Sunday, April 06, 2025

J. Virology: Synergistic Effects of PA (S184N) & PB2 (E627K) Mutations on the Increased Pathogenicity of H3N2 Canine Influenza Virus Infections in Mice and Dogs

Just one of many scenarios - Dogs as `mixing vessels' for Influenza

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The revelation - just over a year ago - that goats and dairy cattle were susceptible to HPAI H5 infection wasn't the first such `Aha!' moment with unexpected influenza hosts.  A little over 20 years ago, most researchers believed cats and dogs weren't susceptible to influenza A viruses. 

That is, until spillovers occurred in both species (equine H3N8 in dogs and avian H5N1 in cats) in 2003-2004 (see A Dog & Cat Flu Review).  A few years later (2007), an Avian H3N2 virus spilled over into dogs in Korea, and has since spread globally, arriving in the United States in 2015.

In 2017 the CDC added Canine H3N2 to their IRAT List of zoonotic influenza viruses with pandemic potential, albeit with relatively low (3.7) Emergence and Impact Scores. 

H3N2: [A/canine/Illinois/12191/2015]

The H3N2 canine influenza virus is an avian flu virus that adapted to infect dogs. This virus is different from human seasonal H3N2 viruses. Canine influenza A H3N2 virus was first detected in dogs in South Korea in 2007 and has since been reported in China and Thailand. It was first detected in dogs in the United States in April 2015. H3N2 canine influenza has reportedly infected some cats as well as dogs. There have been no reports of human cases.

But Canine H3N2 continues to evolve (along with both Canine H3N8 and a recently discovered Canine H3N6 virus). Of the three, however, canine H3N2 appears to be making the most progress (see here, here, and here). 

Just over a month ago, we looked at Frontiers Vet. Sci: Genetic Characterization of an H3N2 Canine Influenza Virus Strain in China in 2023—Acquisition of Novel Human-like Amino Acid Substitutions, which warned of additional evolutionary changes:

CIV-CC23 has acquired 3 novel human-like amino acid substitutions compared to the preceding H3N2 CIV strains. This findings suggest that H3N2 CIV evolves over time, and if it accumulates a sufficient number of human-like amino acid substitutions, it may acquire the ability to efficiently propagate in humans.

Chinese scientists over the past decade have visibly increased their scrutiny of novel H3 viruses, as they are commonly observed in wild birds and poultry, and are increasingly spilling over into mammals (see EID Journal: Evolution of Avian Influenza Virus (H3) with Spillover into Humans, China).

All of which brings us to a new study from researchers at the Guangdong Provincial Pet Engineering Technology Research Center, which used serial passaging experiments (in murine lungs), to generate a more pathogenic and mammalian adapted virus

We've looked at serial passage experiments many times. The concept (see graphic below) is simple.
First, you inoculate a naive host with a strain of a virus, let it replicate a while, then take the virus from the first host and inoculate a second, and then repeat the process five, ten, fifteen times or more.  Often, assuming there are no insurmountable species barriers, adaptive mutations will appear.  

This is the laboratory approximation of what can happen when a novel virus is introduced to a high density population of (often farmed) animals (e.g. mink, swine, poultry, etc.). 

In today's study, researchers report significant mutations appeared in the Canine H3N2 virus after only 18 passages through laboratory mice, including the emergence of PB2-627K, which is associated in enhanced replication and pathogenicity in mammals. 

First the link, Abstract, and some excerpts from the study.  Follow the link to read it in its entirety.  I'll have a bit more after the break. 

Synergistic effects of PA (S184N) and PB2 (E627K) mutations on the increased pathogenicity of H3N2 canine influenza virus infections in mice and dogs

Authors: Xiangyu Xiao , Xinrui Wang, Fengpei Xu, Yanting Liang, Yi Luo, Shoujun Li , Pei Zhou 

https://doi.org/10.1128/jvi.01984-24

ABSTRACT

As companion animals, dogs are susceptible to various subtypes of influenza A virus (IAV), with the H3N2 and H3N8 subtypes of canine influenza virus (CIV) stably circulating among canines. Compared to the H3N8 CIV, the H3N2 CIV is more widely prevalent in canine populations and demonstrates increased adaptability to mammals, potentially facilitating cross-species transmission. Therefore, a comprehensive elucidation of the mechanisms underlying H3N2 CIV adaptation to mammals is imperative.

In this study, we serially passaged the GD14-WT strain in murine lungs, successfully establishing a lethal H3N2 CIV infection model. From this model, we isolated the lethal strain GD14-MA and identified the key lethal mutations PA(S184N) and PB2(E627K). 

Moreover, the GD14-ma[PA(S184N)+PB2(E627K)] strain exhibited markedly enhanced pathogenicity in dogs. Viral titers in lung tissues from infected dogs and mice showed that GD14-ma[PA(S184N)+PB2(E627K)] does not increase its pathogenicity to mice and dogs by upregulating viral titers compared to the GD14-WT strain. 

Notably, sequence alignments across all H3N2 IAVs showed an increasing prevalence of the PA (S184N) and PB2 (E627K) mutations from avian to human hosts. Finally, single-cell RNA sequencing of infected mouse lung tissues showed that GD14-ma[PA(S184N)+PB2(E627K)] effectively evaded host antiviral responses, inducing a robust inflammatory reaction. Considering the recognized role of the PB2 (E627K) mutation in the mammalian adaptation of IAVs, our findings underscore the importance of ongoing surveillance for the PA (S184N) mutation in H3N2 IAVs.

IMPORTANCE

Since the 21st century, zoonotic viruses have frequently crossed species barriers, posing significant global public health challenges. Dogs are susceptible to various influenza A viruses (IAVs), particularly the H3N2 canine influenza virus (CIV), which has stably circulated and evolved to enhance its adaptability to mammals, including an increased affinity for the human-like SAα2,6-Gal receptor, posing a potential public health threat. Here, we simulated H3N2 CIV adaptation in mice, revealed that the synergistic PA(S184N) and PB2(E627K) mutations augment H3N2 CIV pathogenicity in dogs and mice, and elucidated the underlying mechanisms at the single-cell level. Our study provides molecular evidence for adapting the H3N2 CIV to mammals and underscores the importance of vigilant monitoring of genetic variations in H3N2 CIV.

(SNIP)

DISCUSSION

In this study, we successfully established a lethal mouse model for H3N2 CIV and isolated a lethal mouse strain, designated as GD14-MA. Employing reverse genetics, we identified the PA (S184N) and PB2 (E627K) mutations as critical factors contributing to lethality in mice. Pathogenicity studies in dogs revealed that the GD14-ma[PA(S184N)+PB2(E627K)] strain exhibited significantly enhanced virulence compared to the GD14-WT strain. Single-cell RNA sequencing of infected mouse lung tissues showed that GD14-ma[PA(S184N)+PB2(E627K)] effectively evaded host antiviral responses, inducing a robust inflammatory reaction.

         (Continue . . . )


In April of 2020,  China's MOA reclassified dogs as `companion animals' rather than `livestock', although it is estimated that somewhere between 10 and 20 million dogs are farmed/abducted in China each year for fur and/or meat. 

But even in countries where such practices uncommon, animal shelters have proven excellent venues for extended chains of infection (e.g. Canine parvovirus, feline panleukopenia, canine and feline viral respiratory pathogens, etc. )

The avian H7N2 outbreak in cats across several NYC animals shelters over Christmas of 2016 spread to hundreds of felines, and spilled over into several workers (see J Infect Dis: Serological Evidence Of H7N2 Infection Among Animal Shelter Workers, NYC 2016).

Admittedly, the emergence of a human-adapted H3N2 virus is probably a long-shot. But the more opportunities we give it, the greater the chances of it eventually getting lucky. 

And since it isn't just canine H3N2 - but rather a large (and growing) array of novel flu viruses all with varying degrees of zoonotic potential (e.g. H5N1, H5N5, H5N6, H9N2, H10Nx, etc.) -  the smart money is on preparing now for what could be a very bumpy road ahead.   

Saturday, April 05, 2025

Mexico MOH Reports 1st Human H5N1 Case

 
Location of Durango State (pop 1.8 million)

Credit Wikipedia


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Last yesterday Mexico's MOH announced that country's first human HPAI H5N1 infection, in a 3-year old girl from (largely agricultural) Durango State, who is currently hospitalized in serious condition and who tested positive on April 1st.  

How the girl was infected is not known, although authorities are monitoring wild and synanthropic birds around the girl's home. SENASICA (MOA) reports no commercial outbreaks anywhere in the country.

Details on the genotype, and sequences, have not yet been published.   Hopefully they will provide some clue as to the source of this infection.  The Mexican Government Joint Communications press release follows, after which I'll have a bit more.  

Ministry of Health reports detection of the first human case of avian influenza A (H5N1)

Ministry of Health | April 04, 2025 | National
www.gob.mx/salud

The Ministry of Health reports the detection of the first human case of avian influenza A (H5N1) in Mexico.

The case occurred in a three-year-old girl, resident in Durango state. On April 1, the Institute of Epidemiological Diagnosis and Reference (InDRE) confirmed the result to Influenza A (H5N1). The patient initially received treatment with oseltamivir and is currently hospitalized in a third-level unit in the city of Torreón and her condition is reported serious.

Once the case was confirmed, the following actions were implemented immediately:
  • Notification to the World Health Organization, in accordance with the protocol established for it in the International Health Regulations.
Health
  • Health personnel from the Durango and Coahuila Health Services were trained in relation to the National guide for the preparation, prevention and response to an outbreak or event by zoonotic influenza in the animal-human interface.
  • Intentional search of cases with suspected viral respiratory disease began.
Semarnat - Conanp
  • Biological tours and samplings of wild and synanthropic birds were carried out in the area of influence surrounding the home of the positive case of avian influenza A (H5N1), and a permanent monitoring system was established for the timely detection of other similar cases in wildlife that inhabits the place.
Agriculture - Senasica
  • The Ministry of Agriculture and Rural Development, through the National Service of Health, Safety and Agri-Food Quality (Senasica), reported that so far no commercial production units affected by avian influenza A (H5N1) have been reported in any area of the country ; however, Senasica continues with active epidemiological surveillance actions, in order to timely identify any case that may arise, and if so, the corresponding national and international protocols will be implemented.
The Ministry of Health informs the population:

The WHO considers that the public health risk of this virus for the general population is low, so the consumption of well-cooked chicken or egg meat does not represent a danger to human health. Zoonotic influenza is a disease that can be transmitted from birds or other animals to humans. So far there is no evidence of sustained person-to-person transmission.

The Ministry of Health has a strategic reserve of 40 thousand oseltamivir treatments.

The population is recommended:
  • Wash hands frequently with soap and water or 70 percent alcohol-based solutions.
  • Use mouth covers in case of respiratory symptoms and ventilate spaces.
  • Cover your mouth and nose when coughing or sneezing.
  • Wash hands before handling cooked food and after handling raw food.
  • Properly cook chicken and egg meat (greater than 70 ° C)
  • Do not use the same utensils to handle raw and cooked food.
  • Avoid touching or approaching wild animals.
  • Do not handle or collect dead animals.
  • Do not touch sick or dead poultry or poultry for unknown reasons.
  • Wear gloves, mouth covers and protective clothing if you work on farms or slaughterhouses and have contact with birds or other animals, their products and waste.
  • Monitor possible data of disease or abnormal death in farm or backyard animals and notify the authorities immediately.
The Ministry of Health recommends requesting medical attention in case of fever, conjunctivitis (burning, itching, red eyes), cough, sore throat, runny nose, shortness of breath, headache, vomiting, diarrhea, bleeding or disturbances of consciousness, after contact with birds or other sick or dead animals.

X: @SSalud_mx

Facebook: facebook.com/SecretaryadeSaludMX

Instagram: ssalud_mx

YouTube: Mexico Health Secretariat


 As we've discussed (ad nauseum) over the years, detecting sporadic cases of H5 infection often involves a bit of luck, and it is likely that some (perhaps many) go unreported; even in countries with well-equipped and functioning public health systems.

First, an infected person must become sick enough to seek medical care, which - depending on the flu strain - may exclude > 90% of infections. They then must have access to modern medical care, an option not available to > 40% of the world's population, and then be lucky enough to be properly tested for novel influenza. 

In this case, no details are provided on the onset of the patient's illness, how many hospitals or clinics were visited, or how long it took to establish HPAI H5 as the cause. 

As we saw last June, when  Mexico announced the death of a 58-year-old man (who also suffered from serious comorbidities) who tested positive for the HPAI H5N2 virus, it can sometimes be a circuitous route.

The patient died in the hospital on April 24th, but H5N2 wasn't identified until two weeks later (May 8th). Notification of WHO/PAHO occurred on May 23rd, after another 2 week delay. No source of the virus was ever determined. 

A demonstration of how difficult picking up novel flu infections can be; even in a big city hospital, and during a time of increased awareness (see CDC HAN: Accelerated Subtyping of Influenza A in Hospitalized Patients).

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 2 to 3 months before community spread would become apparent.  In rural, or resource scarce regions of the world, presumably even longer. 


A reminder that no news isn't necessarily a sign that nothing is happening, and that anything we say about the threat from H5N1 must carry an implied asterisk. 

A disclaimer that says, ` * based on available, and likely incomplete, information. . .  '

Friday, April 04, 2025

EID Journal: Influenza A(H1N1)pdm09 Virus with Reduced Susceptibility to Baloxavir, Japan, 2024


Credit NIAID

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Although we spend a good deal of time looking at the risks from novel influenza viruses, seasonal flu kills hundreds of thousands every year around the globe.  Even with somewhere near a billion people getting the flu vaccine every year (which is only moderately effective), that leaves a lot of people at risk of serious illness or death. 

Influenza antivirals have been around for nearly 50 years (Amantadine was approved in the US in 1976), while oseltamivir (aka Tamiflu) was approved in 1999, and Baloxavir in 2018.  

But very much like we see with antibiotics and bacteria, antivirals are susceptible to resistance developing over time in targeted viruses. By the end of 2005 our oldest class of flu antivirals - M2 ion channel blockers (e.g. Amantadine, Rimantadine) - had become largely ineffective against seasonal H3N2, and in early 2006 were no longer recommended for use. 

Luckily we had oseltamivir -- an NAI (neuraminidase inhibitor) - to fall back on. It was, however, far more expensive and difficult to produce in quantity. While occasional instances of Oseltamivir resistance (1%) were reported prior to 2007, in nearly every case, it developed after a person was placed on the drug (i.e. `spontaneous mutations’).
Studies suggested that these resistant strains suffered a `fitness penalty', and were therefore unlikely to spread from human-to-human.
An optimistic view that lasted just over 2 years, as by 2008 seasonal H1N1 picked up `permissive mutations' (Cite) that enabled resistant seasonal H1N1 viruses to spread  rapidly around the globe. By the end of 2008, the CDC was forced to issue major new guidance for the use of antivirals (see CIDRAP article With H1N1 resistance, CDC changes advice on flu drugs).

This resistance was due primarily to the acquisition of an H275Y mutation, and had seasonal H1N1 not been supplanted by a (still NAI susceptible) pandemic swine H1N1 virus in the spring of 2009, oseltamivir might still be off the table. 

We've been watching ever since 2009 for any signs that the replacement pH1N1 virus has been gaining resistance to oseltamivir, but for the most part, the news has been pretty good.  And in 2018 a new (albeit more expensive) class of antivirals (Baloxavir) was added to our armamentarium. 

But recently we've seen some cracks in the veneer.  While 99% of wild-type seasonal flu viruses remain susceptible to Oseltamivir/Baloxavir, we follow reports of resistant strains with considerable interest. A few of many include:

Eurosurveillance: An outbreak of A(H1N1)pdm09 Exhibiting Cross-resistance to Oseltamivir & Peramivir in an Elementary School in Japan, Sept 2024

Viruses: Increase of Synergistic Secondary Antiviral Mutations in the Evolution of A(H1N1)pdm09 Influenza Virus Neuraminidases

EID Journal: Multicountry Spread of Influenza A(H1N1)pdm09 Viruses with Reduced Oseltamivir Inhibition, May 2023–February 2024

Eurosurveillance: A community Cluster of Influenza A(H3N2) Virus infection with Reduced Susceptibility to Baloxavir - Japan 2023

EID Journal: H-2-H Transmission Of A(H3N2) with Reduced Susceptibility to Baloxavir, Japan

This week we have a new dispatch, published in the CDC's EID Journal, that describes another instance of Baloxavir resistance in Japan (where the drug is mostly widely used).  While only one case is reported, it was in a child who had not been treated with the antiviral, and it was due to a previously unassociated mutation. 

I've posted the link, abstract, and some excerpts, but many will want to read the full dispatch.  I'll have a bit more after the break. 

Dispatch

Influenza A(H1N1)pdm09 Virus with Reduced Susceptibility to Baloxavir, Japan, 2024

Emi Takashita, Hiroko Morita, Shiho Nagata, Seiichiro Fujisaki, Hideka Miura, Tatsuya Ikeda, Kenichi Komabayashi, Mika Sasaki, Yohei Matoba, Tomoko Takahashi, Naomi Ogawa, Katsumi Mizuta, Sueshi Ito, Noriko Kishida, Kazuya Nakamura, Masayuki Shirakura, Shinji Watanabe, and Hideki Hasegawa

Abstract

Influenza A(H1N1)pdm09 virus carrying an I38N substitution was detected in an untreated teenager in Japan. The I38N mutant virus exhibited reduced susceptibility to baloxavir but remained susceptible to neuraminidase inhibitors and showed reduced growth capability. Monitoring antiviral drug susceptibility of influenza viruses is necessary to aid public health planning and clinical recommendations.

(SNIP)

The PA I38T substitution is the most frequent substitution and has the greatest effect on baloxavir susceptibility (5). Influenza A(H1N1)pdm09 (pH1N1) and A(H3N2) viruses with the PA I38T substitution isolated from baloxavir-treated patients show similar replication fitness and pathogenicity to wild-type isolates tested in hamsters and efficiently transmit between ferrets by respiratory droplets (6). 

We have monitored baloxavir susceptibility of seasonal influenza viruses in Japan since the 2017–18 season and reported human-to-human transmission of PA I38T mutant H3N2 viruses in children <10 years of age (7,8).

Researchers detected a PA I38N substitution in a pH1N1 virus isolated from a patient during a phase 3 clinical trial of baloxavir. That substitution conferred a 24-fold reduction in baloxavir susceptibility in recombinant A/WSN/33(H1N1) and a 10-fold reduction in recombinant A/Victoria/3/75(H3N2) and reduced growth capability in both viruses (3,9). However, its effect on pH1N1 virus has not been reported. 

During our 2023–24 surveillance, we detected a PA I38N mutant pH1N1 virus in a 14-year-old patient not treated with baloxavir. Here, we report the in vitro characterization of the PA I38N mutant pH1N1 virus.

Conclusions

In this study, we showed that the PA I38N mutant pH1N1 virus had reduced susceptibility to baloxavir but remained susceptible to NA inhibitors. Our results indicate that the PA I38N substitution in the pH1N1 virus contributed to a reduction in baloxavir susceptibility, but the reduction in susceptibility was less than that caused by the PA I38T substitution (3,9).

PA I38 is highly conserved in influenza A and B viruses (1). During October 2023–March 2024, medical institutions that serve ≈3.7 million persons in Japan received baloxavir to use for antiviral treatment. The PA I38N substitution may negatively affect the growth capability of the virus in vitro; however, our findings suggest possible transmission of the PA I38N mutant pH1N1 virus from another host harboring the mutant virus, which may have emerged under the selective pressure of baloxavir or as a result of a rare spontaneous mutation.

In Japan, influenza activity was low throughout the COVID-19 pandemic; the first influenza outbreak occurred in the 2022–23 season (13). The influenza outbreak in the 2023–24 season was larger than that of 2022–23 (Figure 1). Influenza pH1N1 virus activity peaked in November 2023 and then declined.

The PA I38N mutant pH1N1 virus in this study was detected in March 2024. By March, the pH1N1 outbreak was almost over, and no regional spread of the PA I38N mutant pH1N1 virus was observed.

We reported a community cluster of influenza A(H3N2) viruses with reduced susceptibility to baloxavir caused by a PA E199G substitution in Japan in February–March 2023 (13). In addition, researchers reported widespread community clusters of pH1N1 viruses with cross-resistance to oseltamivir and peramivir in Australia and Japan (14,15). Monitoring of antiviral drug susceptibility of influenza viruses is necessary to aid public health planning and clinical recommendations for antiviral drug use.

Dr. Takashita is a virologist with the National Institute of Infectious Diseases, Tokyo, Japan. Her research interests include antiviral drug susceptibilities of influenza viruses. 

 

While a loss of one (or both) of our main classes of antivirals would be a disaster for seasonal flu, it could have even greater impact during a pandemic.  For most people, a novel flu vaccine would only be available 6 months or more into an outbreak (see Referral: SCI AM - A Bird Flu Vaccine Might Come Too Late to Save Us from H5N1).

Although we've not seen any reports of H275Y in D1.1 samples collected in the United States, last November the CDC did report finding a far-less impactful mutation (NA-S247N) in 3 poultry workers from Washington State, which they stated may slightly reduce the virus's susceptibility to antivirals.

While other studies (conducted 2022-2024) have reported relatively little resistance in HPAI H5 viruses tested in the United States (see here, and here), the one thing you can count on with influenza viruses is they are always changing. 

Although I remain hopeful our antiviral stockpiles (mostly oseltamivir) can help `take the edge off' the opening months of the next pandemic, it is by no means assured.

To be most effective, antivirals ideally need to be given early (< 48 hours) into an infection. Stockpiles are finite, and even during moderately severe seasonal flu epidemics we've seen difficulties in rapidly dispensing these drugs (see 2022's CDC HAN #0482: Prioritizing Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir).

Any way you cut it, our first line of defense will - once again - rely heavily on NPIs (non-pharmaceutical interventions), like face masks, hand washing, ventilation, staying home while sick, and avoiding crowds.

Thursday, April 03, 2025

ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats

 

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Eighteen years ago - after H5N1 managed to spread rapidly out of Southeast Asia into Europe, Africa, and the Middle East for the first time - pandemic planning suddenly became a global priority. Nearly every nation (and every U.S. state and Federal Agency) crafted a pandemic plan, and table top exercises and drills were held regularly.

Some of these plans, and drills, were better conceived than others, of course. Far too many envisioned a `mild' pandemic, or focused on delivering unlikely-to-be-available vaccines (see No Such Thing As A `Planacea').

A few (out of hundreds of) examples include:

 When an influenza pandemic finally did emerge in 2009, it came from a swine H1N1 virus, and was relatively mild (except for those who died from it)

Critics of pandemic planning (which was, admittedly expensive and time consuming) insisted the age of severe pandemics was over (pointing to 3 successively weaker pandemics since 1918), and that modern medicine could more than cope with anything that might emerge. 

Having dodged a bullet, interest in pandemic planning, and drills, gradually declined and most existing pandemic plans gathered dust on the shelf.  While there were constant concerns raised that the `world was ill prepared' for a pandemic, little actual progress in preparing for the next pandemic occurred. 

Although once again from an unexpected source, COVID in 2020 reaffirmed that severe pandemics still happened, and that 10 years after the last pandemic, we were still woefully unprepared to deal with one (see The Most Predicted Global Crisis of the 21st Century).

A few, of many challenges included:
NIOSH Update: More Fake/Counterfeit N95 Masks Entering Market
JAMA: A Framework for Rationing Ventilators & ICU Beds During the COVID-19 Pandemic
Contemplating A Different `Standard of Care'

HHS ASPR-TRACIE: COVID-19 Crisis Standards of Care Resources

Rather than learn from these mistakes, five years after the start of the COVID pandemic we've dismantled much of our surveillance and reporting systems, in order to declare the emergency ended (see No News Is . . . Now Commonplace).

Worse, the international sharing of emerging disease information is - as near as I can tell - the most dysfunctional its been since I began this blog nearly 20 years ago (see The Wrong Pandemic Lessons Learned).  

While the world appears to be sleepwalking towards the next global health crisis, we've seen some movement.  Last summer both South Korea and Japan issued revised pandemic plans, and last November Hong Kong held a Coordinated Avian Flu Drill `Amazonite'.

A number of countries and regions have purchased (or arranged to purchase) limited quantities of H5N1 vaccine.

Over the past year the ECDC has been busy issuing guidance documents to its member nations.  Like with our own CDC - these are not mandates, only recommendations - and it is up to each individual public health entity to decide what to incorporate in their planning. 

While most of this recent surge in preparedness is likely inspired by the continued spread of H5N1, the reality is we could easily be blindsided (again) by something other than avian flu with the next pandemic. 

Just over a year ago (March 20th, 2024) we looked at the first part of this 2-part plan (see  ECDC Guidance: Public Health and Social Measures for Health Emergencies and Pandemics in the EU/EEA), which was published less than a week before the announcement of H5N1 in American livestock. 

I've only included the link and executive summary of this 49-page installment.  Follow the link to read it in its entirety.  I'll have a bit more after you return.

Public health guidance
2 Apr 2025

This document aims to provide public health authorities in European Union and European Economic Area (EU/EEA) countries with guidance for improved preparedness planning taking the lessons that have been identified through various activities in the context of recent public health crises (e.g. COVID-19 pandemic, mpox multi-country outbreak 2022–23) and translating them to concrete advice.

Executive summary


This document, together with the ECDC recommendations on the implementation of public health and social measures (PHSMs) for health emergencies and pandemics published in 2024, form a package of concrete recommendations for preparedness planning for the EU/EEA countries.

Lessons learned primarily from the response to the COVID-19 pandemic, but also from the response to the multicountry mpox outbreak in 2022–23, were collected through various activities from Member States, the European Commission, the World Health Organization (WHO) and the WHO Regional Office from Europe. We have then presented these in the form of specific recommendations for planners within each phase of the continuous cycle of preparedness (Anticipation, Response and Recovery), following a prototype structure of a preparedness and response plan. In each section, we have presented a relevant example from a Member State or international organisation to illustrate their practice or attempt to implement lessons after COVID-19 or the mpox outbreak. These examples were identified either through literature review or communication with representatives of the countries within ECDC’s network for Preparedness and Response.

Annex 1 includes an overview of the main lessons for the public health sector and Annex 2 includes a compiled catalogue of documents, tools and other resources for public health preparedness planning.

Download

Over the past year, PAHO (Pan American Health Organization) has repeatedly urged its member nations to proactively prepare to deal with a potential influenza pandemic. While H5N1 is assumed, it could certainly be from another coronavirus (or something entirely unexpected).
Just over 4 months ago, in A Personal Pre-Pandemic Plan, I wrote about the practical things you and your family can do now to prepare for a possible pandemic in the months or years ahead.

While I still hope we can avoid (or at least delay) that eventuality, the simple truth is, preparedness is always easier before the next emergency starts. 

And the clock is always ticking.

Wednesday, April 02, 2025

NOAA/NWS SPC: Another `High Risk' Severe Storm Day


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While we sometimes can go a year or longer without seeing a `High Risk' forecast from the Storm Prediction Center (SPC), today they've issued their second in just over 2 weeks (see previous).  Although the High Risk region is relatively small, the moderate and enhanced risk areas for today are substantial.  


Somewhere between 1000 and 1200 tornadoes are reported each year in the U.S., although that number has been going up in recent years, possibly because of better detection methods. Roughly half occur between March and May, making the spring - particularly in the South and Central states - prime time for these storms. 

 During the summer, the focus for severe weather moves away from the south (Dixie Alley), and into the mid west (aka `Tornado Alley')


For most Americans, a severe weather event is their biggest regional disaster threat; hurricanes, tornado outbreaks, blizzards, Derechos, and ice storms affect millions of people every year. Having a good (and well rehearsed) family emergency plan is essential for any disaster.

It is important for your plan to include emergency meeting places, out-of-state contacts, and individual wallet information cards - before you need it (see #NatlPrep : Create A Family Communications Plan).

Together with adequate emergency supplies, a solid first aid kit, and an emergency battery operated NWS Weather Radio, these steps will go a long ways to protecting you, and your family, from a wide variety of potential disasters.
Because it's not a matter of `if' another disaster will strike . .  . 

It's only a matter of wherewhen, and how bad. 


Media Reports Of Fatal H5N1 Case in Child In Andhra Pradesh, India

 d

#18,400

Overnight the India press has lit up with multiple reports (hat tip FluTrackers and @vinodscaria) on the death - two weeks ago - of a 2-year-old child from H5N1 in Andhra Pradesh. A quick tour of the local AP MOH website and twitter accounthowever, turns up no confirmation of the story.

The Indian press, admittedly, has a history of `jumping the gun' when it comes to reporting H5N1 cases (see 2007's India Admits 8 Boys to Hospital With `Bird Flu' Symptoms) - while the government is often slow to confirm - but this one sounds plausible. 

While we've seen many false alarms, there are precedents.  

In the summer of 2021, after several days of unconfirmed newspaper reports, we saw India: MOH Statement On Investigation Of 1st Human H5 Avian Flu Infection. The patient, an 11-year-old boy with acute myeloid leukemia, was infected with the clade 2.3.2.1a virus, and died after a week in the hospital.

An in-depth interview with family members indicated that the patient often frequented a family-owned poultry business and may have been exposed to birds with undetected infection, although no infected domestic or wild avian sources or any environmental contamination had been reported in or around the residence of the child.
Last May Australia reported their first H5N1 case (see Australia: Victoria Reports Imported H5N1 Case (ex India)) in a 2 year-old child who recently traveled from India. The virus was originally identified as  clade 2.3.2.1a virus, which is known to circulate in poultry in Bangladesh and India.

Last December the CDC's EID Journal published a dispatch which revealed this older clade was actually a new genotype, with contributions from newer clade 2.3.4.4b viruses.

And given the number of confirmed human cases in neighboring Bangladesh (n=8) and Pakistan (n=3) over the years - which are likely undercounts - it seems likely that some actual cases in India have been missed.  

According to the following English Language report from the Deccan Chronical (seAP Reports First Bird Flu Death as 2-Year-Old Succumbs to H5N1) the child was admitted to the hospital on March 4th after falling ill after consuming a small piece of raw chicken. 

The child died 12 days later. Swab samples initially tested positive for Influenza A, but were later confirmed to be H5N1 by AIIMS and the National Institute of Virology (NIV), in Pune.  So far, we have no indication of the clade. 

It is worth noting that India has been reporting as surge in H5N1 in recent months, in poultry, wild birds, and even cats.   Last week Andhra Pradesh reported 8 outbreaks (see WOAH report) in poultry, although none appear to be near to where this child was infected.  

Hopefully we'll get some better information in the next few days. 

Stay tuned.