CDC Strategy for Enhanced Summer 2024 Influenza Surveillance

9 States Reporting 69 Cattle Outbreaks

#18,095

Although only 3 mild human H5 infections have been reported in the United States since the avian flu outbreak in cattle began earlier this year, there are reasons to believe some number of cases may have gone undetected, and worries that the spread of the virus is far greater than we know. 

Last week Alpacas were added to the susceptible livestock list, which previously included cattle, goats, and mink, and there are concerns the virus could jump to pigs, or other farmed animals.  A number of dogs and cats have been infected as well. 

While we've stared into the abyss with H5N1 before, only to see it recede, this time `feels' different.  The virus has become more environmentally stable, allowing it to persist in the wild over the summer. It now infects a much wider range of avian and mammalian hosts, and it has diversified into scores of new genotypes. 

While none of this guarantees that H5N1 will spark a pandemic, they are warning signs we can ill afford to ignore.

Unfortunately, this comes at a very bad time.  The world is still bruised and battered from the last pandemic, and in an attempt to `move on', has largely dismantled its surveillance and reporting capabilities.  

A month ago, the following ill-timed rule when into effect:

While the CDC is asking that hospitals continue to submit reports, it isn't clear how many are doing so. Additionally, seasonal influenza surveillance is normally scaled back during the summer, and data collection is largely in the hands of state and local health departments. 

Added to all of this, APHIS/USDA officials have publicly confirmed that they've met `resistance' from farmers who don't want their herds tested, and there are reports (see here, and here) indicating that some states have decided not to `invite' the CDC and USDA into their investigations of avian flu.  

While the CDC and USDA continue to churn out reams of guidance documents (see here, here, here and here), it isn't known how diligently they are being followed.  Some - like the recommended PPE for farm workers - have been a tough sell. 

Yesterday the CDC released their strategy for enhanced summer 2024 influenza surveillance (see below), which - while prudent - is largely dependent upon the participation and cooperation of state and local authorities.   

Of the 7 steps, the first 5 fall primarily under the jurisdiction of state and local authorities, with `CDC and USDA support as requested'.   

Some states (like Michigan) are obviously aggressively looking for cases.  Other states have provided far less information in the opening months of this outbreak, and it isn't clear how aggressively they are testing livestock or people.

The CDC's statement follows, after which I'll have a short postscript.

CDC Strategy for Enhanced Summer 2024 Influenza Surveillance

Español | Other Languages Print

As the multistate outbreak of avian influenza A(H5N1) in dairy cows, poultry and other animals continues and agricultural fair season approaches, conducting surveillance for seasonal influenza viruses and monitoring for novel influenza A virus infections remains critical to inform public health actions. CDC, in collaboration with STLT public health agencies, has developed a multi-faceted enhanced summer influenza surveillance strategy that will be modified as new information is learned or the situation changes warranting a revised approach.

The activities described below are aimed at identifying spread of HPAI A/H5 to and among people, beginning with those exposed to infected/potentially infected animals and extending outward to the general population.

While I firmly believe we should be putting considerable resources into testing and surveillance this summer - as a practical matter - we could throw all of our resources at this virus only to see it begin its world tour from some other country.  

But in doing so, we might have a better handle on what we are dealing with, and hopefully, more time to create antivirals, produce vaccines, and to prepare.   

While the next pandemic may be inevitable, how prepared we are for it when it comes is strictly up to us.