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Marburg in Rwanda: What to Expect
Rwanda is battling its first outbreak of Marburg virus, a severe and often fatal disease. Discovered less than two weeks ago, the outbreak is already the third largest on record, accounting for 58 confirmed cases and 13 deaths as of October 10.
Despite the ostensible delay in detection, once the outbreak was recognized and declared on September 27, 2024, the Rwandan Ministry of Health launched an ambitious response to contain the spread—scaling up clinical care resources, dramatically expanding testing, and reaching out to global partners for international expertise and access to experimental medical countermeasures.
Rwanda's response to Marburg has been helped by its health system, which has rebuilt from the ashes of the genocide three decades ago to become one of the strongest in the region. Even with this infrastructure, the emergency has posed a significant challenge and important lessons are emerging about preparing for and responding to future outbreaks and global health security.
Having worked in the field response to multiple outbreaks, including as physician and a country-level epidemiologist in Guinea during Ebola in 2014, I know the next few weeks could be even harder as they work to get it under control and prevent further spread, especially among their own health-care workforce and to other countries.
Yet we've already seen promising signs.
Marburg, Briefly Explained
Marburg belongs to the same virus family as Ebola (filoviruses), and the approach to containing each disease is similar. Like Ebola, Marburg spreads from human to human via infected body fluid and has a similar incubation period (2–21 days). Both diseases can cause fever, headache, diarrhea, and severe bleeding. Fatality rates up to 88% have been reported for Marburg, but good clinical care can lower that figure.
The Marburg virus was first discovered in 1967 when laboratory workers in Marburg and Frankfurt-am-Main, West Germany, and Belgrade, Serbia (then Yugoslavia), simultaneously fell ill after handing African green monkeys imported from Uganda.
In total, 18 Marburg outbreaks have been reported; their frequency appears to be increasing, with five outbreaks in the last three years alone.
Rwanda's Health System, Clinical Care Needs, and Early Promise
Building on expertise learned during the COVID pandemic, Rwanda's contact tracing for Marburg was quickly put in place in an effort to understand the different chains of transmission. This labor-intensive work requires epidemiologists to compile exhaustive lists of any people who could have been in contact with a confirmed case. Each identified contact is then followed for 21 days to record symptoms, monitor temperature, and refer anyone for testing. Rwanda has reported that it is following more than 400 contacts.
The current Marburg outbreak in Rwanda is in many ways typical for filovirus outbreaks. As is often the case, recognition and confirmation of the diagnosis was delayed. Epidemiologic analysis has tied the index case back to September 8, nearly three weeks before the outbreak was declared late in the month. No case of Marburg had ever been reported in Rwanda, which likely delayed the initial diagnosis. Similarly, the index case tested positive for malaria, ostensibly providing an explanation for his symptoms and preventing any further exploration of his death.
More than 80% of the initial Marburg cases were in health-care workers, a common finding in the early days of filovirus outbreaks, when disease spread takes place within health structures. Providers often come in close contact with patients who present for care at the most infectious phase of their illness.
In developing clinical capacity for Marburg outbreaks, two goals are critical: reduce the risk of infection for providers while providing high-quality clinical care to patients. Both are resource and labor intensive, requiring a sufficient supply of personal protective equipment and the implementation of strict protocols to reduce exposure risk.
No vaccines or therapeutics for Marburg are currently approved, but experimental treatments—including monoclonal antibodies and an antiviral drug—have already reached Rwanda and are being used in patient care.
Otherwise, the mainstay of treatment is early and intensive supportive care, which can help lower mortality. This requires medical providers to perform frequent assessment of vital signs and address any abnormalities, appropriately replace fluid losses, monitor laboratory results (including kidney and liver function), and perform potentially more clinically demanding and higher risk interventions such as renal dialysis or intubation. This also requires vast quantities of personal protective equipment and strict adherence to protocols created for safely using it, particularly for properly removing it when the risk of exposure is highest.
A remarkable achievement is the arrival of an experimental Marburg vaccine just days after the outbreak was reported. More than 700 doses were provided by the Sabin Vaccine Institute, a nonprofit organization promoting global vaccine development, and another 1,000 doses will reportedly arrive soon in the country. These vaccines were developed with significant financial and research backing from the Administration for Strategic Preparedness and Response (ASPR) and the National Institutes of Health (NIH), highlighting the importance of U.S. contributions to supporting global health response.
The swift deployment of vaccines in Rwanda contrasts sharply with that for previous filovirus outbreaks, when complicated paperwork and formal bureaucracy often delayed arrival of vaccines and other medical countermeasures until after the period they could be used in a trial, most recently in the 2022 Ebola Sudan outbreak in Uganda.
Yet these vaccine doses arrived in Rwanda within a week of the request and were already being administered to frontline providers the day they arrived.
International Risk: Avoiding Past Missteps
Outside the confines of its hospitals, Rwanda will face different challenges in containing this outbreak. Cases were initially reported from seven of Rwanda's 30 districts, with most concentrated in and around the capital city, Kigali. During the 2014–2016 West Africa Ebola outbreak, transmission to capital cities led to a dramatic rise in case counts given the greater level of potential exposure.
Similarly, Rwanda's capital is a global travel hub and booming tourist destination, with more then 1.4 million arrivals last year and direct connections to London, Paris, and many other country destinations. As a result, Rwanda has put in place guidelines and issued travel advisories, as has the Centers for Disease Control and Prevention (CDC) in an effort to "inform clinicians and health departments" about the outbreak. On October 7, the U.S. Department of Health and Human Services issued a press release outlining a plan to begin, next week, public health entry screening of travelers entering the United States who have been in Rwanda in the past 21 days to "reduce the risk of importation of Marburg cases."
The following day, the Africa CDC released a statement criticizing any travel bans or restrictions, arguing these measures are "inconsistent with international health guidelines and risk undermining public health responses, deepening economic challenges, and reigniting the inequities and mistrust that surfaced during the COVID-19 pandemic."
Potentially more concerning is the risk of international spread to Rwanda's neighbors, notably in Burundi and Democratic Republic of Congo where instability, weak health infrastructure, and the ongoing mpox outbreak would hamper the ability to launch the scale of response needed to contain Marburg.
The Give and Take of Information Sharing
A week into the outbreak, global experts outside the country expressed frustration with a perceived deficiency of important data. Virologists wanted more genomic information, epidemiologists wanted greater clarity on the contact tracing, and health-care providers wanted more clinical data.
Given my field experience with the 2014 Ebola response, I understand how difficult and time consuming it is to conduct this disease detective work, especially while trying to manage requests from an influx of international experts, setting up auxiliary structures for isolation and clinical care, ramping up testing capacity, and overseeing a growing number of meetings and interview requests. This data gathering and reporting is sometimes a challenge even in countries with excellent technical capacity, as evidenced by the current response to H5N1 bird flu outbreak in the United States.
During the COVID-19 pandemic, society became accustomed to nearly instantaneous updates on the number of new cases or hospital capacity. These are important metrics to help guide response but take significant time and effort to step up, especially in the early days of any new outbreak. International requests come as leaders haggle over the pandemic agreement—and to what degree low- or middle-income countries should receive medical products in return for sharing information on emerging outbreaks.
African nations are increasingly seeking to assert their independence on public health. They have not forgotten the inequitable distribution of COVID-19 vaccines that put many African countries last in the global queue. The Africa Union recently set a goal to produce 60% of the vaccines needed on the continent by 2040, up from less than 1% today. To that end, Rwanda recently opened a mRNA vaccine manufacturing facility in Kigali.
They have also not forgotten the punitive travel bans put in place after scientists in South Africa first discovered the COVID-19 variant omicron in November 2021. The bans targeted seven southern African countries, lasted more than a month, hobbled the region's much-needed tourism industry, and ultimately did little to prevent the new variant's spread. If the global community expected greater transparency in future disease outbreaks, reassurances that their pronouncements won't be met with unscientific and stigmatizing repercussions will be needed.
Rwanda's swift response to Marburg is a testament to the country's growing health infrastructure and resilience. However, the real challenge ahead lies in managing regional vulnerabilities and balancing international expectations while working to effectively contain the outbreak at its source.
Read Article
Despite the ostensible delay in detection, once the outbreak was recognized and declared on September 27, 2024, the Rwandan Ministry of Health launched an ambitious response to contain the spread—scaling up clinical care resources, dramatically expanding testing, and reaching out to global partners for international expertise and access to experimental medical countermeasures.
Rwanda's response to Marburg has been helped by its health system, which has rebuilt from the ashes of the genocide three decades ago to become one of the strongest in the region. Even with this infrastructure, the emergency has posed a significant challenge and important lessons are emerging about preparing for and responding to future outbreaks and global health security.
Having worked in the field response to multiple outbreaks, including as physician and a country-level epidemiologist in Guinea during Ebola in 2014, I know the next few weeks could be even harder as they work to get it under control and prevent further spread, especially among their own health-care workforce and to other countries.
Yet we've already seen promising signs.
Marburg, Briefly Explained
Marburg belongs to the same virus family as Ebola (filoviruses), and the approach to containing each disease is similar. Like Ebola, Marburg spreads from human to human via infected body fluid and has a similar incubation period (2–21 days). Both diseases can cause fever, headache, diarrhea, and severe bleeding. Fatality rates up to 88% have been reported for Marburg, but good clinical care can lower that figure.
The Marburg virus was first discovered in 1967 when laboratory workers in Marburg and Frankfurt-am-Main, West Germany, and Belgrade, Serbia (then Yugoslavia), simultaneously fell ill after handing African green monkeys imported from Uganda.
In total, 18 Marburg outbreaks have been reported; their frequency appears to be increasing, with five outbreaks in the last three years alone.
Rwanda's Health System, Clinical Care Needs, and Early Promise
Building on expertise learned during the COVID pandemic, Rwanda's contact tracing for Marburg was quickly put in place in an effort to understand the different chains of transmission. This labor-intensive work requires epidemiologists to compile exhaustive lists of any people who could have been in contact with a confirmed case. Each identified contact is then followed for 21 days to record symptoms, monitor temperature, and refer anyone for testing. Rwanda has reported that it is following more than 400 contacts.
The current Marburg outbreak in Rwanda is in many ways typical for filovirus outbreaks. As is often the case, recognition and confirmation of the diagnosis was delayed. Epidemiologic analysis has tied the index case back to September 8, nearly three weeks before the outbreak was declared late in the month. No case of Marburg had ever been reported in Rwanda, which likely delayed the initial diagnosis. Similarly, the index case tested positive for malaria, ostensibly providing an explanation for his symptoms and preventing any further exploration of his death.
More than 80% of the initial Marburg cases were in health-care workers, a common finding in the early days of filovirus outbreaks, when disease spread takes place within health structures. Providers often come in close contact with patients who present for care at the most infectious phase of their illness.
In developing clinical capacity for Marburg outbreaks, two goals are critical: reduce the risk of infection for providers while providing high-quality clinical care to patients. Both are resource and labor intensive, requiring a sufficient supply of personal protective equipment and the implementation of strict protocols to reduce exposure risk.
No vaccines or therapeutics for Marburg are currently approved, but experimental treatments—including monoclonal antibodies and an antiviral drug—have already reached Rwanda and are being used in patient care.
Otherwise, the mainstay of treatment is early and intensive supportive care, which can help lower mortality. This requires medical providers to perform frequent assessment of vital signs and address any abnormalities, appropriately replace fluid losses, monitor laboratory results (including kidney and liver function), and perform potentially more clinically demanding and higher risk interventions such as renal dialysis or intubation. This also requires vast quantities of personal protective equipment and strict adherence to protocols created for safely using it, particularly for properly removing it when the risk of exposure is highest.
A remarkable achievement is the arrival of an experimental Marburg vaccine just days after the outbreak was reported. More than 700 doses were provided by the Sabin Vaccine Institute, a nonprofit organization promoting global vaccine development, and another 1,000 doses will reportedly arrive soon in the country. These vaccines were developed with significant financial and research backing from the Administration for Strategic Preparedness and Response (ASPR) and the National Institutes of Health (NIH), highlighting the importance of U.S. contributions to supporting global health response.
The swift deployment of vaccines in Rwanda contrasts sharply with that for previous filovirus outbreaks, when complicated paperwork and formal bureaucracy often delayed arrival of vaccines and other medical countermeasures until after the period they could be used in a trial, most recently in the 2022 Ebola Sudan outbreak in Uganda.
Yet these vaccine doses arrived in Rwanda within a week of the request and were already being administered to frontline providers the day they arrived.
International Risk: Avoiding Past Missteps
Outside the confines of its hospitals, Rwanda will face different challenges in containing this outbreak. Cases were initially reported from seven of Rwanda's 30 districts, with most concentrated in and around the capital city, Kigali. During the 2014–2016 West Africa Ebola outbreak, transmission to capital cities led to a dramatic rise in case counts given the greater level of potential exposure.
Similarly, Rwanda's capital is a global travel hub and booming tourist destination, with more then 1.4 million arrivals last year and direct connections to London, Paris, and many other country destinations. As a result, Rwanda has put in place guidelines and issued travel advisories, as has the Centers for Disease Control and Prevention (CDC) in an effort to "inform clinicians and health departments" about the outbreak. On October 7, the U.S. Department of Health and Human Services issued a press release outlining a plan to begin, next week, public health entry screening of travelers entering the United States who have been in Rwanda in the past 21 days to "reduce the risk of importation of Marburg cases."
The following day, the Africa CDC released a statement criticizing any travel bans or restrictions, arguing these measures are "inconsistent with international health guidelines and risk undermining public health responses, deepening economic challenges, and reigniting the inequities and mistrust that surfaced during the COVID-19 pandemic."
Potentially more concerning is the risk of international spread to Rwanda's neighbors, notably in Burundi and Democratic Republic of Congo where instability, weak health infrastructure, and the ongoing mpox outbreak would hamper the ability to launch the scale of response needed to contain Marburg.
The Give and Take of Information Sharing
A week into the outbreak, global experts outside the country expressed frustration with a perceived deficiency of important data. Virologists wanted more genomic information, epidemiologists wanted greater clarity on the contact tracing, and health-care providers wanted more clinical data.
Given my field experience with the 2014 Ebola response, I understand how difficult and time consuming it is to conduct this disease detective work, especially while trying to manage requests from an influx of international experts, setting up auxiliary structures for isolation and clinical care, ramping up testing capacity, and overseeing a growing number of meetings and interview requests. This data gathering and reporting is sometimes a challenge even in countries with excellent technical capacity, as evidenced by the current response to H5N1 bird flu outbreak in the United States.
During the COVID-19 pandemic, society became accustomed to nearly instantaneous updates on the number of new cases or hospital capacity. These are important metrics to help guide response but take significant time and effort to step up, especially in the early days of any new outbreak. International requests come as leaders haggle over the pandemic agreement—and to what degree low- or middle-income countries should receive medical products in return for sharing information on emerging outbreaks.
African nations are increasingly seeking to assert their independence on public health. They have not forgotten the inequitable distribution of COVID-19 vaccines that put many African countries last in the global queue. The Africa Union recently set a goal to produce 60% of the vaccines needed on the continent by 2040, up from less than 1% today. To that end, Rwanda recently opened a mRNA vaccine manufacturing facility in Kigali.
They have also not forgotten the punitive travel bans put in place after scientists in South Africa first discovered the COVID-19 variant omicron in November 2021. The bans targeted seven southern African countries, lasted more than a month, hobbled the region's much-needed tourism industry, and ultimately did little to prevent the new variant's spread. If the global community expected greater transparency in future disease outbreaks, reassurances that their pronouncements won't be met with unscientific and stigmatizing repercussions will be needed.
Rwanda's swift response to Marburg is a testament to the country's growing health infrastructure and resilience. However, the real challenge ahead lies in managing regional vulnerabilities and balancing international expectations while working to effectively contain the outbreak at its source.
The H5N1 virus, also known as bird flu, has created an enduring crisis this year, massacring millions of birds and other wild animals, while stirring outbreaks in dairy farms across the U.S. But now more and more human cases are being reported, raising the risk of another pandemic like COVID-19. As the number of confirmed bird flu cases continues to climb in various states across the country, many public health experts are anxiously awaiting results from testing performed in Missouri that will determine whether an infected individual passed the virus onto health care workers and a member of the household who later developed symptoms.
A third case of bird flu reported in California this week (with two others pending confirmation) is the 17th confirmed human case in the current U.S outbreak, which began in April 2022, according to the Centers for Disease Control and Prevention (CDC). All but one of these cases have occurred in farmworkers working with poultry or dairy cows who were exposed to the virus. The other occurred in Missouri.
There, someone who didn’t work on a farm became infected with H5N1, the first case of its kind to not have a direct link to animals. This is worrisome because it could indicate human-to-human transmission, which is a key component of any widespread illness, including a pandemic. So far, it seems that most, if not all, human H5N1 cases have involved the virus jumping from animals but petering out before spreading to others. All patients have recovered.
Although the infection was confirmed Sept. 6, the investigation to determine whether the people the individual came into contact with were infected is still ongoing. Yet it’s critical to find out this information quickly to keep the outbreak under control, said Dr. Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.
“There are enough worrisome signs that I think we should be using this advanced warning to try to get ahead of [H5N1] as best we can,” Nuzzo told Salon in a phone interview. “That includes doing a really thorough investigation anytime we find cases to make sure they didn't spread to somebody else and to figure out if there is anything about this virus that's changing in additional ways that we don't want to see change.”
Most cases reported have been classified as “mild” with symptoms like conjunctivitis (pink eye), fever and respiratory symptoms. In a case study published in the New England Journal of Medicine (NEJM), a man working with dairy cows in Texas who was infected with H5N1 experienced subconjunctival hemorrhage — which means he started bleeding from the whites of his eyes. However, bird flu infections can be more severe and even fatal. The overall fatality rate across H5N1 outbreaks is estimated to be above 50%, but that may be an overestimate due to many milder infections being missed. Regardless, it is not clear how this could change if the virus evolved to transmit between humans.
“We cannot rule out that future cases won't be severe,” Nuzzo said. “We're pinning our entire strategy for responding to this virus on the hope that it's not severe.”
Strategies are being enacted to reduce the spread of the virus: using personal protective equipment (PPE) on farms, increasing testing, and stockpiling vaccines. (An mRNA H5N1 vaccine is being developed, and a bird flu vaccine from Sanofi is also on its way.) Notably, the CDC is urging farmworkers in particular to get the flu vaccine this year because of the risk of co-infection. If multiple virus strains circulate together at once, genetic material could be swapped around in a process called viral reassortment, potentially producing more dangerous evolutions of either virus.
However, all of these strategies should be ramped up, said Dr. Scott Roberts, an infectious diseases specialist at Yale Medicine. The CDC has run around 52,000 specimens that could detect the virus in humans since late February. But a study in Nature last month suggested the contract tracing necessary to mitigate the spread of the virus among infected farmworkers was not being performed and that veterinarians anecdotally reported that testing on farms was lacking.
“I would hope that public health infrastructure and public health leadership here in the United States would have learned the lessons of COVID to really respond to this in a more robust way than it seems they have so far,” Roberts told Salon in a phone interview.
Some of these strategies have been challenging to implement, with direct health consequences. In Colorado, for example, poultry workers got infected in July because it was 104 degrees Fahrenheit and they couldn’t keep their PPE on properly, said Dr. Abraar Karan, Stanford infectious disease physician and post-doctoral researcher.
“That should never happen,” Karan told Salon in a phone interview. “That is a problem we could anticipate … It’s more logistics and coordination and doing it consistently every single time because if you mess up one time or you let your guard down one time, you can easily be dealing with an outbreak.”
The CDC has thus far assured the public that a person’s threat of being infected with bird flu is low if they don’t work with farm animals. In the Missouri case, contact tracing interviews with the infected person "detected that the household contact had been symptomatic with nausea, vomiting and diarrhea with a simultaneous onset of symptoms, implying a common exposure rather than human-to-human transmission," said Dr. Demetre Daskalakis the CDC’s Director of the National Center for Immunization and Respiratory Diseases at a media briefing.
Still, the more the virus spreads, the more chances it has to evolve, said Nahid Bhadelia, an associate professor of infectious diseases at Boston University School of Medicine.
“Every time this virus goes from an animal to a human, it’s giving the virus one more chance to adapt to potentially get better at affecting humans,” Bhadelia told Salon in a phone interview.
Public health experts are concerned that — with 281 dairy herds affected in 14 states and counting — cases are falling through cracks in surveillance systems and increasing those chances. Many farms have reportedly been hesitant to test animals for economic consequences throughout the outbreak. In California, the country’s largest dairy supplier, it was originally estimated that 10% of cows would be infected, but a newsletter from the California Dairy Quality Assurance Program suggests that number could be far higher at 50 to 60%. In a letter published in the NEJM, H5N1 was detected in the wastewater of 10 out of 10 cities tested.
“We've always known that there's likely more cases that have been missed, particularly among dairy farm workers that never were tested,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “The testing among dairy cattle is not very robust, and the amount of proactive action taken by certain states is not enough to give a lot of confidence that this is being handled properly.”
Human cases are likely going under the radar as well, if, for example, infected people are not going through the health care systems where these cases are tracked, said Dr. Meghan Davis, an associate professor at Johns Hopkins Bloomberg School of Public Health.
“These workforces are often marginalized and this is a lot of migrant and immigrant workers who may lack trust with authorities or not have great access to healthcare and may need extra support beyond what we might be able to do in other workplace settings,” Davis told Salon in a phone interview.
The CDC is currently testing whether exposed individuals in Missouri have traces of H5 antibodies in their blood to retroactively determine if they were infected. However, the process to create a test that could specifically detect the virus that was genetically identical to the infected patient's is complex and involves reverse genetics, taking the CDC about three weeks, Daskalakis said at the briefing.
"We realize people, including all of us at CDC, are anxious to see results from this testing," he said.
Although many believe the chances are low that there was human-to-human transmission in Missouri at this point in part due to the nature of the index patient’s condition and the symptoms of those exposed, it can’t be ruled out until the final results are made public. There is a lot riding on the findings.
“If this virus gains the ability to spread between people, we would be in a new pandemic,” Nuzzo said.
Read Article
A third case of bird flu reported in California this week (with two others pending confirmation) is the 17th confirmed human case in the current U.S outbreak, which began in April 2022, according to the Centers for Disease Control and Prevention (CDC). All but one of these cases have occurred in farmworkers working with poultry or dairy cows who were exposed to the virus. The other occurred in Missouri.
There, someone who didn’t work on a farm became infected with H5N1, the first case of its kind to not have a direct link to animals. This is worrisome because it could indicate human-to-human transmission, which is a key component of any widespread illness, including a pandemic. So far, it seems that most, if not all, human H5N1 cases have involved the virus jumping from animals but petering out before spreading to others. All patients have recovered.
Although the infection was confirmed Sept. 6, the investigation to determine whether the people the individual came into contact with were infected is still ongoing. Yet it’s critical to find out this information quickly to keep the outbreak under control, said Dr. Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.
“There are enough worrisome signs that I think we should be using this advanced warning to try to get ahead of [H5N1] as best we can,” Nuzzo told Salon in a phone interview. “That includes doing a really thorough investigation anytime we find cases to make sure they didn't spread to somebody else and to figure out if there is anything about this virus that's changing in additional ways that we don't want to see change.”
Most cases reported have been classified as “mild” with symptoms like conjunctivitis (pink eye), fever and respiratory symptoms. In a case study published in the New England Journal of Medicine (NEJM), a man working with dairy cows in Texas who was infected with H5N1 experienced subconjunctival hemorrhage — which means he started bleeding from the whites of his eyes. However, bird flu infections can be more severe and even fatal. The overall fatality rate across H5N1 outbreaks is estimated to be above 50%, but that may be an overestimate due to many milder infections being missed. Regardless, it is not clear how this could change if the virus evolved to transmit between humans.
“We cannot rule out that future cases won't be severe,” Nuzzo said. “We're pinning our entire strategy for responding to this virus on the hope that it's not severe.”
Strategies are being enacted to reduce the spread of the virus: using personal protective equipment (PPE) on farms, increasing testing, and stockpiling vaccines. (An mRNA H5N1 vaccine is being developed, and a bird flu vaccine from Sanofi is also on its way.) Notably, the CDC is urging farmworkers in particular to get the flu vaccine this year because of the risk of co-infection. If multiple virus strains circulate together at once, genetic material could be swapped around in a process called viral reassortment, potentially producing more dangerous evolutions of either virus.
However, all of these strategies should be ramped up, said Dr. Scott Roberts, an infectious diseases specialist at Yale Medicine. The CDC has run around 52,000 specimens that could detect the virus in humans since late February. But a study in Nature last month suggested the contract tracing necessary to mitigate the spread of the virus among infected farmworkers was not being performed and that veterinarians anecdotally reported that testing on farms was lacking.
“I would hope that public health infrastructure and public health leadership here in the United States would have learned the lessons of COVID to really respond to this in a more robust way than it seems they have so far,” Roberts told Salon in a phone interview.
Some of these strategies have been challenging to implement, with direct health consequences. In Colorado, for example, poultry workers got infected in July because it was 104 degrees Fahrenheit and they couldn’t keep their PPE on properly, said Dr. Abraar Karan, Stanford infectious disease physician and post-doctoral researcher.
“That should never happen,” Karan told Salon in a phone interview. “That is a problem we could anticipate … It’s more logistics and coordination and doing it consistently every single time because if you mess up one time or you let your guard down one time, you can easily be dealing with an outbreak.”
The CDC has thus far assured the public that a person’s threat of being infected with bird flu is low if they don’t work with farm animals. In the Missouri case, contact tracing interviews with the infected person "detected that the household contact had been symptomatic with nausea, vomiting and diarrhea with a simultaneous onset of symptoms, implying a common exposure rather than human-to-human transmission," said Dr. Demetre Daskalakis the CDC’s Director of the National Center for Immunization and Respiratory Diseases at a media briefing.
Still, the more the virus spreads, the more chances it has to evolve, said Nahid Bhadelia, an associate professor of infectious diseases at Boston University School of Medicine.
“Every time this virus goes from an animal to a human, it’s giving the virus one more chance to adapt to potentially get better at affecting humans,” Bhadelia told Salon in a phone interview.
Public health experts are concerned that — with 281 dairy herds affected in 14 states and counting — cases are falling through cracks in surveillance systems and increasing those chances. Many farms have reportedly been hesitant to test animals for economic consequences throughout the outbreak. In California, the country’s largest dairy supplier, it was originally estimated that 10% of cows would be infected, but a newsletter from the California Dairy Quality Assurance Program suggests that number could be far higher at 50 to 60%. In a letter published in the NEJM, H5N1 was detected in the wastewater of 10 out of 10 cities tested.
“We've always known that there's likely more cases that have been missed, particularly among dairy farm workers that never were tested,” said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “The testing among dairy cattle is not very robust, and the amount of proactive action taken by certain states is not enough to give a lot of confidence that this is being handled properly.”
Human cases are likely going under the radar as well, if, for example, infected people are not going through the health care systems where these cases are tracked, said Dr. Meghan Davis, an associate professor at Johns Hopkins Bloomberg School of Public Health.
“These workforces are often marginalized and this is a lot of migrant and immigrant workers who may lack trust with authorities or not have great access to healthcare and may need extra support beyond what we might be able to do in other workplace settings,” Davis told Salon in a phone interview.
The CDC is currently testing whether exposed individuals in Missouri have traces of H5 antibodies in their blood to retroactively determine if they were infected. However, the process to create a test that could specifically detect the virus that was genetically identical to the infected patient's is complex and involves reverse genetics, taking the CDC about three weeks, Daskalakis said at the briefing.
"We realize people, including all of us at CDC, are anxious to see results from this testing," he said.
Although many believe the chances are low that there was human-to-human transmission in Missouri at this point in part due to the nature of the index patient’s condition and the symptoms of those exposed, it can’t be ruled out until the final results are made public. There is a lot riding on the findings.
“If this virus gains the ability to spread between people, we would be in a new pandemic,” Nuzzo said.
A third farmworker has tested positive for bird flu in California, according to the state’s health department. If confirmed by the US Centers for Disease Control and Prevention, this would be the 17th human case of H5N1 flu in the US since March, when the virus was first detected in cows.
It comes as farmers and veterinarians in California are warning that the infection seems to be striking herds more severely than it has in other states, leading to higher percentages of sick and dead cows in affected herds.
There are no signs of more serious illness in people. Like the first two human cases in California, this third case involves a farmworker who was in contact with sick dairy cattle. Investigators don’t see any connections between the most recent case and either of the first two, suggesting that this is another instance of animal-to-human transmission, the California Department of Public Health said in a news release. In all three cases, symptoms were mild and involved red, bloodshot eyes, a sign of conjunctivitis.
The CDC’s principal deputy director, Dr. Nirav Shah, said Friday that these cases were not a surprise.
“Additional cases may continue to be found as additional herds continue to test positive,” Shah said.
While public health officials are taking the infections in stride, outside experts say each new human infection is a sign that the outbreak is not under control and that the people who are working with cattle and other sick animals are not being adequately protected.
“These reports only increase my worries that this virus, if left unchecked will cause severe harms to human health,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University.
“Many people have been far too dismissive of the threat posed by H5N1 on farms, wrongly assured by a handful of cases that have been mild. But epidemiologists know that the more people who become infected, the more likely we will see severe outcomes,” Nuzzo wrote in an email.
“I have seen little that abates my worry that this virus will eventually cause hospitalizations or deaths,” she added
Dozens of California herds affected
Since late August, more than 80 herds in California have been affected by bird flu, according to the latest update from US Department of Agriculture. California is the nation’s largest milk producer.
The California Department of Food and Agriculture has been conducting bulk milk tank sampling in areas where herds test positive.
As in Colorado, where bulk milk tank testing was mandated by the state, the testing has helped quickly identify more affected herds, said Dr. Eric Deeble, acting senior adviser for the USDA’s H5N1 response.
Deeble said the USDA has sent a strike team to help California track the outbreak as it expands, and the state is looking for ways to expand its milk testing beyond the areas with known infections.
Even as investigators are ramping up their efforts to follow the spread of the virus in California, farmers there are warning that the H5N1 infection in their herds is more severe than previously reported.
In other states, about 10% of cows in an affected herd have shown symptoms, resulting in the death of less than 2% of the animals, according to the American Veterinary Medical Association.
In contrast, dairy farms in California are reporting that the virus is infecting 50% to 60% of their herds, and 10% to 15% of the cows are dying from their infections, according to the California Dairy Quality Assurance Program. The higher infection and fatality rates in California were first reported by the Los Angeles Times.
The increase in severity of cases has raised questions for scientists who are wondering whether environmental factors, such as heat, may be playing a role or if maybe the virus is changing as it adapts to cows and is causing more severe infections.
Scientists would better be able to tell if genetic changes to the virus might be playing a role, they say, if state and federal officials would publicly share more information about the genetics of the viruses they’re finding and do it more quickly.
The first infected herds in California were found in late August. On Monday, the CDC shared the gene sequences of viruses isolated from the first two farm workers in the state to test positive to a widely used data sharing site called GISAID.
In the same database, there are also what seem to be recently shared sequences from dairy cattle in the United States, shared by the USDA’s Animal and Plant Health Inspection Service, but these sequences are missing vital information needed to place them in the context of the larger outbreak, including what state they came from and the date they were collected.
The USDA says it continues to follow the same process it has throughout the outbreak, uploading raw sequences on Fridays, as they become available and often within two weeks of the sample’s collection. The agency adds more information about the sample, including the state where it was collected and the collection date, after the epidemiological investigation has been completed, about six weeks later.
Other countries, including some in Africa, operating with basic equipment and minimal resources, share the sequences of viruses within days and usually with more information than is being provided by the USDA, a spokesperson for GISAID told CNN.
Without this information, it’s difficult for scientists to be able to follow the evolution of the virus and understand whether it is changing to become a more serious threat.
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It comes as farmers and veterinarians in California are warning that the infection seems to be striking herds more severely than it has in other states, leading to higher percentages of sick and dead cows in affected herds.
There are no signs of more serious illness in people. Like the first two human cases in California, this third case involves a farmworker who was in contact with sick dairy cattle. Investigators don’t see any connections between the most recent case and either of the first two, suggesting that this is another instance of animal-to-human transmission, the California Department of Public Health said in a news release. In all three cases, symptoms were mild and involved red, bloodshot eyes, a sign of conjunctivitis.
The CDC’s principal deputy director, Dr. Nirav Shah, said Friday that these cases were not a surprise.
“Additional cases may continue to be found as additional herds continue to test positive,” Shah said.
While public health officials are taking the infections in stride, outside experts say each new human infection is a sign that the outbreak is not under control and that the people who are working with cattle and other sick animals are not being adequately protected.
“These reports only increase my worries that this virus, if left unchecked will cause severe harms to human health,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University.
“Many people have been far too dismissive of the threat posed by H5N1 on farms, wrongly assured by a handful of cases that have been mild. But epidemiologists know that the more people who become infected, the more likely we will see severe outcomes,” Nuzzo wrote in an email.
“I have seen little that abates my worry that this virus will eventually cause hospitalizations or deaths,” she added
Dozens of California herds affected
Since late August, more than 80 herds in California have been affected by bird flu, according to the latest update from US Department of Agriculture. California is the nation’s largest milk producer.
The California Department of Food and Agriculture has been conducting bulk milk tank sampling in areas where herds test positive.
As in Colorado, where bulk milk tank testing was mandated by the state, the testing has helped quickly identify more affected herds, said Dr. Eric Deeble, acting senior adviser for the USDA’s H5N1 response.
Deeble said the USDA has sent a strike team to help California track the outbreak as it expands, and the state is looking for ways to expand its milk testing beyond the areas with known infections.
Even as investigators are ramping up their efforts to follow the spread of the virus in California, farmers there are warning that the H5N1 infection in their herds is more severe than previously reported.
In other states, about 10% of cows in an affected herd have shown symptoms, resulting in the death of less than 2% of the animals, according to the American Veterinary Medical Association.
In contrast, dairy farms in California are reporting that the virus is infecting 50% to 60% of their herds, and 10% to 15% of the cows are dying from their infections, according to the California Dairy Quality Assurance Program. The higher infection and fatality rates in California were first reported by the Los Angeles Times.
The increase in severity of cases has raised questions for scientists who are wondering whether environmental factors, such as heat, may be playing a role or if maybe the virus is changing as it adapts to cows and is causing more severe infections.
Scientists would better be able to tell if genetic changes to the virus might be playing a role, they say, if state and federal officials would publicly share more information about the genetics of the viruses they’re finding and do it more quickly.
The first infected herds in California were found in late August. On Monday, the CDC shared the gene sequences of viruses isolated from the first two farm workers in the state to test positive to a widely used data sharing site called GISAID.
In the same database, there are also what seem to be recently shared sequences from dairy cattle in the United States, shared by the USDA’s Animal and Plant Health Inspection Service, but these sequences are missing vital information needed to place them in the context of the larger outbreak, including what state they came from and the date they were collected.
The USDA says it continues to follow the same process it has throughout the outbreak, uploading raw sequences on Fridays, as they become available and often within two weeks of the sample’s collection. The agency adds more information about the sample, including the state where it was collected and the collection date, after the epidemiological investigation has been completed, about six weeks later.
Other countries, including some in Africa, operating with basic equipment and minimal resources, share the sequences of viruses within days and usually with more information than is being provided by the USDA, a spokesperson for GISAID told CNN.
Without this information, it’s difficult for scientists to be able to follow the evolution of the virus and understand whether it is changing to become a more serious threat.
Governing
To Fight Bird Flu, Lock Down the Cows
The bird flu may be entering a dangerous new phase. The risk that any given person will be sickened or die remains low, but the risk of this virus mutating into the next human pandemic is high enough to warrant action. That starts with much more aggressive measures to test and contain infected dairy herds.
“If we really don't want this to come into people, we need to do something about the cows,” says Seema Lakdawala, an immunologist at the Emory University School of Medicine. And she’s right.
Every time the virus reaches new host — bovine or human — it makes billions of new copies of itself and increases its odds of hitting on the combination of mutations it needs to start the next human pandemic.
Ever since the virus known as H5N1 was identified in dairy cows in March, it’s continued to spread around the country, turning up in 200 herds over at least 14 states. In Texas, a study of wastewater in September found the virus in 10 out of 10 samples. Scientists can’t be sure whether those signals are coming from animals or from people.
So far, only 14 people in the U.S. have tested positive for H5N1, but there’s very little testing taking place. A hospitalized patient in Missouri tested positive in September despite no known contact with birds or cows. A household contact of that person also tested positive. Two health care workers who were in contact with the hospitalized person reported flulike symptoms. (The workers recovered before they could be tested.)
H5N1 has been killing domestic chickens and wild birds and threatening people since the 1990s. The current outbreak dates to late 2022 or early 2023, when it started killing mammal species around the world, including seals, sea lions, grizzly bears, foxes, cats, mice and mink.
In previous human outbreaks, H5N1 had a staggering 50 percent fatality rate. This latest variant appears to be milder, but as we saw with COVID, even a disease that’s less than 1 percent fatal can be devastating if it circulates widely.
Big gaps remain in scientists’ knowledge. They still don’t know if infected cows become immune or can get re-infected. They don’t know if some infections might be asymptomatic. They don’t know how long diseased cows can spread the virus.
We urgently need answers to those questions. That starts with a more aggressive posture from the U.S. Department of Agriculture, the Centers for Disease Control and Prevention, and state public health departments.
Most of the surveillance is currently being done through testing of pooled milk, said Lakdawala. While some infected cows show symptoms, others might be spreading the disease silently. Farmers whose pooled milk tests positive need the tools to follow up by testing each individual cow, enabling them to isolate the infected ones and stop further spread.
Lakdawala said dairy farms often use machines to milk cows and these aren’t always sanitized. Research that her group has done showed that the virus persists for long periods of time on milking equipment. She says contaminated equipment is likely one of the primary routes of spread among cows.
She’s also worried about the contaminated milk that farmers have been sending down the drain. “We have reports that these cows can have as much as 100 million infectious virus particles in one little milliliter of milk,” she said. And dairy farmers are pouring away gallons. The infectious milk goes to manure lagoons, she said, where solids are separated out and liquids can go into irrigation fields. In some cases, they’re finding dead cats on these fields. (Cats are known to be susceptible to H5N1).
It’s possible to kill the virus by treating the milk with high heat, but farmers don’t always have the means to do that, she said, so her lab is working on less expensive ways to sanitize infectious milk before it’s discarded.
And cows are still being moved across the U.S., sometimes without sufficient testing, she says. “We need to have a temporary ‘stay at farm’ order where cattle are just not moved while we figure out which cattle are infected,” she said.
More testing in humans would also help monitor the situation, said epidemiologist Jennifer Nuzzo, director of the pandemic center at Brown University. “We’re not getting ahead of the problem.”
“The fact that farm workers continue to be infected in the course of their jobs means that this is a serious public health situation,” she said. “I don't think we should wait for a farm worker to die before we get concerned about protecting them.”
The risk of a more dangerous variant emerging will rise with the start of the fall flu season. Different influenza viruses can infect the same person and exchange genetic material. Something new could emerge with the ability to spread easily from human to human — “our worst-case scenario,” she said.
If this virus were spreading in dairy farms in China rather than the U.S., she said, we’d be demanding more testing, more transparency about the extent of the disease, and the details of those mysterious cases in Missouri. “I've gotten assurances from CDC and local health that they've done contact tracing [but] there's no data about it,” Nuzzo said. If we want other countries to be transparent with us, “we need to be transparent.”
Right now, scientists can’t put a number on the odds this virus will cause the next pandemic. But the risk goes up the longer the virus circulates in domestic animals. It’s time to lock down the cows.
©2024 Bloomberg L.P. Distributed by Tribune Content Agency, LLC. F.D. Flam is a Bloomberg Opinion columnist covering science. She is host of the “Follow the Science” podcast.
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“If we really don't want this to come into people, we need to do something about the cows,” says Seema Lakdawala, an immunologist at the Emory University School of Medicine. And she’s right.
Every time the virus reaches new host — bovine or human — it makes billions of new copies of itself and increases its odds of hitting on the combination of mutations it needs to start the next human pandemic.
Ever since the virus known as H5N1 was identified in dairy cows in March, it’s continued to spread around the country, turning up in 200 herds over at least 14 states. In Texas, a study of wastewater in September found the virus in 10 out of 10 samples. Scientists can’t be sure whether those signals are coming from animals or from people.
So far, only 14 people in the U.S. have tested positive for H5N1, but there’s very little testing taking place. A hospitalized patient in Missouri tested positive in September despite no known contact with birds or cows. A household contact of that person also tested positive. Two health care workers who were in contact with the hospitalized person reported flulike symptoms. (The workers recovered before they could be tested.)
H5N1 has been killing domestic chickens and wild birds and threatening people since the 1990s. The current outbreak dates to late 2022 or early 2023, when it started killing mammal species around the world, including seals, sea lions, grizzly bears, foxes, cats, mice and mink.
In previous human outbreaks, H5N1 had a staggering 50 percent fatality rate. This latest variant appears to be milder, but as we saw with COVID, even a disease that’s less than 1 percent fatal can be devastating if it circulates widely.
Big gaps remain in scientists’ knowledge. They still don’t know if infected cows become immune or can get re-infected. They don’t know if some infections might be asymptomatic. They don’t know how long diseased cows can spread the virus.
We urgently need answers to those questions. That starts with a more aggressive posture from the U.S. Department of Agriculture, the Centers for Disease Control and Prevention, and state public health departments.
Most of the surveillance is currently being done through testing of pooled milk, said Lakdawala. While some infected cows show symptoms, others might be spreading the disease silently. Farmers whose pooled milk tests positive need the tools to follow up by testing each individual cow, enabling them to isolate the infected ones and stop further spread.
Lakdawala said dairy farms often use machines to milk cows and these aren’t always sanitized. Research that her group has done showed that the virus persists for long periods of time on milking equipment. She says contaminated equipment is likely one of the primary routes of spread among cows.
She’s also worried about the contaminated milk that farmers have been sending down the drain. “We have reports that these cows can have as much as 100 million infectious virus particles in one little milliliter of milk,” she said. And dairy farmers are pouring away gallons. The infectious milk goes to manure lagoons, she said, where solids are separated out and liquids can go into irrigation fields. In some cases, they’re finding dead cats on these fields. (Cats are known to be susceptible to H5N1).
It’s possible to kill the virus by treating the milk with high heat, but farmers don’t always have the means to do that, she said, so her lab is working on less expensive ways to sanitize infectious milk before it’s discarded.
And cows are still being moved across the U.S., sometimes without sufficient testing, she says. “We need to have a temporary ‘stay at farm’ order where cattle are just not moved while we figure out which cattle are infected,” she said.
More testing in humans would also help monitor the situation, said epidemiologist Jennifer Nuzzo, director of the pandemic center at Brown University. “We’re not getting ahead of the problem.”
“The fact that farm workers continue to be infected in the course of their jobs means that this is a serious public health situation,” she said. “I don't think we should wait for a farm worker to die before we get concerned about protecting them.”
The risk of a more dangerous variant emerging will rise with the start of the fall flu season. Different influenza viruses can infect the same person and exchange genetic material. Something new could emerge with the ability to spread easily from human to human — “our worst-case scenario,” she said.
If this virus were spreading in dairy farms in China rather than the U.S., she said, we’d be demanding more testing, more transparency about the extent of the disease, and the details of those mysterious cases in Missouri. “I've gotten assurances from CDC and local health that they've done contact tracing [but] there's no data about it,” Nuzzo said. If we want other countries to be transparent with us, “we need to be transparent.”
Right now, scientists can’t put a number on the odds this virus will cause the next pandemic. But the risk goes up the longer the virus circulates in domestic animals. It’s time to lock down the cows.
©2024 Bloomberg L.P. Distributed by Tribune Content Agency, LLC. F.D. Flam is a Bloomberg Opinion columnist covering science. She is host of the “Follow the Science” podcast.
The Washington Post
Why fears of human-to-human bird flu spread in Missouri are overblown
The case of a Missouri hospital patient who tested positive for bird flu five weeks ago has confounded disease detectives and frustrated public health experts.
The patient reported no exposure to animals that carry the virus — the first known U.S. case of a person who contracted the avian influenza strain known as H5N1 without working on a farm. The virus was discovered in dairy cows in the United States this spring, raising concerns about eventual human-to-human spread and another pandemic.
A member of the patient’s household had also fallen ill the same day with gastrointestinal symptoms. And six health-care workers reported mild respiratory symptoms such as coughing and sore throats after being exposed to the patient.
But public health officials stress there is no evidence so far of a bird flu cluster or that the virus is spreading easily among humans.
Missouri’s state epidemiologist said in an interview that additional testing is being conducted to confirm whether the patient, who has recovered, had bird flu. The patient did not develop the usual symptoms associated with bird flu or have exposure to known sources of the virus. The illnesses experienced by the patient’s contacts, he said, could have been caused by common pathogens such as the coronavirus.
Blood samples that could hold the key to the mystery arrived at the Centers for Disease Control and Prevention’s Atlanta headquarters this week. Investigators will search for antibodies in blood to learn whether the patient and the people who were exposed had H5N1 infections.
Results are not expected until mid-October, federal health officials said, because scientists need time to grow a sample of the virus.
Demetre C. Daskalakis, a top CDC official involved in the response, characterized the likelihood of bird flu transmission in the Missouri investigation as “extremely low” and said testing is being done out of an abundance of caution.
“This is not a cluster,” said Daskalakis, director of the National Center for Immunization and Respiratory Diseases.
Some public health experts say that there should be more transparency and urgency in investigating the illnesses and that the saga reveals gaps in the nation’s public health defenses.
The health officials at the vanguard of the investigation counter that the Missouri case shows a system that is working.
“Everyone needs to be patient,” said Missouri state epidemiologist George Turabelidze, who is leading the investigation. He offered new details about the case in the health department’s first extensive interview. “Sometimes people jump to judgment without having enough information or enough patience. And we should know everything soon enough.”
The patient
The infected patient’s case bore none of the hallmarks of influenza — let alone bird flu.
The Missouri patient was hospitalized on Aug. 22 with primarily gastrointestinal symptoms rather than respiratory problems. The patient normally coughs often because of an underlying lung condition, Turabelidze said, but the coughing had not worsened. While H5N1 can cause gastrointestinal issues, the patient had no fever or conjunctivitis — often the telltale signs of bird flu.
But respiratory testing, common for hospital patients, showed an influenza infection. The sample went to a state lab for routine surveillance of flu cases, where sequencing on Aug. 30 revealed the infection was caused by H5N1. A CDC lab confirmed the results on Sept. 5. It was the 14th confirmed human bird-flu case in the United States this year.
There was barely enough virus in the sample to meet the threshold for a positive result on the highly sensitive PCR test given to the patient, according to the CDC and state health officials. Hospital workers did not test the patient’s diarrhea, which could have identified another condition causing the gastrointestinal symptoms. This, combined with the absence of classic bird flu symptoms or exposures, fostered doubts among some health officials.
“This makes you think, are we dealing here with a real case?” Turabelidze said.
He wondered if contamination was to blame. The sample was stored and transported properly, he said. Perhaps the patient was exposed to the virus in a way that let it linger near their nose, where a test could pick it up even if they weren’t actually sick? That can happen, Turabelidze said, if the patient had touched droppings from an infected bird or consumed unpasteurized dairy products.
But the patient did not report drinking raw milk and mostly spends time at home because of their chronic medical condition and age, he said. The patient does not work, travel or use public transportation. Turabelidze would not disclose the patient’s age, gender or location for privacy reasons.
This withholding of information has frustrated some public health experts, who noted that health officials provided much more detail in earlier bird flu cases. Experts also want to see a more detailed timeline of when people were exposed, developed symptoms and were tested.
Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health, said such information is crucial to gauge how effectively health officials are responding — with urgent stakes.
“What this virus to date has not been great at is infecting humans and being transmitted between people. It’s usually very close contacts like health-care workers with extraordinary exposure or household contacts,” Nuzzo said. “If it gained ability to go beyond that, we are in a new pandemic.”
After three intensive interviews with the patient, health officials still have no idea how the person would have become infected.
But their investigation did turn up other people who got sick.
The contacts
A person who lived in the patient’s household also developed similar gastrointestinal symptoms on the same day, Aug. 20, but also did not experience fever, conjunctivitis or flu-like symptoms. This person was not hospitalized or tested for influenza.
The emergence of symptoms simultaneously in the two people suggests a common exposure rather than one person infecting the other.
Within hours of receiving the patient’s positive test result for H5N1 on Aug. 30, health officials alerted the hospital (which they did not name) to start tracking down workers who might have been exposed.
Of the 18 workers considered at heightened risk for exposure, three said they experienced mild respiratory symptoms after encountering the patient. One had tested negative for influenza when they were sick; the other two did not test.
At the CDC’s direction, investigators cast a wider net to 94 hospital workers with lower levels of exposure. Another three reported mild respiratory symptoms but were not tested.
Of the five hospital contacts who reported symptoms but had not been tested, one reported a low-grade fever. None reported conjunctivitis.
It was too late to conduct PCR tests for influenza, which should be conducted within 10 days of symptoms emerging. Officials had to wait at least three weeks after symptoms started to draw blood to detect antibodies.
On its face, it seems troubling that people got sick after exposure to someone with bird flu. But disease detectives aren’t particularly alarmed. Coughs and sore throats are common, and wastewater tracking showed coronavirus and other respiratory pathogens circulating at the time. The Missouri school year also started in late August, which usually coincides with a jolt in respiratory illness.
Turabelidze, the state epidemiologist, said the risk of contracting bird flu after being exposed to the virus is low. In the past two years, the state monitored more than 200 people exposed to poultry flocks infected with H5N1. Just four reported symptoms and none tested positive for bird flu, he said.
“There are infectious agents that never transmit from person to person,” Turabelidze said, “and there are infections that transmit like a wildfire like measles or covid.”
The episode does not seem to have sparked concern among health care workers so far, but that may be due to the lack of available information, said Lenny Jones, director of the Missouri section of Service Employees International Union Healthcare, one of the largest health-care unions in the Midwest.
“First and foremost, there needs to be transparent sharing from the CDC on exactly what’s taking place,” Jones said. “The sooner that we can be part of those conversations to know how we can help spread the message to our members, the better.”
Looking ahead
For now, those monitoring the outbreak await the outcome of the CDC’s antibody tests.
Serology screening generally involves exposing blood to a virus to see whether antibodies bind to the virus, a sign that the body recognizes the virus from past infections. But changes in the virus’s structure could prevent the Missouri patient’s antibodies from binding to the virus used in the CDC’s typical H5N1 test. So scientists have to grow new virus to match the one that infected the patient to avoid a false negative test result.
Even if the serological testing does reveal signs of an earlier bird flu case, the results won’t explain when and how the patient — and the people exposed — were infected, officials said. The hospital where the patient was hospitalized is in an agricultural area, according to the state epidemiologist, opening up the possibility that the health care workers could have had other exposures.
It’s possible the patient’s antibody test could be negative, despite previously testing positive for H5N1, due to a low viral load.
“The unsatisfying piece is that we are never going to know from the patient history or from the virus or from the serology how that virus got into that test,” Daskalakis said.
Experts take comfort knowing there is no evidence of a broader outbreak or unusual influenza activity in Missouri.
“If this H5N1 had suddenly developed the ability to be as contagious as measles or chickenpox, we’d already know that by now,” said Steven Lawrence, professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis. “There would be already hundreds of cases that would be evident.”
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The patient reported no exposure to animals that carry the virus — the first known U.S. case of a person who contracted the avian influenza strain known as H5N1 without working on a farm. The virus was discovered in dairy cows in the United States this spring, raising concerns about eventual human-to-human spread and another pandemic.
A member of the patient’s household had also fallen ill the same day with gastrointestinal symptoms. And six health-care workers reported mild respiratory symptoms such as coughing and sore throats after being exposed to the patient.
But public health officials stress there is no evidence so far of a bird flu cluster or that the virus is spreading easily among humans.
Missouri’s state epidemiologist said in an interview that additional testing is being conducted to confirm whether the patient, who has recovered, had bird flu. The patient did not develop the usual symptoms associated with bird flu or have exposure to known sources of the virus. The illnesses experienced by the patient’s contacts, he said, could have been caused by common pathogens such as the coronavirus.
Blood samples that could hold the key to the mystery arrived at the Centers for Disease Control and Prevention’s Atlanta headquarters this week. Investigators will search for antibodies in blood to learn whether the patient and the people who were exposed had H5N1 infections.
Results are not expected until mid-October, federal health officials said, because scientists need time to grow a sample of the virus.
Demetre C. Daskalakis, a top CDC official involved in the response, characterized the likelihood of bird flu transmission in the Missouri investigation as “extremely low” and said testing is being done out of an abundance of caution.
“This is not a cluster,” said Daskalakis, director of the National Center for Immunization and Respiratory Diseases.
Some public health experts say that there should be more transparency and urgency in investigating the illnesses and that the saga reveals gaps in the nation’s public health defenses.
The health officials at the vanguard of the investigation counter that the Missouri case shows a system that is working.
“Everyone needs to be patient,” said Missouri state epidemiologist George Turabelidze, who is leading the investigation. He offered new details about the case in the health department’s first extensive interview. “Sometimes people jump to judgment without having enough information or enough patience. And we should know everything soon enough.”
The patient
The infected patient’s case bore none of the hallmarks of influenza — let alone bird flu.
The Missouri patient was hospitalized on Aug. 22 with primarily gastrointestinal symptoms rather than respiratory problems. The patient normally coughs often because of an underlying lung condition, Turabelidze said, but the coughing had not worsened. While H5N1 can cause gastrointestinal issues, the patient had no fever or conjunctivitis — often the telltale signs of bird flu.
But respiratory testing, common for hospital patients, showed an influenza infection. The sample went to a state lab for routine surveillance of flu cases, where sequencing on Aug. 30 revealed the infection was caused by H5N1. A CDC lab confirmed the results on Sept. 5. It was the 14th confirmed human bird-flu case in the United States this year.
There was barely enough virus in the sample to meet the threshold for a positive result on the highly sensitive PCR test given to the patient, according to the CDC and state health officials. Hospital workers did not test the patient’s diarrhea, which could have identified another condition causing the gastrointestinal symptoms. This, combined with the absence of classic bird flu symptoms or exposures, fostered doubts among some health officials.
“This makes you think, are we dealing here with a real case?” Turabelidze said.
He wondered if contamination was to blame. The sample was stored and transported properly, he said. Perhaps the patient was exposed to the virus in a way that let it linger near their nose, where a test could pick it up even if they weren’t actually sick? That can happen, Turabelidze said, if the patient had touched droppings from an infected bird or consumed unpasteurized dairy products.
But the patient did not report drinking raw milk and mostly spends time at home because of their chronic medical condition and age, he said. The patient does not work, travel or use public transportation. Turabelidze would not disclose the patient’s age, gender or location for privacy reasons.
This withholding of information has frustrated some public health experts, who noted that health officials provided much more detail in earlier bird flu cases. Experts also want to see a more detailed timeline of when people were exposed, developed symptoms and were tested.
Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health, said such information is crucial to gauge how effectively health officials are responding — with urgent stakes.
“What this virus to date has not been great at is infecting humans and being transmitted between people. It’s usually very close contacts like health-care workers with extraordinary exposure or household contacts,” Nuzzo said. “If it gained ability to go beyond that, we are in a new pandemic.”
After three intensive interviews with the patient, health officials still have no idea how the person would have become infected.
But their investigation did turn up other people who got sick.
The contacts
A person who lived in the patient’s household also developed similar gastrointestinal symptoms on the same day, Aug. 20, but also did not experience fever, conjunctivitis or flu-like symptoms. This person was not hospitalized or tested for influenza.
The emergence of symptoms simultaneously in the two people suggests a common exposure rather than one person infecting the other.
Within hours of receiving the patient’s positive test result for H5N1 on Aug. 30, health officials alerted the hospital (which they did not name) to start tracking down workers who might have been exposed.
Of the 18 workers considered at heightened risk for exposure, three said they experienced mild respiratory symptoms after encountering the patient. One had tested negative for influenza when they were sick; the other two did not test.
At the CDC’s direction, investigators cast a wider net to 94 hospital workers with lower levels of exposure. Another three reported mild respiratory symptoms but were not tested.
Of the five hospital contacts who reported symptoms but had not been tested, one reported a low-grade fever. None reported conjunctivitis.
It was too late to conduct PCR tests for influenza, which should be conducted within 10 days of symptoms emerging. Officials had to wait at least three weeks after symptoms started to draw blood to detect antibodies.
On its face, it seems troubling that people got sick after exposure to someone with bird flu. But disease detectives aren’t particularly alarmed. Coughs and sore throats are common, and wastewater tracking showed coronavirus and other respiratory pathogens circulating at the time. The Missouri school year also started in late August, which usually coincides with a jolt in respiratory illness.
Turabelidze, the state epidemiologist, said the risk of contracting bird flu after being exposed to the virus is low. In the past two years, the state monitored more than 200 people exposed to poultry flocks infected with H5N1. Just four reported symptoms and none tested positive for bird flu, he said.
“There are infectious agents that never transmit from person to person,” Turabelidze said, “and there are infections that transmit like a wildfire like measles or covid.”
The episode does not seem to have sparked concern among health care workers so far, but that may be due to the lack of available information, said Lenny Jones, director of the Missouri section of Service Employees International Union Healthcare, one of the largest health-care unions in the Midwest.
“First and foremost, there needs to be transparent sharing from the CDC on exactly what’s taking place,” Jones said. “The sooner that we can be part of those conversations to know how we can help spread the message to our members, the better.”
Looking ahead
For now, those monitoring the outbreak await the outcome of the CDC’s antibody tests.
Serology screening generally involves exposing blood to a virus to see whether antibodies bind to the virus, a sign that the body recognizes the virus from past infections. But changes in the virus’s structure could prevent the Missouri patient’s antibodies from binding to the virus used in the CDC’s typical H5N1 test. So scientists have to grow new virus to match the one that infected the patient to avoid a false negative test result.
Even if the serological testing does reveal signs of an earlier bird flu case, the results won’t explain when and how the patient — and the people exposed — were infected, officials said. The hospital where the patient was hospitalized is in an agricultural area, according to the state epidemiologist, opening up the possibility that the health care workers could have had other exposures.
It’s possible the patient’s antibody test could be negative, despite previously testing positive for H5N1, due to a low viral load.
“The unsatisfying piece is that we are never going to know from the patient history or from the virus or from the serology how that virus got into that test,” Daskalakis said.
Experts take comfort knowing there is no evidence of a broader outbreak or unusual influenza activity in Missouri.
“If this H5N1 had suddenly developed the ability to be as contagious as measles or chickenpox, we’d already know that by now,” said Steven Lawrence, professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis. “There would be already hundreds of cases that would be evident.”
It is a deadly disease linked to high temperatures, airborne dust, and overcrowded living conditions – some of the very conditions that climate change threatens to exacerbate . It caused an estimated 250,000 deaths in 2019, ranks among the top killers of young children, and can leave survivors with brain damage and hearing loss.
This disease is bacterial meningococcal meningitis, and it can appear anywhere at any time. But it disproportionately affects the Meningitis Belt, which stretches across 26 countries in Africa and is home to hundreds of millions of people. Each year, this region experiences hot and dusty conditions that can enable meningitis to spread, and every 5-12 years, has devastating epidemics causing massive disease.
The good news? Meningitis can be defeated. In fact, the world managed to effectively eliminate the most common cause in the Meningitis Belt: meningitis A, where not a single case of that strain has been reported since 2017.
As we mark World Meningitis Day on October 5, we should work to build on this remarkable success by following a World Health Organization (WHO) road map that lays out what needs to be done to eliminate meningitis as a public health threat by 2030. But achieving this requires us to act together and decide to dedicate resources to preventing new cases and outbreaks, including deploying the most state-of-the-art vaccines, investing in diagnosis, treatment, and surveillance, and doing all we can to support people who survive meningitis. Doing so by 2030 would prevent nearly a million deaths and 800,000 people from living with the devastating consequences of infection.
First, prevention. Vaccines are available to prevent bacterial meningitis, and it was the widespread deployment of MenAfriVac®, a vaccine developed by the Meningitis Vaccine Project (MVP), a partnership between WHO, Serum Institute of India, and PATH, that helped effectively eliminate meningitis A in the Meningitis Belt.
Other strains of meningitis are rising, and may be moving into the ecological niche that meningitis A used to fill, but new tools are available. The MenFive® vaccine protects against a broader range of five strains including meningitis A. It has received WHO prequalification and has been recommended for use in the Meningitis Belt by the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, which encouraged countries to switch to the newer vaccine.
Nigeria is leading the way with support from Gavi, the Vaccine Alliance, becoming the first country to launch a vaccination campaign with MenFive® in response to an epidemic and is now considering introducing it routinely to prevent cases and epidemics. More countries should follow suit and build on Nigeria’s leadership by integrating the vaccine into their routine immunization programmes to ensure long-term protection against meningitis. Effectively eliminating meningococcal meningitis, A involved vaccination efforts across 24 countries in the Meningitis Belt. A similarly comprehensive campaign to roll out a vaccine that provides broader coverage against growing strains is needed to help save more lives.
Prevention is an important step, but not the final one. Rapid diagnosis and treatment with antibiotics are key for a disease that can kill within 24 hours. Diagnostics are available but have their limitations, especially in the resource-limited environments found in many Meningitis Belt countries, where health workers may not have access to the necessary training or tools. More affordable, simpler, and rapid point of care tests are needed to help save as many lives as possible.
Beyond diagnosis, bacterial meningitis can be treated with antibiotics, but certain medicines may not always be available or appropriate depending on the nature of the infection. Updated treatment guidelines are needed, especially given the growing global threat of antimicrobial resistance.
In addition, improved surveillance is needed to address a persistent lack of information. Without detection, outbreak response efforts, including mass vaccination campaigns, may be delayed, and it is difficult to understand how different strains of the disease are evolving.
Finally, we must help care for survivors, one of every five of whom lives with severe issues like brain damage, and hearing and vision loss. Rehabilitative care can be prohibitively expensive or simply not available at all. Health workers need to be trained and equipped to help survivors navigate their lives.
There is much to be done to eliminate meningitis by 2030. But thankfully, we know it is possible. The effective elimination of meningitis A in the meningitis belt shows that it can be done, and the WHO road map points the way. The science and the know-how exist, but we still must dedicate the will and resources. Lives depend on it.
Seth Berkley, MD, is an Adjunct Professor at the Pandemic Center, Brown University School of Public Health and an advisor to numerous technology and vaccine companies including the Serum Institute of India. He served as CEO of Gavi, the Vaccine Alliance from 2011-2023.
Samba O. Sow, MD, MSc, FASTMH, is the Directeur Général CVD-Mali. He served as Minister of Health and Public Hygiene for Mali from 2017-2019.
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This disease is bacterial meningococcal meningitis, and it can appear anywhere at any time. But it disproportionately affects the Meningitis Belt, which stretches across 26 countries in Africa and is home to hundreds of millions of people. Each year, this region experiences hot and dusty conditions that can enable meningitis to spread, and every 5-12 years, has devastating epidemics causing massive disease.
The good news? Meningitis can be defeated. In fact, the world managed to effectively eliminate the most common cause in the Meningitis Belt: meningitis A, where not a single case of that strain has been reported since 2017.
As we mark World Meningitis Day on October 5, we should work to build on this remarkable success by following a World Health Organization (WHO) road map that lays out what needs to be done to eliminate meningitis as a public health threat by 2030. But achieving this requires us to act together and decide to dedicate resources to preventing new cases and outbreaks, including deploying the most state-of-the-art vaccines, investing in diagnosis, treatment, and surveillance, and doing all we can to support people who survive meningitis. Doing so by 2030 would prevent nearly a million deaths and 800,000 people from living with the devastating consequences of infection.
First, prevention. Vaccines are available to prevent bacterial meningitis, and it was the widespread deployment of MenAfriVac®, a vaccine developed by the Meningitis Vaccine Project (MVP), a partnership between WHO, Serum Institute of India, and PATH, that helped effectively eliminate meningitis A in the Meningitis Belt.
Other strains of meningitis are rising, and may be moving into the ecological niche that meningitis A used to fill, but new tools are available. The MenFive® vaccine protects against a broader range of five strains including meningitis A. It has received WHO prequalification and has been recommended for use in the Meningitis Belt by the WHO Strategic Advisory Group of Experts (SAGE) on Immunization, which encouraged countries to switch to the newer vaccine.
Nigeria is leading the way with support from Gavi, the Vaccine Alliance, becoming the first country to launch a vaccination campaign with MenFive® in response to an epidemic and is now considering introducing it routinely to prevent cases and epidemics. More countries should follow suit and build on Nigeria’s leadership by integrating the vaccine into their routine immunization programmes to ensure long-term protection against meningitis. Effectively eliminating meningococcal meningitis, A involved vaccination efforts across 24 countries in the Meningitis Belt. A similarly comprehensive campaign to roll out a vaccine that provides broader coverage against growing strains is needed to help save more lives.
Prevention is an important step, but not the final one. Rapid diagnosis and treatment with antibiotics are key for a disease that can kill within 24 hours. Diagnostics are available but have their limitations, especially in the resource-limited environments found in many Meningitis Belt countries, where health workers may not have access to the necessary training or tools. More affordable, simpler, and rapid point of care tests are needed to help save as many lives as possible.
Beyond diagnosis, bacterial meningitis can be treated with antibiotics, but certain medicines may not always be available or appropriate depending on the nature of the infection. Updated treatment guidelines are needed, especially given the growing global threat of antimicrobial resistance.
In addition, improved surveillance is needed to address a persistent lack of information. Without detection, outbreak response efforts, including mass vaccination campaigns, may be delayed, and it is difficult to understand how different strains of the disease are evolving.
Finally, we must help care for survivors, one of every five of whom lives with severe issues like brain damage, and hearing and vision loss. Rehabilitative care can be prohibitively expensive or simply not available at all. Health workers need to be trained and equipped to help survivors navigate their lives.
There is much to be done to eliminate meningitis by 2030. But thankfully, we know it is possible. The effective elimination of meningitis A in the meningitis belt shows that it can be done, and the WHO road map points the way. The science and the know-how exist, but we still must dedicate the will and resources. Lives depend on it.
Seth Berkley, MD, is an Adjunct Professor at the Pandemic Center, Brown University School of Public Health and an advisor to numerous technology and vaccine companies including the Serum Institute of India. He served as CEO of Gavi, the Vaccine Alliance from 2011-2023.
Samba O. Sow, MD, MSc, FASTMH, is the Directeur Général CVD-Mali. He served as Minister of Health and Public Hygiene for Mali from 2017-2019.
Deccan Herald
Disease outbreaks need hurricane-style warning systems
It’s hurricane season once again, and once again Floridians were warned to evacuate as a deadly storm bore down on the state. Not everyone follows such warnings, but many do. That saves lives. Now, thanks to advances in biotechnology, we can do even better with disease outbreaks — alerting people when and where a threat is growing long before it can become a pandemic.
“Just like we made our buildings more resistant to hurricanes and earthquakes and fires, we have to do that kind of stuff in our society for infectious diseases,” says epidemiologist Jennifer Nuzzo, head of the Pandemic Center at Brown University. “They’re just going to keep coming.”
Hurricane forecasting has gotten better by leaps and bounds, even as climate change is making such storms tougher to predict. Pathogens are also increasing, yet scientists have invented a system for predicting outbreaks of infectious disease: a new way of testing wastewater for emergent signs of known viruses.
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“Just like we made our buildings more resistant to hurricanes and earthquakes and fires, we have to do that kind of stuff in our society for infectious diseases,” says epidemiologist Jennifer Nuzzo, head of the Pandemic Center at Brown University. “They’re just going to keep coming.”
Hurricane forecasting has gotten better by leaps and bounds, even as climate change is making such storms tougher to predict. Pathogens are also increasing, yet scientists have invented a system for predicting outbreaks of infectious disease: a new way of testing wastewater for emergent signs of known viruses.
Reimagining the Future of Talent: A multi-generational dialogue at Spelman College
ATLANTA, Sept. 25, 2024 /PRNewswire/ -- In partnership with Spelman College, Tapestry Networks brought together corporate leaders, faculty, and students for a knowledge exchange on Reimagining the Future of Talent. Held on Spelman's Atlanta campus during National HBCU Week, the dialogue focused on how companies are adapting their talent strategies to shifts in workforce demographics, changing expectations from younger workers, and seismic developments in technology. Corporate executives and board members joined from over 40 organizations, including Accenture, AIG, Boston Scientific, Bristol-Myers Squibb, Cigna, The Coca-Cola Company, Google, Novartis, Salesforce, Warner Brothers, Kohl's, Honeywell, Celsius, LHH, Arthur M Blank Family Foundation, and Assemble.fyi. Leading academic administrators, faculty, and students engaged in the conversation, coming from Spelman College, Morehouse College, Morehouse School of Medicine, Georgetown University, and Brown University.
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ATLANTA, Sept. 25, 2024 /PRNewswire/ -- In partnership with Spelman College, Tapestry Networks brought together corporate leaders, faculty, and students for a knowledge exchange on Reimagining the Future of Talent. Held on Spelman's Atlanta campus during National HBCU Week, the dialogue focused on how companies are adapting their talent strategies to shifts in workforce demographics, changing expectations from younger workers, and seismic developments in technology. Corporate executives and board members joined from over 40 organizations, including Accenture, AIG, Boston Scientific, Bristol-Myers Squibb, Cigna, The Coca-Cola Company, Google, Novartis, Salesforce, Warner Brothers, Kohl's, Honeywell, Celsius, LHH, Arthur M Blank Family Foundation, and Assemble.fyi. Leading academic administrators, faculty, and students engaged in the conversation, coming from Spelman College, Morehouse College, Morehouse School of Medicine, Georgetown University, and Brown University.
Seth Berkley, M.D., Arup Chakraborty, Ph.D., and Ashish Jha, M.D., MPH, join the Board
CAMBRIDGE, Mass., Sept. 24, 2024 /PRNewswire/ -- Apriori Bio, a biotechnology company aimed at providing humanity with variant-resilient protection against rapidly-evolving viruses, announced today the addition of three esteemed leaders to its Board of Directors. The new directors include Seth Berkley, M.D., former CEO of Gavi, the Vaccine Alliance, Arup Chakraborty, Ph.D., Scientific Advisor and Academic Partner at Flagship Pioneering, and Ashish Jha, M.D., MPH, former White House COVID-19 Response Coordinator. They join Board Chair Lovisa Afzelius, Ph.D., General Partner at Flagship Pioneering and Co-Founder and CEO of Apriori, and Travis Wilson, Growth Partner at Flagship Pioneering.
The Board will support Apriori's leadership team and the company as they advance Octavia™, Apriori's biology-informed artificial intelligence platform, for the development of vaccines to protect against current and potential viral threats.
"I am pleased to welcome Seth, Arup and Ashish to Apriori's Board of Directors," said Board Chair Lovisa Afzelius, Ph.D., General Partner at Flagship Pioneering and Co-Founder and CEO of Apriori. "When we launched Apriori, we set out to create a future where we can get ahead of viruses, instead of chasing them as they evolve. The unparalleled wisdom and experience of Seth, Arup and Ashish will be instrumental as we pioneer transformative solutions to better protect the global community against viral threats."
Apriori, a 2023 World Economic Forum Technology Pioneer, recently received a grant from CEPI to further advance Octavia to focus on viruses beyond coronaviruses. The research Apriori conducts on this front will feed into and be supported by CEPI's newly established Biosecurity function.
Seth Berkley, M.D.
Seth, a medical doctor and infectious disease epidemiologist, is an advisor to the Pandemic Center at the Brown University School of Public Health and several biotech, vaccine and technology companies. Previously, Seth was the CEO of Gavi, the Vaccine Alliance. Under his leadership, Gavi accelerated global immunization access in its mission to save lives, reduce poverty and protect the world against the threat of epidemics and pandemics. He also co-founded and led COVID-19 Vaccines Global Access (COVAX), which provided more than two billion COVID-19 vaccine doses to 146 countries, and founded the International AIDS Vaccine Initiative. Seth has worked with the Special Pathogens Branch of the U.S. Centers for Disease Control and Prevention, the Massachusetts Department of Public Health, the Ministry of Health of Uganda and the Rockefeller Foundation. In 2022, he was elected to the National Academy of Medicine and has been recognized by several publications for his contributions to global health, including Newsweek, TIME and WIRED.
Arup Chakraborty, Ph.D.
Arup is a scientific advisor and academic partner at Flagship Pioneering. He is one of a maximum of 12 Institute Professors at MIT, the highest rank awarded to a MIT faculty member. He is also a professor of chemical engineering, physics and chemistry. Arup was the founding director of MIT's Institute for Medical Engineering and Science and is a founding member of the Ragon Institute of MIT, MGH and Harvard. For over two decades, Arup's work has largely focused on bringing together approaches from immunology, physics and engineering. Arup is one of less than 30 individuals who are members of all three branches of the US National Academies – National Academy of Sciences, National Academy of Medicine and National Academy of Engineering.
Ashish Jha, M.D., MPH
Ashish is the former White House COVID-19 Response Coordinator, appointed by President Joe Biden. While serving in this role, he led the work that increased the development of and access to treatments and newly formulated vaccines, dramatically improved testing and surveillance, facilitated major investments in indoor air quality measures and put in place an infrastructure to respond to current and future disease outbreaks more effectively. Before his appointment to the White House, Ashish served as the Dean of the Brown School of Public Health and a Professor of Health, Policy, and Practice. Prior to joining Brown University, Ashish was the Faculty Director of the Harvard Global Health Institute from 2014 until 2020 and served as the Dean for Global Strategy at the Harvard T.H. Chan School of Public Health from 2018 to 2020. He is also a practicing physician with deep expertise in infectious diseases.
About Apriori Bio
Apriori is working to create a world that is protected against viral threats. Our pioneering approach centers on a unique technology platform, Octavia™, which allows us to survey the entire landscape of existing and potential variants to design new vaccines against the most threatening viruses. Octavia can also inform public health policy in real time by predicting the impact of emerging variants. Apriori was founded in 2020 in Flagship Labs, a unit of Flagship Pioneering. For more information visit www.aprioribio.com or follow us on LinkedIn and X at @AprioriBio.
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CAMBRIDGE, Mass., Sept. 24, 2024 /PRNewswire/ -- Apriori Bio, a biotechnology company aimed at providing humanity with variant-resilient protection against rapidly-evolving viruses, announced today the addition of three esteemed leaders to its Board of Directors. The new directors include Seth Berkley, M.D., former CEO of Gavi, the Vaccine Alliance, Arup Chakraborty, Ph.D., Scientific Advisor and Academic Partner at Flagship Pioneering, and Ashish Jha, M.D., MPH, former White House COVID-19 Response Coordinator. They join Board Chair Lovisa Afzelius, Ph.D., General Partner at Flagship Pioneering and Co-Founder and CEO of Apriori, and Travis Wilson, Growth Partner at Flagship Pioneering.
The Board will support Apriori's leadership team and the company as they advance Octavia™, Apriori's biology-informed artificial intelligence platform, for the development of vaccines to protect against current and potential viral threats.
"I am pleased to welcome Seth, Arup and Ashish to Apriori's Board of Directors," said Board Chair Lovisa Afzelius, Ph.D., General Partner at Flagship Pioneering and Co-Founder and CEO of Apriori. "When we launched Apriori, we set out to create a future where we can get ahead of viruses, instead of chasing them as they evolve. The unparalleled wisdom and experience of Seth, Arup and Ashish will be instrumental as we pioneer transformative solutions to better protect the global community against viral threats."
Apriori, a 2023 World Economic Forum Technology Pioneer, recently received a grant from CEPI to further advance Octavia to focus on viruses beyond coronaviruses. The research Apriori conducts on this front will feed into and be supported by CEPI's newly established Biosecurity function.
Seth Berkley, M.D.
Seth, a medical doctor and infectious disease epidemiologist, is an advisor to the Pandemic Center at the Brown University School of Public Health and several biotech, vaccine and technology companies. Previously, Seth was the CEO of Gavi, the Vaccine Alliance. Under his leadership, Gavi accelerated global immunization access in its mission to save lives, reduce poverty and protect the world against the threat of epidemics and pandemics. He also co-founded and led COVID-19 Vaccines Global Access (COVAX), which provided more than two billion COVID-19 vaccine doses to 146 countries, and founded the International AIDS Vaccine Initiative. Seth has worked with the Special Pathogens Branch of the U.S. Centers for Disease Control and Prevention, the Massachusetts Department of Public Health, the Ministry of Health of Uganda and the Rockefeller Foundation. In 2022, he was elected to the National Academy of Medicine and has been recognized by several publications for his contributions to global health, including Newsweek, TIME and WIRED.
Arup Chakraborty, Ph.D.
Arup is a scientific advisor and academic partner at Flagship Pioneering. He is one of a maximum of 12 Institute Professors at MIT, the highest rank awarded to a MIT faculty member. He is also a professor of chemical engineering, physics and chemistry. Arup was the founding director of MIT's Institute for Medical Engineering and Science and is a founding member of the Ragon Institute of MIT, MGH and Harvard. For over two decades, Arup's work has largely focused on bringing together approaches from immunology, physics and engineering. Arup is one of less than 30 individuals who are members of all three branches of the US National Academies – National Academy of Sciences, National Academy of Medicine and National Academy of Engineering.
Ashish Jha, M.D., MPH
Ashish is the former White House COVID-19 Response Coordinator, appointed by President Joe Biden. While serving in this role, he led the work that increased the development of and access to treatments and newly formulated vaccines, dramatically improved testing and surveillance, facilitated major investments in indoor air quality measures and put in place an infrastructure to respond to current and future disease outbreaks more effectively. Before his appointment to the White House, Ashish served as the Dean of the Brown School of Public Health and a Professor of Health, Policy, and Practice. Prior to joining Brown University, Ashish was the Faculty Director of the Harvard Global Health Institute from 2014 until 2020 and served as the Dean for Global Strategy at the Harvard T.H. Chan School of Public Health from 2018 to 2020. He is also a practicing physician with deep expertise in infectious diseases.
About Apriori Bio
Apriori is working to create a world that is protected against viral threats. Our pioneering approach centers on a unique technology platform, Octavia™, which allows us to survey the entire landscape of existing and potential variants to design new vaccines against the most threatening viruses. Octavia can also inform public health policy in real time by predicting the impact of emerging variants. Apriori was founded in 2020 in Flagship Labs, a unit of Flagship Pioneering. For more information visit www.aprioribio.com or follow us on LinkedIn and X at @AprioriBio.
Bulletin of the Atomic Scientists
Strengthening democracy and pandemic preparedness go hand in hand
American democracy and public health effectiveness are inextricable. American health security depends on maximizing the ability to live in a free, pluralistic society able to coherently manage a public health emergency. In turn, the health of US democracy depends on citizens’ faith and trust in institutions—especially government—to protect them in a crisis such as a pandemic. Given disease threats like mpox or H5N1 avian flu, the looming potential for a worst-case biological crisis begs for a well-prepared nation. Unfortunately, the United States, because of or despite the challenges of the COVID pandemic, is now more politically polarized and less prepared to mount a united response to a major health emergency. That is a collective danger that threatens Americans and imperils the world.
Any effective future response to a biological crisis must protect individual freedom, foster responsibility for one another, and address the unique needs and concerns of every community, including the most vulnerable. Yet pandemic response tools like masking, vaccinations, and social distancing have become flashpoints that pit individual freedoms against collective responsibility. And trust in US governmental institutions has consequently eroded. Confidence in the Centers for Disease Control and Prevention (CDC) dropped nearly 30 points—79 percent to 52 percent—from March 2020 to May 2022.
This steep drop in trust comes at a dangerous time.
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Any effective future response to a biological crisis must protect individual freedom, foster responsibility for one another, and address the unique needs and concerns of every community, including the most vulnerable. Yet pandemic response tools like masking, vaccinations, and social distancing have become flashpoints that pit individual freedoms against collective responsibility. And trust in US governmental institutions has consequently eroded. Confidence in the Centers for Disease Control and Prevention (CDC) dropped nearly 30 points—79 percent to 52 percent—from March 2020 to May 2022.
This steep drop in trust comes at a dangerous time.
The ongoing mpox outbreak in Africa is a stark reminder of the persistent threat of infectious diseases. It also highlights a game-changing opportunity to leverage artificial intelligence (AI) and digital health applications in response to not just mpox, but any future infectious disease outbreaks.
AI’s transformative potential, when integrated into digital health tools, can empower individuals and healthcare providers, enabling a more rapid, effective and equitable response to emerging health threats.
The rapid advances in AI over the past few years, particularly since the onset of the Covid-19 pandemic, offer a glimpse into a future where data-driven insights and intelligent tools can empower us to act swiftly and decisively against emerging health threats. AI-powered digital health apps can serve as critical tools in this endeavour.
Imagine two innovative applications: one designed for people to safely self-navigate infectious disease outbreaks and another tailored for community health workers to efficiently provide vaccinations and medical care. Both can revolutionise public health responses and enhance our ability to manage outbreaks proactively.
During an infectious disease outbreak, timely and accurate information is crucial for the public to make informed decisions. An AI-powered app that helps individuals and families self-navigate outbreaks by providing real-time, personalised guidance based on the latest information can radically improve infectious disease response and containment.
The consumer app would deliver easy-to-understand and concise summaries of the pathogen, the most vulnerable cohorts, local exposure risk factors, a person’s risk of death if infected, and the availability of vaccinations and infection treatment.
Such an app offers a single source of truth for informed infectious disease management tailored to each family’s circumstances. The actionable insights are a lens into prevention measures, symptom monitoring and when to seek medical care.
Read Article
AI’s transformative potential, when integrated into digital health tools, can empower individuals and healthcare providers, enabling a more rapid, effective and equitable response to emerging health threats.
The rapid advances in AI over the past few years, particularly since the onset of the Covid-19 pandemic, offer a glimpse into a future where data-driven insights and intelligent tools can empower us to act swiftly and decisively against emerging health threats. AI-powered digital health apps can serve as critical tools in this endeavour.
Imagine two innovative applications: one designed for people to safely self-navigate infectious disease outbreaks and another tailored for community health workers to efficiently provide vaccinations and medical care. Both can revolutionise public health responses and enhance our ability to manage outbreaks proactively.
During an infectious disease outbreak, timely and accurate information is crucial for the public to make informed decisions. An AI-powered app that helps individuals and families self-navigate outbreaks by providing real-time, personalised guidance based on the latest information can radically improve infectious disease response and containment.
The consumer app would deliver easy-to-understand and concise summaries of the pathogen, the most vulnerable cohorts, local exposure risk factors, a person’s risk of death if infected, and the availability of vaccinations and infection treatment.
Such an app offers a single source of truth for informed infectious disease management tailored to each family’s circumstances. The actionable insights are a lens into prevention measures, symptom monitoring and when to seek medical care.
New York Times
Missouri Bird Flu Case Raises Prospect of Human Transmission
Someone who lived with a Missouri resident infected with bird flu also became ill on the same day, the Centers for Disease Control and Prevention reported on Friday.
The disclosure raises the possibility that the virus, H5N1, spread from one person to another, experts said, in what would be the first known instance in the United States.
On Friday night, C.D.C. officials said that there was “no epidemiological evidence at this time to support person-to-person transmission of H5N1,” but that additional research was needed.
The coincidental timing of the illnesses, especially outside flu season, concerned independent experts. H5N1 has been known to spread between close contacts, including those living in the same household.
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The disclosure raises the possibility that the virus, H5N1, spread from one person to another, experts said, in what would be the first known instance in the United States.
On Friday night, C.D.C. officials said that there was “no epidemiological evidence at this time to support person-to-person transmission of H5N1,” but that additional research was needed.
The coincidental timing of the illnesses, especially outside flu season, concerned independent experts. H5N1 has been known to spread between close contacts, including those living in the same household.
News from the Pandemic Center
News from the Pandemic Center
Pandemic Center Game Changers: New Fellowship to Prepare Next Gen Leaders to Shape the Future of Biosecurity
News from the Pandemic Center
At 77th World Health Assembly: New Initiative Launches To Establish Global Health Security Network
Biosecurity Readiness through Intelligence, Data, and Global Engagement Alliance
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News from the Pandemic Center
Dr. Seth F. Berkley to Receive the 2024 Jimmy And Rosalynn Carter Humanitarian Award
Brown University Pandemic Center leader honored for outstanding humanitarian efforts and achievements in the field of global public health
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News from the Pandemic Center
Pandemic Center Interview: Professor William Goedel on using cutting edge tools to reveal our pandemic history
A new exercise, highlighting the ability of Artificial Intelligence (AI) to meet pandemic threats, will be tested this week at the Munich Security Conference.
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News from the Pandemic Center
Brown Pandemic Center & Brown in Washington (DC) Program Offer New Course to Prepare Future Pandemic Leaders
New partnership expands student opportunities
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News from the Pandemic Center
Pandemic Center Opens New Washington, D.C. Office
New office will expand impact and connect current and future public health leaders with national and global policymakers
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The Advance Warning and Response Exemplars (AWARE) project will identify positive outliers in successful early warning and response to significant public health events, including outbreaks of pathogens of pandemic potential as well as climate-sensitive infectious diseases
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News from the Pandemic Center
Pandemic Center Launches Groundbreaking Media Program with Brown Arts Institute
"Our Storied Health Film and Media Series" opens with a screening of 'Shot in the Arm,' a film that explores vaccine hesitancy in COVID-19 and more.
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News from the Pandemic Center
World-renowned global health expert Dr. Seth Berkley to join Brown University Pandemic Center as Senior Advisor
Global health leader will bring invaluable experience to Brown’s newly created Pandemic Center.
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News from the Pandemic Center
Dr. Wilmot James named as Chair of Wellcome Trust’s Climate Impacts Advisory Committee
The Committee considers applications for awards for projects that drive change in climate policy and practice.
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News from the Pandemic Center
Pandemic Preparedness Matters: Interview with Jorge Ledesma
The Pandemic Center sat down with Mr. Ledesma to dive into the results of his recent paper on pandemic preparedness, its impact on mortality rates during the COVID-19 pandemic, and what it can tell decision makers.
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