Avian Flu Diary: Readout of CDC Call with State Public Health Partners on H5N1 Influenza Monitoring

#18,072

Although there were plans in place to reduce the reporting requirements of hospitals (see above) starting May 1st, given the multi-state infection of dairy herds with HPAI H5N1 - along with anecdotal reports of farm workers suffering from `flu-like illnesses' - the CDC has been forced to find alternatives (see CDC Update: New Influenza A Dashboard & Reporting Changes For Hospitals).

Last week, the CDC asked:

Despite this change in mandatory reporting, CDC and CMS are encouraging hospitals to continue submitting data voluntarily to NHSN. CDC has begun sharing the voluntarily reported data on its website with weekly updates. Full details on NHSN hospital data reporting guidance are available on the NHSN website.

At the same time also seen media reports - and official acknowledgements - that some states where H5N1 has been detected in dairy cattle have not been exactly welcoming of federal investigators (see here, and here), and without an invitation, the CDC has no jurisdiction.

Turf wars between local and federal officials are nothing new, although until fairly recently the CDC appeared immune. The deep political divide over the agency's COVID response appears to have changed that dynamic.

Yesterday the CDC held a telephone meeting with State Public Health partners, asking them to step up their surveillance efforts over the summer. I'll have a bit more after the break.

Readout of CDC Call with State Public Health Partners on H5N1 Influenza Monitoring
Media Alert

For Immediate Release: Tuesday, May 21, 2024
Contact: Media Relations
(404) 639-3286
media@cdc.gov

May 21, 2024 – Today, in a meeting with public health partners, CDC Principal Deputy Director Nirav D. Shah laid out the agency’s recommendations that influenza surveillance systems continue operating at enhanced levels during the summer and to increase the number of positive influenza A virus samples submitted for subtyping to help detect even rare cases of human H5N1 virus infection in the community.

CDC Influenza Division Director Vivien Dugan joined leaders and members from the Association of State and Territorial Health Officials (ASTHO), the Association of Public Health Laboratories (APHL), Big Cities Health Coalition (BCHC), the Council of State and Territorial Epidemiologists (CSTE), and the National Association of County and City Health Officials (NACCHO) on the call.

Shah emphasized the importance of remaining vigilant and outlined a nationwide influenza virus monitoring plan for the summer season, which is a time when influenza activity and testing typically decline. The goal of this plan is to maintain heightened awareness of circulating influenza viruses given the ongoing outbreak of H5N1 among poultry and U.S. dairy cattle.

Specifically, Shah asked jurisdictions to work with clinical laboratories to increase submissions of positive influenza virus samples to public health laboratories for subtyping. Subtyping is a process that determines whether the influenza A sample is a common, seasonal influenza virus or a novel virus like H5N1.

CDC is committed to supporting state and local public health officials and will continue to provide information to support their H5N1 influenza response efforts.

While all of this seems reasonable and prudent, it isn't clear how aggressively individual jurisdictions will respond.

From a strict public health perspective, it makes sense to pull out all the stops while you still can. To try to mitigate the H5N1 threat before it evolves into a `humanized' strain.

But there are other considerations. While they involve `cold calculations', they deserve mention.

The best case scenario is that H5N1 is incapable of sparking a pandemic. We've been watching it for nearly 3 decades, and it hasn't managed yet. Although it would be a huge gamble, those who doubt its pandemic potential may find any proposed `cures' to be far worse than the disease.

A more cynical view would be that yes, H5N1 has genuine pandemic potential. But stopping it (at great pain and expense) in any one state or by any one industry won't prevent it from taking off in another state, a different country, or via a different host species next week or next month.

While I'm not a fan of either approach, I understand the lure of each. Both grant us permission to `do nothing' while we wait to see what happens. Very much the way we've decided to deal with climate change.