Monday, February 28, 2022

HK Monitoring 4 More H5N6 Cases On the Mainland


 

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China continues to belatedly report human cases of HPAI H5N6, adding two more cases with onsets on or before end of last month. This makes 9 new cases reported between January 1st and the 31st, 2022, and a total 71 cases since the virus first emerged in 2014 (see map above). 

Three of the 4 cases announced today are listed in critical condition, while the 4th died. Although human infection with H5N6 is relatively rare, it usually results in serious, often fatal, illness. 

Until a little over a year ago, China was averaging fewer than 5 cases a year.  Over the past 14 months the Mainland has reported 46 new cases.  Given the delays in reporting, there may be others in the queue we've yet to hear about. 

CHP closely monitors four human cases of avian influenza A(H5N6) in Mainland
 
The Centre for Health Protection (CHP) of the Department of Health is today (February 28) closely monitoring four human cases of avian influenza A(H5N6) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

Details of the cases are listed in the table below:


From 2014 to date, 71 human cases of avian influenza A(H5N6) have been reported by Mainland health authorities.

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," a spokesman for the CHP said.

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchasing live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

While local surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below when handling poultry:
  • Avoid touching poultry, birds, animals or their droppings;
  • When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume the eggs immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
  • Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
  • Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
  • Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.
​The public may visit the CHP's pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

Ends/Monday, February 28, 2022
Issued at HKT 18:52

So far, avian influenza remains primarily a threat to those who have direct contact with infected birds.  And it should be also be noted that the HPAI H5N1 clade 2.3.4.4b virus currently circulating in wild birds in North America has never been linked to severe illness. 

While H5N6 remains confined to China and parts of Southeast Asia, this recent uptick in human cases has not gone unnoticed by public health agencies around the world, and we've seen the following statements issued over the past few months. 

CDC Adds A New H5N6 Avian Flu Virus To IRAT List

WHO: Assessment of Risk Associated with Influenza A(H5N6) Virus

UK HSA Risk Assessment On HPAI H5N6

Since H5N6 has yet to acquire the ability to transmit efficiently from human-to-human, the risks of seeing large, sustained outbreaks is currently low.  

But, as we saw in PLoS Path: H9N2 Virus-derived M1 Protein Promotes H5N6 Virus Release in Mammalian Cells these HPAI H5 viruses continue to evolve, making them a genuine concern. 

Which is why we watch events in China intently, looking for any signs this virus has acquired new abilities to transmit among humans.  

Hong Kong Cases Reach New Heights (n=34,466) As Lockdown Rumors Increase

 
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With COVID cases doubling roughly every 48 hours, rumors of an impending lockdown in Hong Kong have become so pervasive that their Legislative Council issued a statement a short while ago denying that it had even been discussed (see below). 

The Legislative Council clarifies the ban rumors

February 28, 2022

The Legislative Council Secretariat stated that the Legislative Council and its committees had not held any discussions on matters relating to the ban, and reiterated that meetings held by the Legislative Council were open, transparent and live.

          (Continue . . . .)

With the Mainland sending more `advisors' to Hong Kong today - more than a week after the original contingent was scheduled to leave - and Beijing's patience running thin, the decision to impose a lockdown may come from a higher level. 

Some news headlines from the past couple of hours include:

Coronavirus: Hong Kong confirms more than 34,000 cases as health chief refuses to rule out citywide lockdown for universal testing drive - SCMP
 

Bloomberg News is reporting a run on cold and flu medications as people fear being ordered to `stay-home' for at least 7 days (see Hong Kong Pharmacies Run Out of Flu Meds Amid Covid Panic Buying).  There are anecdotal reports on Twitter of bare grocery store shelves as well. 

While still officially following the Zero-COVID policies that worked so well keeping COVID under control, as case loads have exploded, the city's ability to quarantine, isolate, and contact trace positive cases has substantially eroded (see Overwhelmed By COVID Cases, Hong Kong Revises Testing & Quarantine Procedures).

Today Chief Executive Carrie Lam released a video speech (transcript excerpts below) on the importance of stabilizing the fifth wave of the epidemic as soon as possible, but acknowledging it could take 2 to 3 months. 

In the past week, Hong Kong recorded 117,033 confirmed cases of the novel coronavirus, bringing the cumulative number of cases since the outbreak began on December 30 last year to 158,683, which is 12 times the total number of confirmed cases in Hong Kong in the past two years. In contrast, the spread of the virus caused by the highly transmissible mutant virus strain Omicron has also been out of control, resulting in a geometric increase in the number of infection cases.

During the unprecedented severe epidemic in Hong Kong, I am very grateful to the public for staying calm, actively cooperating with various anti-epidemic measures, accepting mandatory testing, working at home, and reducing going out in an orderly manner. In the past weekend, the market was sparsely populated, which reflects the concerted efforts of the public to fight against the epidemic. 

Hong Kong has been strictly following the strategy of preventing importation from outside and preventing the spread of the virus inside, and has adopted a multi-pronged approach to contain the virus. In order to cope with the fifth wave of the epidemic, the SAR government has continuously invested a lot of resources to strengthen the ability of various anti-epidemic links, but the speed of the virus spread has far exceeded the SAR government's own ability to handle it.

At this critical moment, as the Chief Executive, I submitted a report to the central government in early February, hoping that the state would help. Measures to assist Hong Kong have been introduced continuously, including sending three batches of epidemiological experts and critical care medical experts, mobile testing vehicles, testing technicians, nucleic acid testing personnel, etc. to Hong Kong in batches; entrusting mainland contractors to the Lok Ma Chau Loop and eight other localities in Hong Kong. Build community isolation and treatment facilities at each location; guarantee the supply of medical supplies, donate anti-epidemic proprietary Chinese medicines, and guarantee other mainland supply of fresh food and daily necessities to Hong Kong.

With the support of the strong backing of the central government, the SAR government will follow the important instructions of President Xi Jinping, earnestly assume the main responsibility, take the current overriding task of stabilizing the epidemic situation as soon as possible, mobilize all the forces and resources that can be mobilized, and take all necessary measures. measures to ensure the safety and health of Hong Kong citizens and the overall stability of Hong Kong society.

Dear citizens, the next two to three months will be a critical moment for stabilizing and controlling the epidemic. I announced on February 22 that we will intensify efforts to implement five measures:

(SNIP) 
Dear citizens, Hong Kong, the city we all love, has experienced countless challenges in the past, overcame countless difficulties, demonstrated incomparable resilience, and maintained its strong strength. At this moment, the epidemic situation is ruthless and the situation is critical, but with the full support of the central government, Hong Kong will surely be able to turn danger into safety again, win the battle against the epidemic, and allow citizens to return to normal life as soon as possible.
(The above is the text of the video speech delivered by the Chief Executive, Carrie Lam Cheng Yuet -ngor, to the public on February 28 on stabilizing the fifth wave of the epidemic as soon as possible)


As to what steps will be enacted next, today Dr. Liang Wannian - the leader of the Mainland's NHC COVID Response Expert Team - will arrive to advise the city and presumably update Beijing.  He was on the ground in Wuhan two years ago, and his recommendations will likely carry a good deal of weight.

 

Sunday, February 27, 2022

Another Preprint On SARS-CoV-2 In White-Tailed Deer To Ponder


 

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Although incredibly well-adapted to humans, the SARS-CoV-2 virus is also known to infect more than 2 dozen other mammalian species, and has shown signs of increasing its host range as it evolves.  The big  concern is this virus may take divergent evolutionary paths in these other hosts, and produce variants that could `spill back' into humans down the road. 

And in fact, we've already seen that happen with farmed mink. 

In November of 2020 SARS-CoV-2 jumped from humans to mink in Denmark, spread like wildfire, and began to mutate into new mink-variants (see Denmark Orders Culling Of All Mink Following Discovery Of Mutated Coronavirus). 

Several mutated viruses jumped back into humans, and began to spread in the community (see WHO 2nd Update: SARS-CoV-2 mink-associated variant strain – Denmark), forcing North Denmark To Lockdown Over Mutated Coronavirus Concerns.

This emergency was relatively short-lived, as the Alpha variant emerged in Europe in late 2020 and quickly supplanted these mink-variants.  But it did demonstrate the problem; carriage of SARS-CoV-2 by other host species can produce new variants, which can jump back into humans. 

Since then we've seen mink farms around the world (including in the United States) infected with COVID, and additional evidence that humans have been infected by mink-variant viruses (see CDC: Investigating Possible Mink-To-Human Transmission Of SARS-CoV-2 In The United States).

We saw a similar scenario play out in Hong Kong (see Hong Kong Detects COVID In Pet Store Hamsters - Suspends Sales & Orders Cull) in early January (see Nature How sneezing hamsters sparked a COVID outbreak in Hong Kong). 

Fortunately, most farmed animals (pigs, chickens, cattle, etc.) are poor hosts for the SARS-CoV-2 virus. Dogs and cats are mildly susceptible, but since they don't have contact with hundreds of other animals, aren't as likely to generate mutations.  

There are concerns that SARS-CoV-2 may be spreading silently in other wildlife - such as rodents and semi-aquatic mammals - but biggest findings thus far have been in North American White-Tailed Deer (WTD).  A few of many studies we've seen since last summer include:

Preprint: Evolutionary Trajectories of SARS-CoV-2 Alpha and Delta Variants in White-Tailed Deer in Pennsylvania

More Documented Spillovers Of COVID-19 Into North American Deer

Nature: SARS-CoV-2 Infection in Free-ranging White-tailed Deer

Two New Reports Find Widespread SARS-CoV-2 In North American Deer

While this growing reservoir of SARS-CoV-2 in North American deer has been a growing concern, until very recently the viruses that have been detected have been quite similar to the variants currently (or previously) circulating in humans.  

But last week's report on Evolutionary Trajectories of SARS-CoV-2 reported finding ". . .deer-derived alpha variants diverged significantly from those in humans, consistent with a distinctive evolutionary trajectory in deer."

And today, we have a preprint from researchers in Ontario Canada that finds Highly divergent SARS-CoV-2 variants in WTD, and potential evidence of deer-to-human transmission.  This 31-page page is highly detailed, and while there are admittedly gaps in the data, makes a plausible case for a spillback of a WTD-Variant into humans (see graphic below). 


The abstract, and a couple of excerpts from the PDF follow, but you'll want to read the report in its entirety.   I'll have a bit more after you return. 

Highly divergent white-tailed deer SARS-CoV-2 with potential deer-to-human transmission

Brad Pickering, Oliver Lung, Finlay Maguire, Peter Kruczkiewicz, Jonathon D Kotwa, Tore Buchanan, Marianne Gagnier, Jennifer Guthrie, Claire Jardine, Alex Marchand-Austin, Ariane Masse, Heather McClinchey, Kuganya Nirmalarajah, Patryk Aftanas, Juliette Blais-Savoie, Hsien-Yao Chee, Emily Chien, Winfield Yim, Melissa Goolia, Matthew Suderman, Mathieu Pinette, Greg Smith, Daniel Sullivan, Jossip Rudar, Elizabeth Adey, Michelle Nebroski,Marceline Cote, Genevieve Laroche, Allison McGeer, Larissa Nituch, Samira Mubareka, Jeff Bowman

doi: https://doi.org/10.1101/2022.02.22.481551

          PDF FILE  

Abstract

Wildlife reservoirs of SARS-CoV-2 can lead to viral adaptation and spillback from wildlife to humans (Oude Munnink et al., 2021). In North America, there is evidence of spillover of SARS-CoV-2 from humans to white-tailed deer (Odocoileus virginianus), but no evidence of transmission from deer to humans (Hale et al., 2021; Kotwa et al., 2022; Kuchipudi et al., 2021).

Through a multidisciplinary research collaboration for SARS-CoV-2 surveillance in Canadian wildlife, we identified a new and highly divergent lineage of SARS-CoV-2. This lineage has 76 consensus mutations including 37 previously associated with non-human animal hosts, 23 of which were not previously reported in deer. There were also mutational signatures of host adaptation under neutral selection.

Through a multidisciplinary research collaboration for SARS-CoV-2 surveillance in Canadian wildlife, we identified a new and highly divergent lineage of SARS-CoV-2. This lineage has 76 consensus mutations including 37 previously associated with non-human animal hosts, 23 of which were not previously reported in deer. There were also mutational signatures of host adaptation under neutral selection.


Phylogenetic analysis revealed an epidemiologically linked human case from the same geographic region and sampling period. Together, our findings represent the first evidence of a highly divergent lineage of SARS-CoV-2 in white-tailed deer and of deer-to-human transmission.

(SNIP)

Potential deer-to-human transmission

 Our phylogenetic analysis also identified a human-derived sequence from Ontario (ON-PHL-21-44225) that was both highly similar (80/90 shared mutations; Table S2) and formed a well-supported monophyletic group (100% UFB) with the WTD samples (Figure 3). The small number of samples and relative diversity within the WTD clade make it difficult to determine the exact relationship between the human sample and other WTD samples (78% UFB for a most recent common ancestor with 4658). However, global (FIgure 2) and focal (Figure 3) ML analyses and an Usher-based (Turakhia et al., 2021) (Figure S6) parsimony analysis all support this human sample belonging to the WTD clade. 

The human sequence also has a plausible epidemiological link to the WTD samples as it was collected in the same geographical region (Southwestern Ontario), during the same time period (autumn 2021) after having known close contact with deer. At the time of the human case detection 100% of eligible confirmed PCR positive SARS-CoV-2 samples collected from human cases were requested by Public Health Ontario and Ontario COVID-19 Genomic Network partners for genome sequencing, and no other genetically related human-derived samples were identified. However, it should be noted that not all requested samples are received and/or successfully sequenced, and the surge of Omicron cases necessitated a reduction in the proportion human-derived SARS-CoV-2 sampled for sequencing in the region, moving from 100% to 50%, 20%, and 5% sampling on the 7th, 20th, and 30th of December 2021 respectively (Public Health Ontario, 2022) 

(SNIP)

At this time, there is no evidence of recurrent deer to human or sustained human to human transmission of the Ontario WTD SARS-CoV-2 clade. However, the emergence of Omicron and the end of deer hunting season has meant both human and WTD testing and genomic surveillance in this region has been limited since these samples were collected. Therefore, we cannot determine with certainty whether the lack of additional human cases reflects no onward transmission from the human case, no further spillover events from WTD, or limited genomic surveillance. Enhanced surveillance is of particular importance given human population density and mobility in the region, coupled with WTD population dynamics.

This work underscores the need for a broader international One Health lens to identify new intermediate or reservoir hosts capable of driving sustained transmission and divergent viral evolution. Selective advantage has led to the emergence of new variants outcompeting those in circulation. However, the absence of a variant in the human population does not mean universal absence of variants across a much broader range of under-sampled potential host species. To date, many sampling strategies have been based on access and convenience. Focusing efforts at human-animal interfaces and integration of human epidemiological data would enable analysis of determinants of spillover and inter-species transmission. A broader analysis examining human drivers of spillover and spillback and knock-on effects on wildlife and human health is urgently needed to identify, develop and implement mitigation strategies, beginning with reducing viral activity in humans. 

          (Continue. . . )


Five months ago, in CCDC Weekly Perspectives: COVID-19 Expands Its Territories from Humans to Animals, we looked at the concerns of two well-known Chinese scientists who warned "The host expansion of SARS-CoV-2 is not over".  

After discussing the growing list of known mammalian species susceptible to SARS-CoV-2, they wrote

However, these are just the tip of the iceberg as the susceptibility of most terrestrial wild animals to SARS-CoV-2 has not been tested. In addition, the research on susceptibility of marine wildlife (especially marine mammals) to SARS-CoV-2 is still lacking. Due to frequent marine human activities (such as mariculture and marine fishing), the frequency of human contact with marine organisms is high. If some marine organisms are highly susceptible to SAR-CoV-2, there is a risk that SARS-CoV-2 could be transmitted from humans to marine organisms, and worse, SARS-CoV-2 then might spread in the marine ecosystem, which may lead to the generation of some novel SARS-CoV-2 variants with unknown threats to humans.
Therefore, it is necessary to carry out large-scale SARS-CoV-2 screening for terrestrial and marine wildlife, especially those susceptible ones, in order to monitor the status of infection and mutation of SARS-CoV-2 in wild animals, so as to formulate further prevention and control strategies. It also provides more clues to the study of the origin and cross-species transmission of SARS-CoV-2.

          (Continue . . . )

 
While the co-circulation of SARS-CoV-2 in other mammalian species doesn't guarantee we'll be faced with the emergence of new, and possibly more dangerous, variants in the future - it would appear to raise the risks. 

We've two examples (Denmark and Hong Kong) of SARS-CoV-2 spillback from animal hosts, and there are some researchers who believe Omicron may have evolved in mice, and then spilled back as well.  

While our pandemic-weary world seems intent on declaring victory and moving on, we need to consider that the virus may have other plans. 

Saturday, February 26, 2022

Overwhelmed By COVID Cases, Hong Kong Revises Testing & Quarantine Procedures

 

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Four days ago Hong Kong broke records reporting 8,000 daily COVID casesyesterday they reported over 10,000 cases, and today Hong Kong reported a record 17,063 cases. This rapid rise is all the more remarkable because a little over a month ago, Hong Kong was often reporting fewer than 20 cases a day. 

Cases have quadrupled since China's President Xi Jinping told HK Officials their "Overriding mission" is to Stabilise & Control the epidemic 10 days ago, and dispatched a team of advisors to Hong Kong. 

With the Mainland reportedly pushing for even stricter lockdowns, and Hong Kong's ability to deal with this tsunami of cases eroding by the day, we are seeing major adjustments being made by local authorities practically on a daily basis. 

Hong Kong Tightens Social Distancing As Daily Cases Exceed 8,600

Hong Kong Orders City-Wide Compulsory Testing In March - School Closures

Hong Kong CHP Revises COVID (Hospital & Community Isolation) Discharge Criteria

Today - in order to reduce the strain on testing facilities, and open up beds for quarantine and isolation facilities - Hong Kong announced that positive results from home test kits would no longer need to be confirmed by PCR testing, and further reduced the quarantine and/or isolation time for fully vaccinated individuals who test negative on day 6 or 7. 

It is proposed that those who are positive in the rapid test will be exempted from nucleic acid re-examination
February 25, 202

The government announced that it will update the priority and method of testing services from now on. In addition to adding rapid test kits to high-risk locations and replacing mandatory testing after the containment operation with rapid testing, it also plans to allow those who have tested positive for rapid testing to register their positives directly through the online system. As a result, no nucleic acid test re-examination is required to be treated as a positive case.

The government stated that the epidemic situation in Hong Kong has been very severe recently, and the number of new cases has continued to be high. Although testing resources have been gradually strengthened, the demand is increasing day by day. As a result, the work of testing nucleic acid testing samples is under heavy pressure, and a large number of samples are yet to be tested. Some members of the public may feel anxious after submitting the samples for many days and still have not received the test results. Obviously, the situation is not ideal.

The authorities pointed out that although the sensitivity of the rapid test kit is slightly lower than that of nucleic acid testing, it can still quickly and relatively accurately detect patients with high viral load, and it is convenient and easy to use, and can be used on a large scale; the public has also adapted very well in the past few weeks. Do a quick test yourself.

With the strong support of the central government, the government has purchased a large number of rapid test kits. Therefore, it has decided to revise the mandatory testing strategy on the basis of risk-based principles until further notice.

The government will continue to impose restrictions and test announcements on higher-risk buildings, and plans to cover more buildings, and subsequent mandatory testing regulations will be changed to allow residents to undergo rapid testing.


February 26, 2022

The Secretary for Food and Health, Sophia Chan, said that infected people who have been admitted to community isolation facilities and close contacts of home quarantine who have received at least two doses of the new crown vaccine can undergo rapid testing on the sixth and seventh days. If the results are negative, Leave the community isolation facility or home early.

Chen Zhaoshi said at the briefing today that the scale of the new wave of the epidemic is unprecedented and is not expected to reach its peak. All sectors of society must face up to the threat of the epidemic.

She said the latest figures showed 20,087 people were under home quarantine and 5,897 completed quarantine. According to past requirements, infected persons admitted to community isolation facilities, persons who are yet to be hospitalized, and close contacts under home quarantine are subject to 14-day medical surveillance.

After the latest risk assessment, the government has decided that if these people have received at least two doses of the new crown vaccine, rapid testing can be carried out on the sixth and seventh days. Leave a community isolation facility or home.

Chen Zhaoshi said that in order to speed up the circulation of hospital beds and allow medical resources to be used for urgent cases, the Hospital Authority will make professional judgments on the specific discharge conditions of admitted patients. Facility admission will allow patients to be discharged as soon as possible, stay and recuperate in homes, institutions or other suitable facilities until a negative result is obtained, and then they can leave safely.


Unlike the mainland, which has thrown huge national resources at containing local outbreaks, Hong Kong - a city of just over 7 million people - has a limited infrastructure and capacity to manage large numbers of cases.  
 
Since Omicron has peaked and retreated in other countries - it is reasonable to assume it will eventually do so in Hong Kong - but every day until that happens increases the risk the virus will jump to the Mainland.

And while Omicron is not as severe as earlier variants, China's leaders are well aware their widely distributed Sinovac vaccine is expected to provide little protection, and their population is assumed to have little acquired immunity against COVID. 

It is possible that enough highly transmissible Omicron has already reached the mainland to ensure pandemic wave, but for now Chinese leaders are treating Hong Kong as their biggest and most critical firewall against the virus. 

And that means the people of Hong Kong are likely in for a very difficult March. 

WHO Recommended 2022-2023 Northern Hemisphere Flu Vaccine Composition

 

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Twice each year international influenza experts meet to discuss recent developments in human and animal influenza viruses around the world, and to decide on the composition of the next influenza season’s flu vaccine. Due to the time it takes to manufacture and distribute a vaccine, decisions on which strains to include must be made six months in advance.

Which means the composition of the northern hemisphere’s vaccine must be decided upon in February of each year, while decisions on the southern hemisphere’ vaccine are made in September.

Even during normal times, this is a formidable task as seasonal influenza viruses are constantly mutating, and a new, or unexpected strain can emerge and spread rapidly, diminishing the effectiveness of the vaccine (see 2014's CDC HAN Advisory On `Drifted’ H3N2 Seasonal Flu Virus).

We saw a similar scenario unfold with last fall's vaccine (see Preprint: Antigenic & Virological properties of an H3N2 Variant That Will Likely Dominate the 2021-2022 Influenza season), although its impact has been limited by this year's short-lived flu season 

Two years into the coronavirus pandemic, and the job is even tougher.  Influenza activity has been greatly diminished globally for the past two flu seasons, due to `viral interference' from COVID, and the social distancing and NPIs used to fight the pandemic.  As a result, far fewer flu samples have been sequenced. 

The WHO describes COVID's impact on their vaccine decisions in their FAQ.

18. How has the COVID-19 pandemic impacted the 2022-2023 northern hemisphere influenza vaccine recommendation? 

The volume of data available from recently circulating influenza viruses and the geographic representation have been lower for this northern hemisphere vaccine recommendation meeting than was typical prior to the COVID-19 pandemic. The reduced number of characterised viruses raises uncertainties regarding the full extent of the genetic and antigenic diversity of currently circulating influenza viruses and those likely to pose a threat in forthcoming seasons. Nevertheless, some groups of A(H3N2) and B/Victoria-lineage viruses have expanded and spread internationally during the current period. Consequently, the A(H3N2) and B/Victoria lineage component recommendations have been changed from the previous northern hemisphere recommendation.

 
Despite the level of uncertainty, decisions must be made, and yesterday's recommendations - which are very much in line with this year's (yet to be deployed) Southern Hemisphere vaccine - were released by the WHO. 


25 February 2022
 
News release
Reading time: 1 min (271 words)

The World Health Organization (WHO) today announced the recommendations for the viral composition of influenza vaccines for the 2022-2023 influenza season in the northern hemisphere. The announcement was made at an information session at the end of a 4-day Information Meeting on the Composition of Influenza Virus Vaccines, a meeting that is held twice annually.

The WHO organizes these consultations with an advisory group of experts gathered from WHO Collaboration Centres and WHO Essential Regulatory Laboratories to analyse influenza virus surveillance data generated by the WHO Global Influenza Surveillance and Response System. The recommendations issued are used by the national vaccine regulatory agencies and pharmaceutical companies to develop, produce, and license influenza vaccines for the following influenza season.

The periodic update of viruses contained in influenza vaccines is necessary for the vaccines to be effective due to the constant evolving nature of influenza viruses, including those circulating and infecting humans.

The WHO recommends that quadrivalent vaccines for use in the 2022-2023 influenza season in the northern hemisphere contain the following:

Egg-based vaccines
  • an A/Victoria/2570/2019 (H1N1)pdm09-like virus;
  • an A/Darwin/9/2021 (H3N2)-like virus;
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus; and
  • a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

Cell culture- or recombinant-based vaccines
  • an A/Wisconsin/588/2019 (H1N1)pdm09-like virus;
  • an A/Darwin/6/2021 (H3N2)-like virus;
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus; and
  • a B/Phuket/3073/2013 (B/Yamagata lineage)-like virus.

The WHO recommends that trivalent vaccines for use in the 2022-2023 influenza season in the northern hemisphere contain the following:

Egg-based vaccines
  • an A/Victoria/2570/2019 (H1N1)pdm09-like virus;
  • an A/Darwin/9/2021 (H3N2)-like virus; and
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus.

Cell culture- or recombinant-based vaccines
  • an A/Wisconsin/588/2019 (H1N1)pdm09-like virus;
  • an A/Darwin/6/2021 (H3N2)-like virus; and
  • a B/Austria/1359417/2021 (B/Victoria lineage)-like virus


The full 11-page PDF document describing their rationale can be read at:


As always, we probably won't know how effective this vaccine formulation will be against next fall's flu season until early 2023.  But even if it isn't a perfect match, a little protection beats none at all. 

Friday, February 25, 2022

UKHSA: Updated Risk Assessment On Omicron BA.2


Prevalence of Pangolin lineages in UK with sequence data 

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Although we continue to get conflicting reports regarding the threat posed by Omicron BA.2 (see here, here, and here), the one thing they all seem to agree on is that it is gaining ground on the other Omicron sublineages (B.1.1.529, BA.1, BA.1.1, BA.3), and appears destined to overtake and probably supplant them. 

Despite some animal studies in Japan suggesting BA.2 produces more severe illness in immunologically naive hamsters - in highly vaccinated countries like Denmark and the UK - they have not reported increased hospitalizations or deaths. 

Whether those trends will hold across less-vaccinated populations remains to be seen. 

Today the UK's Health Security Agency has published their bi-weekly technical report, and a new Risk Assessment, on BA.2.  Buried within we find that the BA.2 variant now likely accounts for more than 50% of new cases in the UK, a significant jump in just over 2 weeks. 

SARS-CoV-2 variants of concern andvariants under investigation in England 

Technical briefing 37 25 

February 2022

VUI-22JAN-01 (BA.2) 

BA.2 does not usually contain the spike gene deletion at position 69-70 and is S-gene target positive (SGTP) on diagnostic assays with targets in this area. SGTP is now a reasonable proxy for BA.2, which accounts for 97.2% of sequenced SGTP cases. The proportion of SGTP cases has increased: the overall proportion of SGTP amongst cases tested by the relevant assay in England on 20 February 2022 is 52.3% compared to 18.7% on 6 February 2022. 

There is geographical variation with the highest proportion of SGTP in London (63%) and the lowest in the North East region (33%). The proportion of BA.2 in sequenced data in the 7 days starting 13 February was 30.5%. This is compatible with the known lag in sequence data compared to test data.

 Growth rate 

BA.2 has demonstrated an increased growth rate compared to BA.1 in all regions of England. The growth rate estimated with data up to 21 February 2022 is 0.83 per week, compared to 1.03 using data up until 7 February 2022. Growth rates can be overestimates early in the emergence of a variant, and the growth advantage remains substantial. 

Hospitalisation 

Preliminary analysis finds no evidence of a greater risk of hospitalisation following infection with BA.2 compared to BA.1. These are early estimates which may change as data accrue. 

Vaccine effectiveness 

A test negative case control analysis continues to indicate no evidence of reduced vaccine effectiveness against symptomatic disease with BA.2 compared to BA.1. Two weeks after a booster dose vaccine effectiveness against symptomatic disease with the BA.2 variant was  67%. Further details of the BA.2 vaccine effectiveness analyses are available in the weekly vaccine surveillance report. 

Reports from Variant Technical Group Members

 Oxford University reported that in laboratory assessment, ACE2 binding was increased for the BA.2 receptor binding domain compared to the BA.1 receptor binding domain. Imperial College London reported that in preliminary experiments hamsters infected with BA.2 showed mild disease, similar to those infected with BA.1. Hamsters previously infected with BA.1 were reinfected upon exposure by co-housing to Delta-infected animals but were not reinfected upon exposure to BA.2 infected animals.

Updated risk assessment   

Demark SSI: Covid-19 Infection Appears to be Declining


 Credit Our World In Data - Confirmed Cases Relative to Population 

#16,600


Unlike the United States - which saw a steep, but relatively brief, surge in COVID Omicron BA.1 cases over December and January - Denmark has endured a much longer, and steeper wave (see chart above) due primarily to the Omicron BA.2 subvariant (see Denmark SSI: Omicron Subvariant BA.2 Now Accounts For Nearly Half Of All Danish Cases).

The BA.2 sublineage of the Omicron variant has been gettin a lot of attention in the mainstream media, and on the internet, because:

But as we discussed earlier this week, in WHO Statement On Omicron BA.2 Sublineage, we haven't seen any real-world evidence of increased severity in humans.  There does appear to be some risk of reinfection by BA.2 following BA.1 infection, but the SSI describes those cases as `rare' and `mild'. 

After nearly 3 months Denmark's Omicron wave appears to be running out of steam, as described in the following report from their Statens Serum Institut. 

Covid-19 infection appears to be declining

The number of new covid-19 cases fell by almost a quarter from week 6 to week 7. At the same time, the positive percentage is stable at 40.1%, although fewer were tested in week 7. This is shown by the latest trend report from the Statens Serum Institut.

Last edited on February 24, 2022

There are signs that the Covid-19 epidemic has begun to subside in Denmark during the winter holidays.

This is the overall conclusion in the latest trend report from the Statens Serum Institut (SSI).

According to the report, the number of new cases of infection decreased by as much as 24% from week 6 to week 7. This is a change compared to the development from week 5 to week 6, where the number of new cases of infection increased by 7%.

The decrease can also be immediately read on the incidence for the whole country, which was a total of 4,081 cases per year. 100,000 inhabitants in week 7 against 5,395 cases per. 100,000 inhabitants in week 6.

Read the new trend report

The incidence is still highest in North Jutland

The decline in the number of cases of infection has been felt in all five regions of the country. At least in the North Jutland Region, where the incidence decreased by approximately 21% from week 6 to week 7, while in the other four regions it decreased by 24% -26%.

The incidence is also still highest in the North Jutland Region, where in week 7 it fell to 5,717 covid-19 cases per. 100,000 inhabitants. This is followed by the Central Jutland Region with an incidence of 4,879 covid-19 cases per 100,000 inhabitants in week 7.

The Capital Region of Denmark still has the lowest incidence and has had it since week 4. Here the incidence fell by a further quarter in week 7 to 2,889 covid-19 cases per week. 100,000 inhabitants.

The positive percentage is stable

However, the positive percentage is stable at 40.1% in week 7 compared to 39.8% in week 6. That is, more than 4 out of 10 of all PCR tests taken in week 7 were positive.

“Test activity has declined during the winter holidays, but despite the decline in test activity, we do not see a positive percentage increase. At the same time, we are seeing a decrease in the number of cases of infection, and this points in the direction that the infection may be declining, ”says ward doctor Rebecca Legarth from SSI.

She continues:

“We can also see a stagnation in the concentration of SARS-CoV-2 in the wastewater at national level, however with an increase in the Capital Region. Overall, therefore, it indicates that the infection is stable or stagnant, but there is uncertainty about the week's results due to the winter holidays. ”
The epidemic is now most prevalent in adults

If you look at who gets infected, the pattern changes compared to the beginning of the year. The infection now falls in virtually all age groups except among the 70-79-year-olds and the age group from 80 years and up.

But the infection is still highest among the 25-29-year-olds in week 7, where it was 4,715 covid-19 cases per. 100,000 inhabitants full of the 30-39-year-olds with an incidence of 4,704 per. 100,000 inhabitants in week 7.

Nationwide, the incidence was 4,081 covid-19 cases per. 100,000 inhabitants against 5,395 covid-19 cases the week before.

Half of the deaths did not occur due to covid-19

Overall, the number of covid-19-related deaths has been stable in the first three weeks of the year at 106-111 deaths per week. Since then, it started to rise. First to 137 deaths in week 4 and 145 deaths in week 5, while in week 6 there were 209 covid-related deaths. By week 7, the number had reached 210 deaths.

As in recent weeks, the report includes inventories of validated causes of death among the covid-19-registered deaths.

"The survey shows that the proportion of people who are estimated to die from a cause other than covid-19 has increased in the past month, and the increase has occurred in parallel with the number of covid-19-related deaths having increased. From week 3, the proportion of deaths that have occurred for a reason other than covid-19 has increased to 50% ", says Rebecca Legarth.

The same is seen around the covid-19-related admissions. In week 5, the proportion of admissions due to covid-19 decreased to 50% against 52% in week 4.

 
The good news here is - at least in a highly vaccinated population - BA.2 doesn't appear to have produced any greater illness severity, or worse outcomes, than BA.1  BA.2 did, however, produce a longer and steeper wave of relatively mild illness in Denmark. 

How all of this plays out in the coming months is the big question. COVID continues to evolve, and individual immunity - whether from vaccines or infection - wanes over time.  

 All of which adds more than a little uncertainty to predictions about what comes next. 

Thursday, February 24, 2022

MDARD Reports HPAI In A Backyard Flock In Michigan


#16,599

Today Michigan became the 7th state to confirm HPAI (presumably H5) in commercial or backyard poultry since the virus began spreading in January (others include Delaware, Maine, Indiana, Kentucky, New York, and Virginia).

The  announcement from Michigan's Department of Agriculture does not provide many specifics, such as the size of the flock, the type of birds, or the subtype of the virus.

But we've been watching the rapid spread of HPAI H5N1 - carried by migratory birds - down the eastern seaboard - and westward into the middle of the country - for about a month. 

HPAI H5 is primarily a concern to poultry interests, and the CDC considers it a low public health risk at this time (see Updated: H5N1 Bird Flu Virus in U.S. Wild Birds and Poultry Poses a Low Risk to the Public).  They are, however, monitoring closely.

With some migratory birds already beginning to move north, and the overlapping of the major migratory flyways, states even further west than Michigan may find themselves visited by HPAI in weeks and months ahead.  

Poultry interests around the nation - both large and small - need to be beefing up their biosecurity. 

This statement from MDARD. 

Highly Pathogenic Avian Influenza Detected in Michigan Backyard Flock; MDARD Urges Poultry Owners to Increase Biosecurity

February 24, 2022

LANSING, MI – Following an investigation by the Michigan Department of Agriculture and Rural Development (MDARD), the U.S. Department of Agriculture’s National Veterinary Services Laboratories (NVSL) has confirmed the discovery of highly pathogenic avian influenza (HPAI) in a non-commercial backyard flock in Kalamazoo County. This detection shows that the virus is present in the environment and highlights the need for poultry owners to protect their flocks by increasing biosecurity.

After several birds from the affected flock died and others showed signs of illness, samples were sent to the Michigan State University Veterinary Diagnostic Laboratory (MSU VDL) for testing. The results from MSU VDL were then confirmed by NVSL.

“MDARD is always preparing for situations like this when they arise, which is why we were able to take quick action to contain this disease and help protect against its spread,” said MDARD Director Gary McDowell. “At this time, this is an isolated case. There is no threat to public health or food safety. We do not anticipate any disruptions to supply chains across our state. As this situation develops, we will continue to work with our partners at local and federal levels to best mitigate spread and provide outreach."

To protect other flocks in Michigan, the premises is currently under quarantine, and the birds have been depopulated to prevent further disease spread.

Fortunately, according to the U.S. Centers for Disease Control and Prevention, these HPAI detections do not present an immediate public health concern. No human cases of these avian influenza viruses have been detected in the United States. Also, no birds or bird products infected with HPAI will enter the food chain. As a reminder, all poultry and eggs should be handled and cooked properly.

"Now, with HPAI present in Michigan, it is critical for poultry owners to increase biosecurity measures and to keep wild birds out in order to protect their flocks. Increasing those measures will be important to ensure domestic birds are kept healthy and safe," said State Veterinarian Dr. Nora Wineland. "Simply put, no matter how many birds or which type of birds someone owns—now is the time to protect them. I’m asking all owners to sign-up for our email alerts so we can provide them with critical updates on this developing situation.”

Avian influenza is a highly contagious virus that can be spread in various ways from flock to flock, including by wild birds, through contact with infected poultry, by equipment, and on the clothing and shoes of caretakers.

Whether you have a few backyard birds or a large commercial flock, following these biosecurity measures can help protect Michigan’s domestic birds:
  • Preventing contact between domestic and wild birds by bringing them indoors or ensuring their outdoor area is fully enclosed.
  • Washing your hands before and after handling birds as well as when moving between different coops.
  • Disinfecting boots and other gear when moving between coops.
  • Not sharing equipment or other supplies between coops or other farms.
  • Cleaning and disinfecting equipment and other supplies between uses. If it cannot be disinfected, discard it.
  • Using well water or municipal water as drinking water for birds.
  • Keeping poultry feed secure so there is no contact between the feed/feed ingredients and wild birds or rodents.
Poultry owners and caretakers should watch for unusual deaths, a drop in egg production, a significant decrease in water consumption, or an increase in sick birds. If avian influenza is suspected, contact MDARD immediately at 800-292-3939 (daytime) or 517-373-0440 (after-hours).

CDC Updates On Avian Influenza In the U.S.






#16,598

With a few notable exceptions, most of the public health impacts from avian flu have occurred outside of the United States.  The most dangerous types of avian flu - H5N1, H5N6 and H7N9 - have all emerged from China, and while H5N1 has managed to spread widely across Europe, the Middle East, and Africa, North America has been protected by vast oceans. 

A far less dangerous HPAI H5Nx did arrive via migratory birds from Asia in 2015, and that sparked a 6-month epizootic that caused the loss of 50 million birds, but no human infections were reported. 

2015 Avian Flu Epizootic

While there have been roughly three thousand HPAI H5 and H7 human infections reported around the world over the past 25 years, so far no human infections with HPAI viruses have been reported in the United States.  

There have been at least 4 human infections with LPAI H7N2 (see J Infect Dis: Serological Evidence Of H7N2 Infection Among Animal Shelter Workers, NYC 2016). But unlike the more aggressive Asian H5 & H7 viruses, these cases were all either mild or moderate. 

Today we are faced with another epizootic caused by a descendant of the HPAI H5N8 virus that ravaged U.S. poultry 7 years ago.  But since then, this HPAI H5Nx has undergone several reassortments which appear to have increased the virus's affinity for mammalian species (see here, here, and here).

There have been a small number of reports of this Eurasian H5N1 virus (mildly) infecting humans, and 3 months ago we saw the ECDC/EFSA Raise The Zoonotic Risk Potential Of Avian H5Nx

Simply put, although the risk of human infection from H5N1 in North America is very low, it isn't quite as low as it was during out last epizootic.  The risk to the general public is likely minimal, but that risk increases for those in close contact with poultry, particularly those depopulating infected flocks. 

Since HPAI H5N1 began turning up in the eastern half of the United States a month ago, the CDC has issued 3 statements advising that H5N1 Bird Flu Virus in U.S. Wild Birds and Poultry Poses a Low Risk to the Public.

Yesterday the CDC published a lengthy, and quite detailed summary of the avian flu situation in North America, the history of avian flu, the (currently) low risk of infection, and what people can do to reduce the risk of infection. 

I've only reproduced some excerpts, so you'll want to follow the link to read it in its entirety.  I'll have a bit more after the break. 

Avian Influenza Current Situation Summary

Current situation in Wild Birds

Domestic Summary
The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, and backyard birds in the United States are available from the USDA website

*clades are described in the “Classification of avian influenza A viruses” section.

Global Summary
  • In the past decade there have been increases in the reported number and geographic spread of avian influenza A virus infections in birds, increases in the number of subtypes of avian influenza A viruses that have infected birds, and increases in the numbers of bird species that avian influenza A viruses have infected. The largest increase in HPAI A(H5N1) virus outbreaks in poultry and wild birds occurred during 2004-2006,
  • During 2013-2021, different HPAI A(H5) and A(H7) virus subtypes as well as low pathogenic avian influenza (LPAI) A(H3), A(H5), A(H6), A(H7), and A(H9) virus subtypes caused animal outbreaks globally.
  • Since 2020, there has been a global increase in the number of HPAI A(H5) outbreaks reported in wild birds and poultry. There were more outbreaks reported in 2020-2021 than in the previous four years combined. Europe, Africa, and Southeast Asia reported multiple outbreaks of HPAI A(H5N8) starting in 2020 and HPAI A(H5N1) starting in 2021. During this same time, HPAI A(H5N6) virus outbreaks were reported in Asia, particularly China and Vietnam, and Southeast China (Chinese Taipei) reported outbreaks of HPAI A(H5N2) virus in poultry. In 2021, Europe reported multiple outbreaks of HPAI A(H5N5) virus and reported the first outbreaks of HPAI A(H5N4) virus in wild birds.
  • In December 2021,HPAI A(H5N1) viruses were detected in birds in Newfoundland, Canada, marking the first identification of this virus in the Americas since June 2015.
    • Ancestors of these HPAI A(H5N1) viruses first emerged in Asia in the late 1990s and began spreading widely in birds throughout Asia in 2003, and later spread to Africa, Europe, and the Middle East, causing sporadic human infections.
    • Since 2003, multiple different clades of A(H5N1) viruses have circulated over the years, including a clade that was introduced by wild birds into the United States in 2014 and circulated until 2016.
    • 54 countries reported an H5N1 outbreak in birds in 2021 and 2022.
  • Specifically, from 2013-2021, the following HPAI and LPAI virus subtypes were reported in animals, mostly in wild aquatic waterfowl or domestic poultry:
    • HPAI A(H5) virus subtypes detected included: H5N1, H5N2, H5N3, H5N4, H5N5, H5N6, H5N8, H5N9, and H5Nx*
    • HPAI A(H7) virus subtypes detected included: H7N1, H7N2, H7N3, H7N7, H7N8 and H7N9
    • LPAI A virus subtypes detected included H3N1, H5N1, H5N2, H5N3, H5N5, H5N6, H5N8, H5N8, H5Nx*, H6Nx*, H7N1, H7N2, H7N3, H7N4, H7N6, H7N7, H7N8, H7N9, and H7Nx*
* ”x” refers to avian influenza subtypes where the “N” neuraminidase protein number was not determined or reported.

(SNIP)

Current U.S. situation in Humans

Humans
  • No human cases of HPAI A virus infection have ever been detected or reported in the United States. Only four human infections with LPAI A(H7N2) viruses resulting in mild-to-moderate illness have ever been identified in the United States.
  • CDC considers the current risk to the U.S. public’s health from HPAI A(H5N1) virus outbreaks in wild birds or poultry in the United States to be low.
  • As of February 2022, USDA APHIS announced multiple detections of highly pathogenic avian influenza (HPAI) A(H5N1) viruses in U.S. commercial poultry and backyard flocks. This follows detections of HPAI A(H5) viruses in wild birds in the United States in January 2022. The detection of these viruses in poultry does not change the risk to the general public’s health, which CDC considers to be low. However, outbreaks in domestic poultry, in addition to infections in wild birds, might result in increased exposures in some groups of people, poultry workers, for example.
  • During past HPAI A(H5N1) virus outbreaks that have occurred in poultry globally, human infections were rare. Globally since 2003, 19 countries have reported rare, sporadic human infections with HPAI A(H5N1) viruses to the World Health Organization (WHO). Monthly case counts are available on the WHO website
  • Rare, limited, non-sustained, human-to-human transmission of A(H5N1) viruses has occurred in other countries in the past. No known human-to-human transmission has occurred with the A(H5N1) virus lineage that is currently circulating in birds in the United States and globally.
  • CDC and USDA have developed guidance for specific audiences, including the general public, hunterspdf icon, poultry producers, poultry outbreak responders, and health care providers.
  • More information is available from a CDC spotlight article: Recent Bird Flu Infections in U.S. Wild Birds and Poultry Pose a Low Risk to the Public.
       (Continue . . . )

While the CDC and USDA are reassuring the public about the low risk of human infection, and the safety of the food chain, they are taking the threat seriously. Novel flu viruses, like HPAI, continue to evolve and their threat profile can increase quickly. 

The CDC describes what they have done, and are currently doing, preparing for such an eventuality. 

What is CDC Doing?

Based on available gene sequencing, CDC has determined:
  • CDC has produced a candidate vaccine virus (CVV) that is nearly identical to the recently detected HPAI A(H5N1) viruses in birds that could be used to produce a vaccine for people, if needed.
  • These viruses are susceptible to currently available antiviral medications used to treat influenza.
  • These viruses can be detected using CDC’s diagnostic tools for seasonal influenza viruses which are used at more than 100 public health laboratories in all 50 U.S. states and internationally as well.
CDC is working with USDA and state public health partners to monitor for potential infections in exposed persons in the states where H5N1 bird flu virus detections in poultry and backyard flocks have occurred. If human infections with H5N1 bird flu virus are identified, CDC will assist with surveillance, contact tracing, and steps to reduce further spread, in the affected jurisdictions. CDC will also alert clinicians and other health professionals through clinician outreach networks. CDC has guidance documents including recommendations for personal protective equipment and information for people exposed to birds infected with avian influenza A viruses and guidance for testing and treatment of suspected cases to prevent severe illness and transmission to other people. CDC is currently reviewing and updating this guidance as needed.
Risk Assessment Ongoing

CDC will continue its ongoing assessment of the risk posed by these viruses, including conducting laboratory experiments to further characterize the HPAI A(H5N1) virus. For example, continuing to look for genetic markers that might result in greater transmissibility to and between people or suggest reduced susceptibility to antivirals, as well as changes in the virus that might require the development of a new CVV. While sporadic bird-to-human infections would not raise the public health risk assessment, identification of multiple instances of HPAI A(H5N1) virus spread from birds to people, or of markers of mammalian adaptation in the virus, would raise CDC’s risk assessment. These changes could indicate the virus is adapting to spread more readily from birds to people. If human-to-human spread with this virus were to occur, that would raise the public health threat because it could mean the virus is adapting to spread better between people. Note that sustained human-to-human spread is needed for a pandemic to occur.

*Clades are explained on CDC’s Avian Influenza Current Situation Summary webpage in the section titled “Classification of Avian Influenza A viruses.”

**There have been four human infections with low pathogenic avian influenza A viruses identified in the United States since 2002. The designation of pathogenicity is related to severity of illness in poultry, not illness in people.


While HPAI H5N1 currently poses little threat to the general public, it wouldn't be terribly surprising - given the events in Russia, Nigeria, and most recently the UK - if similar cases are eventually detected here in the United States.