The Anxiety Equation: Assessing Our Fears in Today’s World

With the highly pathogenic avian influenza virus, known as H5N1, continuing to attract global attention, the pressing question remains: How concerned should we be?

Although the virus is changing, experts from USF Health indicate we are not confronted with an imminent pandemic; however, we must stay alert as they assess the virus’s capacity to mutate and disseminate, along with the necessary response strategies to maintain readiness.

“Recent findings reveal mutations of H5N1 in mammals, suggesting the virus is adjusting,” stated Sten H. Vermund, MD, PhD, dean of the USF College of Public Health and chief medical officer of the Global Virus Network (GVN). “H5N1 poses a significant risk because of its pandemic capability and history of high virulence. While we are relieved that the current outbreak in North America has been less lethal, we cannot predict its future trajectory.”

Last year, the Global Virus Network, now based internationally at USF, facilitated
three discussions regarding H5N1, with plans for additional gatherings in 2025.

Currently, human cases of H5N1 remain infrequent, yet there have been a few alarming reports in 2024. This year, the Louisiana Department of Health noted a patient who succumbed after hospitalization due to H5N1. This individual was over 65 and had pre-existing health issues. Although H5N1 harbors a high potential mortality rate for humans, the virus has not efficiently transferred between individuals, with most instances being isolated.

Some human cases have been associated with domestic dairy cattle and cows in North America, while other isolated cases—mostly mild—have emerged in pediatric patients along the Pacific coasts of both Canada and the U.S. The U.S. Department of Agriculture reported 184 new confirmed cases in cattle across California and Texas in the past month.

H5N1 continues to be a significant danger to poultry and wild bird populations, resulting in extensive culling of domestic birds in various nations over recent years to manage outbreaks and minimize economic damage. The virus caused a notable increase in avian infections globally, especially in Asia, Europe, and North America during 2022 and 2023.

Monitoring initiatives are crucial for tracking both animal and human instances of H5N1, according to Christian Bréchot, MD, PhD, director of the Microbiomes Institute and senior associate dean for research in global affairs within the USF Health Morsani College of Medicine, and also vice chair of the board of directors and president emeritus of the GVN.

“Through our One Health initiatives, we are closely observing the virus,” Dr. Bréchot remarked. “Nations are already stockpiling vaccines and antiviral medicines in anticipation of potential future human outbreaks, and we recognize that rising temperatures and shifting migration patterns could facilitate the virus’s spread.”

Scientists at the GVN are working to create a universal flu vaccine that would provide protection against various flu strains, including H5N1. While this experimental vaccine shows promise, it remains in the preliminary development stages and is not yet accessible to the general public. Until a breakthrough is achieved, Dr. Vermund suggests that farmers and ranch workers, who are more susceptible to H5N1 exposure, receive currently available vaccines that guard against more common flu strains.

“If a worker in the poultry, dairy, or cattle industry were to contract a human-adapted flu strain simultaneously, the reassorted virus could potentially spread from person to person. An assertive vaccination campaign among at-risk workers is advisable,” Dr. Vermund advised.

For individuals who become ill with the virus, there are therapeutic options available that may alleviate the severity of the disease. Medications such as oseltamivir (administered orally) and zanamivir (inhaled) serve as neuraminidase inhibitors that can mitigate symptoms and reduce the virus’s advancement when administered promptly. Another potential remedy, baloxavir, targets an essential enzyme required by the virus to multiply, which may also lessen the effects of H5N1.

“These treatments provide hope, yet the journey to managing H5N1 remains intricate,” Dr. Bréchot stated. “We need ongoing research, effective vaccination efforts, and dependable treatments to ensure that we are thoroughly geared up for any potential outbreaks.”

Both Dr. Vermund and Dr. Bréchot concur that the primary concern centers on whether the virus will evolve to spread easily among humans. The virus has already exhibited the ability to infect diverse mammals, including terrestrial and marine species, leading to further mutations that are nearly inevitable. These alterations, now involving animals like dairy cows, young goats, felines, and even canines, could pose heightened risks to human health. It is unusual to observe H5N1 affecting such a broad array of species.

“We also advocate for a decentralized monitoring strategy to assist global health officials in gaining a clearer understanding of the extent of outbreaks and to better direct where control measures should be implemented,” Dr. Bréchot remarked.

Composed of specialists from across the globe, including those affiliated with USF, the GVN is advocating for enhanced surveillance, prompt detection, and swift deployment of vaccines and treatments. The reality is that the landscape is continually changing—and staying ahead necessitates international collaboration and ongoing investment in scientific research.

In the interim, Dr. Vermund and Dr. Bréchot stressed the significance of remaining prepared and closely monitoring developments. Our attentiveness today could avert a far larger health crisis tomorrow, they cautioned.

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