RonO
2025-01-01 20:52:28 UTC
https://www.nih.gov/news-events/news-releases/nih-officials-assess-threat-h5n1
Published Dec 31.
QUOTE:
In a commentary published in the New England Journal of Medicine, NIAID
Director Jeanne M. Marrazzo, M.D., M.P.H., and Michael G. Ison, M.D.,
M.S., chief of the Respiratory Diseases Branch in NIAID’s Division of
Microbiology and Infectious Diseases, say people should find a balance
between enhanced vigilance and “business as usual” with respect to HPAI
H5N1.
END QUOTE:
This is an indirect way of stating that the CDC and USDA haven't been
doing their jobs.
QUOTE:
Against this backdrop, Drs. Marrazzo and Ison say there are four keys to
controlling the current outbreak. The first imperative is timely,
effective collaborations among investigators in human and veterinary
medicine, public health, health care, and occupational workers, such as
dairy and poultry workers.
This involves cultivating trust not only between numerous entities, but
with people seeking care for symptoms of concern, including
conjunctivitis, the authors write. Fortunately, so far most U.S. cases
of HPAI H5N1 have been mild and resolved on their own without the need
for treatment.
END QUOTE:
This has not happened, and it is fortunate that the human cases have
been mild. The CDC still has not put out any information on their human
dairy worker testing that they were supposed to start in early Nov, and
California initally claimed that they were going to start a worker
testing program early in their infection, but that never happened and
out of the 5,000 workers that they could have tested they only tested
130 after essentially quiting after their initial success with their
first 39 tested.
QUOTE:
Their second key is a focus on the Canadian HPAI H5N1 patient, who
developed respiratory failure and required life-saving medical
intervention and treatment before recovering. The authors write that
mutations found in the virus in this patient highlight an urgent need
for vigilant disease surveillance to identify and assess viral changes
to evaluate the risk for person-to-person transmission. Effective
surveillance, they say, requires that complete genomic sequencing data
from animals and people are made rapidly and readily available.
Without information pertaining to where and when isolates were
collected, the data cannot be linked phylogenetically to other reported
sequences, limiting insight into how the virus is spreading, they write.
These data would also provide opportunity for early detection of
mutations that might portend avidity for human respiratory epithelium,
which may require as little as one mutation in the virus.
END QUOTE:
Even the NIH needs to differentiate the D1.1 genotype from the B3.13
dairy genotype. The Canadian and Louisiana patients both with severe
symptoms were genotype D1.1. In both cases the D1.1 genotype had the
same mutations that were not found in the local virus in birds, so they
claimed that these mutations that, apparently made the infections more
severe had occurred within each patient independently. The D1.1
genotype should be tracked more diligently than the Dairy virus. This
is also the virus that they need to be checking the efficacy of the
current H5 vaccine strain on.
This seems to be a direct rebuke of the current policy of not releasing
the conclusions of the sequencing efforts. The last half month there
has been suppression of the results. The cat infection case in Oregon
had been sequenced and they knew that the sequence was identical in the
dead cat and in the pet food that the cat ate, but they would not state
if it was the dairy virus or not. The same goes for the Washington big
cat cases and California cat cases, and also the Wisconsin poultry
worker. A phylogeny and epidemiological sequence analysis has not been
done since early in the infection when they determined that some
infected states had not gotten infected cattle, but had obviously been
infected from Texas. They refused to start testing dairy workers that
had likely taken the virus to other states that did not get cattle.
They could tell which farms in Texas had the most closely related virus
sequence, but never initiated contact tracing between those farms and
the states with infected dairies.
The Colorado virus was found to be most closely related to the virus
that had infected a Michigan dairy worker, so there wasn't much doubt as
to how Colorado got infected with a Michigan strain, and they should not
have gotten Michigan Cattle.
The USDA is still not releasing the sequence information so that it can
be effectively used to trace the spread of the infection. They just
give the sample submission date, date of sequencing, and claim the
location is the USA. This was determined to be inadequate with the
first epidemiological sequence analysis, but the USDA never changed, and
kept putting out nearly worthless sequence information. Before I
retired I contacted the USDA avain lab in Georgia and asked for the
contact information for the USDA researchers that were responsible for
putting out the sequence data, so that I could get more information
about the sequences that those researchers obviously would have. I was
told that they did not give out that information. The USDA should have
been doing a weekly epidemiological sequence analysis from the beginning
of the infection, but that has never been initiated (or the results have
been suppressed) and researchers that are willing to do it, can't do it
because of the nearly worthless way in which the sequence is annotated.
QUOTE:
Third, researchers must continue to develop and test medical
countermeasures—such as vaccines and therapies that eliminate or
alleviate disease—against H5N1 and other influenza viruses. Fortunately,
current vaccine candidates neutralize the circulating strains, which so
far are susceptible to antivirals that could mitigate transmission and
severity of illness, they write.
Lastly, Drs. Marrazzo and Ison encourage people to take precautions to
prevent exposure to the virus and minimize the risk of infection. For
example, people who work with poultry and cows should use personal
protective equipment and educate themselves about occupational risks
when working with birds and mammals, as CDC and USDA have repeatedly
recommended.
END QUOTE:
They are testing countermeasures, but so what? The statement about
current vaccine efficacy is dated. The virus tested was isolated from a
dairy worker at the beginning of the dairy infection (March 2024), and
was found to be neutralized by the then vaccine H5 antigen. The virus
has since mutated, and the CDC found that they had to make a synthetic
H5 antigen with the Missouri amino acid substitutions in it in order to
detect neutralizing antibodies in the Missouri patient's blood (Oct
2024) and still 2 of the three antibody tests failed. The current
vaccine strain of H5, likely has lost efficacy against the current
virus. The California virus is also supposed to have multiple amino
acid substitutions in the H5 gene.
A recent news article that I put up claimed that some infected dairies
in California were not using personal protective equipment to protect
their dairy workers. It is only a "recommendation" by the USDA and CDC,
just as it was voluntary (and still is in most states) to test your herd
for infection. Workers were only "recommended" to not go to other farms
if they worked with infected animals and that obviously was not enforced
even in California when they knew that the workers were likely spreading
the virus. All the infected dairies and poultry farms in California is
a testament to the fact that the denial of workers transmitting the
virus should have been dealt with long ago when the USDA determined that
it was likely worker transmission to poultry farms and other dairies in
Michigan back in June.
Since they never wanted to identify all the infected herds even their
"recommendations" did not have to be followed on farms that would not
admit to being infected, and refused to be tested. So workers have been
freely infected since the start of the dairy epidemic, probably, on most
of the infected farms because most of the infected farms, likely never
were determined to be infected. In states where infected herds were
searched for like Colorado and California more than 60% of the herds in
those states were found to be infected. That should tell you how sad
the response has been in all the other states with known infected herds,
and even states like Florida and Washington that have had infected
poultry flocks, but refused to test their dairy herds.
Ron Okimoto
Published Dec 31.
QUOTE:
In a commentary published in the New England Journal of Medicine, NIAID
Director Jeanne M. Marrazzo, M.D., M.P.H., and Michael G. Ison, M.D.,
M.S., chief of the Respiratory Diseases Branch in NIAID’s Division of
Microbiology and Infectious Diseases, say people should find a balance
between enhanced vigilance and “business as usual” with respect to HPAI
H5N1.
END QUOTE:
This is an indirect way of stating that the CDC and USDA haven't been
doing their jobs.
QUOTE:
Against this backdrop, Drs. Marrazzo and Ison say there are four keys to
controlling the current outbreak. The first imperative is timely,
effective collaborations among investigators in human and veterinary
medicine, public health, health care, and occupational workers, such as
dairy and poultry workers.
This involves cultivating trust not only between numerous entities, but
with people seeking care for symptoms of concern, including
conjunctivitis, the authors write. Fortunately, so far most U.S. cases
of HPAI H5N1 have been mild and resolved on their own without the need
for treatment.
END QUOTE:
This has not happened, and it is fortunate that the human cases have
been mild. The CDC still has not put out any information on their human
dairy worker testing that they were supposed to start in early Nov, and
California initally claimed that they were going to start a worker
testing program early in their infection, but that never happened and
out of the 5,000 workers that they could have tested they only tested
130 after essentially quiting after their initial success with their
first 39 tested.
QUOTE:
Their second key is a focus on the Canadian HPAI H5N1 patient, who
developed respiratory failure and required life-saving medical
intervention and treatment before recovering. The authors write that
mutations found in the virus in this patient highlight an urgent need
for vigilant disease surveillance to identify and assess viral changes
to evaluate the risk for person-to-person transmission. Effective
surveillance, they say, requires that complete genomic sequencing data
from animals and people are made rapidly and readily available.
Without information pertaining to where and when isolates were
collected, the data cannot be linked phylogenetically to other reported
sequences, limiting insight into how the virus is spreading, they write.
These data would also provide opportunity for early detection of
mutations that might portend avidity for human respiratory epithelium,
which may require as little as one mutation in the virus.
END QUOTE:
Even the NIH needs to differentiate the D1.1 genotype from the B3.13
dairy genotype. The Canadian and Louisiana patients both with severe
symptoms were genotype D1.1. In both cases the D1.1 genotype had the
same mutations that were not found in the local virus in birds, so they
claimed that these mutations that, apparently made the infections more
severe had occurred within each patient independently. The D1.1
genotype should be tracked more diligently than the Dairy virus. This
is also the virus that they need to be checking the efficacy of the
current H5 vaccine strain on.
This seems to be a direct rebuke of the current policy of not releasing
the conclusions of the sequencing efforts. The last half month there
has been suppression of the results. The cat infection case in Oregon
had been sequenced and they knew that the sequence was identical in the
dead cat and in the pet food that the cat ate, but they would not state
if it was the dairy virus or not. The same goes for the Washington big
cat cases and California cat cases, and also the Wisconsin poultry
worker. A phylogeny and epidemiological sequence analysis has not been
done since early in the infection when they determined that some
infected states had not gotten infected cattle, but had obviously been
infected from Texas. They refused to start testing dairy workers that
had likely taken the virus to other states that did not get cattle.
They could tell which farms in Texas had the most closely related virus
sequence, but never initiated contact tracing between those farms and
the states with infected dairies.
The Colorado virus was found to be most closely related to the virus
that had infected a Michigan dairy worker, so there wasn't much doubt as
to how Colorado got infected with a Michigan strain, and they should not
have gotten Michigan Cattle.
The USDA is still not releasing the sequence information so that it can
be effectively used to trace the spread of the infection. They just
give the sample submission date, date of sequencing, and claim the
location is the USA. This was determined to be inadequate with the
first epidemiological sequence analysis, but the USDA never changed, and
kept putting out nearly worthless sequence information. Before I
retired I contacted the USDA avain lab in Georgia and asked for the
contact information for the USDA researchers that were responsible for
putting out the sequence data, so that I could get more information
about the sequences that those researchers obviously would have. I was
told that they did not give out that information. The USDA should have
been doing a weekly epidemiological sequence analysis from the beginning
of the infection, but that has never been initiated (or the results have
been suppressed) and researchers that are willing to do it, can't do it
because of the nearly worthless way in which the sequence is annotated.
QUOTE:
Third, researchers must continue to develop and test medical
countermeasures—such as vaccines and therapies that eliminate or
alleviate disease—against H5N1 and other influenza viruses. Fortunately,
current vaccine candidates neutralize the circulating strains, which so
far are susceptible to antivirals that could mitigate transmission and
severity of illness, they write.
Lastly, Drs. Marrazzo and Ison encourage people to take precautions to
prevent exposure to the virus and minimize the risk of infection. For
example, people who work with poultry and cows should use personal
protective equipment and educate themselves about occupational risks
when working with birds and mammals, as CDC and USDA have repeatedly
recommended.
END QUOTE:
They are testing countermeasures, but so what? The statement about
current vaccine efficacy is dated. The virus tested was isolated from a
dairy worker at the beginning of the dairy infection (March 2024), and
was found to be neutralized by the then vaccine H5 antigen. The virus
has since mutated, and the CDC found that they had to make a synthetic
H5 antigen with the Missouri amino acid substitutions in it in order to
detect neutralizing antibodies in the Missouri patient's blood (Oct
2024) and still 2 of the three antibody tests failed. The current
vaccine strain of H5, likely has lost efficacy against the current
virus. The California virus is also supposed to have multiple amino
acid substitutions in the H5 gene.
A recent news article that I put up claimed that some infected dairies
in California were not using personal protective equipment to protect
their dairy workers. It is only a "recommendation" by the USDA and CDC,
just as it was voluntary (and still is in most states) to test your herd
for infection. Workers were only "recommended" to not go to other farms
if they worked with infected animals and that obviously was not enforced
even in California when they knew that the workers were likely spreading
the virus. All the infected dairies and poultry farms in California is
a testament to the fact that the denial of workers transmitting the
virus should have been dealt with long ago when the USDA determined that
it was likely worker transmission to poultry farms and other dairies in
Michigan back in June.
Since they never wanted to identify all the infected herds even their
"recommendations" did not have to be followed on farms that would not
admit to being infected, and refused to be tested. So workers have been
freely infected since the start of the dairy epidemic, probably, on most
of the infected farms because most of the infected farms, likely never
were determined to be infected. In states where infected herds were
searched for like Colorado and California more than 60% of the herds in
those states were found to be infected. That should tell you how sad
the response has been in all the other states with known infected herds,
and even states like Florida and Washington that have had infected
poultry flocks, but refused to test their dairy herds.
Ron Okimoto