Perhaps most concerning, FDA inspectors noted that employees were never seen washing their hands. Instead, they wore gloves, and if they touched dirty surfaces or items, they would simply put hand sanitizer on their dirty gloves and carry on. What they should have been doing was removing their dirty gloves, washing their hands, and getting clean gloves. However, the FDA inspectors never saw this happen, and managers confirmed that hand sanitizing gloves was common practice.
The inspectors also noted that the facility’s equipment was always wet. Employees applied sanitizing solutions on knives and other equipment used to dice and chop fresh produce. The sanitizing solution is meant to be air-dried before use, but Taylor Farms employees immediately used the equipment—still dripping with sanitizing solution—to cut RTE produce.
On one day of the inspection, FDA agents saw employees chop RTE lettuce with equipment that was wet with sanitizing solution at the maximum concentration, which was 200 ppm. In another instance, the inspectors saw an employee mix cleaning chemicals together to make a sanitizing solution, which the employee said was done “routinely.” When inspectors asked about the mixture, Taylor Farms “could not find the source of this recipe,” nor could they find the manufacturer label or other information stating the mixture was designed for use.
“Highest expectations”
In a statement to CBS, Taylor Farms said that it “immediately took steps to address” the problems found in the FDA’s inspection, which resulted in no “administrative or regulatory action” against the company.
“Taylor Farms is confident in our best-in-class food safety processes, and in turn, the quality and safety of our products,” the company said in the statement. “As is common following an inspection, FDA issued observations of conditions that could be improved at one of our facilities.” The company added that “no illnesses or public health threat has been linked to these observations” in the inspection.
McDonald’s, meanwhile, said it had stopped getting onions from the facility.
“We hold our suppliers to the highest expectations and standards of food safety. Prior to this inspection, and unrelated to its findings, McDonald’s stopped sourcing from Taylor Farms’ Colorado Springs facility,” McDonald’s said in a statement.
A British Columbia teen who contracted Canada’s first known human case of H5 bird flu has deteriorated swiftly in recent days and is now in critical condition, health officials reported Tuesday.
The teen’s case was announced Saturday by provincial health officials, who noted that the teen had no obvious exposure to animals that could explain an infection with the highly pathogenic avian influenza. The teen tested positive for H5 bird flu at BC’s public health laboratory, and the result is currently being confirmed by the National Microbiology Laboratory in Winnipeg.
The teen’s case reportedly began with conjunctivitis, echoing the H5N1 human case reports in the US. The case then progressed to fever and cough, and the teen was admitted to BC’s Children’s hospital late Friday. The teen’s condition varied throughout the weekend but had taken a turn for the worse by Tuesday, according to BC provincial health officer Bonnie Henry.
“This was a healthy teenager prior to this—so, no underlying conditions—and it just reminds us that in young people, this is a virus that can progress and cause quite severe illness,” Bonnie Henry said in a media briefing streamed by Global News on Tuesday.
Health officials in the province have opened an investigation to understand the source of the outbreak. Around three dozen contacts of the teen have been tested, and all have been negative. “The source of exposure is very likely to be an animal or bird and is being investigated by BC’s chief veterinarian and public health teams,” health officials noted in the announcement over the weekend. The teen was reportedly exposed to pets, including dogs, cats, and reptiles, but testing so far has been negative on them.
Slivered onions are the likely source of the multi-state E. coli outbreak linked to McDonald’s Quarter Pounder burgers that continues to grow, the Centers for Disease Control and Prevention announced Wednesday.
Onions were one of two primary suspects when the CDC announced the outbreak on October 22, with the other being the beef patties used on the burgers. But onions quickly became the leading suspect. The day after the CDC’s announcement, McDonald’s onion supplier, Taylor Farms, recalled peeled and diced yellow onion products and several other fast food chains took onions off the menu as a precaution. (No other restaurants have been linked to the outbreak to date.)
According to the CDC, traceback information and epidemiological data collected since then have all pointed to the onions and, according to McDonald’s, state and federal testing of the beef patties has all come back negative.
In the CDC’s update Wednesday, the agency reported that 15 more people were identified as sickened in the outbreak, including five who were hospitalized. In all, that brings the outbreak to 90 cases, including 27 hospitalizations and one death, which collectively span 13 states.
All the newly reported illnesses had onsets prior to the October 23 onion recall. The most recent illness onset was October 16. Additional illnesses may be reported, as it can take three to four weeks to link illnesses to an outbreak.
“Due to the product actions taken by McDonald’s and Taylor Farms, the CDC believes the continued risk to the public is very low,” the agency said in a media alert.
McDonald’s says that Quarter Pounders—without onions—will return to the menus of affected restaurants this week. Prior to the recall, 900 restaurants had received onions from Taylor Farms, including in Colorado, Kansas, and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, Oklahoma, and Utah.
For some, microwaving fish in the employee lunch room is the ultimate work faux pas. But for one (likely mortified) employee of a seafood distribution plant in Maryland, it’s probably causing a mass poisoning with the homemade noodle dish they brought to share for lunch. The dish sickened 46 employees, spurring their employer to hastily release a statement assuring customers that it wasn’t the company’s food that caused the illnesses.
On October 21, first responders and paramedics arrived at the NAFCO Wholesale Fish Distribution Facility in Jessup, where dozens of employees had abruptly fallen ill about three hours after lunch. Helicopter footage of the event captured images of workers around picnic tables outside the plant, some doubled over and with their heads down.
Ultimately, 46 people were sickened, and at least 26 were treated at an area hospital with symptoms of food poisoning, according to The Baltimore Banner. They all recovered.
“NAFCO maintains the highest standards of food safety and regularly undergoes rigorous inspections by health authorities,” NAFCO said in a written statement. “Its products continue to be safely produced and consumed by customers nationwide, and there are no issues related to its supply chain.”
Enterotoxins
In an update on Tuesday, the Maryland Department of Health announced that testing found that Staphylococcus aureus was the cause of the illnesses. S. aureus is often thought of as a skin bacterium, but the pathogen can spread to food from unwashed hands, the Centers for Disease Control and Prevention notes. In food that isn’t thoroughly cooked or is held at warm temperatures (between 40° F and 140° F) conducive to bacterial growth, the germ can grow and produce toxins.
The 26 new cases represent a 50 percent increase in the case count from October 22, bringing the total to 75 cases. With the new cases, health officials also reported 12 more hospitalizations, including one new adult case of hemolytic uremic syndrome (HUS), a severe complication to an E. coli O157:H7 infection. Three more states are also newly affected: Michigan, New Mexico, and Washington.
In all, the outbreak now stands at 75 cases, including 22 hospitalizations and two cases of HUS, across 13 states. The number of deaths linked to the outbreak remains at one. The most recent illness onset for the cases identified so far is October 10.
The states with cases now include: Colorado (26 cases), Montana (13), Nebraska (11), New Mexico (5), Utah (5), Missouri (4), Wyoming (4), and Michigan (2), and one case each in Iowa, Kansas, Oregon, Washington, and Wisconsin.
The source of the outbreak has not yet been confirmed, but investigators have focused on the beef patties and slivered onions used on McDonald’s Quarter Pounders. McDonald’s immediately pulled the popular burger off the menu and paused distribution of the slivered onions from affected restaurants when the CDC announced the outbreak Tuesday. McDonald’s considered the affected areas to be Colorado, Kansas, Utah, and Wyoming, as well as portions of Idaho, Iowa, Missouri, Montana, Nebraska, Nevada, New Mexico, and Oklahoma.
Onions recalled and destroyed
On Wednesday, one of McDonald’s onion suppliers, Taylor Farms, recalled peeled and diced yellow onion products. Taylor Farms told Bloomberg earlier this week that its testing had not turned up E. coli, but that it decided to issue the recall anyway.
If you’re going to eat a bear, make sure it’s not rare.
You’d be forgiven for thinking that once the beast has been subdued, all danger has passed. But you might still be in for a scare. The animal’s flesh can be riddled with encased worm larvae, which, upon being eaten, will gladly reproduce in your innards and let their offspring roam the rest of your person, including invading your brain and heart. To defeat these savage squirmers, all one must do is cook the meat to at least 165° Fahrenheit.
But that simple solution continues to be ignored, according to a report today in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. In this week’s issue, health officials in North Carolina report that rare bear meat was served at a November 23 gathering, where at least 22 people ate the meat and at least 10 developed symptoms of a worm infection. Of the 10, six were kids and teens between the ages of 10 and 18.
The infection is from the roundworm Trichinella, which causes trichinellosis. While the infection is rarely fatal, the nematodes tend to burrow out of the bowels and meander through the body, embedding in whatever muscle tissue they come across. A telltale sign of an infection in people is facial swelling, caused when the larvae take harbor in the muscles of the face and around the eyes. Of the 10 ill people in North Carolina, nine had facial swelling.
Local health officials were onto the outbreak when one person developed flu-like symptoms and puzzling facial swelling. They then traced it back to the gathering. The report doesn’t specify what kind of gathering it was but noted that 34 attendees in total were surveyed, from which they found the 22 people who ate the rare meat. The 10 people found with symptoms are technically considered only “probable” cases because the infections were never diagnostically confirmed. To confirm a trichinellosis infection, researchers need blood samples taken after the person recovers to look for antibodies against the parasite. None of the 10 people returned for blood draws.
Enlarge/ A recall notice is posted next to Boar’s Head meats that are displayed at a Safeway store on July 31, 2024, in San Rafael, California.
The Boar’s Head deli-meat plant at the epicenter of a nationwide Listeria outbreak that killed nine people so far harbored the deadly germ in a common area of the facility deemed “low risk” for Listeria. Further, it had no written plans to prevent cross-contamination of the dangerous bacteria to other products and areas. That’s according to a federal document newly released by Boar’s Head.
On Friday, the company announced that it is indefinitely closing that Jarratt, Virginia-based plant and will never again produce liverwurst—the product that Maryland health investigators first identified as the source of the outbreak strain of Listeria monocytogenes. The finding led to the recall of more than 7 million pounds of Boar’s Head meat. The Jarratt plant, where the company’s liverwurst is made, has been shuttered since late July amid the investigation into how the outbreak occurred.
In the September 13 update, Boar’s Head explained that:
[O]ur investigation has identified the root cause of the contamination as a specific production process that only existed at the Jarratt facility and was used only for liverwurst. With this discovery, we have decided to permanently discontinue liverwurst.
While the statement seems to offer some closure on the outbreak’s source, previously released inspection reports described a facility riddled with sanitation failures. Between August 1, 2023, and August 2, 2024, the facility was cited for 69 violations, which included water leaks, mold in numerous places, algal growth, “meat buildup” caking equipment, and walls that were also crawling with flies and gnats, sightings of other insects, rancid smells, trash and debris on the floors, and even “ample amounts of blood in puddles.”
The New York Times also reported that a 2022 inspection found that the plant posed an “imminent threat” to public health and that inspectors cited “extensive rust, deli meats exposed to wet ceilings, green mold and holes in the walls.”
Cross-contamination
The document newly released by Boar’s Head is a letter dated July 31 from the US Department of Agriculture’s Food Safety and Inspection Service notifying the company that the Jarratt facility was suspended. The basis of the suspension was an inspection finding from July 24 and 25 of L. monocytogenes contaminating a pallet jack in a large room where ready-to-eat meats were processed. The room was a common area not specific to liverwurst processing and was deemed by Boar’s Head to be “low risk” for Listeria.
Meats from eight processing lines were in the room, with lines 1 through 4 on the left side and 5 through 8 on the right, handling hot dogs and other small sausages. The contaminated pallet jack was designated for production line 2, which was handling Beechwood Hams, and was used to move racks of hams from blast coolers to production lines in the processing room.
However, inspectors noted that the pallet jacks and product racks in the room weren’t kept to designated production lines, and instead, employees moved them between all of the lines and all of the blast coolers, enabling cross-contamination. And, while the equipment was moved around, people did, too. Although employees typically stuck to one production line, they would sometimes move between lines, and there were no procedures for employees to change personal protective equipment (PPE)—gloves, disposable aprons, and arm covers—when they switched. Inspectors saw them switching without changing their PPE.
“They also observed employees who freely move between all lines without directly interacting with product such as those removing garbage, removing product debris from the floors, removing condensation from overhead structures, or performing maintenance,” the USDA officials wrote.
Outbreak spread
Given that this was in a room full of meats that were supposedly ready to eat, the USDA concluded that Boar’s Head “failed to maintain sanitary conditions” and that its Listeria control program was “ineffective.”
To date, 57 people from 18 states have been sickened. All 57 were hospitalized, and nine people died. The Centers for Disease Control and Prevention reported that health officials have interviewed 44 people sickened during the outbreak, who said they ate various deli-sliced meats. Only 25 reported eating deli-sliced liverwurst.
In light of the outbreak, Boar’s Head said it is revamping its safety and quality assurances at its other facilities and hiring experienced food safety experts. “You have our promise that we will work tirelessly to regain your trust and ensure that all Boar’s Head products consistently meet the high standards that you deserve and expect. We are determined to learn from this experience and emerge stronger.”
Enlarge/ A recall notice is posted next to Boar’s Head meats that are displayed at a Safeway store on July 31, 2024, in San Rafael, California.
Federal inspections found 69 violations—many grisly—at the Boar’s Head meat facility at the center of a deadly, nationwide Listeria outbreak that has now killed nine people, sickened and hospitalized a total of 57 across 18 states, and spurred the nationwide recall of more than 7 million pounds of meat.
The Jarratt, Virginia-based facility had repeated problems with mold, water leaks, dirty equipment and rooms, meat debris stuck on walls and equipment, various bugs, and, at one point, puddles of blood on the floor, according to inspection reports from the US Department of Agriculture’s Food Safety and Inspection Services. The reports were obtained by CBS News through a Freedom of Information Act Request. In all, the reports outline 69 violations just between the dates of August 1, 2023, and August 2, 2024.
The findings in the reports reveal the perfect conditions for the company’s meat to become contaminated with the germ behind the deadly outbreak, Listeria monocytogenes. This is a hardy germ that is ubiquitous in the environment, including in soil and water, and it spreads among people via the fecal-oral route. In healthy people, it usually only causes gastrointestinal infections. But for older people, newborns, and the immunocompromised, it can cause a life-threatening invasive infection with a fatality rate of around 17 percent. It’s also a significant danger to pregnant people, causing miscarriage, stillbirth, premature delivery, and life-threatening infections in newborns.
While it’s always lurking, L. monocytogenes especially plagues the food industry because it has the notable ability to reproduce at refrigerator temperatures—a condition that typically limits the growth of other nasty germs.
Buildup and bugs
In the Boar’s Head facility, L. monocytogenes appeared to have various opportunities to beef up its numbers. For one, the facility had a long track record of trash and meat debris in various places, which was sometimes reported alongside insect sightings. For instance, on June 10, an inspector entered the “pickle vat pump room” and noted “heavy meat buildup” on the walls, which were also crawling with flies and gnats. On the same day, an inspection of a different area found a rollup door with meat buildup on it, and a water pipe over the door leaked a steady stream of water down the wall and onto the floor. There was also a “steady line of ants” and an inventory of ladybugs, a cockroach, and a beetle of some sort. Earlier, on March 13, an inspection of a room next to where netted hams were handled, an inspector found trash and meat protein on the floor, including “whole pork muscles.”
Going back to August 8, 2023, an inspection likewise found processing lines covered in meat particles and trash. “Heavy discolored meat buildup” was found covering a hydraulic pump, and pieces of meat and fat clung to the support braces of a catwalk. An inspection-line scale had meat pieces and trash in it—and it smelled bad. “Multiple instances of meat were found around the department on the floor. As well as standing water containing a brown mud/dirt-like substance,” the inspection read.
The facility had numerous problems with water leaks and condensation, which fits with the other numerous sightings of mold. The facility temporarily fixed water pipe leaks by wrapping the pipes in plastic. On October 26, an inspector noticed a plastic-wrapped pipe in the cure cooler. The plastic was dated August 17, and there was “orange/brown water pooled in the lowest hanging point.”
Bubbles and blood
On January 9, the inspection of a holding cooler found spots of black mold as large as a quarter throughout the room. On July 23, an inspector noticed bubbled paint on the wall around employee hand-washing sinks. The bubbles were filled with water. And under the sinks, the inspector found black mold and pink mildew.
On July 17, the inspector found “green algal growth” in a puddle of standing water in a raw holding cooler. And on July 27, an inspector noted clear liquid leaking out from a square patch on the ceiling. Behind the patch, there were two other patches that were also leaking. An employee came and wiped the liquid away with a sponge, but it returned within 10 seconds. The employee wiped it again, and the liquid again returned within 10 seconds. Meanwhile, a ceiling fan mounted close by was blowing the leaking liquid onto uncovered hams in a hallway outside the room.
To top if off, a report on February 21 found a raw cooler with “ample amounts of blood in puddles on the floor” and a “rancid smell.”
According to USDA documents, the agency has not taken enforcement actions against Boar’s Head, and there is no data available on swab testing for Listeria at the Virginia facility. The plant has been shut down since late July after health investigators found the outbreak strain of L. monocytogenes in unopened containers of Boar’s Head liverwurst.
In a statement updated on August 29, Boar’s Head said, “We are conducting an extensive investigation, working closely with the USDA and government regulatory agencies, as well as with the industry’s leading food safety experts, to determine how our liverwurst produced at our Jarratt, Virginia facility was adulterated and to prevent it from happening again… We will not resume operations at this facility until we are confident that it meets USDA regulatory standards and Boar’s Head’s highest quality and safety standards.”
To date, 57 people across 18 states have been sickened, all of whom required hospitalization. A total of eight have died. The latest tally makes this the largest listeriosis outbreak in the US since 2011, when cantaloupe processed in an unsanitary facility led to 147 Listeria infections in 28 states, causing 33 deaths, the CDC notes.
The new cases and deaths come after a massive recall of more than 7 million pounds of Boar’s Head meat products, which encompassed 71 of the company’s products. That recall was announced on July 30, which itself was an expansion of a July 26 recall of an additional 207,528 pounds of Boar’s Head products. By August 8, when the CDC last provided an update on the outbreak, the number of cases had hit 43, with 43 hospitalizations and three deaths.
In a media statement Wednesday, the CDC says the updated toll of cases and deaths is a “reminder to avoid recalled products.” The agency noted that the outbreak bacteria, Listeria monocytogenes, is a “hardy germ that can remain on surfaces, like meat slicers, and foods, even at refrigerated temperatures. It can also take up to 10 weeks for some people to have symptoms of listeriosis.” The agency recommends that people look through their fridges for any recalled Boar’s Head products, which have sell-by dates into October.
If you find any recalled meats, do not eat them, the agency warns. Throw them away or return them to the store where they were purchased for a refund. The CDC and the US Department of Agriculture also recommend that you disinfect your fridge, given the germs’ ability to linger.
L. monocytogenes is most dangerous to people who are pregnant, people age 65 years or older, and people who have weakened immune systems. In these groups, the bacteria are more likely to move beyond the gastrointestinal system to cause an invasive listeriosis infection. In older and immunocompromised people, listeriosis usually causes fever, muscle aches, and tiredness but may also cause headache, stiff neck, confusion, loss of balance, or seizures. These cases almost always require hospitalization, and 1 in 6 die. In pregnant people, listeriosis also causes fever, muscle aches, and tiredness but can also lead to miscarriage, stillbirth, premature delivery, or a life-threatening infection in their newborns.
Enlarge/ A cicada from a 17-year cicada brood clings to a tree on May 29, 2024, in Park Ridge, Illinois. The state experienced an emergence of cicadas from Brood XIII and Brood XIX simultaneously. This rare occurrence hasn’t taken place since 1803.
A plague of parasitic mites has descended upon Illinois in the wake of this year’s historic crop of cicadas, leaving residents with raging rashes and incessant itching.
The mighty attack follows the overlapping emergence of the 17-year Brood XIII and the 13-year Brood XIX this past spring, a specific co-emergence that only occurs every 221 years. The cacophonous boom in cicadas sparked an explosion of mites, which can feast on various insects, including the developing eggs of periodical cicadas. But, when the mites’ food source fizzles out, the mites bite any humans in their midst in hopes of finding their next meal. While the mites cannot live on humans, their biting leads to scratching. The mite, Pyemotes herfsi, is aptly dubbed the “itch mite.”
“You can’t see them, you can’t feel them, they’re always here,” Jennifer Rydzewski, an ecologist for the Forest Preserve District of DuPage County, told Chicago outlet The Daily Herald. “But because of the cicadas, they have a food source [and] their population has exploded.”
The mites are around 0.2 millimeters in length and very difficult to see with the naked eye, according to agriculture experts at Pennsylvania State University. They have four pairs of legs and are tan with a reddish tinge. Female itch mites can produce up to 250 offspring, which emerge from her abdomen as adults. Emerged adult offspring quickly mate, with the males then dying off and the newly fertilized females dispersing to find their own food source.
Itchy outbreak
Besides “itch mites” these parasites have also been called the “oak leaf itch mite” or “oak leaf gall mite,” because they have often been found feasting on the larvae of oak gall midges. These midges are a type of fly that lays eggs on oak trees. The resulting larvae feast on the tree, spurring the formation of unusual growths (galls) around the larvae.
The first known outbreak of itch mites in the US occurred in Kansas in August 2004. The Kansas Department of Health and Environment had called in the Centers for Disease Control and Prevention to help investigate a puzzling outbreak of rashes in Crawford County. At the start, 300 residents in the small city of Pittsburg reported extremely itchy rashes, primarily on the limbs, neck, and face. The rashes looked similar to those from insect bites, but few of the affected people recalled being bitten by anything.
With the help of entomologists, outbreak investigators pinned the rashes to the itch mites. The area had experienced a mild winter and cooler summer temps, leading to an explosion of oak gall midges and subsequent infestation of oak galls. A detailed investigation determined that county residents were nearly four times more likely to have an itchy rash if they had a pin oak tree on their property. Once the itch mites invade a gall-infected oak tree, more than 16,000 mites can emerge from the galls on a single leaf. The mites can then drop from trees and are even small enough to be carried by the wind, giving them ample opportunity to find their way onto humans.
By the end of the outbreak, investigators estimated that 54 percent of the roughly 38,000 residents in Crawford County—that is, around 20,500 people—had been bitten by the mites.
Profuse parasites
But oak gall midges are far from the only insect the itch mites feed upon. In 2007, the emergence of a particularly prolific brood of cicadas led to an outbreak of itch mites in the Chicago area. The Illinois Department of Public Health noted that the “proposed common name ‘oak leaf itch mite’ for P. herfsi is misleading and contributed to the delay in identifying the causative agent of the 2007 Illinois outbreak.” The department noted that at least five insect orders and nine insect families are prey to the mites.
In the US, cases of itch mite rashes have been documented in at least Illinois, Nebraska, Ohio, Oklahoma, Pennsylvania, Missouri, Tennessee, and Texas.
If bitten, humans develop an itchy red rash, typically with pimple-like bumps, which can stick around for up to two weeks. The rash develops between 10 to 16 hours after exposure, which can make it difficult to identify the source. But, the mites typically don’t produce groupings of bite marks like bedbugs or burrowing like scabies.
To try to avoid rashes, experts recommend wearing protective clothing when outside—including gloves while gardening or doing yard work—and washing clothes and showering after a potential exposure. The insect repellent DEET is often recommended, but anecdotal reports indicate DEET may not be entirely effective. If you already have a rash, the only thing to do is treat the symptoms with things like ice packs, soothing lotions (like calamine), oral antihistamines, over-the-counter hydrocortisone creams, and, if needed, prescription topical steroids. The good news is that the mites will not live on you and are not known to spread any diseases.
Enlarge/ A negative stain electron micrograph of a mpox virus virion in human vesicular fluid.
The World Health Organization on Wednesday declared an international health emergency over a large and rapidly expanding outbreak of mpox that is spilling out of the Democratic Republic of the Congo.
It is the second time in about two years that mpox’s spread has spurred the WHO to declare a public health emergency of international concern (PHEIC), the highest level of alarm for the United Nations health agency. In July 2022, the WHO declared a PHEIC after mpox cases had spread across the globe, with the epicenter of the outbreak in Europe, primarily in men who have sex with men. The outbreak was caused by clade II mpox viruses, which, between the two mpox clades that exist, is the relatively mild one, causing far fewer deaths. As awareness, precautions, and vaccination increased, the outbreak subsided and was declared over in May 2023.
Unlike the 2022–2023 outbreak, the current mpox outbreak is driven by the clade II virus, the more dangerous version that causes more severe disease and more deaths. Also, while the clade I virus in the previous outbreak unexpectedly spread via sexual contact in adults, this clade II outbreak is spreading in more classic contact patterns, mostly through skin contact of household members and health care workers. A large proportion of those infected have been children.
To date, Democratic Republic of the Congo (DRC), where the virus is endemic, has reported more than 22,000 suspect mpox cases and more than 1,200 deaths since the start of January 2023. In recent months, the outbreak has spilled out into multiple neighboring countries, including Burundi, Central African Republic, Republic of the Congo, Rwanda, Kenya, and Uganda.
Earlier on Wednesday, the WHO convened an emergency committee to review the situation, in which experts from affected countries presented data to independent international experts. The committee concluded that the outbreak constituted a PHEIC, and WHO Director-General Dr. Tedros Adhanom Ghebreyesus followed their recommendation.
“The emergence of a new clade of mpox, its rapid spread in eastern DRC, and the reporting of cases in several neighboring countries are very worrying,” Tedros said in a statement announcing the PHEIC. “On top of outbreaks of other mpox clades in DRC and other countries in Africa, it’s clear that a coordinated international response is needed to stop these outbreaks and save lives.”
On Tuesday, the Africa Centers for Disease Control and Prevention declared a similar emergency. Africa CDC Director General Dr. Jean Kaseya said the declaration will “mobilize our institutions, our collective will, and our resources to act—swiftly and decisively. This empowers us to forge new partnerships, strengthen our health systems, educate our communities, and deliver life-saving interventions where they are needed most.”
For now, the US Centers for Disease Control and Prevention assess the risk to the US public to be “very low,” given that there is limited and no direct travel between the US and the epicenter of the outbreak. So far, no clade I cases have been detected outside of central and eastern Africa.
A small study in Texas suggests that human bird flu cases are being missed on dairy farms where the H5N1 virus has taken off in cows, sparking an unprecedented nationwide outbreak.
The finding adds some data to what many experts have suspected amid the outbreak. But the authors of the study, led by researchers at the University of Texas Medical Branch in Galveston, went further, stating bluntly why the US is failing to fully surveil, let alone contain, a virus with pandemic potential.
“Due to fears that research might damage dairy businesses, studies like this one have been few,” the authors write in the topline summary of their study, which was posted online as a pre-print and had not been peer-reviewed.
The study authors, led by Gregory Gray, were invited to two undisclosed dairy farms in Texas that experienced H5N1 outbreaks in their herds starting in early and late March, respectively. The researchers had a previously approved research protocol to study novel respiratory viruses on dairy farms, easing the ability to quickly begin the work.
Rare study
“Farm A” had 7,200 cows and 180 workers. Illnesses began on March 6, and nearly 5 percent of the herd was estimated to be affected during the outbreak. “Farm B” had 8,200 cows and 45 workers. After illnesses began on March 20, an estimated 14 percent of the herd was affected.
The researchers first visited Farm A on April 3 and Farm B on April 4, collecting swabs and samples at each. Based on the previously approved protocol, they were limited to taking nasal swabs and blood samples from no more than 10 workers per farm. On Farm A, 10 workers provided nasal swabs and blood samples. On Farm B, only seven agreed to give nasal swabs, and four gave blood samples.
While swabs from cows, milk, a dead bird, and a sample of fecal slurry showed signs of H5N1, all of the nasal swabs from the 14 humans were negative. However, when researchers looked for H5N1-targeting antibodies in their blood—an indicator that they were previously infected—two of the 14, about 14 percent, were positive.
Both of the workers with previous infections, a man and a woman, were from Farm A. And both reported having flu-like symptoms. The man worked inside cattle corrals, close to the animals, and he reported having a cough at the time the samples were taken. The woman, meanwhile, worked in the cafeteria on the farm and reported recently recovering from an illness that included fever, cough, and sore throat. She noted that other people on the farm had similar respiratory illnesses around when she did.
The finding suggests human cases of H5N1 are going undetected. Moreover, managing to find evidence of two undetected infections in a sample of just 14 workers suggests it may not be hard to find more. The Centers for Disease Control and Prevention estimates that around 200,000 people work with livestock in the US.
Known infections in humans have all been mild so far. But experts are anxious that with each new infection, the wily H5N1 virus is getting new opportunities to adapt further to humans. If the virus evolves to cause more severe disease and spread from human to human, it could spark another pandemic.
Federal officials are also worried about this potential threat. In a press briefing Tuesday, Nirav Shah, the CDC’s principal deputy director, announced a $5 million effort to vaccinate farm workers—but against seasonal flu.
Shah explained that the CDC is concerned that if farm workers are infected with H5N1 and the seasonal flu at the same time, the viruses could exchange genetic segments—a process called reassortment. This could give rise to the pandemic threat experts are worried about. By vaccinating the workers against the seasonal flu, it could potentially prevent the viruses from comingling in one person, Shah suggested.
The US does have a bird flu-specific vaccine available. But in the briefing, Shah said that the use of that vaccine in farm workers is not planned for now, though there’s still active discussion on the possibility. The lack of severe disease and no documented human-to-human transmission from H5N1 infections both argue against deploying a new vaccine, Shah said. “There has to be a strong and compelling case,” he added. Shah also suggested that the agency expects vaccine uptake to be low among farm workers.
