US - Human H5N1 bird flu case confirmed in Missouri - September 06, 2024+

[Pathfinder]

September 06, 2024

Human H5 bird flu case confirmed in Missouri


Media Contact:
Lisa Cox
Missouri Department of Health and Senior Services


JEFFERSON CITY, MO — The Centers for Disease Control and Prevention (CDC) has confirmed a human case of avian influenza A (H5) (“H5 bird flu”) detected by the Missouri Department of Health and Senior Services (DHSS), the first human case detected in Missouri. The risk of sustained transmission or infection among the general public remains low.

The case was identified through DHSS’ ongoing influenza surveillance program. The Missouri State Public Health Laboratory was sent a specimen from a patient who was hospitalized on Aug. 22. The adult patient has underlying medical conditions and tested positive for influenza A. The patient has reported no exposure to animals. The patient has recovered and was discharged home. To ensure patient privacy is maintained, no additional patient information will be provided.

As part of the normal influenza surveillance testing program, the Missouri State Public Health Laboratory conducted additional testing to determine the influenza subtype. This resulted in the presumptive detection of the H5 subtype. The specimen was forwarded to CDC for additional testing and was confirmed as H5 subtype of flu, also known as a bird flu, or avian flu. Additional virus characterization is underway at CDC.

H5 is primarily found in wild birds and poultry, and recently in dairy cows and other animals, and can occasionally infect humans through close contact with infected animals or contaminated environments. This is the fifteenth human case of H5 reported in the U.S. since 2022 (fourteenth this year). No H5 infection in dairy cattle has been reported in Missouri; some H5 cases in commercial or backyard flocks and wild birds have been reported.

Nationally, this is the first case of H5 that has been detected as part of the flu surveillance system, rather than the targeted H5-outbreak specific surveillance that has been conducted as part of ongoing animal outbreaks which has identified all the other cases. Missouri’s flu surveillance system involves a collaborative partnership between clinical laboratories, Missouri health care providers, local public health agencies and the Missouri State Public Health Laboratory. DHSS continues to closely monitor available data from influenza surveillance systems, and there has been no sign of unusual influenza activity in people, including no increase in emergency room visits for influenza and no increase in laboratory detection of human influenza cases in Missouri.


###
https://health.mo.gov/news/newsitem/...ed-in-missouri

[Pathfinder]

CDC Confirms Human H5 Bird Flu Case in Missouri

STATEMENT

For immediate release: September 6, 2024
CDC Media Relations
(404) 639-3286
media@cdc.gov

September 6, 2024 -- CDC has confirmed a human case of avian influenza A(H5) ("H5 bird flu") reported by the state of Missouri. The case was identified through that state's seasonal flu surveillance system. The specimen was forwarded to CDC for confirmatory testing per usual protocols and confirmed yesterday. An investigation into the potential exposure is ongoing by the Missouri Department of Health and Senior Services (DHSS).

Case Information

Missouri DHSS reports that the patient, who was hospitalized, had underlying medical conditions, was treated with influenza antiviral medications, subsequently discharged, and has recovered. There is no immediate known animal exposure. No ongoing transmission among close contacts or otherwise has been identified.

This is the 14^th human case of H5 reported in the United States during 2024 and the first case of H5 without a known occupational exposure to sick or infected animals. H5 outbreaks in cattle have not been reported in Missouri, but outbreaks of H5 have been reported in commercial and backyard poultry flocks in 2024. H5N1 bird flu has been detected in wild birds in that state in the past.

While other novel flu cases have been detected through the country's national flu surveillance system, this is the first time that system has detected a case of H5. Targeted H5-outbreak specific surveillance has been conducted as part of ongoing animal outbreaks and has identified all the other cases. In this case, the specimen from the patient originally tested positive for flu A, but negative for seasonal flu A virus subtypes. That finding triggers additional testing.

CDC continues to closely monitor available data from influenza surveillance systems, particularly in affected states, and there has been no sign of unusual influenza activity in people, including in Missouri.

Identification of the neuraminidase (the "N") in the patient specimen is pending further sequencing. Attempts to sequence the genome of the virus also are underway at CDC.

Based on available data, CDC's current assessment is that the risk to the general public from H5N1 remains low. CDC's recommendations related to H5 virus have not changed at this time. As always, circumstances may change quickly as more information is learned. The results of this investigation will be particularly important in light of the current lack of an obvious animal exposure. It is important to note that, while rare, there have been novel influenza A cases where an animal source cannot be identified. The main concern in these situations is that no onward transmission is occurring. Findings from the ongoing investigation will inform whether guidance changes are needed.

...

https://www.cdc.gov/media/releases/2024/s0906-birdflu-case-missouri.html

[sharon sanders]

We count 16 total US cases because we count the two cases described in a research paper. link

FluTrackers 2016+ Global H5N1 Human Cases List

[sharon sanders]

Please see:

Missouri - Cole County - CDC website tracks health factors for communities - August 30, 2024

[Shiloh]

Source: https://www.nbcnews.com/health/healt...now-rcna170010

Person infected with bird flu in Missouri had no contact with animals
The case adds to growing anxiety about the risk of the H5 virus spreading among humans.

Sept. 6, 2024, 6:22 PM EDT
By Berkeley Lovelace Jr.

A person in Missouri has been infected with bird flu, the Centers for Disease Control and Prevention said Friday. The adult, who didn't have known contact with poultry or dairy cows, was hospitalized on Aug. 22 and has recovered.

The case adds to growing anxiety about the risk of bird flu spreading among humans, especially since this is the first infection in a person in the U.S. who didn't work with poultry or dairy cows.

The CDC said the risk among the general public remains low....

[Pathfinder]

First human case of Avian Flu (H5N1) confirmed in Missouri

The City of St. Louis Department of Health is encouraging extra vigilance and safety precautions

September 10, 2024 | 2 min reading time

With the recent confirmation of Missouri’s first human case of H5N1 Avian Flu [www.cdc.gov] confirmed by the Department of Health and Senior Services, the City of St. Louis Department of Health is encouraging extra vigilance and safety precautions by residents who own or frequently come into contact with domestic birds, such as chickens and ducks, or wild birds.

Wild birds, including crows and various species of songbirds, are the most prominent carriers of the avian flu virus, and evidence has shown that these animals can spread the disease to humans. If you own a flock of chickens, the Department of Health recommends the following precautions:

• Wear protective gear such as gloves and a facemask when coming into direct contact with the birds or their living environment
• Wash hands thoroughly with soap and warm water for at least 20 seconds after handling the animals or items belonging to them
• Keep other animals such as dogs or cats away from the birds
• Report deceased birds that recently suffered an illness to the Missouri Division of Animal Health at (573) 751-3377 or animal.health@mda.mo.gov. Carefully wrap the bird in a plastic bag so that it can be submitted for laboratory testing

Avian flu is most commonly transmitted by direct contact with animals that carry it, whether or not they are displaying symptoms of illness. It is very rare for the disease to be transmitted from person to person.

Household pets, primarily cats, are particularly susceptible to avian flu because of predation of wild birds. If you notice your cat or dog suddenly developing respiratory symptoms, contact your vet immediately - a quick response increases the animal’s chance for recovery and your vet will want to confirm or rule out avian flu.

If you find a deceased wild bird in your yard, place it in a sealed plastic bag for disposal. The department strongly recommends wearing a face mask and gloves when handling deceased birds and washing your hands for at least 20 seconds afterward.

For more information, reach out to the Department of Health at (314) 612-5100 or health@stlouis-mo.gov.

https://www.stlouis-mo.gov/government/departments/health/news/first-human-bird-flu-case-missouri.cfm

[sharon sanders]

Alexander Tin
@Alexander_Tin


An update on probe of Missouri human case of H5 bird flu that
@CDCgov
confirmed last week Spokesperson for state health department says: "All contacts remained asymptomatic throughout the observation period." https://tinalexander.github.io/notes/2024/09#missouri-spokesperson-on-testing-of-h5-case

[sharon sanders]

Alexander Tin
@Alexander_Tin


At meeting this week,
@NIAIDNews
's
@DrJeanneM
said of recent bird flu case in Missouri: - "quite nervous" about case - "predisposition to pulmonary infection" - no contact to anything "remotely" tied to H5N1 -
@CDCgov
can't sequence much because high CT https://tinalexander.github.io/notes/2024/09#niaid-director-on-bird-flu-case-in-missouri…

[sharon sanders]

Alexander Tin
@Alexander_Tin


At meeting this week,
@NIAIDNews
's
@DrJeanneM
said of recent bird flu case in Missouri: - "quite nervous" about case - "predisposition to pulmonary infection" - no contact to anything "remotely" tied to H5N1 -
@CDCgov
can't sequence much because high CT https://tinalexander.github.io/notes/2024/09#niaid-director-on-bird-flu-case-in-missouri…

From the above link -



September 11, 2024

NIAID director on bird flu case in Missouri

• Source: recording
• Attribution: meeting of the National Institute of Allergy and Infectious Diseases Advisory Council
• Date: aired September 9, 2024

Jeanne Marrazzo, NIAID [00:28:31]

We heard that there was another case of H5N1 in Missouri.

I’m actually quite nervous about that case. I think that, from what we know, as you probably heard in the news, this case had no known link to exposure to H5N1.

It was a person with underlying predisposition to pulmonary infection, but no contact to anything that could remotely be linked back to a likelihood of H5N1 exposure.

The CDC, I was on a call this morning, is continuing to try to sequence the relative relevant parts of what they got.

Unfortunately, the CT value for the isolate that was retrieved was 38. So they’re really not gonna be able to probably assemble very much of the genome.

That said, it’s almost certainly consistent with the bovine strain. So it is not a mistake it’s real.

And you know, there are no herds infected with H5N1 in Missouri, which further contributes I think to the mystery.

…

Jeanne Marrazzo, NIAID [00:29:58]

It’ll be interesting to see now that birds are migrating back from the Arctic, what their situation is.

It looks like the mortality rate in migrating birds has probably leveled off a bit, which gives us some hope.

I think that they’re not gonna be perhaps as contagious, perhaps, we don’t really know, maybe that’ll decrease the likelihood of a spill over event. We really don’t know.

…

Jeanne Marrazzo, NIAID [00:45:40]

I can tell you the H5N1, I do have more details, some I can’t share, but I will say that if there was suspicion of human to human transmission, the threat level would be elevated considerably.

So there is at this time, no evidence to suggest human to human transmission.

But that is of course our worst fear, because once you go there, then obviously all bets are off.

[Commonground]

Weekly U.S. Influenza Surveillance Report

Updated September 13, 2024
Excerpt:

Novel Influenza A Virus:


One new human infection with a novel influenza A virus was reported by the Missouri Department of Health and Senior Services. The patient was infected with an influenza A(H5) virus.

The patient is >18 years and has multiple underlying medical conditions. The patient developed symptoms during the week ending August 24, 2024, was hospitalized, and has since recovered. A respiratory specimen collected from the patient tested positive for influenza A at the hospital. The specimen was then forwarded to the Missouri State Public Health Laboratory (MSPHL) with the Department of Health and Senior Services as part of routine influenza surveillance. CDC confirmed the infection was caused by an influenza A (H5) virus. A subsequent investigation by state and local public health officials did not find any known direct or indirect contact with wild birds, domestic poultry, cattle (including no consumption of raw dairy products), or other wildlife prior to the patient’s illness onset. One close contact of the patient was also ill at the same time, was not tested, and has since recovered.

During the 2023-2024 influenza season, a total of 14 cases of human infection with influenza A (H5) virus have been reported in the United States. Four of these occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Seven variant influenza virus cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v virus), for a total of 20 novel influenza A virus cases reported this season.

Information about avian influenza is available at https://www.cdc.gov/flu/avianflu/index.htm.

[sharon sanders]

Helen Branswell
@HelenBranswell
·
39m


The plot thickens: @CDCgov says a close contact of the Missouri
#H5 #birdflu case was sick at the same time but wasn't tested.
Not clear why that info wasn't shared Thurs during an hour-long
press briefing when CDC said Missouri was looking like a "one-off" case.
https://statnews.com/2024/09/13/h5n1-bird-flu-missouri-close-contact-cdc/



FluTrackers.com
@FluTrackers
·
32s


This is 100% accurate reporting.

[sharon sanders]

My informal notes from the HHS media event on September 12, 2024

These are unbiased notes. No politics, religion, messaging slant, product bias, etc.
Edited today for typos and format. I made a few comments while I was taking the notes as indicated.


Jeff - Moderator doing introductions.....

Dr. Shah from CDC:

Missouri human case:
14th confirmed case
initially identified by Missouri - chest pain, diarrhea, weakness - has significan co-morbidities, recovered and released.
case investigation - interviewing case to find out possible source - not found source yet.... not unusual...
characterizing dna sequence....low viral load....have not been able to get Na info
show H5 virus close to that of dairy cows
is this case a one-off? right now indicated as a one-off (Wishful thinking. s.s.)
no increase of flu visits to hospitals or other indicators
Missouri state was on top of the situation since the H5 presumptive test came in

Seasonal flu shots to ag workers:
focused on states with + dairy herds
will start giving shots in October

CDC efforts to create tests with commercial labs:
1st $ awards to several labs including Quest....working with them on:
test design and development
rfp to be sent this week for more work
new arrangement to move more testing to these labs
CDC will pay these labs to do the testing in an emergency - cutting the red tape with insurers
add the commercial labs to the CDC team - that changes today



Dr. Deeble - USDA:

USDA can confirm 8 California dairy herds H5N1
1st 3 herds have same strain as in other states
addition 5 herds to be sequenced by this weekend
all affected premises are quarantined
USDA working with Calif. offering help

Bovine H5N1 vaccine....on Aug 28th asked for peeps to participate in field safety trial...
non- viable vaccine, no shedding, expect project ideas in the next several weeks


------------------------------------------------------------------


technical problem in question and answer period....

other moderator placed herself on mute by accident....ok now.....


Reuters - Has Missouri invited CDC to do on the ground investigations? When was case identified?

Ans. CDC not invited on ground. Phone assistance. Closely connected daily. Some of the dates are confidential. Admitted to hospital on Aug. 22


NY Times - Flu incidental? Hospital for the flu or other reasons?

Ans. Not incidental. Can't really give private health info. Was hospitalized due to the H5 symptoms not other conditions. Also added vomiting as a symptom.


Washington Post - Has H2H been ruled out?

Ans. So far no signs of H2H. No contacts have H5N1.



AP - Serology results? Are you expecting more "one-offs"?

Ans. Discussed getting blood serum.....on the table to detect anti-bodies....Missouri is ready to do this when the case consents....

Ans. Animals and human contact raises the risk and there can be more cases....as more species get H5 (What! - like all of them already? s.s.)



Helen Braswell - Can you determine reassort if can't get Na? Has raw milk been ruled out as source? Any understanding how virus got to CA?

Ans. So far this case has not said drank any raw milk.

Ans. Still working on trying to get Na. Without a full sequence there will be a limit to genetic data.

Ans. Very closely related to other herds in 1st 3 herds....not genetically changed to show transmission by migratory birds for example. Increasingly complex how and when introduced to Calif.



NBC news - Sept.6 announcement - why info delayed? How determine a "one-off"

Ans. Do see a case who had significant underlying conditions. Other peeps in same situation may have not shown any symptoms. No contants infected. No peeps in area with symptoms. Investigation is not over.

Ans. Timeline - CDC released info on Fri. Got data on Wed. Tested on Thursday. Delay caused by being found through general surveillance. Hospital batches flu samples and sent to state lab....doing regular surveillance....



CNN - Was patient tested before or after antiviral? $$$ to labs amount?

Ans. Patient tested in a normal course based on symptoms and underlying medical condition. Got tamiflu. Missouri would have to answer this. Prob not something that will be disclosed. Follow the state's lead.

Ans. 5 million. Can get to 118 million in the next 5 years. Depends on any emergency happening.



Bloomberg - What happens if H2N happens - what CDC actions will happen? Oropouche question.

Ans. Orapouche - Want the labs to also be ready - a preparedness effort.

Ans. Don't want to spec. Do think about the "what-ifs". There would be a number of things to consider if H2H....who is the risk group? Any high degree of H2H then look at anti-viral as preventative.....if really ramps up....then vaccine gets major consideration.....


Medical Pulse? Don't know these peeps....Asking sequence data....

Ans. 8 herds in Calif can be as low as 1 cow. Count the entire herd.


Someone else who talked over the moderator during intro..Karen?....asked a bunch of case questions....

Ans. Can't answer particulars....

Ans. Respiratory symptoms are not the prominent symptoms.

Ans. There is some data that animals have some cross immunity from other flu. (What? s.s) Do not expect this in humans. Do not want to message this.



ABC News - H2H confirmation process? Risk?

Ans. Contact tracing is the lynch pin. Line up their exposures. May have flu from the same aquired source. Look at congregate settings....schools...etc. Put a puzzle together. Same process with any pathogen.

Ans. Continue to assess risk to general pop. to be low. Looking for indicators like increasing severity....continuously look at risk



CBS News - Update on H5N1 human vaccines? Missouri patient and contacts cooperating? What is questionaire like? Ruled out all the sources?

Ans. Have pre-filled syringes, and have pre-fill ready to go - cleared company testing...in stockpile...not approved by FDA.

Ans. The case is cooperative. Questionaire extremely detailed....asks where have you gone, what have you eaten....domestic animals..wild animals exposures....goes deep on meat from a variety of sources....

Ans. Keep going deeper to find answers....doing that now...."that's where we are".....no overt exposure known....



STR - don't know this peep - How is cow spread being prevented?

Ans. Rate of spead seems to have slowed considerably....comfortable with affected states..do not know how Calif herds got infected. Calif peeps are good and working on it.


Over.

[sharon sanders]

Rick Bright

@RickABright

Anticipated sequence from human #H5N1 case in
Missouri w/ lack of clear exposure source, just released by
@CDCFlu through @GISAID
[EPI_ISL_19413343]. Clade 2.3.4.4b,
similar to dairy cattle H5N1 virus. Sample collected 8/22/24,
sequence took over 3 weeks to release!

Source of infection investigation ongoing, but very interesting to
see HA sequence relation to Texas dairy cow in April.

H/t @HealthyLivingMO @cdcflu for sharing data. https://gisaid.org/resources/gisaid-in-the-news/highly-pathogenic-avian-influenza-outbreak-in-the-united-states/…

4:26 PM · Sep 13, 2024
·

[sharon sanders]

Raj Rajnarayanan
@RajlabN
·
52s


#H5N1 updates Quick analysis of the sequence from the human #H5N1 case
HA mutations: L120M, L131Q, P152S, *A172T*, T211I, V226A, I526V
Reference: A/Astrakhan/3212/2020

[Michael Coston]

CDC FluView Update On Missouri H5 Case Adds An Important Detail


Credit CDC


#18,295


Details on Missouri's H5 case have been slow in coming, and yesterday the CDC revealed that sequencing of the virus was not going well, and a full genomic analysis (including sub-typing) may not be possible.

Today, the CDC published a small update in their weekly FluView report which carried a previously undisclosed tidbit; that a second person (in contact with the identified case) was ill, but was not tested for the virus.

Why we are just learning about this now, more than a week after the initial report, is unclear.

Hopefully serological studies will be performed (assuming the contact is willing) to see if that illness was from an H5 infection. These types of studies must usually wait until several weeks after the illness, for peak antibody detection.

First the statement (emphasis mine), after which I'll have a postscript.

Novel Influenza A Virus:

One new human infection with a novel influenza A virus was reported by the Missouri Department of Health and Senior Services. The patient was infected with an influenza A(H5) virus.

The patient is >18 years and has multiple underlying medical conditions. The patient developed symptoms during the week ending August 24, 2024, was hospitalized, and has since recovered. A respiratory specimen collected from the patient tested positive for influenza A at the hospital. The specimen was then forwarded to the Missouri State Public Health Laboratory (MSPHL) with the Department of Health and Senior Services as part of routine influenza surveillance. CDC confirmed the infection was caused by an influenza A (H5) virus. A subsequent investigation by state and local public health officials did not find any known direct or indirect contact with wild birds, domestic poultry, cattle (including no consumption of raw dairy products), or other wildlife prior to the patient’s illness onset. One close contact of the patient was also ill at the same time, was not tested, and has since recovered.

During the 2023-2024 influenza season, a total of 14 cases of human infection with influenza A (H5) virus have been reported in the United States. Four of these occurred in individuals working with dairy cows, nine in individuals associated with poultry depopulation and disposal, and one in an individual with an unknown source of exposure. An ongoing outbreak of H5N1 continues in domestic dairy cows and poultry, and monitoring for additional human cases is ongoing.

Seven variant influenza virus cases were also reported during the 2023-2024 season (four A(H1N2)v, two A(H3N2)v, and one A(H1N1)v virus), for a total of 20 novel influenza A virus cases reported this season.

Information about avian influenza is available at https://www.cdc.gov/flu/avianflu/index.htm.

Interim recommendations for Prevention, Monitoring, and Public Health Investigations are available at https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html.

The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, backyard or hobbyist flocks, and mammals in the United States are available from the USDA athttps://www.aphis.usda.gov/aphis/ourfocus/animalhealth/animal-disease-information/avian/avian-influenza/2022-hpai.

Additional information on influenza in swine, variant influenza virus infection in humans, and guidance to interact safely with swine can be found at www.cdc.gov/flu/swineflu/index.htm.

I won't make any assumptions about who is responsible for the decision to slow-roll the release of this important detail - since it could have occurred at the local, state or federal level - but it does little to inspire confidence in the investigation or the agencies involved.

For six months, we've seen HPAI H5 treated as more of an economic or political problem, than a potential public health concern, and that should give everyone pause.

If things go badly, and the HPAI H5 threat escalates, public health are going to need the trust and support of an already pandemic-weary and skeptical public.

And public trust is an asset that is far-too-easily squandered by trying to `manage' the facts.

https://afludiary.blogspot.com/2024/09/cdc-fluview-update-on-missouri-h5-case.html