“Much stronger surveillance” of deadly H5N1 and other avian influenza strains in both domestic and wild animals is needed both in The United States as well as globally so as to head off pandemic risks from variants that could mutate to infect humans more directly. 

A senior World Health Organization official, Dr Maria Van Kerkkove, issued the appeal at a WHO press briefing on Thursday. She also said that WHO ‘always’ recommends drinking pasteurized, instead of raw, milk – due to the risks of contamination by a number of pathogens, including H5N1 virus.

At the briefing, WHO Director General Dr Tedros Adhanom Ghebreyesus also welcomed  the new cease-fire between Israel and Lebanon.  But he said that much more still needs to be done to end hostilities between Israel and Hamas in Gaza – where 90% of Gaza Palestinians are now facing winter in tents, with risks of respiratory diseases, cold exposure and malnutrition even more acute than last year. See related story:

WHO Welcomes Israel-Lebanon Ceasefire – But Onset of Winter Increasing Desperation in Gaza   

‘Epizotic’ of Avian flu in animals worldwide 

While the number of human infections from H5N1 is “still small, relatively speaking,” it is also growing  “not only in the US, but around the world over the last several years,”  Van Kerkhove told journalists.

But what is really “concerning” she added, is the “massive epizootic of avian influenza, including H5N1, but not just H5N1, in wild birds, in poultry, expanding to other animals, livestock, dairy cattle in the United States, but also land mammals, marine mammals. 

“And over the last couple of years, this expansion of H5N1 of avian influenza is putting more people at risk,” she added.  

So far, there have been about 55 human infections reported in 2024, she said, 52 in the United States. All but two of others had “known exposure” to infected animals. And there are extensive investigations that are underway looking at the pathway of exposures in the different cases, to see how people were in fact infected, she added. 

“But what we really need globally, in the US and abroad, is much stronger surveillance in animals, in wild birds, in poultry, in animals that are known to be susceptible to infection, which includes swine, which include dairy cattle to better understand the circulation in these animals, ,” stressed Van Kerkhove. And, she added, “we need much stronger efforts in terms of reducing the risk of infection between animals to new species and to humans.”

The US Department of Agriculture has confirmed cases of infected cattle in some 505 dairy herds in 15 US states since the outbreak was first reported in March, as well as in 50 commercial poultry flocks, according to the latest government data.

More protection of people occupationally exposed also needed

Van Kerkhove also called for more protection of people most at risk – those working with, or handling animals, “making sure that they have the right personal protective equipment, that it’s worn appropriately and properly when they are handling infected animals or even suspected infected animals. 

“We need to make sure that they have testing, that they have access to care, so that we can mitigate any potential spread. We have not seen evidence of human to human infection, but again, for each of these human detected cases, we want to see a very thorough investigation taking place, including further testing of context.

Finally, she added that WHO recommends that the public always drink pasteurized milk rather than raw milk products “for a number of different health benefits…. This is just as important for H5N1 as it is for other pathogens, other bacteria.”

WHO appeals risk a chilly reception from the new US administration 

The recommendations for stepped-up surveillance of H5N1 in animals and people, as well as  avoidance of raw milk consumption, are likely to meet with a chilly reception in the new US administration of President-elect Donald Trump, who will be inaugurated on 20 January 2024.  

Although US dairy cattle are currently at the epicenter of an outbreak of H5N1 surveillance of both human and animal cases has so far been based largely on voluntary testing and reporting. 

And Robert F Kennedy Jr, Trump’s nominee for the head of the US Department of Health and Human Services (HHS), has long been a proponent of expanding raw milk consumption, and he wants to put a bigger focus on the US epidemic of non-communicable diseases, as compared to infectious disease risks.  

At the same time, concerns over raw milk contamination are rising after some state and county health officials, notably in California, recently began testing bulk milk supplies – finding traces of avian flu in one lot just last week, produced by Raw Farm LLC of Fresno. The company voluntarily recalled the lot.  

The enhanced testing followed an announcement by the US Department of Agriculture, 30 October, that it would support more bulk milk sampling as well as enhanced testing of dairy cattle herds’ milk samples for H5N1 nationally, in collaboration with veterinarian groups.  

But it remains unclear if Trump’s new DOA nominee, Brooke Rollins, a conservative lawyer and Trump loyalist who grew up on a Texas cattle farm, would continue to expand or restrict such surveillance.  

Meanwhile, Trump’s nominee for the head of the US Food and Drug Administration, Johns Hopkins Professor Martin Makary, is a more conventional pick. But his track record during the COVID-19 pandemic, when he argued against lockdowns, masking, questioned the benefits of vaccine boosters, and incorrectly predicted in February 2021 that “COVID-19  will be mostly gone by April” due to acquired herd immunity, bodes ill for closer tracking of H1N1 infections, or future pandemic preparedness measures. 

Image Credits: Raw_farm_USA, US Department of Agriculture.