California health officials reported Tuesday that a child in Alameda County tested positive for H5 bird flu last week.

The source of infection is not known — although health officials are looking into possible contact with wild birds — and the child is recovering at home with mild upper respiratory symptoms.

Health officials have confirmed the "H5" part of the virus, not the "N1." There is no human "H5" flu; it is only associated with birds.

The child was treated with antiviral medication, and the sample was sent to the U.S. Centers for Disease Control and Prevention for confirmatory testing.

The initial test showed low levels of the virus and, according to the state health agency, testing four days later showed no virus.

"The more cases we find that have no known exposure make it difficult to prevent additional" infections, said Jennifer Nuzzo, professor of epidemiology and director of the Brown University School of Public Health's Pandemic Center. "It worries me greatly that this virus is popping up in more and more places and that we keep being surprised by infections in people whom we wouldn't think would be at high risk of being exposed to the virus."

Read more: Canadian teenager infected with H5N1 bird flu in critical condition

A statement from the California Department of Public Health said that none of the child's family members have the virus, although they, too, had mild respiratory symptoms. They are also being treated with antiviral medication.

The child attended a day care while displaying symptoms. People the child may have had contact with have been notified and are being offered preventative antiviral medication and testing.

“It’s natural for people to be concerned, and we want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious — and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said CDPH Director and State Public Health Officer Dr. Tomás Aragón.

The case comes days after the state health agency announced the discovery of six new bird flu cases, all in dairy workers. The total number of confirmed human cases in California is 27. This new case will bring it to 28, if confirmed. This is the first human case in California that is not associated with the dairy industry.

The total number of confirmed human cases in the U.S., including the Alameda County child, now stands at 54. Thirty-one are associated with dairy industry, 21 with the poultry industry, and now two with unknown sources.

In Canada, a teenager is in critical condition with the disease. The source of that child's infection is also unknown.

Genetic sequencing of the Canadian teenager's virus shows mutations that may make it more efficient at moving between people. The Canadian virus is also a variant of H5N1 that has been associated with migrating wild birds, not cattle.

Genetic sequencing of the California child's virus has not been released, so it is unclear if it is of wild bird origin, or the one moving through the state's dairy herds.

In addition, WastewaterScan — an infectious disease monitoring network led by researchers from Stanford University and Emory University, with laboratory support from Verily, Alphabet Inc.’s life sciences organization — follows 28 wastewater sites in California. All but six have shown detectable amounts of H5 in the last couple of weeks.

There are no monitoring sites in Alameda Co., but positive hits have been found in several Bay Area wastewater districts, including San Francisco, Redwood City, Sunnyvale, San Jose and Napa.

"This just makes the work of protecting people from this virus and preventing it from mutating to cause a pandemic that much harder," said Nuzzo.

For years, Robert F. Kennedy Jr., has leveraged his famous name, his celebrity connections and his nonprofit, Children’s Health Defense, to spread misinformation about vaccines and call their safety and efficacy into question. Soon, he might have the power to go much further.

If Mr. Kennedy is confirmed by the Senate to be secretary of health and human services, he would be in charge of the nation’s pre-eminent public health and scientific agencies, including those responsible for regulating vaccines and setting national vaccine policy.

Legal and public health experts agree that he would not have the authority to take some of the most severe actions, such as unilaterally banning vaccines, which Mr. Kennedy has said he has no intention of doing.

“I’m not going to take anyone’s vaccines away from them,” he wrote on social media last month. “I just want to be sure every American knows the safety profile, the risk profile, and the efficacy of each vaccine.”

But Mr. Kennedy, who has said that he wants federal researchers to pull back from studying infectious diseases, could exert his influence in many other ways. His actions could reduce vaccination rates, delay the development of new vaccines and undermine public confidence in a critical public health tool.

In the last three decades alone, childhood vaccines have prevented more than 500 million cases of disease, 32 million hospitalizations and more than one million deaths in the United States, according to a recent report from the Centers for Disease Control and Prevention. But vaccination rates have been falling in recently years, and Mr. Kennedy could accelerate the trend, public health experts said.

“A lot of damage is possible,” said Dr. Thomas Frieden, a former director of the C.D.C. who now leads Resolve to Save Lives, a public health nonprofit. “The secretary of health has a life-or-death responsibility. And if unscientific statements and decisions are made, if agencies are damaged, if public confidence is undermined, then you can get spread of disease.”

Here are five things Mr. Kennedy could do.

He could revise the government’s vaccine recommendations.
As the federal health secretary, Mr. Kennedy would oversee the C.D.C., the agency that issues guidance on which immunizations Americans should get and when.

Health insurers look to those recommendations to determine what vaccines to cover and state health departments use them to inform their own vaccine policies.

Mr. Kennedy would have final say over which experts sit on the external committee that advises the C.D.C. on vaccines, and he would be the boss of the C.D.C. director, who decides whether to adopt that guidance. “That’s, in my mind, a recipe for a disaster,” said Lawrence O. Gostin, an expert in public health law at Georgetown University.

A C.D.C. director or advisory committee that is hesitant toward vaccines could usher in changes in the childhood vaccine schedule, such as removing vaccines from the list of recommended immunizations or changing the ages at which they are advised.

“If the question is purely, could the H.H.S. secretary unilaterally remove vaccines from a schedule or alter the schedule, I think the answer to that would ultimately be no,” said Dr. Michael Mina, an epidemiologist and former professor at Harvard University. “But with a little bit of planning, through like-minded appointments and top-down pressure, the answer to that starts to move the needle toward yes.”

One thing he could not do is abolish vaccine mandates, such as requirements that children receive certain immunizations before attending school. Those are set by state and local governments. The federal health secretary does not have the authority to override them.

But some public health experts fear that some state health authorities, particularly in Republican-led states, could follow a C.D.C. that is skeptical of vaccines. One result might be lower vaccination rates — and worse public health outcomes — in red states than in blue ones, Mr. Gostin said, similar to the pattern that played out with the Covid-19 vaccines.

He could slow vaccine development and approval.
Mr. Kennedy would also be in charge of the F.D.A., the agency responsible for approving new vaccines.

He has repeatedly criticized the agency, which fast-tracked the authorization of the Covid-19 vaccines, as well as the shots themselves. As health secretary, he would not be able to remove them or any other already authorized vaccines from the market without strong scientific evidence, Mr. Gostin said. If he tried, vaccine manufacturers could sue over such a decision and courts would most likely rule in their favor, he said.

But he could bring people who share his views into the F.D.A. Together, they could make the process for approving new vaccines more onerous and lengthy, including requiring more data.

“He could say, ‘I don’t think this has been studied in the right way,’” said Dr. Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia and an adviser to the F.D.A.

He could also stop or slow vaccine development research conducted at or funded by the National Institutes of Health, the federal government’s top medical research agency, which would also fall under his purview. He has been clear about his plans to empty some divisions that focus on advancing vaccine research and development. He has said he would fight the next pandemic instead by “building people’s immune systems.”

“I’m going to say to N.I.H. scientists, ‘God bless you all,’” Mr. Kennedy said as a presidential candidate last November. “‘Thank you for public service.’ We’re going to give infectious disease a break for about eight years.”

Infectious diseases are still looming, however. And a slowdown in vaccine research, development or approval could have particularly dire consequences in the event of another public health emergency like Covid-19.

Bird flu, for instance, continues to infect American farm workers, and experts have worried that the virus could evolve to spread more easily among humans. If that happened, “we would be in a new pandemic,” said Jennifer Nuzzo, the director of the Pandemic Center at Brown University. “And that pandemic would move very quickly. Any attempt to not act with urgency would be deadly.”

He could emphasize vaccine side effects.
Decades of scientific study confirm that the benefits of vaccines far outweigh the risks, but like all medications, they carry the possibility of side effects, including some rare but serious ones. Mr. Kennedy — who has said he wants more public visibility into safety data — is poised to draw outsize attention to adverse outcomes.

His nonprofit promotes a database of research that includes hundreds of misleading interpretations of vaccine data. In September, the group released “Vaxxed 3: Authorized to Kill,” a film claiming that Covid vaccines led to “tragic outcomes of either death or serious injury.”
Under Mr. Kennedy, federal agencies like the F.D.A. could highlight potential side effects by requiring vaccine makers to list even very rare ones on the packaging label.

Mr. Kennedy could also draw attention to unverified reports of adverse events collected by federal agencies. “What I would worry about is an abuse of the data,” said Dr. Peter Lurie, the president of the Center for Science in the Public Interest and a former associate commissioner at the F.D.A.

Mr. Kennedy could also push federal agencies to conduct more research into vaccine safety. That would not be a bad thing in itself, said Dr. Ofer Levy, director of the precision vaccines program at Boston Children’s Hospital and an adviser to the F.D.A. “There is more research that can be done, particularly on some of the newer vaccines,” he said.

But, the research must be scientifically rigorous, he added, and build upon decades of scientific evidence related to vaccine safety. “If you signal this to the public as, ‘Well, we have to start from scratch, all of these vaccines are suspect,’ I would disagree with that approach,” Dr. Levy said. “Because many of these vaccines have been very, very well studied, and they’re a huge win for kids.”

He could weaken legal protections for vaccine makers.
Under a longstanding federal law, people who experience serious side effects after receiving certain routine vaccinations are limited in their ability to sue drug companies. Instead, they can seek compensation through a government-run program. The law is intended to encourage drug companies to invest in vaccine development.

Mr. Kennedy could not make major changes to the law without congressional approval, but he could remove specific vaccines from the program. Whether he could take every vaccine off the list is “difficult to say, because it’s uncharted waters, legally speaking,” said Ana Santos Rutschman, an expert on health law and policy at Villanova University.

If vaccines are removed from the program, some companies may decide to stop making them. “And that’s going to have two effects: driving vaccine costs up and reducing availability for those who want the vaccines,” said Dorit Reiss, an expert on vaccine policy and law at the University of California College of the Law, San Francisco.

(And because the program is more favorable to plaintiffs than the courts are, paring down the list could actually make it more difficult for people with vaccine injuries to be compensated, Dr. Reiss added.)

A more recent law also provides liability protections to companies making vaccines for public health emergencies, such as the Covid-19 pandemic. These protections are put in place by a declaration from the secretary of health; in the event of another pandemic, Mr. Kennedy could simply refrain from making one.

Over the longer term, experts said, weakening the liability protections would probably prompt some pharmaceutical companies to abandon vaccine development. “Which, from a public health perspective, may mean fewer vaccines in the future,” Ms. Rutschman said.

He could speak out against vaccines.
Many experts say they worry most about Mr. Kennedy’s bully pulpit. If confirmed, Mr. Kennedy would have a new platform for spreading misinformation about vaccines and amplifying fears about their safety.

“It’s very hard to claw back outrageous ideas when social media algorithms propel them forward,” Dr. Nuzzo said.

Vaccine hesitancy grew during Mr. Trump’s first term as president and persisted after he left office.

Vaccine experts have said that Mr. Kennedy is particularly skilled at taking good, peer-reviewed science and skewing the findings.

Dr. Mina said he expected Mr. Kennedy to “to do exactly what he’s been doing for years: fudging the way that data is meant to be interpreted, using very manipulative tactics to drive a message that makes vaccines look dangerous. He is a master at it — truly a master.”

During a measles outbreak in Samoa in 2019, Mr. Kennedy stoked the skepticism driving the spread. He wrote to the nation’s prime minister on the Children’s Health Defense letterhead, suggesting that the failure of vaccines given to pregnant women and children was the true culprit. More than 50 children died in the outbreak.

RFK Jr. is ‘exactly the wrong pick’ for HHS secretary

Dr. Jennifer Nuzzo, director of Brown University’s Pandemic Center, criticizes President-elect Donald Trump's pick for Health and Human Services secretary.

November 15, 2024

Canadian health officials announced Tuesday that a teenager infected with H5N1 bird flu from an unknown source is in critical condition.

According to British Columbia Provincial Health Officer Bonnie Henry, the child is suffering from acute respiratory distress and was hospitalized on Friday.

The teen is the first presumptive case of H5N1 bird flu in Canada.

“Our thoughts continue to be with this person and their family,” said Henry.

Authorities believe the virus was acquired via an animal source; however, the teen was not on a farm nor near any known wild birds or backyard poultry — common reservoirs for the disease.

According to a CBC interview with Henry, the teen did not have any contact with birds but did interact with a variety of other animals — including a dog, cats and reptiles — in the days before becoming ill. Testing on those animals has so far been negative.

The health authorities are also tracing people the teen was in contact with; so far they have not identified other infections.

The situation is “horrifying,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University. “The idea that we have a child, a teenager, who is seriously ill from this virus is just really an utter tragedy. But sadly, it’s not surprising, given everything we’ve known about H5N1 and its potential to cause illness.”

She noted that since the late 1990s, when this current strain of bird flu originated in China’s Guangdong province, the fatality rate was close to 60%. That number is likely inflated, she said, as presumably most people tested for the disease were those who went to hospitals or clinics to seek treatment; people who had mild symptoms, or were asymptomatic, were likely not tested.

Nevertheless, Nuzzo said, while this virus could “be a lot less deadly than what we’ve seen to date,” it could still be far more deadly than any pandemic we’ve seen in a long time, including COVID.

She said the case causes her concern for three reasons: The first is the severity of the teen’s illness. The second is that “we don’t understand how the teenager got infected,” she said. Her third concern is how government officials are dealing with this outbreak, which she described as “letting it continue to spread from animals to people, without trying to do more to get ahead of it.”

She said the virus may in the end not end up becoming more virulent or efficient at moving between people, “but I don’t think we want to wait around and on the chance that it might.”

Since the virus appeared in North American wild birds in 2021, human cases have mostly presented as mild. Since 2022, there have been 47 human cases in the U.S. — 25 in dairy workers, 21 in poultry workers, and one case in Missouri where the source has not yet been identified.

However, a recent study from the U.S. Centers for Disease Control and Prevention shows the virus is more widespread in dairy workers than had previously been assumed. An examination of antibodies in 115 dairy workers from Michigan and Colorado showed that eight people were positive for the disease, or 7% of the study population — indicating that either workers were not reporting illness, or they were asymptomatic.

Nuzzo also pointed to a recent study published in Nature, led by Yoshihiro Kawaoka, an H5N1 expert at the University of Wisconsin, in Madison, that showed the virus that infected the first reported dairy worker in Texas had acquired mutations that made it more severe in animals as well as allowing it to move more efficiently between them — via airborne respiration.

When Kawoaka exposed ferrets to this viral isolate, 100% died. In addition, the amount of virus they were initially exposed to didn’t seem to matter. Even very low doses caused mortality.

Kawoaka told The Times in an interview that the mutations seen in this particular isolate have appeared elsewhere in past outbreaks in birds and mammals, “so in that sense, it’s a very orthodox mutation.”

On Wednesday, Canadian health authorities announced they had genetically sequenced the virus in the teen, and it is the newer D1.1 version that has affected poultry flocks in the Pacific Northwest this fall, and was likely carried by wild birds migrating south. It is not the version being seen in dairy cows or dairy workers, which has been called B3.13. Both are of the H5N1 2.3.4.4b clade that has been wreaking havoc across North and South America since 2021, and in Europe, Asia and Africa since 2020.

Fortunately, the mutated isolate that infected the lone dairy worker in Texas has not been seen since. It’s unclear why the worker did not present with more severe symptoms.

However, there are a few hypotheses.

Kawaoka’s research shows “inefficient replication” of the virus in human corneal cells. If the worker was exposed by a splash of contaminated milk to the eye, or a rub of the eye with a contaminated glove, the virus may have been stalled out — unable to replicate like it could have had the worker been exposed via inhalation.

Nuzzo said there are other hypotheses — which she stressed are just hypotheses — including one that posits people who were exposed to the H1N1 swine flu outbreak in 2009 may have acquired some immunity to the “N1” part of the virus.

The other goes back to a person’s first influenza exposure.

There is a scientific hypothesis called the “original antigenic sin” that suggests that a person’s first exposure to a particular virus “may sort of kind of set the tone” for that person’s immune system going forward — so this worker’s first flu exposure may have provided his immune system with the defenses needed to suppress H5N1.

“There are a lot more questions than answers at this point. So there are a lot of interesting hypotheses for why the more recent cases have been mild, there’s not enough evidence to simply discard more than two decades worth of evidence about this virus that tells us that it could be quite deadly,” said Nuzzo.

As human flu season ramps up, Nuzzo said it’s critically important that people do what they can to prevent the spread of disease.

She said both seasonal flu and H5N1 vaccines should be provided to dairy workers.

Unfortunately, she said, “our surveillance efforts for trying to find outbreaks on farms, while getting better, are still not even close to what we need to know about these outbreaks.”

In the meantime, vaccines and antiviral medications need to be on hand.

“The news of a deeply serious human case of bird flu is a massive wake-up call that should immediately mobilize efforts to prevent another human pandemic,” said Farm Forward Executive Director Andrew deCoriolis. “We could have prevented the spread of bird flu on poultry farms across America, and we didn’t. We could have prevented the spread of bird flu on dairy farms, and we didn’t.”

“Factory farms notorious for raising billions of sickly animals in filthy, cramped conditions provide a recipe for viruses like bird flu (H5N1) to emerge and spread,” said deCoriolis in a statement. “We are now on the cusp of another pandemic and the agencies responsible for regulating farms and protecting public health are moving slower than the virus is spreading.”

As of Wednesday, there have been 492 dairy herds infected with H5N1 across 15 states. More than half, 278, are in California. Two pigs in Oregon have also been infected.

A Canadian teenager is hospitalized in critical condition with bird flu, health officials reported Tuesday.

The teen has been receiving care at BC Children’s Hospital in Vancouver since Friday, the same day an initial test came back positive for H5 influenza. Government testing confirmed that the strain is H5N1, the Public Health Agency of Canada said Wednesday.

The young person’s first symptoms, which began a week before they were hospitalized, were conjunctivitis or red eyes, fever and cough, said Dr. Bonnie Henry, an epidemiologist who is the provincial health officer for British Columbia.

The illness has progressed to acute respiratory distress syndrome, or ARDS. People with ARDS typically need help breathing with machines such as a ventilator, but officials did not offer specifics on the teen’s treatment except to say they’re receiving antiviral medications.

This is the first known human case of bird flu acquired in Canada. The country had one case in 2014, which was travel-related, Henry said.

It is still unknown how the teen caught this strain of flu, which has been circulating widely in wild birds, poultry and some mammals, including cattle in North America since 2022.

“Because this is such a rare event and a sentinel event, it is important for us to do as thorough an investigation as possible, and we’re committed to doing that,” Henry said.

There have also been 46 confirmed human infections in the United States as part of the ongoing outbreak this year, mostly among farm workers tending infected animals. All those cases have been mild, and people who have tested positive have recovered from their illnesses after treatment with antiviral medications.

These cases have all been among adults, however, and Henry said it’s possible that the teen’s case is more severe because as a younger person, they’d had less exposure to seasonal strains of the flu, which may offer some degree cross-protection against H5 bird flu strains.

The teen, who was described as healthy before they caught the virus, began experiencing symptoms November 2. They went to an emergency room, were sent home and returned to the hospital a few days later when their condition got worse.

Canadian officials are following more than 40 people who had contact with the teen during their infectious period, which started two days before they began experiencing symptoms.

“I will also say that there are many other tests that are being done on a number of people across the province to try and really get an understanding of what’s happening here,” Henry said.

Officials have no other evidence of anyone else becoming ill after contact with the teen.

“We don’t see right now that there’s a risk of a lot of people being sick,” she said.

More than two dozen poultry farms in British Columbia have been affected by H5N1, Henry said. Since 2022, about 11 million birds have been destroyed, with most of them in British Columbia. Unlike in the US, H5N1 has not been detected dairy cattle or milk in Canada.

“We are looking very, very carefully at all potential animal exposures, bird exposures. There were other pets in the house, and there was contact with pets in other houses,” Henry said. The teen had contact with dogs, cats and reptiles, but none has tested positive for H5N1. Investigators have not identified any contact between the teen and birds.

“Right now, we have no specific source identified, but the testing is ongoing in partnerships with our veterinary colleagues, and we’ll be continuing that investigation very thoroughly,” she added.

The US Centers for Disease Control and Prevention says that the current public health risk remains low but that it’s continuing to monitor the outbreak.

“This is a tragic development. It is an unfortunately unsurprising development,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at the Brown University School of Public Health.

“I think there’s been a lot of wishful thinking about this virus, that it wouldn’t cause people to become severely ill, but that hope, really, I think, stands in contrast to several decades worth of data,” she said.

Since 2003, over 900 human cases of H5N1 have been reported to the World Health Organization. Slightly more than half have been fatal.

“What I think this absolutely underscores is that H5N1 is a very serious public health threat, and we need to be doing more to stay ahead of it, to prevent more people from becoming severely ill or die,” Nuzzo said.

Eight out of 115 dairy workers, or 7%, who worked with H5N1-infected cows in Michigan and Colorado have antibodies to bird flu, according to a new study from the US Centers for Disease Control and Prevention (CDC) – a rate significantly higher than known cases of the highly pathogenic virus, which means existing efforts are not protecting, diagnosing and treating people at risk, experts said.

It could become even harder to detect cases amid the fall migration of wild birds, the upcoming human flu season, and repercussions of the second Trump administration’s proposed policies to curtail public health and expand deportation of immigrants, who serve as the backbone of the agricultural workforce in the US.

The new survey from the CDC and state health departments looked at blood samples from people who worked with H5-infected cows in Michigan and Colorado between June to August 2024.

Out of the eight people who had previously undetected cases of the highly pathogenic bird flu, four remembered having symptoms, mostly conjunctivitis, and the other four did not recall having symptoms.

All eight workers were Spanish speakers who reported milking infected cows or cleaning milk parlors. None of them wore respirators, and less than half wore eye protection like goggles.

Notably, only one person said they had worked with infected cows, even though all of them were working with cows on farms with known infections – pointing to barriers in workers understanding the risks they face.

“It really speaks to the importance of more on-farm training around H5 as well as ways to protect from H5,” Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases, told reporters on Thursday.

The news of cases that flew beneath the radar is “completely unsurprising”, said Jennifer Nuzzo, the director of the Pandemic Center and a professor of epidemiology at Brown University School of Public Health.

“When you test people at their place of work, and if the consequence of testing positive is that they have to stay home and possibly not earn an income, you should expect that people might not tell you if they’ve had symptoms. Also, everything we know about flu gives us the very strong suspicion that there would be asymptomatic infections,” Nuzzo said.


Until now, the CDC has recommended testing only people who report symptoms after having direct animal contact.

“We are not doing enough to make sure that we are protecting people from getting infected and certainly making sure that people who are infected get access to medicines that could potentially keep them from getting severely ill,” Nuzzo said.

The CDC is now bolstering measures to protect workers, including expanding recommendations to test farm workers who are exposed to the virus but don’t develop symptoms, and offering those workers access to flu antivirals.

“We in public health need to cast a wider net in terms of who is offered a test so that we can identify, treat and isolate those individuals,” Nirav Shah, the CDC’s principal deputy director, said on Thursday. Identifying cases and treating people helps to keep a mild infection from turning into a severe one – and it reduces the chances that the virus will spread onward among people.

“The less room we give this virus to run, the fewer chances it has to cause harm or to change,” Shah said. The agency is also improving guidance and education on the importance of personal protective equipment.

“Because we haven’t seen severe illness and deaths yet, I think there’s been some complacency around trying to control this virus, but I’ve always said we shouldn’t wait for farm workers to die before we take action to protect them,” Nuzzo said. “I just don’t think you should gamble with people’s lives like that.”

She believes existing stockpiles of H5N1 vaccines should be offered to farm workers, pending their authorization from regulatory agencies. Vaccines can help prevent severe illness, particularly among a population that may be hesitant to come forward with an illness that could jeopardize their job or even their ability to stay in the country.

“Just offer it for people who may want to protect themselves,” Nuzzo said. “This virus is not going away. This virus is going to represent an even greater threat to human health as it continues to find its way into more and more US farms.”

If the “moral imperative” to protect agricultural workers doesn’t move Americans, perhaps the economic effects of higher costs of milk, eggs and meat will, she said. “Nobody wants the cost of groceries to be any higher than they already are.”

So far, there have been 46 official cases of H5N1 diagnosed in people this year, more than half of which have been among dairy farmworkers. Another nine people have now been identified by blood testing, for a total of 55 people affected by bird flu in 2024.

Other influenza variants will soon begin circulation in people this fall, which raises the possibility of reassortment – a process where different flu variants combine and potentially gain worse attributes.

“By allowing this virus to circulate, we could give it a runway to develop the ability to more easily infect people, and crucially, to be able to spread easily between people,” Nuzzo said. “If the virus can do that, we will be in a new pandemic.”

Dairy workers who’ve been exposed to bird flu should be tested for the virus even if they don’t have symptoms and be offered Tamiflu to cut their risk of getting sick, the Centers for Disease Control and Prevention said Thursday.

The recommendation coincides with a new report finding asymptomatic bird flu infection in some workers. Those cases were discovered using blood, or serology, testing and seem to have been transmitted from sick animals, not people.

“There is nothing that we’ve seen in the new serology data that gives us any concern about person-to-person transmission,” Dr. Nirav Shah, the CDC’s principal deputy director, said during a media briefing.

To date, 46 people have been diagnosed with bird flu, also known as H5N1, in the United States this year. All but one of those patients had been exposed to sick cattle or poultry on farms.

Most cases have been reported in California (21), Washington (11) and Colorado (10).

The new CDC study looked at blood tests from workers at 115 dairy farms who were exposed to H5N1 over the summer in either Colorado or Michigan.

Of those 115, eight (7%) had antibodies showing they’d been infected with the bird flu.

“All eight reported milking cows or cleaning the milking parlor,” Dr. Demetre Daskalakis, who heads the CDC’s National Center for Immunization and Respiratory Diseases, said during the call. Masks and safety goggles were rare.

“None wore respiratory protection, and less than half wore eye protection,” Daskalakis said.

Most of those found with H5N1 said they’d had red, itchy eyes with drainage.

But four of the eight who were infected didn’t recall ever being sick.

Until now, workers who had a known exposure to bird flu but didn’t have symptoms haven’t been routinely tested. The new results clearly show cases have been missed — a concern that veterinarians have had since the spring.

The CDC is now “intensifying” recommendations meant to protect farmworkers, Shah said. “We in public health need to cast a wider net in terms of who is offered a test so that we can identify, treat and isolate those individuals,” he said.

The new advice is to test anyone with a significant bird flu exposure, such as an unprotected worker who’s been splashed in the face with raw milk on a dairy farm with known H5N1 infections in the herds.

Even if the person never feels ill, that worker should be tested and given the antiviral drug Tamiflu to reduce their risk of ever developing symptoms or passing the virus to close contacts.

This is a move the CDC should have made months ago, said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health.

“We’ve always suspected strongly and now have confirmation that that was going to miss people who are infected,” Nuzzo said. “This is very bad because one of these infections could turn out to be serious.”

All the H5N1 cases reported so far this year have been mild, including pinkeye and some minor coughs or sneezes. No one has died.

That runs counter to previous H5N1 mortality rate estimates from other parts of the world suggesting more than half of those who become infected die.

Daskalakis said that could be because “not all H5N1s are built the same. These are potentially different genotypes.”

There is no indication that the commercial milk or beef supplies have been affected, the Food and Drug Administration has said.

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

Mustafa Fattah
Mustafa Fattah is a medical fellow with the NBC News Health and Medical Unit.

Learn the bipartisan lessons of the past to prevent future biological crises

For decades, American presidential administrations of both parties have made combatting biological threats a priority on their national security to-do list. In 2020, I spoke out about President Donald Trump’s mishandling of the COVID-19 pandemic and dismissiveness towards bipartisan lessons and preparedness tools his team received when he entered office. Though no administration could have been perfectly prepared for COVID, the results of Trump’s disregard were predictable; when the virus struck, chaos ensued. Instead of uniting in the face of crisis, states and cities were left divided and competing for scarce resources. Americans suffered and lives were lost as a result.

Looking forward, important new plans and response playbooks have emerged not only from COVID-19, but from the many additional outbreaks the United States has fought over the last four years from mpox to H5N1 influenza, to Marburg. I draw hope from state and local innovations, such as those uncovered by the American Democracy and Health Security Initiative. The federal government and our nation’s governors, mayors, tribal leaders, school administrators, businesses and community organizations learned precious lessons, which must be preserved. The path ahead for our nation’s biodefense is clear: we must lean into and build on this vital work.

In this spirit, the administration should reject a biosecurity to-do list that sows divisiveness, driving Democrats and Republicans into their respective corners and failing to capitalize on hard-fought lessons from states, cities, and tribes. Instead, it should adopt a bipartisan biosecurity agenda that protects all Americans by onshoring and friend-shoring critical supplies, while simultaneously bolstering global financing solutions that enable low- and lower-middle-income countries to access countermeasures and stop outbreaks at the source. It should double down on investing in the 100 Days Mission, an effort built on Operation Warp Speed, achieve safe and effective vaccines, tests, and treatments for every potentially pandemic pathogen. And it must strengthen preparedness to deter and guard against the potential for deliberate or accidental biological misuse.

Such an agenda would recognize that biological disasters affect everyone, everywhere, all at once and that Americans can only be safe from disease threats if diseases are fought and stopped everywhere in the world. Crucially, this means doubling down on the US target to assist at least 50 countries with health security capacity and catalyze capacity in 50 more through a strong Pandemic Fund. It would require not only remaining at the table in the World Health Assembly, the governing body of the World Health Organization (WHO), but also using that seat to play a stronger leadership role in advancing global health security. Conversely, walking away would have negative impacts on Americans and create space for competitors and adversaries that seek harm to our interests. And it would mean working to build the world’s strongest bioeconomy, safeguarding emerging biotechnologies against deliberate and accidental misuse, and building capacity to detect and respond to disease threats around the world.

Finally, to achieve these goals, the incoming administration must adopt and invest in the work of the National Security Council’s Directorate on Global Health Security and Biodefense and the White House Office on Pandemic Preparedness and Response. These non-partisan experts have spent years building a national and global firefighting team to enhance American readiness for biological threats. This team should be empowered and expanded, not shuttered.

It’s highly likely the incoming administration will have to deal with a major health emergency very early in its tenure. In 2025, we will learn whether the new administration will pick up where it left off or whether it can turn the page on past pandemic performance and prevent future biological catastrophes.

–Elizabeth (Beth) Cameron is a professor of the practice and senior advisor to the Pandemic Center at the Brown University School of Public Health.

Marburg virus is notorious for its killing ability. In past outbreaks, as many as 9 out of 10 patients have died from the disease. And there are no approved vaccines or medications.

That was the grim situation in Rwanda just over a month ago, when officials made the announcement that nobody wants to make: The country was in the midst of its first Marburg outbreak.

Now those same Rwandan officials have better news to share. Remarkably better.

“We are at a case fatality rate of 22.7% — probably among the lowest ever recorded [for a Marburg outbreak],” said Dr. Yvan Butera, the Rwandan Minister of State for Health at a press conference hosted by Africa Centers for Disease Control and Prevention on Thursday.

There’s more heartening news: Two of the Marburg patients, who experienced multiple organ failure and were put on life support, have now been extubated — had their breathing tubes successfully removed — and have recovered from the virus.

“We believe this is the first time patients with Marburg virus have been extubated in Africa,” says Tedros Adhanom Ghebreyesus, director general of the World Health Organization. “These patients would have died in previous outbreaks.”

The number of new cases in Rwanda has also dwindled dramatically, from several a day to just 4 reported in the last two weeks, bringing the total for this outbreak to 66 Marburg patients and 15 deaths.

“It's not yet time to declare victory, but we think we are headed in a good direction,” says Butera. Public health experts are already using words like “remarkable,” “unprecedented” and “very, very encouraging” to characterize the response.

How did Rwanda — an African country of some 14 million — achieve this success? And what can other countries learn from Rwanda’s response?

Doing the basics really well
Rwanda is known for the horrific 1994 genocide — one of the worst in modern times. Since then, the country has charted a different path. In 20 years, life expectancy increased by 20 years from 47.5 years old in 2000 to 67.5 years old in 2021 — about double the gains seen across the continent. And Rwanda has spent decades building up a robust health-care system.

“The health infrastructure, the health-care providers in Rwanda — they're really, really great,” says Dr. Craig Spencer, an emergency physician and professor at Brown University School of Public Health. Spencer specializes in global health issues and has been following the Rwandan outbreak closely.

There are well-run hospitals and well-trained nurses and doctors, he says. There are laboratories that can quickly do diagnostic testing. There is personal protective equipment for medical workers.

For this outbreak, there was the know-how and infrastructure to set up a separate Marburg treatment facility. That's been a boon for other patients and medical staff, preventing exposure to the virus — which crosses over from bats to humans and can be transmitted through bodily fluids like blood, sweat and diarrhea.

And even though there aren't approved medications to treat Marburg, patients in Rwanda have received good supportive care for all their symptoms — like the IV fluids critical for symptoms like high fevers, nausea, vomiting and diarrhea.

This stands in stark contrast to the response in past Marburg scenarios. For example, the Democratic Republic of Congo — next door to Rwanda — had an outbreak between 1998 and 2000. Dr. Daniel Bausch, now a professor at the London School of Hygiene and Tropical Medicine and an expert in tropical diseases like Marburg, provided care in that outbreak. He says what the country’s health centers were able to offer patients was rudimentary at best.

“We called it a care center or treatment center, but really it was a separate mud hut that people were placed in. We didn't have really anything available to us,” he remembers. “People were lucky that they got paracetamol, or Tylenol, and some fluids to drink, if they could get them down without the nausea and vomiting preventing them.”

In the world's 18 recorded Marburg outbreaks, the mortality rate varies considerably. Several small outbreaks have had fatality rates below 30% but the largest outbreak — in Angola in 2004 and 2005 — had a case fatality rate of 90% with 252 cases and 227 deaths.

Rwanda’s “more modern medical centers” make a big difference, Bausch says.

Getting to patients lickety-split
It wasn’t just the caliber of care that made a difference. It’s also the speed with which patients get care.

As soon as the outbreak started, Rwandan officials jump-started a major operation to trace the contacts of those who were infected, monitoring the health of over 1,000 family members, friends, health-care workers and others at risk. They also started door-to-door surveillance in neighborhoods where there might have been an exposure.

And they did a lot of testing – over 6,000 tests, especially among health-care workers, who’ve comprised 80% of the Marburg patients in this outbreak.

Spencer says many of these capabilities were built up during the COVID pandemic and could be rolled out rapidly. “In Rwanda, you have providers able — within hours really of this outbreak being declared — to get tested,” says Spencer, who has worked with Doctors Without Borders treating Ebola patients. “[Rwanda’s testing is] absolutely remarkable in terms of the response.”

This surveillance and testing allowed “us to detect cases quickly and provide them with treatments in the very, very early phases of their diseases,” explains Butera. He says that caring for patients before they become critically ill likely helped lower the mortality rate.

Embracing experimental vaccines and medications
Rwanda’s speed carried over into other anti-Marburg efforts.

“Everything I have witnessed was really expedited,” says WHO’s Ghebreyesus, who visited Rwanda last week and said what he saw was “very, very encouraging.”

While there are no vaccines or treatments approved for Marburg, Rwanda acted quickly to get experimental vaccines and treatments to people at the center of the outbreak.

“I can't imagine another scenario in which a country went from identifying this outbreak to just over a week later having investigational [experimental] vaccines in country already being provided to frontline health-care workers,” says Spencer, who adds the doses started being administered the same day they arrived in the country. The nonprofit Sabin Vaccine Institute provided the doses, which were developed with major support from the U.S. government.

“I rarely, rarely use the word unprecedented in global health response” Spencer says, but this speed was “unprecedented.”

The vaccine itself is still in development. Testing has shown that it’s safe — but not whether it actually works. Nonetheless, Rwanda decided to inoculate those at risk, hoping that it would help.

Those officials also decided to vaccinate without a randomized controlled trial, where a segment of the recipients get a placebo. Some in the international scientific community say this was a missed opportunity to start learning whether the vaccine is effective — although they concede that it’s far more complicated and slow to roll out a trial. And the size of the outbreak was unlikely to yield enough data to be conclusive.

Did the vaccines help stop the spread or reduce the mortality rate? It’s impossible to know, says Bausch. He points out that in the first recorded Marburg outbreak — in 1967 in Marburg, Germany and what was then Yugoslavia — the mortality rate was 23% with only good supportive care.

Meanwhile, in Rwanda, the next round of vaccines will go to at-risk groups, including mine workers who are in close proximity to the fruit bats that can spread Marburg; that vaccine effort will be randomized.

In addition to the vaccines, Rwanda very swiftly started giving patients two medications — an antiviral called Remdesivir and a monoclonal antibody. As with the vaccine, they hoped these treatments would help even though they haven’t been approved for Marburg.

An early stumble, a course correction
In addition to the speed and high-quality patient care, there’s another less glamorous — but equally important — dimension to quashing Marburg and other viruses, says Bausch. It’s infection control: basically, ensuring Marburg patients don’t infect others. In the hospital, this means that staff take precautions like wearing gowns, masks and double gloves. In public, it can mean sanitizing shared items like motorcycle helmets and installing handwashing stations in public places, as Rwanda has done.

Rwanda stumbled early on with infection control. That’s because it took a couple weeks to diagnose the disease in the individual who is considered the first patient in this outbreak — and the first known Marburg case in the country.

That individual, who likely contracted the virus from exposure to fruit bats in a mining cave, also had a severe case of malaria. Clinicians did not determine that Marburg was also present until other people around that patient started falling ill. As a result, many health care workers were exposed before infection control measures were improved.

While Rwanda rapidly improved their infection control once officials understood what they were dealing with — and not just in health facilities. The mining community linked to the initial patient has seen several cases. So surveillance needs to be sure to cover those populations, says Rob Holden, WHO’s incident manager for Marburg.

“As we go forward, we fine tune, we refine, we reinforce all our surveillance systems, our contact follow ups, our investigations, and we leave no stone unturned,” he says. “If we let our guard down, then I think we'll end up with some nasty surprises and a very long tail on this outbreak.”

Spencer agrees. But he is optimistic. He says that Rwanda’s robust health infrastructure and speedy response has helped protect the rest of the world from a much bigger Marburg outbreak.

NEW YORK (AP) — A pig at an Oregon farm was found to have bird flu, the U.S. Department of Agriculture announced Wednesday. It’s the first time the virus has been detected in U.S. swine and raises concerns about bird flu’s potential to become a human threat.

The infection happened at a backyard farm in Crook County, in the center of the state, where different animals share water and are housed together. Last week, poultry at the farm were found to have the virus, and testing this week found that one of the farm’s five pigs had become infected.

The farm was put under quarantine and all five pigs were euthanized so additional testing could be done. It’s not a commercial farm, and U.S. agriculture officials said there is no concern about the safety of the nation’s pork supply.

But finding bird flu in a pig raises worries that the virus may be hitting a stepping stone to becoming a bigger threat to people, said Jennifer Nuzzo, a Brown University pandemic researcher.

Pigs can be infected with multiple types of flu, and the animals can play a role in making bird viruses better adapted to humans, she explained. The 2009 H1N1 flu pandemic had swine origins, Nuzzo noted.

“If we’re trying to stay ahead of this virus and prevent it from becoming a threat to the broader public, knowing if it’s in pigs is crucial,” Nuzzo said.

The USDA has conducted genetic tests on the farm’s poultry and has not seen any mutations that suggest the virus is gaining an increased ability to spread to people. That indicates the current risk to the public remains low, officials said.


A different strain of the bird flu virus has been reported in pigs outside the U.S. in the past, and it did not trigger a human pandemic.

“It isn’t a one-to-one relationship, where pigs get infected with viruses and they make pandemics,” said Troy Sutton, a Penn State researcher who studies flu viruses in animals.

This version of bird flu — known as Type A H5N1 — has been spreading widely in the U.S. among wild birds, poultry, cows and a number of other animals. Its persistence increases the chances that people will be exposed and potentially catch it, officials say.

It isn’t necessarily surprising that a pig infection was detected, given that so many other animals have had the virus, experts said.

The Oregon pig infection “is noteworthy, but does it change the calculation of the threat level? No it doesn’t,” Sutton said. If the virus starts spreading more widely among pigs and if there are ensuing human infections, “then we’re going to be more concerned.”

So far this year, nearly 40 human cases have been reported — in California, Colorado, Washington, Michigan, Texas and Missouri — with mostly mild symptoms, including eye redness, reported. All but one of the people had been to contact with infected animals.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

U.S. agriculture officials said Wednesday that a pig on a backyard farm in Oregon had tested positive for the H5N1 bird flu, raising worries that the virus that is now spreading among U.S. dairy cattle could eventually pose a risk to humans.

Although H5N1 has been found in a long list of wild and domestic mammal species in the U.S. since 2022, including black bears and house cats, an infection in a pig could have bigger implications.

That’s because human and bird flu viruses can mix inside pigs to create new viruses that have, in the past, caused influenza pandemics. The 2009 swine flu pandemic was caused by a pig virus with bird flu genes.

“This is an unsurprising but worrisome development,” said Jennifer Nuzzo, director of the Pandemic Center at Brown University’s School of Public Health, in an email to Barron’s. “Virologists have long worried about avian influenza viruses spending time in pigs because it could make it easier for the virus to be able to infect and spread between humans.”

The U.S. Department of Agriculture said Wednesday that one of five pigs on a backyard, non-commercial farm in Crook County, Ore., had tested positive for H5N1 on Tuesday.

Poultry on the farm tested positive for H5N1 last week. H5N1 tests were negative for two of the pigs, while the results of two more tests are still pending.

The agency said that the livestock and poultry on the farm had shared water sources, housing, and equipment. Genetic sequencing of the virus taken from the pig is not yet available, meaning that it’s not yet possible to tell whether the virus is the same strain of H5N1 moving through U.S. dairy farms.

If not, the animals on the backyard farm could have contracted the virus from wild birds, which carry different strains of H5N1.

For now, the implications of the positive test remain unclear, and it’s likely good news that the pig infection occurred on a small farm, not at a large pig operation.

While H5N1 has been found in nearly 400 dairy herds across the U.S., according to the USDA, and led to the destruction of tens of millions of domestic poultry, only a handful of humans has been sickened during the current outbreak.

The Centers for Disease Control and Prevention says there have been 36 human cases in the U.S. this year, virtually all of them in farm workers, and virtually all of them mild.

The worry from experts is that the presence of the virus in pigs could allow it to evolve in a way that might make it more dangerous to humans.

“The virus that caused last influenza pandemic we had—the one that occurred in 2009—likely went from pigs to humans,” Nuzzo said. “This new finding increases our worries that H5N1 could gain the abilities to cause a human pandemic.”

While scientists have seen H5N1-infected pigs in a handful of other countries, the virus has never before been seen in pigs in the U.S.

“For me, it’s another wake-up call to be vigilant, especially for our pig producers,” Dr. Marie Culhane, a professor at the University of Minnesota College of Veterinary Medicine, told Barron’s.

Culhane said that most pigs in the U.S. are kept indoors, not in outdoor farmyards.

“When we mix species together, there’s always that risk that we’re going to share diseases,” Culhane said. “As much as it’s nice to have Old MacDonald’s farm… it just increases the chances you’re going to share virus, and that’s what happened here.”

Dr. Jennifer Nuzzo, DrPH, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health, is one of 100 new members to join the National Academy of Medicine (NAM) as part of its 2024 class. Among the reasons cited for Dr. Nuzzo’s election was her role in “co-creating the Global Health Security Index and conducting research to measure and improve national preparedness for infectious disease threats.”

Working in partnership with NTI’s Global Biological Policy & Programs (NTI | bio) and Economist Impact, Dr. Nuzzo demonstrated critical leadership in developing the 2019 and 2021 versions of the Global Health Security (GHS) Index. The Index measures capacities of 195 countries to prevent and prepare for epidemics and pandemics, analyzing more than 60,000 data points across the traditional prevention, detection, and response measures. The Index is the only comprehensive, independent tool that quantitatively assesses the global baseline of preparedness for catastrophic biological threats in a way that can be repeated every few years.

“We have experienced first-hand Dr. Nuzzo’s impressive dedication to making the world safer from infectious disease threats. We are grateful for Jennifer’s partnership and expertise in developing the GHS Index, and we are so pleased that her work on this critical initiative has been recognized by the National Academy of Medicine. It is a well-deserved honor,” NTI | bio Vice President Dr. Jaime Yassif said.

NAM also recognized Dr. Nuzzo’s efforts to co-establish a global COVID-19 testing data tracker and to create a health systems resilience checklist for biological emergencies.

One of three academies that comprise the National Academies of Sciences, Engineering, and Medicine in the United States, NAM membership reflects the height of professional achievement and commitment to service.

CDC: NO PERSON-TO-PERSON SPREAD — Public health experts say they would “love” more answers about why a close contact of a Missouri avian flu patient had antibodies against the virus — but they’re relieved that the CDC found no evidence of person-to-person spread of the virus.

The fact that five health care workers exposed to the Missouri patient had no antibodies to bird flu reduces the level of concern, said Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health.

“I would love to better understand how these two people became infected,” Nuzzo said. “Not knowing that makes it hard for me to say, ‘Well, OK, this is just a freak thing that’ll never happen again.’ We just literally don’t know.”

Dr. Michael Mina, chief science officer at digital health firm eMed, said he wants to know why more individuals in Missouri were not tested with the serology test. He also wanted the CDC to disclose more data on the thresholds for positivity on the antibody tests.

“They could have collected from 1,000 people to do a [serology] survey,” Mina said. “Clearly, the person got infected somewhere.”

Health officials took three weeks to develop reverse genetic viruses that were then used to test blood samples from the Missouri patient, their household contact and five health care workers. Both the Missouri avian flu patient and the household contact had evidence of an immune response to avian flu and an identical symptom onset date.

The CDC said that following the serological tests, the risk of avian flu for the public and people without contact with an infected animal remains low. But those exposed to infected animals have a higher risk of infection.

“These similar immunologic results coupled with the epidemiologic data that these two individuals had identical symptom onset dates support a single common exposure to bird flu rather than person-to-person spread within the household,” the agency said in its report on the Missouri blood testing.

Nuzzo acknowledged that it is unlikely health officials will ever figure out how the two individuals were potentially exposed to bird flu. Both individuals did not have a known exposure to animals.

Government officials cautioned that more human infections could emerge from Washington state — where seven workers at a farm with infected poultry tested presumptively positive for bird flu. Two of those cases have been confirmed by the CDC, which is working to conduct testing on other samples.

“It’s growing at an enormous clip,” Nuzzo said. “This is here to stay, this is going to be a persistent occupational threat to farmworkers and it is going to be an increasing cause of economic losses for the agriculture industry.”

Send tips to David Lim (dlim@politico.com or @davidalim) and Lauren Gardner (lgardner@politico.com or @Gardner_LM).

Bird flu cases have more than doubled in the country within a few weeks, but researchers can’t determine why the spike is happening because surveillance for human infections has been patchy for seven months.

Just this week, California reported its 15th infection in dairy workers and Washington state reported seven probable cases in poultry workers.

Hundreds of emails from state and local health departments, obtained in records requests from KFF Health News, help reveal why. Despite health officials’ arduous efforts to track human infections, surveillance is marred by delays, inconsistencies, and blind spots.

Several documents reflect a breakdown in communication with a subset of farm owners who don’t want themselves or their employees monitored for signs of bird flu.

For instance, a terse July 29 email from the Weld County Department of Public Health and Environment in Colorado said, “Currently attempting to monitor 26 dairies. 9 have refused.”

The email tallied the people on farms in the state who were supposed to be monitored: “1250+ known workers plus an unknown amount exposed from dairies with whom we have not had contact or refused to provide information.”

Other emails hint that cases on dairy farms were missed. And an exchange between health officials in Michigan suggested that people connected to dairy farms had spread the bird flu virus to pet cats. But there hadn’t been enough testing to really know.

Researchers worldwide are increasingly concerned.

“I have been distressed and depressed by the lack of epidemiologic data and the lack of surveillance,” said Nicole Lurie, formerly the assistant secretary for preparedness and response in the Obama administration.

Bird flu viruses have long been on the short list of pathogens with pandemic potential. Although they have been around for nearly three decades in birds, the unprecedented spread among U.S. dairy cattle this year is alarming: The viruses have evolved to thrive within mammals. Maria Van Kerkhove, head of the emerging diseases unit at the World Health Organization, said, “We need to see more systemic, strategic testing of humans.”

A key reason for spotty surveillance is that public health decisions largely lie with farm owners who have reported outbreaks among their cattle or poultry, according to emails, slide decks, and videos obtained by KFF Health News, and interviews with health officials in five states with outbreaks.

In a video of a small meeting at Central District Health in Boise, Idaho, an official warned colleagues that some dairies don’t want their names or locations disclosed to health departments. “Our involvement becomes very sketchy in such places,” she said.

“I just finished speaking to the owner of the dairy farm,” wrote a public health nurse at the Mid-Michigan district health department in a May 10 email. “[REDACTED] feels that this may have started [REDACTED] weeks ago, that was the first time that they noticed a decrease in milk production,” she wrote. “[REDACTED] does not feel that they need MSU Extension to come out,” she added, referring to outreach to farmworkers provided by Michigan State University.

“We have had multiple dairies refuse a site visit,” wrote the communicable disease program manager in Weld, Colorado, in a July 2 email.

Many farmers cooperated with health officials, but delays between their visits and when outbreaks started meant cases might have been missed. “There were 4 people who discussed having symptoms,” a Weld health official wrote in another email describing her visit to a farm with a bird flu outbreak, “but unfortunately all of them had either already passed the testing window, or did not want to be tested.”

Jason Chessher, who leads Weld’s public health department, said farmers often tell them not to visit because of time constraints.

Dairy operations require labor throughout the day, especially when cows are sick. Pausing work so employees can learn about the bird flu virus or go get tested could cut milk production and potentially harm animals needing attention. And if a bird flu test is positive, the farm owner loses labor for additional days and a worker might not get paid. Such realities complicate public health efforts, several health officials said.

An email from Weld’s health department, about a dairy owner in Colorado, reflected this idea: “Producer refuses to send workers to Sunrise [clinic] to get tested since they’re too busy. He has pinkeye, too.” Pink eye, or conjunctivitis, is a symptom of various infections, including the bird flu.

Chessher and other health officials told KFF Health News that instead of visiting farms, they often ask owners or supervisors to let them know if anyone on-site is ill. Or they may ask farm owners for a list of employee phone numbers to prompt workers to text the health department about any symptoms.

Jennifer Morse, medical director at the Mid-Michigan District Health Department, conceded that relying on owners raises the risk cases will be missed, but that being too pushy could reignite a backlash against public health. Some of the fiercest resistance against covid-19 measures, such as masking and vaccines, were in rural areas.

“It’s better to understand where they’re coming from and figure out the best way to work with them,” she said. “Because if you try to work against them, it will not go well.”

Cat Clues

And then there were the pet cats. Unlike dozens of feral cats found dead on farms with outbreaks, these domestic cats didn’t roam around herds, lapping up milk that teemed with virus.

In emails, Mid-Michigan health officials hypothesized that the cats acquired the virus from droplets, known as fomites, on their owners’ hands or clothing. “If we only could have gotten testing on the [REDACTED] household members, their clothing if possible, and their workplaces, we may have been able to prove human->fomite->cat transmission,” said a July 22 email.

Her colleague suggested they publish a report on the cat cases “to inform others about the potential for indirect transmission to companion animals.”

Thijs Kuiken, a bird flu researcher in the Netherlands, at the Erasmus Medical Center in Rotterdam, said person-to-cat infections wouldn’t be surprising since felines are so susceptible to the virus. Fomites may have been the cause or, he suggested, an infected — but untested — owner might have passed it on.

Hints of missed cases add to mounting evidence of undetected bird flu infections. Health officials said they’re aware of the problem but that it’s not due only to farm owners’ objections.

Local health departments are chronically understaffed. For every 6,000 people in rural areas, there’s one public health nurse — who often works part-time, one analysis found.

“State and local public health departments are decimated resource-wise,” said Lurie, who is now an executive director at an international organization, the Coalition for Epidemic Preparedness Innovations. “You can’t expect them to do the job if you only resource them once there’s a crisis.”

Another explanation is a lack of urgency because the virus hasn’t severely harmed anyone in the country this year. “If hundreds of workers had died, we’d be more forceful about monitoring workers,” Chessher said. “But a handful of mild symptoms don’t warrant a heavy-handed response.”

All the bird flu cases among U.S. farmworkers have presented with conjunctivitis, a cough, a fever, and other flu-like symptoms that resolved without hospitalization. Yet infectious disease researchers note that numbers remain too low for conclusions — especially given the virus’s grim history.

About half of the 912 people diagnosed with the bird flu over three decades died. Viruses change over time, and many cases have probably gone undetected. But even if the true number of cases — the denominator — is five times as high, said Jennifer Nuzzo, director of the Pandemic Center at Brown University, a mortality rate of 10% would be devastating if the bird flu virus evolved to spread swiftly between people. The case fatality rate for covid was around 1%.

By missing cases, the public health system may be slow to notice if the virus becomes more contagious. Already, delays resulted in missing a potential instance of human-to-human transmission in early September. After a hospitalized patient tested positive for the bird flu virus in Missouri, public health officials learned that a person in the patient’s house had been sick — and recovered. It was too late to test for the virus, but on Oct. 24, the CDC announced that an analysis of the person’s blood found antibodies against the bird flu, signs of a prior infection.

CDC Principal Deputy Director Nirav Shah suggested the two people in Missouri had been separately infected, rather than passing the virus from one to the other. But without testing, it’s impossible to know for certain.

The possibility of a more contagious variant grows as flu season sets in. If someone contracts bird flu and seasonal flu at the same time, the two viruses could swap genes to form a hybrid that can spread swiftly. “We need to take steps today to prevent the worst-case scenario,” Nuzzo said.

The CDC can monitor farmworkers directly only at the request of state health officials. The agency is, however, tasked with providing a picture of what’s happening nationwide.

As of Oct. 24, the CDC’s dashboard states that more than 5,100 people have been monitored nationally after exposure to sick animals; more than 260 tested; and 30 bird flu cases detected. (The dashboard hasn’t yet been updated to include the most recent cases and five of Washington’s reports pending CDC confirmation.)

Van Kerkhove and other pandemic experts said they were disturbed by the amount of detail the agency’s updates lack. Its dashboard doesn’t separate numbers by state, or break down how many people were monitored through visits with health officials, daily updates via text, or from a single call with a busy farm owner distracted as cows fall sick. It doesn’t say how many workers in each state were tested or the number of workers on farms that refused contact.

“They don’t provide enough information and enough transparency about where these numbers are coming from,” said Samuel Scarpino, an epidemiologist who specializes in disease surveillance. The number of detected bird flu cases doesn’t mean much without knowing the fraction it represents — the rate at which workers are being infected.

This is what renders California’s increase mysterious. Without a baseline, the state’s rapid uptick could signal it’s testing more aggressively than elsewhere. Alternatively, its upsurge might indicate that the virus has become more infectious — a very concerning, albeit less likely, development.

The CDC declined to comment on concerns about monitoring. On Oct. 4, Shah briefed journalists on California’s outbreak. The state identified cases because it was actively tracking farmworkers, he said. “This is public health in action,” he added.

Salvador Sandoval, a doctor and county health officer in Merced, California, did not exude such confidence. “Monitoring isn’t being done on a consistent basis,” he said, as cases mounted in the region. “It’s a really worrisome situation.”

KFF Health News regional editor Nathan Payne contributed to this report.

On Wednesday, community members gathered to watch “Power of the Dream,” a 2024 documentary by Dawn Porter following the WNBA’s historic 2016 and 2020 seasons and the Black Lives Matter movement. The event was part of “Our Storied Health,” a film and media series hosted by Brown’s Pandemic Center.

The film starts in 2016 with the killings of Alton Sterling and Philando Castile, two Black men, by police. The film follows the league through 2020, when players from all teams came together to fight for justice for Black Americans, helping Rev. Raphael Warnock win his 2020 U.S. senate election in the process.

After the film, Porter spoke with Lucia Hulsether, a professor of religious studies at Skidmore College, in a panel discussion moderated by Jennifer Galvin ’95, a filmmaker-in-residence at the center.

Porter discussed how important visual mediums are in displaying and spurring political action. “Every story can help social change. The common element with visual storytelling is its ability to empathize with people in a very visceral way,” she said. “You can always find the humanity in people in every story.”

Reflecting on the WNBA players’ unified front, both Hulsether and Porter emphasized the importance of “thinking beyond the individual” as the 2024 election approaches.

“They had to rely on one another … they had to abide by their own social contract,” Porter said of the players. “We think about the safety of others in the same way we think about our own safety.”

“Life or death stakes are with us every day, not just during presidential elections,” Hulsether added. “Get people to the polls, help people vote … but what can we do to get people primed to act before the moments are essential such that there is greater power when something big is at stake?”

Hulsether and Porter criticized the way Black WNBA players are often depicted in the media. The film shows “how deep the solidarity is” within the WNBA, Hulsether said. “Perhaps, people who think the WNBA needs to be catering to a racist fanbase could watch this film and say, ‘Maybe there’s something here that’s full of potential if they don’t.’”

While many of the films in the “Our Storied Health” film series directly focus on public health issues, Galvin and Jennifer Nuzzo, Director of the Pandemic Center stressed the tie between voting and public health.

“The traditional way of communicating information about health and science just doesn’t work,” Nuzzo told The Herald. “If we were going to reach people in the way that we truly need to reach them to save lives, we have to speak to their beliefs. That’s not something science does well or easily, but it is what the arts do.”

“Health is political. People are making decisions about your health and your family’s health every day.” Galvin said at the panel.

In an interview with The Herald, Galvin added that “‘Power of the Dream’ speaks to the heart of the values of public health. Everyone deserves a healthy and safe place to live, learn, work, and play.”

“My hope is that people will remember that every vote counts, that their voices matter,” Nuzzo followed. “We are a nation of individuals. Elections are individual votes rolled up. Individual acts compound to larger impact.”

A Missouri resident who shared a home with a patient hospitalized with bird flu in August was also infected with the virus, federal officials reported on Thursday.

But symptomatic health care workers who cared for the hospitalized patient were not infected, testing showed. The news eased worries among researchers that the virus, H5N1, had gained the ability to spread more efficiently among people.

Still, the number of human cases is rising in the United States. California said this week that it had confirmed 15 human cases of bird flu. Washington State has reported two poultry workers who are infected and five others presumed to be positive.

There are 31 confirmed cases in the country, but experts have said the figure is likely to be an undercount. “Additional cases may be found as investigations continue,” Dr. Nirav Shah, the principal deputy director of the Centers for Disease Control and Prevention, said at a news briefing on Thursday.

“The identification of these additional cases of H5 in people with exposures to infected animals does not change C.D.C. risk assessment for the general public, which continues to be low,” he said.

The poultry workers in Washington State were infected with a version of the virus that is distinct from the one circulating in dairy cattle, he added.

Except for the two people in Missouri, all infections have been linked to exposure to infected poultry or cattle. None of the infected are thought to have passed the virus to anyone else, although uncertainties about the Missouri infections persist.

Investigators do not know how the Missouri patient and the household member became infected. They had no exposure to infected animals and had not consumed raw milk products that may have carried the virus, officials said.

Jennifer Nuzzo, the director of the Pandemic Center at Brown University, said, “We need to know how the two people in Missouri who had no known contact with animals contracted the virus.”

“I’d feel better if we know these two people likely got sick from a freak encounter with wildlife than a food product that may be distributed to other people,” she added.


The hospitalized patient in Missouri had been tested for influenza as part of routine surveillance and turned out to be positive for H5N1, the bird flu virus.

The C.D.C. later said that one household member and six health care workers who had been in contact with that patient had developed symptoms associated with flu.

Only one of those individuals had been tested for the virus at the time of illness. That health care worker was negative for flu.

To determine whether the others had been infected, C.D.C. scientists customized a test to detect antibodies to the version of the virus taken from the hospitalized patient. None of the health care workers carried antibodies, suggesting that they had not been infected, the agency said at the news briefing.

Results from such tests are not always definitive. They may miss evidence of infection if someone produces too few antibodies. The health care workers did not experience severe symptoms.


Federal officials said they had ruled out person-to-person infection in Missouri partly because the two people developed symptoms at the same time, suggesting a shared source of infection.

But other experts have said that two people may develop symptoms simultaneously even if they were exposed to the virus at different times.

If it were the case that one person had infected the other, “that’s pretty huge,” said Dr. Gregory Gray, an epidemiologist at the University of Texas Medical Branch.

“Some limited human-to human transmission is in the pathway to full-on high human-to-human transmission, and so it is concerning,” he said.

“There may not have been a robust enough infection to induce a very strong immune response,” said Seema Lakdawala, a virologist at Emory University.

Technically, test results for the household contact did not meet criteria set by the World Health Organization for it to be called a “case.” Yet the individual carried antibodies to the virus, suggesting an infection, C.D.C. officials said.

Other factors, including the low levels of virus found in the hospitalized patient, also suggested that the person did not pass the virus along to anyone else, federal officials said.

“There is no evidence that I think meets the bar to suggest that it’s spreading human to human,” said Ryan Langlois, a viral immunologist at the University of Minnesota.

Both the infected people in Missouri had low levels of virus when tested, and had gastrointestinal problems, but not the respiratory symptoms more usually associated with flu infections.

“It doesn’t appear to have any of the traits that I would be worried about for a virus that is fit for respiratory spread,” Dr. Langlois said. “Of course, that can change with a just a couple of mutations.”

Genetic analysis of the virus taken from three infected Californians showed some mutations, but none that would make it easier for the virus to spread among people, according to the C.D.C.

Still, every new human infection gives the virus opportunities to evolve and gain the needed mutations.

“It is clear that there’s a lot of human infection going on,” said Scott Hensley, a viral immunologist at the University of Pennsylvania. “What makes me worried is that there’s just a whole heck of a lot of shots on goal.”

Experts are particularly worried as the flu season draws nearer. Flu viruses can acquire new abilities by swapping genes with one another.

An individual infected with both bird flu and a seasonal flu virus might provide the perfect opportunity for H5N1 to gain the ability to spread as easily among people as seasonal flu does.

California is the nation’s biggest dairy producer, but the state did not detect its first infected herds until the end of August. As of Oct. 24, the virus had been confirmed on 137 dairy farms in the state, the hardest hit in the nation.

The 15 human cases were identified in dairy workers who had direct exposure to infected cows. Their symptoms were mild, and none were hospitalized, according to state officials.

But the number of infected cattle herds suggests that the virus is widespread, and the state health department acknowledged that more human cases could be identified.

“California is incredibly concerning,” Dr. Hensley said.

“It’s unclear if the number of cases that we continue to see come in each week — is that due to just good surveillance and good reporting, or is something different going on in California right now?” he added. “We just don’t know.”

Ideally farmworkers would be tested for antibodies using so-called serology tests to detect people who may have been infected without developing symptoms, and to learn more about the course of infection.

“There’s probably so many undocumented exposures,” Dr. Hensley said. “Through serology, we may be able to learn more about that.”

Blood tests of several people who were in contact with a patient in Missouri who caught H5N1 bird flu without any known exposure to infected animals reveal that at least one of them — a person who lived in the same house and had symptoms at the same time — also had the virus, according to two sources with knowledge of the investigation.

H5N1 is a type of influenza that’s rare in humans but is highly contagious and deadly in several species of animals, including poultry and dairy cattle, raising fears that it could mutate and become a virus that preys on people, too.

The specialized blood tests, which were conducted by scientists at the US Centers for Disease Control and Prevention in Atlanta, looked for immune proteins called antibodies made in response to an infection. These antibodies confirm that a person has had an infection with a particular pathogen. The results were shared more widely with public health officials, scientists and the media in several calls hosted by health officials on Thursday morning.

The tests were conducted to understand whether the Missouri patient – who is the first known person to catch H5N1 influenza in the United States without any apparent exposure to infected animals – infected anyone else. So far, the H5N1 virus has not been able to spread easily between people. Infectious disease experts fear that if the virus gains that ability, it could touch off a new pandemic.

Although the results don’t definitively rule out human-to-human transmission of the virus, they do suggest that it isn’t common or widespread and that it didn’t happen in a health-care setting where caregivers have close physical contact with patients, CDC officials said. Even though a person living in the patient’s household was also positive, the CDC says the timing of their illness suggests that both had a common exposure rather than one catching it from the other.

Around the United States, more than two dozen people have tested positive for H5N1 flu this year, and nearly all of them have reported exposure to infected dairy cows or chickens, according to the CDC.

Source of the infections is still a mystery
The new test results show that the health-care workers who developed symptoms of respiratory illness after caring for the patient — before doctors were aware of the H5N1 infection — were negative for antibodies against the infection. However, a person who lived in the same house with the patient and got sick at the same time did have antibodies to H5N1 infection.

In a briefing Thursday, CDC officials explained that the household contact would not be counted as an official case because they didn’t test positive on at least two of three ways to test for infection that are accepted by the CDC and the World Health Organization.

Dr. Demetre Daskalakis, head of the CDC’s National Center for Immunization and Respiratory Diseases, said the agency’s testing was like the sonar on a ship trying to find something below the surface of the water.

“We know that there’s something down there and that the case and household contact were likely exposed to or infected with H5N1, but we can’t say if what we’re seeing below the ocean surface is a whale or a submarine,” Daskalakis said.

Infectious disease experts with knowledge of the findings said it was a relief to see the results.

“I am very reassured by the fact that the health-care workers were not positive, and that gives me a lot more confidence that this is not really spreading in a sustained way between people,” said Dr. Jennifer Nuzzo, who directs the Pandemic Center at the Brown University School of Public Health.

At the same time, Nuzzo said, information gaps limit what can be learned about how both the patient and a member of their household became ill.

Experts agree with the CDC’s findings that because both people began having symptoms at roughly the same time, it’s more likely that they shared a common exposure instead of one person giving it to the other, but say person-to-person transmission in that case still can’t be completely ruled out.

“We’re still left with all those questions,” said Dr. Michael Osterholm, who directs the Center for Infectious Disease Research and Policy at the University of Minnesota. “Was it the same source? Was it person-to-person?”

Another question relates to symptoms. Both people who tested positive for H5N1 didn’t have typical flu symptoms. Instead, they had gastrointestinal issues, including diarrhea, which initially led investigators to suspect that food poisoning might be the cause of their simultaneous illnesses.

Osterholm said it’s unclear whether the H5N1 virus was causing those symptoms or whether they might have had more than one infection at the same time.

“I’ve seen that happen before,” he said.

Both the Missouri patient and their household member have been interviewed several times about potential exposures to the virus. Neither has indicated they had any raw milk or other raw dairy products, and neither could recall any contact with potentially infected animals, including “direct or indirect contact with wild birds, domestic poultry, cats, cattle including no consumption of raw dairy products, or other wildlife by the case and close contacts,” said Lisa Cox, a spokesperson for the Missouri Department of Health and Senior Services, in an email. That agency has been leading the investigation with assistance from the CDC.

Experts said the test results shed little light on how both people caught the virus.

“I don’t think we’re going to get good data out of it to tell us much,” said Dr. Rick Bright, an immunologist and vaccine researcher who previously led the Biomedical Advanced Research and Development Authority.

Bright said it would be an important case to keep bookmarked in the event that similar instances come to light that might suggest the virus is causing unusual symptoms or perhaps is infecting people through a route of exposure that hasn’t yet been recognized.

“There are so many weird things about this one, I don’t think we can put a lot of weight in it,” Bright said, though he added that the CDC did a thorough job looking for antibodies in the case. He said the fact that the health-care workers did not test positive was both “convincing and comforting.”

Searching for evidence of past infections
In order to get these test results, the CDC had to reconstruct the exact virus carried by the patient in Missouri in order to look for antibodies that might attach to its unique structure. The agency explained in a recent news briefing that it was taking those extra steps to avoid falsely negative or falsely positive results.

The extra efforts increased the agency’s confidence in its findings, but it also added another delay to a case that took weeks to be identified and investigated. The patient was originally hospitalized on August 22.

The delays, while perhaps unavoidable, have frustrated preparedness experts who say any system that takes this long to identify and track infections hamper the country’s ability to respond should H5N1 infections become more widespread.

“I am thrilled that we’re finally getting data that should have been shared weeks ago. I think every case, every human case of H5 is an important case. They’re all valid and they’re all worth [blood testing], because this is a virus that should not be in a human host and is one that we need to better understand so that we can prevent possible human-to-human transmission,” said Dr. Erin Sorrell, a senior scholar at the Johns Hopkins Center for Health Security.

“Every data point is essential at this point in the process,” Sorrell said. “So just that delay, I think, is a massive, massive issue.”

On Thursday, health officials announced that H5N1 testing would soon be available through several commercial lab companies including Quest Diagnostics. These tests would be available to patients with a doctor’s prescription.

The CDC said it is working with health-care providers to educate them about the circumstances that would qualify someone for bird flu testing, such as a dairy worker with symptoms of a bird flu infection.

The professor of epidemiology and director of the Pandemic Center at Brown’s School of Public Health received the honor in recognition of her work to measure and improve national preparedness for infectious disease threats.

PROVIDENCE, R.I. [Brown University] — Jennifer B. Nuzzo, a professor of epidemiology and director of the Pandemic Center at the Brown University School of Public Health, has been elected to the National Academy of Medicine as a member of its 2024 class.

Nuzzo is one of 100 new members invited by current academy members to join this year’s class. Election to the academy is considered one of the highest honors in health and medicine, and recognizes individuals at the top of their field who have demonstrated “outstanding professional achievement and commitment to service.”

“It is a profound honor to join the National Academy of Medicine, recognized around the world for providing rigorous, evidence-based guidance to improve public health.” Nuzzo said. “The work of the national academy is more important than ever in the wake of a pandemic that demonstrated evidence-based decision-making is essential to guide us in times of crisis and calm. Its mission — to advance science, inform policy and catalyze action to achieve human health, equity and well-being — is paramount, and I look forward to contributing to this work."

According to the academy, Nuzzo was elected “for co-creating the Global Health Security Index and conducting research to measure and improve national preparedness for infectious disease threats.” She was also recognized for co-founding a global COVID-19 testing data tracker and creating a health systems resilience checklist for biological emergencies.

More of than a million people in the U.S. died from COVID-19 during the pandemic, but health officials acknowledge that another casualty was trust in the public health officials, particularly at the federal level.

The topic of yesterday’s opening plenary session of the 2024 ID Week meeting was preparing for the next pandemic and rebuilding the shattered trust was the first thing the three experts were asked about during the discussion part of the session.

“I worry a little bit sometimes when we talk about trust that we put it as a bin that we put everything that is too hard into and say, ‘Well it is about trust’” said Jennifer Nuzzo, Dr.P.H., S.M., a professor of epidemiology at Brown University School of Public Health and director of the pandemic center there.

But Nuzzo and the other panelists, Paul Friedrichs, M.D., the director of The White House Office of Pandemic Preparedness and Response Policy, and Nicole Lurie, M.D., M.S.P.H., the executive director for preparedness and response for the Coalition for Epidemic Preparedness Innovations (CEPI), shared some thoughts on why trust in public health decayed and what can be done to bring it back.

Nuzzo said that when the pandemic started, trust in a variety of institutions was high and then eroded over time. “I think that is really important to recognize that, because what it points to is that trust isn’t a thing you either have or you don’t. It’s the result of a process.”

From her conversations with people during the pandemic, Nuzzo said she came to see that trust ebbed partly people believed their needs weren’t being met or the response was against their best interest.

Healthcare providers remain trusted sources of information, Nuzzo noted, but people would tell her that they didn’t have a regular provider. She said the primary healthcare infrastructure in the U.S. need to be rebuilt partly because it would help the country cope with disease outbreaks.

“If you first show up in people’s lives in an emergency, you can say, ‘Trust us. We’re here to help you,’ but you’ve never been in someone’s life, day in and day out trying to help them, then, good luck having that conversation,” Nuzzo said.

Lurie referenced her eight years as the assistant secretary for preparedness and response HHS prior to her current position at CEPI. “One of the big takeaways for me is what a huge country it is and how different different parts of the country are. And I think there’s not a one-size-fits-all to trust,” Lurie said.

Trust, Lurie said, can’t be manufactured at the federal level. “We can certainly destroy it at the federal level, but we can’t manufacture it,” she said. As has been said about healthcare and politics, trust is local, Lurie added, she urged the members of ID Week audience to speak to people at the local level.

“You are known in your neighborhoods You’re known in your institutions. You are people who can go out there and apolitically explain to people what’s going on and to speak the truth,” she said.

Lurie also urged the audience to speak to elected officials at the local and state level” “Explain to them what infectious disease is. Explain to them what infectious clinicians do and explain to them why they should care about that and become a resource for them as well as develop a trust relationship so that when they have a question or when something happens, you’re a person they call and you can spread the trust.”

Friedrichs said he agreed with Lurie about speaking to elected officials and added an admonition to avoid “medicalspeak” and talk in plain English. He said that there had been communication successes during the pandemic including “novel partnerships with atypical communicators — people who didn’t usually serve as spokesman or spokeswomen [on] medical issues, reaching out to historically underserved communities.”

Friedrichs also said that trust must be anchored equity. “Trust means that every American has to believe that they have the same opportunities to access high quality care. Trust means that people around world have to believe that their children can get the care when they need it, not just because they live in a wealthy country but because that is the right thing to do.”

SACRAMENTO, California — Health officials across the U.S. are working to prevent a potentially dangerous combination virus as avian flu rips through one of the nation’s largest milk-producing regions during the height of flu season.

Public health experts have long warned that avian flu poses a significant pandemic threat to humans, and the number of infections among dairy workers in California continues to grow. The timing of the outbreak will soon collide with the seasonal flu, complicating efforts to track bird flu and raising the risk that the two viruses could mix, potentially creating a virulent combo that could spread beyond dairy workers to the rest of the population.

Despite what California officials say is a proactive approach, public health experts outside the state say too little is being done to track and respond to avian flu, which has spread to 105 dairy farms since the virus was first found here in August. The stakes are high: Approximately half of documented human H5N1 avian flu cases in the past two decades were deadly, according to the World Health Organization.


“It will mutate to become increasingly optimal in humans as soon as it gains any foot in the door for human-to-human transmission,” said Michael Mina, chief science officer at digital health company eMed. “How far that goes and how fast it means the virus starts to transmit … is almost entirely unknown right now.”

Other states have had a handful of avian flu cases in humans this year, including one in Texas and 10 in Colorado. But as the largest dairy-producing state in the country, with over 1.7 million cows, California’s response could serve as a test case for how to deal with large numbers of infected cows or people.

Since the California Department of Public Health disclosed the state’s first presumptive infection on Oct. 3, 11 human infections have been confirmed, according to the state. All of the individuals — who work at nine different farms — have had direct contact with infected dairy cattle.

“It’s important to note that to date, there has been no evidence of human-to-human transmission of bird flu in the U.S.,” a CDPH spokesperson said in an email.

But between March 31 and Oct. 14, only 25 individuals in the state have been tested for avian flu, according to CDPH. Workers who are symptomatic are first screened for flu before additional bird-flu-specific testing is performed. California is home to over 17,500 dairy workers, most of whom are in the Central Valley.

The CDC set aside more than 100,000 doses of seasonal flu vaccine for the 12 states with outbreaks. Five thousand of those doses are meant for California’s dairy workers, and counties with many herds can now order them, but they weren’t available until Oct. 14.

Getting regular flu vaccines into dairy workers’ arms is meant to help detect avian flu better. With fewer people exhibiting regular flu symptoms, health workers should be better able to find avian flu cases. The effort is also intended to cut down on the chance that avian flu goes through a process known as reassortment that could result in a virus that can transmit human to human.

“That alone, without contemplating high pathogenicity, equates to huge numbers of increased hospitalizations and deaths nationally and globally,” said Mina of eMed.

It’s something the world has seen before. The swine flu pandemic of 2009 was a “quadruple-reassortant virus” made up of swine, avian and human flu genes. Over 60 million people got sick between April 2009-2010, and almost 12,500 people died.

State officials say proactive preparation has enabled quick detection of human avian flu infections in farmworkers with exposure to infected dairy cows. Those efforts — concentrated in California’s Central Valley — are leveraging what public health officials learned from an avian flu tabletop simulation earlier this summer and Covid lessons learned even earlier than that.

“Once we first heard about what’s happening in Texas and dairy herds in other states, and knowing we’re a large dairy state, we activated sort of an instant management team early,” California State Epidemiologist Dr. Erica Pan said in an interview, referring to the first infections in dairy herds that officials traced back to the Texas panhandle.

Anyone testing positive is being offered antivirals, and so are their close contacts, who are also told to monitor for symptoms for 10 days. If any develop symptoms, CDPH recommends they be tested for bird flu. So far, cases have all been mild, with most experiencing conjunctivitis, also known as pink eye.

The state has repeatedly warned that it expects more cases to be detected in individuals who work with infected dairy cattle.

“[The cases] represent the tip of an iceberg and a massive risk and game of chicken we are playing with this virus,” said Mina, who advocated for broad testing at the start of the Covid-19 pandemic. “The only problem is that we are likely on the losing end. We still have done exceedingly little around surveillance testing and diagnostic testing so we don’t know how frequently it is spreading to humans or among humans.”

Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health, also argued that too little information is being provided about human avian flu infections.

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“I’ve been very frustrated that we haven’t had crucial details like the date of symptom onset and the date they were actually tested,” Nuzzo said. “These are outbreak standard data to report, but they’re not being reported, and the absence of these data make it really hard to understand what’s going on.”

In California, the response has been divided into human and animal health, with agriculture departments taking the lead on testing milk to find infected herds, then flagging those farms to public health officials who look for infected people, according to interviews with four public health departments in the Central Valley.

“California is doing bulk testing, so I think they’re identifying a lot of herds through aggressive disease surveillance, and I think identifying infected herds is allowing them to better identify human cases,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security who was a founding associate director of the CDC’s Center for Forecasting and Outbreak Analytics.

In the meantime, until the extra doses of seasonal flu vaccines arrive, dairy-producing counties are pushing vaccines in their regularly scheduled seasonal flu outreach, setting up walk-up clinics at the Kern County swap meet or contracting with mobile health clinics in Tulare to visit farms.

“Because of Covid-19 we had relationships established with our dairy industry partners, we did outreach of Covid vaccines with the local dairy cooperatives in Tulare County because we wanted to get farm workers vaccinated for Covid,” said Carrie Monteiro, a spokesperson for the Tulare County Health and Human Services Agency. “So we had those relationships established, which proved to be beneficial for us.”

There’s no statistics yet on how well this outreach is working, as the counties don’t keep occupational data on who is getting shots. Overall, Californians are getting vaccinated against flu at the same rate as last year, said Brian Micek, a spokesperson with CDPH.

Since the beginning of the outbreak in dairy cattle, some farmers have expressed reluctance to allow public health officials onto their farms to conduct testing and surveillance. USDA requires farmers to test lactating dairy cattle before crossing state lines, and offers financial support to farmers who lose milk production from sick animals. But tight margins in the dairy industry and limited federal support for impacted farms mean that farmers may be less inclined to test.

USDA’s voluntary bulk milk testing program has enabled some states and farmers to comply with federal testing regulations and conduct additional surveillance, but just 64 herds have enrolled and just three in California.

“The Department does not believe mandatory bulk milk testing is necessary at this time,” wrote USDA spokesperson Will Clement in a statement. “Since the beginning of this outbreak, USDA has been working closely with states, and if requested, working with states to help them implement testing programs.”

The Food and Drug Administration plans to beef up milk testing later this month, deploying a separate study across participating states to discern how far the virus has spread.

California’s bulk milk testing, required by the state “where there is elevated risk of the disease,” has contributed to the state’s high caseload and the state has plans to continue expanding its testing, according to Steve Lyle, a spokesperson for the California Department of Food and Agriculture. The state is currently testing more than 350 dairies with a combined total of more than 1 million cattle.

“California is the largest dairy state in the nation, and we’re implementing a scale of testing that hasn’t been employed previously in any other state,” wrote Lyle in a statement.

On the human health side, the state has tried to lean into preparation, relying on lessons learned and technology developed during Covid-19.

The state has around 700,000 doses of antivirals in the state stockpile, and sent doses to 18 local health departments ahead of the outbreak. Some of those doses are going to the close contacts of infected workers to take prophylactically so they don’t get sick too.

Local health departments are using CalCONNECT, an IT system developed for Covid-19, that consolidates information for local health departments from other systems, like disease surveillance and vaccine registries. Some counties are deploying wastewater surveillance, another Covid-era technology, to keep track of where the virus is showing up, although it’s complicated by the presence of infected wild birds.

The state also reopened a mass procurement system so counties can quickly request more PPE to distribute to farms. A huge part of California’s response has been getting PPE to dairies ahead of outbreaks, especially gloves, goggles and face shields. Tulare County officials, for instance, say they distributed a million pieces of PPE to farms before their first positive case.

Still, experts say more needs to be done for workers, like financial compensation for missed work.

“We probably need to be thinking about ways of supporting our workforce, more than just recommending PPE,” said Dr. Meghan Davis, associate professor at the Johns Hopkins Bloomberg School of Public Health and a veterinarian. “There likely are other things that we need to be thinking about doing to help prevent their exposure.”

With dairy workers traveling between counties and dairy owners operating in multiple jurisdictions, the Central Valley’s dairy producing counties have been trying for a uniform approach.

In August, the six counties sent out a joint advisory to health care providers, telling them what to look for in their dairy worker patients, and reminding them to immediately report cases to local health departments. It’s meant to provide a kind of backstop, if patients or their employers aren’t reporting cases to the health department their doctors will.

It’s important information to get out, because clinicians may not know what they’re dealing with and it could be putting farm workers at risk, said Amy Liebman, chief program officer for workers, environment and climate with the Migrant Clinicians Network.

“The bottom line is we … think that the symptoms are mild, and as a result, we don’t really have the documentation that we need,” she said, noting that workers may not seek care for mild illness. “We’re not testing everybody, and we’re not testing everybody when they have these symptoms, and so I don’t think we really understand the extent of it at all.”

Public health is treading lightly and trying to make it easy for dairy farms to participate and comply. As the state epidemiologist Dr. Erica Pan noted, “There’s a lot of competing priorities as these farms are dealing with their sick cattle.”

Officials are trying to use more social media to get the word out to workers, and texting to check in on people. Gone are the days of “contact tracing,” which carries a lot of Covid-era baggage.

“We’re really framing this as ‘these are health checks for your employees’ and to the workers themselves,” Pan said. “I think we’re kind of getting away from terms like monitoring. These are health checks, this is what we can do to help your workers stay healthy.”

Flu antivirals must be given within days of symptom onset, meaning there is only a small window to administer medicine that could potentially save lives.

“Fortunately, the cases have been mild, but it’s a real gamble to assume that the rest of them will be,” Nuzzo said.

The Florida Department of Health is warning people to avoid contact with floodwaters from Hurricane Milton to prevent exposure to a flesh-eating bacteria that causes life-threatening infections.

Vibrio vulnificus, a bacteria commonly found in warm coastal waters, can cause illness when open wounds are exposed to contaminated water, the Florida Department of Health said in a statement. After heavy rain and flooding, the concentration of this bacteria can rise, especially in brackish (salty) water.[1]
“Because of flooding and storm surges associated with hurricanes, there is a big increase in people who tend to be exposed to floodwaters after these events,” says Craig Baker-Austin, PhD, a senior research scientist at the Centre for Environment, Fisheries, and Aquaculture Sciences in the United Kingdom.

There have been spikes in vibrio infections, called vibriosis, in the wake of several major hurricanes that made landfall in the United States, including Katrina in 2005 and Ian in 2022, Dr. Baker-Austin says. “Milton and Hurricane Helene this year are no different, and I imagine there will be an increase in infections because of people coming into contact with floodwaters.”

How Common Are Vibrio Infections?

Even amid the increased risk posed by hurricanes, vibrio infections are quite rare, says Scott Rivkees, MD, a professor of public health at Brown University in Providence, Rhode Island, and a former state surgeon general and secretary of health in Florida. “Each year in Florida there are millions of people who swim recreationally, and the number of cases per year ranges from 20 to 40.”

Nationwide, there are about 150 to 200 vibrio infections a year, and about 1 in 5 cases are fatal, according to the U.S. Centers for Disease Control and Prevention.[2]
People who have compromised immune systems, liver disease, or open wounds are at higher risk of vibrio infections from exposure to floodwaters.[3]

What Are the Symptoms of Vibrio Infection?

Symptoms of vibrio infection can include:[1]
Diarrhea
Vomiting
Abdominal pain
Fever or chills
Fast or high heart rate
Confusion or disorientation
Anyone with symptoms, especially after exposure to floodwaters, should seek immediate medical attention.

The Florida Health Department offers the following tips to minimize the risk of exposure to vibrio:

Avoid swimming or wading in floodwaters, standing water, seawater, and brackish water, if possible.
Cover open cuts or wounds with waterproof bandages if they could come in contact with floodwaters, standing water, seawater, or brackish water.
Wash skin and any open cuts or wounds thoroughly with soap and clean water after any contact with floodwaters.
The most important thing is to monitor wounds for any sign of inflammation or infection in the first 24 hours after exposure to seawater or floodwaters that may have been contaminated, says Lisa Waidner, PhD, an assistant professor of biology at the University of West Florida in Pensacola.

“Immediate attention is necessary, and it is particularly important to notify the medical provider of the exposure to seawater that may contain vibrio,” Dr. Waidner says. “Medical professionals on the Gulf Coast are generally more aware of the danger of contracting vibriosis, but it is essential for the person who seeks medical attention to make it very clear that they suspect they may have come in contact with seawater, and to mention vibrio as a possible bacterium that they were exposed to before the inflammation began.”
_________________________

Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.

Sources
FDOH Urges Floridians to Avoid Floodwaters and Prevent Exposure to Vibrio Vulnificus. Florida Department of Health. October 8, 2024.
Hughes M et al. Notes From the Field: Severe Vibrio vulnificus Infections During Heat Waves — Three Eastern U.S. States, July–August 2023. Morbidity and Mortality Weekly Report. February 1, 2024.
FDOH Urges Floridians to Avoid Floodwaters and Prevent Exposure to Vibrio Vulnificus. Florida Department of Health. October 8, 2024.

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.

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.

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.

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.

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.”

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.

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.

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.

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.

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.

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.

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.

With the approach of fall and cooler weather across the United States, officials say the risk posed by the H5N1 bird flu virus could rise — and they’re taking steps to prevent the creation of a hybrid flu virus that could more easily infect humans.

Fall and winter months present more opportunities for H5N1 to spread and change since both cows and other flu viruses will be on the move. While most human infections in the current outbreak have been mild and self-limiting, each new host gives the virus a chance to get better at infecting people.

“To be clear, we have no evidence so far that this virus can easily infect human beings or that it can spread between human beings easily in a sustained fashion,” said Dr. Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. “If it did have those abilities, we would be in a pandemic.

“The second we know that someone gave it to someone else relatively easily, that’s a new pandemic, and it will be around the globe, probably in a matter of weeks,” Nuzzo said at a seminar hosted by the Health Coverage Fellowship.

The concern comes as scientists are urgently trying to solve the mystery of how a person in Missouri who had no contact with animals became infected by a type of bird flu.

A newly confirmed human bird flu infection in Missouri is being seen as a sign that the virus could pose a growing threat to humans.

The new case, which the Centers for Disease Control and Prevention and state officials disclosed late last week, is the first bird flu case in the U.S. this year not tied to a known exposure to animals.

The ongoing bird flu outbreak has sickened dairy cattle in herds across 14 states and is known to have sickened 13 workers at U.S. dairy and poultry farms.

The CDC has said for months that the risk from the virus to the general public is low, but that farm workers should take precautions. The apparent emergence of a patient with no known ties to animals is a significant development.

Brown University epidemiology professor Jennifer Nuzzo says she has been concerned about the threat to farm workers, and the new case may expand the threat.

“If it gained the ability to more easily infect humans and spread between humans, we would be in another pandemic,” Nuzzo says.

Many questions about the Missouri case remain unanswered.

Last Friday, the Missouri health department announced a recent human case of bird flu. What’s unsettling about the case is that the patient — hospitalized on August 22 and later released — is the first among 15 people infected in the US who didn’t report having contact with animals. That raises the possibility that the illness has already begun spreading among humans.

It’s not yet clear whether the virus involved is the H5N1 influenza subtype that has infected wild birds, poultry, and dairy cows worldwide since it was first identified in 2020 and raised flags among experts about another potential pandemic. If it is, though, there’s concern about what the Missouri case could represent. “There’s a few steps before this potentially becomes a pandemic threat,” says Nahid Bhadelia, who directs the Boston University Center on Emerging Infectious Diseases. “But I’m a lot more worried about it than I was.”

Bird flu’s threat to most people remains pretty low. Still, here’s what makes this case concerning to experts, and what you can do to keep yourself safe.

What experts are worrying about
The Missouri patient was sick enough to be hospitalized
Since the virus first spread to American dairy cows in January of this year, all 13 of the bird flu cases identified in humans before last Friday caused pretty mild disease — eye redness, otherwise known as conjunctivitis, and in one person, a cough without a fever.

That’s where the latest case is different: The patient was hospitalized, suggesting severe disease. The Missouri health department noted the adult patient “has underlying medical conditions,” but we don’t know their age or other risk factors.

For a flu virus to cause a human pandemic, says Seema Lakdawala, a virologist and flu expert at Emory University, it needs to overcome three hurdles: It must access and replicate efficiently within the respiratory tract to cause disease; it must spread easily from person to person; and it must be novel to our immune systems. If the virus infecting the latest case turns out to be H5N1, the fact the patient was hospitalized suggests this germ is evolving to replicate more efficiently in our airways (and coming closer to overcoming the first hurdle).

Infectious disease experts say many people are not taking the latest Covid-19 wave in the US seriously enough and are not getting vaccinated or using antiviral drugs when sick, despite a summer wave that was larger and came earlier than anticipated.

Epidemiologists are saying that while symptoms of this wave are more mild than earlier strains, the virus remains a threat – particularly for older adults and people with underlying health conditions.

In response, public health officials are urging people to get a booster now – unless they recently had Covid, in which case they should wait three to four months – and to take a rapid test when sick. And if they have Covid, they should ask their doctors about antiviral treatments.

A nurse prepares a booster dose of the Moderna Covid-19 vaccine, Spikevax – a closeup of hands wearing surgical gloves drawing the vaccine from a small bottle into a syringe
Communicate risks of not getting Covid vaccine to boost uptake, study suggests
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“There is a ton of Covid out there,” said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at the Brown University School of Public Health. “If you’re experiencing any kind of symptoms, test yourself because you might benefit from getting medicine. At the very least, you can learn that you’re infected and stay home so you don’t give it to other people.”

Notably, the Covid viral activity in wastewater in August in the United States was almost twice as high as the same time last year and about the same as the peak of summer 2023, according to Centers for Disease Control and Prevention data. Still, hospitalizations and deaths are a fraction of what they were in 2022.

Updated COVID-19 vaccines are now available: They’re meant to give you the best protection against the strain of the virus that is making people severely sick now and even causing deaths.

Many people were infected during the persistent summer wave, which may leave you wondering when you should get the updated vaccine. The short answer is that it depends on when you last got infected or vaccinated and on your particular level of risk.

We heard from six experts—including medical doctors and epidemiologists—about when they recommend getting an updated vaccine. Read on to learn what they said. And to make it easy, check out the flowchart below.

It’s been about five months since the Texas Department of State Health Services announced that a worker on a dairy farm had tested positive for avian influenza A (H5N1) virus after being exposed to apparently infected cattle. Since then, the U.S. public health response has been slow and disjointed, bringing back memories of how the federal government responded during the early phase of the Covid-19 pandemic.

Despite having a pandemic playbook in early 2020, the U.S. appeared flat-footed in its response to Covid-19, including inadequate testing and unavailable personal protective equipment. And throughout the pandemic, mixed messaging on masks and later vaccines set back public health efforts.

As H5N1 circulates, it seems that lessons from Covid-19 remain unlearned. It appears that missteps are being made regarding testing, surveillance, transparency, and failure of communication and coordination throughout the health care system, the same kinds of things that hurt the response to Covid-19.

“The World Health Organization,” according to NPR, “considers the virus a public health concern because of its potential to cause a pandemic.” What may be concerning is that the genetic sequence of the Spanish flu that killed between 50 and 100 million people from 1918 to 1919 was later found to be an H1N1 virus that originated in birds and then somehow adapted to humans. And based on confirmed cases, the case fatality rate could be as high as 50 percent, as over the past two decades roughly half of about 900 people around the globe known to have contracted bird flu died from it. (There are two caveats, however: Due to limited testing, there were likely more cases that were undetected which would lower the mortality rate. And in the last two years, the global case fatality rate seems to have decreased.)

As of Aug. 30, the U.S. Department of Agriculture reports that 196 dairy cow herds in 14 U.S. states have confirmed cases of avian influenza.

COVID-19 hasn’t gone away, and data from the Centers for Disease Control and Prevention suggests it’s on the upswing around the country.

“We’ve seen these summer increases every summer that COVID-19 has been with us,” said Dr. Amesh Adalja, a Johns Hopkins University infectious disease physician. “What’s different about these cases this summer vs. prior summers is that they don’t translate into hospitals in crisis.”

Adalja said factors in the seasonal increase could be increased travel, people staying indoors to avoid summer heat and the virus’ continued evolution – which could help it get around people’s immunity.

Testing for COVID-19 is sporadic and the true number of cases isn’t clear because many infections aren’t reported. But one way to spot trends is to see what percentage of lab tests come back positive. By that metric, COVID-19 is surging.

As of 28 July 2024, a total of 14,250 cases of mpox (2,745 confirmed; 11,505 suspected) and 456 deaths have been recorded in 10 African countries, including Burundi, Cameroon, Central African Republic, Congo-Brazzaville, Democratic Republic of Congo (DRC), Ghana, Liberia, Nigeria, Rwanda and South Africa.

The DRC outbreak, ongoing since 2022, accounts for more than 90% of the reported cases of severe mpox clade 1b. This year, the DRC identified 13,791 cases, with children under 15 accounting for 68% of cases and 85% of deaths.

Four countries – Burundi, Kenya, Rwanda and Uganda – previously unaffected by mpox, have reported cases since mid-July 2024 (at least 50 confirmed cases, with clade 1b now confirmed in Kenya, Rwanda and Uganda).

There is a vaccine that is effective against both clades, but it is not widely available. The resources to contain and avoid this unfolding crisis exist but must be brought to bear to contain the outbreak with the greatest urgency possible.

This zoonotic virus, endemic to the forested regions of east, central and west Africa, has shown increased human-to-human transmission, including by way of sexual transmission, which deviates from the historically zoonotic (animal) nature of the disease.

Kenya’s Ministry of Health confirmed an outbreak of mpox clade 1b on 29 July 2024, originating from a traveller moving through Uganda and Rwanda. The development underscored the urgent need for enhanced public health measures across east Africa, as the high mobility of populations through key transport corridors poses a significant risk for regional transmission.

Four years after SARS-CoV2 sparked a devastating global pandemic, U.S. health officials now consider COVID-19 an endemic disease.

"At this point, COVID-19 can be described as endemic throughout the world," Aron Hall, the deputy director for science at the CDC's coronavirus and other respiratory viruses division, told NPR in an interview.

That means, essentially, that COVID is here to stay in predictable ways.

The classification doesn't change any official recommendations or guidelines for how people should respond to the virus. But the categorization does acknowledge that the SARS-CoV2 virus that causes COVID will continue to circulate and cause illness indefinitely, underscoring the importance of people getting vaccinated and taking other steps to reduce their risk for the foreseeable future.

There’s no way to put a price on the pain and suffering prevented by childhood vaccines. But as it turns out, you can pinpoint the savings to the country.

For nearly three decades, childhood vaccines — including those that target measles, tetanus and diphtheria — have saved the United States $540 billion in health care costs, according to a new report from the Centers for Disease Control and Prevention.

Routine childhood vaccinations have prevented approximately 508 million cases of illness, 32 million hospitalizations and 1,129,000 deaths, the agency estimated on Thursday.

“These vaccine programs, when you create the right infrastructure to implement them, they pay for themselves right away,” said William Padula, a health economist at the University of Southern California who was not involved in the new research.

The savings estimate includes money that would have been spent on treating the initial infection and managing later, related conditions. The figure dwarfs the cost of developing the shots.

But vaccine-preventable illnesses can also cause indirect economic effects if children become permanently disabled from an infection, or parents miss work while caring for their sick children.

When factoring in those costs, the C.D.C. bumped the estimated savings to $2.7 trillion.

Dr. Padula said those figures are on par with savings from medical breakthroughs like curing hepatitis C, or major pieces of public health legislation like the Clean Air Act.

Despite the considerable health and economic benefits, attitudes toward childhood vaccines are shifting. A Gallup poll published earlier this week found that just 40 percent of Americans think it’s important for children to get vaccinated, down from about 64 percent in 2001.

How Dangerous is Avian Flu, Officially Known as “Highly pathogenic avian influenza A H5N1 clade 2.3.4.4b genotype B3.13.”?

Dr. Jennifer Nuzzo, a senior fellow for global health at the Council on Foreign Relations (CFR), and Dr. Rick Bright, former CEO of the Pandemic Prevention Institute at the Rockefeller Foundation and director of the Biomedical Advanced Research and Development Authority (BARDA) recently discussed the growing risk of avian influenza spreading in North America among poultry, dairy cows – and a small number of farm workers in direct contact with infected animals.

Dr. Nuzzo reminds us that this disease, called Highly Pathogenic Avian Influenza (HPAI) influenza virus H5N1, is a closely related strain of the H1N1 influenza A virus that infected an estimated 500 million people worldwide during the Spanish Flu pandemic of 1918-1920 – resulting in an estimated 17 to 50 million people dying from the virus

BIRD FLU CHECK-IN — More cows and humans continue to test positive for avian influenza, but the CDC maintains that the risk to the public remains low.

We checked in with several infectious disease experts to learn more about what the recent outbreak at poultry farms in Colorado means for the U.S. response to the virus.

There have been several infections at two poultry farms in Colorado. What should the public take away from these cases?

Jennifer Nuzzo, a professor of epidemiology and director of the Pandemic Center at Brown University School of Public Health: “The number of cases that we’re seeing in Colorado, and the involvement of a large number of people with symptoms at the same time at multiple farms, screams at us that this virus is not going away — that this is becoming a recurring hazard for farmworkers.”

For nearly four months, the spread of bird flu in the nation’s dairy cattle has stoked fears that, if left unchecked, the virus could eventually unleash a pandemic.

The recent cluster of human cases connected to poultry farms in Colorado only underscores that the threat remains real.

Genetic sequencing of the virus collected from the sickened poultry workers closely resembles what’s circulating in dairy herds, suggesting that cattle somehow introduced the virus into the poultry flock.

At one massive poultry facility, workers culled the birds under particularly dangerous circumstances.

The outdoor temperature flirted with 100 degrees and heat advisories blanketed the region earlier this month as workers arrived at a commercial poultry operation in Weld County to start killing chickens.

Of the 1.8 million egg-laying hens inside the operation’s barns, at least some were infected with highly pathogenic avian influenza — bird flu. The strain of the virus that is now circling the globe has shown a remarkable ability to infect all kinds of animals, from seals to skunks to mountain lions. But it spreads most rapidly and lethally in wild birds and domestic poultry.

When a commercial flock is infected, standard practice is grim but efficient: Kill all the birds at the farm, devastating one operation in the hopes of stopping the virus and sparing the rest of the industry. By the time the workers in Weld County were done, though, some discovered that the virus had survived at least for one infection longer. It had found a new host: Their own bodies.

JUST HOW deadly is the H5N1 avian flu? The virus, which is currently sweeping through U.S. dairy herds, rarely jumps to human beings, at least for now. But when it does the consequences can be grave: The World Health Organization reports that 52 percent of people known to be infected with H5N1 have died from the disease.

The figure has been widely cited in academic papers, public health communications, and media reports, where it can provoke apocalyptic visions. “Bird flu pandemic could be ‘100 times worse’ than COVID,” claimed one New York Post headline. An article in The Guardian leads with the WHO’s “enormous concern” about the spread of H5N1, which, according to one lead scientist quoted, has an “‘extraordinarily high” human mortality rate.

The Race to Protect Condors Against Bird Flu

The actual picture, while still alarming, is more complicated. The WHO’s H5N1 mortality figure, an average of wildly different death rates from past outbreaks, doesn’t factor in mild cases that went undetected. Even less certain is how lethal H5N1 would be if it evolves to spread not just from animals to humans, but also from person to person.

The first step in combating any infectious disease outbreak is detection. Without widespread testing, health officials have little sense of who is infected, when to treat patients and how to monitor their close contacts.

In that sense, the bird flu outbreak plaguing the nation’s dairy farms is spreading virtually unobserved.

As of Monday, the virus had infected 157 herds in 13 states. But while officials have tested thousands of cows and are monitoring hundreds of farmworkers, only about 60 people have been tested for bird flu.

Officials do not have the authority to compel workers to get tested, and there is no way for workers to test themselves. In the current outbreak, just four dairy workers and five poultry workers have tested positive for H5N1, the bird flu virus, but experts believe that many more have been infected.