H5N1 Bird Flu: What You Need to Know

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BY KATHY KATELLA MAY 16, 2024

The CDC says the public health risk is “low,” but experts continue
to monitor the situation.

Avian influenza A (H5N1), or bird flu, has killed millions of wild birds and caused sporadic outbreaks among
poultry. Now, there is an ongoing multistate outbreak among cows in the United States. While bird flu is rare
in humans—and there have been no reports of the disease spreading from person to person—the infection in
a dairy worker in Texas in April 2024 marked the first report of a cow-to-human H5N1 infection.

Meanwhile,
We in the wake
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similar
among humans is raising concern.
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The good news is that, so far, H5N1 is not considered a major public health threat in the U.S. The Centers for
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Disease Control and Prevention (CDC) has categorized the risk to the general public as “low,” but continues
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to monitor the situation carefully.
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“In the short provide
thereyou with
is very thethreat,” says Yale Medicine infectious diseases specialist Scott Roberts,
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MD. “In You
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hasdisable
been a mortality (or death) rate of about 50% in the almost 900 people
around the world who have been infected with bird flu between 2003 and 2024.
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However, 50% may be an overestimate, Dr. Roberts says, adding that there may be cases where people have
no symptoms, are only mildly symptomatic, or haven’t sought care for their symptoms. He also noted that if
the virus did spread in humans, the percentage might be significantly lower if preventive approaches,
including a vaccine, and treatments were made widely available.

Another reason for concern is that bird flu is now being detected in new animal species. In addition to
outbreaks in cows—a relatively new development for the bird flu virus—there have been sporadic infections
in some wild mammals. “It’s natural to wonder if it’s only a matter of time before this virus is able to spread
among humans,” Dr. Roberts says.

Below, Dr. Roberts answers eight common questions people have about bird flu.

1. What is H5N1 bird flu, and where did the new

wave of infections start?
"Avian influenza A (H5N1)," "bird flu," and "H5N1 bird flu" all refer to an illness caused by influenza type A
viruses, which primarily affect birds. H5N1 bird flu was first identified in geese in China in 1996 and in people
in Hong Kong the following year. Almost 25 years later, in 2020, a new variant of H5N1, referred to as Highly
Pathogenic Avian Influenza (HPAI), was detected in wild birds in Europe; it was first seen in birds in the U.S.
and Canada in late 2021, and has since been detected in a variety of wild bird species in all 50 states.

(The term “highly pathogenic” relates to how the virus impacts birds, not necessarily humans. There is also a
low pathogenic avian influenza [LPAI] that usually causes mild illness in birds and poultry; however, some
LPAI strains can mutate into strains that can cause severe illness and even death in poultry.)

In February 2022, the virus began causing sporadic outbreaks of HPAI H5N1 in backyard and commercial
poultry flocks in the U.S., causing serious illness and death in infected chickens. The number of outbreaks
has increased and spread over time—as of May 2024, the CDC reported poultry outbreaks in 48 states.

In addition, there have been sporadic infections in mammals (including bears, bobcats, minks, mountain
lions, raccoons, skunks, and others), according to the CDC. And now, as of early May, there have been
outbreaks in dairy cattle in nine states.

In the two human cases in the U.S., neither involved person-to-person spread—both people were infected
after exposure to animals presumed to have bird flu. The most recent case, in April 2024, occurred in a dairy
worker in Texas who became infected after being exposed to cows that were presumed to be infected, as
described in a letter to the editor published in the New England Journal of Medicine in May.

We
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previous case, and similar
reported in April 2022 in Colorado, involved a person exposed to poultry also presumed
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work. We also use optional according to the CDC. Both cases in humans were mild, and both people
opposed to an actual infection,
recovered.
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2. Why is there concern about bird flu infecting
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cows?
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Dairy cows are a “new and unexpected host” of the H5N1 virus, and the spread of the virus among cows is a
sign that it could mutate in them, making it easier for it to spread to other animals or potentially humans,
according to the CDC.

The disease appears to be milder in cows, although this could make it more difficult to track, Dr. Roberts
says. “The virus is also infecting other animals,” he adds. “To me, that sounds like it's mutating to adapt,
evolve, and infect new species.”

Many experts are concerned about the possibility of this virus infecting pigs at some point, because pigs
can be infected with both human and animal flu viruses, adds Dr. Roberts. “Then, we have this sort of mixing
pot, where you can get a genetic reassortment of different flu strains. That's really the big, long-term
concern that could take years or decades—if it were to happen,” he says.

3. Is anyone at risk for bird flu?

While the risk of a bird flu infection is very low for most people in the U.S., “people who work with birds or
poultry, own them, or have recreational exposure to them are at higher risk than other people,” Dr. Roberts
says. “I would say that anyone who works on a farm in a state that has reported animal infections, where the
farmer has identified illness in their animals, should monitor for flu-like symptoms and contact public health
officials if any symptoms develop.”

4. Can I get tested for bird flu?

At this point, there is no publicly available H5N1 test, and commercial tests cannot distinguish human
influenza A viruses (such as H1N1) from bird flu (H5N1). The CDC says tracking the specimens that test
positive for influenza A can be helpful in monitoring for unusual increases in flu activity that may be an early
sign of the spread of new influenza A viruses, including H5N1. Dedicated bird flu testing can only be
performed at public health laboratories.

Any test for bird flu would need to be sent out to public health departments, says Dr. Roberts. “If you are
concerned, alert your doctor, and they will need to talk to the state public health department,” he says.
“However, at this point, I don't think they would authorize a test unless somebody was a farm worker or was
working in an area or on a site where there was known H5N1 infection, since the risk for the general public is
so low.”

5. The virus has been found in milk—should

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Bird flu in the milk supply has been a major concern among consumers, but the Food & Drug Administration
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(FDA) has been sampling retail milk and other dairy products, such as cottage cheese and sour cream, as
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well as powdered milk formula and powdered milk products sold as toddler formula; it reports that although
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the virus clickbeen present, it found no live infectious virus, thanks to pasteurization, a
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However, the FDA advises people not to drink, manufacture, or sell raw cow milk and products, such as
cheeses, ice cream, and yogurt, made with raw milk. (Raw, unpasteurized milk and milk products are sold
legally in most states.) While neither of the two human infections was linked to raw milk, more than half of a
resident population of domestic cats on a farm in Texas died after they were fed raw, unpasteurized
colostrum (milk produced during the first few days after birth) from H5N1-infected cows, according to a
CDC report.

There also is no evidence that anyone in the U.S. has gotten bird flu after eating properly handled and
cooked poultry products, but the CDC notes that uncooked poultry and poultry products (such as blood)
may have caused a small number of H5N1 infections in people in Southeast Asia.

Poultry and other animal foods should be safe to eat as long as they are prepared properly, according to the
CDC. This includes cooking poultry and eggs to an internal temperature of 165°F, which can kill viruses,
including H5N1. (Use a food thermometer to be sure.) The FDA provides more information on raw milk on its
website.

6. What are the symptoms of bird flu?

They range from no symptoms to mild flu-like illness to severe illness that requires hospitalization. The dairy
worker infected in the U.S. in April reported mild illness, with the main symptom being conjunctivitis
(irritation or inflammation of the conjunctiva, a clear mucous membrane that protects the eye). Other
common symptoms are consistent with influenza, according to the CDC:

● Cough

● Fatigue

● Fever

● Headaches

● Muscle or body aches

● Runny nose

● Shortness of breath

7. Are there vaccines or treatments for bird flu if it

were to spread in humans?
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There are currently no vaccines for bird flu, but the CDC reports that there has been preliminary work
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vaccine, in case one is needed. (The seasonal flu shot cannot prevent bird flu infection.)
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If anyone were to become infected with bird flu—or is suspected of having an infection—the CDC
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treatment marketing
soon as possible with antiviral drugs.
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Thereexperience. You can click
are several FDA-approved antiviral drugs for seasonal flu that can be used for bird flu, such as
oseltamivir phosphate (available generically or under the brand name Tamiflu®) and baloxavir marboxil
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(Xofluza®). Both are oral prescription medications that should be taken as soon as possible, within 48 hours
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of experiencing symptoms.
Antiviral drugs can also be given soon after a person has had unprotected exposure to an infected animal or
sick or dead poultry, meaning they did not wear gloves, face masks, eye protection, or other protective gear,
according to the CDC.

8. What precautions can you take to avoid bird

flu?
Since bird flu isn’t spreading among humans, most people don’t need to worry about precautions, Dr.
Roberts says. But people who are exposed to cows or poultry, especially in states where bird flu has been
identified, should consider them, he says. So should hunters who handle wild birds and people who raise
chickens at home.

One problem is that experts are still learning how bird flu is transmitted. “We understand much less about
H5N1 transmission than we do about COVID,” Dr. Roberts says. But most people infected with bird flu get it
from unprotected contact with infected birds, according to the CDC. The agency adds that infection also
can happen when people inhale the virus in droplets or dust from the infected animals, or touch a
contaminated surface.

The CDC has a list of recommended precautions, including:

● Avoid sick or dead birds. Check with your state or local government about their policy for reporting
wild birds and other animals that look sick or are dead. Avoid wild birds even if they don’t look sick,
since they can have an infection without symptoms.

● Don’t touch surfaces or materials that could be contaminated. That includes animal litter or feces,
mucus, raw milk, or saliva.

● Avoid poultry farms and bird markets. If you must visit those places, wear a well-fitting face mask
and don’t touch the animals.

● Use the following protective measures if you are unable to avoid contact with wild birds or sick or
dead animals:

○ Wear gloves and, after removing them, wash your hands properly.

○ Wear an N95 respirator or a well-fitting mask.

○ Use eye protection, such as goggles.

It’s important to throw away your gloves and face mask after any exposure.

Check the CDC website for further advice for specific situations and groups, including hunters and people
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