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Bird flu in Missouri: KSMU speaks with Fenit Nirappil, public health reporter for the Washington Post

Avian Flu impacts commercial chickens
U.S. Department of Agriculture

A Missouri bird flu case first reported by the CDC in September has drawn national attention. The CDC released findings related to the case last week, October 24. Monday KSMU spoke by phone with Fenit Nirappil public health reporter for the Washington Post, to help put this story in context and ask about what he has learned in his reporting.

The CDC last week released a report on the potential human-to-human spread of bird flu in Missouri. They found there was no human-to-human spread in this case. That incident received a lot of coverage; widespread attention. You reported on it. Why was this case in Missouri attracting so much attention? What answers were provided last week and what questions still remain? And maybe how important are those questions?

Sure. So, to just back up here, bird flu has been on the radar of public health officials this year because you saw a certain strain, H5n1, jump into dairy cows for the first time this spring. And this was concerning because we'd never seen that before. And it was raising concerns that we might start to see more spread among mammals, and that eventually you could start seeing humans spread it to each other. And that could be the start of a new pandemic.

There have been humans getting H5n1 throughout the year, but it's largely been in dairy workers and people who have exposure to infected animals. So that's not new. So, what was concerning about the Missouri case was this was a person who, when public health officials interviewed them three times, there was no known exposure to animals. They didn't work on a farm. They didn't report drinking raw milk. They didn't report basically any of the factors that usually cause someone to get bird flu. And I interviewed the Missouri state epidemiologist who told me that this person tends to just stay at home. They have a chronic health condition, they don't use public transportation. So, it was really stumping public health officials how someone like this person could get bird flu. And then adding to this mystery was that the person who lived in the house is that same patient, also ended up developing similar symptoms. And health care workers who had cared for this patient at a hospital also reported having respiratory symptoms.

The issue for public health investigators is by the time they discovered the people around this bird flu patient had developed symptoms, it was too late to test them. What they had to do was they had to wait several weeks for people to develop antibodies if they did, in fact have bird flu. And then you have to do what's called a serology screening or basically antibody tests. Ultimately, the CDC found with the health care workers, there was no evidence that they had any sort of immune response to H5n1, meaning that they didn't get bird flu. But with the household patient, there was evidence that this person had an immune response to bird flu, and it didn't meet the threshold of being considered a bird flu case. They still did have enough evidence that this person did have did either have exposure to bird flu or were infected with bird flu. But the CDC and other public health agencies said that it wasn't likely that it was human to human transmission or that one person infected the other. There's still a lot of mystery around this. The Missouri case. This is one of those things that scientists are just perplexed here, that they're never really going to have a good answer for how this person ended up testing positive for bird flu, but because there's no evidence that it it turned into a cluster or this person ended up infecting other people, they're not too worried about it. And there's still no evidence of human-to-human spread.

Have officials in Missouri been handling this any differently than other states?

So, one of the one of the things that public health experts have been frustrated about with Missouri's handling is that there hasn't been as much public disclosure about some of the details of this patient. We still don't know their gender, their age. But the distinction between this case and some of the other cases we've seen is there's less, demographic details. And that's the kind of information that public health experts say is valuable.

This implies, I think, to a lot of people, that there are active cases on farms in Missouri. Across the country there have been lots of cases on poultry farms and dairy farms. What impact are you seeing there? And is that potentially more concerning than the human impact?

So, the official tally of 31 cases of H5n1 in humans is almost certainly an undercount. All the symptoms that we've seen so far have been relatively mild. So, you may have instances where people just aren't going to a doctor or aren't going to a hospital. And there's also a concern that many of workers wouldn't want to participate in a public health investigation or go to the doctor. They may be living in the country without a legal authorization to live here. So, there might be concerns of a backlash effect or getting or or getting deported or otherwise losing their job. If you come forward with, with signs and symptoms of having avian influenza. So, there's that barrier here.

So, we are almost certainly seeing a lot more bird flu in poultry farms and dairy herds in the United States then official tallies suggest. But we also haven't really seen an impact on access to dairy products like milk or eggs or chicken and beef products. Testing so far has suggested that even if there is a viral fragments of bird flu in the milk that's sold at stores, it's not going to be the kind that can infect you because pasteurization kills it. But there is concern that if people are drinking raw milk that hasn't been pasteurized, they may be able to develop bird flu if they are exposed to it.

And you mentioned agriculture workers. I would think they are often a part of the populace that's maybe not necessarily engaging with health care workers regularly.

I would say just broadly agricultural workers have been hard for public health officials to reach.

One kind of big question I have is what do you think is, or what do you see as public officials' most pressing concerns right now? What do you think average people should be paying attention to?

So, I think that Covid has skewed views of public health because, I mean, Covid is just such a massive scale in terms of the kind of impact that it has on society. But the thing about public health is that you really want to respond to outbreaks, and you want to respond to infectious disease threats when they're still in their early stages. Because one of the great things about scientific advancement and modern medicine is that we have the ability to stamp out disease. We have the ability to sort of stop these disease outbreaks when they're still embers before it turns into a configuration or before it turns into a wildfire. So, what we're seeing with avian influenza is kind of just the classic public health response and the classic response to an infectious disease threat. So, it's at that point that the average person doesn't necessarily need to be panicking about bird flu or contracting it themselves. The risk to the general public, federal health officials keep saying, is low.

That said, if you are interested in public health and just want to stay posted on what your government is doing, this is one of the top issues before the CDC right now. This is getting a lot of attention at the highest levels of the FDA and the USDA, because you want to be able to stamp the avian influenza threat early before it does start to turn into an issue of dairy, of dairy herds across the country, all having to deal with avian influenza infections or mass culling of poultry across the country because chickens are the ones that are really susceptible to dying from contact with avian influenza.

We're not seeing the same kind of high mortality in cows that you usually see with birds that get into contact with H5n1. And I should also back up to say that public health experts do think that we're making some of the same mistakes with the response to avian influenza that we made to Covid in the early days. So testing is a big barrier right now. We are not testing enough cows and enough dairy workers to really understand the true prevalence of H5n1 across the country. There's still efforts to make sure that we have enough production of vaccines in the event that you do need a widespread vaccine campaign. But the concern here is that the United States is a bit in the dark when it comes to responding to the bird flu crisis.

Yeah, I feel like there was at least some concerns over the fact that, the initial Missouri case was reported in September. They released October 3rd, the report saying that they were doing these antibody tests, and it took almost a month to get the results. So that's a pretty long process for trying to test and contain something like this. Right?

Right. So that's the concern here because this Missouri patient was hospitalized in late in late August, and it took nearly two months to get to get the test to confirm that the context around them likely did not get, um, avian influenza from that patient. But if it turns out that those patients were getting infected and there was human to human transmission, that would have been a very long time to stop a further spread of the virus, because if you've had that evidence of human to human transmission, you would need to start getting a hold of anyone else who is exposed to those health care workers or exposed to that person who lives in the house with that Missouri patient. So, when there's that long of a gap that hinders the public health ability to respond.

Find more from Fenit at this link. Read his most recent reporting on bird flu here.

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