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Now tracking the new emerging South Africa Omicron Variant

H5N1 Risk

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Dutch Josh View Drop Down
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    Posted: March 30 2023 at 3:59am

[url]https://afludiary.blogspot.com/2023/03/uk-technical-briefing-3-on-risk-to.html[/url] or https://afludiary.blogspot.com/2023/03/uk-technical-briefing-3-on-risk-to.html 

Although it still isn't clear whether avian H5N1 has the `right stuff' to spark a human pandemic, over the past 18 months we've seen it spread across two new continents (North & South America), spillover into dozens of mammalian species (including a few humans), and reinvent itself into more than 5 dozen new genotypes. 

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Level 0  Avian influenza circulating in birds, with normal epidemiology.
Level 1  Avian influenza circulating in birds, with abnormal epidemiology.
Level 2  Evidence of propensity to infect humans or other mammalian species. 
Level 3  Limited mammalian transmission (excluding human).
Level 4  Limited human-to-human transmission.
Level 5  Sustained transmission in mammals.
Level 6  Sustained human-to-human transmission.

Emerging influenza viruses may jump levels in this scheme (for example, from level 3 to 6), either because they emerge directly and successfully into humans, or because intermediate stages are not detected through surveillance.
Assessment

The UK risk is assessed as level 3 (limited mammalian transmission, low confidence).

Influenza A(H5N1) clade 2.3.4.4b can successfully infect mammals and humans with high levels of direct exposure (for example, scavenger mammalian species, humans working closely with birds).

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Severity

Three scenarios have been developed, each assuming a different level of clinical severity associated with the disease. All 3 scenarios should be considered severe compared to the most recent influenza pandemic in 2009.

In scenario 1, the infection-fatality rate (IFR) is around 0.25%, similar to that of coronavirus (COVID-19) in autumn 2021, though considerably higher than the overall severity of the 2009 H1N1 outbreak (0.01% IFR) (Riley and colleagues, 2011Wong and colleagues, 2013). There are very few studies with estimates of an infection-hospitalisation rate (IHR), and for this scenario it has been set at 1%.

Scenario 2 is more severe. We base our parameters on the 1918 influenza pandemic, which had an IFR of around 2.5% (Murray and colleagues, 2006). We also assume in this scenario an IHR of 5%. Although various H5N1 outbreaks have much higher fatality estimates, these are not examples of sustained human-to-human transmission and are therefore not directly comparable (for example see Li and colleagues, 2008Poovorawan and colleagues, 2013).

In scenario 3, we choose a higher IHR of 10%, with IFR 5%.
This approximates the type of outbreak seen with SARS-CoV-1 in 2002 (9% reported case fatality rate). We note significant variation in reported CFR rates for SARS-CoV-1, suggesting the underlying IFR may have been even higher than the crude average of reported deaths as a fraction of reported cases.


DJ, Another human H5N1 case -this time in Chile 53 y/o male...Also lots of spread in mammals. However both may -still- be linked to bird-mammal transfer NOT M2M (Mammal-spread).

Again-if the H5N1 virus develops into better spreading from infected birds to mammals that still is a major problem ! You do not need H2H spread if H5N1 is able to spread very well from birds into humans...

We cannot solve our problems with the same thinking we used when we created them.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: July 20 2023 at 1:34am

DJ, the outbreak outbreak of H5N1 in Polish cats may have been linked to cat food -raw poultry- with H5N1...








Just out:  &  review #influenza #H5N1 & #COVID19 in #mink & “strongly urge governments to consider the mounting evidence suggesting that fur farming, particularly mink, be eliminated in the interest of #pandemic preparedness.”

link [url]https://www.pnas.org/doi/10.1073/pnas.2303408120[/url] or https://www.pnas.org/doi/10.1073/pnas.2303408120 ;

As with any intensive farming, fur farming takes place in a high-density animal environment that allows for rapid spread of viruses with pandemic potential—and for virus adaptation to animals that would be unlikely to occur in nature. This is particularly true for normally solitary, undomesticated carnivores, such as mink. Here, we argue that mink, more so than any other farmed species, pose a risk for the emergence of future disease outbreaks and the evolution of future pandemics.

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As recently as October 2022, there were disturbing reports of sustained transmission of the panzootic, highly pathogenic avian influenza (H5N1) at a Spanish mink farm (11). At least one mammalian adaptation in the virus polymerase emerged in the mink during this outbreak; in all likelihood, we narrowly escaped a larger disaster, as the incident appears to have been contained.
Any situation in which an RNA virus is allowed to transmit among multiple densely housed animals may lead to the evolution of virus with altered phenotypes, including those with enhanced pandemic potential. Under many current regulatory authorities, an equivalent laboratory “experiment” of this nature would be classed as “gain of function” research and therefore prohibited. Even if it were approved, regulations would require that it be performed under high-containment conditions following an extensive risk–benefit assessment. Current practice in mink farms opens up the possibility for similar adaptation to occur in a completely unregulated and uncontrolled manner.
Furthermore, as they are susceptible to both human and avian influenza viruses (381012), mink could also serve as mixing vessels for reassortment, a known pathway to pandemic emergence. A hypothetical route to co-infection is easy to envisage: Mink infected with avian influenza virus—which they acquired from being fed dead poultry or via exposure to wild birds—could become directly co-infected with human seasonal influenza transmitted to them from infected handlers. The last three influenza pandemics arose after the mixing of influenza genes among avian and human-origin strains, which are often thought to occur in a “mixing vessel” species. Swine are often cited as the vessel because pigs are susceptible to many avian and human strains. Pigs, however, are somewhat refractory to H5N1 infections, including the currently panzootic clade 2.3.4.4b viruses (13). Mink clearly are not. Mink farms could provide ample opportunity for the reassortment between H5 subtype avian influenza viruses and human-adapted strains.

see also (a.o.) [url]https://www.wormsandgermsblog.com/2023/07/articles/diseases/other-diseases/h5n1-avian-flu-on-fur-farms-when-will-we-learn/[/url] or https://www.wormsandgermsblog.com/2023/07/articles/diseases/other-diseases/h5n1-avian-flu-on-fur-farms-when-will-we-learn/ 

and [url]https://afludiary.blogspot.com/2023/07/finland-finnish-food-authority-adds-5.html[/url] or https://afludiary.blogspot.com/2023/07/finland-finnish-food-authority-adds-5.html 

Highly pathogenic avian #influenza #H5N1 diagnosed in a small #poultry farm (220 birds, mixed species) in #Maracajá#Brazil. So far in Brazil, widespread virus presence in wild birds but only 2 reports in poultry, both in small farms. #vogelgriep   https://wahis.woah.org/#/in-review/5057%E2%80%8B

DJ, [url]https://www.coronaheadsup.com/coronavirus/rumours-of-human-to-human-transmission-of-h5n1-bird-flu-in-england/[/url] or https://www.coronaheadsup.com/coronavirus/rumours-of-human-to-human-transmission-of-h5n1-bird-flu-in-england/ ;

We are hearing rumours of sustained human-to-human transmission of H5N1 bird flu in Cumbria, England.

We don’t usually report rumours on Coronaheadsup, but we are making an exception in this case, as the level of detail we have received is unusually explicit and difficult to dismiss.

We are placing this post as a marker to update if any other information becomes available, or if we can confirm what we have received so far.

If you are aware of an outbreak of bird flu in humans in England, please do get in touch, anonymously if necessary, (use a VPN to connect), and tell us what you have heard or what you know.

If we fact-check the information in this post to be incorrect, we will also update it accordingly. In this instance, we sincerely hope the information is NOT correct.

ignoring problems is policy in many countries....

H5N1 in (wild) birds now is as good as global...with that it is all year round...Ignoring mammals eating infected birds is resulting in spread in mammals. Co-infections with other types of flu, or other diseases, is worsening the potential global health disaster...

We cannot solve our problems with the same thinking we used when we created them.
~Albert Einstein
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: July 23 2023 at 2:30am

[url]https://twitter.com/PeacockFlu/status/1682696057744916480[/url] or https://twitter.com/PeacockFlu/status/1682696057744916480 ;

There have been some interesting developments with the panzootic (aka a pandemic of animals) H5N1 in mammals over the last few months. Though I'd write a brief thread covering Polish cats, South American sealions and European fur farms.

-[url]https://twitter.com/PeacockFlu/status/1682696057744916480/photo/1[/url] or https://twitter.com/PeacockFlu/status/1682696057744916480/photo/1 on types of flu...what kind of flu in what animal...

Firstly, a quick situational update on the panzootic in birds. We're now 3 years into this outbreak and the virus is continuing to spread across the world, largely impacting waterfowl and seabirds (including many that are endangered)

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Beyond birds though, we're seeing more and more infections in wild mammals that we've ever seen before. This is particularly widespread in scavengers and predators (for example foxes in Europe)

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Firstly, the cats in Poland. This is a very unusual outbreak - over 30 cats with H5N1 infections throughout Poland, sequences are incredibly similar (no regional differences). All viruses share a pair of mammalian adaptations

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Genomic data has now been shared from both Chile and Peru. An unusual combination of mammalian adaptations suggests that there may be some stable transmission between sealions. In fact this same combination is also found in the Chilean human sequence...

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Final point, fur farms - we need to have a serious conversation about whether it is a good idea to continue farming carnivores for fur during an H5N1 panzootic.  recently wrote an opinion piece for PNAS arguing its a really bad idea.

However in our piece, we argue that there is a second reason fur farming is a bad idea. Mink (and foxes) are highly susceptible to H5N1. Normally wild foxes or mustelids (the family of animals that contains mink, polecats, ferrets, stoats etc) are fairly solitary.

Fur farming puts thousands of these animals together in close proximity, creating the perfect conditions for mammalian transmission and adaptation

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For an H5 virus to become a human pandemic it would need to gain changes in the H5 haemagglutinin protein that enabled binding to human-like receptors, and allowed to to stay stable in airborne droplets (see below for a nice article on this topic)

DJ [url]https://www.science.org/content/article/bad-worse-avian-flu-must-change-trigger-human-pandemic[/url] or https://www.science.org/content/article/bad-worse-avian-flu-must-change-trigger-human-pandemic 

The twitter link also mentions H3N2, H3N8 flu in US dogs...H3N6 in dogs in China may also be a risk if it would mix with H5N1 (after a dog eats infected dead animals(droppings)...

Asymptomatic spread in UK poultry workers may be yet another warning...If a poultry worker with an asymptomatic H5N1 infection also gets H3N2/H1N1 or other type of flu it may recombine into a "major risk"...

DJ-H5N1 is now not only worldwide in millions of birds...it may be spreading in dozens of other (wild) species...in fact it is out of control and will become a major problem...

However it may NOT spread as a H5N1-flu in humans...H1,H2,H3 types of flu can become much more of a risk...

Of course not only fur farming has to stop ! We have to reduce meat consumption to stop spread a.o. in poultry...Pigs is also "high risk"...via taxation meat can be made more expensive to reduce the price for alternatives with lower pandemic (and climate)  risks...

Politics keeps ignoring all kinds of risks..."popularity=ignoring risks"...

We cannot solve our problems with the same thinking we used when we created them.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: September 01 2023 at 1:56am

DJ-One may discuss what part of the news is worse...the finding of bird-pet-bird H5N1 spread or that this finding is ignored...

[url]https://afludiary.blogspot.com/2023/08/eurosurveillance-asymptomatic-infection.html[/url] or https://afludiary.blogspot.com/2023/08/eurosurveillance-asymptomatic-infection.html ;

As we've discussed previously, there are now dozens of genotypes of HPAI H5 clade 2.3.4.4b viruses circulating around the world, and many genetic variations may exist within each genotype. 
It is not totally unexpected that dogs and cats infected with one genotype might experience severe illness or death, while those infected with another might remain asymptomatic. 

And that's the rub.  We aren't dealing with a single, monolithic, HPAI H5N1 virus. We are dealing with literally scores of similar avian viruses, on multiple continents, all pursuing their own evolutionary path.

Those viruses that remain in wild birds or poultry are expected to evolve differently than those that spill over into marine mammals, mink, or peridomestic animals. 

The fact that some mammals - particularly companion animals - may be able to carry (and potentially spread) the virus without showing overt signs of illness, means that investigators will have to rely on more than cursory inspections when it comes to ruling out mammalian infections. 

DJ...are we in a H5N1 pre-pandemic phase ? 

Level 3  Limited mammalian transmission (excluding human).

Should we increase testing/monitoring and sequencing ? I think "YES !!!!"...but we are -again- ignoring a major problem...

We cannot solve our problems with the same thinking we used when we created them.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: November 12 2023 at 4:21am

[url]https://www.rtvutrecht.nl/nieuws/3658473/vogelgriep-in-renswoude-kippen-geruimd-en-opnieuw-ophokplicht-in-omgeving[/url] or https://www.rtvutrecht.nl/nieuws/3658473/vogelgriep-in-renswoude-kippen-geruimd-en-opnieuw-ophokplicht-in-omgeving ;

Renswoude - Bird flu is prevalent at a laying hen farm in Renswoude. About 65,000 chickens are being culled by the Dutch Food and Consumer Product Safety Authority (NVWA) to prevent the virus from spreading.
The Ministry of Agriculture, Nature and Food Quality reports that there are two other poultry farms within 1 kilometre of the farm. Both companies are screened and sampled for bird flu by the NVWA. There are 31 poultry farms within a radius of 3 kilometres. All companies will be tracked for the next ten days.
Within 10 kilometres of the affected farm, there is an immediate ban on the transport of birds and eggs. There are 202 other poultry farms in this area. In the entire area, the confinement obligation also applies. It had only been withdrawn in the region for 9 days, since November 3.

DJ, hard to get rid of

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: November 19 2023 at 10:10pm
Netherlands: New variant H5N1 bird flu virus causes infection in Renswoude. H5N1 has acquired a new PB1 segment by reassortment, rearrangement of groups of genes, with a low pathogenic virus.

link in Dutch-google translate into English does a great job [url]https://www.nieuweoogst.nl/nieuws/2023/11/17/nieuwe-variant-h5n1-vogelgriepvirus-oorzaak-besmetting-renswoude[/url] or https://www.nieuweoogst.nl/nieuws/2023/11/17/nieuwe-variant-h5n1-vogelgriepvirus-oorzaak-besmetting-renswoude 


DJ, H5N1 high risk virus did pick up mutations from a low risk avian flu virus

[url]https://www.wur.nl/en/research-results/research-institutes/bioveterinary-research/show-bvr/new-variant-bird-flu-virus-in-renswoude.htm[/url] or https://www.wur.nl/en/research-results/research-institutes/bioveterinary-research/show-bvr/new-variant-bird-flu-virus-in-renswoude.htm ;

WBVR investigated the virus detected in Renswoude and showed that it is again a highly pathogenic H5N1 virus. Further research into the genetic composition of the virus shows that this is a new variant. The virus acquired a new PB1 segment by reassortment with a low pathogenic virus. “The virus in Renswoude has a new genetic composition, but bears a strong resemblance to the virus that has caused many outbreaks since 2021,” said WBVR researcher Nancy Beerens, head of the National Reference Laboratory for Avian Influenza.

This summer, the HPAI H5N1 genotype BB caused high mortality among black-headed gulls and other gull species. This virus variant contains three pieces of genome of a H13 gull virus. The gull variant caused the outbreak at the laying farm in Biddinghuizen (24 July), but did not cause any outbreaks in poultry thereafter despite the fact that the virus circulated heavily among gulls. “Our analysis shows that the virus in Renswoude does not contain any of the three pieces of gull virus genome,” Beerens said.

An increase in mortality of ducks and geese has been seen since November. Genetic analyses by WBVR show that these dead wild birds are also infected with the new HPAI H5N1 virus variant. A list of sites of infected dead wild birds is displayed on the WBVR website.


Also 









Jerusalem Post: New variant of bird flu spotted in Netherlands. "Within living memory, no avian influenza has affected wild birds in the  same capacity"

link [url]https://www.jpost.com/health-and-wellness/article-773983[/url] or https://www.jpost.com/health-and-wellness/article-773983 ;

The discovery of the new variant comes as avian influenza continues to spread across the Americas, Europe, and other locations around the world in a global outbreak that has continued almost without pause since 2021. The virus has affected tens of millions of birds and thousands of mammals worldwide.

DJ, It may be hard to get a realistic view on how widespread H5N1 is in what animals...Not all animals may develop symptoms...Some birds seem to develop a sort of immunity after infection-but may still spread the H5N1 virus-variants...

"tens of millions" of birds/mammals -DJ-very likely "hundreds of millions" may bring "unpleasant surprises";

-Shortage of both eggs and poultry

-Growing chance of H5N1 recombination with H1/H2/H3 "human" flu virus

-But also H5N1 could develop variants that may be better able to spread into mammals/humans...a possible risk might be lots of birds spreading the virus without getting ill. So far H5N1 "contained itself" at least somewhat by killing a lot of its hosts...

DJ-A shift from affected species/symptoms may mean another variant of H5N1 is spreading. And-again-if H5N1 would kill all its hosts within 24 hours the problem would be "self containing"...R0 would very likely get <1 so the disease would end...

The pattern however is in another direction; H5N1 in more hosts-lots of them surviving long enough to spread the virus...R0 "speed of spread" may be increasing...If mammals would get ill from H5N1 (co)infection and birds stop getting ill the "H5N1 problem" might be "on the move" to humans...

As long as fur-farms are not stopped, we fail to decrease meat consumption, we are NOT stopping H5N1 from becoming a growing human risk !

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: November 30 2023 at 3:57am

[url]https://afludiary.blogspot.com/2023/11/who-don-update-on-2-cambodian-h5n1-cases.html[/url] or https://afludiary.blogspot.com/2023/11/who-don-update-on-2-cambodian-h5n1-cases.html ;

Last Friday and Saturday the Cambodian MOH announced their 5th and 6th human H5N1 infections of 2023 - all of which come after 9 years without reporting a single case.  Other than their ages, and gender (female), and the fact that they lived in close proximity to each other, we haven't had much in the way of details. 

Today we learn that the first case - a 20-25 year old woman - has died, while the 4 year-old neighbor remains hospitalized. The virus - as expected - belongs to H5N1 clade 2.3.2.1c - an older lineage of avian flu which predates our current clade 2.3.4.4b epizootic

While human-to-human transmission cannot be ruled out, it is likely both shared a common exposure to infected poultry.  So far, most of the nearly 900 cases of H5N1 in humans over the past 20 years appears to have come from direct or indirect contact with infected bids. 

DJ, there are several H5N1 risks;

-It could mutate into a H2H (H2H=Human to Human) spreading variant...very unlikely

-spread in mammals co-infected with human flu-types (H1, H2,H3 like) could bring new variants better "fitted" for spread in humans (fur-farms are high risk !)

-Exposure in poultry/fur-farm workers-asymptomatic spread may bring a new H5N1 variant that could become a risk later on -while spreading H2H...

-Since we did give up testing H5N1 human spread may be missed to stop it from become a problem...mistaken as "CoViD/cold" why test ? 

The main risk factor is NOT the virus...it is us...carelessness kills...

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: December 02 2023 at 5:09am

[url]https://www.gld.nl/nieuws/8054569/een-zware-klap-voor-de-ondernemer-burgemeester-geraakt-na-uitbraak[/url] or https://www.gld.nl/nieuws/8054569/een-zware-klap-voor-de-ondernemer-burgemeester-geraakt-na-uitbraak ;

 "A heavy blow for the entrepreneur and a blow for the entire poultry sector in Putten". This is how Mayor Lambooij of the municipality of Putten characterizes the outbreak of bird flu in his municipality. On Saturday morning it was announced that 110,000 chickens will be culled in Putten.
Immediately after the Dutch Food and Consumer Product Safety Authority (NVWA) detected the bird flu, the mayor contacted the affected entrepreneur to support him and his family.

'One of our largest poultry farms'

"This is one of our largest poultry farms. The impact is huge. Not only for this company, but also for the immediate environment."
To prevent the spread of the virus, not only the 110,000 chickens in Putten are being culled by the NVWA. There are also two other poultry farms within a radius of one kilometre. These are screened and sampled.

Transport ban and measures

If the radius becomes three kilometres, then in addition to these two, there are another eight poultry farms inside. All ten companies are being sampled for bird flu by the NVWA.
There are 82 other farms within 10 kilometres of the affected farm, including three poultry slaughterhouses. A corridor will be established for the supply of animals for slaughter to poultry slaughterhouses. Within the 10-kilometre zone, a transport ban applies immediately.

DJ, largest outbreak of new variant of H5N1 since the start af another wave half november in Renswoude/NL

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: February 13 2024 at 8:06am

[url]https://afludiary.blogspot.com/2024/02/eid-journal-recent-changes-in-patterns.html[/url] or https://afludiary.blogspot.com/2024/02/eid-journal-recent-changes-in-patterns.html ;

After making a brief appearance in Hong Kong in 1997, HPAI H5N1 went to ground for 5 years, only to resurface in 2003 and begin its slow spread out of Southeast Asia and into Europe, the Middle East and Africa. 

While some scattered mammalian infections were reported - particularly among zoo animals fed infected chicken (see Fatal H5N1 Infection In Tigers By Different Reassortant Viruses - China) - mammalian infections were only rarely reported (see HPAI H5: Catch As Cats Can).


In 2014 a new clade of HPAI H5 emerged in South Korea (clade 2.3.4.4) which spread rapidly to Europe, and for the first time, to North America where it sparked a major epizootic.

The virus was not, however, well adapted for long-term carriage by migratory birds, and it disappeared completely over the summer of 2015.


But the following summer H5N8 underwent a reassortment event in Russia/China that increased its ability to be carried by migratory birds (see EID Journal: Reassorted HPAI H5N8 Clade 2.3.4.4. - Germany 2016) and allowed it to spark the first of several major epizootics in Europe.


Over the next five years HPAI H5 would undergo a convoluted array of reassortment events around the world, with H5N8 eventually giving way to a new and improved H5N1 clade 2.3.4.4b - which not only travels more readily in migratory birds - it has displayed an enhanced ability to spillover into mammals.


As a result, H5N1 has since spread from Europe/Asia to both North and South America, and has been detected in both the Arctic and Antarctic regions for the first time. Even more ominously, HPAI H5N1 continues to expand its host range in both terrestrial and marine mammals. 


The HPAI H5Nx threat of today is far different from what it was just 4 or 5 years ago, and is very likely to continue to evolve over time. While human infections remain thankfully rare, every spillover into a mammal provides the virus with another opportunity better adapt to human physiology. 


Today we've got an early release from the EID journal that compares the impact of the HPAI H5 virus between its earlier waves of infection (2003–2019) and its current (2020-2023) presentation.

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Some studies, especially in the current panzootic, suggest that mammal-to-mammal transmission might be responsible for some infections; some mutations found could help this avian pathogen replicate in mammals. H5N1 virus may be changing and adapting to infect mammals. Continuous surveillance is essential to mitigate the risk for a global pandemic.

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H5N1 has affected several mammal species since 2003 (6,7), thus raising concern because H5N1 mammalian adaptation could represent a risk not only for diverse wild mammals but also for human health (810). 

Unfortunately, information about this topic, especially related to the current panzootic (2020–2023), is disperse and available often only in gray literature (e.g., databases and official government websites). This fact complicates access and evaluation for many stakeholders working on the front lines (e.g., wildlife managers, conservationists, and public health authorities at regional and local levels).

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Mutations in the virus found in diverse mammal species, especially in the current panzootic, are of great concern. For instance, the T271A mutation reported in minks in Spain is also present in the H1N1 that produced a pandemic in 2009 (9). Similarly, the PB2-E627K mutation found in this virus in diverse geographic areas could indicate an adaptation for replication in mammals (28,31). 

Moreover, some infected species, such as minks, may act as a mixing vessel for interspecies transmission between birds, mammals, and humans (9). 

Mutations and infections with H5N1 in potential mixing-vessel species (e.g., minks and wild and domestic pigs) should be followed closely because of the potential risk to human health.

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While the recent changes in the behavior of HPAI H5N1 clade 2.3.4.4b are a legitimate concern, it is far from the only pandemic threat we face.  

In terms of likelihood of sparking a pandemic, many researchers - including the CDC - view the swine-origin EA H1N1 `G4' virus as topping the list.  Other swine viruses (H1, H2, or H3) are also believed likely to require less of an evolutionary leap to adapt to humans than an avian H5 virus. 


A pretty good case case could be made for a number of other avian subtypes, including H5N6, H3N8, H6N1,  H7N9, H10Nx, and even LPAI H9N2, either as a standalone virus or a reassortment with a seasonal flu virus.

And then there are the non-flu exotics, like Nipah, or MERS-CoV, or `Disease X'; the one we don't yet recognize as a threat. 

The inevitability isn't that HPAI H5 will spark the next pandemic, it is that something will.  And we need to be better prepared for it than we were for the last one. 

DJ...it is very likely lots of H5N1 human cases are missed...Poultry-workers-as an example-may run high risks...however may show no or only mild symptoms. 

Also pets can bring risks; cats, dogs, (but also birds) can get infected-spread it further...

[url]https://afludiary.blogspot.com/2024/02/cdc-update-on-first-4-h5n1-cases-of.html[/url] or https://afludiary.blogspot.com/2024/02/cdc-update-on-first-4-h5n1-cases-of.html ;

Over the past 3 weeks we've seen 4 new human H5N1 infections reported out of Cambodia (see here, here, here, and here) - which when added to 6 cases in 2023 - make 10 cases in the past 12 months after an absence of reports of 9 years. 


Although the reasons behind this abrupt resurgence of an older clade (2.3.2.1.c) of H5N1 aren't clear, last fall we looked at a Preprint: A Timely Survey of Knowledge, Attitudes, and Practices Related to Avian Influenza (H5N1) in Rural, Cambodia, which found very lax attitudes regarding avian flu among the rural population (e.g. 23% of participants cooked sick or dead poultries for their families).

The investigations into these latest two cases are still ongoing, and it would not be surprising to see additional cases in the days and weeks ahead. 

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The four infections occurred in three children, one of whom died, and an adult, all of which were identified in late January and early February. All patients reportedly had a history of recent exposure to sick or dead poultry prior to their illness. Currently, there is no indication of person-to-person spread associated with these four cases of H5N1 virus infection in Cambodia, and they are not thought to pose a threat to the health of the U.S. public.

The first two patients were epidemiologically unrelated and were admitted to different hospitals in Cambodia; they both recovered and were discharged home. The third patient died shortly after transfer to a pediatric hospital in the capital, and the fourth patient was admitted for monitoring and treatment.
 
The third and fourth patients are siblings but lived in different villages; dead poultry was brought from the household of the fourth patient to the household of the third patient, and both siblings were exposed.

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Genetic sequencing of the first and third patients’ specimens by IPC and NIPH identified both H5N1 viruses as H5 clade 2.3.2.1c, which has circulated in Cambodia among birds and poultry for many years. This H5 virus clade 2.3.2.1c in Cambodia is different from the H5N1 virus that has caused wild bird and poultry outbreaks in the United States (clade 2.3.4.4b) and other countries. Genetic sequencing of the fourth patient’s specimens is in process.

DJ, so the 4 latest H5N1 human infections-all in Cambodia-were from an older clade...

It is very likely we miss over 90% of H5N1 infections both in mammals and humans...even with symptoms the idea may be "it is CoViD" so no need for testing...(CoViD does NOT rule out also catching flu !!!)...So...more "sorts" of H5N1 seem to be a -so far limited- risk for humans...

Let us hope it stays that way...more testing/monitoring/sequencing should be a priority...

We cannot solve our problems with the same thinking we used when we created them.
~Albert Einstein
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: 16 hours 58 minutes ago at 9:09am

[url]https://afludiary.blogspot.com/2024/02/cambodia-h5n1-case-map-timeline-2023.html[/url] or https://afludiary.blogspot.com/2024/02/cambodia-h5n1-case-map-timeline-2023.html ;

Today's report of a 5th H5N1 case in Cambodia in less than a month demonstrates that even after going early a decade without a human case, older disease threats can still stage a comeback.  A reminder that old scourges like SARS-CoV, MERS-CoV, and even avian H7N9 could someday regroup and threaten public health. 

I've put together a map showing the locations and the timeline of Cambodian cases over the past 12 months, one which shows that infections have been spread across 5 provinces, with most of the cases reported from 3 southern provinces (Kampot, Prey Veng, and Svay Rieng)

Even more striking, the first two cases were reported in February of 2023, which were followed by nearly 10 months without a case.  In October 2 more cases were reported, followed by another two in November. 

While December was quiet, we've seen 5 cases reported since the 4th week of January. 

This acceleration in cases isn't totally unexpected, as avian flu transmission tends to increase during the winter months.  Of course, winter is a relative thing, and in Cambodia January daytime temperatures still often reach the 90s.

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Convincing people that something they have been doing for generations - like raising chickens in their backyard, or buying live poultry at bird markets - could suddenly be dangerous can be a hard `sell'. 

We've seen similar (and often bitter) resistance to the notion that beloved camels in Saudi Arabia could carry  a new, deadly coronavirus (see Saudi Camel Owners Threaten Over MERS `Slander’).

Over the past few years, fur farms around the the world are suddenly viewed as potential `flu factories' (see PNAS: Mink Farming Poses Risks for Future Viral Pandemics), while some pet owners have had consider the possibility that their companion animals may be at risk from avian flu in the outdoor environment. 


As the level of H5N1 (and other zoonotic viruses) continue to increase around the world, we find ourselves living in a `new normal', where old practices and traditions may need to be reconsidered and modified if we hope to reduce the risk of future outbreaks. 

DJ, the "background" is changing high speed; CoViD decreasing immunity so a lower level of (H5N1) virus may cause symptoms/disease...Climate change also worsening the picture-urbanization-people moving into the jungle-also a risk...

We cannot solve our problems with the same thinking we used when we created them.
~Albert Einstein
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