EID Journal: Detection of HPAI A(H5N1) Virus in Cat and Rats during Outbreak in Backyard Poultry, United States, 2025

 

#19,340

Today we've a dispatch, published yesterday in the CDC's EID Journal, which describes the findings of HPAI H5N1 in a cat and a rat from an Illinois farm which experienced a bird flu outbreak in March of 2025.  

While it is not exactly `news' that both species are susceptible to H5N1 infection (see below), our understanding of how HPAI may spread among peridomestic animals on farms remains limited. 

EID Journal Dispatch: Seroprevalence of Influenza A(H5N1) Virus in Domestic Cats at Epicenter of Dairy Cattle Outbreaks, California, USA, 2024–2026

MMWR: Serologic Evidence of HPAI A(H5N1) Virus Infection in a Veterinary Professional Exposed to an Infected Domestic Cat

Experimental Infection of Rats with Influenza A Viruses: Implications for Murine Rodents in Influenza A Virus Ecology

Emer. Microbe & Inf.: HPAI Virus H5N1 clade 2.3.4.4b in Wild Rats in Egypt during 2023

CDC MMWR: HPAI H5N1 Virus Infection of Indoor Domestic Cats Within Dairy Industry Worker Households — Michigan, May 2024

The USDA's Detections of Highly Pathogenic Avian Influenza in Mammals dashboard lists more than 200 feline detections in the U.S. and a dozen H5N1 positive rats. Curiously, while I can find one entry of a cat from Bond County Illinois in March of 2025 (which may, or may not, refer to the cat in this study), there appear to be no reports of any rats infected in Illinois. 

According to this report, a farmer brought the remains of six animals (a chicken, a turkey, a goose, 2 Guinea fowl, and a rat (Rattus norvegicus)) to his veterinarian after nearly all of his chickens died. Suspecting H5N1, the vet sent the remains to the University of Missouri Veterinary Medical Diagnostic Laboratory (VMDL; Columbia, MO, USA) for postmortem examination.

VMDL ran a qRT-PCR on 1 chicken sample, which came back presumptive  positive for H5, and forwarded tissue samples to NVSL in Ames, IA for confirmatory testing (which verified HPAIV H5N1 clade 2.3.4.4b virus).

Four days after the first report, the local vet visited the farm and collected the remains of a 13-year-old cat and a second feral rat from the farm. They were then sent to the University of Illinois Veterinary Diagnostic Laboratory (VDL) for necropsy and additional testing. 

According to this report, state and local authorities were notified, and the Illinois Department of Agriculture and USDA quarantined the farm and monitored it for 4 months.

Today's report is primarily an analysis of the extensive infection of both the cat and the rat submitted to VDL. Sadly, while the first rat underwent necropsy, it was never tested for H5N1, so all we have is a sample of one.  

This seems like it was a great opportunity to explore the potential spread of HPAI among peridomestic animals on an infected poultry farm. But there is no indication that any attempts were made to collect and test additional samples. 

That said, this is a fascinating report that strongly suggests that an H5N1 farm outbreak should be viewed as a whole-premises event. Animals living around infected livestock - including cats and rats - may also be infected, and contribute to the evolution and further spread of the virus. 

Another finding of this dispatch is that all 3 animal species tested (cat, rat, and chicken) carried the PB2 E627K mutation which is generally considered a mammalian adaptation.  While not unheard of, reports of this mutation in birds are rare. 

Since only 1 chicken was tested, we've no idea of the frequency of this mutation in the rest of the flock.  

I've only posted the Abstract and some excerpts from the dispatch, so follow the link to read it in its entirety.  I'll have a postscript after the break.

Detection of Highly Pathogenic Avian Influenza A(H5N1) Virus in Cat and Rats during Outbreak in Backyard Poultry, United States, 2025

Suzanna M. Storms, Jade Rathmann, Lynette Hemker, Miranda Vieson, and Leyi Wang

Abstract

In 2025, highly pathogenic avian influenza A(H5N1) virus was detected in a poultry flock in Illinois, USA. Quantitative reverse transcription PCR, sequencing, and histopathology on cat and rat samples from the farm showed multiple positive tissues and high sequence identity to an avian isolate. Small mammals might contribute to H5N1 transmission.

The Study

On March 12, 2025, a farmer in southern Illinois with a small backyard poultry flock brought remains of 6 animals to their primary veterinarian for a necropsy workup after acute illness and near-complete mortality (100/105 birds) of the flock. The farm, ≈2 miles from a 25,000-acre reservoir lake within the Mississippi Flyway, housed 4 turkeys (Meleagris gallopavo), 1 goose (Anser sp.), 20 Guinea fowl (Numida spp.), 80 chickens (Gallus gallus domesticus), 17 cattle, 15 cats, and 2 dogs. Because HPAI virus (HPAIV) was suspected, the 6 animals, a chicken, a turkey, a goose, 2 Guinea fowl, and a rat (Rattus norvegicus), were sent to the University of Missouri Veterinary Medical Diagnostic Laboratory (VMDL; Columbia, MO, USA) for postmortem examination.

VMDL collected and evaluated fresh and formalin-fixed tissues and performed influenza A virus (IAV) quantitative reverse transcription PCR (qRT-PCR) on 1 chicken sample, according to guidelines from the US Department of Agriculture (USDA) National Animal Health Laboratory Network (NAHLN; https://www.aphis.usda.gov/labs/nahln). The sample tested presumptive positive per NAHLN guidelines, and VDML subtyped it as H5 influenza. VDML then forwarded the sample to the National Veterinary Services Laboratories (NVSL; Ames, IA, USA) for confirmatory testing, which verified HPAIV H5N1 clade 2.3.4.4b virus.

Further PCR testing of the avian species for Mycoplasma gallisepticum, M. synoviae, and avian paramyxovirus were all negative. The necropsy findings reported hepatitis, pulmonary hemorrhage, and pulmonary edema in the poultry species and bronchopneumonia and meningoencephalitis in the rat. No additional testing was performed on the rat or other bird species.

Upon report of HPAIV on the farm, state and federal agencies were notified. The Illinois Department of Agriculture and USDA quarantined the farm and monitored it for 4 months.

On March 16, 2025, the primary veterinarian collected the remains of a 13-year-old domestic shorthaired cat and a second feral rat from the farm. In conjunction with Illinois Department of Agriculture and USDA, the cat and rat specimens were sent to the University of Illinois Veterinary Diagnostic Laboratory (VDL; Urbana, IL, USA) on March 19. VDL performed gross necropsy and collected fresh and formalin-fixed tissues. VDL screened lung tissues from the cat and rat for IAV by qRT-PCR, following NAHLN guidelines. The cat lung tested presumptive positive (cycle threshold [Ct] value 21.2), subtyped as H5; NVSL confirmed H5N1 clade 2.3.4.4b virus. The rat lung tissue was negative upon initial screening, but NVSL conducted follow-up testing on tracheal swab samples, which were H5N1-positive.

Quantitative reverse transcription PCR results from HPAIV A(H5N1) in cat and rats during outbreak in backyard poultry, United States, 2025. Specimens obtained from a cat (A) and a rat (B) found dead on farm where the outbreak occurred were confirmed to be positive for H5N1 clade 2.3.4.4b, genotype D1.1 virus.

(SNIP)

Conclusions

We describe a strain of H5N1 that resulted in high mortality in a poultry flock and fatal illness in small mammals on a backyard farm in Illinois, USA. Our results show that extensive systemic H5N1 virus spread occurred in both cat and rat tissues after natural infection. Rat nasal turbinates and trachea preferentially expressed α2,3-linked sialic acid receptors relative to lung, likely explaining the lower Ct values in upper respiratory tissues and presence of bacterial bronchopneumonia, potentially leading to increased viral shedding (10).

Cat feces and urine have previously been shown to harbor H5N1 virus (11,12), which our results corroborate. Rats have previously been reported to harbor HPAIV in agricultural settings and have been detected in the current epizootic (13,14). Detection of HPAIV in rat urine and kidney tissue suggests that rodent urine could be a potential transmission medium and warrants further investigation.

Rats reside on many farms, can predate birds, and might serve as an intermediate step between infected avian species and susceptible mammalian hosts (15). That coexistence is particularly threatening for commercial poultry and swine confinement farms, which frequently harbor rodent populations despite strict biosecurity efforts. A limitation of our study was that no virus isolation was performed on tissues or urine due to biosafety constraints.

Although cats have been shown to participate in HPAIV transmission, our findings indicate that further investigation is needed to clarify the role of rodents. This study raises awareness of small mammals at the wildlife–livestock interface and highlights the potential role of rats in influenza transmission to commercial livestock production.

Dr. Storms is a veterinarian-scientist at Texas A&M Veterinary Medical Diagnostic Laboratory, College Station, Texas, USA. Her research interests center around influenza virus transmission and diagnostic development.

Our continued reliance on passive surveillance severely limits our ability to understand the ecology and threat of HPAI H5. 

Because of the limited sampling on this farm, we can't say whether the PB2-E627K mutation was `fixed' in the poultry flock, or whether rat-to-rat transmission occurred, or whether any other species in and around the farm were affected. 

And we saw last year, in Nature: Lengthy Delays in H5N1 Genome Submissions to GISAID, the median delay in submitting sequences to GISAID was 7 months (228 days), with some countries taking nearly 2 years. 

Despite the mounting evidence of the susceptibility of cattle, sheep, goats, pigs, cats, and rats (ad nauseam) to HPAI H5 - and the continued calls from the scientific community for more aggressive surveillance and testing of livestock (see here, here, here, here, and here) - the world seems content to don blinders and hope for the best.

Sadly, the world continues to treat the spread of HPAI as more of an economic or political concern, than a public health threat. And while that optimistic assessment may be true today, there are no guarantees for tomorrow.

Preprint: Near real-time data on the human neutralizing antibody landscape to influenza virus in summer of 2026 shows antigenic advance of H3N2 subclade K region D mutants and H1N1 D.3.1.1 Sa mutants

 

#19,339

Hopefully the daunting title of today's paper won't deter both of my readers, because the preprint in question is well worth reading given what we are already seeing with the approach of the Northern Hemisphere's flu season:

Taiwan CDC: Both influenza and the COVID-19 epidemic are currently in their peak season, with influenza cases continuing to rise

South Korean CDC Issues Early Seasonal Flu Epidemic Advisory

Japan MHLW Reports Unusually Early Start to the Fall Flu Season

Due to the time it takes to manufacture and deploy hundreds of millions of doses, recommendations on the composition of the northern hemisphere’s vaccine must be made in February of each year, while recommendations on the southern hemisphere’s vaccine are made in late September.

Flu viruses, however, don't stop evolving.  Last year, we famously saw the late emergence of a `drifted' H3N2 subclade K virus (see Increasing Concerns Over A `Drifted' H3N2 Virus This Flu Season), which was less than an ideal match to the vaccine. 

H3N2, in particular, has a reputation for rapid evolution (see The Enigmatic, Problematic H3N2 Influenza Virus), and threw us curve balls in 2014 and again in 2017.  Since 2009, H1N1 has been viewed as the more stable subtype, but it too continues to evolve. 

Last February, following observed antigenic changes in all three circulating strains (H1N1, H3N2, Influenza B), the WHO recommended changes to all 3 components of the fall vaccine, which is being delivered now.  Later this month, they will meet to discuss next year's Southern Hemisphere flu vaccine. 

But, as the title of today’s preprint suggests, both H3N2 and H1N1 have continued  to evolve, and recent data suggest that some newly emerged variants are less well  neutralized by human sera - including sera from a vaccinated subset.

None of this suggests we face an imminent `vaccine failure'. Despite last year's mismatch with H3N2 Subclade K, the flu vaccine still produced a beneficial VE (Vaccine Effectiveness) according to the MMWR. 

Interim 2025–26 seasonal influenza VE estimates were derived from three U.S. VE networks. Among children and adolescents, VE was 38%–41% against influenza-associated outpatient visits and 41% against influenza-associated hospitalization. Among adults aged ≥18 years, VE was 22%–34% against influenza-associated outpatient visits and 30% against influenza-associated hospitalization.

But it does suggest VEs this year could be lower than desired, regardless of whether H1N1 or H3N2 dominates this winter. Additionally, the future course and speed of these antigenic changes are unclear, which complicates decisions on next year's Southern Hemisphere vaccine. 

Among their findings, the authors identified 72 serum samples in which an H1N1 D.3.1.1 virus carrying G155E was more than twofold less effectively neutralized than a comparable virus without that mutation. Those samples tended to come from teenagers and young adults (roughly 15–25 years old).

 

It is well recognized that one's first flu exposure makes a significant, and lasting, impression on the immune system (see Nature: Declan Butler On How Your First Bout Of Flu Leaves A Lasting Impression). People in this age cohort were first exposed to H1N1 either during or after the 2009 pandemic, whereas older adults were likely first exposed to the previous H1N1 virus. 

There is a lot here to unpack, and there are still a lot of questions of how these emerging variants will impact this year's flu season (or beyond). 

Those wishing a deeper dive will want to follow the link to read the full 18-page preprint, but fair warning, much of it is highly technical.  I'll have a bit more after the break.

Near real-time data on the human neutralizing antibody landscape to influenza virus in summer of 2026 shows antigenic advance of H3N2 subclade K region D mutants and H1N1 D.3.1.1 Sa mutants
 Caroline Kikawa, Andrew Butler,  John Huddleston, Sam A Turner, Heidi Peck,  Janet A Englund, Kirsten Lacombe  Michael Busch, Marion C Lanteri, Mars Stone, Bryan Spencer,  Alexander L Greninger, Derek J Smith, Stephanie Wallace, Helen S Marshall,  Shidan Tosif, Scott E Hensley,  Ian G Barr,  Jesse D Bloom
doi: https://doi.org/10.64898/2026.09.15.751855
This article is a preprint and has not been certified by peer review [what does this mean?].

Preview PDF

Abstract

Human seasonal influenza evolves rapidly, necessitating twice yearly decisions about whether to update the strains in the vaccine. To help inform this decision, we have been using high-throughput sequencing-based neutralization assays to make twice yearly measurements of how recent human sera neutralize current human H3N2 and H1N1 strains.

Here we provide the third installment in this series of measurements by reporting 47,851 titers representing neutralization of 148 viral strains by 325 human sera collected between April and August of 2026.

Our measurements show that new H3N2 subclade K strains with mutations in antigenic region D and new H1N1 subclade D.3.1.1 strains with mutations in antigenic region Sa (such as G155E) have reduced neutralization by human sera, with notable heterogeneity in the impact of some of these mutations across sera from different individuals. This paper is accompanied by an interactive summary (https://jbloomlab.github.io/flu-seqneut-2026/summary.html) that enables detailed exploration of the results, and all titer data are publicly available for further analysis to aid vaccine antigen selection and studies of viral evolution.

(SNIP)

Discussion

We have measured how a large set of human sera neutralize current human H3N2 and H1N1 influenza strains. Our results show that the two subclades that spread widely over the last year (subclade K for H3N2 and D.3.1.1 for H1N1) are now spawning descendants with reduced neutralization by human sera.

These descendant strains have HA mutations that are associated with decreased neutralization, some of which have arisen independently in different combinations.

• For H3N2, mutations at sites in antigenic region D (e.g., 223 and 222) have arisen recurrently and reduce neutralization; mutations at sites in antigenic regions A and B are also present in strains with reduced neutralization (e.g., 145, 156, 157). 

• For H1N1, strains with mutations at sites in antigenic region Sa (e.g., 155 and 157) have arisen recurrently and reduce neutralization; mutations at sites in antigenic regions Sb and Ca1 (e.g., 190 and 205) are also present in strains with reduced neutralization.

However, the diversity of new antigenic variant strains makes it challenging to use our data alone to determine which strains will dominate a year from now. For H1N1, our data show that D.3.1.1 is antigenically advanced over D.3.1, and virtually all human H1N1 influenza observed over the last few months is D.3.1.1 or a descendant strain.

However, it is uncertain which more antigenically advanced variant of H1N1 will spread over the next year— G155E reduces neutralization of all H1N1 strains and has recently arisen recurrently, but it occurs in multiple genetic backgrounds and there are also other antigenic mutations that could outcompete it. Similarly, although our data identify multiple new antigenic variant strains of subclade K, it remains unclear which of these new variants will dominate over the next year.

(Continue . . . )

In addition to these antigenic changes, we are also following concurrent reports of creeping antiviral resistance in H1N1 (see Eurosurveillance: Emergence and spread of NA-I223V and NA-S247N double-mutant A(H1N1)pdm09 influenza viruses with reduced oseltamivir susceptibility in the Netherlands and beyond, 2023 to 2026). 

While neither of these trends are anywhere near a crisis point, they are reminders that the global `fluscape' is constantly changing, and that every flu season remains highly unpredictable. 

Reduced VE or not, this year's vaccine is still expected to provide modest - perhaps even substantial - benefit.  So I'll still gladly roll up my sleeve this fall, albeit with slightly tempered expectations.    

I'll avail myself of antivirals if I am infected.  But I'll also be wearing a facemask in crowded indoor venues, using copious amounts of hand sanitizer, and avoiding crowds whenever possible. 

Because prevention is always preferable to a treatment.

EID Journal: Experimental Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Alpacas, 2026

 

#19,338

In 2024 - just over 2 months after the discovery of HPAI H5N1 in U.S. dairy cattle - the USDA reported that HPAI H5N1 had been Detected In Alpacas from a premises (in Idaho) where HPAI-affected poultry had recently been depopulated. 

Alpacas belong the the family Camelidae, which includes 3 types of camels ( dromedary camels, Bactrian camels, wild Bactrian camels), and 4 lamoids (llama, alpaca, guanaco, and vicuña).

Camelidae - including both camels and alpacas - are known to be susceptible to MERS-CoV (see EID Journal: MERS-CoV Antibodies In Alpacas - Qatar), but less is known about their susceptibility to influenza A viruses.  

In recent years we've seen the mammalian host range of HPAI continue to expand,  with the virus detected in horses, pigs, goats, sheep, mink, dogs, and cats and a growing list of peridomestic animals (see below).

Some animals are clearly more susceptible than others to the virus, and some appear to be dead-end hosts; susceptible to infection but unlikely to contribute to the spread of of the virus. 

In an attempt to determine how vulnerable Alpaca are to the virus, and their ability to carry, and shed the virus, researchers at Germany's FLI (Friedrich-Loeffler-Institut) experimentally infected 6 alpaca with the HPAI H5N1 genotype B3.13 (`bovine') virus.

While they found that H5N1 B3.13 can induce a mild, but productive, upper respiratory infection in alpacas (including nasal shedding of the virus for several days and seroconversion), it still isn't established whether alpacas can efficiently transmit virus to one another. 

That said, there would seem to be enough here to warrant inclusion of camelids in farm biosecurity and surveillance plans. 

Due to its length, I've only posted the highlights. Follow the link to read the report in its entirety. 

Research
Experimental Highly Pathogenic Avian Influenza A(H5N1) Clade 2.3.4.4b Virus Infection in Alpacas, 2026
 
Jacob Schön , Angele Breithaupt, Nico Joel Halwe, Maxi Hertel, Ann Kathrin Ahrens, Andrea Aebischer, Donata Hoffmann, and Martin Beer
 
Abstract

Highly pathogenic avian influenza (HPAI) A(H5N1) clade 2.3.4.4b virus continues to spread globally and sporadically transmits from avian reservoirs to mammalian hosts. In May 2024, H5N1 infections in young goats and alpacas in the United States were reported. Nevertheless, the overall susceptibility of camelids to clade 2.3.4.4b virus remains unclear. 

We conducted a controlled experimental infection study in 6 alpacas, assessing clinical signs, viral shedding, tissue distribution, and serologic responses after intranasal inoculation with HPAI H5N1 genotype B3.13 virus. 

Observed illness was generally mild; body temperature increased slightly and food intake reduced for up to 3 days postinfection. We detected viral RNA in nasal swab samples and confirmed infectious HPAI H5N1 virus. Immunohistochemistry and RNA in situ hybridization detected virus only in the nasopharyngeal tonsil and nasal conchae at 4 days postinfection.

Our findings suggest alpacas are susceptible to productive H5N1 infection, highlighting implications for livestock surveillance and biosecurity in regions with ongoing circulation.

       (SNIP)

We experimentally confirmed that alpacas can be intranasally infected with a bovine HPAIV H5N1 B3.13 isolate, leading to subsequent nasal shedding of infectious virus. IHC and ISH confirmed H5N1 virus replication in the nasopharyngeal tonsil and the nasal conchae. Productive infection was corroborated by seroconversion at 20 dpi. We detected individual variation of neutralizing antibody levels, but the small number of animals does not enable general conclusions. The infection did not cause fever, but alpacas reduced feed intake. Whether the viral load shed by the alpacas would be sufficient to cause transmission to contact animals remains undetermined. Intermittent viral RNA detection and low viral titer at 3 dpi might reflect technical variability of the sampling procedure rather than reduced shedding.

Our data did not suggest that alpacas replicate H5N1 clade 2.3.4.4b genotype B3.13 virus with exceptionally high efficiency. However, nasal replication occurred, and infectious virus was detectable in nasal swab samples for up to 6 dpi, but sequencing did not indicate accumulation of mutation to that timepoint. Nevertheless, viral adaptation after infection or shedding to naive contact animals or humans cannot be excluded. A follow-up study should include direct-contact animals to assess the biologic relevance of low-level shedding and to clarify the potential role of alpacas in H5N1 transmission. In addition, future studies should include experimental intramammary inoculation of female alpacas to evaluate susceptibility via that route.

In conclusion, H5N1 clade 2.3.4.4b virus will likely continue to drive substantial mortality rates in wild birds and marine mammals across North and South America. Risk for virus spillover into domestic animals, including poultry and potentially camelids, will continue considering their large populations on the continents. The demonstrated capacity of H5N1 clade 2.3.4.4b virus to acquire mammalian-adaptive mutations heightens concern about cross-species transmission and possible establishment in new mammalian hosts, which could intensify wildlife losses, disrupt livestock production, and generate new zoonotic risks. Sustained surveillance, strengthened biosecurity, and rapid response measures will be essential to limit those impacts.

       (Continue . . . )

 

WHO: Bangladesh Reports 4th H5N1 Human Infection for 2026

 


#19,337

In their latest Influenza at the human-animal interface Summary and risk assessment (8 August to 6 September 2026) - published this week - the WHO has announced the 4th H5N1 case in a Bangladeshi child in the past 9 months.

• Last April, we saw a fatal case reported from the Chattogram Division, in a child who fell ill on January 22nd, was hospitalized on January 28th, and who died on February 1st. The H5N1 infection was only determined posthumously, via lab analysis on Feb 7th.

• In early June we learned of a 2nd case, a child from Sylhet Division who was hospitalized on March 28th with a clinical diagnosis of measles with bronchopneumonia. The child was discharged on March 31st, but delayed testing by the IEDCR only revealed a positive H5N1 result on April 20th.

• And last July the WHO reported a 3rd child - also from Sylhet Division - diagnosed with H5 (later confirmed as H5N1). The child (now recovered) fell ill in May, and reportedly had no travel history and no history of exposure to poultry.

In addition to the new H5N1 case in Bangladesh, the WHO also details 3 H9N2 cases in China (previously reported in this blog) and 2 H1N2v Cases from Michigan (reported by CDC here).

Avian influenza viruses in humans

A(H5N1), Bangladesh

On 30 August, Bangladesh, through the national IHR focal point, notified WHO of one laboratory-confirmed human infection with an A(H5) virus in a child from Rangpur division. On 15 August 2026,  the child developed a fever, cough and rhinitis and was admitted to hospital on 17 August. 

On 18 August, a nasopharyngeal swab and throat swab was collected as part of hospital-based influenza surveillance and tested positive for influenza A(H5) by real-time RT-PCR at the icddr,b laboratory on the same day. The sample was subsequently confirmed positive for influenza A(H5N1) at the Molecular and Genomic Laboratory Department of Institute of Epidemiology, Disease Control and Research (IEDCR) and National Influenza Centre (NIC) of Bangladesh. Genetic sequencing is underway. The child remained hospitalized and was improving clinically at the time of reporting.

There was no reported history of travel outside the area of residence. The child had a history of exposure to duck and chickens, including some that were sick, in the household and adjacent households. Poultry meat and oropharyngeal swab specimens collected from several backyard chickens on 26 August tested negative for influenza A(H5).

Close contacts were identified and placed under monitoring and all contacts remained asymptomatic during the observation period, except for two health care workers. Respiratory specimens collected from these two individuals tested negative for influenza A viruses.

This is the 4th laboratory-confirmed human case of avian influenza A(H5) reported in Bangladesh in 2026.

While full genetic sequencing has not been released, the H5N1 virus circulating in India and Bangladesh is typically clade 2.3.2.1a - not 2.3.4.4b which is currently dominant in much of Europe, Asia, and North/South America.

This is the 16th case reported by Bangladesh since 2008 (2 fatal: 1 in 2013 and 1 in 2026), and it reminds us that older clades of the H5 virus continue to circulate, and occasionally spill over into humans. 

While this is just the 10th human H5 case reported to WHO in 2026 (see chart below), the expectation is that many cases go unreported around the globe. 

#Natlprep 2026: Pandemic Planning At Both Ends of the Spectrum

 

Note: This is the 16th day of National Preparedness Month. Follow this year’s campaign on Twitter by searching for the #NatlPrep #BeReady or #PrepMonth hashtags.

This month, as part of NPM26, I’ll be rerunning some updated preparedness essays, along with some new ones.

#19,336

Next week (Sept 25th) the U.N. will host a meeting for world leaders in New York City for the purposes of pandemic planning, which will be broadcast live on UN Web TV.  

As this is a 1 day meeting, and it comes amid headwinds from several directions, it isn't clear exactly what will come from it.

Earlier this month, The Lancet published a comment (excerpts below) on this upcoming meeting, which discussed some of the many challenges it faces.

From commitment to governance: what should the 2026 UN high-level meeting on pandemic preparedness deliver?

Nelson Aghogho Evaborhenea,b Send email to nelsone@ruc.dk ∙ Maureen Lubac,d ∙ Hawi Getnet Degue ∙ Marc Bosonkief ∙ Douglas Muthinji Wanjag ∙ Pimchanok Ratanapisesh ∙ et al.  Article Info

Published September 4, 2026
DOI: 10.1016/j.langlo.2026.104070 External Link Also available on ScienceDirect External Link
Copyright: © 2026 The Author(s). Published by Elsevier Ltd.
 
Download PDF 

In September, 2026, world leaders will convene in New York for the second UN high-level meeting on pandemic prevention, preparedness and response (PPPR).1 The first high-level meeting produced a political declaration that reaffirmed commitments to strengthen pandemic preparedness and advance equity, catalysed the WHO Pandemic Agreement negotiations, and emphasised a whole-of-government and society approach to PPPR.1 Since then, member states have amended the International Health Regulations, adopted the Pandemic Agreement, expanded preparedness financing mechanisms, and proposed reforms to the broader global health architecture.

These developments represent substantial progress. However, the environment in which they must now operate has changed profoundly.

Geopolitical competition has intensified, multiple crises have diverted political attention and financial resources, official development assistance and multilateralism have come under increasing pressure, and the withdrawal of the USA from WHO has accelerated a turn towards nationalism and bilateral approaches to pandemic preparedness,2 adding another layer to an already complex architecture.

Meanwhile, regional institutions have assumed greater responsibilities for PPPR.3 In Africa, for example, the revised statute of Africa Centers for Disease Control and Prevention (CDC) adopted in 2022 expanded the Africa CDC’s mandate and gave it authority to declare a Public Health Emergency of Continental Security, a power Africa CDC exercised during the 2024 mpox outbreak and again during the ongoing Ebola outbreak, alongside WHO’s declaration of a Public Health Emergency of International Concern. Without meaningful coordination, parallel initiatives risk creating overlapping mandates, fragmented financing, and competing expectations relating to surveillance, pathogen sharing, data governance, and equitable access to medical countermeasures.4

Against this backdrop, the credibility of the high-level meeting should not be measured on the basis of yet another ambitious political declaration, but instead, on the basis of whether the meeting delivers a credible governance framework that aligns ongoing reforms, strengthens their coherence, and translates political commitments into sustained preparedness. We outline three priorities.

       (Continue . . . )

The expectation is that these world leaders will adopt a non-binding "political declaration" on preventing and preparing for future pandemics which was drafted over the summer. While long on good intentions, this document lacks much in the way of `teeth' (enforcement mechanisms, dedicated funding, or even a detailed roadmap).

Meanwhile, public health entities and researchers around the world continue to sound the alarm. A few (of many) examples: 

• In April of 2025 the ECDC published ECDC Guidance: Recommendations for Preparedness Planning for Public Health Threats

• In July 2025 Switzerland Unveiled a New Pandemic Plan

• Also in 2025, Canada announced plans to Purchase 500,000 doses Of H5N1 Vaccine and the EU announced plans to purchase up to 27 million doses. 

• Last December the ECDC published Pre-pandemic Guidance: Strategies to Fight Avian and Swine flu in Humans

• And just last month we looked at Referral: Two Related Papers (PNAS & The Lancet) on Preparing for The Next Pandemic

Whether these plans - or the vaccines and antivirals being stockpiled - will be adequate or appropriate for the next global health crisis remains to be seen. As we've seen before, No Pandemic Plan Survives Contact With A Novel Virus.

But having a framework for dealing with a crisis, and running realistic exercises, can be invaluable when the next pandemic strikes.

Most of these pandemic plans are created by - and for - national governments.  What planning may be going on at state/province/or local levels - or for the private sector - is harder to discern. 

But as many people learned to their cost during the last pandemic, it is just as important to be prepared on the individual, family, and neighborhood level.

Sadly, over the past few years much of the public guidance that was once heavily promoted by the CDC and HHS on pandemic preparedness has been expunged from their websites. 

It's as if the first rule of pandemic preparedness in the 2020's is . . . we don't talk about pandemic preparedness.

Buried in the CDC's archives, however, are a number of useful documents, including these from 2017 (download them while they are still available):

• Get Your Household Ready For Pandemic Flu {PDF - 16 pages]
• Get Ready for Pandemic Flu: Educational Settings [PDF – 16 pages]

• Get Ready for Pandemic Flu: Workplace Settings [PDF – 16 pages]  

In addition to the advice offered in these (and other) guidance documents, I'd like to offer 5 things you can do today to prepare for a possibility of seeing another pandemic sometime in the reasonably near future.

1. Get, and become, a `Flu Buddy'

The first item is one we've discussed often (see Yes, We Have No Pandemic . . . But Line Up A Flu Buddy Anyway). I first fleshed out the idea in a 2008 blog called Lifelines In A Pandemic.

A `Flu Buddy’ is simply someone you can call if you get sick, who will then check on you every day (by phone, social media, or in person), make sure you have the food and medicines you need (including fetching prescriptions if appropriate), help care for you if needed, and who can call for medical help if your condition deteriorates.

Those people who care for others, like single parents, also need to consider who will take care of their dependents if they are sick.

2. Avail yourselves of the vaccines that are available now.

While the evidence is limited, there are some studies suggesting that getting the seasonal flu vaccine may give you some small degree of protection against the H5N1 virus. Even if it doesn't, it may reduce your chances of having a dual infection, which could either be more serious, or even lead to a reassortant virus.

COVID remains a threat, and a dual COVID-flu infection can be worse than either one alone, so if you can get one - keeping current with that vaccine makes sense as well.

Since bacterial co-infections are common with influenza, getting the latest appropriate pneumonia vaccines can also a smart move. In 2023, I also updated my Tetanus shot (Tdap), and those over 75 will want to consider the RSV vaccine.

3. Get a Dr. Checkup, Renew Rx Meds, & Handle any Medical Issues

Over the past 3 years I've endured two 21-day scalp and face field treatment (Fluorouracil) following my skin cancer surgery in 2024 (and again in 2026). 

I also got my Rx meds renewed, and have laid in a stock of any OTC meds I might need.

4. Stock up on PPEs or other supplies you might need

I went into COVID with an existing supply of N95 masks and gloves, and I refreshed my stocks in 2022, but if you don't already have all the N95/KN95 or other personal protective gear you would want or need during a pandemic, now is the time buy them.

Once a crisis begins, it is often too late to stock up. And that goes for any preparedness supplies or gear you might desire in an emergency (Hand Sanitizers/OTC meds/etc.)

5. Be prepared to Shelter in Place

If there was one lesson from the opening months of COVID, it is that many of us may elect - or be forced - to stay home, and avoid public places. Supply chains may be compromised, and there may be runs on `necessities' leaving some store shelves bare.

We see this every year before blizzards and hurricanes, and so it makes sense - whenever possible - to keep a stocked pantry, along with the other staples of life.

 
Last winter, in The Gift of Preparedness 2025 we looked a number of items that might make life more bearable during an extended `bug-in' situation.The good news is, much of what you need to do now to prepare for a pandemic would hold you in good stead for any prolonged emergency or disaster. Frankly, there is not much here I wouldn't do to be prepared for hurricanes, blizzards, or earthquakes.

And if we get lucky, and no pandemic (or other emergency) occurs in the near term, I'll count my blessings - and sleep much better at night - knowing I'd done everything I could to be prepared.

And as a wise man once said:

“Everything you say in advance of a pandemic seems alarmist. Anything you’ve done after it starts is inadequate." - Michael Leavitt, Former Secretary of HHS

Taiwan CDC: Both influenza and the COVID-19 epidemic are currently in their peak season, with influenza cases continuing to rise

 

#19,335

A little over 2 weeks ago (Aug 28th), Japan announced the earliest start to their influenza season since the 2009 H1N1 pandemic (see Japan MHLW Reports Unusually Early Start to the Fall Flu Season), while last week Taiwan reported  `. . . emergency room visits reached 11.2%, exceeding the epidemic threshold (11.0%), indicating the start of the epidemic period.'

Four days ago (Sept 11th) South Korea announced the early start to their flu season, and recent reports from China suggest flu is gaining ground in their southern provinces. 

While all of this is unusually early flu activity, Hong Kong - which often sees a biphasic (summer & winter) flu season - continues to report substantial flu (see Update on cluster of Influenza A cases in TWGHs Wong Tai Sin Hospital) as well. 

Today Taiwan's CDC has updated their flu report, and is urging the public to take precautions and to be aware of early warning signs of severe illness. 

        (translation)

Both influenza and the COVID-19 pandemic are currently in their peak season, with influenza cases continuing to rise

The public is urged to implement self-protective measures such as frequent handwashing and wearing masks, and to be aware of the risk signs of severe illness.  

Release Date: 2026-09-15 The Centers for Disease Control (CDC) stated today (September 15th) that both influenza and the COVID-19 pandemic are currently in their epidemic season, and the influenza epidemic continues to rise. The public should strengthen their precautions against influenza and COVID-19, and practice good handwashing, cough etiquette, and wear masks when entering crowded or poorly ventilated places. If symptoms appear, people should wear masks, seek medical attention, and rest at home to reduce the risk of transmission.

The CDC pointed out that the domestic influenza epidemic is rising and in its epidemic season. In the 36th week (September 6th-12th), there were 136,796 outpatient and emergency room visits for influenza-like illnesses, an increase of 16.5% compared to the previous week.

Additionally, last week (September 8th-14th), there were 92 new cases of severe influenza complications (79 H1N1, 5 H3N2, and 8 untyped A cases) and 21 deaths (18 H1N1, 2 H3N2, and 1 untyped A case).

Laboratory monitoring data shows that the influenza virus currently circulating in the community is mainly type A, with type A H1N1 accounting for 82.2%. This flu season (114-115), there have been 1,421 cumulative severe cases (800 H1N1, 503 H3N2, 28 untyped A, 90 B) and 274 deaths (149 H1N1, 104 H3N2, 9 untyped A, 12 B), with most severe cases occurring in people over 65 (65.0%) and those with chronic conditions (82.7%), and 68.3% had not received this season’s flu vaccine.

According to data from the Taiwan Centers for Disease Control (CDC), the COVID-19 epidemic in Taiwan is declining, but it is still in its epidemic period. In week 36 (September 6-12), there were 17,847 outpatient and emergency room visits related to COVID-19, a 13.3% decrease compared to the previous week (August 30-September 5). Last week (September 8-14), there were 53 new locally transmitted severe cases and 18 local deaths. Since October 2025, there have been a cumulative total of 675 locally transmitted cases of COVID-19 complicated by severe illness, of which 124 have died. Severe cases are predominantly among those aged 65 and above (73.3%) and those with a history of chronic diseases (82.8%). 83.6% of these cases have not received the COVID-19 vaccine this season. In the past four weeks, the most prevalent local variants have been NB.1.8.1 and PQ.16.1.1.

The Centers for Disease Control (CDC) reminds the public to pay attention to their health as temperatures gradually cool in autumn. Those who are at high risk of influenza, including themselves and their families, should be especially vigilant. If they experience flu-like symptoms such as fever or cough, they should wear a mask, seek medical attention promptly, or rest at home. If they experience any warning signs (such as shortness of breath, difficulty breathing, cyanosis, bloody sputum, chest pain, altered consciousness, or low blood pressure), they should seek medical attention immediately. A doctor will assess whether they meet the eligibility criteria for publicly funded antiviral influenza medication to ensure timely treatment and reduce the risk of severe complications.

Whether any of this translates to an early flu season for North America or Europe remains to be seen.  The most recent data from the CDC suggests that influenza and RSV activity remains very low, and COVID is only slightly elevated.

 
While it is impossible to predict exactly what kind of winter respiratory season we'll see, past experience suggests it isn't something we should take lightly.  Last year's `moderately severe' flu season is estimated to have caused:

Which is why I'll be rolling up my sleeve again in the next few weeks for both my flu and COVID shots, and I won't hesitate to wear a face mask this winter in crowded indoor public places.