From the Chief Medical Officer: Key Takeaways from ASTHO’s HPAI Scientific Symposium

May 01, 2024 | Marcus Plescia, Jessica Baggett, Meredith Allen

While only one human case of Highly Pathogenic Avian Influenza (HPAI) has been reported in the United States this year, the discovery of transmission of HPAI in cattle has led to an increase in the need for federal, state, and local public health agencies to enter a heightened phase of readiness. The risk to the general population remains low but this change signals the need for an increase in collaboration, research, and communication.

Last week, ASTHO hosted a virtual symposium in partnership with the Infectious Diseases Society of America and the Council for State and Territorial Epidemiologists that featured public health leaders and scientists driving the U.S. government’s response to HPAI. Experts outlined potential actions for managing further spread and identified areas requiring additional investigation and guidance.

Using a One Health Approach is Critical

One Health recognizes that the health of people is closely connected to the health of animals and our shared environment. This is not a new concept but has become more important in recent years. The disciplines of public health and agriculture are inextricably linked. The symposium emphasized the importance of building and maintaining partnerships between CDC, USDA, FDA, ASPR, NIAID, and state and local public health departments. Recognizing the interconnectedness of these domains is essential for effective disease prevention and control.

Public Health Recommendations will Evolve with the Science

A key insight from the symposium was the dynamic nature of the situation. While we know a great deal about pandemic flu response, spread through dairy cattle is new. More in-depth epidemiologic studies will call out changes in transmission between cattle, people and cattle, and the potential for person-to-person spread. Collaboration between public health, agriculture, and farm owners will allow public health to gather epidemiologic data that can be translated into clear and data-supported recommendations to prevent continued transmission. As scientific understanding evolves and new evidence emerges, so must our public health response. As always, the public health community will commit to continuous learning, flexibility, and readiness to adjust strategies accordingly to ensure that interventions remain evidence-based and effective.

Assessing the Current State of Readiness

The supporting federal government response to HPAI appears to be well positioned; our federal partners don’t anticipate challenges with the commercial supply chain for personal protective equipment (PPE), vaccine, or therapeutics. The commercial system continues to be the primary source for PPE, but there are federal stockpiles available from ASPR, and the Food Safety and Inspection Service (FSIS) national veterinary stockpile. There is no indication of viral resistance to existing antiviral treatments and, in addition to commercial supplies, "tens of millions of courses" of Tamiflu area available through the strategic national stockpile should they be needed. CDC is providing ongoing surveillance of emerging flu strains and anticipates rapid availability of vaccine should infection begin to occur in workers in high-risk settings.

State and Local Public Health Officials are Increasing Planning and Coordination

The interface between public health agencies and state or local agriculture departments is critical. A public health response includes rapid situational awareness, laboratory testing, implementing public health recommendations around screening/isolation, and providing appropriate care (medications).

Questions and planning scenarios specific to health officials may include the following:

• How will your team determine whether people are exposed and, importantly, symptomatic?
• Who will you dispatch to the farm to obtain testing for those symptomatic individuals?
• What is your approach to case investigations?
• How will you engage in symptom monitoring in this population?
• On the laboratory side, how will specimens be transported to the public health lab?
• Are your laboratories ready to receive/run those specimens, even if they are, for example, conjunctival?
• If positive, how will that specimen be sent to CDC for confirmatory testing?
• If positive, how will you communicate the result to the individual and counsel them on isolation?
• How will Tamiflu be provided (if indicated)? From what cache?
• What is your communications plan if positive?

ASTHO will continue to work closely with our partners to monitor this situation and provide updates as they become available.