Bird Flu: ‘We Are All Over It,’ CDC Director Says

WASHINGTON — Although the risk to humans is very low, the case of the Texas farmworker apparently contracting pathogenic avian influenza A (H5N1) from a cow illustrates the importance of data collection, CDC Director Mandy Cohen, MD, MPH, said Tuesday.

“We need to continue to invest in data, in lab capacity, in our ability to respond to health threats, and we need a talented workforce,” Cohen said here at the World Vaccine Congress. In the realm of modernizing data collection, she added, “We cannot solve problems we don’t see.”

Cohen’s remarks about the “bird flu” came toward the end of a keynote speech about vaccines’ role in preventing disease, in which she also discussed her concerns about “steps backward” in routine childhood vaccinations. She stressed that the CDC has been focused on and invested in ways to protect the nation and the world from avian flu for 20 years.

The person thought to be infected with highly pathogenic avian influenza A (HPAI) was exposed to dairy cattle in Texas and later reported “eye redness (consistent with conjunctivitis)” as the sole symptom. The patient was treated with “an antiviral drug for flu,” told to isolate, and is currently recovering, according to a CDC press release.

While Cohen acknowledged that this was the first time HPAI viruses have been seen in cows, it’s something the agency has been watching and paying attention to. “We are all over it,” she told MedPage Today. CDC and the U.S. Department of Agriculture (USDA) are working together to address the issue, she noted.

The USDA announced the news of the first cases in dairy cows last week. As of Tuesday, the agency confirmed that virus had been found in five states — Kansas, Texas, Michigan, New Mexico, and Idaho. “But the good news is the risk to human health is low. We have tests. We have treatment. This is not a new pathogen,” Cohen added.

Asked what clinicians need to know now, she encouraged any clinicians caring for farmworkers, or anyone who is exposed to cattle or poultry that might be sick, to test for flu-A and to send for confirmatory studies. In addition, the CDC’s website offers specific recommendations for monitoring, testing, and treating patients with suspected or confirmed avian influenza A virus infections.

The treatment for avian influenza is oseltamivir phosphate (Tamiflu), Cohen told MedPage Today, and there are “millions of doses of Tamiflu, not just in our stockpile, but in pharmacies and in states around the country. So, we know how to treat this, we know how to identify it, but we have to stay vigilant.”

This case marks the second time a person has tested positive for influenza A (H5N1) viruses in the U.S. A prior case occurred in Colorado in 2022.

Beyond avian influenza, Cohen also discussed how the U.S. is “losing some ground” in routine vaccinations of children during her keynote speech. “Whether that’s the measles vaccine, the polio vaccine, the varicella vaccine — we have seen a small decrease,” she said — from 94% to 92% — in vaccination rates for children entering kindergarten.

While a 2-percentage-point drop may not sound worrisome, it represents 725,000 kids starting kindergarten without having been vaccinated, Cohen said. Such children are susceptible to diseases like measles and polio that were eliminated or have not been seen in the U.S. for some time, she added.

The goal is to achieve a 95% vaccination rate across children. “For every percentage point that we drop below 95%, we put more and more kids, and frankly the population, at risk,” Cohen said. In particular, because vaccination rates have fallen globally and because people have resumed travel following the pandemic, it’s likely that more viruses will be brought back into the U.S.

Zeroing in on measles, Cohen pointed out that in 2023 there were 58 cases total, but in the first 3 months of 2024, there have already been 97 cases. “It transmits really easily. So it’s often the canary in the coal mine for what we may see in terms of trends related to other vaccine-preventable diseases,” Cohen warned.

The CDC is trying to turn things around through initiatives like the Routine Immunizations on Schedule for Everyone (RISE) program. However, the problem is a global one. As many as 25 million children worldwide missed routine vaccines during the last 2 to 3 years, Cohen said, and as many as 18 million are “no-dose children.”

“We are going the wrong direction here,” she said, adding that reversing that trend “has to be a global effort.”

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