Q&A: Optometrists ‘on the frontlines’ for early detection of bird flu
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According to the CDC, H5N1 bird flu has caused recent outbreaks in poultry and dairy cows, with a total of four human cases reported among U.S. dairy and poultry workers. In at least two cases, the only reported symptom was red eyes.
As of July 1, poultry and dairy cow outbreaks have been reported in 48 and 12 states, respectively, with 136 dairy herds affected. While the current public health risk is low, the ongoing multistate outbreak in dairy cattle raises concern.
Healio spoke with Scott A. Edmonds, OD, FAAO, who specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia, about the current situation and how optometrists can provide assistance in disease detection and reporting.
Healio: What should ODs know about bird flu?
Edmonds: It’s an infection that normally just affects wild birds, and it’s been in the U.S. since the turn of the 21st century. In recent years, it has crossed over to first affect poultry and now cattle. In March 2024, the first human case of crossover infection was reported in the U.S., and this was from an infected dairy cow in Texas.
In the more recent cases in Michigan, the presenting symptom was conjunctivitis. In one case, they swabbed the nose and the eye tissue; the nose came back negative, and only the eye tissue demonstrated that the patient had bird flu. This was also unusual.
In the past month, the FDA approved testing at local public health labs. Prior to that, swabs had to be sent to the CDC in Atlanta, but now eye doctors can get results locally. Optometrists are critical for early detection and diagnosis, because, as seen in the case in Michigan, only the eye swab was identified as positive for bird flu. Optometrists are on the frontlines to identify patients at risk, intervene and get patients treated. Fast action on the front end may help prevent a pandemic.
Although bird flu in humans is pretty rare — worldwide to date there have been only 900 cases — but of those, more than 50% were fatal, so it is a dangerous virus if it becomes established.
Healio: What should patients know?
Edmonds: Patients in any state in the U.S. should avoid contact with sick or dead wild birds, and either ignore them or, if multiple birds are affected, contact authorities to see whether the birds should be tested.
Patients who work in the dairy or poultry industry — particularly in states where human crossover of bird flu has been reported — should be aware that if they develop red eyes, they should come in immediately and be tested. They should also consider wearing protective eye wear when handling the animals or when exposed to feces or other contaminated material.
Patients also should avoid drinking raw milk, as the virus has reportedly been detected in milk that has not been pasteurized or homogenized.
Healio: Who else may be at higher risk?
Edmonds: I think hikers or campers who may come into contact with dead birds are at risk, as are people who live on farmland or who are accustomed to drinking raw milk.
Healio: Anything else our readers should know?
Edmonds: All optometrists should be prepared to take conjunctival swabs and send them to a public health lab to test for H5N1. This is especially critical for ODs in Michigan and Texas, where we know of human cases, but also in states where H5N1 was reported in dairy cows — Idaho, South Dakota, Colorado, New Mexico, Texas, Kansas, Michigan, Ohio, Minnesota, Wyoming, Iowa and North Carolina. If you’re an OD who practices in one of those states, you should be ready to do swabs and know where to send them for testing.
It’s a good idea for all ODs to be ready, though, because I can’t imagine this will be limited to just those states.
References:
- Avian influenza virus type A (H5N1) in U.S. dairy cattle. https://www.avma.org/resources-tools/animal-health-and-welfare/animal-health/avian-influenza/avian-influenza-virus-type-h5n1-us-dairy-cattle. Updated June 28, 2024. Accessed July 2, 2024.
- CDC reports second human case of H5 bird flu tied to diary cow outbreak. https://www.cdc.gov/media/releases/2024/s0522-human-case-h5.html. Published May 22, 2024. Accessed June 26, 2024.
- H5N1 bird flu: Current situation. https://www.cdc.gov/bird-flu/situation-summary/index.html. Updated July 1, 2024. Accessed July 2, 2024.
For more information:
Scott A. Edmonds, OD, FAAO, specializes in vision-based neurorehabilitation at Edmonds Eye Associates in Philadelphia. He can be reached at scott@edmondsgroup.com; linkedin.com/in/scott-edmonds-3427a2a; or @scottedmondsOD.
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