The virus has been found in raw milk, deepening concerns about bird flu spread. Experts discuss the symptoms and how to prevent getting sick.
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Dec. 6, 2024, 8:33 AM PST / Source: TODAY
By A. Pawlowski
H5N1 bird flu, a type of avian influenza, has infected dozens of people in the U.S., and spread to seven states and Canada this year.
As concern grows over whether it could lead to another pandemic or lockdown, California has announced a broad recall of raw milk and cream after the virus was found in some of the dairy.
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There have been 32 human cases of bird flu in California this year — including the first U.S. child — according to the CDC. (None are linked to raw milk.) There have been 58 in the U.S. in total.
Almost all human bird flu patients have had contact with infected animals, but three cases in North America are getting particular attention because it’s not known how they were exposed to the virus: the child in California, a teenager in Canada and a person in Missouri.
The Canadian teen remained in critical condition at the end of November, weeks after symptoms started, and was being treated for acute respiratory distress at a children’s hospital in British Columbia after testing positive for H5N1 bird flu, the country’s first human case, the CBC reported.
The patient “was a healthy teenager prior to this” with no underlying conditions, the province’s health officer, Dr. Bonnie Henry, said in a news conference.
The young person’s deterioration was “quite rapid,” Henry said.
“It reminds us that in young people, this is a virus that can progress and cause quite severe illness,” she noted.
Could bird flu cause the next pandemic? Here’s what to know about raw milk and bird flu, symptoms, how to protect yourself and more.
Raw milk recall amid bird flu outbreak
The recall was implemented after “multiple bird flu virus detections” were found in products from Fresno’s Raw Farm, LLC, the California Department of Public Health announced.
All sizes of Raw Farm milk and cream produced between Nov. 9 and Nov. 27, have been pulled from store shelves, according to the notice. The affected lot numbers are 20241109 through 20241127.
The California Department of Public Health has also placed the farm under quarantine.
While the recall only applies to raw whole milk and cream, the agency urged people to also avoid consuming the company’s cheese and kefir, and avoid raw milk pet food topper and pet food kefir marketed to pet owners.
There are no reports of anyone getting sick, but consumers “should immediately return” any of the recalled products they may have in their fridge, the agency added.
California is the epicenter of the current outbreak of H5N1 in dairy cows, Meghan Davis, an associate professor of environmental health at the Johns Hopkins Bloomberg School of Public Health, told NBC News.
Raw milk, which is not pasteurized, can expose people to germs and lead to serious health risks, the Centers for Disease Control and Prevention has warned.
Consumers don’t realize the raw milk they buy is not from a single cow, but pooled from many cows, says Dr. Ian Lipkin, an expert on emerging viral threats.
“If one cow in that group has H5N1, then it gets distributed to many, many more people,” Lipkin, professor of epidemiology at the Columbia University Mailman School of Public Health, tells TODAY.com. “It’s not a good situation.”
Drinking or accidentally inhaling raw milk containing bird flu virus may lead to illness, California health officials warn. So can touching your face after touching the contaminated milk.
Pasteurized milk is safe to drink because pasteurization kills the bird flu virus and other germs, the experts emphasize.
What is bird flu?
Like people, birds can get the flu, and the avian influenza viruses that make birds sick can sometimes infect other animals like cows and, rarely, people, the National Library of Medicine explains.
H5 is one family of bird flu viruses. It has caused widespread flu in wild birds worldwide and is causing outbreaks in poultry and U.S. dairy cows, the CDC notes. Some farm workers exposed to those animals have also gotten sick.
H5 has nine subtypes, including H5N1, the strain responsible for the recent illnesses.
Which states have human cases of bird flu?
There have been 58 confirmed human cases in seven states in the U.S. during the 2024 outbreak, according to the CDC.
They’ve been reported in:
- California: 32 cases
- Colorado: 10 cases
- Michigan: 2 cases
- Missouri: 1 case
- Oregon: 1 case
- Texas: 1 case
- Washington state: 11 cases
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Almost all U.S. patients had contact with infected cattle or poultry. The two exceptions — a patient in Missouri and a child in California — had no known animal exposure.
There’s been no confirmed person-to-person spread.
Bird flu outbreak 2024
“We do have an outbreak of human infections of H5N1,” says Dr. Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security and a spokesperson for the Infectious Diseases Society of America.
The current public health risk from H5 bird flu is low, the CDC says. Its flu monitoring systems currently show no signs of unusual flu activity in people, including the H5N1 virus, or any unusual flu-related trends in emergency department visits.
But the agency is “watching the situation carefully” — as are experts in the field.
Lipkin calls it an important health concern.
“Emerging infectious diseases are unpredictable. If you told me 20 years ago that we were going to have major problems with coronaviruses, I wouldn’t have predicted that,” Lipkin says.
“So nobody knows what’s going to happen with this particular flu.”
Human infection with bird flu can happen when virus gets into a person’s eyes, nose or mouth, or is inhaled, according to the CDC. The illness can range from mild to severe and can be deadly.
Human H5N1 cases in the U.S. have been relatively mild, perhaps because people are mostly getting infected through their eyes, Adalja notes.
It might happen when a dairy worker is milking an infected cow and gets squirted in the face with the milk, for example.
“You’re getting infected from the eyes rather through the respiratory route,” Adalja tells TODAY.com. That may be “less risky than respiratory inhalation” of the virus, he adds, when it can go to the lungs.
Is bird flu a global health emergency?
No, the World Health Organization doesn’t currently categorize the bird flu outbreak as a global health emergency. Outbreaks that do fall into this category include COVID-19, cholera, dengue, Marburg virus and mpox.
Could bird flu turn into a pandemic?
Experts say it’s unlikely this particular strain of bird flu would lead to a pandemic because it doesn’t have the ability to spread efficiently between people.
H5N1 has been infecting humans since 1997, so it’s had time to evolve, but still doesn’t easily jump from person to person, Adalja points out.
“I don’t think that this is the highest risk bird flu strain,” he says. “You can’t say the risk is zero. But of the bird flu viruses, it’s lower risk.”
Lipkin had a similar take.
“Nobody ever wants to say never because you can be wrong,” he cautions. “Could this virus evolve to become more transmissible? Yes. Has it done so thus far? No. Do I personally think it’s going to be responsible for the next pandemic? No. Could it be? Yes.”
One concerning development is that a pig in Oregon tested positive for H5N1 in October — the first time the virus has been detected in swine in the U.S., NBC News reported.
It’s worrisome because pigs can become infected with both bird and human viruses at the same time, allowing mutated strains to emerge.
“Pigs are considered a mixing vessel for flu viruses. So we always worry when a pig gets infected with a bird flu strain because pigs can also be infected with other strains,” Adalja says.
“Those strains can all recombine in the pig as a mixing vessel and then something different will come out.”
Since there are many different avian influenza strains, one of them may be able to cause a pandemic at some point in the future, Adalja adds.
The bird flu strain he’s more worried about as a pandemic risk is H7N9, which was first reported in humans in China in 2013 and expanded to more than 1,500 people by 2017. This virus also doesn’t spread easily from person to person, but when people do get infected, most become severely ill, the World Health Organization warns.
The most recent human H7N9 virus infection was reported in China in 2019, according to the CDC.
Could there be a lockdown due to bird flu?
A lockdown due to bird flu is not likely for this strain, since H5N1 isn’t posing a threat to the general public, both experts say.
If that were to change, people should realize lockdowns, like those during COVID-19, are not the “go-to measure” for an infectious disease emergency, Adalja says, calling them “very blunt tools.”
Instead, proactive measures — such as more aggressive testing of farm animals — will allow health officials to be much more precise when it comes to stopping the spread of infection, he notes.
When it comes to lockdowns, there’s also the question of how far authorities are willing to go.
“If H5N1 were to become a major health problem, we would have to talk about (containment),” Lipkin says. “But I don’t think that this incoming administration is going to be amenable to that.”
What is the treatment for bird flu?
It’s oseltamivir, also known as Tamiflu, the same antiviral medication used for ordinary cases of flu.
It’s important to start that drug as soon as possible after symptoms start for it to have impact, Lipkin says. Some close contacts of people who’ve been infected with H5N1 have also received the drug as a precautionary measure to prevent infection.
Is there a bird flu vaccine?
Four vaccine candidates for dairy cows have been approved for field trials, according to the U.S. Department of Agriculture.
In poultry, four potential bird flu vaccines began to be tested in 2023, Reuters reported.
When it comes to humans, the CDC says the U.S. government is developing vaccines against H5N1 viruses “in case they are needed.”
The agency adds it has H5 candidate vaccine viruses that could be used to produce a vaccine for people, and preliminary analysis shows “they are expected to provide good protection” against H5N1.
There are also some vaccines in the strategic national stockpile that are closely — if not exactly — matched to this particular strain of bird flu, Adalja says.
“There are efforts to make more updated vaccines. But there is no widespread vaccination program being initiated against H5N1 at this time in the U.S.,” he notes.
In the summer of 2024, Finland became the first country in the world to offer bird flu vaccinations for people at risk of exposure, including workers at fur and poultry farms.
Finland bought vaccines for 10,000 people, each requiring two injections, Reuters reported.
In December 2024, the United Kingdom announced it has secured more than 5 million doses of human H5 influenza vaccine. The purchase will “boost the country’s resilience in the event of a possible H5 influenza pandemic,” the UK Health Security Agency said in a statement.
What does bird flu do to humans?
Bird flu in humans can cause no symptoms, or anywhere from mild to severe symptoms, according to the CDC. Most people who have been infected with bird flu have reported mild symptoms, such as eye infections and flu-like symptoms, according to Yale Medicine.
The CDC lists the following bird flu symptoms:
- Eye redness
- Mild flu-like upper respiratory symptoms
- Fever or feeling feverish
- Cough
- Sore throat
- Runny or stuffy nose
- Muscle or body aches
- Headaches
- Fatigue
- Shortness of breath or difficulty breathing
- Pneumonia requiring hospitalization
- Diarrhea, nausea, vomiting or seizures (these are less common symptoms).
H5N1 mortality rate
The mortality rate of bird flu in humans, based on the roughly 900 confirmed people infected with the virus between 2003 and 2024, is about 50%, according to Yale Medicine.
However, it’s likely that many more people have been infected without knowing it because they had no or mild symptoms, so the mortality rate could be much lower than 50%. And the mortality rate would likely drop even further if treatment and vaccines were made more wildly available, should human-to-human spread start to occur.
How do you get bird flu?
There are several ways the bird flu virus can spread from animals to people, according to the CDC:
- Touching something contaminated with the virus and then touching your nose, eyes or mouth
- A liquid that contains bird flu virus splashing into your eyes (such as raw milk from an infected cow)
- Eating, drinking or breathing in droplets containing the virus
How to protect from bird flu
The people most at risk for H5N1 bird flu are dairy and poultry workers who might be around infected animals, Adalja says. They should wear personal protective equipment while working on farms affected by the virus, the CDC advises.
When it comes to the general public, “don’t consume raw milk, full stop” since H5N1 is viable in it, Lipkin says. Pasteurized milk can eliminate the risk of infection, he notes.
Properly cooked chicken is safe to eat, but wash your hands with soap and water after handling raw chicken, he adds.
It might be wise to skip petting zoos or events where you can learn how to milk a cow, Adalja adds.
Avoid direct contact with sick or dead wild birds, poultry and other animals, the CDC advises.
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