MDHHS Announces The First Case Of H5N1 'Bird Flu' In A Michigan Dairy Worker

November is getting closer.  Time for another lockdown?

https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2024/05/30/h5n1-updates

Additional influenza A (H5) case detected in Michigan
By Chelsea Wuth - May 30, 2024

The Michigan Department of Health and Human Services (MDHHS) is announcing an additional case of influenza A (H5) in a Michigan farmworker, who worked closely with influenza A (H5) positive cows. This worker was employed at a different farm than the case announced on May 22. The Centers for Disease Control and Prevention (CDC) continues to highlight that the risk to the public remains low; this farm worker was quickly provided antivirals and is recovering from respiratory symptoms.

This virus has been associated with the ongoing multistate outbreak of influenza A (H5N1). As part of the ongoing response, state and local public health are closely monitoring for potential human cases, which can occur sporadically in individuals with close contact to infected animals. It is not unexpected that comprehensive testing is identifying sporadic human infections in farm workers.

“Michigan has led a swift public health response, and we have been tracking this situation closely since influenza A (H5N1) was detected in poultry and dairy herds in Michigan. Farmworkers who have been exposed to impacted animals have been asked to report even mild symptoms, and testing for the virus has been made available,” said Dr. Natasha Bagdasarian, chief medical executive. “With the first case in Michigan, eye symptoms occurred after a direct splash of infected milk to the eye. With this case, respiratory symptoms occurred after direct exposure to an infected cow. Neither individual was wearing full personal protective equipment (PPE). This tells us that direct exposure to infected livestock poses a risk to humans, and that PPE is an important tool in preventing spread among individuals who work on dairy and poultry farms. We have not seen signs of sustained human-to-human transmission, and the current health risk to the general public remains low.”

"In Michigan, we continue to respond to influenza A (H5N1) with a one-health approach, working closely with our federal, state, and local partners to address human and animal health," said Michigan Department of Agriculture and Rural Development (MDARD) Director Tim Boring. "Proper use of personal protective equipment is the best tool we have to protect farm workers. MDARD is currently offering assistance to dairy farms in need of additional protective equipment. MDARD has and will continue to take bold actions to assist farms impacted by this disease."

MDHHS recommends seasonal flu vaccination for people working on poultry or dairy farms. It will not prevent infection with avian influenza viruses, but it can reduce the risk of coinfection with avian and flu viruses.

MDHHS will be posting additional case identifications at www.Michigan.gov/influenzaA.

The Michigan Department of Health and Human Services (MDHHS) sent out a 'Dear Colleagues' email on H5N1 this morning.  Nothing new, but a good summary of the situation for health care providers:

Influenza A (H5N1) Update - June 2024
Public Health Bulletin for Health Care

Dear colleagues, 

Influenza A (H5N1) has been spreading across dairy and poultry farms throughout the country, including in Michigan. Earlier this year, a human case was identified in a Texas farmworker; and more recently, two human cases have been identified in Michigan farmworkers.

Sporadic human cases are not unexpected, given the current knowledge regarding disease transmission of H5N1. Sustained human-to-human transmission has not been reported at this time. The situation remains a low risk to the general public. However, this is a situation we would like to highlight for the following reasons: 

• Increasing numbers of impacted animals create more opportunities for human exposure.
• Human cases can range in severity, but it is important to identify even mildly symptomatic cases, to better understand disease transmission dynamics.
• The cases identified thus far have occurred in individuals with exposure to infected animals. The first case in Michigan, occurred after a splash of infected milk to the eye, resulting in conjunctivitis. The second case occurred after direct contact with an infected cow in the absence of PPE, resulting in respiratory symptoms. These cases highlight the importance of PPE in high-risk settings.

In light of the above, we respectfully ask the following: 

1. Ask your patients with influenza-like illness about exposures to wild birds, poultry, dairy cows, or other potential interactions with sick animals.  
2. Individuals with compatible signs/symptoms plus risk factors should be tested for influenza A (H5N1) - send samples to the Michigan Department of Health and Human Services (MDHHS) Bureau of Laboratories (BOL) as described below.  
3. Have a low clinical threshold for starting antiviral medications*, such as oseltamivir, in patients with clinical symptoms and risk factors – even while testing is pending.
4. If you work with a high proportion of individuals working on poultry or dairy farms, please remind them about the importance of wearing personal protective equipment (PPE) to protect themselves from contaminated materials
5. Remind patients of the risks of drinking raw or unpasteurized milk, which includes potential exposures to influenza A (H5N1), as well as pathogens like Campylobacter, Cryptosporidium, E. coli, Salmonella, or Listeria monocytogenes. 

*If treatment is not clinically indicated, please don’t let that deter you from testing. Case ascertainment is important at this time. 

Thank you for all you do to provide outstanding clinical care to Michiganders across our state! 

Natasha Bagdasarian, MD, MPH, FIDSA, FACP
Chief Medical Executive, State of Michigan

Sarah Lyon Callo, MS, PhD
Senior Deputy Director and State Epidemiologist, MDHHS Public Health Administration

Michigan Case Updates

On May 22, 2024, MDHHS announced Michigan’s first human case of influenza A (H5) in a farmworker who had regular exposure to livestock. The farmworker had mild symptoms and has recovered.

The individual worked closely with cows at a dairy known to be impacted by influenza A (H5N1). Cows infected with H5N1 still need to be milked for their welfare. Note that the milk from these cows does not enter the food supply. The individual got infected material – raw, unpasteurized milk – directly in their eye while milking the animal. The next day, the farmworker reported redness and watery discharge in that eye. The individual recovered two days later and has reported no other signs or symptoms of illness. It is encouraging that the symptoms experienced by this individual were mild and resolved, even after direct exposure to raw, unpasteurized milk from an infected cow. 

Then on May 29, 2024, the state announced an additional human case of influenza A (H5) – also occurring in a farmworker who worked closely with ill cows. This individual was quickly provided with antivirals and is recovering from classic influenza-like respiratory symptoms. This is the first human Influenza A (H5N1) infection in the U.S. that has reported respiratory symptoms.

The individual had significant exposure to ill cows, including cow respiratory secretions, as part of their job function. This worker is not related to the first human case reported in Michigan and works on a different farm than the previous case reported in Michigan.

These cases, and the one in Texas, demonstrate that use of personal protective equipment (PPE) on farms, including proper eye goggles, gloves, and respirators, should be considered on all dairy farms - and especially on farms impacted by influenza A (H5N1).

Farmworkers who have been exposed to impacted animals have been asked to report even mild symptoms. Then, testing for the virus has been provided. Michigan is grateful for the cooperation of farm owners and workers for participating in monitoring. We also appreciate the continued cooperation and support of local health departments and clinicians in the jurisdictions impacted by influenza A (H5N1).

For more information on the H5N1 situation in Michigan, visit Michigan.gov/influenzaA.

Background

Since the first case of influenza A (H5N1) was identified in a domestic poultry flock in February 2022, the virus is continuing to impact Michigan’s wildlife and domestic animals.

In 2024, the Michigan Department of Agriculture and Rural Development (MDARD) announced detections of influenza A (H5N1) in dairy herds and poultry flocks. View a list of impacted counties, here. Identification of impacted premises is ongoing, and risk should not be considered limited to those geographies. Backyard flock owners should also monitor their birds for symptoms and deaths and follow MDARD’s suggested biosecurity measures. 

To reduce the spread of this disease between farms, the United States Department of Agriculture and MDARD recommend that dairy and poultry farms delay or stop non-essential visitors from entering farms and implement enhanced biosecurity measures. More details regarding MDARD’s requirements are outlined in the recent Determination of Extraordinary Emergency, HPAI Risk Reduction Response Order (HRRRO).

Assessment

Affected dairy and poultry farms have been working closely with federal, state and local officials to monitor the cases in animals and to detect and prevent animal to human transmission. 

Since 2022, there have been three confirmed human cases related to bird and dairy exposure in the U.S. According to the U.S. Centers for Disease Control and Prevention, current risks to public health are low. 

However, it is important to understand and prepare for additional infections in humans as infections can range in severity. 

Recommendations

Here are a few things we hope you will keep in mind as public health agencies continue to monitor the situation:    

• Be aware that this illness is primarily circulating in wildlife, domestic poultry, and dairy cattle. 
• Consider the possibility of influenza A (H5N1) virus infection in persons showing signs or symptoms of conjunctivitis and/or respiratory illness who have relevant exposure history.  
  • Relevant Exposure History refers to: 
    • Persons who have had contact with wildlife, domestic birds, livestock (especially dairy cattle) or other animals within the week before symptom onset. 
    • Considering if the ill person has prepared or consumed uncooked or undercooked food, including unpasteurized milk or dairy products. 
    • Considering if the ill person had prolonged exposure to potentially infected birds or animals in a confined space.  

• Patients that present with these symptoms and exposures should be tested for novel influenza infection. Testing should be coordinated with local health departments and MDHHS regional epidemiologists. Then, tests should be sent to the MDHHS Bureau of Laboratories (BOL) to be quickly analyzed. 
• Follow these recommendations to collect and submit specimens to the BOL. 
• While there is no vaccine available for influenza A (H5N1) the seasonal influenza vaccine can protect populations at risk of exposure to influenza A (H5N1) by reducing the risk of coinfection between seasonal and avian strains.  
• Antiviral drugs, such as Oseltamivir (Tamiflu) and Zanamivir (Relenza), can be effective in treating novel influenza infection. Early treatment works best and may be especially important for people with a high-risk condition.  
• Advise patients to avoid eating or drinking raw (or unpasteurized) milk products. 

If you have any questions, please contact MDHHS – Monday through Friday, 8 a.m. to 5 p.m., at (517) 335-8165; and after hours or on holidays at (517) 335-9030. 

As a reminder, register with the Michigan Health Alert Network (MiHAN) to stay up to date with all Michigan public health alerts. 

Additional Resources

CDC: 

• Updated Interim Recommendations for Worker Protection and Use of Personal Protective Equipment (PPE) to Reduce Exposure to Novel Influenza A Viruses Associated with Disease in Humans | Avian Influenza (Flu) (cdc.gov).  
• Sequence for Donning Personal Protective Equipment (PPE) (cdc.gov). 
• Protect yourself from getting sick when working with cattle_complete (cdc.gov). 

 USDA: 

• Microsoft Word - Updated FAQ_042424 (usda.gov). 

 FDA: 

• Questions and Answers Regarding Milk Safety During Highly Pathogenic Avian Influenza (HPAI) Outbreaks | FDA. 

 Michigan Press Releases: 

• Additional influenza A (H5) case detected in Michigan
• First case of influenza A (H5) detected in Michigan resident
• MDHHS, MDARD remind Michiganders about risks of consuming raw (unpasteurized) milk and milk products. 
• MDARD - Highly Pathogenic Avian Influenza Detected in Newaygo County Flock (michigan.gov). 
• MDARD - Highly Pathogenic Avian Influenza Detected in Three New Michigan Dairy Herds. 
• MDARD - Farmers, Backyard Poultry Owners Must Tighten and Heighten Biosecurity to Protect Their Animals from Bird Flu (michigan.gov). 
• View more press releases from MDARD on HPAI. 

The death of a 59 year old man in Mexico that the World Health Organization attributed to H5N2 probably wasn't:

https://x.com/PeterSweden7/status/1798798709980795365

CAN'T MAKE IT UP.

Turns out that the man that WHO claimed died from bird flu in Mexico was confined to a bed with type 2 diabetes and kidney failure.

This is the same hoax they did during covid.