Officially, there is only one documented case of bird flu spilling over from cows into humans during the current U.S. outbreak.
But epidemiologist Gregory Gray suspects the true number is higher, based on what he heard from veterinarians, farm owners and the workers themselves as the virus hit their herds in his state.
“We know that some of the workers sought medical care for influenza-like illness and conjunctivitis at the same time the H5N1 was ravaging the dairy farms,” says Gray, an infectious disease epidemiologist at the University of Texas Medical Branch in Galveston.
“I don’t have a way to measure that, but it seems biologically quite plausible that they too, are suffering from the virus,” he says.
Gray has spent decades studying respiratory infections in people who work with animals, including dairy cattle. He points out that “clustering of flu-like illness and conjunctivitis” has been documentedwith previousoutbreaks involvingbird flu strains that are lethal for poultry like this current one.
Luckily, genetic sequencing of the virus doesn’t indicate it has evolved to easily spread among humans.
Still, epidemiologists say it’s critical to track any possible cases. They’re concerened some human infections could be flying under the radar, especially if they are mild and transient as was seen in the Texas dairy worker who caught the virus.
“I think based on how many documented cases in cows there are, probably some decent human exposure is occurring,” says Dr. Andrew Bowman, associate professor of veterinary preventive medicine at The Ohio State University. “We just don’t really know.”
Limited testing raises concerns
There have been 36 herds affected in nine states. Local and state health departments have tested about 25 people for the virus and monitored over 100 for symptoms, federal health officials said at a briefing on Wednesday.
These people are in “the footprints of where the bovine detections are,” says Dr. Demetre Daskalakis, who’s with the Centers for Disease Control and Prevention, although he didn’t provide details on the actual locations.
“There’s a very low threshold for individuals to get tested,” he adds.
The lack of testing early in the outbreak isn’t necessarily surprising. In places like Texas and Kansas, veterinarians weren’t thinking about bird flu when illnesses first cropped up in early March and it took time to identify the virus as the culprit.
But the total number of tests done on humans at this point seems low to Jessica Leibler, an environmental epidemiologist at Boston University School of Public Health.
“If the idea was to try to identify where there was spillover from these facilities to human populations, you’d want to try to test as many workers as possible,” says Leibler, who has studied the risk of novel zoonotic influenza and animal agriculture.
Also, notes Gray, the virus is probably much more geographically widespread in cattle than the reported cases show, “possibly spilling over much more to humans than we knew, or then we know.”
The federal government has been quick to assess the safety of the dairy supply. On Wednesday, the Food and Drug Administration released findings, showing that infectious virus wasn’t present in about 200 samples collected from dairy products around the country. Initial results on ground meat are also reassuring.
However, there still remain “serious gaps” in public health officials’ ability to detect bird flu among those who work with cows, a task made all the more difficult by the fact that some cases may not be symptomatic, says Leibler. “There’s really widespread opportunity for worker exposure to this virus.”
Only complicating matters — the true scale of the outbreak in cattle remains murky, although new federal testing requirements for moving cattle between states may help fill out the picture.
“Some of the dairy herds seem to have clinically normal animals, but potentially infected and [that] makes it really hard to know where to do surveillance,” says Bowman.
Calls for proactive steps to track down possible human cases
The health care system would likely catch any alarming rise in human cases of bird flu, according to modeling done by the CDC.
Federal health officials monitor influenza activity in emergency departments and hospitals. Hundreds of clinical laboratories that run tests are tasked with reporting findings. And in early April, a CDC health alert was sent to clinicians advising them to be on the lookout for anyone with flu-like symptoms or conjunctivitis who’d worked with livestock.
But even these safeguards may not be sufficient to get ahead of an outbreak.
“I worry a bit that if we wait until we see a spike in those systems that perhaps we would already be seeing much more widespread community transmission,” says Dr. Mary-Margaret Fill, deputy state epidemiologist for the Tennessee Department of Health. Instead she says there should be proactive testing.
Fill notes there are anecdotes about farmworkers with mild illness while working with cattle in some of the areas where the virus has spread and “not enough visibility on the testing that’s happening or not happening in those populations to understand what might be going on.”
To get ahead of the virus, Leibler says not only do workers need to be screened but also their family members and others in the community, in the event that the virus does evolve to spread easily among humans.
Dr. Rodney Young says doctors in the Texas panhandle have been vigilant about any cases of influenza, particularly among those who are around livestock, but so far there are no indications of anything out of the ordinary.
“We just haven’t seen people who fit that description in order to suddenly be testing a lot more,” says Young,regional chair of the Department of Family and Community Medicine at the Texas Tech Health Sciences Center School of Medicine in Amarillo.
Getting buy-in from dairy farms
Gray says it can be hard to detect and measure the illness in these rural workers for many reasons — their remote location, a reluctance to seek out health care, a lack of health insurance, concerns about immigration status, and a reticence among farmers “to wave the flag” that there are infections.
The farms he works with consider protecting workers and curbing the spread of this virus “a huge priority,” but right now they bear all the risks of going public, he says.
Dr. Fred Gingrich says this is a major barrier to closer cooperation between federal health officials and the industry during the current crisis.
Dairy cattle farmers currently don’t get compensated for reporting infections in their herds — unlike poultry farmers who receive indemnity payments for losses related to culling birds when they find cases, says Gingrich, executive director of the American Association of Bovine Practitioners.
“So what is their incentive to report?” he says, “It’s the same virus. It just doesn’t kill our cows.”
Gray has managed to start collecting samples from humans and cattle at several dairy farms that recently dealt with the virus. It’s part of a study that he launched before the H5N1 outbreak in response to concerns about SARS-CoV-2 spillover on farms.
They’ll look for evidence of exposure to novel influenza, including bird flu –something he’s able to pull off because of his background in this area and his guarantee that the farms will be kept anonymous in the published work.
What concerns him most is the possibility the outbreak could wind up at another kind of farm.
“We know when it hits the poultry farms because the birds die, but the pigs may or may not manifest severe illness,” he says, “The virus can just churn, make many copies of itself and the probability of spilling over to those workers is much greater.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
