Public health preparedness for bird flu varies widely in the US.

U.S. states and territories varied widely in their ability to monitor people exposed to the H5N1 avian influenza virus and how they would recommend the use of antivirals and the H5N1 vaccine, according to a joint survey by the CDC and the Council of State and Territorial Epidemiologists. .

Although 89% of the 55 state and territory jurisdictions surveyed reported having the capacity to identify the H5N1 virus in humans, 66% of the 50 jurisdictions that reported monitoring people exposed to H5N1 noted barriers to monitoring, including staff shortages, funding and lack of other resources, CDC’s Noah Kojima, MD, and colleagues reported in a research letter in JAMA.

Additionally, while 49 of the 50 jurisdictions reported having the capacity to test for H5N1, only 59% reported testing respiratory specimens from symptomatic patients.

Of the 50 health authorities who responded, only 38% said they would recommend empiric antiviral treatment before testing exposed and symptomatic people for H5N1, and 33% said they would recommend post-exposure antiviral prophylaxis for close contacts of people with laboratory confirmed H5N1. .

These responses are not in line with current CDC recommendations, which state that antiviral treatment with oseltamivir (Tamiflu) should be initiated as soon as possible for symptomatic outpatients with confirmed, probable, or suspected H5N1, and that close contacts of a person with confirmed H5N1 should receive post-exposure prophylaxis with oseltamivir.

“The reported challenges in monitoring exposed persons and differences in antiviral recommendations highlight the need to strengthen and standardize public health preparedness and response to (highly pathogenic avian influenza) A(H5N1) viruses in the US. , particularly if more A(H5N1) viruses are transmitted, virus transmission events are reported,” Kojima and the authors wrote.

Of the jurisdictions, 62% reported maintaining stocks of antivirals in case of an influenza pandemic.

When epidemiologists were asked if they would recommend an H5N1 vaccine if it were available for veterinary staff working with H5N1-infected poultry, 67% said they would do so. However, only 36% said they would offer such a vaccine to public health personnel who monitor or investigate people exposed to H5N1.

Of human exposures to H5N1 since January 2022, 88% occurred in poultry flocks, 82% in commercial birds, 54% in wild birds, including rescued birds, and 18% in mammals, including animals farm, domestic pets or wild animals.

The CDC and the Council of State and Territorial Epidemiologists conducted the online survey from January 10 to March 6, 2024, before H5N1 outbreaks in dairy cattle occurred in several states and a dairy farm worker in Texas developed conjunctivitis. for working with H5N1 infected people. cattle.

The current avian flu outbreak has been spreading around the world since 2020, and the H5N1 clade virus was first identified in wild birds in North America in 2021, the authors noted. In the US, H5N1-infected wild birds were found in 49 states as of February 2022, and in land and marine mammals in 27 states. Outbreaks have occurred in backyard poultry flocks or on commercial poultry farms in 48 states.

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    Katherine Kahn is a MedPage Today staff writer covering infectious diseases. She has been a medical writer for more than 15 years.


Kojima and colleagues reported no relevant conflicts of interest.

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Source Reference: Kojima N, et al “US Public Health Preparedness and Response to Highly Pathogenic Avian Influenza A (H5N1) Viruses” JAMA 2024; DOI: 10.1001/jama.2024.10116.

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