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CDC - Clinician Update on Human Cases of H5N1 and Influenza A Virus Surveillance (COCA Call, May 06, 2025)

Pathfinder

Pathfinder

Editor, Senior Moderator
May 6, 2025

Clinician Update on Human Cases of H5N1 and Influenza A Virus Surveillance

At a glance


During this COCA Call, presenters will give updates on the current situation with human cases of influenza A(H5) and CDC's surveillance and monitoring efforts for influenza A virus infections among people in the United States.

Overview


The Centers for Disease Control and Prevention (CDC) continues to emphasize the importance of ongoing surveillance to detect human infections with highly pathogenic avian influenza A(H5N1) virus or H5N1 bird flu. From 2022 to mid-April 2025, 71 human cases of influenza A(H5) were identified in the United States, including 70 occurring during 2024 and 2025. Most human cases reported unprotected workplace exposures, such as contact with avian influenza A(H5N1) virus-infected dairy cows or poultry without using recommended personal protective equipment; however, two cases involved exposure to backyard poultry, and the source of exposures in three cases could not be determined. Given the pandemic risk posed by novel influenza A viruses, including avian influenza A(H5N1) viruses, healthcare providers should remain alert to the possibility of human infections with novel influenza A viruses, particularly if a patient has relevant exposure history.

During this COCA Call, presenters will give updates on the current situation with human cases of influenza A(H5) in the United States and CDC's surveillance and monitoring efforts for influenza A virus infections among people in the United States. The discussion will emphasize what is expected of state and local partners and clinicians during the summer months when seasonal influenza virus circulation is typically low.

Presenters


Tim Uyeki, MD, MPH, MPP
Chief Medical Officer
Influenza Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

Alicia Budd, MPH
Team Lead, National Surveillance and Outbreak Response Team
Epidemiology and Prevention Branch
Influenza Division
National Center for Immunization and Respiratory Diseases
Centers for Disease Control and Prevention

Call Objectives

COCA Call Objectives


At the conclusion of the session, the participant will be able to accomplish the following:
  1. Cite background information on the topic covered during the presentation.
  2. Discuss CDC's role in the topic covered during the presentation.
  3. Describe the topic's implications for clinicians.
  4. Discuss concerns and/or issues related to preparedness for and/or response to urgent public health threats.
  5. Promote health improvement, wellness, and disease prevention in cooperation with patients, communities, at-risk populations, and other members of an interprofessional team of healthcare providers.
Activity-specific Objectives
  1. Provide an update on human infections with avian influenza A(H5N1) viruses in the United States.
  2. Discuss CDC's surveillance and monitoring efforts for avian influenza A(H5N1) virus infections in people.
  3. Outline the public health implications of avian influenza A(H5N1) virus in animals and the importance of early detection of human infections and control measures.
  4. Describe expectations for summertime influenza surveillance activities in the United States, including collecting and testing recommended clinical specimens for influenza viruses, subtyping influenza A positive specimens, and submitting influenza A(H5) positive specimens to CDC.
Additional Resources
...
​https://www.cdc.gov/coca/hcp/trainings/h5n1_influenza_a_virus_surveillance.html
 
H5N1 Bird Flu Cases Have Slowed in Animals and People

— However, CDC researchers recommend continued surveillance

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today
May 6, 2025 • 3 min read

Detections of H5N1 avian influenza have slowed in both animals and humans, but continued surveillance is warranted, CDC researchers said.

In dairy cattle, cases surged over the fall and early winter but eased in January, while cases in poultry flocks fell after February, and came down last month in backyard flocks, according to data on CDC's website that was shared during a clinician outreach and communication activity (COCA) call on Tuesday.

"Most of our human cases are known to be associated with animal exposures, so fewer infections in the animals leads to fewer infections in people," Alicia Budd, MPH, team lead of the national surveillance and outbreak response team at the National Center for Immunization and Respiratory Diseases (NCIRD), said during the call.

"It's certainly great to see these declines in both animal and human cases, but it's also critical that we maintain targeted monitoring and our general surveillance, so that if this situation changes, we'd be able to identify that quickly," Budd added.

During the question and answer session of the call, someone questioned whether there was seasonality to H5N1, and whether that may be tied to the lull in cases.

Todd Davis, PhD, chief of the virology, surveillance, and diagnosis branch at NCIRD, said any seasonality noted in other countries "primarily corresponds to migratory bird patterns."

"It's quite different from seasonality for human influenza viruses, in that the distribution of the virus among wild birds tends to follow migratory patterns, so we expect to see more circulation of H5N1 in wild birds in the fall and early winter as birds are migrating south," Davis said.
...
https://www.medpagetoday.com/infectiousdisease/birdflu/115454
 
I have to wonder if less cases in animals, birds, humans, is real or not. Is it a lack of proper surveillance/testing or a real lessening?
 
Centers for Disease Control and Prevention Office of Communications

Clinician Update on Human Cases of H5N1 and Influenza A Virus Surveillance

Clinician Outreach and Communication Activity (COCA) Call

Tuesday, May 6, 2025


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https://www.cdc.gov/coca/media/pdfs/2025/COCA-Call-Slides_05.06.2025.pdf
 
Transcript of the Clinician Outreach and Communication Activity (COCA) Call​

Excerpt:
Thank you very much. And as we were at time, we have time for just one last question. And the

question asks, what are your recommendations for isolation for patients that are confirmed H5N1,

but are exhibiting mild illness?

Right, thank you for that question. So, if the patient is mild, has mild illness, does not require

hospital admission, we do recommend isolation at home, so that would be ideally it depends on

the characteristics of the home, but ideally in a separate room with a separate caregiver who when

they have contact, both the patient is wearing a face mask for source control, and the caregiver is

wearing a recommended face mask. We do recommend N95 for respirator or equal. And then

ideally gloves and with frequent hand hygiene for both the patient as well as the caregiver. So, in

those situations, both the patient needs to be monitored closely for potential worsening clinical

progression, and the household members are recommended to receive Oseltamivir post exposure

prophylaxis.

So, that's a treatment dosing twice daily for five days, but ongoing exposures, you would extend the

Oseltamivir dosing. And then there are situations where it may not be possible, practically possible

to isolate that mildly ill person in a separate room. And so I think that you have to do as much as

possible, given the situation, social distancing as much as possible, hand hygiene, source control

by the patient with a face mask and respirator by the household members, if possible, when they

have to be in somewhat close contact. But everybody should be monitored for potential symptoms

in those who have been exposed, and then worsening of symptoms in the patient. Over.
​
https://www.cdc.gov/coca/media/pdfs/2025/COCA-Call-Transcript_05.06.2025.pdf
 
​Hat tip to Commonground

​More from the PDF transcript link posted above:

We are very pleased to have with us Dr. Tim Uyeki, who is the Chief Medical Officer of the Influenza Division in the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention. And Miss Alicia Budd, who is the Team Lead of the National Surveillance and Outbreak Response Team in the Epidemiology and Prevention Branch at CDC's National Center for Immunization and Respiratory Diseases. It is now my pleasure to turn it over to Dr. Uyeki. Dr. Uyeki, please proceed.
...
As I mentioned before, we've had no cases attributed to consumption of raw milk or to
consumption of products made from raw milk, but it remains a theoretical concern. I would also
say that any animal anywhere in the world that is infected with highly pathogenic avian influenza
A(H5N1) virus, poses a transmission risk to a person who is in direct and close contact with that
animal.

Then there have been historically a small number of cases that probably were acquired through
limited non sustained human to human transmission. And this has occurred through prolonged
exposure to a symptomatic H5N1 patient without any protection. So, for example, a family member
taking care of a very sick patient at home before that patient was admitted to the hospital, this has
also occurred in some hospital settings through unprotected prolonged exposure. This is not
through very short casual contact, but this is through many hours of very close prolonged exposure
to a symptomatic patient who's coughing. And the last known event of non-sustained limited
human- to-human transmission was last reported in 2007. But it is always a concern. And that is
why every single human case of H5N1 virus infection needs to be investigated epidemiologically,
virologically, to see if there are any changes that it may have occurred that suggest an increase in
transmission to humans and among people. Next slide.
...
We all know that there are seasonal flu epidemics every winter. But flu viruses are also circulating in
the summer, albeit at much lower levels. But during the summer, we have seen flu cause outbreaks
at camps, on cruise ships, during sorority rush, just to name a few circumstances. But the other
thing that goes on in the summer is it's agricultural fair season. And so that's a perfect environment
for animals and people to interact with each other, and potentially share flu viruses.

So, we always want to be thinking about novel flu viruses in the summer. We always want to be
thinking about just, you know, these sort of combined living environments, like summer camps,
cruise ships, things like that. That's our routine summer. And then on top of that, we continue to
have this ongoing situation of H5 infections in animals. So, now more than ever we really need your
help to make sure that flu testing occurs throughout the summer, especially important for
symptomatic people who have a recent history of relevant exposures, who have participated in
communal activities and settings like camps, and people who are severely ill.

So, what you can do to help with this is, you know, be aware and think flu, even though it's summer,
and make sure you're evaluating your patients accordingly. Talk to patients about their exposures
and their risk. Collect specimens when it's warranted. And facilitate subtyping of flu A positive
specimens, either in the clinical setting, if it's possible, or by notifying your state or local public
health department if you have a patient is one of these categories, either that you've tried to
subtype the virus and it wouldn't subtype as a human, H1 or H3, or if you have a patient who's flu A
positive and has one of these relevant exposures, or is severely ill. Any of these situations needs to
be investigated further to determine what virus might be causing the illness. And, if warranted, you
know, dig deeper, do investigation into particular exposures and contacts so that public health
action can be taken quickly. Next slide, please.
...​
 

COCA Call Clinician Update on Human Cases of H5N1 and Influenza A Virus Surveillance 5.06.25
...
13 May 2025

During this COCA Call, presenters will give updates on the current situation with human cases of influenza A(H5) and CDC's surveillance and monitoring efforts for influenza A virus infections among people in the United States.

This video can also be viewed at
​https://www.cdc.gov/coca/media/videos...​
 
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