10 Comments
User's avatar
Bernard Nash's avatar

ebruary 3, 2025

TO: FROM: Hospitals, Laboratories, Emergency Medicine, Critical Care, Family Medicine,

Pediatrics, Adolescent Medicine, Internal Medicine, Infectious Disease, Infection

Control Practitioners, Urgent Care, Primary Care Providers, Director of Nursing,

Local Health Departments

New York State Department of Health (NYSDOH), New York City Department of

Health and Mental Hygiene (NYCDOHMH)

HEALTH ADVISORY:

Accelerated Subtyping of Influenza A in Hospitalized Patients

Please see the below Health Advisory from the Centers for Disease Control and

Prevention (CDC) regarding accelerated subtyping for influenza A specimens among

hospitalized individuals testing positive for influenza.

Although the ongoing global outbreak of highly pathogenic avian influenza A(H5N1)

virus has primarily affected dairy cows, poultry, and other animals, 66 human cases

(including one death) have been identified in the United States in 2024. CDC is now

recommending ordering subtyping for all influenza A-positive specimens

collected from hospitalized individuals within 24 hours of hospital admission to

help rapidly detect any human cases of avian influenza A(H5N1).

New York clinicians should:

1. Ask people with suspected or confirmed influenza about potential exposures

to wild and domestic animals, animal products, or symptomatic people with

probable or confirmed avian influenza A(H5).

2. Implement appropriate infection control measures when influenza is

suspected.

o If avian influenza A(H5) is suspected, place the individual in an

airborne infection isolation room (AIIR) with negative pressure, with

standard, contact, and airborne precautions. If none is available, place

a facemask on the individual and isolate in an examination room with

the door closed. The individual should not be placed in any room

where room exhaust is recirculated without high-efficiency particulate

air (HEPA) filtration.

3. Test for influenza A in all hospitalized people with suspected seasonal

influenza or avian influenza A(H5) virus infection, using whatever diagnostic

test is most readily available for initial diagnosis.

o If the initial diagnostic test cannot subtype, order a seasonal

influenza A subtyping diagnostic test within 24 hours of hospital

admission for those who tested positive for influenza A.

• The two main types of seasonal influenza A subtypes are H1

and H3. If a specimen tests positive for one of these subtypes,

H5 testing is not needed, unless exposure history suggests H5

infection.

 Seasonal influenza A subtyping tests (e.g., respiratory pathogen

panel with fluA(H1)/(H3) analytes) can be performed in one of

the following settings:

• Hospital clinical laboratory

• Commercial clinical laboratory

• Public health laboratories, if seasonal influenza A

subtyping is not feasible through in-house or commercial

testing.

o If preliminary seasonal influenza subtyping yields an

unsubtypeable result, samples should be promptly submitted to a

public health laboratory for further characterization and potential H5

testing.

o If exposure history or symptoms strongly suggest H5 infection, submit

specimens to a public health laboratory for characterization in lieu of

seasonal subtyping, in line with previous guidance.

o To submit a specimen to a public health laboratory:

 For people residing in NYC:

• Send specimens to the NYC Public Health Laboratory for

testing. Call the NYC Health Department’s Public Health

Laboratory at 212-671-5890 to coordinate specimen

submission.

 For people residing outside NYC:

• Send specimens to NYS Wadsworth for testing. Specifics

regarding influenza specimen collection and shipping to

Wadsworth Center can be found at:

https://www.wadsworth.org/programs/id/virology/services/

specimen-collection

• A shipping manifest from an electronically submitted

Remote Order OR an Infectious Disease Requisition

(IDR) form requesting influenza testing with subtyping

should accompany all specimens sent to Wadsworth.

• For questions about shipping on holidays or week

Expand full comment
Bernard Nash's avatar

New York State is now screening for sub types of influenza a in the appropriate sub group of patients to look for it avian flu. Unfortunately, it now exists in pigs and pig to human transmission is much easier than bird to human transmission. I am assuming that shortly we will have a flu outbreak. I’m concerned about another epidemic and I’m more concerned that the current government has no interest in epidemiology and infection prevention and dealing with a global epidemic.

Expand full comment
Darin L. Wolfe MD's avatar

I am also very concerned. For much of the last 2-3 months my alert level has been sitting around a 5 out of 10 due to the number of animals infected. I’d say I’m at a 6 or a 7 now because it seems to be more widespread across the states + multiple different types of animals. And we can virtually assume that it’s worse than we know because some states aren’t testing as much for it.

Expand full comment
Prisrob's avatar

How close are we to a vaccine for H5N1?

Expand full comment
Susan Johnson's avatar

Brilliant to prep! Once this H5N1 is human to human spread the human mortality rate becomes 52-60%…. When one of every two people infected starts dying…no one will be going to work…no deliveries no healthcare workers no transportation workers no public works employees…no first responders! No one will want to take a 50% chance of dying! So wise to prep now… because once that happens there’s no prep

Expand full comment
Pamela Cass's avatar

Birds (chickens and ducks) are being destroyed in my state. Question: the outsides of ducks and chickens can expose people to bird flu…but what about eating their eggs?

Expand full comment
Sylvie SV's avatar

More people should mutually ensure their destruction of capitalism like declaring a general strike

Get whatever temporary assistance you might be able to apply for and soon and then try to stay indoors when you don't need to be in any kind of supercell-based storm welcome to a new age of super storm monsoon season of wet season

Expand full comment
Anon's avatar

On a related note, I read DC is infested with rats (actual rodents) wondering if plague could reoccur in our brave new ignorant world

Expand full comment
Stacey Virgin's avatar

Great information. I will share

Expand full comment
Gretchen's avatar

Watched my idiot science denying neighbor pick up a dead bird out of his yard yesterday while I was rolling out the garbage. Upon looking closer (from my yard across the street, at a safe distance) today while grabbing the cans, I saw a ton of feathers all over. I truly hope it was attacked by one of the neighborhood hawks and wasn't a victim of bird flu. If he actually cared about others, he would've called our health dept, but surprise surprise, he didn't.

Expand full comment