Welcome to the fortieth edition of FOI Clinical. Each week, we'll send you a briefing on outbreak news. When something urgent breaks, you'll get an alert the same day.
In this edition
H5N1: new details on Washington death – Measles: three deaths in a week, and an elimination review – Influenza and Covid-19 updates – Mpox: clade Ib without travel in Alaska – Hib: 31 cases YTD – National surveillance, week 43 – Dengue: Florida passes 500 – Ebola: past 11,000
National interest
H5N1 — new details on Washington death
As we covered last week, the Yakima Health District reported on November 1 that a county resident died from severe avian influenza after exposure at a dairy with infected cattle. The patient had underlying health conditions. The district also reported a third human case the same day, in a resident exposed at a county dairy who has not had severe illness or been hospitalized. Both were adults who worked on dairy farms with H5N1 detections.
New details are emerging about the death. CDC's FluView for week 43 adds that the patient who died developed respiratory symptoms during the week ending October 24 and was hospitalized after an emergency department visit, and that the third patient developed conjunctivitis. FluView notes that human-to-human transmission of H5 has not been identified in the United States.
In a recent social media post, the labor union United Farm Workers says it believes “the official case numbers are a vast undercount” and that workers with symptoms are milder reluctant to get tested.
On November 4, USDA reported that sequencing of virus from the first two Washington herds found genotype B3.13, and that the findings are consistent with an introduction from Idaho, likely through cattle movement. Washington had confirmed H5N1 in 43 dairy herds as of November 5, 41 in Yakima County and two in Benton County, up from 40 in our last issue, according to the state agriculture department's detection table.
Oregon has reported its first infected herd. On November 10, it confirmed H5 clade 2.3.4.4b in a herd in Morrow County, Oregon that had tested negative in earlier rounds. Sequencing of the Oregon virus is pending. Oregon is the 22nd state with infected dairy cattle since March 2024, and USDA has counted 51 newly affected herds nationally in the past 30 days. Oregon health officials are monitoring exposed farm workers; no human cases have been linked to the herd.
Clinical note: the Yakima Health District's advisory to providers, which we covered in Issue 37, asks clinicians to take an exposure history from every patient with suspected or confirmed influenza, including contact with livestock, sick or dead animals, raw milk or raw pet food. Because symptoms can look like seasonal flu, that history is the main signal while H1N1 is rising. Influenza A specimens that cannot be subtyped must be reported to the local health jurisdiction immediately, and the advisory notes that a negative influenza test does not rule out avian influenza in a symptomatic patient with a relevant exposure.
Measles — three deaths in a week, and an elimination review
CDC's measles page, updated November 6, reports 5,182 confirmed cases as of November 5, up from 4,852 as of October 29, an increase of 330. There have been 43 outbreaks this year, 96% of cases are outbreak-associated, and 11% of patients have been hospitalized. CDC's death count has risen from three to four; CDC's reporting trails state announcements.
Three measles-associated deaths were announced in one week: