WHO: Mpox: Recombinant Virus With Genomic Elements of Clades Ib and IIb - Global

 
Mpox Multi-country external situation report no. 62 

#19,055

Although details were scant, on December 8th, 2025 the UKHSA Identified a New Recombinant Strain of Mpox Virus in a traveler recently returning from an (undisclosed) country in South-East Asia.

For the very first time, genomic sequencing showed this mpox genome contained elements of clade Ib and IIb mpox.  

While a new development, we've seen warnings for more than a decade on the potential for Mpox to mutate (see 2014's Genomic Variability of Monkeypox Virus among Humans, Democratic Republic of the Congo).

Two days later we looked at academic reactions to this announcement (see  The UK Recombinant Mpox Case: Reactions from the UK Science Media Centre), which included the following:

Dr Boghuma Titanji, Assistant Professor of Medicine, Emory University, said:

“The identification of a recombinant mpox strain containing elements of both Clade I and Clade II is precisely what experts in the field feared would happen if the virus continued to spread globally without a decisive response to stop it.

Orthopoxviruses are well known for their ability to exchange portions of their genome and recombine to generate new variants, this is a core mechanism of their evolution. The key concern now is whether events like this will alter the virus’s transmissibility or virulence. There are also implications for how well existing testing platforms can identify these emerging recombinant strains. 

The more mpox circulation we permit, the more opportunities the virus has to recombine and adapt, further entrenching mpox virus as a human pathogen that is not going away.”

Since then, a second (albeit, earlier) case has been identified, which was reported by India in a resident with recent travel to another (undisclosed) country on the Arabian Peninsula.  

Despite originating from two different regions of the world, Whole‑genome sequencing (WGS) showed >99.9% similarity between the two viruses.

While routine PCR tests can identify these cases as Mpox, it requires full WSG to identify correctly flag them as being a `mixed-strain' virus; tests that are generally only run in a minority of cases, and mostly by high-income nations.  

 Leaving us with an uncomfortably large knowledge gap at this point. 

I've reproduced several excerpts from the WHO DON report below. Follow the link to read it in its entirety.  I'll have a bit more after the break.

Mpox: recombinant virus with genomic elements of clades Ib and IIb - Global
14 February 2026

Situation at a glance

Recombination of monkeypox virus (MPXV) strains has been documented in recent months, with two cases of a recombinant strain comprising clade Ib and IIb MPXV reported. Recombination is a known natural process that can occur when two related viruses infecting the same individual exchange genetic material, producing a new virus.

The first case was detected in the United Kingdom of Great Britain and Northern Ireland (hereafter “United Kingdom”), with travel history to a country in South-East Asia, and the second in India, with travel history to a country in the Arabian Peninsula. 

Detailed analysis of the virus genomes shows that the two individuals fell ill several weeks apart with the same recombinant strain, suggesting that there may be further cases than are currently reported. Both cases had similar clinical presentation to that observed for other clades. Neither patient experienced severe outcomes. Contact tracing for both cases in the reporting countries has been completed; no secondary cases were detected. 

Based on available information, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.

Description of the situation

In December 2025, the United Kingdom detected the first reported case of a clade Ib/IIb MPXV recombinant strain.​5​ After classification of this case and posting in a public database as a novel MPXV recombinant strain, a case of mpox detected in India in September 2025 was retrospectively reclassified as a closely-related recombinant strain based on sequencing data. To date, these are the only known cases of this recombinant virus.

Case detected in the United Kingdom of Great Britain and Northern Ireland

The case was identified following testing of a vesicular swab from a traveler who had returned from a country in the Asia Pacific region in October 2025. During laboratory confirmation, the virus was initially typed as clade Ib MPXV by qPCR. Subsequent whole genome sequencing revealed that the MPXV strain identified was distinct from other known clade Ib MPXV strains with phylogenetic analysis indicating that the genome had regions similar to both clade Ib and clade IIb MPXV reference sequences, suggesting that it is an inter-clade recombinant. 

To confirm this unusual finding, sequencing was repeated on the original extract from the primary sample, a fresh extract from the same primary sample, a second swab collected from the patient at the same time, and a cultured isolate derived from the initial swab. This repeat sequencing yielded identical viral genome sequences from the two clinical swabs and the cultured isolate, supporting the initial findings of a new recombinant strain, and showing that it can replicate and presents potential for onward transmission. 

This strain is a recombinant MPXV, containing genetic elements from both clade Ib and clade IIb MPXV. A small number of contacts were identified and followed up in the United Kingdom; none developed any clinical features of mpox. Health worker contacts had worn full personal protective equipment (PPE) during provision of medical care to the patient. The authorities of the United Kingdom continue to investigate the significance of this recombinant MPXV strain through phenotypic characterization studies.

Case detected in India

On 13 January 2026, the National IHR Focal Point (NFP) of India notified WHO of a mpox case with an inter‑clade recombinant MPXV which was, upon whole-genome sequencing, found to have genomic elements of clades Ib and IIb MPXV.

The recombinant virus was found in samples from a man with mpox who had presented for care in September 2025. The patient had reported recent travel from a country in the Arabian Peninsula, where he resides as an overseas worker.

He developed symptoms on 1 September 2025, while still abroad. After his return to India, real‑time PCR confirmed MPXV infection on 11 September 2025. Clade differentiation PCR performed on 15 September 2025 initially identified this virus as clade II MPXV. Initial genomic sequencing analysis suggested features consistent with clade IIb MPXV. However, following the update of the global Nextclade database on 16 December 2025, which included the recombinant clade Ib/IIb MPXV strain reported by the United Kingdom, the virus from the patient in India was reclassified as belonging to the recombinant strain. Recombination analysis demonstrated mosaic patterns containing genomic regions derived from both parent clades.

Following the initial diagnosis, the patient was hospitalized, did not experience any medical complications, and fully recovered, testing negative for MPXV on 29 September 2025. The case reported no close contacts in India, and no known secondary cases were identified following this introduction of the recombinant clade Ib/IIb MPXV in India.

Full or near‑full genome retrieval (>99%) from both the sample and a sample-derived virus isolate enabled phylogenetic analysis showing >99.9% similarity to the recombinant strain detected in the United Kingdom. A total of 34 recombinant tracts were observed in the sequence reported by India, while 28 recombinant tracts were observed in the sequence reported by the United Kingdom; 16 recombinant tracts were common to both strains. This case in India therefore represents the earliest known detection of this recombinant strain globally, having preceded the event reported in the United Kingdom.

Consistent with the case reported in the United Kingdom, clinical presentation was consistent with cases due to clade I or clade II MPXV (non-recombinant MPXV) infection.

(SNIP)

WHO risk assessment

Mpox outbreaks must be considered in their local context, with meaningful involvement of affected communities, to ensure an in-depth understanding of the epidemiology, modes of transmission, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control.

Multiple strains of MPXV are circulating through interconnected sexual networks across many countries and settings. Co-infection with different strains, that could lead to emergence of recombinant virus strains, while rare, can be expected. The case in India was infected with the same recombinant Ib/IIb MPXV strain detected in the United Kingdom. Symptom onset in the case reported in India occurred more than two months earlier than the case in the United Kingdom, and the great degree of similarity between their sequences suggests a common evolutionary history. This information has two important implications: i) the origin of the recombinant strain remains unknown; and ii) transmission of this recombinant virus already involves at least four countries in three WHO regions, and is therefore likely to be more widespread than currently documented.

For the cases in the United Kingdom and India, the initial clade differentiation PCR results indicated clade Ib and IIb MPXV, respectively. Thus, clade differentiation PCR assays alone may not reliably identify recombinant MPXV strains, and genomic sequencing is likely to be required for their detection.

Due to the small number of cases found to date, conclusions about transmissibility or clinical characterization of mpox due to recombinant strains would be premature, and it remains essential to maintain vigilance regarding this development.

In light of the limited information available on this recombinant MPXV strain, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.

All countries should remain alert to the possibility of MPXV genetic recombination. The public health risk posed by any newly detected recombinant strain should be assessed on a case-by-case basis, considering available epidemiological, clinical and genomic information.

       (Continue . . . ) 

Increasingly over the past few years we've entered the age of the `redacted' epidemiological report (see last December's ECDC Epidemiological Update: 2 Imported MERS-CoV Cases In France), where key details are sometimes omitted in order to encourage countries to report without fear of stigma or economic/political fallout.

While disappointing, it is probably safe to assume this recombinant has already spread beyond the borders of the two undisclosed countries. 

With only limited data, the WHO appears to be taking a conservative, but cautious, approach. For now, their risk assessment remains unchanged, but they urge member nations to expand WGS in order to detect hidden spread of this emerging strain. 

Sound advice, since this is unlikely to be the last evolutionary leap that Mpox makes. 

Cambodia Reports 1st H5N1 Case of 2026

 

#19,054

Just three days before the Lunar New Year, Cambodia's MOH has announced the first HPAI H5 human infection since last November. This is the 36th case reported since February of 2023, and unlike the milder H5N1 cases reported in the United States, > 40% of those have died. 

Cambodia's recent cases are due to a new reassortment of an older clade of the H5N1 virus (recently renamed 2.3.2.1e) - which appears to be spreading rapidly through both wild birds and local poultry.

While we are usually informed by Cambodian officials  as soon as a diagnosis is made, this afternoon the Cambodian MOH Facebook page  announced their latest (now fully recovered) case, that of a 30-year-old man from Kampot Province.

It isn't clear exactly when this person was infected, or how long he was hospitalized.  

I've provide a translation of the announcement below.  

(Translation)

Kingdom of Cambodia

Ministry of Health

Press Release

A case of bird flu in a 30-year-old man

The Ministry of Health of the Kingdom of Cambodia would like to inform the public: There is 1 case of bird flu in a 30-year-old man who was confirmed positive for the H5N1 avian influenza virus by the National Institute of Public Health. The patient resides in Meanrith village, Kandol commune, Teuk Chhou district, Kampot province and has symptoms of fever, cough and abdominal pain.

After receiving careful care from the medical team, the patient recovered and returned home on February 14, 2026. Investigations revealed that there was a dead chicken in the patient's house and it was cooked 3 days before the patient started feeling sick.

The emergency response team of the national and sub-national ministries of health has been collaborating with the teams of the provincial agriculture departments and local authorities at all levels to actively investigate the outbreak of bird flu and respond according to technical methods and protocols, find the source of transmission in both animals and humans, and search for suspected cases and contacts to prevent further transmission in the community, as well as distribute Tamiflu to close contacts and conduct health education campaigns among residents in the affected villages.

The Ministry of Health would like to remind all citizens to always pay attention to and be vigilant about bird flu because H5N1 bird flu continues to threaten the health of our citizens. We would also like to inform you that if you have a fever, cough, runny nose, or difficulty breathing and have a history of contact with sick or dead chickens or ducks within 14 days before the onset of symptoms, do not go to gatherings or crowded places and seek consultation and examination and treatment at the nearest health center or hospital immediately. Avoid delaying this, which puts you at high risk of eventual death.

How it is transmitted: H5N1 bird flu is a type of flu that is usually spread from sick birds to other birds, but it can sometimes be spread from birds to humans through close contact with sick or dead birds. Bird flu in humans is a serious illness that requires prompt hospital treatment. Although it is not easily transmitted from person to person, if it mutates, it can be contagious, just like seasonal flu.

(Continue . . . )

While we tend to focus on clade 2.3.4.4b H5N1 viruses, these case remind us that there are several other subclades of HPAI H5 circulating around the globe - with new ones emerging at an increasing rate - each on their own evolutionary trajectory.

FluView Week 5: Influenza Remains Elevated & Slight Uptick In Antiviral Resistance

 

CDC FluView Report Week 5

#19,053

For the 9th consecutive week, influenza remains above the National Baseline, and with the recent rise in influenza B cases, has spiked upwards again slightly (see FluView chart above). 

While obviously the biggest story, buried deep in the narrative we also see a small increase (see chart below) in viruses showing signs of (mostly) moderate antiviral resistance. 

Although the numbers remain reassuringly low, they are worth noting, as we've been following reports of creeping antiviral resistance around the globe for the past 2 years, primarily in seasonal H1N1 (and occasionally HPAI H5). 

This is in contrast to the week 53 FluView report which showed zero resistance (among 193 viruses tested) between Sept 28th and the end of December. 

Since then an additional 233 H1N1 viruses have been tested, and 10 (4.29%) have shown varying levels of oseltamivir resistance.  The summary from this week's FluView reads:

Three A(H1N1)pdm09 viruses had NA-H275Y amino acid substitution conferring highly reduced inhibition by oseltamivir and peramivir.

Seven A(H1N1)pdm09 viruses had amino acid substitutions NA-I223V and NA-S247N and showed reduced inhibition by oseltamivir.

Two B viruses had amino acid substitution NA- M464T and showed reduced inhibition by peramivir.

High levels of resistance to the adamantanes (amantadine and rimantadine) persist among influenza A(H1N1)pdm09 and influenza A(H3N2) viruses (the adamantanes are not effective against influenza B viruses). Therefore, use of these antivirals for treatment and prevention of influenza A virus infection is not recommended and data from adamantane resistance testing are not presented.

While none of these numbers are alarming, they are elevated, and they come on the heels of increasing reports of growing resistance being reported around the globe. 

A brief recap:

In March of 2024 we saw a worrisome report in The Lancet - Global Emergence of Neuraminidase Inhibitor-Resistant Influenza A(H1N1)pdm09 Viruses with I223V and S247N Mutations - which reported a much higher incidence of oseltamivir resistance among samples tested in Hong Kong in 2023.

Unlike the near total collapse of oseltamivir effectiveness in 2008 - which was due toan H275Y mutation in the NA - this was due to I223V and S247N, and was not as profound of a loss in effectiveness. 

Since then we've seen a number of studies on the rise of NAI resistance around the globe, including 2024's Viruses: Increase of Synergistic Secondary Antiviral Mutations in the Evolution of A(H1N1)pdm09 Influenza Virus Neuraminidases, where the authors warned:

It seems likely that the viruses have reached the next stage in the evolution of prerequisite viruses that enable the emergence and spread of stable lineages of resistant viruses. . . 

While most of these increases have been modest, just over 4 months ago Taiwan's CDC reported that 6.5% of the H1N1 viruses they have characterized in 2025 have shown signs of oseltamivir resistance.

And China's Influenza Surveillance Weekly Report has been reporting roughly  4%  (range 3.8%-4.2%) of H1N1 viruses tested have shown signs of resistance since last summer (translation of most recent report follows).

The National Influenza Center conducted drug resistance analysis on some influenza virus strains collected since March 31 , 2025. The results showed that: 3.9% ( 32/829 ) of the A(H1N1)pdm09 subtype influenza virus strains showed reduced or highly reduced sensitivity to neuraminidase inhibitors.

Many of these reports have been vague, and have not specified the degree of reduced susceptibility to oseltamivir, making their clinical significance difficult to ascertain. 

Somewhat more concerning, last December, in Eurosurveillance: Expansion of influenza A(H1N1)pdm09 NA:S247N Viruses with Reduced Susceptibility to Oseltamivir, Catalonia, Spain, and in Europe, July to October 2025, we looked at the abrupt rise in resistance in Catalonia, Spain over the summer and fall.

Based on limited testing, over a 3 month period 45% of H1N1 viruses showed signs of reduced susceptibility to oseltamivir, with 2 weeks coming in  at 100%. 

For now, these resistance reports have turned up primarily in seasonal H1N1, although we've seen some scattered reports in HPAI H5 (Emerg. Microbes & Inf: Oseltamivir Resistant H5N1 (Genotype D1.1) found On 8 Canadian Poultry Farms).

The CDC also reported finding the above mentioned NA-S247N mutation in 3 HPAI H5 infected poultry workers from Washington State, which they stated may slightly reduce the virus's susceptibility to antivirals.

And eleven months ago St. Jude Researchers warned: Current Antivirals Likely Less Effective Against Severe Infection Caused by Bird Flu in Cows’ Milk.

Although there are alternatives to oseltamivir for the treatment of influenza A (e.g. Baloxavir) - with the exception of Japan - oseltamivir remains the most widely available (and affordable) antiviral stockpiled today. 

Twice in the past two decades we've lost our primary influenza antiviral due to rising resistance; Amantadine in 2006 and (temporarily) Oseltamivir in 2008 (note: Oseltamivir was unexpectedly resurrected with the arrival of a susceptible pandemic H1N1 strain in April 2009). 

While we are only seeing sporadic hints of increased resistance - and this trend could always fizzle - the reality is most antibiotics, antifungals, and antivirals enjoy a limited lifespan.

Nature eventually figures out a way around them, making it important that we take note of findings like those listed above, and plan accordingly.  

Several States Warn On Contact With Wild Birds/Mammals

#19,052

Two months ago, in Declining Mammalian Spillover Submissions To USDA Over Past 8 Months, we looked at the recent drop in reported spillovers of HPAI H5 to mammalian wildlife, despite increased detections in wild birds.

The above graph is based on collection dates, not confirmation dates (which may come months later). During the 1st 3 months of 2025, the USDA averaged 43 positive submission per month.

Over the past 11 months, the USDA has averaged 10 positive submissions per month (range 1-17), a decline of over 75%.

Reporting by states remains uneven, with 9 states (Alabama, Arkansas, Hawaii, Maryland, Mississippi, New Hampshire, South Carolina, Tennessee, and West Virginia) yet to submit a case, while New Mexico (n=73) and Colorado (n=77) top the list.

These disparities may come down to differences in climate and terrain (swamps vs. forests vs. deserts), varying activity by migratory flyways, and the fact that infected wildlife quite often die in remote, difficult to access places where their carcasses are quickly scavenged by other animals, making them unlikely to be discovered or tested. 

But it also possible that some states are simply more proactive in investigating, and reporting suspected cases, than others.

While the USDA now lists 51 unique mammalian species of wildlife (excluding livestock) confirmed with HPAI H5N1 in the United States, the bulk of reports come from 10 species:

Although domestic cats lead the list, the number of reports has declined sharply over the past 12 months (see chart below).  This may be due, in part, to  changes ordered by the FDA in the manufacturing of pet food.

All of these numbers are presumed to represent a small fraction of the actual number of spillovers, as limited seroprevalence studies have found antibodies in a number of wildlife species (see Viruses: The Seroprevalence of Influenza A Virus Infections in Polish Cats During a Feline H5N1 Influenza Outbreak in 2023).

Despite these declining numbers a number of states have issued fresh warnings to the public over the past week on avoiding contact with wild birds and/or potentially infected mammalian wildlife. 

While it has yet to be posted on a state website, yesterday media outlets in Colorado were reporting that a Skunk tests positive for Avian Influenza in Pueblo County, and warning of the risks of avian flu to both humans and pets. 

Yesterday, the state of Arkansas released the following:

State Agencies Urge Public to Avoid Contact With Wild Birds Due to Avian Influenza
Posted on February 12, 2026

LITTLE ROCK, AR –Arkansas agriculture and health agencies are urging the public to avoid contact with wild birds, especially birds that appear sick or are found dead, due to detections of highly pathogenic avian influenza (HPAI) in Arkansas.

Testing has confirmed HPAI in wild birds and in backyard and commercial flocks statewide. Wild birds, particularly migrating waterfowl, are the primary source of virus spread to domestic poultry and other birds.

Agencies warn that handling sick or dead wild birds, or bringing them into homes, barns, or vehicles, can spread the virus and pose risks to people, pets, and domestic flocks.

Key Guidance for the Public

• Do not touch, move, or attempt to rescue wild birds that appear sick or are found dead.
• Do not bring wild birds into your home, vehicle, barn, or coop for any reason.
• Keep your distance from wild birds, especially waterfowl, that appear lethargic or disoriented.
• Keep pets away from wild birds and carcasses.
• Avoid areas where large numbers of wild birds are congregating when possible.
• Hunters and bird watchers should take precautions, including wearing gloves when handling birds or equipment, washing hands thoroughly after contact, and avoiding consumption of birds that appear sick or were found dead.

Who to Call

Wild bird activity: Report concentrations of sick or dead wild birds, or other unusual activity, to the Arkansas Game and Fish Commission at agfc.com/education/avian-influenza/.
Backyard or commercial poultry: Report suspected or confirmed poultry illness or deaths to the Arkansas Department of Agriculture’s sick bird hotline at (501) 823-1746.

Biosecurity for Bird Owners

Poultrygrowers should follow basic biosecurity practices to reduce the risk of HPAI. These include washing hands and footwear before and after contact with birds, restricting visitors to poultry areas, limiting exposure to wild birds, and quarantining new birds for at least two weeks before introducing them to existing flocks.

Human Health Precautions

Although human cases of HPAI are rare, people exposed to infected birds or contaminated environments should wash hands thoroughly with soap and water and wear appropriate protective equipment if handling birds is necessary. Anyone who develops flu-like symptoms after exposure to birds or other animals potentially infected with HPAI should contact the Arkansas Department of Health (ADH) Zoonotic Disease Section at (501) 280-4136 or adh.zoonotic@arkansas.gov. ADH can coordinate appropriate testing and, if indicated, post-exposure antiviral treatment. To help prevent unnecessary exposure to others and ensure proper evaluation, individuals are encouraged to contact ADH before seeking in-person medical care.

And this week, from Texas a warning from the Amarillo health authorities (see 12 birds test 'non-negative' for bird flu after hundreds of dead birds found in Amarillo), and this reminder from the Houston Health Department.

The public remains largely apathetic to the threat of HPAI (see Two Surveys (UK & U.S.) Illustrating The Public's Lack of Concern Over Avian Flu), and many governments appear more than happy to downplay the threat for political or economic reasons.

While the decline in reported spillovers to the USDA may turn out to be a good sign, a lack of evidence is not evidence of lack. 

Given that many other signs suggest we are at or near the peak of the fall/winter avian flu season, a modicum of caution around wild birds, poultry, and other wildlife seems more than prudent. 

South Korea: Joint Government-Wide Response to Livestock Infectious Diseases during the Lunar New Year Holiday

 

#19,051

South Korea is no stranger to dealing with outbreaks of Avian Influenza, African Swine Fever (ASF), and Foot & Mouth Disease (FMD), but this year their messaging and response have taken on a more urgent tone. 

Even before the fall avian flu season began, last September South Korea Conducted A 19-day, Nationwide, Mock-Training Exercise to Prepare for Zoonotic Influenza, immediately followed by South Korea: MAFRA Conducts A Preemptive Virtual Quarantine Exercise (CPX). 

In November, South Korea MAFRA Ordered Strengthened Quarantine Measures After 3 HPAI H5 Subtypes (H5N1, H5N6, H5N9) Detected In Wild Birds, and issued stern warnings to farms over lapses in biosecurity South Korea: MAFRA Identifies Biosecurity Breaches On HPAI Infected Poultry Farms).

By the end of December, MAFRA Reported Increased Infectivity & Pathogenicity of This Year's Avian Flu Strains, and in early January announced Special Quarantine Measures Implemented for one Month to Prevent the Spread of HPAI,

By the end of January, however, MAFRA was also reporting an uptick in ASF outbreaks, and an outbreak of FMD; all just two weeks before the biggest holiday travel period for Asian countries (see South Korea: MAFRA Warns on Risks From HPAI, ASF & FMD During Upcoming Lunar New Year).

While we've seen worse avian flu outbreaks in South Korea in past years, and even concurrent outbreaks with ASF and FMD, this year's response continues to be unusually robust. 

Last week, the South Korea CDC announced `Traveler Respiratory Disease Testing Service' Expanded to 13 Airports & Ports Nationwide and today South Korea's Quarantine Policy Bureau has announced an all-out effort to prevent the spread of livestock diseases during the Lunar New Year holiday. 

Typically, Asia government agencies revert to a skeleton crew, and often `go dark', during the extended Lunar New Year Holiday period. 

The fact that they are making their Central Disaster and Safety Countermeasures Headquarters (CDSCHQ) the hub of a 24‑hour, multi‑ministry system specifically through Seollal speaks to how seriously they view the current situation.

Due to its length, I've only posted some (translated) excerpts from today's announcement.  I'll have a brief postscript after the break. 

Joint government-wide response to livestock infectious diseases during the Lunar New Year holiday

2026.02.12 15:00:00 Quarantine Policy Bureau, Quarantine Policy Division

The Central Disaster and Safety Countermeasures Headquarters for Highly Pathogenic Avian Influenza (AI), African Swine Fever (ASF) , and Foot-and-Mouth Disease ( Headquarters: Minister of Agriculture , Food and Rural Affairs Song Mei-ryeong , hereinafter referred to as the Central Disaster and Safety Countermeasures Headquarters ) will, in cooperation with relevant ministries such as the Ministry of the Interior and Safety and the Ministry of Climate, Energy and Environment, and local governments, promote quarantine rules for livestock farms and the public in preparation for the Lunar New Year holiday, operate an emergency response system during the holiday period , and thoroughly inspect and implement quarantine management measures for livestock infectious diseases 

Since the first outbreak of highly pathogenic avian influenza in Paju, Gyeonggi Province, on September 12th of last year, 43 cases have occurred in poultry farms . Recently, the wild bird population * and the number of AI detections ( 49 cases in total ) have also increased, so the risk of additional outbreaks in poultry farms remains high .

* AI outbreak status ( total 43 cases ): 9 cases in Gyeonggi , 18 cases in South and North Chungcheong , 11 cases in South and North Jeolla , 3 cases in South and North Gyeongsang , 1 in Sejong , 1 in Gwangju

** Status of wild bird population ( Ministry of Climate ): (December ) 1.25 million → ( January ) 1.35 million (8% increase )

In addition, in the case of African swine fever, since the first outbreak in Gangneung, Gangwon Province on January 16th of this year, sporadic outbreaks ( 11 cases in total ) have occurred in areas where there had been no outbreaks before, so thorough quarantine management is necessary to prevent the virus from entering farms .

* ASF outbreak status ( total 11 cases ): 4 cases in Gyeonggi , 1 in Gangwon , 2 in Chungcheongnam- do, 1 in Jeollabuk-do , 2 in Jeollanam-do , 1 in Gyeongsangnam -do

Foot-and - mouth disease broke out in Ganghwa-gun, Incheon on January 30 , about 10 months after it first appeared in Yeongam and Muan, South Jeolla Province, in March of last year . To prevent further spread, a temporary 48- hour movement ban was issued for Incheon and the neighboring Gimpo area, and emergency vaccinations (865 cases , 92 cases ) were quickly completed (February 6). Quarantine management such as disinfection and testing was strengthened, and there have been no additional outbreaks to date .

        (SNIP) 

□ Operation of a 24- hour response system centered on the Central Disaster and Safety Countermeasure Headquarters , comprehensive disinfection , and public relations for livestock farms and the public

The Central Disaster and Safety Countermeasures Headquarters will maintain a 24-hour emergency response system even during the holiday period. In addition, in order to block the spread of the virus due to the increase in people and vehicles during the Lunar New Year holiday, February 13 (Friday) and February 19 ( Thursday ) before and after the holiday have been designated as “ National Disinfection Days ” and disinfection resources will be fully mobilized ( 1,023 disinfection vehicles ) to intensively disinfect livestock farms , livestock - related facilities , and livestock vehicles . In particular, for highly pathogenic avian influenza, disinfection of high-risk areas such as roads around migratory bird arrival sites will continue at least twice a day for two weeks from February 7 to February 20 , including the holiday period .

In addition, we will strengthen publicity by using various means such as text messages on quarantine rules, village broadcasts, posters and banners, electronic bulletin boards at railway stations and highways, broadcast subtitle exposure*, and websites in cooperation with local governments, public institutions, and producer groups. We will also strengthen publicity by informing livestock farmers of quarantine rules , asking people returning home to refrain from visiting livestock farms , prohibiting entry into migratory bird arrival areas and wild boar ASF outbreak areas , and prohibiting the bringing in of illegal livestock products when entering the country after traveling abroad .

* Disaster subtitle broadcasting (2.9.~2.18, 144 companies including KBS , twice a day ) , etc.

        (SNIP)

□ Requests during the Lunar New Year holiday period

Park Jeong-hoon, director of the Food Policy Bureau at the Ministry of Agriculture, Food and Rural Affairs , said , “ We plan to maintain the emergency response system centered around the Central Disaster and Safety Countermeasures Headquarters even during the Lunar New Year holidays, ” and urged , “ Livestock farms across the country should immediately report any suspected symptoms of livestock infectious diseases to livestock quarantine authorities , and all livestock officials should also be careful to prevent safety accidents from occurring during quarantine activities due to the cold wave in winter . ” He continued , “ I ask farms to do their best to quarantine their farms during the holiday period , and I ask those returning home to actively participate in livestock quarantine, such as refraining from visiting livestock farms and migratory bird arrival sites, to prevent the spread of livestock infectious diseases . ”

He also added , “ Despite the outbreak of livestock infectious diseases such as highly pathogenic avian influenza and African swine fever , the supply conditions for livestock products such as eggs and pork during the Lunar New Year holiday are relatively stable , and we will closely monitor the supply and demand situation going forward . ”

* ( Egg ) Production : ('25) 49.53 million / day → ('26p) 4,925 ( 7.6% ↑ compared to the average year , 0.6% ↓ compared to the previous year ) Retail price : (1. Lower ) 6,928 won / 30 eggs → (2. Upper ) 6,107 ( 6.3% ↓ compared to the average year , 8.1% ↓ compared to the previous year )

* ( Pig ) Slaughter (January ) : ('25) 1.572 million → ('26) 1.589 million ( 0.4% ↑ compared to the average year , 1.1% ↑ compared to the previous year ) Retail price : (1. Lower ) 26,270 won /kg → (2. Upper ) 26,360 ( 12.2% ↑ compared to the average year , 4.4% ↑ compared to the previous year )

Hong Jong-wan, Director of the Social Disaster and Safety Bureau at the Ministry of the Interior and Safety, said, “ Compliance with the core quarantine rules for farms is essential for preventing livestock infectious diseases , and if these are violated, strict measures such as fines and reductions in compensation for culling will be taken .”

He added , “ Local governments, led by heads of sub-organizations, should make an all-out effort to prevent the spread of livestock infectious diseases , and the Ministry of the Interior and Safety will not spare administrative and financial support . ”

Lee Chae-eun, Director of the Nature Conservation Bureau at the Ministry of Climate Change, said , “ If you find a carcass of a wild bird or wild boar, please report it to your local government or the National Institute of Wildlife Disease Control and Prevention instead of contacting it directly . We ask local governments to prevent contamination from being left unattended or leaking from the affected farm and spreading it to the surrounding area . ” She added , “ We will do our best to maintain an emergency work system during the Lunar New Year holiday period in cooperation with relevant organizations to ensure that there are no quarantine gaps . ”

While one could argue that this heightened response is due to the triad of livestock disease threats in South Korea, we were seeing extraordinary measures being ordered last December, before the recent spike in ASF and FMD.

Regrettably, few countries are as open about their avian flu problem - and their response - as is South Korea. Which means we don't have a good handle on how the virus is spreading, and evolving, around the globe.

The fact, however, that South Korea - which has 20 years experience dealing with Avian flu - is this concerned, should give all of us pause. 

Viruses: Avian Influenza H5N1 Infection During Pregnancy: Preparing for the Next Flu Pandemic and Improving Perinatal Outcomes

Photo Credit – CDC

#19,050

During the 1918 pandemic an abnormally high number of pregnant women died from the influenza, and those that survived endured a very high miscarriage rate. Again, during the much milder 1957 Asian Flu, pregnant women reportedly suffered disproportionately higher mortality rates than non-pregnant women of the same age.

Historical reviews of both events are available in a Perspective, written by 3 CDC physicians (Sonja A. Rasmussen, Denise J. Jamieson, Joseph S. Bresee) and published in the CDC Journal of EID article, Pandemic Influenza and Pregnant Women in February of 2008.

A year after its publication, the arrival of the 2009 H1N1 pandemic saw similarly high rates of influenza complications among pregnant women, often with tragic results. 

• During the 2009 H1N1 pandemic, pregnant women were six times more likely to be hospitalized than non-pregnant women (see Pregnancy & Flu: A Bad Combination).
• And in 2011, in BMJ: Perinatal Outcomes After Maternal 2009/H1N1 Infection we saw a study where pregnant women who were admitted to the hospital with an  H1N1 infection experienced a 3 to 4 times higher rate of preterm birth, 4 to 5 times greater risk of stillbirth, and a 4 to 6 times higher rate of neonatal death.

In late 2024, in EID Journal: Systematic Review of Avian Influenza Virus Infection and Outcomes during Pregnancy - among 30 pregnant women diagnosed with avian flu (H5N1 n = 16, H7N9 n = 13, and H5N6 n = 1) - researchers reported high mortality rates for both mothers (90.0%, 27/30) and their babies (86.7%, 26/30).

Admittedly, this data is biased towards hospitalized cases with severe disease, and many other pregnant women with milder infections likely saw less dire outcomes. 

 

But we also continue to see evidence of the harm to the developing fetus from  maternal seasonal flu infection (see Nature: Severe Influenza in Pregnancy Linked to Neurodevelopmental Disorders in Offspring).

Despite these dangers, pregnant women and young children are often the last cohort to be approved to receive a novel flu (or CoV) vaccine, since most early clinical trials exclude them over safety concerns.

All of which brings us to a narrative review article published in Viruses that looks at the limited data we have on novel flu and pregnancy, and argues that H5N1 could be particularly dangerous to pregnant women and their offsprings if it should begin to spread in humans.

The authors propose a basic algorithm for initial clinical management of suspected H5N1 in pregnancy and lobby for prioritizing both antivirals and vaccines (when available) for high-risk patients, including those who may be pregnant. 

I've only posted the abstract and a few excerpts, so follow the link to read it in its entirety.  I'll have a bit more after the break. 

Avian Influenza H5N1 Infection During Pregnancy: Preparing for the Next Flu Pandemic and Improving Perinatal Outcomes
Matthew J. Zuber1,2,*, Callie L. Brown2,3 and Cara B. Janusz2,4
Viruses2026, 18(2), 212; https://doi.org/10.3390/v18020212

Abstract

Influenza (flu) is a common respiratory virus with seasonal global spread. Zoonotic viruses can occasionally cross species, leading to pandemic-level spread, and for flu viruses, this is considered an “antigenic shift”. The flu can be particularly severe during pregnancy due to immune system adaptations that occur during pregnancy, with prior global pandemics causing excess hospitalizations, deaths, and other complications in the mothers and the neonates.

We aim to review the current literature with respect to novel avian H5N1 and the potential impact of infection with flu during pregnancy. A systematic literature search was conducted.

Here we provide a rapid summary of epidemiology and understanding of viral spread, published risks of H5N1 in pregnancy, the unique physiologic, cellular, and molecular adaptations making H5N1 infection unique in pregnancy, implementation of an effective vaccine program in event of a pandemic specific to pregnant individuals, optimizing peripartum care for infected individuals, and direction for future research to direct vaccine strategy and mitigate risks in a future flu pandemic.

(SNIP)

Pregnancy has long been recognized as a risk factor for severe disease. Historically, pregnant persons have suffered increased rates of morbidity and mortality compared to their non-pregnant peers during the last several flu A pandemics of the past century, most recently during the 2009 H1N1 pandemic [2]. Similarly, pregnant persons had elevated morbidity and mortality during the recent COVID-19 pandemic [3]. Vaccine clinical trials continue to routinely exclude pregnant persons, creating substantial limitations in closing equitable care gaps for pregnancy and generating robust and early data during a pandemic to help support vaccine programs for pregnant persons at heightened risk for severe disease. 

(SNIP)

 (SNIP)

7. Conclusions

While there is limited data on H5N1 or novel avian influenza viruses’ effects during pregnancy, the available data suggest we should prepare for and anticipate cases of severe disease in the perinatal setting in the event of a future global pandemic. We outlined here the current epidemiology, unique pathophysiology of the disease in the setting of pregnancy, suggested clinical approach during pregnancy and birth, and suggested future directions regarding vaccine research and policy approaches to vaccination strategy. As new viral strains evolve, so should the approach in pregnancy management and close surveillance that will help mitigate risk and improve perinatal outcomes.

       (Continue . . . ) 

While COVID hit the elderly the hardest (see CIDRAP Older adults made up 90% of US COVID deaths in 2023), there are reasons to believe that an H5Nx pandemic might severely impact a much younger cohort (see Preprint: Immune History Shapes Human Antibody Responses to H5N1 Influenza viruses).

As far back as 2007  - in A Predilection For The Young - we looked at the disturbing skewing of H5N1 cases (and deaths) among younger individuals (see WHO Chart below).

We've seen similar patterns in past pandemics, including in 1918 and again in 2009. Here is what the CDC had to say about the impact of the 2009 pandemic virus in 2012's First Global Estimates of 2009 H1N1 Pandemic Mortality Released by CDC-Led Collaboration.

2009 H1N1 Pandemic Hits the Young Especially Hard

This study estimated that 80% of 2009 H1N1 deaths were in people younger than 65 years of age which differs from typical seasonal influenza epidemics during which 80-90% of deaths are estimated to occur in people 65 years of age and older.

Complicating matters, vaccine hesitancy continues to grow, with nearly a 33% drop in uptake of influenza vaccine by pregnant women since 2019.

While an H5 pandemic is by no means assured, these are two (of many) reasons why HPAI H5 might have an even greater impact on society than COVID. 

Making it imperative that we consider the risks - and how we might handle them - now, while we still have the luxury of time.