Q&A: Should the US be testing more for bird flu?
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Key takeaways:
- As of May 2, 36 dairy cow herds in nine U.S. states have tested positive for H5N1 virus.
- The U.S. is not testing enough dairy cows or dairy farm workers, an expert told Healio.
H5N1 “bird flu” is widespread among wild birds and has caused sporadic outbreaks among poultry for more than a couple years. A recent outbreak among dairy cow herds in the United States has raised the virus’ profile.
As of May 2, H5N1 avian influenza cases have been reported in 36 dairy cattle herds in nine states, according to U.S. health officials, who continue to categorize the risk that H5N1 poses to the public as low.
A dairy farm worker in Texas also has been infected — possibly the first ever case of mammal-to-human transmission of H5N1. Although the worker’s symptoms were mild, the case raised questions about the testing of dairy cattle and dairy farm workers in the U.S.
According to the U.S. Department of Agriculture, testing done by the National Veterinary Services Laboratories has not found changes to H5N1 that would make it more transmissible to humans, but health officials have noted that there is an increased risk for people who have close or prolonged unprotected contact with infected birds or other animals.
We asked Jennifer B. Nuzzo, DrPH, director of the Pandemic Center at Brown University School of Public Health, if the U.S. is doing enough to prevent additional cases.
Healio: What are your overall thoughts on the H5N1 bird flu situation?
Nuzzo: My biggest worry today is that H5N1 now poses a serious occupational risk to farm workers. Our top priority right now should be to make sure we protect dairy workers and others who are likely to have exposure to the H5N1 virus. I am also worried about the possibility that this virus could evolve to become better able to infect humans, and, as a worst-case scenario, transmit easily between humans. This would start a new pandemic.
We learned from the COVID-19 pandemic that a proactive approach to stopping a potential infectious disease outbreak is the only effective course of action. The U.S. government should, today, be working to get a clearer picture of the spread of the virus through expanded testing of cattle and protecting dairy workers who have been in contact with sick animals by expediting vaccines to make them available to farmworkers as soon as possible.
Healio: How would testing help?
Nuzzo: While there’s been only one reported human case in the U.S., there are anecdotal reports of other dairy workers getting sick at the same time as cows. Testing of sick dairy workers would give us a clearer picture of how widespread the virus has become and the amount of resources needed to protect farmworkers who have been or may come in contact with sick animals and mitigate the spread.
But we also have to acknowledge that testing farmworkers is challenging and, possibly, punitive — especially given the lack of sick days, and worker’s compensation. Any testing we do needs to be tied to incentives, such as easier access to antivirals and job protection assurances.
Healio: Should we be vaccinating people against H5N1?
Nuzzo: As there is not yet proof of widespread human infection, in the current moment the focus should be on testing dairy workers. But work must be ongoing to ensure we will have the vaccines that would be needed and take steps to identify any bottlenecks in making sure we have the vaccines we need as soon as we need them.
I am worried that global supplies will be inadequate to meet demand, which could mean losing supplies that the U.S. is counting on getting. This happened in the 2009 H1N1 pandemic. One of the U.S.’s overseas vaccine suppliers informed the U.S. that it would first have to fulfill domestic orders before honoring contracts from the U.S.
Healio: Is there anything the U.S. is not doing now that it should be doing?
Nuzzo: There should be much more testing of dairy cows that expands on the federal government’s recent decision to test sick dairy cows and dairy cows crossing state lines. To do this more effectively, we need tests that can be performed directly on farms instead of having to send samples to labs for testing.
And there must be much more work to engage with and protect dairy workers — first through education about the importance of using personal protective equipment and, ultimately, by making vaccines available. This will be challenging, but not impossible.
Public health agencies are used to engaging with vulnerable groups in this way. We need farms to help in this work — to protect their workers and to maintain confidence in the safety and quality of their agricultural products.
References:
- Brooks R. A message to the AG industry about H5N1. Bovin Veterinarian. April 24, 2024. Accessed May 8, 2024. https://www.bovinevetonline.com/news/industry/message-ag-industry-about-h5n1.
- CDC. H5N1 bird flu: Current situation summary. https://www.cdc.gov/flu/avianflu/avian-flu-summary.htm. Updated May 7, 2024. Accessed May 8, 2024.
- FDA. Updates on highly pathogenic avian influenza (HPAI). https://www.fda.gov/food/alerts-advisories-safety-information/updates-highly-pathogenic-avian-influenza-hpai. Updated May 1, 2024. Accessed May 8, 2024.
- Updates on H5N1 beef safety studies. https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/livestock/h5n1-beef-safety-studies. Last reviewed May 1, 2024. Accessed May 8, 2024.
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