Monday, May 27, 2024

Clues From Bird Flu’s Ground Zero on Dairy Farms in the Texas Panhandle


 
MAY 27, 2024
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Photo: USDA.

In early February, dairy farmers in the Texas Panhandle began to notice sick cattle. The buzz soon reached Darren Turley, executive director of the Texas Association of Dairymen: “They said there is something moving from herd to herd.”

Nearly 60 days passed before veterinarians identified the culprit: a highly pathogenic strain of the bird flu virus, H5N1. Had it been detected sooner, the outbreak might have been swiftly contained. Now it has spread to at least eight other states, and it will be hard to eliminate.

At the moment, the bird flu hasn’t adapted to spread from person to person through the air like the seasonal flu. That’s what it would take to give liftoff to another pandemic. This lucky fact could change, however, as the virus mutates within each cow it infects. Those mutations are random, but more cows provide more chances of stumbling on ones that pose a grave risk to humans.

Why did it take so long to recognize the virus on high-tech farms in the world’s richest country? Because even though H5N1 has circulated for nearly three decades, its arrival in dairy cattle was most unexpected. “People tend to think that an outbreak starts at Monday at 9 a.m. with a sign saying, ‘Outbreak has started,’” said Jeremy Farrar, chief scientist at the World Health Organization. “It’s rarely like that.”

By investigating the origins of outbreaks, researchers garner clues about how they start and spread. That information can curb the toll of an epidemic and, ideally, stop the next one. On-the-ground observations and genomic analyses point to Texas as ground zero for this outbreak in cattle. To backtrack events in Texas, KFF Health News spoke with more than a dozen people, including veterinarians, farmers, and state officials.

An early indication that something had gone awry on farms in northwestern Texas came from devices hitched to collars on dairy cows. Turley describes them as “an advanced fitness tracker.” They collect a stream of data, such as a cow’s temperature, its milk quality, and the progress of its digestion — or, rather, rumination — within its four-chambered stomach.

What farmers saw when they downloaded the data in February stopped them in their tracks. One moment a cow seemed perfectly fine, and then four hours later, rumination had halted. “Shortly after the stomach stops, you’d see a huge falloff in milk,” Turley said. “That is not normal.”

Tests for contagious diseases known to whip through herds came up negative. Some farmers wondered if the illness was related to ash from wildfires devastating land to the east.

In hindsight, Turley wished he had made more of the migrating geese that congregate in the panhandle each winter and spring. Geese and other waterfowl have carried H5N1 around the globe. They withstand enormous loads of the virus without getting sick, passing it on to local species, like blackbirds, cowbirds, and grackles, that mix with migrating flocks.

But with so many other issues facing dairy farmers, geese didn’t register. “One thing you learn in agriculture is that Mother Nature is unpredictable and can be devastating,” Turley said. “Just when you think you have figured it out, Mother Nature tells you you do not.”

Cat Clues

One dairy tried to wall itself off, careful not to share equipment with or employ the same workers as other farms, Turley recalled. Its cattle still became ill. Turley noted that the farm was downwind of another with an outbreak, “so you almost think it has to have an airborne factor.”

On March 7, Turley called the Texas Animal Health Commission. They convened a One Health group with experts in animal health, human health, and agriculture to ponder what they called the “mystery syndrome.” State veterinarians probed cow tissue for parasites, examined the animals’ blood, and tested for viruses and bacteria. But nothing explained the sickness.

They didn’t probe for H5N1. While it has jumped into mammals dozens of times, it rarely has spread between species. Most cases have been in carnivores, which likely ate infected birds. Cows are mainly vegetarian.

“If someone told me about a milk drop in cows, I wouldn’t think to test for H5N1 because, no, cattle don’t get that,” said Thomas Peacock, a virologist at the Pirbright Institute of England who studies avian influenza.

Postmortem tests of grackles, blackbirds, and other birds found dead on dairy farms detected H5N1, but that didn’t turn the tide. “We didn’t think much of it since we have seen H5N1-positive birds everywhere in the country,” said Amy Swinford, director of the Texas A&M Veterinary Medical Diagnostic Laboratory.

In the meantime, rumors swirled about a rash of illness among workers at dairy farms in the panhandle. It was flu season, however, and hospitals weren’t reporting anything out of the ordinary.

Bethany Boggess Alcauter, director of research at the National Center for Farmworker Health, has worked in the panhandle and suspected farmworkers were unlikely to see a doctor even if they needed one. Clinics are far from where they live, she said, and many don’t speak English or Spanish — for instance, they may speak Indigenous languages such as Mixtec, which is common in parts of Mexico. The cost of medical care is another deterrent, along with losing pay by missing work — or losing their jobs — if they don’t show up. “Even when medical care is there,” she said, “it’s a challenge.”

What finally tipped off veterinarians? A few farm cats died suddenly and tested positive for H5N1. Swinford’s group — collaborating with veterinary labs at Iowa State and Cornell universities — searched for the virus in samples drawn from sick cows.

“On a Friday night at 9 p.m., March 22, I got a call from Iowa State,” Swinford said. Researchers had discovered antibodies against H5N1 in a slice of a mammary gland. By Monday, her team and Cornell researchers identified genetic fragments of the virus. They alerted authorities. With that, the U.S. Department of Agriculture announced that H5N1 had hit dairy cattle.

Recalling rumors of sick farmworkers, Texas health officials asked farmers, veterinarians, and local health departments to encourage testing. About 20 people with coughs, aches, irritated eyes, or other flu-like symptoms stepped forward to be swabbed. Those samples were shipped to the Centers for Disease Control and Prevention. All but one was negative for H5N1. On April 1, the CDC announced this year’s first case: a farmworker with an inflamed eye that cleared up within days.

Thirteen dairy farms in the panhandle had been affected, said Brian Bohl, director of field operations at the Texas Animal Health Commission. Farmers report that outbreaks among the herds last 30 to 45 days and most cows return to milking at their usual pace.

The observation hints that herds gain immunity, if temporarily. Indeed, early evidence shows that H5N1 triggers a protective antibody response in cattle, said Marie Culhane, a professor of veterinary population medicine at the University of Minnesota. Nonetheless, she and others remain uneasy because no one knows how the virus spreads, or what risk it poses to people working with cattle.

Although most cows recover, farmers said the outbreaks have disrupted their careful timing around when cattle milk, breed, and birth calves.

Farmers want answers that would come with further research, but the spirit of collaboration that existed in the first months of the Texas outbreak has fractured. Federal restrictions have triggered a backlash from farmers who find them unduly punishing, given that pasteurized milk and cooked beef from dairy cattle appear to pose no risk to consumers.

The rules, such as prohibiting infected cattle from interstate travel for 30 days, pose a problem for farmers who move pregnant cattle to farms that specialize in calving, to graze in states with gentler winters, and to return home for milking. “When the federal order came out, some producers said, ‘I’m going to quit testing,’” Bohl said.

In May, the USDA offered aid, such as up to $10,000 to test and treat infected cattle. “The financial incentives will help,” Turley said. But how much remains to be seen.

Federal authorities have pressed states to extract more intel from farms and farmworkers. Several veterinarians warn such pressure could fracture their relationships with farmers, stifling lines of communication.

Having fought epidemics around the world, Farrar cited examples of when strong-arm surveillance pushed outbreaks underground. During an early 2000s bird flu outbreak in Vietnam, farmers circumvented regulations by moving poultry at night, bribing inspection workers, and selling their goods through back channels. “Learning what drivers and fears exist among people is crucial,” Farrar said. “But we always seem to realize that at a later date.”

A powerful driver in the U.S.: Milk is a $60 billion industry. Public health is also bound to bump up against politics in Texas, a state so aggrieved by pandemic restrictions that lawmakers passed a bill last year barring health officials from recommending covid-19 vaccines.

Texas Agriculture Commissioner Sid Miller said that when he heard that federal agents with the CDC and USDA were considering visits to farms — including those where farmers reported the cattle had recovered — he advised against it. “Send federal agents to dairy that’s not sick?” he said. “That doesn’t pass the smell test.”

From Texas to the Nation

Peacock said genomic analyses of H5N1 viruses point to Texas as ground zero for the cattle epidemic, emerging late last year.

“All of these little jigsaw puzzle pieces corroborate undetected circulation in Texas for some time,” said Peacock, an author on one report about the outbreak.

Evidence suggests that either a single cow was infected by viruses shed from birds — perhaps those geese, grackles, or blackbirds, he said. Or the virus spilled over from birds into cattle several times, with only a fraction of those moving from cow to cow.

Sometime in March, viruses appear to have hitched a ride to other states as cows were moved between farms. The limited genomic data available links the outbreak in Texas directly to others in New Mexico, Kansas, Ohio, North Carolina, and South Dakota. However, the routes are imprecise because the USDA hasn’t attached dates and locations to data it releases.

Researchers don’t want to be caught off guard again by the shape-shifting H5N1 virus, and that will require keeping tabs on humans. Most, if not all, of about 900 people diagnosed with H5N1 infections worldwide since 2003 acquired it from animals, rather than from humans, Farrar said. About half of those people died.

Occasional tests of sick farmworkers aren’t sufficient, he said. Ideally, a system is set up to encourage farmworkers, their communities, and health care workers to be tested whenever the virus hits farms nearby.

“Health care worker infections are always a sign of human-to-human transmission,” Farrar said. “That’s the approach you want to take — I am not saying it’s easy.”

This story was originally published by KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

Amy Maxman is public health local editor and correspondent for KFF Health News.

 Michigan reports a human case of bird flu, the nation’s second linked to H5N1 outbreak in dairy cows

Asecond human case of bird flu infection linked to the current H5N1 outbreak in dairy cows has been detected, in a farm worker who had exposure to infected cows, Michigan state health authorities announced on Wednesday.

In a statement, health officials said the individual had mild symptoms and has recovered. Evidence to date suggests this is a sporadic infection, with no signs of ongoing spread, the statement said.

“Farmworkers who have been exposed to impacted animals have been askd to report even mild symptoms, and testing for the virus has been made available,” Natasha Bagdasarian, the state’s chief medical executive, said in the statement.

“The current health risk to the general public remains low,” she added. “This virus is being closely monitored, and we have not seen signs of sustained human-to-human transmission at this point. This is exactly how public health is meant to work, in early detection and monitoring of new and emerging illnesses.”

This is only the third human case ever of H5N1 reported in the United States. A man in Texas who worked on a dairy farm was infected there earlier in this outbreak. The country’s first case, in the spring of 2022, was in a man in Colorado who was involved in culling H5N1-infected birds in a poultry outbreak there.

The Centers for Disease Control and Prevention said a nasal swab taken from the Michigan farm worker was negative for flu. But a swab of the person’s eye was sent to the CDC, where it tested positive for H5 flu virus, though final confirmation that it’s the H5N1 subtype is pending genetic sequencing. This was the only symptom the individual had, the CDC said.

In the Texas case in late March, the only symptom reported was conjunctivitis, also known as pink eye.

“We found this case because we were looking for this case. And we were looking for it because we were prepared. And in particular, the state of Michigan was prepared,” CDC’s Principal Deputy Director Nirav Shah said during a press conference organized by the U.S. Department of Health and Human Services.

Jennifer Nuzzo, director of the Pandemic Center at Brown University’s School of Public Health, said she wished other states were looking for H5N1 cases as aggressively as Michigan is.

“If there’s any takeaway from this finding it’s that this is probably the tip of the iceberg because this is the one state that we know of that has done the most in terms of testing on farms of both cows and also monitoring workers that are on the farms where they found cattle infections,” she told STAT.

Nuzzo said she took no comfort from the fact that only two human cases have been detected so far in this outbreak, and worries that people may be reading too much into that low number.

“The absence of finding cases is being interpreted as reassuring, that this [outbreak] is perhaps something that is abating,” she said. “And I have absolutely no ability to tell you that’s happening, in part because I think the testing that we’re doing could very well be qualitatively … misleading.”

During the press conference, Dawn O’Connell, assistant secretary for preparedness and response at HHS, revealed that 4.8 million doses of H5N1 vaccine that has been stockpiled in bulk is in the process of being put into vials — a process called fill and finish. This is a little less than half of the vaccine believed to be effective against the current strain of H5N1 that is stored in the National Pre-Pandemic Influenza Vaccine Stockpile.

O’Connell said the decision to make the vaccine more readily deployable was taken a couple of weeks ago. “It takes a couple of months to be able to fill and finish vaccine doses… so I thought it made sense, given what we were seeing,” she said.

O’Connell said a decision to use the vaccine has not been made.

To date, nearly 900 people in 24 countries have been confirmed to have been infected with H5N1 since 2003, with most cases tied to exposure to infected poultry. On rare occasions, there have been small clusters of cases that raised questions about whether limited person-to-person spread has occurred — something that is hard to prove when multiple people have the same exposures to infected animals. Ongoing spread among people has not been detected, and it is believed the virus would need to evolve further to gain the ability to spread easily to and among people.

The outbreak in cattle, the first known to have occurred with this virus, was confirmed in late March, though evidence suggests that it had been underway for several months before testing revealed the cause of a drop in milk production among cows.

Since then the U.S. Department of Agriculture has confirmed outbreaks in 52 herds in nine states, including Michigan, which has reported 19 infected herds — more than any other state. (The USDA’s most recent tally does not include four that Michigan reported since May 17.)

Experts following the outbreak believe the national count of affected herds significantly underestimates the scope of the problem. Both the USDA and the CDC have admitted that farmers have been reluctant to allow testing of their cows or their workers, afraid of the stigma attached to being associated with the outbreak.

But that has been less true in Michigan, where state officials have taken a uniquely aggressive stance in its public health response, informed, in part, by the devastating impacts H5N1 has had on the state’s poultry flocks in the past few years.

On May 1, Tim Boring, director of the state’s Department of Agriculture, declared an “extraordinary animal health emergency,” signing an order requiring Michigan farmers to step up their biosecurity measures. “Most farms have been good cooperators with that,” Boring told STAT in an interview last week.

Farmers have also been open to working with local health authorities to fill out questionnaires that could help investigators track how the virus is moving between dairy herds throughout the state. “Hundreds and hundreds of farm workers here in Michigan have been interviewed,” Boring said. “They understand the importance of understanding how this is moving around so we can limit the spread of this.”

Local health authorities have also been monitoring workers from farms with infected herds for symptoms — either through regular phone calls with farm supervisors or automated text messages that ask if they’ve been experiencing conjunctivitis or any flu-like symptoms, even mild ones. Testing is being offered to any symptomatic workers who’ve been exposed to animals on affected farms or are living in congregate settings with people who’ve been exposed.

In an interview Wednesday afternoon, Bagdasarian, the Michigan health official, described the discovery of a human case as a sign these efforts to find new infections are paying off. “Michigan has really been one of the states leading in terms of testing, so it’s not surprising that we have picked up on this sporadic case,” she said. At least 35 people have been tested so far, she said. This case is the first to have come back positive.

Bagdasarian said officials have seen no evidence of secondary infections. But the state is not yet conducting serological surveys — looking for antibodies to H5N1 in the blood of farm workers and those they’ve been in contact with — to determine if there have been unreported cases, and possibly even spread from those individuals to others.

“We’ve always talked about the need to do additional studies to do additional engagement, and to do a big look at serology, especially for people who may have remained asymptomatic throughout,” Bagdasarian said. “That would be a next step.”

Shah said the CDC would very much like to conduct serology studies among dairy farm workers, including those, like the Michigan individual, who test positive. “At this time, we’re not there yet,” he said.

Eric Deeble, the USDA’s acting senior advisor for H5N1, announced during the news conference that additional financial incentives are being planned to try to entice dairy farmers to report infections in their herds and take steps to reduce the risks to cows and workers on the farms. Compensation for lost milk — a substantial drop in milk production is the most notable sign of infection in a herd — is planned, but will take a few more weeks to finalize, he said.

This story has been updated throughout with comments from the HHS news conference and interviews with Bagdasarian and Nuzzo.

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Chickens, ducks, seals and cows: A dangerous bird flu strain is knocking on Australia's door

dairy cows
Credit: Pixabay/CC0 Public Domain

A dangerous strain of avian influenza (bird flu) is now wreaking havoc on every continent except Australia and the rest of Oceania. While we remain free from this strain for now, it's only a matter of time before it arrives.

Penguins in Antarctica, pelicans in Peru, sea lions in South America and dairy cows in the United States have all been hit by fast-spreading and often lethal high pathogenicity , known as HPAI H5N1.

Indeed, avian influenza is knocking on our door right now. Just today, a case of avian influenza was reported in a return traveler, and Victorian authorities have confirmed avian influenza on an egg farm. Importantly, authorities have confirmed the virus affecting chickens is not the virus we are most worried about. Authorities are responding and we expect more information to come in the days ahead.

Researchers and biosecurity authorities are on high alert, monitoring poultry farms and testing wildlife. They could do with our help. Anyone who comes across dead or dying birds—or mammals—should report them to the Emergency Animal Disease Watch Hotline.

The rise of an animal pandemic

Avian influenza is a viral disease that infects birds, but can infect other animals.

There isn't just one strain of avian influenza found in wild birds—there's a diversity of subtypes and strains. Most cause no disease at all, and are naturally found in wild birds, including in Australia.

But others are deadly. The HPAI H5N1 clade was first detected in a goose in China, back in 1996. HPAI viruses cause high levels of sickness and death in both wild birds and poultry. It spreads rapidly and kills many of the birds—and animals—it infects.

HPAI H5N1 has been endemic in poultry in Asia for decades, driving  and the emergence of a diversity of different virus clades (a clade is similar to a variant).

In 2005 we saw the first mass mortality event in wild birds. The virus spread to Europe and Africa through both poultry trade and potentially wild birds.

In 2014 the virus again entered Europe with wild birds, with spread to North America the same year, and in 2016, to Africa.

But the real change came in 2020. The number of outbreaks in poultry and wild birds dramatically increased. In 2021, reports streamed in of mass mortality events in Europe and the virus rapidly traveled the world. The world was in the grip of a "panzootic"—a global pandemic in animals.

This particularly lethal clade of the virus jumped the Atlantic and reached North America around October 2021. A few months later, it again jumped to North America, but this time across the Pacific. In around October 2022, the virus entered South America, where it traveled an astonishing 6,000 kilometers to the southern tip of the continent in approximately six months.

The first cases were detected on the sub-Antarctic islands in October 2023 in brown skuas, scavenging birds. It's since been found in penguins, , fur seals and Antarctic terns. By February this year, the virus was detected on the Antarctica Peninsula).

Globally, millions of wild birds are likely to have been affected. In South America alone, about 650,000 wild birds were reported dead. Many more are never reported.

This virus is threatening the survival of entire species. For example, 40% of all Peruvian pelicans in Peru have died. Scientists spent years trying to bring back Californian condors from extinction, only to watch them succumb in 2023.

It will take years to fully comprehend the impact this panzootic has had around the world. Some populations of birds and even entire species may never recover.

Scientists are especially concerned about Antarctic wildlife.

Most Antarctic species are found nowhere else on Earth. Many live in large colonies, which makes it easier for the virus to spread.

Questions remain over whether the virus will persist in Antarctica over winter and how it will spread in spring or summer.

From birds to mammals

More than 50 species of predatory and scavenging mammals have now been recorded dying from avian influenza, most likely after eating dead birds.

Particularly concerning are the deaths of 30,000 South American sea lions, 18,000 southern elephant seal pups in Argentina and dairy cows on at least 51 farms across the US.

A recent study from Uruguay shows  were dying before mass bird deaths, suggesting mammal-to-mammal spread may be driving outbreaks in coastal South America.

Since the virus appeared in dairy cows in America, it has spread to herds across 10 US states. We are still learning about how the virus affects cows, but infected cows produce less milk because of infection in their udders. A recent study suggests this is because udders have receptors similar to those found in birds.

The US Food and Drug Administration states pasteurization is effective against this virus.

Globally, only 13 human cases have been confirmed due to this particular variant of HPAI H5N1, but noting that over 800 cases have been recorded since 2005. So far, one dairy worker is known to have caught the virus from cows.

The World Health Organization considers the risk of human infection to be low although the risk is higher (low to medium) for poultry farmers and other animal-exposed workers. There is no sign of human-to-human transmission.

Australia, the lucky country

To date, Australia and New Zealand have avoided HPAI H5N1. Australia has a nationally coordinated surveillance system for wild birds. This includes long-distance  such as shorebirds and seabirds.

Millions of migratory birds arrive from northern Asia each year in spring. That means August to November will be our highest risk period.

In response, in both 2022 and 2023 we collected almost 1,000 samples from recently arrived migratory birds without detecting the virus. Routine testing of dead birds by others around Australia has also come back negative.

We know migratory birds have arrived carrying other strains of avian influenza into Australia. It is only a matter of time before this HPAI H5N1 arrives.

Ducks have played a crucial role in moving the virus from place to place in the Northern Hemisphere. Studies in Asia and North America have shown some duck species are able to migrate while infected, as not all ducks die from the infection. One reason we think that Australia may have been spared so far because no ducks migrate here from Asia.

When the virus does arrive, it will likely threaten entire species. Black swans are highly susceptible. Overseas, pelicans, cormorants, penguins, gannets, terns, gulls and seals have been among the hardest hit.

This spring, please look out for sick or dead  or marine mammals and report it. Surveillance could help us manage the virus.

Provided by The Conversation 

This article is republished from The Conversation under a Creative Commons license. Read the original article.The Conversation