A dangerous type of bird flu virus discovered in the lung of a U.S. dairy cow that didn’t show symptoms. Viral particles identified in processed, pasteurized milk. Genetic sequences showing distinct changes in this H5N1 strain that’s been rapidly spreading throughout American cattle.
Those were just a handful of the rapid-fire developments this week as an unprecedented H5N1 outbreak among U.S. dairy cattle continued to evolve.
Scientists now warn this form of avian influenza is likely more widespread in cows, and was transmitting for longer than official reports suggest. And while American officials are ramping up testing — all in an effort to keep sick cows from being moved between states — others say we’re already several steps behind the spread of a disease that could pose a major threat to human health.
Michael Worobey, a researcher from B.C. who’s now head of the department of ecology and evolutionary biology at the University of Arizona, said these cattle infections may have been “flying under our radar for months,” providing ongoing opportunities for this virus to acquire adaptations that could lead to a flu pandemic.
“I think, in many ways, this is the biggest news story in the world right now.”
Tracing the root of outbreak
After the U.S. Department of Agriculture posted more than 230 genetic sequences from the country’s growing H5N1 outbreak last Sunday, Worobey was among the scientists racing to analyze the complex set of data.
The sequences were from cattle — amid an outbreak impacting more than two-dozen herds across nine U.S. states — but also several bird species, cats, skunks and raccoons.
It’s possible that local birds passed the virus to local farms, in different states, and they’re all spreading a genetically similar lineage, he said. But Worobey believes what’s far more likely is that the cattle outbreak has a single origin point.
In an interview with CBC News, he outlined H5N1’s evolutionary tree, with a distinct branch of sequences linked to cattle. All those sequences share the same mutations, Worobey added.
“This is the hallmark of a single jump, that’s at the root of this outbreak,” he said.
Thermometers are seen atop a small-scale pasteurizer. The discovery of viral RNA in milk in the U.S. doesn’t actually mean it can make people sick. (Toby Talbot/The Associated Press)
A single introduction could have happened as far back as November or December, with a distinct lineage of H5N1 then spreading undetected for months, Worobey said. He added missing details in the initial U.S. data dump — including exact cattle locations and dates — made it tough to know for sure.
The cattle sequences also contain “at least two distinct mutations” that are known for increasing the risk of a flu virus infecting and transmitting in humans, Worobey added.
“We just are producing more and more [opportunities] for evolution to arrive at something that can transmit in humans, and potentially kill a large proportion of them,” he said.
Milk discoveries
What’s not yet clear is how, exactly, the virus is spreading among cattle, though several scientists told CBC News that possibilities include close contact between cows being transported between states or contaminated milking equipment.
“If the cattle indeed have [infection] in the udders, then transmission could be through milking equipment,” said Michelle Wille, a senior research fellow with the University of Melbourne’s Centre for Pathogen Genomics and the department of microbiology and immunology.
“A number of infected states have indicated that [avian flu] was detected in dairy herds that recently received cattle from Texas — so transport of cattle is likely playing a role in spread.”
At this point, it’s still unclear how the virus is “sustaining transmission” in cattle populations, added virologist Angela Rasmussen, from the University of Saskatchewan’s Vaccine and Infectious Disease Organization.
It’s also likely the virus is being transmitted even when cows aren’t showing symptoms — which have so far been mild, including low appetite and reduced milk production — several scientists agreed.
Bird flu is spreading in cows. Are humans at risk? | About That
For the first time ever, avian influenza, or H5N1 bird flu, was detected in roughly a dozen dairy cow herds across the U.S. About That producer Lauren Bird explores why scientists and public health officials are concerned about the cross-species transmission and whether humans are now at higher risk.
This week, officials announced dual discoveries of H5N1 in the lung of an asymptomatic cow in North Carolina, along with viral particles in pasteurized milk, suggesting infected cows almost slipped into the food supply chain.
Ohio State University researchers also said they recently did their own independent sleuthing, collecting 150 commercial milk products from dairy processing plants across 10 states. The team found fragments of viral RNA in close to 60 samples — nearly 40 per cent of the products, all of it available on store shelves.
Rasmussen stressed that the discovery of viral RNA in milk doesn’t necessarily mean it can make people sick if it’s fragments of a virus, not something infectious. Dairy products also go through pasteurization, a heating process meant to eliminate a variety of pathogens.
But in a Thursday update, the U.S. Food and Drug Administration (FDA) said additional testing is still needed “to determine whether intact pathogen is still present and if it remains infectious, which would help inform a determination of whether there is any risk of illness associated with consuming the product.
The FDA added retail milk studies so far have shown no results that would change its assessment that the commercial milk supply in the U.S. is safe.
What’s more concerning, Rasmussen said, is that these developments suggest the cattle outbreak is “much larger than originally thought.”
Like buying lottery tickets
To better understand the scope of H5N1’s spread among cattle, increased testing of dairy cows is now a key facet of the American response.
The U.S. will require dairy cattle moving between states for commerce to be tested for bird flu, Secretary of Agriculture Tom Vilsack told reporters this week. All labs and states must also report positive tests for any form of influenza.
The concern from both officials and scientists alike stems from the potential impacts on animal health and the food supply chain, and the possibility that this virus is inching closer to a pandemic-level threat to humans as well. While the reported cattle infections haven’t been serious, scientists warn they could fuel adaptations that could make it easier to infect more mammals.
Dr. Samira Mubareka, an infectious disease specialist and virologist, is watching for any signs of the H5N1 virus becoming more adept at transmitting between mammals, including humans. (Kevin van Paassen/Sunnybrook Health Sciences Centre)
Since 2022, only two human infections have been reported in the U.S., with the latest one tied to these recent cattle outbreaks. Both were mild. But sporadic human cases linked to contact with infected animals in previous outbreaks have been happening around the world, with many causing serious symptoms, severe pneumonia, or even death.
Based on available human case data to date, the death rate of this form of bird flu is thought to be a staggering 52 per cent, though scientists say there are likely far more mild cases going underreported and skewing that data.
Even so, with so many cattle being infected and coming into contact with farm workers every day, the number of human exposures is going up, Worobey warned. “It’s kind of like buying more and more lottery tickets in the lottery of, ‘Can a new pandemic virus actually evolve?'”
Infectious disease physicians in Canada are keeping a close eye on the places where livestock, wildlife and humans intersect.
Doctors and veterinarians say it’s important to find out whether those in close contact with cattle or wildlife are at higher risk from the latest H5N1 virus in the U.S. (Paul Chiasson/The Canadian Press)
Officials at the Canadian Food Inspection Agency have not yet responded to a series of questions from CBC News, but said online it has not detected this type of avian influenza in Canadian cattle, so it’s not currently testing raw or pasteurized milk.
“[Highly pathogenic avian influenza] is not a food safety concern as pasteurization kills harmful bacteria and viruses,” the agency said on X, formerly Twitter.
Dr. Samira Mubareka, a clinician scientist at Sunnybrook Research Institute and the University of Toronto, is watching for any signs of the virus becoming more adept at transmitting between mammals, including humans.
“From the virus’s perspective, the more transmission there is, the more opportunities to adapt,” Mubareka said. “That is concerning.”
Mubareka said any enhanced change in transmission among mammals would also signal an enhanced ability to transmit among humans, which is why it’s so important to find out whether those in close contact with cattle or wildlife are at higher risk.
She said even if this H5N1 virus doesn’t infect more people, the virus has already hit animal health significantly and could affect food prices, food security and livelihoods.
Rasmussen agreed, and said the impacts could be grim if human-to-human transmission begins.
“It would have a devastating impact on human and animal health, on the economy, on the food supply,” she said. “It would be a worst case scenario.”
The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.
New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.
The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.
Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.
Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.
“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.
“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”
McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.
But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.
The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.
He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.
“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.
“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.
McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”
McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.
He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.
“Early identification of reading difficulty can truly change the trajectory of a child’s life.”
This report by The Canadian Press was first published Oct. 23, 2024.
LONDON (AP) — Britain’s drug regulator approved the Alzheimer’s drug Kisunla on Wednesday, but the government won’t be paying for it after an independent watchdog agency said the treatment isn’t worth the cost to taxpayers.
It is the second Alzheimer’s drug to receive such a mixed reception within months. In August, the U.K. regulator authorized Leqembi while the same watchdog agency issued draft guidance recommending against its purchase for the National Health Service.
In a statement on Wednesday, Britain’s Medicines and Healthcare regulatory Agency said Kisunla “showed some evidence of efficacy in slowing (Alzheimer’s) progression” and approved its use to treat people in the early stages of the brain-robbing disease. Kisunla, also known as donanemab, works by removing a sticky protein from the brain believed to cause Alzheimer’s disease.
Meanwhile, the National Institute for Health and Care Excellence, or NICE, said more evidence was needed to prove Kisunla’s worth — the drug’s maker, Eli Lilly, says a year’s worth of treatment is $32,000. The U.S. Food and Drug Administration authorized Kisunla in July. The roll-out of its competitor drug Leqembi has been slowed in the U.S. by spotty insurance coverage, logistical hurdles and financial worries.
NICE said that the cost of administering Kisunla, which requires regular intravenous infusions and rigorous monitoring for potentially severe side effects including brain swelling or bleeding, “means it cannot currently be considered good value for the taxpayer.”
Experts at NICE said they “recognized the importance of new treatment options” for Alzheimer’s and asked Eli Lilly and the National Health Service “to provide additional information to address areas of uncertainty in the evidence.”
Under Britain’s health care system, most people receive free health care paid for by the government, but they could get Kisunla if they were to pay for it privately.
“People living with dementia and their loved ones will undoubtedly be disappointed by the decision not to fund this new treatment,” said Tara Spires-Jones, director of the Centre for Discovery Brain Sciences at the University of Edinburgh. “The good news that new treatments can slow disease even a small amount is helpful,” she said in a statement, adding that new research would ultimately bring safer and more effective treatments.
Fiona Carragher, chief policy and research officer at the Alzheimer’s Society, said the decision by NICE was “disheartening,” but noted there were about 20 Alzheimer’s drugs being tested in advanced studies, predicting that more drugs would be submitted for approval within years.
“In other diseases like cancer, treatments have become more effective, safer and cheaper over time,” she said. “ We hope to see similar progress in dementia.”
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Women living in states with abortion bans obtained the procedure in the second half of 2023 at about the same rate as before the U.S. Supreme Court overturned Roe v. Wade, according to a report released Tuesday.
Women did so by traveling out of state or by having prescription abortion pills mailed to them, according to the #WeCount report from the Society of Family Planning, which advocates for abortion access. They increasingly used telehealth, the report found, as medical providers in states with laws intended to protection them from prosecution in other states used online appointments to prescribe abortion pills.
“The abortion bans are not eliminating the need for abortion,” said Ushma Upadhyay, a University of California, San Francisco public health social scientist and a co-chair of the #WeCount survey. “People are jumping over these hurdles because they have to.”
Abortion patterns have shifted
The #WeCount report began surveying abortion providers across the country monthly just before Roe was overturned, creating a snapshot of abortion trends. In some states, a portion of the data is estimated. The effort makes data public with less than a six-month lag, giving a picture of trends far faster than the U.S. Centers for Disease Control and Prevention, whose most recent annual report covers abortion in 2021.
The report has chronicled quick shifts since the Supreme Court’s Dobbs v. Jackson Women’s Health Organization ruling that ended the national right to abortion and opened the door to enforcement of state bans.
The number of abortions in states with bans at all stages of pregnancy fell to near zero. It also plummeted in states where bans kick in around six weeks of pregnancy, which is before many women know they’re pregnant.
But the nationwide total has been about the same or above the level from before the ruling. The study estimates 99,000 abortions occurred each month in the first half of 2024, up from the 81,000 monthly from April through December 2022 and 88,000 in 2023.
One reason is telehealth, which got a boost when some Democratic-controlled states last year began implementing laws to protect prescribers. In April 2022, about 1 in 25 abortions were from pills prescribed via telehealth, the report found. In June 2024, it was 1 in 5.
The newest report is the first time #WeCount has broken down state-by-state numbers for abortion pill prescriptions. About half the telehealth abortion pill prescriptions now go to patients in states with abortion bans or restrictions on telehealth abortion prescriptions.
In the second half of last year, the pills were sent to about 2,800 women each month in Texas, more than 1,500 in Mississippi and nearly 800 in Missouri, for instance.
Travel is still the main means of access for women in states with bans
Data from another group, the Guttmacher Institute, shows that women in states with bans still rely mostly on travel to get abortions.
By combining results of the two surveys and comparing them with Guttmacher’s counts of in-person abortions from 2020, #WeCount found women in states with bans throughout pregnancy were getting abortions in similar numbers as they were in 2020. The numbers do not account for pills obtained from outside the medical system in the earlier period, when those prescriptions most often came from abroad. They also do not tally people who received pills but did not use them.
West Virginia women, for example, obtained nearly 220 abortions monthly in the second half of 2023, mostly by traveling — more than in 2020, when they received about 140 a month. For Louisiana residents, the monthly abortion numbers were about the same, with just under 700 from July through December 2023, mostly through shield laws, and 635 in 2020. However, Oklahoma residents obtained fewer abortions in 2023, with the monthly number falling to under 470 from about 690 in 2020.
Telehealth providers emerged quickly
One of the major providers of the telehealth pills is the Massachusetts Abortion Access Project. Cofounder Angel Foster said the group prescribed to about 500 patients a month, mostly in states with bans, from its September 2023 launch through last month.
The group charged $250 per person while allowing people to pay less if they couldn’t afford that. Starting this month, with the help of grant funding that pays operating costs, it’s trying a different approach: Setting the price at $5 but letting patients know they’d appreciate more for those who can pay it. Foster said the group is on track to provide 1,500 to 2,000 abortions monthly with the new model.
Foster called the Supreme Court’s 2020 decision “a human rights and social justice catastrophe” while also saying that “there’s an irony in what’s happened in the post-Dobbs landscape.”
“In some places abortion care is more accessible and affordable than it was,” she said.
There have no major legal challenges of shield laws so far, but abortion opponents have tried to get one of the main pills removed from the market. Earlier this year, the U.S. Supreme Court unanimously preserved access to the drug, mifepristone, while finding that a group of anti-abortion doctors and organizations did not have the legal right to challenge the 2000 federal approval of the drug.
This month, three states asked a judge for permission to file a lawsuit aimed at rolling back federal decisions that allowed easier access to the pill — including through telehealth.
