FAO: Recommendations for the Surveillance of Influenza A(H5N1) in cattle

#18,507

Today the FAO has released a 32-page document with recommendations for the surveillance for H5N1 in cattle (with broader application to other farmed mammals), even for countries outside of the Americas. 

El Masry, I., Delgado, A.H., Silva, G.O.D., Dhingra, M. & Lyons, N.A. 2024. Recommendations for the surveillance of influenza A(H5N1) in cattle – With broader application to other farmed mammals. FAO Animal Production and Health Guidelines, No. 37. Rome, FAO. https://doi.org/10.4060/cd3422en

A press release is available at FAO publishes new guidelines for surveillance of influenza in cattle, while from the FAO website, we get this short description:

Synopsis (short abstract)

As influenza A(H5N1) of clade 2.3.4.4b continues to spread from wild birds to poultry and to both terrestrial and marine mammals, the recent cases in cattle highlight the critical importance of being prepared for and responding rapidly to spillover events and of planning for early detection and response at the country level, especially in countries of low and middle income.

These recommendations from the Food and Agriculture Organization of the United Nations (FAO) aim to support countries in enhancing influenza A(H5N1) surveillance in cattle populations, with broader application to other farmed mammals, to inform risk assessment and evidence-based disease control measures. Integrated surveillance strategies can leverage existing programmes for avian influenza and other cattle diseases, enabling countries to enhance monitoring capabilities while maintaining cost efficiency.

With regard to preparing effectively, FAO recommends a combination of different surveillance methods including risk-based surveillance strategies tailored to individual country contexts. Adopting these recommendations will strengthen early detection efforts, support evidence-based decision-making and help implement targeted risk mitigation measures to protect both livestock and public health

From the document:

The Food and Agriculture Organization of the United Nations (FAO) recommends that all countries maintain passive surveillance for A(H5N1) to rapidly detect spillover events in non-avian species, using an appropriate case definition alongside education and outreach to relevant stakeholders to improve awareness of this emerging disease. Additionally, countries may choose to use other surveillance approaches to leverage routine and opportunistic sampling to evaluate the health of cattle populations.  

`Passive surveillance' is described in this document as:

Passive surveillance of influenza A(H5N1) in cattle describes the surveillance that is achieved when:

• farmers identify that they have some sick cattle and they contact a veterinarian to seek help (FAO, 2014); and 

• veterinary and/or animal health professionals report unexplained mortality, neurological symptoms and/ or respiratory symptoms in other animal species on dairy premises to the veterinary services 

Passive surveillance, as has been demonstrated here in the United States, is not without its drawbacks. But in many countries it may be the best that can be realistically hoped for. 

Some of the different levels of surveillance discussed include:



While HPAI H5 in cattle has only been detected in America thus far - and from genotype B3.13 - there are studies showing other genotypes may be capable of infecting cattle, and we've seen evidence of H5N1 in Mongolian horses, making it plausible that other spillovers could occur almost anywhere. 

Follow the link to download and review the full document.

Review: Significant HPAI H5 Related Events Over The Past 2 Weeks

#18,506

It's been just over 2 weeks since our last review (see An Overview of Significant HPAI H5 Related Events Over The Past 4 Weeks) of recent HPAI milestones, and if anything the pace of new developments has quickened. 

Over the past 2 weeks:

• The number of confirmed H5 human cases in the U.S. has increased by 6, to 64 (although probable cases brings that to 71). Four new states have reported human cases (Delaware - 1, Iowa - 1, Louisiana - 1, Wisconsin-1).

• While most of the H5 infections in the United States have been uncharacteristically mild, last month British Columbia reported a severe case in a teenager, and last week the CDC Confirmed the First Severe Case of H5N1 Bird Flu in the United States.

• The number of known infected dairy herds has grown from 720 to > 875 (a 21% increase), and the USDA has reported well over 10 million head of poultry lost to the virus.

• With half of the state's dairy herds infected, last week the Governor of California Declared a Bird Flu Emergency.

• We've seen major die offs of wild migratory birds reported from a number of Midwest states, including Illinois, Missouri, and Louisiana, which appear to be due to the new D1.x genotype.

• Last week, we saw a report out of Galveston County, Texas regarding potential exposure of several individuals to an H5 infected wild bird brought into animal rescue and we've seen multiple reports of feline deaths from the virus, some linked to consuming raw milk  and/or raw meat. 

In case you missed them, some significant H5 publications from past 2 weeks (from oldest to newest) include:

• In EID Journal: Influenza A(H5N1) Virus Clade 2.3.2.1a in Traveler Returning to Australia from India, 2024, we looked at an unexpected reassortment between older H5N1 clade 2.3.2.1a virus and the newer clade 2.3.4.4b clade in India.

• In Emerg. Microbes & Inf.: Marked Neurotropism and Potential Adaptation of H5N1 Clade 2.3.4.4.b Virus in Naturally Infected Domestic Cats, we looked at an outbreak of H5 in a house full of domestic cats, all of which died, many with severe neurological symptoms. The authors also documented a number of potentially significant mutations in these cats, along with demonstrating their ability to serve as a potential `mixing vessel' for influenza.

• In EID Journal: Replication Restriction of Influenza A(H5N1) Clade 2.3.4.4b Viruses by Human Immune Factor, 2023–2024, we looked at a paper on ways the H5 virus could potentially evade the MxA protein, which currently suppresses its replication in human hosts. 

• In one of the more disconcerting reports of 2024, we looked at a study (Lancet Microbe: Novel Human-Type Receptor-Binding H5N1 Virus in Live Poultry Markets, China) which found signs of human adaptation in H5 viruses Chinese poultry. 

• In EID Journal: Systematic Review of Avian Influenza Virus Infection and Outcomes during Pregnancy, we revisited the extreme toll novel flu viruses have often had on pregnant women, and their offspring.

These are just some of the highlights, you'll find other reports on:

• Virus Evolution: Recurring Incursions & Dissemination of Novel Eurasian-origin H5Nx Avian Influenza Viruses in Atlantic Canada

• Updated joint FAO/WHO/WOAH public health assessment of recent influenza A(H5) virus events in animals and people

• ECDC/EFSA Quarterly Avian Influenza Overview Sept 2024 - Dec 2024

• LA County Issues Another Raw Milk Warning

• China CDC Weekly: Infection Tracing and Virus Genomic Analysis of Two Cases of Human Infection with Avian Influenza A(H5N6) — Fujian Province, China

Along with other, non-bird flu reports on Mpox, Seasonal flu & antiviral resistance, and novel swine flu viruses.

Some Last Minute Preparedness Stocking Stuffers

CDC Infographic

#18,505

Although nature never sleeps, public health reporting from government agencies and news sources tend to slow markedly over the holidays. Many science journals don't publish much in the second half of December, and things often don't return to `normal' until the second week of January. 

While blogging topics may be in short supply this week and next, I'm fairly confident a few of my readers are still scrambling for last minute gift ideas, or stocking stuffers, for this holiday season.

Each fall, during and just after National Preparedness Month, I make the case for buying preparedness items for holiday gift giving, with my most recent appeal in November (see The Gift of Preparedness 2024).

In that blog you’ll find both low cost `stocking stuffers’ along with some bigger ticket items like solar panels, battery banks, and FRS and crank radios.

With time running short, and most of our wallets running thin, I thought I’d run through my list of under $25 preparedness gift ideas. Most should be easy to find on the shelves, even at this late date.

A good place to look are the sporting goods section of big box stores, in home improvement centers, or discount stores like Big Lots.

NOTE: Products mentioned here are to provide a general idea of the type of gift, and should not be viewed as an endorsement of one brand over another.

Batteries, and battery chargers make terrific preparedness gifts. Just about everyone uses AA or AAA batteries, and you can either buy a decent quantity of disposable batteries, or go `green’ with a handful of rechargeable batteries and a charger for under $25.

When the lights go out, nothing beats having a few good LED flashlights or lanterns. And each year they get brighter, and cheaper. Most run between $5 and $10, and that beats the heck out of cursing the darkness.

A couple of years ago I bought several water filtration systems, one to keep and a couple to give to prepping buddies. LifeStraw ® weighs just 2 ounces, and this personal water filter will reportedly filter 1000 liters down to .2 microns. Not bad for around $20.



I've also added the Sawyer Mini-Filter to my preps, again about $20.



Emergency cook stoves can be had for under $20. A 1 burner propane camp stove costs about $15, add a couple of 1 pound propane cylinders (about $5 each) and you can cook for a family for a week.   Other options include `Sterno' or `canned heat' stoves, which run under $10 (plus fuel).



At about $4 each, magnesium fire starters each year make excellent stocking stuffers.


Something as simple, and as utilitarian, as a multi-function `Swiss’ army knife or a `Multi-tool’ makes a great preparedness gifts.




For emergency electrical power, I found an 80 watt cigarette lighter inverter for my car. It can power a small laptop, and has a USB charger port as well. Under $20.


And for under $10, you can pick up a cigarette lighter USB charger, that can top off your phone or mobile device.

There are a lot of combination AM/FM Weather ALERT radios available for under $25, many have alternate power options (solar, hand crank, AA batteries, etc.).  Every home and business should have at least one emergency alert radio.

This year - with flu steadily rising, COVID still hanging on, and the specter of bird flu in the wings -  safety goggles, a box of vinyl or nitrile gloves, or a box of facemasks (or N95 masks) should be in everyone’s emergency kit as well.




There are, of course, many other gift possibilities.  As we discussed last September in #NatlPrep: Prolonged Grid Down Preparedness, most disasters boil down to unscheduled camping - for days, or sometimes weeks - in your home, in a community shelter, or possibly even in your backyard.

Anything that would make that easier, or safer, makes a good preparedness item. 

While I can’t predict what the new year will bring - if 2025 turns out anything like 2024 - there's a pretty good chance that there are going to be plenty of people who will wish they had most – if not all – of these items on hand before the next disaster strikes.

Because, during any emergency, the advantage always goes to those who were prepared.

Virus Evolution: Recurring Incursions & Dissemination of Novel Eurasian-origin H5Nx Avian Influenza Viruses in Atlantic Canada

Map Credit Wikipedia

#18,504

Last August, in Something Winged This Way Comes, we discussed our `knowledge gap' of what evolutionary changes might have occurred over the summer among HPAI H5 viruses in the high latitude summer roosting areas for migratory waterfowl. 

I wrote:

Exactly what returns this fall is unknown, as the virus has had numerous opportunities to reassort or mutate over the summer. We could see something worse, or if we get very lucky, an attenuated threat (see Sci Repts.: Southward Autumn Migration Of Waterfowl Facilitates Transmission Of HPAI H5N1).

And true to form, this fall we've seen two new H5N1 genotypes (D1.1 and D1.2) join the fray, causing numerous outbreaks in poultry, more than a dozen human infections, and apparently causing significant die offs of wild birds across the country.  

These D1.x genotypes are genetically distinct from the B3.13 `Bovine' strain, and have been linked to at least 2 `severe' human infections.  A reminder that HPAI H5 is a constantly moving target. 

But at the same time, we've been tracking another viral interloper - HPAI H5N5 - making inroads both in Europe, and (repeatedly) crossing the Atlantic, and appearing in Eastern Canada (see The Continued Expansion of HPAI H5N5).

New subtypes or new genotypes of the HPAI H5 virus are a product of the H5 virus reassorting with other LPAI viruses - which can occur in both birds and mammals around the globe.  

We've seen reports of H5N5 in European birds going back to 2016, but it was first detected in dead raccoons on Prince Edward Island about 18 months ago (see CIDRAP Report).  Since last May, we've seen increasing reports of its western expansion (see WAHIS: More Reports of HPAI H5N5 in Canada).

Last July, in Cell Reports: Multiple Transatlantic Incursions of HPAI clade 2.3.4.4b A(H5N5) Virus into North America and Spillover to Mammals, researchers reported finding the mammalian adaptive E627K mutation in a number of samples.

They wrote:

Thus, while A(H5N5) viruses are comparably uncommon, their high virulence and mortality potential demand global surveillance and further studies to untangle the molecular markers influencing virulence, transmission, adaptability, and host susceptibility.

While still a relatively minor player, we've seen increased H5N5 activity in both Europe and the UK in recent months.  To that we can also add the following journal article from Virus Evolution, which describes its repeated introductions into Canada and recent evolutionary changes. 

A link and some excerpts from the report, after which I'll have a bit more. 

Recurring incursions and dissemination of novel Eurasian-origin H5Nx avian influenza viruses in Atlantic Canada

Ishraq Rahman, Cassidy N.G Erdelyan, Anthony V Signore, Ifeoluwa Ayilara, Jordan Wight, Megan E.B Jones, Daniel S Sullivan, Oliver Lung, Tamiko Hisanaga, Sabina I Wilhelm 
Virus Evolution, veae111, https://doi.org/10.1093/ve/veae111
Published: 17 December 2024 

PDF

Abstract

Wild birds are important hosts of influenza A viruses (IAVs) and play an important role in their ecology. The emergence of the A/goose/Guangdong/1/1996 H5N1 (Gs/GD) lineage marked a shift in IAV ecology, leading to recurrent outbreaks and mortality in wild birds from 2002 onwards.

This lineage has evolved and diversified over time, with a recent important derivative being the 2.3.4.4b sub-lineage, which has caused significant mortality events in wild bird populations. An H5N1 clade 2.3.4.4b virus was transmitted into North America from Eurasia in 2021, with the first detection being in Newfoundland and Labrador in Atlantic Canada, and this virus and its reassortants then spread broadly throughout North America and beyond.

Following the first 2021 detection, there have been three additional known incursions of Eurasian-origin strains into Atlantic Canada, a second H5N1 strain in 2022 and two H5N5 strains in 2023.

In this study we document a fifth incursion in Atlantic Canada that occurred in 2023 by another H5N5 strain. This strain spread throughout Atlantic Canada and into Quebec, infecting numerous species of wild birds and mammals.

Genomic analysis revealed mammalian-adaptive mutations in some of the detected viruses (PB2-E627K and PB2-D701N) and mutations in the hemagglutinin (HA) and neuraminidase (NA) genes that are associated with enhanced viral fitness and avian transmission capabilities.

Our findings indicate that this virus is continuing to circulate in wildlife, and confirms Atlantic Canada is an important North American entry point for Eurasian IAVs. Continued surveillance and genomic analysis of IAVs detected in the region is crucial to monitor the evolution of these viruses and assess potential risks to wildlife and public health.

          (SNIP)

Conclusions

This study describes the fifth incursion and dissemination of a Eurasian 2.3.4.4b clade H5Nx virus into Atlantic Canada since November 2021. These viruses have been found in a wide range of wild bird species and have been transmitted to mammals. Phylogenetic analyses indicated that this H5N5 strain was a novel introduction from Eurasia and was not the continued spread and dissemination of H5N5 viruses that were detected earlier in 2023.

Several amino acid changes detected in the HA, NA, and PB2 sequences of these H5N5 viruses are known to affect pathogenicity and transmission, HA glycosylation, and the ability to bind to avian receptors.

 The presence of these mutations suggests ongoing selective pressure for adaptation to avian hosts, which may facilitate the rapid spread among wild birds and result in additional spillovers to mammals.

Our findings provide direct evidence that these H5N5 viruses can infect and be transmitted by a broad range of host species, and as such have quickly become globally disseminated.

Continued surveillance of IAVs in wild animals with a focus in high-transmission zones such as Atlantic Canada is crucial to track the evolution of these viruses during their ongoing circulation and to assess potential impacts they may have on wildlife and public health.

         (Continue . . . )

Over the past decade we've seen the rise (and fall) of a highly successful H5N8 virus, followed by the surprise return of a far more capable clade 2.3.4.4b H5N1 virus. 

In the 3 years since H5N1 arrived in North America, the virus has evolved into more than 100 genotypes.  

Globally, H5's diversity is even greater.  Admittedly, most of these variants will fall by the wayside, unable to successfully compete against more biologically `fit' strains.   

Right now, it isn't clear how much of a player H5N5 will turn out to be. For now, however, it appears to be on the ascendant. 

The growing array of H5 viruses circulating globally arguably poses a much greater pandemic threat than it did just a few years ago.  Meaning - even if we somehow manage to suppress or eradicate `bovine H5N1' - there are a number of other H5Nx contenders out there to take its place.

There's an old joke about a tourist asking a NYC cabby, `What’s the best way to get to Carnegie Hall?” and the cabby replies, “Practice, practice, practice”.

Unfortunately, our largely passive (`don't test, don't tell')  approach to HPAI over the past year has given HPAI nearly unfettered opportunities to practice; on cattle, humans, cats, and dozens of other peridomestic species. 

Whether or when the virus will ever be ready for Carnegie Hall remains unknown.

But the longer it circulates and the more opportunities it is given to evolve (or reassort), the greater the odds are that a viral prodigy will eventually emerge. 

LA County Animal Health Alert : H5 bird flu confirmed in Domestic Cats

 

Credit  -  LA County H5 Bird Flu in Animals

#18,503

On Thursday, in L.A. County Confirms H5 In Two Cats - Investigating 3 More Suspected Feline Cases, we learned of a second household where HPAI H5 was suspected in the infection, and deaths, of cats in Los Angeles.  

Unlike the first event - which was linked to raw milk consumption - the second outbreak appears linked to commercial raw meat pet food. 

Yesterday the LA County Health Department (animal health division) published the following AHAN - for veterinarians - on the second incident. This is a lengthy document, and I've only reproduced some excerpts, starting with the summary below.

Veterinarians in particularly will want to follow the link to read it in its entirety. 

Animal Health Alert: H5 bird flu confirmed in four domestic cats that consumed recalled raw milk, and in one cat that consumed commercially produced raw pet food.

12.20.2024

Key Points:

• Five indoor-only, domestic cats in one household in Los Angeles (LA) County died after consuming recalled raw milk. Four of these cats were tested and confirmed to be infected with H5 Bird Flu. This group includes the two cats described in an earlier alert issued 12/12/2024.
• There are additional recalls on raw dairy products. The current recalls include:

• All sizes of raw milk and cream produced by Raw Farm, LLC in California betweenNovember 9-27, 2024 (lot numbers 20241109 through 20241127).
• All “Valley Milk Simply Bottle Raw Cow Milk” and “DESI Milk Raw Cow Milk” distributed in quart (32oz), half-gallon (64 oz), and one-gallon (128 oz) plastic judges with a code date marked on the container of “DEC 23 2024 through DEC 30 2024”, produced by Valley Milk Simply Bottled of Stanislaus County.

• From a separate household in LA County, a symptomatic cat has tested presumptive positive for H5 bird flu after consuming two different brands of raw pet food composed of raw poultry and raw beef. The investigation for this case is currently ongoing.

• Animal health staff should specifically ask pet owners about exposure to raw milk and raw diets, share information about the risk of raw milk and raw diets, and caution pet owners NOT to consume raw dairy products, nor offer them to pets.

• Animal health staff should wear appropriate personal protective equipment (PPE) when in contact with animals suspected or confirmed of being infected with H5 bird flu; acutely sick animals that have history of exposure to raw milk or raw milk products, wild birds or raw or undercooked animal products.

• Animal health staff are strongly recommended to receive their seasonal flu vaccine. Although this vaccine is not proven to prevent infection with H5 Bird Flu, it can help protect staff from seasonal human flu which is circulating right now.

•  REPORT suspected cases of H5 bird flu in cats and other animals. Testing for the virus may be available. A complete dietary history for the animal (including raw dairy, raw poultry and/or meat, and bird exposure) is needed.

We get more details on the investigation (which includes 13 affected cats, with at least 7 deaths).  

On 11/22/24, eight cats in one household were offered raw milk produced by Raw Farm, LLC. The raw milk was from a lot that was not included in the recalls issued on 11/24/24 and 11/27/24 but was included in the third recall issued on 12/3/24. Between November 20 and December 7, 2024, seven of the cats became ill. Between December 2-10, five died or were euthanized. The other two cats are under quarantine and improving.

 This group includes the two cats described in an earlier alert issued on 12/12/2024. Clinical signs were variable but progressive. They included fever, lethargy, dehydration, anorexia, icterus, respiratory distress, and neurologic signs (primarily seizures, although one had nystagmus). One cat had evidence of lung lobe consolidation. 

Of the five deceased cats that drank the recalled raw milk, four were tested for influenza A by PCR testing of samples from multiple body sites (oropharyngeal, rectal, and/or brain). All samples collected were confirmed positive for Influenza A, and further subtyped as H5N1 also known as H5 Bird Flu, by the National Veterinary Services Laboratory (NVSL). 

These are the first confirmed cases of H5 bird flu infections in cats in Los Angeles County. They were sequenced by NVSL with sequences identical to the raw milk they ingested which was recalled from Raw Farms. H5 bird flu has been detected in domestic cats in other states since the beginning of this national and international outbreak that began in wild birds in late 2021. 

From a separate household in LA County, Veterinary Public Health is investigating five indoor only domestic cats that became ill presumably after consuming two different brands of raw pet food diets composed of raw poultry and raw beef. 

Approximately 2 weeks after consuming the raw diets, two cats presented with acute respiratory distress to veterinary clinics and were humanely euthanized. One of these cats had known pre-existing cardiac disease. Two other cats presented with symptoms including lethargy, reduced appetite, upper respiratory, neurologic, and ocular signs of disease. One cat was treated for corneal edema and uveitis in one eye. The other cat displayed ataxia, uveitis and bilateral retinal detachment in both eyes and was tested with a respiratory panel from a commercial veterinary diagnostic laboratory, which resulted as presumptive positive for Influenza A and Feline Calicivirus.

This sample was further detected as positive for H5 bird flu at the California Animal Health and Food Safety (CAHFS) Laboratory and the sample will be sent to NVSL for confirmation, subtyping, and sequencing. The investigation is ongoing and includes testing of the raw pet food diets by the Food and Drug Administration (FDA). 

They report no evidence of cat-to-cat transmission or cat-to-human transmission, although we've seen some evidence of both with other avian flu viruses (see EID Journal: Avian H7N2 Virus in Human Exposed to Sick Cats).

They caution, however:

. . . people who come into close contact with animals, especially wild birds and their feces, infected cats, infected poultry, or with infected dairy cattle or their milk, have a higher level of risk of exposure. It is important to take proper precautions.

 For more on HPAI H5 in domestic cats, you may wish to revisit:

Emerg. Microbes & Inf.: Marked Neurotropism and Potential Adaptation of H5N1 Clade 2.3.4.4.b Virus in Naturally Infected Domestic Cats

Eurosurveillance: (HPAI) H5 virus Exposure in Domestic & Rural Stray Cats, the Netherlands, October 2020 to June 2023

ECDC Risk Assessment: Avian influenza in domestic cats - Poland - 2023

Eurosurveillance: Asymptomatic infection with clade 2.3.4.4b HPAI A(H5N1) in carnivore pets, Italy, April 2023

Illinois Dept Public Health Monitoring A Large-scale Waterfowl Mortality Event Due to HPAI

 

#18,502

Ten days ago, in Louisiana & Missouri Report Waterfowl Die Offs As H5N1 Moves East, we noted the rapid spread of HPAI via migratory birds from the Western states - shifting both south and east - increasing the risk of human (and pet) exposure to the virus.

Earlier this week, we saw a report out of Galveston County, Texas regarding potential exposure of several individuals to an H5 infected wild bird brought into animal rescue. 

While most outbreaks and/or die offs in wild birds, or mammalian wildlife, go undetected, from the reports we are seeing there is obviously a lot of HPAI virus in the environment right now. 

Much of this fall's activity appears to be driven by a new D1.x genotype, which has proved particularly aggressive both in wild birds and poultry, and has infected more than a dozen humans.

Overnight Lisa Schnirring emailed me the above notice from the Illinois Department of Public Health X account, which leads to the following joint agency announcement.

IDNR, IDPH, and IDOA monitoring avian influenza mortality events in waterfowl throughout Illinois

Press Release - Friday, December 20, 2024

SPRINGFIELD - The Illinois Department of Natural Resources (IDNR) is monitoring a large event of waterfowl mortality at numerous locations throughout Illinois. Test results received so far indicate highly pathogenic avian influenza (HPAI) is the cause.

The public is reminded to not handle or attempt to capture waterfowl or other wild birds displaying signs of illness.

IDNR will continue to monitor for HPAI mortality events throughout the state during the seasonal bird migration. Members of the public are encouraged to report concentrations of five or more deceased birds found at one location to IDNR district wildlife biologists by going online.

Due to risk of infection to other animals, dogs and other pets should be kept away from the carcasses of birds that may have died from HPAI. If carcasses need to be disposed of, IDNR recommends following guidance from the Illinois Department of Public Health (IDPH). IDNR is unable to assist with carcass removal from non-IDNR properties in most situations.

Local animal control agencies should also take similar precautions and follow the guidelines above in disposing of dead birds. In addition, IDPH recommends: 

• Do not send dying or dead birds to veterinarians, wildlife refuges, etc., for testing. Instead, notify your local health department or alert IDNR wildlife biologists in cases of five or more deceased birds found in one location.
• People can get on antiviral medications after exposures to prevent illness.
• If the public develops any symptoms of the "flu" - fever, cough, sore throat, difficulty breathing, body aches, headaches, eye redness, vomiting or diarrhea - after exposure to sick or dead birds, please notify the local health department immediately. Upon seeking medical attention, please let any health care facility know of your exposure.
• Treatment must be started within two days of illness for it to be most effective, so the public is urged to not delay seeking care. 

"While avian influenza generally poses a low risk to the population, it is essential to take the necessary steps to avoid exposure, and to seek treatment quickly if you are exposed," said IDPH Director Dr. Sameer Vohra. "We encourage all Illinoisans to follow the advice of the experts at IDNR in order to avoid contact with sick birds, and to take any potential exposure seriously. These common-sense steps can help reduce the likelihood of spreading this illness."

IDNR recommends that wildlife rehabilitators not accept waterfowl and other aquatic birds because of the elevated risk of infection by HPAI at this time. Caution should also be taken when accepting raptors, scavengers, and other birds displaying signs of illness due to risk of exposure to HPAI. Further guidance for wildlife rehabilitators regarding HPAI can be found online.

The Department reminds waterfowl hunters to take precautions and thoroughly cook game meat to an internal temperature of 165 degrees Fahrenheit. Avoid handling sick or dead waterfowl found in the field. Further guidance for hunters can be found online.

In addition to detections in wild birds, Illinois and other states across the United States have seen detections in poultry.

"The Illinois Department of Agriculture (IDOA) encourages poultry owners to be aware of the risk, increase biosecurity measure and prevent contact with wild birds," said Dr. Mark Ernst, IDOA state veterinarian. "In addition, we encourage poultry owners to report unusually large mortalities in their flocks and to be aware of IDPH's recommendations regarding exposure to sick birds."

While the risk of infection to the `general population' continues to be described as `quite low', in recent months we've seen an growing number of groups - animal rescue workers, pet owners, backyard flock owners, and hunters - added to the traditional list of high risk individuals (agricultural workers, veterinarians, etc.).

It is also worth noting that not all birds (or mammals) infected with HPAI H5 will appear to be sick, dead, or dying.  Asymptomatic carriers, however, may shed less virus and (hopefully) be less capable of spreading the disease.

The CDC also updated the following guidance document yesterday:

Highly Pathogenic Avian Influenza A(H5N1) Virus: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations

WHAT TO KNOW

This guidance outlines CDC’s recommendations for preventing human exposures to highly pathogenic avian influenza (HPAI) A(H5N1) viruses and infection prevention and control measures, including the use of personal protective equipment, testing, antiviral treatment, patient investigations, monitoring of exposed persons, and antiviral chemoprophylaxis of exposed persons.

The following small excerpt outlines their general recommendations to the public.

Recommendations for the Public

Avoid exposure to sick or dead animals. If you are unable to avoid exposure, avoid unprotected (not using respiratory and eye protection) exposures to sick or dead animals including wild birds, poultry, other domesticated birds, and other wild or domesticated animals, as well as with animal feces, litter, or materials contaminated by birds or other animals with suspected or confirmed HPAI A(H5N1) virus infection.

Personal protective equipment (PPE) should be worn when in direct or close contact (within about six feet) with sick or dead animals including poultry, wild birds, backyard bird flocks, or other animals, animal feces, litter, or materials potentially contaminated with HPAI A(H5N1) viruses. PPE includes properly fitted unvented or indirectly vented safety goggles, disposable gloves, boots or boot covers, a NIOSH-Approved particulate respirator (e.g., N95® filtering facepiece respirator, ideally fit-tested), disposable fluid-resistant coveralls, and disposable head cover or hair cover. Adding a face shield over the top of goggles and a fluid resistant apron can enhance protection. Additional information on PPE recommendations for workers can be found online.

Cook poultry, eggs, and beef to a safe internal temperature to kill bacteria and viruses. Refer to CDC's safer foods table for a complete list of safe internal temperatures. Choosing pasteurized milk and products made with pasteurized milk is the best way to keep you and your family safe. Unpasteurized (raw) milk and products made from raw milk, including soft cheese, ice cream, and yogurt, can be contaminated with germs that can cause serious illness, hospitalization, or death. Pasteurization kills bacteria and viruses, like avian influenza A viruses, in milk.

People exposed to HPAI A(H5N1)-virus infected birds or other animals (including people wearing recommended PPE) should monitor themselves for new respiratory illness symptoms, and/or conjunctivitis (eye redness), beginning after their first exposure and for 10 days after their last exposure. Influenza antiviral post-exposure prophylaxis can be considered to prevent infection, particularly in those who had unprotected exposure to HPAI A(H5N1)-virus infected birds or other animals (more information below).

Persons who develop any illness symptoms after exposure to HPAI A(H5N1) virus infected birds or other animals should seek prompt medical evaluation for possible influenza testing and antiviral treatment by their clinician or public health department. Symptomatic persons should isolate away from others, including household members, except for seeking medical evaluation until it is determined that they do not have HPAI A(H5N1) virus infection.

Additionally, the CDC provides specific guidance to pet owners on how to limit their risk of infection from the virus (see What Causes Bird Flu in Pets and Other Animals).

While one would be hard-pressed to call all of this the `new normal', it is rapidly becoming our new reality.