California Reports a Presumed Positive H5 Case in a Child Without Known Animal Contact
California Reports a Presumed Positive H5 Case in a Child Without Known Animal Contact
Mild illness with no spread to contacts documented to date; CDC to confirm results
Michael Coston again today alerted us to news from the California Department of Public Health regarding a new H5 case announced today:
SACRAMENTO – California has identified a possible bird flu case in a child in Alameda County who was tested for mild upper respiratory symptoms. The child, who has been treated, is recovering at home. They had no known contact with an infected animal, but public health experts are investigating a possible exposure to wild birds.
The California Department of Public Health (CDPH) is working with local public health officials and the Centers for Disease Control and Prevention (CDC) to investigate the cause of the initial positive test in the child. The positive test showed a low-level detection of the virus, indicating the child was not likely infectious to others. Repeat bird flu testing on the child four days later was negative, and additional testing shows the child was also positive for respiratory viruses that could be the cause of their cold and flu symptoms.
The test specimens are being sent to CDC for confirmatory testing.
Family Members Tested Negative
No person-to-person spread of the virus has been detected or is suspected. Due to mild respiratory symptoms, all close family members of the child were tested – and all are negative for bird flu and not suspected of having the virus at all. Family members were also confirmed to have the same, more common respiratory viruses as the child. They are also being treated with preventive medication.
Additional Contacts Involved, No Indication of Larger Outbreak
Out of an abundance of caution, other individuals who had contact with the child are being notified and offered preventive treatment and testing. Public health officials are aware that the child attended daycare with mild symptoms before the child’s test was reported as a possible bird flu infection. Local public health officials have reached out to potentially exposed caregivers and families to conduct health checks for symptoms and offer connections to preventive treatment and testing if they develop symptoms.
“It’s natural for people to be concerned, and we want to reinforce for parents, caregivers and families that based on the information and data we have, we don’t think the child was infectious – and no human-to-human spread of bird flu has been documented in any country for more than 15 years,” said CDPH Director and State Public Health Officer Dr. Tomás Aragón.
We shall see how this situation develops. A primary question to answer is the genotype of the infection. If B3.13, that would indicate some sort of link back to the dairy and poultry outbreaks currently ravaging the state. If it is of the D1.2 or D1.2 lineage, that would lend credence to a wild bird source of infection for the child. This case is a great example of why all H5 is not the same H5 and knowing the genotype is a key epidemiological question.
Second, we cannot assume that there was no human-to-human spread. This child was in a day care situation and may not have been the index case. A lot of epidemiological work and serological studies remain to be accomplished in that cohort of daycare children and their contacts, before we can be confidently conclude that this is a “one-off” mild infection with no lateral spread. The stakes are too high to not follow up, despite the current resolving clinical picture in the patient.
In the meantime, the New York Times this morning reminds us once again how the world views our H5N1 agricultural response. How long will we remain lucky?
The World Is Watching the U.S. Deal with Bird Flu, and It’s Scary
Stay tuned,
John