In light of avian flu, seasonal flu, CDC urges clinicians to speed influenza A subtyping

Due to ongoing sporadic H5N1 avian flu infections and brisk levels of seasonal flu activity, the US Centers for Disease Control and Prevention (CDC) today urged healthcare providers to subtype all influenza A specimens in hospitalized patients, especially those in the intensive care unit (ICU), as soon as possible.

At a briefing today, federal health officials spelled out the rationale for speedier testing, addressed issues related to next week’s shift from the Biden to the Trump presidential administration, and announced new steps to bolster infectious disease preparedness.

Effects of quicker subtyping results

The CDC detailed its new recommendations for clinicians today in a Health Alert Network (HAN) advisory.

Nirav Shah, MD, JD, the CDC’s principal deputy director, said at today’s Department of Health and Human Services (HHS) briefing—its sixteenth for H5N1—hospitals typically send patients’ influenza A samples in batches for subtyping every few days, which he said could lead to delays in antiviral treatment. 

“Timeliness matters,” he said, adding that quicker subtyping has the ability to improve public health investigations, contact tracing, infection control measures in the hospital, and public health response.

Shah said the change doesn’t reflect a growing level of concern or that the current surveillance system is inadequate. “This policy won’t alter the volume, but will accelerate the train,” he said.

This policy won’t alter the volume, but will accelerate the train.

Influenza A subtyping remains fast-tracked for people who have had known exposure to avian flu virus, but the new policy change reflects the current epidemiology, including a few recent cases in people who had no known exposure to H5N1. 

Demetre Daskalakis, MD, MPH, who directs the CDC’s National Center for Immunization and Respiratory Diseases, called the change an “add-on to a robust system.”

The CDC said the risk of avian flu to the general public remains low, except for people who have exposure to sick animals or their byproducts. In its last pandemic threat assessment in August, it put said the risk at moderate. And yesterday the CDC spelled out the criteria it would use to upgrade the risk assessment.

Transition developments

At today’s briefing, Paul Friedrichs, deputy assistant to the president and director of the White House Office of Pandemic Preparedness and Response, said his team has met with president-elect Donald Trump’s incoming team, passed along a pandemic playbook, and has offered to continue meeting to provide more information.

Eric Deeble, DVM, acting senior adviser for the US Department of Agriculture’s (USDA’s) H5N1 response, said though agency political appointees may be changing, much of the work will remain in the hands of about 300 career staff who he said are tremendously knowledgeable and are the best in the world. 

More pandemic preparedness support

In other developments, HHS today announced it will provide $211 million to the Rapid Response Partnership Vehicle (RRPV) Consortium to enhance mRNA platform capabilities so that the nation is better prepared to respond to emerging infectious diseases such as avian flu. 

The RRPV is designed to create flexible strategic partnerships between government and industry to support the research and development of vaccines, treatments, and diagnostics.

mRNA technology can be faster to develop and easier to update than other vaccines, making it a helpful tool to have.

The funding is from the Biomedical Advanced Research and Development Authority (BARDA), part of HHS. Dawn O’Connell, JD, assistant secretary for preparedness and response, said in the statement, “mRNA technology can be faster to develop and easier to update than other vaccines, making it a helpful tool to have against viruses that move fast and mutate quickly.”

More affected poultry, zoo animals

The USDA Animal and Plant Health Inspection Service (APHIS) today confirmed more outbreaks in poultry in five states, including on a large layer farm in Missouri’s Newton County that has more than 1.5 million birds and more turkey farms in Ohio.

Also, APHIS reported detections in backyard poultry in Connecticut and Idaho, as well as at two live-bird markets in Florida, one in Hillsborough County and the other in Orange County. 

Separately, the Michigan’s agriculture department reported the first detection in Wayne County, which involves a backyard flock.

Regarding dairy cattle, APHIS reported 1 more detection, another in California, raising the national total to 928 and the state’s total to 711. 

In another related development, Chicago’s Lincoln Park Zoo yesterday announced that tests have confirmed highly pathogenic avian flu in a Chilean flamingo and a harbor seal, which died from their infections last week. Officials said the source isn’t certain, but is likely contact with infected waterfowl.