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In early March, Dr. Blake Hansen and his colleagues at The Texas Outbreak Public Health Institute was preparing for a fire drill.
What if a virus with the potential to trigger the next outbreak is found in the wastewater they control? And what about the H5N1 bird flu, which has killed millions of animals and nearly half of the 900 or so people worldwide over the past two decades?
What kind of exercise did you do on Monday? On Thursday of that week, Hansen's colleague Dr. Michael Tiza, a molecular virologist and microbiologist at Baylor College of Medicine in Houston, was sounding the alarm.
This time, there was no drill.
“Mike called me and said, 'Hey, I think I've got it,'” says Hansen, an epidemiologist at UTHealth Houston, who uses big data methods and genomics to diagnose infectious diseases.
It was March 7, nearly three weeks before the United States Department of Agriculture announced the H5N1 outbreak. Infected dairy cattle First time in Texas.
As the idea of sampling sewage systems for the virus that causes Covid-19 and other pathogens has caught on across the country over the past two years, the Texas Outbreak Public Health Institute — or TEPHI — took a different approach.
Researchers there decided to use sophisticated techniques and computers to screen for the vast genetic material in their wastewater samples, rather than just looking for specific viruses. By doing this, you can find viruses that you expect to see and never know to look for.
“We can capture every known virus in the sample, and then the computational team will analyze the data and see signals for multiple viruses, and I think that's an advantage we're doing over other sites,” Dr. Anthony Maresau, a molecular virologist and microbiologist at Baylor College of Medicine in Houston, envisioned the system. They said that their conscience saw it.
At least two other organizations have also been looking for signs of H5N1 in wastewater.
It is led by the WastewaterSCAN network. Researchers at Stanford and Emory universities and Verily, recently A pre-print has been posted By looking for a specific part of the virus, H.
In addition to the previous data, the team tested three additional sewage systems: one in North Carolina near an H5N1 cattle outbreak, one in a California city with an unseasonably high number of human influenza, and one in a city in Hawaii with no dairy processing plants and highly pathogenic bird flu. In the absence of diseases. In each case, the test was determined correctly in H5N1 infections. It has been so successful that WastewaterSCAN plans to use the test at the 190 wastewater sites it monitors.
The US Centers for Disease Control and Prevention also recently Launch the dashboard It shows areas with unusually high levels of influenza A viruses.
H5N1 is a type of flu virus, like some seasonal flu strains. Maresso said that currently identifying the A strain, which is on hiatus, is a reasonable proxy for H5N1, but it will be less useful when seasonal influenza re-emerges in the winter.
On the other hand, the TPI system can serve as an early warning for new viruses, preventing outbreaks. The group Since monitoring began in 2022, they have found more than 400 viruses in Texas wastewater.
Unlike removing a person's—or a cow's—body's privacy, wastewater monitoring is easy to see and doesn't depend on getting a permit for testing or getting someone to come to a clinic or emergency room, care that's out of reach. Farm workers. Researchers get data every time a person goes to the toilet, or perhaps when wastewater systems treat farm waste, such as the disposal of discarded milk.
The biggest obstacle to monitoring wastewater is that it is difficult to identify the source of pathogens.
Since March 4, the day H5N1 was first detected by the TEPHI team, the researchers found it in the wastewater of nine cities in Texas, all over the state. And they control in 19 out of 23 stations. They did not name the cities they tested in the study, but said they have notified local public health officials and the CDC. About their results.
Their findings as a A pre-publication studyBefore being examined by outside experts.
“We don't really know where it came from,” said Dr. Eric Borwinkle, dean of the UTHouston School of Public Health and director of TEPHI.
“We all have an idea, and some people have an idea that they like,” he said, noting that Texas is on the path of two major flight routes and has a large agricultural industry that includes poultry and cows.
But H5N1 has been ravaging wild and commercially raised flocks of birds in the U.S. since 2022, when the team began monitoring wastewater, and so far they haven't seen it in any of their samples.
“Definitely, something different now, that is,” Tiza said. It is commonly infecting dairy cows.
Only a person In connection with the occurrence of cattle for HIV. That person, a farm worker who had close contact with infected cows and grew up a A severe case of conjunctivitisOr redness and swelling of the eyes, but there is no breathing problem or Congestion. He was treated with antiviral drugs and recovered, according to public health officials.
The CDC says the risk to public health is currently low, but it is monitoring the situation closely.
The FDA recently tested 297 samples of dairy products purchased at grocery stores across the country. Broadly speaking Test results In a release Monday, the agency said it was responsible for the deaths of H. About 1 in 5 samples had signs of the virus, suggesting the outbreak may be more widespread than previously thought.
TEPI Director Maresso said they cannot rule out that what they are seeing is a virus spilled into milk or even a symptomatic human infection. He notes that they are not seeing an increase in the number of flu cases in hospitals, which indicates serious infections.
“If it's just one or two sites and we have some dairies or other processing plants near the plant we choose, it can be a puzzle that can be easily solved. He would explain things. But we've found that the symptom is almost everywhere and in every town up to this point,” said Maresau — even the biggest towns in the state aren't near dairy farms.
As for the trajectory of the Texas epidemic, whether it's getting worse or going away, Tiza says, it's hard to say. Early on, some cities had symptoms from H5N1 as strong as what their team's inspectors see from seasonal influenza in the winter.
“But overall, it's probably only 25 percent of that mark,” he said.
“In terms of overall direction, it's really kind on the plateau right now. He doesn't spit, he doesn't go. So it's interesting in itself,” she said. “And I'm sure you'll hear from us again if there's a big outcry.”