#USA, #Influenza A #H5N1 in #Humans: #Epidemiology & #Laboratory #Update {as of Feb. 26 '25}

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Epidemiology Updates

As of February 24, CDC has confirmed three human cases of H5 bird flu in people who became ill in 2025:

-- a dairy worker with exposure to infected dairy cows (Nevada),

-- a poultry worker with exposure to infected commercial poultry (Ohio), and

-- the owner of an infected backyard poultry flock (Wyoming).

These are all considered higher-risk exposures. While the dairy worker was not hospitalized, both people with poultry exposures experienced severe illness and were hospitalized. Both hospitalized cases were confirmed positive from lower respiratory specimens, including a bronchoalveolar lavage and sputum. To date, there has been no evidence of onward spread from any of these people to anyone else.

The dairy worker in Nevada had conjunctivitis (eye redness and irritation) and has recovered. Most infections associated with U.S. dairy cows to date have involved mild respiratory symptoms or conjunctivitis. This person was exposed to infected dairy cows and tested positive for avian influenza A(H5N1) virus.

The poultry worker in Ohio had respiratory symptoms and is home and recovering. This person participated in culling activities on a farm with infected poultry. The initial upper respiratory specimens could not be confirmed as positive for avian influenza A(H5) virus at CDC, so CDC initially reported this as a probable case; a subsequent specimen from the person was confirmed positive for avian influenza A(H5) virus at CDC.

The backyard flock owner in Wyoming had respiratory symptoms and is reported to have underlying health conditions that can make people more vulnerable to severe influenza illness. This person has been discharged from the hospital and is recovering. This person had direct contact with poultry infected with avian influenza A(H5) virus that died on their property. Initial upper respiratory specimens were negative for influenza viruses; a lower respiratory specimen collected several days later in the hospital was positive for avian influenza A(H5N1) virus.

Laboratory Updates

CDC has successfully sequenced the viruses from the Nevada and Wyoming cases. Genetic data have been posted in GISAID (Wyoming: EPI_ISL_19749443, Nevada: EPI_ISL_19726293) and GenBank. Sequencing data are not yet available for the Ohio case.

CDC's analysis of the genetic sequence of the virus isolated from the patient in Nevada identified the virus as an avian influenza A(H5N1) virus from clade 2.3.4.4.b (genotype D1.1). The nucleotide sequence was nearly identical to that of the viruses that USDA reported from dairy cows in Nevada that the person worked with. The virus had a genetic mutation in its polymerase basic 2 (PB2) protein that has previously been associated with more efficient virus replication in mammalian cells (i.e., change of PB2 D701N). This change was previously identified in a human case in Chile in 2023. No other changes associated with mammalian adaption were identified in the sequence data. CDC also did not identify any changes that might impact effectiveness of influenza antiviral medications or existing clade 2.3.4.4b H5 candidate vaccine viruses.

CDC's analysis of the genetic sequence of the virus from the patient in Wyoming identified an avian influenza A(H5N1) virus from clade 2.3.4.4.b (genotype D1.1). The virus had a genetic mutation in its PB2 protein that has previously been associated with more efficient virus replication in people and other mammals (i.e., change of PB2 E627K). This change was previously identified in a human case in Texas during 2024. No other changes associated with mammalian adaption were identified in the sequence data. CDC also did not identify any changes in the sequence data that might impact effectiveness of influenza antiviral medications or existing H5 candidate vaccine viruses. Virus was isolated from the case and will undergo further testing and analysis.

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Source: US Centers for Disease Control and Prevention, https://www.cdc.gov/bird-flu/spotlights/h5n1-response-02262025.html

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#Neuroinvasive #Oropouche virus in a patient with #HIV from extra-Amazonian #Brazil

{Excerpt} A novel reassortant Oropouche virus (OROV) lineage (with medium [M], large [L], and small [S] RNA segments : M1L2S2) has driven Brazil's largest and most geographically widespread OROV epidemic , expanding beyond the endemic Amazon basin to establish local transmission across multiple Brazilian states and other previously unaffected Latin American countries . The rapid spread of this lineage underscores its evolutionary potential and reinforces its significance as a public health threat .1 Similar to chikungunya and Zika viruses, expanding arboviruses can exhibit unexpected clinical and epidemiological shifts , including vertical transmissions , neuroinvasive effects, and potentially fatal outcomes.2–4 Although OROV typically causes self-limited febrile illness, accumulating clinical and experimental evidence suggests neurotropic potential .5 This Correspondence describes the first confirmed case of neuroinvasive OROV infection caused by the emergent M1L2S2 lineage in ext...

No evidence of immune #exhaustion after repeated #SARS-CoV-2 #vaccination in vulnerable and healthy populations

Abstract Frequent SARS-CoV-2 vaccination in vulnerable populations has raised concerns that this may contribute to T cell exhaustion , which could negatively affect the quality of immune protection. Herein, we examined the impact of repeated SARS-CoV-2 vaccination on T cell phenotypic and functional exhaustion in frail older adults in long-term care (n = 23), individuals on immunosuppressive drugs (n = 10), and healthy adults (n = 43), in Canada . Spike-specific CD4+ and CD8+ T cell levels did not decline in any cohort following repeated SARS-CoV-2 vaccination, nor did the expression of exhaustion markers on spike-specific or total T cells increase. T cell production of multiple cytokines (i.e. polyfunctionality) in response to the spike protein of SARS-CoV-2 did not decline in any cohort following repeated vaccination. None of the cohorts displayed elevated levels of terminally differentiated T cells following multiple SARS-CoV-2 vaccinations. Thus, repeated SARS-CoV-2 vaccination was...

Chimeric #hemagglutinin and #M2 #mRNA #vaccine for broad #influenza subtype protection

Abstract Since multiple and unpredicted influenza viruses cause seasonal epidemics and even high-risk pandemics , developing a universal influenza vaccine is essential to provide broad protection against various influenza subtypes. Combined with the mRNA lipid nanoparticle-encapsulated (mRNA-LNP) vaccine platform and chimeric immunogen strategy , we developed a novel cocktail mRNA vaccine encoding chimeric HAs (cH5/1-BV, cH7/3) and intact M2 (termed Fluaxe), which confers broad protection against major circulating IAVs and IBVs , as well as highly pathogenic avian influenza . Two-dose intramuscular immunization of Fluaxe in mice elicited cross-reactive neutralizing antibodies , T cell responses, and long-lived immunity, resulting in robust protection against multiple lethal influenza virus infections and severe acute lung injuries . In particular, intramuscular administration stimulated systemic immunity together with a prominent lung tropism of memory cells . Moreover, Fluaxe immuniza...

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