December 19, 2024



Note: This is the last issue of Health Security Decoded in 2024. We will return on January 9, 2025.

US CDC confirms nation’s first severe H5N1 case; California declares state of emergency; more cats die of presumed bird flu infection

The US CDC’s human influenza A(H5N1) bird flu case count rose this week to 61 in 8 states: California (34), Washington (11), Colorado (10), Michigan (2), Missouri (1), Texas (1), Oregon (1), and Louisiana (1). The case in Louisiana is the nation’s first known severe illness from the virus and the first linked to exposure to sick or dead birds in a backyard flock. The person, who is over age 65 and has underlying medical conditions, is hospitalized in critical condition with severe respiratory symptoms. According to CDC officials, the person is infected with the H5N1 virus that is circulating in wild birds—clade 2.3.4.4b genotype D1.1—instead of the genotype B3.13 that is circulating among US dairy cows and that has generally caused mild infections in humans. The D1.1 genotype also recently caused severe infection in a teenager in British Columbia, Canada; they are no longer in critical care but remain in hospital.

Several US states are reporting additional cases that meet the Council of State and Territorial Epidemiologists (CSTE) probable case definition but that tested negative on confirmatory testing at CDC. Arizona reported 2 such cases and Washington reported 3 cases with poultry exposure, California reported 1 case with dairy cow exposure, and Delaware recently reported 1 case meeting this definition that was identified during routine flu surveillance and has no defined exposure risk. The Wisconsin Department of Health Services also this week reported that state’s first presumptive positive human H5N1 case in a person who was exposed to an infected flock of commercial poultry.

California state of emergency

In California, which has reported the highest number of affected dairy herds and human H5N1 cases, Governor Gavin Newsom this week declared a state of emergency to streamline and expedite the state’s response to avian influenza. The proclamation provides state and local agencies with additional flexibility around staffing, contracting, and other rules to support the response. The California Department of Food and Agriculture (CDFA) over the weekend announced a recall of raw milk from a second producer—Valley Milk Simply Bottled in Stanislaus County—based on positive tests for avian flu from bulk-milk testing samples. Earlier this month the state recalled raw whole milk and cream products from a different producer, Raw Farm LLC, due to detections of bird flu virus.

More cats with H5N1

Los Angeles County officials are investigating the case of 3 cats in the same household presumed to have become infected with H5N1. Two of these cats died, and one tested positive for influenza A, which is unusual in cats that have not been exposed to infected birds or contaminated dairy. Two other cats died earlier this month after drinking raw milk from the recalled Raw Farm lots. Officials said they are not sure how the most recent 3 became infected but are investigating raw meat as a possible source.

County officials urged people to avoid raw dairy and undercooked meat products, limit contact with sick or dead animals, keep pets or poultry away from wild animals and birds, and report sick or dead birds. Experts say the continued exposure and viral circulation of H5N1 among cats raises concerns that the virus could mix with other influenza viruses and better adapt to infecting humans.

Experts urge precautions

Overall, the risk to the general public remains low, but the increasing number of animal and human detections has prompted the need for heightened vigilance, especially among those who work with commercial farm birds or animals or who have contact with wild animals, zoo animals, or backyard flocks. Those who may be exposed to infected animals or birds should take preventive measures, like wearing masks, gloves, or goggles, and people with backyard flocks should limit their contact with wild birds, according to experts. Health authorities also stress that pasteurized milk is safe but to avoid raw milk products.

Stay informed about the bird flu situation with the Center for Outbreak Response Innovation, which provides updates, risk assessments, and a factsheet on avian influenza A(H5).

DRC health authorities say mystery outbreak identified as severe malaria; WHO conducting confirmatory testing

Health authorities in the Democratic Republic of the Congo (DRC) have identified the cause of a previously unidentified flu-like illness outbreak in the remote Kwango province as severe malaria presenting as a respiratory illness. Malnutrition, which can weaken the immune system, exacerbated the symptoms, which included fever, headache, cough, runny nose, body aches, and anemia. Local health authorities reported more than 500 cases since October, with more than 140 deaths. The outbreak primarily affected females and children under age 15, with those under 5 being particularly vulnerable to severe disease.

While local health officials have declared the mystery solved, WHO has not confirmed the findings and is conducting further testing. Anti-malaria medicine provided by WHO is being distributed in the Panzi health zone. The situation, in a rural and difficult-to-access area with few health resources, illustrates the need to strengthen global systems to rapidly detect, investigate, and respond to disease outbreaks.

Number of mpox cases continues to rise in Africa; Germany reports 4 new clade Ib cases linked to traveler

The number of mpox cases in Africa continues to rise. The Democratic Republic of the Congo (DRC) has reported the highest number of cases, followed by Burundi and Uganda. The first doses of Japan’s LC16 vaccine were expected to arrive in DRC this week, allowing the nation to begin vaccinating young children. Also, this week, Bavarian Nordic, which manufactures the MVA-BN/Jynneos mpox vaccine, signed an agreement with the Serum Institute of India to produce the vaccine for the Indian market and expand global access, once regulatory approvals are obtained. India is one of 7 nations to report cases of the novel clade Ib mpox virus, which was first detected in DRC and has since spread to dozens of countries in Africa. Germany reported 4 new clade Ib mpox cases this week among a family that recently traveled to Africa. Two of the cases were in school-aged children, causing their school to close for a week as a precaution.

Scientists call for global discussion on risks of developing ‘mirror life,’ call for moratorium on related research

Science: Leading scientists warn against developing ‘mirror-image’ bacteria

New York Times: A ‘Second Tree of Life’ Could Wreak Havoc, Scientists Warn

Axios: Scientists call for ban on creating "mirror life"

CNN: Scientists warn of ‘unprecedented’ risks of research into mirror life

See also: The Scientist: The Art of Microbial Disguise

Biden-Harris Administration publishes 2024 Global Health Security Strategy outlining goals to prevent, detect, respond to infectious disease threats

The White House: FACT SHEET: Biden-⁠Harris Administration Releases Global Health Security Annual Report Demonstrating the Impact of United States Leadership and Investments U.S. Government Support for Global Health Security

The White House: U.S. Government Support for Global Health Security: Protecting Lives and Safeguarding Economies

See also: US CDC: Global Health Security

Opinion pieces discuss risk of, preparedness for bird flu or other pandemic

Bloomberg: Another Pandemic Is Inevitable, and We’re Not Ready

Le Monde: 'America's handling of the bird flu crisis is putting, and will continue to put, the entire world at risk'

Los Angeles Times: Opinion: Bird flu is coming for humans. We can either get ready or court disaster

The Guardian: Bird flu is a real pandemic threat. Are we prepared for the worst?

Climate change is ‘fundamentally a health crisis,’ WHO DG tells International Court of Justice

Health Policy Watch: Climate Crisis ‘Catastrophic’ for Global Health, WHO Chief Tells ICJ

WHO: WHO Director-General's statement at the International Court of Justice - Responding to the Climate Change Health Crisis - 13 December 2024

Immediate, cooperative action needed to address interconnected issues such as food security, biodiversity loss, climate change, human health, report says

New Scientist: Unified approach could improve nature, climate and health all at once

BBC: Major report joins dots between world's nature challenges

European Union: New IPBES reports reveal huge economic and business opportunities for accelerating biodiversity action

See also: Scientific American: How to Stop the Next Viral Pandemic

And also: Washington Post: Scientists just confirmed the largest bird-killing event in modern history

US Senate Republican leader warns incoming administration nominees to avoid undermining polio vaccines after reports key advisor petitioned to revoke vaccine’s approval

AP: Trump nominees should ‘steer clear’ of undermining polio vaccine, McConnell says

USA Today: Trump repeats support of polio vaccine, as RFK Jr., allies come under fire

CNN: Kennedy says he’s ‘all for’ polio vaccine as GOP senators raise questions about his views

New York Times: Kennedy’s Lawyer Has Asked the F.D.A. to Revoke Approval of the Polio Vaccine

Articles examine influence of HHS secretary over vaccines, as Trump nominee meets with some US Senators

Politico: The ‘really sticky’ situation facing the public health establishment: RFK Jr.

NPR: How much power would RFK Jr. have at HHS? A former health secretary weighs in

NBC News: As health secretary, RFK Jr. could hold enormous influence over childhood vaccines

STAT: Republicans show no signs of blocking Trump’s health secretary pick RFK Jr. so far

Roll Call: Kennedy faces questions about food, vaccines in GOP meetings

Trump’s CDC nominee has promoted disproven link between vaccines, autism

Washington Post: Trump’s CDC pick wouldn’t let go of false theory that vaccines cause autism

Washington Post: Why Trump’s CDC pick is raising concern in the public health community

See also: STAT: Outgoing CDC director girds against an overhaul, and tries to calm staff nerves

Articles examine vaccine-preventable diseases, discuss safety of today’s shots

New York Times: Six Childhood Scourges We’ve Forgotten About, Thanks to Vaccines

New York Times: What the Polio Vaccine Has Meant for Public Health

New York Times: Are Childhood Vaccines ‘Overloading’ the Immune System? No.

See also: New York Times: Tiny Coffins: Measles Is Killing Thousands of Children in Congo

Flu, influenza-like illness activity increasing in US; COVID rising from low levels

CIDRAP: Indicators show US flu and COVID activity rising

Force of Infection: Outbreak Outlook - National - Dec 16

Your Local Epidemiologist: Up, up, and away

Time: COVID-19 Rates Are Strangely Low This Holiday Season

See also: CIDRAP: Europe says flu, RSV on the rise and affecting health systems

Fewer children getting vaccinated for flu this year despite record number of deaths last year

Axios: Fewer kids are getting their flu shots so far this year

The Hill: Flu vaccines drop among kids despite record deaths last year: CDC

See also: CIDRAP: Despite guidelines, few US children receiving flu antivirals

“Flu and COVID-19 tend to have overlap in their activity and get worse as it gets colder in the northern hemisphere. In the US, in our winter months and in September and October, you start to get people interested in getting vaccinated.” – Amesh Adalja, MD, FIDSA, senior scholar at the Center for Health Security, speaking to Pharmaceutical Today

Controversial 2020 study on disproven COVID-19 treatment retracted on ethical, scientific grounds

USA Today: Study retracted years after it set off an infamous COVID-19 treatment scandal

Nature: Controversial COVID study that promoted unproven treatment retracted after four-year saga

Science: Infamous paper that popularized unproven COVID-19 treatment finally retracted

About 8% of US adults self-report ever having long COVID in 2023; about 2% had symptoms currently limiting daily activities

CIDRAP: About 8% of US adults have ever had long COVID, survey finds

News Medical: Long COVID affects 8.4% of U.S. adults, with income and geography shaping impact

See also: News Medical: New long COVID index highlights five symptom subtypes

3 nations report more polio cases; UK detects virus in wastewater samples; Pakistan begins last vaccination drive of year with delays, attacks

CIDRAP: Three nations report more polio cases; UK notes wastewater detections

AP: Pakistan begins last anti-polio vaccination campaign of the year after a surge in cases

AP: Pakistan postpones polio vaccination drive in southwest after health workers boycotted it

AP: Roadside bomb kills 3 police officers escorting polio workers in northwest Pakistan

Policy paper, explainer, opinion piece discuss various ways world can reduce impacts of malaria

Center for Global Development: Avoiding Another Lost Decade on Malaria Vaccines

The Guardian: What is gene drive and how could it help in the fight against malaria?

New York Times: For the Sake of 600,000 Children, Science Must Be Bold (opinion)

Injectable HIV prevention drug could help end epidemic; rollout dependent upon regulatory approvals, funding

NPR: This drug is the 'breakthrough of the year' — and it could mean the end of the HIV epidemic

Health Policy Watch: Pepfar and Global Fund Target Rollout of HIV Prevention Injectable

See also: Journal of the International AIDS Society: The ground has shifted under PEPFAR: what does that mean for its future?

FROM THE CENTER

Health Security journal call for papers: One Health, One Future: Bridging Health Security

Health Security, the peer-reviewed journal of the Johns Hopkins Center for Health Security, invites researchers, practitioners, and leaders to submit manuscripts for a special feature on One Health and health security by March 31, 2025. One Health explores the interconnected nature of human, animal, and environmental health, addressing complex global challenges like zoonotic diseases, antimicrobial resistance, and climate change.

The special feature welcomes submissions focusing on key areas including:

• Emerging zoonotic diseases and biosecurity
• International governance and policy
• Practical applications of One Health principles
• Health security frameworks
• Climate change impacts
• Future directions in One Health research

Manuscripts should explore innovative approaches to cross-sectoral health challenges, emphasizing prevention, early detection, and collaborative action. Articles on other aspects of One Health and health security are also welcome. Submissions can include original research, case studies, and commentaries ranging from 2,500 to 5,000 words.

Health Security provides an international forum for multidisciplinary analysis of global health threats.

For more details, see: https://centerforhealthsecurity.org/our-work/journal-health-security/call-for-papers#onehealth

Editor: Alyson Browett, MPH

Contributing Editor: Prarthana Vasudevan, MS, MSPH, DrPH (c)