health officials were criticized for crying wolf. But the arguably mild flu epidemic still filled hospital emergency departments with pneumonia cases, spreading the virus to scores of health-care workers; kids still fell sick in droves. So many young people died that, in terms of years of life lost, Osterholm told me, the toll of 2009 still exceeded those of the flu pandemics that began in 1957 and 1968. Nor are comparisons with seasonal flus exactly a comfort: Most years, those epidemics kill tens of thousands of people in the U.S. alone.

H5N1 could also permanently alter the worlds annual flu burden. An avian-flu pandemic could present the perfect opportunity for this virus to join the other flus that transmit seasonallybecoming endemic threats that may be with us for good. Weve seen that with every flu pandemic thats occurred, Sutton told me. More circulating flu viruses could mean more flu cases each yearor, perhaps, more chances for these viruses to mingle their genetic material and generate new versions of themselves to which the population lacks immunity.

However likely those possibilities are, halting H5N1s spread now would preclude all of them. Scientists have foresight on this avian flu in a way they never did with pre-pandemic swine flu. Capitalizing on that differenceperhaps the most important one between these two fluscould keep us from experiencing another outbreak at all.

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How Much Worse Would a Bird-Flu Pandemic Be? - The Atlantic

By Izzy Ross, Interlochen Public Radio

This coverage is made possible through a partnership withIPRandGrist, a nonprofit independent media organization dedicated to telling stories of climate solutions and a just future.

Laurie Stanek shovels hay in front of a group of young, black and white Holstein cows.

Were out here at 5 oclock every morning to get started feeding the babies, she said. In a nearby barn, she points to a small calf shakily getting to its feet.

That guy over there was yesterdays new one, she said. Theyre born about 100 pounds, 120 pounds.

Stanek has worked at her familys dairy farm in Antrim County for almost 50 years. Right now, they have about 200 milking cows.

This is among the Michigan farms that have to abide by new state and federal measures to protect their animals against the bird flu.

Officially called H5N1, this latest outbreak of the virus emerged in wild birds in Europe in 2020. In 2022, it was detected in commercial flocks in the United States. Its led to the deaths of tens of millions of farmed birds and infected many mammals, from sea lions to foxes.

The jump to cows is new.

The first reported case from cattle was in Texas earlier this year. And Michigan has reported the most cases of the bird flu in dairy herds in the country officials here say thats because of widespread testing. It also has two of the nations three confirmed cases of the disease in people (the other was a dairy worker in Texas).

Scientists say controlling the disease is important, because this latest jump to cattle could pose an increased threat to human health, as well as to other animals.

So far, nine states have confirmed the presence of bird flu in dairy herds, according to the U.S. Department of Agriculture.

Across the country, the response has been rocky. Some states have pushed back against federal efforts to address the virus. Public health experts have warned that the true reach is likely greater that official counts, and have raised concerns about the lack of testing. The federal government announced that it would spend $824 million on its response, and the USDA just launched a voluntary pilot program to test cow milk in bulk.

An extraordinary emergency

Last month, Michigan declared an extraordinary emergency. Officials said the flu is a threat to animal health, human health, trade and the economy. The states largest egg producer laid off 400 workers last month amid the outbreak. In cows, bird flu causes a reduction in milk production. It may also be passed from dairy facilities to poultry farms, where it could be deadly.

We want to make sure that were limiting the further spread of the virus, so that were continuing to protect human health, and we dont have so much virus in the environment that could potentially mutate and affect humans in a different way, said Tim Boring, the director of the state Department of Agriculture and Rural Development.

The Centers for Disease Control and Prevention have maintained that the danger to the public is relatively low. But farm workers face increased risk of exposure to the bird flu; the CDC has said its likely that those who have tested positive contracted the virus from cows. The people who experienced the illness recently have reported mild symptoms.

Over the past month, farms have faced new state and federal biosecurity requirements. The USDA has required that lactating cows moving across state lines receive a negative test.

And Michigan has prohibited poultry or lactating cows from being shown at events like fairs, and says farms should limit the people and animals coming in.

Two rows of cows at the Stanek farm in Antrim County. June 3, 2024. (Photo: Izzy Ross/IPR News)

That aspect isnt a huge concern for the Stanek farm, which has whats called a closed herd.

We raise our own, so they dont come up against other herds that have been in other states or other places. So theyve all been raised here, Stanek said.

To lower the risk of infection, the state says farms should also name a biosecurity manager. The Staneks appointed one of their adult sons to that post, where hes responsible for designating a secure perimeter around the herd and keeping track of visitors.

How the illness moves

The question of how the virus has jumped from birds to cows is, so far, unanswered. And scientists say gaining a better understanding of how the bird flu moves between animals is critical to determining how to respond to this outbreak and plan for the next one.

Im a virologist by training, and my other virologist buddies and I all have to admit: None of us saw this coming, said Kim Dodd, the director of the Veterinary Diagnostic Laboratory at Michigan State University.

We didnt expect to find [highly pathogenic] avian influenza in dairy cattle, and to find that it amplifies so well, and that we have so much virus in the milk, she said. And so thats really a big part of trying to understand, you know, what do we do about that to be able to help control the outbreak.

The milking equipment at the Stanek farm. June 3, 2024. (Photo: Izzy Ross/IPR News)

When poultry are exposed to or contract the bird flu, they usually either die from the disease or are euthanized, which generally stops the viral spread. Thats not the case for cows.

These guys recover after a period of seven to 10 days of mild to moderate illness, Dodd said. So those animals are still there and still producing virus while they recover, which gives individuals who are caring for them the opportunity to come into contact with that virus and potentially spread it themselves.

The climate factor

Looming in the background is climate change. Its role in this outbreak of H5N1 is unclear. But generally, research has shown that climate change could join a host of other factors in making the transmission of viruses between species more likely something called viral spillover.

Absolutely, as we see climates change, we see changes in migratory patterns and the timing of migratory patterns, Dodd said. To what degree climate change may have played a role in how long this outbreak has gone on, I think, remains to be seen.

As the climate warms, animals are pushed into new places at different times of year. That can create more opportunities for pathogens to infect new hosts. For example, the spread of tick populations has brought certain diseases to new places.

State agriculture officials say more safety measures on farms could become a bigger part of their approach to climate change.

Improving biosecurity in new ways that we hadnt previously considered, I think, will increasingly be a component of robust climate resiliency actions, said Boring, the director of Michigans agriculture department. So were seeing a little bit of that in real time here with our response to H5N1 here in the state.

Dodd said Michigans response so far has been relatively strong. And the fact that the state has seen so many positive cases among cattle is because its testing for them. That, critically, relies on collaboration between state and federal agencies and farmers.

That takes two sides, she said. It takes the people who are looking and the people who are testing, but it also requires that the people who own the animals are opening their doors and allowing testing to occur.

No dairy herds in northern Michigan have reported signs of bird flu yet, according to the state. But back in Antrim County, Laurie Stanek said dealing with animal sickness is just part of running a farm; theyre paying attention to the new rules and doing what theyve always done.

A lot of its just good herdsmanship just common sense, she said. You keep your animals healthy so they in turn give you a healthy product.

That, she said, is what their livelihood depends on.

Featured image: A group of Holstein cows jostle for hay at the farm run by Laurie Stanek and her family. June 3, 2024. (Photo: Izzy Ross/IPR News)

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'None of us saw this coming': Michigan confronts bird flu in cows - Great Lakes Now