Global surveillance of influenza viruses in animals needs to be intensified to “rapidly detect any changes to the virus that could pose a greater threat to humans”, World Health Organization (WHO) Director-General Dr Tedros Adhanom Ghebreyessus told a media briefing on Wednesday.

He also urged the media to ensure that the humanitarian crisis in Sudan, one of the worst in the world, was not forgotten.

The outbreak of H5N1 avian influenza in US dairy herds has almost tripled in the past five weeks, now affecting 92 herds in 12 states. The number of human cases has increased from one to three, and 500 people are being monitored after exposure to infected cattle.

The US H5N1 clade affecting the cattle derives from Eurasian geese and is the same clade that has affected wild birds, commercial poultry flocks and “sporadic infections in several species of wild mammals and neonatal goats in one herd in the US”, according to the American Veterinary Medical Association.

“Collaboration, communication and information sharing between the animal and human health sectors is essential in all countries. This is the meaning of One Health,” Tedros urged.

However, the WHO continues to assess the risk to public health as low because of its limited spread in humans.

“Since 2003, there have been 893 reported infections of H5N1 in humans, including 11 so far this year: five in Cambodia, three in the U.S., and one each in Australia, China and Viet Nam. In that time, the virus has not shown signs of having acquired the ability to spread easily among humans,” said Tedros.

“In recent years, H5N1 has spread widely among wild birds, poultry, land and marine mammals on several continents,” said Tedros.

Timely investigation of every human case

“WHO recommends that anyone working with any infected animals, in any country, should have access to, and use, personal protective equipment”, and urged systematic follow-up, testing and care of people exposed to the virus.

“Early medical care and support, and thorough and timely investigation of every human infection is essential to evaluate and interrupt potential onward transmission between humans.”

Dr Wenqing Zhang, head of the WHO’s Global Influenza Programme, said that previous large avian flu outbreaks in seals had been contained and had not spread to humans.

While it was “too earlier” to predict the trajectory of the US cattle infection, Zhang said it was possible that it could be eliminated.

However, Dr Maria van Kerkhove, the WHO’s director of  epidemic and Pandemic preparedness and prevention, said that the WHO is concerned about the geographic spread of H5N1 and the fact that it is infecting new animal species, and put more people at risk.

“We need to be able to rapidly assess the viruses that are circulating, any changes in those viruses that are circulating, to make sure that the system that is in place so we can react as quickly as possible, should we need to produce vaccines,” she added.

“We’re not in that situation yet.”

She stressed that a lot of work needs to be done at a local level with communities using this One Health approach.

“The stronger the biosecurity we have within the farms, the earlier that we can mitigate any potential spillover into human populations and potential onward spread.”

‘Forgotten and ignored’ Sudan 

Tedros also drew media attention to Sudan, noting that this is the war the world has “either forgotten or ignored”.

“Sudan is the world’s largest humanitarian crisis, with 12 million people displaced – 10 million internally, while two million have fled to neighbouring countries.”

“More than 70% of hospitals in conflict-affected states, and 45% of health facilities in another five states are not working, and the remaining ones are overwhelmed with people seeking care,” he noted.

“Critical services, including maternal and child health care, the management of severe acute malnutrition, and the treatment of patients with chronic conditions, have been discontinued in many areas.”

He noted that insecurity and operational hurdles, such as the current break in telecommunication services, were disrupting WHO’s ability to deliver supplies and services.

Famine in Gaza

Turning to Gaza, Tedros said that the WHO welcomes the UN Security Council resolution adopted on Monday, which calls for a full and immediate ceasefire, the unconditional release of all hostages, a permanent end to hostilities, and the reconstruction of Gaza.

We urge all parties to take steps to implement the resolution immediately, and bring a permanent end to the suffering of millions of people.” said Tedros.

“A significant proportion of Gaza’s population is now facing catastrophic hunger and famine-like conditions,” he noted. “Over 8,000 children under five years old have been diagnosed and treated for acute malnutrition, including 1,600 children with severe acute malnutrition.

“Our inability to provide health services safely, combined with the lack of clean water and sanitation, significantly increase the risks for malnourished children. There have already been 32 deaths attributed to malnutrition, including 28 among children under 5 years old.”

However, due to insecurity and lack of access, only two stabilization centres for severely malnourished patients are operational, he added.

Image Credits: WFP/Ala Kheir, Josh Kelahan, WHO.