#18,038
On a number of occasions we've discussed how difficult it would be for even a well-equipped western nation to monitor for - and detect - novel influenza cases in the community.
A year ago, in UK Novel Flu Surveillance: Quantifying TTD, health authorities estimated the TTD (Time To Detect) a novel H5N1 virus in the community - with aggressive testing - to take several weeks.
We are now more than a month since the first human H5N1 infection linked to infected dairy cattle was reported (see CDC Statement & Risk Assessment On The Texas H5N1 Case) - and instead of an aggressive and widespread testing testing campaign - only about 30 people appear to have been tested for H5 over the past 5 weeks.
Today, Helen Branswell of STAT news has an extensive and illuminating interview with Vivien Dugan, Director of the CDC’s influenza division, on some of the challenges that agency is facing, including a lack of cooperation by states where HPAI outbreaks have been reported.
According to Dugan, the CDC doesn't have the authority to go into a state without an invite. And so far, no state has requested their assistance.
Some of this was telegraphed last week. In An HPAI Cattle Roundup - April 25th we looked anecdotal reports (by a veterinarian) of numerous `sick people' working in dairy farms next to sick cows.
During a joint agency teleconference 9 days ago, CDC Deputy Director Nirav Shah acknowledged there have been obstacles to testing farm workers.
“We’ve had a diversity of levels of engagement with farms,” Shah said. “These situations are challenging. There may be owners that are reluctant to work with public health to say nothing of individual workers who may be reluctant to sit down with somebody who identifies themself as being from the government in some way.”
Mike Watson from APHIS confirmed that the USDA had `met some resistance' from some farmers with infected cows, and they are unable to determine whether orders to discard infected milk are being strictly followed.
If the point is to keep a potentially bad situation from getting worse, this is not the way to go about it. I have to believe the frustration levels at the CDC and APHIS over this lack of cooperation are running sky high.
First, the weekly update from the CDC, after which I'll have a postscript.
How CDC is monitoring influenza data to better understand the current avian influenza A (H5N1) situation in people
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Updated May 3, 2024
Weekly Snapshot for Week Ending April 27, 2024
CDC influenza (flu) surveillance systems show no indicators of unusual influenza activity in people, including avian influenza A(H5N1).
This page provides information on how CDC systems that monitor national, state, and local level influenza data are being used during the current avian influenza A(H5N1) situation
- Influenza virus and illness activity are monitored year-round through a collaborative effort between CDC and many partners, including state, local, and territorial health departments; public health and clinical laboratories; clinics; and emergency departments.
- Human cases of novel influenza, which are human infections with non-human influenza A viruses that are different from currently spreading seasonal human influenza viruses, are nationally notifiable. Every identified case is investigated and reported to CDC.
- CDC is actively looking at multiple flu indicators during the current situation to monitor for influenza A(H5N1) viruses, including looking for spread of the virus to, or among people, in jurisdictions where the virus has been identified in people or animals.
While I'm not in the camp that believes the H5N1 virus is certain to spark a pandemic, it is high on my list of contenders. We've certainly seen it threaten before, only to recede. But this time it `feels' different, since we are seeing scores of mammalian species infected, and things could go from 0 to 60 in hurry.
I have a hard time envisioning any novel flu scenario where a full-blown public health response and epidemiological investigation wouldn't be appropriate, so I'm at a loss to explain why this one should be treated any different.
One thing is certain, we better hope we get lucky again and H5 fizzles. Because we aren't anywhere nearly as well prepared for severe influenza pandemic as we need to be.
