Roundup and analysis of the top headlines on health security, pandemic preparedness, COVID-19, and other news from the Johns Hopkins Center for Health Security
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April 25, 2024
Note: Health Security Decoded is taking a 2-week hiatus. We will resume publishing on May 16, 2024. In the meantime, follow the Johns Hopkins Center for Health Security on LinkedIn and X to keep in touch.
TOP NEWS
Avian flu outbreak in US dairy cows appears more widespread than initially believed; USDA releases genetic sequencing data, issues federal order for more testing
Several important developments have occurred since our reporting last week on the ongoing outbreak of highly pathogenic avian influenza (HPAI) H5N1 virus among dairy cows. The US Department of Agriculture (USDA), which first reported HPAI in dairy cows in Texas and Kansas in late March, has detected the virus in 33 affected herds in 8 states as of April 24.
Genetic data
Late on April 21, the agency made publicly available 239 genetic sequences from the H5N1 clade 2.3.4.4b influenza virus found in samples associated with the ongoing outbreak among poultry, wild birds, and dairy cattle. Based on analysis of those sequences, the cattle outbreak likely began with a single transmission from bird to cow, probably in Texas in late 2023 or early 2024.
Based on sequencing, the USDA has identified spread of H5N1 between cows within the same herd, from cows back to poultry, and between dairies associated with cattle movements. Additionally, a genetic mutation was detected in an H5N1 sample from a sick cow in Kansas that could indicate better adaptation to mammals, but further analysis did not change the US CDC’s overall risk assessment for the public. Additionally, at least one cow destined for slaughter had signs of the virus in its lung tissue, but it did not enter the food supply.
Commercial milk supply
On April 24, the US FDA announced it found genetic evidence of H5N1 virus in commercially purchased milk samples. The testing, conducted with polymerase chain reaction (PCR), cannot distinguish between whole virus or viral fragments. H5N1 viral remnants have also been identified in milk samples by NIAID-funded researchers and a team from Ohio State University. The results indicate the H5N1 outbreak in dairy herds is likely far more widespread than official counts indicate. Preliminary culture tests are so far negative for viable virus in the milk supply, but tests are ongoing.
The FDA and USDA have said that based on currently available information, the US commercial milk supply is safe because it undergoes the pasteurization process and milk from cows known to be sick is diverted from the supply and destroyed. Pasteurization is likely to inactivate the virus but not eliminate the presence of viral particles that could be detected using PCR testing. HPAI H5N1 has been found almost exclusively in raw milk in the current outbreak, and the FDA reiterated its longstanding recommendation to avoid its consumption.
Test before transport
Also on April 24, the USDA issued a federal order requiring lactating dairy cows to test negative for H5N1 before interstate transport, and for labs and state veterinarians to report positive results. Cows that test positive must be held for 30 days before movement. The order aims to limit viral transmission and fill data gaps on asymptomatic infections in cows
Vaccines for cattle and humans
The USDA's Agricultural Research Service has started assessing the potential to develop an H5N1 vaccine for cows, but it's unclear how long development would take given remaining questions about transmission and infection characteristics in cattle.
While there is no way to predict whether the virus will evolve to spread efficiently between humans, that ability would trigger a scramble to produce human vaccines to prevent a pandemic. At least 3 H5N1 vaccines for humans are already approved in the US, but ramping up production likely would take weeks to months. Federal officials asserted that Tamiflu would be an effective treatment, and the US has a stockpiled supply. So far, only 1 human case has been reported this year in the US.
Federal response criticized
Scientists have criticized the federal response to the H5N1 outbreak in dairy cattle, especially the slow and opaque response from USDA, noting the limited and slow sharing of genetic information with scientists and a lack of mandatory testing for cattle. The USDA has been reimbursing farmers for testing only the visibly sick cows, up to 20 per farm, and the agency has met some resistance from farmers who are reluctant to allow information gathering from their farms.
“Given this is a novel outbreak, testing needs to be done widely and rapidly, investigators need to be on affected farms, and scientists and policymakers need to be bringing it all together to set a coordinated plan of action.” – Center for Health Security Director Dr. Tom Inglesby told the Washington Post
WHO concerns
Last week, the WHO’s chief scientist called HPAI H5N1 an “enormous concern.” The virus has an “extraordinarily high” mortality rate in humans who have been infected through contact with sick animals over the past 20 years. So far, there is no evidence that H5N1 is spreading between humans.
MORE HEADLINES
Negotiators to begin last 2-week round of talks on pandemic agreement next week; pathogen access and benefit sharing remains most contentious issue
Washington Post: The pandemic cost 7 million lives, but talks to prevent a repeat stall
Washington Post: ‘The most momentous time in global health security since 1948'
Devex: Experts warn about deferring hard parts of pandemic treaty for later
“This process of pandemic preparedness and response is not going to depend just on the text. It will depend on implementation. It's more than simply creating more texts. It's about rebuilding trust.” – Center for Health Security Senior Scholar Dr. Alexandra Phelan speaking with Think Global Health
Final scheduled talks on amendments to international health regulations underway this week in Geneva
WHO: Eighth meeting of the Working Group on Amendments to the International Health Regulations (2005)
Health Policy Watch: Praise and Criticism as Talks to Amend International Health Rules Near Conclusion
International organizations discuss climate change implications on human health on Earth Day
International Labour Organization: Climate change creates a ‘cocktail’ of serious health hazards for 70 per cent of the world’s workers, ILO report finds
World Economic Forum: This Earth Day we consider the impact of climate change on human health
WHO: WHO Technical Webinar Series on Climate Change and Health
See also: Johns Hopkins Bloomberg School of Public Health: To Protect Human Health, We Must Protect the Earth’s Health
Nearly 40% of US residents live in areas with unhealthy levels of air pollution, new report warns
NBC News: 131 million in U.S. live in areas with unhealthy pollution levels, lung association finds
Washington Post: Nearly 2 in 5 Americans breathe unhealthy air. Why it’s getting worse.
AP investigation examines how research into COVID-19 origins became politicized, stalled
AP: Toxic: How the search for the origins of COVID-19 turned politically poisonous
AP: Takeaways from AP report on how the search for the coronavirus origins turned toxic
Dr. Fauci to testify in June before US House Select Subcommittee on the Coronavirus Pandemic
Washington Post: Fauci agrees to testify in Congress on covid origins, pandemic policies
The Hill: Fauci to testify before Congress for the first time since stepping down
US states with more nursing home-, home healthcare-related COVID policies did not lower disease burden; White House rule will set minimum staffing levels for federally funded care homes
CIDRAP: State COVID policies didn't translate into fewer cases, deaths, study suggests
AP: The pandemic exposed staff shortages at nursing homes. A new White House push aims for a remedy
COVID-19 treatment guidelines vary widely among WHO, member states, study finds
News Medical: Global study reveals mismatch in COVID-19 treatment guidelines with WHO standards
CIDRAP: National COVID-19 guidelines vary widely, often promote ineffective treatments
People in US prisons died at rate 3.4 times higher than general population at peak of COVID-19 pandemic, study shows
Axios: COVID prison death rate increased 3 times higher than broader population: study
The Guardian: How the US failed people in prisons during Covid: ‘Really important to learn from what happened’
US NIH director misspeaks about viral persistence in long COVID; chronic condition advocates criticize Sen. Sanders’ narrow focus on long COVID in call for US$10B in research grants
New York Times: The N.I.H.’s Words Matter, Especially to Long Covid Patients (opinion)
The Hill: Sanders’s long COVID funding bill misses opportunity to aid a similar chronic condition (opinion)
See also: University of York: More than a quarter of people with Covid infection develop Long Covid, new research reveals
Community notes on X provide accurate information in response to vaccine misinformation, study says
MedPage Today: No, Marburg Virus Isn't in COVID Shots: Users Debunk Vax Misinfo on X
UC San Diego Today: Study Finds X’s Community Notes Provides Accurate Responses to Vaccine Misinformation
Nasal application of neomycin ointment could help prevent, treat respiratory viral infections, study shows
HealthDay News: Neosporin Ointment in the Nose Might Be Potent Antibiotic
YaleNews: Common antibiotic may be helpful in fighting respiratory viral infections
Introduced legislation in US Senate, opinion piece, research article highlight need for US to lead in AI, biotechnology innovation, policy development
US Senate Committee on Commerce, Science & Transportation: Cantwell, Young, Hickenlooper, Blackburn Introduce Bill to Ensure U.S. Leads Global AI Innovation
Time: We Need to be Ready for Biotech’s ChatGPT Moment (opinion)
Health Security: Seven Opportunities for Effective Biosafety and Biosecurity Governance
In report critical of US federal mpox response, GAO recommends HHS implement coordinated after-action program to identify, resolve challenges
The Hill: Government watchdog critical of federal mpox response
CIDRAP: GAO report: HHS mpox failures show persistent emergency response gaps
US CDC: Mpox Risk Assessment (updated April 17, 2024)
Republic of the Congo declares mpox epidemic; new data from DRC showing virus can spread through sexual contact concerns researchers; public health officials intensify efforts against disease
Reuters: Congo Republic declares mpox epidemic
Nature: Monkeypox virus: dangerous strain gains ability to spread through sex, new data suggest
Science: Africa intensifies battle against mpox as ‘alarming’ outbreaks continue
See also: CIDRAP: Data: Mpox rates steady year-round in Africa, vary by season in Northern Hemisphere tropics
Many gay men affected by mpox report stigma, shame; WHO publishes risk communication, community engagement toolkit
HealthDay News: Stigma, Shame Hit Many Gay Men Affected by Mpox Outbreak
WHO: Risk communication and community engagement readiness and response toolkit: mpox
Number of US measles cases reach 125; West Virginia, Vermont report cases for first time in more than a decade
CBS News: U.S. measles cases reach 125 this year, topping 2022's large outbreaks
CIDRAP: West Virginia reports first measles case in 15 years
Vermont Department of Health: Health Department Confirms Case of Measles in Vermont
The Hill: The insidious US measles resurgence should terrify us all (opinion)
See also: Precision Vaccinations: London's 76 Measles Cases Surpass Chicago's Outbreak
‘Emergency situation’ in Americas amid surge in dengue, PAHO says; climate change will drive more outbreaks, expert warns
Reuters: Dengue cases surge by nearly 50% in Americas amid 'emergency situation', UN agency says
Think Global Health: Why Nations Need to Prepare for Climate-Fueled Dengue (commentary)
See also: The Telegraph: Dengue surges in war-torn Sudan as healthcare system nears collapse
As humans interact, encroach more on primate areas, risk increases for disease transmission
Science: Forced to eat bat feces, chimps could spread deadly viruses to humans
MedPage Today: Herpes B: A Hidden Menace in Monkeys (opinion)
See also: Science: Policy Forum: Developing transmissible vaccines for animal infections
World Malaria Day brings renewed sense of urgency as warming climate enables wider geographic distribution of mosquitoes
WHO: World Malaria Day 2024: “Accelerating the fight against malaria for a more equitable world”
The Guardian: Mosquito-borne diseases spreading in Europe due to climate crisis, says expert
AP: Climate change is bringing malaria to new areas. In Africa, it never left
AP: Malaria is still killing people in Kenya, but a vaccine and local drug production may help
See also: Devex: Opinion: Why the silence on the shortfall in malaria vaccine doses? (opinion)
Several articles highlight importance of vaccination, new global communication campaign amid World Immunization Week
WHO: 24 to 30 April is World Immunization Week
UN News: New global campaign boosts lifesaving vaccines
Health Policy Watch: Immunisation Saved At Least 154 Million Lives Over Past 50 Years – WHO
Health Policy Watch: Study Finds Adult Vaccination Programs Deliver 19x Returns
PAHO: Despite vaccination gains, 1.2 million children under one remain unprotected in the Americas
See also: CIDRAP: Study highlights heavy global burden of infectious diseases
Many children used to die before their fifth birthday; vaccines helped change that, experts write
Your Local Epidemiologist: Kids don't need to get sick to be healthy
Washington Post: The Checkup With Dr. Wen: Readers recall the suffering of vaccine-preventable diseases (opinion)
More RSV hospitalizations among young children, earlier infections among older children highlight need for more widespread use of new prevention measures
Contagion Live: Earlier RSV Seasonal Peaks Point to Need for Prevention in Older Children
CIDRAP: Hospitalizations for RSV rose in 2021, 2022 for preschoolers
See also: CIDRAP: US respiratory virus activity continues to tail off
FROM THE CENTER
March/April issue of Health Security now available, including second part of special feature on threat agnostic approaches to biodefense and public health
The new issue of Health Security is now online! The March/April 2024 issue includes Part 2 of the Threat Agnostic Approaches to Biodefense and Public Health special feature, which begins with an introduction by guest editors Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security; Kelsey Lane Warmbrod, previously a research analyst with the Pacific Northwest National Laboratory; and Dr. Mary Lancaster, a senior scientist at the Pacific Northwest National Laboratory.
You can find the issue, which includes many open access articles, here: https://www.liebertpub.com/toc/hs/22/2
Editor: Alyson Browett, MPH
Contributing Editor: Prarthana Vasudevan, MS, MSPH, DrPH (c)
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