Saturday, September 07, 2024

EID Journal: Pathogenicity of HPAI H5N1 Viruses Isolated from Cats in Mice and Ferrets, South Korea, 2023

 

#18,285

The concern whenever we see spillover of an avian-adapted virus to mammals - and particularly when it involves long chains of infections - is the potential for host adaptations to emerge (as demonstrated by the classic serial passage experiment shown above).

In July of 2023, while we were watching an outbreak of HPAI H5N1 in cats in Poland, we were also seeing a similar outbreak in South Korea, where cats at two different animal shelters tested positive for the virus.



At the time of these two outbreaks, reports of outbreaks in domestic cats were uncommon. We'd only seen a handful of sporadic HPAI H5 feline infections in the United States (see NVDC Report: 2 Domestic Cats Infected With HPAI H5N1), and in Europe (see WOAH: France Reports Cat Infected With Avian H5N1).

Since then, of course, we've seen dozens of additional infections, many involving severe neurological manifestations (see USDA Adds 16 Additional Cats To Mammals with HPAI H5N1 List (n=53)).  

Last December, in  Emerg. Microbes & Inf.: Characterization of HPAI A (H5N1) Viruses isolated from Cats in South Korea, 2023,  a letter from researchers in South Korea classified this virus as a new genotype (South Korea genotype III), and identified a number of mammalian adaptions (most notably D701N in PB2).

Yesterday the CDC's EID Journal published another report on this outbreak, which in addition to the previously reported D701N, also reports finding an isolate with E627K. They write:

We identified amino acid substitutions related to mammal adaptation in both YS/2023 and GA/2023 viruses.
In both viruses, we found mutations S123P, S133A, and T156A (H5 numbering), which enhance binding affinity of the HA protein to α2,6-sialic acid on the host cell surface and contribute to increased mammal receptor tropism (20; J. Yang et al., unpub. data, External Link). 

In addition, in the polymerase basic 2 (PB2) gene segment, we identified mutations encoding D701N in YS/2023 and E627K in GA/2023; both substitutions are mammal-adapting mutations known to increase polymerase activity and virulence in mammals (Table 2) (21–23). However, mutations associated with antiviral drug resistance, such as H274Y in NA and S31N in the matrix protein, were not detected (21,24).
Notably, both isolates produced fatal illness in mice and ferrets, with ferrets displaying neurological manifestations. Additionally, infected ferrets demonstrated mammal-to-mammal contact transmission.

Due to its length and technical nature, I've only posted some excerpts. Follow the link to read the full report.  I'll have a postscript after the break. 

Research
Pathogenicity of Highly Pathogenic Avian Influenza A(H5N1) Viruses Isolated from Cats in Mice and Ferrets, South Korea, 2023
Il-Hwan Kim1, Jeong-Hyun Nam1, Chi-Kyeong Kim, Yong Jun Choi, Hyeokjin Lee, Bo Min An, Nam-Joo Lee, Hyoseon Jeong, Su-Yeon Lee, Sang-Gu Yeo, Eun-Kyoung Lee, Youn-Jeong Lee, Jee Eun Rhee, Sang Won Lee, Youngmee Jee, and Eun-Jin Kim

Abstract

The prevalence of highly pathogenic avian influenza (HPAI) A(H5N1) viruses has increased in wild birds and poultry worldwide, and concomitant outbreaks in mammals have occurred. During 2023, outbreaks of HPAI H5N1 virus infections were reported in cats in South Korea. 
The H5N1 clade 2.3.4.4b viruses isolated from 2 cats harbored mutations in the polymerase basic protein 2 gene encoding single amino acid substitutions E627K or D701N, which are associated with virus adaptation in mammals.
Hence, we analyzed the pathogenicity and transmission of the cat-derived H5N1 viruses in other mammals. Both isolates caused fatal infections in mice and ferrets. We observed contact infections between ferrets, confirming the viruses had high pathogenicity and transmission in mammals. Most HPAI H5N1 virus infections in humans have occurred through direct contact with poultry or a contaminated environment. Therefore, One Health surveillance of mammals, wild birds, and poultry is needed to prevent potential zoonotic threats.
(SNIP)

During July 2023, unusual deaths of cats at animal shelters occurred in the Yongsan and Gwanak Districts of Seoul, South Korea, caused by HPAI H5N1 viruses (15,16); viruses isolated from cats were obtained from each animal shelter. 

(SNIP)
Discussion

HPAI H5N1 outbreaks continue worldwide, posing considerable threats to humans and animals. HPAI H5N1 clade 2.3.4.4b viruses have been detected in wild birds and domestic poultry in South Korea (14). In addition, infection outbreaks in cats caused by HPAI H5N1 clade 2.3.4.4b viruses occurred in 2 animal shelters in South Korea during July 2023.
Both H5N1 viruses isolated from cats had genetic constellations similar to that of the predominant influenza virus circulating in wild birds and poultry in South Korea during 2022–2023. An investigation of the source of infection found that the cats were infected by ingesting raw duck feed contaminated with the prevalent circulating virus. The raw feed–derived viruses were genetically identical to the poultry virus; however, we found 2 mutations related to mammal adaptation (E627K and D701N) in PB2 of the isolates from cats.
Therefore, it is critical to prevent HPAI virus infections in mammals because avian-derived influenza viruses have been found to mutate after infecting mammals. We performed genetic analysis and animal model experiments to assess the potential mammal-to-mammal transmission and pathogenicity of HPAI H5N1 clade 2.3.4.4b viruses isolated from cat outbreaks in other mammals.

(SNIP)

The H5N1 PB2 substitution E627K was observed in cats in Poland, and the PB2 D701N substitution was observed in sea lions in Argentina (10,26). According to sequence data registered in GISAID, >50% of human HPAI virus isolates exhibit E627K or D701N substitutions in PB2. Those mammal-adaptive mutations are critical factors that increase replication and virulence of H5N1 viruses in cell culture and animal experiments (27–30).

Ferrets are useful animal models to study influenza virus transmission and are frequently used for influenza pathogenicity evaluation because they exhibit influenza-like symptoms after infection, including fever, malaise, anorexia, sneezing, and nasal discharge (31–33).
The H5N1 viruses isolated from cats exhibited high virus replication levels and systemic infection along with severe symptoms and high mortality rates in mice and ferrets; in addition, contact transmission among ferrets was confirmed. Therefore, it was inferred that YS/2023 and GA/2023 are highly pathogenic in mammals and are capable of mammal-to-mammal transmission.
It was also presumed that the amino acid substitutions E627K and D701N in PB2, previously associated with increased replication and virulence in mammals (29), might be responsible for the pathogenicity and transmission of H5N1 viruses in mammals. YS/2023 and the GA/2023 are genetically similar, except for the PB2 substitutions D701N in YS/2023 and E627K in GA/2023.
The GA/2023 virus with the E627K substitution showed stronger contact transmission in ferrets than the YS/2023 virus with the 701N substitution. It has been reported that the E627K substitution in PB2 of H5N1 viruses affects airborne transmission in ferrets (34). Therefore, the E627K mutation might have a greater effect on transmission of the cat-derived viruses than D701N, although this possibility requires further investigation.

(SNIP)

In conclusion, the increased pathogenicity and transmission among mammals observed in ferrets exposed to cat-derived HPAI H5N1 viruses indicate a need to conduct surveillance for H5N1 viruses in wild birds and mammals to prepare for potential zoonotic threats. A One Health surveillance approach is crucial, and sharing and integrating information, such as sequencing data, reference viruses, and experimental data, during outbreaks in birds and mammals are essential to prevent human HPAI H5N1 virus infections.

Dr. Kim is a scientific deputy director of the Division of Emerging Infectious Diseases at the Korea Disease Control and Prevention Agency (KDCA). His main research interests are infectious disease and microbiology.


For more on spillovers of HPAI into peridomestic mammals, you may wish to revisit these recent posts:

Virology: Susceptibilities & Viral Shedding of Peridomestic Wildlife Infected with Clade 2.3.4.4b HPAI Virus (H5N1)

Pathogens: Susceptibility of Synanthropic Rodents to H5N1 Subtype HPAI Viruses

Emer. Microbe & Inf.: HPAI Virus H5N1 clade 2.3.4.4b in Wild Rats in Egypt during 2023

CAHSS/Animal Health Canada: HPAI H5N1 in Cats

Preprint: Recent Bovine HPAI H5N1 Isolate is Highly Virulent for Mice, Rapidly Causing Acute Pulmonary and Neurologic Disease
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Friday, September 06, 2024

CDC Statement On Missouri H5 Case



#18,284


The CDC has now released a statement on the Missouri H5 case (see below).  Given the lack of occupational exposure - and no known exposure to animals - the epidemiological investigation into this case will be of extreme interest. 

We should get more information on the full subtype, and hopefully complete genomic sequencing, sometime next week.


CDC Confirms Human H5 Bird Flu Case in Missouri

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


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

Case Information

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

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

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

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

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

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


Missouri - Credit Wikipedia


#18,283

It's been a frustrating past hour, with media reports of a human H5 case identified in Missouri, but with no official announcement available online.   A few moments ago, however, the following statement was posted on the Missouri DHSS website. 

September 06, 2024

Human H5 bird flu case confirmed in Missouri

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

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

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

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

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

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

 

Last July the CDC held a COCA Call for clinicians to help them identify, treat, and report suspected novel flu infections (see CDC COCA Call On H5N1 for Clinicians & Healthcare Centers Now Online).

This presentation also included a 48-slide PDF file.  

As we've seen previously from the UKHSA (see TTD (Time to Detect): Revisited), identifying community spread of a novel virus could take weeks, and only come after dozens or even hundreds of people had been infected. 

While this is hopefully an isolated case, the fact that it was only confirmed 2 weeks after the patient was hospitalized (and now released), illustrates how difficult it can be to detect novel flu viruses like HPAI H5N1 in real-time. 

As we've seen, detecting H5 cases in the community often requires a bit of luck, but the harder we look, the earlier we are apt to identify cases. 

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Virology: Susceptibilities & Viral Shedding of Peridomestic Wildlife Infected with Clade 2.3.4.4b HPAI Virus (H5N1)

image

Striped Skunk – Credit Wikipedia 

#18,282

While we've been following various incarnations of HPAI H5 for more than 2 decades, since 2020 a new clade (2.3.4.4b) of H5N1 has demonstrated enhanced, and still growing, abilities to infect a much wider range of avian and mammalian hosts.  

Bird species that once were thought immune to the virus are now routinely infected (see DEFRA: The Unprecedented `Order Shift' In Wild Bird H5N1 Positives In Europe & The UK), and new species of mammals are being added to the USDA's list of affected wildlife on a regular basis.

While far from complete, the USDA lists > 2 dozen mammals affected, including:


Regular readers will recall that we've looked at a number of studies on the susceptibility of peridomestic wildlife (both avian & mammalian) to HPAI H5 viruses, many of which were led by Dr Jeffery Root; a Research Wildlife Biologist at the National Wildlife Research Center.

  • again in 2016, in Report: Skunks and Rabbits Can Catch And Shed Avian Flu, we looked at an AP News report that quoted Dr. Root as saying that small mammals like rabbits and skunks can become infected with avian flu, and they can shed enough of the virus to pass it onto ducks (and presumably other types of birds).
  • And in 2018, in HPAI H5Nx Clade 2.3.4.4. Shedding In Cottontail Rabbits, Dr. Root et al. showed that the HPAI H5 clade 2.3.4.4. virus - which previously had shown little ability to infect mammals - could infect cottontail rabbits, and that they could then shed the virus for one or more days.

All of which leads us to a new study penned by Dr. Root et al., which finds the 2.3.4.4b clade of H5N1 able to readily infect a variety of peridomestic species, and that two (striped skunks and Viriginia Opossums) shed copious amounts of the virus. 

The full report is behind a paywall. Due to copyright I've only posted the link, and a snippet from the abstract.  Follow the link to read the extended summary or the full report.  I'll return with a bit more after the break. 

Susceptibilities and viral shedding of peridomestic wildlife infected with clade 2.3.4.4b highly pathogenic avian influenza virus (H5N1)
J. Jeffrey Root 1, Stephanie M. Porter 1, Julianna B. Lenoch 2, Jeremy W. Ellis 1, Angela M. Bosco-Lauth 31U.S. 

Received 3 July 2024, Revised 3 September 2024, Accepted 4 September 2024, Available online 5 September 2024.

https://doi.org/10.1016/j.virol.2024.110231Get rights and content


Highlights
  • Six of six peridomestic wildlife species tested had the ability to replicate HP H5N1. 
  • HP AIVs circulating in the U.S. during 2022-2024 may have an extremely broad range of species that can be impacted by and/or replicate and shed these viruses. 
  • Peridomestic mammals shed higher viral titers than peridomestic birds in this study.

Abstract

(SNIP)

Overall, the results of this study indicate that certain peridomestic species could pose a biosecurity threat to poultry operations in some situations. In addition, this study and field reports indicate that the HP AIVs circulating in the U.S. during 2022-2024 may have an extremely broad range of species that can be impacted by and/or replicate and shed these viruses.

          (Continue . . . . )


When taken with other recent reports, including:




NPJ Viruses: Panzootic HPAIV H5 and Risks to Novel Mammalian Hosts
 
It is pretty clear this HPAI virus is rapidly becoming entrenched in our environment.  This not only provides the virus with multiple pathways to infect poultry operations, it increases the chances it will spread to other mammalian species. 

And while this virus remains primarily an avian-adapted pathogen, with every mammalian infection comes new opportunities for the virus to better adapt to non-avian hosts. 

Whether that leads to a pandemic strain is unknowable, but is seems increasingly unlikely that this virus will simply `burn itself out', as so many seem inclined to believe. 

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South Korea Releases Updated Pandemic Plan

 


#18,281

Two decades ago, when H5N1 was making its initial threatening moves in Southeast Asia, countries around the world began crafting pandemic plans, and conducting preparedness drills.  Here in the United States, every state and territory, and every major government agency, was expected to craft a plan. 

There was admittedly a wide variance in the quality of these plans, and many assumptions were  never tested, but it was seen as significant progress. 

Following the unexpectedly mild 2009 H1N1 pandemic, many countries simply locked their plans away, and stopped preparing.  Pandemics, they believed, had been over-hyped.  Modern medicine (vaccines & antivirals) would save us.  

When a novel coronavirus emerged in 2020, many countries were forced to rely on 15-year-old pandemic plans which only envisioned an influenza pandemic. Plans that often emphasized the rapid deployment of vaccines - that, in the case of COVID - wouldn't exist for at least a year. 

Despite years of dire warnings that the world was ill-prepared for a pandemic, we went into that COVID pandemic with long predicted critical shortages of ventilators and PPEs (masks, gowns, gloves). Much of what was stored in our Strategic National Stockpile had deteriorated with age. 

You'd think that after enduring COVID, the nations of the world would be rushing to update, and improve, their pandemic response plans.  But once again most countries seem to be ignoring the threat. Surveillance and reporting on infectious diseases is, in many cases, worse than it was a decade ago. 

We have seen a few bright spots.

Ten weeks ago South Korea's CDC unveiled a draft of their new `Influenza Pandemic and Response Plan' at an expert symposium, calling for comments. 

Today they unveiled their final draft, which emphasizes the importance of `flattening the curve' during the opening months of a pandemic (see EID Journal: Evaluating Social Distancing Interventions To Delay or Flatten The Curve - COVID-19). 



As you might expect, the document is in Korean (although it can be run through a translator).  The (translated) summary, published by the South Korea CDC follows:


 - Novel influenza is a strong candidate for the next pandemic, and the goal is to minimize health damage and social and economic impacts.


 - A strategy to delay the peak of the epidemic from 110 to 190 days and reduce the maximum number of patients on the peak day by 35% in the worst-case scenario (high transmission rate and high mortality rate).


 On September 6, the Korea Disease Control and Prevention Agency (KDCA) (Director Young-Mi Ji) announced the ‘New Influenza Pandemic Preparedness and Response Plan’ to prepare for the next infectious disease pandemic.


 This plan is being completely revised for the first time in six years since it was established in 2006 and revised twice in 2011 and 2018, and reflects the recommendations of the World Health Organization, which strongly identifies a new type of influenza as the next pandemic and recommends that the country prepare for it as a priority in its national plan. 


In particular, as the risk level is increasing due to the continuous reports of human infections with avian influenza, the need to prepare preemptively before the risk of avian influenza outbreaks, such as the influx of migratory birds in the fall, has arisen.

  * A total of 907 cases of human infection with avian influenza A (H5N1) type reported in 24 countries since 2003 (`24.8.5., ECDC)

 ** Recent cases: Human infection from cattle (USA, April 24), Human infection with avian influenza death (Vietnam, March 24)


  Before preparing the revision, the Korea Disease Control and Prevention Agency collected opinions from various experts and medical professionals regarding the limitations of the COVID-19 response and areas in need of improvement.


 In addition, the scale of damage from a new or variant influenza pandemic was predicted. According to this, in a situation of high transmission rate and high fatality rate, if there is no quarantine intervention, it is estimated that up to 40% of the population will be infected within 300 days and it will take about 110 days to reach the peak. In this pandemic situation, a strategy was established to reduce the maximum number of patients occurring on the peak day to 35% through quarantine measures, delay the peak of the epidemic from 110 days to 190 days, and quickly develop a vaccine during that period.


This plan aims to minimize not only the health damage but also the social and economic impact in the event of a novel influenza pandemic, and includes the following as key tasks before a pandemic: ▲ surveillance system, ▲ resource securing, ▲ vaccine strategy, and ▲ establishment of a One Health integrated management system, as well as response strategies for each phase (initial phase, spread phase, recovery phase) in the event of an outbreak.


  First, the surveillance system aims to detect the emergence of a new virus early, expand overseas information collection, establish an information verification system*, and expand the number of medical institutions conducting surveillance from 300 to 1,000 for domestic surveillance. 


  Laboratory surveillance for pathogen genetic analysis will also be expanded from the current 180 to 200 sites, and links between medical institutions and public testing agencies to identify avian influenza will be strengthened. In addition, a surveillance system for unknown causes for respiratory infection patients visiting emergency rooms and outpatient clinics will be newly established. 

 * Select local information → Request information from ODA agency → Analyze after verifying information through local dispatched personnel

In addition, we plan to develop a multidisciplinary prediction model using artificial intelligence and mathematics/statistics in collaboration with the private sector to improve the prediction of patient occurrence by epidemic stage, and to establish a basis for effective quarantine policies through analysis of the effectiveness of various pharmacological and non-pharmacological quarantine measures.


Second, in the resource sector, we will stockpile 25% of the total population of treatment drugs to be able to respond for the first six months, and we will also stockpile quarantine supplies such as protective gear and masks to enable rapid supply, and operate the Disaster Management Resources Integrated Management System*. 


  For rapid diagnosis, a new one-step test method** will be developed to enable confirmation within 12 hours, compared to the current 72 hours. In preparation for the demand for large-scale testing and hospital beds in the event of an epidemic, genetic-based testing and rapid testing infrastructure will also be expanded, and the number of infectious disease beds will be expanded from the current 1,100 to 3,500. 

  * Distribution and logistics ICT-based system for real-time integrated management of national disaster management resource information

 ** Rapid diagnosis possible in case of human infection with subtypes (H5N1, H5N8, H9N2) that mainly occur in birds


 Third, for vaccines, as a strategy to develop a vaccine within 100 or 200 days of an outbreak, we prepare for two situations: developing a vaccine or prototype* (trial product) for the predicted antigen type of the outbreak in advance and using it for rapid development (100 days) in the event of an outbreak, or starting from the strain introduction stage and developing anew (200 days) in the event of an outbreak with a strain different from the pre-developed antigen type. 


  Currently, the avian influenza H5N1 vaccine has been developed domestically, so if a pandemic occurs due to a subtype of this, a vaccine can be developed in just 90 days through the strain change procedure.

  * Currently in possession of fertilized egg-based H5N1, pandemic H1N1, and additional development of H5N1, H7N9 based on various platforms


 In order to secure an mRNA platform for rapid vaccine development, the government promoted the 'Pandemic mRNA Vaccine Development Support Project (hereinafter referred to as the 'mRNA Vaccine Project') through a Cabinet meeting last August, and the National Research and Development Project Evaluation General Committee of the Ministry of Science and ICT recognized the need for rapid vaccine development and acquisition, and selected this project as a project exempted from preliminary feasibility study.


  Through this project, we aim to secure an mRNA vaccine platform by 2028, and in the first year, 2025, we submitted a government budget proposal to the National Assembly to invest 29 billion won to support non-clinical and clinical trials for mRNA vaccine development. The total project scale and period, etc. will be finalized after reviewing the feasibility of the business plan.


  The fourth is One Health Integrated Management. Influenza is a zoonotic disease that infects both animals and humans. Influenza from birds such as chickens and ducks can spread to mammals such as cattle and pigs, and if it crosses the species barrier and infects humans, it can cause a pandemic. Therefore, One Health surveillance and response are required for the entire chain of infection transmission, including animals and the environment. 


  Surveillance of animal influenza will expand the current system centered on poultry and wild birds to include mammals and companion animals. In addition, an early warning system will be established to identify risks early and take preventive measures by tracking viruses originating from humans and animals and linking and analyzing information such as habitats and migratory bird movements.


  In addition, we will regularize joint mock training among relevant ministries to strengthen real-time joint epidemiological investigations and responses to protect high-risk groups such as livestock workers or contacts in the event of an animal influenza outbreak. We plan to establish One Health policies and implementation plans and check their implementation through an inter-ministerial consultative body comprised of relevant ministries.


  In response to an outbreak, strategies were specified according to the characteristics of each epidemic situation. In the early stages, plans were specified for minimizing transmission, preventing severe cases and deaths during the spread period, and effective recovery and reorganization during the recovery period. The “Initial 3 Days” plan was presented as an example to focus on rapid initial response.


  In the early stages of an outbreak, pathogen characteristics and epidemiological information are insufficient, so pathogen information is quickly obtained through in-depth epidemiological investigations of early cases. A crisis response system is activated to establish a patient management system including screening and isolation of confirmed cases, and diagnostic testing methods are established and distributed, while crisis response R&D is activated to secure vaccines.


This is a time when stable medical resource management is required. In addition, the vaccination infrastructure prepared in the preparation stage will be activated for priority vaccination of high-risk groups and short-term, simultaneous, and rapid vaccination.


  In the recovery phase, tasks are carried out to reorganize for the next pandemic, including effective damage recovery according to priorities and supplementary measures through response evaluation. 


  Meanwhile, on the morning of Friday, September 6, the Korea Disease Control and Prevention Agency reported on the “Plan to Prepare for and Respond to a Novel Influenza Pandemic” at the State Affairs Ministerial Meeting at the Government Complex Seoul, and held a public briefing on the plan with experts* that afternoon. 

* Professor Jaegap Lee (Hallym University)


  Ji Young-mi, the director of the Korea Disease Control and Prevention Agency, emphasized that “a pandemic can affect not only the health of the people but also essential social services, education, industry, and other areas, so advance preparation is important.” She added, “Since we have vaccines and antiviral drugs to respond to influenza, we will develop vaccine prototypes that match the characteristics (antigenic types) of new influenza and accelerate the development of vaccine platform technologies such as mRNA so that we can quickly secure vaccines in the event of a new virus outbreak.” She added that “We will also prepare by sufficiently stockpiling treatments and quarantine supplies in advance so that we can respond appropriately in the early stages of a pandemic.” 


  The Korea Disease Control and Prevention Agency requested cooperation from relevant ministries to ensure that the “Plan to Prepare for and Respond to a Novel Influenza Pandemic” is implemented well, and will continue to check for any obstacles in the field where the plan is to be implemented and evaluate its effectiveness. In addition, it explained that it will share this plan with the international community to support each country in establishing its own plan, and prepare for the next pandemic together. 

While it is true that No Pandemic Plan Survives Contact With A Novel Virus, having a framework for dealing with a crisis, and running realistic exercises, can be invaluable in a crisis. 

But most importantly, it provides a road map for what can be done today to prepare for the inevitable public health threats of tomorrow. 

Which, based on our past performance, would be a novel response to a novel virus. 

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