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H5N1 SPOTREP #2

June 6, 2024  /  TLP:GREEN

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Contents

• Situation Overview and Highlights
• Mitigation and Testing
• Treatments and Vaccine Development
• Government Response

Situation Overview and Highlights

• Since March 2024, there have been three individuals in the US diagnosed with the H5N1 avian influenza virus. The three cases are unrelated, separate events, related to exposure from infected cattle. Importantly, there is no evidence of human-to-human transmission in these instances.
  • Two cases in Michigan and one case in Texas – all on separate farms.
• The most recent case was confirmed on May 30, 2024, in Michigan. This dairy farmworker was exposed to infected cattle and is the first human case in the US that reported respiratory symptoms – unlike the other two cases where the patients’ symptoms were pinkeye.
  • The patient received Tamiflu and is being monitored while isolating at home. Their symptoms are resolving and other people who have been in close contact with him have not developed symptoms which continues to reassure that the virus is unable to spread from human to human at this time.
  • The CDC’s stance on H5N1 remains the same – being alert, not alarmed.
• Eleven house mice in New Mexico tested positive for H5N1. This raises some concerns around human transmission because mice live in people’s homes. While populations of concern were originally farmworkers in close proximity with affected cattle and poultry, now this increases the risk of direct exposure to people in their homes.
• A resident of Mexico has died after being infected with H5N2, a subtype of avian flu. This is the first case where a human has been confirmed with H5N2.
  • The individual was suffering from other medical conditions and WHO continues to rate the current risk to general population low.
  • Other people who came in contact with the individual before his death have not tested positive for H5N2.
• As of June 4, the CDC is reporting that 81 dairy herds have been affected by H5N1 and 9 states have reported outbreaks in cattle. The amount of poultry affected, across the 48 states that have reported outbreaks, is close to 100 million. CDC maintains that while the current public health risk is low, they are actively monitoring the situation and working with state public health departments to monitor, test, and promptly report any instances of H5N1 exposure. Currently, the primary focus for both the public and private sector revolves around implementing monitoring and mitigation strategies.

Mitigation and Testing

• It is important for all states to actively monitor cattle farmworkers and conduct testing when necessary.
  • State public health departments should disseminate messaging around the importance of farmworkers wearing full PPE to curb the spread of H5N1 from infected cattle and poultry to humans. This is particularly crucial for eye protection given the first two cases in Michigan and Texas came from infected milk splashing into the eyes.
  • With extreme heat waves becoming more common due to climate change, it is important that farmworkers are getting full protection from H5N1 with PPE but are also managing work conditions in the heat.
• As of June 5, WastewaterSCAN, a nonprofit dedicated to wastewater monitoring for eleven infectious diseases across the US, released data suggesting that the spread of H5N1 may be affecting less states than expected.
  • Detections of H5N1 were in 14 water treatment plants in five states – mainly Texas and Michigan.

Treatments and Vaccine Development

• The use of oseltamivir, or Tamiflu, is a recommended treatment for people with the H5N1 virus.
  • As of May 4, oseltamivir is currently on the ASHP drug shortage list. The FDA has determined that it is likely spot shortages due to increased demand . However, if H5N1 continues to be a concern, there could be an even greater increase in demand.
• The CDC has developed H5 candidate vaccine viruses (CVVs) which can be used to produce a vaccine for the public if needed. CVVs are weakened versions of the virus that can be sent to a licensed vaccine manufacturer to potentially develop millions of doses.
• CSL Seqirus announced that they had been awarded a contract to complete the fill and finish process of 4.8 million doses of pre-pandemic vaccines.
  • Filling and finishing the H5N1 vaccine doses will take a couple months and will not disrupt the production of season flu vaccines. Their North Carolina facility is positioned to deliver up to 150 million influenza vaccine doses within six months of a pandemic declaration.
  • Determining thresholds for vaccine deployment are still under consideration. CDC has noted that potential triggers could be human to human transmission, increases in severity of symptoms, or even H5N1 infections in people who don’t work on dairy or poultry farms.

Government Response

• The Department of Health and Human Services (HHS) in partnership with the US Department of Agriculture (USDA) continue to respond to the H5N1 outbreak in dairy cattle. While they continue to stress the idea that the risk to the general public is low, there is still a high risk of infection for those working with potentially infected cattle and poultry. Here are some steps the federal government has taken so far:
  • The Administration for Strategic Preparedness and Response (ASPR) has made PPE available, for farmworkers, for states to request through the Strategic National Stockpile (SNS). Along with an assortment of PPE available to states, ASPR has also made oseltamivir available upon request.
  • CDC and USDA have developed guidance for farmworkers and continue to work with states on monitoring and testing capabilities.
    • USDA had issued a Federal Order, on April 24, to limit the spread of the disease by mandating testing prior to interstate movement of cattle.
  • CDC is working with state public health officials to monitor, test, and report potential H5N1 cases.

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