On September 6, the Missouri Department of Health announced that it had recently confirmed a novel case. Unlike its counterpart, this instance stood out due to the individual’s explicit denial of any animal contact, significantly increasing the likelihood that human-to-human transmission was already underway.
The Centers for Disease Control and Prevention quietly released updated information on September 13 regarding the situation, revealing two additional potential cases of chicken flu infection in individuals who had close contact with the initial patient. According to public health guidelines, a close family member of the afflicted individual contracted the illness with similar symptoms on the same day as the initial case, but was not tested and has subsequently made a full recovery. The second case involved a healthcare worker who initially presented with mild symptoms and tested negative for the flu.
According to the Centers for Disease Control and Prevention’s press briefing on September 11, data at the time indicated that none of the close family contacts of those affected by the outbreak had developed symptoms, as reported just a day prior. Confusion surrounding mixed signals has sparked concern about the scarcity of clear information in US public health announcements.
Uncertainty surrounds the initial decision by the Centers for Disease Control and Prevention (CDC) to withhold knowledge about a patient’s medical history: The Missouri Department of Health has chosen not to solicit the CDC’s assistance in its investigation of the case, a common practice among states that typically control what patient data they share with the CDC during outbreaks.
During a press briefing, CDC officials revealed that while the virus’s subtype was unlikely to be identified, genetic analysis confirmed its “strong association” with a strain circulating among dairy cattle, raising concerns among experts about the potential for another pandemic. According to Dr. Jennifer Nuzzo, Director of the Boston College Center for Emerging Infectious Diseases, “Just a few more steps and this undoubtedly becomes a pandemic risk.” (Early September) I’m far more apprehensive about this now than I was in the past.
According to CDC officials, the first confirmed case exhibited significant comorbidities, with symptoms including chest pain, nausea, vomiting, diarrhoea, and lethargy – manifestations more commonly associated with gastrointestinal illnesses rather than typical influenza cases.
The risk of contracting chicken flu remains relatively low for the majority of people. Despite the challenges, here’s what sets this situation apart for experts, and how you can safeguard yourself accordingly?
A healthcare professional confirmed that a Missouri resident required hospitalization due to their illness.
Since the virus first emerged among American dairy cows in January this year, all 13 reported human cases of avian influenza detected prior to last Friday were linked to symptoms including eye redness, also known as conjunctivitis, with one individual additionally experiencing a cough but no fever.
The preliminary Missouri case stands out distinctly in that regard: the individual requiring hospitalization, indicating severe illness. The Missouri Department of Health and Senior Services has publicly disclosed that the adult patient had underlying medical conditions, although the exact age and other risk factors remain unknown.
According to Dr. [Name], a virologist and flu expert at Emory College, a flu virus must clear three key barriers to spark a human pandemic: first, it must efficiently enter and replicate throughout the respiratory tract to cause illness; second, it must spread easily from person to person; and third, it should be novel enough to evade our immune systems. As the latest case indicates a suspected H5N1 infection, it’s crucial to note that hospitalization of the patient implies the virus is adapting to replicate more efficiently within human airways, potentially bridging the gap to overcome the primary transmission barrier.
It’s unclear how the individual from Missouri contracted the infection.
All earlier US human H5N1 cases had one thing in common: they were linked to contact with contaminated farmed poultry or dairy herds. This case appears to lack a functional link.
While in-person transmission via casual contact – like between people standing side by side on a bus – has not been documented with this virus, it can be far more concerning.
Without apparent transmission to an infected animal, concerns arise that H5N1 may also spread through alternative routes – such as consumption of raw milk or, more significantly, human-to-human transmission, potentially leading to a much larger outbreak if not contained.
While sporadic cases of transmission have occurred between family members or from a sick individual to healthcare staff in the context of H5N1 infections in the past, such events have not been sustainable, according to Dr. [Name], an epidemiologist and director of Brown University’s Pandemic Center at the School of Public Health. These additional circumstances reported on September 13 categorically fit within these distinct groupings. Despite the lack of official reports, there’s concern that casual, in-person interactions – like those that occur when people stand next to each other on a bus – haven’t been linked to this virus, but could potentially be even more concerning.
Building informal connections could pave the way to surmounting the second major obstacle in combatting a pandemic – namely, sustaining person-to-person transmission. “When the last major flu pandemic struck in 2009, its global spread was unprecedented, with the virus reaching every corner of the world within just a few days,” says Nuzzo.
The detection of a flu-like illness in a Missouri resident, who subsequently required hospitalization, serves as an encouraging indication of the virus’s presence within the state. While Nuzzo notes she doesn’t anticipate a vast, unseen iceberg in the market, she emphasizes that more detailed information about the situation would alleviate concerns among herself and other experts.
Transmission through uncooked milk could potentially pose a significant risk to public health. While most US milk supplies undergo pasteurization – a process that heats milk to an extremely high temperature, effectively killing off bacteria and viruses – roughly one in every 100 people surveyed in the late 2010s admitted they still consumed unpasteurized dairy products. During a September 12 briefing, CDC Principal Deputy Director Nirav Shah noted that the individual involved had no recorded history of consuming raw dairy products.
Two weeks transpired between the individual’s hospitalization and the authorities’ notification regarding the incident.
The prolonged pause in flu surveillance, according to Nuzzo, implies that the US has not yet activated its sensitive detection system capable of rapidly identifying H5N1 influenza cases in individuals exhibiting symptoms such as fever, cough, muscular aches, and other flu-like manifestations.
Given the abundance of in-person interactions, enabling this system to detect unfolding events earlier – potentially even before they escalate and become uncontainable – could prove crucial in halting their progression. Without effective system control, however, transmission among people can quickly spiral out of control before vaccines and drugs proven to mitigate severe flu symptoms and curb transmission have a chance to take effect.
The prolonged delay preceding the announcement of the two distinct scenarios has instilled additional anxiety, with Nuzzo highlighting in a subsequent email that the scarcity of information surrounding these circumstances is particularly unsettling. “I am deeply concerned that the family contact was not thoroughly investigated… and that public health authorities have failed to disclose the exact dates when the hospitalized individual and healthcare worker were tested.” “These normalised reports provide crucial insights into evaluating whether this virus was transmitted between individuals.”
It’s unclear just how widespread infections are on many US dairy farms.
On dairy farms, an additional risk of infection exists not only among the cattle but also amongst those who work closely with them, further increasing the likelihood of transmission; concurrently, this raises the possibility of alternative mutations emerging for H5N1 to evolve into a highly contagious virus between humans.
Despite the risks, many states rely heavily on farmers to voluntarily report any infections affecting their livestock? Across the agricultural sector, widespread skepticism towards presidential actions and concerns about public health have led to a reluctance among farms to implement checks, which cannot be enforced until state agencies explicitly require them. “If state public health agencies are unwilling to take proactive measures and state governors fail to acknowledge the severity of the ongoing outbreak, which poses a significant public health concern, we will be left without crucial data,” Lakdwalas states.
Although chicken flu has been confined to poultry farms in Missouri without any recorded instances on dairy farms, this does not necessarily mean it is absent from the latter, notes Nuzzo. Without widespread testing and reporting, farmers are unlikely to detect instances of COVID-19 among their staff or cattle.
As we continue to navigate the aftermath of COVID-19, many people are left wondering: Are we truly prepared to face another global health crisis? The answer is a resounding no.
As experts warn, widespread skepticism towards institutions would pose formidable hurdles if another airborne pandemic were to occur. To successfully navigate the current crisis, it is crucial to take immediate action and work collaboratively towards finding a solution, according to Lakdawala. To mitigate the risk of disease transmission in high-risk dairy farm environments, proactive measures are crucial, including implementing strict biosecurity protocols and maintaining a reserve of vaccines tailored to the specific needs of susceptible animals.
As winter approaches, the highly contagious seasonal flu virus will likely begin spreading rapidly across the United States in just a matter of months.
When animals are co-infected with distinct influenza viruses simultaneously, they may act as a “mixing bowl” for the viruses, allowing them to swap genetic material. The emergence of these new viruses could lead to the development of more transmissible, severe, and unprecedented strains that are unfamiliar to the human immune system.
To get H5N1 virus closer to overcoming Lakdawala’s third obstacle would necessitate further refinement. According to Nuzzo, there’s no necessity for these two viruses to engage in gene swapping.
To minimize an already relatively low level of risk.
The presence of each H5N1 episode in humans sparks a case study, according to Nuzzo, highlighting the potential risks for individuals working in poultry and dairy farming industries. Individuals who are immunized against seasonal influenza are significantly less likely to serve as a conduit for the emergence of novel and potentially catastrophic strains of the virus, thereby reducing the risk of a pandemic.
Concerns over H5N1 virus outbreaks: The Centers for Disease Control and Prevention (CDC) reported in April that 14% of raw milk products from American farms tested positive for the highly pathogenic avian influenza subtype H5N1, a figure that may escalate as more farms are impacted. While drinking raw milk has never been entirely safe, the risk has increased substantially; adhering to pasteurized dairy products remains a much safer option, according to Nuzzo.
Forestall dangerous contact with cattle
As autumn arrives, rural communities often host farm festivals, providing opportunities to interact with animals that may unknowingly carry asymptomatic cases of the H5N1 virus, according to Lakdawala. “Don’t get caught up with animals,” advises Lakdawala, “and make sure to wash your hands frequently throughout and after visiting any farm.” When working in a dairy farm or a veterinarian’s office, wear personal protective equipment (PPE) that includes a face shield and other protective gear as recommended by the Centers for Disease Control and Prevention (CDC) to safeguard yourself against potential splashes.
Protect yourself against life-threatening diseases.
According to Bhadelia, individuals often respond with only two emotional settings when considering their risk of contracting an emerging infection: “low risk” or “oh my god.” However, it’s more practical to view risk as a spectrum, and on that scale, Covid-19 and mpox currently pose a significantly greater threat to most people than H5N1.
To avoid falling ill, experts recommend getting vaccinated by autumn, wearing face masks in crowded areas, and opting for outdoor gatherings instead of indoor events. If you would benefit from an investment, consider getting one.
While it may seem primarily the responsibility of public officials and farmers to worry about avian influenza. For the sake of the ultimate survivors, it’s crucial to control what can be controlled, advises Nuzzo. “Worrying isn’t a protecting motion.”
