Two candidate #H5N1 vaccines but they’re based on strains from 4 years ago

Small lots of both candidates are available; 10 million doses can be produced within weeks, 125 million within 4 months

Issues include potential for rapid changes in virus (reassortment w/in a host like…

Not sure why this is surprising. The constitutional authority for public health rests with the states. States invite CDC when they WANT help, not necessarily when they NEED it. Federal funding is often a big incentive. Right now there are no incentives. politico.com/news/2024/05/0…

“We haven’t found a dairy farm that is interested in participating,” said Lara Anton, a spokesperson for the Texas Department of State Health Services.

Substantial rise in mpox cases prompts NYC health alert

Officials also urged health providers to watch for possible clade 1 cases in people with travel history or epidemiological connections to African outbreak locations.

ow.ly/WZax50Rxzy6

A few points about the H5N1 outbreak that I'd like to share.

1. If we had a pan-influenza wastewater screen in place nationally that differentiates the influenza sources by sequencing (which isn't that hard to do), we probably would have detected this outbreak months ago.
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Working urgent care shifts now, with many coming in with likely run-of-the-mill respiratory infections but important to be asking about animal/farm exposures. Nonetheless relying on subjective history alone is bound to miss potential cases but it’s the best we can do right now…

All the reports about farmers & farms not wanting to cooperate with testing should be further evidence that a public health system that is fundamentally reactive will not be built on the strong foundations that need to be there before a spillover happens.

“In late March 2024, an adult dairy farm worker had onset of redness and discomfort in the right eye. On presentation that day, subconjunctival hemorrhage and thin, serous drainage were noted in the right eye…” #H5N1

nejm.org/doi/full/10.10…

'To date, 36 herds in nine states have tested positive for the virus, though it is believed that many more have experienced outbreaks but have not been tested. Both the U.S. Department of Agriculture and the CDC have acknowledged that farmers have often refused to cooperate with…

Interview with the CDC's influenza division director on #H5N1

'Have any states invited CDC in?'

'No. Not officially yet. We’re speaking to these partners if not once a day, more than that.'

statnews.com/2024/05/03/bir…

New paper on #mpox in DR Congo—> high number of cases among female sex workers
“The findings from this cohort suggest increased risk of transmission associated with heterosexual (92%) and homosexual transmission (4%), with women largely affected.”

thelancet.com/journals/lanin…

New: USDA scientists find that the H5N1 avian influenza entered cattle from wild birds via a single spillover, likely in December 2023.

(From a preprint analysis of thousands of viral genomes, including 220 from US cattle)

statnews.com/2024/05/02/bir…

The challenges of testing on farms/ with farmers speaks to how far behind our public health system is. When you come to people only when you need something from them, which may also appear to be a threat to their livelihood, they logically would resist.

.FDA says pasteurization does appear to kill #H5N1 #birdflu in milk, and sour cream and cottage cheese too. Megan Molteni reports. statnews.com/2024/05/01/bir…

“Although the US Food and Drug Administration has indicated the commercial milk supply remains safe, the detection of influenza virus in unpasteurized bovine milk is a concern because of potential cross-species transmission.”

wwwnc.cdc.gov/eid/article/30…

On some recent urgent care shifts I've seen (as always) many run-of-the mill upper respiratory infections that don't have a confirmed microbiologic cause. As clinicians, we can ask about farm exposures but I doubt most patients, if any, will answer 'yes' to coming into contact…

Here are the clinical and epidemiologic criteria for testing people for #H5N1

Notably, epi criteria is if they have close exposure to birds or other animals with *confirmed infection*

These criteria inherently will leave us playing catch-up on human spillovers if/when they…

Detection of #H5N1 viral RNA in milk supply is an important finding, even if there is no live virus in culture attempts (per what has been reported). Supposedly only milk from healthy animals is supposed to be processed for human consumption. As some have mentioned, this suggests…

Detection of #H5N1 from wastewater treatment plants

'At two of the wastewater plants, industrial discharges containing animal waste, including milk byproducts, were permitted to discharge into sewers.'

medrxiv.org/content/10.110…