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Bird Flu Update

Updated By Dr. Howard Topoff and Dr. Eskild Petersen

What is bird flu?

Bird flu (avian influenza) is an infection from a type of influenza (flu) virus that usually spreads in birds and other animals. Rarely, humans can get bird flu from infected animals. Like the versions of flu that people usually get, bird flu can be mild or serious. It’s extremely rare for it to spread from person to person.

Here are a series of articles that should answer MOST questions we receive from our community.


New Human Cases of Avian Flu Anticipated - Are We 2 Mutations Away From Widespread Human Infections?

(From Medscape) With avian influenza spreading quickly around the globe, the virus has more opportunities to mutate and cause problems for people. By some calculations, H5N1 bird flu is still at least two mutations away from widespread human infections, but experts warn that new flu symptoms in individuals at high risk are likely to start turning up in health systems this summer.

"There is a broad range of symptoms to be watching for," said Vivien Dugan, PhD, director of the influenza division at the US Centers for Disease Control and Prevention (CDC). "Some of this will not be obvious or at the forefront of our minds."

Dugan is leading the team of CDC scientists that is working with partners from the US Department of Agriculture, the US Food and Drug Administration (FDA), and state and local health departments to track and respond to the H5N1 bird flu outbreak currently sweeping through the US.

Since 2022, avian influenza A viruses have been detected in more than 9300 wild birds in 50 states and territories and in commercial and backyard flocks.

"It's a bad situation," said Florian Krammer, PhD, professor of vaccinology at the Icahn School of Medicine at Mount Sinai in New York. "Globally, we've seen tons of exposure in cities around the world and even in the birds here in New York City where I am.”

Birds shed the virus in their saliva, mucous, and feces, so people or other animals with close, unprotected contact with infected birds or their contaminated environments can be infected. 

And for the first time in March 2024, H5N1 bird flu was reported in dairy cows. The US Department of Agriculture said that at last count 101 dairy herds in 12 states had been infected, with several cases also found in dairy workers.

From Birds to Cattle and Farm Workers

The National Veterinary Services Laboratories confirmed the infections were highly pathogenic avian influenza H5N1 clade of Eurasian lineage. Also known as the goose, Guangdong clade from China, phylogenetic analysis and epidemiology suggests a single introduction into cows followed by onward transmission.

"I was surprised when H5 was introduced to dairy cattle in this way," Dugan said during an interview. "Influenza viruses are always surprising us and it reminds me to stay humble and keep an open mind when dealing with them."

People rarely inhale or get sufficient virus in their eyes or mouth to get sick, Dugan said, but those in close contact with animals are still at risk for infection, which could lead to upper respiratory tract symptoms such as shortness of breath, cough, sore throat, or runny or stuffy nose.

Like with other viruses, people can also experience muscle or body aches, headache, fatigue, fever or, as was seen in farm workers, conjunctivitis.

But there are less-common symptoms too like diarrhea, nausea, and vomiting — and sometimes, even seizures.

The risk to the general public is still low, Dugan said, but authorities recommend that people working with animals wash their hands with soap and water and wear personal protective equipment that includes fluid-resistant coveralls, a waterproof apron, a safety-approved respirator, properly fitted goggles or face shield, a head or hair cover, gloves, and boots.

Dugan said that healthcare providers often don't take a history of occupational exposures when a patient presents with flu. But with rising rates of bird flu in new animal hosts, "this will be an important next step."

Asking Unusual Questions

This approach is not standardized on most electronic health records, so these are questions that clinicians will need to initiate themselves.

"Physicians should ask about work," said Meghan Davis, PhD, associate professor at the Johns Hopkins Bloomberg School of Public Health in Baltimore. "If it's not already on the radar, asking about any direct contact with dairy cows, poultry, pigs, wild birds or wild mammals is important."

Davis says she's worried about a new study tracking risk factors for farm-to-farm transmission because it shows that farms testing positive for avian influenza often have workers with a family member also employed on another farm. "This suggests that we might need to be on the lookout for possible transmission within families," she said. Now, we have to ask "not just if the person with symptoms has contact with or works on a dairy farm, milk processing plant, or slaughterhouse, but also if any family member does."

Davis said that it's important to bear in mind when taking these histories that there may be younger workers on farms and in slaughter and processing facilities due to exemptions or illegal work.

What is important now is to get the situation under control this season in dairy cattle, Krammer said. "This will be easier to stop in cows than humans, so this is the time to stop moving dairy cattle and start vaccinating them."

Spotting New Cases

Since April 2024, there have been three human cases of avian influenza after exposure to dairy cows reported. "And what we don't want to see this summer is an unusual human cluster of influenza. It's important we keep a close, watchful eye for this," Krammer said.

"Influenza viruses do very interesting things and as we head into fall and winter flu season, we don't want new human co-infections that could cause major problems for us," he said.

If people become mixing vessels of a seasonal cocktail of multiple viruses, that could empower H5N1 to mutate again into something more dangerous, sparking a new pandemic.

"It wasn't all that long ago that we were asking China difficult questions about the steps Chinese authorities took to protect human lives from SARS-CoV-2 in the COVID pandemic. Now, we must ask ourselves many of these questions," Krammer said. "We are at a crucial crossroad where we will either elude a new pandemic or see one take off, risking 10 to 20 million lives."

There is a precedent for safely evading more trouble, Krammer pointed out. Government agencies have already been working with the poultry industry for a couple of years now. "And here, we have successfully stopped H5N1 with new regulations and policies."

But moving from poultry farms to cattle has not been an easy transition, Dugan said. Cattle farms have no experience with bird flu or tactics to contain it with regulations, and officials too are working in new, unfamiliar terrain.

"What we have now isn't a science problem, it's a policy issue, and it hasn't always been clear who is in charge," Krammer said.

"Agencies are working together at the state, federal, and global level," said Dugan. "We are increasing our transparency and are working to share what we know, when we know it."

The infrastructure built during the COVID pandemic has helped teams prepare for this new crisis, Dugan said. Year-round, layered monitoring has clinical labs reporting seasonal influenza and novel cases.

"Laboratories are ready to help with testing," Dugan said.

Specimens should be collected as soon as possible from patients with flu symptoms. A nasopharyngeal swab is recommended with a nasal swab combined with an oropharyngeal swab. If a patient has conjunctivitis with or without respiratory symptoms, both a conjunctival swab and a nasopharyngeal swab should be collected. 

People with severe respiratory disease should also have lower respiratory tract specimens collected.

Standard, contact, and airborne precautions are recommended for patients presenting for medical care who have illness consistent with influenza and recent exposure to birds or other animals.

Antiviral Drugs

There are four FDA-approved antivirals for influenza:

    •    Oseltamivir phosphate (available as a generic drug or by the trade name Tamiflu)

    •    Zanamivir (Relenza)

    •    Peramivir (Rapivab) 

    •    Baloxavir (Xofluza)

For people with suspected or confirmed avian influenza, treatment is recommended as soon as possible. 

There are no clinical trials measuring the outcome of antivirals in people infected with avian influenza. However, data from animal models and human observational studies suggest a benefit.

"We can't afford to wait this summer," Krammer said. "We have an opportunity right now to stop this in cows before we risk infecting more people. I hope we do."


As bird flu spreads in the US, is it safe to eat eggs? What to know about the risk to humans.

Avian influenza, aka bird flu, has spread to dairy cows in multiple states and one person in Texas. What to know about transmission, symptoms, and food risks.

Earlier this month, a dairy worker in Texas tested positive for bird flu, aka avian influenza, amid an outbreak of the virus among dairy cattle.

It's the first time this virulent strain of bird flu —referred to as highly pathogenic H5N1— has been detected in cows and the first documented cow-to-human transmission of an avian influenza virus, according to the U.S. Centers for Disease Control and Prevention. It's also only the second case of bird flu in a human in the United States.

Is bird flu a problem now?

The multi-state bird flu outbreak is affecting cows in over a dozen dairy farms across the country. Although health officials are on high alert, the current risk to the general public is low, experts say.

While the thought of "bird flu" may sound alarming and stoke COVID-19 pandemic fears, influenza among birds is not new.

“The current bird flu strain that we’re concerned with, H5N1, has actually been circulating around the world for quite some time,” Dr. William Schaffner, professor of infectious diseases at Vanderbilt University Medical Center, tells TODAY.com.

What is bird flu?

Bird flu is a disease caused by infection with avian influenza type A viruses. Avian influenza A viruses occur naturally among wild aquatic birds, such as geese, ducks and swans, says Schaffner, but they can also circulate among domestic poultry.

“Bird flu viruses occasionally get into other mammalian species (like pigs). We’ve all heard of swine flu,” Schaffner says. Avian influenza A viruses can also infect horses, bats and dogs, per the CDC — rarely, they spread to humans.

"More recently, we have seen an increase of infections in cattle," Dr. Hilary M. Babcock, infectious disease specialist at Washington University of St. Louis andBJC Healthcare, tells TODAY.com.

This is the first time the avian influenza strain of highly pathogenic H5N1, which causes severe and often fatal disease in birds, has been found in cows. “That’s pretty unusual,” says Schaffner. However, this H5N1 strain does not seem to be making cows very sick, he adds.

What states have bird flu?

Highly pathogenic avian influenza viruses (which include the strain of H5N1 that’s currently spreading)have been detected in the U.S. in wild aquatic birds, commercial poultry and backyard bird flocks beginning in January 2022, according to the CDC.

Overall, 48 states have reported cases of highly pathogenic H5N1.

The current outbreak of H5N1 affecting diary cows has spread to nine states so far:

 Texas-Colorado-Kansas-Michigan-New Mexico-Idaho-Ohio-North Carolina-South Dakota

Currently, only 3 human cases are known to have contracted H5N1 in this outbreak, the experts say.

As H5N1 surveillance increases, experts anticipate the number of cases among cows to increase. "We’re looking harder now and finding more cases (among cattle) that even 10 years ago would have gone undetected," says Schaffner.

The risk to the general public in the U.S. is low, the experts say. For people exposed due to their line of work, the risk is considered “low-to-moderate,” the World Health Organizagtion said in a statement.

How does the bird flu spread to humans?

"Every once in a while, a bird flu virus can get into a human, but that's rare," says Schaffner. Avian influenza viruses can spread from infected birds to humans in a few ways, according to the CDC:

    Directly from an infected bird

    From environments contaminated with avian influenza virus

    Through an intermediate host, such as an animal

Infected birds can shed the virus in their saliva, nasal secretions, mucus and feces. People can become infected when a large enough amount of the virus gets into the mouth, nose, eyes or is inhaled, says Schaffner.

Transmission to humans typically occurs through close contact with infected birds without protective gear. It can also occur if a person touches contaminated surfaces and puts their hands in their eyes or mouth, or if they breathe in droplets from the air, per the CDC.

It is not immediately clear how the dairy cow infected the person in Texas, the experts note. The only other person who contracted H5N1 in the U.S. was directly involved in the culling of birds presumed to be infected with H5N1, says Babcock.

Sporadic cases of H5N1 in humans have been reported around the world, often in rural areas where people live closely with poultry or other birds. According to the WHO, since 2003 there have been 889 cases and 463 deaths caused by H5N1 in 23 countries.

Once the bird flu gets into a human, “it is almost never spread to anyone else,” says Schaffner. However, “there are ultra-rare instances of transmission from a person very sick with bird flu to a family member or caregiver.”

When does happen, it does not lead to continued spread between people "because the virus doesn’t have the (genetic) capacity to spread easily from person to person,” says Schaffner.

“This strain of bird flu has been around for about a decade and it still has not picked up this capacity to spread readily from person to person, thankfully. ... That should be a matter of reassurance, but also keep us in public health on alert,” says Schaffner.

No human-to-human spread has occurred with the contemporary H5N1 viruses currently spreading in birds, the CDC said.

Can you get bird flu through eggs?

There is no evidence that people can get bird flu from food that’s been properly prepared and cooked, and it is safe to eat eggs, chicken and beef, and drink pasteurized milk, the experts say.

"We have not seen cases that have been from ingesting animal products or animals that may have been infected," says Babcock.

The infected dairy cow herds that have been detected are in quarantine and their milk is being destroyed, says Schaffner.

In a statement, the USDA said the commercial milk supply in the U.S. remains safe. The U.S. Food and Drug Administration said it does not currently have concerns about the safety of pasteurized milk products, including pasteurized cheese.

“The pasteurization process in the U.S. keeps our milk supply very safe,” says Babcock. Pasteurization heats the milk to a high enough temperature to kill bacteria and viruses, including influenza.

Drinking unpasteurized or "raw" milk, which is increasingly trendy, is associated with various infectious disease hazards, says Schaffner. "I discourage people from drinking raw milk,” he adds.

The risk of humans becoming infected by eating eggs from poultry with H5N1 is low, says the FDA, and there are safeguards in place to identify infected poultry and remove their eggs from the market.

It's possible for products from infected animals to end up in the food supply, says Babcock, but the risk to humans is still very low. Properly storing and cooking food further reduces that risk.

Although beef cattle are not involved in this outbreak, Schaffner recommends cooking beef to a safe internal temperature. The FDA recommends cooking eggs until the white and yolk are firm.

“There are other reasons that you shouldn’t eat raw eggs (or meat), because these can carry lots of different pathogens," says Babcock.

What happens if a human gets the bird flu?

Bird flu infections in humans can range in severity, the experts note. Some people have zero or only mild symptoms, while others develop severe disease, according to the CDC. "It can be a serious infection with a high mortality rate,” says Schaffner.

The Texas patient had a mild infection, with eye redness as the only symptom, the CDC said. "It was not even a respiratory infection. It was ... conjunctivitis or pink eye," Schaffner notes.

The patient was treated with flu antivirals and is recovering. "We have antiviral medications, the same ones we use to treat regular flu, that work against this avian influenza strain," Schaffner says.

The other human case of H5N1 in the U.S. in 2022 was a mild infection as well, Babcock adds.

Symptoms of bird flu in humans

According to the CDC and experts, the reported signs and symptoms of avian influenza in humans include:

Fever-Cough-Runny nose-Muscle or body aches-Headache-Fatigue-Shortness of breath-Eye redness or inflammation (conjunctivitis)-Diarrhea-Nausea

Bird flu in humans may look similar to a regular flu or upper respiratory infection, says Babcock, or a person may have no obvious symptoms. It can also lead to pneumonia, respiratory failure and other complications. "There's a full range," she adds.

There is no way to diagnose an infection with bird flu by symptoms alone, the CDC says. Laboratory testing is required.

Can you recover from bird flu?

Yes, you can recover from bird flu. The human recently infected in Texas was treated with flu antivirals and is recovering. The Colorado patient infected in 2022 also recovered.

Globally, bird flu symptoms have ranged from mild to severe, resulting in death in some cases, according to the CDC.

How to prevent spread of bird flu

Although the risk of getting bird flu is low, the CDC recommends the following protective actions:

    Avoid visiting poultry farms if possible

    If visiting poultry farms, wear a mask and avoid touching birds

    Avoid sick or dead birds

    Maintain good hand hygiene

    Do not eat raw or undercooked poultry

    Visit a doctor if you become sick after contact with birds.