Saturday, December 21, 2024

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

 

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

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

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

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

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

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

Press Release - Friday, December 20, 2024

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

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

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

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

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

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

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

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

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

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

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

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

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

The CDC also updated the following guidance document yesterday:

WHAT TO KNOW

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

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


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

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

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

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

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

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

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

Iowa Reports Their First Human H5 Infection



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As mentioned eighteen hours ago in CDC FluView Week #50: Seasonal Flu Rising - 3 Confirmed & 1 Probable H5 Cases For the Week, the CDC's official H5 case count - which then stood at 61 - was likely to increase before the day was out.  

A few hours later, California announced 2 more cases (n=36), and late yesterday, Iowa announced their first case (see statement below). 

Iowa HHS Reports First Human Case of Highly Pathogenic Avian Influenza (HPAI) in Iowa, Risk Remains Very Low to Public

Friday, December 20, 2024
News Release

The Iowa Department of Health and Human Services (Iowa HHS) is reporting the first human case of avian influenza A(H5) in the state. The individual was exposed to infected poultry while working with a commercial flock in northwest Iowa. The individual reported mild symptoms, has received appropriate treatment and is recovering. The case was identified through testing at the State Hygienic Laboratory and confirmed by the Centers for Disease Control and Prevention (CDC).

As of December 20, 2024, the CDC has reported 64 confirmed human cases of H5 HPAI across nine states. The majority of the exposures are linked to infected poultry or dairy cows. There is no evidence that human-to-human transmission of influenza A(H5) is occurring in the U.S.

Although human infections are rare, the virus is spread through prolonged exposure around infected flocks and herds, through the eyes, nose or mouth. Any individuals with direct contact who develop flu-like symptoms or an eye infection should contact their doctor. To reduce the risk of infection or spread, people in direct contact with exposed animals should wear proper PPE and avoid direct contact with sick or dead animals, including birds.

“Iowa has monitored the spread of avian influenza closely since it was first detected in poultry in the state in 2022, and our state is prepared with the established knowledge, strong partnerships, and effective tools to mitigate its impact on our community,” said Iowa HHS State Medical Director Dr. Robert Kruse.

There is no concern about the safety of eggs and poultry products or pasteurized milk and dairy products. As a reminder, consumers should always properly handle and cook eggs and poultry products, including cooking to an internal temperature of 165˚F. Pasteurization has continually proven to successfully inactivate bacteria and viruses, like influenza, in milk.

Twelve states have now reported either CDC confirmed (n=10) or probable (n=2) H5 infections.  In addition to their confirmed cases, California also has identified 1 probable and Washington has identified 3.  

Combined, the number of H5 cases now sits well over 70 (not including serologically identified cases).

Last yesterday the CDC updated their chart (see below) to include 2 new cases from California, and 1 from Wisconsin. Note: it does not include the newest Iowa case.


While we watch these numbers intently, they likely only represent a portion of the human H5 cases out there. We know from experience that surveillance and testing only picks up a fraction of the total number of cases. 

 The proverbial `tip of the iceberg’ or in the case of the graphic below, the `top of the pyramid’. 

Our challenges in identifying and tracking cases H5N1 infections are topics we've looked at previously. Last summer the ECDC published Enhanced Influenza Surveillance to Detect Avian Influenza Virus Infections in the EU/EEA During the Inter-Seasonal Period which cautioned:
Sentinel surveillance systems are important for the monitoring of respiratory viruses in the EU/EEA, but these systems are not designed and are not sufficiently sensitive to identify a newly emerging virus such as avian influenza in the general population early enough for the purpose of implementing control measures in a timely way.
Similarly, in 2023's analysis from the UKHSA (see TTD (Time to Detect): Revisited), they estimated there could be dozens or even hundreds of undetected human H5N1 infections before public health surveillance would likely detect them, potentially over a period of weeks or months. 

While great emphasis is placed on the latest official numbers of people, cattle herds, poultry flocks,  or other animals infected by the virus, the reality is - they likely only represent a small part of a much larger picture. 

And while low numbers may be reassuring, they can also lull us into dangerous complacency. 

Friday, December 20, 2024

CDC FluView Week #50: Seasonal Flu Rising - 3 Confirmed & 1 Probable H5 Cases For the Week


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The post-Thanksgiving bounce in seasonal flu is readily apparent from the above graphic, with the CDC estimating nearly 2 million illnesses, and 1,000 deaths, already this fall.  Key points from this week's FluView include:

Key Points

Seasonal influenza activity continues to increase across the country.
• Nationally, percent positivity for influenza, the percentage of emergency department visits for influenza, percentage of outpatient visits for respiratory illness, and influenza-associated hospitalizations increased this week compared to last week.
• During Week 50, of the 871 viruses reported by public health laboratories, 842 were influenza A and 29 were influenza B. Of the 593 influenza A viruses subtyped during Week 50, 274 (46.2%) were influenza A(H1N1)pdm09, 317 (53.5%) were A(H3N2), and 2 (0.3%) were A(H5).
Three confirmed cases and one probable case of influenza A(H5) virus were reported to CDC this week. To date, human-to-human transmission of influenza A(H5) virus has not been identified in the United States.
• Two pediatric deaths associated with seasonal influenza virus infection were reported this week, bringing the 2024-2025 season total to four pediatric deaths.
• CDC estimates that there have been at least 1.9 million illnesses, 23,000 hospitalizations, and 970 deaths from flu so far this season.
• CDC recommends that everyone ages 6 months and older get an annual influenza (flu) vaccine.1
• There are prescription flu antiviral drugs that can treat flu illness; those should be started as early as possible and are especially important for higher risk patients.2

• Influenza viruses are among several viruses contributing to respiratory disease activity. CDC is providing updated, integrated information about COVID-19, flu, and respiratory syncytial virus (RSV) activity on a weekly basis. 

Details on this week's HPAI H5 human infections follow.  Not mentioned in today's report (possibly because of pending test results) is the case reported by Wisconsin a couple of days ago.  


Novel Influenza A Virus

Three confirmed cases and one probable influenza A(H5) case were reported to CDC this week. To date, human-to-human transmission of influenza A(H5) virus has not been identified in the United States.

Two of these confirmed cases were reported by the California Department of Public Health. The cases occurred in a workers aged ≥18 years at a commercial dairy cattle farm in an area where highly pathogenic avian influenza (HPAI) A(H5N1) viruses had been detected in cows. The individuals had mild symptoms, which they reported to local health department officials. There have now been 34 total confirmed cases and one probable case in California.

The other confirmed case was reported by the Louisiana Department of Health. This case occurred in an individual aged ≥18 years. This individual developed respiratory symptoms during week 48 and was hospitalized with their illness. A respiratory specimen was collected at the healthcare facility and tested positive for influenza A, but negative for seasonal virus subtypes. The specimen was sent to the Louisiana Public Health Laboratory for further testing, where it tested presumptive positive for influenza A(H5) virus using the CDC influenza A(H5) assay. Influenza A(H5) virus was confirmed at CDC. The investigation by public health officials identified exposure to backyard poultry prior to the patient's illness onset. The patient remains hospitalized. This is the first influenza A(H5) case in Louisiana and the first instance of severe illness from influenza A(H5) virus infection in the United States.

The probable case was reported by the Delaware Division of Public Health. The case occurred in an individual aged ≥18 years. This individual developed respiratory symptoms during week 48 and sought healthcare for their illness. A respiratory specimen was collected at the healthcare facility and tested positive for influenza A. The specimen was sent to the Delaware Public Health Laboratory for routine surveillance, where it tested presumptive positive for influenza A(H5) virus using the CDC influenza A(H5) assay. The specimen was negative for influenza A(H5) virus using diagnostic RT-PCR at CDC. The investigation by public health officials did not find any exposure to poultry or cows or consumption of raw dairy products prior to the patient's illness onset. The patient has since recovered. This is the first probable case in Delaware.

Notification of the case reported by the Louisiana Department of Health to WHO was initiated per International Health Regulations (IHR). More information regarding IHR can be found at http://www.who.int/topics/international_health_regulations/en/. No additional notification to WHO of the probable case or confirmed cases exposed to dairy cows in California is required per International Health Regulations (IHR).

The CSTE position statement, which includes updated case definitions for confirmed, probable, and suspected cases is available at http://www.cste.org/resource/resmgr/position_statements_files_2023/24-ID-09_Novel_Influenza_A.pdf

An up-to-date human case summary during the 2024 outbreak by state and exposure source is available at www.cdc.gov/bird-flu/situation-summary/index.html

Information about avian influenza is available at https://www.cdc.gov/flu/avianflu/index.htm.

Interim recommendations for Prevention, Monitoring, and Public Health Investigations are available at https://www.cdc.gov/bird-flu/prevention/hpai-interim-recommendations.html.

The latest case reports on avian influenza outbreaks in wild birds, commercial poultry, backyard or hobbyist flocks, and mammals in the United States are available from the USDA at https://www.aphis.usda.gov/aphis/ourfocus/animalhealth/animal-disease-information/avian/avian-influenza/2022-hpai.


Given that we've seen late Friday HPAI announcements nearly every Friday this fall, these numbers are absolutely subject to change. 


 

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


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Today FAO/WHO/WOAH released an updated assessment of the threat posed by HPAI H5, and while they currently gauge the public health impact of such infections globally as minor, a couple of caveats are in order.

  • First, this is based on information received by these agencies as of Nov 18th;
  • Second, it is based on what is being reported by member nations, which history has shown not always to be complete or timely. 
While member nations are required under the 2005 IHR to report novel virus detections to the WHO with 24-hours, the reality is that many governments are often slow - or reluctant - to release `bad news' which may impact their economy, or political stability (see From Here To Impunity).

With that in mind, you'll find the link - and some excerpts - from today's 13-page update below.  Follow the link to read it in its entirety. 

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

Assessment based on data as of 18 November 2024

20 December 2024

Key points

At the present time, based on available information, FAO-WHO-WOAH assess the global public health risk of influenza A(H5N1) viruses to be low, while the risk of infection for occupationally exposed persons is low to moderate depending on the risk mitigation measures in place and the local avian iwork with national agencies and partners to better understand the exposure to and risk from raw/unpasteurized milk and milk product   
nfluenza epidemiological situation. Transmission between animals continues to occur and, to date, a growing yet still limited number of human infections are being reported. Although additional human infections associated with exposure to infected animals or contaminated environments are expected to occur, the overall public health impact of such infections at a global level, at the present time, is minor.

This risk assessment from FAO, WHO, and WOAH updates the assessment of the risk of zoonotic transmission (for example, animal to human) considering additional information made available since the previous assessment of 14 August 2024. This update is limited to the inclusion of additional information being made available globally.

Due to the potential risk to human health and the farreaching implications of the disease on the health of wild birds, poultry, livestock and other animal populations, the use of a One Health approach is essential to tackle avian influenza effectively, to monitor and characterize virus circulation, to prevent within species and to new species transmission, to reduce spread among animals, and to prevent human infections from exposure to animals.

         (SNIP)

Detections in humans

Since the last joint assessment of August 2024 and as of 27 November 2024, an additional 49 human cases of infection with A(H5) viruses have been reported. Of these, 45 were reported from the USA: 28 in persons with exposure to A(H5N1)-infected dairy cattle in California, 15 in persons with exposure while involved in depopulation of A(H5N1)-infected commercial poultry farms, and two in persons with unknown exposure at the time of reporting. Samples from three cases related to poultry depopulation in the State of Colorado were confirmed to contain A(H5N1) clade 2.3.4.4b, genotype B3.13, virus while cases related to poultry depopulation in the State of Washington contained viruses belonging to the D1.1 genotype.

Intensive epidemiological investigation of the case with unknown exposure in the State of Missouri could not identify any animal or animal product exposure. Five health care workers in contact with the case were shown to be A(H5N1) seronegative, the case and one household contact who reported symptoms with the same onset date were weakly A(H5N1) seropositive. The timing of symptom onsets supports a single common exposure, which at present remains unknown, rather than human-to-human transmission.32

All but one of the detected cases in the USA have reported mild symptoms, including conjunctivitis and mild respiratory symptoms, and recovered without hospitalization. The one exception who had comorbidities reported gastrointestinal symptoms and was hospitalized.33,34

A recent sero-study in 115 persons in Colorado and Michigan working on dairy farms during A(H5N1) outbreaks among dairy cattle found that eight (7.0%) had serologic evidence of recent infection(seropositive, ≥40 antibody titres to H5 2.3.4.4b by both micro-neutralization and hemagglutination inhibition assays). These seropositive individuals reporting working with dairy cattle or in the milking parlour, and four reported being ill when A(H5) was detected among the dairy cattle.35

work with national agencies and partners to better understand the exposure to and risk from raw/unpasteurized milk and milk product   

Three human cases of clade 2.3.2.1c A(H5N1) virus infection were reported from Cambodia since the last update of August 2024. All were hospitalized; two recovered and the other died. All three cases had exposure to sick or dead backyard poultry.

On 13 November, one human case of domestically acquired A(H5N1) infection was confirmed by Canadian authorities in a young person without underlying conditions. The condition of the case was reported as critical. There are several ongoing investigations to better understand the exposures of this case, and so far investigations have not been able to identify the source of exposure. The virus from the case belonged to clade 2.3.4.4b, specifically the D1.1 genotype, which was similar to viruses concurrently affecting poultry in the region.36

         (SNIP)

Recommended actions 

It is recommended that Member States and national authorities: 

increase surveillance and vigilance, in human populations, especially amongst occupationally exposed persons, for the possibility of zoonotic infections, particularly through National Influenza Centres (NICs) and other influenza laboratories associated with GISRS; 

assess and reduce the risk among occupationally exposed persons using methods such as active case finding and molecular and serologic methods, reducing environmental exposures, providing adequate and appropriate personal protective equipment; 

conduct active case finding around suspected and confirmed human cases to determine if there are additional cases or indications of human-to-human transmission; and 

work with national agencies and partners to better understand the exposure to and risk from raw/unpasteurized milk and milk product         

Under the International Health Regulations (IHR) (2005),55 States Parties are required to notify WHO within 24 hours of any laboratory-confirmed case of human influenza caused by a new subtype according to the WHO case definition. 56 WHO has published the case definition for human infections with avian influenza A(H5) virus requiring notification under IHR (2005).

          (Continue . . . )

 

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

Human H5 Case Reports past 6 years 
 

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The ECDC publishes a highly detailed avian influenza surveillance report roughly every 3 months, and while they tend to be EU centric, in its 60+ pages you'll find ample coverage of outbreaks and infections from around the world.

Four years ago, following a complex series of genetic changes to the HPAI H5 virus, we began to see a global surge and spread of H5N1, characterized by increased spillovers into mammals (mink, foxes, marine mammals, and eventually even cattle).

The graphic above illustrates that by 2019 the the number of reported H5 human infections had dwindled to near zero, but have increased significantly each year since. In 2024, the focus of H5 spillovers into humans shifted largely over to the United States.

These quarterly reports make excellent reference material, well worth perusing.  I've posted the ECDC summary and link below. 


Avian influenza overview September-December 2024
Surveillance and monitoring
18 Dec 2024
Publication series: Avian influenza overview

Translate this page

Between 21 September and 11 December 2024, 45 cases of zoonotic avian influenza infection with A(H5N1) clade 2.3.4.4b virus were reported from North America. These infections were mainly linked to exposure to infected animals through occupational activities. Human infections with avian influenza viruses remain rare and sporadic, without evidence of sustained human-to-human transmission so far.

Many HPAI outbreaks in domestic birds were clustered in areas with high poultry density and characterised by secondary farm-to-farm spread. Waterfowl, particularly the mute swan, were primarily affected during this reporting period, with HPAI virus detections focused on south-eastern Europe. Notably, A(H5N5) viruses expanded their geographic and host range, resulting in a surge in detections and mortality events described in gulls and crows.
No new HPAI virus detections in mammals were reported in Europe during this reporting period, but the number of dairy cattle farms reportedly affected in the United States of America (USA) rose to > 800 in 16 States, and HPAI virus was identified in two pigs in a mixed-species farm. Between 21 September and 11 December 2024, 56 new human cases with avian influenza virus infection were reported from North America (45 A(H5N1) cases), Viet Nam (one A(H5)) and China (ten A(H9N2) cases). Most of the A(H5) human cases in North America (95.6%, n = 43/45) had reported exposure to poultry, live poultry markets, or dairy cattle prior to avian influenza virus detection or onset of illness.
Human infections with avian influenza viruses remain rare and no evidence of human-to-human transmission has been documented in the reporting period. The risk of infection with currently circulating avian A(H5) influenza viruses of clade 2.3.4.4b in Europe remains low for the general public in the European Union/European Economic Area (EU/EEA). The risk of infection remains low-to-moderate for those occupationally or otherwise exposed to infected animals or contaminated environments.

LA County Issues Another Raw Milk Warning


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Despite ample evidence of its dangers, the `raw milk' movement in the United States continues to grow. A 2022 study published in the Journal of Food Protection found that:

Results show that 4.4% of U.S. adults reported consuming raw milk at least once in the past year, with 1.6% reporting frequent consumption of raw milk (once per month or more often) and 1.0% reporting consumption once per week or more often
Over the past month we've seen several recalls of raw milk in California after evidence of H5N1 contamination surfaced (see here, here, and here), and this week it was confirmed that at least 2 cats died in Los Angeles from the H5 virus after consuming raw milk.

Two days ago California's governor declared a State of Emergency over the bird flu threat (see statement) and this week we've seen several new states report human infections (Delaware, Louisiana, Wisconsin), including one which is in intensive care.

While it may not deter raw milk aficionados, the LA County Dept. of Public Health issued another warning late yesterday on the dangers of consuming unpasteurized dairy products.  I'll have a bit more after the break.

For Immediate Release:

December 19, 2024

The Los Angeles County Department of Public Health is urging residents to avoid consuming or feeding to their pets raw milk due to the ongoing spread of H5 bird flu in dairy cows. A recent statewide recall by the California Department of Food and Agriculture (CDFA) reported additional detections of bird flu virus in samples taken from a raw milk bulk tank at the Valley Milk Simply Bottled dairy farm of Stanislaus County.

Residents should avoid consumption of all raw milk and not feed it to their pets -- whether obtained from a licensed retailer, local farm, neighbor, or friend. Raw milk, which is milk that has not been pasteurized, can harbor harmful bacteria and viruses, including bird flu, which can pose serious risks to public health. While consuming raw milk is never advised from a public health standpoint, the risk is especially concerning at this time, given the ongoing spread of bird flu virus among dairy cattle and following recent multiple detections of the virus in raw milk products.

Obtaining raw milk through unlicensed distributors carries an elevated risk as these products are not permitted or regulated by The California Department of Food and Agriculture’s (CDFA) rigorous requirements for milk producers. In order to be sold commercially in California, raw milk must be produced on a dairy farm that holds a market milk permit issued by CDFA. CDFA inspects farms and bottling facilities, collecting milk samples for laboratory analysis, and communicating with the dairy farmers on any issues indicated by laboratory test results. While permitted raw milk is tested and regulated, there is no guarantee that it is completely safe and may still pose significant health risks for both humans and pets.

Anyone can become sick from drinking raw milk or consuming raw milk products. The people at the highest risk for severe illness include people who are pregnant, adults 65 years and older, children younger than 5 years, and people with weakened immune systems.

The products impacted by this new recall may be marketed as Valley Milk Simply Bottled Raw Cow Milk and DESI Milk Raw Cow Milk and are distributed in quart (32 oz), half gallon (64 oz), and one gallon (128 oz) plastic jugs. The recalled jugs have an expiration date of DEC 23 2024 through DEC 30 2024 marked on the container.

CDFA is notifying retailers to remove the affected raw milk from their shelves. People may have already purchased the raw milk that may be contaminated with H5 bird flu virus from retailers prior to the recall and should immediately discard any remaining product or return it to the retail point of purchase. This includes frozen raw milk products since freezing does not eliminate harmful germs that can cause illness.

No human illnesses associated with this raw milk recall have been reported in LA County. Public Health recently confirmed H5 bird flu in four cats that consumed recalled raw milk and became sick and died, which is part of an ongoing investigation. Cats infected with H5 bird flu can develop severe illness that may including neurologic signs, respiratory signs or liver disease that can rapidly progress to death.

Anyone who has consumed these specific recalled raw milk products and is experiencing symptoms should immediately contact their health care provider or local health department.

About Raw Milk

Raw milk is milk that has not been pasteurized to kill harmful bacteria. Raw milk—and products made from it such as queso fresco—can carry harmful germs, such as Listeria, SalmonellaCampylobacterE. coli, viruses and parasites. These germs can present serious health risks to you and your family.

Pasteurization is the process of heating milk to a high enough temperature for enough time to kill harmful germs, which can cause serious illness. This process does not eliminate milk’s nutritional value.

Raw milk, even from healthy cows, may be contaminated with harmful germs that can make you very sick. In fact, raw milk is one of the riskiest foods to consume. People who get sick from raw milk might have many days of diarrhea, stomach cramping, and vomiting. Some people might develop severe or even life-threatening diseases, including pregnancy loss; blood infection; hemolytic uremic syndrome, which can result in kidney failure, stroke, and even death; Guillain-Barré syndrome, which can cause paralysis and even death.

Anyone can become sick from drinking raw milk or consuming raw milk products. The people at the highest risk for severe illness include people who are pregnant, adults 65 years and older, children younger than 5 years, and people with weakened immune systems. People in these groups should not consume raw milk or products made with it.

Drinking or accidentally inhaling raw milk containing bird flu virus may lead to illness. In addition, touching your eyes, nose, or mouth with unwashed hands after touching raw milk with bird flu virus may also lead to infection. Symptoms of bird flu infection in humans include eye redness or discharge, cough, sore throat, runny or stuffy nose, diarrhea, vomiting, muscle or body aches, headaches, fatigue, trouble breathing and fever.

For questions or to find a nearby clinic or doctor, residents can call the Public Health InfoLine at 833-540-0473. Open every day from 8 a.m. to 8 p.m.

For more information, visit our websites:

Avian flu in animals: publichealth.lacounty.gov/vet/HPAI.htm

Avian flu in humans: ph.lacounty.gov/acd/diseases/h5n1.htm


While H5N1 hasn't demonstrated the ability to spread efficiently from human-to-human, the virus is constantly reinventing itself, and we really don't know how much further it must evolve before it could spark a pandemic.  

Reports of HPAI being `one mutation away' are likely over-stated, but the virus can sometimes make giant leaps literally overnight via Antigenic `Shift' or Reassortment.   


And that can happen anytime the H5 virus co-infects a host (avian, human, mammalian) with another, potentially more transmissible, influenza virus.  The concern being that even a mild H5 infection - in someone who is also infected with seasonal flu - could produce a more transmissible `H5Nx' virus.

It is also possible that a reassortment could produce a more severe H1 or H3 influenza virus; one with the internal genes from H5. 

Although this may sound far-fetched, at least twice in my lifetime (1957 & 1968) a reassortment between seasonal flu and an avian flu virus - likely in a human host - produced a pandemic virus.

  • The first (1957) was H2N2, which According to the CDC `. . . was comprised of three different genes from an H2N2 virus that originated from an avian influenza A virus, including the H2 hemagglutinin and the N2 neuraminidase genes.'
  • In 1968 a novel H3N2 virus emerged (a reassortment of 2 genes from a low path avian influenza H3 virus, and 6 genes from H2N2which supplanted H2N2 - killed more than a million people during its first year - and continues to spark yearly epidemics more than 50 years later.

Note: The 2009 H1N1 pandemic - although it was a triple-reassortment containing some avian-origin genetic contributions - emerged from swine.  

The consumption of raw milk - particularly during flu season - increases the chances of having someone co-infected with avian and seasonal flu, which opens the door to seeing a reassortment event.  

And while the generation of a pandemic virus may be a statistical long-shot, influenza viruses have a long history of beating the odds.