Distinguishing viruses responsible for influenza-like illness

How Are Influenza A And B Different?

There are four different types of influenza viruses: Influenza A, B, C, and D. Influenza A and B cause epidemic seasonal infections nearly every year, but A is more common.

Influenza, known as "the flu," is a highly contagious respiratory virus. It's most common during the fall and winter months. It typically spreads through respiratory droplets when a person with the flu sneezes or coughs.

The family of viruses that influenza is a part of is large. You may have heard that there are different types of influenza viruses — particularly influenza A and influenza B.

Influenza A can be found in many species, including humans, birds, and pigs.

Due to the breadth of potential hosts and its ability to genetically change over a short amount of time, influenza A viruses are very diverse. They're capable of causing a pandemic. This happens when a virus that's significantly different from circulating influenza A strains emerges.

Influenza B is typically only found in humans.

Influenza C mainly occurs in humans, but has been known to also occur in dogs and pigs.

Influenza D is found mainly in cattle. According to the Centers for Disease Control and Prevention (CDC), it's not known to infect or cause illness in humans.

Influenza A is further divided into different subtypes. These subtypes are based off of the combination of two proteins on the viral surface: hemagglutinin (H) and neuraminidase (N). There are 18 different H subtypes and 11 different N subtypes.

For example, the most common influenza A subtypes that go around seasonally in humans are H1N1 and H3N2. In 2017, H3N2 spread to dogs in Florida. In 2015, this same strain also infected dogs in an earlier outbreak in Chicago.

Influenza A viruses can be further broken down into strains.

Unlike influenza A, influenza B isn't further divided into subtypes. But it can be broken down further into specific viral lineages and strains.

The naming of influenza virus strains is complex. It includes information such as:

influenza type (A, B, C, or D)

species of origin (if isolated in an animal)

geographical origin

strain number

year of isolation

H or N subtype for influenza A

It's estimated that influenza A infections account for 75 percent of confirmed seasonal influenza infections overall. Influenza B infections account for the remaining 25 percent.

While most confirmed infections during flu season will be influenza A, the occurrence of influenza B infections can increase late in the flu season. This happened in the 2017 to 2018 flu season.

Both influenza A and influenza B are extremely contagious. People who get either type can spread the virus to others from up to six feet away when they cough or sneeze.

You can also contract the virus by touching a surface that has the virus on it and then touching your nose or mouth.

Treatment for an influenza infection is the same regardless of the type you've contracted.

Unfortunately, there's no treatment that can kill the virus. Treatment is focused around relieving symptoms until your body clears the virus naturally.

Antiviral medications may decrease the amount of time that you're ill, which may also reduce your symptoms. Common antiviral prescriptions include:

There is also an antiviral drug called baloxavir marboxil (Xofluza) that was approved by the U.S. Food and Drug Administration (FDA) in late 2018.

The zanamivir, oseltamivir, and peramivir medications noted above work by reducing the ability of the virus to release itself from infected cells. The newer drug, baloxavir marboxil works by reducing the ability of the virus to replicate.

These antiviral medications are most effective when started within the first 48 hours of your illness. They're ineffective in treating illness caused by influenza C.

Over-the-counter medications can be taken to relieve nasal congestion, fever, and aches and pains.

Getting lots of rest, eating a healthy diet, and drinking plenty of fluids helps your body fight the virus as well.

An uncomplicated infection with either influenza A or influenza B can cause symptoms that last around one week. Some people may still have a cough or feel fatigued after two weeks.

Some influenza A subtypes can cause more severe disease than others. For example, in the recent past influenza A (H3N2) viruses have been associated with more hospitalizations and deaths in children and the elderly than in other age groups, according to the CDC.

In the past, it was thought that infection with influenza A was more severe than infection with influenza B. However, a 2015 study in adults with influenza A and influenza B found they both resulted in similar rates of illness and death.

Additionally, in a Canadian study looking at children 16 years old and younger, influenza B infection was associated with a higher risk for mortality than influenza A.

Influenza C is regarded as the least serious of the three types that humans can get. It typically produces a mild respiratory illness in adults. But there's some evidence that it can cause serious respiratory illness in children under age 2.

The CDC estimates that each year, from 2010 to 2018, influenza infection resulted in between 9.3 and 49 million illnesses, 140,000 to 960,000 hospitalizations, and 12,000 to 79,000 deaths.

Data for the 2017 to 2018 influenza season indicates that 84.1 percent of positive samples were influenza A, while 15.9 percent were influenza B. Among hospitalizations, 86.4 percent were associated with influenza A, while 13.2 percent were associated with influenza B infection.

The seasonal flu vaccine is developed many months in advance of flu season. The viruses selected for the vaccine are based on research into which strains will likely be most common.

Sometimes the circulating influenza viruses can mutate from one season to the next. Since experts must select the viruses to include in the vaccine months before flu season, there may not be a good match between the vaccine and the circulating viruses.

This can lead to a decrease in the effectiveness of the vaccine. But even when this happens, the vaccine still offers some protection.

Flu vaccines can be either trivalent or quadrivalent.

A trivalent vaccine protects against three flu viruses:

H1N1 influenza A virus

H3N2 influenza A virus

influenza B virus

A quadrivalent vaccine protects against the same three viruses as the trivalent vaccine plus protection against an additional influenza B virus.

Influenza C virus isn't included in influenza vaccines.

There are several different types of influenza virus: A, B, C, and D.

Influenza types A, B, and C can cause illness in humans. But types A and B cause seasonal epidemics of respiratory illness nearly every year.

Influenza A typically causes the majority of illnesses during flu season. It has the potential to lead to pandemics due to its dynamic, faster changing nature and large host range.

Both influenza A and B are extremely contagious and cause the same type of illness and symptoms. While there's no cure for influenza virus, antiviral medications, plenty of fluids, and rest can help your body fight the infection.

Yearly vaccination can also help you prevent contracting influenza A or B.

Timeline Of Bird Flu Outbreak In United States

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Bird flu has spread among 168 dairy herds in the U.S.,

To date, seven cases of bird flu have been documented in humans since the 2022 outbreak. 

The current outbreak began in February 2022. The USDA reported an outbreak of highly pathogenic avian flu in an Indiana turkey flock, the nation's first case in a commercial poultry operation since 2020.

The H5N1 bird flu virus has spread to dairy cows in the United States, raising concerns about its spread to humans.

Since 2022, bird flu in the U.S. Has infected 168 dairy herds, seven people who were exposed to poultry, four people who were in close contact with infected cattle, more than 100 million chickens and over 9,500 wild birds.

The following is a timeline of the current outbreak in the country:

HEALTH EXPERTS RAISE CONCERN OVER THE DISPOSAL OF INFECTED POULTRY BIRDS AS AVIAN FLU SPREADS

July 19 - fifth, sixth cases of bird flu in humans in CO this year

The U.S. Centers for Disease Control and Prevention on Friday confirmed two additional cases of bird flu in Colorado poultry farm workers in addition to four previously confirmed human cases in the state this year.

The health agency also said preliminary results from blood samples collected from 35 people who work in dairy farms in Michigan with infected herds did not show neutralizing antibodies specific to the H5N1 virus, an indication that the disease was not present in a wider group.

Jon Arizti Sanz, PhD, Postdoctoral Fellow, works in the Broad institute's Sabeti Lab testing purchased milk at area grocery stores for the presence of bird flu in Cambridge, Massachusetts, on May 14, 2024. (David L. Ryan/The Boston Globe via Getty Images)

July 15 - 13th US state finds bird flu in dairy herd

Oklahoma became the 13th U.S. State to detect bird flu in dairy cows, the U.S. Department of Agriculture confirmed.

July 2 - US awards $176M to Moderna to advance bird flu vaccine

The U.S. Government awarded $176 million to Moderna MRNA.O to advance development of its bird flu vaccine.

June 7 - 12th US state finds bird flu in dairy herd

Wyoming became the 12th state to report an infected dairy herd.

June 6 - 11th US state finds bird flu in dairy herd

Minnesota became the 11th state to report an infected dairy herd.

June 5 - 10th US state finds bird flu in dairy herd

Bird flu outbreak in dairy cows expanded to a tenth state as Iowa reported its first infection in a herd.

May 30 - third case of bird flu in humans this year

A third U.S. Dairy worker tested positive for bird flu in 2024 after exposure to infected cows, and was the first to suffer respiratory problems. The infection was the second human case in the state of Michigan.

May 22 - second case of bird flu in humans this year

Another human case of bird flu is confirmed in the U.S. With the infection of a dairy worker in Michigan. It is the second case in humans this year after the virus was detected in cattle.

April 26 - ninth US state finds bird flu in dairy herd 

Colorado became the ninth U.S. State to report an infected dairy herd.

April 25 - Colombia restricts US beef imports

Colombia restricted the import of beef and beef products coming from U.S. States due to bird flu in dairy cows.

April 24 - US tightens restrictions on dairy cow movement 

The U.S. Government said it will require dairy cattle moving between states to be tested for bird flu.

April 23 - FDA detects bird flu in pasteurized milk

The U.S. Food and Drug administration said it had found bird flu virus particles in some samples of pasteurized milk, but said the commercial milk supply remains safe due to pasteurization.

April 11 - eighth US state finds bird flu in dairy herd

South Dakota became the eighth U.S. State to find avian influenza in a dairy herd, after the U.S. Department of Agriculture (USDA) reported infections in North Carolina, Texas, Kansas, Ohio, Michigan, Idaho and New Mexico.

April 4 - bird flu spreads to Ohio herd

Bird flu dairy cow outbreak widened to a dairy herd in Ohio.

April 2 - bird flu found in Mexican dairy cattle

Mexico's agriculture ministry said it was taking preventative measures to increase surveillance and reinforce inspections of U.S. Livestock imports after bird flu was found in dairy cattle there.

April 1 - second case of bird flu in humans

The second known human case of bird flu in the United States is reported in a person from Texas who had contact with dairy cows presumed to be infected with the virus.

The virus was detected in dairy cattle in New Mexico, Michigan and Idaho, along with Texas and Kansas.

March 25 - bird flu detected in milk

The USDA said samples of milk collected from sick cattle in Kansas and Texas tested positive for avian flu, but the nation's milk supply was safe.

Dec. 12, 2023 - bird flu in Kansas halts Cal-Maine egg production

Egg producer Cal-Maine Foods CALM.O said it had temporarily ceased production at a facility in Kansas after some of the flock tested positive for avian flu.

Nov. 3, 2023 - Arkansas reports first bird flu outbreak in a year

Arkansas, a major U.S. Chicken producer, reported its first outbreak of lethal avian flu in a commercial poultry flock in a year.

Oct. 6, 2023 - US detects first bird flu case since April

The United States detected its first case of avian flu on a commercial poultry farm since April, in a flock of 47,300 turkeys in Jerauld County, South Dakota.

April 14, 2023 - US tests 4 bird flu vaccines for poultry

The U.S. Government said it was testing four potential bird flu vaccines for poultry, after more than 58 million chickens, turkeys and other birds had died in the nation's worst outbreak ever.

March 20, 2023 - vaccine makers get ready

Some of the world's leading makers of flu vaccines say they could make hundreds of millions of bird flu shots for humans within months if a new strain of avian influenza ever jumps across the species divide.

Oct. 7, 2022 - 47 million birds killed or culled from bird flu

Avian flu infected a commercial flock of breeding chickens in Arkansas, widening an outbreak of the disease in the southern region.

Nationwide, more than 47 million birds have been killed by avian flu or culled to control its spread this year in the nation's worst outbreak since a record 50 million birds were wiped out in 2015.

April 29, 2022 - first human case of bird flu in US 

The first known human case of H5N1 bird flu in the United States appeared in a person in Colorado, who was involved in culling birds at a commercial poultry facility.

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March 7, 2022 - 22 million chickens, turkeys die from bird flu

More than 22 million commercially raised U.S. Chickens and turkeys have been killed since February 2022 due to outbreaks of a highly lethal type of bird flu.

March 4, 2022 - bird flu spreads to 4 states

A bird flu outbreak is reported in a commercial flock of chickens being raised for meat in Stoddard County, Missouri, taking the spread of the virus to 10 commercial chicken and turkey farms in four states.

Feb. 9, 2022 - USDA reports first bird flu outbreak since 2020

The USDA reported an outbreak of highly pathogenic avian flu in an Indiana turkey flock, the nation's first case in a commercial poultry operation since 2020.

Everything You Need To Know About The Bird Flu Outbreak In Colorado

Colorado is leading the nation in human cases of the H5 bird flu and millions of poultry in the state have been killed to stop the threat of the virus. It also has hit dairy cows in the state.

What does this mean for the general public? What about all the county and state fairs that show off chicken and cows?

What exactly is bird flu?

Avian influenza, also called H5 bird flu or H5N1, is a highly pathogenic avian influenza. It's widespread in wild birds around the globe. It's responsible for outbreaks in poultry and dairy cows in Colorado and the U.S., with double digit recent human cases in agricultural workers.

The virus is found in an infected bird's poop and fluids from the bird's mouth, eyes and nose, according to the CDC.

It can cause severe respiratory symptoms. 

What is the risk to people?

The viruses don't usually infect people, according to the CDC, but can happen if you come into contact with an infected bird, dead or alive and touch your eyes, nose or mouth, touch surfaces or handles item contaminated and tough your eyes, nose or mouth, or breath virus-contaminated dust or droplets.

If you get sick from it, symptoms range from none to severe illness. Mild symptoms include conjunctivitis (red eye), cough, sore throat, runny or stuffy nose,  muscle or body aches, headaches and tiredness. Among more serious symptoms are high fever, shortness of breath and difficulty breathing. Severe illness can result in pneumonia that may require hospitalization and can lead to death, though that's only to date happened in other countries, not the U.S.

Most at risk are people working with infected poultry, waterfowl, including ducks and geese and livestock.

Can I get H5 bird flu from eating dairy, chicken or eggs?

It is safe to eat properly handled and cooked poultry products, according to the Colorado Department of Public Health and Environment (CDPHE). The proper handling and cooking of poultry, meat, and eggs kills bacteria and viruses, including bird flu viruses.

People should separate raw poultry from cooked foods and foods that won't be cooked.

"We (the state health department) and CDC believe that the risk continues to be low here for the general public," said Dr. Rachel Herlihy, the state epidemiologist with CDPHE.

Many experts and health agencies advise against consuming raw milk. "Always choose pasteurized milk and dairy products to protect your health and the health of your family," the CDC wrote on its web page regarding raw, or unpasteurized, milk.

The CDC suggests health care providers tell patients raw milk and any products made from it, including cheese, ice cream, and yogurt "can be contaminated with germs that can cause serious illness, hospitalization, or death."

The risk to the general public is low, so should I be worried?

The more virus out in farms or the wild, the greater the chance it will infect other animals, including humans. Also, more infections means a greater possibility that virus could mutate into a much more serious threat, one that could cause a pandemic.

"H5N1 registers as what we call 'a virus with pandemic potential,'" according to the Johns Hopkins Bloomberg School of Public Health. Unlike other flu viruses, humans have no preexisting immunity to H5 viruses. "Therefore, similar to what we saw with COVID, in the worst case scenario, if this virus enters humans and starts to spread, all of us are susceptible, and we could see massive increases in numbers of cases."

May Chu, an epidemiologist and clinical professor from the Colorado School of Public Health,  said that's one key reason infected poultry are culled: to limit rapid spread through a flock that could then be transmitted to humans. 

"You can nip it before it gets into the human population widely," she said. "That is the best public health protection."

But what about people who work on dairy farms or in egg-laying facilities?

The state health department cited the CDC and said that people who work on those farms are at higher risk of being exposed to H5 bird flu.

And that is showing up in Colorado. 

As of Thursday, the state health department said it has recorded a total of 10 cases; six at one poultry operation and three at another. That's in addition to the case of a dairy worker earlier this month, the state's first case this year.

"The risk to the general public is still low. We are only seeing this in workers with direct contact with these animals," said Scott Bookman, senior director for Public Health Readiness and Response with the CDPHE.

People who are in close contact with dairy and egg-laying facility workers who tested positive are being monitored as well, said Herlihy. 

"We want to know if there is any illness among household contacts," Herlihy said. "That would obviously be a concerning scenario. So the folks that have closest contact with an ill worker would be our highest priority, and that has not been identified to date." 

Herlihy said there has been no sign of the virus spreading via human-to-human transmission.

"We've been tracking this virus since 2022, and during that time we have not seen evidence of person-to-person transmission," she said."We know that there's going to be increased exposure in certain industries, including the poultry industry and on dairy farms right now." 

"We also have had behavioral health services out there, not only working with our teams, but working with the workers out on site to ensure that if folks are struggling, that we've got people out there they can talk with," said the agency's Bookman. "We also have our Agricultural  Workers service program that has been out the last couple of days as well."  

Colorado is providing up to four weeks of free PPE (personal protective equipment) to farmworkers, according to its website. There it also offers updated situation reports, links to a webinar via YouTube. A link for poultry owners, veterinarians and backyard, hobby and commercial products to report, in English or Spanish, information about sick or dead animals.

Similar resources are also available on the state's website for HPAI in dairy cattle. That includes information about the state order regarding licensed dairy cow farms in the state to submit weekly milk samples for testing. Farmworkers can also order free PPE from the site.

Workers are also getting information, testing and monitoring from health providers visiting the facilities via mobile clinics. "We outreach to seasonal workers, migrant workers, and other workers that may have a hard time, because of their work schedules, to come in," said Dr. Mark Wallace of  Chief Clinical Officer for Sunrise Community Health.

I'm going to my county or the state fair, do I need to be worried?

While your risk of coming into contact with a sick animal at the fair is low, there are things you can do to protect yourself.

"For the general public, what I would say to anybody at all times is wash your hands. Don't touch your mouth, don't put your hands on your face. Things like that," Scott Bookman said.

For animals, the state veterinarian's office did put out guidance for poultry and dairy cows that recommended monitoring animals for signs of illness. The office said if you are bringing lactating dairy cattle to a show or event of some kind, that they should be tested within seven days of arrival.

"We know that there's no such thing as no risk," Baldwin said. "What we're trying to get to is low risk. And so testing within that seven day timeframe will help us be assured that at that time of that test, that cow was not shedding virus. So I think we are putting that in place and we're asking show and fair and event organizers to implement that guidance and require testing for those lactating dairy cattle going to fairs."

As for poultry, the state won't require testing because poultry show obvious signs of illness when infected with H5 bird flu. 

"All of the animals, when they get to the fairgrounds, are inspected," said Baldwin, the state veterinarian. "So we've got teams from CSU, the CSU avian health diagnostic team that goes out and they do at a number of the fairs across the state, they'll do inspections at check-in for all of the poultry coming to those events."

Some veterinarians and agricultural experts nationally are recommending farmers not bringing lactating cows to fairs "Given the high risk posed by lactating dairy cattle to other cattle, the rest of the exhibition community, and the public, lactating dairy cattle should not attend exhibitions including county and state fairs, at this time," according to a paper published by the University of Minnesota Extension and its College of Veterinary Medicine.

Can my pets get H5 bird flu?

The risk to domestic animals is lower than in birds, but cats or dogs could become infected. That can happen when they go outside and eat or are exposed to sick or dead birds infected with bird flu viruses. That risk extends to an environment contaminated with infected bird feces.

People should keep their pets away from wild birds and from areas contaminated with the virus. 

If you suspect your pet may have been exposed to H5 bird flu, and is showing symptoms of illness, contact your veterinarian and monitor yourself for symptoms. 

If I work on a farm, how do I protect myself?

Farm workers can protect themselves by wearing protective clothing — like coveralls, gloves, face masks or shields, and goggles —  when working with sick or dead animals, manure, or milk, according to the state's website. The state also suggests washing hands with soap and water throughout the day, especially before eating, drinking or smoking, and before going home. They recommend cleaning areas that have come in contact with animals, manure or milk and using chemical disinfectants effective against viruses. 

If you work animals suspected or confirmed to have H5 bird flu and you start to feel sick, call CDPHE at 303-692-2700 (after normal business hours: 303-370-9395). The Department can help you get a flu test and medicine if you need it.

If you have questions about sick or dead animals on the farm, ask your farm manager and veterinarian.

The CDC sent a team to Colorado. Are they still here?

While most of the original deployment team has left the state as of Tuesday, July 30, Colorado continues to have smaller numbers of CDC staff deployed to assist with the state response, according to the state health department.

How did H5 bird flu start?

The bird flu has been circulating in the migratory bird populations for the last two and a half years. Colorado State Veterinarian Maggie Baldwin said it has historically impacted the state's poultry operations.

"We have seen peaks and valleys of incursions because the virus has come in with migratory birds and typically leaves with migratory birds," Baldwin said.

How does H5 bird flu affect birds?

The mortality rates for birds that are infected are between 90 percent and 100 percent. That's what highly pathogenic avian influenza means: it kills a lot of birds.

"They get sick very quickly and die very quickly," said Colorado Veterinarian Baldwin. For the last two and a half years, we've had single spillover events from wild birds that have been spilling over this virus into our poultry flocks. And what changed significantly is that jump into dairy cattle earlier this year."

Because the virus spreads so widely in birds and can spread to humans, infected poultry flocks, like those in commercial egg operation, are culled or put down. 

H5 bird flu was first detected among Colorado cattle in April. Since then, nearly 50 percent of Colorado herds have tested positive for the virus. What is going on?

Colorado has what the state vet calls "sustained virus" in dairy herds, meaning it's continually present. It was actually the dairy cows that infected poultry in the state, Baldwin said.

"We've had three spillover events into three large commercial flocks. Two of those are confirmed that they are the dairy strain. We're waiting on whole genome sequencing on the last one, but that has impacted three commercial poultry flocks," Baldwin said. "And so this virus right now is not only challenging and putting strain on our dairy industry, but this spillover from dairy to our poultry industry is what is posing a really significant risk."

Colorado has begun mandatory testing of all cattle in the state to help control the spread of the virus among herds.

What is the mandatory testing the state implemented in herds going to tell us?

The Colorado Department of Agriculture and CDPHE announced July 23 that they are now requiring dairy farmers to submit weekly samples for testing. Colorado is the first state in the U.S. To implement a testing requirement.

The testing is to get a better handle on how widespread the virus is among cattle.

"Our goal in implementing the mandatory testing order for the dairies statewide is really to identify what that reservoir of disease is" Baldwin said

Baldwin said that their current process is to place herds that test positive for the virus in quarantine, then work with cattle owners to "implement really strong biosecurity measures to try and prevent further spillover from that herd."

The state is tracking testing on its website.

Cows bred for meat do not need to be tested, as H5 bird flu cases have only been confirmed among dairy cattle.

What happens with infected milk that has tested positive?  Is it disposed of or pasteurized later? 

Abnormal milk and milk from sick cows is disposed of onsite, according to a spokesperson with the CDPHE. According to the agency, onsite disposal is the safest and most convenient process to ensure there is no further contamination from the virus.  If a dairy has the ability to heat treat discarded milk, CDPHE recommends doing that before disposing of it down the drain. In all cases, discarded milk should be disposed of in the farm's sanitary sewer with other on farm liquid wastes, the agency said.

Dairies are required to send only milk from healthy animals into processing for human consumption. Pasteurization eliminates potentially harmful bacteria and viruses, according to the FDA.

Back to the poultry problems, what's happening there?

It all started pretty recently, with three flocks needing to be culled in Welc County — the first one was confirmed positive for the virus on July 8. The second one was confirmed on July 16 and the third on July 19.

State Veterinarian Baldwin said about 3 million laying hens were killed (or "depopulated" as Baldwin called it). It was more than half of the state's total inventory of laying hens, she said. There were 5.2 million egg-producing hens in Colorado two years ago. She said two of the facilities where flocks were culled were egg laying operations.

"They were, I believe, our two largest egg laying facilities in the state. And the third one was a commercial pullet facility. Pullets are the baby birds before they become laying hens." Baldwin said.

What happens to the farms and facilities that have to kill their flocks?

There is compensation and USDA has a program in place. Gov. Jared Polis declared a disaster emergency after the first outbreak was detected at a large commercial egg operation in Weld County. That freed up state resources to help agriculture officials and farmers respond to the situation.

"So they are provided indemnity for the lost birds as well as the lost eggs at that facility. And they're also provided compensation for all of the activities associated with response to the disease," said Baldwin.

What about infected birds? How are they disposed of after culling?

The decision for disposal in what the state calls a "mass mortality event" is made jointly between USDA, the Colorado Department of Agriculture, the producer, and CDPHE or other local authorities. It is typically a combination of multiple disposal methods that commonly include burial and composting, which follows a very strict and lengthy process to ensure proper decomposition and virus elimination, according to the agency.

We know about virus evolution and mutations from the COVID-19 pandemic — how will this virus mutate over time?

No one knows, but if the COVID-19 pandemic has taught anything, it's that viruses can spread widely, around the world, like wildfire and that protective measures can help greatly avoid the worst.

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