#17,547
Over the past 2 weeks we've only seen one public statement by Polish Animal Health authorities on the recent spate of cat deaths due to avian H5N1, and that was primarily concerned with lambasting the media for what they called `journalistic provocations'.
What we know from other sources, including yesterday's avian flu update from the ECDC, is that genome sequences from 20 dead cats from the second half of June have been examined, and all were infected with an H5N1 virus with two specific mammalian mutations (E627K and K526R in PB2).
While Polish authorities have pushed back hard against any suggestion that the virus might be in locally produced (and sold) poultry, these viruses all appear to have a common source, and many of these cats were reportedly kept indoors. From yesterday's ECDC update:
Among the affected cats, 13 were kept indoors with only occasional access to outdoor areas (i.e. balconies or terraces), whereas four were free-ranging and reportedly had contact with wildfowl. Raw poultry meat and offal were fed to 13 of the affected cats, but the exact time of feeding is unknown and no causal relationship has been established
As far as the number of cats affected, the official count has changed little since the end of June, while media reports suggest a far greater number (70-90). How many go unreported is unknown. Again from yesterday's ECDC/EFSA avian flu update, the following advice was offered:
It is recommended to avoid exposure of domestic cats and dogs, and in general carnivore pets, to dead or diseased animals (mammals and birds), and to avoid feeding domestic cats and dogs offal and raw meat from wild or kept birds in areas where mortality in gulls or other potentially HPAI virus-infected animals are reported. Possible measures are keeping dogs on a leash, and confining cats indoors in areas where extensive circulation of HPAI viruses in wild birds has been confirmed.
None of this is happening in a vacuum; as at the same time we've also seen reports of H5N1 Seroconversion In Dogs & Cats On Affected Poultry Farm In Brescia, Italy, yesterday's report from Finland on 5 Fur Farms infected with H5N1, and the deaths of thousands of marine mammals from avian H5.
Two days ago the WHO, FAO, and WOAH issued a joint statement warning that the Ongoing Avian Influenza Outbreaks in Animals Pose Risk to Humans that stressed the need for increased surveillance and the international sharing of information, and yesterday the European Food Safety Authority (EFSA) released the following statement as well.
Avian Influenza: EFSA recommends increased surveillance
Published:
13 July 2023
Highly pathogenic avian influenza (HPAI) virus continues to circulate extensively among seabirds in Europe causing high mortality, while the overall situation in poultry has eased. Epidemiological investigations of an outbreak in cats in Poland are ongoing. The risk to the general public remains low, according to the latest report on avian influenza by the European Food Safety Authority (EFSA), the European Centre for Disease Prevention and Control (ECDC), and the EU reference laboratory (EURL).
From 29 April to 23 June, HPAI affected an extended range of wild bird species from the northernmost parts of Norway down to the Mediterranean coast. Seabirds have now also been found dead inland and not only along coastlines. EFSA recommends active surveillance of the disease in wild birds, especially waterfowl, to understand the circulation and maintenance of different HPAI viruses.
HPAI in mammals
The majority of wild mammals affected by HPAI are carnivores that hunt wild birds, feed on dead wild birds, or both. Twenty-four domestic cats and a captive caracal (also known as Desert lynx) tested positive to HPAI A(H5N1) in Poland, some of them developing severe clinical signs leading to death. The source of infection remains uncertain, with no cat-to-cat or cat-to-human transmission proven so far. The presence of antibodies was detected in five dogs and a cat without clinical signs on an Italian farm affected by an HPAI outbreak in poultry.
EFSA recommends increased surveillance of HPAI viruses in wild and free-roaming domestic carnivores in high-risk areas and avoiding exposure of carnivore pets to dead or diseased animals (mammals and birds).
Low risk to the general population
ECDC assessed that the risk of infection with HPAI virus in Europe remains low for the general population, and low to moderate for occupationally or otherwise exposed people to infected birds or mammals (wild or domesticated). To further reduce the risk of infection experts recommend raising awareness among the public to avoid exposure to dead or diseased seabirds or mammals.
- Awareness should be raised among the general population to prevent exposure to sick or dead seabirds or mammals. Pet owners should also be informed about clinical symptoms in infected pets, protective measures and contact details of veterinarians and other authorities investigating avian influenza virus infections in mammals.
- Appropriate personal protective equipment should be used when in contact with potentially infected animals. People should contact a veterinarian if their pet develops severe peracute respiratory or neurological symptoms, avoid contact with sick or dead animals as well as clean and disinfect potentially contaminated surfaces.
- People exposed to sick or dead birds, infected mammals and contaminated environment should be followed-up for 10–14 days after last exposure and tested immediately following the onset of respiratory or any other symptoms to identify transmission events early.
- Testing of pet owners exposed to infected cats or other pets is recommended irrespective of symptoms.
- People developing symptoms 10–14 days after exposure to avian influenza infected animals should self-isolate, wear a surgical mask or FFP2 respirator when in contact with others, and seek medical advice to inform their healthcare provider about the previous exposure and initiate testing.
- Any suspected or confirmed human infection with avian influenza should be reported as early as possible according to the Regulation on cross-border health threats 2022/2071 to the Early Warning and Response System (EWRS) and according to International Health Regulations (IHR).
- Antiviral pre- and post-exposure prophylaxis with antiviral drugs should be considered following national guidelines and a situational risk assessment.
- Specimens from patients with severe influenza type A infection in hospital settings should be subtyped according to the ECDC guidance on ‘Enhanced surveillance of severe avian influenza virus infections in hospital settings in the EU/EEA’ (ECDC, 2023b).
- Patients with viral encephalitis of unknown aetiology should be tested for influenza type A viruses, and specimens should be subtyped if positive to identify potential sporadic infections with similar clinical picture to that observed in infected mammalian species.
- Samples positive for influenza type A virus but negative for A(H1N1)pdm09 or A(H3N2) should be immediately sent to the national influenza reference laboratories for further analysis and subtyping, including H5.
Last March, in UK Novel Flu Surveillance: Quantifying TTD (time to detect) UKHSA officials said it might take weeks, and hundreds of local cases, before routine surveillance could identify community spread. Hence the repeated calls for enhanced surveillance and testing.
Unfortunately, in many parts of the world the ability to conduct proper surveillance, or run laboratory tests, is severely limited. In other places, the political will to do so is lacking; no country wants to be perceived as the origin of the next pandemic.
Don't test, Don't Tell is one strategy to avoid that. Or at least, delay the inevitable.
Hopefully the world will get its act together before the virus does.
