Nature Comms: Pre-existing Cross-reactive Immunity to HPAI 2.3.4.4b A(H5N1) Virus in the United States

Credit CDC Antigenic Characterization

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While every distinct HPAI H5 clade/subclade/subtype - and sometimes variants within these groups - can pose a different risk to human health, the emergence of a a `mammalian adapted' bovine B3.13 genotype in the United States nearly 2 years ago sent alarm bells ringing. 

So far, most human infections (≈ 40) with this bovine genotype have been mild, presenting with conjunctivitis and mild flu-like symptoms, while we've seen 2 deaths (1 from U.S., 1 from Mexico) from a smaller number of genotype D1.1 H5N1 human infections. 

Although there are some known virulence factors we look for, exactly what makes D1.1 more aggressive than B3.13 isn't exactly known. Nor can we predict the future trajectory of these two genotypes, or what new variants or subtypes may emerge in the months ahead.

Last summer, in CDC A(H5N1) Update: Population Immunity to A(H5N1) clade 2.3.3.4b Viruses, the CDC reported finding extremely low to no population immunity, even among those who recently received a seasonal flu vaccine.

Other studies have suggested there may be low levels of immunity due to repeated (or childhood) exposure to H1N1 (or H2N2) (see Preprint: Population Immunity to HPAI 2.3.4.4b A(H5N1) Viruses in the United States and the Impact of Seasonal Influenza on A(H5N1) Immunity).

It has also been suggested that repeated receipt of the seasonal flu shot might provide some degree of protection, due to the similarity of the H1N1 and the Bovine H5N1 NA gene segment (see EID Journal: A(H5N1) NA Inhibition Antibodies in Healthy Adults after Exposure to Influenza A(H1N1)pdm09).

While none of this is expected to make anyone fully immune to H5 infection, it might reduce the severity of infection, and decrease mortality and the overall impact of a pandemic. 

At least, that's the hope. 

To this growing list of population immunity studies we can add following research report - published yesterday in Nature Communications - by researchers from the CDC, BARDA, and the University of Wisconsin school of Medicine.

As with previous studies, they found`very low levels of pre-existing binding antibodies to the HA head of the HPAI A(H5N1) 2.3.4.4b virus', but slightly more encouragingly, `. . . substantial cross-reactive binding antibodies to N1 neuraminidase (NA) of 2.3.4.4b A(H5N1). 

How much impact this cross-reactive binding to the NA would have is unknown. The hope is, it might provide some non-trivial reduction in disease severity.  The authors wrote:

Neuraminidase antibodies have been considered as an independent correlate to protect against influenza 20. Although they cannot prevent infection, neuraminidase antibodies can prevent virus egress, reduce viral shedding, and thus could attenuate disease and lessen disease severity 21,22,23.

The `very low levels' of HA binding antibodies were highest in those over 70 years of age, which correlates with early childhood exposures to HA Group 1 viruses (H2N2 and H1N1) in the 1950's and 1960s (see 2018's Nature: Declan Butler On How Your First Bout Of Flu Leaves A Lasting Impression). 

Once again, how much actual `protection' that might provide is unknown - particularly given their age-related comorbidities - although we did see lower impacts on that birth cohort during the 2009 H1N1 pandemic.

On a more positive note, the authors report `. . . pre-pandemic stockpiled 2.3.4.4c vaccine can elicit cross-reactive neutralizing antibodies to 2.3.4.4b A.', although vaccine supplies would be quite limited during the opening months of any pandemic (see Maggie Fox's SCI AM - A Bird Flu Vaccine Might Come Too Late to Save Us from H5N1).

Today's report is both lengthy and detailed, and you'll want to follow the link to read it in its entirety.   I'll have a brief postscript after you return.  

Pre-existing cross-reactive immunity to highly pathogenic avian influenza 2.3.4.4b A(H5N1) virus in the United States

Open access Published: 08 December 2025
Volume 16, article number 10954, (2025)

Download PDF

Zhu-Nan Li, Feng Liu, Yu-Jin Jung, Stacie Jefferson, Crystal Holiday, F. Liaini Gross, Wen-Pin Tzeng, Paul Carney, Ashley Kates, Ian A. York, Nasia Safdar, James Zhou, Marie-jo Medina, Vittoria Cioce, Christine M. Oshansky, C. Todd Davis, James Stevens, Terrence Tumpey & Min Z. Levine 

Abstract

The unprecedented 2.3.4.4b. A(H5N1) outbreak in dairy cattle, poultry, and spillover to humans in the United States (US) poses a major public health threat. Population immunity is a critical component of influenza pandemic risk assessment.

We assessed the pre-existing cross-reactive immunity to 2.3.4.4b A(H5N1) viruses and analyzed 1794 sera from 723 people (0.5–88 yrs) in multiple US geographic regions during 2021–2024. Pre-existing neutralizing and hemagglutinin (HA)-head-binding antibodies to A(H5N1) were low, but there were substantial cross-reactive binding antibodies to N1 neuraminidase (NA) of 2.3.4.4b A(H5N1). Antibodies to group 1 HA stalk were also prevalent and increased with age.

A(H1N1)pdm09 infection and influenza vaccination did not induce neutralizing antibodies to A(H5N1) viruses but induced significant rise of functional NA inhibition (NAI) antibodies to N1 of 2.3.4.4b A(H5N1), and group 1 HA stalk antibodies. Moreover, pre-pandemic stockpiled 2.3.4.4c vaccine can elicit cross-reactive neutralizing antibodies to 2.3.4.4b A. 

        (SNIP)

In this study, we assessed the levels of neutralizing antibodies, HA head binding antibodies, functional NA inhibition antibodies (NAI), NA binding antibodies to HPAI clade 2.3.4.4b A(H5N1) viruses, and antibodies to group 1 HA stalk using 1794 sera collected from 723 participants (aged 0.5–88 yrs) from multiple geographic regions in the US across recent influenza seasons (2021–2024). We investigated whether there were pre-existing cross-reactive immunity to 2.3.4.4b A(H5N1) viruses in the US population, and whether current seasonal influenza A virus infection or seasonal influenza vaccination can induce antibodies that are cross-reactive to 2.3.4.4b A(H5N1) viruses. Lastly, we also assessed the ability of the pre-pandemic stockpiled 2.3.4.4c A(H5) vaccine to elicit cross-reactive antibody responses to these newer 2.3.4.4b viruses.

        (SNIP)

Our study has limitations, first, the clinical protective functions of the cross-reactive neuraminidase and HA stalk antibodies to A(H5N1) viruses in humans need to be further understood; second, although we assessed multiple antibody targets; other adaptive immunity, such as cell-mediated immunity which can also be associated with reduction of influenza disease severity16, were not assessed here.

Host immunity is a critical parameter in assessing population susceptibility to influenza virus infections. The Centers for Disease Control and Prevention (CDC) uses the Influenza Risk Assessment Tool (IRAT)49 to evaluate the pandemic potential for a novel influenza A virus. Population immunity is one of the risk elements used in the IRAT. Our study provides additional data for A(H5N1) pandemic risk assessment. Further studies are needed to better understand the immune responses to A(H5N1) viruses in humans and to what extent pre-existing immunity can deter infection and/or lessen disease severity. Continued surveillance is essential to closely monitor A(H5) viruses for pandemic preparedness.

        (Continue . . . )

 As alluded to at the top of this blog, HPAI H5 comes in a lot of `flavors', and this study focussed on the `bovine' H5N1 virus isolated in Texas last year. Exactly how other genotypes/subtypes would compare, remains to be elucidated. 

Complicating matters further, we've also seen cautionary reports (see St. Jude Researchers: Current Antivirals Likely Less Effective Against Severe Infection Caused by Bird Flu in Cows’ Milk), suggesting our antiviral armamentarium may be inadequate for dealing with an H5 pandemic.

Which means - unpopular as they might be - NPIs (non-pharmaceutical interventions like masks, social distancing, etc.) will once again become our first line of defense.

Not ideal, obviously. But they proved their worth during the last pandemic, and will likely do so again.

Assuming, of course, enough people have the foresight to stockpile masks and respirators before the next crisis emerges.

UKHSA Identifies New Recombinant Strain of Mpox Virus

 

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As we've discussed often over the past dozen years, Mpox (formerly Monkeypox) continues to evolve. In the 2014 EID Journal article Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo the authors cautioned:

Small genetic changes could favor adaptation to a human host, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (40). The ability to spread rapidly and efficiently from human to human could enhance spread by travelers to new regions.

In the decade since, 2 new clades (Ib and IIb) have emerged, with both (IIb and, to a lesser extent Ib) managing to spread internationally.  Just three days ago the WHO warned of Broader Transmission of Mpox Due to clade Ib MPXV – Global situation, and limited community spread in at least 6 non-African nations (including the United States). 

Given this track record, new emerging variants and/or clades of the mpox virus are not totally unexpected.  

Today, the UKHSA has announced the detection of a new recombinant strain (Ib & IIb) in a traveler recently returning from Asia.  Details are still quite limited, and its impact or significance is unknown. 

First, the brief statement from the UKHSA, after which I'll have a postscript. 

Latest update

The UK Health Security Agency (UKHSA) has identified a new recombinant mpox virus in England in an individual who had recently travelled to Asia.

Genomic sequencing showed that the mpox genome contained elements of clade Ib and IIb mpox.

This is not unexpected as both clades are circulating, but highlights the continued potential for mpox virus to evolve and the importance of continued genomic surveillance.

UKHSA continues to assess the significance of the strain.

Dr Katy Sinka, Head of Sexually Transmitted Infections at UKHSA, said:

Our genomic testing has enabled us to detect this new mpox strain. It’s normal for viruses to evolve, and further analysis will help us understand more about how mpox is changing.

Although mpox infection is mild for many, it can be severe. Getting vaccinated is a proven effective way to protect yourself against severe disease, so please make sure to get the jab if you are eligible.

It is important to remain alert to the risks from this unpleasant illness. Anyone who thinks they may have mpox should contact NHS 111 for advice on what to do.

The UK has a routine mpox vaccination programme in place for eligible groups, including those who have multiple sexual partners, participate in group sex, or visit sex-on-premises venues. Studies show the vaccine is around 75% to 80% effective in protecting against mpox.

UKHSA has shared its findings with relevant international partners, including the World Health Organization (WHO), to support global monitoring efforts.

As our collective immunity from the smallpox vaccine - which was discontinued in the late 1970s - wanes, there will be increased opportunities for emerging pox viruses to stage a comeback. 

While Mpox is currently at the top of our watch-list, some of the other poxviruses we've looked at in recent years include:

Alaska Health Department Announces A Fatal Alaskapox Infection

A Newly Discovered Poxvirus Detected In Reindeer in Sweden & Norway

EID Journal: Novel Poxvirus in Proliferative Lesions of Wild Rodents in East-Central Texas, USA

A Novel Zoonotic Orthopoxvirus Resurfaces In Alaska

South Korea: MAFRA Identifies Biosecurity Breaches On HPAI Infected Poultry Farms

Biosecurity Violations - Photo Credit MAFRA

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South Korea's Ministry of Agriculture (MAFRA) has been dealing with HPAI H5 for more than 20 years, and while farmers compensated for their losses - in return - they are expected to strictly follow containment and biosecurity procedures. 

Last January MAFRA issued a scathing report finding that of the 15 poultry farms investigated since October 2024, the vast majority have failed to comply with those procedures, and warned that strong punitive action would be taken.

In early September South Korea's CDC Announced A 19-day, Nationwide, Mock-Training Exercise to Prepare for Zoonotic Influenza, and South Korea's Ministry of Environment issued a new statement on mandatory steps to increase the safety of personnel dealing directly with avian influenza, and to ensure a more coordinated and efficient quarantine response.

Last month, South Korea's MAFRA Ordered Strengthened Quarantine Measures After 3 HPAI H5 Subtypes (H5N1, H5N6, H5N9) Detected In Wild Birds, and once again warned of harsh punitive measures (fines, and possible incarceration) for biosecurity lapses. 

 Today MAFRA has published an investigation that once again finds serious lapses in biosecurity on recently infected poultry farms; including failures to disinfect vehicles, and allowing people to enter farms and barns without protective clothing. 

This growing diversity of HPAI H5 viruses in wild birds is not a trivial concern, particularly given the events of last month here in the U.S., when the first known human infection with HPAI H5N5 was reported in Washington State.  

 I've posted a machine translation of the South Korean announcement below. 

Several quarantine deficiencies were identified at farms where highly pathogenic avian influenza outbreaks occurred, and strict measures were taken and management was strengthened.

2025.12.08 15:51:35 Avian Influenza Prevention Division, Quarantine Policy Bureau

The Central Disaster and Safety Countermeasures Headquarters for Highly Pathogenic Avian Influenza ( Director Song Mei-ryeong, Minister of Agriculture, Food and Rural Affairs , hereinafter referred to as the Central Disaster and Safety Countermeasures Headquarters ) announced that as a result of the epidemiological investigation conducted so far on poultry farms where highly pathogenic avian influenza occurred this winter , numerous quarantine deficiencies were identified, and as the risk has increased with the increase in the occurrence of highly pathogenic avian influenza worldwide , quarantine management has been strengthened to prevent further outbreaks .

1. Interim results of the outbreak situation and epidemiological investigation

Since the first outbreak of highly pathogenic avian influenza at a native chicken farm in Paju , Gyeonggi Province on Friday , September 12 , there have been 7 cases in domestic poultry farms and 13 cases in wild birds

The seven poultry farms identified to date with outbreaks have been found to be non-compliant with basic quarantine guidelines, as determined by interim epidemiological investigations . Accordingly, the Central Disaster and Safety Countermeasures Headquarters plans to impose administrative sanctions, including fines, and reduce culling compensation , in accordance with the Livestock Infectious Disease Prevention Act, on farms found to be violating relevant regulations .

* According to the “ Standards for Payment and Reduction of Compensation in Appendix 2 of the Enforcement Decree of the Livestock Infectious Disease Prevention Act ,” the basic amount equivalent to 20/100 of the livestock appraisal value is reduced , and if any insufficient quarantine measures are identified, the compensation is additionally reduced for each applicable item. 

Domestic and international risk analysis

Looking at the status of overseas highly pathogenic avian influenza outbreaks in poultry farms, the number of outbreaks this year ( '25) has increased by about twice compared to the same period (January to November ) of the previous year ('24) . In particular , the number of outbreaks in Europe and the United States has been increasing since September , and neighboring Japan has had six outbreaks so far this winter .

In Korea, three serotypes (H5N1, H5N6, H5N9) were detected for the first time in wild birds , and in poultry farms, two serotypes ( H5N1, H5N6) were confirmed this time, the same as in the winter season of 2023-2024 .

* On November 12, H5 antigen was detected at a duck farm in Buan, North Jeolla Province , but the final virus was not isolated . During a detailed inspection of a duck farm that was culled as a precaution within the quarantine area (3 km), H5N6 highly pathogenic avian influenza was confirmed.

* For reference , 32 cases of highly pathogenic avian influenza occurred in the winter of 2023/2024 , with two serotypes (H5N1, H5N6) confirmed.

Considering these domestic and international situations , this is a serious situation where highly pathogenic avian influenza can occur anywhere in the country, so it is necessary to strengthen quarantine measures at each farm and promptly report to quarantine authorities when suspicious symptoms are present .

3. Requests

The Ministry of Agriculture, Food and Rural Affairs' Director of Quarantine Policy, Dong-sik Lee, stated , " As a result of the epidemiological investigation into poultry farms where highly pathogenic avian influenza occurred this winter , it was confirmed that most farms were not properly following basic quarantine rules .

Accordingly, the local governments in question should strictly punish them according to relevant regulations and provide guidance and education so that poultry farms can be vigilant and make every effort to prevent quarantine on their farms . "

In addition , “ Looking at past outbreaks, highly pathogenic avian influenza occurs the most in December and January , so poultry farms are at a high risk of additional outbreaks of highly pathogenic avian influenza. Therefore, they should thoroughly follow basic quarantine rules such as disinfection, changing boots , and prohibiting egg vehicles from entering farms with the mindset of ‘ I protect my own farm . ’” he emphasized .

* 47.6% occurred in December - January (654 cases out of 1,374 cases since 2003)

Although most commercial poultry operations should already know and understand their obligations to maintain strict biosecurity due to avian influenza, there are more than 11 million backyard poultry flocks in the United States alone, and tens of millions more in Europe and Asia. 

So far, more than 100 backyard flocks have been infected since September of this year in the United States, and we've seen at least one death `linked to contact with backyard or wild birds'. 

While the CDC has released guidelines (see Backyard Flock Owners: Protect Yourself from Bird Flu) - it is unknown how many backyard poultry owners have actually read it - or would bother to follow their - at times - stringent recommendations.

Last October, in UF/IFAS Extension: What Backyard Flock Owners Need to Know about Bird Flu (Influenza H5N1), we looked at two less daunting H5N1 related publications; one for backyard poultry owners, and another for consumers of poultry products and milk.

A few short years ago - at least here in the United States - the biggest health concern from raising backyard poultry was salmonella. Today, we've must contend with at least two different HPAI viruses (H5N1, H5N5) capable of infecting humans, and it is possible more are on the way.

While I dislike the phrase `the new normal', as long as HPAI H5 continues to circulate at high levels, this our new shared reality. 

 And we must either get better at combating it, or get used to living with it. 

The Gift of Preparedness 2025

CDC Infographic

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Just over 18 years ago, in a blog called Hickory Farms Will Hate Me For This, I began promoting the idea that - instead of gifting cheese platters, fruitcakes and ugly sweaters to friends and family - we should be giving preparedness items for holidays, birthdays, and anniversaries.

Most disasters boil down to unscheduled camping - for days, or sometimes weeks - in your home, in a community shelter, or possibly even in your backyard. Preparedness can not only make that process possible, it can make it less miserable as well.

So, in what has become a holiday tradition at AFD, for the 19th year running I present my updated list of preparedness items - ranging from stocking stuffers to some big ticket items - that I've either recently bought or built for myself, or have given as gifts (sometimes both).

Living in hurricane country, my biggest concerns revolve around prolonged power outages, which also can impact other utilities (including water, sewer, and internet). 

Following last year's one-two punch from Hurricanes Helene & Milton, I got my power back after only 4 days (although internet took a week). Before that, I went nearly a week without power following Irma in 2017, but many people had it far  worse (most of Puerto Rico was without power for months after hurricane Maria in 2017). 

Not quite five years ago, in February of 2021, 3 successive winter storms swept across Texas, Louisiana, and Oklahoma, causing the worst collapse of the Texas energy grid on record (see Texas: The Latest - But Not The Last - Grid Down Crisis), resulting in hundreds of deaths (see City of Austin & Travis County 2021 WINTER STORM URI AFTER-ACTION REVIEW).

And just last July, the U.S. Department of Energy published a 73-page report that warns that if current schedules for retirement of reliable power generation (especially baseload) continue, without enough firm replacement, the risk of blackouts in 2030 could increase by 100× over current levels.

While those with tens of thousands of dollars to spend can have a whole-house solar system or generator - one capable of running freezers, refrigerators, and air conditioners - even a small system can make life a little more bearable.

My primary goal is to have enough sustainable power for lights, radio, phone charging, and fans. Trying to run appliances, HVAC, or other high-draw devices is simply beyond my budget (but if you have enough money . . . . it can be done ).

The following is an example of how you can put together a plug-and-play mini solar power system for under $100; one that will keep your phones, lanterns, and charged, along with some mini-fans.

While I'm not recommending specific brands or suppliers, these are all typical of items I've purchased and used myself. 

The `core' ingredients are 1 (or more) USB battery banks, preferably 20,000 milliamps each ($20 each), and at least one solar panel. I went with a single 30 watt 5 volt panel ($35) since two of my battery banks have (very) small integral solar panels.

The accessories: . . . in my case, they include mini-fans, rechargeable lanterns, cell phones, my iPAD, and a USB powered battery charger. This allows me to recharge my supply of Ni-CD or Ni-MH batteries that power my walkie-talkies, battery operated lanterns, radios, and other devices.

Many people are now opting for  `solar generators' being sold by a number of companies. These are not true `generators', but rather large batteries with a variety of output options to power devices. Most will only run a large appliance (like a refrigerator) for a few hours, without recharging.

While more expensive, solar generators are a plug-and-play solution that can be set up by just about anyone, and that have a good deal more capacity than the USB system described above. 

But if something breaks, you have to send it back to the factory for repairs. That turnaround time might be weeks. No matter how good the warranty, it's of limited comfort when the power is already out.

A year ago, I detailed my home build of (3) USB power banks (see Post-Milton Improvements To My Power Preps). By building my own, I saved some money, and if one breaks, I have a decent chance of being able to repair it (I have spare parts for major components).

Weighing in at less than 15 lbs, this 50 amp/hr (600 watt/hour) setup is self contained, with storage for cables, a wall charger, and a small 110v inverter. All you need to add is a solar panel (100 watts or better).

Whether home built, or store bought, these `solar generators' can greatly expand what you can do during a prolonged blackout. 

For Christmas presents two years ago I purchased some very nice 4-packs of LED lanterns, and some USB battery powered water pumps that attach as a faucet to large water jugs. Just three days after they arrived I endured a 3-day water outage at home, and found the faucets actually worked pretty well.

Sometimes I make the gifts myself, as when several years back I cobbled together some first aid kits, and distributed them to a number of friends and relatives. You can either put one together yourself, or purchase one already assembled.

Believe me, there is no substitute for having a well stocked first aid kit when you really need one. Having a kit isn't enough. Knowing what to do in an emergency is equally important. Luckily there are a number of good first aid books available, including:

High on the list of things to have is a way to make water potable.

Although (unscented) bleach will work, it requires measuring, and imparts a taste to the water many dislike. An option that has gotten a lot less expensive in recent years are personal filtration systems, like the LifeStraw ®.


At just 2 ounces, this personal water filter will reportedly filter 1000 liters down to .2 microns. Not bad for around $20. I've recently added the Sawyer Mini-Filter to my preps, again about $20.

Speaking of water, having a way to store enough water for three days (1 gal/person/day) is essential. A family of 4 will need at least 12 gallons for 72 hours. Personally, I keep enough on hand for a couple of weeks.

While there are plenty of `free options’ – like rinsed and recycled 2-liter plastic soda bottles or other food-safe plastic jugs – you can also buy collapsible 5 gallon containers.

A couple of years ago I bought several 5 gal. buckets (with lids) from a home improvement store, along with mylar bags and oxygen absorbers from Amazon, and put together some long-term food storage buckets for friends.

Cost per bucket? About $40. But enough food (rice, beans, tinned meat, etc.) to keep two people going for ten days or more in an emergency. I keep a couple on hand (one for me, one for the cat), myself.

With a propane or butane camp stove or even a single burner Propane burner (see below) and a couple of 1 pound gas cylinders (about $5 each) and you can cook for a week or longer. Typically, a 1lb cylinder proves 1.5 to 2.0 hours of cooking.

Indoors, even a `Sterno Stove' can be used for basic `heat and eat' cooking. 

Something as simple, and as utilitarian, as a multi-function `Swiss’ army knife, a flashlight, or a USB charger for the car make great stocking stuffers. 

Every home should have a battery operated radio (with NWS weather band), yet many do not. Some are available with crank or solar charging. In any event, you'll want something which can pick up the NOAA NWS Emergency Broadcaster in you region.

While my primary concern in Florida is staying cool during a summer power outage, in colder climes, staying warm can be a major concern. Even here in Florida it can drop below freezing. Sleeping bags, pop-up tents (that can be used indoors or out), and propane or kerosene heaters can be lifesaving.

This year - with a mutated seasonal H3N2 virus steadily rising, COVID still hanging on, and the specter of bird flu in the wings - safety goggles, a box of vinyl or nitrile gloves, or a box of facemasks (or N95 masks) should be in everyone’s emergency kit as well.

And while not necessarily lifesaving, having a way to occupy your mind (or your kids) during an extended grid down situation can help maintain your sanity. 

Books, board games, and having good old-fashioned conversations are undoubtedly the best, but when they run dry having a low-drain-battery-powered MP3 player, or a battery run DVD player, can seem like a lifesaver.


As an aside - I've collected (public domain) OTR (Old Time Radio) shows since the early 1990s, and have literally thousands of hours stored on CDs in MP3 format. The Internet Archive has a huge repository where you can download them for free, along with thousands of audio books.

I keep a couple of MP3 players filled with these shows and with audio books in my bug-out bag. When the power and internet were down, they provided me with hours of entertainment.  

Over the years I've bought several cheap MP3 players ($20-$30) and filled them with thousands of hours of these shows (mostly from the 1940s and 1950s), giving them as gifts.  And the nice thing is, you don't have to wait for an emergency to enjoy them. 

Admittedly, some of the items listed above are useful more for comfort and convenience, than for survival.

But the physical and psychological impacts stemming from the hardships following a disaster are quite real (see Post-Disaster Sequelae), and a modicum of creature comforts can go a long ways towards mitigating their effects.

FEMA, Ready.gov and a myriad of other state and national entities know the risks we face, and would like to see Americans adopt and embrace a culture of preparedness.

And we can do that for ourselves, our families, and our friends.

One gift at a time.

WHO DON: Broader Transmission of Mpox Due to clade Ib MPXV – Global situation

 

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Although the 2nd declaration of a public health emergency of international concern (PHEIC) for mpox was lifted 3 months ago, since then we've seen a small, but growing number of `community cases' from around the globe (see chart above). 

Overnight the World Health Organization published a lengthy DON (Disease Outbreak Report) on these recent cases. Due to its length, I'll just provide a link for you to follow, and a couple of brief excerpts.  

I'll have a bit more after the break.  

Broader transmission of mpox due to clade Ib MPXV – Global situation
5 December 2025

Description of the situation

Since the lifting of the second PHEIC for mpox on 5 September 2025, and as of 24 November 2025, 43 new confirmed cases of clade Ib MPXV have been reported across six WHO regions outside areas where sustained community transmission of this virus strain has been occurring. In four of these regions (Region of the Americas, South-East Asia Region, European Region and the Western Pacific Region), 24 cases had reported no recent international travel, suggesting local transmission.

Based on this, Italy, Malaysia, the Netherlands, Portugal, Spain, and the United States of America are now considered to be experiencing community transmission of clade Ib MPXV. In addition, travel-related cases continue to be reported in many countries.

Among the 43 cases, half (22) were documented among men who have sex with men, while other cases were linked to travel to countries with known community transmission of clade Ib, or secondary to travel-related cases (household contacts and/or sexual partners).

This report provides an overview of these recent cases of mpox confirmed to be due to clade Ib MPXV, by WHO region and country, summarizing key available epidemiological information, followed by WHO’s rapid risk assessment and public health advice.

        (SNIP)

WHO risk assessment

In light of the epidemiological developments presented above and confirmation of community transmission of clade Ib MPXV in all WHO regions, WHO assesses the public health risk posed by clade Ib MPXV as moderate for men who have sex with men with new and/or multiple partners, and the risk to the general population as low.

       (Continue . . . )

While the number of community cases reported outside of the endemic regions of Africa remain limited, they do appear to be increasing.  In recent months we've looked at a number of reports, including:

Preprint: A three-dose MVA-BN Mpox Vaccination Series Improves the Quality of Anti-monkeypox Virus Immunity

UKHSA: Updated Risk Assessment On Mpox Clade Ib

ECDC Statement & Threat Assessment Brief Following Recent Reports of Local Transmission of Mpox Clade Ib in Europe

Los Angeles County Reports 3 (locally acquired) Clade I Mpox Cases in a Week

Like all viruses, Monkeypox continues to evolve and diversify, a topic that was addressed in the 2014 EID Journal article Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo, where the authors cautioned:

Small genetic changes could favor adaptation to a human host, and this potential is greatest for pathogens with moderate transmission rates (such as MPXV) (40). The ability to spread rapidly and efficiently from human to human could enhance spread by travelers to new regions.

In the decade since, 2 new clades (Ib and IIb) have emerged, and have spread outside of Africa. 

While clade Ib continues to struggle to establish a foothold outside of Africa, our collective immunity from the smallpox vaccine - which was discontinued in the late 1970s - continues to wane.

Which only increases the chances that it - or another emerging pox virus - will someday find a way to make a comeback.

ECDC Epidemiological Update: 2 Imported MERS-CoV Cases In France

 
Credit WHO 

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Details on the two imported MERS-CoV cases reported by France earlier this week remain scant, with no additional press releases from the French MOH, although a brief report yesterday in the BMJ identified the two patients as being men in their 70s, who are both reportedly in stable condition. 

Their itinerary, onset dates, number of close contacts, and likely route of exposure have not been released. 

Yesterday the ECDC released two reports on this incident: 1) a brief synopsis in their Communicable disease threats report (Week 49), and 2) an Epidemiological Update, neither of which shed light on the above mentioned questions.

Both, however, stress that while the risk to the EU is currently low, `.  .  sporadic MERS cases in travellers returning to the EU/EEA can be expected'. Therefore:

European public health authorities should remain vigilant, continue surveillance of acute respiratory infections and maintain preparedness for travel-related MERS-CoV cases entering the EU/EEA. 

I've reproduced the Epidemiological Update below.  I'll return with a brief postscript after the break. 

Two cases of Middle East respiratory syndrome (MERS) in travellers returning to France from the Arabian Peninsula
Epidemiological update
5 Dec 2025
 
On 3 December 2025, the French Ministry of Health reported two imported human Middle East respiratory syndrome (MERS) cases with travel history to the Arabian Peninsula. The two affected individuals participated in the same group trip. No secondary cases have been identified so far.

French authorities are implementing response measures and monitoring the situation. (More information from the French Ministry of Health)

European public health authorities should continue surveillance of acute respiratory infections and maintain preparedness for potential travel-related MERS cases entering the EU/EEA. Information about the recent cases, case definitions and diagnostic approaches should be shared with clinicians to maintain increased awareness for early identification, isolation and diagnosis of possible MERS cases. Adherence to strict infection control protocols during contact with patients that may have a Middle East respiratory syndrome coronavirus (MERS-CoV) infection – including hand hygiene and respiratory measures – is critical to prevent further spread of the virus in healthcare settings.

Countries should also advise travellers returning from areas where MERS-CoV may be circulating to seek medical attention if they develop a respiratory illness with fever and cough or diarrhoea during the two weeks following their return and to disclose their recent travel history to their healthcare provider. Travellers to the Arabian Peninsula are also advised to avoid contact with dromedary camels and consumption of camel products. When visiting markets or places where dromedary camels are present, strict hygiene measures should be followed. These include hand hygiene before and after touching animals and avoiding any contact with sick animals. Further information can be found in the World Health Organization’s MERS-CoV factsheet.

Although sporadic MERS cases in travellers returning to the EU/EEA can be expected, the probability of sustained human-to-human transmission among the general population in Europe remains very low and the impact of the disease in the general population is considered low. The current MERS situation poses a low risk to the EU/EEA, and recommendations from the Rapid Risk Assessment published by ECDC on 29 August 2018 still apply.

ECDC published a technical report, ‘Health emergency preparedness for imported cases of high-consequence infectious diseases’, in October 2019 that is still useful for EU/EEA countries wishing to assess their level of preparedness for a disease such as MERS. ECDC also published ‘Risk assessment guidelines for infectious diseases transmitted on aircraft (RAGIDA) – Middle East respiratory syndrome coronavirus (MERS-CoV)’ on 22 January 2020.

MERS-CoV is a zoonotic virus transmitted mostly from infected dromedary camels and via consumption of raw or undercooked camel products, including milk. Human-to-human transmission is possible, with documented events occurring mostly in hospital settings. Since April 2012, and as of 1 December 2025, a total of 2 640 cases of MERS, including 958 deaths, have been reported by health authorities worldwide. The majority of these have been reported in the Middle East. Excluding these two recent cases, the latest imported case in Europe occurred in 2018.

While the number of reported MERS-CoV cases from the Middle East has plummeted in recent years, so too have surveillance and reporting. A decade ago - flawed as it sometimes was - Saudi Arabia provided daily MERS-CoV updates.

Several times, however, their MOH went dark for months at a time on the subject (see 2018's The Saudi MOH Breaks Their Silence On MERS-CoV).

Regular MERS reporting ended in 2020 with the arrival of COVID, but starting in 2022, KSA announced they would report MERS-CoV cases on a bi-annual basis.  

To be fair, we don't hear much from other nations on the Arabian peninsula, where MERS-CoV has also been been detected in both camels and humans. And it seems likely that cases are being missed in North and Central Africa as well (see EID Journal: Geographic Distribution of MERS-CoV among Dromedary Camels, Africa).

Over the past decade we've looked at many of the challenges of MERS-CoV surveillance, including:

EID Journal: Sensitivity and Specificity Of MERS-CoV Antibody Testing

AJIC:Intermittent Positive Testing For MERS-CoV

JIDC: Atypical Presentation Of MERS-CoV In A Lebanese Patient

And in 2018 - in Evaluation of a Visual Triage for the Screening of MERS-CoV Patients - we looked at a highly critical review of the screening methods used by the Saudis for selecting patients for MERS testing. As a result, the official total of 2,640 cases is highly suspect.

Last August, in IJID Editorial: Al-Tawfiq on Global Epidemiology and Public Health Challenges of Middle East Respiratory Syndrome Coronavirus (MERS-CoV), we looked at what may be the most challenging aspect of MERS detection; asymptomatic or mildly symptomatic cases. 

Also last June, in JEGH: Epidemiological Characteristics of MERS-CoV Human Cases, 2012- 2025, we looked at the changing epidemiology of MERS-CoV cases since 2012, as well as substantial gaps in our current understanding of the disease.

Prior to the emergence of COVID in late 2019, MERS-CoV was viewed as being the top coronavirus pandemic threat (see 2017's A Pandemic Risk Assessment Of MERS-CoV In Saudi Arabia), with its R0 (basic reproduction number) briefly flirting with 1.0.

Whether MERS-CoV will re-emerge as a global health threat remains unknown, but it continues to circulate - and evolve - on both the Arabian Peninsula and in Africa.  

We ignore its potential at considerable risk.