#18,417
The reduction in avian flu reports in these pages the past few months is likely a testament to the slowdown in testing, and release of information, by nations around the globe on H5N1. Our ability to track outbreaks has deteriorated badly as many countries have decided there is little to gain by disclosing `bad news' (see From Here To Impunity).
While every WHO report diplomatically `reminds' nations of their duty to report, 90% of the worlds nations no longer reliably report COVID deaths and ICU admissions, and many countries appear equally silent on other disease outbreaks, including H5Nx and MERS-CoV.
This, despite the 2005 IHR agreement which requires nations to report certain disease outbreaks and public health events to the WHO in a timely manner. A goal which has long been hampered by a lack of any enforcement options in the agreement (see Adding Accountability To The IHR).
Genetic sequences - when they eventually do get submitted to GISAID - often lack crucial metadata (i.e. collection date, exact location, host-specific information, etc.), limiting their value to the scientific community.
Last month, in Nature: Lengthy Delays in H5N1 Genome Submissions to GISAID, we learned that the average delay for submitting non-human sequences was 7 months, and that Canada came in last at 20 months.
As we've discussed (ad nauseum), detecting sporadic cases of H5 infection often involves a bit of luck, and it is likely that some (perhaps many) infections go unreported; even in countries with well-equipped and functioning public health systems.Some nations (e.g. The Netherlands & Czech Republic), however, manage to do so in less than a month.
Two years ago, in UK Novel Flu Surveillance: Quantifying TTD, UK health authorities released HPAI H5 Technical Briefing #3, which modeled the TTD (Time to Detect) community spread of HPAI H5 under 3 different scenarios (in the UK).
Assuming a relatively low R0 of 1.2, it could take as much as 2 to 3 months before community spread would become apparent. In rural, or resource scarce regions of the world, the virus could presumably spread undetected even longer.
The WHO, ECDC, PAHO, CDC, and many other health agencies lack regulatory authority - and can only offer guidance - and we continue to see calls for enhanced surveillance and reporting. A few recent examples include:
CDC HAN: Accelerated Subtyping of Influenza A in Hospitalized Patients
ECDC Preparedness, prevention and control related to zoonotic avian influenza
PAHO: Epidemiological Alert on Human Cases of Avian Influenza A(H5N1) in the Americas Region - 3 December 2024
Today the WHO has released updated guidance on the surveillance and reporting of human infections with Avian H5 viruses. Included in this 17-page PDF is a copy of the detailed reporting form to be submitted to the WHO.
I've only included the overview and a few excerpts. Follow the link to to download and read the document in its entirety.
Surveillance for human infections with avian influenza A(H5) viruses
objectives, case definitions, testing and reporting
11 April 2025
| Guidance (normative)
Download (411.9 kB)
Overview
The overall objective of continual global surveillance for human infection with avian influenza A(H5) viruses is to detect and characterize any influenza A(H5) viruses infecting humans in order to: (1) promptly trigger public health control and response actions, (2) assess the trends of such infections and the public health risks posed (including the risk of a pandemic); and (3) inform global pandemic preparedness activities. This document summarizes the WHO implementation guidance on surveillance for human infection with influenza A(H5) viruses.
(Excerpt)
Key points• The overall objective of continual global surveillance for human infection with avian influenza A(H5) viruses is to detect and characterize any influenza A(H5) viruses infecting humans in order to: (1) promptly trigger public health control and response actions, (2) assess the trends of such infections and the public health risks posed (including the risk of a pandemic); and (3) inform global pandemic preparedness activities.• Specific surveillance objectives include rapidly detecting human cases of influenza A(H5) virus infection, monitoring the incidence of new cases over time and geographical distribution, assessing and monitoring changes in transmission patterns to promptly detect any unusual events that may signal human-to-human transmission of the virus, characterizing and monitoring changes in any influenza A(H5) viruses infecting humans relative to those circulating in animals to inform control strategies, describing the clinical presentation of illness and identifying risk factors for infection and severe outcomes.• Close collaboration with the animal health and environment sectors is essential to understand the extent of the risk of human exposures, to target enhanced surveillance and case finding activities, and to prevent and control the spread of influenza A viruses in animals.• Under the International Health Regulations (IHR) (2005) (1), States Parties are required to notify WHO within 24 hours of any laboratory-confirmed case of human influenza caused by a new subtype according to the WHO case definition (2). Human infection caused by a new subtype has been established as being unusual or unexpected and may have serious public health impact. For this reason, even a single case of human infection with a new influenza subtype that fulfils the WHO case definition must always be notified immediately to WHO, regardless of the context in which it occurs. For events involving suspected cases of human influenza caused by a new subtype (e.g., in the absence of laboratory confirmation), States Parties are required to carry out an assessment of such events according to the decision instrument contained in Annex 2 of the IHR (2005), and then to notify WHO of all qualifying events within 24 hours of such an assessment. Notifications and other event-related communications under the IHR are carried out, by the most efficient means of communication available, between the National IHR Focal Point on behalf of the State Party concerned and the WHO IHR Contact Point at the respective WHO Regional Office.
(SNIP)
Background and rationaleThe avian influenza A(H5N1) epizootic has led to unprecedented numbers of deaths in wild birds; outbreaks and culling in domestic poultry; and A(H5N1) infections in mammals, including humans. Such human infections remain rare and thus far have been associated with exposure to infected animals or to contaminated environments, without subsequent sustained human-to-human transmission. However, A(H5N1) viruses pose a significant public health risk, with human infections often causing severe disease and high mortality. In addition, such viruses have the potential to adapt to humans and with pandemic potential. Other influenza A(H5) virus subtypes, such as A(H5N2), A(H5N6) and (H5N8), have also been detected in birds and mammals, including in humans.The current influenza A(H5) situation warrants intense global monitoring and a coordinated global response (3). Due to the potential significant risk to human health, and the far-reaching implications of the disease for the health of wild birds and other animal populations, a “One Health” approach is essential in effectively tackling avian influenza. Close collaboration with the animal health and environment sectors is vital for understanding the extent of the risk of human exposures, and for preventing and controlling the spread of A(H5) and other influenza A viruses in animals. In addition to surveillance approaches at the human-animal-environment interface, it is recommended that countries, through their National Influenza Centres (NICs) and other influenza laboratories within the WHO Global Influenza Surveillance and Response System (GISRS), remain alert to the possibility of human influenza A virus infections of zoonotic origin. Following prompt testing, early and appropriate clinical management should be initiated, and precautionary measures put in place to assess and prevent potential further spread among humans and animals. Epidemiological and virological surveillance, and the follow-up of suspected and confirmed human cases, should be conducted systematically. (4, 5)
And when that happens, we'll truly wish we had the time back we are currently squandering, pretending the next pandemic won't happen on our watch.
