Idaho Health HAN: Consider Avian Influenza A (H5N1) in Patients with Dairy Cattle or Poultry Exposure

 

#19,211

While reporting of HPAI H5 in dairy herds has slowed in 2026, we continue to see scattered outbreaks, with the most pronounced currently in the state of Idaho. 

Similarly, we've not seen a human H5N1 case reporting in the United States in more than a year, but serological testing suggests some mild or asymptomatic cases may be flying under the radar. 

Detection is highly dependent upon clinicians maintaining an elevated index of suspicion, and their willingness to order HPAI H5 specific tests. As we've seen often (see QJM: Avian Influenza in Humans: Virology, Transmission, and Clinical Priorities) the diagnosis is often missed - or at least delayed - even in hospitalized cases. 

This past week, with the increase in outbreaks in Idaho's dairy herds, their Central District Health agency issued the following HAN Health Advisory:

Health Advisory: Consider Avian Influenza A (H5N1) in Patients with Dairy Cattle or Poultry Exposure

by Trent Young on June 16, 2026


HEALTH ALERT NETWORK – Health District 4

Advisory for Healthcare Providers: Consider Avian Influenza A (H5N1) in Patients with Dairy Cattle or Poultry Exposure

Key Messages

Local Situation: Avian Influenza A (H5N1) has been confirmed in over 80 Idaho dairy premises, including 12 in District 4 currently under ISDA quarantine.

Clinical Suspicion: Consider H5N1 infection in patients presenting with conjunctivitis or acute respiratory illness who report recent exposure to dairy cattle, sick poultry, or contaminated environments.

Report Immediately: Novel influenza A infections are immediately reportable. Contact CDH at 208-327-8625 to report suspected cases.

Occupational Risk: While the risk to the general public remains low, agricultural workers and others with direct animal exposure are at increased risk.

Background and Current Situation

Due to ongoing H5N1 detections in Idaho dairy herds and continued circulation in poultry, clinicians should consider H5N1 in patients with compatible illness and relevant exposure histories.

Since its detection in U.S. dairy cattle in March 2024, H5N1 has spread to more than 1,100 dairy herds across at least 20 states. There have been 71 reported human cases in the U.S. since 2024, most associated with dairy cattle exposure and direct contact with infected animals or contaminated milk. No human cases have been reported in Idaho. Most U.S. infections have been mild and characterized by conjunctivitis, although respiratory illness and severe disease can occur. There is no evidence of sustained person-to-person transmission.

Individuals at increased risk of exposure include:

• Dairy farm workers and milkers
• Veterinarians and animal health personnel
• Farm support staff (cleaning, transport, equipment handling)
• Household contacts of exposed workers

Clinical Presentation

Mild / Typical Illness:

• Conjunctivitis (redness, irritation, discharge, foreign body sensation)
• Fever, cough, sore throat, rhinorrhea
• Fatigue, headache, myalgia, arthralgia
• Gastrointestinal symptoms

Moderate to Severe Illness:

• Shortness of breath
• Altered mental status or seizures
• Pneumonia, ARDS, sepsis, multi-organ failure

Asymptomatic Testing:

Consider testing asymptomatic individuals with high-risk exposures (e.g., exposure to infected animals without recommended PPE or after a PPE breach). Collect respiratory and conjunctival specimens as recommended.

Laboratory Testing and Specimen Collection

• Idaho Bureau of Laboratories (IBL) Submission:
• Order Name: Influenza Subtyping
• Aliases: Flu A/B PCR, Flu A subtyping, H5N1, HPAI
• Commercial Lab Availability for Influenza A (H5):ARUP: Respiratory or conjunctival swabs
• LabCorp: Nasopharyngeal (NP) swabs only
• Quest: NP, nasal, OP, BAL, or conjunctival swabs

Standard Specimen Collection:

• Nasopharyngeal (NP) swab in one viral transport medium (VTM) tube
• Nasal and oropharyngeal (OP) swabs combined in a second VTM tube
• If conjunctivitis is present, collect a conjunctival swab in a separate VTM tube
• For severe illness, collect lower respiratory specimens (e.g., bronchoalveolar lavage or endotracheal aspirate) when feasible
• Rapid influenza diagnostic tests have limited sensitivity and should not be used to rule out H5N1 infection

Handling and Transport

• Coordinate specimen collection and submission with Central District Health before shipping.
• Store specimens:2–8°C for up to 72 hours, OR
• ≤ −20°C for longer storage (up to 30 days)
• If frozen:Do NOT thaw before testing
• Ship on dry ice for overnight delivery
• If refrigerated, transport promptly on cold packs

Antiviral Treatment and Prophylaxis

Do NOT delay treatment while awaiting results.

• Initiate oseltamivir 75 mg orally twice daily for 5 days for symptomatic adolescents and adults with suspected H5N1 infection. Refer to CDC guidance for pediatric dosing.
• Consider post-exposure prophylaxis for individuals with high-risk exposures, using recommended treatment dosing for 5 or 10 days, depending on the exposure scenario.

Central District Health Contact: 208-327-8625

Resources

Avian Influenza (Bird Flu): Highly Pathogenic Avian Influenza A(H5N1) Virus: Interim Recommendations for Prevention, Monitoring, and Public Health. CDC.gov Updated December 26, 2024. Accessed January 09, 2026.
https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html
Emergency Use Instructions (EUI) Fact Sheet for Healthcare Providers: Oseltamivir for Treatment or Post-Exposure Prophylaxis of Novel Influenza A. February 18, 2025. https://www.cdc.gov/bird-flu/media/pdfs/2024/07/Oseltamivir-EUI-HCP_1.pdf
Avian Influenza (Bird Flu): Interim Guidance on Specimen Collection and Testing for Patients with Suspected Infection with Novel Influenza A Viruses Associated with Severe Disease or with the Potential to Cause Severe Disease in Humans. CDC .gov. Updated May 15, 2025. Accessed January 09, 2026. https://www.cdc.gov/bird-flu/php/severe-potential/index.html

While most known human H5 infections have been epidemiologically linked to a specific agricultural exposure (cows, chickens, wild birds, etc.), over the past 2 years we've seen a handful (U.S. x 4, Mexico x 3, Canada x 1) where the source of exposure remains unexplained.

Given the limits of surveillance and testing, it would not be terribly surprising if there are other cases in the community that have not been officially confirmed.

Particularly since some percentage of infections are asymptomatic or very mild (see MMWR: Serologic Evidence of Recent Infection with HPAI A(H5) Virus Among Dairy Workers).

Three years ago, in UK Novel Flu Surveillance: Quantifying TTD, we looked at a UKHSA report that it would likely take between 3 and 10 weeks before community spread of a novel flu virus would become apparent to authorities, after anywhere between a few dozen to a few thousand community infections

Anything we can do to shorten those delays could pay important dividends should HPAI take off. 

Australia Awaits Test Results On 1st Suspected H5N1 Detection (wild bird)

Virology Down Under

#19,210

I awoke this morning (4am EDT) to find an overnight message from Ian McKay - author of Virology Down Under - on the first suspected case of H5N1 in Australia. Details are scant, but you can read Ian's blog post (and hopefully peruse some of his other posts while you are there).

It was only yesterday we looked at a preprint on H5N1 threatening Australia's Heard Island Elephant Seal population, and over the past few years we've looked at a number of reports (see here, here, and here) on Australia's all-but-inevitable fate. 

Remarkably, even though H5N1 emerged in Southeast Asia more than 25 years ago, and has been widely reported across much of the Indonesian archipelago for decades, the virus has never managed to get a foothold in Oceania.

It has long been believed that that this good fortune is due in part to the Wallace and Weber lines - imaginary dividing lines used to mark the difference between animal species found in Australia and Papua New Guinea and the rest of Southeast Asia. 

While separated by a relatively narrow strait, on the western side you'll find Elephants, monkeys, leopards, tigers, and water buffalo while on the eastern side, you'll mostly find marsupials (kangaroos, Koalas, wombats, etc.).

These stark faunal differences also extend to birds, reptiles, and even insects.

But in 2023 HPAI was detected in the the Antarctic region - providing the virus with a potential southerly approach - raising fears that Oceania's luck with H5 may be on borrowed time (see Australia : Biodiversity Council Webinar on HPAI H5 Avian Flu Threat).

While today's suspected case has not been confirmed, and a single incursion is hardly an invasion, today's report reminds us how tenuous Oceania's HPAI H5N1-free status genuinely is. 

Of particular concern, when HPAI H5N1 conquers new territories it typically reassorts with a variety of local LPAI viruses, sometimes generating unique genotypes.  

Oceania may provide the virus with unique opportunities to improve to evolve, or to adapt to new hosts. 

Hopefully we'll get further clarification from Australia in the hours and days ahead.

Preprint: Mass mortality of southern elephant seals during multi-species outbreak of HPAI H5N1 on sub-Antarctic Heard Island

Heard & McDonald Islands - Credit Wikipedia

#19,209

Last October, in Australia DAFF & DCCEEW: Suspected H5 bird flu in Elephant Seals at Australian Sub-Antarctic Island, we learned of the first suspected incursion of HPAI into an Australian possession; Heard Island.

 

Australia, NZ, and the islands of Oceania are the only major regions of the earth that remain HPAI H5 free - and while Heard Island is far-removed from the Mainland (see map above) - this was a sobering reminder that the virus continues to increase its geographic range.

In late November we saw Confirmation of H5 Bird Flu on Sub-Antarctic Heard Island, but the full extent of the spillover was undetermined. Previously we've seen very large die-offs of of marine mammals, which have included signs the virus may be close to achieving sustained mammal-to-mammal transmission.

• Two years ago, in a research letter (see EID Journal: HPAI A(H5N1) Viruses from Multispecies Outbreak, Argentina, August 2023), researchers wrote: ". . . it seems likely that pinniped-to-pinniped transmission played a role in the spread of the mammal-adapted HPAI H5N1 viruses in the region . . ."

• In the summer of 2024, we looked at a Preprint: Massive outbreak of Influenza A H5N1 in elephant seals at Peninsula Valdes, Argentina: increased evidence for mammal-to-mammal transmission

• And a year ago, in Nature Comms: Cross-species and mammal-to-mammal transmission of clade 2.3.4.4b HPAI A/H5N1 with PB2 adaptations, the authors wrote:

• Several mutations were detected months later in sea lions in the Atlantic coast, indicating that the pinniped outbreaks on the west and east coasts of South America are genetically linked. These data support sustained mammal-to-mammal transmission of HPAIV in marine mammals over thousands of kilometers of Chile’s Pacific coastline, which subsequently continued through the Atlantic coastline.

Earlier this year California reported a limited die-off of Elephant seals from H5N1 for the very first time.  Unfortunately, much of the impact of H5 on marine mammals likely goes unreported. 

Yesterday, a team of researchers reported that the carnage from the Heard Island outbreak was worse than originally feared, with 76% mortality among Elephant Seal pups. 

Due to its length (n=25 pages), I've only posted some brief excerpts from the preprint.  Follow the link to read it in its entirety.  I'll have a brief postscript after the break.

Mass mortality of southern elephant seals during multi-species outbreak of HPAI H5N1 on sub-Antarctic Heard Island
 Julie C McInnes,  Tristan Burgess,  Georgia Mergard,  Melanie R Wells,  Clive R McMahon,  Matthew J Neave,  Andrea Polanowski,  Aleks Terauds,  Jérémy Tornos,  Mathilde Lejeune,  François-Xavier Briand,  Guy Baele,  Thierry Boulinier,  Helen Achurch, Rachael Alderman, Anna Lashko,  Barbara Wienecke,  Louise P Wynen,  Benjamin Viola,  Patti Virtue,  Jarrod C Hodgson
doi: https://doi.org/10.64898/2026.06.16.732752
This article is a preprint and has not been certified by peer review  

Preview PDF

Abstract

High pathogenicity avian influenza (HPAI) has spread across the sub-Antarctic, causing significant wildlife impacts. We report its first detection in an Australian external territory, Heard Island and McDonald Islands, which supports over one million breeding seabirds and seals. Drone and ground surveys (October 2025, January 2026), combined with viral genome analysis, confirmed infection with Influenza A H5N1 clade 2.3.4.4b at Heard Island. 

Drone surveys revealed mass mortality in southern elephant seals, with 8,573 pups (62%) recorded dead across Heard Island by the final surveys. Mortality increased at an average rate of 5.6% per day in a subset of harems, and the highest observed mortality in a harem was 97%. Based on the average (76%) mortality in the final surveys, total estimated pup mortality at Heard Island was 13,359 (from a total population of 17,364 pups), though this may be an underestimate as mortality was ongoing at this time. 

HPAI was detected in six of nine species tested and, we suspect, led to elevated mortality in king and gentoo penguins. Phylogenetic analysis indicates the virus was introduced from Crozet Islands, with an estimated arrival around August 2025. These data show the continued easterly spread of HPAI around the sub-Antarctic, with severe but heterogeneous impacts across taxa. Our results demonstrate the value of drones for large scale monitoring, underscoring the need for continued and enhanced HPAI surveillance across the Southern Ocean.

        (SNIP)

 DISCUSSION

HPAI H5N1 clade 2.3.4.4b has spread rapidly and widely across the globe and has now been detected  at the remote territory of Heard Island and McDonald Islands in the southern Indian Ocean. This is the  first detection of the panzootic clade 2.3.4.4b HPAI in Australian sub-Antarctic territory. 

We confirmed  the presence of H5N1 in southern elephant seals, Antarctic fur seals, gentoo and king penguins, a   brown skua and a South Georgia diving petrel, and observed mass mortality in elephant seals and   elevated mortality in king and gentoo penguins.

 Our results provide strong evidence that the virus was  introduced from Crozet Islands(<1,700 km from HIMI) based on current availability of virus sequences. It is clear from our observations and those of others 2,12,36  that HPAI can and does spread across vast  ocean basins. 

While the transport host(s) cannot be confirmed, southern giant petrels are a plausible candidate and have been suspected as long-distance transport hosts elsewhere 6,12. As the virus progresses eastwards around the sub-Antarctic, including along circumpolar flyways, there is potential for further geographic spread to additional HPAI-free regions, including Macquarie Island, New  Zealand, Australia and East Antarctica.

        (Continue . . . ) 

 
While the authors acknowledge that the Heard island viruses carried `new mutations' some of which were `likely to facilitate mammalian transmission', they stop short of declaring sustained mammal-to-mammal transmission.

They do suggest this outbreak likely began from a single introduction of the virus - probably in August of last year - and most likely from the Crozet Islands.  Elephant seals were most affected, but exactly how the virus spread on the island isn't fully understood. 

The authors wrote:

However, the HIMI genomes had lower-than-expected root-to-tip divergence compared with other H5N1 2.3.4.4b viruses. This is most consistent with a low-cadence transmission chain involving few hosts, either on land or at sea, though incomplete sampling of intermediate viruses may also contribute. Hotspots of infection likely generate many such chains of transmission as infected animals disperse, though most likely die out without seeding new, distant outbreaks.

Regardless of the method of transmission, HPAI H5 quickly burned through the seal population taking a deadly toll.  Add in H5's ability to cross vast distances of open ocean, and the ongoing bird-flu free status of Australia and New Zealand is precarious at best.  

ECDC: Preparedness and response for imported cases of Ebola disease into an EU/EEA country

 

#18,208

Given the spread of the Ebola Bundibugyo outbreak in the DRC and Uganda - and the aggressive estimates of its potential current and future size - the expectation is that at some point we could see sporadic exported cases to other parts of the world. 

Earlier this week Hong Kong held an interdepartmental Ebola response exercise (see photo below), for that very reason. 

While these cases could turn up anywhere - given current travel patterns - countries of the EU/EEA appear to be at highest risk outside of Africa. Today the ECDC has published ebola preparedness and response guidance for EU/EEA member nations. 

Preparedness and response for imported cases of Ebola disease into an EU/EEA country

Operational support
18 June 2026

This operational checklist presents an overview of health preparedness and response planning elements for the potential importation of a case of Ebola disease into a European Union/European Economic Area (EU/EEA) Member State health system.

The current Ebola disease outbreak caused by Bundibugyo virus (BDBV) in the Democratic Republic of the Congo (DRC) and Uganda, which has been ongoing since May 2026, poses significant challenges due to its magnitude and to the complex setting. On 17 May 2026, the outbreak was elevated to a Public Health Emergency of International Concern (PHEIC).

As of today’s date, the overall risk of Ebola disease caused by BDBV for the general population in the EU/EEA is assessed as very low. The importation risk is estimated by ECDC to be approximately one importation per 24 000 travellers (90% Uncertainty Interval, UI: 13 000–54 000) from the main outbreak region (North Kivu and Ituri, DRC) to the EU/EEA, with a low probability. Nevertheless, it is important to be prepared for every eventuality, given the severity of Ebola disease.

This document is organised into four focus areas, representing the potential health system contact points of an imported Ebola disease case. All four areas must operate effectively and in coordination with public health services to prevent further community transmission.

Publication file

Preparedness and response for imported cases of Ebola disease into an EU/EEA country English (1.32 MB - PDF)

Due to its size (n=21 pages), I've only posted a couple of screenshots below. Follow the link to download the full report. I'll have a bit more after the break.

In the fall of 2014, during the West African Ebola outbreak, the United States saw its first Ebola transmission event at a Dallas Hospital, where a recent traveller from Liberia was treated for a fever. 

The details are laid out in the CDC MMWR report Ebola Virus Disease Cluster in the United States — Dallas County, Texas, 2014 November 14, 2014 and numerous contemporary AFD blog posts (see here, here, here, and here).

The MMWR described the contact tracing process:

Initial tracing of potentially exposed contacts (i.e., "contact tracing") identified 48 close, unprotected contacts (i.e., had exposure to the patient, a potentially contaminated environment, or patient specimens without minimum recommended personal protective equipment [PPE]). Of the 48 contacts, 17 were persons within the community with exposure to the patient before he was admitted to the hospital and while he was symptomatic, 10 were persons who had been transported in the same ambulance that had transported the patient before it was completely cleaned and disinfected, and 21 were health care workers (HCWs) with potential exposures to body fluid without the protection of complete PPE. Beginning October 1, all 48 contacts underwent direct active monitoring (one in-person and one telephone follow-up per day to check for fever or symptoms of Ebola) for 21 days (the upper limit of the Ebola incubation period) from their last exposure date; six close community contacts were quarantined. Patient 1 died on October 8.

On October 11, a nurse (patient 2) previously involved in direct care of patient 1 developed fever (100.6°F [38.1°C]) and sore throat; she was confirmed to have Ebola by real-time PCR later that day. On October 14, a second nurse (patient 3) with similar exposure had a fever (100.5°F [38.1°C]) and rash and was confirmed to have Ebola by real-time PCR on October 15. Before her diagnosis, patient 3 had visited Ohio during October 10–13 (3). Contact tracing of patients 2 and 3 identified three household contacts of the two patients. Additional community contacts of patient 3 were identified from the Ohio visit and have been described (3).

Somewhat reassuringly, out of nearly 50 `close contacts' of the index patient, only 2 were infected.  And thanks to proactive contact tracing, and daily monitoring, a larger outbreak was averted.

Despite this positive outcome, the U.S. response wasn't without its problems (see Nurses Claim Lack Of Safety Protocols For Dealing With Ebola), which included repeated poor risk communications, and which required some mid-course corrections (see NIH: `More Stringent’ PPE Standards For Ebola On The Way).

But out of this initial chaos, new protocols were developed (see HHS Launches National Ebola Training & Education Center) and we became better prepared for dealing with High Consequence Infectious Diseases (HCIDs).

Assuming we remember the lessons of 2014, we should now be in a much better position to deal with imported cases than we were a dozen years ago.

At least, that's the hope. 

A Double Head's Up for Severe Weather Today

#19,207

For most Americans, a severe weather event is their biggest regional disaster threat; hurricanes, tornado outbreaks, blizzards, Derechos, and ice storms affect millions of people every year. Having a good (and well rehearsed) family emergency plan is essential for any disaster.

Today, the upper Gulf Coast is likely to be inundated with flooding rains from an (as yet) unnamed tropical cyclone, while the upper Midwest will be under the gun for a possible outbreak of severe storms, which may include hail, high winds, and tornadoes.

Meanwhile, millions of people who are outside of these areas - particularly across the southeastern and southwestern states, are facing another day of dangerously high heat and humidity. 

Welcome to summer in the United States. While NOAA Predicts a Below-Normal 2026 Atlantic Hurricane Season, they still expect between 8 and 14 named storms and 1 to 3 major hurricanes.

Somewhere between 1000 and 1200 tornadoes are reported each year in the U.S.. Roughly half occur between March and May, making the spring - particularly in the South and Central states - prime time for these storms.

During the summer, the focus for severe weather moves away from the south (Dixie Alley), and into the midwest (aka `Tornado Alley'), although this has been creeping east in recent years.

But no matter where you live, there is a risk of severe storms, flooding, blizzards, earthquakes, or other natural disasters.  Last month we looked at preparedness for hurricanes (see NOAA Hurricane Prep: social media).  

But regardless of the threat, it is important for your plan to include emergency meeting places, out-of-state contacts, and individual wallet information cards - before you need it (see #NatlPrep : Create A Family Communications Plan).

Together with adequate emergency supplies, a solid first aid kit, and an emergency battery operated NWS Weather Radio, these steps will go a long ways to protecting you, and your family, from a wide variety of potential disasters.

For some more detailed prepping information, you may wish to revisit:

The Gift of Preparedness 2025

NERC Issues Level 3 Alert As Grid Faces `Unprecedented Challenges' Due to Surge In Large Power Consumers

How Not To Swelter In Place

Emergency Preparedness: A Medicine For The Melancholy

Because it's not a matter of `if' another disaster will strike . .  . 

It's only a matter of where, when, and how bad. 

ECDC Assessment: Overview of available modelling evidence to inform the scale and potential spread of Bundibugyo virus in the current Ebola disease outbreak

 
Credit WHO DON report 6/13/26

#19,206

Just over a month ago (May 15th) the Africa CDC Convened an Emergency Meeting After Reports of a Large Outbreak of Non-Zaire Ebola In the DRC.  Since then we've learned this is the 3rd outbreak of the Bundibugyo virus, and according best estimates (see IJID: Regional Signals Preceding the 2026 Bundibugyo Virus Disease Outbreak), it probably began sometime in February or March.

As if June 11th, the WHO reported:

695 confirmed cases; 676 from the Democratic Republic of the Congo and 19 from Uganda; and 138 deaths including  two from Uganda, have been reported from both countries, while at least 37 people have recovered from the disease. 

But this is believed to be only the tip of the iceberg. Much of the affected area is a conflict zone, and has only limited public health capacity.  

Ten days ago, in CDC MMWR: Modeled Scenario Projections for the Ebola Disease Outbreak Caused by Bundibugyo Virus, 2026, we saw an analysis which stated:`The scope of the outbreak is likely larger than that represented by available data and might prove challenging to contain and control.'

Yesterday CIDRAP reported Africa CDC head warns Ebola outbreak could be worst ever.  The 2014-2016 West African outbreak infected at least 28,000, killing > 11,000.

 Today the ECDC has released a 7-page assessment of recent modeling, one of which estimates the current outbreak is likely much (3x to 10x) larger than reported, but warns this is based on limited data.

The brief overview follows, but you'll want to follow the link to read the full report.

Overview of available modelling evidence to inform the scale and potential spread of Bundibugyo virus in the current Ebola disease outbreak

17 June 2026

This assessment presents an overview and critical appraisal of the available modelling evidence to inform the scale and potential spread of Bundibugyo virus (BDBV) in the context of the ongoing Ebola disease outbreak in the Democratic Republic of the Congo (DRC) and Uganda.

Key findings

• So far in the current outbreak of Ebola disease caused by Bundibugyo virus, international modelling efforts have focused on estimating the outbreak size and near-term trajectories, as well as the risk of regional and international spread.

• Multiple modelling groups suggest that the true size of the outbreak is larger than reported. One model estimated that cumulative infections as of 13 June were between 3.0 and 10.2 times the reported number of cases (90% credible interval).

• Epistorm estimated the relative risk of importation to be highest for Rwanda, Tanzania and Kenya, which together account for approximately 54% of the relative risk. ECDC has estimated the risk of importation into the EU/EEA to be low.

• The United States Centers for Disease Control and Prevention published scenario modelling analysis results that estimated a 65% probability that the outbreak will exceed 20 000 cases within three months under a scenario where 20% of individuals with Bundibugyo virus infection were isolated and no other interventions were implemented.

• Current modelling estimates are highly uncertain due to data limitations. Multiple epidemic trajectories remain compatible with the available surveillance data, limiting confidence in estimates of outbreak size and future trends.

Publication file

Overview of available modelling evidence to inform the scale and potential spread of Bundibugyo virus in the current Ebola disease outbreak

As we've discussed often (see Flying Blind in the Viral Storm), we've seen a noticeable decline in surveillance and reporting of infectious diseases around the world since COVID.  

While all WHO member states have pledged to report disease outbreaks with epidemic potential (ideally within 48 hours), many still lack the capability to fully investigate cases (see Lancet Preprint: National Surveillance for Novel Diseases - A Systematic Analysis of 195 Countries).

And some nations -  and for a variety of political or economic reasons - appear to selectively ignore this reporting obligation, since there are few tangible penalties for doing so (see From Here To Impunity).

This outbreak is a reminder that wearing blinders may provide short-term comfort, but it can become quite costly in the long run. 

Although Ebola Bundibugyo remains a regional crisis, spillovers to neighboring countries seem likely, which increases the risks of seeing sporadic exported cases around the world.

All of which suggests this is a tragic story we'll be following for many months to come.