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A new study lends weight to concerns that animal workers are more susceptible to bird flu than reported.
Gregory Gray, an infectious disease researcher at the University of Texas Medical Branch who led the study, said: “I'm pretty sure a lot of people we know are infected.” Posted online Wednesday and under review to be published in a well-known infectious disease journal. “This is mainly because our monitoring was very poor.”
When cases of bird flu are delayed, health officials fear they may be slow to recognize if the virus is more contagious. High numbers of infections outside of farmworker communities trigger the government's flu surveillance system, but by then it's too late to catch it.
“We have to figure out what we can do to stop this,” Gray said. “It's not just about going.”
The Centers for Disease Control and Prevention will base its decisions on surveillance. For example, the agency has bird flu vaccines on hand but has decided not to give them to farm workers, citing a small number of cases.
But avian flu testing remains rare among farmers, which is why Gray's research stands out as the first to look for signs of early, undiagnosed infections in people exposed to sick dairy cattle and those who are sick and recovered.
Gray's team previously found symptoms of bird flu in workers at two dairy farms in Texas earlier this year. Blood samples from 14 farm workers who had not been tested for the virus were tested and antibodies were found in two. That's nearly 15% of the more than 170 dairy farms affected by bird flu in 13 states this year.
One of the workers with antibodies was taking medication for a persistent cough when he allowed his blood to be tested in April. Another recently recovered from a respiratory illness. She did not know what caused it, but she told researchers that untested farm workers around her were also sick.
Richard Webby, director of the WHO Collaborating Center at St. Jude Children's Research Hospital in Memphis, Tennessee, said the results confirmed suspicions that the 13 cases of human bird flu reported by the CDC this year were understated.
“Maybe what we're seeing isn't exactly the tip of the iceberg, but it's certainly not the whole story,” Webby said.
Although small, the study provides new urgency Reports of unknown illnesses between farmers and veterinarians. The CDC warns that if people are infected with seasonal flu and bird flu at the same time, the two types of virus can exchange genes in a way that allows bird flu to spread easily between people as a seasonal strain.
There is no information as to what is happening now. And asymptomatic bird flu cases appear to be rare, a Michigan Antibody Research It was announced by the CDC on July 19. Researchers analyzed blood samples from workers at 35 dairy farms affected by the outbreak in Michigan, and none showed signs of missed infection. Unlike the study in Texas, these workers did not get sick.
“This is a small study, but it's a first step,” said Natasha Baghdasarian, CEO of Michigan Medicine. She said the state is stepping up efforts to vet farm workers, but said the efforts leave them vulnerable to being fired due to systemic issues such as heavy work and calling in sick.
Without more help for farmers and cooperation between the government and the animal industry, America risks being left in the dark about this virus.
“There's a lot of genomic studies and lab work, but farms are where the real action is, and we're not looking at it,” he said.
A dairy worker in Colorado told KFF Health News that he sought medical attention a month ago for eye irritation — a common symptom of bird flu. The doctor did a complete routine examination with urinalysis. But the farm worker had never heard of bird flu, and the clinic didn't mention it or diagnose the virus. “They told me I don't have anything,” he said in Spanish, speaking on condition of anonymity for fear of reprisals from employers.
This dairy worker and two in Texas said their employers did not provide goggles, N95 masks, or gowns to protect them from milk and other potentially contaminated fluids. Money is tight so buying their own gear is a tall order.
Like going to the doctor. A worker in Texas said he didn't seek care for a pounding headache and sore throat because he didn't have health insurance and couldn't afford the cost. He attributed the symptoms to working long hours in water-restricted barns. “They won't give you water or anything,” he said. “Bring your own bottles” But there's no way to know the cause of symptoms — bird flu or something else — without testing.
One-fifth of farm workers are uninsured. According to KFF analysisAnd a similar share have a household income of less than $40,000 a year.
The three farm workers hadn't heard about bird flu from their employers or state health officials, never mind testing supplies. The CDC boasted. Latest updateThrough a partnership with Meta, which owns Facebook and Instagram, Bird Flu's posts have flashed more than 10 million times on computer and smartphone screens.
Bethany Boggess-Alcauter, director of research and public health programs at the National Center for Farmworker Health, said such services are lost among farmworkers who scroll, don't speak English or Spanish, or don't have smartphones or Internet access. She and others said supplies of protective equipment from health officials had not reached the farms.
“We've heard that employers are reluctant to accept the offer,” said Christine Savye, policy and engagement manager at the Michigan Center for Immigrant Rights. “If this starts to spread easily from person to person, we're in trouble,” she said, “because farmers' homes are very crowded and poorly ventilated.”
Clinics can alert health authorities if sick farm workers need medical attention. But many farmworkers don't have health insurance and can't be fired.
“The biggest fear we hear is retaliation from employers or that someone might be blacklisted from other jobs,” Sauve said.
The CDC rates the current state of bird flu as a low public health threat because the nation's flu surveillance system has not raised alarming alerts.
The system monitors unusual increases in hospital visits. Nothing strange was found there. It also tests a subset of patient samples for unusual flu viruses. As of the end of February, the agency has evaluated nearly 36,000 samples. There is no bird flu.
However, epidemiologist Samuel Scarpino, who specializes in disease surveillance, says that this system misses many new health risks because, by definition, a relatively small number of infections start. About 200,000 people in the United States work on farms with livestock, according to the CDC. This is only 0.1% of the country's population.
Scarpino said the CDC's surveillance will be triggered if people start dying from bird flu. The 13 known issues are simple. And if the virus spreads beyond farm workers and their close contacts, the system will probably be upended – but by then it's too late to catch it.
“We don't want to find ourselves in another Covid situation,” Scarpino said, recalling how schools, restaurants and businesses had to close because the coronavirus was too widespread to control through testing and targeted individual isolation. “When we were dealing with cases, there were so many that we were left with only bad options,” he said.
Researchers have warned that the H5N1 bird flu virus has evolved to become more transmissible to mammals, including humans, over the past two years. This drives home the importance of monitoring what is happening as the outbreak spreads to dairy farms across the country.
The bird flu virus seems to be spread primarily through milk and milking equipment. But for the first time, researchers have reported In May And July Inefficiently diffusing through the air between a few laboratory horses a few inches apart. And in Cattle trialsSome cows have been infected by breathing in tiny droplets of the virus – something that can happen if an infected cow is in close contact with another.
Cows actually cough. The new study, conducted in Texas, showed that cattle in the outbreaks on farms coughed and showed other signs of respiratory illness.
Other observations were grim: half of the 40 cats on one farm died suddenly during the outbreak.
Most people who get bird flu are infected by animals. Gray sees hints in his new study that the virus may occasionally be transmitted from person to person, but adds that this is speculative. One of the two people with antibodies worked in the farm's cafeteria next to the milking center – with farm workers but not cattle.
“We need to find a way to have better monitoring so that we can make informed decisions instead of making decisions based on guesswork,” he said.