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Not quite 3 weeks ago the ECDC issued a guidance document (see Enhanced Influenza Surveillance to Detect Avian Influenza Virus Infections in the EU/EEA During the Inter-Seasonal Period) urging member nations to step up surveillance for potential human avian flu infections over the summer.
As was reported in last year's analysis from the UKHSA (see TTD (Time to Detect): Revisited), there could be dozens of undetected cases of human H5N1 infection before public health would likely detect them, perhaps even hundreds.
While the ECDC may only present non-binding recommendations to member states, yesterday they reiterated the need for increased vigilance in the months ahead.
First the ECDC statement, followed by details on a related COCA call next week (July 16th) for Clinicians and Healthcare centers. I'll have a brief postscript after the break.
Avian flu: increased vigilance recommended
News
8 Jul 2024
Avian influenza viruses continue to circulate, albeit at low levels, among wild bird populations across the European Union and the European Economic Area (EU/EEA).
In the United States, transmission of highly pathogenic avian influenza HPAI A(H5N1) viruses has recently been observed in dairy cattle and four cases of human avian influenza have been reported among farm workers exposed to cattle since April 2024.
Whilst transmission from infected animals to humans remains a rare event, avian influenza viruses can spill over to wild, farm and domestic animals, leading to infection and outbreaks in poultry, and occasionally in mammals.“As we closely monitor the current situation on avian influenza, both in the EU and globally, there is reason for increased awareness but not for increased concern. ECDC remains committed in our support of the actions taken by national authorities in EU Member States. This threat to human health should not be underestimated, and it is important that we stay alert and proactive in our joint collaboration.” says Pamela Rendi-Wagner, Director of ECDC.
While currently no infection with the avian influenza A(H5N1) virus in humans has been recorded in the EU/EEA, ECDC advises on the importance of continuing to raise awareness among healthcare professionals, both at primary and secondary care level, regarding the possibility of encountering human cases of infection.
As part of its ongoing commitment to public health, ECDC is implementing a comprehensive strategy to support the early detection and containment of potential human cases in the EU.
It is important to note that currently the risk of zoonotic avian influenza, i.e. human infections, for the EU/EEA remains low for the general population and low-to-moderate for occupationally or otherwise exposed individuals.
ECDC has been taking numerous initiatives to address the potential threat of avian influenza for human health and has produced several guidance documents and reports in recent months on testing of exposed individuals, on surveillance, outbreak investigation and public health options for response.
In recently updated surveillance guidance for the summer period, ECDC recommends lowering the threshold for testing for avian influenza in humans, including using a risk-based approach for exposed asymptomatic individuals. We also recommend testing for influenza all cases hospitalised due to symptoms compatible with avian influenza and to further investigate those influenza A-positive samples that are negative for seasonal influenza virus. Biosafety and personal protective measures in place at occupational and recreational sites with an increased risk of avian influenza remain crucial to minimise the risk of spillover events to humans. These protective measures should be complied with to the greatest extent possible.
Furthermore, ECDC has strengthened its support to EU countries on laboratory activities on zoonotic avian influenza, including support on laboratory preparedness to detect and characterise zoonotic influenza viruses. ECDC also offers EU centralised testing and further characterisation for human specimens known or suspected to contain an avian influenza virus.
In addition to its national partners in the EU and EEA, ECDC continues to closely monitor avian influenza in the EU and globally together with the European Food Safety Authority (EFSA), and in close collaboration with other relevant EU agencies such as the European Medicines Agency (EMA) and the European Agency for Safety and Health Work (EU OSHA) as well as international organisations such as the WHO and major CDCs.
ECDC is committed to maintaining high vigilance to ensure the safety of the public regarding the risk to humans of avian influenza and will continue to provide updates and guidance as needed and according to the epidemiological situation.
The following COCA Call description was obviously written before the detection of the 4th case, last week. The recent revelations about bovine H5N1 having increased affinity to bind to human receptor cells, have also raised concerns.
= Free Continuing Education
Overview
Highly Pathogenic Avian Influenza (HPAI) (H5N1) virus is widespread among wild birds and continues to cause outbreaks in poultry and spillover to mammals. In March 2024, HPAI A(H5N1) virus was detected in dairy cattle. To date, there have been three human cases of HPAI A(H5N1) virus infection identified in dairy farm workers in the United States.
The risk to the public from HPAI A(H5N1) viruses is low; however, people who have job-related or recreational exposure to infected birds or animals, including dairy cattle, are at greater risk of HPAI A(H5N1) virus infection. During this COCA Call, presenters will give an update on the current outbreak in the United States and current CDC surveillance and monitoring efforts. They will also provide information for clinicians on testing, using antivirals, and infection prevention and control recommendations.
Presenters
Alicia Budd, MPHTeam LeadNational Surveillance and Outbreak Response TeamEpidemiology and Prevention BranchInfluenza DivisionNational Center for Immunization and Respiratory DiseasesCenters for Disease Control and Prevention
Ryan Fagan, MD, MPH&TMMedical OfficerPrevention and Response BranchDivision of Healthcare Quality PromotionNational Center for Emerging and Zoonotic Infectious DiseasesCenters for Disease Control and Prevention
Tim Uyeki, MD, MPH, MPPChief Medical OfficerInfluenza DivisionNational Center for Immunization and Respiratory Diseases
Call Details
When:
Tuesday, July 16, 2024,
2:00 PM – 3:00 PM ET
Webinar Link:
https://www.zoomgov.com/j/1618350375
Passcode: 143703
Dial In:
US: +1 669 254 5252 or +1 646 828 7666
International numbers
One-tap mobile:
US: +16692545252,,1618350375#,,,,*143703#
Webinar ID: 161 835 0375
These presentations are often technical, and are of greatest interest to clinicians and healthcare providers, but also may be of interest to the general public.
As always, If you are unable to attend the live presentation, these (and past) webinars are archived and available for later viewing at this LINK.
In addition to being on the alert for avian flu, clinicians are also being asked to have a high index of suspicion for Mpox cases (see COCA Call : Mpox - Clinical Management & Outbreaks), and suspected swine-variant infections.
Tasks that are only made tougher due to a recent spike in COVID cases across the country.
Stay tuned. It could be a bumpy summer.
