flu

china-is-having-standard-flu-season-despite-widespread-hmpv-fears

China is having standard flu season despite widespread HMPV fears

There’s a good chance you’ve seen headlines about HMPV recently, with some touting “what you need to know” about the virus, aka human metapneumovirus. The answer is: not much.

It’s a common, usually mild respiratory virus that circulates every year, blending into the throng of other seasonal respiratory illnesses that are often indistinguishable from one another. (The pack includes influenza virus, respiratory syncytial virus (RSV), adenovirus, parainfluenza virus, common human coronaviruses, bocavirus, rhinovirus, enteroviruses, and Mycoplasma pneumoniae, among others.) HMPV is in the same family of viruses as RSV.

As one viral disease epidemiologist at the US Centers for Disease Control summarized in 2016, it’s usually “clinically indistinguishable” from other bog-standard respiratory illnesses, like seasonal flu, that cause cough, fever, and nasal congestion. For most, the infection is crummy but not worth a visit to a doctor. As such, testing for it is limited. But, like other common respiratory infections, it can be dangerous for children under age 5, older adults, and those with compromised immune systems. It was first identified in 2001, but it has likely been circulating since at least 1958.

The situation in China

The explosion of interest in HMPV comes after reports of a spike of HMPV infections in China, which allegedly led to hordes of masked patients filling hospitals. But none of that appears to be accurate. While HMPV infections have risen, the increase is not unusual for the respiratory illness season. Further, HMPV is not the leading cause of respiratory illnesses in China right now; the leading cause is seasonal flu. And the surge in seasonal flu is also within the usual levels seen at this time of year in China.

Last week, the Chinese Center for Disease Control and Prevention released its sentinel respiratory illness surveillance data collected in the last week of December. It included the test results of respiratory samples taken from outpatients. Of those, 30 percent were positive for flu (the largest share), a jump of about 6 percent from the previous week (the largest jump). Only 6 percent were positive for HMPV, which was about the same detection rate as in the previous week (there was a 0.1 percent increase).

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As US marks first H5N1 bird flu death, WHO and CDC say risk remains low

The H5N1 bird flu situation in the US seems more fraught than ever this week as the virus continues to spread swiftly in dairy cattle and birds while sporadically jumping to humans.

On Monday, officials in Louisiana announced that the person who had developed the country’s first severe H5N1 infection had died of the infection, marking the country’s first H5N1 death. Meanwhile, with no signs of H5N1 slowing, seasonal flu is skyrocketing, raising anxiety that the different flu viruses could mingle, swap genetic elements, and generate a yet more dangerous virus strain.

But, despite the seemingly fever-pitch of viral activity and fears, a representative for the World Health Organization today noted that risk to the general population remains low—as long as one critical factor remains absent: person-to-person spread.

“We are concerned, of course, but we look at the risk to the general population and, as I said, it still remains low,” WHO spokesperson Margaret Harris told reporters at a Geneva press briefing Tuesday in response to questions related to the US death. In terms of updating risk assessments, you have to look at how the virus behaved in that patient and if it jumped from one person to another person, which it didn’t, Harris explained. “At the moment, we’re not seeing behavior that’s changing our risk assessment,” she added.

In a statement on the death late Monday, the US Centers for Disease Control and Prevention emphasized that no human-to-human transmission has been identified in the US. To date, there have been 66 documented human cases of H5N1 infections since the start of 2024. Of those, 40 were linked to exposure to infected dairy cows, 23 were linked to infected poultry, two had no clear source, and one case—the fatal case in Louisiana—was linked to exposure to infected backyard and wild birds.

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flu-surges-in-louisiana-as-health-department-barred-from-promoting-flu-shots

Flu surges in Louisiana as health department barred from promoting flu shots

The statement seemed to offer an assurance that other vaccines were not subject to the new restrictions. “Changes regarding seasonal vaccines like COVID and influenza do not change the Department’s policy or messaging regarding childhood immunizations,” it read.

This flu season, the health department has reportedly canceled standard vaccination events and clinics. On social media, the department has avoided mentioning flu shots in posts about the flu, instead advising people to wash their hands and cover their coughs.

While Louisiana is seeing an early surge in influenza, the rest of the country is on an upward trend in what appears to be a normal-looking season so far. Nationally, the percentage of doctor visits that were for ILIs is 3.8 percent, with the upswing in ILI activity similar to what was seen in the 2019–2020 flu season at this point in the year. At the peak of flu seasons, the percentage of visits for ILIs usually tops out around 7 percent to 8 percent.

US ILI activity charted by week across several flu seasons Credit: CDC

Two children died last week of flu, bringing the season’s total pediatric deaths to four. In the 2023–2024 season, 206 children died with influenza-associated disease. Most of the deaths occurred in early 2024.

COVID-19 is also ramping up a winter wave. While standard disease burden indicators—hospitalization and deaths—are low, they’re trending positive. Wastewater surveillance, meanwhile, is showing a steep incline, with levels of the virus being detected at “moderate” levels.

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louisiana-bars-health-dept.-from-promoting-flu,-covid,-mpox-vaccines:-report

Louisiana bars health dept. from promoting flu, COVID, mpox vaccines: Report

Louisiana’s health department has been barred from advertising or promoting vaccines for flu, COVID-19, and mpox, according to reporting by NPR, KFF Health News, and New Orleans Public Radio WWNO.

Their investigative report—based on interviews with multiple health department employees who spoke on the condition of anonymity for fear of retaliation—revealed that employees were told of the startling policy change in meetings in October and November and that the policy would be implemented quietly and not put into writing.

Ars Technica has contacted the health department for comment and will update this post with any new information.

The health department provided a statement to NPR saying that it has been “reevaluating both the state’s public health priorities as well as our messaging around vaccine promotion, especially for COVID-19 and influenza.” The statement described the change as a move “away from one-size-fits-all paternalistic guidance” to a stance in which “immunization for any vaccine, along with practices like mask wearing and social distancing, are an individual’s personal choice.”

According to employees, the new policy cancelled standard fall flu vaccination events this year and affects every other aspect of the health department’s work, as NPR explained:

“Employees could not send out press releases, give interviews, hold vaccine events, give presentations or create social media posts encouraging the public to get the vaccines. They also could not put up signs at the department’s clinics that COVID, flu or mpox vaccines were available on site.”

“We’re really talking about deaths”

The change comes amid a dangerous swell of anti-vaccine sentiment and misinformation in Louisiana and across the country. President-elect Trump has picked Robert F. Kennedy Jr.—a high-profile anti-vaccine advocate and one of the most prolific spreaders of vaccine misinformation—to head the US Department of Health and Human Services.

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covid-shot-now-or-later?-just-getting-it-at-all-is-great,-officials-respond.

COVID shot now or later? Just getting it at all is great, officials respond.

Viral defences —

As the summer wave peaks, officials are prepping for the coming winter wave.

A 13-year-old celebrates getting the Pfizer-BioNTech COVID-19 vaccine in Hartford, Connecticut, on May 13, 2021.

Enlarge / A 13-year-old celebrates getting the Pfizer-BioNTech COVID-19 vaccine in Hartford, Connecticut, on May 13, 2021.

With the impending arrival of the 2024–2025 COVID-19 vaccines approved yesterday, some Americans are now gaming out when to get their dose—right away while the summer wave is peaking, a bit later in the fall to maximize protection for the coming winter wave, or maybe a few weeks before a big family event at the end of the year? Of course, the group pondering such a question is just a small portion of the US.

Only 22.5 percent of adults and 14 percent of children in the country are estimated to have gotten the 2023–2024 vaccine. In contrast, 48.5 percent of adults and 54 percent of children were estimated to have gotten a flu shot. The stark difference is despite the fact that COVID-19 is deadlier than the flu, and the SARS-CoV-2 virus is evolving faster than seasonal influenza viruses.

In a press briefing Friday, federal health officials were quick to redirect focus when reporters raised questions about the timing of COVID-19 vaccination in the coming months and the possibility of updating the vaccines twice a year, instead of just once, to keep up with an evolving virus that has been producing both summer and winter waves.

“The current problem is not that the virus is evolving so much, at least in terms of my estimation,” Peter Marks, the top vaccine regulator at the Food and Drug Administration, told journalists. “It’s that we don’t have the benefits of the vaccine, which is [to say] that it’s not vaccines that prevent disease, it’s vaccination. It’s getting vaccines in arms.” When exactly to get the vaccine is a matter of personal choice, Marks went on, but the most important choice is to get vaccinated.

Estimates for this winter

The press briefing, which featured several federal health officials, was intended to highlight the government’s preparations and hopes for the upcoming respiratory virus season. The FDA, the Centers for Disease Control and Prevention, and the Department of Health and Human Services (HHS) are urging all Americans to get their respiratory virus vaccines—flu, COVID-19, and RSV.

CDC Director Mandy Cohen introduced an updated data site that provides snapshots of local respiratory virus activity, national trends, data visualizations, and the latest guidance in one place. HHS, meanwhile, highlighted a new outreach campaign titled “Risk Less. Do More.” to raise awareness of COVID-19 and encourage vaccination, particularly among high-risk populations. For those not at high risk, health officials still emphasize the importance of vaccination to lower transmission and prevent serious outcomes, including long COVID. “There is no group without risk,” Cohen said, noting that the group with the highest rates of emergency department visits for COVID-19 were children under the age of 5, who are not typically considered high risk.

So far, CDC models are estimating that this year’s winter wave of COVID-19 will be similar, if not slightly weaker on some metrics, than last year’s winter wave, Cohen said. But she emphasized that many assumptions go into the modeling, including how the virus will evolve in the near future and the amount of vaccine uptake. The modeling assumes the current omicron variants stay on their evolutionary path and that US vaccination coverage is about the same as last year. Of course, beating last year’s vaccine coverage could blunt transmission.

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as-bird-flu-spreads-in-cows,-us-close-to-funding-moderna’s-mrna-h5-vaccine

As bird flu spreads in cows, US close to funding Moderna’s mRNA H5 vaccine

New jab —

If trials are successful, US government likely to buy doses for vaccine stockpile.

Testing for bird flu, conceptual image

Digicom Photo/Science Photo Library via Getty

The US government is nearing an agreement to bankroll a late-stage trial of Moderna’s mRNA pandemic bird flu vaccine, hoping to bolster its pandemic jab stockpile as an H5N1 outbreak spreads through egg farms and among cattle herds.

The federal funding from the government’s Biomedical Advanced Research and Development Authority, known as BARDA, could come as early as next month, according to people close to the discussions.

It is expected to total several tens of millions of dollars and could be accompanied by a commitment to procure doses if the phase-three trials are successful, they said.

Talks between the government and Pfizer over supporting the development of its mRNA vaccine targeting the H5 family of viruses are also ongoing. Pfizer, like Moderna, played a pivotal role in supplying mRNA vaccines for Washington’s jab rollout during the COVID-19 pandemic.

Bird flu has been detected on poultry farms in 48 states and in dairy cow herds across nine states as part of one of the worst outbreaks in recent history, according to the US Centers for Disease Control and Prevention. The CDC has also reported two cases affecting dairy workers in recent months, adding to concerns of the virus spreading in human populations.

US health authorities continue to classify the public health risk from bird flu as low, but their efforts to build up and diversify the pandemic vaccine stockpile have gathered pace. Federal health officials said last week that the government was moving ahead with plans to fill 4.8 million vials from its existing portfolio of protein-based bird flu vaccines and was in discussions with Moderna and Pfizer.

The possibility of contributing to the US pandemic vaccine stockpile also represents a commercial opportunity for the mRNA vaccine makers, whose market valuations have fallen significantly from pandemic highs. Moderna’s share price is up nearly 37 percent since the start of April.

Moderna has completed dosing of a mid-stage trial of its H5 pandemic flu vaccine, with interim data expected soon. Pfizer said in a statement on Wednesday that it “would be prepared to deploy the company’s capabilities to develop a vaccine for strategic stockpiles,” confirming that it had launched a phase-one trial for a pandemic flu vaccine last December.

Applications for BARDA grant funding for an mRNA-based pandemic flu vaccine closed in December last year, according to a project proposal seen by the Financial Times. But the bird flu outbreak has increased the urgency of talks, with federal officials acknowledging that the speed with which mRNA vaccines were designed and deployed during the COVID-19 pandemic showed their value compared with more traditional vaccine technology.

The jabs from GSK, Sanofi, and CSL Seqirus, which make up the US government’s existing pandemic vaccine portfolio, provide immunity to the current strain of bird flu, according to laboratory testing, but rely on a more time-intensive manufacturing process using egg- and cell-based cultures.

The US health department, Moderna, and Pfizer declined to comment on the potential funding.

© 2024 The Financial Times Ltd. All rights reserved. Not to be redistributed, copied, or modified in any way.

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after-mice-drink-raw-h5n1-milk,-bird-flu-virus-riddles-their-organs

After mice drink raw H5N1 milk, bird flu virus riddles their organs

Deadly dairy —

No, really, drinking raw milk during the H5N1 outbreak is a bad idea.

Fresh raw milk being poured into a container on a dairy farm on July 29, 2023, in De Lutte, Netherlands.

Enlarge / Fresh raw milk being poured into a container on a dairy farm on July 29, 2023, in De Lutte, Netherlands.

Despite the delusions of the raw milk crowd, drinking unpasteurized milk brimming with infectious avian H5N1 influenza virus is a very bad idea, according to freshly squeezed data published Friday in the New England Journal of Medicine.

Researchers at the University of Wisconsin-Madison squirted raw H5N1-containing milk from infected cows into the throats of anesthetized laboratory mice, finding that the virus caused systemic infections after the mice were observed swallowing the dose. The illnesses began quickly, with symptoms of lethargy and ruffled fur starting on day 1. On day 4, the animals were euthanized to prevent extended suffering. Subsequent analysis found that the mice had high levels of H5N1 bird flu virus in their respiratory tracts, as well their hearts, kidneys, spleens, livers, mammary glands, and brains.

“Collectively, our data indicate that HPAI [Highly Pathogenic Avian Influenza] A(H5N1) virus in untreated milk can infect susceptible animals that consume it,” the researchers concluded. The researchers also found that raw milk containing H5N1 can remain infectious for weeks when stored at refrigerator temperatures.

Bird flu has not historically been considered a foodborne pathogen, but prior to the unexpected outbreak of H5N1 in US dairy cows discovered in March, it had never been found at high levels in a food product like milk before. While experts have stepped up warnings against drinking raw milk amid the outbreak, the mouse experiment offers some of the first data on the risks of H5N1 from drinking unpasteurized dairy.

Before the mouse data, numerous reports have noted carnivores falling ill with H5N1 after eating infected wild birds. And a study from March in the journal Emerging Infectious Diseases reported that over half of the 24 or so cats on an H5N1-infected dairy farm in Texas died after drinking raw milk from the sick cows. Before their deaths, the cats displayed distressing neurological symptoms, and studies found the virus had invaded their lungs, brains, hearts, and eyes.

While the data cannot definitely determine if humans who drink H5N1-contaminated raw milk will suffer the same fate as the mice and cats, it highlights the very real risk. Still, raw milk enthusiasts have disregarded the concerns. PBS NewsHour reported last week that since March 25, when the H5N1 outbreak in US dairy cows was announced, weekly sales of raw cow’s milk have ticked up 21 percent, to as much as 65 percent compared with the same periods a year ago, according to data shared by market research firm NielsenIQ. Moreover, the founder of California-based Raw Milk Institute, Mark McAfee, told the Los Angeles Times this month that his customers baselessly believe drinking H5N1 will give them immunity to the deadly pathogen.

In normal times, the Centers for Disease Control and Prevention and the Food and Drug Administration strongly discourage drinking raw milk. Without pasteurization, it can easily be contaminated with a wide variety of pathogens, including Campylobacter, Cryptosporidium, E. coli, Listeria, Brucella, and Salmonella.

Fortunately, for the bulk of Americans who heed germ theory, pasteurization appears completely effective at deactivating the virus in milk, according to thorough testing by the FDA. Pasteurized milk is considered safe during the outbreak. The US Department of Agriculture, meanwhile, reports finding no H5N1 in retail beef so far and, in laboratory experiments, beef patties purposefully inoculated with H5N1 had no viable virus in them after the patties were cooked to 145°F (medium) or 160°F (well done).

To date, the USDA has reported that H5N1 has infected at least 58 dairy herds in nine states.

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Fragments of bird flu virus genome found in pasteurized milk, FDA says

Milk testing —

The test cannot tell if the virus is live. The FDA still assess milk supply as safe.

Cows being milked

Enlarge / Cows being milked

The Food and Drug Administration on Tuesday announced that genetic fragments from the highly-pathogenic avian influenza virus H5N1 have been detected in the pasteurized, commercial milk supply. However, the testing completed so far—using quantitative polymerase chain reaction (qPCR)—only detects the presence of viral genetic material and cannot tell whether the genetic material is from live and infectious viral particles or merely remnants of dead ones killed by the pasteurization process.

Testing is now ongoing to see if viable, infectious H5N1 can be identified in milk samples.

So far, the FDA still believes that the milk supply is safe. “To date, we have seen nothing that would change our assessment that the commercial milk supply is safe,” the agency said in a lengthy explanation of the finding and ongoing testing.

H5N1 made its startling jump to US dairy cows recently, with the first ever documented cases in a Texas herd confirmed on March 25. It has spread widely since then with at least 32 herds in eight states now known to be infected. The unexpected spread to bovines has raised fears that the virus is evolving to infect mammals more efficiently, and so poses a heightened risk of spread to and among humans.

But amid the alarming outbreak among the country’s dairy herds, federal agencies have appeared confident that the virus poses little risk to no risk to the safety of the milk supply.

“At this time, there continues to be no concern that this circumstance poses a risk to consumer health, or that it affects the safety of the interstate commercial milk supply because products are pasteurized before entering the market” the FDA wrote in an FAQ published Friday. “Pasteurization has continually proven to inactivate bacteria and viruses, like influenza, in milk.”

In the announcement Tuesday, the FDA also highlighted that multiple studies have shown that the pasteurization process for eggs, which uses lower temperatures than what is used for milk, is effective at inactivating H5N1.

Nevertheless, the FDA, along with the Centers for Disease Control and Prevention and the US Department of Agriculture, have continued to investigate potential risks, including establishing whether pasteurization can inactivate this specific virus. The FDA noted in its announcement Tuesday that, while pasteurization is expected to kill the virus, pasteurization is “different than complete sterilization.”

As such, it carried out the qPCR tests, expecting it might find some genetic fragments in the pasteurized milk because virus has been detected in raw milk. “Based on available information, pasteurization is likely to inactivate the virus, however the process is not expected to remove the presence of viral particles,” the FDA explained. “Therefore, some of the samples collected have indicated the presence of HPAI [Highly Pathogenic Avian Influenza] using quantitative polymerase chain reaction (qPCR) testing.”

The FDA did not indicate how many samples it has tested, where the samples were collected from, or the level of viral genetic material the samples contained.

The agency is now working on assessing whether it can identify if any virus particles are infectious using egg inoculation tests, which are considered a gold-standard for determining viral viability. It added that it will release results from those tests and others in “the next few days to weeks.”

“[W]e take this current situation and the safety of the milk supply very seriously. We recognize the importance of releasing further, actionable information,” the FDA said.

Meanwhile, the agency reported that the CDC’s food safety group has been closely monitoring emergency department data and flu testing data for any unusual trends in flu-like illness, flu, or conjunctivitis, which could indicate spread of H5N1 to people. “To date, surveillance systems do not show any unusual trends or activity,” the FDA said.

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