Zoonotic Bird Flu News from 17 Feb till 23 Feb 2023

Flu experts gather with H5N1 risk on the agenda [Reuters.com, 23 Feb 2023]

By Jennifer Rigby

LONDON, Feb 24 (Reuters) - The world's leading experts on influenza met this week to discuss the threat posed to humans by a strain of H5N1 avian flu that has caused record numbers of bird deaths around the world in recent months.

The group of scientists, regulators and vaccine manufacturers meets twice a year to decide which strain of seasonal flu to include in the vaccine for the coming winter season, in this case for the northern hemisphere.

It is also a chance to discuss the risk of animal viruses spilling over to humans and causing a pandemic. At this week's meeting, H5N1 clade 2.3.4.4b was a key topic, the World Health Organization (WHO) and global flu experts told Reuters.

"We are more prepared (than for COVID), but even if we are more prepared, we are not yet prepared enough," Sylvie Briand, WHO director of global infectious hazard preparedness, said ahead of the meeting. "We need to really continue the efforts for a flu pandemic."

Briand in a briefing after the meeting said that the recent rise in cases in birds and mammals was "worrying" and that the agency was working with Cambodia after two confirmed human cases of H5N1 were found in one family there. They are trying to determine if the family members were exposed to the virus through the environment - such as exposure to birds or other mammals - or if there was human-to-human transmission.

Disease experts have raised the idea that the virus would need to change for it to be conducive to human transmission.

Experts have been tracking H5N1 clade 2.3.4.4b since it emerged in 2020 and recent reports of mass deaths in infected mammals from seals to bears, as well as potential mammal-to-mammal transmission on a Spanish mink farm last year, have raised concern.

However, there have been very few human cases, and the WHO currently assesses the threat to humans as low.

"This is a natural experiment playing out in front of us, and I don't think we are complacent," said Nicola Lewis, director of the WHO Collaborating Centre on Influenza at the Crick Institute in London. Speaking before the meeting, she said it would include assessments of the situation worldwide.

Experts also discussed potential vaccine development.

WHO-affiliated labs already hold two flu virus strains that are closely related to the circulating H5N1 virus, which could be used by vaccine manufacturers to create a human vaccine if needed. One of them was added after the previous WHO flu meeting in September 2022, and the experts decided at this week's meeting to add another subtype that more closely matches the virus spreading among animals.

A number of companies that produce seasonal flu vaccines can also make pandemic flu vaccines. For example, GSK and CSL Seqirus are already working with the United States Biomedical Advanced Research and Develop

ment Authority (BARDA) to test shots based on one of the closely related strains.

Having these strains ready could save about two months in the development of a vaccine, said the WHO's Briand. But getting enough vaccine developed quickly would still remain a challenge in a pandemic situation, the experts said.

Bird flu death in Cambodia: How worried should we be about H5N1 spilling over into humans? [Euronews, 24 Feb 2023]

By Giulia Carbonaro

An 11-year-old girl has died from bird flu in Cambodia’s first known human case of H5N1 since 2014, according to health officials, who said her father had also been infected.

Bird flu, also known as avian influenza, normally spreads in poultry and wasn’t deemed a threat to people until a 1997 outbreak in Hong Kong.

Most human cases around the world have involved direct contact with infected poultry, but cases have recently been recorded in various mammals, reviving fears the virus could mutate to spread more easily to humans.

WHO concerns about bird flu
The girl from the rural southeastern province of Prey Veng became ill on February 16 and was sent to hospital in the capital Phnom Penh. She was diagnosed on Wednesday after suffering a fever up to 39 C with coughing and throat pain and died shortly afterward, the health ministry said.

Symptoms of H5N1 infection are similar to that of other flus, including cough, aches and fever. In serious cases, patients can develop life-threatening pneumonia.

Earlier this month, WHO Director-General Tedros Adhanom Ghebreyesus voiced concern about bird flu infections in mammals including minks, otters, foxes and sea lions.

“H5N1 has spread widely in wild birds and poultry for 25 years, but the recent spillover to mammals needs to be monitored closely,” he warned.

He advised people not to touch dead or sick wild animals and called on countries to strengthen their surveillance of settings where people and animals interact.

The WHO still assesses the risk from bird flu to humans as low, he added.

“But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he said.

In a very concrete way, the spread of what scientists have confirmed is the world's worst bird flu outbreak - which has now been unfolding for over a year - is already affecting us.

The disease is one of the contributing factors making both poultry meat and eggs more expensive, together with the lingering impact of COVID-related disruptions and the Russian invasion of Ukraine.

Overall, the outbreak is exacerbating the cost of living crisis, disrupting food supply chains and forcing the culling of millions of poultry destined to end up on the shelves of our grocery retailers.

Is bird flu getting worse?
One of the biggest concerns for humans is also that the rampaging bird flu could enter territories previously uncharted - including mutating into the next pandemic.

"The situation is unprecedented. Last winter we had the worst outbreak of highly pathogenic avian influenza in the UK. This year is on track to equal or beat that", Professor Paul Digard, Chair of Virology at the University of Edinburgh, told Euronews Next.

"It's unprecedented because of the number of those infection numbers that have occurred in poultry and because of the infections that we've seen in wild birds as well, particularly seabirds", he continued.

"The other thing that's changed is that normally, in northern Europe and the UK, we get sporadic incursions of high pathogenic avian flu in the winter, but then they disappear over the summer.

“Last summer, it never entirely went away, it died down quite a lot, but it never fully went away. So the virus has changed its behaviour in ways that we've not seen before in this part of the world".

While bird flu - or highly pathogenic avian influenza, to be exact - has been around for at least 200 years and probably more, said Digard, outbreaks have become more common.

"The numbers [of outbreaks] have picked up since the 1980s, and then everything changed in 1996-97 when the ancestor of the current virus appeared in Hong Kong," Digard said.

"And that virus was different from all the previous ones in that it could survive in wild birds as a sort of a long-term infection, and that gave it the ability to spread around the world so that that virus or descendants of it have been with us for the last 25 years.

"And the number of outbreaks of that lineage of the virus has been very large indeed. The numbers are higher than they've been in the past. That's probably fair to say".

What's the risk to humans?
"There is a risk to human health, but at the moment I would say it's low", said Digard.

During the 1997 outbreak, 18 people got infected with bird flu, and six died.

"It was a rare infection in humans, but when it did happen, it had roughly a 50 per cent case fatality rate", said Digard.

Until at least the early to mid-2010s, the situation stayed the same, said Digard, with very rare cases of human infections but causing severe illness in those who contracted the virus.

"Since then the virus has changed, and from the human perspective, it has changed for the better", said Digard. "It seems to be causing far fewer human infections, and when it does infect people, it seems to cause milder disease in most people".

So, the risk to human health is lower than it has been in the past, and there's no need to panic.

"This lineage of the virus has been with us for 25 years and in that time, although it's been able to infect people, it's never shown any signs of really evolving the ability to transmit from person to person, which is what you would need for a major outbreak in humans," said Digard.
But chances are that the virus might change in the future.

Health authorities in the UK are now modelling scenarios to assess what might happen should the virus mutate and spread more aggressively among humans, sparking a new health crisis similar to the COVID-19 pandemic.

"Like COVID, [the bird flu virus] is permanently changing, it never stays still," said Digard.

"You can't say it will never adapt, it'll never change in a way that will cause the next pandemic, but I think it’s very low-risk at the moment," he continued.

"I don't think it's low-risk that we'll get another flu pandemic; I think that's the case of when not if. But my guess would be it's not going to be this strain. It'll be something else that catches us by surprise".

After the outbreak of COVID-19, which is believed to have spilled over from a yet unidentified animal into humans, experts warn that the next pandemic will likely come from another zoonotic disease like coronavirus.

"This is a problem that's grown over the years. But we have become better able to try and head off some of these problems," said Digard.

We have found a way to create vaccines against the flu - including the H5 virus strain - and we are able to produce them on a large scale.

Researchers are getting better at the "social science's side of things, trying to understand the factors that make zoonotic diseases more of a threat, as you get larger numbers of people and more contact between people and food animals and food animals and wild animals," said Digard.

In this context, the way we farm animals for the meat and dairy market is of crucial importance to avoid virus spillovers.

"We can change your security procedures, you can change the way you design farms to reduce the chance of those transmission events happening in the first place".

Human Bird Flu Cases Investigated in Cambodia [The New York Times, 24 Feb 2023]

By Apoorva Mandavilli and Emily Anthes

Two family members were infected with H5N1; the daughter died. Eleven contacts, some with symptoms, have tested negative, according to the W.H.O.

After a father and daughter were diagnosed with bird flu, officials in Cambodia scrambled to test nearly a dozen of their contacts for infection the H5N1 virus, which has been causing mass die-offs of birds worldwide. The daughter, an 11-year-old, has died, but the World Health Organization said on Friday that 11 contacts have so far tested negative for the infection.

Why the concern? While hundreds of human cases have occurred over the years, scientists have become increasingly concerned that the virus one day may become adapted to people.

Any evidence of human-to-human transmission would accelerate worries that a new pandemic could be on the way.

Most experts believe that the cases in Cambodia were likely caused by direct exposure to infected birds. At the moment, the risk to most people remains low, they say.

Cambodia has reported two cases of bird flu infection in people, a father and daughter in a village in Prey Veng Province. The 11-year-old girl died earlier this week.

The cases, the first reported in Cambodia since 2014, raised fears that the virus had acquired the ability to spread among people and may trigger another pandemic. But the World Health Organization said on Friday that 11 contacts of the girl, four of whom have flulike symptoms, had tested negative for infection with the H5N1 flu virus.

The 49-year-old father who has tested positive was not showing any symptoms, according to the Health Ministry. The W.H.O. is working closely with the Cambodian government to determine whether the father and daughter both caught the virus from direct contact with infected birds — the most likely possibility — or whether they infected each other.

Experts noted that there had been hundreds of sporadic cases of H5N1 infection in people since the virus was first identified and that there was no evidence that it had become adapted to humans.

Transmission among people is “very, very rare, versus a common source of infection,” said Richard Webby, a bird flu expert at St. Jude Children’s Research Hospital in Memphis and an adviser to the W.H.O.

But people should take care to avoid contact with wild birds that may be infected, Dr. Webby said.

“The risks from this virus to your average person on the street right now is very low, but it’s not zero,” he said. “And that’s primarily because there’s just so many more infected birds around right now.”

Bird flu, or avian influenza, is a group of flu viruses that are primarily adapted to birds. The particular virus in these new cases, called H5N1, was first identified in 1996 in geese in China, and in people in Hong Kong in 1997.

Since then, there have been nearly a thousand cases in people in 21 countries, but a vast majority have resulted from prolonged, direct contact with birds. H5N1 does not yet seem to have adapted to spread efficiently among people.

“At the end of the day, this is a continuum of the same outbreak that started back in 1996,” said Dr. Malik Peiris, chief of virology at the University of Hong Kong, who has helped oversee responses to several bird flu outbreaks in Southeast Asia. “Really, it never went away.”

H5N1 is typically carried by aquatic birds, such as ducks, that can transmit the virus to domestic poultry via feces, saliva or other secretions.

The current version of the virus has been unusually widespread, causing the largest ever bird outbreaks in Europe and in the United States, affecting 58 million farmed birds in the latter. It is now considered endemic in several countries in Asia and Europe, according to Dr. Webby.

The virus has taken a heavy toll on wild birds too, triggering mass die-offs, and it has been spilling over into mammals, especially scavengers, like foxes, that might feed on infected carcasses.

Any reports of infection in people warrant investigation to confirm that H5N1 has not yet adapted itself to human-to-human transmission. There have been six other cases of H5N1 reported in people since September, according to the W.H.O. The death of the 11-year-old girl this week is Cambodia’s first bird flu death since 2014.

Experts have been closely monitoring H5N1, especially since an outbreak on a Spanish mink farm in October suggested that the virus could spread efficiently among some mammals.

Samples of the virus isolated from the mink carried a genetic mutation that is known to help flu replicate better in mammals.

No human infections were detected. But a mink-adapted version of the virus might be one step closer to efficient transmission among people.

If the version of H5N1 identified in Cambodia were found to be closer to the one seen in Spain than to those in previous Asian outbreaks, scientists would be concerned, Dr. Peiris said. “It is important to try to understand exactly what has gone on” in Cambodia, he added.

The W.H.O. is “updating a bank of vaccine candidate viruses that are suitable for manufacturing, should it be needed,” the agency said in a statement. W.H.O. is also providing antiviral drugs from an available stockpile.

How will scientists know if H5N1 begins spreading among people?
Genetic analysis can reveal whether H5N1 has acquired mutations that help it spread among people.

“That should give us a good hint as to whether or not the virus has really jumped one step further,” said Dr. Shayan Sharif, an avian immunologist at the Ontario Veterinary College at the University of Guelph in Canada.

But it will be more difficult to determine how the two family members were infected in Cambodia. That’s because H5N1 samples from the father and daughter are likely to be nearly identical regardless of whether the virus was acquired from a person or from the same infected birds, Dr. Webby said.

“If both of them were infected from the same set of chickens, they are going to be infected with very similar viruses,” he said. It may be more informative for scientists to chart the path of the virus by examining the nature of the contact among infected people.

Can we prevent the virus from spilling over into humans?
The virus poses the biggest risk to people who are in direct contact with birds, such as poultry farmers. Security measures on farms and poultry processing plants, including the use of personal protective equipment by workers, can help reduce the risks of infection.

To contain local outbreaks, infected flocks are generally culled and farms are put under quarantine. But the virus is now so widespread in birds that experts are beginning to consider whether broader measures, such as the vaccination of poultry, might be needed.

Vaccination has not traditionally been used to control avian influenza in poultry in the United States or Europe. But officials are rethinking that stance, and trials of bird flu vaccines are underway.

“I don’t really think that we should panic at the moment,” Dr. Sharif said. But “as we see all of these various different bits and pieces of the puzzle coming together,” he said, “I believe we need to get really seriously ready for an emergency.”

WHO says avian flu cases in humans ‘worrying’ after girl’s death in Cambodia [The Guardian, 24 Feb 2023]

By George Monbiot

The discovery of two cases of bird flu within the same family in Cambodiahas highlighted the concern over potential human-to-human spread of the virus, although experts have stressed the risk remains low.

On Thursday, Cambodian authorities reported an 11-year-old girl from Prey Veng province had died from H5N1, with subsequent testing of 12 of her contacts revealing that her father also had the virus.

Be warned: the next deadly pandemic is not inevitable, but all the elements are in place

However, it remains unclear whether the two cases were down to human-to-human transmission, or the result of both father and daughter having had close contact with animals infected with H5N1.

The World Health Organization said on Friday that increasing reports of bird flu in humans are “worrying”.

Sylvie Briand, the WHO’s epidemic and pandemic preparedness and prevention director, said the UN agency was in close contact with the Cambodian authorities for updates on the case and on tests of other people who had been in contact with the girl.

“So far, it is too early to know if it’s human-to-human transmission or exposure to the same environmental conditions,” Briand told a virtual press conference hosted in Geneva.

“The global H5N1 situation is worrying given the wide spread of the virus in birds around the world and the increasing reports of cases in mammals including humans,” she added. “WHO takes the risk from this virus seriously and urges heightened vigilance from all countries.”

Earlier this month, the WHO assessed the risk to humans from H5N1 bird flu as low, although its director-general, Dr Tedros Adhanom Ghebreyesus, said the recent spillover to mammals needs to be monitored closely.

“Since H5N1 first emerged in 1996, we have only seen rare and non-sustained transmission of H5N1 to and between humans. But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he said.

H5N1 –– often called bird flu– – is a highly infectious strain of avian influenza A virus that can cause severe respiratory disease and death in birds. While it has caused outbreaks before, the current epidemic has led to the devastation of avian populations around the world, including wild birds and commercial poultry.

The virus has also been known to jump from birds to other animals as well as humans, with the WHO noting that sporadic human cases are not unexpected as a result of exposure to infected poultry or contaminated environments.

Data from the WHO reveals that from January 2003 to 5 January 2023, there have been 868 cases of human infection with avian influenza A(H5N1) virus around the world, 457 of which were fatal. However, only six of these cases, and two deaths, occurred since the start of 2021.

Prof James Wood, head of the department of veterinary medicine at Cambridge University, said that despite the current epidemic in birds, there is no sign of a dramatic rise in cases or deaths in humans.

“There has been massive global challenge of wild and domestic birds with the current H5N1 avian influenza virus over the last few months and years, which will have exposed many humans; despite this, what is remarkable is how few people have been infected,” he said.

“Tragic though this case in Cambodia is, we expect there to be some cases of clinical disease with such a widespread infection. Clearly the virus needs careful monitoring and surveillance to check that it has not mutated or recombined, but the limited numbers of cases of human disease have not increased markedly and this one case in itself does not signal the global situation has suddenly changed,” he added.

Jonathan Ball, professor of molecular virology at the University of Nottingham, added the likelihood of onward human-to-human transmission is very low, but that it is important to monitor circulation of flu in bird and mammal populations and do everything possible to reduce the number of infections seen.

“It also highlights why efforts to develop next-generation cross-reactive vaccines are so important,” he said.

Bird flu kills 11-year-old girl in Cambodia, officials say [ABC News, 23 Feb 2023]

By SOPHENG CHEANG

An 11-year-old girl in Cambodia has died from bird flu in the country’s first known human H5N1 infection since 2014

PHNOM PENH, Cambodia -- An 11-year-old girl in Cambodia has died from bird flu in the country's first known human H5N1 infection since 2014, healthofficials said.

Bird flu, also known as avian influenza, normally spreads in poultry and wasn’t deemed a threat to people until a 1997 outbreak among visitors to live poultry markets in Hong Kong. Most human cases worldwide have involved direct contact with infected poultry, but concerns have arisen recently about infections in a variety of mammals and the possibility the virus could evolve to spread more easily between people.

The girl from the rural southeastern province of Prey Veng became ill Feb. 16 and was sent to be treated at hospital in the capital, Phnom Penh. She was diagnosed Wednesday after suffering a fever up to 39 Celsius (102 Fahrenheit) with coughing and throat pain and died shortly afterward, the Health Ministry said in a statement Wednesday night.

Health officials have taken samples from a dead wild bird at a conservation area near the girl's home, the ministry said in another statement Thursday. It said teams in the area would also warn residents about touching dead and sick birds.

Cambodian Health Minister Mam Bunheng warned that bird flu poses an especially high risk to children who may be feeding or collecting eggs from domesticated poultry, playing with the birds or cleaning their cages.

Symptoms of H5N1 infection are similar to that of other flus, including cough, aches and fever, and in serious cases, patients can develop life-threatening pneumonia.

Cambodia had 56 human cases of H5N1 from 2003 through 2014 and 37 of them were fatal, according to the World Health Organization.

Globally, about 870 human infections and 457 deaths have been reported to the WHO in 21 countries. But the pace has slowed, and there have been about 170 infections and 50 deaths in the last seven years.

WHO Director-General Tedros Adhanom Ghebreyesus earlier this month expressed concern about avian influenza infections in mammals including minks, otters, foxes and sea lions.

“H5N1 has spread widely in wild birds and poultry for 25 years, but the recent spillover to mammals needs to be monitored closely,” he warned.

In January, a 9-year-old girl in Ecuador became the first reported case of human infection in Latin America and the Caribbean. She was treated with antiviral medicine.

Tedros said earlier this month that the WHO still assesses the risk from bird flu to humans as low.

“But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he said. He advised for people not to touch dead or sick wild animals and for countries to strengthen their surveillance of settings where people and animals interact.

New pandemic fears as girl dies as deadly bird flu jumps from mammals to humans [Daily Star, 23 Feb 2023]

By Adam Cailler

Scientists had predicted that a new pandemic could be on the way after bird flu jumped to mammals, and it has now shockingly killed an 11-year-old girl in Cambodia

A girl has died from bird flu, confirming the worst fears of scientists who predicted it could jump from mammals to humans just last month.

The sad death of the 11-year-old was reported in Cambodia earlier today (Thursday, February 23).

The girl first became ill just six days before her death, and suffered from a fever, cough and sore throat.

As a result, the World Health Organization has said: "The recent spillover to mammals needs to be monitored closely."

The news comes just a weeks after we reported that it was found that a deadly strain of the avian bird flu had mutated and can now impact mammals.

Just a year after most of the world came out of a pandemic, news of the new strain of bird flu has sparked fears of a new one after 50 million poultry were slaughtered in Europe in the space of one year.

And scientists had found that the avian flu had been transmitted from wild birds to a group of mink on a farm in the Spanish city of La Coruna.

The study, published on top infectious disease surveillance website Euro Surveillance, stated that the outbreak happened in Spain in October 2022.

It claimed that the coronavirus was passed from farmed minks to humans during the pandemic – and it can happen against with the new strain of avian flu, labelled as HPAI H5N1.

The experts state: “Given the concerns caused by the susceptibility of minks to emerging viruses such as HPAI H5N1 viruses and SARS-CoV-2, it is necessary to strengthen the culture of biosafety and biosecurity in this farming system and promote the implementation of ad hoc surveillance programs for influenza A viruses and other zoonotic pathogens at a global level.”

In response, Dutch virologist Marion Koopmans said humans are now “playing with fire”, while British doctor Jeremy Farrar added: “The greatest risk of a devastating flu pandemic is avian or animal flu that infects intermediate mammals, and evolves to mammal-to-mammal and human-to-human transmission with little or no human immunity.”

Highly pathogenic avian influenza virus from wild goshawks - Utsunomiya [NHK, 22 Feb 2023]

A wild goshawk found dead on the grounds of a house in Utsunomiya City on February 17 has been confirmed to be infected with a highly pathogenic avian influenza virus after detailed genetic testing was conducted.

On the 17th of this month, a wild goshawk was found dead on the grounds of a house in Utsunomiya City, and a simple test conducted by the prefectural government confirmed that it had tested positive for avian influenza.

A more detailed genetic test was conducted at a national research institute in Tsukuba City, Ibaraki Prefecture, and as a result, a highly virulent and highly pathogenic avian influenza virus was detected on March 22.

This is the fifth case of highly pathogenic avian influenza virus being detected in dead wild birds in the prefecture since last December.

The prefectural government is strengthening its surveillance to check for other dead wild birds within a 10-kilometer radius of where the goshawk was found, and is urging people to contact the prefectural government if they find a dead or weakened bird. (translated by M.Y.)

H5N1: Governments should invest in vaccines for all flu strains, says incoming WHO chief scientist [The BMJ, 22 Feb 2023]

By Elisabeth Mahase

Governments around the world should be investing in a H5N1 vaccine and running phase 1 and 2 trials to prepare for a potential outbreak among humans, outgoing Wellcome director Jeremy Farrar has said.

Farrar—who is leaving Wellcome after a decade to become the World Health Organization’s chief scientist later this year—said that in terms of potential pandemic events, H5N1 is a “big worry.”

Speaking at a Wellcome media briefing in which he shared his views on the barriers that science must overcome, Farrar warned that the current situation, whereby H5N1 influenza viruses are being allowed to spread among poultry, wild birds, and mammals, is the perfect way to “create something nasty.”

“If there was an outbreak of H5N1 in humans tomorrow, we wouldn’t be able to vaccinate the world in 2023,” Farrar said, when asked by The BMJ about the current outbreaks in animal populations. “My concern is that we’re in slow motion watching something—which may never happen, but if it were to happen—we would look back on and ask why we didn’t do more.”

Before his time at Wellcome, Farrar spent 18 years in Vietnam where he worked on understanding infectious diseases such as dengue, influenza, malaria, typhoid, and tuberculosis.

Interspecies transmission
While H5N1 viruses have been circulating among birds and poultry in various parts of the world for years, the latest outbreaks have sent warning signals to the scientific community, as the virus has been able to spread to places and species that were previously unreached.

This includes South America, where 10 countries have recorded their first ever cases. Both Argentina and Uruguay have declared national health emergencies after outbreaks. In Peru around 55 000 wild birds have died in coastal nature preserves, as well as around 600 sea lions, while in the US 58 million commercial poultry and backyard flocks have been affected.1
The virus has also reached mammals, invading a mink farm in Spain last October. In a report on the outbreak, researchers warned that mink “could serve as a potential mixing vessel for interspecies transmission among birds, mammals, and humans.”

So far, WHO has said it’s working with manufacturers to ensure that supplies of vaccines and antivirals would be available for global use if needed. It has also advised countries to “strengthen surveillance in settings where humans and farmed or wild animals interact.”

“Prepare for a 1918-like episode”
Farrar said it’s not just H5N1 that governments should be preparing for.

“What I would like to see, which I’m pushing for, is governments investing in vaccines for every single other strain of influenza that exists in the animal kingdom through at least phase 1 and 2 studies. So you know they’re safe, they’re immunogenic, and you know you could manufacture them,” he said.

On the size of the task, he said, “There’s not an unlimited number of influenza strains.” Farrar said it is key to have those vaccines in the bank, with a route to regulation and manufacturing in place. He added that even if H5N1 does not turn into a human pandemic situation this time, these investments would not be a loss.

“If at some point in the future we have a non-human influenza strain that causes a 1918-like episode, these vaccines would exist and you wouldn’t be starting from scratch. So it’s not as if it’s money that’s sunk and is not going to be of benefit,” Farrar said.

On top of investment in research, he has called on governments to improve their domestic security around farms and reduce the wildlife trade.

References
1. Mahase E. H5N1: Do we need to worry about the latest bird flu outbreaks?BMJ2023;380:401.doi:10.1136/bmj.p401 pmid:36801821

BMJ 2023;380:p434

Opinion | Is the United States Ready for Back-to-Back Pandemics? [The New York Times, 22 Feb 2023]

By David Wallace-Wells
Whatever happened to our Roaring Twenties? In the first year of the pandemic, it was common to hear predictions that however brutal and harrowing the near future seemed, the world would find itself, at some point, celebrating the end of Covid-19 — perhaps in a grand bacchanal to recall the dizzying decade that followed the Spanish flu of 1918 and 1919, which killed 675,000 Americans.
But that end never really came, not definitively. That the pandemic is no longer seen as an emergency is obvious; just look outside. But the country didn’t turn the page so much as limp forward, through a fog of exhaustion and loneliness and long Covid, into the dawn of a new period in which the coronavirus has retreated for most as an everyday threat but may well continue as gothic background noise, killing tens of thousands of Americans each year.

Bird Flu Continues: "Three Types of Viruses Invaded This Season" [NHK, 11 Feb 2023]

The National Institute of Agrobiological Sciences (NIAS), a national research institute located in Tsukuba City, Japan, has conducted a detailed investigation of the highly pathogenic avian influenza virus that has been spreading this season, and found that three types of the virus have entered the country.

The National Agricultural Research Institute (NRIRI) is calling for greater vigilance, as it is possible that the virus was brought in by migratory birds and spread over a wide area.

The National Agricultural Research Institute (NARI) conducted a detailed genetic study of 60 cases of highly pathogenic avian influenza that occurred at poultry farms and other facilities nationwide between late October last year and mid-January this year.

Of the 60 cases, 59 were H5N1 and one was H5N2, and as a result of genetic analysis, a total of three types of viruses were detected.

In addition to the two types of viruses identified in Japan last season, one type of virus identified in Western Siberia and Central China last season was newly detected.

This season, highly pathogenic avian influenza viruses have been confirmed in a wide range of areas in Japan, and the number of chickens and other birds destroyed in Ibaraki Prefecture has reached a record high of approximately 4.3 million.

The National Institute of Agrobiological Sciences (NIAS) has stated, "There is a possibility that the virus was brought to Japan by migratory birds and spread widely. We need to be even more vigilant about the possibility of the virus entering farms in the future." The organization is calling for thorough disinfection and inspection of bird nets and other measures to prevent the spread of the virus.

According to the National Agricultural Research Institute (NARI), genetic analysis of the viruses found in various locations revealed that two of the three highly pathogenic avian influenza viruses detected this season were also confirmed in Japan last season.

The first, called "20E," is a virus that is believed to have been spread by migratory birds from Europe to their breeding grounds in Siberia three summers ago, and entered Russia, Italy, Sweden, and other countries in autumn.

The second virus, called "21E," is believed to have been spread by migratory birds that were in Siberia in the summer before last and entered Japan in the fall.

Both viruses are believed to have migrated between Siberia and Europe, and between Siberia and Japan in both directions.

In addition, the virus called "21RC," which was confirmed in Japan for the first time this season, is presumed to have originated from migratory birds that moved from Western Siberia and China to Siberia in the summer of last year.

According to the National Institute of Agrobiological Sciences, the detection of viruses originating from Western Siberia and China has been increasing in Japan this season, and they have been confirmed in a wide range of areas in Japan.

(translated by M.Y.)

An avian flu outbreak is spreading to mammals. What is the risk to humans? [Medical Express, 21 Feb 2023]

by Ben Knight

The latest outbreak is not a cause for alarm in humans at this stage. Credit: Shutterstock.

Avian influenza—or bird flu, as it's commonly known—continues to run through bird populations, killing millions of animals worldwide. Now, a particularly infectious and lethal strain of the virus called H5N1 appears to be spreading to mammals, with cases reported in wild otters, foxes, seals and in farmed minks.

While transmission from an infected bird to another animal is not uncommon, it is unusual for the virus to spread between mammals, as is suspected with the H5N1 outbreak in minks. The virus not only appears to have passed from mink to mink, but in doing so, may have developed genetic mutations which could help it better infect other mammals.

Professor Bill Rawlinson, a virologist from the School of Biomedical Sciences, UNSW Medicine & Health, says the situation remains an issue with animal health but is not a cause for alarm in humans at this stage.

"The worry is a deadly H5N1 strain could mutate in a mammal like a mink and become more adaptable to people, but it doesn't appear we're on the cusp of that at the moment," Prof. Rawlinson says.

While we're still likely several steps away from a human-adapted version of the virus, there may be more chances that people will encounter it.

"The overall risk of contracting it is quite low, but the risk may be slightly higher for those who have close unprotected contact with infected birds and their saliva, mucous, and feces in industries like poultry," Prof. Rawlinson says.

A low, but anticipated threat
Since its emergence in the mid-1990s, scientists and health authorities have worried about the potential of H5N1 to evolve into a pandemic. Still, the threat remains low, and no human-to-human transmission has ever been recorded.

"Avian flu tends not to infect people because it simply can't bind as well in humans, so you're almost certainly not going to be infected by it walking around today in Australia," Prof. Rawlinson says.

However, in the rare instances H5N1 has jumped the species barrier and infected humans, it has been deadly. According to the World Health Organization, over half of the 868 cases of human infection with H5N1 since 2003 have been fatal.

Prof. Rawlinson says the current situation would be more worrying if there were signs the virus was spreading between mammals more genetically similar to humans, such as other primates.

"Pigs would be the other concern as they can be more easily infected with both human and avian flu strains, so may have potential to pass a super strain on to humans," Prof. Rawlinson says.

"Thankfully, that doesn't always seem to be the primary way avian infections cause human infections and hasn't been as much of an issue as we've feared to this point."

Monitoring the risks of animal viruses
Prof. Rawlinson says we should continue with routine preparedness measures in case the virus changes and becomes a more significant threat to human health. This includes strengthening a One Health System, with all health professionals, from doctors and vets to virologists and epidemiologists, working closely together to assess changing risks.

"We should continue sampling and testing wild birds and poultry, which is essential to be on top of any early signals if the situation is changing," Prof. Rawlinson says.

"If you do have regular contact with birds, and you observe sudden unexplained changes, it's essential to talk to a local vet or contact The Ministry of Health, so they can investigate.

"We also need to be on the lookout for people with unexpected, undiagnosed pneumonia-like infections."

Prof. Rawlinson also says it's also essential people get vaccinated for the flu every year, which may reduce the capacity for a person to host, and mix, avian and human strains.

"It's not so much about cross-protection with avian flu, although there may be a small amount.

But by vaccinating against human flu, we're less likely to see a mixing of avian and human flu strains.

"People have been very switched on to vaccination with COVID-19, and that needs to extend to the human flu, especially as we're likely to have another moderate to severe outbreak this year."

Ultimately, Prof. Rawlinson says the virus should warn us about the need to be wary of the increasing presence of zoonotic—animal-derived—diseases in our world.

"There are a range of zoonotic viruses, not just avian flu, that seem to be becoming part of a more regular cycle between animals and humans," Prof. Rawlinson says. "That doesn't mean they will always be a pandemic risk, but we should be continuing to monitor these events and be prepared to respond to any pandemic risk."

Avian flu strain shows transmissibility among mammals [PBS NewsHour, 21 Feb 2023]

By William Brangham & Courtney Norris

A highly contagious avian flu is infecting birds all over the globe. In the U.S., farmers have lost, or had to kill, over 58 million birds to try and prevent the spread of the virus. The H5N1 strain hasn’t caused any serious threat to humans, but outbreaks in some mammals raised concerns about the potential to spread further. Influenza researcher Scott Hensley joined William Brangham to discuss.

Amna Nawaz:
A highly contagious avian flu is infecting birds all over the globe.

Here in the U.S., farmers have lost or had to kill over 58 million birds to try and prevent the virus' spread. So far, this flu hasn't caused any serious threat to humans.

But as William Brangham reports, there are several new outbreaks that are raising some alarm.

William Brangham:
Thanks, Amna.

Over the last two years, the spread of this strain, known as H5N1, has been largely limited to birds. But now two particular outbreaks, one among farmed mink in Spain and another among wild sea lions in Peru, suggests that H5N1 might now be able to spread between mammals.

And that's raised concerns about the virus' potential to spread further and perhaps even make humans sick.

Scott Hensley is a professor of microbiology and an influenza researcher at the University of Pennsylvania.

Scott, thank you so much for being here.

Before we get to the mink and the sea lions, can you just remind us how bad H5N1 is among birds all over the world right now?

Scott Hensley, Penn Institute for Immunology: We have seen H5N1 circulate in birds before.

What makes this current situation unique is how widespread this particular clade of H5N1 virus is spreading. It's not a good time to be a bird today, because this virus has infected wild bird populations. And it's also infected domestic birds all across the world.

And, again, the unique thing about this particular virus is, it is getting into bird populations that we have not seen be infected historically with H5 viruses in the past.

William Brangham:
Yes, I was actually at an avian center in Minnesota several months ago, and we're seeing eagles and owls and raptors of all kinds getting this virus.

But, with regards to this — these cases of the sea lions and the mink, those seem to suggest that the virus is now spreading within mammals. Do you think that that evidence is — do you think that that's what's happening? And, if so, why is that a problem?

Scott Hensley:
Yes, so that's exactly what makes us a little bit nervous.

So, these viruses are obviously very good at attaching to avian cells and getting into bird cells and replicating. We know that because the virus is spreading again very rapidly among birds.

The good news is, is, the virus doesn't appear to be able to replicate in human cells very effectively.

But we have seen cases now, as you just outlined, the virus getting into mink, and there's likely mink-to-mink transmission that have occurred in the situation that we have seen in Spain. And we see the virus spreading to other mammals as well. This is alarming, because what we're afraid is that the virus might start changing. It might undergo acquiring different substitutions that enable better replication in these mammals.

And we're afraid that some of those same substitutions might enable the virus then to attach to human cells more effectively. Right now, again, the good news is, the virus appears to be very poor at infecting human cells. But we start to get nervous when we see these essential crossover events, when these avian viruses are getting into other animals.

William Brangham:
There have been, as I have mentioned briefly, some cases where the virus has jumped in, mostly when — I think of this one case in Colorado where a person was cleaning out a chicken farm that had suffered a big outbreak.

And so that wasn't a human-to-human transmission. It was just someone getting a big dose of this virus. What do we know about what this virus does to people if it does get into people?

Scott Hensley:
Well, there — luckily, there's been very limited number of infections with this particular H5N1 virus.

In the past, H5N1 viruses have been shown to have very high mortality rates. But, again, in this current outbreak, we have seen a limited number of human infections, mostly with folks who have had very close contact with birds. And there has not been many serious infections to date.

So, H5N1 certainly has the potential to cause a lot of disease and high mortality rates. This particular virus does not seem well-adapted at infecting humans. But this could change, of course, and something that we have to keep our eye on.

William Brangham:
So can you help put this into perspective for people?

Those people who might be seeing these reports and being alarmed about this idea of it jumping into humans, how worried should we be?

Scott Hensley:
Look, we don't have to be alarmed right now.

Look, don't run out to your pharmacy and buy 1,000 rolls of toilet paper.
(LAUGHTER)

Scott Hensley:
If you see a dead bird or a sick bird, certainly, stay away from it.

It's likely that this virus needs to acquire several substitutions before it can efficiently spread from human to human and start infecting humans. But we need to remain vigilant. The research community right now has to come together. We need to increase funding for surveillance to be able to track this virus in real time. And we have to understand better what changes this virus needs to have take place for it to jump into the human population.

So, an everyday person right now, again, avoid sick birds. I think, other than that, there's not a whole lot that you need to do. But this is the time for the research community to really come together and increase our surveillance efforts and start developing new vaccines in case this virus does jump into humans.

William Brangham:
All right, that is Scott Hensley at the University of Pennsylvania.

Thank you so much.

Scott Hensley:
OK. Thank you for having me.

Avian Influenza to Cause a Pandemic in Humans? Possibility of Adaptation to Mammals Shows "Tipping Point" Coming [WIRED.jp, 20 Feb 2023]

by Daisuke Takimoto

Avian influenza (H5N1) is spreading rapidly in the United States, Europe, and Japan. In what is said to be the worst outbreak in history, it is suspected that the virus may have adapted to mink, which are considered to be similar to humans as mammals, and that we have reached a tipping point in terms of the risk of causing a pandemic among humans.

The outbreak of highly pathogenic avian influenza (H5N1) in Argentina and Uruguay led to the declaration of national public health emergencies in both countries in mid-February 2023. It has been feared for decades that it could cause a pandemic in humans.

This latest outbreak brings to 10 the number of countries in South America where H5N1 has been confirmed for the first time. Peru, in particular, saw the deaths of more than 50,000 wild birds in the fall of 2010 and more than 600 sea lions in January 2011.

The fact that sea lions, which are mammals, were also infected, and the new revelation that H5N1 also occurred on a mink farm in Spain in October 2010, have forced public health officials to confront the possibility that H5N1, which is evolving unexpectedly, has adapted to pose a threat to other species as well. The public health community is being forced to confront the possibility that H5N1, which has evolved unexpectedly, may be adapting to become a threat to other species.

Emerging "Trends of Concern"
To be clear, H5N1 is not yet a threat to humans. While we have seen cases of avian flu outbreaks spreading to humans in the past few decades, there have been only two confirmed cases in the past 12 months. Specifically, there has only been one case of infection in an adult in Colorado in May 2010 and one in a 9-year-old girl in Ecuador in January (neither of which resulted in death).

And there is no evidence at this stage of the possible spread of the disease from newly confirmed mammals, such as sea lions and mink, to humans. However, the fact that the disease has spread from birds to mammals and then among mammals is a worrisome trend.

According to the International Veterinary Medical Bureau, outbreaks of H5N1 have recently been confirmed in at least 60 countries. H5N1" is the name given to two proteins on the surface of the virus.

Countries with recently confirmed outbreaks include the United States. In the United States, 43 million egg-laying chickens have died or been culled to prevent the spread of avian influenza in the past 22 years.

According to the USDA, this eliminated nearly one-third of the U.S. egg-laying chickens, resulting in a significant shortage of eggs. As a result, egg prices were 210% higher at the end of 2010 than at the end of 2009. The Department of Agriculture estimates that a total of nearly 58 million egg-laying chickens, chickens for egg-laying, and poultry raised by individual households died or were killed in 2010, and 500,000 were killed in 2011.

Increased Biosecurity Needed
The poultry industry is huge. In the U.S. alone, more than 9 billion chickens are raised for meat, 216 million for chickens, and 325 million for egg-laying. Chicken is the most consumed meat in the world.

Because of this scale, it is difficult to put the losses caused by avian influenza into a precise context. However, the current epidemic is the worst animal disease outbreak in U.S. history. It is also the worst recorded avian disease outbreak in the UK, Europe, and Japan. As for wild birds, they are difficult to monitor, but according to wildlife biologists, the damage to wild birds is also significant.

What can be done to protect wild birds may be almost nonexistent. Avian influenza is spread by migrating waterfowl during the season, but waterfowl can carry the virus without being harmed by infection.

For this reason, the poultry industry is attempting to prevent transmission by adopting procedures and poultry farm construction methods that are broadly referred to as "biosecurity." Biosecurity was introduced or enhanced following a devastating outbreak in 2003 that killed over 50 million birds.

As the H5N1 outbreak shows no signs of stopping, those who study the poultry industry are beginning to question whether it is possible to sufficiently increase biosecurity to prevent avian influenza, and if not, what other changes can be made to keep birds and humans safe? If not, what else can be changed to keep birds and humans safe?

Biosecurity can be effective, and we know it is. But it is a lot of work and may not be sustainable with the way poultry farms are built and the current workforce," said Carol Cardona, a veterinarian and professor of avian medicine at Veterinary Medicine University in Minnesota.

"The reason it could be valid is that companies that had outbreaks [of highly pathogenic avian influenza] in 2015 had fewer outbreaks in 22 years. That means they learned some lessons and took some measures. However, few companies were able to reduce outbreaks to zero."

Human Adaptation a Concern
The relentless spread of H5N1 is not only a concern in terms of its impact on poultry and wildlife, but also in terms of human transmission.

Avian influenza has long been considered the animal disease most likely to cause a global pandemic among humans. Even after the onslaught of the new coronaviruses, many scientists have not yet changed their minds.

The first case of H5N1 avian influenza transmitted from birds to humans was in 1997 in Hong Kong, where 18 people became ill and six died. Although a small number, the fatality rate was a shocking 33%.

Since then, human infections with various variants of H5N1 have been reported regularly. According to the World Health Organization (WHO), there have been 868 cases of human infection and 457 deaths through 2010. Based on these figures, the fatality rate is 52%.

However, the fact that the overall number is small still indicates that H5N1 has not adapted to humans to the extent that it can be easily transmitted from human to human and trigger a major outbreak.

Nevertheless, scientists are constantly monitoring H5N1 to see if a situation has arisen that would allow H5N1 to adapt to humans. For example, in January 2011, Spanish and Italian scientists revealed that in October 2010, a subspecies of H5N1 was confirmed to have infected a mink for fur on a mink farm in northwestern Spain.

H5N1 could have infected just one mink from a single wild bird or a dead chicken for food. Once it entered the farm, however, H5N1 adapted through minor mutations and was able to transmit from mink to mink. All of the farm's nearly 52,000 mink have been killed in an effort to contain this outbreak.

The outbreak was worrisome in two ways: H5N1 is beginning to adapt to mammals, and more importantly, to mink, a mammal directly related to humans.

Mink belong to the same family as ferrets, and when ferrets are infected with influenza, their symptoms progress in the same manner as humans. For this reason, they are so similar to humans that they are already being used in influenza research. The Challenge of High Density Breeding
There is one more concern about the mink outbreak. Although it has become so common in the livestock industry that almost no one is concerned about it, this Spanish farm is not the type of farm where mink are allowed to roam freely in large areas for fur. It was a farm where mink were raised in high-density cages.

Most of the poultry farms in the U.S. where bird flu outbreaks have occurred were also poultry farms that raised poultry in high-density confinement as well. The specific type of facility, however, depends on the type of poultry. Young chickens for poultry are housed in large metal sheds, egg-laying chickens are housed in sheds or, in some cases, indoor cages, and chickens for chickens are housed in sheds with mesh sides.

High-density confinement does not necessarily increase the risk of infection on a given farm, but once the virus is on the property, it can be transmitted to other animals. However, once the virus is on the property, high-density confinement ensures that a large number of individuals are exposed to the virus at any one time. In fact, some egg-laying poultry farms that were devastated by the avian influenza in 2010 lost 5 million birds.

Not only that, but infecting a large number of individuals also increases the risk of the virus mutating. For this reason, there are calls from outside the poultry industry that if huge poultry farms pose a risk of amplifying the virus, it may be necessary to take measures to reduce the size of the farms for defense purposes.

In the public debate about zoonotic diseases," says Dr. Baker, "it tends to quickly turn to vaccination, preparedness, and biosecurity. But no one discusses root cause control," says Jan Dutkiewicz, a political economist and visiting fellow at the Brooks McCormick Jr. Animal Law and Policy Clinic at Harvard Law School. If we were talking about preventing cancer caused by tobacco products, we would first talk about quitting smoking." But when we talk about the risk of zoonotic diseases, we rarely talk about reducing livestock production.

Reducing livestock production may seem an unthinkable proposition. In fact, it is estimated that 1.45 billion chicken wings were eaten in the United States during the Super Bowl on February 13 alone. And American culture doesn't question how the food on the plate is made.

The premise of industrial-scale animal agriculture is that consumers should not have to feel close to the reality of what goes on in the field and the violence against animals. You might even say that it wouldn't work without that premise," says Adam Scheingate, a professor of political science at Johns Hopkins University who studies food and agriculture policy. Most people really don't want to know how the food they eat is produced."

Still, Scheingate points out that outside the United States, when food-related disease risks are identified, action is taken quickly. For example, when bovine spongiform encephalopathy (BSE), also known as "mad cow disease," infected humans in the mid-1990s, killing 178 people with variant Creutzfeldt-Jakob disease, cattle farming practices were changed in the UK.

It's not about quitting poultry farming," says Andrew DiCoriolis, executive director of Farm Forward, a nonprofit organization dedicated to improving the welfare of livestock. "It's about understanding what factors are putting us most at risk and, in some cases, creating laws to eliminate those factors. For example, moving poultry farms off migratory bird routes, reducing the number of sheds that can be located in a particular area, reducing the density of individuals in sheds."

The Importance of a Reality-Accepted Approach
While the current avian influenza outbreak is frightening, it can also be seen as an opportunity to begin collecting big data on why poultry farming is so vulnerable to avian influenza. With avian influenza spreading to such a large scale, analyzing the data may reveal patterns that were previously unknown.

For example, is a particular feeding or watering system being used at the poultry farm where the outbreak occurred? Are chicks of a particular strain being purchased? Are they located in a particular geographical area? Are they on a specific migratory bird route?

There are not many studies that offer a complete set of best practices," he said. There's not a lot of research that gives us a complete version of best practices, because there's so much chance with viruses that we don't know exactly when they enter," said Megan Davis, a veterinarian, epidemiologist, and associate professor at Johns Hopkins University's Bloomberg School of Public Health.

In the wake of the avian flu outbreak of 2003, which was the worst outbreak the poultry industry had ever imagined, the industry sought to focus on the dangers posed to poultry farms by human traffic. To prevent visitors from unknowingly carrying the virus, companies took steps to address the risk of people working on separate properties living in the same house, trucking from infected poultry farms to uninfected ones, and bringing potentially contaminated mail and smart phones into the poultry industry. The H5N1 avian influenza virus is a major cause of death in the United States.

Now that the H5N1 avian influenza has infected wild birds so extensively, producers may also have to consider the risk of carrying the virus from the surrounding environment itself. If there are wetlands, ducks will come. A wooded area provides a habitat for raptors that target rodents that feed on fallen ears of grain. There is no such thing as perfect biosecurity, and it is impossible to completely separate the production system from the rest of the world. We need an approach that accepts this reality.

(translated by M.Y.)

As Bird Flu Spreads Across Globe, Can it Cause the 'Next Pandemic'? Explained [News18, 17 Feb 2023]

Explained: Avian flu virus has migrated from Europe and Asia to North America, where it has quickly expanded. Amid a human case in Ecuador, News18 answers - should we worry?

Nearly 15 million birds have been culled in Japan, a record high for a single season, amid an unprecedented spread of bird flu across the country, the farm ministry said Thursday. Japan’s Ministry of Agriculture, Forestry and Fisheries said the number of culled birds now stands at 14.78 million, about 50 per cent more than the record 9.87 million logged during the 2020-2021 season, Xinhua News Agency reported.

Meanwhile, the avian flu virus has migrated from Europe and Asia to North America, where it has quickly expanded to bird populations in South and Central America, said a report by Al Jazeera.

The report said the flu is no longer limited to birds. The list of wild mammals killed or culled in the United States is growing: grizzly bears in Nebraska and Montana, a red fox in Montana, six skunks and raccoons in Oregon, a Kodiak bear in Alaska, and others.

Zoonotic Bird Flu News since 11 Feb till 16 Feb 2023

Bird Flu Is Infecting More Mammals. What Does That Mean for Us? [WebMD, 16 Feb 2023]

By Lucy Hicks

Feb. 16, 2023 ? A highly infectious strain of bird flu ? known as H5N1? is sweeping across the globe, devastating backyard flocks and commercial farms alike. While this virus mostly infects birds, growing reports of mammals infected with the virus have some experts worried. The main concern, they say, is as H5N1 continues to spread and multiply in different species, there are more opportunities for the virus to potentially gain mutations that could help it more easily infect humans.

“Just by the sheer numbers game, the more chances it has to infect humans or [other] mammals, the more chance you're going to get that rare event happening,” says Richard Webby, PhD, the director of the World Health Organization Collaborating Center for Studies on the Ecology of Influenza in Animals and Birds at St. Jude Children’s Hospital in Memphis.
Since May 2022, the U.S. Department of Agriculture has detected 121 mammals infected with the H5N1 virus, including red foxes, skunks, bears, and even seals. In October 2022, an outbreak at a mink farm in Spain resulted in the culling of over 51,000 animals, and earlier this month, Peru confirmed 585 sea lions had died from the virus in coastal nature preserves. While H5N1 infections have been detected in mammals over the past 25 years, “we’re certainly seeing an uptick in reported cases over the past 12 months,” Webby says.

The World Health Organization has stated that the risk to humans remains low, “but we cannot assume that will remain the case, and we must prepare for any change in the status quo,” WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said at a news briefingthis month.

Human Infections Remain Rare
H5N1 infections in humans are rare. They mostly happen when someone has unprotected, direct exposure to birds infected with H5N1 or surfaces contaminated with the virus. Since 1997, there have been about 870 human cases reported to the WHO, with roughly half dying from the infection. Even if someone is infected with the virus, it is even rarer that the infection would spread to another human.

“H5N1 viruses currently circulating in wild birds and causing poultry outbreaks are well-adapted to spread among birds,” Tim Uyeki, MD, chief medical officer of the Influenza Division's Office of the Director at the CDC, said in an online Q&A. "However, these H5N1 bird flu viruses do not have the ability to easily bind to receptors in the upper respiratory tract of humans, or to transmit among people.”

Even with the record-breaking numbers of infected wild birds and poultry, human infections have become rarer in the last few years. Since the beginning of this century, it was not uncommon to have at least 30 to 40 recorded human H5N1 per year. Since 2021, there have been fewer than 10 infections reported around the world, according to the CDC.

More Spread in Mammals
H5N1 infections in wild mammals are not unheard of, though they are also rare events. Most of these cases likely occur when an animal eats an infected bird and is exposed to the virus.

Like in humans, these infections have been sporadic. But a report last month about an outbreak at a mink farm in Spain caused experts to worry, as the researchers suggested the virus may have spread by one mink infecting others. Minks are related to ferrets, which scientists use as an animal model for studying flu transmission.

“If we see something that transmits in mink, it’s not a stretch to think, ‘Maybe that is something that could also transmit in ferrets,’” Webby says. “We certainly would use transmission in ferrets as an alarm bell for human risk."

But so far, there is no evidence that the virus has picked up the ability to more easily infect humans, says William Schaffner, MD, a professor of infectious diseases at the Vanderbilt University Medical Center in Nashville.

“In fact, one of the reassuring things is in that mink farm in Spain, the people who work on the farm ? and had very close contact with those mink ? were all tested, and they were found to be negative,” he says. The minks were also very closely confined in cages ? which may have aided spread of the virus, he notes.

The more recent report of infections in sea lions had some people speculating online about possible spread of the virus among the animals, but these marine mammals may have also been exposed to birds infected with H5N1.

What is clear is that the virus is widespread, and is popping up in more and more animals, says Jennifer Nuzzo, DrPH, who heads the Pandemic Center at the Brown University School of Public Health in Providence, RI. Why that is happening is less obvious.

“Does that mean that [H5N1] has gained some fitness to mammals? What does that mean for the potential to infect humans? We just don't know,” she says.

Will Bird Flu Become the Next Pandemic?
Unfortunately, it’s not possible to predict what type of virus will cause the next pandemic. But the WHO Global Influenza Surveillance and Response System is already hard at work monitoring influenza strains around the world, Schaffner says .

“It’s like a radar system, trying to detect the enemy” as early as possible, he says. The network not only tracks infections in humans, but also in birds and other animals.

If the bird flu did begin to pose a real threat to the public, the U.S. already has a stockpile of bird flu vaccines.

“If we need them, they can be updated to the latest strain and immediately start to be manufactured,” Schaffner says.

While experts agree that the public’s risk for H5N1 is low, people should avoid contact with sick or dead wild birds, poultry, and wild animals. Do not eat uncooked or undercooked poultry, eggs, and other poultry products. It is safe to consume cooked poultry, poultry products, and eggs. Additional protective measures can be found on the CDC’s website.

Will bird flu spark the next pandemic? [Al Jazeera English, 16 Feb 2023]

By Ian Graber-Stiehl

A dramatic series of outbreaks is leading to concerns that a mutation could eventually hit humans and make COVID-19 seem mild.

It is a bloody trail: Avian flu has killed 15 million domestic birds and led to the culling of an unprecedented 193 million more since October 2021. The rampant virus has jumped from Europe and Asia to North America ? spreading shortly afterwards to bird populations in South and Central America.

And it is no longer restricted to birds. In the United States, the list of wild mammals either killed by or culled over avian influenza outbreaks is growing: grizzly bears in Nebraska and Montana, a red fox in Montana, six skunks and raccoons in Oregon, a Kodiak bear in Alaska and more.

Then in January, the World Health Organization (WHO) reported avian influenza in a young girl in Ecuador, the first such case ever in Latin America.

The story of these outbreaks is playing out like the opening shots of a pandemic movie ? with the scene-stealer from last October in Galicia, Spain. There, week by week, the mortality rate in a mink farm of 50,000 animals rose. Coming soon after another outbreak on the coast near Coruna, which left 27 seabirds sick or dead, avian influenza became a suspect. But sequencing revealed something more sinister: a mutation that had enabled the first-ever large-scale case of direct mammal-to-mammal transmission of bird flu.

There have only been five human bird flu cases in the last year. But past human cases of H5N1 avian influenza have had a 53 percent mortality, according to the WHO.

With the virus driving poultry shortages, killing droves of wild birds, and increasingly spilling over to mammals, the situation begs an overarching question: Could avian influenza evolve from an ecological disaster to a full-blown pandemic?

The short answer: For the moment, the risk of consistent bird flu transmissions to ? and between ? humans is low, according to scientists. But the fast-proliferating avian influenza infection is becoming a contender virus that could drive the next pandemic, one with a mortality rate that, if it spreads among humans, could make COVID-19 seem mild in comparison.

The mafia takes over
Avian influenza is actually a catch-all term for several strains of flu. The strain typically of concern is H5N1, each letter-number pair classifying the types of bonding proteins the virus has on the surface. But to truly understand H5N1 and contextualise its recent proliferation, one has to rewind to the late 1990s in China.

Speaking to Al Jazeera, Isabella Monne, a researcher with Italy’s Istituto Zooprofilattico Sperimentale delle Venezie who recently studied the mink outbreak in Galicia, noted that in 1996, H5N1 emerged in Chinese poultry production. The dense quarters and high populations favoured the emergence of more virulent strains, which jumped to wild bird populations in 2005.

This enabled the virus to spread further around Asia, Europe and the Middle East. Between 2003 and 2009, 468 human cases, primarily among poultry workers, resulted in 282 deaths. All the way through 2020, the number of host species and populations expanded exponentially. In all, the virus has killed 457 people in the last 20 years.

Then, in 2021, a front-running clade, or family, of H5N1 variants executed a mafia-esque takeover. By the end of 2021, the 2.3.4.4b clade was not only behind the vast majority of new cases in Europe, Asia, and the Middle East ? but had also jumped to Canada and the US. In 2022, the clan made its move to Central and South America, as well.

With the rise in outbreaks among poultry and wild birds, the increase in mammalian infections is not surprising, Kaitlin Sawatzki, a molecular virologist and animal surveillance coordinator with Tufts University, told Al Jazeera, describing the cases of spillover to mammals as individual incidents.

In birds, said Sawatzki, H5N1 is primarily a gastrointestinal infection that spreads through faeces.

In order to infect humans, said William Schaffner, a professor of medicine at Vanderbilt University’s Division of Infectious Diseases, the virus has to attach to receptors in the lungs ? receptors it lacks the ability to readily bond with. This forced adaptation to replicating in the lungs is why only poultry workers, who breathe in contaminated faecal dust, are typically infected. It is also why there had never been any large-scale cases of mammal-to-mammal transmission.
Until Galicia.

Minks, seals … humans?
According to Monne, following outbreaks of H5N1 in local bird populations, the Galician minks were most likely infected by contact with wild birds. As Monne herself helped uncover, the virus, in the dense population of mammalian hosts, developed a mutation in a gene called PB2.

While it is too early to know how much this contributed to the virus’ jump to minks, the PB2 mutation is known to increase the activity of an enzyme involved in viral replication in mammalian cells. This same mutation was also found in the strain of H1N1 swine flu that caused the 2009 pandemic, killing between 123,000 and 203,000 people worldwide.

“The mutation is a signal that this virus is trying to cross the barrier between species and adapt to the mammalian population,” Wenqing Zhang, the head of the World Health Organization (WHO) global influenza programme, told Al Jazeera.

Sawatzki believes the mink case is not necessarily an example of sustained transmission. The PB2 mutation was concerning but did not enable the virus to jump to humans or other species.

It was a dead end. No workers were infected. The minks were culled. The viral genome was sequenced and closely monitored.

More concerning for her is last year’s mass mortality of harbour seals off the US coast of Maine, as well as the more recent deaths of 2,500 seals off the coast of Dagestan, Russia.

Seals, she said, do not consume or get exposed to birds in quantities that would explain their high infection rates.

The implication: While it has yet to be confirmed, the seals may have an as-of-yet unidentified, alternative route of infection in a wild population that cannot be as easily monitored or culled.

No immunity
What does all of this mean for human health?

There are two potential ways humans can get an H5N1 respiratory infection: from animals or through person-to-person spread. The latter has only been suspected in an exceedingly small and largely unconfirmed handful of cases ? the most recent being from 10 years ago.

Furthermore, many of the recent bird flu headlines have been a story of successful monitoring. According to Zhang, the WHO has been tracking influenza outbreaks and viruses for more than 70 years. The organisation actively sequences variants that arise worldwide, tracking mutations of concern as they arise ? a capability that has only improved since the COVID-19 pandemic.

In the event of an outbreak, the WHO’s Pandemic Influenza Preparedness Framework mandates that a portion of any vaccines manufactured be donated to the organisation.

Likewise, stockpiles of existing antivirals would likely be relatively effective against an outbreak.

The threat of an H5N1 pandemic is not currently high. However, sooner or later, “there will be another influenza pandemic,” said Zhang. If the culprit of that pandemic is avian influenza, the consequences could be heavy.

The flip side of H5N1 viruses rarely infecting humans is the complete lack of immunity to the virus, Zhang said. So if the virus did evolve a way to reliably transmit from animals to humans, or worse yet, between humans, it would almost certainly mean a pandemic.

And there is a readily available mechanism for that evolution.

Influenza viruses have an eight-segment genome. Each segment can potentially swap genes with other influenza viruses inside a host, a process known as reassortment. This, Schaffner told Al Jazeera, makes minks and swine ? which can contract human, swine, and avian influenza viruses ? potential mixing bowls.

In, say, a pig simultaneously infected with a human-associated flu virus and avian influenza, this genetic reshuffling could result in a deadly new virus: one with H5N1’s virulence and mortality, and the receptors to precisely target humans.

Already a crisis
Developing an entirely new vaccine would likely take six to seven months, said Schaffner.

Existing stockpiles of antivirals, he said, would likely be consumed quickly. Thus, if the bird flu sweeping the world does lead to a pandemic among humans, it would probably fall on lockdown procedures to buy time for a vaccine.

“COVID has told us about the effects of behavioural interventions,” said Schaffner. During lockdowns, “while we were social distancing and all wearing masks, we had a season with almost no influenza”.

In the wake of COVID-19, people are practised at distancing procedures. Granted, another lockdown might be a hard sell to a weary public. Nevertheless, given the high mortality of historical H5N1 cases, Schaffner believes that once casualties start rising, people would likely toe the line ? slowing the spread of a potential avian influenza outbreak.

To be sure, there is only a slight risk of avian influenza targeting humans at the moment, but that comfort belies three concerning certainties. There will be an influenza emergency at some point; there are simply too many types of influenza, which mutate easily, and for which humans have limited resistance. Bird flu is a growing contender for the pandemic prize, threatening a mortality rate that far eclipses that of COVID-19. And in some ways, H5N1 is already a pandemic.

It is a pandemic on the beaches of Peru, where more than 10,000 pelicans have washed ashore in recent months. It is a pandemic in the empty nests of seabird colonies the world over. It is a pandemic for those who rely on both the money and food provided by poultry production, who had to cull millions of animals in the past 15 months.

Nutritionally, economically and ecologically, H5N1 is already a crisis. And despite the current low risks, the high-stakes threat of a bird flu pandemic among humans has the world at attention.

The Bird Flu Outbreak Has Taken an Ominous Turn [WIRED, 16 Feb 2023]

The avian flu has killed millions of chickens, decimated wild birds?and moved into mammals. Now the poultry industry needs new measures to stop its spread.

THIS WEEK, ARGENTINA and Uruguay declared national health emergencies following outbreaks of highly pathogenic avian influenza H5N1, the fast-moving virus that destroys poultry flocks and wild birds, and for decades has been feared as a possible spark for a pandemic among people. That makes 10 South American countries that have recently marked their first-ever encounter with the virus, including Peru?where more than 50,000 wild birds died last fall, and more than 600 sea lions in January. Combine the sea lion infections with the revelation that H5N1 flu invaded a mink farm in Spain in October, and health authorities must now confront the possibility that the unpredictable virus may have adapted to threaten other species.

To be clear, this does not yet include people. Although past decades have witnessed bird flu outbreaks that spread to humans, only two cases have been identified in the past 12 months: a Colorado adult last May, and a 9-year-old girl in Ecuador in January. (Neither died.) And there’s no evidence yet that the virus has been able to jump from newly infected mammals to people. But the fact that it was transmitted from bird to mammals, and then spread among them, indicates a disquieting trend.

According to the World Organization for Animal Health, at least 60 countries have recently experienced outbreaks of H5N1, which is named for two proteins found on the virus’s surface.

That includes the US, where 43 million laying hens were either killed by avian flu last year or slaughtered to prevent the disease from spreading. Those losses took out almost a third of the national flock of laying hens; according to the US Department of Agriculture, they cut into egg supplies so much that prices at the end of the year were 210 percent higher than at the end of 2021. Overall, the USDA estimates just under 58 million birds?mostly layers, turkeys, and backyard poultry?died or were killed in 2022, and another half-million so far this year.

The poultry industry is enormous. Just the US portion comprises more than 9 billion meat chickens and 216 million turkeys grown each year, plus 325 million laying hens; chicken is the most-consumed meat worldwide. That scale makes it difficult to put the losses from bird flu into context. But the ongoing epidemic has become the worst animal-disease outbreak in US history, as well as the largest poultry outbreak ever recorded in the UK, Europe, and Japan. And though surveillance is difficult, wildlife biologists say the damage to wild birds has been disastrous.

There may be little that can be done to protect wild birds; avian flu is spread by seasonally migrating waterfowl, which carry the virus without being harmed by it. But the poultry industry relies on a complex set of behaviors and building features, broadly called biosecurity, that it developed or reinforced after a catastrophic outbreak killed more than 50 million birds in 2015. Given the virus’s relentless advance, people who study the industry are beginning to ask whether biosecurity can ever be hardened enough to exclude avian flu?and if not, what has to change to keep birds and humans safe.

“We know that biosecurity can work and does work, but it’s a heroic effort, and it may not be sustainable given current building styles and current workforce,” says Carol Cardona, a veterinarian and professor of avian health at the University of Minnesota College of Veterinary Medicine. “The reason I say it can work is that companies that had [highly pathogenic avian flu] in 2015 had fewer cases in 2022. So they learned some lessons and changed some things?but very few of them kept it out completely.”

The relentless attack of H5N1 is important not just for its impact on poultry or wildlife, but for what it portends for people. Avian flu was long considered the animal disease most likely to break out into a global human pandemic, and even after the onslaught of SARS-CoV-2, many scientists still feel that way.

The H5N1 subtype first spilled from birds to humans in 1997 in Hong Kong. It sickened 18 people and killed six of them?small numbers, but a disturbing 33 percent mortality rate. Since then, variants of H5N1 have periodically infected people, causing 868 human cases through 2022 according to the World Health Organization, and 457 deaths. Those numbers represent a 52 percent mortality rate?but at the same time, an indication that the virus had not adapted enough to spread easily from person to person and ignite large outbreaks.

Still, scientists are always watching for the virus to find situations that would encourage those adaptations. For instance: Spanish and Italian scientists disclosed last month that in October 2022, an H5N1 variant infected minks on a fur farm in northwest Spain. The virus might have been passed to a single mink by a wild bird, or via chicken carcasses used for feed. But once on the farm, it made minute adaptations that allowed it to spread from one mink to another. To stop the outbreak, all the farm’s minks?almost 52,000?were killed.

That outbreak was unnerving, twice over. Not only had the virus begun adapting to mammals, but to a particular mammal that might have direct relevance for people. Minks belong to the same family as ferrets, which are already used by scientists for flu research because they develop symptoms in the same progression that humans do.

But there’s a third reason why the mink outbreak was notable, something that is so normal in animal agriculture that it mostly goes unnoticed. The Spanish farm was not a property where minks gamboled freely while they grew their fur. Instead, it was an intensive farm where the animals were confined in cages. Most of the poultry farms affected in the US have been intensive confinement farms also, though what that means differs by bird species: large metal barns for broilers, barns and sometimes interior cages for layers, and mesh-curtained sheds for turkeys.

Operating in confinement doesn’t necessarily make a farm more vulnerable to infection, but once a virus penetrates the premises, confinement ensures that very many animals are exposed at once. That puts a lot of animals at risk?some of the egg farms wiped out by flu last year lost more than 5 million birds?and it also gives the virus a plethora of hosts to mutate in. This drives people outside the poultry industry to suggest that if very large farms pose a risk of amplifying a virus, maybe making them smaller should be part of viral defense.
“When there’s public discussion of addressing zoonotic disease, it almost immediately turns to vaccination, preparedness, biosecurity?but no one discusses addressing the root cause,” says Jan Dutkiewicz, a political economist and visiting fellow at Harvard Law School’s Brooks McCormick Jr. Animal Law and Policy Clinic. “We would never have a debate about preventing cancer from tobacco products without talking about stopping smoking. Yet when it comes to zoonotic disease risk, there is a huge reticence to discuss curbing animal production.”

That might be an unthinkable proposal, given that Americans ate an estimated 1.45 billion wings during the Superbowl last Sunday?and that as a culture, we’re not inclined to ask many questions about how our food arrives at our plates. “Industrial animal production operates and maybe even depends on a distance between the consumer and the realities and violence of industrial animal production,” says Adam Sheingate, a professor of political science at Johns Hopkins University who studies food and agriculture policy. “Most people really prefer not to know how their food is produced.” Still, he points out, when disease risks from food become clear, other nations respond rapidly?such as when the UK changed cattle-farming practices after Creutzfeldt?Jakob disease, the human variant of bovine spongiform encephalopathy, or “mad cow disease,” killed 178 people in the mid-1990s.

“This is not to say we get rid of poultry,” says Andrew deCoriolis, executive director of Farm Forward, a nonprofit that works to improve farm animal welfare. “It's to say: We have to understand what are the factors that are the biggest risk drivers, and perhaps legislate changes to them. That could be moving farms out of flyways, it could be reducing the number of barns on a particular location, it could be reducing animal density within the barns.”

Dreadful though it is, it’s possible to construe the current outbreak as an opportunity to begin gathering big data about what makes poultry production so vulnerable. Precisely because the disease has spread so widely, data could reveal patterns that haven’t been visible before?whether affected farms use certain feed or water systems, for instance, or buy just-hatched birds from specific breeding lines, or are sited in particular landscape features or lie under the migration routes of identifiable birds. “There isn't a lot of research to show what are absolute best practices, because viruses are stochastic?you don't know exactly when you're going to get an introduction,” says Meghan Davis, a veterinarian and epidemiologist and associate professor at the Johns Hopkins Bloomberg School of Public Health.

After the 2015 outbreak, which up to that point was the worst poultry producers could imagine, the industry focused on identifying the human networks that made its farms vulnerable. Companies tried to control how visitors might unknowingly expose them to the virus: through sharing housing with workers from another property, or driving a truck from an infected farm onto a clean one, or carrying mail or even a cell phone that might have been contaminated. The extraordinary expansion of H5N1 flu into wild birds now may mean that producers also have to think about how the environment itself invites exposure. Wetlands attract ducks. Copses shelter raptors that pursue rodents that scavenge spilled grain. It’s an approach that concedes that biosecurity can never be perfect, and that a production system can never fully seal itself off from the world.

Avian flu hits Peru, killing thousands of sea birds and infecting some marine mammals [Mongabay.com, 16 Feb 2023]

by Tim Vernimmen

? H5N1, a highly pathogenic avian influenza virus carried generally by wild birds, has arrived in Latin America, causing unprecedented mortality in sea bird colonies along the west coast.
? The virus has killed tens of thousands of sea birds in Peru alone, including some species that are considered endangered in the country, and scientists worry other vulnerable species like the Andean condor might also become infected.
? Hundreds of sea lions and a dolphin have also been infected, which raises concerns regarding transmission to humans and is especially worrisome if it is confirmed that mammals can infect each other.
? The outbreaks also threaten Peru’s guano industry, which provides affordable fertilizer to many small-scale farmers in the region, and could expose people harvesting guano to H5N1.

Since late 2021, a highly pathogenic avian influenza virus of the type H5N1 has wreaked havoc on wild and captive birds across Asia, Africa, Europe and North America, killing millions. In November, it also arrived in Latin America, causing unprecedented mortality in sea bird colonies along the region’s west coast. “The first cases in Peru were confirmed on Nov. 13, 2022,” says Victor Gamarra-Toledo, an ornithologist at the Universidad Nacional de San Agustin de Arequipa in Peru. “By now, outbreaks have been reported in Ecuador, Colombia, Venezuela, Chile and Central American countries like Panama and Costa Rica.” The virus continues to spread southward: earlier in February, it was found in Ancud on the Isla Grande de Chiloe in Chile, about 1,125 kilometers (700 miles) south of Santiago.

“I’ve been working with Peruvian sea birds for 30 years,” says Carlos Zavalaga, an ornithologist at the Universidad Cientifica del Sur in Lima, “and I’ve never seen such massive mortality due to disease outbreaks.”

The occurrence of avian influenza in Peru is not unusual in itself, says Giancarlo Inga Diaz, wildlife veterinarian at the Peruvian National Service of Natural Areas Protected by the State (SERNANP), as variants of the virus have been found in the country before. “But in 2022, we’ve observed an unusual impact on wild populations of coastal sea birds. Our wildlife monitoring system recorded nearly 50,000 dead birds in eight protected areas [in Peru alone]. In the last week of January, we’ve observed a high mortality of resident birds in the Paracas National Reserve,” Inga Diaz tells Mongabay about the reserve located 265 km (165 mi) south of Lima.

Some of the heaviest impact seems to be on the islands just off Peru’s coast. “Authorities have banned researchers from entering the islands close to the coast where the main areas of mortality are,” says Zavalaga. “But about a month ago, we sent a drone with cameras from the coast to two of them, Pachacamac and Asia, and counted thousands of dead birds.” The most affected species, he says, are Peruvian pelicans (Pelecanus thagus), Peruvian boobies (Sula variegata) and Guanay cormorants (Leucocarbo bougainvilliorum). The pelicans and boobies have been designated as endangered by Peruvian authorities, while Guanay cormorants are considered to be near threatened by the IUCN. “We know that the numbers of the Peruvian pelicans in Peru never exceeded 100,000 individuals in the last 20 years,” says Zavalaga. “So the death of at least 20,000 of them is quite significant.”

The damage seems to go beyond birds. Hundreds of dead sea lions and a few dead fur seals have been discovered in several protected areas, including in Paracas National Reserve. Live sea lions there showed uncoordinated behaviors, a potential indication of infection of the nervous system, and had excessive mucus in their eyes, nose and mouth ? possible symptoms of avian flu, says Inga Diaz of SERNANP.

Still pending review, a recent analysis reveals that the sea lions had been infected by H5N1 ? but whether this was also what killed them has yet to be confirmed. A dead dolphin found in the north in the region of Piura was also shown to be infected with the virus. The deadly infections increase concerns that the virus may be able to spread from one mammal to another ? though that is also unconfirmed at the moment ? and may be able to infect people as well.

Farmers in trouble
The outbreak affecting the pelicans, cormorants and boobies is also affecting a particular sector of the local economy: guano harvesting. The birds’ dried, compacted excrement is a prized fertilizer in agriculture. “These three species produce around 86,000 tons of guano per year, which is roughly worth $50 million,” says biologist Daniel Plazas-Jimenez, from the Unitropico University in Colombia.

Plazas-Jimenez says the guano’s importance far exceeds its monetary value. “In Peru, most guano is sold to organic or traditional farmers, many from Indigenous communities, at a price that is low in comparison to that of inorganic fertilizers. In 2021, the Peruvian authorities planned to extract around 25,000 tons to provide for more than 40,000 families. Many people need guano to keep their organic certifications and often have few economic resources to buy other fertilizers. So this also affects their food security.”

“The guano industry in Peru is not industrial,” Zavalaga adds, “it’s very local. For example, last year only two islands in Peru were under guano harvesting. This year, I think they were planning [to harvest on] three or four [other islands].” He doubts whether the virus can survive in the harsh environment presented by the guano itself. “I’d be more afraid that live birds would pass the virus to humans, either on the islands or on the mainland beaches, where there are also dead animals. It’s summer now, so many people go there.”

In response to the outbreak, the Peruvian Ministry of Health has declared a 90-day state of emergency to prevent the virus from infecting people. According to Inga Diaz, measures include banning the collection of guano, advising against handling wild animals and using high-risk beaches, and training park rangers to monitor animal health.

Condors at risk
Local governments have sent teams wearing personal protective equipment to collect the carcasses found on beaches and bury them, says Zavalaga. He worries, however, that “on the islands, where the main colonies are found, there is a lack of adequate disposal of the carcasses.” As long as few people are allowed to go there, the risk of human infection is low. But in the meantime, dead and sick birds do pose an infection risk to other birds and mammals that share their habitat, and scavengers that feed on them.

That includes a very iconic and vulnerable one, the Andean condor (Vultur gryphus), says Gamarra-Toledo, who is studying how the condor’s feeding behavior exposes it to pollution.

“We are very concerned about the possible fatal consequences of this outbreak on this species.”

“We’ve found there is a population of Andean condors feeding mainly on sea lions, but sometimes also on dead pelicans,” says Sergio Lambertucci, an ornithologist at the Universidad Nacional del Comahue in Argentina. “Andean condors may be feeding on the coastline in the morning and roosting in the high mountains in the evening, 4,000 meters [13,120 feet] above sea level.” He also worries about turkey vultures, which roam more or less across the continent and might spread the disease even if it doesn’t kill them. “We are trapping them in Argentina now to find out.”

Bird migration is probably at the root of the outbreak, says Zavalaga, as the virus appears to have arrived with birds migrating from North America in spring, though the exact routes or culprits have not been identified. “Since the first report in mid-November, the deaths have not stopped,” he adds. “Animals are still dying on the islands. What kind of conservation measures are we going to take? I don’t see anything like a strategy for that yet.”

Gamarra-Toledo agrees that monitoring outbreaks and burying dead birds may not be enough to save them. “We should also reduce human impacts that negatively affect them ? environmental pollution, habitat loss and the overexploitation of resources ? so we can give these birds a better chance of survival.”

Citations:
Gamarra-Toledo, V., Plaza, P. I., Gutierrez, R., Luyo, P., Hernani, L., Angulo, F., & Lambertucci, S. A. (2023). Avian flu threatens Neotropical birds. Science, 379(6629), 246?246. https://doi.org/10.1126/science.adg2271
Wille, M., & Barr, I. G. (2022). Resurgence of avian influenza virus. Science, 376(6592), 459?460. https://doi.org/10.1126/science.abo1232
Gamarra-Toledo, V., Plaza, P. I., Inga, G., Gutierrez, R., Garcia-Tello, O., Valdivia-Ramirez, L.,
Huaman-Mendoza, D., Nieto-Navarrete, J. C., Ventura, S., & Lambertucci, S. A. (2023). First mass mortality of marine mammals caused by highly pathogenic influenza virus (H5n1) in south america [Preprint]. Pathology. https://doi.org/10.1101/2023.02.08.527769
Gamarra-Toledo, V., Plaza, P. I., Pena, Y. A., Bermejo, P. A., Lopez, J., Cano, G. L., Barreto, S., Caceres-Medina, S., & Lambertucci, S. A. (2023). High incidence of plastic debris in Andean condors from remote areas: Evidence for marine-terrestrial trophic transfer. Environmental Pollution, 317, 120742. https://doi.org/10.1016/j.envpol.2022.120742

Deadly new avian flu strain detected in wild mammal in California [San Francisco Chronicle, 16 Feb 2023]

By Jessica Flores

For the first time, the deadly new strain of avian influenza virus that has caused an unprecedented outbreak among birds in the Bay Area and statewide has been detected in a wild mammal in California, state wildlife officials announced.

Federal veterinary officials in January detected the highly pathogenic avian influenza strain, H5N1, in a bobcat after its remains were collected in Butte County in December and submitted for testing, the California Department of Fish and Wildlife said in a news release Wednesday.

“This is the first detection of the virus in a wild mammal in the state,” state officials said, adding that the deadly virus had been found in mammals ? including foxes, raccoons and skunks ? in other states and Canada.

Until now, only wild birds had been infected with the virus in California. H5N1 was first identified in wild birds in July 2022 and has been found in wild birds in 44 counties and domestic birds from 18 counties, officials said.

Avian influenza typically circulates among wild water birds and domestic poultry, and transmits to other birds through feces, saliva and respiratory droplets, according to the wildlife department.

But the current H5N1 strain has been infecting and killing a greater diversity of wild bird species than in past outbreaks, affecting raptors and scavengers such as turkey vultures and ravens, the release said.

Both mammalian and avian predators and scavengers may be exposed when they feed on infected birds, officials said.

The infected bobcat was wearing a GPS collar that alerts state officials when an animal stops moving, officials said. State biologists found it in an area where the virus had been recently detected in a turkey vulture, and began investigating the cause of death.

“Notwithstanding this detection, infection of wild mammals with avian influenza viruses appears to be relatively rare,” state officials said.

The disease causes neurological symptoms including tremors and seizures in birds. People who see a bird exhibiting strange behavior, experiencing tremors or appearing weak and lethargic should call a local animal control or wildlife center, officials say.

Because no vaccine or treatment exists, a bird that shows symptoms will not survive, experts say.

Transmission to people is considered low, but wildlife officials say people should not touch injured or dead birds or allow children or pets near them. Dead birds should be reported to the Department of Fish and Wildlife.

The Centers for Disease Control and Prevention urges people who are in contact with wildlife to take basic protective measures, such as wearing gloves and face masks, and washing their hands.

Mutating Bird Flu Virus Triggers Mass Die-Off Among Sea Lions | Weather.com [The Weather Channel, 15 Feb 2023]

Since the beginning of 2023, over 600 sea lions have been found dead or dying on Peruvian beaches. And we finally know the cause: the bird flu virus.

For the unversed, Peru has been facing a bird flu crisis since late last year, leading to the authorities declaring a 180-day health alert after finding three cases of highly contagious bird flu in pelicans in November 2022.

What followed was a massive event where 37,000 birds on a chicken farm had to be culled due to another outbreak in December.

Now, we know what you're thinking: what does avian influenza have to do with the death of mammals?

Before the sea lions died, the majestic carnivores were apparently suffering from agonising convulsions and were struggling to swim. With nothing like this having been observed before, a scientific team of Peruvian and Argentine researchers ran tests on the dead seals and have now confirmed that the mass mortality of the sea lions is due to the A(H5N1) bird flu virus that seems to have jumped from seabirds to these wild mammals.

Argentine biologist Sergio Lambertucci, one of the leaders of the investigation, suggested that the mammals were infected one after another ? either by living with sick birds or by feeding on their corpses.

However, addressing the strange episode on January 27 where a hundred dead sea lions were found floating in the waters of Isla Asia, Lambertucci said, "it wouldn't be strange if a few of them had eaten infected birds, but all of them?"

This has led researchers to consider a terrifying hypothesis suggesting that the virus had perhaps learned to spread from mammal to mammal. It would be the first time that this has occurred in nature.

While the pathogen has jumped from bird to mammal several times, even to people in exceptional cases, there had not been any cases of mammal-to-mammal transmission ? until now. And scientists fear that the virus could mutate and cause a deadly pandemic among humans.

"Given the large number of specimens found dead, it seems more likely that there was direct transmission between sea lions.

This is the second mass mortality episode to suggest that this virus can readily adapt to efficient mammal-to-mammal transmission. If it can occur in mink and sea lions, why wouldn't it happen in humans?" wondered Dutch veterinarian Thijs Kuiken from the Erasmus University Medical Center in Rotterdam.

Peruvian authorities have yet to monitor and conduct an epidemiological analysis to see what other species were affected by the H5N1 virus. But Peru's National Forest and Wildlife Service (SERFOR) has urged people and their pets to avoid contact with sea lions and seabirds on the beach.

Mountain lion near Gunnison found to have had bird flu ? The Crested Butte News [Crested Butte News, 15 Feb 2023]

by Mark Reaman

Be aware and protect your pets and yourself
While rare that the Highly Pathogenic Avian Influenza (HPAI), more commonly known as the bird flu, is discovered in mammals, count Gunnison County as a place to be marked with such a rare occurrence. A deceased mountain lion found near the city of Gunnison on January 15 was analyzed and determined to have HPAI. What that means is that it is still rare for mammals to contract the disease, but it does happen, and it could impact other wildlife and even pets and people in the area.

“I think the most important thing for people to remember is that this is first and foremost a disease among bird species. Wherever waterfowl are present, it is expected that HPAI is currently present,” said Southwest Region public information officer for Colorado Parks and Wildlife John Livingston. “While we have confirmed a few mammal cases, the concern here is still primarily with wild and domestic bird populations. Transmission to other wild animals most likely happens when they feed on wild birds that are sick or have died from HPAI. It’s also important to note that not every wild animal that does feed on a bird with HPAI will become sick or die.”

As far as humans, the CPW says HPAI strains can infect people very rarely but it can happen, so it is important to protect yourself. Avoid handling sick or dead birds and keep a distance from wildlife. Livingston said anyone handling birds should utilize personal protective equipment such as rubber or latex gloves. People should not eat wildlife found sick or dead.
HPAI has already killed thousands of wild birds in the U.S., including in Colorado. HPAI has been particularly contagious among domestic poultry. Three cases of this bird flu have now been confirmed in mammals in the state. They include the mountain lion found near Gunnison, a black bear in Huerfano County and a skunk from Weld County. Other deceased mammals are being tested. According to the CPW, symptoms of the disease include seizures or circling, general signs of illness including weakness or lack of responsiveness to human presence, and organ damage including encephalitis, hepatitis, and pneumonia.

The mountain lion, found near Gunnison in a place common for mountain lion habitat, had necrosis in the liver and broncho interstitial pneumonia which had been seen in domestic cats with HPAI. “Similar to many local species, mountain lions move through our communities on a regular basis as they travel between seasonal ranges throughout the year,” said CPW area wildlife manager Brandon Diamond of Gunnison. “It was only a matter of time before the first HPAI case was confirmed in Gunnison County based on known cases in adjacent counties.

While this is an interesting case study with the lion, it’s important to point out that HPAI has been documented previously in a variety of mammals from across the country. In Gunnison County, CPW routinely investigates reports of sick and injured wildlife and is always interested in hearing from the public if they encounter something that doesn’t look quite right.”

CPW is currently focusing surveillance by species, county and season. Once HPAI has been confirmed in a certain species and county, Livingston said the organization will not test additional birds of that species within that county until the next season. “We still appreciate reports of sick and dying birds to help inform us of the extent of an event, but we do not need to test every sick or dead bird,” he explained. “Testing of mammals is on a case by case basis determined by the wildlife officers and biologists who may find reason to send an animal in for testing.

“Mammalian cases across the country have included some species such as various bears, foxes, raccoons and bobcats, animals that are also found in Colorado,” emphasized Livingston. “It is important to remember that these cases are rare and this issue remains primarily a concern among wild and domestic bird populations. But it’s also important to keep pets away from wildlife at all times, and people should always keep their pets away from dead birds or other animal carcasses.”

Mass death of sea lions from bird flu suggests virus may be spreading between mammals in the wild [EL PAIS USA, 15 Feb 2023]

By MANUEL ANSEDE

Hundreds of dead or dying sea lions have washed up on the beaches of Peru since January.

Before dying, the animals ? majestic carnivores that can weigh up to 350 kilos ? had been suffering from agonizing convulsions and struggling to swim. Nothing like this had ever been observed in the region. A scientific team of Peruvian and Argentine researchers has now confirmed that the mass mortality of the sea lions is due to the A(H5N1) bird flu virus, which has jumped from seabirds to these wild mammals. Researchers are not ruling out a terrifying hypothesis: that the virus may have learned to spread from mammal to mammal, as it apparently did on a Spanish mink farm. It would be the first time that this has occurred in nature.

A total of 634 sea lions have been found dead in Peru. The leading theory is that the mammals were infected one by one, independently, by living with sick birds or eating their corpses, according to Argentine biologist Sergio Lambertucci, one of the leaders of the investigation.

The scientist, however, points to a concerning episode on January 27, when a hundred dead sea lions were found floating in the waters of Isla Asia, less than 60 miles (100 kilometers) south of Lima, the capital of Peru. “It wouldn’t be strange if a few of them had eaten infected birds, but all of them?” says Lambertucci, who is a researcher at the Biodiversity and Environment Research Institute in the Argentine city of San Carlos de Bariloche.

Dutch veterinarian Thijs Kuiken, an expert on emerging diseases, is also skeptical of the hypothesis that each sea lion was infected independently. “Given the large number of specimens found dead, it seems more likely that there was direct transmission between sea lions,” says Kuiken, from the Erasmus University Medical Center in Rotterdam. “It’s worrying,” he continues. “This is the second mass mortality episode to suggest that this virus can readily adapt to efficient mammal-to-mammal transmission. If it can occur in mink and sea lions, why wouldn’t it happen in humans?”

The A(H5N1) virus circulating around the world is a subtype of the highly pathogenic avian influenza. In Europe, it has caused the most devastating epidemic in history, with more than 50 million poultry slaughtered in just one year. The virus reached South America in late 2022, wreaking havoc in Peru, where it has killed more than 50,000 wild birds, mostly pelicans and boobies, according to data from Peruvian and Argentine scientists. The pathogen has jumped many times from bird to mammal, even to people in exceptional cases. In these case, however, there has not been mammal-to-mammal transmission. Scientists fear that the virus could mutate and cause a deadly pandemic among humans.

Thijs Kuiken lists another reason for concern: “There is video footage showing people in Peru trying to rescue sea lions potentially infected with the virus. This close contact increases the chances of the virus being transmitted from sea lions to humans.” The Peruvian government has asked citizens not to approach the wild animals. On January 3, a nine-year-old girl from Ecuador ? who was in contact with backyard poultry ? was admitted to the intensive care unit in critical condition after being infected with the A(H5) virus. According to the World Health Organization, the girl recovered from the virus. It was the first reported case of human infection by this strain of the avian influenza in Latin America.

In Peru, the 634 dead sea lions have been found on various beaches and protected areas in the country, such as the Paracas National Reserve. Researchers analyzed six specimens and found the virus in all of them. Autopsies of other specimens also detected traces of bird flu, i.e. hemorrhagic pneumonia in the lungs and hemorrhagic encephalitis in the brain.

Lambertucci points out that sea lions are very social animals, living in colonies that are often overcrowded. “If you have to think of wild species with the highest probability of mammal-to-mammal transmission, you would look to social animals such as sea lions, which live very close to each other,” says Lambertucci.

Before publishing their findings on the sea lions, the team of Peruvian and Argentine scientists had warned that the arrival of the bird flu virus posed a threat to protected birds in South America, including the Andean condor. Faced with the mass mortality of the sea lions, the researchers decided to urgently publish the first draft of their study on the mammals, without waiting to complete it. “We wanted to raise the alert as soon as possible due to the worrying nature of the situation. It is the first case of mass mortality of wild mammals in South America and could be the first event of intraspecies transmission in wild mammals in the world,” explains Lambertucci. The Argentine biologist stresses that they will need to carry out genetic studies of the virus to confirm or rule out their hypotheses ? work that will take weeks.

Peruvian ornithologist Victor Gamarra, co-author of the study, laments the slow reaction of the authorities. “We published the letter in Science precisely to draw the attention of Latin American governments to the need to do monitoring, an epidemiological analysis and to see what other species were affected,” explains Gamarra, from the National University of San Agustin de Arequipa. “There was an epidemiological silence, in which the public institutions stated that everything was under control. And suddenly these reports appeared of people finding dead sea lions all over the Peruvian coast. That is when the institutions began to take some samples,” says Gamarra. Among the Peruvian co-authors of the study, seven are members of the National Service of Natural State-Protected Areas.

In Spain last year, there were 37 outbreaks of the highly pathogenic avian influenza in poultry and another 138 cases in wild birds. In one of the outbreaks, on a farm with 150,000 laying hens in the city of Guadalajara, two workers became infected without developing symptoms. In October, the virus entered a fur farm with 52,000 American mink in Carral, a few minutes’ drive from the city of A Coruna. Mortality in this outbreak exceeded 4% in a single week. A study led by Montserrat Aguero, from the Spanish Ministry of Agriculture’s Central Veterinary Laboratory, suggested that the avian virus mutated at the mink farm and was then transmitted from mammal to mammal. The Spanish outbreak set off alarm bells around the world. Even the British doctor Jeremy Farrar, newly appointed scientific director of the World Health Organization, warned on social media of the risk of “a devastating flu pandemic.”

Bird flu isn't a direct threat to humans, experts say, but they're keeping a close eye on the virus [CNN, 14 Feb 2023]

By Jen Christensen

CNN ?
Avian flu has infected a record number of birds and some mammals across the United States, and scientists are keeping close watch.

World Health Organization Director General Tedros Adhanom Ghebreyesus said Thursday that the risk to humans remains low but added, “we cannot assume that will remain the case.”

As with the coronavirus that causes Covid-19 that is believed to have started in animals before spreading to humans, some animal viruses can mutate, jump species to make humans sick and spread quickly around the world.

But highly pathogenic avian influenza is no Covid-19. Scientists are reassuring the public that, with a few rare exceptions, the virus hasn’t made the jump to humans at a large enough scale to trigger an outbreak.

It has gone far beyond birds, though, and its recent spread among members of a separate species has some experts concerned about the way the virus is changing.

What is bird flu?
Avian flu is a type A influenza virus that originated in birds. The version that’s predominantly causing problems in the Americas and Europe is called H5N1. There are several subtypes, and H5N1 bird flu viruses commonly in circulation now are genetically different from earlier versions of the virus, according to the US Centers for Disease Control and Prevention.

Since late 2022, scientists have detected this virus in more than 100 species of wild birds like ducks, seagulls, geese, hawks and owls in the US.

Globally, this strain of the virus has actually been around a lot longer, said Richard Webby, an infectious disease researcher at St. Jude Children’s Research Hospital in Memphis, Tennessee, and director of WHO’s Collaborating Centre for Studies on the Ecology of Influenza in Animals and Birds.

“We saw the sort of great-great-granddad of the virus in the late 1990s in Southeast Asia, and we’ve been following its evolution and change ever since,” Webby said.

By the 2000s, it had spread into parts of Europe and Africa and then got carried into the rest of the world through infected migratory birds. It came to the Americas more recently, Webby said.

The first infection with this version of the virus was reported in wild birds in the US in January 2022, according to the CDC. The next month, the US Department of Agriculture announced an outbreak among turkeys in a commercial facility.

Studies have shown that bird flu may spread to songbirds, but the ones that typically gather at feeders ? such as cardinals, sparrows or blue jays ? and those you may see on the street like pigeons or crows do not typically carry bird flu viruses that would be a threat to humans, according to the CDC.

Ducks and geese can carry the virus without appearing sick. Poultry isn’t always so lucky.

Highly pathogenic avian influenza carries “very high mortality rates”among chickens and turkeys. The disease can affect multiple internal organs, causing death in 90% to 100% of chickens within 48 hours of infection, according to the CDC.

Because it can spread rapidly, farmers usually have to cull uninfected birds along with infected ones to prevent a wider outbreak. It is considered one of the largest known threats to domestic birds.

As of Wednesday, 6,111 cases had been detected in wild birds in all 50 states, the USDA says. The virus has affected more than 58.3 million poultry birds in 47 states, according to the CDC.
The sheer volume of cases means that the virus has a better chance of spilling over into other species, experts say.

More animals getting sick
Bird flu spreads through things like feces and saliva. It can also spread through contact with a contaminated surface.

The virus has infected many mammals in the US, mostly in the West and Midwest, as part of the latest outbreak.

In Alaska, cases have been reported among bears and foxes, according to the USDA. The virus has also been found in a bobcat in California, a skunk in Colorado, a raccoon in Washington, possums in Illinois and Iowa, a mountain lion and grizzly bear in Nebraska, seals in Maine and even a bottlenose dolphin in Florida.

In total, 17 non-bird species have been infected in 20 states.

Scientists say that all of those sick mammals probably caught the virus when they ate or otherwise interacted with infected birds.

But in a concerning development last fall, the virus seemed to spread between mammals ? perhaps for the first time ? at a mink farm in Spain, according to a study published in the journal Eurosurveillance.

The mink got bloody noses, developed tremors, lost their appetite and seemed depressed, the scientists said, and had to be killed to keep the threat in check.

The virus did not spread to humans who worked at the mink farm, but what worried scientists were the multiple mutations found in the virus that made it distinct from sequences found in birds. One mutation made it better at replicating in mammals, although it’s not clear whether the mutation was in the virus before it got to the farm.

“But it’s when it starts to spread from one mammal to the next mammal to the next mammal, it’s in those environments where we think it’s most likely that it will pick up these changes that allow us to switch hosts, and that’s why we get concerned,” Webby said.

A handful of human cases
There have been less than 10 known avian flu cases in humans since December 2021, and none has come from human-to-human transmission, the CDC says.

The most recent US case was in a person in Colorado who got sick after culling infected birds in April. The person reported being tired for a few days. They were isolated and treated with an antiviral, according to the CDC.

The agency said at the time that the threat to public health remained low, but it urged people who had any kind of exposure to birds to take precautions.

“People who’ve typically become ill are one of those individuals who have very intense interactions with wildlife either alive or dead,” said Dr. W. Ian Lipkin, director of the Center for Infection and Immunity and the John Snow professor of epidemiology at the Columbia University Mailman School of Public Health. “I wouldn’t say there’s another pandemic upon us, because it’s not. We’re not there.

“What we need to do right now is to watch very closely the way this spreads. We need to contain it in farms and wildlife as best we can,” he added.

How to stay safe
Although the threat to people is low, the CDC suggests avoiding direct contact with wild birds.
Webby says that if you need to handle a dead bird, such as removing it from a feeder, use gloves and a mask. Always wash your hands after touching birds or feeders.

It’s safe to eat poultry and eggs that are properly handled and cooked, the CDC said. Bird flu is not a foodborne illness, and the poultry industry is closely monitored and has strict health standards that include monitoring and controlling bird flu.

Always cook poultry and eggs to 165 degrees, a temperature that kills bacteria and viruses, including bird flu.

In the highly unlikely case that someone became sick, the CDC recommends getting treated right away. Most bird flu infections can be treated with currently available flu antiviral drugs, the agency says.

The US government also has a stockpile of vaccines, including against bird flu viruses, that could be used if this flu were ever to spread easily from person to person, the CDC says.

“The chances are not zero that you could get this, and anything you can do to further reduce that risk is a good thing,” Webby said. “But you probably really have to work hard to be infected with this virus.”

Fukushima City swan bird flu found to be highly pathogenic virus; bird surveillance strengthened in 10-kilometer radius [FNN Prime Online, 12 Feb 2023]

In Okabe, Fukushima City, Fukushima Prefecture, bird flu was detected on February 12 in a swan (Tundra swan) that was debilitated on a residential property.

Subsequent detailed analysis by the Ministry of the Environment revealed that what was detected was a highly pathogenic virus with a high fatality rate.

Fukushima Prefecture has already designated an area within a 10-kilometer radius of the discovery site as a "priority wild bird monitoring zone" and is stepping up surveillance.

This is the first confirmed case of avian influenza in wild birds in Fukushima Prefecture this fiscal year.

11 More Mammals Positive for Bird Flu [Precision Vaccinations, 11 Feb 2023]

by Robert Carlson

Mammal to mammal transmission of bird flu virus confirmed
UNITED STATES OF AMERICA (Precision Vaccinations)

Since the avian influenza outbreak began in the U.S. in early 2022, millions of birds have been detected with Highly Pathogenic Avian Influenza (HAPI) influenza type A viruses.

The Eurasian H5N1 strain initially appeared in North America in January 2022 and has impacted 47 states, leading to the loss of over 58.3 million various types of birds as of February 11, 2023.

And this HAPI outbreak has crossed over into mammals.

The United States Department of Agriculture's latest report indicates 121 HAPI H5N1 detections in mammals such as skunks, bears, raccoons, and foxes.

Expanding this list was a new report from the Colorado Parks and Wildlife (CPW), which detected this strain of HPAI in wild geese in Northeast Colorado in March of 2022.

The CPW announced on February 9, 2023, several cases of HPAI in free-ranging wildlife.
A black bear from Huerfano County was affected by the disease in October, a skunk from Weld County was found positive for the disease in November, and a mountain lion that died in Gunnison County was recently confirmed to have the disease.

Other similar suspected mammalian cases have been detected in the state, with confirmatory testing pending.

"The decision to humanely euthanize the animal by our wildlife officer was made following the abnormal behavior and knowledge that numerous infectious diseases cause neurological symptoms," said CPW Area Wildlife Manager Mike Brown in a press release.

"Extremely ill animals have difficulty moving and often act abnormally."

The Gunnison County mountain lion was found dead just outside of Gunnison city limits in 2023, in an area where mountain lion activity is commonplace.

The mountain lion had necrosis in the liver and bronchointerstitial pneumonia, which have been seen in domestic cats with HPAI.

CPW Area Wildlife Manager Brandon Diamond commented, "While this is an interesting case study with the lion, it's important to point out that HPAI has been documented previously in various mammals across the country."

The U.S. is not alone in reported bird flu cases in mammals.

Over the past year, various mammals in Mexico, Canada, South America, and the U.K. have also been infected by HAPI viruses.

And in Spain, a mink (Neovison vison) farm in Carral offers evidence that the H5N1 virus strain can spread between infected mammals.

While there are no vaccines to protect birds or mammals from this type of HAPI, there is one U.S. Food and Drug Administration (FDA) approved vaccine for people.

The Audenz monovalent, adjuvanted, cell-based inactivated influenza (H5N1) subunit vaccine is designed to protect people six months of age and older in the event of bird flu pandemics.

Audenz's initial FDA authorization was in January 2020, with a Supplemental authorization in 2021.

Bird flu and humans: Will avian influenza become a pandemic? [USA TODAY, 11 Feb 2023]

By Adrianna Rodriguez

As health officials continue to track and manage one of the largest bird flu outbreaks in recorded history, the virus is beginning to spill over into mammals ? including humans.

While human infections are still few and far between, health experts say it only takes one perfect combination of mutations for the virus to cause widespread transmission among the human population.

“There’s a tremendous amount of uncertainty about what is currently happening with bird flu and what might happen in the future,” said Dr. Jay Varma, director of Cornell University’s Center for Pandemic Prevention and Response.

Will avian influenza be the next human pandemic, and is the world ready? Here's what we know.

Tracking avian influenza: How widespread is it?
Bird flu has been on officials’ radar since the late 1990s, health experts say.

The strains causing widespread outbreak now ? avian influenza A (H5N1) 2.3.4.4b viruses ? first arose in 2020 and spread via migratory birds to Africa, Asia and Europe, according to the World Health Organization.

In late 2021, the H5N1 strains crossed to North America. The U.S. Department of Agriculture reports over 58 million chickens have been affected in 47 states. Nearly 6,200 wild birds have been infected including eagles, hawks, geese and ducks, as of this week.

“It seems like it spreads very easily among different bird species. You have so many different bird species that die off so rapidly from it,” said Varma, who is also the chief medical adviser at Kroll, a risk consulting firm.

Health experts, however, are more concerned with how the virus is affecting mammals. The USDA has detected H5N1 in various animals all over the country including skunks, foxes, raccoons, bears, mountain lions and dolphins, among others.

Most of these infections appear to be individual cases where the animal may have gotten sick from eating an infected bird, experts say.

Mammalian transmission: Why experts are concerned
However, two instances of possible mammalian transmission have rung alarm bells for health experts.

Between June and mid-July, over 150 dead seals in Maine were attributed to the bird flu, according to the National Oceanic and Atmospheric Administration. Although it’s possible the seals could have eaten infected birds, health experts say the large number of dead seals and their proximity to one another suggests mammal-to-mammal transmission.

Another outbreak on a Spanish mink farm suggests the virus may have adapted to mammal transmission. Scientific investigators were called when minks began showing signs of infection including loss of appetite, hypersalivation, depression, bloody snout and tremors.

After swabbing two infected animals, they determined the rest of the sickened minks had bird flu. It’s unclear exactly how many minks were infected, but researchers noted the animals began dying a few days after exhibiting symptoms.

More than 51,000 minks were killed to prevent further spread. Post-mortem examination of infected minks found pneumonia in their lungs. This also sounded the alarm for health experts, who say a mink's respiratory tract is closer to that of a human than bird.

"Ferrets, which are close relatives of mink, are our best animal model for human influenza infection," said Stephen Morse, a professor epidemiology at Columbia University's Mailman School of Public Health. "So, finding natural infection in mink seems a step closer to potentially infecting humans."

After sequencing the offending strain, researchers discovered the H5N1 had a slight mutation that doesn't exist in strain affecting birds. This "uncommon" mutation ? T271A in the PB2 gene ? was also seen in the swine flu H1N1 virus responsible for the 2009 pandemic that the CDC estimates caused more than 12,000 deaths in the U.S.

“We worry that this might be the prelude to the virus mutating in such a way that becomes a human epidemic," Varma said.

Can humans get bird flu? How does it spread to humans?
As of December, the WHO has reported six human infections from the circulating bird flu strains in China, Spain, the U.K., the U.S. and Vietnam.

All four cases in the U.S. and Europe were asymptomatic or mild infections, with fatigue reported as the only symptom. The patient in Vietnam developed severe disease but recovered, while the patient in China died.

“So far, the virus is difficult to transmit between people and the overwhelming majority of cases have been in people who have in direct and close contact with birds,” said Dr. Hana El Sahly, professor of molecular virology and microbiology at Baylor College of Medicine.

Bird flu tends to infect the lower respiratory tract, showing “it has a preference” in the lungs, said Dr. Katherine Baumgarten, medical director for infection control and prevention at Ochsner Health.

This suggests it could be less transmissible between humans because not as many viral particles are concentrated in the upper respiratory tract, like the nose or mouth, she said. But it also suggests the virus may be more capable of causing severe disease.

Can avian influenza cause a human pandemic?
Although researchers have identified certain mutations that may be associated with mammalian adaptation, health experts say these genes don’t seem to support widespread transmission between animals.

But that doesn’t mean it can’t happen. The more virus spreads, the more opportunities it gets to mutate and adapt.

“Flu viruses are always evolving, making them very unpredictable,” Morse said. “Could it spill over to the human population, and could it eventually become a pandemic? We really can’t say. It’s possible, but we don’t know how likely or, if it happens, when.”

Government agencies and international organizations track and study cases among birds, mammals and humans to detect any abnormalities that would be a cause for concern.

Health experts say it’s important to prepare for the possibility of an H5N1 pandemic because humans don’t have any immunity to the virus and it’s likely to cause severe disease.

Is the US ready for a bird flu pandemic?
In addition to surveillance, health experts say the U.S. needs vaccines, treatments and personal protective equipment to prevent spread.

The United States has antivirals for the seasonal influenza virus ? the most widely used is known by its brand name Tamiflu ? but health experts say it’s unclear if those will work against the circulating H5N1 strains.

A vaccine for H5N1 has been approved by the Food and Drug Administration for people 18 through 64 years who are at increased risk of exposure, according to an agency spokesperson.

The country has a small supply of vaccine, a spokesperson from the Health and Human Services told USA TODAY. The vaccine can be used to match against strains with pandemic potential and scale-up as needed, which health experts estimate could take up to six months.

About 100 public health laboratories across the country are also equipped with testing that can detect H5 viruses or novel influenza A viruses, according to the CDC.

Even if testing wasn't available, a CDC spokesperson told USA TODAY that most commercial testing for the seasonal flu would be able to detect a new influenza A virus should an outbreak occur.

How to protect yourself against the bird flu
To prevent infection, the CDC recommends avoiding unprotected contact with wild or domesticated birds that may look sick or have died. If contact can't be avoided, the agency recommends:
? Wearing personal protective equipment, like disposable gloves, boots, an N95 mask and eye protection.
? Avoid touching your mouth, nose or eyes during and after contact with birds or contaminated surfaces.
? Wash your hands with soap and water.
? Change your clothes after contact.

Zoonotic Bird Flu News since 9 Feb till 10 Feb 2023

More than 500 sea lions die from bird flu in Peru [Euronews, 10 Feb 2023]

By Rosie Frost

Hundreds of sea lions have died of bird flu in Peru in recent weeks, authorities say, urging people to stay away from the beaches.

It is thought that migratory birds from the US were responsible for transmitting the disease.
55,000 dead birds including pelicans and penguins have been discovered across eight protected coastal areas, the Sernanp natural area protection agency said.

Wildlife rangers in the region found that the bird flu which killed them had also claimed the lives of 585 sea lions in seven different protected marine areas. Lab tests confirmed the presence of the virus in these animals, prompting authorities to announce a “biological vigilance protocol”.

Peru's National Forest and Wildlife Service (SERFOR) has urged people and their pets to avoid contact with sea lions and seabirds on the beach.

In November, Peru declared a 180-day health alert after finding three cases of highly contagious bird flu in pelicans.

Then, in December, 37,000 birds on a chicken farm were culled after a previous outbreak affected wildlife. Killing the birds is a part of standard protocol to prevent the spread of avian influenza.

Is bird flu a risk to humans?
It is rare that the H5N1 bird flu virus jumps over to mammals and even rarer that humans catch it. But recently it has been found in foxes and otters in Britain, a cat in France and grizzly bears in Montana, US.

All of the mammals that caught the virus are thought to have eaten infected birds.

Since late 2021, Europe has been gripped by the worst-ever outbreak of the virus. North and South America have seen severe outbreaks too.

By Rosie Frost with AFP ? Updated: 10/02/2023 - 12:36

Hundreds of sea lions have died of bird flu in Peru in recent weeks, authorities say, urging people to stay away from the beaches.

It is thought that migratory birds from the US were responsible for transmitting the disease.

55,000 dead birds including pelicans and penguins have been discovered across eight protected coastal areas, the Sernanp natural area protection agency said.

Wildlife rangers in the region found that the bird flu which killed them had also claimed the lives of 585 sea lions in seven different protected marine areas. Lab tests confirmed the presence of the virus in these animals, prompting authorities to announce a “biological vigilance protocol”.

Peru's National Forest and Wildlife Service (SERFOR) has urged people and their pets to avoid contact with sea lions and seabirds on the beach.

? Fur farming: Here's which EU countries still support the industry
? World’s oldest dog narrowly escaped death as a puppy, owner reveals

In November, Peru declared a 180-day health alert after finding three cases of highly contagious bird flu in pelicans.

Then, in December, 37,000 birds on a chicken farm were culled after a previous outbreak affected wildlife. Killing the birds is a part of standard protocol to prevent the spread of avian influenza.

Scientists at the Paracas National Reserve are deploying a monitoring and surveillance protocol for cases of bird flu.SERNANP / AFP

Is bird flu a risk to humans?
It is rare that the H5N1 bird flu virus jumps over to mammals and even rarer that humans catch it. But recently it has been found in foxes and otters in Britain, a cat in France and grizzly bears in Montana, US.

All of the mammals that caught the virus are thought to have eaten infected birds.

Since late 2021, Europe has been gripped by the worst-ever outbreak of the virus. North and South America have seen severe outbreaks too.
? Wildlife Photographer of the Year: ‘Dream’ shot of elusive snow leopard wins people’s choice award
? Beavers are returning to London - and they might protect a local train station from flooding
World Health Organisation director general Tedros Adhanom Ghebreyesus warned on Wednesday that these cases of H5N1 in mammals must be “closely monitored”.

He said that the risk to humans was currently low but “we cannot assume that that will remain the case and we must prepare for any change in the status quo.”

Ghebreyesus cautioned people against touching sick or dead animals and encouraged those who find them to report them to local authorities.

As Bird Flu Spreads to Mammals, Health Officials Urge Caution [Smithsonian Magazine, 10 Feb 2023]

By Will Sullivan

Transmission between minks has called attention to the potential risks to humans, though experts say not to panic

Amid a global bird die-off from avian flu, officials have also noticed the deadly virus strain, called H5N1, infecting a growing number of mammals. This week, the World Health Organization (WHO) urged authorities to remain vigilant?but not panic?about the virus’s potential risk to humans.

“The recent spillover to mammals needs to be monitored closely,” Tedros Adhanom Ghebreyesus, the WHO’s director-general, told reporters on Wednesday, according to the Agence France-Presse (AFP). But “for the moment, WHO assesses the risk to humans as low.”

Avian flu is not adapted to infect people, making human cases rare and person-to-person transmission even more difficult. But experts say that the more H5N1 spreads among animals, the more likely it is to evolve into a variant that can jump to humans, per the AFP.

Despite the current low risk to public health, officials must prepare “to face outbreaks in humans, and be ready also to control them as soon as possible,” Sylvie Briand, director of Global Infectious Hazard Preparedness and Emergency Preparedness at the WHO, tells Fortune’s Erin Prater.

H5N1 was first detected in domestic waterfowl in 1996 and spread to migratory birds around 2005. Then, these long-distance fliers carried the virus across the world, writes Science’s Kai Kupferschmidt. Over that time, the virus has infected relatively few humans?but those cases have proven deadly. According to the WHO, there were 868 global cases of H5N1 in humans between January 2003 and November 2022, 457 of which were fatal.

Currently, a massive outbreak of bird flu is taking place around the world. The United States is experiencing the worst avian flu outbreak in its history, with the virus directly or indirectly leading to 58 million bird deaths in the past year, per Fortune. Europe is also experiencing its most severe outbreak, according to the AFP.

“With high levels of transmission we are seeing unprecedented numbers of dead birds and outbreaks,” Michelle Wille, a bird flu researcher at the University of Sydney in Australia, tells the Sydney Morning Herald’s Liam Mannix.

H5N1 doesn’t tend to infect mammals, because they have fewer of the receptors in their upper airways that the virus binds to.

But during this year’s outbreak, foxes, raccoons, bears and other mammals have caught the virus. In the U.S., mammalian infections have been detected in nine different states, according to USA Today’s Adrianna Rodriguez. In Peru, at least 585 sea lions have been found dead, likely due to bird flu. Other infected animals include dolphins and opossums, per Fortune.

Most of these cases are probably caused by a mammal eating an infected bird, Jurgen Richt, who studies avian flu at Kansas State University, tells USA Today. But in a paper published in January in the journal Eurosurveillance, researchers document evidence that the virus might have spread between minks on a farm in Spain last October. Genetic sequencing revealed a genetic change known to make some influenza viruses more capable of reproducing in mammals, writes Nature News’ Saima May Sidik.

The mink outbreak “confirmed a fear that I had” that bird flu could spread efficiently in mammals, Thijs Kuiken, a veterinary pathologist at Erasmus University Medical Center in the Netherlands, tells the Times.

“We’ve never seen mammal-to-mammal transmission, ever. It has never happened,” Wille says to the Sydney Morning Herald. “Now it’s no longer just a hypothetical. Now we’ve actually seen it happen.”

Experts say this development is not a cause for alarm. “It’s not, in my mind, a particularly worrisome situation for human health,” Jim Lowe, a veterinarian at the University of Illinois at Urbana-Champaign, tells the Times. “Obviously it’s not very good for the mink.”

The tightly packed, caged minks could have transmitted H5N1 due to their conditions rather than a fundamental change in the virus, Frank Wong, a bird flu expert at Australia’s Commonwealth Scientific and Industrial Research Organization, tells the Sydney Morning Herald. “It’s still a bird-adapted virus.”

But evidence of spread between mammals is also a warning sign, others say. “This outbreak signals the very real potential for the emergence of mammal-to-mammal transmission,” Wille told the CBC News’ Lauren Pelley in an email.

“We need to be vigilant to make sure that spread in animals is contained,” Briand tells the AFP.

“The more the virus circulates in animals, the higher is the risk for humans as well.”

Largest observed bird flu outbreak in Europe to date: Scientists concerned spread to mink signals growing threat to humans [The Indian Express, 9 Feb 2023]

By Deutsche Welle

A bird flu outbreak on a Spanish mink farm has alarmed scientists. The virus may be spreading for the first time from mammal to mammal ? and could become a danger for humans.

It started in October 2022, when several dead mink were discovered on a farm in Galicia in northwestern Spain. Veterinarians initially blamed the coronavirus. But tests revealed that the highly pathogenic avian flu virus H5N1 was the culprit.

To stop the spread of the dangerous pathogen, more than 50,000 mink on the farm were killed. While farm workers themselves were not infected, the case remains a cause of concern for scientists.

Why is the mink farm outbreak ‘incredibly concerning’?
The spread of the virus from birds to other species is nothing new. The pathogen that causes bird flu, or avian influenza, has been found in raccoons, foxes and seals, though these remain isolated cases.

While there have been some cases of H5N1 infecting humans, the World Health Organization has said there’s no evidence of human-to-human transmission so far.

When the disease has spread to humans and other mammals, it has been via direct contact with excrement from infected birds or their carcasses, according to Timm Harder, an avian influenza expert at the Friedrich Loeffler Institute’s diagnostic virology department in Germany.

But the mink outbreak appears to be a rare case where mammals are transmitting the disease to each other rather than through direct contact with an infected bird. This is something “new,” said Harder.

Part of the problem is that mink are intensively farmed. They’re kept in high numbers in confined spaces, which means infection spreads rapidly in the highly susceptible mammals, said Harder.

Harder added that researchers have identified several pathogen mutations in the mink, one of which allows “the virus to better reproduce in mammals.”

Scientists are worried that the virus, which has led to the deaths of tens of millions of birds globally, could spread to more mink farms and become “more transmissible.”

“This is incredibly concerning,” said Tom Peacock, a virologist at Imperial College London, in an interview with the scientific journal, Science. “This is a clear mechanism for a H5 pandemic to start.”

Could avian influenza trigger a human pandemic?
Of the 868 known cases of H5N1 infection in humans worldwide between January 2003 and November 2022, 457 were fatal, according to the WHO.

However, because there has been no sustained human-to-human transmission, the risk of human infection from avian flu is low, said the WHO.

Some highly pathogenic avian influenza viruses have an increased potential to cause new zoonotic diseases ? which are transmissible from animals to humans and vice versa.

While Timm Harder said there are “numerous hurdles for a more extensive adaptation to humans,” he added the mutations seen in the virus that infected mink must be further studied and evaluated.

How a harmless virus became dangerous
Waterfowl have long played host to influenza viruses, but these early strains were low in pathogenicity, said Wolfgang Fiedler, an ornithologist at the Max Planck Institute of Animal Behavior. The viruses weren’t too contagious or damaging.

But when these viruses that were harmless to wild birds spread to factory poultry farms ? where thousands of animals were crammed tight ? the disease spread rapidly and the virus could mutate, Fiedler explained.

The result was the highly contagious virus strains H5N1 and H5N8, which likely originated on poultry farms in East Asia, according to the Scientific Task Force on Avian Influenza and Wild Birds established by the UN.

Farmed ducks likely become infected from wild birds. Ducks are “kept together with pigs, for example,” which aided the mutation process, noted Fiedler. Such animal husbandry methods “make a virus like this insanely happy.”

In fact, outbreaks of these highly pathogenic strains are typically associated with “intensive domestic poultry production and associated trade and marketing systems … via contaminated poultry, poultry products and inanimate objects,” according to the UN’s bird flu task force.

The highly contagious H5N1 and H5N8 virus strains were in turn transmitted to wild birds via infected farmed birds, explained virologist Timm Harder. The viruses could then be transmitted over great distances during bird migrations.

How much damage has the bird flu outbreak caused?
The ongoing avian flu outbreak is considered the largest observed in Europe to date, according to the European Food Safety Authority, an EU agency.

Between October 2021 and September 2022, 50 million farm birds had to be culled in 37 countries.

More than 3,800 highly pathogenic bird flu cases were counted in wild birds. Experts believe the number of unreported cases is probably much higher.

Until recently, bird flu mainly occurred in fall and winter.

“Now the virus is also circulating in wild birds during the summer months,” confirmed Harder, noting that the animals breed closely in large colonies in the warmer months, providing ideal conditions for the spread of the virus.

The avian influenza wave also reached South America for the first time in the fall. Peru, Venezuela, Ecuador and Colombia were among the countries affected. In Honduras, more than 240 dead pelicans were found in one week alone.

Harder said he is concerned that the virus could spread from South America to Antarctica and endanger penguin populations. Apart from Antarctica, only Australia has escaped the virus.

Despite the acute outbreak among birds, Harder sees one ray of hope in that the broad spread of the virus could promote immunity in wild birds. Antibodies have already been found in live animals.

Risk to humans from H5N1 bird flu remains low but we must prepare - WHO [Reuters.com, 9 Feb 2023]

By Jennifer Rigby and Gabrielle Tetrault-Farber

LONDON, Feb 8 (Reuters) - The recent spread to mammals of H5N1 influenza - commonly known as bird flu - needs to be monitored, but the risk to humans remains low, the World Health Organization said on Wednesday.

H5N1 has spread among poultry and wild birds for 25 years, Director-General Tedros Adhanom Ghebreyesus told reporters in a virtual briefing, but the recent reports of infections in mink, otters and sealions "need to be monitored closely".

He said the risk to humans remained low, noting that human cases have been rare since the flu strain emerged in 1996.

"But we cannot assume that will remain the case and we must prepare for any change in the status quo," Tedros said.

He said people were advised not to touch dead or sick wild animals and to instead report them to local and national authorities, who were monitoring the situation.

The WHO also recommended strengthening surveillance in settings where humans and animals interact, he said.

"WHO is also continuing to engage with manufacturers to make sure that, if needed, supplies of vaccines and antivirals would be available for global use," he said.

WHO Warns Bird Flu Could Jump to Humans [Gizmodo, 9 Feb 2023]

By Lauren Leffer

Avian influenza has recently been recorded spreading among minks and other mammals. The World Health Organization has now acknowledged that could be very bad.

The World Health Organization has issued an ominous warning about bird flu. In a Wednesday press briefing, the international agency’s director-general, Tedros Adhanom Ghebreyesus, noted that the disease’s current trajectory leaves humans worryingly exposed.

Over the past year, avian influenza has gone viral, worldwide?obviously in a bad way. Outbreak after outbreak of a particularly dangerous strain of H5N1 bird flu has popped up in both wild and domestic birds on every continent aside from Antarctica (and scientists are becoming increasingly worried about the penguins there too.) Now, even mammals appear to be falling victim to the disease.

“H5N1 has spread widely in wild birds and poultry for 25 years, but the recent spillover to mammals needs to be monitored closely,” WHO’s Ghebreysus said. “Since H5N1 first emerged in 1996 we have only seen rare and non-sustained transmission of H5N1 to and between humans. But we cannot assume that will remain the case, and we must prepare for any change in the status quo,” he added.

Usually, H5N1 only spreads between birds. But in this ongoing series of outbreaks, something unsettling has started to happen. Mammals are getting sick too. In test results announced last month, three grizzly bears in Montana tested positive for bird flu. Similar cases have been noted among otters and foxes in the United Kingdom. Earlier this week, Peruvian officials confirmedthat they’d detected the viral strain among multiple sea lions and at least one dolphin in the South American country.

Most disconcertingly: in an outbreak among minks on a Spanish fur farm, H5N1 appeared to spread from weasel to weasel. In other instances of mammalian infection, the assumption is that mammals pick up avian influenza through direct contact with wild, infected birds. With the (now culled) minks though, science suggests that wasn’t the case.

A report about the incident published in October 2022 concluded that the number of infected animals and the way the spread occurred “indicate that an onward transmission of the virus to other minks may have taken place.” The report researchers also noted that the viral strain found among the farmed weasels carried mutations, some of which could potentially make the disease more transmissible between a wider array of species?though more conclusive studies on this are ongoing.

Minks have very similar respiratory tracts to humans. Among animals, they’re considered a likely vector point for new and emerging diseases. Already, we’ve seen this play out with covid-19. One 2021 study concluded that that the weasels could be a “highly susceptible host species,” of avian influenza, specifically.

In the past year, there’s been one documented case of the virus infecting a person in the U.S., along with at least one case in China. In total, the current spreading H5N1 variant has led to fewer than 10 known cases in people since December 2021. Further, there’s been no evidence of any human-to-human transmission in this current set of outbreaks, according to WHO and the Centers for Disease Control. Though human-to-human transmission is possible, the phenomenon has rarely occurred since the disease first emerged in people in 2003. H5N1 has never before been documented passing among humans in any sustained way.

For those reasons, Ghebreyesus qualified his remarks and noted that “For the moment, WHO assesses the risk to humans as low.” But without enough attention and action?there’s no guarantee things stay that way.

WHO says it is working with international governments to carefully keep tabs on the situation. And the agency recommends that countries boost their own internal surveillance programs as well?particularly where humans and animals commonly interact.

The agency also had a guidance for individual humans. “As always, people are advised not to touch or collect dead or sick wild animals, but to report them to the local authorities,” Ghebreyesus said. If you want to avoid becoming patient zero for the next global pandemic, Gizmodo suggests you follow that advice.

Bird Flu Isn’t a Danger to Humans...Yet [TIME, 9 Feb 2023]

BY HALEY WEISS

Avian Flu is Far From Becoming a Human Pandemic | Time

Bird flu appears to be on the move. A particularly nasty strain of the H5N1 virus is currently causing the worst outbreak of the disease among birds since it was first identified in China in 1996. Europe is deep into its second commercial season of widespread contagion, and the U.S. is seeing its deadliest 12-month period for poultry in recorded history, with 58 million animalsaffected so far. Records are also being broken in Japan, where a plan to cull 10 million poultry was announced in mid-January amid the appearance of a different but similar subtype, H5N2.

The past few years have taught us all how quickly a virus can spread, and avian influenza is no exception. Already, the current strain has affected a wider geographic area and more species than any other bird flu in the last two decades. Though it’s still too early for experts to say exactly why this is, the unique features of this outbreak (and what we do know about avian flu as a category of viruses), can get us a bit closer to understanding what might come next.
Is avian flu going to be the next human pandemic?

According to experts, the current form of avian flu spreading among poultry is unlikely to significantly impact human populations. For as long as the virus has been around, there have been cases of infection in humans, of which over 50% have been fatal. But overall cases have been fairly rare.

This is primarily due to the way that flu viruses bind to cells during the process of infection. The receptors that they exploit on the outside of cells look a bit different in every vertebrate class, and viruses tend to play favorites, evolving to stick to certain creatures’ cells more effectively than others. For H5N1, the target is birds. Still, “just because it has an avian-receptor binding preference does not mean that it cannot bind at all to human cells,” says Samantha Lycett, a University of Edinburgh researcher who studies how disease evolves and spreads. “It just doesn’t do it very well.” In fact, it does it so poorly that there are only a handful of recorded instances of H5N1 being spread from one human to another?and a virus can’t pose a real pandemic risk unless it’s great at that.

As we’ve seen with SARS-CoV-2, however, viruses can evolve to sidestep biological obstacles.

If H5N1 mutates into a strain better suited to attack human cells, we could be in trouble. H5N1 has already been found in other mammalian species, including foxes, bears, and most concerningly, in an outbreak at a Spanish mink farm in October. “The thing that was different about the mink farm was that it was clearly spreading from mink to mink,” says Paul Digard, chair of virology at the University of Edinburgh. “That that variant of it was a mammalian-transmissible virus makes it intrinsically more worrying.” It’s unclear how exactly the minks contracted the virus in the first place, but after numerous infected wild birds were found in the surrounding area, experts have suggested that excrement or remains from the wild birds could have somehow been tracked into the farm.

Why the current bird flu has spread so far, so fast
Even among birds, the current H5N1 strain also seems to be more infectious than past iterations. Most wild birds are generally less susceptible to infection than domestic poultry, primarily because more dramatic cellular differences across the many species of birds out in nature make it harder for the virus to be equally effective everywhere. But the recent outbreaks have spread to more unusual bird species, explains Lycett, including those who may be responsible for carrying the virus to new areas. In Scotland, where she and Digard live, there’s been a record number of deaths among seabirds. “We’ve lost a substantial fraction of the world population of things like gannets and skewers,” says Digard. “It’s a bit too soon to say whether they’ll bounce back or not.” Seabirds generally don’t catch avian flus, and the distances they travel have been a main cause of the recent spread.

“Seabirds have a slightly different mix of flu subtypes than do other migrating wildlife. So it’s kind of unusual, because they normally seem to have their own separate circulation,” Lycett says. As far as animals go, wild birds make for a nearly impossible-to-track disease vector, as they move around before researchers can formally count the infected. Even rats needed help from ships to spread the plague.

Without better understanding the current strain of the virus, it’s hard for experts to say exactly why this one is so much more virulent or how likely it is that mutations that make it more of a threat to mammals will occur in the future. In the meantime, the burden of the outbreak in the U.S. is being shouldered by farmers who keep commercial poultry, more of whom have had to kill off their flocks this year than ever before?and consumers who have had to pay high prices for eggs over the past few months.

“It is devastating to see these animals dying,” says Gino Lorenzoni, assistant professor of poultry science and avian health at Penn State. “Especially to the people that work with poultry.

I mean, they get attached to their flocks. It’s devastating, emotionally and also economically.”

Should you worry about bird flu right now?
Across the U.S., some 58 million birds have died or had to be killed because of infection. These nationwide depopulations are one of the main reasons that eggs are so expensive right now?a shortage of laying hens means a shortage of eggs.

The good news: Aside from the damage they’ll cause to your wallet, there are no other dangers to eating eggs and poultry right now, especially if they’re well-cooked. In the past, when humans have occasionally caught avian flu, none have been infected by consuming eggs or poultry products. There are also good failsafe measures in place to prevent sick birds from entering the production line in the first place. When a chicken has avian flu, it’s not that hard to tell. The incubation period is relatively short, and when they get sick, they get really sick, and can even drop dead, seemingly out of nowhere. The U.S. Department of Agriculture also keeps a complete and public record of all reported detections of disease in commercial flocks, and people who work regularly with poultry have long lists of protocols and protective measures that they’re already used to?for them, the threat is currently larger, but not new.

For the rest of us, the main priority for the time being should be to “treat the virus with respect,” as Lorenzoni puts it. If you keep one or two chickens in your backyard, that means keeping them where wild animals can’t touch them and making extra sure to wear full protective gear like goggles, Tyvek suits, and most importantly, shoe coverings that eliminate the risk of tracking potentially virus-ridden bird poop inside any enclosure. If you have pets, this means keeping a close eye on them when they’re outside the home, and preventing them from picking up any bird carcasses or excrement that may be laying around. And if a seagull tries to steal your sandwich, maybe let him have it this time.

Bird flu infects Colorado mountain lion, black bear and skunk, all now dead [The Denver Post, 9 Feb 2023]

By CONRAD SWANSON

The highly pathogenic avian influenza has killed thousands of wild birds and has now infected more Colorado wildlife

Three animals in Colorado, each of them now dead, tested positive for the highly pathogenic avian influenza that’s sweeping across the country, state wildlife officials said in a release.

The H5N1 variant of the bird flu is ravaging bird populations across the world. Mammals, including humans, can also catch it.

State Parks and Wildlife officials first confirmed this strain of the bird flu among wild geese in northeast Colorado last March, agency spokesman Travis Duncan said in a release. Now they’ve confirmed three cases of the virus in mammals, which showed signs of neurologic symptoms, general weakness and organ damage before their deaths.

First came a black bear in Huerfano County, which state wildlife officials euthanized after seeing it suffer from seizures, Duncan said. The animal’s remains froze in the wild until it thawed enough to be taken to a health lab for testing, which confirmed traces of H5N1.

Then, a skunk from Weld County tested positive for the virus in November, Duncan said.

And finally, in mid-January, a mountain lion was found dead in Gunnison County, Duncan said. The lion also tested positive for H5N1 and suffered liver damage and bronchointerstitial pneumonia.

“Similar to many local species, mountain lions move through our communities on a regular basis as they travel between seasonal ranges throughout the year,” Brandon Diamond, a Parks and Wildlife manager, said in the release. “It was only a matter of time before the first (bird flu) case was confirmed in Gunnison County based on known cases in adjacent counties.”

Other cases of the virus in Colorado mammals await testing confirmation, Duncan said.

Mammals typically contract the virus after feeding on infected birds.

Humans should avoid contact with sick or dead birds, Duncan added.

Fewer than 10 human cases have been reported since December 2021 and human-to-human transmission has not been documented, according to the U.S. Center for Disease Control and Prevention. The disease is rare among humans, with fewer than 1,000 cases documented since 1997, but the virus can carry a fatality rate of about 50%.

Bird flu: Don't assume risk to humans will remain low, WHO warns [Sky News, 9 Feb 2023]

The World Health Organisation says reports of bird flu in mink, otters and sealions "need to be monitored closely" and we must prepare for a change in the risk level to humans.

The risk of bird flu spreading in humans is low at the moment - but it doesn't mean it will necessarily stay that way, the World Health Organisation (WHO) has warned.

H5N1 influenza - commonly known as bird flu - has cropped up in mammals around the world, from grizzly bears to dolphins and domestic cats.

Last week it was confirmed bird flu has spilled to mammals in the UK, with otters and foxes testing positive for the virus.

WHO director-general Dr Tedros Adhanom Ghebreyesus said in a briefing that the recent reports of infections in mink, otters and sealions "need to be monitored closely".

He said the risk to humans remained low, noting that human cases have been rare since the flu strain emerged in 1996.

"But we cannot assume that will remain the case and we must prepare for any change in the status quo," Dr Tedros said.

The current outbreak started in October 2021, sweeping through poultry farms and wild birds.

The virus is highly infectious and causes rapid illness and death in birds.

Whole flocks have to be culled to try to curb the spread, with the number of dead birds now in the millions.

Since the outbreak started there have been five cases of H5N1 in humans worldwide, including one in the UK and one death in China.

In the last 20 years, there have been 868 cases and 457 deaths, according to the WHO.

In October last year, mink started dying of bird flu at a farm in Spain.

They weren't the first mammals to contract the virus, but the cases differed this time as it appeared to be spreading between the animals, from pen to pen.

In most instances where mammals become ill - including the otters and foxes in the UK - it's likely because they ate infected dead wild birds or their droppings.

Dr Tedros said people were advised not to touch dead or sick wild animals and to instead report them to local and national authorities, who were monitoring the situation.

The WHO also called on countries to strengthen surveillance in settings where humans and animals interact.

"WHO is also continuing to engage with manufacturers to make sure that, if needed, supplies of vaccines and antivirals would be available for global use," he said.

U.S. to test shots against bird flu outbreak, as Biden administration weighs poultry vaccinations [CBS News, 9 Feb 2023]

BY ALEXANDER TIN

Federal scientists are gearing up to test the first vaccines in poultry against bird flu in years, as Biden administration officials say they have now begun weighing an unprecedented shift in the U.S. strategy to counter the growing outbreak.

The move comes amid mounting concern over the threat posed by the ongoing spread of highly pathogenic avian influenza over the past few years, which has devastated flocks of wild and commercial birds around the continent.

A record 58 million birds ? mostly commercially-raised poultry ? have died in the outbreak so far, according to figures tallied by the USDA's Animal and Plant Health Inspection Service ? either killed by the virus itself or put down in efforts to quash its transmission. Every state has detected the virus spreading among wild birds and 47 have spotted them in poultry.

"The decision to proceed with vaccination is complex, and many factors must be considered before implementing a vaccination strategy," USDA spokesperson Mike Stepien said in a statement, adding that the inspection service is discussing the options and "soliciting input from many different industry stakeholders that would be impacted."

While the Biden administration has so far not greenlighted the use of vaccines for highly pathogenic avian influenza, several shots had been licensed for potential use in previous outbreaks. Poultry are already regularly vaccinated for other diseases, like infectious bronchitis.

While animal vaccines can take years to be licensed, Stepien said some parts of the process can be accelerated for emergencies.

It is not yet clear whether vaccines are available that will work against clade 2.3.4.4b, the strain behind the current outbreak in the U.S.

"There are a lot of moving parts to this kind of testing. And some of it is just pure logistics of getting everything in place to do the testing, getting the vaccines that are updated, getting things from parties that are involved, different manufacturers," said Erin Spackman, a virologist who studies avian influenza vaccines at the USDA.

While it is not always a requirement for animal shots to be licensed by the department, the trials will offer an early independent evaluation of how well a vaccine works in this case.

Antibody studies suggest earlier vaccines might not be as well-matched against the strain now driving the current outbreak, prompting the need for tests.

"On the test, it's a twofold reduction, but that makes it sound a lot closer related than it is. In vaccine-speak, it means it's starting to drift away," said Spackman.

Spackman said evaluating the vaccines can take three months, from when birds get their shot ? often in the back of the neck or thigh ? to studying their response to the virus after immunity develops.

Vaccine makers say they are also closely tracking deliberations by the U.S. and other countries over the possibility of poultry vaccination, as well as assessing their own shots.

A spokesperson for Merck Animal Health said the company has an "extensive, ongoing research program" developing vaccines that can work with so-called Differentiating Infected from Vaccinated or DIVA strategies ? an approach that involves systematically hunting for the virus among vaccinated flocks, in hopes of preventing undetected spread among immunized birds.

When to vaccinate poultry?
Officials have so far been wary of deploying vaccines against the outbreak, citing concerns that the use of the shots could make it harder to export American poultry products.

"What is the trigger point of when you might use vaccination? And that's what they're looking at. Is it so many birds in a poultry farms in an area getting infected? Or is it a certain amount of economic loss? Or is it because a neighboring state has the virus in poultry, and you're concerned? So there's those are really the tough, tough questions," said poultry veterinarian David Swayne.

Before retiring to become a consultant, Swayne served for nearly three decades in the USDA's infectious disease arm and was the director of the department's top research facility for dangerous pathogens.

Swayne noted there are several high-income countries in Europe that are "further along" in exploring DIVA strategies that would work with poultry exports, after wrestling for years with their outbreak. Others, including Indonesia and China, have already rolled out poultry vaccinations for bird flu.

Under one approach, birds who die of any cause in a vaccinated flock could be aggressively tested for the virus, Swayne said, or live birds might be systematically sampled for antibodies in their blood through a more complex process. Surveillance may also be possible through swabbing the environment, like checking the containers birds drink water from.

"We want to make sure our partners understand that, if we use them, we're going to use them in the right the right manner so that they can feel secure and safe that the products they buy are not products that might contain, say, a highly pathogenic avian influenza virus," said Swayne.

Authorities would also need a way to coordinate tracking viruses for updates to the vaccines, potentially similar to how the World Health Organization issues recommendations for manufacturers of human flu shots to keep pace with the latest strains.

However, Swayne cautioned that poultry producers will still need to take steps to shield their flocks from contact with wild birds and other ways the virus could spread.

Like their counterparts abroad, American wildlife officials have spotted the virus decimating groups of birds across a range of species. Officials believe the virus is largely being transmitted to commercial poultry flocks by wild birds migrating across the Americas.

"Biosecurity really is the first line of defense, and any vaccination that might be done is only sort of another layer of protection, sort of an insurance policy," he said.

Is it a threat to humans?
Authorities say the risk the virus poses to humans seems to be low for now, despite a 56% fatality rateamong the handful of people who have tested positiveafter direct contact with infected birds.

Out of more than 6,000 poultry workers that American health authorities have tracked after exposure to infected birds, only one has tested positive for the virus.

Regardless, officials have urged Americans to avoid handling dead or sick birds to reduce their risk. The virus has spilled over from birds to other species, often from coming into contact with the carcasses of infected birds.

"Somewhat concerning is that there's been transmission to mammals in a variety of terrestrial mammals, which are basically the most of them are predatory mammals," the Centers for Disease Control and Prevention's Tim Uyeki told a webinar hosted by Emory University last month.

The federal Administration for Strategic Preparedness and Response also already maintains a program with vaccinemakers to "make and test small quantities" of shots for humans that can be ramped up to large-scale production if needed.

"High on my radar. We've already been in touch with our teams as to where we are with both surveillance and detection, as well as our USDA colleagues on the detection in the avian population as well," CDC Director Dr. Rochelle Walensky told a panel of the agency's advisers this week.

The spillover of bird flu to mammals must be ‘monitored closely,’ WHO officials warn: ‘We need to be ready to face outbreaks in humans’ [Fortune, 9 Feb 2023]

BY ERIN PRATER

Cases of HN51 bird flu in mammals like those reported recently must be “monitored closely,” the head of the World Health Organization said Wednesday, as the organization’s experts called on public health officials to prepare for human outbreaks of the disease.

H5N1 avian flu has existed for a quarter century. Only rarely have human cases occurred, with no sustained transmission reported. But “we cannot assume that will remain the case,” WHO Director General Tedros Adhanom Ghebreyesus said at a news conference. New, frequent reports that the disease has crossed into small mammals like minks, otters, foxes, and sea lions are cause for alarm, given the species’ similarities with humans, he noted.

While the risk to people remains low, public health officials must prepare “to face outbreaks in humans, and be ready also to control them as soon as possible,” Dr. Sylvie Briand, director of Global Infectious Hazard Preparedness and Emergency Preparedness at the WHO, told Fortune.

Ghebreyesus cautioned against touching or collecting sick or dead animals, and encouraged those who encounter such to report them to local authorities. Countries must strengthen their avian flu surveillance in areas where humans and wild animals interact, he insisted. And public health officials must work with manufacturers to ensure that vaccines and antivirals are available for global use, he said.

‘Only the tip of the iceberg’
Tests on several sea lions and a dolphin found dead in Peru in November have returned positive for the concerning strain of bird flu, Peruvian veterinary authorities said Tuesday, the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported. At least 585 sea lions and 55,000 birds have been found dead in the country, their deaths likely due to H5N1, a federal agency reported Monday.

What’s more, a lion held in a Peruvian zoo recently died of the virus, CIDRAP recently reported, citing media reports. Foxes, dolphins, opossums, skunks, raccoons, and other types of bears are among other species that have been infected since last year, according to the U.S. Department of Agriculture. A “mass mortality event” among seals on Russia’s Caspian Sea coast in December was caused by avian flu, though the strain was not named, CIDRAP recently reported, citing Dagestan State University.

In late January, the first grizzlies to be documented with the highly pathogenic avian flu were euthanized in Montana after they were found partially blind and disoriented, with other neurologic issues. And surviving infected harbor and gray seals identified in New England last summer by a team led by Jonathan Runstadler, professor and chair of the Department of Infectious Disease and Global Health at Tufts University’s Cummings School of Veterinary Medicine, were unable to orient themselves and swim properly, he told the Journal of the American Medical Association in a recent article.

These instances are just a few of numerous recent reports of outbreaks among mammals, including at a worrying outbreak at a mink farm in Spain. It’s trend that should worry public health officials, Mike Ryan, executive director of the WHO’s health emergencies program, told Fortune on Wednesday.

“Small mammals may not look like us,” but they share many physical similarities with humans, he said.

The H5N1 virus could win the lottery, so to speak, by quickly and ably adapting to humans and starting an epidemic somewhere?then, possibly, a pandemic. Most viruses don’t get that lucky. But the more opportunity the virus has to spread, the better the chance that it will succeed, Ryan added.

While there have been identified instances of H5N1 in mammals since the virus was first detected in the late 1990s, never have there been so many, Dr. Jay Varma, chief medical adviser at the New York-based think tank Kroll Institute, told Fortune.

Recently discovered H5N1 mass fatality events among mammals “are probably only the tip of the iceberg,” he cautioned.

“We only know about these events when there are very large die-offs that are recognized by people and somebody actually does the testing and reports the results,” he said. “There may be smaller die-offs, larger die-offs, people afraid that no one will buy their chickens if they report a die-off. We know there are many instances where lab testing isn’t done.”

Worst outbreak in U.S. history for birds
The H5N1 strain of avian flu has been responsible for the deaths of tens of millions of birds in the U.S. in recent months, and countless millions worldwide. The strain?first identified in domestic waterfowl in China in 1996?is behind more than 58 million U.S. bird deaths in the past year. These deaths have occurred both directly due to the virus and indirectly, when flocks are culled to curb further exposure, according to the U.S. Centers for Disease Control and Prevention. The virus has a near 100% fatality rate among birds, killing most infected within 48 hours.

This season’s bird flu outbreak is the worst in U.S. history, having surpassed a 2015 outbreak the CDC once called “arguably the most significant animal health event in U.S. history.” That year, nearly 51 million birds died nationally due to H5N1 and related avian flu viruses. This season’s outbreak is also the worst in U.K. history, with farmers in England ordered to keep their birds indoors as of Nov. 7 in a poultry “lock down” of sorts.

The so-called “R naught” value?or the number of people infected by a single infected person, on average?for COVID initially ranged from 1.5 to 7, and now sits upwards of 12. The R naught value of H5N1 among birds: “around 100,” Rajiv Chowdhury, senior epidemiologist and professor of global health at Florida International University, recently told Fortune.

Trend of ‘low’ risk to humans may not hold
Economic and food-supply issues aside, the strain poses a threat to humans because it can severely sicken them, though it has only done so in relatively small numbers so far. Hundreds of human cases were identified in Egypt earlier this century, though there were no confirmed reports of sustained human-to-human transmission.

But that trend may not hold, experts warn. In January the WHO reported that a previously healthy Ecuadorian girl had been hospitalized with the virus, and was under sedation and on a ventilator. Just how she contracted the virus was uncertain and under investigation, but poultry her family had recently purchased died without apparent cause.

The world appears to have dodged a proverbial bullet, with the girl’s condition improving and no additional human cases reported since, WHO officials said Wednesday. They also confirmed that the girl contracted the virus from poultry, not from another human.

The likelihood of human-to-human transmission of H5N1 is “very low,” Chowdhury recently told Fortune. But if it were to occur in a sustained manner, it could rock the globe in a way not seen since the 1918 Spanish Flu.

If H5N1 indeed makes a sustained crossover to humans, “the potential impact could be significant,” he said, signifying the start of a “new global influenza pandemic.”

The risk for sustained transmission among humans could be anything from one in 10 to one in 100,000, Varma said, adding that the uncertainty necessitates the conveyance of a mixed risk message. The average person shouldn’t be alarmed by H5N1 at the moment. But governments must take actions like “investing more heavily in programs that detect and characterize these viruses,” in addition to funding lab testing among animals.

Governments must also ensure there’s a safe and effective vaccine ready to go for humans, and that supplies are adequate. If a vaccine were developed and approved for animals like chickens, turkeys, and pigs, it could reduce spread among livestock, as well as the risk of spillover to humans who work with them, he added.

“We know from COVID that you can’t just vaccinate your own country,” Varma said.

“Everywhere around the world needs to be protected. There needs to be more investment in this.”

The Spanish Flu as a cautionary tale
The 1918 flu pandemic serves as a cautionary tale as the world faces a potential H5N1 pandemic, Chowdhury said. Like the H5N1 flu, the Spanish Flu is thought to have avian origins.

And both viruses contain genes that allow them to replicate efficiently in human bronchial cells, according to a 2006 report from the Washington, D.C.-based Population Reference Bureau.

When H5N1 infects humans, the inflammation it causes can lead to lung cells becoming “intensely inflamed”?to an extent not seen in a usual flu. A similar effect was noted in Spanish Flu victims, autopsies of which revealed “lungs choked with debris from the excessive inflammation,” resulting in drowning, the report noted.

While seasonal flu symptoms include fever, cough, sore throat, runny nose, aches, and fatigue, according to the CDC, symptoms of H5N1 in humans are typically much more severe. They include an often high fever, weakness, cough, sore throat, muscle aches, abdominal pain, chest pain, and diarrhea, according to the WHO. These symptoms can quickly give way to difficulty breathing, pneumonia, and/or Acute Respiratory Distress Syndrome, which is often deadly, as well as neurologic effects like seizures.

Because the virus hasn’t crossed over to humans in a sustained manner, it’s uncertain what an easily transmissible human version of H5N1 might look like, Varma said. “But we can guess, based on prior flu epidemics, that it would be very deadly to humans.”

COVID has been “somewhat manageable” because younger individuals are typically less likely to suffer severe disease, he said. The same was not true of the Spanish Flu, which killed more young than old. If human-to-human transmission of H5N1 begins to occur, “we shouldn’t automatically assume that young people or even children will be better protected,” he said. “They may very well be at higher risk.”

New zoonotic diseases, or diseases that transmit from animals to people, tend to result in high mortality rates among the people they infect. They’re not well adapted to humans and tend to cause copious amounts of damage in the lungs, though they’re not usually very transmissible, Briand said.

Once such viruses adapt to human transmission?if they do?the fatality rate may drop. While the Spanish Flu killed a whopping 50 million?around seven times greater than COVID’s official global death toll of just under 7 million?it killed no more than 4% of those it infected, according to Briand?a fatality rate much lower than that of H5N1 in birds.

“In 1918, we didn’t have antibiotics,” she said. “We didn’t have antivirals either. We didn’t have vaccines. And we didn’t have any of the tools we have now to control flu outbreaks. We’re in a much better place, of course, now than we were a century ago.”

While the risks to humans posed by H5N1 are weighty, they can be mitigated, Ryan emphasized.

The point is “not to be scared of viruses,” he said, adding that “they’re out there and always will be.”

“We need to focus on our game plan, what we need to do to make sure we keep everybody safe,” he said. “Don’t just spend time thinking of the risk. Act upon those risks and they can be significantly reduced, in terms of impact.”

The spillover of bird flu to mammals must be ‘monitored closely,’ WHO officials warn: ‘We need to be ready to face outbreaks in humans’ [Yahoo Finance, 9 Feb 2023]

By Erin Prater

Cases of HN51 bird flu in mammals like those reported recently must be "monitored closely," the head of the World Health Organization said Wednesday, as its experts called on public health officials to prepare for human outbreaks of the disease.

H5N1 avian flu has existed for a quarter century, WHO Director General Tedros Adhanom Ghebreyesus said at a news conference. But new, frequent reports that the disease has crossed into small mammals like minks, otters, foxes, and sea lions are cause for alarm, given the species' similarities with people.

While the risk to people remains low, according to Ghebreyesus, public health officials must prepare "to face outbreaks in humans, and be ready also to control them as soon as possible, so the virus doesn't spread any farther," Dr. Sylvie Briand, director of Global Infectious Hazard Preparedness and Emergency Preparedness at the WHO, said.

Since H5N1 was identified nearly three decades ago, only rarely have human cases occurred, and there has been no sustained transmission among them, Ghebreyesus said. But he added: "We cannot assume that will remain the case. We must prepare for any change in the status quo."

He cautioned people against touching or collecting sick or dead animals, and encouraged them to report the incidences to local authorities.

Countries must strengthen their avian flu surveillance in areas where humans and wild animals interact, Ghebreyesus insisted. And public health officials must work with manufacturers to ensure that vaccines and antivirals are available for global use, he said.

A growing mammalian outbreak
Tests on several sea lions and a dolphin found dead in Peru in November have returned positive for the concerning strain of bird flu, Peruvian veterinary authorities said Tuesday, the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota reported. At least 585 sea lions and 55,000 birds have been found dead in the country, their deaths likely due to H5N1, a federal agency reported Monday.

What's more, a lion held in a Peruvian zoo recently died of the virus, CIDRAP recently reported, citing media reports.

The cases join other recent similar reports of bird flu outbreaks among mammals, especially small mammals?including at a mink farm in Spain. A "mass mortality event" among seals on Russia's Caspian Sea coast in December was caused by avian flu, though the strain was not named, CIDRAP recently reported, citing the country's Dagestan State University.

It's trend that should worry public health officials, Mike Ryan, executive director of the WHO's health emergencies program, told Fortune on Wednesday.

"Small mammals may not look like us," but they share many physical similarities with humans, he said. "That's why drugs are tested on animals."

"The more a virus circulates in animals, the higher the risk for humans as well," Briand told Fortune on Wednesday.

The H5N1 virus could win the lottery, so to speak, by quickly and ably adapting to humans and starting an epidemic somewhere?then, possibly, a pandemic. Most viruses don't get that lucky. But the more opportunity the virus has to spread, the better the chance that it won't hit a dead end and fizzle out, Ryan said.

While there have been identified instances of H5N1 in mammals since the virus was first detected, never have there been this many, Dr. Jay Varma, chief medical adviser at the New York-based think tank Kroll Institute, told Fortune, adding that the recent known H5N1 mass-die-off events among mammals "are probably only the tip of the iceberg."

"We only know about these events when there are very large die-offs that are recognized by people and somebody actually does the testing and reports the results," he said. "There may be smaller die-offs, larger die-offs, people afraid that no one will buy their chickens if they report a die-off or something. We know there are many instances where lab testing isn't done."

Worst outbreak in U.S. history for birds
The H5N1 strain of avian flu has been responsible for the deaths of tens of millions of birds in the U.S. in recent months, and countless others worldwide. The strain?first identified in domestic waterfowl in China in 1996?is behind nearly 58 million U.S. bird deaths in the past year. These deaths have occurred both directly due to the virus and indirectly, when flocks are culled to curb further exposure, according to the U.S. Centers for Disease Control and Prevention. The virus has a near 100% fatality rate among birds, killing most infected within 48 hours.

This season’s bird flu outbreak is the worst in U.S. history, having surpassed a 2015 outbreak the CDC once called “arguably the most significant animal health event in U.S. history.” That year, nearly 51 million birds died nationally due to H5N1 and related avian flu viruses. This season’s outbreak is also the worst in U.K. history, with farmers in England ordered to keep their birds indoors as of Nov. 7 in a poultry “lock down” of sorts.

The so-called “R naught” value?or the number of people infected by a single infected person, on average?for COVID initially ranged from 1.5 to 7, and now sits upwards of 12.

The R naught value of H5N1 among birds: “around 100,” Rajiv Chowdhury, senior epidemiologist and professor of global health at Florida International University, recently told Fortune.

Dangerous for people, too
Economic and food-supply issues aside, the strain poses a threat to humans because it can sicken them, though it has only done so in relatively small numbers so far. Hundreds of human cases were identified in Egypt earlier this century, though there was no sustained human-to-human transmission.

But the trend of minimal transmission among humans may not hold, experts warn. The WHO reported in January that a previously healthy Ecuadorian girl had been hospitalized with the virus and was under sedation and on a ventilator as of Jan. 17. Just how she contracted the virus was uncertain and under investigation, but poultry her family had recently purchased died without apparent cause.

The world appears to have dodged a proverbial bullet, with the girl's condition improving and no additional human cases reported sense, WHO officials said Wednesday. They also confirmed that the girl contracted the virus from poultry, not from another human.

The likelihood of human-to-human transmission of H5N1 is “very low,” Chowdhury said. But if it were to occur in a sustained manner, it could rock the globe in a way not seen since the 1918 Spanish Flu.

If H5N1 indeed makes a sustained crossover to humans, “the potential impact could be significant,” he says, signifying the start of a “new global influenza pandemic.”

The risk for sustained transmission among humans could be anything from one in 10 to one in 100,000, Varma said, adding that the uncertainty necessitates the conveyance of a mixed risk message. The average person shouldn't be alarmed by H5N1 at the moment. But governments must take actions like "investing more heavily in programs that detect and characterize these viruses," in addition to funding lab testing among animals, in preparation for a potential pandemic.

Governments must also do what they can to ensure there's a safe and effective vaccine ready to go for humans, and that supplies are adequate. If a vaccine were developed and approved for animals like chickens, turkeys, and pigs, it could reduce spread among livestock, as well as the risk of spillover to humans who work with them, he added.

"We know from COVID that you can't just vaccinate your own country," he said. "Everywhere around the world needs to be protected. There needs to be more investment in this."

The Spanish Flu as a cautionary tale
Chowdhury says the 1918 flu pandemic, however, serves as a cautionary tale. Like the H5N1 flu, the Spanish Flu is thought to have avian origins. Both viruses contain genes that allow them to replicate efficiently in human bronchial cells, according to a 2006 report from the Washington, D.C.-based Population Reference Bureau.

In the case of H5N1 among humans, such inflammation can lead to lung cells becoming “intensely inflamed”?much more so than would be seen in a usual flu. A similar effect was noted in Spanish Flu victims, autopsies of which revealed “lungs choked with debris from the excessive inflammation,” resulting in drowning, the report noted.

While seasonal flu symptoms include fever, cough, sore throat, runny nose, aches, and fatigue, according to the CDC, symptoms of H5N1 in humans are typically much more severe. They include an often high fever, weakness, cough, sore throat, and muscle aches, abdominal pain, chest pain, and diarrhea, according to the WHO. These symptoms can quickly give way to difficulty breathing, pneumonia, and/or Acute Respiratory Distress Syndrome, which is often deadly, as well as neurologic effects like seizures.

The virus hasn't crossed over to humans in a sustained manner, so it's uncertain what an easily transmissible human version of H5N1 might look like, Varma said. "But we can guess, based on prior flu epidemics, that it would be very deadly to humans."

COVID has been "somewhat manageable" because younger individuals are typically less likely to suffer severe disease, he said. The same was not true of the Spanish Flu, which killed more young than old?"which is pretty terrifying, if you think about it."

If human-to-human transmission of H5N1 begins to occur, "we shouldn't automatically assume that young people or even children will be better protected," he said. "They may very well be at higher risk."

New zoonotic diseases, or diseases that transmit from animals to people, tend to result in high mortality among those they infect. They're not well adapted to humans and tend to do copious amounts of damage in the lungs, Briand said.

"When you look at the case fatality rate, we're scared because it's quite higher, 30% to 50%, but those viruses are not very transmissible," she added.

Once such viruses adapt to human transmission?if they do?the fatality rate may drop. While the Spanish Flu killed a whopping 50 million?around seven times greater than COVID's official global death toll of just under 7 million?it killed no more than 4% of those it infected, according to Briand.

"In 1918, we didn't have antibiotics," she said. "We didn't have antivirals either. We didn't have vaccines. And we didn't have any of the tools we have now to control flu outbreaks. We're in a much better place, of course, now than we were a century ago."

While the risks to humans posed by H5N1 are real and substantial, they can be mitigated, Ryan said.

The point is "not to be scared of viruses," he said, adding that "they're out there and always will be."

"We need to focus on our game plan, what we need to do to make sure we keep everybody safe. Don't just spend time thinking of the risk. Act upon those risks and they can be significantly reduced, in terms of impact."

This story was originally featured on Fortune.com

Zoonotic Bird Flu News from 7 Feb till 8 Feb 2023

Tracking the bird flu, experts see a familiar threat — and a virus whose course is hard to predict [STAT, 8 Feb 2023]

By Helen Branswell

Veteran influenza epidemiologist Keiji Fukuda remembers vividly when he first became fearful that a virulent bird flu virus, H5N1, might be on the verge of triggering a devastating pandemic. The virus, seemingly out of nowhere, did something bird flu viruses were thought not to be able to do. It infected 18 people, killing six of them.

That happened in 1997, in Hong Kong.

A quarter century later, H5N1 has returned to the headlines, with an outbreak at a Spanish mink farm — reported in mid-January — triggering the latest round of fears that the virus might be inching closer to acquiring the ability to easily transmit among humans.

The mink outbreak is concerning, there is no doubt about that. Minks are closely related to ferrets, the animals most often used as a proxy for people when scientists study the characteristics of flu viruses.

But it’s important to remember that we’ve been somewhere like this before with this virus. Not precisely this spot — H5N1 has a much larger geographic footprint now and it’s been found to infect many more species of mammals. But there have been periods, some spanning years, when H5N1 was wreaking havoc, doing things that until that point had been thought to be out of reach for bird flu viruses, raising global concerns a pandemic might be right around the corner. And then, unexpectedly, it quieted down for a while.

So while scientists who have been studying it for a couple of decades have a very healthy respect for H5N1, a number with whom STAT spoke are hedging their bets about the path H5 may be on.

“I still think that this thing is as unpredictable as it has ever been,” said Ron Fouchier, a virologist at Erasmus Medical Center in Rotterdam who moved into the field of influenza research, at Erasmus, because of the 1997 H5N1 outbreak. Scientists there, along with a colleague from Hong Kong, were the first to report that the virus was a bird flu virus.

“Trying to predict what H5N1 will do in the human population absolutely requires a great deal of scientific humility,” cautioned Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy.

“I will never, ever, take H5N1 for granted,” he said.“I just don’t know what it’s going to do.”

Fukuda, who in 1997 was an influenza scientist with the Centers for Disease Control and Prevention, was sent to Hong Kong by the agency to help in the investigation of that first outbreak.

“Everything was really new and the sense of things back then was that we were deeply, deeply afraid that this was the beginning of the next pandemic, of a really severe pandemic,” said Fukuda, who later went to the World Health Organization, where he served for a time as an assistant director-general. He retired from Hong Kong University at the end of 2021.

How does he feel about the latest act in the multi-act play that is H5N1’s evolution, the spread into wild birds and poultry flocks throughout the Americas, and the lengthening list of mammalian species seen to have been infected with the virus? What does he think it portends?

Fukuda gives the auditory equivalent of a shrug. “Anyone who tries to predict anything about influenza is a bit foolish and hasn’t been in the field very long,” he said.

“I definitely have no idea what H5 is going to do, in 20 years whether we would have a similar discussion ‘Oh is it ever going to do anything?’ or if we’d be having a discussion saying ‘Oh, my God, couldn’t imagine that it was going to do that! That was really horrible,’” Fukuda said. “I think both of those discussions are plausible.”

STAT asked a number of experts, all of whom have been studying or following H5N1 for years, how they assess the current situation and how they’d describe their individual level of concern.

None of them ever stopped worrying about H5N1. None of them like what they’re seeing now. But most of them struggled to answer when asked if they are more worried now than earlier.

Like in 2004, when a cluster of cases in a Vietnamese family raised the specter of limited person-to-person spread. Or 2005, when what was by then a poultry virus moved back into wild birds, which spread it to North Africa, Turkey and Europe. Or in the mid-to-late teens, when Egypt recorded more than 250 human cases in unsettling succession, 93 of them fatal.

Since the 1997 outbreak, about 870 confirmed human cases have been detected. Just over half of those people died from the infection.

STAT in DC: The Politics of Health Care
On March 7, join STAT for a deep dive into the biggest discussions and decisions taking place in Washington.

“I grapple with this a little bit myself,” said Richard Webby, an influenza virologist who heads the WHO Collaborating Center for Studies on the Ecology of Influenza in Animals at St. Jude Children’s Hospital in Memphis. “The way I look at the current situation, I don’t think the virus itself is necessarily any more worrying than what we’ve been seeing for the past 20-plus years.

But what worries me right now is that this is a change in the epidemiology and the ecology of the disease. So we’re absolutely seeing more chances of people coming in contact with this virus.”

Fouchier agreed.

“For me, that risk hasn’t changed. In ’97 there was a pandemic threat. And that pandemic threat has continued to exist, and we cannot really quantify the threat because we still don’t really understand what it takes,” said Fouchier, who in 2011 showed that with some mutations, H5N1 viruses could gain the capacity to transmit easily among ferrets.

Yoshihiro Kawaoka, a virologist at the University of Wisconsin-Madison, did similar work and got the same result. Both scientists had to fight to publish their studies, because of concerns the so-called gain of function work could provide a dangerous how-to guide for bad actors.

(The debate this work sparked continues to this day, and it constrains — with good reason, critics say — the research that can be done to delve into what is keeping H5 from becoming a human flu virus.)

Malik Peiris, a professor of virology at Hong Kong University, does not view the mink farm outbreak in Spain as H5N1’s third act. “I mean to me it’s just one big act,” he said.

The outbreak, which occurred in October, saw H5N1 viruses move about a large mink farm in Galicia, in the northwest of Spain, sickening and killing a number of the animals. Eventually all the remaining minks — there were nearly 52,000 animals before the outbreak began — were euthanized.

It is not clear how the virus entered the farm. But it seems possible, perhaps even probable, that at some point H5N1 spread from mink to mink. “Our findings also indicate that an onward transmission of the virus to other minks may have taken place in the affected farm,” the scientists who reported the event wrote in the journal Eurosurveillance. “This is suggested by the increasing number of infected animals identified after the confirmation of the disease and the progression of the infection from the initially affected area to the entire holding.”

The mere idea of mink-to-mink transmission gives flu researchers pause. If a virus can transmit from one mammal to another, what’s to stop it from transmitting between other mammalian species — like ours?

The U.S. Department of Agriculture alone reports 110 reports of mammalian infections with H5N1 in 2022-2023 — multiple types of bears, foxes, skunks, possums, racoons, even seals.

It’s hard, though, to assess the significance of these infections in mammals. For starters, the virus has long had the capacity to infect mammals. Tigers and snow leopards in a zoo in Thailand died in late 2003 after being fed poultry infected with H5. Over the years infections in domestic cats and dogs, stone martens, and civet cats have been detected.

“We have been there. But we also shouldn’t be lulled into complacency when there are new facts,” said Kanta Subbarao, director of the WHO’s Collaborating Centre for Reference and Research on Influenza in Melbourne, Australia. Subbarao, who in 1997 was at the CDC, was the lead author on the first scientific publication characterizing the H5N1 virus.

Related: Experimental flu vaccine, developed using mRNA, seen as potential game changer
She said it’s not clear if the virus is entrenched in some animal populations — which she said would “escalate our problems quite significantly” — or if there is just so much virus in wild bird populations at this point that carnivores are becoming infected because they happen upon and eat infected birds.

Even with the mink farm, one cannot say with certainty whether there was ongoing transmission or if the infected animals all had a common exposure, such as contaminated food — they were fed poultry byproducts — or contact with wild birds that could have moved about the netted cages the animals were housed in. Dead and sick birds infected with H5N1 were reported in the region in the weeks leading up to the outbreak.

Webby doesn’t like the sheer geographic spread of the virus and the increasing reports of spillover events — instances when the bird virus infects mammals — though he noted the viruses don’t appear to have changed in significant ways.

“If we look at the virus and the sequence of it, there’s nothing that suggests to us that it’s become more infectious. But of course we don’t know everything about that,” he said. “The virus may be the same, but there’s just a whole lot more of it out there.”

“So absolutely worried from this new development in the ecology, epidemiology,” Webby said. “But luckily nothing that’s associated with that from the virologic side that has me running for the hills yet.”

One thing that does mitigate some of the concern is the fact that in recent years, there have been few human infections with H5N1. Whereas at points in the first two decades of this century it wasn’t uncommon to have 20 or 30 cases a year, reports of human cases are rare these days, and often involve such mild disease it is not clear if the person who tested positive was infected or simply had viruses in their nostrils. A man in Colorado who was culling infected poultry last spring. Two poultry workers in Spain in November. A British man who had infected ducks in 2021. A recent H5 infection in a young girl reported from Ecuador is a rare severe case.

One school of thought is that the decline in human cases is due to genetic changes in the virus that took place a while back.

For years, the internal genes of H5N1 were unchanging. Their origin was another bird flu virus, H9N2. Many, even most, of the human infections with bird flu viruses were caused by viruses that had that combination of internal genes from H9N2, Fouchier said. The current version of H5N1, known by the unwieldy name 2.3.4.4b, acquired other internal genes through reassortment, a gene-swapping process that can occur when multiple viruses infect a single host. “If you like, the engine under the bonnet is different,” Peiris said.

Fouchier worries primarily at the moment about the virus’ impact on biodiversity. Some species of wild birds are being decimated by the virus. But he also believes countries should be dusting off their pandemic influenza plans.

“There will be a new pandemic for sure. Whether it is this one, I don’t know. But I think that the current situation is enough that countries actually [should] review their pandemic preparedness plans again,” Fouchier said.

None of the scientists quoted here would disagree. But Fukuda, and one of his former colleagues from the CDC, Tim Uyeki, think at this point the world would be better off focusing on spillover threats plural than one single type of bird flu.

“I think it’s a major problem for the agricultural industry. And certainly there is a public health threat, but right now, it’s probably low,” said Uyeki, the chief medical officer of CDC’s flu division. Uyeki joined the CDC the year after the 1997 outbreak, but was involved in the investigations of many of the outbreaks that happened from 2003 onward.

“This is not the only virus that we should be concerned about for pandemic preparedness,” he stressed. “There are many other avian influenza A viruses circulating in birds and poultry that have sporadically transmitted to people and have caused a wide range of illness, including severe lower respiratory tract infection and fatal outcomes. And for that matter, if we even step back further and take a really big picture perspective… wherever you go in the world if you sample pigs, you will find swine influenza viruses.”

Fukuda said it would be short-sighted to focus solely on H5 bird flu, suggesting the world needs to invest more in being ready to detect and mitigate outbreaks caused by the array of animal viruses that could jump from animals to people and start transmitting among us. He worries that the Covid-19 experience, rather than strengthening our response capacity, has eroded political support for this type of work. And Osterholm worries about what the Covid pandemic has done to public support for public health.

“If we did have another pandemic right now I think it would be very difficult to get the public to do anything to try to limit or control transmission. That is to me a big setback,” he said.

Fukuda concurred. “What has become clear to me over time is that the big challenge is not the viruses. That’s not what gives me a pit in my stomach,” he said. “The real challenge is whether people, whether governments, whether policymakers have the ability to actually address the challenge in the way that needs to be done. And I don’t see so much which encourages me, to be blunt. That’s what gives me a pit in my stomach.”

Be warned: the next deadly pandemic is not inevitable, but all the elements are in place [The Guardian, 8 Feb 2023]

By George Monbiot

If you wanted to kill as many people as possible, deniably and with no criminal consequences, what would you do? You’d do well to start with a bird flu. Bird flus are responsible for all the known flu pandemics: the great influenza that started more than a century ago, “Asian flu”, “Hong Kong flu” and “Russian flu”, which killed tens of millions between them. They also cause many of the annual outbreaks that slaughter hundreds of thousands of people.

Once you have found a suitable variant, two further components are required to weaponise it.

The first is an amplifier. The best amplifier is a giant shed or factory in which thousands of birds are packed. These birds should be genetically homogenous, so that your viral strain can travel freely between them. Intensive poultry farms would serve very well. Before long, a low-pathogenic strain should mutate in these circumstances into a highly pathogenic variety.

To ensure maximum transmission, you should move some of the birds around, faster than the flu’s incubation period. You might carry them across borders. Some would be shifted to free-range or hobby farms, to enhance the possibility of infecting wild birds.

But it’s difficult for a flu virus to travel directly from birds to humans, so another component is required: a mixing vessel. This is a species that can simultaneously harbour the newly pathogenic bird virus and a flu variety already adapted to humans. Then the viruses, conveniently brought together, can exchange genetic material – a process known as “reassortment”.

Pigs are reasonable mixing vessels. They might have played this role in some previous outbreaks and pandemics. But there’s a much better candidate: mink. Mink readily harbour human and avian flu viruses. As predators, they can easily acquire avian flu from the meat they eat. The distribution of sialic acid receptors – a key determinant of infection – in their respiratory tracts is similar to that of humans. Human flu strains can pass between them through aerosol transmission.

Mink also possess, to a remarkable degree, what scientists call “zoonotic potential”: in other words, they can be infected by, and infect, many different species. During the first phases of Covid-19, they proved to be highly effective intermediaries, partly because the virus seemingly evolves faster in mink than in humans. They appear to have generated at least two new variants that spread to humans, one in Spain and one in Italy. Mink are the only known species that both received Covid-19 from humans and passed it back to them.

To enhance their mixing ability, you would cram hundreds or thousands of the tiny cages housing them together, so that this usually solitary animal is forced into contact with others.

You would reduce genetic diversity by breeding only those with a particular fur type. In other words, you would do what mink farms do today. Then you would sit back and wait.

The next pandemic might not have been seeded by a murderous psychopath, but, unless we are lucky, the effect could be the same. H5N1 was a fairly harmless bird flu until a highly pathogenic variant was hatched in a Chinese goose farm in 1996. It is deadly to humans. On the rare occasions when people have contracted this variant, it has proved fatal more often than not: of 868 infected up to October last year, 457 have died. Though it has been devastating to both poultry flocks and wild birds, however, its transmissibility from birds to most mammals, and from person to person, is thankfully extremely low.

But mink farming offers the mixing vessel it needs. In 2021, a paper in the journal Emerging Microbes & Infections reported that about a third of the mink the researchers tested harboured both bird flu and human flu antibodies. It warned that this joint infection could generate novel viruses “with high human infectivity”. The public health threat “should not be ignored”, as it had “pandemic potential”. Needless to say, it was ignored.

A few days ago, the journal Eurosurveillance revealed the first known case of large-scale mammal-to-mammal transmission of the H5N1 flu virus. It happened, to no gasps of surprise, on a mink farm; in Galicia, northern Spain. While the mink were fed with poultry products, a practice scientists have long warned against, it seems that the likely cause of infection was contact with a sick wild bird that might have fallen against the bars of a cage, and was dragged through and eaten. Once inside its mixing vessel, the virus mutated to become transmissible to the other mink, then spread rapidly in this farm of more than 50,000 animals from cage to cage.

This epidemic was contained before it left the farm. All the mink were killed, and we might narrowly have missed a pandemic potentially more deadly than Covid-19. But farming mink for their fur, a cruel and pointless practice, continues in Europe, North America and China. There’s a high chance that the next pandemic, whatever it may be, will emerge in one of these places.

Because of both the abominable cruelty suffered by the animals and the grave threat it presents to human life, we need a global treaty to ban mink farming.

The H5N1 virus, having acquired its deadly mutations on a poultry farm, is now raging through wild bird populations with horrific consequences. It is killing so many that, in conjunction with other threats, it could drive some species towards extinction. In particular, it is shattering colonies of seabirds. As they reproduce late and slowly, they’re especially vulnerable to extinction. Wild birds could easily introduce the virus to another mink farm.

Bird flu is a huge problem now – but we’re just one mutation away from it getting much worse

This threat is bookended by grotesque cruelty: the poultry, mink and pig farms whose horrors we have somehow normalised and accepted. If you treated dogs or cats in the same way as we treat these animals, you would be sent to prison. But do it to farmed species on a large enough scale and you are treated with the special respect accorded to a “captain of industry”.

Governments will sweep the dust from your path. Newspapers will write panegyrics of the kind once accorded to emperors.

So who is the homicidal maniac in this story? It’s a scarcely examined abstraction we call “the economy”, a monster to whom anything and everything must be sacrificed without question or resistance: farmed animals, wild ones, even, unless we are fortunate, human beings in their millions. We will prevent the pandemics of the future only when we value life ahead of money.

Here's Why Experts Are Concerned About Bird Flu [Medpage Today, 8 Feb 2023]

by Kristina Fiore

— Mink paper sets off alarms about potential for viral recombination

What appears to be mammal-to-mammal transmission of highly pathogenic avian influenza (HPAI) A(H5N1) on a mink farm in Spain has caught the attention of infectious disease epidemiologists around the world.

A paper published in Eurosurveillance last monthopens in a new tab or window detailed an H5N1 outbreak among farmed minks in the Galicia region of Spain in October 2022.

Montserrat Agüero, of Spain's agricultural ministry, and colleagues suspected that transmission occurred between the animals based on "the increasing number of infected animals identified after the confirmation of the disease, and the progression of the infection from the initially affected area to the entire holding."

While none of the farm workers were infected, experts said these are the conditions that can ignite a deadly H5N1 pandemic in humans.

That paper has "sent up a yellow caution light" in the infectious disease public health community, said William Schaffner, MD, of Vanderbilt University Medical Center in Nashville, Tennessee, who is also a spokesperson for the Infectious Diseases Society of America.

"There was no evidence of infection among any of the mink caretakers, who had very sustained, close contact with those animals, so everybody took a deep breath," Schaffner said. "But nonetheless, everybody [in the infectious disease public health community] is a little bit anxious, and they are watching this."

There have been increasing global reports of other types of mammals picking up H5N1 -- including bears, foxes, skunks, and raccoonsopens in a new tab or window -- in what has become one of the largest and longest avian flu outbreaksopens in a new tab or window in history. Fortunately, there has so far been no evidence of mammal-to-mammal transmission in those populations.

But the mink example shows that's possible: It allows for the type of recombination of influenza viruses that could lead to a pandemic, Schaffner said.

On farms across the U.S., concern has mostly been about pigs being co-infected with human and avian influenza viruses, he noted.

"If the pig is simultaneously infected with human flu and bird flu, those viruses can exchange genetic material, and that would provide an opportunity for a bird flu virus, which hardly ever infects humans, to pick up the genetic capacity to readily spread among humans," he said.

Indeed, in the mink, Agüero and colleagues noted a novel mutation in the PB2 gene (T271A), which they say could have public health implications. That amino acid influences acquisition of another mutation that confers human receptor recognition, they wrote.

While this change could have arisen de novo in minks, they said, the "data available are not sufficient to exclude the possibility of an unobserved circulation of avian viruses bearing this substitution in the avian population."

Indeed, a December report from the U.K. Health Security Agencyopens in a new tab or window said the risk to human health of avian influenza currently stands at Level 3 out of 5: "Evidence of viral genomic changes that provide an advantage for mammalian infection."

Schaffner said global surveillance systems are homed in on detecting a "pandemic" influenza in its early stages. Such was the case for the most recent example of pandemic influenza, the 2009 H1N1 "swine flu" pandemic, he added.

The World Health Organization's Global Influenza Surveillance and Response System monitors influenza viruses globally, and the CDC serves as a "Collaborating Center" in this network. The U.S. Department of Agriculture's Animal and Plant Health Inspection Serviceopens in a new tab or window also surveils animals for the virus, including both farmed and wild birds.

Should a pandemic occur, H5N1 vaccines are available, Schaffner said, as the U.S. has built a stockpile of bird flu vaccines. If a new strain pops up, vaccine makers would have to modify the vaccine to attempt a better match, and ramp up manufacturing of new vaccines, he said.

However, mRNA vaccine technology could cut down that timeline, he added.

So far, this has been the deadliest avian flu outbreak on record, with almost 50 million wild and domestic birds killed or culled in the U.S. and another 50 million killed or culled in Europeopens in a new tab or window.

Only one person in the U.S. has become infected with H5N1 during this outbreak -- a patient in Colorado in April 2022opens in a new tab or window. CDC maintains a bird flu trackeropens in a new tab or window that reports data for wild birds, poultry, and humans.

The first time HPAI H5N1 was detected in North America was in 2014, and it caused widespread poultry outbreaks and deaths of wild birds in the U.S. and Canada before it disappeared in 2016, according to the CDCopens in a new tab or window. It first emerged in southern China and led to large poultry outbreaks in Hong Kong in 1997. It was controlled, but not eradicated, and re-emerged in 2003, spreading widely among birds throughout Asia and then later in Africa, Europe, and the Middle East.

Globally, there have been more than 860 human infections since 2003, with a substantial mortality rate of about 53%, the CDC reported.

While the risk to humans currently remains low -- the only impact at the moment appears to be higher egg prices, which are also driven by inflation overall -- Schaffner warned an influenza pandemic is something the U.S. should always be ready for.

"There will be another pandemic," he said. "I hope we've learned lessons from having gone through COVID, so that we can do better the next time around."

Correction: An earlier version of this story incorrectly reported New Mexico as the state in which one person was infected with H5N1.

Peru: Over five hundred sea lions, 55,000 pelicans, gulls and penguins die due to bird flu [WION, 8 Feb 2023]

By Manas Joshi

STORY HIGHLIGHTS
It is rare that bird flu jumps over into mammals -- and rarer still that humans catch the potentially deadly virus.

Peru on Tuesday (February 7) said that H5N1 bird flu virus has caused the death of 585 sea lions and 55,000 wild birds in recent weeks. This has been mentioned in the country's latest report on the disease's impact.

Following the discovery of 55,000 dead birds in eight protected coastal areas, rangers found the bird flu that killed them had also claimed 585 sea lions in seven protected marine areas, the Sernanp natural areas protection agency said.

The agency further said that the dead birds include pelicans, various types of gulls and penguins.

Presence of H5N1 in dead sea lions, confirmed by laboratory tests has led authorities to announce a "biological vigilance protocol."

For its part, Peru's National Forest and Wildlife Service (SERFOR) urged people and their pets to avoid contact with sea lions and sea birds on the beach.

The authorities in Peru culled 37,000 birds on a chicken farm over bird flu in December.

Killing infected birds is part of the usual protocol to control avian influenza outbreaks.

In November, the country declared a 180-day health alert after finding three cases of highly contagious H5N1 in pelicans.

According to the SENASA agricultural health agency, the disease is transmitted by migratory birds from North America.

Since late 2021 Europe has been gripped by its worst-ever outbreak of bird flu, while North and South America are also experiencing severe outbreaks.

It is rare that bird flu jumps over into mammals -- and rarer still that humans catch the potentially deadly virus.

Nearly 600 sea lions die due to bird flu outbreak in Peru [Hindustan Times, 8 Feb 2023]

In November, the country declared a 180-day health alert after finding three cases of highly contagious H5N1 in pelicans. According to the SENASA agricultural health agency, the disease is transmitted by migratory birds from North America.

Peru said Tuesday that 585 sea lions and 55,000 wild birds have died of the H5N1 bird flu virus in recent weeks, the latest report on the disease's impacts.

Following the discovery of 55,000 dead birds in eight protected coastal areas, rangers found the bird flu that killed them had also claimed 585 sea lions in seven protected marine areas, the Sernanp natural areas protection agency said.

The dead birds included pelicans, various types of gulls, and penguins, the Sernanp said in a statement.

Laboratory tests also confirmed the presence of H5N1 in the dead sea lions, prompting the authorities to announce a "biological vigilance protocol."

For its part, Peru's National Forest and Wildlife Service (SERFOR) urged people and their pets to avoid contact with sea lions and sea birds on the beach.

In December, Peruvian authorities culled 37,000 birds on a chicken farm over bird flu, following previous outbreaks that affected wildlife.

Killing infected birds is part of the usual protocol to control avian influenza outbreaks.

In November, the country declared a 180-day health alert after finding three cases of highly contagious H5N1 in pelicans.

According to the SENASA agricultural health agency, the disease is transmitted by migratory birds from North America.

Since late 2021 Europe has been gripped by its worst-ever outbreak of bird flu, while North and South America are also experiencing severe outbreaks.

It is rare that bird flu jumps over into mammals -- and rarer still that humans catch the potentially deadly virus.

But the virus has recently been found in foxes and otters in Britain, a cat in France, and grizzly bears in Montana. All the mammals were suspected to have eaten infected birds.

Peru reports hundreds of sea lion deaths due to bird flu [Phys.org, 8 Feb 2023]

Peru said Tuesday that 585 sea lions and 55,000 wild birds have died of the H5N1 bird flu virus in recent weeks, the latest report on the disease's impacts.

Following the discovery of 55,000 dead birds in eight protected coastal areas, rangers found the bird flu that killed them had also claimed 585 sea lions in seven protected marine areas, the Sernanp natural areas protection agency said.

The dead birds included pelicans, various types of gulls, and penguins, the Sernanp said in a statement.

Laboratory tests also confirmed the presence of H5N1 in the dead sea lions, prompting the authorities to announce a "biological vigilance protocol."

For its part, Peru's National Forest and Wildlife Service (SERFOR) urged people and their pets to avoid contact with sea lions and sea birds on the beach.

In December, Peruvian authorities culled 37,000 birds on a chicken farm over bird flu, following previous outbreaks that affected wildlife.

Killing infected birds is part of the usual protocol to control avian influenza outbreaks.

In November, the country declared a 180-day health alert after finding three cases of highly contagious H5N1 in pelicans.

According to the SENASA agricultural health agency, the disease is transmitted by migratory birds from North America.

Since late 2021 Europe has been gripped by its worst-ever outbreak of bird flu, while North and South America are also experiencing severe outbreaks.

It is rare that bird flu jumps over into mammals—and rarer still that humans catch the potentially deadly virus.

But the virus has recently been found in foxes and otters in Britain, a cat in France, and grizzly bears in Montana. All the mammals were suspected to have eaten infected birds.

Study characterizes mutations in neuraminidase of human-like H5N1 influenza viruses [News-Medical.Net, 7 Feb 2023]

By Dr. Sanchari Sinha Dutta

A study published in PLOS PATHOGENS describes the prevalence and functions of mutations in neuraminidase enzyme of avian H5N1 influenza viruses that are preferentially selected in human H5N1 influenza viruses.

Background
Influenza A viruses are negative-sense RNA viruses that infect a wide-range of species, including birds and humans. The classification of these viruses depends on the variations in surface glycoproteins hemagglutinin and neuraminidase.

Some strains of zoonotic influenza viruses are capable of infecting and replicating in humans, causing mild to fatal diseases. Most human influenza viruses carry genetic sequences from avian influenza viruses that encode hemagglutinin, neuraminidase, and polymerase basic-1.

Genetic mutations in these viral proteins are responsible for bird-to-human transmission of avian influenza viruses.

In the current study, scientists have characterized the mutations in viral neuraminidase that facilitate zoonotic transmission of influenza viruses. They have analyzed all neuraminidase sequences of H5N1 influenza viruses of human- and bird-origin from Eurasia and Africa to identify the causative mutations.

Furthermore, they have characterized the functions of identified mutations by infecting chickens, mice, and ferrets with several recombinant viruses carrying these mutations.

Important observations
The analysis of neuraminidase genetic sequences identified A46D, L204M, S319F, and S430G mutations that act synergistically to improve H5N1 viral fitness and adaptability in humans. The scientists determined the functions of these mutations in both in vitroand in vivo (chickens, mice, and ferrets) setups.

The analysis of neuraminidase activity revealed that human-like H5N1 viruses have significantly lower activity compared to bird-like H5N1 viruses. Such reduced activity might be needed to maintain an optimal receptor binding/destroying balance. Moreover, low activity might be required for the selection and adaptation of avian influenza viruses in humans.

Specifically, it was observed in the study that the reduced neuraminidase activity of human H5N1 viruses is due to potential conformational changes in the enzyme, as well as due to a low amount of enzyme incorporation into viral particles.

Regarding the incorporation of neuraminidase into viral particles, the study found that the level of RNA replication and transcription of human-like neuraminidase is lower than that of bird-like neuraminidase. The findings of co-transfection experiments revealed that the abundance of bird-like neuraminidase favors its selection over homologous human-like neuraminidase. This explains the relatively lower incorporation of human-like neuraminidase into viral particles.

Regarding receptor binding activity of neuraminidase, the study found that the S430G mutation is primarily responsible for increasing the binding affinity of human-like neuraminidase for human-like receptors.

The head domain of neuraminidase has sialidase activity, which helps cleave sialic acid (SA) to release progeny viral particles in the respiratory tract for systemic viral transmission. The analysis of human-type 2,6-SA receptors and bird-type 2,3-SA receptors revealed that mutated human-like neuraminidase removes 2,3-SA during viral entry, leading to a reduction in bird-type receptors. This might reduce the adherence of hemagglutinin of progeny viral particles to 2,3-SA during viral release.

As speculated by the scientists, the abundance of 2,6-SA during viral release might act as the main driver for the adaptation of hemagglutinin and neuraminidase of avian influenza viruses to human-type receptors.

The findings of the mutational analysis revealed that all identified mutations in human-like neuraminidase act synergistically to increase viral replication in the human airway epithelium.

These mutations also conferred moderate virulence and longer survival of H5N1 avian influenza virus in mice and ferrets, while not affecting the high virulence of the virus in chickens.

Study significance
The study identifies four mutations in neuraminidase of human-like H5N1 influenza viruses that act synergistically to increase viral replication and induce moderate virulence in mammals, while maintaining high virulence in birds.

Collectively, these mutations reduce neuraminidase activity, expression, and incorporation in viral particles and increase the binding affinity of H5N1 viruses to human-like receptors.
As mentioned by the scientists, these findings are vital to understand the genetic changes that improve the fitness of avian influenza viruses in humans. The scientists highlight the requirement of continuous genomic surveillance to monitor avian virus replication in mammals.

This is particularly needed for the early detection of emerging viruses that have the potential to induce a pandemic condition.

Journal reference:
• Scheibner D. (2023). Phenotypic effects of mutations observed in the neuraminidase of human origin H5N1 influenza A viruses. PLOS PATHOGENS. doi: https://doi.org/10.1371/journal.ppat.1011135 https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011135

Could bird flu in mink signal threat of a human pandemic? [DW (English), 7 Feb 2023]

By Jeannette Cwienk

A bird flu outbreak on a Spanish mink farm has alarmed scientists. The virus may be spreading for the first time from mammal to mammal — and could become a danger for humans.

It started in October 2022, when several dead mink were discovered on a farm in Galicia in northwestern Spain. Veterinarians initially blamed the coronavirus. But tests revealed that the highly pathogenic avian flu virus H5N1 was the culprit.

To stop the spread of the dangerous pathogen, more than 50,000 mink on the farm were killed.

While farm workers themselves were not infected, the case remains a cause of concern for scientists.

Mink farm outbreak 'incredibly concerning'
The spread of the virus from birds to other species is nothing new. The pathogen that causes bird flu, or avian influenza, has been found in raccoons, foxes and seals, though these remain isolated cases.

While there have been some cases of H5N1 infecting humans, the World Health Organization has said there's no evidence of human-to-human transmission so far.

When the disease has spread to humans and other mammals, it has been via direct contact with excrement from infected birds or their carcasses, according to Timm Harder, an avian influenza expert at the Friedrich Loeffler Institute's diagnostic virology department in Germany.

But the mink outbreak appears to be a rare case where mammals are transmitting the disease to each other rather than through direct contact with an infected bird. This is something "new," said Harder.

Part of the problem is that mink are intensively farmed. They're kept in high numbers in confined spaces, which means infection spreads rapidly in the highly susceptible mammals, said Harder.

Harder added that researchers have identified several pathogen mutations in the mink, one of which allows "the virus to better reproduce in mammals."

Scientists are worried that the virus, which has led to the deaths of tens of millions of birds globally, could spread to more mink farms and become "more transmissible."

"This is incredibly concerning," said Tom Peacock, a virologist at Imperial College London, in an interview with the scientific journal, Science. "This is a clear mechanism for a H5 pandemic to start."

Could avian influenza trigger a human pandemic?
Of the 868 known cases of H5N1 infection in humans worldwide between January 2003 and November 2022, 457 were fatal, according to the WHO.

However, because there has been no sustained human-to-human transmission, the risk of human infection from avian flu is low, said the WHO.

Some highly pathogenic avian influenza viruses have an increased potential to cause new zoonotic diseases — which are transmissible from animals to humans and vice versa.

While Timm Harder said there are "numerous hurdles for a more extensive adaptation to humans," he added the mutations seen in the virus that infected mink must be further studied and evaluated.

How a harmless virus became dangerous
Waterfowl have long played host to influenza viruses, but these early strains were low in pathogenicity, said Wolfgang Fiedler, an ornithologist at the Max Planck Institute of Animal Behavior. The viruses weren't too contagious or damaging.

But when these viruses that were harmless to wild birds spread to factory poultry farms — where thousands of animals were crammed tight — the disease spread rapidly and the virus could mutate, Fiedler explained.

The result was the highly contagious virus strains H5N1 and H5N8, which likely originated on poultry farms in East Asia, according to the Scientific Task Force on Avian Influenza and Wild Birds established by the UN.

Farmed ducks likely become infected from wild birds. Ducks are "kept together with pigs, for example," which aided the mutation process, noted Fiedler. Such animal husbandry methods "make a virus like this insanely happy."

In fact, outbreaks of these highly pathogenic strains are typically associated with "intensive domestic poultry production and associated trade and marketing systems ... via contaminated poultry, poultry products and inanimate objects," according to the UN's bird flu task force.

The highly contagious H5N1 and H5N8 virus strains were in turn transmitted to wild birds via infected farmed birds, explained virologist Timm Harder. The viruses could then be transmitted over great distances during bird migrations.

How much damage has the bird flu outbreak caused?
The ongoing avian flu outbreak is considered the largest observed in Europe to date, according to the European Food Safety Authority, an EU agency.

Between October 2021 and September 2022, 50 million farm birds had to be culled in 37 countries.

More than 3,800 highly pathogenic bird flu cases were counted in wild birds. Experts believe the number of unreported cases is probably much higher.

"Now the virus is also circulating in wild birds during the summer months," confirmed Harder, noting that the animals breed closely in large colonies in the warmer months, providing ideal conditions for the spread of the virus.

The avian influenza wave also reached South America for the first time in the fall. Peru, Venezuela, Ecuador and Colombia were among the countries affected. In Honduras, more than 240 dead pelicans were found in one week alone.

Harder said he is concerned that the virus could spread from South America to Antarctica and endanger penguin populations. Apart from Antarctica, only Australia has escaped the virus.

Despite the acute outbreak among birds, Harder sees one ray of hope in that the broad spread of the virus could promote immunity in wild birds. Antibodies have already been found in live animals.

This article was adapted from German by Stuart Braun.

Bird flu is spreading among mammals. How worried should we be? [Sydney Morning Herald, 7 Feb 2023]

By Sydney Morning Herald

In Spain, bird flu appears to have spread from mink to mink for the first time. This is a troubling situation that warrants close attention.

“These are exactly the kind of situations we’re really worried about,” Associate Professor Paul Horwood tells me. Dr Michelle Wille says she and “many of my colleagues globally are very concerned”.

In today’s Examine: what’s happened, and why it matters.

What is bird flu? Why should we worry?
Virus risk is a numbers game. Human viruses tend to come from animals. Animals have been around for a lot longer than humans, so they have many more viruses than we do. The closer we get to animals – by farming and land-clearing – the more we risk a new virus jumping into humans and causing a pandemic.

There are well over 100 known subtype combinations of influenza A; only two subtypes of influenza A and influenza B circulate in humans. Most of the others circulate in waterfowl.

Since the discovery of this particular lineage of H5N1 in 1996, scientists have focused on it as one of the viruses that could plausibly cause a pandemic – for two reasons.

First, H5N1 is endemic in poultry in several countries, including Bangladesh, China and Indonesia. Second, it is extremely lethal in humans.

Influenza viruses bind to certain sialic acid-containing receptors on the surface of cells, using them to get inside and take over. These receptors come in multiple varieties; human influenza viruses bind to alpha-2,6 receptors, while the viruses that infect birds prefer alpha-2,3.

This difference is important. Humans also have alpha-2,3 receptors, but they tend to be deep in the lung rather than in our upper airways. That makes it very hard for H5N1 to get a purchase, giving us good protection from the virus. The tradeoff is when it does take hold, that infection is deep in our body, often leading to severe disease. This explains why bird flu infections in humans are extremely rare but often lethal: the World Health Organisation has tracked 868 cases and 457 deaths since 2003.

Put those two factors together – lots of virus in birds, high lethality in humans – and you have a pandemic risk that worries a lot of scientists and governments.

So what’s changed? Why are minks important?
Since H5N1 was first spotted in 1996, we’ve seen several huge outbreaks in birds. We’re in the middle of a very large one right now, driven by a new viral lineage that appears to be highly transmissible. And we’re seeing more infections of mammals – raccoons, foxes, seals – than we’ve seen previously.

“With high levels of transmission we are seeing unprecedented numbers of dead birds and outbreaks,” says Michelle Wille, a bird flu researcher at the Doherty Institute and the University of Sydney.

In October, a team of scientists arrived at a mink farm in Carral, a small municipality on Spain’s northern coast, to investigate an unexplained viral outbreak. The farm housed more than 51,000 mink in wire cages. Swabs soon revealed the virus was H5N1.

The mink were immediately culled. But the Spanish team’s study, published in January, raises troubling issues.

After H5N1 was first detected at the farm, more and more mink fell sick. The cases at first clustered in several hotspots before spreading across the farm. This suggests the virus wasn’t being spread from birds to mink, but from mink to mink.

“We’ve never seen mammal to mammal transmission, ever. It has never happened,” says Wille. “Now it’s no longer just a hypothetical. Now we’ve actually seen it happen”

This is important for several reasons.

First, mink are mammals. Humans also happen to be mammals.

Second, the mink upper respiratory tract is very similar to that of humans. Humans passed COVID-19 to farmed mink in 2020, leading to huge outbreaks and, eventually, the transmission of COVID-19 back from mink to human.

Third, mink-to-mink transmission may allow the virus to pick up mutations which allow it to better spread in mammals, including humans.

“You’re basically selecting for those kinds of mutations for mammalian adaptation,” says Paul Horwood, a tropical disease researcher at James Cook University who authored a 2021 study warning of H5N1’s pandemic risk. “That becomes more and more refined the more hosts the virus spreads between.”

Indeed, the virus isolated from the mink in Spain had an uncommon mutation that allows it to more-easily infect mammal cells.

And it does not need to take many more steps before it is a danger to humans. Lab evidence suggests as few as five specific amino acid changes are all H5N1 needs to spread effectively in humans. Wild viruses with two of these mutations have been spotted. “It’s not really a big stretch for it to happen,” says Horwood.

Is this an imminent pandemic threat?
“No,” says Professor Ricardo Soares Magalhães, director of the Queensland Alliance for One Health Sciences at the University of Queensland, “the situation is indeed concerning, but not a matter for alarm.”

The Spanish researchers tested all the people who worked with the mink but did not turn up any evidence of H5N1, suggesting the virus has not picked up a mutation that enables easy spread to humans.

And CSIRO bird flu expert Dr Frank Wong points out there’s no evidence the virus has a new mutation that allows it to spread easily in mammals. The mink, which are jammed together in small cages, may be a special case. “The risk of onward, mammal-to-mammal transmission has not really changed,” he says. “It’s still a bird-adapted virus.”

Nor is the situation analogous to COVID-19. That virus was (unfortunately) unexpected by health authorities; scientists have tracked H5N1 for years and have prepared vaccines and antivirals.

But this should be a major warning shot. Our efforts need to concentrate on making sure this virus does not get a chance to pick up any more mammal-adapted mutations.

“We need to make sure we starve the virus of mammal cells to infect,” says Magalhães.

That means close surveillance of farmed animals and wild birds. We should aggressively start vaccinating animals at risk − a strategy that was highly effective during the earlier H7N9 influenza outbreak. And given this scare, and the COVID-19 transmission, it may be time to stop farming mink altogether. Mink fur is used in clothing and furniture; doing without fur coats seems a small price to pay to cut our pandemic risk.

CORRECTION
An earlier version of this story stated there were 27 subtypes of influenza. This is incorrect. There are well over 100 known subtype combinations of influenza A.

Bird flu cases spill over to mammals in Oregon, across the U.S. [OregonLive, 7 Feb 2023]

By Gosia Wozniacka

Oregon wildlife officials said they have diagnosed a handful of wild mammals with highly pathogenic avian flu – but they do not consider it an outbreak.

The disease, commonly known as bird flu, is usually associated with wild birds and backyard flocks. It has killed thousands of birds throughout the state in recent months and led to the death and euthanization of millions of chickens and other domestic birds across the U.S.

The U.S. Agriculture Department has recorded avian flu infections in 110 mammals across the country since May 2022, including six skunks and one raccoon in Oregon. The disease has not affected the state’s wildlife populations, said state wildlife veterinarian Colin Gillin.

In other parts of the U.S., foxes, coyotes, bobcats, fishers, possums, bears and even seals and dolphins also were found to carry the disease.

Health officials say it’s rare for bird flu to spill over to mammals and the risk to humans is very low, though several hundred people across the world have tested positive for the disease in past years.

Typically, the wild mammals diagnosed are scavengers who likely ate a very sick or recently dead bird that carried bird flu, said Gillin. The animals also might have contracted the disease by congregating in areas contaminated with the virus, which can survive in feces or mud for several days.

Transmission of bird flu from mammal to mammal has not been observed so far in Oregon or elsewhere, Gillin said, except on mink farms where the animals are packed in cages nose to nose, with little ventilation. In the wild, he added, most animals don’t congregate in large groups and are usually outside in the open air.

Human infections with bird flu have most often occurred after close or lengthy contact with infected birds or places that the birds touched, according to the Centers for Disease Control and Prevention. While more than 800 cases have been recorded world-wide since 2003, fewer than 10 cases have been reported since 2021. The U.S. recorded its first case of avian influenza in humans last April.

Owners of backyard flocks should be especially cautious about letting their birds go outside if nearby properties have ponds where wild birds could land, Gillin said. They also should watch for wild animals who might be sick or dead, he said.

In one recent case in Columbia County, investigators with the Oregon Department of Agriculture who responded to a backyard flock sick with bird flu found six skunks dead nearby, department spokeswoman Andrea Cantu-Schomus said.

Approximately 20 birds in a noncommercial flock had to be euthanized, she said. The skunks were sent to the Oregon Department of Fish and Wildlife and tested positive for bird flu.

It’s unclear whether the dead skunks had contracted bird flu by eating contaminated backyard birds or wild birds or by being present in an environment contaminated by the virus, Gillin said.

Deadlier strains of bird flu have been on the rise in recent years. Highly pathogenic avian influenza has devastated wild birds and the poultry industry across the globe. The virus is now endemic in Europe and Asia.

And avian flu cases will likely increase soon in Oregon and elsewhere, Gillin said, as wild birds start to migrate from their southern wintering grounds up north as part of their annual migrations. As more wild birds and backyard flocks get sick, more mammals might also be diagnosed.

Could bird flu in mink signal threat of a human pandemic? [DW (English), 7 Feb 2023]

By Jeannette Cwienk

A bird flu outbreak on a Spanish mink farm has alarmed scientists. The virus may be spreading for the first time from mammal to mammal — and could become a danger for humans.

It started in October 2022, when several dead mink were discovered on a farm in Galicia in northwestern Spain. Veterinarians initially blamed the coronavirus. But tests revealed that the highly pathogenic avian flu virus H5N1 was the culprit.

To stop the spread of the dangerous pathogen, more than 50,000 mink on the farm were killed.

While farm workers themselves were not infected, the case remains a cause of concern for scientists.

Mink farm outbreak 'incredibly concerning'
The spread of the virus from birds to other species is nothing new. The pathogen that causes bird flu, or avian influenza, has been found in raccoons, foxes and seals, though these remain isolated cases.

While there have been some cases of H5N1 infecting humans, the World Health Organization has said there's no evidence of human-to-human transmission so far.

When the disease has spread to humans and other mammals, it has been via direct contact with excrement from infected birds or their carcasses, according to Timm Harder, an avian influenza expert at the Friedrich Loeffler Institute's diagnostic virology department in Germany.
But the mink outbreak appears to be a rare case where mammals are transmitting the disease to each other rather than through direct contact with an infected bird. This is something "new," said Harder.

Part of the problem is that mink are intensively farmed. They're kept in high numbers in confined spaces, which means infection spreads rapidly in the highly susceptible mammals, said Harder.

Harder added that researchers have identified several pathogen mutations in the mink, one of which allows "the virus to better reproduce in mammals."

Scientists are worried that the virus, which has led to the deaths of tens of millions of birds globally, could spread to more mink farms and become "more transmissible."

"This is incredibly concerning," said Tom Peacock, a virologist at Imperial College London, in an interview with the scientific journal, Science. "This is a clear mechanism for a H5 pandemic to start."

Could avian influenza trigger a human pandemic?
Of the 868 known cases of H5N1 infection in humans worldwide between January 2003 and November 2022, 457 were fatal, according to the WHO.

However, because there has been no sustained human-to-human transmission, the risk of human infection from avian flu is low, said the WHO.

Some highly pathogenic avian influenza viruses have an increased potential to cause new zoonotic diseases — which are transmissible from animals to humans and vice versa.

While Timm Harder said there are "numerous hurdles for a more extensive adaptation to humans," he added the mutations seen in the virus that infected mink must be further studied and evaluated.

How a harmless virus became dangerous
Waterfowl have long played host to influenza viruses, but these early strains were low in pathogenicity, said Wolfgang Fiedler, an ornithologist at the Max Planck Institute of Animal Behavior. The viruses weren't too contagious or damaging.

But when these viruses that were harmless to wild birds spread to factory poultry farms — where thousands of animals were crammed tight — the disease spread rapidly and the virus could mutate, Fiedler explained.

The result was the highly contagious virus strains H5N1 and H5N8, which likely originated on poultry farms in East Asia, according to the Scientific Task Force on Avian Influenza and Wild Birds established by the UN.

Farmed ducks likely become infected from wild birds. Ducks are "kept together with pigs, for example," which aided the mutation process, noted Fiedler. Such animal husbandry methods "make a virus like this insanely happy."

In fact, outbreaks of these highly pathogenic strains are typically associated with "intensive domestic poultry production and associated trade and marketing systems ... via contaminated poultry, poultry products and inanimate objects," according to the UN's bird flu task force.

The highly contagious H5N1 and H5N8 virus strains were in turn transmitted to wild birds via infected farmed birds, explained virologist Timm Harder. The viruses could then be transmitted over great distances during bird migrations.

How much damage has the bird flu outbreak caused?
The ongoing avian flu outbreak is considered the largest observed in Europe to date, according to the European Food Safety Authority, an EU agency.

Between October 2021 and September 2022, 50 million farm birds had to be culled in 37 countries.

More than 3,800 highly pathogenic bird flu cases were counted in wild birds. Experts believe the number of unreported cases is probably much higher.

Until recently, bird flu mainly occurred in fall and winter.

"Now the virus is also circulating in wild birds during the summer months," confirmed Harder, noting that the animals breed closely in large colonies in the warmer months, providing ideal conditions for the spread of the virus.

The avian influenza wave also reached South America for the first time in the fall. Peru, Venezuela, Ecuador and Colombia were among the countries affected. In Honduras, more than 240 dead pelicans were found in one week alone.

Harder said he is concerned that the virus could spread from South America to Antarctica and endanger penguin populations. Apart from Antarctica, only Australia has escaped the virus.

Despite the acute outbreak among birds, Harder sees one ray of hope in that the broad spread of the virus could promote immunity in wild birds. Antibodies have already been found in live animals.

This article was adapted from German by Stuart Braun.

Study characterizes mutations in neuraminidase of human-like H5N1 influenza viruses [News-Medical.Net, 7 Feb 2023]

By Dr. Sanchari Sinha Dutta,

A study published in PLOS PATHOGENS describes the prevalence and functions of mutations in neuraminidase enzyme of avian H5N1 influenza viruses that are preferentially selected in human H5N1 influenza viruses.

Background
Influenza A viruses are negative-sense RNA viruses that infect a wide-range of species, including birds and humans. The classification of these viruses depends on the variations in surface glycoproteins hemagglutinin and neuraminidase.

Some strains of zoonotic influenza viruses are capable of infecting and replicating in humans, causing mild to fatal diseases. Most human influenza viruses carry genetic sequences from avian influenza viruses that encode hemagglutinin, neuraminidase, and polymerase basic-1.

Genetic mutations in these viral proteins are responsible for bird-to-human transmission of avian influenza viruses.

In the current study, scientists have characterized the mutations in viral neuraminidase that facilitate zoonotic transmission of influenza viruses. They have analyzed all neuraminidase sequences of H5N1 influenza viruses of human- and bird-origin from Eurasia and Africa to identify the causative mutations.

Furthermore, they have characterized the functions of identified mutations by infecting chickens, mice, and ferrets with several recombinant viruses carrying these mutations.
Important observations

The analysis of neuraminidase genetic sequences identified A46D, L204M, S319F, and S430G mutations that act synergistically to improve H5N1 viral fitness and adaptability in humans. The scientists determined the functions of these mutations in both in vitroand in vivo (chickens, mice, and ferrets) setups.

The analysis of neuraminidase activity revealed that human-like H5N1 viruses have significantly lower activity compared to bird-like H5N1 viruses. Such reduced activity might be needed to maintain an optimal receptor binding/destroying balance. Moreover, low activity might be required for the selection and adaptation of avian influenza viruses in humans.

Specifically, it was observed in the study that the reduced neuraminidase activity of human H5N1 viruses is due to potential conformational changes in the enzyme, as well as due to a low amount of enzyme incorporation into viral particles.

Regarding the incorporation of neuraminidase into viral particles, the study found that the level of RNA replication and transcription of human-like neuraminidase is lower than that of bird-like neuraminidase. The findings of co-transfection experiments revealed that the abundance of bird-like neuraminidase favors its selection over homologous human-like neuraminidase. This explains the relatively lower incorporation of human-like neuraminidase into viral particles.

Regarding receptor binding activity of neuraminidase, the study found that the S430G mutation is primarily responsible for increasing the binding affinity of human-like neuraminidase for human-like receptors.

The head domain of neuraminidase has sialidase activity, which helps cleave sialic acid (SA) to release progeny viral particles in the respiratory tract for systemic viral transmission. The analysis of human-type 2,6-SA receptors and bird-type 2,3-SA receptors revealed that mutated human-like neuraminidase removes 2,3-SA during viral entry, leading to a reduction in bird-type receptors. This might reduce the adherence of hemagglutinin of progeny viral particles to 2,3-SA during viral release.

As speculated by the scientists, the abundance of 2,6-SA during viral release might act as the main driver for the adaptation of hemagglutinin and neuraminidase of avian influenza viruses to human-type receptors.

The findings of the mutational analysis revealed that all identified mutations in human-like neuraminidase act synergistically to increase viral replication in the human airway epithelium.

These mutations also conferred moderate virulence and longer survival of H5N1 avian influenza virus in mice and ferrets, while not affecting the high virulence of the virus in chickens.

Study significance
The study identifies four mutations in neuraminidase of human-like H5N1 influenza viruses that act synergistically to increase viral replication and induce moderate virulence in mammals, while maintaining high virulence in birds.

Collectively, these mutations reduce neuraminidase activity, expression, and incorporation in viral particles and increase the binding affinity of H5N1 viruses to human-like receptors.
As mentioned by the scientists, these findings are vital to understand the genetic changes that improve the fitness of avian influenza viruses in humans. The scientists highlight the requirement of continuous genomic surveillance to monitor avian virus replication in mammals. This is particularly needed for the early detection of emerging viruses that have the potential to induce a pandemic condition.

Journal reference:
•　Scheibner D. (2023). Phenotypic effects of mutations observed in the neuraminidase of human origin H5N1 influenza A viruses. PLOS PATHOGENS. doi: https://doi.org/10.1371/journal.ppat.1011135 https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1011135

Zoonotic Bird Flu News since 24 Jan till 6 Feb 2023

'Major Leap' in Bird Virus Threatens Yet Another Pandemic [The Daily Beast, 6 Feb 2023]

By David Axe

The same highly pathogenic bird-flu virus that’s killed tens of millions of chickens and other birds over the past year just got a lot closer to infecting people, too.

An unusual outbreak of the H5N1 virus in minks—relatives of weasels—at a Spanish fur farm last fall also exposed the farm’s staff to the virus. Swift action by health authorities helped prevent any human infections. This time.

But bird flu isn’t going away. And as H5N1 continues to circulate in domestic and wild birds, causing millions of animal deaths and tightening the supply of eggs, it’s also getting closer and closer to the human population. “This… avian influenza has the potential to become a major problem to humans,” Adel Talaat, a professor of pathobiological sciences at the University of Wisconsin-Madison, told The Daily Beast.

It might be a matter of time before H5N1 achieves large-scale “zoonosis” and makes the leap to the human species. If and when that happens, we could have yet another major viral crisis on our hands. On top of the COVID pandemic, worsening seasonal RSV, the occasional monkeypox flare-up and annual flu outbreaks.

Reports this week suggested that the current wave of bird flu could be crossing over into mammals with more regularity. Scientists found traces of bird flu in seals that died in a “mass mortality event” in the Caspian Sea in December, and the BBC reported this week that tests in Britain had found the virus in a range of mammals up and down the country. On Jan. 9, the World Health Organization was informed that a 9-year-old girl in Ecuador had tested positive.
Bird flu isn’t new. Scientists first identified the virus back in the 1870s. There’ve been dozens of major outbreaks over the years—and they’ve grown more frequent, and more severe, as the global population of domestic poultry has expanded in order to feed a growing human population.

H5N1, a more-severe “highly pathogenic avian influenza” virus—or HPAI—first appeared in China in the 1990s. It and other HPAIs have achieved zoonosis on a small scale, mostly in Asia. Several dozen people have died of bird flu in recent decades.

But so far, bird flu has mostly infected, well, birds. That makes it a huge problem for poultry farmers. And for people who buy eggs, of course. The current H5N1 outbreak has killed, or compelled farmers to cull, nearly 60 million chickens, turkeys, geese and ducks in the United States alone. The cullings drove up the price of eggs to nearly $5 per dozen at U.S. grocery stores last fall, according to the U.S. Department of Agriculture. That’s several times the long-term average price.

“The ability to achieve sustained transmission in a mammal is a major leap for flu viruses, so the mink event is a big deal.”
— James Lawler, University of Nebraska Medical Center

Bird Flu Taking the Leap
Higher egg prices will be the least of our problems if large-scale zoonosis ever triggers a human bird-flu pandemic. And that’s why scientists and health officials keep a close eye on H5N1 and related HPAIs as they spread and mutate. For epidemiologists, the bird-flu outbreak at the mink farm in northwestern Spain was a giant red flag. An ominous sign that major zoonosis might be getting more likely.

Spanish health officials first noticed the outbreak in early October, when the death rate among minks at a large farm in Galicia tripled. Biological samples from the farm’s 52,000 minks contained H5N1. It was the first time bird flu had infected farmed minks in Europe.

Authorities ordered the culling of all the minks at the affected farm. At the same time, they quarantined and tested the farm’s 11 workers. Luckily, none had caught the virus.

It was a close call. And all the more worrying because no one knows for sure what happened.

“The source of the outbreak remains unknown,” a team led by virologist Montserrat Agüero reported in the latest issue of Eurosurveillance, an epidemiology journal. It’s possible wild birds spread the virus to the minks. It’s also possible the pathogen was present in the minks’ food, which contains raw chicken.

Equally troubling, the virus didn’t just spread from birds to minks. It may also have spread from minks to other minks, as well, Agüero’s team discovered. “This is suggested by the increasing number of infected animals identified after the confirmation of the disease.”

That post-zoonosis transmission within a new species is how an animal virus such as H5N1 could cause a new pandemic. It’s what happened with COVID, after the SARS-CoV-2 virus spread from bats or pangolins to people back in late 2019. It’s what happened with monkeypox, after that pathogen first leaped from monkeys and rodents to human beings, possibly decades ago.

Alarming Spread of Bird Flu Continues as More Species Infected [ScienceAlert, 6 Feb 2023]

Experts have warned that the recent detection of bird flu in mammals including foxes, otters, minks, seals, and even grizzly bears is concerning but emphasized that the virus would have to significantly mutate to spread between humans.

Since late 2021, Europe has been gripped by its worst-ever outbreak of bird flu, with North and South America also experiencing severe outbreaks.

This has led to the culling of tens of millions of domestic poultry worldwide, many with the H5N1 strain. The global outbreak is also responsible for the deaths of tens of thousands of wild birds.

Tom Peacock, a virologist at the Imperial College London, told AFP that it constitutes a "panzootic" – a pandemic among animals, in this case birds.

"We are not fully sure why it's happening now but we think this might be driven by a slightly different strain of H5N1 which is spreading very effectively in wild, migratory birds," Peacock said.

It is rare that bird flu jumps over into mammals – and rarer still that humans catch the potentially deadly virus.

On Thursday, the UK Health Security Agency said that a fox had recently tested positive for H5N1.

It joins eight foxes and otters which tested positive in the UK last year, all of which had a PB2 mutation.

Peacock said that this mutation "allows the virus to replicate better in mammalian cells".

But further mutations would be "required for the virus to cause a flu pandemic" in humans, he added.

France announced last week that a cat had been put down after testing positive for H5N1.
And last month, the US state of Montana's parks service said three grizzly bears with bird flu had been euthanized.

All of these mammals were suspected to have eaten infected birds.

Paul Wigley, a professor of animal microbial ecosystems at the UK's Bristol University, said that while "there is no transmission within mammalian populations, the risk to humans remains low".

Potential to cause pandemic?
However two recent larger scale infections have raised concerns that bird flu has the potential to spread between mammals.

One was an outbreak of H5N1 with the PB2 mutation at a Spanish farm in October that led to the culling of more than 50,000 minks.

Research published in the journal Eurosurveillance last month said its findings "indicate that an onward transmission of the virus to other minks may have taken place in the affected farm".

Transmission between the minks has not been confirmed, with further research ongoing.

The mass death of some 2,500 endangered seals found along Russia's Caspian Sea coast last month has also raised concern.

A researcher at Russia's Dagestan State University, Alimurad Gadzhiyev, said last week that early samples from the seals "tested positive for bird flu", adding that they were still studying whether the virus caused the die-off.

Peacock warned there have been mixed reports from Russia about the seals, which could have contracted the virus by eating infected seabirds.

But if the seals did give bird flu to each other it "would be yet another very concerning development", he added.

"The mink outbreaks, the increased number of infections of scavenger mammals and the potential seal outbreak would all point to this virus having the potential to cause a pandemic" in humans, he said.

Mixing point
David Heymann, an infectious disease specialist at the London School of Hygiene and Tropical Medicine, urged caution.

More bird flu cases could be being detected in mammals because countries have ramped up testing, he said.

"This may have been going on for years and nothing has really occurred," he told AFP.

But it was always concerning when a flu virus enters mammals "because they're often the mixing point of influenza viruses, or they create an environment where mutations can occur and then can become adapted in humans", he added.

Even if that did occur, he said there were excellent surveillance systems in Europe and North America, and that H5N1 has been heavily researched since it first emerged in China and Hong Kong in 1996.

If H5N1 did mutate into a strain that could circulate among humans, the current seasonal flu vaccine could be fairly easily updated to include it, he said.

The UK Health Security Agency said "there is no evidence of sustained human to human transmission" of bird flu.

Over the last two decades, there have been 868 confirmed H5N1 cases in humans with 457 deaths, according to the World Health Organization. There were four confirmed cases and one death last year.

Last month, Ecuador reported South America's first case of the A(H5) bird flu virus in a human – a nine-year-old girl who was in contact with backyard poultry.

The experts called for continued surveillance of avian influenza in wild birds, poultry and mammals, in order for humans to limit their exposure.

An Even Deadlier Pandemic Could Soon Be Here [The New York Times, 3 Feb 2023]

By ZEYNEP TUFEKCI

Opinion | H5N1 Bird Flu is Causing Alarm. Here’s Why We Must Act.
As the world is just beginning to recover from the devastation of Covid-19, it is facing the possibility of a pandemic of a far more deadly pathogen.

Bird flu — known more formally as avian influenza — has long hovered on the horizons of scientists’ fears. This pathogen, especially the H5N1 strain, hasn’t often infected humans, but when it has, 56 percent of those known to have contracted it have died. Its inability to spread easily, if at all, from one person to another has kept it from causing a pandemic.

But things are changing. The virus, which has long caused outbreaks among poultry, is infecting more and more migratory birds, allowing it to spread more widely, even to various mammals, raising the risk that a new variant could spread to and among people.

Alarmingly, it was recently reported that a mutant H5N1 strain was not only infecting minks at a fur farm in Spain but also most likely spreading among them, unprecedented among mammals. Even worse, the mink’s upper respiratory tract is exceptionally well suited to act as a conduit to humans, Thomas Peacock, a virologist who has studied avian influenza, told me.

The world needs to act now, before H5N1 has any chance of becoming a devastating pandemic.

We have many of the tools that are needed, including vaccines. What’s missing is a sense of urgency and immediate action.

The best defense against a new deadly pathogen is aggressively suppressing early outbreaks, which first requires detecting them quickly. The United States, the World Health Organization and global health officials already have influenza surveillance networks, but many avian influenza experts told me they don’t think the networks are functioning well enough given the threat level. Such surveillance would need to prioritize people in the poultry industry but also expand beyond that.

Thijs Kuiken, an expert in avian influenza at Erasmus University Medical Center in Rotterdam, the Netherlands, says farms for pigs — another species susceptible to influenza — should also be surveilled for bird flu. People interacting with wild birds and animals, as well as susceptible species of pets like ferrets, are also at higher risk. It’s not enough to detect, though: Suppression would require a major effort and global coordination.

Unfortunately, mink farms must be shut down — even if it means killing the minks. They are typically killed anyway for their fur at about 6 months of age. It’s hard to imagine a better way to incubate and spread a deadly virus than letting it evolve among tens of thousands of animals with an upper respiratory tract similar to ours crowded together. When the coronavirus infected Danish mink farms in 2020 and the minks generated new variants that then infected humans, the efforts to save the industry were futile because the outbreaks were uncontrollable.

If different strains of flu have infected the same person simultaneously, the strains can swap gene segments and give rise to new, more transmissible ones. If a mink farmworker with the flu also gets infected by H5N1, that may be all it takes to ignite a pandemic.

To avoid this, quick testing should be widely available and easy to obtain globally, especially for poultry workers and people handling wild birds or other wildlife. And current testing capabilities should be quickly expanded. There are 91 public health labs in the United States that can test for H5 influenza. Positive results are sent to the Centers for Disease Control and Prevention, where further analyses can detect H5N1 within about 48 hours. But plans should be in place to increase the amount of tests and testing facilities in case demand ramps up.
Perhaps the best news is that we have several H5N1 vaccines already approved by the Food and Drug Administration whose safety and immune response have been studied.

The U.S. government has a small H5N1 vaccine stockpile, but it would be nowhere near enough if a serious outbreak occurred. The current plan is to mass-produce them if and when such an outbreak occurs, based on the particular variant involved.

There are several problems, though, with this approach even under the best-case scenarios. Producing hundreds of millions of doses of a new vaccine could take six months or more.

Worryingly, all but one of the approved vaccines are produced by incubating each dose in an egg. The U.S. government keeps hundreds of thousands of chickens in secret farms with bodyguards. (It’s true!) But the bodyguards are presumably there to fend off terror attacks, not a virus. Relying on chickens to produce vaccines against a virus that has a 90 percent to 100 percent fatality rate among poultry has the makings of the most unfunny which-came-first, the-chicken-or-the-egg riddle.

The only company with an F.D.A.-approved non-egg-based H5N1 vaccine expects to be able to produce 150 million doses within six months of the declaration of a pandemic. But there are seven billion people in the world.

The mRNA-based platforms used to make two of the Covid vaccines also don’t depend on eggs. Scott Hensley, an influenza expert at the University of Pennsylvania, told me that those vaccines can be mass-produced faster, in as little as three months. There are currently no approved mRNA vaccines for influenza, but efforts to make one should be expedited.

If the W.H.O. is to take the lead in expanding global vaccine manufacturing, it needs the support of wealthy countries and the cooperation of large pharmaceutical companies that have the patents and know-how.

A big challenge to stockpiling flu vaccines is that they can lose potency over time and need updating as new variants arise. The U.S. government is skeptical about creating a large stockpile, fearing that stored vaccines may not be effective against whatever strain became pandemic, and worries that stockpiles will expire anyway. Officials also have faith that they can get new flu vaccines mass-produced rapidly.

Many influenza experts told me that older vaccines could still provide some protection against severe outcomes or death. Peter Palese, a professor of microbiology at the Icahn School of Medicine at Mount Sinai, who established the first genetic maps for influenza A, B and C viruses, told me that such stockpiles would be especially useful for essential workers.

In 2017, the C.D.C. found that the H5N1 vaccine made in 2004 and 2005 helped protect ferrets against an H5N2 virus in 2014. Investigations in 2006 showed that 80 percent of the U.S. stockpile of earlier H5N1 vaccines were still potent a full year after their expected one-year shelf life had passed. In 2019, another study found that H5N1 vaccines produced as early as 2004 were still potent a full 12 years later.

We could also allow voluntary vaccination, especially for high-risk groups like poultry workers and health care workers, who would be treating patients should outbreaks occur. Voluntary vaccination could also produce larger-scale data on the safety and dosing specifics of vaccines. Vaccinating poultry workers has the additional big benefit of helping suppress outbreaks in the first place.

Several influenza experts I spoke to bemoaned the lack of more widespread vaccination for chickens and turkeys. Had all poultry been vaccinated earlier, perhaps H5N1 would have never spread so widely to wild birds. It’s late, but mass vaccination of poultry and pigs should begin quickly.

Even getting more people vaccinated — especially poultry and pig farmworkers — against the regular influenza can help. With less regular flu in the world, there would be fewer hosts for an H5N1 virus to co-infect, a process that can lead to strains of H5N1 that can spread more easily.

We already have antivirals for influenza, which work regardless of strain, but they need to be administered early, which requires widespread early testing, easy access, and sufficient and equitable stockpiles globally.

Scientists are working toward a universal flu vaccine, potentially covering all variants as well as future pandemic ones — a moonshot, perhaps, but worth the investment.

The pace of developments has been disquieting. Until 2020, when the new H5N1 strain began to spread extensively among wild birds, most big outbreaks occurred among poultry. But now, with wild birds acting as conduits, it’s not just the biggest outbreak ever among poultry, causing the death of at least 150 million animals so far, but it is also steadily expanding its reach, including to mammal species like dolphins and bears.

In 2006, when scientists discovered that H5N1 had not spread easily among humans because it settles deep in their lungs, Kuiken of Erasmus University Medical Center warned that if the virus evolved to bind to receptors in the upper respiratory tract — from which it could become more easily airborne — the risk of a pandemic among humans would rise substantially. The mink outbreak in Spain is a signal that we might be moving along exactly that path.

It’s hard to imagine clearer and more alarming warning signs of a potentially horrific pandemic.
The public, of course, doesn’t want to hear about another virus, and Congress isn’t even willing to keep funding efforts against the current one.

We could get lucky — we’ve had bird flu outbreaks before without human spread. But it seems foolish to count on that. A pandemic strain may have a much lower fatality rate than the 56 percent of known human cases so far, but it still could be much more deadly than the coronavirus, which is estimated to have killed 1 percent to 2 percent of those infected before vaccines or treatments were available. Deadly influenza pandemics occur regularly in human history, and they don’t wait until people recover from an earlier outbreak, no matter how weary we may all feel.

This time, we have not just the warning, but also many of the tools we need to fend a pandemic off. We should not wait until it’s too late.

Bird flu outbreak is spilling over into mammals. What does that mean for humans? [USA Today, 3 Feb 2023]

By Adrianna Rodriguez

One of the world’s largest outbreaks of bird flu, which led to the slaughter of millions of chickens to limit its spread, appears to be spilling over into mammals.

The U.S. Department of Agriculture said the avian influenza A virus has been detected in mammals such as skunks, bears, a raccoon and a red fox.

Though most cases were detected in Oregon, positive tests in mammals were confirmed in the following states, according to the USDA's Animal and Plant Health Inspection Services:
• Alaska
• Colorado
• Idaho
• Illinois
• Montana
• Nebraska
• New York
• Washington

Meanwhile in the United Kingdom, the Animal and Plant Health Agency found positive cases in otters and foxes. The agency also said a cat tested positive in France, and the highly contagious pathogen caused a large outbreak in a Spanish mink farm.

How is the bird flu being transmitted?
Most of these infections are probably independent cases in which a mammal eats an infected bird, said Jürgen Richt, professor and director of the Center on Emerging and Zoonotic Infectious Diseases at Kansas State University.

It may be happening more often during this outbreak as viral transmission increases among wild birds, such as ducks, geese and swans.

The outbreak at the Spanish mink farm could be a special case in which the virus transmitted from mammal to mammal, Richt said.

What does this mean for humans?
Though more research is needed, it doesn't bode well for humans.

"If this virus has mammalian adaption and can transmit between mammals, humans are immunologically naive … and humans are mammals," Richt said.

The U.S. Centers for Disease Control and Prevention said the “bird flu situation remains primarily an animal health issue.” Only four human infections have ever been reported in the U.S., the CDC said.

Bird flu is not a foodborne illness, so poultry and eggs found in grocery stores are safe to eat, Gregory Martin, a poultry educator at Penn State Extension, told USA TODAY last month.
Symptoms of bird flu in humans

The bird flu virus can cause mild to severe symptoms, including:
• Eye redness
• Fever
• Cough
• Sore throat
• Runny or stuffy nose
• Muscle or body aches
• Headaches
• Fatigue
• Shortness of breath

Less common symptoms include diarrhea, nausea, vomiting and seizures.

Avian Flu Jumps to Mammals: Could Humans be Next? - HS Today [HSToday, 2 Feb 2023]

By Kylie Bielby

According to the World Health Organization (WHO), zoonotic influenza infections in humans may be asymptomatic or may cause disease, from conjunctivitis or mild, flu-like symptoms to severe, acute respiratory disease or even death.

While public health officials say the risk to humans is still very low, they are concerned about mutations after a number of mammals have been found to have contracted the bird flu virus.

According to the World Health Organization (WHO), zoonotic influenza infections in humans may be asymptomatic or may cause disease, from conjunctivitis or mild, flu-like symptoms to severe, acute respiratory disease or even death, depending on factors related to the virus causing infection and the infected host. Rarely, gastrointestinal or neurological symptoms have been reported. WHO assesses the risk to the human population to be low, however recent studies show that the virus has shown potential mutation among cases in mammals.

In the U.K., the Animal and Plant Health Agency (APHA) has tested 20 mammals, and found eight were positive for highly pathogenic avian influenza (HPAI) H5N1. It is likely that these mammals fed on very sick or dead birds but there is also concern that the virus is spreading between mammals following additional data from around the world.

APHA says that four of the eight positive cases have genome sequences available and all show the presence of a mutation which is associated with potential advantages for mammalian infection. Together with supporting international data, the results are suggestive of sporadic mammalian spillover events. Last year for example, infections were found in about a dozen species in the United States, including raccoons, foxes, seals and grizzly bears. An outbreak of avian influenza on a mink farm in Spain provides the strongest evidence so far that the H5N1 strain of flu can spread from one infected mammal to another, and Hualan Chen, a virologist at the Harbin Veterinary Research Institute in China said the spread of the virus between mammals imposes a higher risk to public health.

APHA is working with the UK Health Security Agency (UKHSA) and the Department for Environment, Food and Rural Affairs to investigate the risk to human health of avian influenza in England. A recent UKHSA report noted that from October 1, 2022 to December 15, 2022, health protection systems recorded 2,085 human exposure episodes (where a person was directly exposed to an infected bird). There is likely to be substantial under ascertainment.

Based on the 29% of incidents for which there is data, personal protective equipment was used in 27.3% of exposures, and antiviral prophylaxis in 15.9% of exposures. Symptoms were reported following 31 (4.3%) exposures, with 24 symptomatic swabs being carried out (77.4% of those eligible).

Last year, a man in Colorado was diagnosed with avian influenza. Media reports at the time indicated he was involved with culling poultry and infected by a sick bird. According to the Centers for Disease Control and Prevention (CDC), he had mild symptoms, was isolated, and recovered. Nichola Hill, an assistant professor of biology at the University of Massachusetts said the fact that his symptoms were mild is concerning because it makes the virus harder to detect and track, as infected individuals may ignore mild symptoms and not seek treatment—much like COVID-19.

And last month, WHO was notified of a human infection caused by an avian influenza virus. The case, a nine-year-old girl, living in a rural area in the province of Bolívar, Ecuador, was in contact with backyard poultry, which was acquired a week before the onset of her symptoms.

As of January 18, WHO reported that she remained hospitalized, in isolation, and treated with antivirals.

CDC says that human infections with bird flu viruses have occurred most often after unprotected contact with infected birds or surfaces contaminated with bird flu viruses.

However, it notes that some infections have been identified where direct contact with infected birds or their environment was not known to have occurred.

“The spread of bird flu viruses from one infected person to a close contact is very rare and when it has happened, it has only spread to a few people,” CDC says. “However, because of the possibility that bird flu viruses could change and gain the ability to spread easily between people, monitoring for human infection and person-to-person spread is extremely important for public health.”

Currently there are no approved vaccines for preventing avian influenza in humans. However, candidate vaccines have been developed for pandemic preparedness purposes.

Jonathan Runstadler, professor and chair of the Department of Infectious Disease & Global Health at Cummings School of Veterinary Medicine, believes this particular outbreak will not be going away any time soon. It differs from earlier outbreaks in that this time around the whole H5N1 virus, not just a part of it, is circulating, and it is doing so faster than previous outbreaks. “There’s reason to expect this virus is here to stay, and it’s not going to disappear,” said Runstadler.

Prof Ian Brown, APHA’s director of scientific services, recently shared his concerns with the BBC. “The virus is absolutely on the march. And it’s almost remarkable – it’s a single strain,” he said, adding that he was “acutely aware of the risks” of avian flu becoming a pandemic like COVID-19.

Bird flu 'spills over' to otters and foxes in UK [BBC, 2 Feb 2023]

By Claire Marshall & Malcolm Prior

The largest ever outbreak of bird flu is spilling over into mammals, including otters and foxes in the UK.

Figures released to the BBC show the virus has led to the death of about 208 million birds around the world and at least 200 recorded cases in mammals.

Public health bosses warn the mutation in mammals could see a jump to humans but the risk to the public is very low.

There will now be more targeted surveillance and testing of animals and humans exposed to the virus in the UK.

The UK Health Security Agency (UKHSA) still advises that avian flu is primarily a disease of birds, but experts across the globe are looking at the risks of it spilling over into other species.

Worldwide, the virus has been found in a range of mammals, including grizzly bears in America and mink in Spain, as well as in dolphin and seals.

In the UK, the Animal and Plant Health Agency (APHA) has tested 66 mammals, including seals, and found nine otters and foxes were positive for highly pathogenic avian influenza (HPAI) H5N1.

Cases have been found in Durham, Cheshire and Cornwall in England; Powys in Wales; Shetland, the Inner Hebrides and Fife, Scotland.

It is believed they had fed on dead or sick wild birds infected with the virus.

The animals were found to have a mutation of the virus that could make it easier to infect mammals, but there was no evidence of transmission between mammals.

The APHA added that there was "a very low likelihood of any widespread infection in GB mammals".

Prof Ian Brown, APHA's director of scientific services, said: "A sick or a dead wild bird contains an awful lot of virus. So scavenging mammals that will be opportunistic and predate on dead or sick birds will be exposed to very large quantities of virus. That gives a possibility for the virus to enter a host population that it doesn't normally maintain in."

Prof Brown said that the UK's national avian flu taskforce was now ramping up its surveillance of cases in mammals and genome analysis of the virus itself while keeping a close eye on its spread in global populations of wild birds.

"The virus is absolutely on the march. And it's almost remarkable - it's a single strain," he said, adding that greater international action to tackle its spread was needed.

He told the BBC he was "acutely aware of the risks" of avian flu becoming a pandemic like Covid-19.

He said: "This global spread is a concern. We do need globally to look at new strategies, those international partnerships, to get on top of this disease.

"If we don't solve the problem across the globe, we're going to continue to have that risk."

Since October 2021, when the latest outbreak began, there have been five confirmed human cases of the H5N1 virus, including one in the UK, and one death, in China.

Last month, a nine-year old girl in Ecuador was found to be infected with avian influenza A(H5).

The World Health Organization (WHO) said that, in the past 20 years, there have been almost 870 cases of human infection with the avian influenza H5N1 virus reported from 21 countries. Of these, 457 were fatal.

It said the virus has "not acquired the ability for sustained transmission among humans. Thus the likelihood of human-to-human spread is low."

But it added: "Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect and monitor virological, epidemiological, and clinical changes associated with emerging or circulating influenza viruses that may affect human (or animal) health, and timely virus-sharing for risk assessment."

Dr Wenqing Zhang, the head of WHO's global influenza programme, said of the threat posed by the virus spilling over: "It is very concerning and the risk has been increasing over the years as reflected in the number of outbreaks in animals as well as a number of infections in humans."

Intergovernmental organisation the World Organisation for Animal Health (WOAH) told the BBC it has recorded almost 42 million individual cases in domestic and wild birds since the outbreak began in October 2021.

Almost 15 million domestic birds, including poultry, have died from the disease, and more than 193 million more have been culled.

It also shows 119 outbreaks affecting mammals, with about 200 individual cases recorded - although a WOAH spokesperson warned the spread to mammals was likely to be under-reported.

Dr Gregorio Torres, WOAH's head of science, said there had been an increase in reports of non-avian species being affected by the virus over the past 18 months.

He said it "could be a signal of very sensitive surveillance - an indicator that we are doing a good job".

But he added: "On the other hand, it could also be an indicator that there is a change in the epidemiology of the disease or a change in the dynamic of the disease. And that will require close monitoring.

"There is a risk for further transmission between species and we cannot underestimate the potential adaptation to humans."

In a recent report, the UK Health Security Agency (UKHSA) warned that the "rapid and consistent acquisition of the mutation in mammals may imply this virus has a propensity to cause zoonotic infections", meaning it could jump to humans.

The agency also raised concerns about limited wild bird and mammal surveillance and genomic data collection in England, and warned that there was not enough testing of people who had been contact with infected birds.

It is now looking to develop new ways of testing humans who have been exposed to the disease but may be asymptomatic

Dr Meera Chand, incident director for avian influenza at UKHSA, said: "Latest evidence suggests that the avian influenza viruses currently circulating in birds do not spread easily to people. We remain vigilant for any evidence of changing risk.

"There have recently been some detections of avian influenza viruses in a small number of mammals in the UK. However, the risk assessment conducted by UKHSA and partners did not identify any signals of increased risk to the general public from avian influenza at present."

Meanwhile, the public is being warned not to touch any dead or sick birds, but to report any dead birds of prey, three or more dead wild waterfowl or gulls or five or more dead birds of any species that they find to the Department for Environment, Food and Rural Affairs.

Bird flu has jumped to mammals in the UK - so how worried should humans be? [Sky News, 2 Feb 2023]

By Josephine Franks

Bird flu has been found in foxes and otters in the UK and around the globe it's cropped up in dolphins, bears and cats. Does that mean avian flu is heading for humans, and should we prepare for a pandemic? It's not that alarming - but scientists do have warnings.

Why you can trust Sky News
Bird flu has been creeping slowly closer to home since the outbreak started in October 2021.
First there were the headlines about poultry being culled, then the shortage of Christmas turkeys and the barren supermarket shelves where eggs were once stacked high.

Now bird flu has spilled to mammals in the UK, with otters and foxes testing positive for the virus.

With COVID now in its fourth year, people are naturally alert to the possibility of another pandemic sweeping through the population.

Bird flu isn't about to become the next Omicron, but the possibility of the virus mutating means scientists are keeping a watchful eye.

What animals has bird flu been found in?
On Thursday, the Animal and Plant Health Agency (APHA) confirmed five foxes and four otters have tested positive for avian flu in England, Scotland and Wales since 2021.

The UK isn't alone in seeing the virus crop up in mammals. Around the world it's been found in domestic cats, grizzly bears, dolphins, leopards and more, according to the United Nations Food and Agriculture Organisation.

In October last year, mink started dying at a farm in Spain. Testing revealed they had H5N1 avian flu.

How worried should we be about bird flu in mammals?
The spread at the mink farm set alarm bells ringing. In most cases where mammals become ill - including the otters and foxes in the UK - it's likely because they ate infected dead wild birds or their droppings.

But at the mink farm, the virus appeared to spread between the animals, from pen to pen.

Genetic sequencing showed the mink were infected with a new variant of H5N1 which includes a genetic change that means animal-flu viruses are better able to reproduce in mammals,
according to a report by Nature.

A UKHSA risk assessment from January concluded the apparent transmission between mink was of "significant concern" but said there was no "clear evidence" this had happened in any other species of mammal.

When it comes to the strain found in mammals in the UK, there's "currently no reason to suspect that the jump is due to a change in the virus's genetic make-up", according to Dr Alastair Ward, associate professor of biodiversity and ecosystem management at the University of Leeds.

He said foxes and otters are known to scavenge, and it's likely the bird carcasses would have had high viral loads.

"Such high exposure is likely to have overwhelmed the mammal's immune system, resulting in infection," he said.

What does this mean for humans?
Just because bird flu has been found in mammals, it doesn't mean humans are next in line.

As Dr Ward points out: "Humans rarely come into contact with wild foxes or otters, and potentially infectious contact is likely to be rarer still."

Professor Ian Jones, virologist at the University of Reading, said while the jump to different species provides an opportunity for the virus to adapt to mammals, "the natural barriers to this occurring are quite high".

"The risk to people right now therefore appears no more than it is for direct spread from infected birds."


"The risk to people right now therefore appears no more than it is for direct spread from infected birds."

But low risk doesn't mean no risk
The kicker is that phrase "right now". The Pirbright Institute, which carries out research into viral diseases in animals, warns that new avian flu virus strains are created frequently, meaning there is "a constant risk that one of the new strains may spread easily among people".

If this happened, we could be facing a new influenza virus pandemic.

It notes the viruses responsible for all four of the worldwide human influenza pandemics seen in the last 100 years have originated from birds.

What's being done?
The APHA is boosting its surveillance programme to make sure it tracks any instances of the virus passing from mammal to mammal.

Speaking on BBC Radio 4's Today programme, Prof Jones said Defra and the devolved administrations are supporting a programme for actively looking for mammals that we believe might scavenge and feed on wild birds.

"We analyse those viruses if we detect them, and we share that data very rapidly with our public health counterparts, so we can make clear and rapid assessments."

He added: "If you analyse the genetic code of the virus, you can work out whether it's come from a bird or whether it's going from one mammal to another."

Bird Flu Warning: Its Spreading, Mutating, and Infecting Mammals [Infection Control Today, 24 Jan 2023]

By Kevin Kavanagh

As many of us remain focused on COVID-19 and its immunosuppressive augmentation of other infectious diseases, mother nature is not sitting still. I was again reminded of this fact when I attempted to purchase a dozen eggs for over $6. The average price in the United States was over $4 in December 2022. In January 2023, the New York Timesreported a cost of over $7. This consumer price gouge is not the grocery store's fault, the COVID-19 bailout, or even our bloated federal deficit. It is the result of mother nature and the H5N1 bird flu pandemic.

Along with RSV, SARS-CoV-2, and Seasonal influenza, the bird flu is spreading rapidly in the United States at epidemic proportions. According to the New York Times, 60 million birds have been infected or killed (culled) in 47 states. So far, this has surpassed the second-largest outbreak in 2015, when 50.1 million birds died in 21 states. The number of states affected has more than doubled.

Bird flu has rarely affected humans; when it does, it is from directly handling birds. The virus rarely spreads from human to human. The concern is that when it infects humans, according to the Centers for Disease Control and Prevention (CDC), there is an approximately. From 2003 to 2006, H5N1 infected 232 people and killed 134.

But the one thing we have all learned from COVID-19 is that when RNA viruses spread rapidly, they mutate. This is what appears to have happened with H5N1. A new strain that is “highly pathogenic” has emerged and killed 1,600 snow geese in Colorado. To make matters worse, 3 Montana grizzly bears had to be euthanized after they caught the virus. This outbreak was described as the most significant foreign animal outbreak in US history and raises fears that the virus has mutated to promote the infection of mammals. A capability that could have profound consequences for the mammalian species, homo sapiens.

Unfortunately, this outbreak appears not to be a single occurrence. In Spain, a highly pathogenic H5N1 virus has infected the mink population. As of early October 2022, 52,000 minks were placed in cages, and the expected overall mortality of 0.2% to 0.4% rose to a mortality rate of 4%. Samples from the minks that died revealed the H5N1 virus. This virus was also found in 27 birds in the province and a neighboring province. The authors report that mink-to-mink transmission has occurred.

The virus which affected the mink population was a new strain, having the “uncommon mutation (T271A) in the PB2 gene.” Zhang Y et al (2012) have observed, “that amino acid 271A of PB2 plays a key role in virus acquisition of the mutation at position 226 of HA that confers human receptor recognition.” In other words, the strain which infected the mink population may be one step away from being able to spread in humans efficiently.

There have also been several gain-of-function laboratory experiments which, as dangerous as these experiments are, have shown the potential for the avian flu virus to take on characteristics of seasonal influenza. In 2006, CDC made 2 hybrid viruses (avian flu and human influenza) and infected ferrets, but the infection failed to spread. But research reported in 2010 by Dr. Yoshihiro Kawaoka from the University of Wisconsin produced a highly pathogenic hybrid with the pandemic ability of H1N1 (human influenza). The report states, “the new findings raise concerns that H5N1 and pandemic H1N1 viruses could reassort in individuals exposed to both viruses and generate an influenza strain that is both highly virulent and contagious.” The published research in the Proceedings of the National Academy of Sciences also stressed the importance of monitoring the emergence of avian flu viruses with mutations in the PB2 segment.

“…that the human virus PB2 segment functions in the background of an avian H5N1 virus, enhancing its virulence. Our findings highlight the importance of surveillance programs to monitor the emergence of human H5 reassortant viruses, especially those containing a PB2 segment of human origin.”

I’m starting to experience dé·jà Vu. Gain-of-Function experiments performed on a hazardous virus, viral spread from birds to mammals, spread between mammals, and mutations beginning to arise, which may be the first step in conferring the ability to transmit in humans.

I do not want to go through this again, especially since our current pandemic is not under control. We need to aggressively contain the spread of bird flu and increase our genomic surveillance for this disease. This is not a certainty since our current genomic surveillance for COVID-19 needs to be strengthened at a time when mutations are flourishing, and the dangers of long COVID are becoming more ominous.

Mass death of seals raises fears bird flu is jumping between mammals, threatening new pandemic [iNews, 1 Feb 2023]

By Jane Merrick

Avian flu has been found in seals that died a ‘mass mortality event’ in the Caspian Sea. Now scientists are investigating whether it is the first transmission of the virus between mammals in the wild

Scientists are investigating the possibility that bird flu has been transmitted between mammals in the wild for the first time – fuelling fears it could lead to the next pandemic in humans.

In what is being described as a “mass mortality event”, more than 700 seals were found dead in December in the Caspian Sea, near to where the highly contagious H5N1 variant of avian flu was found in wild birds months earlier.

Scientists from Dagestan State University have identified bird flu in tissue from the dead seals, although it is too early to say whether it was the cause of death or if the animals transmitted it to each other.

The situation is being monitored by the UK Government, i has learned, with Defra and the UK Health Security Agency being given regular updates.

Individual seals and other mammals have previously been infected with avian flu directly from birds, but up until now the only recorded incidents of it transmitting between mammals is among mink bred in close quarters in captivity at a farm in Spain.

If the H5N1 variant has adapted to pass between mammals, virologists fear that it could make a further evolutionary jump to become transmissible between humans and trigger a pandemic.

There is currently no evidence that the virus can pass between humans. Since the latest global outbreak of H5N1 began a year ago, fewer than 10 people have caught the virus, directly from close contact with poultry or other birds, and only one human death has been reported.

But samples from four mink which caught H5N1 in an outbreak at a mink farm in Galicia, northwestern Spain, in October revealed changes in the virus, including a mutation called T271A which can more easily replicate in mammalian tissue.

If it is confirmed that bird flu was passed between the seals in the Caspian Sea, it would be the first known transmission between mammals in the wild.

Dr Tom Peacock, a virologist at Imperial College London, told i: “If this turns out to be sustained transmission in a wild mammalian species this is yet another worrying ‘first’ with these H5N1s that shouldn’t be ignored. It would be yet more evidence these H5N1s could be poised to cause the next pandemic.”

Defra is aware of the developments in the Caspian Sea and the report by Dagestan State University that it has identified avian flu in seal tissue, i understands.

The latest risk assessment from the UK Health Security Agency is that the risk to the human population from bird flu is “very low”, but that there is evidence that the H5N1 strain has evolved to become more easily replicated in mammals.

The current threat is Level 3, that there is “evidence of viral genomic changes that provide an advantage for mammalian infection”, which is one below Level 4, evidence of sustained mammal-to-mammal transmission, and two below Level 5, human-to-human transmission.

H5N1 has been responsible for the deaths, from both infection and culling, of millions of birds in the UK and globally, with farmers ordered to bring free range turkey and other poultry indoors from last autumn.

In the waters around Britain, stranded seals are collected and any possible cause of death is investigated for disease including avian flu. No seals, dolphins or whales have yet tested positive for bird flu around Britain during the current outbreak, which began in December 2021, but there have been previous cases in these sea mammals.

The UKHSA has advised people not to handle sick or dead poultry or other birds.

Announcing that avian flu had been identified in the Caspian seals, Dagestan State University said: “Preliminary studies of the mass mortality of Caspian seals showed that the animals were infected with avian influenza. At the same time, it is too early to conclude that it was the virus that caused the death, research is ongoing.”

Alimurad Gadzhiev, director of the Institute of Ecology and Sustainable Development at DSU, said: “Specialists of the Institute of Ecology and Sustainable Development, together with colleagues from the Research Institute of Virology and experts from the Compass Foundation, took tissue samples from dead seals in December to determine the causes of death. Based on the first results, we can say that the samples tested positive for bird flu.”

The incident in Dagestan was first reported by the Avian Flu Diary blog, which said: “While we’ve seen a number of different influenza A viruses infect seals in the past – including H3N8, H10N8, H7N7, etc. – HPAI H5N1 is the most obvious suspect right now. Hopefully we’ll get confirmation in the days ahead.”

An ‘unprecedented pandemic of avian flu’ is wreaking havoc on the U.S. poultry industry. Humans may be at risk too, experts warn [Fortune, 24 Jan 2023]

BY ERIN PRATER

The H5N1 strain of avian flu responsible for the deaths of tens of millions of birds in the U.S. in recent months, and countless more worldwide, poses an existential threat to the poultry industry in the U.S.—and a potentially widespread human health threat, experts say.

The strain—first identified in domestic waterfowl in China in 1996—is behind nearly 58 million U.S. bird deaths in the past year. These deaths have occurred both directly due to the virus and indirectly, when flocks are culled to curb further exposure, according to the U.S. Centers for Disease Control and Prevention. The virus has a near 100% fatality rate among birds, killing most infected within 48 hours.

This season’s bird flu outbreak is the worst in U.S. history, having surpassed a 2015 outbreak the CDC once called “arguably the most significant animal health event in U.S. history.” That year, nearly 51 million birds died nationally due to H5N1 and related avian flu viruses. This season’s outbreak is also the worst in U.K. history, with farmers in England ordered to keep their birds indoors as of Nov. 7 in a poultry “lock down” of sorts.

The so-called “R naught” value—or the number of people infected by a single infected person, on average—for COVID initially ranged from 1.5 to 7, and now sits upwards of 12.

The R naught value of H5N1 among birds: “around 100,” according to Chowdhury.

It’s an environmental crisis already impacting humans, sending the price of poultry skyrocketing and making eggs harder to come by. U.S. egg retail costs have doubled over the past year, and oven-ready chicken prices are up by a quarter or more in the U.K., Bloomberg recently reported.

“The world is facing an unprecedented pandemic of avian flu among caged and wild bird populations,” Rajiv Chowdhury, senior epidemiologist and professor of global health at Florida International University, tells Fortune.

What’s more, the poultry industry likely cannot “sustain itself in countries like the U.S. if we continue to see annual surges,” Dr. Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy (CIDRAP), adds.

Economic and food-supply issues aside, the strain has sickened people, too, albeit in small numbers so far. But the trend of minimal transmission among humans may not hold, experts warn. Last week the WHO reported that a previously healthy Ecuadorian girl had been hospitalized with the virus. Just how she contracted the virus is uncertain and under investigation, but poultry her family had recently purchased died without apparent cause.

Oserholm and Chowdhury are concerned about additional spread from birds to humans, and about possible transmission from humans who contract the bird flu to other humans—especially as the virus traverses the globe and makes the leap to more mammals, due to mutations.

Last week the first grizzlies to be documented with the highly pathogenic avian flu were euthanized in Montana after they were found partially blind and disoriented, with other neurologic issues. Foxes, dolphins, opossums, skunks, seals, other types of bears, and a bottlenose dolphin are among other species that have been infected since last year, according to the U.S. Department of Agriculture.

The likelihood of human-to-human transmission of H5N1 is “very low,” Chowdhury says. But if it were to occur in a sustained manner, it could rock the globe in a way not seen since the 1918 Spanish Flu.

If H5N1 indeed makes a sustained crossover to humans, “the potential impact could be significant,” he says, signifying the start of a “new global influenza pandemic.”

‘Unusual’ among humans, but highly fatal
The virus’s Ecuadorian victim—the country’s first, as well as the first in the Latin America/Caribbean region—was admitted to a hospital for symptoms of nausea, vomiting, and constipation on Dec. 30, where she was presumptively treated for meningitis, according to a Jan. 18 WHO disease outbreak update.

On Jan. 3, she was transported to a pediatric hospital in critical condition after suffering septic shock and being diagnosed with pneumonia. She tested positive for the H5N1 strain on Jan. 7 and remained hospitalized, under sedation and on a ventilator as of Jan. 17, the international health organization stated.

The previously healthy girl becomes the seventh individual the virus has sickened since 2020, according to the World Health Organization. While H5N1 is considered highly infectious, that’s only among birds. It’s typically difficult for the virus to make the leap to humans, and transmission from human to human is “unusual,” the international health organization says.

When the virus does make the leap, however, it’s highly fatal, with a mortality rate of greater than 50% among humans, according to the CDC.

H5N1 outbreaks have come and gone throughout a quarter century, without sustained transmission in humans, Osterholm points out. Hundreds of human cases were identified in Egypt earlier this century, though there was no sustained human-to-human transmission. The virus’ track record gives reason to hope that transmission to humans, and among them, will remain the exception rather than the rule.

Chowdhury says the 1918 flu pandemic, however, serves as a cautionary tale. Like the H5N1 flu, the Spanish Flu is thought to have avian origins. Both viruses contain genes that allow them to replicate efficiently in human bronchial cells, according to a 2006 report from the Washington, D.C.-based Population Reference Bureau.

In the case of H5N1 among humans, such inflammation can lead to lung cells becoming “intensely inflamed”—much more so than would be seen in a usual flu. A similar effect was noted in Spanish Flu victims, autopsies of which revealed “lungs choked with debris from the excessive inflammation,” resulting in drowning, the report noted.

While seasonal flu symptoms include fever, cough, sore throat, runny nose, aches, and fatigue, according to the CDC, symptoms of H5N1 in humans are typically much more severe. They include an often high fever, weakness, cough, sore throat, and muscle aches, abdominal pain, chest pain, and diarrhea, according to the WHO. These symptoms can quickly give way to difficulty breathing, pneumonia, and/or Acute Respiratory Distress Syndrome, which is often deadly, as well as neurologic effects like seizures.

The seasonal flu vaccine doesn’t cover H5N1, according to the WHO. And while candidate vaccines for the viral strain have been developed, “they are not ready for widespread use,” according to the organization.

When it comes to planning for the next pandemic, influenza has always been considered a likely culprit, Dr. Georges Benjamin, executive director of the American Public Health Association, tells Fortune.

While the Ecuadorian girl and her disturbing bout with H5N1 “may very well be a one-off” case, “we could easily have an H5N1 or another pandemic of influenza,” he says.

“It should scare you.”

While there’s currently no reason to suspect sustained H5N1 transmission among humans, the outlook may not be so hopeful for the U.S. poultry industry, which is in “deep trouble right now,” Osterholm tells Fortune.

“They’ve got to change biosecurity procedures,” he says, adding that the virus can’t be kept away from flocks simply by “putting a screen up” because it’s transmitted in an airborne manner.

“These barns are going to require a great deal more air-handling considerations,” he adds.

“H5N1 has fundamentally rewritten avian influenza.”

Avian flu outbreak at Spanish mink farm sets off global alarm bells [EL PAÍS USA, 24 Jan 2023]

By MANUEL ANSEDE

Research on a case that occurred three months ago suggests that the virus jumped from wild birds and mutated at the facility, where all the animals were culled

It’s like a script for a disaster movie that everyone has already seen. Europe is going through the most devastating bird flu epidemic in its history, with more than 50 million poultry slaughtered in one year. At the beginning of autumn, seagulls and gannets killed by this virus appeared on the beaches of Spain’s northwestern Galicia region. Days later, in early October, American mink began to die of hemorrhagic pneumonia on a fur farm in Carral, a few minutes’ drive from the city of A Coruña. Mortality in this outbreak exceeded 4% in a single week.

A scientific study now suggests that the avian flu virus jumped from wild birds to mink and mutated on the farm, beginning to spread from mammal to mammal but failing to infect mask-wearing farm workers. This outbreak has set off alarm bells across the planet. The Dutch virologist Marion Koopmans, who traced the origin of the Covid pandemic for the World Health Organization (WHO), has issued a warning on her social media accounts: “We are playing with fire.”

The British doctor Jeremy Farrar, an expert in emerging diseases who was recently appointed chief scientist at the WHO, has also alerted about the recent outbreak in Spain on his social media. “The greatest risk of a devastating flu pandemic is avian or animal flu that infects intermediate mammals, and evolves to mammal-to-mammal and human-to-human transmission with little or no human immunity,” he said on Twitter. Farrar, who correctly alerted the world to a strange pneumonia in the Chinese city of Wuhan on December 31, 2019, is now urging authorities to prepare vaccines and treatments for each type of animal flu.

A mixing vessel
Mink are susceptible to both bird flu and human flu, so these animals can act as a mixing vessel in which viruses mix and more lethal versions emerge, warns the study, which was led by Montserrat Agüero of the Central Veterinary Laboratory of Spain’s Ministry of Agriculture and her Italian colleague Isabella Monne, from the Istituto Zooprofilattico Sperimentale delle Venezie (IZSVe).

The culprit in the Galician outbreak is a highly pathogenic avian influenza A (H5N1) virus, with an unusual mutation called T271A, a disturbing characteristic that was already present in the swine flu virus that caused a pandemic in humans in 2009. Regional health authorities decided on October 18 to immediately cull the 52,000 mink on the farm, located outdoors and with easy access to wild animals.

Virologists’ worst nightmare would be the leap to humans of a deadly flu virus. The WHO had already warned in 2019, before Covid, that “the world is not prepared for a pandemic of virulent and rapidly transmitted respiratory pathogens.” The institution then said that a pandemic such as the 1918 flu could kill 80 million people, “causing panic, destabilizing national security and seriously affecting economy and trade.”

It’s pretty scary. In Europe there had never been such an outbreak in mink before
Elisa Pérez, virologist

The virologist Elisa Pérez, an expert in emerging viruses at Spain’s Animal Health Research Center (INIA-CISA), is very concerned. “It’s pretty scary. In Europe there had never been such an outbreak in mink before, there were only a few cases described in China. We had never had such a big scare,” she warns. Pérez would like for all mink farms to be shut down as soon as possible. “What else needs to happen?”

Before the Covid pandemic, there were around 2,900 fur farms in the European Union, producing 27 million mink pelts each year, according to official industry figures. After the coronavirus outbreaks in hundreds of farms in 2020, some countries, such as Denmark and the Netherlands, ordered massive culls and closures. A report by European authorities estimated that there were 755 mink farms left in operation at the start of 2021, mainly in Finland, Poland, Lithuania and Greece. In Spain, that crisis caused some security measures to be implemented, such as mandatory face masks for workers.

One of the mink from a Dutch farm where Covid cases were recorded.

Bird flu is spreading around the world. The virus has already settled in South America, a team of scientists from Argentina and Peru warned last week. On the Peruvian coasts, 22,000 wild birds died in just one month, especially pelicans and boobies. On January 9, a nine-year-old girl from a village in Bolívar (Ecuador), admitted to intensive care after being in contact with chickens, became the first human case of highly pathogenic avian influenza in Latin America.

The WHO warned last Wednesday that the diversity of flu viruses that are jumping from animals to people is “alarming.”

In Spain last year there were 37 outbreaks of highly pathogenic avian influenza in poultry, the last two in a farm with 150,000 laying hens in Guadalajara and in another with 1,500 geese in La Cistérniga (Valladolid), according to figures provided by the Ministry of Agriculture. Two workers at the Guadalajara farm became infected with the virus without developing symptoms. In the Carral outbreak, the 11 employees who were in contact with the mink remained in isolation for 10 days, despite having tested negative for avian flu.

The virus is easily transmitted between birds, but only rarely does it pass from bird to human. Between people it has not yet managed to jump effectively, although the outbreak in mink in A Coruña suggests that the virus is capable of mutating and adapting rapidly to jumping from mammal to mammal.

The epidemiologist Matthew Baylis, former director of The Pandemic Institute in Liverpool, has also reacted to the analysis of the Galician outbreak. “Two years ago I wrote about the risks of mink farming for Covid. And now we see even greater risks for avian influenza, as mink provide a wonderful opportunity for the virus to adapt to mammals. This is where the next pandemic may come from,” he tweeted. “Is anyone heeding the warning sign? Clearly not.”

'Incredibly concerning': Bird flu outbreak at Spanish mink farm triggers pandemic fears [Science, 24 Jan 2023]

BY KAI KUPFERSCHMIDT

Spread among captive mink could give the H5N1 strain opportunities to evolve and adapt to mammals

When mink at a big farm in Galicia, a region in northwestern Spain, started to die in October 2022, veterinarians initially thought the culprit might be SARS-CoV-2, which has struck mink farms in several other countries. But lab tests soon revealed something scarier: a deadly avian influenza virus named H5N1. Authorities immediately placed workers on the farm under quarantine restrictions. The more than 50,000 mink at the facility were killed and their carcasses destroyed.

None of the farm workers became infected. But the episode, described in a paper in Eurosurveillance last week, has reignited long-smoldering fears that H5N1 could trigger a human pandemic. The virus is not known to spread well between mammals; people almost always catch it from infected birds, not one another. But now, H5N1 appears to have spread through a densely packed mammalian population and gained at least one mutation that favors mammal-to-mammal spread. Virologists warn that H5N1, now rampaging through birds around the world, could invade other mink farms and become still more transmissible.

“This is incredibly concerning,” says Tom Peacock, a virologist at Imperial College London. “This is a clear mechanism for an H5 pandemic to start.” Isabella Monne, a veterinary researcher at the European Union’s Reference Laboratory for Avian Influenza in Italy, where the samples from Spain were sequenced, calls the finding “a warning bell.”

H5N1 was first detected at a goose farm in China in 1996. A big poultry outbreak in Hong Kong in 1997 led to the first documented human deaths and sparked the first pandemic fears.

Around 2005, the virus spilled over into migratory birds, which have since spread it across the world in several big waves. A new variant named 2.3.4.4b that emerged in 2020 has spread faster and farther than any predecessor, dealing huge blows to the poultry industry in Europe and North America before arriving in Central and South America in the fall of 2022. “It seems this virus is just more adapted to all birds than any others have been,” says Richard Webby, an influenza researcher at St. Jude Children’s Research Hospital.

Because the receptors the virus binds to in the upper airways of birds are less common in mammalian upper airways, H5N1 largely spares mammals. But this time around many mammalian species have become infected, including foxes, cats, ferrets, seals, and dolphins, presumably through contact with infected birds. On 17 January, Montana authorities said three juvenile grizzly bears euthanized in the fall after becoming very sick were infected with H5N1 as well. People have caught it, too. So far there have been six confirmed human infections in the current global wave, including one death.

There are some signs that 2.3.4.4b is less pathogenic in humans than earlier versions, which killed roughly half of those infected, says Thomas Mettenleiter, head of the Friedrich Loeffler Institute. “Of course that can be bad news, too, because it might make it easier for the virus to start spreading under the radar, giving it more opportunity to evolve,” he says. The more often the virus infects mammals, the greater the risk, Webby says. “It’s a numbers game.”

There have been some past reports of avian influenza outbreaks on mink farms in China, but no clear evidence that the virus spread between the animals. In the Spanish outbreak, there seems to be little doubt it did. In theory, all of the sick animals could have picked up the virus from their feed, which included poultry byproducts, but H5N1 outbreaks have not been reported in the region where the poultry farms and slaughterhouses supplying the feed are located. And the virus spread from pen to pen as expected if it was transmitted between mink.

The chain of infections might have begun after one animal caught a sick bird and pulled it into its cage, says Thijs Kuiken, a veterinary pathologist at Erasmus University Medical Center.

How readily the virus found in Spain might infect humans—or spread between them—is unknown. Sequenced virus samples from four mink show several changes compared with the bird virus, including T271A, a mutation in the gene for an enzyme, polymerase. The change, also seen in viral samples from other infected mammals, is known to help H5N1 better replicate in mammalian tissues. E627K, another worrisome mutation in the polymerase gene, has not emerged, however, and the gene for hemagglutinin—a protein on the viral surface that latches on to the host ¬receptor—has not changed, Peacock says. “We may still have been lucky with this one.”

Monne says her team and others are now studying the properties of the mink virus and the effects of the mutations it has accumulated. Among other things, they want to study how well the virus transmits through close contact between animals. “We are planning to also do aerosol transmission studies,” she says.

The outbreak again puts the spotlight on the risks of mink farming. SARS-CoV-2, introduced at farms by humans, spread like wildfire among the animals but was also passed back to their caretakers, and researchers worried the mink industry might become a permanent source of infections and a breeding ground for genetic variants. The Netherlands, which had already decided to phase out mink farming by 2024 for ethical reasons, closed all remaining farms in 2021. Denmark culled all mink in the country in 2020, but a ban on mink farming expired at the beginning of this year.

The farms pose just as big of a threat when it comes to H5N1, Kuiken says. Most of the mammalian species infected with the virus so far are wild predators and scavengers feeding on infected birds—“solitary animals, or animals that live in small families,” he says. They are unlikely to spread the virus far or infect humans. At mink farms, thousands of such solitary carnivores are forced to live together, creating ideal conditions for the avian virus to adapt to mammals. “It’s a human construct,” Kuiken says.

At the very least, biosafety measures on mink farms need to be tightened, Monne says. Farm workers should wear masks and take other measures to prevent infection, and the farms should reduce the risk of accidental H5N1 introductions. “They should be really carefully keeping the animals far away from wild birds.” Peacock says perhaps it’s time to just end mink farming. “That this is happening in Europe in this day and age, and after COVID-19, is doing my head in,” he says. “It’s a bit of an existential threat.”

Mink-farm outbreak shows bird flu can spread between mammals [Nature.com, 24 Jan 2023]

BY Saima May Sidik

A new variant of H5N1 influenza could pose an increased risk to people and wild animals.

An outbreak of avian influenza on a mink farm in Spain provides the strongest evidence so far that the H5N1 strain of flu can spread from one infected mammal to another.

The outbreak of H5N1 flu, described in a report in Eurosurveillance on 19 January1, occurred on an American mink (Neovison vison) farm in Carral in October 2022. Genetic sequencing showed that the animals were infected with a new variant of H5N1, which includes genetic material from a strain found in gulls, as well as a genetic change known to increase the ability of some animal-flu viruses to reproduce in mammals.

The new variant puts bird flu in “uncharted territory”, says Wendy Puryear, a virologist at Tufts University in Medford, Massachusetts. Researchers have warned that, without careful precautions, the disease might eventually spread among people.

Jumping species
Over the past year, H5N1 has shown an increasing ability to jump from birds to mammals. In the United States, infections have been found in about a dozen species, including raccoons, foxes, seals and grizzly bears.

Until this particular outbreak, all mammalian infections could be attributed to direct contact with virus-contaminated material, says Hualan Chen, a virologist at the Harbin Veterinary Research Institute in China. For example, animals that ingest wild-bird droppings, or that prey on infected animals, can develop the disease. But its spread between mammals “implies that this H5N1 virus may pose a higher risk to public health”, Chen says.

During the first week of October 2022, workers on the affected mink farm noticed that the minks’ mortality rate had increased from a baseline of 0.25% per week to 0.77%, prompting tests on the affected animals for the H5N1 and SARS-CoV-2 viruses. The animals tested positive for H5N1. In the following weeks, more animals fell sick, and the disease seemed to spread from ‘hot spots’ of between two and four pens, in which all animals became infected and died. Workers were forced to cull all 51,986 mink on the farm. Eleven farm workers were in contact with the infected mink, but all tested negative for H5N1.

“This species could serve as a potential mixing vessel for the interspecies transmission among birds, mammals and human,” the report’s authors write. “It is necessary to strengthen the culture of biosafety and biosecurity in this farming system and promote the implementation of ad hoc surveillance programs for influenza A viruses and other zoonotic pathogens.”

Preventing spread
Measures taken to prevent the new strain from spreading beyond the farm seem to have been “vigorous, comprehensive and successful”, says infectious-disease specialist William Schaffner at Vanderbilt University Medical Center in Nashville, Tennessee.

But Puryear thinks that because the new variant contains genetic material from gull flu, it’s likely that at least some of its genetic changes arose in gulls before entering the mink farm.

This means that a strain containing those mutations is probably still circulating in the bird population. But for human populations, the outlook is still good: if the new strain did start to infect people, health authorities could probably produce a vaccine quickly, and the antiviral drug Tamiflu can reduce the severity of the disease.

The potential risk to wild animals is greater. Bird flu has consistently caused high levels of sickness and death among wild birds and mammals over the past year, and how the new variant will affect that trend remains to be seen. “We just simply don’t know,” says Puryear.
References

1. Agüero, M. et al. Eurosurveillance 28, 2300001 (2023).

New Coronavirus News from 1 Feb 2023

Covid deaths in Japan hit record high as fears mount for ‘super-ageing society’ [South China Morning Post, 1 Feb 2023]

• Japan’s Covid hospitals were overwhelmed by a winter wave that started in October, leading to thousands of patients being turned away multiple times
• Scientists worry the fast-ageing society, where 29 per cent of people are older than 65, will have one of the world’s highest death rates eventually

Japan is no longer the best-performing wealthy nation when it comes to avoiding Covid deaths.
The country, which has one of the oldest populations in the world, is quietly experiencing its biggest outbreak of the pandemic. A wave of Omicron infections overwhelmed its health system this winter and delayed medical care for patients, sending daily deaths to a record high of more than 500 on January 14, according to data compiled by Bloomberg.

The increase pushed Japan’s overall mortality rate above New Zealand’s, which now has the fewest deaths per capita among the Organisation for Economic Co-operation and Development’s 38-member countries, according to Our World in Data. Infection rates in Japan, while still among the lowest in the world, are now rising rapidly.

That status left more room for people to contract the virus for the first time this winter, which increased the risk of death, said Norio Ohmagari, head of the disease control and prevention centre at the National Centre for Global Health and Medicine, and an adviser to the Tokyo government.

Japan’s long-standing success in managing the pandemic was underpinned by extensive mask wearing, widespread vaccination, an already-healthy population and easy access to healthcare.

“The number of infected people will likely increase at a faster pace than in other countries from now on,” Ohmagari said. “Japan is a super-ageing society, which means the proportion of people with a greater mortality risk is high. In the long run, it’s possible that Japan will be among the countries with high mortality rates.”

Japan is one of the fastest-ageing societies in the world, with people older than 65 making up 29 per cent of the 125 million population. The group is among the highest-risk for Covid, with reports that many deaths during the current wave have occurred among those with underlying conditions such as Alzheimer’s and heart disease.

The about-turn in Japan reflects the ongoing devastation wrought by the virus even as the world, including previous holdouts like China, resume pre-pandemic life.

While mainland China’s abrupt abandonment of zero-Covid in early December unleashed a wave of infections that contributed to a recent uptick in the global death rate, the figure was relatively stable for most of 2022.
•
The health system structure likely exacerbated the toll. Japan classifies Covid as a serious disease, much like tuberculosis or bird flu, and sends patients to specialised facilities equipped to handle it.

The designated Covid hospitals were overwhelmed by the rapid increase of patients during the wave that started in October and turned patients away, said Kenji Shibuya, an epidemiologist at the Tokyo Foundation for Policy Research.

Thousands of emergency patients were denied care by hospitals three times or more since the outbreak began, with the figure hitting a record 8,161 the week of January 9, according to the Fire and Disaster Management Agency.

“The number of emergency transports by ambulance increased, placing a heavy burden on designated hospitals already lacking manpower as medical professionals also got infected,” Shibuya said. “Communities can’t respond quickly enough to elderly people whose underlying conditions worsened because of Covid,” he said, calling for the classification to be quickly changed so more hospitals can treat the infected.

There have been calls to downgrade Covid’s classification, and treat it like influenza, for more than a year. But the government has resisted, despite the signs that the cautious approach meant to control the spread of the virus is now contributing to making the death toll worse. A key political consideration is to avoid passing on costs to patients – if the classification is downgraded, people have to pay for treatment themselves like for other illnesses.

Prime Minister Fumio Kishida last week said the nation will prepare to relax its indoor mask guidelines and lower Covid’s classification on May 8. His support rate rose 4 percentage points to 39 per cent from the previous month, according to a poll by the Nikkei newspaper conducted between January 27 and January 29.

Covid measures still linger everywhere in Japan. Most people wear masks outdoors, hotels check temperatures and restaurants continue to place plastic sheets between tables. How they adjust to the reopening will determine the coming infection and death rates, health experts said.

“Our future depends on how elderly people protect themselves and if other people cooperate,” Ohmagari said. “I sincerely hope that there will not be a division in the society.”

COVID's quiet creep in Japan fuels its deadliest outbreak yet [The Japan Times, 1 Feb 2023]

By KANOKO MATSUYAMA

Japan is no longer the best-performing wealthy nation when it comes to avoiding COVID-19 deaths.

The country, which has one of the oldest populations in the world, is quietly experiencing its biggest outbreak of the pandemic. A wave of omicron infections overwhelmed its health system this winter and delayed medical care for patients, sending daily deaths to a record high of more than 500 on Jan. 14, according to data compiled by Bloomberg.

The increase pushed Japan’s overall mortality rate above New Zealand’s, which now has the fewest deaths per capita among the OECD's 38-member countries, according to Our World in Data. Infection rates in Japan, while still among the lowest in the world, rose rapidly in recent months.

That status left more room for people to contract the virus for the first time this winter, which boosted the risk of death, said Norio Ohmagari, head of the disease control and prevention center at National Center for Global Health and Medicine, and an adviser to the Tokyo Metropolitan Government.

Japan’s long-standing success in managing the pandemic was underpinned by extensive mask wearing, widespread vaccination, an already-healthy population and easy access to health care.

"The number of infected people will likely increase at a faster pace than in other countries from now on,” Ohmagari said. "Japan is a super-aging society, which means the proportion of people with a greater mortality risk is high. In the long run, it’s possible that Japan will be among the countries with high mortality rates.”

Japan is one of the fastest-aging societies in the world, with people older than 65 making up 29% of its roughly 125 million people. The group is among the highest-risk for COVID-19, with reports that many deaths during the current wave have occurred among those with underlying conditions such as Alzheimer’s and heart disease.

The about-turn in Japan reflects the ongoing devastation wrought by the virus even as the world, including previous holdouts like China, resume pre-pandemic life. While mainland China’s abrupt abandonment of "zero-COVID" in early December unleashed a wave of infections that contributed to a recent uptick in the global death rate, the figure was relatively stable for most of 2022.

System setbacks
The health system structure likely exacerbated the toll. Japan classifies COVID-19 as a serious disease, much like tuberculosis or avian influenza, and sends patients to specialized facilities equipped to handle it.

The designated COVID-19 hospitals were overwhelmed by the rapid increase of patients during the wave that started in October and turned patients away, said Kenji Shibuya, an epidemiologist at the Tokyo Foundation for Policy Research.

Thousands of emergency patients were denied care by hospitals three times or more since the outbreak began, with the figure hitting a record 8,161 the week of Jan. 9, according to the Fire and Disaster Management Agency.

"The number of emergency transports by ambulance increased, placing a heavy burden on designated hospitals already lacking manpower as medical professionals also got infected,” Shibuya said. "Communities can’t respond quickly enough to elderly people whose underlying conditions worsened because of COVID,” he said, calling for the classification to be quickly changed so more hospitals can treat the infected.

Downgrading COVID
There had been calls to downgrade COVID’s classification, and treat it like influenza, for more than a year. But the government had resisted, despite the signs that the cautious approach meant to control the spread of the virus is now contributing to making the death toll worse. A key political consideration has been to avoid passing on costs to patients — if the classification is downgraded, people have to pay for treatment themselves like for other illnesses.

Prime Minister Fumio Kishida last week said the nation will prepare to relax its indoor mask guidelines and lower COVID-19’s classification on May 8. His support rate rose 4 percentage points to 39% from the previous month, according to a poll by the Nikkei Shimbun conducted between Friday and Sunday.

Mostly voluntary COVID-19 measures still linger everywhere in Japan. Most people wear masks outdoors, hotels check temperatures and restaurants continue to place plastic sheets between tables. How they adjust to the reopening will determine the coming infection and death rates, health experts said.

"Our future depends on how elderly people protect themselves and if other people cooperate,” Ohmagari said. "I sincerely hope that there will not be a division in the society.”

Nipah Outbreak News in Bangladesh and elsewhere since 30 Jan 2023

One dies of Nipah virus in Rajshahi [Dhaka Tribune, 2 Mar 2023]

By Abdullah Al Dulal

Complications escalated after she was diagnosed with Nipah virus on Wednesday morning and was eventually referred to Nipah ICU

One woman died of Nipah virus in Rajshahi Medical College Hospital (RMCH) Wednesday afternoon.

The deceased, Farida Yasmeen, 25, was admitted to the neuro medicine ward of RMCH with common symptoms like fever and seizures.

Complications escalated after she was diagnosed with Nipah virus on Wednesday morning and was eventually referred to Nipah ICU. She died around 5pm while undergoing treatment.

Besides, her mother-in-law Rahima Begum is admitted in the Nipah Suspect Ward with the same symptoms. Farida's father-in-law Abdul Haque had died at home with the same symptoms two weeks ago.

Although the family thinks it was a natural death, however, doctors believe that her father-in-law was also infected with Nipah virus. Besides, it has been reported that their entire family eats date juice without boiling it, a common cause of the spread of this disease.

Dr Azizul Haque, medicine specialist at Rajshahi Medical College Hospital, said: “Relatives of deceased patients are at higher risk of infection. So, they need to be extra careful. We are working in coordination with IEDCR.”

He urged to be careful while drinking date juice.

However, Rajshahi Civil Surgeon Dr Abu Yusuf Mohammad Farooq said that there is no need for regular care of the patient's relatives. The IECCR has collected and tested the samples of everyone who came in contact with the infected patient. However, everyone should be careful while drinking date juice

A total of five people has died in Rajshahi Medical College Hospital (RMCH) so far. All of them have a history of drinking date palm juice. Besides, everyone was admitted to the general ward of the hospital with common symptoms like jaundice. Then suddenly the physical condition started to deteriorate. Death occurred on admission to the ICU. Nipah of one of the deceased was identified after death.

Another death from Nipah virus [The Business Standard, 14 Feb 2023]

A young man died from Nipah virus infection at Dhaka Medical College Hospital on Monday.

The deceased identified as Shah Alam, 20, hailing from Narshingdi's Raipura upazila, passed away around eight o'clock yesterday.

"The young man was undergoing treatment here since last week," Dhaka Medical College Director Brigadier General Nazmul Haque told The Business Standard.

"After the victim showed symptoms of Nipah virus infection, his sample was sent to the Institute of Epidemiology Disease Control and Research (IEDCR) for examination," he said.

The lab test report came out positive on Monday, the same day Shah Alam succumbed to the deadly infection, Nazmul Haque added.

With this, eight out of ten Nipah-infected people in the country have died so far this year pushing the mortality rate of Nipah virus infection even higher.

Nipah virus spreads via unfiltered date juice and partly eaten fruits, which has been contaminated by bats in Bangladesh.

No vaccine has been discovered for the virus yet. Bat is the main carrier of the deadly virus. A person can contract the virus from both people and animals. The virus killed many people in the country since 2001.

According to icddr,b, the Nipah virus emerged in Bangladesh in 2001. Even if people recover from the sickness, they remain vulnerable to severe neurological issues. It also causes complications toward the end of pregnancy for women.

Bangladesh reports two new Nipah virus deaths [bd24, 6 Feb 2023]

The death toll from the virus this winter reaches seven

Government’s disease control agency has reported two more deaths from Nipah virus infection, taking the toll this winter to seven.

Dr Tahmina Shirin, director at the Institute of Epidemiology Disease Control And Research, said on Sunday the number of Nipah virus cases this season was 10 until Feb 3.

The zoonotic virus can be transmitted from animals to humans, through foods contaminated by animals and from humans to humans.

Fruit bats, which infect date juice in winter, are the natural host of the virus, which is currently one of the deadly emerging pathogens.

Most of the cases were from Rajshahi Division and all were currently receiving treatment, Health Minister Zahid Maleque said on Jan 29, while revealing eight cases and five deaths from the disease this winter.

He said the number of infected was “higher” than last year. Efforts to prevent the disease from spreading were underway through promotional materials on TV and in newspapers, he added.

Health authorities have marked 32 districts in Bangladesh as being at risk of the Nipah virus infection and directed physicians to take adequate precautionary measures while attending to patients with fevers, a primary symptom of the illness, in hospitals.

The Dhaka North City Corporation's COVID-dedicated hospital in Mohakhali has also been instructed to prepare 20 beds for the treatment of Nipah virus patients.

Since 2001, Nipah virus patients have been found in 33 districts, according to the IEDCR
Any area where a case of the Nipah virus is detected is considered 'risky', said Dr Mushtuq Husain, an adviser at the IEDCR.

“This is because anywhere a Nipah virus patient is found is also likely to have bats and palm sap. All parts of the country are vulnerable to the Nipah virus, but the districts where it has been detected are advised to take extra precautions."

Last Thursday, Sheikh Daud Adnan, acting director of the health directorate's hospital and clinic wing, issued a letter to local health authorities as well as public and private hospitals across the country, urging doctors to take special precautions. These include wearing a mask and also washing hands with soap before and after seeing a patient.

They have also been advised to move a patient to the isolation ward if they start showing symptoms of a fever. In addition to fevers, patients should be admitted to the intensive care unit if their condition is critical. Caregivers of patients in intensive care are only required to wear gloves and masks.

But the Nipah virus is not aerially transmissible, according to the health directorate.

Cases of the virus have been reported in the Rajbari, Naogaon, Rajshahi, Shariatpur, Pabna and Dhaka districts this year, according to Prof Md Nazmul Islam, director of the DGHS's infectious disease control branch.

Dr Nazmul believes there is no need to panic, but stressed the need to proceed with 'extreme caution'.

“There is no vaccine for this disease. More than 70 percent of people affected by the disease die. Those who survive develop physical disabilities. The number of patients may not be high, but most of those who were infected have died. That is why we need to be extremely careful," he said.

Dr Nazmul advises against the consumption of raw date sap. Sales, marketing and promotion of raw date palm sap should also be restricted, he said.
In a follow-up on the Nipah virus situation in Bangladesh in 2023, the Institute of Epidemiology Disease Control and Research (IEDCR) is now reporting nine Nipah infections since the beginning of the year, the most cases seen since 2015 (15 cases/11 deaths).

The nine cases (three in children, six in adults up to age 35) have been reported from six districts – Rajshahi, Naogaon, Rajbari, Shariatpur, Pabna, and Dhaka. Five fatalities, including two in childtren have been reported.

The primary source of infection in the cases has been the consumption of date palm sap contaminated with bat saliva or urine.

Nipah virus: An introduction

Since the first cases were reported in Bangladesh in 2001, 334 cases, including 235 deaths (70% case fatality rate) have been recorded.

Nipah virus infections at highest numbers in Bangladesh since 2015 [Outbreak News Today, 5 Feb 2023]

In a follow-up on the Nipah virus situation in Bangladesh in 2023, the Institute of Epidemiology Disease Control and Research (IEDCR) is now reporting nine Nipah infections since the beginning of the year, the most cases seen since 2015 (15 cases/11 deaths).

The nine cases (three in children, six in adults up to age 35) have been reported from six districts – Rajshahi, Naogaon, Rajbari, Shariatpur, Pabna, and Dhaka. Five fatalities, including two in childtren have been reported.

The primary source of infection in the cases has been the consumption of date palm sap contaminated with bat saliva or urine.

Nipah virus: An introduction
Since the first cases were reported in Bangladesh in 2001, 334 cases, including 235 deaths (70% case fatality rate) have been recorded.

Nipah virus spreads to 28 districts of Bangladesh [Dhaka Tribune, 3 Feb 2023]

DGHS issues directive to keep hospital beds ready for Nipah virus patients

The government on Friday gave directives to the relevant authorities to keep the Dhaka North City Corporation (DNCC) Dedicated Covid-19 Hospital ready in the wake of the spread of the Nipah virus in 28 districts of the country.

The Directorate General of Health Services (DGHS) issued the directives asking the hospital authorities to keep 10 beds at the isolation ward and 10 Intensive Care Unit (ICU) beds prepared, said a press release signed by Dr Sheikh Daud Adnan, director (hospitals and clinics) of the DGHS.

On January 29, Health Minister Zahid Maleque said a total of five people died of Nipah virus across the country this year.

Eight people were infected with Nipah virus and of them five people died.

Usually more than 70% of infected people die and people who drink raw date juice and fruits partially eaten by birds, especially bats, have the possibility of being infected with the virus.

Besides, healthy people who come in contact with the infected ones also have the possibility of being infected with the virus and it spreads from person to person quickly which is a matter of concern.

9 diseases that keep epidemiologists up at night [Oregon Public Broadcasting, 31 Jan 2023]

By Sheila Mulrooney Eldred

Just three years ago, on Jan. 30, 2020, the head of the World Health Organization made a landmark declaration: A “novel coronavirus” that had first been identified in China had spread to a degree where it was now a “Public Health Emergency of International Concern (PHEIC).”

The virus now known as SARS-CoV-2 — which causes the disease COVID-19 — is still spreading. But for those who study infectious diseases, talking about possible next pandemics is a necessity.

That's why the World Health Organization keeps a list of viruses and bacteria with pandemic potential. Jill Weatherhead of Baylor College of Medicine says prioritizing diseases is generally based on two factors: their ability to spread and the ability of humans to treat them.

The list helps guide scientists, governments and organizations in investing energy and funds to study the pathogens most likely to cause the greatest devastation to humans. The WHO develops "blueprints" with strategic goals and research priorities for each disease on the list.

Here are the diseases on the current list. A revised list is expected in the coming months: In late 2022, the World Health Organization convened more than 300 scientists to assess and update the list.

Note: The infrastructure to detect diseases in different parts of the world varies, as does the fact that mild cases of an illness may not be known or reported. Fatality rates are based on the best available data.

Nipah virus
What animals carry it: fruit bats, including those called flying foxes, and domestic animals such as pigs, horses, cats and dogs

How it spreads: Nipah virus can be transmitted to humans from animals or contaminated foods. It can also be transmitted directly from human to human.

Its toll: 40% to 75% fatality rate. The virus can also cause encephalitis, or swelling of the brain.

Medical toolbox: There is no vaccine available for either people or animals. Monoclonal antibody therapies are in development.

Pandemic potential: Outbreaks occur almost every year in parts of Asia, but there are known ways to prevent spread of the virus. Prevention efforts include avoiding exposure to bats and sick animals, avoiding consumption of fruits that bats may have nibbled on and not drinking certain raw juices from fruits that bats feed on. The risk of international transmission can be lowered by washing those fruits and fruit products thoroughly and peeling them before eating.

Crimean-Congo hemorrhagic fever
What animals carry it: ticks, livestock
How it spreads: Humans usually get the virus from contact with ticks or infected livestock. To get the virus from another person requires close contact with blood or other bodily fluids from an infected person.

Its toll: 10% to 40% fatality rate. The disease is endemic, meaning it occurs regularly, in Africa, the Balkans, the Middle East and Asia. The virus causes severe outbreaks of viral hemorrhagic fever, a condition that can damage the body's organ systems and cardiovascular system and that often includes severe bleeding.

Medical toolbox: Although a vaccine is in use in Bulgaria, no research has been published on how well it works, and it's not licensed anywhere else. Other vaccines are in development, and an antiviral drug called ribavirin appears to help treat infections.

Pandemic potential: It's difficult to tell when an animal is infected and should be avoided, and the WHO says the ticks that carry the virus are numerous and widespread. The threat could be reduced by trying to avoid tick bites and wearing gloves and other protective clothing when around livestock.

Lassa fever
What animals carry it: rats and other rodents
How it spreads: The virus is endemic in parts of West Africa. Rats excrete the virus, and humans pick it up when exposed to the rodents' urine and feces, either through direct contact or eating contaminated food. It can also spread between humans through direct contact with an infected person's secretions (blood, urine, feces), through sexual contact and in medical settings via contaminated equipment.

Its toll: 1%, but up to 15% in severe hospitalized cases. It can be deadly for people and fetuses in the third trimester of pregnancy. Besides death, a common complication is deafness, which can be permanent.

Medical toolbox: There is no vaccine, but ribavirin seems to help treat infections.

Pandemic potential: Because the primary method of transmission is exposure to a certain type of rat, potential for the spread of the disease is most likely limited to the countries where the rat lives.

Rift Valley fever
What animals carry it: mosquitoes. The insects can transmit the virus to both humans and their own offspring. Livestock such as cattle, sheep, goats, buffalo and camels can also get infected.

How it spreads: It spreads to people through contact with blood, other body fluids or tissues of infected animals.

Its toll: Although the fatality level is less than 1% and the disease is mild for most people, about 8% to 10% of people infected develop severe symptoms, including eye lesions, encephalitis and hemorrhagic fever.

Medical toolbox: Although a vaccine has been developed, it is not yet licensed or available.
Pandemic potential: Rift Valley fever has spread from Africa to Saudi Arabia and Yemen.

Flooding seems to contribute to more Rift Valley fever because more virus-infected mosquitoes buzz about after heavy rainfalls. Rapid case detection, including prompt laboratory testing of people with symptoms, has limited recent outbreaks.

Zika
What animals carry it: mosquitoes
How it spreads: In addition to mosquito bites, the virus can spread from a pregnant person to a fetus. The disease can also be transmitted through sex and probably through blood transfusions.

Its toll: It's rarely fatal, but Zika can cause severe brain defects in fetuses, including microcephaly. It has also been linked to miscarriage, stillbirth and other birth defects.

Medical toolbox: No treatment or vaccine

Pandemic potential: So far, it's largely limited to areas where Zika-carrying mosquitoes live.
Ebola and Marburg virus disease

What animals carry them: Bats and nonhuman primates are believed to carry the viruses, from the filovirus family, that cause these hemorrhagic fevers.

How they spread: Both viruses are believed to spread in the same way. After the initial spillover from an animal, humans spread the viruses to other humans through direct contact with blood or other bodily fluids of a person who is symptomatic or who has died from the disease. The viruses can also spread through objects or surfaces contaminated with bodily fluids and through semen from people who have recovered from the disease.

Their toll: The average fatality rate is about 50%, though rates have varied from 25% to 90% in past outbreaks.

Medical toolbox: Vaccines have been used for Ebola in Guinea and the Democratic Republic of Congo. Monoclonal antibodies approved by the Food and Drug Administration in 2020 can also help with treatment of Ebola. Vaccines for Marburg virus are in development.

Pandemic potential: These viruses can spread quickly in health care settings, especially when proper sterilization isn't used. However, the disease spreads only when a person is symptomatic, making it easier to control.

MERS (Middle East respiratory syndrome)
What animals carry it: camels
How it spreads: After the initial spillover event from camels to humans, this coronavirus can spread from person to person through close contact with an infected person.

Its toll: The reported fatality rate, according to the WHO, is 35%.

Medical toolbox: Several vaccines are in development, but none has been approved.

Pandemic potential: 27 countries have reported infections since 2012. Unlike SARS-CoV-2, the coronavirus that causes MERS grows deep in the respiratory tract, making it much less likely to be transmitted through sneezing and coughing.

SARS (severe acute respiratory syndrome)
What animals carry it: Palm civets were largely blamed for the 2003 outbreak. Bats and possibly other wildlife also carry it.

How it spreads: After the initial spillover event from animal to human, SARS can spread from person to person through close contact with an infected person. It's believed to usually spread through droplets from coughs and sneezes and sometimes through surfaces touched by infectious people.

Its toll: less than a 1% fatality rate

Medical toolbox: No treatment or vaccine has been approved.

Pandemic potential: Unlike SARS-CoV-2, which can spread before people know they're infectious, this SARS virus is usually spread only by those with known symptoms, making it much easier to contain through public health measures such as quarantining. The 2003 outbreak was contained after causing about 8,000 cases and 700 deaths in 29 countries.

Disease X
The WHO says it does not rank diseases in any order of potential threat, but it acknowledges the possibility that an as-yet-unknown disease could cause a serious pandemic.

In her work with bat viruses, for example, Raina Plowright of Cornell University says that even in the small proportion of bat species that have been studied, the animals carry thousands of viruses, "and we have no clue how many present risk," she says. "We don't have the technology to take a sequence and say with certainty whether it can infect humans or can transmit from human to human. We're blind, really."

Not to mention that variants pose threats, she says. "Just the tiniest genetic change can have a profound effect. What if we had [a pathogen] with a 50% fatality rate that transmitted efficiently?"

Trying to crack the Nipah code: How does this deadly virus spill from bats to humans? [KVPR, 31 Jan 2023]

By Ari Daniel, Rebecca Davis

Nipah virus, which can rapidly infect and kill members of a community, is carried by bats.

Exactly how does it cross over into humans? Researchers in Bangladesh are trying to find out.

It's dusk in central Bangladesh, in a community within the district of Faridpur. A 50-year-old man sits outside his home beside a rice paddy. His name is Khokon. A fiery beard, dyed a bright orange, rings his chin.

He says the procession of disease and death all started in the spring of 2004. "So the first one was the mother-in-law of my elder brother. She was really sick," Khokon says. "She had been sick for some time. Then she died. We took her to the grave. Then my father got sick."

Khokon stares off into the distance as he explains that his father was a spiritual leader in the community. When he became ill, many came to pay their respects and offer their prayers. "Just 12 days after, my father died," he says. "Suddenly, he was no more."

Many of his visitors also got sick. One person traveled to an adjacent village, where four more people fell ill. "It was not understood what was happening," says Mahmudur Rahman, who worked for the Bangladeshi government around that time as director of the Institute of Epidemiology, Disease Control and Research. "Some people who were transporting the patients to the hospital were also getting sick."

Sick often meant encephalitis — a swelling of the brain. Epidemiologist Emily Gurley led an on-site outbreak investigation back then and is now based at Johns Hopkins University. She says, "The signs and symptoms of encephalitis are fever, headache, but often altered mental status or coma." Disorientation and seizures were common. "But many of these patients also had respiratory disease," Gurley adds, which often led to coughing, vomiting and difficulty breathing.

The virus appeared to be spreading through respiratory droplets and saliva. And the sicker people got, the more infectious they became.

For Khokon and his wife, Anwara, the nightmare continued for weeks as they watched relative after relative get sick, suffer and die. Khokon's older brother, his sister, two uncles, his aunt, his nephew and his mom and dad ... all dead. It was numbing. "In Bangla, they say 'it is a bad wind' or 'an act of God,'" explains Rahman.

Anwara says, "When people started dying out of the virus, people were very afraid. No one came here! Nobody, not even a dog came to this house."

And then, the two of them came down with the virus. (Because the disease carries such a stigma, we are using only their first names.) "I actually have no recollection of that time," says Khokon. "I don't even remember who carried me to the hospital or who carried me to the bed. I was in no shape to remember anything. Me and my wife were unconscious. People couldn't say if we were dead or alive."

In addition, Khokon says those caring for them "said that we had high fever, very high fever."

Anwara says a neighbor told her, "Like whenever they were touching us, it was like touching fire."

Somehow, they survived. "It was a miracle," says Khokon.

This outbreak, says Rahman, made something brutally evident. The as yet unidentified virus was "obviously showing that we are unable to control it, and it is spreading," he says, from person to person. "That is the clear message."

And with a kill rate of roughly 70%, what virus could be that deadly? At the time, Gurley says,

"We didn't know! I was just looking at the data to see what do we think is going on here?"

Gurley wondered, could it be SARS — a coronavirus that infected some 8,000, mainly in China and Hong Kong, from 2002 to 2004?

Or perhaps another, and even more disturbing possibility — could it be a rare, poorly understood virus called Nipah?

"Nipah is terrifying, unusually terrifying," says Dr. Stephen Luby, currently a professor of medicine at Stanford University, who was in charge of the outbreak investigation for eight years at the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). He says it's terrifying, in part, because the virus is so deadly in people. Also, the outbreaks are tightly clustered. "And so the people who are sick know each other," he says. "And because of this, it is a clear community crisis."

In addition, part of what makes Nipah so worrisome is that its history offers evidence that it might, under the right conditions, launch a pandemic. It had first shown up in Malaysia and Singapore in the late '90s. Around that time, Malaysia had started farming pork at an industrial scale — huge numbers of pigs wedged into cramped conditions. When the pigs got Nipah from local fruit bats, the virus spread easily. And then, pig farmers caught it as well.

But in Bangladesh, things were different. "There were a few pigs being raised in this village," says Gurley. "None of them had been sick. And none of the cases had had any contact with these pigs. Pretty clearly," she says, pigs didn't seem to be behind these Nipah outbreaks.
A puzzle to solve: How does the virus spill from bats into humans?

A few weeks later, the Centers for Disease Control and Prevention in Atlanta sent an email to Gurley and her colleagues confirming the deadly virus to be Nipah. So they wondered: Just how was the virus spilling over from bats into humans? This was the puzzle that needed solving for two reasons. First, to prevent more people from getting sick. And second, to rein the virus in.

"So what we did is walk through the village and thought about all the possible ways people could come into contact with bats or bat secretions, bat urine, bat saliva," says Gurley.

They thought that maybe it came from climbing trees where the bats had fed or roosted. Or eating fruit off the ground that bats had already taken a bite out of. They considered a much beloved local delicacy: the sap traditionally harvested from date palm trees. "And we thought, 'Well, this would be a great way to have contact with bat secretions because I'm sure the bats love the sap and so do people,'" says Gurley.

The urgency to figure out the connection between bats and humans continued to mount, as Nipah flared again the following year. The investigators came to realize there had also been earlier outbreaks — in 2001 and 2003. Bangladesh decided to set up its own Nipah surveillance system.

Finally, a link emerged, but the researchers needed more evidence. In 2007, they got their chance with yet another outbreak, this time in Thakurgaon in northwest Bangladesh. Of the seven people who contracted Nipah, three were dead. People were again in a panic.

Rebeca Sultana, an anthropologist with the icddr,b, remembers a call to join the investigation team. "Our colleague called me and asked, 'Rebeca, would you like to go? Are you ready?' I said, 'Yes, I am ready to go there.'"

The next morning, Sultana drove with the team from Dhaka to Thakurgaon. Once she arrived in the village, she went straight to the home of patient zero. "I tried to talk to the elder sister-in-law of the guy who died," she says, "and she was so upset and she just ran and came to me, and hugged me and started crying."

Getting that close to her scared Sultana. As Syed Moinuddin Satter, who leads the Emerging Pathogen research group at icddr,b, says, doing this work is like putting "your soul in your hand. You don't know what is waiting for you in the field."

But Sultana's heart went out to the woman. And she hugged her back. She said to her, "Please don't worry. We're here." She explained that although they didn't know for sure what had caused her relatives to fall ill, "we are here to understand why this happened" by listening openly to the people who had witnessed Nipah firsthand.

(At the research center icddr,b, anthropologists are routinely asked to join these kinds of outbreak investigations when trying to piece together routes of transmission. Their job, in Sultana's words, is "to learn from the community." As Sultana's colleague, Shahana Parveen, says, "Our role as anthropologists, when we get into the community, first we give them space to listen to them — their anger, their stress. But we didn't respond, 'OK, this is not right, or this is wrong.'")

After Sultana finished her preliminary interviews, she then asked the community to meet her in the town market to help draw a map of the village. About two dozen people showed up. "I don't do anything," she explains. "I just ask questions. And then they draw it."

Using sticks in the dirt, the residents roughed out houses, roads, bat roosts. The shape of the outbreak gradually emerged. Soon, the villagers began sketching in date palm trees.

"This is the first time the people informed me," Sultana says, of multiple date palm trees and "a sap harvester in this community."

She hadn't seen the date palm trees on the drive in. But staring back at her from the dirt was the possible link between how the fruit bats had passed Nipah into this community. In particular, when the bats drank the sap, the researchers suspected that Nipah could have moved from their saliva or urine into the sap stream, contaminating the sweet liquid. So someone who drank that sap would be in danger of becoming infected.

Sultana and her colleagues tracked down the sap harvester. And he led them to some friends of the guy who was patient zero for this outbreak.

"They said 'we all used to drink raw sap in the morning,'" she says. This was Sultana's aha moment — that patient zero had drunk raw sap before falling ill. She says this helped the researchers trace a line between the bats, the sap and the outbreaks. "It's a long journey," she admits. This journey included work over the next few years where researchers took infrared cameras and caught the bats (among other creatures, including rats, bugs and owls) at night drinking from the same stream of sap that people were harvesting.

Eventually, the government had enough evidence to launch a campaign against the drinking of raw sap. However, it was a lot to ask people to set aside something that had been a cultural practice for hundreds of years. So despite the warnings, people continued to drink the sap.
Ausraful Islam, a veterinarian and infectious disease specialist at the icddr,b, explains that the consumption of raw date palm sap "is not something you can control. You cannot send police to every house, every village to stop them drinking it. It is not possible."

Sultana and her team developed an alternative messaging campaign to promote "safe sap." They helped produce a couple of TV docudramas in which the actors explain how to collect the sap safely — by putting a protective skirt (called a "bana") around the part of the tree with the tap, which keeps the bats out. But people don't always do it. So not every tree is protected. And the spillovers of Nipah virus from bats to people have continued.

Two tricks are the key to Nipah's persistence
It has been 20 years since the harrowing, practically yearly outbreaks started rocking Bangladesh, claiming more than 200 lives to date. And still there's no treatment for Nipah.

There's no vaccine. It remains on the World Health Organization's list of viruseswith pandemic potential. That's because it has two main tricks.

First, it can jump between species. "We've shown cattle, goats, pigs, cats, dogs can all get infected with Nipah and have been infected with Nipah in Bangladesh," says Gurley. "We don't know how." Perhaps, she says, it's through sap or dropped fruit. Or for pigs and carnivores, it may be through scavenging bat carcasses or placentas. "We're starting a new study to try to figure this out," Gurley says.

The second trick is that Nipah spreads from person to person. So far, Nipah doesn't do a particularly good job of that because the virus tends to kill its host. That means that despite these nearly yearly outbreaks in Bangladesh (with a larger one every four or five years), each has fizzled relatively fast. But each time Nipah makes that leap from bat to person, it gets another chance to find the right combination of mutations to become more transmissible, which could propel it into the realm of a deadly pandemic.

"If we want to contain the virus," says Islam, "we have to understand the virus."

That's why, at 3 a.m. on a cold December morning, Islam stops at the edge of a forest and looks up into the sky, some four stories above the ground, where a 70-foot net stretches between two mahogany trees. He's out here early "because the bats will start coming back from foraging after 3, so this is the best time to catch them," he says.

Early December marks the beginning of what's notoriously known as Nipah season: the four months when the virus is most likely to show up in people. This is when the date palm sap is flowing.

Every month, Islam brings a team out near Faridpur to capture bats. This place is nestled inside the "Nipah Belt," the chunk of central and northwest Bangladesh where — in the words of local physician Dr. Abu Faisal Md Pervez — the virus is synonymous with "death."

The answer isn't getting rid of the bats. Islam has enormous respect for the animals and their importance to the local ecosystem.

Rather, years of studying and sampling thousands of greater Indian fruit bats out here have shown that most of them carry Nipah virus. However, fewer than 1% of them actually release it into the environment. Islam is trying to work out why that is — what's prompting those few animals to shed it.

Most likely, it's connected to some kind of stress the bats are facing. "Is it lack of food?" he wonders. "Is it pregnancy stress? Is it lack of habitat?"

And knowing the answers to those questions could help Islam and his colleagues figure out what action to take to keep Nipah from finding its way into people in the first place.

On and off over the past 15 or so years, Islam and his team have analyzed which strains of the virus are circulating and — in so far small and unconcerning ways — how it's evolving. One of Islam's colleagues, Mohammed Ziaur Rahman, who heads up the One Health Laboratory at icddr,b, says this is the information they need to ultimately conquer the virus. And yet, "we are at the very earliest stages of preparing ourselves to combat Nipah," he confesses.

Nabbing bats and pondering a glass of date sap
The coming dawn is full of sound. Multiple calls to morning prayer from nearby mosques envelop the small research team. Jackals cackle. And birds flute.

Finally, about an hour before daybreak, a female bat is caught in the net. The team brings her down to earth and untangles her with care. She's big — an adult's wingspan easily reaches 3 feet. Her body is brown and furry. The wings are deep black, like a silky, papery fabric. Islam points out her big eyes, like two orbs of amber staring back.

"If it gets the chance," Islam cautions, "it will bite you, like, 10, 15 times. They're very bite-y." To avoid such an outcome, the team has the bat well restrained. The researcher whose hand is in the most vulnerable position has protected himself with a thick glove.

The team finishes untangling the bat and places her in a cotton bag. For now, the bag hangs from a line strung between two trees. It's possible to just make out the contorting and wriggling bat inside.

The researchers nab one more bat, then call it quits. It's getting too light, and any remaining bats will easily spot and avoid the net. They'll transport the animals to a local one-room lab, but not in a van. "Sometimes bats urinate on themselves to mark them," Islam explains. "So if you carry it in the van, the whole van will be stinking."

So they put the bats into a little three-wheeled car and ferry them to the lab some 20 minutes away, where they'll take blood and urine samples. When they're done, they'll release the two bats.

On the drive to the lab, Islam makes a pit stop at a village with a household that's harvesting date palm sap. "It is possible that they will offer you a glass of sap," he remarks to the group. "Please gently deny it, OK?"

When Islam arrives, he walks up to a huge metal tray over a fire. The air is sugary. Gallons of caramel-colored sap are at a rolling boil. It's thickening into molasses.

"It's really sweet," says Muhammad Seraj Khan, the 74-year-old property owner. "It gets sold all around the village. People will buy it to make household sweets and cakes."

The molasses, says Islam, is harmless — any virus gets cooked away. But that's not the case with raw sap. Still, the villagers like to down glasses of the traditional delicacy when they have the chance. And before Islam leaves, Khan offers some of the raw sap.

And there it is — a slightly cloudy liquid. A delicacy and possible poison all at once, because you never know if that invisible menace is lurking within the sweetness.

Scientists hope to curb the deadly Nipah virus that terrorizes Bangladesh villages [KVPR, 30 Jan 2023]

By Ari Daniel

Valley Public Radio

JUANA SUMMERS, HOST:
Three years ago today, the World Health Organization declared COVID-19 a public health emergency of international concern. That emergency eventually turned into one of the world's deadliest pandemics. To keep this from happening again, scientists have been studying how to detect and stop viruses with pandemic potential.

AILSA CHANG, HOST:
One of those is the deadly Nipah virus. Today, to kick off our series Hidden Viruses: Stopping The Next Pandemic Before It Starts, NPR's Ari Daniel takes us to a part of the world known as the Nipah Belt.

ARI DANIEL, BY LINE: It's early morning in a lush, rural community in central Bangladesh. I'm with a group, and we've just made a pit stop in a village within the district of Faridpur, deep in the heart of the Nipah Belt. It's the start of the season when sap is harvested from date palm trees and is then turned into molasses. That's what I'm here to see.
(SOUNDBITE OF FIRE CRACKLING)

DANIEL: I walk up to a huge metal tray over a fire. Gallons of caramel-colored sap are at a rolling boil, thickening into molasses. Mohammed Siraj Khan (ph) is the 74-year-old property owner.

MOHAMMED SIRAJ KHAN: (Through interpreter) This is actually a delicacy in Bangladesh. Mostly, we make cakes and sweets with it.

DANIEL: Then I'm offered some of the raw sap to drink. And there it is, the slightly cloudy liquid I've heard so much about, a delicacy and possible poison all at once. I was warned that this exact thing might happen. I was given advice about what to say.

(SOUNDBITE OF CHICKEN CLUCKING)

DANIEL: The evening before, just a few miles away, I pay a visit to a local family. A 50-year-old man named Kokon (ph) sits outside his home beside a rice paddy. A fiery beard dyed a bright orange rings his chin. And he says he'll never forget the spring of 2004, when the procession of disease and death came on suddenly.

KOKON: (Through interpreter) The first one was the mother-in-law of my elder brother. She was really sick. She had been sick for some time. Then she died. We took her to the grave. Then my father got sick.

DANIEL: Kokon stares off into the distance as he tells me his father was a spiritual leader in the community. When he became ill, many came to pay their respects.

KOKON: (Through interpreter) Just 12 days after my father died, suddenly, he was no more.

DANIEL: As for the visitors, they also got sick. One traveled to an adjacent village, where four more people fell ill.

MAHMUDUR RAHMAN: It was not understood what was happening.

DANIEL: Mahmudur Rahman is the former director of the Institute of Epidemiology, Disease Control and Research for the Bangladeshi government.

RAHMAN: Some people who were transporting the patients to the hospital were also getting sick.

DANIEL: Sick often meant encephalitis, a swelling of the brain. Epidemiologist Emily Gurley, now at Johns Hopkins University, was leading an on-site investigation at the time.

EMILY GURLEY: The signs and symptoms of encephalitis are, well, fever, headache but often altered mental status or coma, seizures.

DANIEL: Then Kokon and his wife Anwara (ph) fell ill. It's why I'm only using their first names - because the disease carries stigma.

ANWARA: (Through interpreter) People couldn't say if we are dead or alive.

They said that we had high fever. Like, whenever they were touching us, it was like touching fire.

DANIEL: Miraculously, they both survived. But Kokon's older brother, his sister, two uncles, his aunt, his nephew and his mom and dad - all dead. This outbreak, says Dr. Rahman, made something brutally evident.

RAHMAN: This is obviously showing that we are unable to control it, and it is spreading.

DANIEL: And with roughly 70% of those who got it dying, what virus could be that lethal?

GURLEY: We didn't know. I was just looking at the data. I was just looking at data to see what do we think is going on here?

DANIEL: A few weeks later, Gurley and her colleagues got an email from the CDC in Atlanta that this was the Nipah virus. They knew the virus came from bats 'cause in the '90s in Malaysia, when it first emerged, Nipah was spreading from local fruit bats to pigs to pig farmers. That's bad enough, but in Bangladesh, the virus was behaving differently.

GURLEY: It was being transmitted person to person, which had never been reported before. So that was a scary time.

DANIEL: An urgent question hung over Gurley. Just how did Nipah spill over from bats into humans in the first place? That was what needed answering to shut this thing down.

GURLEY: So what we did is walk through the village and thought about all the possible ways people could come into contact with bats or bat secretions, bat urine, bat saliva.

DANIEL: Finding this link - it's agonizingly slow work that takes years because an outbreak blazes quickly. The victims are dead, and eyewitnesses often flee or clam up. But the outbreaks kept happening almost every year afterwards, which was deeply worrying to experts because each time the virus leaps from bat to person, it gets another opportunity to mutate, possibly becoming more transmissible - the fear being the right combination of mutations could propel it into the realm of a deadly pandemic. Finally, the connection emerged, one that offered a remedy for stopping the Nipah spillovers. But the researchers needed more evidence. In 2007, they got their chance.

REBECA SULTANA: Our colleague called me and asked, Rebeca, are you ready? I said, yes, I'm ready to go there.

DANIEL: The next morning, anthropologist Rebeca Sultana joined the Nipah outbreak investigation team. She's with the International Centre for Diarrheal Disease Research, Bangladesh, or icddr,b for short. When she arrived in the village, she went straight to the home of patient zero.

SULTANA: I tried to talk to the elder sister-in-law of the guy who died. And she was so upset, and she just ran and came to me and hugged me and started crying.

DANIEL: Getting that close to her scared Sultana. As one Nipah researcher told me, doing this work is like putting your soul in your hand. But Sultana - she hugged her back and said...

SULTANA: Please don't worry. We are here to understand why this happened.

DANIEL: She asked the community to meet her in the town market to help her draw a map of the village. About two dozen people showed up.

SULTANA: I don't do anything. I just ask question, and then they draw it.

DANIEL: Using sticks in the dirt, the residents roughed out houses, roads, bat roosts, and then they began sketching in date palm trees.

SULTANA: This is the first time the people informed me, you know, there is a date palm tree, and there is a sap harvester in this community.

DANIEL: Sultana hadn't seen the date palm trees on the drive in. But staring back at her from the dirt, there it was, the possible link between how the fruit bats had passed Nipah into this community - through the drinking of the sweet sap. Emily Gurley.

GURLEY: We thought, well, this would be a great way to have contact with bat secretions because I'm sure the bats love the sap and so do people.

DANIEL: So Rebeca Sultana and her colleagues tracked down that sap harvester, and he led them to a few pals of the guy who was patient zero.

SULTANA: They said, we all used to drink raw sap in the morning.

DANIEL: This was Sultana's aha moment, that patient zero had had raw sap before falling ill. The line between the bats, the sap and the outbreaks was becoming clear.

Over the next few years, researchers took infrared cameras and caught the bats at night drinking from and sometimes peeing into the same stream of sap that people were harvesting.

Eventually, the government had enough evidence to launch a campaign against the drinking of raw sap. But many people have continued to drink the sap, and the spillovers of Nipah virus from bats to people have continued, too.

(SOUNDBITE OF PLANTS RUSTLING)

DANIEL: It's December 1, the beginning of what's known around here notoriously has Nipah season, the four months when the virus is most likely to show up. This is when the sap is harvested and when Zhahirul Islam keeps an especially close eye on Nipah.

ZHAHIRUL ISLAM: If we want to contain the virus, we have to understand the virus.

DANIEL: It's 3 in the morning. Islam stops at the edge of a patch of forest and looks up into the sky. A net stretches between two mahogany trees.

Why are we out here so early?

ISLAM: Because the bats soon start coming back from foraging after 3. So this is the best time to catch them.

DANIEL: Islam is a veterinarian and infectious disease specialist at the icddr,b. He's searching for another way to stop Nipah. Every month, he brings a team out here near Faridpur to capture bats. The answer isn't getting rid of these animals. Islam has great respect for their importance to the local ecosystem. Rather, years of studying thousands of greater Indian fruit bats have shown that most of them do carry Nipah virus. But here's the thing - fewer than 1% of them actually release it into the environment through their urine or saliva. Why do so few of these animals shed the virus? Islam thinks for that small group, it's likely connected to stress.

ISLAM: Is it lack of food? Is it pregnancy stress? Is it lack of habitat?

DANIEL: Knowing what's behind the shedding could help Islam and his colleagues figure out how to keep Nipah from infecting people in the first place.

(SOUNDBITE OF BATS CHIRPING)

DANIEL: The coming dawn is full of sound. There are jackals and fruit bats.
What just happened?

UNIDENTIFIED PERSON: We able to capture bat.

DANIEL: OK. So a bat just flew into the net. The bat's body is like a brown and furry, and the wings are just deep black, like a silky papery fabric.

ISLAM: If you go around, you'll see the big eyes.

DANIEL: I gaze into them, like two orbs of amber. She's big. An adult's wingspan easily reaches 3 feet.

ISLAM: If it gets the chance, it'll bite you, like, 10, 15 times. They're very bitey.

DANIEL: Just untangled it.

The team nabs one more bat and then calls it quits. It's getting too light. They put the bats into a three-wheeler and ferry them to a local lab, an unassuming one-room building, and yet a crucial outpost in the battle against Nipah. It's where the researchers will sample blood and urine from the bats. And once they're done, they'll release the animals back into the woods. It's on the drive to the lab when Islam makes a pit stop in that village. He wants to show me the date palm trees, the boiling molasses. That's when he'd given me that advice.

ISLAM: It is possible that they will offer you a glass of sap. Please, gently deny it, OK?

DANIEL: The bubbling molasses I see before me is harmless. Any virus gets cooked away. And to be fair, Khan, the property owner, he doesn't recommend drinking it raw. But before we leave, sure enough, I'm offered a taste of the cool, cloudy sap, a chalice of what could be delectable poison. I smell the sweet air, and I politely decline.