Has testing of humans for asymptomatic and mild H5N8 bird flu begun in other nations with H5N8 outbreaks after seven infected workers in Russia’s Astrakhan region?

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By Daniel R. Lucey MD, MPH, FIDSA

On Saturday (Feb. 20 ), the Russian news agency TASS reported:

“At the beginning of December 2020, an outbreak of bird flu occurred at a poultry farm in Akhtubinsky district . . . During this period, seven employees of the poultry farm had a slight health disorder (sore throat) . . .”

An earlier TASS article, on Dec. 16, had reported:

“The poultry population at the Vladimirovskaya poultry farm in the Akhtubinsky district of the Astrakhan region, numbering more than 800 thousand heads, will be completely eliminated due to an outbreak of bird flu . . . An outbreak of bird flu at the enterprise was detected on December 8. The poultry farm was quarantined, and the city of Akhtubinsk and the nearest village were also supervised.”

It is a tribute to Russia, given the minimal symptoms of these seven persons, that they diagnosed the first-ever humans with H5N8 influenza infection. This sentinel event emphasizes the need to test mildly symptomatic or even asymptomatic persons exposed to H5N8 virus, whether by nucleic acid testing and sequencing in the acute phase, or by antibody testing in the  convalescent phase of illness.

Specific studies to assess asymptomatic transmission of H5N8 from person-to-person must also be undertaken. This is especially true given the experience with COVID-19 pandemic, another “Disease X” novel virus for which asymptomatic and pre-symptomatic transmission was initially underappreciated.

Importantly, there are very likely more human infections with H5N8 avian flu if the genetic sequence of the H5N8 virus causing the infections in these seven humans is the same as the H5N8 virus outbreaks in some of the 17 other European and 4 Middle East nations reported since October 2020 by the UN Food and Agriculture Organization (FAO) (see Table for nation-by-nation listing). .

The memorable map below of the hundreds of H5N8 outbreaks since October 2020 is illustrated by FAO on their same Jan. 27, 2021 update, with H5N8 in purple circles.

Map 1. Global distribution of AIV with zoonotic potential* observed since 01 October 2020 (i.e. current wave)

On Feb.18 the World Organization for Animal Health (OIE) added Estonia to this list of European nations reporting avian outbreaks of H5N8 influenza.

  1. The Feb. 20 TASS article cited above was found on the excellent Russian-language ProMED website.
  2. Here is a google map with the location of Astrakhan (near the northwestern Caspian Sea, on the Volga River.) 

Dr. Daniel Lucey

Daniel Lucey, M.D. MPH, FIDSA, FACP, is a Clinical Professor of Medicine at Dartmouth Geisel School of Medicine, Infectious Disease adjunct Professor at Georgetown Medical Center, senior scholar at Georgetown Law, Anthropology Research Associate at the Smithsonian Museum of Natural History and a member of the Infectious Diseases Society of America Global Health Committee. He served as a volunteer to outbreaks overseas including hands-on Ebola patient care in Sierra Leone and Liberia (Doctors without Borders) 2014, MERS 2013, SARS 2003, as well as HIV, H5N1, Zika, yellow Fever, and pneumonic plague 2017 (with WHO/USAID/CDC).  Since Jan. 6, 2020 he has contributed over 75 posts to Science Speaks on COVID-19 and traveled to China in February 2020. He initially proposed, then fundraised and helped design the content for 2018-2022 Smithsonian Exhibition on Epidemics due to zoonotic viruses. From 1982-1988 he trained at University of California San Francisco and Harvard and was an attending physician at the NIH (NIAID) in the 1990s while in the US Public Health Service.

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