Category: Flu Virus

As a recent example of what may ensue, Pitesky points to the repeated African swine fever outbreaks across various Asian countries in the past decade, which decimated the pig farming industry to the extent that pork was briefly usurped by poultry as the most widely consumed animal protein on the planet. Pitesky argues, however, that the current model of governments heavily compensating farmers for their livestock losses in the wake of a viral outbreak is financially unsustainable, and more investment needs to be diverted toward AI-driven technologies that can prevent these infections in the first place.

I work on predictive models, using a combination of weather radar, satellite imagery, and machine learning, to understand how waterfowl behavior around different farms is changing, says Pitesky. We can use this information to understand which of the 50,000 to 60,000 commercial poultry facilities in the US are at most risk, and form strategies to protect all the birds in those facilities.

Technology may ultimately offer a path toward eliminating the virus in commercial poultry. In October, a team of researchers in the UK published a study in the journal Nature Communications demonstrating that it is possible to use the gene-editing tool Crispr to make chickens resistant to avian influenza. This was done through editing genes that make the proteins ANP32A, ANP32B, and ANP32E in chickens, which the virus uses to gain access to chicken cells.

Crispr has been shown to be capable of making livestock resistant to other infections such as the cancer-causing viral disease avian leukosis and porcine reproductive and respiratory syndrome, which is responsible for widespread economic losses in pig farms.

The currently available methods are the use of strict farm biosecurity, poultry vaccinations in some countries, and massive depopulation of infected or exposed chicken flocks, says Alewo Idoko-Akoh at the University of Bristol, the lead researcher on the Nature Communications study. These methods have been partially successful but have so far failed to stop recurrent bird flu outbreaks around the world. Gene editing of chickens to introduce disease resistance should be considered as an additional tool for preventing or limiting the spread of bird flu.

Pitesky described the paper as really interesting but pointed out that it would require widespread public acceptance toward consuming gene-edited chicken for it to become commercially viable. I think that those technological solutions have a lot of potential, but the issue more than anything, especially in the United States, is sentiment toward chickens that have been genetically modified, he says.

For now, Iqbal says that the best chance of keeping avian influenza under control is more active surveillance efforts in animal populations around the world, to understand how and where the H5N1 is spreading.

The surveillance system has been improved, and any infection that appears unusual is thoroughly investigated, he says of the situation in the US. This has helped to identify unusual outbreaks, such as infections in goats and cattle. However, he says, much more work is needed to detect the virus in animals that dont show signs of disease.

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Bird Flu Is Spreading in Alarming New Ways - WIRED

Whats going on with the avian flu?

AP: This virus has been around for over 20 years. It's been mutating over time, and something happened in the last couple of years to cause an explosion of cases in wild birds. Not surprisingly, that's led to spillover infections in some poultry farms. There's also been an increase in mammals that have been infected, such as skunks, bears, and foxes, presumably from feeding on dead infected birds. And recently, we've seen spillover of this virus into dairy cows.

Cattle have not been reported to be infected with any of the influenza A viruseshuman or animalto date. Anytime this virus enters a new host, we set off some alarm bells in the scientific community to see what's going on.

Can we expect to see more cases in humans?

AP: I expect that over the next few weeks, we're going to be seeing more cases in cows and humans, because humans are in close contact with cows during many dairy processes. Hopefully, this will not be a large outbreak, but we certainly expect to see more cases.

Were you surprised by this outbreak?

MD: I am surprised that it's in dairy cows, because when we think about animal models for influenza, we think about mustelids, like ferrets or mink. We have also seen a number of sick farm cats that tested positive. What is most interesting about seeing [H5N1] in dairy is that researchers haven't been focusing on biosecurity and biocontainment for things like avian influenzawhich is typically transmitted from a bird reservoir. Dairy farms are often quite open to the airbirds might spend time in areas where the cows eat, for example.

One of the other things we are seeing is some symptoms of disease in the cows. I've not heard of high mortality yet, but they have been showing fairly nonspecific signs, like not eating or milking well. Most of these tend to be somewhat older cows because adult cows who are lactating are in a different category of susceptibility than young calves. What we don't know yet is if perhaps the virus is in all the populations within the farm, and only some of them are showing symptoms.

Is the milk they produce safe for consumption?

MD: For the average person buying commercial milk, we don't have any evidence that would suggest concern. If you buy pasteurized milk from a commercial dairy processor, the risk is extremely low. Pasteurization, which involves temperature and pressure and time, is designed to inactivate microbes to make the milk safer to consume and to give it longer shelf life. I strongly advise against consuming raw milk products, no matter where you live, because there are other risks, not just avian influenza.

What can the surveillance data from infected cows tell us?

AP: Two things are really important. One is: The virus has gone from the respiratory tract through lots of different organs, through the blood, and made it all the way to the milk. In humans, the influenza virus stays within the respiratory tract. We have seen H5N1 move out of the respiratory tract in other animals, but usually that's associated with a really fast mortality. As soon as the virus leaves the lungs, the animals are so sick that they die. We're seeing a case here where the animals don't seem to be really sick, but the virus is making it to other parts of the animal. That's going to tell us something perhaps unique about the H5N1 virus compared to seasonal human viruses.

The second critical thing is: If there is spread of this virus from cow to cow, is the virus changing and getting better adapted to replicating or spreading in cows? Bird flu jumping to mammals is important because anything that allows the virus to adapt to a mammal has the potential for making it better able to infect humans. Understanding what happens now with the spread of the virus and how the sequence of the virus changes is going to be critically important. The first sequences [from cows] look like the virus is almost identical to the bird virus. But we haven't really sampled animals that presumably acquired the infection from other cows.

If it's spreading from cow to cow, is that a wholly different problem?

MD: There is a lot of swapping of cows in the dairy industry, and there is a diverse population of farmers, each of them has their own way of doing things. And that means that we may need to educate farmers about perhaps restricting certain sales or trade of dairy cows if evidence shows that you could introduce avian flu through a cow brought in from outside the farm.

The USDA has releasedrecommendationsfor state animal health officials, veterinarians, and producers, including trying to exclude birds and cats from areas where livestock are kept, not moving sick or exposed cows, using PPE among workers with exposure to dairy cows, and other measures.

Something I'm very interested in is: Where were each of these cows exposed? To what degree was this one event that is now spreading through these networks of sale and trade and movement of dairy cows? Or is this multiple events in which you've had an introduction [of the virus] from birds? Because that also changes the dynamics as we think about genetics and the potential for evolution.

AP: Its also clear that the USDA has not ruled out that spread from cow to cow is happening via contaminated milking equipment because the amount of virus in the milk is much greater than what is found in the nose of infected cows. If this is contributing to virus spread, it should be straightforward to institute equipment disinfection protocols that could slow or stop virus spread.

Is H5N1 considered a major threat at this time?

AP: H5N1 registers as what we call a virus with pandemic potential. Humans presumably all have some immunity to H1 and H3 influenza viruses, which can cause seasonal epidemics, but they can't cause pandemics at the level of what we saw with COVID because there's just too much immunity in the population that limits the spread and dampens down disease severity.

However, the human population is essentially completely naivehas no preexisting immunityto H5 viruses. Therefore, similar to what we saw with COVID, in the worst case scenario, if this virus enters humans and starts to spread, all of us are susceptible, and we could see massive increases in numbers of cases.

H5 viruses are rather deadly in poultry. They're not so deadly in wild birds, but they seem to be deadly in mammals, and we don't know what they'll do in humans.

MD: Right now, the average person should just be aware and avoid things like raw milk products. However, because we are seeing the potential for disease in cats, and we don't know yet if that came from cows or birds or some other pathwayit's a good idea to prevent your cats from having contact with wild birds. If they're indoors, keep them indoors, and if they become ill, consult your veterinarian.

This interview was edited for length and clarity by Morgan Coulson,an editorial associate in the Office of External Affairs at the Johns Hopkins Bloomberg School of Public Health.

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What's Happening With Dairy Cows and Bird Flu | Johns Hopkins | Bloomberg School of Public Health - Johns Hopkins Bloomberg School of Public Health

Stephanie Rossow / CDC

Carbapenem-resistant and difficult-to-treat (DTR) gram-negative priority pathogens are increasing in most regions of the world, according to ananalysis of global surveillance data published yesterday in the Journal of Global Antimicrobial Resistance.

Using isolates collected by the Antimicrobial Testing Leadership and Surveillance (ATLAS) global surveillance program from 157 medical centers in 49 countries from 2018 to 2022, an international team of researchers conducted antimicrobial susceptibility testing on 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates, which are all on the World Health Organization's list of critical priority pathogens.

They focused on carbapenem resistance and the DTR phenotype, defined as non-susceptibility to all first-line antibiotics used to treat serious infections.

Percentages of carbapenem-resistant Enterobacterales (CRE) resistance increased in the Asia Pacific, Europe, Latin America, Middle East-Africa regions but declined in North America, while annual DTR percentages increased in all five regions. Rates of carbapenem-resistant P aeruginosa (CRPA) and carbapenem-resistant A baumannii-calcoaceticus complex (CRAB) remained stable across all regions, but rates of CRAB and DTR A baumannii-calcoaceticus complex were consistently more than 25 percentage points lower in North America.

Analysis of countries from each region found significant and consistent increases in CRE (10.3% in 2018 to 35.6% in 2022) and CRPA (16.5% to 55.6%) in Brazil, high CRAB rates (more than 84% each year), and increasing detection of CRE (4.4% to 15.4%) in South Africa. For all regions except North America, most changes in CRE rates could be attributed to hospital-acquired infections.

The study authors say that while the findings may have been influenced by the COVID-19 pandemic, which saw increased inappropriate antibiotic use and disruption of infection prevention and control (IPC) measures, the global increase in gram-negative antimicrobial resistance indicates that current antimicrobial stewardship and IPC initiatives aren't getting the job done.

"Decisive action is needed to prevent and control the spread of antimicrobial-resistant pathogens," they wrote. "All initiatives to curb antimicrobial resistance must be supported by continued surveillance at local, national, regional, and global levels."

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Avian flu virus detected in South Dakota dairy herd - University of Minnesota Twin Cities

With diary cows getting bird flu, researchers are trying to figure out what mutations could make the virus a threat to humans. Charlie Neibergall/AP hide caption

With diary cows getting bird flu, researchers are trying to figure out what mutations could make the virus a threat to humans.

The outbreak of bird flu in dairy cattle is still unfolding.

Both North Carolina and South Dakota have detected the virus in dairy herds, bringing the total number of states affected to eight.

The unlikely spread among cattle and one dairy worker has scientists looking through the data to better understand this spillover. They say the risk to humans hinges on whether the virus can evolve in key ways to better infect mammals.

So far, there's some reassuring news: At a recent meeting, scientists from the U.S. Department of Agriculture said the virus is not presenting like a respiratory illness in cattle meaning the animals don't appear to be shedding large amounts of virus from their nose or mouths.

Instead, federal health officials investigating the outbreak suspect some form of "mechanical transmission" is responsible for spreading the virus within the herd. This may be happening during the process of milking the cows, a theory supported by the fact that high concentrations of virus are being found in the milk.

"I want to emphasize really how unusual this is," says Thijs Kuiken, a professor of comparative pathology at Erasmus Medical Center. "In other mammalian species with influenza viruses, it's primarily a respiratory disease, which doesn't seem to be the case in these cattle."

The samples collected from infected animals and shared publicly do not suggest the virus has undergone radical changes that would be cause for alarm.

But there are certain signs of trouble in the genome of the virus that scientists are looking out for as it finds a way into more mammals.

"We really need to keep on top of this, because I think we are at a bit of a precipice where something interesting or unfortunate could happen," says Michelle Wille, a senior research fellow at the Center for Pathogen Genomics at the University of Melbourne.

With bird flu spreading among cows, scientists are concerned about potential future risks to humans. VW Pics/VWPics/Universal Images Group vi hide caption

With bird flu spreading among cows, scientists are concerned about potential future risks to humans.

Genetic sequencing of the virus in the Texas dairy worker showed it had undergone a mutation in a gene, PB2, that commonly gets affected when the virus infects mammals.

This is a clue that the virus is evolving to better replicate inside a mammal, but it's not sufficient to make the virus transmit more easily between humans, says Nichola Hill, a disease ecologist at the University of Massachusetts Boston.

"Sometimes we see these early markers of adaptation," she says, "It needs a handful [of markers] coordinated across multiple different gene segments for it to really be this breakthrough and the next pandemic."

And it would need to become better at transmitting through the air, like the seasonal influenza viruses that humans tend to catch. Currently most cases of bird flu in people are linked to direct contact with an infected animal, oftentime when a chicken is being slaughtered, says David Swayne, a poultry veterinarian who used to work for the USDA.

"It takes a very, very high dose," he says, "It's probably not just exposure to infected poultry it's exposure to processes that aerosolized the virus."

But the fear is that could change as the virus spends more time in mammals:

Specifically, the protein that the virus uses to bind to cells could evolve to lock onto the receptors in the upper respiratory tract of humans. This would allow it to easily gain access and churn out copies of itself.

"That's considered basically a main barrier that prevents this from becoming a virus that could spread efficiently between people," says Darwyn Kobasa, head of high containment respiratory viruses at Canada's National Microbiology Laboratory.

When the virus has spilled into mammals, scientists have not seen a lot of evolution in this function over the last few years, says Anice Lowen, a professor of microbiology and immunology at Emory University.

Lowen says previous research has shown the protein on the virus would not only need to recognize the human receptors in our upper airways but also become more stable, presumably so it doesn't fall apart during transmission through the air.

These two changes plus mutations in the PB2 gene to support replication would all need to come together to support efficient spread in mammals, she says. Of course, she adds, "there's potentially other factors that we don't yet understand."

There are still big questions about exactly how bird flu plays out in cattle, since it's only now being followed closely. "There certainly are many mutations that occurred with this jump from wild birds into cattle and we don't necessarily understand what they mean," says Hill.

With millions of birds infected all over the globe, it's likely that many mammals are being infected through consuming dead birds or being exposed to feces.

Wille says the virus may have been introduced into dairy cattle in a similar way, perhaps infected birds somehow got into their feed.

"It's not that hard to imagine that we have a sort of contaminated feed situation," she says

But this kind of reasoning may not fully explain mass infection events in some mammals, including "unprecedented" die-offs of seals and sea lions in South America and an outbreak on a mink farm in Spain.

It's still not clear what's driving transmission in those instances, maybe animals were spreading it to each other, says Wille.

Experiments done in labs offer some clues. They have shown mammals can pass on this version of H5N1, and even offer some preliminary evidence suggesting limited airborne transmission.

In one recent study, scientists at the Centers for Disease Control and Prevention analyzed how an isolate of the virus taken from a severe human case in Chile spread among ferrets.

They found that variant had a "high capacity to cause fatal disease" among the animals and that it showed enhanced ability to replicate in human cells cultured in the lab, but "did not exhibit productive transmission in respiratory droplets" or via contaminated surfaces when tested in animals.

A separate study by scientists at Canada's National Microbiology Laboratory infected ferrets in the lab with samples of the virus collected from wild animals.

Those experiments found a particular version of the virus, taken from a hawk, could transmit very rapidly from ferret to ferret through direct contact and cause lethal infection in the originally uninfected animals, says Kobasa, senior author of the study which has not yet been published.

They also found evidence the virus had spread through the air between ferrets in different cages, but they didn't see severe illness in the animals who were infected in this way. It's possible there wasn't enough virus being transmitted to "overcome the immune barriers that would prevent infection," he says.

The results are "very preliminary" and what happens under controlled lab conditions isn't necessarily indicative of what can happen in the wild, he says. "We certainly don't see any changes that would suggest that there's any way to support efficient airborne transmission."

While helpful, Lowen says experiments on ferrets need to be interpreted with caution, especially in the context of humans.

She says overall there's still very limited evidence for transmission through the air: "The fact that ferrets transmit pretty consistently in contact exposure is a bit concerning, but these results don't throw up a lot of red flags for me."

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What bird flu's spread among dairy cattle tells us about its risk to humans : Shots - Health News - NPR

The best way to prevent bird flu is to avoid sources of exposurewhenever possible. Infected birds shed avian influenza viruses in their saliva, mucous, and feces and other infected animals may shed bird flu viruses in respiratory secretions and other body fluids (e.g., cow milk). Influenza A viruses also can infect the respiratory tract of mammals and cause infection in other organ tissues. People rarely get bird flu virus infection; however, human infections with avian influenza viruses can happen when enough virus gets into a persons eyes, nose or mouth, or is inhaled. This can happen when virus is in the air (in droplets or possibly dust) and a person breathes it in, or when a person touches something that has virus on it and then touches their mouth, eyes or nose. Bird flu virus infections in people happen most often after close, prolonged and unprotected (no gloves or other protective wear) contact with infected birds or other animals. People with close or prolonged contact with infected birds or animals or their contaminated environments are at greater risk of infection.

People who have job-related contact with infected or potentially infected birds or other animals should be aware of the risk of exposure to avian influenza viruses and should take proper precautions. Groups of people who may have occupational exposure to infected birds include people who work at bird rehabilitation centers, people who work at bird and other animal sanctuaries, poultry farm or dairy farm workers, people who raise backyard bird flocks, andresponders to bird flu outbreaks in birds or other animals. If you must handle infected or potentially infected birds or other animals because of your job, take the following precautions:

Other groups of people who may have contact with birds or other animals infected or potentially infected bird flu viruses include hunters and people who have backyard or hobbyist flocks. People should report sick birds or other animals or unusual bird or other animal deaths to the state or the federal government, either through their state veterinarian or by calling USDAs toll-free number at 1-866-536-7593. Find additional information on biosecurity for backyard flocks onUSDAs APHIS website.

Hunters who handle wild birds should dress game birds in the field when possible and practice good hygiene to prevent any potential disease spread. If possible, wear gloves, an N95 respirator if available or, if not available, a well-fitting facemask (e.g., a surgical mask), and eye protection when dressing birds. Afterwards, throw away the gloves and facemask and then wash your hands with soap and water. More information on general safety guidelines for hunters handling wildlife and their tissuesis available from the U.S. Fish & Wildlife Services website.

Bird owners should practice good biosecurity and prevent contact between their birds and wild birds. Bird owners should follow the protective actions around birds listed at the top of this page. If you must handlesick birds, take the following precautions:

Specific recommendations regarding the appropriate personal protective equipment (PPE) to wear and how to safely put it on and take it off are available at Backyard Flock Owners: Take Steps to Protect Yourself from Avian Influenza (Bird Flu).

CDC has information available [256 KB, 2 pages]for different groups of people who become sick after contact with infected birds.

People who become sick within 10 days of their exposure to infected or potentially infected birds or other animals should isolate at home away from their household members and should not go to work or school until they are proven not to have bird flu virus infection. The local or state public health department should be notified and can assist in monitoring and advising when isolation is no longer required.

Close contacts (e.g., family members) of people who have been exposed to bird flu viruses should monitor their health and report to their health care provider any new symptoms, especially respiratory symptoms or eye redness or conjunctivitis, within 10 days of the last exposure.

For more information about bird flu and what to do if you have been exposed to bird flu, visit: What To Know About Bird Flu (cdc.gov) [154 KB, 2 Pages]

It is especially important that people who may have exposure to infected or potentially infected birds or other animals get a seasonal flu vaccine, ideally 2 weeks before their potential exposure, if possible. Seasonal flu vaccination will not prevent infection with avian influenza viruses but can reduce the risk of getting sick with human and bird flu viruses at the same time.

State and local governments have different policies for collecting dead and testing sick or dead animals, so check with your state health department, state veterinary diagnostic laboratory, or state wildlife agency for information about reporting animals that look sick or are dead in your area.

People should avoid unprotected (not using respiratory and eye protection) exposures to sick or dead animals including wild birds, poultry, other domesticated birds, and other wild or domesticated animals. Wildlife agencies regularly investigate reports of sick or dead animals. This type of reporting could help with the early detection of illnesses like West Nile virus or bird flu. If local authorities tell you to throw away the birds carcass (body), dont touch it with your bare hands. Use gloves or a plastic bag turned inside out to place the body in a garbage bag, which can then be thrown away in your regular trash. To report unusual signs in birds or other animals you have seen in the wild, call 1-866-536-7593.

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Prevention and Antiviral Treatment of Bird Flu Viruses in People | Avian Influenza (Flu) - CDC

The lethal bird flu virus that has already killed hundreds of millions of birds around the world is spreading through Antarctica, according to a warning issued by an international expedition. Researchers aboard a vessel named the Australis traveled through the Weddell Sea for a month, collecting corpses of Antarctic skuas, migratory scavenging seabirds similar to seagulls. These were infected with influenza in four of the 10 areas that were analyzed. One of the researchers, Antonio Alcam of Spains National Research Council (CSIC), explained by telephone that on Beak Island they witnessed a massive outbreak in a colony of skuas. We saw 80 of them alive and 50 dead. Thats crazy, warned the virologist, who works at the Severo Ochoa Molecular Biology Center in Madrid.

The finding adds to what already amounts to the worst avian flu crisis on record. A new subtype of the virus, called H5N1 2.3.4.4b, emerged in 2021 and has since led to the culling of hundreds of millions of farm birds and the deaths of millions of wild birds. The disease had spread across five continents and conservationists were holding their breath at the possibility that it might extend to Antarctica. On February 24, Alcam and his colleague ngela Vzquez confirmed the presence of the virus in Antarctica, in two dead skuas found by Argentine scientists and analyzed at the Spanish Antarctic base Gabriel de Castilla, on Deception Island.

Alcam spent two months on a national mission and a month ago he joined an international expedition led by Australian scientist Meagan Dewar, of the SCAR Antarctic Wildlife Health Network. He and the biologist Begoa Aguado installed their diagnostic laboratory on the sailboat Australis in order to analyze the samples. This had never been done before. We have shown that it can be done, said Alcam. The expedition, made up of 11 people, found skua carcasses in Hope Bay and on Devils and Paulet Islands, in addition to the 50 observed in the massive outbreak on Beak Island. Researchers tested 10 of the 50 samples and all of them were positive. Scientists from the Chilean Antarctic Institute (INACH) also announced on March 14 that they had detected the virus in five skuas on Ross Island.

The sailboat also explored Herona Island, inhabited by a colony of Adlie penguins, which owe their name to Adle Ppin, wife of the French explorer Jules Dumont dUrville, who discovered these birds in 1840. The Alcam and Aguado expedition found a massive mortality among these penguins. We counted 500 bodies and stopped counting after that, said the virologist, who estimates that there could be thousands of dead penguins. His team, however, did not immediately detect traces of the highly pathogenic avian flu viruses, despite analyzing the brains and lungs of the dead penguins.

Hundreds of sea lions with H5N1 flu, either dead or dying, began to show up on the beaches of Peru in January 2023, triggering fears that the virus would learn to jump from mammal to mammal. That terrifying possibility has not come true, at least for now. The pathogen still jumps easily from bird to bird, but when it reaches a mammal it is usually a dead end. The epidemiologist Vijay Dhanasekaran, from the University of Hong Kong, explained to this newspaper in October that humans must nevertheless remain alert. There is a perpetual threat of the virus jumping to humans. This is mainly due to the virus ability to evolve rapidly. It can acquire mutations that help it adhere better to the receptors of human cells, or it can acquire the ability to be transmitted by aerosols, warned Dhanasekaran. Alcam and Aguado have analyzed sea lions and elephant seals, without finding any positive cases.

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Scientists discover massive outbreak of deadly bird flu in Antarctica - EL PAS USA

WHO / FID Thompson

New research conducted in seven sub-Saharan African counties highlights the health and financial impact of inadequate water, sanitation, and hygiene (WASH) in healthcare facilities.

In a report published late last week, non-governmental organization WaterAid estimated that inadequate WASH in healthcare facilities in Ethiopia, Ghana, Malawi, Mali, Nigeria, Uganda, and Zambia contributed to 2.6 billion healthcare-associated infections (HCAIs) and 277,160 excess deaths in 2022. At least 50% of the HCAIs are believed to have been caused by antimicrobial-resistant (AMR) bacteria.

The economic costs of these infections is estimated to range from 2.5% to 10.9% of the healthcare budgets in the seven countries, while lost wages and productivity due to infections accounted for 0.4% to 2.9% of the countries' gross domestic product.

The report notes that globally, nearly 4 million peoplepredominantly those living in low- and middle-income countries (LMICs)lack basic hygiene services at their healthcare facility, and one in five lack basic water services. Inadequate WASH at healthcare facilities in LMICs contributes to a rate of HCAIs that is more than twice that of high-income countries (15.5% vs 7.6%).

"The major transmission pathway for HCAIs is lack of cleanliness and hygiene measures provided during the delivery of healthcare," the report states. "Beyond the health impacts, poor WASH in HCF [healthcare facilities] has additional negative consequences as it relates to other aspects of quality care, including patient satisfaction, dignified and respectful care, future healthcare seeking behaviours and healthcare worker morale, motivation and retention, all of which ultimately impact health outcomes."

WaterAid says the problem is likely to get worse as AMR rates rise, and argues that the less than US$1 per capita needed to provide basic wash services at healthcare facilities in these countries would be covered by savings from a reduction in the medical costs associated with HAIs. The group calls on national governments to develop a dedicated budget line for WASH in healthcare facilities and urges donors, G7 countries, and multilateral financing institutions to prioritize WASH when working with national governments in LMICs.

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Vietnam reports its first human infection from H9 avian flu virus - University of Minnesota Twin Cities

In an effort to prevent domestic cattle from being exposed to highly pathogenic avian influenza virus (HPAI, more specifically avian influenza Type A H5N1), 17 states have restricted cattle importations from states where the virus is known to have infected dairy cows: Alabama, Arizona, Arkansas, California, Delaware, Florida, Hawaii, Idaho, Kentucky, Louisiana, Mississippi, Nebraska, North Carolina, Pennsylvania, Tennessee, Utah, and West Virginia.

The U.S. Department of Agricultures (USDA) Animal and Plant Health Inspection Service (APHIS) will not be issuing federal quarantine orders at this time, nor is the agency recommending any state quarantines or official hold orders on cattle, the agency announced April 2.

However, we strongly recommend minimizing movement of cattle as much as possible, with special attention to evaluating risk and factoring that risk into movement decisions. Do not move sick or exposed animals.

If cattle must be moved, then APHIS strongly encourages extreme diligence by producers, veterinarians, and animal health officials to ensure only healthy cattle are moving and to ensure the validity of interstate health certificates.

The World Organization for Animal Health (WOAH, formerly the OIE) said in an April 5 announcement that the ongoing spread of HPAI in different regions of the world, alongside the recent detections of cases in cattle, is raising concerns within the international community that such infections in cattle could indicate an increased risk of H5N1 viruses becoming better adapted to mammals, and potentially spilling over to humans and other livestock.

Initial investigations so far have revealed no specific adaptation to either humans or mammals, the announcement states. Regardless, several studies are being carried out to further explore the virulence and transmissibility of these viruses, including among cattle, and to assess the risk of transmission to animals and humans, which is currently considered very low.

Yet, WOAH stopped short of endorsing restrictions on the movement of healthy cattle and their products, saying this is not recommended unless justified by an import risk analysis conducted according to WOAH guidelines.

Rather, the international animal health organization shared the following recommendations:

On the same day, the Centers for Disease Control and Prevention (CDC) issued a series of public health recommendations in light of the recent HPAI activity. The guidance covers several areas, including preventing exposures to HPAI viruses, the use of PPE, antiviral treatment, patient investigations, and use of antiviral chemoprophylaxis of exposed persons.

Previously, the CDC reported that a farm worker on a commercial dairy farm in Texas had developed conjunctivitis around March 27, and subsequently tested positive for HPAI A(H5N1) virus infection. HPAI A(H5N1) viruses have been reported in the areas dairy cattle and wild birds. There have been no previous reports of the spread of HPAI viruses from cows to humans.

As of April 11, the USDA's National Veterinary Services Laboratory (NVSL) confirmed that HPAI has been confirmed in dairy cattle in eight states: 10 herds in Texas, five in New Mexico, three in Kansas, two in Michigan, and one each in Idaho, North Carolina, Ohio, and South Dakota.

The affected Ohio dairy operation is known to have received cows from a Texas herd later confirmed to be infected with HPAI. And while the Michigan and Idaho dairy herds received cows from states with HPAI-infected cattle, it was not yet known whether these imported cattle originated from infected herds.

The World Health Organization (WHO) said in an April 9 statement that people should avoid unprotected exposures to sick or dead animals, including wild birds, poultry, other domesticated birds, and other wild or domesticated animals, as well as with animal feces, litter, or materials contaminated by birds or other animals with suspected or confirmed HPAI A(H5N1) virus infection.

In addition, the WHO information states, People should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized (raw) milk, or raw cheeses, from animals with suspected or confirmed HPAI A(H5N1) virus infection (avian influenza or bird flu).

Meanwhile, the American Association of Bovine Practitioners (AABP) announced April 7 that it will call this disease bovine influenza A virus (BIAV) to better distinguish the disease syndrome in cattle from the pathogenesis observed in birds.

The virus isolated from affected animals in herds matching the clinical syndrome has been identified as avian influenza virus Type A H5N1. This virus causes Highly Pathogenic Avian Influenza in birds, however the disease syndrome in cattle does not cause high morbidity and mortality as it does in birds. The AABP does not believe that this disease should be referenced as HPAI in cattle or bird flu in cattle due to these differences, according to the press release.

The AABP has created a working group of its members that, together with AVMA, is communicating with federal officials and working on additional biosecurity guidance.

A version of this story appears in the May 2024 print issue of JAVMA

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States begin to restrict cattle imports from those with influenza cases - American Veterinary Medical Association

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

Featured topic and speakers

Bird flu outbreak: Can you get avian flu from eggs? Are pelvic exams under anesthesia legal? Are birth control pills safe? What is the self-diagnosis trend on TikTok?

AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, shares the latest updates from the CDC on avian flu in cattle and H5N1 symptoms. Also covering the dangers of TikTok medical advice trends on hormonal contraceptives and the teen mental health crisis. AMA Chief Experience Officer Todd Unger hosts.

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

Garcia: Thanks for having me. It's great to be here.

Unger: Well, let's follow up where we started last week, which is about bird flu and the recent case that developed in a person who had been in contact with dairy cattle. Andrea, has there been any update on that situation?

Garcia: Well, there's still only one person in the U.S. known to have tested positive for H5N1, but that virus has continued to spread among cattle. We're now seeing infected herd in Ohio. It was also detected in additional herds in Kansas and New Mexico.

And so the USDA has now confirmed infections in herds across six states in totalthree dairy herds in Kansas, two in New Mexico, seven in Texas, and then one each in Ohio, Idaho and Michigan. They've also said that transmission of the disease between cows cannot be ruled out, which is something that continues to be studied and looked at.

Unger: Andrea, do we have any sense of how all of this got started?

Garcia: Well, those initial cases in Texas and Kansas appear to have been introduced by wild birds. And that strain of the virus in subsequent cases in New Mexico, Michigan and Idaho are very similar. This isn't altogether new. Migratory birds have been spreading avian flu around the globe, infecting poultry and other species.

However, last Thursday, the head of the World Organization for Animal Health said that that spread is increasing in the number of species, and it's widening its geographic reach. And that has raised the risk of humans being infected. I think with that being said, scientists still believe the risk for the general public is low.

Unger: Has the CDC provided any additional guidance for physicians or others?

Garcia: They have. So last Friday, we saw the CDC issue an official health advisory, or a HAN, and the purpose of that was really to ensure awareness of that Texas case among physicians, among state health departments, and of course, among the public.

That advisory included a summary of interim CDC recommendations, as well as details around sequencing. They have sequenced the influenza virus genome from the individual who was infected. They've compared that with H5N1 sequences from cattle, from wild birds and from poultry.

And while there were minor changes identified between the two, both cattle and human sequences lacked changes that would make them better able to infect mammals, which is good news. There were also no markers found that would indicate any sort of resistance to our current antiviral drugs. And the virus is closely related to two existing candidate vaccine viruses that are already available to manufacturers, which could be used to make vaccine if needed.

Unger: Well, that all sounds like relatively good news in terms of treatment and spread. Andrea, you also mentioned interim recommendations. Is there anything new that we need to know there?

Garcia: Well, the CDC specifically recommends that physicians consider the possibility of H5N1 virus infection in people who are showing signs or symptoms of acute respiratory illness or conjunctivitis and who have had a relevant exposure history.

So examples of symptoms to watch for include but are not limited to for mild illness cough, sore throat, eye redness or discharge, fever or feeling feverish, runny nose, fatigue, muscle or joint pain, and headache. For moderate to severe illness, which that could include shortness of breath, difficulty breathing and altered mental state or seizures.

And if signs and symptoms compatible with avian flu are present, physicians should isolate the patient and follow infection control recommendations, including the use of PPE. And they should also initiate empiric antiviral treatment as soon as possible. Don't delay. Don't wait for laboratory confirmed results. Physicians should also be notifying their state and local health departments. They can help arrange testing.

Unger: Now, you mentioned earlier that the risk to the general public is currently considered low. Is there anything that the public needs to know in terms of prevention?

Garcia: Yeah, the advisory recommended that people avoid being near sick or dead animals or surfaces contaminated with the animal's feces, litter, raw milk or other byproducts when not wearing respiratory or eye protection. As always, people should not prepare or eat uncooked or undercooked food or related uncooked food products, such as unpasteurized raw milk or cheeses from animals who have a suspected or confirmed infection.

We don't have time to run through all of the detailed CDC recommendations here, including those for state health departments, farmers and livestock workers. But we will drop a link in the episode description and report, of course, on anything new as it develops.

Unger: Well, thank you for that update, Andrea. And in addition, we've also started to see headlines this week about bird flu hitting poultry and possibly affecting our egg supply. Andrea, what can you tell us about that?

Garcia: Well, last Tuesday, Todd, the largest producer of fresh eggs in the U.S. said that they've temporarily halted production at a Texas plant after bird flu was found in chickens. Officials have said the virus has also been detected at a poultry facility in Michigan.

The company, which is Mississippi-based Cal-Maine Foods, said in a statement that approximately 3.6% of its total flock were destroyed after the infection was found at a facility in Parmer County, Texas. Cal-Maine said it sells most of their eggs in the Southwestern, Southeastern, Midwestern and Mid-Atlantic regions of the U.S.

But the company has said that there is no known bird flu risk associated with eggs that are currently in the market and no eggs have been recalled. According to the USDA, eggs that are properly handled and cooked are safe to eat.

Unger: Well, this does raise questions about our egg and dairy supply. Will we begin to feel the impact of this, perhaps in terms of rising prices or shortages or any other ways?

Garcia: Well, there was an article in The Hill that posed this very question over the weekend. And that article quotes Amy Hagerman, who is a professor of agricultural economics at Oklahoma State University. And she said that we would expect to see some increase in prices because you're rapidly pulling a large number of potential eggs out of the market for the next 30 to 60 days.

Under normal circumstances, egg prices would usually be dropping after the Easter holiday, when demand is high. But that's not expected to be the case this year. The article notes that egg prices really haven't even fully recovered from an outbreak in 2022 when bird flu knocked out about 10% of the country's laying hens and prices skyrocketed.

And this isn't the same with dairy products, though, because with cattle, the virus doesn't appear to be nearly as deadly or as contagious as it is with poultry. If the virus gets into a poultry block, every animal's infected within a very short period of time. That translates to fewer deaths for dairy cattle and fewer production disruptions for the dairy industry.

Unger: We'll obviously keep our eye on that. Andrea, I want to turn now to a headline from the HHS that ran early last week, announcing that teaching hospitals need to get written patient consent for pelvic exams. What do they need to know and what's driving that decision?

Garcia: Yeah, so there was a letter that went to teaching hospitals and medical schools last Monday. And HHS said that these hospitals must obtain that written informed consent from patients before they undergo sensitive exams, like pelvis and prostate exams, especially if the patients are under anesthesia.

There have been recent articles, both in the mainstream media and in the medical literature, that have brought attention to the practice of allowing supervised medical or clinical students to perform these invasive exams on patients who are under anesthesia. They're often conducted as a part of vital skills for clinical students, skills they must obtain during their training and education.

But the CMS letter makes it clear that patients have the right to make informed decisions on the health care services that they receive. We did see some states who had enacted laws to protect against this non-consensual exam of anesthetized patients. But the new HHS guidance expands these protections nationally.

This is being seen as a step to restore trust between the medical community and patients, particularly vulnerable populations. And it's important to note that failure to obtain informed consent would be a violation of the conditions of participation under Medicare and Medicaid and may be subject to fines and investigations for violation of patient privacy laws.

Unger: That's good to know, especially given that trust is so essential in patient care. Andrea, closing out this week, there's also been some news about social media and health, particularly that patients are perhaps putting too much trust in the information that they find out there on social media. What can you tell us about that?

Garcia: Yeah, so late last month, The Washington Post did an extensive report on how some women were getting off birth control based on misinformation they've received through TikTok and Instagram, including videos that are really vilifying hormonal contraception.

Among some of the misconceptions were women blaming their weight gain on the pill, claims that some birth control can lead to infertility, depression and anxiety. Many of these influencers then recommended natural alternatives, such as timing sex to menstrual cycles as a muchwhich is a much less effective method of birth control that doctors warn could result in unwanted or unintended pregnancies.

Physicians say that they are seeing an explosion of birth control misinformation online. It's targeting a really vulnerable demographic, people in their teens and early 20s who are more likely to believe what they see on their phones. This is, of course, a part of a larger, very disturbing trend where teenagers are using social media for health-related concerns.

Unger: Gosh. And the natural method you mentioned there, I think in my parents' day, they were called the rhythm method, things like that. We've come a long way. So I'd encourage folks out there to seek proper medical direction instead of TikTok videos. Andrea, have we seen it being used in other ways?

Garcia: Well, for example, an article in The Hill, also published late last month, revealed that teens are increasingly using social media to self-diagnose their mental health issues. There was a poll by EdWeek Research Center which found 55% of students use social media to self-diagnose. And 65% of teachers say they've seen the phenomenon in their classrooms.

So one of the real dangers here is that after self-diagnosis, teenagers might not only fail to understand their actual problems, but they could pursue solutions or even medications that aren't right for them. The poll also found that teenagers are not just using it to diagnose themselves, but they're also diagnosing their friends, based on what they see.

Parents and physicians can definitely use this as a jumping off point for discussions. But experts are also calling for limits on social media sites, which is part of a much larger discussion.

Unger: Indeed, that deserves a lot more discussion, and one we'll continue to watch. Andrea, thanks so much for joining us today. That wraps up today's episode. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join.

We'll be back soon with another AMA Update. In the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.

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

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CDC avian flu guidelines, bird flu in eggs, plus TikTok mental health & birth control misinformation - American Medical Association

(WXYZ) Over 85 million poultry in 48 states have been affected by theH5N1 avian flu virus. And now, after a dairy worker tested positive for the bird flu in Texas, people are understandably concerned about its potential spread.

The risk is relatively low at the moment. Currently, there's no evidence of the avian flu spreading from person to person, and only two cases have been reported in the U.S. so far. The first case dates back to 2022 and the second involves a Texas dairy farm worker.

But how did someone working with cows get the bird flu? Isnt the bird flu just for birds? Well, infections are caused by avian influenza Type A viruses.

In this particular outbreak, the strain being transmitted is H5N1. While these viruses naturally spread among birds, some can also infect other animals. However, this is the first time the virus has been confirmed in cows and is also the first known instance of cow-to-human transmission of bird flu.

The good news is that samples from infected animals suggest that this virus has not undergone significant changes. Genetic sequencing of the virus from the Texas dairy worker did find a change in a gene called PB2. While this does suggest that the virus is a bit better at multiplying in mammals, it doesn't mean it's become more transmissible between people.

Vaccines for H5N1 flu do exist. But they are not being produced in large quantities, so theyre unavailable for widespread distribution.

As for treatment, there are several antiviral drugs approved for treating influenza. Some of these medications can also be prescribed for post-exposure prophylaxis that just means people whove been exposed but haven't gotten sick can take them.

When it comes to milk and poultry, it's safe to drink pasteurized milk as the process eliminates germs like the flu. I recommend avoiding raw milk or anything made from it. According to the United States Department of Agriculture, its safe to eat poultry including eggs. Just please cook these foods to a safe internal temperature as this kills bacteria and viruses.

For most Americans, getting infected with bird flu would be rare. However, if you work with birds and animals, it's best to take precautions. Infection can happen if you breathe the virus in or it enters your eyes, nose or mouth. So try to avoid touching surfaces where there might be bird droppings, wash hands often and avoid direct contact with wild birds.

THIS WEEK ON 'THE DR. NANDI SHOW'

Many have spent years searching for a known cause or cure for Irritable Bowel Syndrome. Dr. Partha Nandi, MD, speaks with a husband-and-wife doctor team that believes they have found a way to solve this riddle. Dr. Nandi also meets with two doctors who were diagnosed with the disease and the world-renowned Dr. Russell Jaffe, who believes Western medicine is a hindrance to curing this disease. Tune in Monday, April 14t at 2:30 a.m.

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Ask Dr. Nandi: Should I be worried about the bird flu? - WXYZ 7 Action News Detroit