Symptoms You Should Never Ignore - Pain, Shortness of Breath

It Starts With Animals: Health Care Providers Must Be 'alert' To Avian Flu Warning Signs

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Growing up in rural Indiana, I had more animal friends than human ones.

I raised ducks and geese, and enjoyed my time surrounded by nature. I found animals to be better listeners, and I felt calmed by being outdoors. During the COVID-19 pandemic, my husband and I were lucky enough to move into a home that backed up to a pond, and I was again soothed and surrounded by nature. I saw Canada geese and wild ducks nest and raise their young. We watched deer from our dinner table and marveled at the muskrats, egrets, racoons and squirrels living in and around the pond.

This is why on March 27, listening to the news, my heart was broken.

On that date, 130 dead birds washed up on the shore of Lake Michigan — in southwest Michigan — 1 mile from our home. The birds were long-tailed ducks, seagulls and the murky mergansers. There was also a dead deer on the beach that day.

There are numerous case reports of birds dying and washing up on the shores of Lake Michigan — in Wisconsin and Illinois, as well — and all confirmed to be from the H5N1 avian flu virus.

In May of 2024, chickens began dying on a rescue and hobby farm owned by my friends in Lake Odessa, Michigan. The Michigan Department of Rural Development was alerted and within 6 hours swab testing had been completed, which led to the euthanasia of all 86 of their birds.

This euthanasia of the entire flock was performed in cooperation with the U.S. Department of Agriculture (USDA), to prevent the spread of avian flu to a neighboring mass production egg farm. Once avian flu is detected on a farm, it must cull (ie, euthanize) its entire flock and quarantine for 120 days.

This was not an isolated incident. Also in March, the Mississippi Board of Animal Health reported it had detected highly pathogenic avian influenza (HPAI), which is deadly to humans and resulted in the culling of more than 40,000 chickens.

According to the Ohio Department of Agriculture data, 10 million birds have died statewide over the past year. This presents a problem, as Ohio is one of the largest egg producers in the country.

The USDA Animal and Plant Health Inspection Service (APHIS) reports, to date, that more than 100 million birds have died due to the spread of avian flu virus in the United States.

The avian flu virus, which the WHO has labeled as panzootic, as affected more than 500 species of animals worldwide, including 70 species of mammals. Mountain lions, bears, seals, dolphins, coyotes, foxes and others have been infected. Zoos have also experienced outbreaks and animal deaths due to avian flu. Big cats like cheetahs and mountain lions are particularly susceptible to H5N1.

Even domestic cats have been infected with avian flu. In house cats, avian flu carries a 50% mortality risk, according to the CDC. Although not common in dogs, they can catch the virus, according to Amy Attas, VMD, of the American Kennel Club. It is especially important to keep dogs away from dead or infected farm animals and birds.

As the respiratory virus is mutating and changing its genes, animal-to-human transmission is becoming more common. According to Andrew Pekosz, PhD, professor of molecular microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health, there have been, as of May, 80 human cases of avian flu reported in the United States in the past 12 months.

Human transmission is most common in farm workers who are exposed to bird droppings or infected milk from dairy cows. Dairy cows have been the second largest victim of the virus. According to the USDA, more than 900 dairy herds have been infected across the country. H5N1 and HPAI are additionally spread via the respiratory and gastrointestinal tracts of birds, which can lead to rapid transmission via contact with farm equipment and clothing among farm workers.

COVID-19 was caused by coronavirus (SARS-CoV-2) infection and its rapid spread was in part due to this virus being airborne. In the 20th century, the NIH documented three pandemics caused by mutations of the influenza A virus — the 1918 Spanish influenza, (H1N1), the 1957 influenza pandemic in southeast Asia (H2N2), and the 1968 Hong Kong influenza ( H3N2) — all of which killed millions of people.

The question remains, are we setting ourselves up for the next pandemic? Are the animals giving us a warning signal? The animal world is experiencing a pandemic that has spread across every continent except Australia.

There is only one reported human death from the avian flu in the United States. Most human cases have been mild, with 93% of cases reporting conjunctivitis, 49% demonstrating fever and 36% reporting respiratory symptoms, according to the CDC.

The CDC has labeled the threat from avian flu as low, as no human-to-human transmission of the virus has been detected yet.

Still, the trajectory and spread of this virus have not slowed down. We as health care providers need to stay aware and informed. We must pay attention to what is happening on farms and in nature, and protect ourselves and our patients from exposures leading to infection.

We all remember how unprepared we were in our offices in 2020 when the COVID-19 pandemic began. We saw our most vulnerable patients become hospitalized and die due to complications of a virus no one knew how to manage or prevent. We looked for guidance from the CDC but felt helpless when our patients died due to being vulnerable and immunosuppressed.

We all entered the health care field to help our patients maintain and improve their health outcomes and quality of life. Rheumatology provides the unique opportunity to care for our patients throughout their lifespan. I have been lucky enough to care for some patients for 26 years now, and I am concerned about the safety and future of our patients.

We must all be educated, aware and alert to the signs and symptoms of avian flu in our patients, especially those who are farmers or work in the dairy industry. We must insist that individuals remain up to date on their influenza vaccination, as contracting influenza A can weaken the immune system and make one more susceptible to avian flu.

We must also continue to use universal precautions and wash our hands when in contact with animals, as well as raw meat or milk. I recommend that people take their shoes off before entering the home, if you are walking in an area where wild or domestic bird fecal matter is present.

Visit the Cleveland Clinic website for more information regarding how to stay informed and protected.

Iris Zink, MSN, RN, ANP-BC

Rheumatology nurse practitioner

Co-owner

Early Arthritis Intervention Clinic

East Lansing, Michigan

For more information:

Iris Zink, MSN, RN, ANP-BC, can be reached at iriszink@gmail.Com.

References:

H7N9 confirmed in Mississippi broiler flock; American Veterinary Medical Association: https://www.Avma.Org/news/h7n9-confirmed-mississippi-broiler-flock

Avian influenza A (H5N1) in cats; American Veterinary Medical Association: https://www.Avma.Org/resources-tools/animal-health-and-welfare/animal-health/avian-influenza/avian-influenza-h5n1-cats

Bird flu is raising red flags among health officials; Johns Hopkins Bloomberg School of Public Health: https://publichealth.Jhu.Edu/2025/bird-flu-is-raising-red-flags-among-health-officials

Signs and symptoms of bird flu in people; CDC: https://www.Cdc.Gov/bird-flu/signs-symptoms/index.Html

Killing 166 million birds hasn't helped poultry farmers stop H5N1. Is there a better way? (2025, February 26); University of Nebraska Medical Center: https://www.Unmc.Edu/healthsecurity/transmission/2025/02/26/killing-166-million-birds-hasnt-helped-poultry-farmers-stop-h5n1-is-there-a-better-way/

Plaza PI, et al. Emerg Infect Dis. 2024;doi:10.3201/eid3003.231098.

Surge of dead birds on South Haven beaches, DNR urges caution; WWMT: https://wwmt.Com/news/local/south-haven-dead-birds-michigan-department-natural-resources-dnr-wildlife-avian-flu-risk

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Puerto Rico Declared Free Of Highly Pathogenic Avian Flu

The U.S. Territory of Puerto Rico has been declared free of highly pathogenic avian influenza (HPAI).

Puerto Rico had its first and only instance of HPAI confirmed in mid-January, in which a backyard poultry flock of 380 birds in the Culebra municipality tested positive. Clinical signs reported at the time included increased mortality, diarrhea and decreased egg production. 

The serotype of the virus in the affected flock was H5N1.

According to a June 18 report from the World Organisation for Animal Health (WOAH), depopulation and disposal processes were completed on January 16, while the disinfection process was completed on May 17. The premises was released from quarantine, also on May 17.

With surveillance of the control zone having been completed with no further detections of HPAI, the outbreak in Puerto Rico has been declared "resolved" by the WOAH.

According to the United States Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) there have not been any cases of HPAI confirmed in commercial poultry flocks in the U.S. Since an Arizona table egg pullet flock in Maricopa County was affected. That instance was confirmed on June 5.

View our continuing coverage of the global avian influenza situation. 

To learn more about HPAI cases in commercial poultry flocks in the United States, Mexico and Canada, see an interactive map on WATTPoultry.Com. 

Second Case Of Bird Flu Confirmed At Brasilia's Zoo

Tuesday, June 17th 2025 - 08:29 UTC The report from a dead emu found on June 11 was released Monday

Brazilian authorities confirmed Monday a case of avian flu in an Australian emu found dead at the Brasilia Zoo. The infected bird's enclosure was sanitized to prevent the disease from further spreading, and biosecurity measures were adopted while the facility remains closed to the public until further notice.

 It was the second detection of the malady in the Federal District this year, following an earlier case in an irerê (local wild duck), not belonging to the Zoo, although it was found lifeless there. The Federal District's Veterinary Service is intensifying inspections in high-risk areas to prevent the spread of the virus.

Avian influenza, highly contagious among birds, poses a low risk to humans, except for those in direct contact with infected birds. Poultry and eggs remain safe for consumption, and Brazil's health status with the World Organization for Animal Health is unaffected, as the cases involve non-commercial birds, it was explained.

The report confirming the bird's cause of death was released Monday from a sample collected on June 11 and analyzed by the Federal Agricultural Defense Laboratory (LFDA) in Campinas (São Paulo). The result was then relayed to the Federal District's Department of Agriculture, Supply and Rural Development (Seagri-DF) by the Ministry of Agriculture and Livestock (Mapa).

Inspections are being prioritized on properties near commercial farms, lakes, dams, and parks, all deemed strategic for the entry and eventual spread of the virus through wild birds.

Among the main symptoms in birds are difficulty breathing, nasal or eye discharge, sneezing, motor incoordination, torticollis, diarrhea, and high mortality.

All suspicions of avian influenza, which include respiratory or neurological signs or high and sudden mortality in birds, must be reported immediately to the proper authorities for adequate handling.

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