Risk for Infection in Humans after Exposure to Birds Infected with Highly Pathogenic Avian Influenza A(H5N1) Virus, United States, 2022

Kniss, Krista; Sumner, Kelsey M.; Tastad, Katie J.; Lewis, Nathaniel M.; Jansen, Lauren; Julian, Derek; Reh, Mike; Carlson, Emily; Williams, Robin; Koirala, Samir; Buss, Bryan; Donahue, Matthew; Palm, Jennifer; Kollmann, Leslie; Holzbauer, Stacy; Levine, Min Z.; Davis, Todd F.; Barnes, John; Flannery, Brendan; Brammer, Lynnette; Fry, Alicia M.

doi:10.3201/eid2906.230103

Cited by 10 publications

(10 citation statements)

References 7 publications

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“…Human infections with novel influenza viruses are generally rare and isolated events that occur through exposure to infected animals (such as swine or poultry) during recreational or occupational activities. Widespread avian influenza A(H5N1) virus outbreaks among wild and commercial birds that occurred from January 2022 -July 2023 in the United States were associated with just one detected U.S. case in an individual exposed to infected poultry [1,2]. The H5N1 viruses associated with these outbreaks do not easily bind to receptors in the human upper respiratory tract and so the risk to the general public is low [1].…”

Section: Introductionmentioning

confidence: 99%

“…Testing is particularly important to distinguish novel influenza virus infection from seasonal influenza or other respiratory virus infections with similar symptom profiles [4]. Although active monitoring and testing of individuals with exposure to infected animals can identify new spillover infections [2], such measures are not designed to detect cases in the wider community following sustained human-tohuman transmission. Public health surveillance systems must be equipped to detect novel influenza cases through testing in the community or in healthcare settings where infected individuals might seek care.…”

Section: Introductionmentioning

confidence: 99%

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Detection of novel influenza viruses through community and healthcare testing: Implications for surveillance efforts in the United States

Morris,

Gilmer,

Threlkel

et al. 2024

Preprint

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Background: Novel influenza viruses pose a potential pandemic risk. Rapid detection of novel influenza virus infection in humans is critical to characterizing the virus and facilitating the implementation of public health response measures. Methods: We use a probabilistic framework to estimate the likelihood that novel influenza virus cases would be detected under different community and healthcare (urgent care, emergency department, hospital admission, and intensive care unit) testing strategies while at low frequencies in the United States. Model parameters were informed by data on seasonal influenza virus activity and existing testing practices. Results: In a baseline scenario reflecting the presence of 100 infections of a novel virus with similar severity to seasonal influenza, the probability of detecting at least one infection per month was highest in urgent care settings (72%) and when random testing was conducted in the community (77%). However, urgent care testing was over 15 times more efficient (estimated as the number of cases detected per 100,000 tests) due to the larger number of tests required for community testing. In scenarios that assumed increased clinical severity of novel virus infection, probabilities of detection increased across all healthcare settings, with testing in hospital and ICU settings being most efficient. Conclusions: Our results suggest that novel influenza virus circulation is likely to be detected through existing healthcare surveillance, with the most efficient testing setting impacted by the disease severity profile. These analyses can help inform future testing strategies to maximize the likelihood of novel influenza detection.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Detection of novel influenza viruses through community and healthcare testing: Implications for surveillance efforts in the United States

Morris,

Gilmer,

Threlkel

et al. 2024

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…Human infections with novel influenza viruses are generally rare and isolated events that occur through exposure to infected animals (such as livestock) during recreational or occupational activities. At the time of writing (May 10, 2024), widespread avian influenza A(H5N1) virus outbreaks occurring among wild and commercial birds since January 2022 have been associated with just two detected human cases of H5N1 in the United States: one individual who was exposed to infected poultry and one who was exposed to infected dairy cattle [ 1 , 2 ]. The H5N1 viruses associated with these outbreaks do not easily bind to receptors in the human upper respiratory tract, and the risk to the general public is currently low [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

“…Testing is particularly important to distinguish novel influenza virus infection from seasonal influenza or other respiratory virus infections with similar symptom profiles [ 4 ]. Although active monitoring and testing of individuals with exposure to infected animals can identify new spillover infections [ 2 ], such measures are not designed to detect cases in the wider community following sustained human‐to‐human transmission. Public health surveillance systems must be equipped to detect novel influenza cases through testing in the community or in healthcare settings where infected individuals might seek care.…”

Section: Introductionmentioning

confidence: 99%

Detection of Novel Influenza Viruses Through Community and Healthcare Testing: Implications for Surveillance Efforts in the United States

Morris,

Gilmer,

Threlkel

et al. 2024

Influenza Resp Viruses

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BackgroundNovel influenza viruses pose a potential pandemic risk, and rapid detection of infections in humans is critical to characterizing the virus and facilitating the implementation of public health response measures.MethodsWe use a probabilistic framework to estimate the likelihood that novel influenza virus cases would be detected through testing in different community and healthcare settings (urgent care, emergency department, hospital, and intensive care unit [ICU]) while at low frequencies in the United States. Parameters were informed by data on seasonal influenza virus activity and existing testing practices.ResultsIn a baseline scenario reflecting the presence of 100 novel virus infections with similar severity to seasonal influenza viruses, the median probability of detecting at least one infection per month was highest in urgent care settings (72%) and when community testing was conducted at random among the general population (77%). However, urgent care testing was over 15 times more efficient (estimated as the number of cases detected per 100,000 tests) due to the larger number of tests required for community testing. In scenarios that assumed increased clinical severity of novel virus infection, median detection probabilities increased across all healthcare settings, particularly in hospitals and ICUs (up to 100%) where testing also became more efficient.ConclusionsOur results suggest that novel influenza virus circulation is likely to be detected through existing healthcare surveillance, with the most efficient testing setting impacted by the disease severity profile. These analyses can help inform future testing strategies to maximize the likelihood of novel influenza detection.

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“…Despite the high mortality rates in humans associated with previous iterations of H5N1 viruses, (Loeffelholz, 2010), those in clade 2.3.4.4b are considered to be a low risk of infection to the general population (Kniss et al., 2023; Pulit‐Penaloza et al., 2022). However, warning signs of increased zoonotic risk, including limited transmission to humans, transmission to mammals, sporadic identification of viruses with mutations associated with mammalian adaptation (Bordes et al., 2023; Vreman et al., 2023) and ongoing evolution (Adlhoch et al., 2022), make this new virus a potential pandemic risk.…”

Section: Introductionmentioning

confidence: 99%

Responding to avian influenza A H5N1 detection on a hospital property in Maine—An interdisciplinary approach

Krueger,

Myles,

Rice

et al. 2023

Zoonoses and Public Health

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BackgroundThe risk of infection with avian influenza A viruses currently circulating in wild and domestic birds in the Americas is considered low for the general public; however, detections in humans have been reported and warning signs of increased zoonotic potential have been identified. In December 2022, two Canada geese residing on the grounds of an urban hospital in Maine tested positive for influenza A H5N1 clade 2.3.4.4b.AimsGiven the opportunity for exposure to staff and hospital visitors through potentially infected faeces on the property, public health authorities determined mitigation efforts were needed to prevent the spread of disease. The ensuing response relied on collaboration between the public health and animal health agencies to guide the hospital through efforts in preventing possible zoonotic transmission to humans.Materials and MethodsMitigation efforts included staff communication and education, environmental cleaning and disinfection, enhanced illness surveillance among staff and patients, and exposure and source reduction.ResultsNo human H5N1 cases were identified, and no additional detections in birds on the property occurred. Hospital staff identified barriers to preparedness resulting from a lack of understanding of avian influenza A viruses and transmission prevention methods, including avian influenza risk in resident wild bird populations and proper wildlife management methods.ConclusionAs this virus continues to circulate at the animal‐human interface, this event and resulting response highlights the need for influenza A H5N1 risk awareness and guidance for facilities and groups not traditionally involved in avian influenza responses.

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Risk for Infection in Humans after Exposure to Birds Infected with Highly Pathogenic Avian Influenza A(H5N1) Virus, United States, 2022

Cited by 10 publications

References 7 publications

Detection of novel influenza viruses through community and healthcare testing: Implications for surveillance efforts in the United States

Detection of novel influenza viruses through community and healthcare testing: Implications for surveillance efforts in the United States

Detection of Novel Influenza Viruses Through Community and Healthcare Testing: Implications for Surveillance Efforts in the United States

Responding to avian influenza A H5N1 detection on a hospital property in Maine—An interdisciplinary approach

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