By Donna Campisano, specialist, Communications, APHL

The novel highly pathogenic avian influenza A(HPAI H5N1) virus, also known as “H5N1 bird flu,” is an alarming and challenging public health threat.

The virus is widespread in wild birds and is transmitted to domestic birds and mammals via infected feces, saliva, mucus and other body fluids. It may also spread through contact with contaminated surfaces, such as farming equipment.

HPAI H5N1 has proven particularly deadly to domestic poultry flocks. But in recent months, the virus has popped up in a new and unexpected host—the dairy cow. As of September 3, Centers for Disease Control and Prevention (CDC) reports that HPAI H5N1 has been found in 196 dairy herds in 14 states and infected four dairy farm workers. Ten workers on poultry farms have also been sickened.

HPAI H5N1 is a virus with serious consequences, and its public health response requires serious cooperation and collaboration among multiple partners, including CDC, United States Department of Agriculture (USDA) and Food and Drug Administration (FDA). While a lot is still emerging about the threat, some things are already known. Here, the latest update.

1. A “novel” influenza A virus is different from seasonal influenza A viruses. Seasonal influenza A can infect millions of people each year with what’s commonly known as “the flu.” But “novel” viruses, such as HPAI H5N1, are viruses that typically circulate in animals. And while they have the potential to infect people, it’s rare.
2. Public health laboratories are equipped to test for and detect HPAI H5N1. America’s public health laboratory system has a long history of being prepared to detect and monitor any novel infectious event, including a novel influenza event like influenza A H5N1. Over 100 public health laboratories in all 50 states use CDC diagnostic tools to detect and monitor seasonal flu and HPAI H5N1, with over 520 people tested specifically for HPAI H5N1 and 15 cases identified since 2022.
3. Things are not escalating. The country has multiple flu surveillance systems in place that monitor and track a variety of flu strains, including HPAI H5N1, year-round. The nation’s influenza detection systems, which are designed to detect novel viruses, have tested tens of thousands of specimens since February alone. The protocol used to test these specimens would have detected HPAI H5N1 and other novel viruses if they were present. Currently, the nation’s flu surveillance systems show no unusual flu activity.
4. The risk to humans is low. Currently, there has been no human-to-human transmission of the virus detected, and the farm workers who have contracted H5N1 have recovered. At this time, CDC considers the risk to the general US population low. CDC does recommend that people avoid close, prolonged or unprotected exposure to sick or dead animals and birds, including domesticated ones. It also urges the public to avoid unprotected exposure to the feces and bedding of sick animals and to not drink unpasteurized raw milk. Workers with any potential exposure to sick or dead animals should wear personal protective equipment (PPE).
5. What’s highly pathogenic in birds is not necessarily highly pathogenic in humans. HPAI H5N1 is highly pathogenic (meaning it can cause severe illness and death) in birds—not necessarily in humans, points out FDA. While HPAI H5N1 can be fatal, the recent cattle-associated human cases reported in this country have caused only mild illness; in many cases the only symptom was conjunctivitis.
6. The nation’s commercial milk supply is safe. Milk from sick cows is being diverted or destroyed so it doesn’t enter the human food supply. What’s more, commercial milk products in this country are pasteurized before hitting the market. The high heat that pasteurization entails is sufficient to kill the HPAI H5N1 virus. FDA recently surveyed a sample of retail dairy products and found no viable virus in the samples. People are urged not to consume raw milk.
7. It’s safe to eat eggs, poultry and beef. FDA says there’s no evidence HPAI H5N1 can be transmitted through properly handled and prepared food. And chances are low that infected poultry or beef would even enter the nation’s food chain, given the stringent inspection protocols in place. To verify the safety of the meat supply, USDA collected ground beef samples at retailers in states where dairy cows had tested positive for HPAI H5N1. PCR testing found that no virus particles were present in the meat. In another USDA study, ground beef patties were inoculated with very high levels of the HPAI H5N1 virus and then cooked to rare, medium or well done. No virus particles were found in the medium or well-done burgers. The burgers cooked to rare had “substantially inactivated virus,” USDA reported. On September 16, USDA will be adding H5N1 influenza A monitoring in dairy cows at slaughter. This is just another initiative the federal government has instituted to keep the human food supply chain safe from the virus.
8. Get your flu shot. The flu vaccine won’t protect you from HPAI H5N1, but it will help protect you against the most common strains of seasonal influenza, which, at this point in time, is more of a health threat to most people than HPAI H5N1. Like the flu, HPAI H5N1 can be treated with the antiviral drug Tamiflu, and CDC is working on developing a vaccine to provide protection from the virus.

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