Yes, summer doesn't officially begin for almost another 3 weeks (June 20, 4:51 PM EDT is summer solstice where I am), but it's a relatively stagnant time for infectious diseases now. It's sort of nice to view the maps and graphs right now. Just bask in the green of influenza-like activity:
I've mentioned recently that covid and other tracking systems are now ramped down in many jurisdictions, so we're mostly back to crystal ball predictions. Wastewater data, now including influenza in addition to SARS-CoV-2 and mpox, can be helpful in anticipating disease surges, but as you can see in the example below for influenza A, we have almost no data for most of the country - the gray dots aren't reporting.
And, speaking of flu ....
Avian Flu
If you aren't in close contact with fowl (includes backyard poultry aficionados) or cattle, you don't have much to worry about influenza A H5N1. Still, we did see our third human case in the US last week, this time from another dairy farm worker in Michigan who was exposed to infected cows. Symptoms seemed mild but were slightly different from the 2 previous cases that only had conjunctivitis. This third individual complained of cough and eye discomfort with watery discharge and was afebrile. He was treated with oseltamivir.
Front line clinicians assessing anyone for respiratory illness, including conjunctivitis, should ask about close contact with sick or dead animals, particularly wild or domestic birds, wild mammals, and domesticated animals including cows.
The World Organisation for Animal Health now lists 26 different groups of animals confirmed positive for avian influenza A H5N1 across the US:
Wild animals: coyote, Virginia opossum, feral cat, gray seal, bobcat, Mephitidae unidentified (includes skunks and stink badgers), striped skunk, American mink, tiger (where was a wild tiger in the US?), harbor seal, northern raccoon, puma, bottlenose dolphin, American black bear, brown bear, polar bear, red fox, Amur leopard (again, in the wild in the US?), fisher, American marten, and Abert's squirrel
Domestic animals: Camelidae (alpacas in this instance), cat, goat, cow
Also, ingestion of unpasteurized dairy products is a risk factor for mammals, likely including humans. So far it isn't entirely clear whether ingestion of raw beef is a risk factor, but good to ask your patients about. Anyone with a risk factor should undergo influenza testing and, if positive especially this time of year get help from your local health department.
If nothing else, I learned about a few new (to me) animals from investigating the WOAH list. Thank goodness for Wikipedia.
Looking Ahead
The postponed FDA VRBPAC meeting to advise on composition of the next covid vaccine is still scheduled for June 5. Pertinent meeting materials usually appear on the website a day or so before the meeting, but nothing so far to tip FDA's hand on which variant(s) will be included in the next iteration.
In the meantime, enjoy the doldrums!