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California Declares State of Emergency Over Bird Flu

alphaecho said:
Critical illness in an adolescent with influenza A(H5N1) virus infection

Case report

https://twitter.com/x/status/1874829432910970950

The most worrying aspect of this report was the detection of several mutations in the genome of the infecting virus, the same ones that have been linked to a more efficient spread in humans.

https://twitter.com/x/status/1874830465129218449

An H5N1 pandemic seems to be just a matter of time.
The virus is spreading among animal populations.

https://twitter.com/x/status/1874830794335940728
Click to expand...
EDIT: This refers to the British Columbia case. This is my summary of the clinical presentation of the case. The patient was a 13 year old female with a history of obesity and mild asthma. She initially presented with conjunctivitis and mild fever and was discharged home. She returned 5 days later with respiratory distress, low platelet count, low white blood cell count, and kidney failure. The patient deteriorated to Acute Respiratory Distress Syndrome and had to be placed on ECMO. She was placed on several antivirals, including Tamiflu, and eventually recovered after nearly 30 days in the hospital.

https://www.nejm.org/doi/full/10.1056/NEJMc2415890
 
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New reports sharpen clinical picture of recent human H5N1 illnesses in US and Canada​


Two groups of investigators today fleshed out fuller clinical understanding of North American patients recently infected with H5N1 avian influenza, one of them describing a Canadian teen who had a severe infection and the other reviewing illness features of 46 US patients, most of whom had mild infections following exposure to sick dairy cows or poultry.

The teams published their reports today in the New England Journal of Medicine (NEJM).

In the final months of 2024, US health officials continue to battle outbreaks in dairy cattle from the B3.13 genotype, with sporadic spillovers to people and fallout from contamination in raw milk. The United States and Canada are now juggling a steep rise in poultry outbreaks from a different genotype carried by wild birds migrating south, which have been linked two severe human infections—one on each side of the border—and a spate of deaths in US cats. [My emphasis added]

Canadian teen had high viral loads, lower airway sample showed mutations​

In one of the reports, Canadian researchers described clinical findings from a Canadian teen who contracted a severe infection from an undetermined source. The 13-year-old girl has mild asthma and elevated body mass index. She was first seen at an emergency department (ED) after a 2-day history of conjunctivitis in both eyes and a 1-day history of fever, then was sent home without treatment.

Her condition worsened, and 3 days later she returned to the ED in respiratory distress and hemodynamic instability and was admitted to the intensive care unit. The initial nasopharyngeal swab was positive for influenza A, but not the seasonal subtype. Further testing suggested a high viral load with a novel influenza A infection, which was found to be H5 avian influenza. The following day she was started on oseltamivir.

After her respiratory function deteriorated further, she was intubated and placed on extracorporeal membrane oxygenation (ECMO). Doctors also added combination antiviral treatment, which included baloxavir and amantadine.

Over the next few days, serial PCR testing showed declining viral loads. However, lower respiratory samples showed higher viral loads than those from upper-airway samples. Sequencing from a lower-airway isolate obtained 8 days after symptom onset identified three mutations potentially linked to enhanced virulence and human adaptation: E627K in the polymerase basic 2 gene, along with E186D and Q222H in the H5 hemagglutinin gene. Further analysis found that the virus belonged to the D1.1 genotype that was closely related to the virus circulating in British Columbia’s wild birds at the time.

When the patient’s respiratory status improved, her medical team discontinued ECMO on November 22 and extubated her on November 28.

US farm worker cases mild and self-limiting​

In the other report, a team from the US Centers for Disease Control and Prevention (CDC) and collaborators in six states analyzed data from a standardized case-report form that was linked to the CDC’s H5 subtyping kits. Though the CDC has recorded 66 confirmed human cases this year, today’s report covers illnesses reported from March through October.

Of the 46 patients, all but one—a resident of Missouri who was hospitalized—was exposed to dairy cattle or poultry. Twenty-five had been exposed to infected or likely infected dairy cattle and 20 were exposed to sick poultry.

All of the people with animal exposure had mild illnesses, and none were hospitalized. All but three (93%) had conjunctivitis, about half (49%) had fever, and just over a third (36%) had respiratory symptoms. For 15 (33%) of the patients, conjunctivitis was the only symptom. Most patients received oseltamivir, which was started a median of 2 days after symptoms began.

No related cases were found among 97 contacts of patients who had animal exposures.

When researchers looked at the type of personal protective equipment (PPE) animal workers used, they found only 71% used gloves, 60% used eye protection, and 47% wore face masks. “PPE use among occupationally exposed persons was suboptimal, which suggests that additional strategies are needed to reduce exposure risk,” the authors wrote. [My emphasis added]

Lingering questions, deep concerns about preparedness​

In an editorial in the same NEJM issue, two experts from the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) weighed in on both reports. The authors are Michael Ison, MD, with the respiratory diseases branch of the division of microbiology and infectious diseases, and Jeanne Marrazzo, MD, MPH, the group’s director.

Regarding the Canadian patient, they said it’s not clear if the mutations were present in the virus that infected the girl or emerged during her illness course. [My emphasis added]

They said both reports shine a light on critical features of the threat to human health and response options. They said the US report exemplifies collaboration between human and animal health providers, public health leadership, and occupational health authorities. The standard surveillance approach is geared toward detecting novel cases, they noted. “This approach involves cultivating trust not only among numerous entities but with people seeking care for symptoms of concern, including conjunctivitis,” they wrote.

Meanwhile, the Canadian case underscores the urgent need to monitor for mutations, Ison and Marrazzo said. However, they pointed out that genomic sequencing from animals often lacks the metadata, making it difficult to track phylogenetic linkages and how the virus is spreading.

They also noted that the prolonged virus shedding that the Canadian team found highlights the need for longer antiviral therapy, which was recently reflected in updated CDC recommendations.

New reports sharpen clinical picture of recent human H5N1 illnesses in US and Canada
 
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willrod1989 said:

New reports sharpen clinical picture of recent human H5N1 illnesses in US and Canada​


Two groups of investigators today fleshed out fuller clinical understanding of North American patients recently infected with H5N1 avian influenza, one of them describing a Canadian teen who had a severe infection and the other reviewing illness features of 46 US patients, most of whom had mild infections following exposure to sick dairy cows or poultry.

The teams published their reports today in the New England Journal of Medicine (NEJM).

In the final months of 2024, US health officials continue to battle outbreaks in dairy cattle from the B3.13 genotype, with sporadic spillovers to people and fallout from contamination in raw milk. The United States and Canada are now juggling a steep rise in poultry outbreaks from a different genotype carried by wild birds migrating south, which have been linked two severe human infections—one on each side of the border—and a spate of deaths in US cats. [My emphasis added]

Canadian teen had high viral loads, lower airway sample showed mutations​

In one of the reports, Canadian researchers described clinical findings from a Canadian teen who contracted a severe infection from an undetermined source. The 13-year-old girl has mild asthma and elevated body mass index. She was first seen at an emergency department (ED) after a 2-day history of conjunctivitis in both eyes and a 1-day history of fever, then was sent home without treatment.

Her condition worsened, and 3 days later she returned to the ED in respiratory distress and hemodynamic instability and was admitted to the intensive care unit. The initial nasopharyngeal swab was positive for influenza A, but not the seasonal subtype. Further testing suggested a high viral load with a novel influenza A infection, which was found to be H5 avian influenza. The following day she was started on oseltamivir.

After her respiratory function deteriorated further, she was intubated and placed on extracorporeal membrane oxygenation (ECMO). Doctors also added combination antiviral treatment, which included baloxavir and amantadine.

Over the next few days, serial PCR testing showed declining viral loads. However, lower respiratory samples showed higher viral loads than those from upper-airway samples. Sequencing from a lower-airway isolate obtained 8 days after symptom onset identified three mutations potentially linked to enhanced virulence and human adaptation: E627K in the polymerase basic 2 gene, along with E186D and Q222H in the H5 hemagglutinin gene. Further analysis found that the virus belonged to the D1.1 genotype that was closely related to the virus circulating in British Columbia’s wild birds at the time.

When the patient’s respiratory status improved, her medical team discontinued ECMO on November 22 and extubated her on November 28.

US farm worker cases mild and self-limiting​

In the other report, a team from the US Centers for Disease Control and Prevention (CDC) and collaborators in six states analyzed data from a standardized case-report form that was linked to the CDC’s H5 subtyping kits. Though the CDC has recorded 66 confirmed human cases this year, today’s report covers illnesses reported from March through October.

Of the 46 patients, all but one—a resident of Missouri who was hospitalized—was exposed to dairy cattle or poultry. Twenty-five had been exposed to infected or likely infected dairy cattle and 20 were exposed to sick poultry.

All of the people with animal exposure had mild illnesses, and none were hospitalized. All but three (93%) had conjunctivitis, about half (49%) had fever, and just over a third (36%) had respiratory symptoms. For 15 (33%) of the patients, conjunctivitis was the only symptom. Most patients received oseltamivir, which was started a median of 2 days after symptoms began.

No related cases were found among 97 contacts of patients who had animal exposures.

When researchers looked at the type of personal protective equipment (PPE) animal workers used, they found only 71% used gloves, 60% used eye protection, and 47% wore face masks. “PPE use among occupationally exposed persons was suboptimal, which suggests that additional strategies are needed to reduce exposure risk,” the authors wrote. [My emphasis added]

Lingering questions, deep concerns about preparedness​

In an editorial in the same NEJM issue, two experts from the National Institutes of Health (NIH) National Institute of Allergy and Infectious Diseases (NIAID) weighed in on both reports. The authors are Michael Ison, MD, with the respiratory diseases branch of the division of microbiology and infectious diseases, and Jeanne Marrazzo, MD, MPH, the group’s director.

Regarding the Canadian patient, they said it’s not clear if the mutations were present in the virus that infected the girl or emerged during her illness course. [My emphasis added]

They said both reports shine a light on critical features of the threat to human health and response options. They said the US report exemplifies collaboration between human and animal health providers, public health leadership, and occupational health authorities. The standard surveillance approach is geared toward detecting novel cases, they noted. “This approach involves cultivating trust not only among numerous entities but with people seeking care for symptoms of concern, including conjunctivitis,” they wrote.

Meanwhile, the Canadian case underscores the urgent need to monitor for mutations, Ison and Marrazzo said. However, they pointed out that genomic sequencing from animals often lacks the metadata, making it difficult to track phylogenetic linkages and how the virus is spreading.

They also noted that the prolonged virus shedding that the Canadian team found highlights the need for longer antiviral therapy, which was recently reflected in updated CDC recommendations.

New reports sharpen clinical picture of recent human H5N1 illnesses in US and Canada
Click to expand...
The severe case in the teenager is extremely concerning.

Here is a link to the NEJM report.


BREAKING Reported in
@NEJM
today.
First description of a CRITICALLY ILL PAEDIATRIC PATIENT with H5N1 BirdFlu in North America.
The D1.1 virus circulating in BC birds almost KILLED this 13 yr old in less than 96 hours.
She presented in multi-organ failure 3 days after mild conjunctivitis.
Her lungs were WHITE-OUTS.
Only modern day organ support (ECMO/CVVHDF) saved her.
https://twitter.com/x/status/1874241016838185438
 
I am at a loss for words after seeing that x-ray. The first thing tbat popped into my head was Revelation 6:8.

"And I looked, and behold, a pale horse! And its rider's name was Death, and Hades followed him. And they were given authority over a fourth of the earth, to kill with sword and with famine and with pestilence and by wild beasts of the earth."
 
willrod1989 said:
I am at a loss for words after seeing that x-ray. The first thing tbat popped into my head was Revelation 6:8.
Click to expand...
I have no idea what I am looking at, but last time I watched General Hospital, there’s usually some contrast in the lungs on an X-Ray.

If you are horrified, then I’m horrified because you are.

Thankfully this particular strain was limited to one host. Does NOT mean the virus won’t try it again. Mutations are sometimes random, but other times they are oddly strategic.

Scary to think something we can’t see is smarter than us….
 
Spyglass said:
I have no idea what I am looking at, but last time I watched General Hospital, there’s usually some contrast in the lungs on an X-Ray.

If you are horrified, then I’m horrified because you are.

Thankfully this particular strain was limited to one host. Does NOT mean the virus won’t try it again. Mutations are sometimes random, but other times they are oddly strategic.

Scary to think something we can’t see is smarter than us….
Click to expand...
It's not a question of smarter. It's a question of which bacteria or virus particle happens by chance to have a mutation that is favourable to reproduction. Since they reproduce so quickly it doesn't take long for the ones that are better suited to out compete the rest. It's not as if the bacteria/virus is taking a vote of the best course of action to take when they invade a hosts cells.
 
JPod said:
It's not a question of smarter. It's a question of which bacteria or virus particle happens by chance to have a mutation that is favourable to reproduction. Since they reproduce so quickly it doesn't take long for the ones that are better suited to out compete the rest. It's not as if the bacteria/virus is taking a vote of the best course of action to take when they invade a hosts cells.
Click to expand...
You took my “smarter” statement too literally.

Viruses are one of my areas I study regularly so I totally get the whole random generational evolutionary mutation thing.

I do tend to speak in cryptic metaphors during times of uncertainty. Something I am working on.

Be that as it may, Humanity keeps trying to outsmart nature. We never will. Viruses are part of nature. Whether by random mutation or not, the laws of life that govern the cosmos, created a natural process to increase the survivability of ALL organisms. Evolution. We will never be able to predict the next mutation, or when it will hit. Nature decides when to cull, and when to let life flourish. The next mutation could be a doomsday mutation. Are we smart enough to stop that before it happens? Maybe, maybe not. I just know, humanity’s intellect will never outsmart the most basic, yet most cunning of organisms. The virus.
 
Spyglass said:
I have no idea what I am looking at, but last time I watched General Hospital, there’s usually some contrast in the lungs on an X-Ray.

If you are horrified, then I’m horrified because you are.

Thankfully this particular strain was limited to one host. Does NOT mean the virus won’t try it again. Mutations are sometimes random, but other times they are oddly strategic.

Scary to think something we can’t see is smarter than us….
Click to expand...
You are absolutely correct. There is no contrast in the lungs. I have never seen anything like this before, even among other severe cases of avian influenza in places like China. I tend to be a pretty logical person. I get anxious about nuclear warfare because I know that the effects will be apocalyptic. I am usually very calm and level-headed when it comes to disease outbreaks. This case has absolutely stunned me.

I sincerely hope that if this virus goes pandemic, we end up dealing with the possibly milder strain that is mostly infecting cattle. The D1.1 strain appears to be much more virulent if it gets into humans. It is also widespread among wild migratory birds and will most likely seed infections among North American poultry flocks.

We need to keep a very close eye on this!
 
Spyglass said:
You took my “smarter” statement too literally.

Viruses are one of my areas I study regularly so I totally get the whole random generational evolutionary mutation thing.

I do tend to speak in cryptic metaphors during times of uncertainty. Something I am working on.

Be that as it may, Humanity keeps trying to outsmart nature. We never will. Viruses are part of nature. Whether by random mutation or not, the laws of life that govern the cosmos, created a natural process to increase the survivability of ALL organisms. Evolution. We will never be able to predict the next mutation, or when it will hit. Nature decides when to cull, and when to let life flourish. The next mutation could be a doomsday mutation. Are we smart enough to stop that before it happens? Maybe, maybe not. I just know, humanity’s intellect will never outsmart the most basic, yet most cunning of organisms. The virus.
Click to expand...
My mistake.
 
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