Are we at the edge of another pandemic? H5N1

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On 8 June I wrote there has been

The first case of H5N1 in domestic cats appeared on 03/25/2024
The first case of H5N1 in house mouse appeared on 05/24/2024

This has been a fairly large rise.
17 Domestic Cats
11 House Mice

In general this data shows a fairly significant recent explosion of H5N1 in the U.S. It is now in the living areas of most humans. It is in our homes.

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So how does infected mice and cats make the leap to infecting humans?

The answer is insects, primarily mosquitoes.

If this is the case, then who is the most vulnerable?

People who play, work, exercise outdoors. This population will be young children, and healthy people who take advantage of the outdoors. This is an entirely different group then those that were most vulnerable from COVID, primarily the elderly.

Also, primarily this infection route will be a daytime event. Most people are not bitten by mosquitoes while they are sound asleep at night in their homes. Normally when you are bitten by a mosquito, it sucks your blood. But a mosquito that carries an infection, will not only drink the blood but then passes the contaminated blood to the next animal or person it strikes. So therefore it becomes the perfect transmission agent.

So with this in mind, how do you protect yourself from getting a very deadly variant of H5N1?

This answer is known and used many times by people who live, work and play outdoors. This answer is fairly well known. They either use treated clothing that repel insects when outdoors or they spray themselves with insect repellent.

So let us dig a little deeper. There are two approaches to protecting against insect bites.

The first is by applying Permethrin to the clothing you wear outdoors. These are your boots and camping gear. This procedure is described in several places on the internet.

https://www.youtube.com/watch?v=oIbR_X0I-4g

https://www.youtube.com/watch?v=e3Ogpah9QlA

The second approach is to use insect repellent on your body before you go outdoors. This is a spray that you apply each time you leave your home. There are a number of different types of Insect repellent on the market. These include:

-- DEET—This is short for N,N-Diethyl-meta-toluamide

-- Picaridin (known as KBR 3023 and icaridin outside the United States)

-- IR3535

-- Oil of lemon eucalyptus (OLE)—A plant-derived ingredient

-- Para-menthane-diol (PMD)

-- 2-undecanone—A plant-derived ingredient

Preventing Mosquito Bites

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I thought I might try and make a side by side comparison between 2 major pandemics: COVID and H5N1.
I will make this analysis for the area where I live. The northern states of the U.S.

Who was most at risk of dying?
COVID -- Elderly
N5N1 -- Children and Adults

Cycle of Greatest Infection:
COVID -- Winter
H5N1 -- Summer

Primary Location of Infection:
COVID -- Indoors
H5N1 -- Outdoors

How contagious?
COVID -- According to the trackers approximately 704,753,850 people were known to have gotten COVID worldwide as of 13 April 2024 when they stopped counting. This caused 7,010,681 deaths. This information is provided by individual countries at COVID-19 Coronavirus Pandemic
H5N1 -- This is not known. One analysis concluded there was a 52% probability of death for those humans that have been infected with this condition thus far. (According to a recent article from the CDC "Since 1997, a total of 912 sporadic human A(H5N1) cases have been reported from 24 countries, caused by different HPAI A(H5N1) virus clades, with a cumulative case fatality proportion of greater than 50%."

Infection Agent:
COVID -- Airborne virus from infected humans.
N5N1 -- Blood born virus transmitted by mosquitoes and other biting insects from infected humans and other animals.

I came across an interesting article that discussed an H5N1 outbreak in Thailand chickens which began in late 2003. 62 Million.

Thailand beat avian flu 20 years ago. What can we learn from their strategies?

62 million. That’s the number seared in Prasert Auewarakul’s memory. It is the number of birds – mostly chickens – that were dead by the end of Thailand’s avian flu outbreak that started in late 2003. Some died of the disease, others were culled to prevent the virus from spreading.

“It was very bad. Most of the farmers lost everything,” says Dr. Auewarakul, a virologist at Mahidol University in Thailand.

The virus can easily wipe out a flock of chickens in a matter of days. About 20 people in Thailand also fell sick and 13 of them died from 2003 to 2005.

And then Thailand reinvented its poultry industry.

They redesigned their industry to preclude this from happening again. They sealed their poultry in their farms from the rest of the world.

In these big farms chickens often spend their lives entirely indoors. This lifestyle means there’s almost no intermingling with wild waterfowl and contact between flocks. Plus, the farms have instituted lots of protocols for who gets to go in and how. “People don't go in and out that much,” Auewarakul says. “When people go in, they have to disinfect themselves” before and after visiting the poultry areas.

As a result, this poultry pandemic came to an end.

While Maurice Pitesky isn’t opposed to borrowing from the past’s avian flu playbook, he says, it’s also necessary to write a new chapter.

Pitesky — who studies avian flu at the U.C. Davis School of Veterinary Medicine — says that two decades ago when Thailand was developing its strategy, there was one main threat: Wild waterfowl introducing the virus. “Now, we're dealing with an entire ecosystem issue,” he says.

That’s because in the past few years, H5N1 outbreaks have traveled far beyond chickens and cows. The virus has shown up on six continents and in a slew of wild and domestic mammals, from tigers and mink to cats and dogs. All in all, H5N1 has been reported in more than 48 mammal species across 26 different countries, according to a peer-reviewed journal published by the CDC. In South America, it’s caused the death of more than 17,000 elephant seals. Earlier this month, house mice in New Mexico tested positive for the virus.

“It's hard to see how this will ever not be an endemic disease at this point,” says Pitesky.

I came across another interesting article. It shows a timeline.

Bird flu is highly lethal to some animals, but not to others. Scientists want to know why

In the last two years, bird flu has been blamed for the deaths of millions of wild and domestic birds worldwide. It’s killed legions of seals and sea lions, wiped out mink farms, and dispatched cats, dogs, skunks, foxes and even a polar bear.

The flu that’s currently spreading — known as H5N1 — was first identified in birds in 1959. It didn’t really begin to worry health officials until a Hong Kong outbreak in 1997 that involved severe human illnesses and deaths.

It has caused hundreds of deaths around the world, the vast majority of them involving direct contact between people and infected birds. When there was apparent spread between people, it involved very close and extended contact within households.

Like other viruses, however, the H5N1 virus has mutated over time. In the last few years, one particular strain has spread alarmingly quickly and widely.
Take cats, for example. Flu is commonly thought of as a disease of the lungs, but the virus can attack and multiply in other parts of the body too. In cats, scientists have found the virus attacking the brain, damaging and clotting blood vessels and causing seizures and death.

Similarly gruesome deaths have been reported in other animals, including foxes that ate dead, infected birds.

The flu strain’s ability to lodge in the brain and nervous system is one possible reason for “higher mortality rate in some species,” said Amy Baker, an Iowa-based U.S. Department of Agriculture scientist who studies bird flu in animals. But scientists “just don’t know what the properties of the virus or the properties of the host are that are leading to these differences,” Baker said.

Unlike cats, cows have been largely spared. Illnesses have been reported in less than 10% of the cows in affected dairy herds, according to the USDA. Those that did develop symptoms experienced fever, lethargy, decreased appetite and increased respiratory secretions.

[[According to the USDA, Detections of Highly Pathogenic Avian Influenza in Mammals
The first case of H5N1 in red fox in the U.S. appeared on 05/05/2022.
The first case of H5N1 in domestic cats in the U.S. appeared on 03/25/2024.]]

Cow infections largely have been concentrated in the udders of lactating animals. Researchers investigating cat deaths at dairy farms with infected cows concluded the felines caught the virus from drinking raw milk.

[[This is another reason for drinking only pasteurized milk at the present time.]]

Researchers are still sorting out how the virus has been spreading from cow to cow, but studies suggest the main route of exposure is not the kind of airborne droplets associated with coughing and sneezing. Instead it’s thought to be direct contact, perhaps through shared milking equipment or spread by the workers who milk them.

Then there’s the issue of susceptibility. Flu virus need to be able to latch onto cells before they can invade them.

“If it doesn’t get into a cell, nothing happens. ... The virus just swims around,” explained Juergen Richt, a researcher at Kansas State University.

[[This virus is being transmitted by mosquito bites. An Infected mosquito bites a human and passes on some of the blood from the last animal/human it had bitten.]]

I have come to the realization that mosquitoes are the primary source of H5N1 infections for humans in the U.S. and other parts of the world. At this time, H5N1 has made the leap to mice and cats. These live in or nearby our homes. So only one step remains to infect humans and that is where mosquitoes come in play. They bite an animal or person infected with H5N1 and then go on to bite another animal or human and spread the disease.

So yesterday two things occurred relating to this subject.

First, I was bitten by a mosquito. Second, Around six hours after being bitten, the order that I placed through Amazon arrived. The order was for protecting myself from mosquito bites. Perhaps the rule Better Late Than Never will apply in this circumstance. I will dig a little deeper.

We were working outdoors moving dirt, gravel, blocks and drainage pipes in order to allow proper drainage on one area near my home. I was working outdoors wearing bluejeans. But I noticed a few hours latter that I had been bitten. I had a small bump just behind my kneecap and I immediately recognized this as a mosquito bite. There was a small area of swelling that lasted for about a day at the site of the bite.

Several hours later, a UPS truck drove up my yard and dropped off the mosquito repellents that I had ordered a few days earlier. The box contained two items.

The first was Sawyer Premium Insect Repellent. This contains Permethrin that can be applied to boots, clothing and camping gear. Sawyer Permethrin Clothing Insect Repellent not only repels insects, it actually kills mosquitoes, ticks, fleas chiggers, mites, spiders, and more than 53 other kinds of insects on contact. The treated clothing provides protection from insect bites for around 6 weeks.

The second was Repel 100 Insect Repellent. This contains very concentrated DEET (This is short for N,N-Diethyl-meta-toluamide). This liquid is applied to the skin directly. At this concentration 98.11%, it is very concentrated and will last for up to 10 hours. DEET have been used for more than 40 years by millions of people worldwide to repel mosquitoes, ticks, fleas, biting flies and chiggers.

Mosquitoes and other blood-feeding flies (such as black flies and deer flies) are attracted to hosts by skin odors and carbon dioxide from their breath. When a mosquito gets close to a host, DEET and some other repellents jam the insect's sensors and confuse the insect so it is unable to land and bite the host successfully. Repellents are effective only at short distances from the treated surface, so the user may still see mosquitoes flying nearby. As long as the user is not getting bitten, there is no reason to apply more DEET.

Ordinarily, the bites of mosquitoes and other insects are just a nuisance. However, in rare situations, an insect bite can transmit certain diseases such as West Nile virus, St. Louis encephalitis and California (LaCrosse) encephalitis.

In my humble opinion, H5N1 fits that description.

I was attacked today.
I was attacked about 50 times.
But I was prepared.
I had to work outside for many hours. It was very hot, humid and I was sweating. About 50 times, I could hear a mosquito fly away from my body after it had landed on my skin.
But I had treated my skin ahead of time with a few drops of DEET at key locations on my body.
If these mosquitoes had been infected with H5N1, I might have been a goner.
But instead, I was prepared and didn't get a single bit.

This youtube video describes in great deal how mosquitoes transmit viruses.

This is a recent article about H5N1 explosion among different species in the America's.

H5N1 Is Increasingly Adapting to Mammals - Elephant Seal Outbreak Marks First Transnational Spread of Highly Pathogenic Avian Influenza in Mammals

The study’s genomic analysis showed the virus is now evolving into separate avian and marine mammal clades in South America, which is unprecedented. There is growing concern that H5N1 viruses adapted to mammal transmission could jump to other species, including people.

“This is increased evidence that we should be alert, especially for marine mammals,” said co-leading author Marcela Uhart, a veterinarian with the U.C. Davis Karen C. Drayer Wildlife Health Center and its Latin America Program. “The more it adapts to mammals the more important it becomes for humans.”

Bird flu is rampant in animals. Humans ignore it at our own peril

Since it was first discovered in birds in 1996, H5N1 has shown itself to be a Swiss Army Knife of a virus, evolving the necessary tools to break into the cells of a growing list of species. So far, it has infected and killed millions of wild and farmed birds. It’s also been found in at least 26 different kinds of mammals, including, most recently in the United States — cows, cats and house mice.

The voraciousness of the virus prompted Dr. Jeremy Farrar, chief scientist of the World Health Organization in April to call it “a global zoonotic animal pandemic.”

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Naniot had seen wild birds come into Wild Instincts rescue with H5N1 — bald eagles, hawks and owls — but nothing had prepared him for the red fox kits.

The baby foxes were brought in stumbling and uncoordinated, making him think they might have gotten into some kind of poison. Then the seizures started.

“They would have these severe, severe seizures,” Naniot said. “Screaming very loud, whole-body tremors.”

The first seizures lasted for 20 to 30 seconds at a time. “And then it would get longer and longer and longer,” he said.

Naniot hadn’t known his young patients could get bird flu. Further research clued him in to the fact that foxes had recently joined a growing list of species that could succumb, usually after eating the flesh of infected dead birds.

“The severity of the seizures is something I really hadn’t seen before,” Naniot said. “It’s a very sad thing to see, the progression of the disease.”

Mosquito Bites

Mosquitoes appear to be the perfect transmission agent for H5N1.

H5N1 is making the transition from a bird diseases to an animal disease. Recently H5N1 has been showing up in mice and cats. These animals can be found in homes. But there is one more step to go through before we experience a human plague. That is where insects, primarily mosquitoes, come into the picture. They are able to spread the infection between species by their bites.

So I have been working around the house doing some hard labor for the past few weeks. I was bitten by a mosquito. Then I dropped a large concrete block on my foot. Not once but twice. I told my wife, I was finished for the day. Several hours latter the order that I placed for mosquito repellent arrived. So a couple days later, I picked up where I had left off. But this time I applied DEET to my body. I went back to work. Within the span of around 2 hours, I was attacked by around 50 mosquitoes. I could hear them as they flew off my body. But I sustained ZERO bites. The DEET performed its function of protecting me, EVEN THOUGH I HAD BLOOD WOUNDS on my foot.

By being wounded physically, the blood on my body made me a prime target. I had treated and covered my wound on my leg, but the mosquitoes could immediately smell the blood. What does this bring to mind? Avoid getting bitten by mosquitoes when H5N1 is on the move. Use insect repellent to keep them away. I also think that females during the time of their periods need to take extra precautions, to minimize mosquito bites.

We are only at the very beginning of the H5N1 pandemic. How virulent and damaging will this virus pose to humans is still unknown. It will shortly become evident. One of the tools that will be important to assess this threat is wastewater tracking.

Bird flu in Michigan: H5N1 Symptoms, what outbreak means for pets, why wastewater matters

Called highly pathogenic avian influenza, the H5N1 bird flu virus making headlines in Michigan and across the U.S. got its name because it is so well adapted to infecting and killing birds. H5N1 has been circulating in the U.S. since January 2022 and globally since 2021.

What has scientists and researchers worried, however, is that the virus is increasingly spilling over to infect other animals, such as seals and racoons, bobcats, foxes, cows and alpacas — and now, even humans — and how little we know about how widespread the infections actually are.

One tool that can be used to assess how much the virus is spreading in a community is to test the wastewater.

WastewaterSCAN, which is based at Stanford University, did just that. It monitors infectious diseases through wastewater systems, and, earlier this month, publicly posted the results of H5 influenza A virus testing of samples from 38 of the 50 states and the District of Columbia dating to May 21.

In WastewaterSCAN's testing, only six states had detections of the virus in the wastewater — California, Idaho, Iowa, Minnesota, Michigan and Texas — as of Monday. Of them all, Michigan was the only state with high levels detected at each of its six testing sites: Ann Arbor, Jackson, Jenison, Mount Pleasant, Traverse City and Warren.

In other regions of the world, the H5N1 virus has produced a 52% mortality rate in humans. Now this virus is spreading to North/South and Central America. We need to stay on top of this threat.

In other regions of the world, the H5N1 virus has produced a 52% mortality rate in humans. Now this virus is spreading to North/South and Central America. We need to stay on top of this threat. So what do we know about these deaths? One article discusses an H5N1 outbreak in Vietnam in 2004 and 2005. This breakout affected 18 people in Vietnam of which 13 were fatal and resulted in their deaths.

Bird flu’s deadly effects may give clues to treatment

Among the striking observations was a massive release of inflammatory cytokines, causing immune cells to proliferate and provoking inflammation. Some of these cytokines were present at amounts hundreds or thousands of times higher than in patients with ordinary flu.

These observations explain how the infection typically kills patients through pneumonia and multi-organ failure. So far the World Health Organization (as of the year 2006) has recorded 141 deaths from H5N1 flu, mostly in South East Asia.

According to Meno de Jong, of the Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, reported that of all the patients the ones who died from H5N1 had the highest levels of cytokines and the highest levels of virus circulating in their bodies. This underlined the need to treat victims with antivirals very quickly, he said. Once the cytokine burst had started it was usually too late to alter the course of the disease.

Another important discovery was that, in addition to stoking up some components of the immune system, H5N1 infection fatally weakened another arm of the immune response: the body’s ability to fight viral infection with T cells. The number of these cells, crucial for combating viruses, plummeted in people who died from the infection.

Wendy Barclay, a virologist at Reading University said “It shows us that in some people H5N1 causes this cascade of cytokines and macrophage activity that gets out of control. It suggests that stopping the virus replicating early on in the infection with antivirals is the key to treatment.” She then went on to say that treating patients with anti-inflammatory drugs, as some doctors have suggested, “might do more harm than good.” “Immunomodulatory drugs are blunt instruments. The last thing you want to do is weaken parts of the immune system needed to fight the virus,” she said.

Between 2003 and March 2024, the World Health Organization has recorded 888 cases of confirmed H5N1 influenza, leading to 463 deaths.

Source: Human mortality from H5N1

Here is an article from last year about H5N1. It provides a little history and details.

Avian influenza (‘bird flu’) is a highly transmissible and usually mild disease that affects wild birds such as geese, swans, seagulls, shorebirds, and also domestic birds such as chickens and turkeys. (CDC and NIAID), CC BY Bird flu FAQ: What is avian influenza? How is it transmitted to humans? What are the symptoms? Are there effective treatments and vaccines? Will H5N1 become the next viral pandemic?

Influenza viruses belong to the Orthomyxovirus family and are grouped into four species designated by the letters A (Alpha), B (Beta), C (Gamma) and D (Delta). Almost all influenza infections in humans are caused by influenza A and B viruses.

Influenza A viruses have been named avian (bird), swine (pig), equine (horse), canine (dog), chiropteran (bat) and human, based on their natural reservoir (the organism where they are most commonly found).

Avian influenza and other Influenza A viruses are categorized into subtypes according to the composition of their hemagglutinin (H) and neuraminidase (N) surface proteins. There are 18 known H types (H1 to H18) and 11 known N types (N1 to N11). The combination of an H type and an N type defines a specific influenza virus subtype (for example, H5N1).

How is avian influenza transmitted to humans? Avian influenza viruses are not easily transmitted from birds to humans or to other animals. Humans are accidental hosts — meaning that the virus does not typically circulate among people. Humans may acquire the virus after inhaling birds’ respiratory droplets or exposure of their mucus membranes to bird feces, saliva or contaminated surfaces.

Here is where they missed one key component of the transmission. It can be transmitted between animals/humans to other animals/humans by direct blood to blood transmission. This is done by insects, primarily mosquitoes. They suck the blood from one animal/human and deposit it in another. This is the transmission agent.

What are the signs and symptoms of avian influenza in humans? Infections caused by highly virulent forms of H5N1 or H7N9 subtypes may produce internal bleeding, multi-organ failure and a high mortality rate.

This article then goes on to state:

In 2007, the U.S. Food and Drug Administration (FDA) approved an H5N1 vaccine for adults ages 18 and older. These vaccines form part of the U.S. government’s Strategic National Stockpile (SNS) of medicines for deployment in the event of a public health emergency. In 2013, the FDA approved a second H5N1 vaccine that is also part of the SNS.

This is interesting. I wonder how effective this vaccine is and if the stockpiles still exist today in the event of a major outbreak?