Saturday, October 10, 2026

WHO DON : Pneumonia of undetermined etiology - Russian Federation

 

#19,368

For the past week we've been following unverified media reports (see here, here, and here) of a Russian lab leak - supposedly of plague - (vigorously denied by Rospotrebnadzor) after the death of a lab worker from severe pneumonia in early October. 

Despite the Russian denials and reassurances, we really don't know exactly what happened - or may still be happening - at that Siberian lab.  

Today the WHO published a lengthy DON (Disease Outbreak News) report on the incident. While it provides several new details from the Russians, this report continues to stress that there are still a number of unknowns.

The WHO now offers a limited-confidence risk assessment, but it is tempered  by the lack of a confirmed diagnosis in the deceased laboratory worker, and ongoing uncertainty over the `source and mode of exposure'.

Due to its length, I've only posted the link, and a few excerpts.  Follow the link to read the DON in its entirety. 

Pneumonia of undetermined etiology - Russian Federation
10 October 2026

Situation at a glance

On 2 October 2026, WHO became aware through media reports of the death of an employee of the Irkutsk Antiplague Research Institute (APRI) of Siberia and the Far East, the Russian Federation. According to these reports, the individual died on 2 October following hospitalization for severe pneumonia on 29 September, and pneumonic plague was suspected as the cause of death, following occupational exposure in laboratory settings. 

Following requests for verification from WHO, the National Focal Point for the International Health Regulations (2005) (NFP) of the Russian Federation confirmed the death and informed WHO that no case of plague had been registered recently in Irkutsk Oblast, that preventive and control measures had been implemented in accordance with national sanitary legislation, and that the laboratory testing of contacts detected no high-threat pathogens. 

The authorities also reported that no biosecurity incidents had occurred in the laboratory, contrary to reports in the media, and that there were no further case of severe pneumonia linked to this case. The NFP informed WHO that the case and all contacts had been tested for a range of microorganisms, including high-threat pathogens. Test results were negative for the tested high-threat pathogens. All contacts had been medically followed up in healthcare facilities or at home, and all remained asymptomatic throughout. Quarantine measures were instituted in the hospital where the patient was being treated. 

Based on the information provided by NFP, WHO has not identified evidence of ongoing transmission associated with this event. A key uncertainty remains the absence of a confirmed diagnosis in the deceased laboratory worker. WHO will continue to monitor the situation and assess any potential public health implications as further information becomes available.

        (SNIP)

WHO risk assessment

WHO’s rapid risk assessment is a systematic and continuous process that characterizes the risk posed by a public health event and informs measures to reduce its impact and prevent international spread.

A key uncertainty for this event is the absence of a confirmed diagnosis in the deceased laboratory worker. According to information provided by the national authorities, testing did not identify plague or other tested high-threat pathogens, and the death has been classified as pneumonia of undetermined etiology. However, WHO has not received information identifying the causative agent responsible for the fatal illness. Given the absence of a confirmed diagnosis, WHO is not in a position to independently assess whether the duration of the reported monitoring period for contacts was sufficient to exclude all plausible causes of the fatal illness.

The occupational setting of the case remains an important consideration. The deceased individual worked at an institution that handles high-consequence pathogens, and precautionary public health measures were reportedly implemented because of the individual's professional activities. While the information provided by the authorities does not indicate infection with tested high-threat pathogens or identify additional linked cases, the source of the fatal illness remains undetermined. A laboratory-associated exposure therefore cannot be fully excluded at this stage.

Based on the information provided by NFP, WHO has not identified evidence of ongoing transmission associated with this event.

However, confidence in the assessment remains limited by the absence of a confirmed etiological diagnosis, and the remaining uncertainty regarding the source and mode of exposure. Additional clinical, epidemiological and laboratory information, including confirmation of the diagnosis in the deceased laboratory worker, is required to improve confidence in the assessment. WHO will continue monitoring the situation and assess any potential public health implications as further information becomes available. 

        (Continue . . . )

 

ISRV: Nomenclature Updates to the Hemagglutinin Gene Clade Designations Resulting From the Continued Evolution of High Pathogenicity Avian Influenza A(H5) Virus Clades 2.3.2.1c and 2.3.4.4


(Credit CDC)


#19,367

Thirteen years ago in 2013's EID Journal: The Expanding Variants Of H5N1, we looked at the continued evolution and diversification of H5N1 viruses around the globe.  At that time I wrote:

H5N1 virus was first identified in 1996 it has expanded into more than 20 different clades and subclades, and various versions of the virus now circulate in different parts of the world. You can see the evolution of the virus through 2011 in the chart below. 

image

NOTE: Not all of these clades continue to circulate.

 Clade 2.3.2 (and now 2.3.2.1) are very common in South East Asia, clades 2.2.1 and 2.2 are endemic in Egypt and clades 2.1.1, 2.1.2. and 2.1.3 are found in Indonesia.

This snapshot was taken before the emergence, and eventual world domination, of H5N8  clade 2.3.4.4, which would begin decimating South Korean poultry just two months after this was published, and of an H5N6 clade 2.3.4.4a virus which emerged in Sichuan, China a few months after that. 

In many ways, 2014 was a pivotal year for H5Nx viruses, with H5N1's dominance soon to be supplanted by a less deadly (to humans), but more easily spread by migratory birds, H5N8 clade 2.3.4.4x lineage.  

Older clades, such as Cambodia's 2.3.2.1c H5N1 virus went to ground (but would return roughly a decade later).  H5N8 dominated until 2020-2021, when an H5N1 clade 2.3.4.4b came roaring back, largely supplanting H5N8. 

In the spring of 2025, Cambodia's clade 2.3.2.1c was provisionally redesignated clade 2.3.2.1e  after analysis showed it had drifted away from the older clade. 

Similar evolutionary shifts have been happening in other clades over the past dozen years, which is why the WHO/WOAH/FAO H5 Evolution Working Group has updated the naming system for H5 bird flu viruses for the first time since their 2014 update.

Today's report from Influenza and Other Respiratory Viruses updates the official nomenclature for H5 viruses up to July 4, 2024.  

The working group added 12 new subclade designations:

  • Clade 2.3.2.1c was split into 2.3.2.1c–g. 
    • 2.3.2.1d: China, 2014–2016.
    • 2.3.2.1e: Vietnam and Cambodia, 2020–2024. 
    • 2.3.2.1f: India, the Middle East and Africa.
    • 2.3.2.1g: Indonesia, 2012–2016.
  • Clade 2.3.4.4 was split into 2.3.4.4a–h 
    • plus a "2.3.4.4-like" label for 125 outlier viruses that don't fit neatly
Some of these designations have been used provisionally for years, but are now made official. 

Although there was enough divergence among clade 2.3.4.4b viruses to technically warrant additional subclade splits, that decision has been deferred for now:  The Authors explained:
Furthermore, several of the newly designated 2.3.4.4 subclades had intra-clade APDs over the 1.5% threshold required for further splitting of clades due to the rapid expansion of these clades into new regions (e.g., 1.98% intra-clade APD of 2.3.4.4b representing over 13,000 sequences). Due to sampling biases stemming from the overrepresentation of sequences from specific outbreaks and insufficient data from regions with recent introductions, further subdivision of subclades with intra-clade APDs greater than 1.5% was deferred. Additional genetic data are needed to better assess the endemicity of specific clusters and justify further splits beyond the current subclades 2.3.4.4a–h.
Due to the highly technical and niche nature of today's study, I've only posted the link and abstract. Those wanting a deeper dive will want to follow the link to read it in its entirety. 

I'll have a brief postscript after the break.


Tommy T. Lam, C. Todd Davis … See all authors 
First published: 07 October 2026 https://doi.org/10.1111/irv.70317
Group members and collaborators are provided in the Supporting Information (Data S1). 
 
ABSTRACT

Background and Methods

The evolutionary divergence of the A(H5) hemagglutinin (HA) gene of high pathogenicity avian influenza (HPAI) viruses (A/goose/Guangdong/96 lineage) was analyzed by phylogenetic and average pairwise distance methods to identify clades that merit nomenclature updates.

Results and Conclusions

Based on this assessment, 12 new clade designations were recommended based on division of clade 2.3.2.1c and 2.3.4.4 viruses, which were reported in Africa, Antarctica, Asia, Europe, the Middle East, the Americas, and Oceania since the most recent WHO/WOAH/FAO H5 Evolution Working Group update.
        (Continue . . . )

H5's evolution continues, and we will undoubtedly see additional `provisional' clade and subclade designations added in the years ahead.  

The bottom line is that H5 viruses have not only grown more diverse, they are a far cry from what emerged in China in the 1990s, and sparked pandemic fears in the early 2000s. 

Whether any of that gives them the ability to spark a human pandemic remains to be seen.  But it would be reckless to assume that since their ancestors didn't, their descendants never will.  

Friday, October 09, 2026

Isaias Forecast To Become A Major Hurricane Later Today - Landfall Tonight

 

#19,366

While wind shear may lower its intensity a bit (depending on timing) as it approaches the coast, Isaias is expected to be at least a strong CAT 2 storm at landfall, possibly higher.  

Regardless of its intensity, Isaias is expected to produce life-threatening surge, high winds, and torrential rains.  Residents in the affected area should hurry to complete the preparations today. 


While most people prepare for the actual storm, often the days (and sometimes weeks) following the storm are the most stressful.  

The power may be out for days, floodwaters may contain hidden dangers, local stores may be closed, and people may risk injury using chainsaws, generators, or ladders. 


I've written extensively on After The Storm Passes, but many of those preparedness links are no longer active. The CDC has updated their Preparing for Hurricanes or Other Tropical Storms webpage, covering most of those topics. 

A few related blogs you may wish to revisit include:

WSDA: Washington confirms first detection of avian influenza in dairy cattle


#19,365

While the USDA's dashboard (above) has not yet been updated, late yesterday the State of Washington and the USDA/APHIS announced that two cattle herds in Washington have tested positive for HPAI H5 clade 2.3.4.4b (N type and genotype pending); the first such detection in that state. 

This is the first new state to report an outbreak in 2026 (the last being Wisconsin in December 2025), and the 20th state to report dairy cattle H5N1 infection (Oregon is marked on the above map due to H5N1 in pigs). 

First, the Washington State Announcement: 



OLYMPIA – Oct. 8, 2026 –The USDA National Veterinary Services Laboratory (NVSL) confirmed the first detection of highly pathogenic avian influenza (HPAI) H5N1 in two Yakima County dairy farms in Washington state by the Washington Animal Disease Diagnostic Laboratory.

For the last two years, the Washington State Department of Agriculture (WSDA) and the Washington Animal Disease Diagnostic Laboratory at Washington State University have conducted over 7,000 surveillance tests for HPAI that have all been free of the disease.

This marks the first known case of HPAI in cattle in Washington state. Dairy cattle in a total of  19 states have been infected since the start of the outbreak in March 2024. Washington State Department of Agriculture conducted on-farm investigations, testing, and gathered additional epidemiological information to better understand this detection and limit further disease spread. The two farms are under quarantine and have employed strict biosecurity measures. Veterinarians are working to treat sick cows. 

Pasteurized milk products remain safe for consumers, and milk supply shortages are not expected.

WSDA urges livestock owners statewide to report any clinical signs of illness to their veterinarian, including:
  • Changes in milk appearance (thicker, often yellowish to brown)
  • Decreased milk production
  • Decline in feed intake
  • Fever
  • Respiratory symptoms
  • Changes in manure
  • Steep drop in rumination and rumen motility
If you notice any of these signs, isolate affected animals and contact your veterinarian and WSDA at 360-902-1878 or ahealth@agr.wa.gov.

Most cattle affected by HPAI recover with supportive care with recovery typically taking about six weeks.

“We appreciate how difficult this is for our dairy families, farmworkers and veterinarians that are working hard to keep animals safe and healthy,” said Washington State Veterinarian Amber Itle, VMD, MS. “The most important thing you can do is implement enhanced biosecurity and report symptoms immediately if animals show signs of illness.”

HPAI can spread between dairy cattle through infected animals and contaminated milk, equipment, vehicles, clothing, footwear and other materials or people that move between farms. Wild birds can also carry HPAI, but they are not considered the primary source of spread of the virus between dairy herds.

Protecting your herd
  • Follow your biosecurity plan or write one with your veterinarian to incorporate enhanced biosecurity measures:
  • Limit lactating animal movement between farms unless necessary
  • Do not share equipment, vehicles or workers
  • Clean and disinfect footwear before entering livestock areas
  • Limit visitors and require clean clothing and footwear
  • Isolate new animals for 30 days before introducing them to your herd
  • Separate sick or suspect cattle from healthy cattle when possible
  • Practice good milking hygiene and keep milk from sick or suspect cattle out of the bulk tank
  • Restrict access to open water used by wild waterfowl
  • Employ wildlife, wild bird, rodent and vector control
  • Minimize contact with wild birds and other animals, particularly around cattle, feed, water and equipment
Dairy product safety

Pasteurization inactivates viruses and bacteria in milk, including HPAI virus, helping ensure the safety of the dairy supply. Infected cows can shed the virus in their milk, making raw milk and other raw dairy products unsafe for consumption. Avoid raw dairy product consumption, and do not allow your pets to consume raw milk or other dairy products, or raw foods such as raw meat.

Human health and safety

The Centers for Disease Control and Prevention (CDC) and the Washington State Department of Health (DOH) currently consider the risk to the public from avian influenza to be low. However, people who work with or have recreational contact with infected birds, cattle or other potentially infected domestic or wild animals are at higher risk and should take precautions, including wearing personal protective equipment (PPE) such as gloves, masks, eye protection and fluid-resistant coveralls or other outerwear.


The USDA/APHIS statement:


Milk Supply Safe; Considered Low Risk to Human Health and Safety

WASHINGTON, D.C., October 8, 2026—Today, the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) National Veterinary Services Laboratories (NVSL) confirmed via PCR (polymerase chain reaction) detection of highly pathogenic avian influenza (HPAI) H5 clade 2.3.4.4b in two dairy cattle herds in Washington. APHIS will complete genetic sequencing and announce final results as soon as they are available. The affected herds were tested after exhibiting clinical signs consistent with avian influenza. Prior to this detection, the herds consistently tested negative through routine surveillance conducted under the National Milk Testing Strategy program.

These are the first confirmed case detections of HPAI in livestock in the State of Washington. While dairy cattle in a total of 19 states have been infected since the start of the outbreak in March 2024, APHIS has seen cases in only a small number of states this year. APHIS is working closely with the Washington Department of Agriculture to conduct additional on-farm investigations, diagnostic testing, and epidemiological data collection to better understand the detection and prevent further disease spread.

The detection does not change USDA’s HPAI eradication strategy. Biosecurity is still key to mitigating the risk of disease introduction or spread between premises. APHIS recommends enhanced biosecurity measures for all dairy farms. Producers should immediately report any livestock with clinical signs, or any unusual sick or dead wildlife, to their state veterinarian. Financial assistance is available to enhance biosecurity and offset costs associated with HPAI.

This detection does not pose a risk to consumer health or affect the safety of the commercial milk supply. The U.S. Food and Drug Administration is confident that pasteurization is effective at inactivating HPAI virus, and that the commercial, pasteurized milk supply is safe. Dairies are required to send only milk from healthy animals into processing for human consumption; milk from impacted animals is being diverted from the commercial milk tank or destroyed so that it does not enter the human food supply.

According to the U.S. Centers for Disease Control and Prevention (CDC), HPAI viruses circulating in birds and U.S. dairy cattle pose a low risk to the general public in the United States. However, people who have job-related or recreational exposures to infected birds or mammals are at higher risk of infection and should take appropriate precautions outlined in CDC guidance.

While I'm confident in the ability of pasteurization to effectively kill the H5N1 virus in commercial milk, Washington is one of the few U.S. states that allows the sale of raw milk in grocery stores, natural food markets, food co-ops, and direct-to-consumer farm stores.

In 2024 and 2025 both Washington and Oregon repeatedly warned on the dangers of feeding raw milk or raw food products to cats, after a number of cats died from H5N1 (see Washington State (WSDA) Announces 2 Households with H5N1 Infected Cats Linked to Raw Food).

Hopefully people will take the risks seriously, and we won't see a replay of those events - or something worse - this fall. 

Thursday, October 08, 2026

WHO: Dr. Tedros Statement On `Plague' Incident In Russia

 

#19,364

Two days ago the WHO posted the above statement on the Russian `Lab Leak' Story we've been following for nearly a week.  Since then, we've continued to see denials from the Russian government, which insists they are dealing with a single fatal case of pneumonia of unknown etiology.

They have reported no plague; no laboratory accident; and no epidemiological risk to the public.

At the same time, Rospotrebnadzor reportedly claimed they'd performed  nearly 5,000 `laboratory tests'  since this `non-event' supposedly happened, which seems a rather extreme response. 

While it is fair to say that we don't know exactly what happened - or may still be happening - at that Siberian lab, the Russian's explanations are meeting with a fair amount of international skepticism. 

A little over an hour ago the WHO Director-General Tedros Adhanom Ghebreyesus  posted the following statement (made yesterday, Oct. 7th) on Twitter/X    

Last Friday, the 2nd of October, the first media reports emerged of a suspected case of pneumonic plague in a laboratory worker at the Irkutsk Antiplague Research Institute in the Russian Federation. The lab worker died after being hospitalized with severe pneumonia. Initial media reports suggested pneumonic plague following an accidental lab exposure. is aware that the Russian government held a meeting on the 2nd of October because they suspected a resident of the Irkutsk oblast had contracted a dangerous infection. On Saturday, WHO asked the Russian Federation for more information, in accordance with the International Health Regulations. On Tuesday, the Russian Federation responded, saying that no case of plague had recently been reported in the Irkutsk oblast, and that they had placed about 200 contacts in quarantine. However, WHO has requested further information on the laboratory tests conducted on the individual who died and the contacts, more detail on what prompted the public health measures, and details about the health status of the contacts. We have also sought verification of media reports of a second employee with pneumonia of undetermined cause. WHO has offered technical support related to plague and lab biosafety and biosecurity. As we don’t yet have the full picture of this event, we are not able to conduct a full risk assessment. Timely, complete and transparent information sharing under the International Health Regulations is essential to clarify conflicting reports and enable an accurate assessment of potential public health risks.

While cloaked in diplomatic prose, it seems pretty clear the WHO isn't fully buying what the Russian government is selling. 

Stay tuned.  This could have legs. 

ECDC Assessment: Zoonotic influenza A(H5) vaccination in humans in the EU/EEA


#19,363

In the summer of 2024 , the EU Commission secured access for Member States to purchase 665,000 doses of zoonotic influenza vaccines to prevent avian flu, with the first shipment scheduled to go to Finland, which had recently experienced a prolonged H5 outbreak in fur farms (see Finland: MOH Announcement On Avian Flu Vaccine Availability For People At High Risk).

From the EU 6/24 announcement:
The vaccine is intended for those most exposed to potential transfers of avian influenza from birds or animals, such as poultry farm workers and veterinarians. It aims to prevent the spread or potential outbreaks of avian influenza in Europe, protecting citizens and livelihoods. The vaccine is the only preventive zoonotic avian influenza vaccine currently authorized in the EU.

Fifteen EU and EEA Member States are participating in this voluntary procurement with the company Seqirus UK Ltd. The contract allows each participating country to take into account their public health context and order vaccines depending on national need. The contract will run for a maximum of 4 years.
This initial order was enough to vaccinate 330,000 people (assuming 2 doses each), with an option to buy another 40 million doses if needed. But the EU would need nearly 900 million doses to cover their entire population.

Last May, in Vaccines: Lessons from the 2024 avian influenza vaccination campaign in Finland: a qualitative inquiry, we looked at the disappointingly low uptake of the H5 vaccine by Finland's target groups, with the authors reporting:
In 2024, Finland became a global forerunner to offer H5 vaccine to occupational risk groups, specifically fur and poultry workers, following an extensive HPAI H5N1 outbreak in 2023 in fur-farmed minks and foxes. Despite targeted efforts to reach the people at increased risk, only 8,6% of the target population received the first dose and 7,5% completed both doses.

While disappointing, this uptake is not unexpected, given the hurdles public health has faced getting poultry, swine, and fur farmers to get the seasonal flu vaccine to try to prevent reverse zoonosis. 

And, as we've seen previously (see Two Surveys (UK & U.S.) Illustrating The Public's Lack of Concern Over Avian Flu) - in addition to growing vaccine hesitancy - the public appears largely unconvinced over the HPAI threat. 

Last December in ECDC Pre-pandemic Guidance: Strategies to Fight Avian and Swine flu in Humans we looked at a  71-page operations framework for European countries to use when dealing with outbreaks of novel swine or avian influenza. 

One of the topics covered was potential pre-pandemic vaccination of high-risk individuals with a zoonotic influenza A(H5) vaccine.

Yesterday the ECDC published the results of a survey of 30 EU/EEA member nations on their plans for current or future H5 vaccination of humans, of which 27 responded. 

This is a fairly brief report (9 pages), which finds 5 (19%) of reporting countries have begun limited vaccination of high-risk individuals, another 11% plan to begin offering the vaccine in the next year, and the remaining 70% have no plans in place at this time. 


While there are sizable gaps in the data, uptake of the vaccine - as we saw in Finland - appears to have been quite limited.   


All of this is self-reported data, of course - and since there is no standardized reporting format - making comparisons between countries is extremely difficult. 

Follow the link to read the report in its entirety.  I'll have a brief postscript after the break. 



Assessment
7 October 2026

Highly pathogenic avian influenza A(H5N1) continues to circulate widely in wild birds and cause outbreaks in poultry and other animals across Europe. Despite extensive circulation, human infections remain rare and no human cases have been confirmed in the EU/EEA to date.

Considering this, ECDC assesses the risk from A(H5N1) viruses circulating in Europe as low for the general population and low to moderate for people occupationally or otherwise exposed to infected animals or contaminated environments.

Key findings
  • Twenty-seven of 30 EU/EEA countries responded to the survey on influenza A(H5) vaccination in humans – national plans and implementation status in EU/EEA. Eight countries reported having national A(H5) vaccination recommendations in place, eight were currently developing them, and 11 had no plans at the time of the survey.
  • Implementation of the plans remained limited: five countries had started vaccination campaigns (Austria, Finland, Lithuania, the Netherlands and Portugal) and three planned to do so within one year. Priority groups most commonly included in the cohort to be vaccinated were veterinarians and animal-health staff, culling teams, laboratory staff and workers in farming and the poultry sector.
  • Most countries reported that they are monitoring or planning to monitor vaccine uptake; the majority through immunisation registries.
  • Reported vaccine uptake in reporting countries was generally low outside laboratory settings, but data were incomplete and not comparable across countries.
  • Overall, results were heterogeneous in the EU/EEA due to variation in national recommendations, implementation plans, delivery arrangements and uptake monitoring. For preparedness purposes, countries would benefit from clearly defined programme objectives and scenario-based triggers, tested delivery pathways, targeted communication and uptake-monitoring plans. 

Publication file



In addition to the EU's purchase, over the past 3 years we've seen a number of other countries announced their intention to stockpile limited supplies of a pre-pandemic H5N1 vaccine, including: 
All are quantities that might help protect those occupationally most at risk during an H5Nx outbreak, but the general population would likely have to wait 6 months or longer before large quantities of vaccine would be made available (see Referral: SCI AM - A Bird Flu Vaccine Might Come Too Late to Save Us from H5N1).

At least that's the theory.  

Whether we'll be ready to react to an actual human outbreak remains to be seen.