WHO DON: Ebola Virus Disease - Democratic Republic of the Congo (Sept 5th)

 

#18,865

Two days ago we looked at the WHO AFRO Announcement of A New Outbreak of Ebola In the DRC, which cited 28 suspected cases, and 15 deaths (4 HCWs), in the Bulape and Mweka health zones in Kasai Province, DRC.

This is reportedly the 16th Ebola outbreak in the DRC since 1976, and the first reported from the DRC since 2002.  Overall, roughly 3 dozen outbreaks have been reported over the past 4 decades, mostly from central and west Africa.

While most outbreaks are limited in size, twice in the past dozen years we've seen extended outbreaks with the number of deaths running into the thousands (2014-2016 & 2018-2020). 

Overnight the WHO published the first detailed DON (Disease Outbreak News) report on this latest outbreak.  For now, the WHO describes the National risk as high; regional risk is moderate; and the global risk remains low.

Due to its length, I've only posted the link and some excerpts (including the risk assessment).  Follow the link to read it in its entirety. 

Ebola virus disease - Democratic Republic of the Congo
5 September 2025

Situation at a glance

On 1 September 2025, WHO received an alert from the Ministry of Health of the Democratic Republic of the Congo (DRC) regarding suspected cases of Ebola virus disease (EVD) in the Bulape Health Zone, Kasai Province, DRC. The first known index case was a pregnant woman who presented at Bulape General Reference Hospital on 20 August 2025 with symptoms of high fever, bloody diarrhoea, haemorrhage and extreme weakness. She died on 25 August from multiple organ failure. 

On 4 September 2025, following confirmatory laboratory testing, the Ministry of Health declared an outbreak of EVD. Ebola virus disease is a serious, often fatal illness in humans. The virus is transmitted to humans through close contact with the blood or secretions of infected wildlife and then spreads through human-to-human transmission. As of 4 September 2025, 28 suspected cases, including 15 deaths (case fatality ratio (CFR): 54%), have been reported from three areas of the Bulape health zone (Bulape, Bulape Com and Dikolo) and Mweka health zone.

Among the deaths, four are health-care workers. About 80% of the suspected cases are aged 15 years and older. Six samples were collected from five suspected cases and one probable death from Bulape health zone and arrived on 3 September at the National Public Health Laboratory (INRB) in Kinshasa for confirmation testing.

All five samples tested positive for Ebola virus (EBOV) through GeneXpert and Polymerase Chain Reaction (PCR) assays on 3 September 2025. The Ministry of Health, with support from WHO and partners, is implementing public health response measures to contain the outbreak.

WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level.

(SNIP)

 WHO risk assessment

This is the 16th EVD outbreak in the DRC since 1976. The current outbreak occurs after almost three years without a confirmed EVD outbreak in the country. The last EVD outbreak in the country was declared on 15 August 2022 in Beni city, North Kivu province, with one single case reported who later died, and the MoH declared the end of the outbreak on 27 September 2022. In the Bulape district, the epicentre of the current outbreak, the last EVD outbreak was recorded in 2007.

This outbreak is occurring in a complex epidemiological and humanitarian context. The country is facing several outbreaks, including mpox, cholera, and measles. In addition, the country is experiencing a long-term economic and political crisis. The country's resources and capacity to effectively respond to the current outbreak are therefore limited.

The epicentre of this outbreak is in the proximity of the Tshikapa city, the capital city of the Kasai province, and the Angolan border (approximately 100 to 200 kilometres, depending on the nearest border crossing point). Although the affected district is a hard-to-reach rural area relatively far from the two main urban centres of Mbuji Mayi and Kananga, population movements between different parts of the province are frequent, especially between Bulape and Tshikapa.

In addition, epidemiological investigations are ongoing with transmission chains, and the source of the outbreak has not yet been identified; therefore, additional infected people cannot be ruled out. The date of symptom onset for the first case is not yet known, as well as the therapeutic itinerary prior to health facility consultation, which further increases the likelihood of an ongoing community transmission with further risk of spread to other health districts.

WHO assesses the overall public health risk posed by the current EVD outbreak as high at the national level, moderate at the regional level and low at the global level.

       (Continue . . . )
 

MMWR: HPAI H5N1 Infection In A Child With No Known Exposure - San Francisco, CA (Dec 2024-Jan 2025)

 
70 Confirmed H5N1 Cases - 7 Probable

#18,864

While the sharp decline in human infections with HPAI H5N1 in the United States over the past 7 months is somewhat reassuring, the reality is it requires a combination of both diligence and luck to detect community cases of novel influenza infection. 

It has been estimated in the past that less than 1-in-100 novel swine flu infections are picked up by passive surveillance (see CID Journal: Estimates Of Human Infection From H3N2v (Jul 2011-Apr 2012). 

Many with mild or moderate symptoms will not seek a doctor's advice, and among those who do, most will not be tested for novel influenza.  And of course, asymptomatic cases are almost certain to be missed. 

A year ago the ECDC issued guidance for member nations on Enhanced Influenza Surveillance to Detect Avian Influenza Virus Infections in the EU/EEA During the Inter-Seasonal Period, which cautioned:

Sentinel surveillance systems are important for the monitoring of respiratory viruses in the EU/EEA, but these systems are not designed and are not sufficiently sensitive to identify a newly emerging virus such as avian influenza in the general population early enough for the purpose of implementing control measures in a timely way.

While a little over two years ago, a study from the HKHSA (see UK Novel Flu Surveillance: Quantifying TTD) warned that it could take between 3 and 10 weeks - and anywhere between a few dozen to a few thousand community cases - before community spread would become apparent to authorities. 

So, while the recent lull in human cases may be reassuring, it may not fully reflect the situation on the ground.

Yesterday the CDC's MMWR published a long-awaited report on the investigation into a child's infection last December with HPAI H5N1 in California (see Presumptive Bird Flu Case Identified In San Francisco).

This is one of four cases (3 confirmed, 1 Probable) in the United States since mid-2024 where the source of infection remains unknown (i.e. no known exposure to dairy cows, poultry, wild birds, or other infected animals). 

While this investigation found `no laboratory evidence of human-to-human transmission among close contacts', the devil is always in the details.  

• Confirmation of the  child's H5N1 infection was delayed nearly 4 weeks (27 days) after the onset of illness, and contact tracing and testing occurred well past the time where valid PCR results would be expected. 

• Of 84 potential contacts,  67 met the CDC close-contact definition. But of those, only a small number were actually tested via PCR or serology (n=14).  In all, only 9 contacts were tested for post-exposure antibodies. 

 

FIGURE 2. Network analysis of human A(H5N1) influenza cases and possible contacts (N = 84)* — San Francisco, California, January 2025

In their analysis, the authors discuss these (and other) limitations - none of which are unique to this investigation - as we've seen previously:

WHO DON Update On Mexico's Fatal H5N1 Infection

NEJM: Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection

CDC: Serology Results On Missouri H5 Patient's Contacts (Updated)

In January of 2025, we looked at a CDC HAN: Accelerated Subtyping of Influenza A in Hospitalized Patients - and while some progress appears to have been made - it is unclear what the level of compliance is to these guidelines across the nation. 

And of course, these are only likely to capture hospitalized patients. Those attending clinics or private physicians are less apt to be tested for novel flu. 

While I've only posted some excerpts, the following MMWR report is well worth reading in its entirety, particularly for its detailed look at the challenges related to contact tracing and testing in the wake of a delayed diagnosis.

Highly Pathogenic Avian Influenza A(H5N1) Virus Infection in a Child with No Known Exposure — San Francisco, California, December 2024–January 2025

Weekly / September 4, 2025 / 74(33);522–527
 
Farrell A. Tobolowsky, DO1; Eric Morris, MPH1; Lina Castro, MPH1; Tina Schaff1; Monica Jacinto1; Joseph P. Clement, MS1; Min Z. Levine, PhD2; Julia C. Frederick, PhD2; Feng Liu, PhD2; Crystal Holiday, PhD2; Marie K. Kirby, PhD2; C. Todd Davis, PhD2; Krista Kniss, MPH2; Sonja J. Olsen, PhD2; Rahil Ryder, MS3; Debra A. Wadford, PhD3; Godfred Masinde, PhD1; George Han, MD1; A. Danielle Iuliano, PhD2; Seema Jain, MD1 

Summary

What is already known about this topic?

As of January 1, 2025, 37 human cases of highly pathogenic avian influenza (HPAI) A(H5N1) had been detected in California, none of which occurred in San Francisco.

What is added by this report?

On January 9, 2025, a case of HPAI A(H5N1) infection was identified in a school-aged child in San Francisco through enhanced surveillance (influenza A virus subtyping of a sample of specimens weekly). No source of exposure was identified, and investigations found no laboratory evidence of human-to-human transmission among close contacts.

What are the implications for public health practice?

Enhanced surveillance and timely subtyping of a subset of influenza A–positive specimens, including specimens from persons without known A(H5N1) exposure, are important to detect avian influenza A virus infections. Public health investigations are critical to monitoring for human-to-human transmission.

Article PDF


Abstract

In response to a highly pathogenic avian influenza (HPAI) A(H5N1) outbreak in U.S. dairy cows detected in March 2024, with subsequent identification of human cases, the San Francisco Department of Public Health instituted enhanced influenza surveillance (influenza A virus subtyping of a sample of specimens weekly) in June 2024. As of January 1, 2025, 37 human cases of influenza A(H5N1) had been detected in California, none of which occurred in San Francisco. 

On January 9, 2025, enhanced surveillance detected a human influenza A(H5N1) virus genotype B3.13 infection in a school-aged child in San Francisco with mild illness. Case investigation and contact tracing were conducted to ascertain exposures and detect possible human-to-human transmission. Activities comprised a household visit that included an environmental assessment, close contact interviews and surveys, and molecular and serologic testing. 

Sixty-seven close contacts (household, school, and health care) were identified. Upper respiratory tract specimens collected from seven asymptomatic household contacts and four symptomatic school contacts all tested negative for influenza virus by real-time reverse transcription–polymerase chain reaction (rRT-PCR). Although antibodies against influenza A(H5N1) were detected in the index patient, serologic testing of a convenience sample of nine close contacts identified no detectable A(H5)-specific antibodies.

Despite an extensive investigation, the infection source remains unknown; no human-to-human transmission was identified among close contacts by rRT-PCR and serologic testing. Continued enhanced surveillance and timely subtyping of a subset of influenza A–positive specimens are essential components of a comprehensive strategy to detect human novel influenza A virus infections, including among persons without known exposures to A(H5N1) viruses.

(SNIP)
 

Index Case Investigation

The index patient lived in an urban environment, did not travel, and had no reported exposure to dairy cows, cats, poultry, birds or other wild animals in the 10 days prior to the illness onset; the family had a pet dog. There were no animals at school, and the patient’s family did not work in occupations that increase risk for A(H5N1) virus infection (handling, slaughtering, defeathering, butchering, culling, caring for, or milking infected animals). A member of the patient’s family purchased raw poultry at a live bird market 2 weeks before the child’s illness onset; the poultry was cooked and consumed the same day it was purchased.
Investigation of Close Contacts

Among 84 persons identified as possible contacts of the index patient (seven household, 53 school, and 24 health care), 67 (80%) met the close contact definition (Figure 2). No household contacts reported illness. School absences were reported for 34 (64.2%) school contacts, 26 (76.5%) of whom were interviewed (one teacher and parents of 25 children). All interviewed parents reported respiratory illnesses in their children, including seven who were symptomatic at the time of interview. The teacher had had influenza-compatible symptoms but was asymptomatic at the time of interview. Four persons were tested for one or more respiratory viruses (COVID-19, RSV, or influenza) previously while ill; all test results for influenza were negative. Among the 24 health care worker contacts from three facility visits (two urgent care, one emergency department), 11 (45.8%) completed a survey, including seven who had close contact with the patient; none reported influenza-compatible symptoms. All 11 available respiratory (oropharyngeal and nasal) specimens from close contacts (seven household and four school) were A(H5)-negative by rRT-PCR.

Serum specimens were collected from the index patient (32 days from onset to convalescent serum collection), three adult household contacts, two school contacts, and four health care contacts. Among these nine contacts, the median interval between their first exposure to the index patient and serum collection was 45 days (range = 9–47 days), and the median interval between their last exposure and serum collection was 26 days (range = 0–46 days). The patient had antibodies to all three wild-type A(H5N1) viruses, with elevated antibody titers in all assays, consistent with recent H5N1 infection: A/Texas/37/2024 (B3.13) (MN titer = 160, HI titer = 320); A/Michigan/90/2024 (B3.13) (MN titer = 320, HI titer = 226); and A/Washington/240/2024 (D1.1) (MN titer = 113, HI titer = 320). All nine close contacts’ serology results were negative for all three wild-type A(H5N1) viruses.

Discussion

Although no exposure was identified, clinical presentation, molecular testing, and positive serology with elevated antibody titers confirmed HPAI A(H5N1) infection in this child. The absence of laboratory (molecular and serologic) evidence of current or recent A(H5N1) virus infection among close contacts suggests no human-to-human transmission. At least two other U.S. patients with confirmed A(H5N1) infection, including another unrelated pediatric patient in the San Francisco Bay Area, had no known exposure to A(H5N1) virus–infected domestic poultry, wild birds, dairy cows, or other infected animals (3,4).

Although no dairy processing facilities are located in San Francisco, the city is situated on a migratory bird route, and in 2024, A(H5) virus was detected in a live bird market, wild birds, and San Francisco wastewater (H5N1 bird flu detected in SF, first in California city wastewater). Although the family purchased poultry at a live bird market (the child did not accompany them to the market), the parents were confident that the child was not exposed to raw poultry, recent A(H5) testing in the market was negative, the cooked poultry consumption occurred more than 2 weeks before the child’s symptom onset, and neither parent had evidence of infection, arguing against infected poultry exposure as the source. Although no wild bird exposure was reported, the child did spend time outside at school; therefore, environmental exposure is theoretically possible. As there were no clear risk factors or exposure to A(H5N1) virus, the infectious source remains unknown.

The genetic differences between the patient’s two positive specimens collected at separate time points likely reflect replication in the child during the intervening 25 days. Persistently positive influenza PCR test results have been previously reported, yet the duration of A(H5N1) viral nucleic acid detection and infection in humans is unknown and likely varies with virus and host factors (9). Although the second (oropharyngeal) swab collected from the patient was positive for A(H5N1) 4 weeks after the first, sequencing did not reveal mutations indicating mammalian adaptation.

Limitations

The findings in this report are subject to at least three limitations. First, because this case was identified through enhanced surveillance, which at the time included batch testing, there was a delay between specimen collection and the influenza A virus subtyping that led to detection of the case: as a result, the investigation occurred after the patient’s illness had resolved and at the end of the 10-day monitoring period for close contacts, subjecting interviews to recall bias and limiting public health interventions such as real-time testing, isolation, antiviral treatment, and postexposure antiviral prophylaxis.

Second, it was not possible to interview or collect respiratory and serum specimens from all close contacts; therefore, assessment of signs and symptoms and immunologic response was not comprehensive. 

Lastly, although household and health care contacts were assessed for asymptomatic infection, only symptomatic school contacts received molecular or serologic testing; thus, asymptomatic infection might have been missed.

Implications for Public Health Practice

A(H5N1) virus infections in humans without a clear animal exposure have rarely occurred in the United States (CDC Confirms H5N1 Bird Flu Infection in a Child in California) but have been documented in other countries where A(H5N1) viruses have circulated in wild birds for years. Continued enhanced surveillance and real-time subtyping of a subset of influenza A positive specimens at public health laboratories, including among persons without known risk for exposure to A(H5N1) virus, is an important part of comprehensive novel influenza surveillance strategies (Summer 2025 Influenza Surveillance).

Although the child had no known dairy cow exposure, sequencing results indicated that this case was associated with the 2024–2025 California dairy cow outbreak. The B3.13 genotype associated with this outbreak has also been detected in birds and felines (10), highlighting the continued transmissibility of the virus across susceptible species. Given the wild and domestic animal reservoirs for A(H5N1), a continued One Health approach supports surveillance of wild and domestic animal reservoirs for identification of additional animal cases and risk factors for cross-species and animal-to-human transmission.

WHO AFRO Announces A New Outbreak of Ebola In the DRC

 

#18,863

While there have been scattered media reports, and some preliminary press releases from the local health authorities (see FluTracker's Thread) over the past 24 hours, today the WHO African Regional Office officially recognized an outbreak of Ebola in the DRC. 

At this point in time there are 28 suspected cases, and 15 deaths (4 HCWs), in the Bulape and Mweka health zones in Kasai Province. The virus has been identified as Ebola Zaire. 

The official announced from the WHO follows.

Democratic Republic of the Congo declares Ebola virus disease outbreak in Kasai Province
04 September 2025

Kinshasa – Health authorities in the Democratic Republic of the Congo have declared an outbreak of Ebola virus disease in Kasai Province where 28 suspected cases and 15 deaths, including four health workers, have been reported as of 4 September 2025.

The outbreak has affected Bulape and Mweka health zones in Kasai Province where health officials have been carrying out investigations after the cases and the deaths reported presented with symptoms including fever, vomiting, diarrhoea and haemorrhage. Samples tested on 3 September at the country’s National Institute of Biomedical Research in the capital Kinshasa confirmed the cause of the outbreak as Ebola Zaire caused by Ebola virus disease.

A national Rapid Response Team joined by World Health Organization (WHO) experts in epidemiology, infection prevention and control, laboratory and case management has been deployed to Kasai Province to rapidly strengthen disease surveillance, treatment and infection prevention and control in health facilities. Provincial risk communication experts have also been deployed to reach communities and help them understand how to protect themselves.

Additionally, WHO is delivering two tonnes of supplies including personal protective equipment, mobile laboratory equipment and medical supplies. The area is difficult to reach, taking at least one day of driving from Tshikapa (the provincial capital of Kasai), with few air links.

“We’re acting with determination to rapidly halt the spread of the virus and protect communities,” said Dr Mohamed Janabi, WHO Regional Director for Africa. “Banking on the country’s long-standing expertise in controlling viral disease outbreaks, we’re working closely with the health authorities to quickly scale up key response measures to end the outbreak as soon as possible.”

Case numbers are likely to increase as the transmission is ongoing. Response teams and local teams will work to find the people who may be infected and need to receive care, to ensure everyone is protected as quickly as possible.

The country has a stockpile of treatments, as well as 2000 doses of the Ervebo Ebola vaccine, effective to protect against this type of Ebola, already prepositioned in Kinshasa that will be quickly moved to Kasai to vaccinate contacts and frontline health workers.

The Democratic Republic of the Congo’s last outbreak of Ebola virus disease affected the north-western Equateur province in April 2022. It was brought under control in under three months thanks to the robust efforts of the health authorities. In Kasai province, previous outbreaks of Ebola virus disease were reported in 2007 and 2008. In the country overall, there have been 15 outbreaks since the disease was first identified in 1976.

Ebola virus disease is a rare but severe, often fatal illness in humans. It is transmitted to people through close contact with the blood, secretions, organs or other bodily fluids of infected animals such as fruit bats (thought to be the natural hosts). Human-to-human transmission is through direct contact with blood or body fluids of a person who is sick with or has died from Ebola, objects that have been contaminated with body fluids from a person sick with Ebola or the body of a person who died from Ebola.

FDA Issues New Warning On H5N1 Detected In Cat Food

#18,862

Yesterday the USDA added a domestic cat from San Francisco to their Mammals with H5N1 list, with a collection date in July and a confirmation date in late August, making the 3rd cat in a month added to the list (see screenshot below).

While we rarely get details on these cases (145 domestic cats reported to date), late yesterday the FDA issued a new warning on contaminated (raw, frozen) cat food, which is believed linked to this latest death. 

Since late last year we've seen a spate of similar reports, including:

NYC DOH Update: H5N1 In Cats Linked To Raw Food & Suspected Cat-to-Cat Transmission

Washington State (WSDA) Announces 2 Households with H5N1 Infected Cats Linked to Raw Food

Oregon Dept. of Agriculture Statement On H5N1 In Domestic Cats - WSDA Health Alert on Raw Pet Food

LA County Animal HAN: H5 Bird Flu Confirmed in Three Additional Domestic Cats in LA County & in One Commercially Available Raw Pet Food Product

Last January US FDA Issued New Requirements For Pet Food Manufacturers - APHIS Updates Turkey Surveillance Policies, although it left the corrective steps largely up to the manufacturers (see snippet below).

Under the PCAF requirements, animal food businesses must conduct a reanalysis of their food safety plan when the FDA determines it is necessary to respond to new hazards and developments in scientific understanding.

The FDA has determined that it is necessary for cat and dog food manufacturers covered by the PCAF rule, who are using uncooked or unpasteurized materials derived from poultry or cattle (e.g., uncooked meat, unpasteurized milk, unpasteurized eggs) in cat or dog food, to reanalyze their food safety plans to include H5N1 as a new known or reasonably foreseeable hazard.

Admittedly, there are limits to what a manufacturer can do to prevent H5N1 contamination of raw milk, dairy, and poultry products. The only safe assumption is that raw food products carry more inherent health risks than pasteurized, or cooked products.

According to Whole Genome Sequencing (WGS), this incident is linked to the Bovine B3.13 genotype of H5N1, which is primarily found in dairy cows, but has spilled over into poultry on occasion. 

The press release from the USDA (below) curiously states this B3.13 genotype ` . . .  involves a virus lineage that was detected from about November to December 2024 and is no longer circulating' - which based on the data provided, is hard to explain - as the B3.13 genotype has been reported in dairy cattle well into 2025. 

It also appears, based on the dates provided by the USDA, that this cat died sometime in July, and we are only now being informed about it. 

The full statement from the FDA follow. 

FDA Notifies Pet Owners That Tests Show H5N1 Contamination in Certain Lots of RAWR Raw Cat Food Chicken Eats

CVM Updates

Following up on a case of H5N1 Highly Pathogenic Avian Influenza in a cat, testing performed by the U.S. Food and Drug Administration, state and local public health and agriculture partners, and federal partners suggests a link between the strain of H5N1 virus detected in the cat and in certain lots of RAWR Raw Cat Food Chicken Eats, a product the cat consumed before falling ill. FDA is sharing information about the testing for public awareness. The agency continues to investigate and will update this notice should new information become available.

Summary

• FDA has found that certain lots of RAWR Raw Cat Food Chicken Eats sliders tested positive for H5N1. The affected lots are Lot CCS 25 077 (Sell By 09/18/26) and Lot CCS 25 093 (Sell By 10/03/26).

•  The San Francisco Department of Public Health (SFDPH) was notified a cat that ate product from Lot CCS 25 093 became ill with H5N1 and was euthanized. After initial polymerase chain reaction (PCR) testing of the open product sample from Lot CCS 25 093 collected from the pet owner by SFDPH detected H5N1, confirmatory PCR testing and subsequent whole genome sequencing (WGS) of a diagnostic sample from the cat and the open product sample from Lot CCS 25 093 were performed by USDA National Veterinary Services Laboratories (NVSL).

• FDA collected and tested two retail samples of the same RAWR Chicken Eats product with a different lot number (CCS 25 077) and Sell By date (09/18/26). Both samples were positive for Influenza A Virus, and WGS was performed on one sample, which was also positive for H5N1.

• FDA is concerned about the lots of RAWR Raw Cat Food Chicken Eats described above because whole genome sequencing suggests the H5N1 detected in the now-deceased cat and in Lots CCS 25 093 and CCS 25 077 of the Chicken Eats product originated from a common source of contamination.

• WGS results also indicated that H5N1 from all three samples were within the same WGS cluster, indicating relatedness. The cluster involves a virus lineage that was detected from about November to December 2024 and is no longer circulating, supporting that the cat became ill from eating Lot CCS 25 093 of the Chicken Eats product.

• NVSL testing of the cat, Lot CCS 25 093, and Lot CCS 25 077 identified the H5N1 as genotype B3.13. The B3.13 genotype virus has previously been found in other brands of raw poultry-based pet foods that were associated with the illness or death of cats.

• FDA is not aware of any human cases of HPAI contracted through exposure to contaminated pet food.

About H5N1 Highly Pathogenic Avian Influenza in Cats and Dogs

H5N1 is a virus that can cause illness and death in birds/poultry and mammals such as domestic cats and large felids, like panthers, bobcats and mountain lions. Dogs can also contract HPAI, although they usually exhibit mild clinical signs and low mortality compared to cats. At present, HPAI has not been detected in dogs in the United States, but there have been fatal cases in other countries. The United States Department of Agriculture’s Animal and Plant Health Inspection Service maintains a list of animals that have tested positive for the virus.

Animals who are very young, very old, or have weak immune systems are especially at risk of contracting HPAI.

According to the American Veterinary Medical Association, you should seek veterinary care if your cat or dog appears to have any of the following signs:

• Fever
• Lethargy
• Low appetite
• Reddened or inflamed eyes
• Discharge from the eyes and nose
• Difficulty breathing
• Neurologic signs, like tremors, seizures, incoordination, or blindness

While no human H5N1 infections have been identified among people from handling raw pet food products, humans can become infected if active virus gets into their eyes, nose, or mouth. It is important for people to wash their hands after handling any pet food products and sanitize contact surfaces.

Information about Products Tested

RAWR Raw Cat Food Chicken Eats, Sell By 09/18/26, is sold frozen in 2.5-pound resealable plastic bags containing 40 1-ounce sliders. The product is sold in retail stores nationwide and online. The bags are yellow and white with black lettering. This product is also marked with lot code CCS 25 077, printed in the center on the back of the bag.

RAWR Cat Food Chicken Eats, Sell By 10/03/26, is sold frozen in 2.5-pound resealable plastic bags containing 40 1-ounce sliders. The product is sold in retail stores nationwide and online. The bags are yellow and white with black lettering. This product may also be marked with lot code CCS 25 093.

 

South Korea MOE: Strengthening the Safety of Field Response Personnel for Avian Influenza in Wild Birds

#18,861

With another seasonal surge in HPAI H5 expected in the coming weeks or months, two days ago South Korea's CDC Announced A 19-day, Nationwide, Mock-Training Exercise to Prepare for Zoonotic Influenza.   

Over the past several years we've seen an uptick in avian, mammalian, and  human infections - from both clade 2.3.4.4b and 2.3.2.1x viruses - raising concerns over their growing zoonotic potential. 

While no one can truly know how close we might be to an avian flu pandemic, many countries take the risk seriously.  A few recent cautionary reports include:

Preprint: Genetic Reassortment and Diversification of Host Specificity Have Driven Evolutionary Trajectories of Lineages of Panzootic H5N1 Influenza

Preprint: Quantifying H5N1 Outbreak Potential and Control Effectiveness in High-Risk Agricultural Populations

PNAS: Three things we can do now to reduce the risk of avian influenza spillovers

Frontiers: HPAI: Pandemic Preparedness for a Scenario of High Lethality with No Vaccines

Today South Korea's Ministry of Environment issued the following statement on new steps (effective starting tomorrow, Sept 4th), to be taken to increase the safety of personnel dealing directly with avian influenza, and to ensure a more coordinated and efficient quarantine response.

Some of the key points mentioned:

Enhanced Protection for Personnel 

• Mandatory seasonal flu vaccination for field responders.
• Use of  personal protective equipment (PPE) (gloves, masks, etc.).
• 10-day health monitoring following culling or handling potentially infected birds, with immediate reporting if symptoms develop.

New Reporting & Response requirements

• Streamlined reporting of wild bird disease events to local governments and the National Institute of Wildlife Disease Management.
• Centralized precision testing at the National Wildlife Disease Control and Prevention Agency for efficiency and expertise.

Stricter Crisis Management

• Even in the caution stage, serious measures can be applied if  HPAI is detected.
• Local governments to set up warning signs, disinfection stations, and barriers in outbreak areas.
• Regional environmental offices to inspect and oversee quarantine compliance.

The full (translated) news release follows. I'll have a brief postscript after the break. 

Strengthening the safety of field response personnel for avian influenza in wild birds
Registrant name Hwang Ui-jeong
Department name Natural Ecology Policy Division
contact044-201-7491 
Registration date 2025-09-03

▷ Revised Standard Action Guidelines for Avian Influenza in Wild Birds for the 2025-2026 Winter Season

▷ Safe and effective quarantine response by supplementing human infection prevention guidelines for field response personnel.

The Ministry of Environment (Minister Kim Sung-hwan) announced that it will revise the 'Wild Bird Avian Influenza Standard Operating Procedure (AI SOP)' to enable safer and more effective responses in the field when avian influenza (AI) occurs in wild birds and distribute it to local governments and other relevant organizations starting September 4.

This revision focuses on infection prevention for field response personnel and efficient response at quarantine sites, given the potential for avian influenza in wild birds to develop into a zoonotic disease. Recent overseas cases of highly pathogenic avian influenza infecting mammals and humans, and the discovery of avian influenza virus in wild mammals in Korea in March of this year (2025), have led to improvements to existing systemic deficiencies.

First, these revised guidelines supplement the human infection prevention guidelines that must be followed by avian influenza response personnel, including field investigators and migratory bird surveyors.

Field response personnel for avian influenza should be vaccinated against seasonal influenza and wear personal protective equipment, including gloves and masks. Those involved in culling should monitor their health for at least 10 days. If clinical symptoms such as fever, muscle pain, or conjunctival congestion appear, they should avoid external contact and report the situation to the health authorities.

Additionally, the reporting and response system for wild bird diseases has been reorganized. Procedures have been improved to ensure that any carcasses or suspected cases of avian influenza are immediately reported to the local government and the National Institute of Wildlife Disease Management for prompt quarantine measures.

At the same time, precision testing for avian influenza was centralized at the National Wildlife Disease Control and Prevention Agency to increase testing efficiency and expertise.

In addition, measures for each institution were clarified so that even in the crisis stage (caution), if highly pathogenic avian influenza occurs, it can be managed in a manner similar to the serious stage.

Local governments have implemented quarantine measures such as installing warning signs, barriers, and disinfection platforms around outbreak areas, and regional environmental offices have established a systematic management foundation by inspecting the quarantine management status of local governments.


Meanwhile, the Ministry of Environment has established a legal framework for limited rescue of suspected avian influenza cases at wildlife rescue centers equipped with or receiving support for isolation and containment facilities, such as negative pressure cages*, to prevent the spread of disease.

Previously, rescues were prohibited within a 500-meter radius of a highly pathogenic avian influenza outbreak, but this revision allows for more flexible and safer rescue activities. The Ministry of Environment plans to conduct a pilot project using negative pressure cages at the South Chungcheong Wildlife Rescue Center this month and, based on the results, consider expanding the use of negative pressure cages.

* A facility that forms negative pressure inside the cage (with built-in fumigation and disinfection function) to prevent the leakage of air and viruses to the outside, and to isolate and treat suspected infected individuals from general individuals.

In addition, quarantine compliance management will be strengthened in conjunction with the revised "Act on the Management of Zoos and Aquariums" and the licensing system for breeding and exhibition facilities. For public facilities like Seoul Grand Park, the regional environmental office will be responsible for inspecting the implementation of the "Avian Influenza Quarantine Management Plan," while for private facilities, local governments will be responsible for inspecting the implementation of the plan. This will enhance the effectiveness of the system.

Kim Tae-oh, Director of the Ministry of Environment’s Nature Conservation Bureau, said, “This revision will enable field response personnel to avian influenza to respond systematically and safely,” and added, “Starting with the coming winter season, we will reflect this revision to strengthen quarantine measures and closely cooperate with related organizations such as the Ministry of Agriculture, Food and Rural Affairs and the Korea Disease Control and Prevention Agency to effectively block and respond to the occurrence and spread of avian influenza, including through rapid information sharing.”

       (Continue . . . )

While we've seen similar recommendations from the USDA and the CDC - which are primarily advisory agencies - meaning that many of their guidelines are non-binding (see MMWR: PPE Use by Dairy Farm workers Exposed to Cows Infected with HPAI A(H5N1) Viruses — Colorado, 2024)..

 

South Korea's MOE, MAFRA, and CDC all have considerably more regulatory clout, making these requirements more likely to be enforced. 

While South Korea isn't alone in addressing the threat (see Taiwan APHIA Launches "Strengthening Autumn and Winter Avian Influenza Prevention Measures"), the reality is, most of the world continues to watch, wait, and hope.

The $64 question this fall - as it has been for several years - is in what form will  HPAI H5 return (see H5Nx: Reassort & Repeat). While an attenuation of the avian flu threat is always possible, in recent years the trajectory has been towards greater diversity, and increased zoonotic risks. 

And it is not as if HPAI H5 is the only pandemic threat out there. It has plenty of company, and the only thing we can be sure of is that another pandemic is inevitable. 

The only thing we can really control is whether we'll be prepared for it when it comes.

UKHSA: Rule Changes Allowing Doctors & Pharmacists Greater Latitude In Prescribing Flu Medications

Credit UKHSA

#18,860

Now that it is September our attentions are once again focused on the upcoming Northern Hemisphere flu season, and while it is impossible to predict how severe it may be, there are a number of worrisome signs. 

• First, Australia has reported a pretty severe flu season (link), which Dr. Ian Mackay has chronicled in his Virology Down Under blog (see  A Flunami in July). 

• Second, last week Denmark reported An Unusually Early Major Outbreak of Influenza A (H1N1), which displayed unspecified `unique changes'. 

• Third, the UK has seen an unusual surge in avian flu outbreaks in poultry this summer, which increases the risks of human exposure. 
• Fourth, the UK has seen a steady increase in flu severity over the past  couple of seasons, with 2023 being more severe than 2022, and 2024 being more severe than 2024. 

Yesterday (Sept 1st) the UK's Health Security Agency (UKHSA) released several documents outlining changes in this year's flu prevention and treatment policy.  

First, eligibility for this year's flu vaccine has been expanded (see Your guide to who’s eligible for the autumn 2025 flu vaccine).  Essentially:

The NHS recommends flu vaccination for several groups:

From 1 September 2025

• pregnant women
• all children aged 2 or 3 years on 31 August 2025
• children with certain long-term health conditions (aged 6 months to less than 18 years)
• primary school aged children (from reception to Year 6)
• secondary school aged children (from Year 7 to Year 11)
• all children in clinical risk groups aged from 6 months to under 18 years

From 1 October 2025 

• everyone aged 65 years and over
• individuals aged 18 to under 65 with certain long-term health conditions
• care home residents
• carers in receipt of carer's allowance, or those who are the main carer of an elderly or disabled person
• those living with people who are immunocompromised
• frontline health and social care workers

In years past, influenza antivirals have only been made available during the `regular' flu season (October–March), and could only be released out-of-season if their CMO (Chief Medical Officer) issued an annual letter of confirmation. 

While exceptions could be made, GPs and pharmacists had to go through  bureaucratic appeals, which could delay treatment. A serious concern - because to be most effective - antivirals should be given in the first 48 hours on an illness. 

While this doesn't give UK pharmacists carte blanche to prescribe antivirals, it does remove a number of  (mostly seasonal) barriers.  First the press release, after which I'll have a postscript.

Government to combat flu outbreaks by removing red tape

The government will remove red tape, allowing doctors and pharmacists to prescribe flu medicines year-round to reduce winter pressures and protect the NHS.

From:Department of Health and Social Care, UK Health Security Agency and Stephen Kinnock MP Published1 September 2025

• Rule change will allow doctors and pharmacists to better respond to flu outbreaks
• Patients will get access to vital treatment for flu whatever time of the year
• Government reducing restrictions and slashing bureaucracy to help save lives and protect the NHS

Patients will get the flu medicines they need more quickly and at any time of the year, thanks to government changes to prescribing regulations.

As part of its commitment to reduce winter pressures and protect the NHS, the government is removing the restriction that means certain flu medications cannot begin to be prescribed outside the usual ‘flu season’ until an annual letter of confirmation from the Chief Medical Officer is received, which can lead to delays in treatment.

These rules are being removed so action can be taken to tackle flu all year round. This will allow patients to receive treatment sooner and ease winter pressures by allowing outbreaks to be contained.

The move is part of the government’s ongoing drive to slash unnecessary bureaucracy in the health service through the red tape challenge and put power back in the hands of clinicians on the frontline.

It coincides with the NHS launching this year’s improved flu vaccine programme today (1 September 2025). The autumn rollout kicks off with flu vaccines for millions of children and pregnant women. And it follows the recent introduction of the chickenpox vaccine for thousands of children and the RSV vaccine for pregnant women and older adults across the country, as the government continues building the NHS’s defences ahead of winter.

Health Minister, Stephen Kinnock, said

Flu can strike all year round, so it doesn’t make sense to restrict doctors and pharmacists from taking action to protect the most vulnerable in their communities.

That’s why, as well as starting the flu vaccination programme today, we are also removing the need for clinicians to have to ask for permission to prescribe what their patients need.

It is exactly the type of change we wanted to see when we launched the red tape challenge to bulldoze bureaucracy and prioritise patients over paperwork.

While the number of flu outbreaks outside of the ‘flu season’ in October to March is relatively low, the potential outcomes are no less severe. Removing these barriers now will enable the NHS to respond more quickly to health challenges year-round, strengthening its preparation for winter.

Until now GPs and pharmacies had to be commissioned via a patient-specific direction to prescribe certain medicines, which led to delays. It also meant clinicians could prescribe some medicines and not others.

The reasons for the restrictions no longer apply, and removing them means clinicians can provide the right treatment at the right time to patients. Specifically this change will allow oseltamivir (Tamiflu®) and zanamivir (Relenza®) to be prescribed and dispensed outside the flu season.

These antivirals are recommended for treatment of those at highest risk of severe disease outside of the flu season, following a confirmatory test for flu. They are also recommended to prevent disease in specific settings such as care homes where confirmed cases of flu have occurred.

Dr Jamie Lopez Bernal, consultant epidemiologist for immunisation at the UK Health Security Agency, said:


While the majority of influenza cases and outbreaks occur during the flu season, we do continue to see outbreaks outside the peak period.

These changes will allow primary care providers and health protection teams to respond more rapidly with effective treatment to reduce the risk of severe disease and the spread of infection at any time of year.

As the flu vaccination programme gets underway, vaccine teams are working across the country to make it as easy as possible for those eligible to get their jabs - with some school providers now offering vaccines in nursery settings for 2 to 3 year olds for the first time ever.

Expectant mums and all children aged 2 to 16 are eligible for the flu vaccine, expanding to 6 months to 18 years old for those in clinical risk groups.

The NHS national booking system also opens today for all eligible individuals to book their winter flu and COVID-19 vaccinations, with appointments starting from 1 October

These steps are all being promoted as part of a national strategy to reduce impact of the winter respiratory season's on the NHS.  In recent years, hospitals have been in crisis mode for months at a time, with long waits in A&E, lengthy ambulance handover delays, and increased reliance on `corridor care'. 

Over the summer the NHS released a new `10 year health plan'  to deal with this perennial crisis, which is summarized in:

Urgent and emergency care plan 2025/26

A lot will depend upon what kind of flu/COVID/respiratory season emerges. HPAI H5N1 is a wild card, as are any new COVID variants. Seasonal flu can sometimes show us new tricks (see When Seasonal Influenza Goes Rogue), and Norovirus (aka `winter vomiting bug') often exacerbates the problem. 

It is axiomatic that a hospital is `no place for a sick person', and that goes double during flu season.  

Making anything you can do (vaccines, facemasks, hand sanitizer, etc.) to reduce your risks of infection, more than worth the effort.