Category: Flu Virus

May 16, 2024 1:09 pm PDT | Updated May 16, 2024 1:58 pm PDT

CALIFORNIA A unusual surge in flu virus detected in California wastewater is raising alarm bells in the Golden State because the flu is not surging. In fact, flu season is in retreat. Bird flu, however, is spreading among dairy cattle nationwide and infected one farm worker earlier this year. Experts worry the viral spike in wastewater means that bird flu could be spreading more widely than is currently understood.

Bird flu, which refers to strains of influenza that spread among birds, has been documented for decades. Outbreaks have decimated populations of wild birds and poultry farms. The viruses can also spread to mammals which is what has been happening recently with the H5N1 strain. Those kinds of mutations pose a greater risk that the virus could spread to humans, experts say.

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"This virus has the potential to seriously disrupt our agricultural supplies and also jump from other mammals to humans and become an epidemic or even a pandemic," Dr. Michele Barry of the Stanford Center for Innovation in Global Health told Stanford Medicine, a university publication.

Millions of poultry birds in 48 states including California have been sickened by H5N1 since 2022. It was first reported in cattle in March. Since then, outbreaks have spread to 46 dairy herds in nine states, according to U.S. Centers for Disease Control and Prevention data.

One farm worker became infected after being exposed to dairy cattle in Texas, the CDC said in April. The worker reported only eye redness as a symptom and has since recovered. Another person was infected with H5N1 in 2022 after being exposed to poultry, the agency said.

Still, the CDC casts the possibility of a human outbreak of H5N1 as unlikely.

CDC believes the current risk of A(H5N1) infection to the general public remains low, the agency said last week.

But some experts have raised concerns that regulators arent watching H5N1 closely enough amid the spread to mammals, which has also proven to be fatal to dozens of other mammal species worldwide, the PBS NewsHour reported.

What we have is a situation where the virus, in a sense, has more shots on goal to jump from a related species, a mammal like us. And now people are no doubt being exposed on a daily basis in pretty large numbers, Michael Worobey, an evolutionary biologist at the University of Arizona told PBS.

Stanfords Barry pointed out that there has been no evidence of human-to-human transmission. But scientists are lacking data in that area: She said in the case of the Texas dairy worker, researchers were unable to do testing that could help reveal how transmissible the virus might be to humans.

Some experts say more attention should be focused on wastewater, which is routinely tested to determine the levels of influenza A viruses in a community. That includes typical flu bugs that spread between people each winter, but it also includes H5N1, the Los Angeles Times reported.

Recent testing has shown a moderate-to-high upward trend in dozens of communities across California, including in the Bay Area and San Diego. Thats unusual for this time of year flu season has ended. The data doesnt necessarily mean that bird flu is present in local wastewater, but it does raise the concern, the Times reported.

And at this point, its not possible to discern whether those pops of influenza A include H5N1. A number of experts are urging authorities to specifically test wastewater for bird flu in order to get a better understanding of the current state of the virus.

We need to track the spread of the virus and its evolution, which isnt getting done well by USDA and CDC, Eric Topol, a professor of molecular medicine at Scripps Research Institute in La Jolla told the Times.

A California Department of Public Health spokesperson told Patch that officials have not recently seen an increase in human cases of influenza A and noted that bird flu has not been detected in dairy cattle, dairy products or humans in California to date.

"CDPH has been working with the Centers for Disease Control and Prevention, and local health departments, to monitor influenza A in wastewater and investigate increasing prevalence in wastewater that is not following human influenza trends. CDPH is working with these groups to investigate these increases, including testing specifically for H5 within wastewater," the spokesperson said.

"Local public health departments continue to review our wastewater data and trends in combination with other human influenza surveillance system data and collaborate with partners to better understand factors that could contribute to increases, such as animal sources located in individual sewer systems (e.g., livestock, wild birds or waste from a milk processing plant)."

The CDC recommends that people use masks and eye protection if they're exposed to animals who are sick or potentially sick with bird flu. They should also avoid eating uncooked or undercooked food products, as well as unpasteurized (raw) milk and cheeses.

Recent FDA testing found traces of the virus in 20 percent of retail milk samples, but authorities say pasteurization kills the virus.

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Viral Surge In CA Wastewater Raises Alarms: If Not Flu, Then What? - Patch

As researchers increasingly rely on wastewater testing to monitor the spread of bird flu, some are questioning the reliability of the tests being used. Above, the Hyperion Water Reclamation Plant in Playa Del Rey.

(Jason Armond / Los Angeles Times)

As health officials turn increasingly toward wastewater testing as a means of tracking the spread of H5N1 bird flu among U.S. dairy herds, some researchers are raising questions about the effectiveness of the sewage assays.

Although the U.S. Centers for Disease Control and Prevention says current testing is standardized and will detect bird flu, some researchers voiced skepticism.

Right now we are using these sort of broad tests to test for influenza A viruses in wastewater, said epidemiologist Denis Nash, referring to a category of viruses that includes normal human flu and the bird flu that is circulating in dairy cattle, wild birds, and domestic poultry.

Its possible there are some locations around the country where the primers being used in these tests ... might not work for H5N1, said Nash, distinguished professor of epidemiology and executive director of City University of New Yorks Institute for Implementation Science in Population Health.

The reason for this is that the tests most commonly used polymerase chain reaction, or PCR, tests are designed to detect genetic material from a specific organism, such as a flu virus.

But in order for them to identify the virus, they must be primed to know what they are looking for. Depending on what part of the virus researchers are looking for, they may not identify the bird flu subtype.

There are two common human influenza A viruses: H1N1 and H3N2. The H stands for hemagglutinin, which is an identifiable protein in the virus. The N stands for neuraminidase.

The bird flu, on the other hand, is also an influenza A virus. But it has the subtype H5N1.

That means that while the human and avian flu virus share the N1 signal, they dont share an H.

If a test is designed to look for only the H1 and H3 as indicators of influenza A virus, theyre going to miss the bird flu.

Marc Johnson, a professor of molecular microbiology and immunology at the University of Missouri, said he doesnt think thats too likely. He said the generic panels that most labs use will capture H1, H3 and H5.

He said while his lab specifically looks for H1 and H3, I think we may be the only ones doing that.

Its been just in the last few years that health officials have started using wastewater as a sentinel for community health.

Alexandria Boehm, professor of civil and environmental engineering at Stanford University and principal investigator and program director for WastewaterSCAN, said wastewater surveillance really got going during the pandemic. Its become a routine way to look for hundreds if not thousands of viruses and other pathogens in municipal wastewater.

Three years or four years ago, no one was doing it, said Boehm, who collaborates with a network of researchers at labs at Stanford, Emory University and Verily, Alphabet Inc.s life sciences research organization. It sort of evolved in response to the pandemic and has continued to evolve.

Since late March, when the bird flu was first reported in Texas dairy cattle, researchers and public health officials have been combing through wastewater samples. Most are using the influenza A tests they had already built into their systems most of which were designed to detect human flu viruses, not bird flu.

On Tuesday, the CDC released its own dashboard showing wastewater sites where it has detected influenza A in the last two weeks.

Displaying a network of more than 650 sites across the nation, there were only three sites in Florida, Illinois and Kansas where levels of influenza A were considered high enough to warrant further agency investigation. There were more than 400 where data were insufficient to allow a determination.

Jonathan Yoder, deputy director of the CDCs Division of Infectious Disease Readiness and Innovation, said those sites were deemed to have insufficient data because testing hasnt been in place long enough, or there may not have been enough positive influenza A samples to include.

Asked if some of the tests being used could miss bird flu because of the way they were designed, he said: We dont have any evidence of that. It does seem like were at at a broad enough level that we dont have any evidence that we would not pick up H5.

He also said the tests were standardized across the network.

Im pretty sure that its the same assay being used at all the sites, he said. Theyre all based on ... what the CDC has published as a clinical assay for for influenza A, so its based on clinical tests.

But there are discrepancies between the CDCs findings and others.

Earlier this week, a team of scientists from Baylor College of Medicine, the University of Texas Health Science Center at Houston, the Texas Epidemic Public Health Institute and the El Paso Water Utility, published a report showing high levels of bird flu from wastewater in nine Texas cities. Their data show that H5N1 is the dominant form of influenza A swirling in these Texas towns wastewater.

But unlike other research teams, including the CDC, they used an agnostic approach known as hybrid-capture sequencing.

So its not just targeting one virus or one of several viruses, as one does with PCR testing, said Eric Boerwinkle, dean of the UTHealth Houston School of Public Health and a member of the Texas team. Were actually in a very complex mixture, which is wastewater, pulling down viruses and sequencing them.

Whats critical here is its very specific to H5N1, he said, noting theyd been doing this kind of testing for approximately two years, and hadnt ever seen H5N1 before the middle of March.

Blake Hanson, an assistant professor at the University of Texas Health Science Center at Houston School of Public Health and a member of the Texas wastewater team, agreed, saying that PCR-based methods are exquisite and highly accurate.

But we have the ability to look at the representation of the entire genome, not just a marker component of it. And so that has allowed us to look at H5N1, differentiate it from some of our seasonal fluids like H1N1 and H3N2, he said. Its what gave us high confidence that it is entirely H5N1, whereas the other papers are using a part of the H5 gene as a marker for H5.

Boerwinkle and Hanson underscored that while they could identify H5N1 in the wastewater, they cannot tell where it came from.

Texas is really a confluence of a couple of different flyways for migratory birds, and Texas is also an agricultural state, despite having quite large cities, Boerwinkle said. Its probably correct that if you had to put your dime and gamble what was happening, its probably coming from not just one source but from multiple sources. We have no reason to think that one source is more likely any one of those things.

But they are pretty confident its not coming from people.

Because we are looking at the entirety of the genome, when we look at the single human H5N1 case, the genomic sequence ... has a hallmark amino acid change ... compared to all of the cattle from that same time point, Hanson said. We do not see that hallmark amino acid present in any of our sequencing data. And weve looked very carefully for that, which gives us some confidence that were not seeing human-human transmission.

The Texas team approach was really exciting, said Devabhaktuni Srikrishna, the CEO and founder of PatientKnowHow.com, noting it exhibited proof of principle for employing this kind of metagenomic testing protocol for wastewater and air.

He said government agencies, private companies and academics have been searching for a reliable way to test for thousands of microscopic organisms such as pathogens quickly, reliably and at low cost.

They showed it can be done, he said.

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As officials turn to wastewater to monitor bird flu epidemic, questions about testing bubble up - Los Angeles Times

In March 2024, the USDA confirmed that dairy cattle in Texas and Kansas had become infected with a highly pathogenic avian influenza H5N1 strain. Scientists have been monitoring H5N1 infections in wild bird and domesticated poultry populations since the strain popped up in North America in 2021, but they thought that bovines were resistant to influenza A viruses (IAV).

[Cow infection] came as a complete surprise, said Lars Erik Larsen, a veterinary virologist at the University of Copenhagen.

In a preprint posted on bioRxiv, which has not undergone peer review, Larsen and his team measured the distribution of IAV receptors across different cow tissues in search of a mechanistic explanation for how cows contracted the bird flu.1 While their preliminary findings helped explain the symptoms reported in infected cows, they also sparked a new hypothesis on whether cows are potential IAV mixing vessels for the generation of novel flu viruses that could acquire human-to-human transmission.

Wild birds are the natural reservoirs for IAV, but mammalian spillovers into pigs, horses, and humans have occurred.2 For example, the IAV H1N1 and H3N2 subtypes originated in wild birds but evolved to routinely circulate in humans on a seasonal basis. However, the news of the virus spreading between cows came out of left field: Cows experience outbreaks of influenza D viruses, but IAV infections are less common, so scientists did not consider them to be susceptible hosts for H5N1.3

Larsen said that one of the most surprising findings coming from the US reports is that huge amounts of virus are found in the milk, but very little nestles in the respiratory tract. It seems like this virus in bovines behaves completely differently than in other species, said Larsen. These findings suggested that the virus may enter and replicate inside cells housed in the udder, but no one had looked at IAV receptor expression in these tissues.

To transfer their viral genomes, IAV bind to sialic acid (SA) receptors on epithelial cells. One of the main reasons that transmission of IAV from birds to humans is low is that avian viruses prefer to enter cells through the SA-2,3 receptor types, which are highly expressed in birds but less common in humans.4 In order to jump these host barriers and infect humans, avian viruses must evolve to bind to SA-2,6 receptors, the dominant type in humans.

Larsen, whose research primarily focuses on avian and swine influenza viruses, previously measured the expression of these receptors in the pig nasal mucosa using two different plant lectins that bind to either the 2,6 human receptor or the 2,3 avian receptor.5 With tools for making these measurements already in hand, Larsen and his team analyzed the expression of these receptors in cow brain, respiratory tract, and mammary gland tissues that were archived in the freezers in the pathology department of his universitys veterinary school.

Larsen and his team observed high expression of the 2,3 avian receptor in the bovine mammary glands, providing a rationale for why this virus appears to readily replicate in this tissue. That can explain why we find so much virus in the milk, said Larsen. They also found some expression of the avian receptor in the respiratory tract but very little evidence of the receptor in the brain, which matches the minimal respiratory or neurological symptoms observed in infected cows.

When they analyzed the data on the human receptor, the team was surprised to also find high expression in the mammary glands, a finding that brought pigs to mind.

Pigs provide a perfect platform for IAV looking to acquire new hosts. They coexpress both the avian and human receptors in their respiratory tracks. This means that pigs infected with both human and avian flus provide these viruses with a space to mingle and swap genome segments to generate new IAV that the human immune system has never seen before. This happened in 2009 when influenza strains of avian, swine, and human origin infected a pig, underwent genetic reassortment, and created a novel H1N1 strain that kicked off the last swine flu pandemic.6

Although the preliminary evidence from Larsens group provides a mechanistic explanation for why H5N1 is appearing in dairy cattle milk, what worries some scientists is that it also suggests that cows could be a potential mixing vessel for avian and human IAV. Thats just in theory, said Larsen. I dont think that the risk is very high.

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Brian Wasik, a virologist at Cornell University who was not involved in the study, said that he welcomes the preliminary analysis on IAV receptor distribution in bovine mammary tissue, which he noted has been limited in the literature. A rapid dissemination of information about that is always great and open for the community to start building hypotheses of how we understand how influenza is moving in this particular tissue, said Wasik.

With respect to the mixing vessel hypothesis, Wasik said, [They] are good hypotheses and worth discussion and worth setting the framework for future research. My concern, and what I expressed publicly, is that the concern of other people overinterpreting those narrow results and moving clearly beyond the hypothesis framework into something larger.

Unlike a protein receptor, which is transformed from a nucleotide sequence via transcription and translation, SA is carbohydrate that is synthesized by enzymatic processes. There's a lot of heterogeneity and kinetics in that process, and you get lots of different chemical variations of these receptors, said Wasik.

These enzymatic processes lead to different subtypes of the SA-2,6 receptor: the N-Glycolylneuraminic acid (Neu5Gc) and N-Acetylneuraminic acid (Neu5Ac) forms. Neu5Gc is prevalent across different mammals, but the gene that encodes the enzyme that converts Neu5Ac into Neuro5Gc is absent in humans.7 Wasik noted that Sambucus nigra lectin, the molecule used in this study to detect the presence SA-2,6, has a broad binding profile and therefore cannot distinguish between these two subtypes. Therefore, bovine may not express the Neu5Ac form of SA-2,6 that the human influenza strains use to enter cells.

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The methodology needs a lot more rigorous verification, said Wasik, who noted that hed like to see a deeper dive into the chemistry of the bovine receptors to better understand what they look like and how influenza binds to them. Im sure that those studies are coming from this group and a number of others, but at this time we do not have a definitive understanding of what's present in that tissue, he said.

Scientists still need to determine whether cow mammary glands are susceptible to human IAV. More than 70 years ago, researchers injected cow udders with human influenza virus and observed viral replication, suggesting that it is possible.8 However, these were direct injections and it is still unclear if or how human transmission to the mammary glands would occur. Scientists still dont know the mode of transmission of the avian virus into cows.

There are so many unanswered questions about this bovine infection, said Larsen.

In addition to increasing the sample size, Larsen would like to look more closely at the receptor distribution in the respiratory tract. What we fear [is] that this virus starts to spread among cows by droplets because then the risk of human exposure will increase, said Larsen.

Given these are all hypotheses and we don't know what this virus is going to do next, my suggestion is we stamp it out as quickly as possible, said Wasik. While we're concerned about human risk and now this new risk to cattle, what we're seeing is one of the largest ecological die-offs of avian species and sea mammals and a number of other different spillovers.

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Deciphering the Unusual Pattern of Bird Flu Symptoms in Cows - The Scientist

William Brangham:

In fact, unlike cows, this bird flu has been deadly to the nearly two dozen other mammal species that have been infected in this U.S., from a polar bear in Alaska, to a mountain lion in Colorado, to raccoons and foxes. Many of those animals were likely infected by eating dead animals that were carrying the virus.

But, by far, the biggest impact here in the U.S. has been on birds. Since this strain of avian influenza first arrived in the U.S. in early 2022, brought here by migratory birds, more than 90 million domestic birds, mostly chickens and turkeys, have died or been intentionally killed across 48 states.

And unlike previous outbreaks, this variant has affected more wild birds and spread across a wider geographic area, crossing down into South America at the end of 2022.

Dr. Ralph Vanstreels, University of California, Davis: I think the alarm really went off when it reached Peru, and that's a massive seabird community, and we saw just unprecedented mortality in the seabirds there.

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Why scientists are concerned about the latest transmission of bird flu to cows - PBS NewsHour

Texas Techs BTRL confirmed the first human case of HPAI A (H5N1) transmitted from a dairy cow, marking a significant milestone in understanding the viruss transmission and prompting immediate and effective collaboration with the CDC for further research and response.

The Biological Threat Research Laboratory (BTRL) at Texas Tech University was instrumental in identifying the first case of highly pathogenic avian influenza (HPAI) A (H5N1) being transmitted from a mammal (dairy cow) to a human.

The case was made public in an article published in the New England Journal of Medicine. Steve Presley, the director of The Institute of Environmental and Human Health (TIEHH) and the BTRL, and Cynthia Reinoso Webb, the biological threat coordinator at TIEHH, were co-authors on the journal publication.

The journal article explains that in March a farm worker who reported no contact with sick or dead birds, but who was in contact with dairy cattle, began showing symptoms in the eye and samples were collected by the regional health department to test for potential influenza A.

Initial testing of the samples was performed at the BTRL, which is a component of the Centers for Disease Control and Prevention (CDC) Laboratory Response Network-Biological (LRN-B) located at TIEHH.

Its a huge thing that the virus has jumped from birds to mammals, dairy cows in this case, and then to humans, Presley said. Thats why this paper in the New England Journal of Medicine is very significant. Its going to lay the foundation, I believe, for a lot of research in the future of how the virus is evolving.

The involvement of Texas Techs BTRL is a continuation of the partnership between regional, state, and federal public health partners.

Being part of the CDC LRN-B, we have the standing capability to test for a lot of biological threats and some that are considered emergent, Reinoso Webb explained.

The labs standby status allowed Reinoso Webb and the Texas Tech BTRL team to respond quickly to the needs of the regional public health authority. Knowing the potential dangers of the virus, Reinoso Webb pushed the testing into the safest laboratory available, and the team went to work.

Having received the samples in the early evening, results were being reported to regional, state, and federal levels within hours. By the next day, the samples were on their way to the CDC for further testing and confirmation.

We were on the phone with the CDC until around midnight discussing different scenarios and follow-up requirements, Reinoso Webb said. There is a lot of federal reporting. It was a very complicated case, even though it was two samples and one patient.

But we had this wonderful communication with the CDC and made sure we did everything by the book. This is how its been structured, and this is how the communication was supposed to happen.

Reference: Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in a Dairy Farm Worker by Timothy M. Uyeki, Scott Milton, Cherissa Abdul Hamid, Cynthia Reinoso Webb, Steven M. Presley, Varun Shetty, Susan N. Rollo, Diana L. Martinez, Saroj Rai, Emilio R. Gonzales, Krista L. Kniss, Yunho Jang, Julia C. Frederick, Juan A. De La Cruz, Jimma Liddell, Han Di, Marie K. Kirby, John R. Barnes and C. Todd Davis, 2 May 2024, New England Journal of Medicine. DOI: 10.1056/NEJMc2405371

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Alarming Virus Evolution Scientists Identify First-Ever Mammal-to-Human Bird Flu Case - SciTechDaily

It was in 1997 while working at WILL-AM 580 in Urbana that I first heard about Asian highly pathogenic avian influenza (HPAI), i.e. bird flu. A strain of the flu, H5N1, especially deadly for poultry, had somehow infected humans that year during an outbreak in Hong Kong.

I remember asking science folk a lot smarter than me whether the virus could spread from human to human. I was reassured that the chances were miniscule.

Since then, bird flu has spread among poultry and wild birds to more than 50 countries, and the H5N1 virus has reached epidemic proportions for poultry in Bangladesh, China, Egypt, India, Indonesia, and Vietnam.

Still, the spread of HPAI and its bird flu variations to humans remains low, even as cases have ticked up in the last few years. The Centers for Disease Control and Prevention report that:

HPAI A (H5N1) virus infections have been reported in more than 890 people with approximately 50% case fatality proportion since 1997, including 20 cases and seven deaths in Hong Kong during 1997-2003, and more than 870 cases reported in 22 countries since November 2003.

Worrisome for sure. Even as the chances for human to human infection remains very rare, but not impossible.

But since December 2019, we live in a decidedly different world. Thats when Wuhan, China became the epicenter for SARS-CoV-2, the virus that causes COVID-19. Just how SARS was unleashed on the planet still isnt exactly clear. The U.S. office of the director of National Intelligence and National Intelligence Council reports:

All agencies assess that two hypotheses are plausible: natural exposure to an infected animal and a laboratory-associated incident.

Only China knows for sure and they have been less than transparent. Regardless, it was possible that the COVID pandemic was the result of natural exposure plus SARS ability to mutate rapidly.

What was clear is U.S. preparation and initial response to COVID was woefully inadequate. And at the top of the list was downplaying the infection, giving the budding pandemic a foothold on U.S. soil.

Which takes us to the shocking USDA announcement on March 25 that avian influenza has been detected for the first time ever in dairy cattle. A month later, on April 23, the Food and Drug Administration reported that genetic material from H5N1 bird flu is in the commercial milk supply.

As of May 6, USDA had identified infected herds in nine states Texas, Kansas, New Mexico, Michigan, Idaho, Colorado, North Carolina, Ohio, and South Dakota.

No one knows with certainty how big is the true outbreak nor how, where and when H5N1 is mutating. It is reasonable and logical to think the avian flu cattle outbreak is larger than reported.

On April 5, CDC reported the first cow-to-human infection of H5N1 in a person in Texas working with dairy cows.

Its fair to say that the outbreak is evolving, making it crucial that federal, state and local actors play nice in the sandbox together for the good of the public.

Thus far, that has not been the case.

The CDC, state agencies and the dairy industry cant get on the same page on whats necessary to control and contain the current avian flu outbreak among dairy cows.

High ranking CDC officials suggest it might be necessary sooner rather than later to send federal teams to farms to check on the health of dairy workers and collect data that might be helpful to limit the spread.

State agriculture officials have voiced opposition saying farmers dont want any part of federal officials on their property. Texas Agriculture Commissioner Sid Miller, who is speculated to be a possible pick for USDA secretary should Donald Trump win the presidency in November, was blunt: Its overreach. They dont need to do that. They need to back off.

CDC finds itself in the position of sweet talking, coddling and looking for middle ground as it races to determine how the outbreak is spreading among dairy cattle, and to what degree is the human population at risk. Thats less than ideal. Lack of transparency. Lack of data collection. Lack of communication.

USDAs Animal and Plant Health Inspection Service issued a federal order on April 24 requiring mandatory testing for interstate movement of dairy cattle and mandatory reporting of positive influenza A nucleic acid detection. Thats helpful.

It is possible that H5N1 avian flu has been brewing in the U.S. cattle herd since at least last December right under the noses of the feds.

Which is a little scary if one considers the possibility that avian flu may one day somehow infect pigs.

It turns out that bird flu in the pig population would be an epidemiologists worst nightmare, because pigs have both human and avian flu receptors, which could allow the virus to figure out how to adapt easily to human hosts.

Its time for all the avian flu actors to realize theyre playing with fire and learn to work together. Anything less repeats the mistakes learned in the COVID pandemic.

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Response to avian flu in US dairy herd lacking - The Midwest Center for Investigative Reporting

Topline

Heres the latest news about a global outbreak of H5N1 bird flu that started in 2020, and recently spread among cattle in U.S. states and marine mammals across the world, which has health officials closely monitoring it and experts concerned the virus could mutate and eventually spread to humans, where it has proven rare but deadly.

A sign warns of a outbreak of bird flu.

May 15The Centers for Disease Control and Prevention released influenza A waste water data for the weeks ending in April 27 and May 4, and found several states like Alaska, California, Florida, Illinois and Kansas had unusually high levels, though the agency isnt sure if the virus came from humans or animals, and isnt able to differentiate between influenza A subtypes, meaning the H5N1 virus or other subtypes may have been detected.

May 10The Food and Drug Administration announced it will commit an additional $8 million to ensure the commercial milk supply is safe, while the Department of Agriculture said it will pay up to $28,000 per farm to help mitigate the spread of the disease, totaling around $98 million in funds.

May 9Some 70 people in Colorado are being monitored for bird flu due to potential exposure, and will be tested for the virus if they show any symptoms, the Colorado Department of Public Health told Forbesit was not immediately clear how or when the people were potentially exposed.

May 1The Department of Agriculture said it tested 30 grocery store ground beef products for bird flu and they all came back negative, reaffirming the meat supply is safe.

May 1The Food and Drug Administration confirmed dairy products are still safe to consume, announcing it tested grocery store samples of products like infant formula, toddler milk, sour cream and cottage cheese, and no live traces of the bird flu virus were found, although some dead remnants were found in some of the foodthough none in the baby products.

April 30Wenqing Zhang, head of the World Health Organization's Global Influenza Programme, said during a news briefing "there is a risk for cows in other countries to be getting infected," with the bird flu virus, since its commonly spread through the movement of migratory birds.

April 29The Department of Agriculture told Forbes it will begin testing ground beef samples from grocery stores in states with cow outbreaks, and test ground beef cooked at different temperatures and infected with the virus to determine if it's safe to eat.

April 24The USDA said cow-to-cow transmission may be occurring due to the cows coming into contact with raw milkand warned against humans and other animals, including pets, consuming unpasteurized milk to prevent potential infection.

April 18Jeremy Farrar, chief scientist for the World Health Organization, said during a press conference the threat of bird flu spreading between humans was a great concern, since its evolved and has increasingly been infecting mammals (on land and sea), which means it could possibly spread to humans.

April 1The CDC reported the second U.S. human case of bird flu in a Texas dairy farmer who became infected after contracting the virus from infected dairy cows, but said the person was already recovering.

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Bird flu doesnt transmit easily from person-to-person, according to the World Health Organization. Bird flu rarely affects humans, and most previous cases came from close contact with infected poultry, according to the CDC. Because human-to-human spread of bird flu poses pandemic potential, each human case is investigated to rule out this type of infection. Though none have been confirmed, there are a few global casesnone in the U.S.where human-to-human transmission of bird flu was thought to be probable, including in China, Thailand, Indonesia and Pakistan.

It is very deadly. Between January 2003 and March 28, 2024 there have been 888 human cases of bird flu infection in humans, according to a report by the World Health Organization. Of those 888 cases, 463 (52%) died. To date, only two people in the U.S. have contracted H5N1 bird flu, and they both were infected after coming into contact with sick animals. The most recent case was a dairy worker in Texas who became ill in March after interacting with sick dairy cows, though he only experienced pink eye. The first incident happened in 2022 when a person in Colorado contracted the disease from infected poultry, and fully recovered.

Raw, unpasteurized milk is unsafe to drink, but pasteurized milk is fine, according to the FDA. Bird flu has been detected in both unpasteurized and pasteurized milk, but the FDA recommends manufacturers against making and selling unpasteurized milk since theres a possibility consuming it may cause bird flu infection. However, the virus remnants in pasteurized milk have been deactivated by the heat during the pasteurization process, so this type of milk is still believed safe to consume.

The CDC warns against eating raw meat or eggs infected with bird flu because of the possibility of transmission. However, no human has ever been infected with bird flu from eating properly prepared and cooked meat, according to the agency. The possibility of infected meat entering the food supply is extremely low due to rigorous inspection, so properly handled and cooked meat is safe to eat, according to the USDA. To know when meat is properly cooked, whole beef cuts must be cooked to an internal temperature of 145 degrees Fahrenheit, ground meat must be 160 degrees and poultry must be cooked to 165 degrees. Rare and medium rare steaks fall below this temperature. Properly cooked eggs with an internal temperature of 165 degrees fahrenheit kills bacteria and viruses including bird flu, according to the CDC. It doesnt matter if they may or may not have [avian] influenza runny eggs and rare pieces of meat are never recommended, Francisco Diez-Gonzalez, director and professor for the Center for Food Safety at the University of Georgia, told Forbes. To play it safe, consumers should only eat fully cooked eggs and make sure the yolks are firm with no runny parts, Daisy May, veterinary surgeon with U.K.-based company Medivet, said.

Symptoms of bird flu include a fever, cough, headache, chills, shortness of breath or difficulty breathing, runny nose, congestion, sore throat, nausea or vomiting, diarrhea, pink eye, muscle aches and headache. However, the CDC advises it cant be diagnosed based on symptoms alone, and laboratory testing is needed. This typically includes swabbing the nose or throat (the upper respiratory tract), or the lower respiratory tract for critically ill patients.

This years egg prices have increased as production decreased due to bird flu outbreaks among poultry, according to the USDA. A dozen large, grade A eggs in the U.S. costed around $2.99 in March, up almost a dollar from the fall. However, this price is down from a record $4.82 in January 2023, which was also spiked by bird flu outbreaks. Earlier this month, Cal-Maine Foodsthe countrys largest egg producertemporarily halted egg production after over one million egg-laying hens and chickens were killed after being infected with bird flu.

Once chickens have been infected with bird flu, farmers quickly kill them to help control the spread of the virus, since bird flu is highly contagious and fatal in poultry. The USDA pays farmers for all birds and eggs that have to be killed because of bird flu, as an incentive to responsibly try and curb the spread of the disease. The USDA has spent over $1 billion in bird flu compensation for farmers since 2022, according to the nonprofit Food & Environment Reporting Network.

The FDA has approved a few bird flu vaccines for humans. The U.S. has a stockpile of vaccines for H5N1 bird flu, but it wouldnt be enough to vaccinate all Americans if an outbreak were to happen among humans. If a human outbreak does occur, the government plans to mass produce vaccines, which can take at least six months to make enough for the entire population. Sequirs, the maker of one of the approved vaccines, expects to have 150 million vaccines ready within six months of an announcement of a human bird flu pandemic. Although there are approved vaccines for other variants designed for birds, there are none for the H5N1 variant circulating. However, the USDA began trials on H5N1 animal-specific vaccines in 2023.

As of May 14, more than 90 million poultry (primarily chickens) in 48 states have been euthanized because of bird flu since 2022, and 46 dairy cow herds across nine states have tested positive, according to data from the CDC (unlike chickens, cows appear to recover from the virus). The USDA believes wild migratory birds are the original source of the cow outbreaks that recently has experts concerned it may mutate and spread more easily in humans, though the CDC said its risk to the public remains low. Farrar called the cattle infections in the U.S. a huge concern, urging public health officials to continue closely monitoring the situation because it may evolve into transmitting in different ways. The increased number of mammal bird flu infections since 2022 could indicate that the virus is looking for new hosts, and of course, moving closer to people, Andrea Garcia, vice president of science, medicine and public health for the American Medical Association, said. More than 10 human bird flu cases were reported to the World Health Organization in 2023, and all but one survived. Bird flu has devastated bird populations, and 67 countries reported the deaths of 131 million poultry in 2022 alone. Although bird flu typically infects wild birds and poultry, its spread to other animals during the outbreak, and at least 10 countries have reported outbreaks in mammals since 2022. Around 17,400 elephant seal pups died from bird flu in Argentina in 2023, and at least 24,000 sea lions died in South America the same year. Besides cattle, bird flu has been detected in over 200 other mammalslike seals, raccoons and bearsin the U.S. since 2022. Although rare, even domestic pets like dogs and cats are susceptible to the virus, and the FDA warns against giving unpasteurized milk to cats to avoid possible transmission.

WHO Warns Threat Of Bird Flu Spreading To Humans Is Great Concern (Forbes)

One In Five Milk Samples From Across US Had Traces Of Bird Flu Virus, FDA Says (Forbes)

Can Pets Get Bird Flu? Heres What To Know (Forbes)

Avian H5N1 (Bird) Flu: Why Experts Are WorriedAnd What You Should Know (Forbes)

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Bird Flu (H5N1) Explained: Bird Flu Possibly Found In U.S. Wastewater, CDC Reports - Forbes

On May 7, health influencer Paul Saladino, M.D.. posted a video to his X account that promoted feeding "raw dairy" to infants. The post received over 90,000 views and sparked strong backlash before it was removed the following day. Saladino regularly advocates for "animal-based" diets featuring raw milk, including on his TikTok channel where he has over half a million followers.

Interest in raw milk is rising in the U.S., fueled by both "wellness" and conservative influencers on social media. Posts promoting unpasteurized dairy have racked up millions of views, and celebrities including Gwyneth Paltrow have touted the supposed benefits.

But health officials have long warned against consuming raw dairy because it can harbor germs that pose serious health risks. The American Academy of Pediatrics warns that infants, children and pregnant women are at higher risk of illness from dairy products that haven't been pasteurized a process that uses heat to kill off dangerous organisms.

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"Do not consume unpasteurized dairy products," Dr. Nidhi Kumar recentlytold CBS New York. "I know there are people that are real advocates for it, but this is not the time to do it."

The Food and Drug Administration and the Centers for Disease Control and Prevention have stepped up their warnings after outbreaks of H5N1, or bird flu, started spreading through dairy farms in multiple U.S. states this spring.

High concentrations of the virus have been found in raw milk from infected herds, and officials have cautioned people to avoid milk that hasn't been commercially processed. Testing confirms pasteurization kills the virus, and the FDA says the commercial milk supply is safe.

Americans consumed raw milk until the late 19th century, when pasteurization became common practice. Back then, it caused hundreds of outbreaks of tuberculosis and bacterial infections, researchers say. Numerous states began mandating pasteurization and the U.S. federal government eventually banned interstate sales of unpasteurized milk in the late 1980s. Some states outlaw its sale.

Still, the product maintained its popularity with a relatively small number of Americans. Around 4.4% of Americans reported consuming raw milk in the most recent FDA research, which combined surveys from 2016 and 2019.

But in recent years, raw milk has seen a bit of a resurgence. Lawmakers in six states have legalized its sale since 2020, pushing the total number of states in which selling raw milk is legal to more than 30, though some only allow it to be sold on farms. Americans can buy unpasteurized milk in conservative and liberal states at markets in Georgia and high-end grocery stores like Erewhon in California. Google Trends data shows a steady uptick in searches for the product.

And sales of raw milk appear to be on the rise,The Associated Pressreports, citing data from market research firm NielsenIQ. Since the bird flu virus was confirmed in U.S. cattle in March, weekly sales of raw cow's milk have ticked up 21% to 65% compared with the same periods a year ago, according to NielsenIQ, whose figures include grocery stores and other retail outlets. Even so, it remains a very small fraction of overall milk sales.

The growing legalization of unpasteurized dairy has coincided with a decline in confidence in public health advice from the CDC since the coronavirus pandemic, which has been noted in research and polls. The trend has also aligned with an overall growth in the organic food industry.

At the same time, influencers on social media have claimed raw milk has health benefits that are lost in the pasteurization process something scientists and public health officialsstrongly dispute. Saladino, who posted the video advocating raw milk for infants, did not respond to a CBS News request for comment as to why his post was removed. Several other videos on his account promote the consumption of raw milk, including one showing an infant drinking raw milk from a bucket.

TikTok videos promoting raw milk received millions of views in the last year, prompting some doctors and prominent content creators like Hank Greeneto create videos to counter the misinformation they saw spreading about the product.

On Facebook, data from the social monitoring platform CrowdTangle shows that the most popular posts on "raw milk" over the last year referred favorably to the product. And on Truth Social a platform founded by former President Donald Trump users have made light of recent reports about animals dying after drinking raw dairy from infected cows, in posts with thousands of likes.

The FDA and CDC strongly advise against the consumption of or sale of raw milk or raw milk products, warning that it "can carry dangerous bacteria such as Salmonella, E. coli, Listeria, Campylobacter, and others that cause foodborne illness."

"Raw milk can be contaminated with harmful germs that can make you very sick," the CDC says.

The FDA has also debunked what it calls "milk myths," including the false claim that pasteurization kills the nutritional value of milk or that it causes lactose intolerance or allergic reactions.

Officials have renewed warnings to consumers in recent weeks. An outbreak of bird flu in dairy cows was first reported in late March, and researchers do not yet know whether humans can contract bird flu by drinking unpasteurized raw milk from infected cows.

Mark McAfee, owner of Raw Farm USA in Fresno, California, he can't keep his unpasteurized products in stock.

"People are seeking raw milk like crazy," he told AP, noting that no bird flu has been detected in his herds or in California. "Anything that the FDA tells our customers to do, they do the opposite."

The federal government has not banned milk from infected herds from being sold, but officials advised farmers not to sell milk from cattle that have been infected. They've also recommended that milk from asymptomatic cows that were exposed gets pasteurized before being sold or fed to animals.

FDA testing has shown the pasteurization process is effective at inactivating the virus. The agency continually tests samples of the U.S. milk supply to ensure that pasteurized milk sold in grocery stores is safe for consumption.

The FDA has found high viral loads of H5N1 avian influenza in the raw milk of some of the infected herds, which are located across nine U.S. states. The United States Department of Agriculture has saidtesting indicates the disease may be spreading through dairy farms as healthy cows come in contact with the raw milk of infected cows. But officials are still studying to determine exactly how the virus is moving.

Somecats died after drinking the raw milk of cows infected with H5N1, according to areportpublished in the CDC journal Emerging Infectious Diseases.

So far, a Texas farmworker is the only personin the U.S. currently known to have contracted the virus after exposure to infected cows. His case was mild and presented as conjunctivitis. Officials have not publicly reported how the transmission occurred.

The CDC has said the bird flu virus currently poses a "low risk to the general public" but the agency also said H5N1 has "pandemic potential." Health officials say they are working to be prepared for the possibility of a bird flu outbreak in humans.

"Unless you're in close contact with potentially infected animals or you're drinking unpasteurized milk, the risk to you right now is very low," said CBS News chief medical correspondent Dr. Jon LaPook.

"But remember, things can change," he added, "especially with viruses ... they can mutate, they can change, we've seen that happen. And that is why there is such concern among public health officials and others, and why the CDC and others are really trying to stay on top of this."

Rhona Tarrant contributed reporting.

Laura Doan is a reporter and associate producer for "Prime Time with John Dickerson." She covers the climate crisis, science and technology, and U.S. politics.

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Influencers promote raw milk despite FDA health warnings as bird flu spreads in dairy cows - CBS News

The H5N1 bird flu, highly infectious and deadly in birds, has been around for nearly three decades, but recently, it has been changing in ways that raise alarms for many scientists and public health officials.

In particular, the recent spread of the virus among dairy cows and the discovery of genetic traces of the virus in 1 in 5 milk samples have sparked concerns that the virus may become more transmissible to humans. (No live virus strains of were found in the milk samples, and the Food and Drug Administration says pasteurized dairy products are safe to consume -- although raw milk and unpasteurized cheeses should be avoided.)

While the public may be weary of pandemic news following four years of COVID-19, now is a critical time for scientists, public health officials and the general public to take preventive action, said Michele Barry, MD, director of the Stanford Center for Innovation in Global Health and senior associate dean of global health.

This includes taking steps to protect and monitor the health of livestock and the people who care for them through a "One Health approach" -- meaning one that fosters collaboration between countries, disciplines, and sectors to prevent disease outbreaks among humans and animals and protect their shared environments.

"This virus has the potential to seriously disrupt our agricultural supplies and also jump from other mammals to humans and become an epidemic or even a pandemic," Barry said.

This virus has the potential to seriously disrupt our agricultural supplies and also jump from other mammals to humans and become an epidemic or even a pandemic.

Barry has responded to global pandemic threats ranging from the 2014 Ebola epidemic in West Africa to COVID-19, developed recommendations for how the CDC can strengthen its Global Migration and Quarantine division to prevent future pandemics, and advises on pandemic prevention as an elected member of the Global Health Advisory Board for the Council on Foreign Relations.

She discussed the response to H5N1, also known as highly pathogenic avian influenza A, and why recent developments should serve as a wake-up call to heighten surveillance by state and federal health officials, increase collaboration between farms and health officials, and improve international collaboration on pandemic prevention. This Q&A has been edited for length and clarity.

What do we know so far about the virus's impact on humans, and what should we be watching for?

We're aware of only one suspected transmission from a mammal to a human -- in a dairy worker this April. The case was mild and presented mainly as conjunctivitis. But birds can also transmit the virus to humans; since 1996, 868 cases have been recorded in humans --of which more than half have been fatal. Most of the sick were infected on the job. While there's still much we don't know about the mortality rate in humans, these numbers are very concerning.

We have no current evidence of human-to-human transmission, but we also lack data. In the recent case of the infected dairy worker, researchers were unable to follow up or do serologic testing to understand how transmissible the virus might be to humans. The CDC must be invited in by states to conduct surveillance, andsome agricultural officials and dairy farms haveconcerns about public health investigators gaining access to farms. To incentivize testing and surveillance, the federal government has offered up to $28,000 to livestock farms.

We need to closely monitor dairy and poultry farms, keeping an eye out for upticks in occupational illnesses and deaths, and ideally conducting blood tests among the animals and workers that can help us detect the virus in a population even if it is spreading asymptomatically.

We also need to closely monitor pig farms, because if this virus jumps to pigs, it could more easily mutate into an effective human-to-human transmitter.

We also need to closely monitor pig farms, because if this virus jumps to pigs, it could more easily mutate into an effective human-to-human transmitter. Pigs are known as mixing vessels for influenza viruses because they can be infected by avian, swine and human influenza viruses. The genetic diversity of influenza viruses in pigs provides opportunities for the viruses to intermix genes and adapt to new hosts, including humans.

Are we any better prepared for bird flu than we were for COVID-19, should it become more transmissible in people?

In terms of treatments and vaccines, we are in a better position than we were at the beginning of COVID-19. Tamiflu, an antiviral medicine for treating the flu, appears to retain its effectiveness against this flu strain, and the U.S. has some stockpile of this medicine. We don't yet have a vaccine for this specific flu strain, but we do have vaccine candidates and a platform with which to build it.

However, it takes time to develop and scale up a vaccine. In a recent presentation to the Council on Foreign Relations, the CDC's deputy director, Nirav Shah, MD, acknowledged that there's a trade-off when it comes to developing an H5N1 vaccine. Doing so could pull resources from the development of the seasonal flu vaccine. In a regular year, the seasonal flu can hospitalize hundreds of thousands of people and kill tens of thousands -- so maintaining seasonal flu vaccination programs is critical.

Describe some key lessons learned in pandemic preparedness and prevention that you've helped surface through your work with the Council on Foreign Relations and the CDC. Are we heeding these lessons now?

We have learned many lessons in pandemic prevention from COVID-19, but I think many of them have been ignored. In terms of surveillance, communication, coordination and cooperation, we're not where we need to be.

We still have not changed our public health response by centralizing it. That's hindering the CDC's ability to go into states and conduct necessary surveillance on farms without being asked to come in.

A key lesson learned from COVID-19 was the importance of a centralized response. In the U.S., we still have not changed our public health response by centralizing it. That's hindering the CDC's ability to go into states and conduct necessary surveillance on farms without being asked to come in.

It's very encouraging that the U.S. government has now committed to providing funding to livestock farms to support their preventive measures and testing for the virus, along with funding to support states that are restricting the movement of affected cattle. This may not be enough to really get our arms around this problem, but it's a promising start.

Another key lesson was the need for a surge fund to ensure that stocks of vaccine, personal protective equipment and medications can be scaled up quickly. These recommendations have not been implemented, nor has the U.S. increased sufficient funding to the CDC to deal with multiple pandemic threats at once.

Internationally, nations have yet to sign a pandemic accord meant to address the shortfalls in pandemic response that surfaced during COVID-19.

We need to educate farmworkers about the risks of exposure to the virus and how they can protect themselves.

What can be done to minimize human exposure and improve surveillance among farmworkers, especially given that this population is often marginalized, faces language barriers and may not trust the government?

Perhaps most importantly, we need to educate farmworkers about the risks of exposure to the virus and how they can protect themselves. The federal government and local public health departments need to offer personal protective equipment such as N95 masks and gloves for farmworkers and teach them how to use it. We could also consider even more substantial financial incentives for dairy farms to participate in surveillance as well as ensure protection for undocumented workers involved in dairy farm work.

We can also protect farmworkers by mitigating the virus's spread in livestock. For instance, a vaccine exists for H5N1 in poultry and has been used, but it's not universal.

If we do face outbreaks on farms, Tamiflu, an antiviral, could be used prophylactically in settings with epidemic spread to help until a vaccine is developed. Of course, we always worry about antiviral resistance developing if Tamiflu is used indiscriminately.

While the current focus is on livestock, H5N1 has already caused widespread deaths in wild bird populations, infected at least 48 mammalian species and been described as "an ecological disaster." What can this impact on wild species tell us?

H5N1 has killed tens of thousands of marine mammals, including 24,000 sea lions in South America, and it threatens many other species. Yet such animal die-offs are often buried in the news -- to our detriment.

In West Africa, mass die-offs of gorillas and other mammals have been important harbingers of Ebola outbreaks in humans. H5N1 is a reminder of the very intimate connection between the health of wild animals, livestock and humans. Supporting healthy ecosystems is critical to preventing the next pandemic.

Image: Emily Moskal

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Could the avian flu be our next pandemic threat? - Scope

Oregon Health Authority (OHA) is reminding people of the risks associated with raw (unpasteurized) milk consumption amid the current H5N1 bird flu outbreak in dairy cattle.

The U.S. Food and Drug Administration (FDA) recently tested 297 retail milk samples from 38 states for H5N1 virus. About 20% of these samples tested positive for H5N1 viral fragments, but none contained live infectious virus because the H5N1 virus had been killed through pasteurization.

According to the U.S. Department of Agriculture (USDA), there are 49 dairy cattle H5N1 outbreaks across nine states. No outbreaks have occurred in Oregon, but H5N1 is believed to be more widespread than current testing suggests.

We know that if H5N1 is present in the milk of infected dairy cattle, it will be killed by pasteurization, said Dean Sidelinger, M.D., M.S.Ed., health officer and state epidemiologist at OHA. Drinking raw milk carries many health risks, and those risks may now include H5N1 infection.

Pasteurized milk is extremely safe and has undergone a heating process that kills disease-causing bacteria and viruses. According to the Centers for Disease Control and Prevention (CDC), people who consume unpasteurized milk are at risk for a variety of illnesses such as E. coli and Salmonella. Only pasteurized milk is sold in stores and provided to children in school lunches.

Raw milk that someone consumes from the same farm over a duration of time may not always be safe. Raw milk can get contaminated in many ways. While good safety practices can reduce the chance of germs getting in raw milk, they cannot eliminate all risk.

Source: Oregon Health Authority

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OHA Recommends Milk Pasteurization To Kill Bird Flu Virus - iHeart