")
for _dt, row in ordered_rows[-dataset.trend_rows:]:
@@ -348,7 +508,14 @@ def latest_value(loc: str) -> float:
f"{_cumulative_line(dataset, entity, dt, row)}. "
f"Source: {html.escape(dataset.csv_url)}."
)
- summary_lines.extend(_trend_table_html(dataset, entity, rows_by_location[entity]))
+ summary_lines.extend(
+ _trend_table_html(
+ dataset,
+ entity,
+ rows_by_location[entity],
+ is_target_entity=entity in target_locations,
+ )
+ )
if top_locations:
summary_lines.append("Top locations by latest cumulative value
")
diff --git a/bioscancast/stages/extraction/custom_scrapers/paho_oropouche_portal.py b/bioscancast/stages/extraction/custom_scrapers/paho_oropouche_portal.py
new file mode 100644
index 0000000..ae81f12
--- /dev/null
+++ b/bioscancast/stages/extraction/custom_scrapers/paho_oropouche_portal.py
@@ -0,0 +1,318 @@
+"""Custom scraper for PAHO ARBO Portal Oropouche weekly CSV.
+
+The PAHO Oropouche portal is dashboard-backed. This scraper pulls the downloadable
+underlying CSV and renders computed weekly/country analytics as compact HTML so
+standard extraction + insight stages can consume the information.
+"""
+
+from __future__ import annotations
+
+import html
+import io
+import re
+import unicodedata
+from datetime import datetime, timezone
+from typing import Callable, Optional
+
+import numpy as np
+import pandas as pd
+from curl_cffi import requests as curl_requests
+
+from bioscancast.stages.extraction.config import ExtractionConfig
+from bioscancast.stages.extraction.fetcher import FetchResult
+
+CSV_URL = (
+ "https://phip.paho.org/vizql/w/AME_OROV_Cases/v/Oropouche/vudcsv/"
+ "sessions/21F758F6EAB9431B932EB51F61EBDE01-1:0/views/"
+ "10956961424773455462_12644916002446576356"
+ "?underlying_table_id=FZ_AME_OROV_Cases_SE_12E30DDB8F874DC6AE5888461B08AB74"
+ "&underlying_table_caption=Full%20Data"
+)
+
+CsvFetcher = Callable[[str, ExtractionConfig], Optional[str]]
+
+
+def _fetch_csv_text(url: str, cfg: ExtractionConfig) -> Optional[str]:
+ try:
+ resp = curl_requests.get(
+ url,
+ timeout=max(cfg.fetch_timeout_seconds, 30.0),
+ impersonate=cfg.impersonate,
+ allow_redirects=True,
+ )
+ except Exception:
+ return None
+
+ if resp.status_code != 200:
+ return None
+
+ text = (resp.text or "").strip()
+ return text or None
+
+
+def _normalize_col(name: str) -> str:
+ folded = unicodedata.normalize("NFKD", name or "")
+ folded = "".join(ch for ch in folded if not unicodedata.combining(ch))
+ folded = folded.lower().strip()
+ folded = re.sub(r"[^a-z0-9]+", "_", folded)
+ return folded.strip("_")
+
+
+def _resolve_columns(df: pd.DataFrame) -> tuple[str, str, str, str] | None:
+ mapping = {_normalize_col(c): c for c in df.columns}
+
+ year = mapping.get("ano")
+ week = mapping.get("semanas_epi")
+ confirmed = mapping.get("week_lab_confirmed")
+ country = mapping.get("pais")
+
+ if not all((year, week, confirmed, country)):
+ return None
+ return year, week, confirmed, country
+
+
+def _r2(y: np.ndarray, yhat: np.ndarray) -> float:
+ ss_res = float(np.sum((y - yhat) ** 2))
+ ss_tot = float(np.sum((y - np.mean(y)) ** 2))
+ if ss_tot <= 0.0:
+ return 1.0 if ss_res <= 1e-12 else 0.0
+ return max(0.0, min(1.0, 1.0 - (ss_res / ss_tot)))
+
+
+def _fit_linear(counts: pd.Series) -> dict[str, float] | None:
+ if counts.shape[0] < 2:
+ return None
+ y = counts.to_numpy(dtype=float)
+ x = np.arange(y.shape[0], dtype=float)
+ slope, intercept = np.polyfit(x, y, 1)
+ yhat = slope * x + intercept
+ return {
+ "intercept": float(intercept),
+ "slope": float(slope),
+ "r2": _r2(y, yhat),
+ }
+
+
+def _fit_exponential(counts: pd.Series) -> dict[str, float] | None:
+ if counts.shape[0] < 2:
+ return None
+ y = counts.to_numpy(dtype=float)
+ x = np.arange(y.shape[0], dtype=float)
+
+ mask = y > 0
+ if int(np.sum(mask)) < 2:
+ return None
+
+ x_pos = x[mask]
+ y_pos = y[mask]
+ b, ln_a = np.polyfit(x_pos, np.log(y_pos), 1)
+ a = float(np.exp(ln_a))
+ yhat = a * np.exp(b * x_pos)
+
+ return {
+ "a": a,
+ "b": float(b),
+ "r2": _r2(y_pos, yhat),
+ }
+
+
+def _fmt_stats(series: pd.Series) -> str:
+ if series.empty:
+ return "n=0"
+ desc = series.describe()
+ std = desc["std"] if pd.notna(desc["std"]) else 0.0
+ return (
+ f"n={int(desc['count'])}, mean={desc['mean']:.2f}, std={std:.2f}, "
+ f"min={desc['min']:.0f}, median={series.median():.0f}, max={desc['max']:.0f}"
+ )
+
+
+def _render_counts_table(title: str, counts: pd.Series, key_header: str) -> str:
+ rows = []
+ for idx, value in counts.items():
+ rows.append(f"| {html.escape(str(idx))} | {int(value)} |
")
+ body = "".join(rows) if rows else "| No data |
"
+ return (
+ f"{html.escape(title)}
"
+ ""
+ f"| {html.escape(key_header)} | sum_week_lab_confirmed |
|---|
"
+ f"{body}
"
+ )
+
+
+def _render_model_section(
+ title: str,
+ counts: pd.Series,
+ *,
+ linear: dict[str, float] | None,
+ exp: dict[str, float] | None,
+) -> str:
+ lines = [f"{html.escape(title)}
"]
+ lines.append(f"Input points: {counts.shape[0]}.
")
+ if linear is None:
+ lines.append("Linear model: unavailable (insufficient data).
")
+ else:
+ lines.append(
+ "Linear model y = intercept + slope*x: "
+ f"intercept={linear['intercept']:.6f}, slope={linear['slope']:.6f}, R^2={linear['r2']:.6f}.
"
+ )
+
+ if exp is None:
+ lines.append(
+ "Exponential model y = a*exp(b*x): unavailable "
+ "(insufficient strictly-positive points).
"
+ )
+ else:
+ lines.append(
+ "Exponential model y = a*exp(b*x): "
+ f"a={exp['a']:.6f}, b={exp['b']:.6f}, R^2={exp['r2']:.6f}.
"
+ )
+ return "".join(lines)
+
+
+def _render_country_summary(df: pd.DataFrame, country_col: str, value_col: str) -> str:
+ if df.empty:
+ return "Per-country summary
No country data available.
"
+
+ g = df.groupby(country_col)[value_col].sum().sort_values(ascending=False)
+ summary = g.describe()
+ std = summary["std"] if pd.notna(summary["std"]) else 0.0
+
+ rows = []
+ for country, value in g.items():
+ rows.append(
+ f"| {html.escape(str(country))} | {int(value)} |
"
+ )
+
+ return (
+ "Per-country summary
"
+ f"Affected states/countries (Pais values): {int(g.shape[0])}. "
+ f"Per-country cumulative summary: n={int(summary['count'])}, mean={summary['mean']:.2f}, "
+ f"std={std:.2f}, min={summary['min']:.0f}, median={g.median():.0f}, max={summary['max']:.0f}. "
+ f"Cumulative confirmed count across all Pais: {int(g.sum())}.
"
+ ""
+ "| Pais | cumulative_week_lab_confirmed |
|---|
"
+ f"{''.join(rows)}
"
+ )
+
+
+def fetch(
+ url: str,
+ *,
+ config: ExtractionConfig | None = None,
+ as_of_date: datetime | None = None,
+ region: str | None = None,
+ question_text: str | None = None,
+ csv_fetcher: CsvFetcher | None = None,
+) -> FetchResult | None:
+ cfg = config or ExtractionConfig()
+ fetched_at = datetime.now(timezone.utc)
+
+ text = (csv_fetcher or _fetch_csv_text)(CSV_URL, cfg)
+ if not text:
+ return None
+
+ try:
+ df = pd.read_csv(io.StringIO(text))
+ except Exception:
+ return None
+
+ cols = _resolve_columns(df)
+ if cols is None:
+ return None
+ year_col, week_col, confirmed_col, country_col = cols
+
+ df = df[[year_col, week_col, confirmed_col, country_col]].copy()
+ df[year_col] = pd.to_numeric(df[year_col], errors="coerce")
+ df[week_col] = pd.to_numeric(df[week_col], errors="coerce")
+
+ value_text = (
+ df[confirmed_col]
+ .astype(str)
+ .str.replace(",", "", regex=False)
+ .str.strip()
+ )
+ df[confirmed_col] = pd.to_numeric(value_text, errors="coerce").fillna(0)
+
+ df = df.dropna(subset=[year_col, week_col]).copy()
+ if df.empty:
+ return None
+
+ df[year_col] = df[year_col].astype(int)
+ df[week_col] = df[week_col].astype(int)
+ df = df[(df[week_col] >= 1) & (df[week_col] <= 53)].copy()
+ if df.empty:
+ return None
+
+ df["week_start"] = [
+ datetime.fromisocalendar(int(y), int(w), 1).date()
+ for y, w in zip(df[year_col], df[week_col])
+ ]
+
+ if as_of_date is not None:
+ cutoff = as_of_date.astimezone(timezone.utc).date()
+ df = df[df["week_start"] <= cutoff]
+ if df.empty:
+ return None
+
+ df["year_week"] = [f"{int(y)}-W{int(w):02d}" for y, w in zip(df[year_col], df[week_col])]
+
+ weekly_counts = (
+ df.groupby(["week_start", "year_week"], as_index=False)[confirmed_col]
+ .sum()
+ .sort_values("week_start")
+ )
+ if weekly_counts.empty:
+ return None
+
+ weekly_series = pd.Series(
+ weekly_counts[confirmed_col].to_numpy(),
+ index=weekly_counts["year_week"].tolist(),
+ )
+
+ recent_24 = weekly_counts.tail(24)
+ recent_24_series = pd.Series(
+ recent_24[confirmed_col].to_numpy(),
+ index=recent_24["year_week"].tolist(),
+ )
+
+ lin = _fit_linear(recent_24_series)
+ exp = _fit_exponential(recent_24_series)
+
+ country_week = (
+ df.groupby(["year_week", country_col], as_index=False)[confirmed_col]
+ .sum()
+ .sort_values(["year_week", country_col])
+ )
+
+ cumulative_all = int(weekly_series.sum())
+ latest_week = str(weekly_counts["year_week"].iloc[-1])
+
+ rendered = (
+ ""
+ "PAHO Oropouche portal - weekly CSV analytics"
+ ""
+ "PAHO Oropouche weekly analytics snapshot
"
+ f"Source portal URL: {html.escape(url)}
"
+ f"CSV source URL: {html.escape(CSV_URL)}
"
+ f"Retrieved at: {fetched_at.isoformat()} | latest year_week: {html.escape(latest_week)}.
"
+ "Weekly counts from Año + Semanas Epi
"
+ f"Summary statistics (weekly summed Week Lab Confirmed): {_fmt_stats(weekly_series)}. "
+ f"Cumulative confirmed count across all weeks: {cumulative_all}.
"
+ f"{_render_counts_table('Counts by year_week', weekly_series, 'year_week')}"
+ f"{_render_model_section('Model fit on past 24 weeks (approx past 6 months)', recent_24_series, linear=lin, exp=exp)}"
+ "Country/state grouping from year_week + Pais
"
+ f"Grouped rows (year_week x Pais): {int(country_week.shape[0])}.
"
+ f"{_render_country_summary(df, country_col, confirmed_col)}"
+ ""
+ ).encode("utf-8")
+
+ return FetchResult(
+ url=CSV_URL,
+ final_url=CSV_URL,
+ status_code=200,
+ content_type="text/html",
+ content_bytes=rendered,
+ fetched_at=fetched_at,
+ error=None,
+ )
diff --git a/bioscancast/stages/extraction/custom_scrapers/usda_aphis_livestock.py b/bioscancast/stages/extraction/custom_scrapers/usda_aphis_livestock.py
new file mode 100644
index 0000000..23d9377
--- /dev/null
+++ b/bioscancast/stages/extraction/custom_scrapers/usda_aphis_livestock.py
@@ -0,0 +1,419 @@
+"""Custom scraper for USDA APHIS HPAI livestock detections.
+
+The public APHIS dashboard is a client-rendered Tableau page; this scraper uses
+headless browser automation to export the Tableau crosstab CSV and renders
+compact analytical prose/tables so the regular HTML parser + insight extraction
+pipeline can operate without additional parser changes.
+"""
+
+from __future__ import annotations
+
+import html
+import logging
+from datetime import datetime, timezone
+from typing import Callable, Optional
+
+import numpy as np
+import pandas as pd
+
+from bioscancast.stages.extraction.config import ExtractionConfig
+from bioscancast.stages.extraction.fetcher import FetchResult
+
+logger = logging.getLogger(__name__)
+
+TABLEAU_VIEW_URL = (
+ "https://publicdashboards.dl.usda.gov/t/MRP_PUB/views/"
+ "VS_Cattle_HPAIConfirmedDetections2024/HPAI2022ConfirmedDetections"
+)
+
+TableauFetcher = Callable[[str, ExtractionConfig], Optional[pd.DataFrame]]
+
+
+def _embed_url(url: str) -> str:
+ if ":embed=y" in url:
+ return url
+ sep = "&" if "?" in url else "?"
+ return f"{url}{sep}:showVizHome=no&:embed=y"
+
+
+def _read_csv_with_fallback(path: str) -> Optional[pd.DataFrame]:
+ attempts = [
+ {"encoding": "utf-16", "sep": "\t", "skiprows": 1},
+ {"encoding": "utf-16-le", "sep": "\t", "skiprows": 1},
+ {"encoding": "utf-8-sig", "sep": "\t", "skiprows": 1},
+ {"encoding": "utf-8", "sep": "\t", "skiprows": 1},
+ {"encoding": "utf-16"},
+ {"encoding": "utf-16-le"},
+ {"encoding": "utf-8-sig"},
+ {"encoding": "utf-8"},
+ {"encoding": "latin-1"},
+ ]
+ for kwargs in attempts:
+ try:
+ df = pd.read_csv(path, **kwargs)
+ logger.info("USDA Tableau: parsed CSV with options=%s", kwargs)
+ return df
+ except UnicodeDecodeError:
+ logger.info("USDA Tableau: decode failed with options=%s", kwargs)
+ continue
+ except Exception as exc:
+ logger.info("USDA Tableau: csv parse error with options=%s: %s", kwargs, exc)
+ continue
+ return None
+
+
+def _fetch_tableau_dataframe(url: str, cfg: ExtractionConfig) -> Optional[pd.DataFrame]:
+ try:
+ from playwright.sync_api import sync_playwright
+ except Exception as exc:
+ logger.info("USDA Tableau: Playwright unavailable: %s", exc)
+ return None
+
+ timeout_ms = int(max(cfg.fetch_timeout_seconds, 45.0) * 1000)
+
+ try:
+ with sync_playwright() as p:
+ logger.info("USDA Tableau: launching headless browser")
+ browser = p.chromium.launch(headless=True)
+ context = browser.new_context(accept_downloads=True)
+ page = context.new_page()
+
+ target_url = _embed_url(url)
+ logger.info("USDA Tableau: navigating to %s", target_url)
+ page.goto(_embed_url(url), wait_until="domcontentloaded", timeout=timeout_ms)
+
+ logger.info("USDA Tableau: waiting for download toolbar button")
+ for _ in range(200):
+ if page.locator("button[data-tb-test-id='viz-viewer-toolbar-button-download']").count() > 0:
+ break
+ page.wait_for_timeout(250)
+ download_btn_count = page.locator("button[data-tb-test-id='viz-viewer-toolbar-button-download']").count()
+ logger.info("USDA Tableau: download button count=%s", download_btn_count)
+ if download_btn_count == 0:
+ logger.info("USDA Tableau: download button not found before timeout")
+ context.close()
+ browser.close()
+ return None
+
+ logger.info("USDA Tableau: opening download menu")
+ page.locator("button[data-tb-test-id='viz-viewer-toolbar-button-download']").first.click(timeout=20_000)
+ logger.info("USDA Tableau: selecting Crosstab")
+ page.locator("[data-tb-test-id='download-flyout-download-crosstab-MenuItem']").first.click(timeout=20_000)
+ page.wait_for_timeout(1500)
+
+ logger.info("USDA Tableau: selecting worksheet 'Table Details by Date'")
+ page.locator("[data-tb-test-id^='sheet-thumbnail-']", has_text="Table Details by Date").first.click(timeout=20_000)
+ logger.info("USDA Tableau: selecting CSV export format")
+ page.locator("[data-tb-test-id='crosstab-options-dialog-radio-csv-Label']").first.click(timeout=20_000)
+
+ downloads = []
+ page.on("download", lambda d: downloads.append(d))
+ logger.info("USDA Tableau: triggering export download")
+ page.locator("[data-tb-test-id='export-crosstab-export-Button']").first.click(timeout=20_000)
+
+ waited = 0
+ step = 250
+ while waited <= timeout_ms and not downloads:
+ page.wait_for_timeout(step)
+ waited += step
+ logger.info("USDA Tableau: download events captured=%s after %sms", len(downloads), waited)
+
+ if not downloads:
+ logger.info("USDA Tableau: no download event received")
+ context.close()
+ browser.close()
+ return None
+ download = downloads[0]
+
+ path = download.path()
+ logger.info("USDA Tableau: download path resolved=%s", bool(path))
+ if path is None:
+ logger.info("USDA Tableau: download path unavailable")
+ context.close()
+ browser.close()
+ return None
+
+ logger.info("USDA Tableau: reading CSV from %s", path)
+ df = _read_csv_with_fallback(path)
+ context.close()
+ browser.close()
+
+ if df is None:
+ logger.info("USDA Tableau: failed to parse CSV with fallback encodings")
+ return None
+ if df.empty:
+ logger.info("USDA Tableau: CSV parsed but DataFrame empty")
+ return None
+ logger.info("USDA Tableau: CSV parsed rows=%s cols=%s", df.shape[0], df.shape[1])
+ return df
+ except Exception as exc:
+ logger.info("USDA Tableau: fetch failed with exception: %s", exc)
+ return None
+
+
+def _resolve_column(df: pd.DataFrame, wanted: str) -> str | None:
+ by_lower = {str(c).strip().lower(): c for c in df.columns}
+ return by_lower.get(wanted.strip().lower())
+
+
+def _r2(y: np.ndarray, yhat: np.ndarray) -> float:
+ ss_res = float(np.sum((y - yhat) ** 2))
+ ss_tot = float(np.sum((y - np.mean(y)) ** 2))
+ if ss_tot <= 0.0:
+ return 1.0 if ss_res <= 1e-12 else 0.0
+ return max(0.0, min(1.0, 1.0 - (ss_res / ss_tot)))
+
+
+def _fit_linear(counts: pd.Series) -> dict[str, float] | None:
+ if counts.shape[0] < 2:
+ return None
+ y = counts.to_numpy(dtype=float)
+ x = np.arange(y.shape[0], dtype=float)
+ slope, intercept = np.polyfit(x, y, 1)
+ yhat = slope * x + intercept
+ return {
+ "intercept": float(intercept),
+ "slope": float(slope),
+ "r2": _r2(y, yhat),
+ }
+
+
+def _fit_exponential(counts: pd.Series) -> dict[str, float] | None:
+ if counts.shape[0] < 2:
+ return None
+ y = counts.to_numpy(dtype=float)
+ x = np.arange(y.shape[0], dtype=float)
+
+ # Log-linear fit requires strictly positive observations.
+ mask = y > 0
+ if int(np.sum(mask)) < 2:
+ return None
+
+ x_pos = x[mask]
+ y_pos = y[mask]
+
+ b, ln_a = np.polyfit(x_pos, np.log(y_pos), 1)
+ a = float(np.exp(ln_a))
+ yhat = a * np.exp(b * x_pos)
+
+ return {
+ "a": a,
+ "b": float(b),
+ "r2": _r2(y_pos, yhat),
+ }
+
+
+def _fmt_stats(series: pd.Series) -> str:
+ if series.empty:
+ return "n=0"
+ desc = series.describe()
+ return (
+ f"n={int(desc['count'])}, mean={desc['mean']:.2f}, std={desc['std'] if pd.notna(desc['std']) else 0.0:.2f}, "
+ f"min={desc['min']:.0f}, median={series.median():.0f}, max={desc['max']:.0f}"
+ )
+
+
+def _render_counts_table(title: str, counts: pd.Series, key_header: str) -> str:
+ rows = []
+ for idx, value in counts.items():
+ rows.append(
+ f"| {html.escape(str(idx))} | {int(value)} |
"
+ )
+ body = "".join(rows) if rows else "| No data |
"
+ return (
+ f"{html.escape(title)}
"
+ ""
+ f"| {html.escape(key_header)} | count |
|---|
"
+ f"{body}
"
+ )
+
+
+def _render_state_summary(df: pd.DataFrame) -> str:
+ if df.empty:
+ return "Per-state summary
No state data available.
"
+
+ g = df.groupby("State").size().sort_values(ascending=False)
+ summary = g.describe()
+
+ rows = []
+ for state, value in g.items():
+ rows.append(f"| {html.escape(str(state))} | {int(value)} |
")
+
+ return (
+ "Per-state summary
"
+ f"State-case-count statistics: n={int(summary['count'])}, "
+ f"mean={summary['mean']:.2f}, std={summary['std'] if pd.notna(summary['std']) else 0.0:.2f}, "
+ f"min={summary['min']:.0f}, median={g.median():.0f}, max={summary['max']:.0f}.
"
+ ""
+ "| State | case_count |
|---|
"
+ f"{''.join(rows)}
"
+ )
+
+
+def _render_first_case_by_state(df: pd.DataFrame) -> str:
+ if df.empty:
+ return "Affected states and first detected dates
No state data available.
"
+
+ first_by_state = (
+ df.groupby("State")["Confirmed Diagnosis"]
+ .min()
+ .sort_values()
+ )
+
+ rows = []
+ for state, dt in first_by_state.items():
+ rows.append(
+ ""
+ f"| {html.escape(str(state))} | "
+ f"{html.escape(dt.date().isoformat())} | "
+ "
"
+ )
+
+ return (
+ "Affected states and first detected dates
"
+ f"Total affected states: {int(first_by_state.shape[0])}.
"
+ ""
+ "| State | first_confirmed_diagnosis_date |
|---|
"
+ f"{''.join(rows)}
"
+ )
+
+
+def _render_model_section(
+ title: str,
+ counts: pd.Series,
+ *,
+ linear: dict[str, float] | None,
+ exp: dict[str, float] | None,
+) -> str:
+ lines = [f"{html.escape(title)}
"]
+ # Repeat the section title in prose so it survives heading-only drops in
+ # some HTML extraction paths and remains quotable for insight extraction.
+ lines.append(
+ f"Section title: {html.escape(title)}. "
+ f"Input points: {counts.shape[0]}.
"
+ )
+
+ if linear is None:
+ lines.append("Linear model: unavailable (insufficient data).
")
+ else:
+ lines.append(
+ "Linear model y = intercept + slope*x: "
+ f"intercept={linear['intercept']:.6f}, slope={linear['slope']:.6f}, "
+ f"R^2={linear['r2']:.6f}.
"
+ )
+
+ if exp is None:
+ lines.append(
+ "Exponential model y = a*exp(b*x): unavailable "
+ "(insufficient strictly-positive points).
"
+ )
+ else:
+ lines.append(
+ "Exponential model y = a*exp(b*x): "
+ f"a={exp['a']:.6f}, b={exp['b']:.6f}, R^2={exp['r2']:.6f}.
"
+ )
+
+ return "".join(lines)
+
+
+def fetch(
+ url: str,
+ *,
+ config: ExtractionConfig | None = None,
+ as_of_date: datetime | None = None,
+ region: str | None = None,
+ question_text: str | None = None,
+ tableau_fetcher: TableauFetcher | None = None,
+) -> FetchResult | None:
+ cfg = config or ExtractionConfig()
+ fetched_at = datetime.now(timezone.utc)
+
+ df = (tableau_fetcher or _fetch_tableau_dataframe)(TABLEAU_VIEW_URL, cfg)
+ if df is None or df.empty:
+ return None
+
+ df = df.copy()
+
+ # Requested behavior: ignore first row.
+ if df.shape[0] < 2:
+ return None
+ df = df.iloc[1:].copy()
+
+ confirmed_col = _resolve_column(df, "Confirmed Diagnosis")
+ state_col = _resolve_column(df, "State")
+ if confirmed_col is None or state_col is None:
+ return None
+
+ if confirmed_col != "Confirmed Diagnosis":
+ df = df.rename(columns={confirmed_col: "Confirmed Diagnosis"})
+ if state_col != "State":
+ df = df.rename(columns={state_col: "State"})
+
+ df["Confirmed Diagnosis"] = pd.to_datetime(
+ df["Confirmed Diagnosis"], errors="coerce"
+ )
+ df = df.dropna(subset=["Confirmed Diagnosis"]).copy()
+ if df.empty:
+ return None
+
+ if as_of_date is not None:
+ cutoff = as_of_date.astimezone(timezone.utc).replace(tzinfo=None)
+ df = df[df["Confirmed Diagnosis"] <= cutoff]
+ if df.empty:
+ return None
+
+ # Normalize to date only for groupings.
+ df["diagnosis_date"] = df["Confirmed Diagnosis"].dt.date
+ df["month"] = df["Confirmed Diagnosis"].dt.to_period("M").astype(str)
+
+ monthly_counts = df.groupby("month").size().sort_index()
+ daily_counts = df.groupby("diagnosis_date").size().sort_index()
+ cumulative_case_count = int(df.shape[0])
+
+ if monthly_counts.empty or daily_counts.empty:
+ return None
+
+ month_window = monthly_counts.iloc[-6:]
+ day_window = daily_counts.iloc[-30:]
+
+ lin_month = _fit_linear(month_window)
+ exp_month = _fit_exponential(month_window)
+ lin_day = _fit_linear(day_window)
+ exp_day = _fit_exponential(day_window)
+
+ latest = str(daily_counts.index.max())
+
+ rendered = (
+ ""
+ "USDA APHIS HPAI Confirmed Cases in Livestock - CSV analytics"
+ ""
+ "USDA APHIS HPAI Confirmed Cases in Livestock - analytics snapshot
"
+ f"Source dashboard URL: {html.escape(url)}
"
+ f"Tableau source URL: {html.escape(TABLEAU_VIEW_URL)}
"
+ f"Retrieved at: {fetched_at.isoformat()} | latest confirmed diagnosis date: {html.escape(latest)}.
"
+ "This summary is computed from Tableau workbook data. The first data row was ignored by design.
"
+ "Cumulative and state coverage summary
"
+ f"Cumulative confirmed cases in livestock (from CSV rows): {cumulative_case_count}.
"
+ f"{_render_first_case_by_state(df)}"
+ "Monthly counts from Confirmed Diagnosis
"
+ f"Summary statistics (monthly case counts): {_fmt_stats(monthly_counts)}.
"
+ f"{_render_counts_table('Counts by month', monthly_counts, 'month')}"
+ f"{_render_model_section('Model fit on past 6 months (monthly counts)', month_window, linear=lin_month, exp=exp_month)}"
+ "Daily counts from Confirmed Diagnosis
"
+ f"Summary statistics (daily case counts): {_fmt_stats(daily_counts)}.
"
+ f"{_render_counts_table('Counts by day', daily_counts, 'date')}"
+ f"{_render_model_section('Model fit on past 30 days (daily counts)', day_window, linear=lin_day, exp=exp_day)}"
+ "State-level counts from Confirmed Diagnosis + State
"
+ f"{_render_state_summary(df)}"
+ ""
+ ).encode("utf-8")
+
+ return FetchResult(
+ url=TABLEAU_VIEW_URL,
+ final_url=TABLEAU_VIEW_URL,
+ status_code=200,
+ content_type="text/html",
+ content_bytes=rendered,
+ fetched_at=fetched_at,
+ error=None,
+ )
diff --git a/bioscancast/stages/forecasting/pipeline.py b/bioscancast/stages/forecasting/pipeline.py
index 309b4b2..68c2fc3 100644
--- a/bioscancast/stages/forecasting/pipeline.py
+++ b/bioscancast/stages/forecasting/pipeline.py
@@ -138,6 +138,8 @@ def run(
question: ForecastQuestion,
records: List[InsightRecord],
options: List[str],
+ historical_context: str | None = None,
+ historical_insight_context: str | None = None,
) -> ForecastResult:
"""Produce a forecast distribution over ``options`` for ``question``.
@@ -168,7 +170,11 @@ def run(
# --- Ensemble of superforecaster reasoning samples ---
system, user, schema = build_forecast_prompt(
- question, options, evidence_digest
+ question,
+ options,
+ evidence_digest,
+ historical_context,
+ historical_insight_context,
)
usable_vectors: List[List[float]] = []
for i in range(config.ensemble_samples):
diff --git a/bioscancast/stages/forecasting/prompts.py b/bioscancast/stages/forecasting/prompts.py
index 6ae466a..1edb4f0 100644
--- a/bioscancast/stages/forecasting/prompts.py
+++ b/bioscancast/stages/forecasting/prompts.py
@@ -121,6 +121,8 @@ def build_forecast_prompt(
question: ForecastQuestion,
options: List[str],
evidence_digest: str,
+ historical_context: str | None = None,
+ historical_insight_context: str | None = None,
) -> Tuple[str, str, dict]:
"""Build the (system, user, json_schema) tuple for one reasoning sample.
@@ -154,6 +156,22 @@ def build_forecast_prompt(
)
parts.append(f"OPTIONS (assign a probability to each, in this order):\n{numbered_options}")
+ if historical_context:
+ parts.append("")
+ parts.append(
+ "FORECAST HISTORY (prior runs for this question; use as context, "
+ "not as a substitute for current evidence):"
+ )
+ parts.append(historical_context)
+
+ if historical_insight_context:
+ parts.append("")
+ parts.append(
+ "PAST INSIGHT SCRAPES (from prior runs; each line includes the "
+ "scrape as-of date):"
+ )
+ parts.append(historical_insight_context)
+
parts.append("")
if evidence_digest:
parts.append("EVIDENCE (most recent first):")
diff --git a/bioscancast/stages/insight/text_extraction/chunk_extractor.py b/bioscancast/stages/insight/text_extraction/chunk_extractor.py
index 4fa8d67..5434374 100644
--- a/bioscancast/stages/insight/text_extraction/chunk_extractor.py
+++ b/bioscancast/stages/insight/text_extraction/chunk_extractor.py
@@ -414,6 +414,20 @@ def extract_facts_from_chunk(
# and content-insertion hallucinations. See ``_quote_matches`` for
# the rationale and the layers.
canonical_quote = _quote_matches(raw_quote, chunk.text)
+ source_chunk_id = chunk.chunk_id
+ if canonical_quote is None:
+ # Minimal fallback for chunk-routing misses: if retrieval sends a
+ # chunk adjacent to the one the model quoted, accept only when the
+ # quote appears verbatim in some other chunk of the same document.
+ for alt_chunk in document.chunks:
+ if alt_chunk.chunk_id == chunk.chunk_id:
+ continue
+ alt_quote = _quote_matches(raw_quote, alt_chunk.text)
+ if alt_quote is not None:
+ canonical_quote = alt_quote
+ source_chunk_id = alt_chunk.chunk_id
+ break
+
if canonical_quote is None:
logger.warning(
"Hallucination guard: dropping fact with non-matching quote. "
@@ -456,7 +470,7 @@ def extract_facts_from_chunk(
sources=[
ChunkReference(
document_id=document.id,
- chunk_id=chunk.chunk_id,
+ chunk_id=source_chunk_id,
source_url=document.source_url,
quote=canonical_quote[:200],
),
diff --git a/bioscancast/tests/test_forecast_history_context.py b/bioscancast/tests/test_forecast_history_context.py
new file mode 100644
index 0000000..97e1307
--- /dev/null
+++ b/bioscancast/tests/test_forecast_history_context.py
@@ -0,0 +1,483 @@
+from __future__ import annotations
+
+import json
+
+import bioscancast.main as orchestrator
+from bioscancast.main import (
+ _build_forecast_history_context,
+ _build_insight_history_context,
+)
+from bioscancast.stages.forecasting.schemas import (
+ ForecastDistribution,
+ ForecastRecord,
+ ForecastResult,
+)
+from bioscancast.stages.insight.pipeline import InsightRunResult
+
+
+def _write_json(path, payload):
+ path.parent.mkdir(parents=True, exist_ok=True)
+ path.write_text(json.dumps(payload), encoding="utf-8")
+
+
+def test_build_forecast_history_context_reads_prior_runs(tmp_path):
+ qid = "q-hist"
+ current = "20260714_120000"
+
+ old_run = tmp_path / qid / "20260701_000000"
+ _write_json(
+ old_run / "question.json",
+ {"id": qid, "as_of_date": "2026-07-01T00:00:00+00:00"},
+ )
+ _write_json(
+ old_run / "forecast.json",
+ {
+ "distributions": [
+ {
+ "forecast_source": "bioscancast",
+ "probabilities": {"YES": 0.72, "NO": 0.28},
+ }
+ ],
+ "samples": [
+ {"ok": True, "rationale": "cases rose over prior two weeks"}
+ ],
+ "baseline_rationale": "prior-only baseline",
+ },
+ )
+
+ context = _build_forecast_history_context(tmp_path, qid, current)
+
+ assert "as_of=2026-07-01T00:00:00+00:00" in context
+ assert "top=YES (0.720)" in context
+ assert "rationale: cases rose over prior two weeks" in context
+
+
+def test_build_forecast_history_context_skips_current_run(tmp_path):
+ qid = "q-hist"
+ current = "20260714_120000"
+
+ cur_run = tmp_path / qid / current
+ _write_json(cur_run / "question.json", {"id": qid, "as_of_date": "2026-07-14"})
+ _write_json(
+ cur_run / "forecast.json",
+ {
+ "distributions": [
+ {
+ "forecast_source": "bioscancast",
+ "probabilities": {"YES": 0.99, "NO": 0.01},
+ }
+ ],
+ "samples": [{"ok": True, "rationale": "current run"}],
+ },
+ )
+
+ context = _build_forecast_history_context(tmp_path, qid, current)
+ assert context == ""
+
+
+def test_build_insight_history_context_reads_prior_scrape_dates(tmp_path):
+ qid = "q-hist"
+ current = "20260714_120000"
+
+ old_run = tmp_path / qid / "20260701_000000"
+ _write_json(
+ old_run / "question.json",
+ {"id": qid, "as_of_date": "2026-07-01T00:00:00+00:00"},
+ )
+ _write_json(
+ old_run / "insight.json",
+ {
+ "records": [
+ {
+ "event_type": "case_count",
+ "location": "Uganda",
+ "metric_name": "confirmed_cases",
+ "metric_value": 42,
+ "summary": "Weekly increase in confirmed cases",
+ "sources": [{"quote": "42 confirmed cases"}],
+ }
+ ]
+ },
+ )
+
+ context = _build_insight_history_context(tmp_path, qid, current)
+ assert "past_scrape_as_of=2026-07-01T00:00:00+00:00" in context
+ assert "metric=confirmed_cases, value=42" in context
+ assert "summary: Weekly increase in confirmed cases" in context
+
+
+def test_orchestrator_passes_history_block_from_prior_runs(tmp_path, monkeypatch):
+ qid = "q-int"
+ current = "20260714_120000"
+
+ # Two prior runs for the same question.
+ for run_id, as_of, probs, rationale in (
+ ("20260712_000000", "2026-07-12T00:00:00+00:00", {"YES": 0.7, "NO": 0.3}, "uptick continued"),
+ ("20260710_000000", "2026-07-10T00:00:00+00:00", {"YES": 0.6, "NO": 0.4}, "signals mixed"),
+ ):
+ rdir = tmp_path / qid / run_id
+ _write_json(rdir / "question.json", {"id": qid, "as_of_date": as_of})
+ _write_json(
+ rdir / "forecast.json",
+ {
+ "distributions": [
+ {
+ "forecast_source": "bioscancast",
+ "probabilities": probs,
+ }
+ ],
+ "samples": [{"ok": True, "rationale": rationale}],
+ },
+ )
+ _write_json(
+ rdir / "insight.json",
+ {
+ "records": [
+ {
+ "event_type": "case_count",
+ "location": "Uganda",
+ "metric_name": "confirmed_cases",
+ "metric_value": 10 if "0712" in run_id else 8,
+ "summary": "Prior scrape saw growth",
+ "sources": [{"quote": "confirmed cases reported"}],
+ }
+ ]
+ },
+ )
+
+ # Unrelated question history must not be included.
+ other = tmp_path / "q-other" / "20260711_000000"
+ _write_json(other / "question.json", {"id": "q-other", "as_of_date": "2026-07-11"})
+ _write_json(
+ other / "forecast.json",
+ {
+ "distributions": [
+ {
+ "forecast_source": "bioscancast",
+ "probabilities": {"YES": 0.99, "NO": 0.01},
+ }
+ ],
+ "samples": [{"ok": True, "rationale": "other question"}],
+ },
+ )
+ _write_json(
+ other / "insight.json",
+ {
+ "records": [
+ {
+ "event_type": "case_count",
+ "location": "Other",
+ "metric_name": "confirmed_cases",
+ "metric_value": 999,
+ "summary": "other question",
+ "sources": [{"quote": "other question"}],
+ }
+ ]
+ },
+ )
+
+ captured: dict[str, str | None] = {
+ "history": None,
+ "insight_history": None,
+ }
+
+ class _DummyLLM:
+ def generate_json(self, **kwargs): # pragma: no cover
+ raise AssertionError("LLM should not be called in this stubbed test")
+
+ def embed(self, texts, *, model):
+ return [[0.0] * 4 for _ in texts]
+
+ class _DummyBackend:
+ pass
+
+ class _SearchStagePipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(self, question):
+ return []
+
+ class _FilteringPipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(self, question, search_results):
+ return []
+
+ class _ExtractionPipeline:
+ def __init__(self, **kwargs):
+ self.docling_telemetry = []
+
+ def run(self, filtered_docs):
+ return []
+
+ class _InsightPipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(self, question, documents):
+ return InsightRunResult(
+ records=[],
+ budget_summary={
+ "total_input_tokens": 0,
+ "total_output_tokens": 0,
+ "per_model": {},
+ },
+ documents_processed=0,
+ documents_skipped=0,
+ notes=[],
+ )
+
+ class _ForecastingPipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(
+ self,
+ question,
+ records,
+ options,
+ historical_context=None,
+ historical_insight_context=None,
+ ):
+ captured["history"] = historical_context
+ captured["insight_history"] = historical_insight_context
+ return ForecastResult(
+ question_id=question.id,
+ options=list(options),
+ distributions=[
+ ForecastDistribution(
+ question_id=question.id,
+ forecast_source="bioscancast",
+ probabilities={"YES": 0.5, "NO": 0.5},
+ )
+ ],
+ records=[
+ ForecastRecord(
+ question_id=question.id,
+ forecast_source="bioscancast",
+ option="YES",
+ probability=0.5,
+ ),
+ ForecastRecord(
+ question_id=question.id,
+ forecast_source="bioscancast",
+ option="NO",
+ probability=0.5,
+ ),
+ ],
+ budget_summary={
+ "total_input_tokens": 0,
+ "total_output_tokens": 0,
+ "per_model": {},
+ },
+ )
+
+ monkeypatch.setenv("OPENAI_API_KEY", "test-key")
+ monkeypatch.setenv("TAVILY_API_KEY", "test-key")
+ monkeypatch.setattr(orchestrator, "OpenAILLMClient", _DummyLLM)
+ monkeypatch.setattr(orchestrator, "TavilyBackend", _DummyBackend)
+ monkeypatch.setattr(orchestrator, "SearchStagePipeline", _SearchStagePipeline)
+ monkeypatch.setattr(orchestrator, "FilteringPipeline", _FilteringPipeline)
+ monkeypatch.setattr(orchestrator, "ExtractionPipeline", _ExtractionPipeline)
+ monkeypatch.setattr(orchestrator, "InsightPipeline", _InsightPipeline)
+ monkeypatch.setattr(orchestrator, "ForecastingPipeline", _ForecastingPipeline)
+
+ args = orchestrator._parse_args(
+ [
+ qid,
+ "--question",
+ "Will cases exceed threshold?",
+ "--out-root",
+ str(tmp_path),
+ "--run-id",
+ current,
+ "--options",
+ "YES,NO",
+ "--no-baseline",
+ "--no-cache",
+ ]
+ )
+
+ orchestrator.run_pipeline(args)
+
+ history = captured["history"] or ""
+ insight_history = captured["insight_history"] or ""
+ assert "as_of=2026-07-12T00:00:00+00:00" in history
+ assert "as_of=2026-07-10T00:00:00+00:00" in history
+ assert "rationale: uptick continued" in history
+ assert "rationale: signals mixed" in history
+ assert "other question" not in history
+ assert "past_scrape_as_of=2026-07-12T00:00:00+00:00" in insight_history
+ assert "past_scrape_as_of=2026-07-10T00:00:00+00:00" in insight_history
+ assert "metric=confirmed_cases" in insight_history
+ assert "other question" not in insight_history
+
+
+def test_orchestrator_no_history_context_flag_disables_prior_context(tmp_path, monkeypatch):
+ qid = "q-int"
+ current = "20260714_130000"
+
+ prior = tmp_path / qid / "20260712_000000"
+ _write_json(
+ prior / "question.json",
+ {"id": qid, "as_of_date": "2026-07-12T00:00:00+00:00"},
+ )
+ _write_json(
+ prior / "forecast.json",
+ {
+ "distributions": [
+ {
+ "forecast_source": "bioscancast",
+ "probabilities": {"YES": 0.7, "NO": 0.3},
+ }
+ ],
+ "samples": [{"ok": True, "rationale": "uptick continued"}],
+ },
+ )
+ _write_json(
+ prior / "insight.json",
+ {
+ "records": [
+ {
+ "event_type": "case_count",
+ "location": "Uganda",
+ "metric_name": "confirmed_cases",
+ "metric_value": 10,
+ "summary": "Prior scrape saw growth",
+ "sources": [{"quote": "confirmed cases reported"}],
+ }
+ ]
+ },
+ )
+
+ captured: dict[str, str | None] = {
+ "history": None,
+ "insight_history": None,
+ }
+
+ class _DummyLLM:
+ def generate_json(self, **kwargs): # pragma: no cover
+ raise AssertionError("LLM should not be called in this stubbed test")
+
+ def embed(self, texts, *, model):
+ return [[0.0] * 4 for _ in texts]
+
+ class _DummyBackend:
+ pass
+
+ class _SearchStagePipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(self, question):
+ return []
+
+ class _FilteringPipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(self, question, search_results):
+ return []
+
+ class _ExtractionPipeline:
+ def __init__(self, **kwargs):
+ self.docling_telemetry = []
+
+ def run(self, filtered_docs):
+ return []
+
+ class _InsightPipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(self, question, documents):
+ return InsightRunResult(
+ records=[],
+ budget_summary={
+ "total_input_tokens": 0,
+ "total_output_tokens": 0,
+ "per_model": {},
+ },
+ documents_processed=0,
+ documents_skipped=0,
+ notes=[],
+ )
+
+ class _ForecastingPipeline:
+ def __init__(self, **kwargs):
+ pass
+
+ def run(
+ self,
+ question,
+ records,
+ options,
+ historical_context=None,
+ historical_insight_context=None,
+ ):
+ captured["history"] = historical_context
+ captured["insight_history"] = historical_insight_context
+ return ForecastResult(
+ question_id=question.id,
+ options=list(options),
+ distributions=[
+ ForecastDistribution(
+ question_id=question.id,
+ forecast_source="bioscancast",
+ probabilities={"YES": 0.5, "NO": 0.5},
+ )
+ ],
+ records=[
+ ForecastRecord(
+ question_id=question.id,
+ forecast_source="bioscancast",
+ option="YES",
+ probability=0.5,
+ ),
+ ForecastRecord(
+ question_id=question.id,
+ forecast_source="bioscancast",
+ option="NO",
+ probability=0.5,
+ ),
+ ],
+ budget_summary={
+ "total_input_tokens": 0,
+ "total_output_tokens": 0,
+ "per_model": {},
+ },
+ )
+
+ monkeypatch.setenv("OPENAI_API_KEY", "test-key")
+ monkeypatch.setenv("TAVILY_API_KEY", "test-key")
+ monkeypatch.setattr(orchestrator, "OpenAILLMClient", _DummyLLM)
+ monkeypatch.setattr(orchestrator, "TavilyBackend", _DummyBackend)
+ monkeypatch.setattr(orchestrator, "SearchStagePipeline", _SearchStagePipeline)
+ monkeypatch.setattr(orchestrator, "FilteringPipeline", _FilteringPipeline)
+ monkeypatch.setattr(orchestrator, "ExtractionPipeline", _ExtractionPipeline)
+ monkeypatch.setattr(orchestrator, "InsightPipeline", _InsightPipeline)
+ monkeypatch.setattr(orchestrator, "ForecastingPipeline", _ForecastingPipeline)
+
+ args = orchestrator._parse_args(
+ [
+ qid,
+ "--question",
+ "Will cases exceed threshold?",
+ "--out-root",
+ str(tmp_path),
+ "--run-id",
+ current,
+ "--options",
+ "YES,NO",
+ "--no-baseline",
+ "--no-cache",
+ "--no-history-context",
+ ]
+ )
+
+ orchestrator.run_pipeline(args)
+
+ assert (captured["history"] or "") == ""
+ assert (captured["insight_history"] or "") == ""
diff --git a/bioscancast/tests/test_forecasting_pipeline.py b/bioscancast/tests/test_forecasting_pipeline.py
index b246ebf..90415c9 100644
--- a/bioscancast/tests/test_forecasting_pipeline.py
+++ b/bioscancast/tests/test_forecasting_pipeline.py
@@ -15,7 +15,9 @@
from bioscancast.stages.forecasting import aggregation
from bioscancast.stages.forecasting.config import ForecastingConfig
from bioscancast.stages.forecasting.evidence import build_evidence_digest, _format_record
+from bioscancast.stages.forecasting.prompts import build_forecast_prompt
from bioscancast.stages.forecasting.pipeline import ForecastingPipeline
+import bioscancast.stages.forecasting.pipeline as forecasting_pipeline_mod
from bioscancast.stages.forecasting.schemas import ForecastResult
from bioscancast.llm.base import LLMResponse
from bioscancast.llm.fake_client import FakeLLMClient
@@ -461,6 +463,90 @@ def test_pipeline_rejects_empty_options():
pipeline.run(QUESTION, [_record()], [])
+def test_prompt_includes_forecast_history_block_when_provided():
+ system, user, schema = build_forecast_prompt(
+ QUESTION,
+ ["YES", "NO"],
+ evidence_digest="[2026-01-15] sample evidence",
+ historical_context=(
+ "- as_of=2026-01-01 run=20260101_000000: top=NO (0.620); "
+ "probs: YES=0.380, NO=0.620; rationale: outbreak appears contained"
+ ),
+ )
+ assert "FORECAST HISTORY (prior runs for this question" in user
+ assert "as_of=2026-01-01" in user
+ assert "rationale: outbreak appears contained" in user
+
+
+def test_prompt_includes_past_insight_scrape_block_when_provided():
+ system, user, schema = build_forecast_prompt(
+ QUESTION,
+ ["YES", "NO"],
+ evidence_digest="[2026-01-15] sample evidence",
+ historical_insight_context=(
+ "- past_scrape_as_of=2026-01-03 run=20260103_000000: "
+ "event_type=case_count, location=Uganda, metric=confirmed_cases, "
+ "value=12; summary: Weekly increase observed"
+ ),
+ )
+ assert "PAST INSIGHT SCRAPES (from prior runs" in user
+ assert "past_scrape_as_of=2026-01-03" in user
+ assert "Weekly increase observed" in user
+
+
+def test_pipeline_threads_historical_context_into_prompt(monkeypatch):
+ captured: dict[str, str | None] = {
+ "historical_context": None,
+ "historical_insight_context": None,
+ }
+ original = forecasting_pipeline_mod.build_forecast_prompt
+
+ def _recording_build_prompt(
+ question,
+ options,
+ evidence_digest,
+ historical_context=None,
+ historical_insight_context=None,
+ ):
+ captured["historical_context"] = historical_context
+ captured["historical_insight_context"] = historical_insight_context
+ return original(
+ question,
+ options,
+ evidence_digest,
+ historical_context,
+ historical_insight_context,
+ )
+
+ monkeypatch.setattr(
+ forecasting_pipeline_mod,
+ "build_forecast_prompt",
+ _recording_build_prompt,
+ )
+
+ client = FakeLLMClient([_forecast_resp([0.6, 0.4])])
+ pipeline = ForecastingPipeline(
+ llm_client=client,
+ config=_config(ensemble_samples=1, emit_baseline=False),
+ )
+ pipeline.run(
+ QUESTION,
+ [_record()],
+ ["YES", "NO"],
+ historical_context="- as_of=2026-01-01 run=old: top=NO (0.620)",
+ historical_insight_context=(
+ "- past_scrape_as_of=2026-01-02 run=older: metric=confirmed_cases, value=7"
+ ),
+ )
+
+ assert captured["historical_context"] is not None
+ assert "as_of=2026-01-01" in (captured["historical_context"] or "")
+ assert captured["historical_insight_context"] is not None
+ assert "past_scrape_as_of=2026-01-02" in (
+ captured["historical_insight_context"] or ""
+ )
+
+
# ---------------------------------------------------------------------------
# Integration with the eval stage scorer
# ---------------------------------------------------------------------------
diff --git a/bioscancast/tests/test_owid_custom_scrapers.py b/bioscancast/tests/test_owid_custom_scrapers.py
index 6ddf1c9..1e72d48 100644
--- a/bioscancast/tests/test_owid_custom_scrapers.py
+++ b/bioscancast/tests/test_owid_custom_scrapers.py
@@ -112,6 +112,9 @@ def test_emits_prose_and_trend_table(self):
# Trend columns present, and the last World trend row is the cutoff date.
assert "total_cases | " in body
assert "2025-03-05" in body
+ assert "Trend summary (total_cases, World):" in body
+ assert "Linear fit on recent cumulative trend (total_cases" in body
+ assert "Incident trend stats (new_cases, World):" in body
def test_returns_none_when_no_rows_before_cutoff(self):
assert (
@@ -146,6 +149,8 @@ def test_region_surfaces_target_entity(self):
)
assert "Africa
" in body
assert "cumulative confirmed cases (Africa): 41,000" in body
+ assert "Region/question-target focus: Africa trend statistics" in body
+ assert "Trend summary (total_cases, Africa):" in body
def test_question_text_infers_target_entity(self):
body = _html(
diff --git a/bioscancast/tests/test_paho_oropouche_portal_scraper.py b/bioscancast/tests/test_paho_oropouche_portal_scraper.py
new file mode 100644
index 0000000..62e3900
--- /dev/null
+++ b/bioscancast/tests/test_paho_oropouche_portal_scraper.py
@@ -0,0 +1,156 @@
+from __future__ import annotations
+
+from datetime import datetime, timezone
+
+from bioscancast.llm.base import LLMResponse
+from bioscancast.llm.fake_client import FakeLLMClient
+from bioscancast.stages.extraction.config import ExtractionConfig
+from bioscancast.stages.extraction.custom_scrapers import paho_oropouche_portal
+from bioscancast.stages.extraction.pipeline import ExtractionPipeline
+from bioscancast.stages.filtering.models import FilteredDocument, ForecastQuestion
+from bioscancast.stages.insight.config import InsightConfig
+from bioscancast.stages.insight.pipeline import InsightPipeline
+
+
+_CSV = """Año,Semanas Epi,Week Lab Confirmed,Pais
+2026,1,10,Brazil
+2026,1,5,Peru
+2026,2,7,Brazil
+2026,3,0,Bolivia
+2026,20,9,Brazil
+2026,21,4,Peru
+2026,22,3,Colombia
+2026,23,8,Brazil
+2026,24,2,Peru
+"""
+
+
+def _fetcher(text: str = _CSV):
+ return lambda url, config: text
+
+
+def _html(result) -> str:
+ assert result is not None
+ assert result.content_type == "text/html"
+ return result.content_bytes.decode("utf-8")
+
+
+def _asof(s: str) -> datetime:
+ return datetime.strptime(s, "%Y-%m-%d").replace(tzinfo=timezone.utc)
+
+
+def test_renders_weekly_and_country_analytics():
+ result = paho_oropouche_portal.fetch(
+ "https://www.paho.org/en/arbo-portal/arbo-portal-oropouche",
+ csv_fetcher=_fetcher(),
+ )
+ body = _html(result)
+
+ assert "Weekly counts from Año + Semanas Epi" in body
+ assert "Counts by year_week" in body
+ assert "2026-W01" in body
+ assert "Cumulative confirmed count across all weeks" in body
+ assert "Model fit on past 24 weeks" in body
+ assert "Country/state grouping from year_week + Pais" in body
+ assert "Per-country summary" in body
+ assert "Affected states/countries (Pais values):" in body
+
+
+def test_as_of_date_filters_future_weeks():
+ result = paho_oropouche_portal.fetch(
+ "https://www.paho.org/en/arbo-portal/arbo-portal-oropouche",
+ as_of_date=_asof("2026-05-25"),
+ csv_fetcher=_fetcher(),
+ )
+ body = _html(result)
+
+ assert "2026-W23" not in body
+ assert "2026-W24" not in body
+
+
+def test_dispatcher_uses_source_id_custom_scraper(monkeypatch):
+ from bioscancast.stages.extraction import fetcher as fetcher_mod
+
+ monkeypatch.setattr(paho_oropouche_portal, "_fetch_csv_text", lambda _url, _cfg: _CSV)
+
+ result = fetcher_mod.fetch(
+ "https://www.paho.org/en/arbo-portal/arbo-portal-oropouche",
+ config=ExtractionConfig(),
+ source_id="paho_oropouche_portal",
+ )
+ assert result is not None
+ assert result.fetch_strategy == "custom:paho_oropouche_portal"
+ assert "PAHO Oropouche weekly analytics snapshot" in _html(result)
+
+
+def test_returns_none_on_missing_required_columns():
+ bad = "year,week,cases,country\n2026,1,10,Brazil\n"
+ result = paho_oropouche_portal.fetch(
+ "https://www.paho.org/en/arbo-portal/arbo-portal-oropouche",
+ csv_fetcher=_fetcher(bad),
+ )
+ assert result is None
+
+
+def test_oropouche_scraper_output_reaches_insight_llm(monkeypatch):
+ monkeypatch.setattr(paho_oropouche_portal, "_fetch_csv_text", lambda _url, _cfg: _CSV)
+
+ fdoc = FilteredDocument(
+ result_id="r-orov-1",
+ question_id="q-orov-1",
+ url="https://www.paho.org/en/arbo-portal/arbo-portal-oropouche",
+ canonical_url="https://www.paho.org/en/arbo-portal/arbo-portal-oropouche",
+ domain="www.paho.org",
+ title="PAHO Oropouche portal",
+ snippet="Dashboard",
+ published_date=None,
+ file_type="html",
+ relevance_score=1.0,
+ credibility_score=1.0,
+ final_score=1.0,
+ source_tier="official",
+ is_official_domain=True,
+ selection_reasons=["test"],
+ extraction_priority=1,
+ extraction_mode="full",
+ expected_value="high",
+ source_id="paho_oropouche_portal",
+ region="Americas",
+ question_text="How many countries/territories report Oropouche?",
+ )
+
+ question = ForecastQuestion(
+ id="q-orov-1",
+ text="How many Americas countries or territories report confirmed Oropouche?",
+ created_at=datetime(2026, 1, 1, tzinfo=timezone.utc),
+ region="Americas",
+ pathogen="Oropouche",
+ event_type="case_count",
+ )
+
+ docs = ExtractionPipeline(config=ExtractionConfig()).run([fdoc])
+ assert len(docs) == 1
+ assert docs[0].status == "success"
+ assert docs[0].chunks
+
+ llm = FakeLLMClient([
+ LLMResponse(
+ content={"facts": []},
+ input_tokens=100,
+ output_tokens=10,
+ model="gpt-4o-mini",
+ raw_text='{"facts": []}',
+ )
+ ])
+
+ insight = InsightPipeline(
+ llm_client=llm,
+ config=InsightConfig(
+ retrieval_top_k=1,
+ max_chunks_per_document=1,
+ low_survival_top_k=1,
+ ),
+ ).run(question, docs)
+
+ assert insight.documents_processed == 1
+ assert llm.call_count == 1
diff --git a/bioscancast/tests/test_usda_aphis_livestock_scraper.py b/bioscancast/tests/test_usda_aphis_livestock_scraper.py
new file mode 100644
index 0000000..7891033
--- /dev/null
+++ b/bioscancast/tests/test_usda_aphis_livestock_scraper.py
@@ -0,0 +1,208 @@
+from __future__ import annotations
+
+import io
+from datetime import datetime, timezone
+
+import pandas as pd
+
+from bioscancast.llm.fake_client import FakeLLMClient
+from bioscancast.llm.base import LLMResponse
+from bioscancast.stages.extraction.config import ExtractionConfig
+from bioscancast.stages.extraction.pipeline import ExtractionPipeline
+from bioscancast.stages.extraction.custom_scrapers import usda_aphis_livestock
+from bioscancast.stages.filtering.models import FilteredDocument, ForecastQuestion
+from bioscancast.stages.insight.config import InsightConfig
+from bioscancast.stages.insight.pipeline import InsightPipeline
+
+
+_CSV = """Confirmed Diagnosis,State,County
+2024-01-01,IGNORE,NA
+2026-01-05,CA,A
+2026-01-15,CA,B
+2026-02-10,TX,C
+2026-03-12,TX,D
+2026-03-20,TX,E
+2026-04-02,NY,F
+2026-04-02,CA,G
+2026-04-03,CA,H
+"""
+
+
+def _df_fetcher(text: str = _CSV):
+ def _fetch(_url, _config):
+ return pd.read_csv(io.StringIO(text))
+
+ return _fetch
+
+
+def _html(result) -> str:
+ assert result is not None
+ assert result.content_type == "text/html"
+ return result.content_bytes.decode("utf-8")
+
+
+def _asof(s: str) -> datetime:
+ return datetime.strptime(s, "%Y-%m-%d").replace(tzinfo=timezone.utc)
+
+
+def test_renders_requested_analytics_sections():
+ result = usda_aphis_livestock.fetch(
+ "https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ tableau_fetcher=_df_fetcher(),
+ )
+ body = _html(result)
+
+ assert "Monthly counts from Confirmed Diagnosis" in body
+ assert "Model fit on past 6 months (monthly counts)" in body
+ assert "Daily counts from Confirmed Diagnosis" in body
+ assert "Model fit on past 30 days (daily counts)" in body
+ assert "Per-state summary" in body
+ assert "Linear model y = intercept + slope*x" in body
+ assert "Exponential model y = a*exp(b*x)" in body
+ assert "Cumulative confirmed cases in livestock (from CSV rows): 8" in body
+ assert "Affected states and first detected dates" in body
+ assert "CA | 2026-01-05 | " in body
+ assert "TX | 2026-02-10 | " in body
+ assert "NY | 2026-04-02 | " in body
+
+
+def test_ignores_first_row_before_aggregation():
+ result = usda_aphis_livestock.fetch(
+ "https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ tableau_fetcher=_df_fetcher(),
+ )
+ body = _html(result)
+
+ # The first row (2024-01-01, IGNORE) should not appear in output.
+ assert "2024-01" not in body
+ assert "IGNORE" not in body
+ # Remaining months do appear.
+ assert "2026-01" in body
+ assert "2026-04" in body
+
+
+def test_as_of_date_applies_cutoff():
+ result = usda_aphis_livestock.fetch(
+ "https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ as_of_date=_asof("2026-03-31"),
+ tableau_fetcher=_df_fetcher(),
+ )
+ body = _html(result)
+
+ assert "2026-04" not in body
+ assert "2026-03" in body
+
+
+def test_dispatcher_uses_source_id_custom_scraper(monkeypatch):
+ from bioscancast.stages.extraction import fetcher as fetcher_mod
+
+ monkeypatch.setattr(
+ usda_aphis_livestock,
+ "_fetch_tableau_dataframe",
+ lambda _url, _cfg: pd.read_csv(io.StringIO(_CSV)),
+ )
+
+ result = fetcher_mod.fetch(
+ "https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ config=ExtractionConfig(),
+ source_id="usda_aphis_livestock",
+ )
+ assert result is not None
+ assert result.fetch_strategy == "custom:usda_aphis_livestock"
+ assert "USDA APHIS HPAI Confirmed Cases in Livestock - analytics snapshot" in _html(result)
+
+
+def test_returns_none_on_missing_columns():
+ bad = "date,state\n2026-01-01,CA\n2026-01-02,TX\n"
+ result = usda_aphis_livestock.fetch(
+ "https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ tableau_fetcher=_df_fetcher(bad),
+ )
+ assert result is None
+
+
+def test_usda_scraper_output_reaches_insight_llm(monkeypatch):
+ monkeypatch.setattr(
+ usda_aphis_livestock,
+ "_fetch_tableau_dataframe",
+ lambda _url, _cfg: pd.read_csv(io.StringIO(_CSV)),
+ )
+
+ fdoc = FilteredDocument(
+ result_id="r-usda-1",
+ question_id="q-usda-1",
+ url="https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ canonical_url="https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/hpai-confirmed-cases-livestock",
+ domain="aphis.usda.gov",
+ title="USDA APHIS HPAI Confirmed Cases in Livestock",
+ snippet="Dashboard",
+ published_date=None,
+ file_type="html",
+ relevance_score=1.0,
+ credibility_score=1.0,
+ final_score=1.0,
+ source_tier="official",
+ is_official_domain=True,
+ selection_reasons=["test"],
+ extraction_priority=1,
+ extraction_mode="full",
+ expected_value="high",
+ source_id="usda_aphis_livestock",
+ region="United States",
+ question_text="How many livestock detections are reported?",
+ )
+
+ question = ForecastQuestion(
+ id="q-usda-1",
+ text="How many HPAI confirmed cases in livestock are reported in the US?",
+ created_at=datetime(2026, 1, 1, tzinfo=timezone.utc),
+ region="United States",
+ pathogen="H5N1",
+ event_type="case_count",
+ )
+
+ docs = ExtractionPipeline(config=ExtractionConfig()).run([fdoc])
+ assert len(docs) == 1
+ assert docs[0].status == "success"
+ assert docs[0].chunks
+
+ llm = FakeLLMClient([
+ LLMResponse(
+ content={
+ "facts": [
+ {
+ "event_type": "case_count",
+ "confidence": 0.9,
+ "location": "United States",
+ "pathogen": "H5N1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 8,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": None,
+ "data_quality": None,
+ "event_date": None,
+ "summary": "USDA cumulative count from dashboard extract.",
+ "quote": "Cumulative confirmed cases in livestock (from CSV rows): 8.",
+ }
+ ]
+ },
+ input_tokens=100,
+ output_tokens=10,
+ model="gpt-4o-mini",
+ raw_text='{"facts": [{...}]}',
+ )
+ ])
+ insight = InsightPipeline(
+ llm_client=llm,
+ config=InsightConfig(
+ retrieval_top_k=1,
+ max_chunks_per_document=1,
+ low_survival_top_k=1,
+ ),
+ ).run(question, docs)
+
+ assert insight.documents_processed == 1
+ assert len(insight.records) == 1
+ assert llm.call_count == 1
diff --git a/data/investigations/q1_ab_no_history.csv b/data/investigations/q1_ab_no_history.csv
new file mode 100644
index 0000000..0224716
--- /dev/null
+++ b/data/investigations/q1_ab_no_history.csv
@@ -0,0 +1,13 @@
+question_id;forecast_version;option;probability
+q1;bioscancast@2025-02-17;70-100;0,969651792406
+q1;bioscancast@2025-02-17;100-150;0,026258338114
+q1;bioscancast@2025-02-17;150-200;0,003322071015
+q1;bioscancast@2025-02-17;200+;0,000767798464
+q1;bioscancast@2025-02-20;70-100;0,978101723325
+q1;bioscancast@2025-02-20;100-150;0,020290419641
+q1;bioscancast@2025-02-20;150-200;0,001234104308
+q1;bioscancast@2025-02-20;200+;0,000373752725
+q1;bioscancast@2025-02-24;70-100;0,983592891363
+q1;bioscancast@2025-02-24;100-150;0,012312603858
+q1;bioscancast@2025-02-24;150-200;0,002995509750
+q1;bioscancast@2025-02-24;200+;0,001098995030
diff --git a/data/investigations/q1_ab_with_history.csv b/data/investigations/q1_ab_with_history.csv
new file mode 100644
index 0000000..141fabb
--- /dev/null
+++ b/data/investigations/q1_ab_with_history.csv
@@ -0,0 +1,13 @@
+question_id;forecast_version;option;probability
+q1;bioscancast@2025-02-17;70-100;0,933075858689
+q1;bioscancast@2025-02-17;100-150;0,048265595551
+q1;bioscancast@2025-02-17;150-200;0,013013367458
+q1;bioscancast@2025-02-17;200+;0,005645178301
+q1;bioscancast@2025-02-20;70-100;0,997874386081
+q1;bioscancast@2025-02-20;100-150;0,001907599059
+q1;bioscancast@2025-02-20;150-200;0,000160697486
+q1;bioscancast@2025-02-20;200+;0,000057317373
+q1;bioscancast@2025-02-24;70-100;0,999910113447
+q1;bioscancast@2025-02-24;100-150;0,000089886553
+q1;bioscancast@2025-02-24;150-200;0,000000000000
+q1;bioscancast@2025-02-24;200+;0,000000000000
diff --git a/data/runs_ab_no_history/q1/traj_20250217/documents.json b/data/runs_ab_no_history/q1/traj_20250217/documents.json
new file mode 100644
index 0000000..1de53ae
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250217/documents.json
@@ -0,0 +1,742 @@
+[
+ {
+ "id": "doc-066ba72014154b3dbb1d75402a7afb24",
+ "result_id": "066ba72014154b3dbb1d75402a7afb24",
+ "source_url": "https://web.archive.org/web/20250209191218id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus",
+ "domain": "who.int",
+ "fetched_at": "2026-07-14T23:34:38.603159+00:00",
+ "document_type": "html",
+ "status": "success",
+ "canonical_url": "https://web.archive.org/web/20250209191218id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus",
+ "title": "Avian influenza A(H5N1) virus",
+ "published_date": "2025-02-09T19:12:18+00:00",
+ "language": "en",
+ "page_count": null,
+ "char_count": 1033,
+ "token_count": 217,
+ "error_message": null,
+ "http_status": 200,
+ "content_type": "text/html",
+ "chunks": [
+ {
+ "chunk_id": "doc-066ba72014154b3dbb1d75402a7afb24-c0",
+ "chunk_index": 0,
+ "text": "Avian influenza A(H5N1) is a subtype of influenza virus that infects birds and mammals, including humans in rare instances. The goose/Guangdong-lineage of H5N1 avian influenza viruses first emerged in 1996 and have been causing outbreaks in birds since then. Since 2020, a variant of these viruses belonging to the H5 clade 2.3.4.4b has led to an unprecedented number of deaths in wild birds and poultry in many countries in Africa, Asia and Europe. In 2021, the virus spread to North America, and in 2022, to Central and South America.\nInfections in humans can cause severe disease with a high mortality rate. The human cases detected thus far are mostly linked to close contact with infected birds and other animals and contaminated environments. This virus does not appear to transmit easily from person to person, and sustained human-to-human transmission has not been reported.",
+ "chunk_type": "prose",
+ "heading": "Avian influenza A(H5N1) virus",
+ "page_number": null,
+ "table_data": null,
+ "token_count": 193,
+ "extractor": "trafilatura"
+ },
+ {
+ "chunk_id": "doc-066ba72014154b3dbb1d75402a7afb24-c1",
+ "chunk_index": 1,
+ "text": "Surveillance",
+ "chunk_type": "prose",
+ "heading": "Technical guidance",
+ "page_number": null,
+ "table_data": null,
+ "token_count": 2,
+ "extractor": "trafilatura"
+ },
+ {
+ "chunk_id": "doc-066ba72014154b3dbb1d75402a7afb24-c2",
+ "chunk_index": 2,
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+ "text": "This map is updated each weekday to depict the number of new confirmed cases in livestock in the last 30 days and the cumulative number of confirmed cases in livestock by State.\nFor information related to the National Milk Testing Strategy, visit Testing.\nUsers may need to refresh the page to see the latest map and table data. To refresh the page, hold down the SHIFT key and click the Reload Page button in the upper left corner of your browser. You can also use SHIFT+F5 on your keyboard.",
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+ "text": "\u2022 H5 bird flu is widespread in wild birds worldwide and is causing outbreaks in poultry and U.S. dairy cows with several recent human cases in U.S. dairy and poultry workers.\n\u2022 While the current public health risk is low, CDC is watching the situation carefully and working with states to monitor people with animal exposures.\n\u2022 CDC is using its flu surveillance systems to monitor for H5 bird flu activity in people.",
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+ "text": "When a case tests positive for H5 at a public health laboratory but testing at CDC is not able to confirm H5 infection, per Council of State and Territorial Epidemiologists (CSTE) guidance, a case is reported as probable.\nConfirmed and probable cases are typically updated by 5 PM EST on Mondays (for cases confirmed by CDC on Friday, Saturday, or Sunday), Wednesdays (for cases confirmed by CDC on Monday or Tuesday), and Fridays (for cases confirmed by CDC on Wednesday and Thursday). Affected states may report cases more frequently.",
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+ "text": "\u2022 11,966 wild birds detected as of 2/11/2025 | Full Report\n\u2022 51 jurisdictions with bird flu in wild birds\n\u2022 159,307,978 poultry affected as of 2/14/2025 | Full Report\n\u2022 51 jurisdictions with outbreaks in poultry\n\u2022 968 dairy herds affected as of 2/12/2025 | Full Report\n\u2022 16 states with outbreaks in dairy cows\nThese data will be updated daily, Monday through Friday, after 4 p.m. to reflect any new data.\nCumulative data on wild birds have been collected since January 20, 2022. Cumulative data on poultry have been collected since February 8, 2022. Cumulative data on humans in the U.S. have been collected since April 28, 2022. Cumulative data on dairy cattle have been collected since March 25, 2024.",
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+ "text": "Birds are the natural hosts for avian influenza viruses. Avian influenza refers to an infectious disease of birds caused by infection with avian influenza viruses. Avian influenza viruses can also infect non-avian species including wild and domestic (including companion and farmed) terrestrial and marine mammals. Avian influenza viruses primarily spread from infected birds to humans through close contact with birds or contaminated environments, such as in backyard poultry farm settings and at markets where birds are sold.\nThere have also been limited reports of transmission from other infected animals to humans.\nSwine influenza is a respiratory disease of pigs caused by influenza A viruses. Most swine influenza viruses do not cause disease in humans, but some countries have reported cases of human infection from certain swine influenza viruses. Close proximity to infected pigs or visiting locations where pigs are exhibited has been reported for most human cases, but some limited human-to-human transmission has occurred.\nJust like birds and pigs, other animals such as horses and dogs, can be infected with their own influenza viruses (canine influenza viruses, equine influenza viruses, etc.).\nDive in\nTechnical guidance",
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+ "text": "Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nInfluenza Investigations & Studies (Unity Studies)",
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+ "text": "\u2022\nNew human cases 1 2 : From 13 December 2024 to 20 January 2025, the detection of influenza\nA(H5) virus in five humans, influenza A(H9N2) virus in two humans, and influenza A(H10N3) virus\nin one human were reported officially. Additionally, five human cases of infection with influenza\nA(H5) viruses were detected.\n\u2022\nCirculation of influenza viruses with zoonotic potential in animals: High pathogenicity avian\ninfluenza (HPAI) events in poultry and non-poultry continue to be reported to the World\nOrganisation for Animal Health (WOAH). 3 The Food and Agriculture Organization of the United\nNations (FAO) also provides a global update on avian influenza viruses with pandemic potential. 4\n\u2022\nRisk assessment 5 : Based on information available at the time of the risk assessment, the overall\npublic health risk from currently known influenza viruses at the human-animal interface has not\nchanged remains low. Sustained human to human transmission has not been reported from\nthese events and the occurrence of sustained human-to-human transmission of these viruses is\ncurrently considered unlikely. Although human infections with viruses of animal origin are\ninfrequent, they are not unexpected at the human-animal interface.\n\u2022\nIHR compliance: All human infections caused by a new influenza subtype are required to be\nreported under the International Health Regulations (IHR, 2005). 6 This includes any influenza A\nvirus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or\nprotein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human\npopulation. Information from these notifications is critical to inform risk assessments for\ninfluenza at the human-animal interface.\nAvian influenza viruses in humans\nCurrent situation:\nSince the last risk assessment of 12 December 2024, influenza A(H5) virus has been detected in nine\nhumans in the United States of America (USA) and one laboratory-confirmed human case of A(H5N1)\ninfection was reported to WHO from Cambodia.\n1 This summary and assessment covers information confirmed during this period and may include information\nreceived outside of this period.\n2 For epidemiological and virological features of human infections with animal influenza viruses not reported in\nthis assessment, see the reports on human cases of influenza at the human-animal interface published in the\nWeekly Epidemiological Record here .\n3 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n4 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .\n5 World Health Organization (2012). Rapid risk assessment of acute public health events. World Health\nOrganization. Available at: https://iris.who.int/handle/10665/70810 .\n6 World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all\ncircumstances under the International Health Regulations (2005). Case definitions for the four diseases\nrequiring notification in all circumstances under the International Health Regulations (2005).",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "2\nA(H5), USA\nOn 14 December 2024, the USA notified WHO of one laboratory-confirmed human case of infection\nwith influenza A(H5) in an adult aged over 65 years from the state of Louisiana. The patient, with\nunderlying conditions, developed symptoms and sought care at an emergency department in early\nDecember 2024. Due to worsening symptoms, the patient returned to the emergency department a\nfew days later, was hospitalized in critical condition with pneumonia, and started on antiviral\ntreatment. Unfortunately, the patient passed away. No household contacts of the case tested\npositive for influenza viruses. The individual owned backyard poultry and had noted deaths in\ndomestic and wild birds on the property prior to symptom onset. A(H5N1) viruses were detected in\npoultry on the property.\nThe viruses identified in two clinical samples from the patent were identified as influenza A(H5N1)\nviruses belonging to the clade 2.3.4.4b and the genotype D1.1. Deep sequencing of the genetic\nsequences from the two clinical specimens were compared to A(H5N1) virus sequences from dairy\ncows, wild birds, poultry and other human cases in the USA and Canada. The hemagglutinin (HA)\ngene sequences of the viruses from the clinical specimens are closely related to other D1.1 viruses\nrecently detected in wild birds and poultry in the Louisiana and other parts of the USA and in recent\nhuman cases detected in Canada and the USA, as well as to existing influenza A(H5N1) candidate\nvaccine viruses. 7\nSome changes in the HA gene segment of one of the clinical specimens from the patient were\ndetected at a low frequency. These changes have rarely been identified in specimens from previous\nhuman infections with A(H5N1) viruses and were not detected in specimens from the poultry on the\nproperty of the patient. It is possible that these changes arise during viral replication in the infected\nhuman cases. No changes in the polymerase genes associated with adaptation to mammals were\nidentified. No changes associated with known or suspected markers of reduced susceptibility to\nantiviral drugs were identified. 8 , 9 , 10\nBetween 20 and 21 December 2024, the USA notified WHO of two additional laboratory-confirmed\nhuman case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin. The\ncases developed symptoms in December 2024 and reported their illness to public health officials as\npart of active monitoring. The cases were not hospitalized and have recovered. Both cases were\nexposed to influenza A(H5N1) while working at poultry facilities.\nOn 15 January 2025, the USA notified WHO of one additional laboratory-confirmed human case of\ninfection with influenza A(H5) from the state of California. The case occurred in a child less than 18\nyears old with no known contact with influenza A(H5N1) virus-infected animals or humans. The\ninvestigation into the source of infection and contact monitoring around this case was ongoing at\nthe time of reporting, and thus far, no human-to-human transmission has been identified. Additional\n7 WHO. Zoonotic influenza: candidate vaccine viruses and potency testing reagents. Available at:\nhttps://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations/zoonotic-\ninfluenza-viruses-and-candidate-vaccine-viruses .\n8 US CDC. CDC Confirms First Severe Case of H5N1 Bird Flu in the United States, 18 Dec 2024. Available at:\nhttps://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html .\n9 US CDC. Genetic Sequences of Highly Pathogenic Avian Influenza A(H5N1) Viruses Identified in a Person in\nLouisiana, 26 Dec 2024. Available at: https://www.cdc.gov/bird-flu/spotlights/h5n1-response-12232024.html .\n10 US CDC. First H5 Bird Flu Death Reported in United States, 6 Jan 2025. Available at:\nhttps://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html .",
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+ "text": "3\nanalysis including genetic sequencing of the virus from the specimen from this case was underway at\nthe time of reporting. 11\nFive additional cases of influenza A(H5) were detected in California in individuals aged over 18 years\nwho worked at commercial dairy cattle farms in areas where highly pathogenic avian influenza\n(HPAI)(H5N1) viruses had been detected in cows. The individuals had mild symptoms. 12 , 13\nLow pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds\nin the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and\nbackyard flocks in 48 states, impacting over 100 million birds. To date, 67 people have tested\npositive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in\n2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy\ncattle, except for two cases where the exposure source could not be identified. 14 To date, no human-\nto-human transmission of influenza A(H5) virus has been identified in the USA. A(H5N1) virus\ninfections in dairy cattle and wild and domestic birds continue to be reported in the USA. 15\nA(H5N1), Cambodia\nOn 10 January 2025, Cambodia notified WHO of one case of human infection with influenza A(H5N1)\nin a 28-year-old male from Kampong Cham Province. The case had onset of fever, sore throat and\nchest pain on 1 January 2025. He sought care at two private local clinics and after his condition did\nnot improve, he traveled to Phnom Penh and was hospitalized due to shortness of breath on 7\nJanuary at a national hospital, which is a severe acute respiratory infection (SARI) sentinel site. The\ncase was isolated upon admission and provided oseltamivir and symptomatic treatment before\npassing away on 10 January. Nasopharyngeal (NP) and oropharyngeal (OP) swab specimens tested\npositive on 9 January for influenza A(H5N1) by real-time reverse transcription-polymerase chain\nreaction (rt-PCR) at the National Institute of Public Health of Cambodia. The Institut Pasteur du\nCambodge (IPC) confirmed the results on 10 January. Sequence analysis of HA gene shows the virus\nbelongs to clade 2.3.2.1c and is closely related to those viruses circulating among birds in Cambodia\nin 2024. Phylogenetic and molecular analysis is ongoing.\nAccording to the early investigation, the case was a guard of a farm in the village where he lived and\nraised poultry for family consumption. There were reports of sick poultry in his farm and samples\nfrom the poultry on the farm have been collected. No further cases were detected among the\ncontacts of the case.\nAccording to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in\nwild and domestic birds in the Americas, Asia and Europe. Infections in non-human mammals are\n11 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 2, ending January 11, 2025.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2025-week-02.html.\n12 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 50, ending December 14, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-50.html .\n13 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 51, ending December 21, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-51.html .\n14 United States Centers for Disease Control and Prevention. H5 Bird Flu: Current Situation. Available at:\nhttps://www.cdc.gov/bird-flu/situation-\nsummary/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbird-flu%2Fphp%2Favian-flu-\nsummary%2Findex.html .\n15 United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock,\n19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-\ndetections/livestock .",
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+ "text": "4\nalso reported, including in marine and land mammals. 16 A list of bird and mammalian species\naffected by HPAI A(H5) viruses is maintained by FAO. 17\nRisk Assessment for avian influenza A(H5) viruses:\n1. What is the current global public health risk of additional human cases of infection with avian\ninfluenza A(H5) viruses?\nMost human cases so far have been infections in people exposed to A(H5) viruses, for example,\nthrough contact with infected poultry or contaminated environments, including live poultry markets,\nand occasionally infected mammals and contaminated environments. While the viruses continue to\nbe detected in animals and related environments humans are exposed to, further human cases\nassociated with such exposures are expected but unusual. The impact for public health if additional\ncases are detected is minimal. The current overall global public health risk of additional human cases\nis low.\n2. What is the likelihood of sustained human-to-human transmission of currently circulating avian\ninfluenza A(H5) viruses?\nNo sustained human-to-human transmission has been identified associated with the recent reported\nhuman infections with avian influenza A(H5). There has been no reported human-to-human\ntransmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007\nand the years prior, small clusters of A(H5) virus infections in humans were reported, including some\ninvolving health care workers, where limited human-to-human transmission could not be excluded;\nhowever, sustained human-to-human transmission was not reported.\nAvailable evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to\nefficiently transmit between people, therefore the likelihood of sustained human-to-human\ntransmission is thus currently considered unlikely at this time.\n3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community-\nlevel spread is considered unlikely as current evidence suggests these viruses have not acquired the\nability to transmit easily among humans.\nA(H9N2), China\nSince the last risk assessment of 12 December 2024, two human cases of infection with A(H9N2)\ninfluenza viruses were notified to WHO from China (Table 1). Both cases were detected through\ninfluenza-like illness (ILI) surveillance, were mild and have recovered. Both cases had a history of\nexposure to live poultry markets prior the onset of symptoms. No further cases were detected\namong contacts of the cases. Influenza A(H9) virus was detected in the poultry-related environments\nassociated with these cases.\n16 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n17 Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential/bird-species-affected-by-h5nx-hpai/en .",
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+ "text": "Onset date\tReporting province\tAge (years)\tGender\tHospitalization date\n27 Nov 2024\tHubei\t8\tFemale\tNot hospitalized\n13 Dec 2024\tChongqing\t1\tFemale\t14 Dec 2024",
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+ "text": "5",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "Onset date\nReporting province\nAge (years)\nGender\nHospitalization date\n27 Nov 2024\nHubei\n8\nFemale\nNot hospitalized\n13 Dec 2024\nChongqing\n1\nFemale\n14 Dec 2024\nRisk Assessment for avian influenza A(H9N2):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H9N2) viruses?\nMost human cases follow exposure to the A(H9N2) virus through contact with infected poultry or\ncontaminated environments. Most human infections of A(H9N2) to date have resulted in mild\nclinical illness in most cases. Nearly 130 human infections with A(H9N2) cases have been reported to\ndate since 2003, and six of these have been severe or fatal and three of these were known to have\nunderlying medical conditions. Since the virus is endemic in poultry in multiple continues in Africa\nand Asia 18 , further human cases associated with exposure to infected poultry are expected but\nremain unusual. The impact to public health if additional cases are detected is minimal. The overall\nglobal public health risk of additional human cases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H9N2)\nviruses?\nAt the present time, no sustained human-to-human transmission has been identified associated with\nthe event described above. Current evidence suggests that influenza A(H9N2) viruses from these\ncases have not acquired the ability of sustained transmission among humans, therefore sustained\nhuman-to-human transmission is thus currently considered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely as current evidence suggests the A(H9N2) virus subtype has not\nacquired the ability to transmit easily among humans.\nA(H10N3), China\nSince the last risk assessment of 12 December 2024, one human case of infection with A(H10N3)\ninfluenza viruses were notified to WHO from China on 3 January 2025. A 23-year-old female from\nGuangxi Zhuang Autonomous Region, with an underlying condition, had symptom onset on 12\nDecember 2024. She was admitted to hospital on 19 December with severe pneumonia and treated\nwith oseltamivir. Initially, she was in critical condition but has improved. A clinical sample collected\non 22 December tested positive for influenza A and influenza A(H10N3) was confirmed a on 26\nDecember. Prior to symptom onset, the patient worked at a supermarket and was exposed to freshly\nslaughtered poultry. No family members have developed symptoms at the time of reporting. All\nclose contacts tested negative for influenza A(H10N3). All environmental samples collected from\nvarious locations tested negative for influenza A(H10N3).\nThis is the fourth case of human A(H10N3) virus infection detected in China and globally to date.\n18 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .",
+ "chunk_type": "prose",
+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "6\nRisk Assessment for avian influenza A(H10N3):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H10N3) viruses?\nHuman infections with avian influenza A(H10) viruses have been detected and reported previously.\nThe extent of circulation and epidemiology of these viruses in birds is unclear. Avian influenza\nA(H10N3) viruses with different genetic characteristics have been detected previously in migratory\nand other wild birds since the 1970s. As long as the virus continues to circulate in birds, further\nhuman cases can be expected but remain unusual. The impact to public health if additional sporadic\ncases are detected is minimal. The overall global public health risk of additional sporadic human\ncases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H10N3)\nviruses?\nNo sustained human-to-human transmission has been identified associated with the event described\nAbove or past events with human cases of influenza A(H10N3) viruses. Current epidemiologic and\nvirologic evidence suggests that contemporary influenza A(H10N3) viruses assessed by the Global\nInfluenza Surveillance and response System (GISRS) have not acquired the ability of sustained\ntransmission among humans, therefore sustained human-to-human transmission is thus currently\nconsidered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H10N3) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely based on current limited evidence.\nOverall risk management recommendations:\nSurveillance and investigations\n\u2022\nDue to the constantly evolving nature of influenza viruses, WHO continues to stress the\nimportance of global strategic surveillance in animals and humans to detect virologic,\nepidemiologic and clinical changes associated with circulating influenza viruses that may affect\nhuman (or animal) health. Continued vigilance is needed within affected and neighbouring areas\nto detect infections in animals and humans. Close collaboration with the animal health and\nenvironment sectors is essential to understand the extent of the risk of human exposure and to\nprevent and control the spread of animal influenza.\n\u2022\nAs the extent of influenza virus circulation in animals is not clear, epidemiologic and virologic\nsurveillance and the follow-up of suspected human cases should continue systematically.\nGuidance on investigation of non-seasonal influenza and other emerging acute respiratory\ndiseases has been published on the WHO website.\n\u2022\nCountries should increase avian influenza surveillance in domestic and wild birds, enhance\nsurveillance for early detection in cattle populations in countries where HPAI is known to be\ncirculating, include HPAI as a differential diagnosis in non-avian species, including cattle and\nother livestock populations, with high risk of exposure to HPAI viruses; monitor and investigate\ncases in non-avian species, including livestock, report cases of HPAI in all animal species,\nincluding unusual hosts, to WOAH and other international organizations, share genetic\nsequences of avian influenza viruses in publicly available databases, implement preventive and\nearly response measures to break the HPAI transmission cycle among animals through\nmovement restrictions of infected livestock holdings and strict biosecurity measures in all",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "7\nholdings, employ good production and hygiene practices when handing animal products, and\nprotect persons in contact with suspected/infected animals. 19\n\u2022\nWhen there has been human exposure to a known outbreak of an influenza A virus in domestic\npoultry, wild birds or other animals \u2013 or when there has been an identified human case of\ninfection with such a virus \u2013 enhanced surveillance in potentially exposed human populations\nbecomes necessary. Enhanced surveillance should consider the health care seeking behaviour of\nthe population, and could include a range of active and passive health care and/or community-\nbased approaches, including: enhanced surveillance in local influenza-like illness (ILI)/SARI\nsystems, active screening in hospitals and of groups that may be at higher occupational risk of\nexposure, and inclusion of other sources such as traditional healers, private practitioners and\nprivate diagnostic laboratories.\n\u2022\nVigilance for the emergence of novel influenza viruses of pandemic potential should be\nmaintained at all times including during a non-influenza emergency. In the context of the co-\ncirculation of SARS-CoV-2 and influenza viruses, WHO has updated and published practical\nguidance for integrated surveillance .\nNotifying WHO\n\u2022\nAll human infections caused by a new subtype of influenza virus are notifiable under the\nInternational Health Regulations (IHR, 2005). 20 State Parties to the IHR (2005) are required to\nimmediately notify WHO of any laboratory-confirmed 5 21 case of a recent human infection caused\nby an influenza A virus with the potential to cause a pandemic 6 22 . Evidence of illness is not\nrequired for this report.\n\u2022\nWHO published the case definition for human infections with avian influenza A(H5) virus\nrequiring notification under IHR (2005): https://www.who.int/teams/global-influenza-\nprogramme/avian-influenza/case-definitions .\nVirus sharing and risk assessment\n\u2022\nIt is critical that these influenza viruses from animals or from people are fully characterized in\nappropriate animal or human health influenza reference laboratories. Under WHO\u2019s Pandemic\nInfluenza Preparedness (PIP) Framework, Member States are expected to share influenza viruses\nwith pandemic potential on a timely basis 23 with a WHO Collaborating Centre for influenza of\nGISRS. The viruses are used by the public health laboratories to assess the risk of pandemic\ninfluenza and to develop candidate vaccine viruses.\n\u2022\nThe Tool for Influenza Pandemic Risk Assessment (TIPRA) provides an in-depth assessment of\nrisk associated with some zoonotic influenza viruses \u2013 notably the likelihood of the virus gaining\nhuman-to-human transmissibility, and the impact should the virus gain such transmissibility.\nTIPRA maps relative risk amongst viruses assessed using multiple elements. The results of TIPRA\ncomplement those of the risk assessment provided here, and those of prior TIPRA analyses will\nbe published at http://www.who.int/teams/global-influenza-programme/avian-influenza/tool-\nfor-influenza-pandemic-risk-assessment-(tipra) .\n19 World Organisation for Animal Health. Statement on High Pathogenicity Avian Influenza in Cattle, 6\nDecember 2024. Available at: https://www.woah.org/en/high-pathogenicity-avian-influenza-hpai-in-cattle/ .\n20 World Health Organization. Case definitions for the four diseases requiring notification in all\ncircumstances under the International Health Regulations (2005).\n21 World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza\n(2011). Available at: https://apps.who.int/iris/handle/10665/44518\n22 World Health Organization. Pandemic influenza preparedness framework for the sharing of influenza viruses\nand access to vaccines and other benefits, 2 nd edition. Available at: https://iris.who.int/handle/10665/341850\n23 World Health Organization. Operational guidance on sharing influenza viruses with human pandemic\npotential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework (2017). Available at:\nhttps://apps.who.int/iris/handle/10665/25940",
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+ "text": "8\nRisk reduction\n\u2022\nGiven the observed extent and frequency of avian influenza in poultry, wild birds and some wild\nand domestic mammals, the public should avoid contact with animals that are sick or dead from\nunknown causes, including wild animals, and should report dead birds and mammals or request\ntheir removal by contacting local wildlife or veterinary authorities.\n\u2022\nEggs, poultry meat and other poultry food products should be properly cooked and properly\nhandled during food preparation. Due to the potential health risks to consumers, raw milk\nshould be avoided. WHO advises consuming pasteurized milk. If pasteurized milk isn\u2019t available,\nheating raw milk until it boils makes it safer for consumption.\n\u2022\nWHO has published practical interim guidance to reduce the risk of infection in people exposed\nto avian influenza viruses.\nTrade and travellers\n\u2022\nWHO advises that travellers to countries with known outbreaks of animal influenza should avoid\nfarms, contact with animals in live animal markets, entering areas where animals may be\nslaughtered, or contact with any surfaces that appear to be contaminated with animal excreta.\nTravelers should also wash their hands often with soap and water. All individuals should follow\ngood food safety and hygiene practices.\n\u2022\nWHO does not advise special traveller screening at points of entry or restrictions with regards to\nthe current situation of influenza viruses at the human-animal interface. For recommendations\non safe trade in animals and related products from countries affected by these influenza viruses,\nrefer to WOAH guidance.\nLinks:\nWHO Human-Animal Interface web page\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza\nWHO Influenza (Avian and other zoonotic) fact sheet\nhttps://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)\nWHO Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nhttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.2\nWHO Public health resource pack for countries experiencing outbreaks of influenza in animals:\nhttps://www.who.int/publications/i/item/9789240076884\nCumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus\nAvian Influenza A(H7N9) Information\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-influenza-a-( h7n9 )-\nvirus\nWorld Organisation of Animal Health (WOAH) web page: Avian Influenza\nhttps://www.woah.org/en/home/\nFood and Agriculture Organization of the United Nations (FAO) webpage: Avian Influenza\nhttps://www.fao.org/animal-health/avian-flu-qa/en/\nOFFLU\nhttp://www.offlu.org/",
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+ "text": "\u2022 Share via\n\u2022 CDC report shows H5N1 infection in veterinarians who did not know they were working with infected cattle\n\u2022 The veterinarians had no symptoms but have antibodies in their blood\n\u2022 One of the veterinarians worked in two states where no known H5N1 infections were reported in cows: South Carolina and Georgia\nA new study published by the U.S. Centers for Disease Control and Prevention shows that the H5N1 bird flu virus is probably circulating undetected in livestock in many parts of the country and may be infecting unaware veterinarians.\nIn the health agency\u2019s Morbidity and Mortality Weekly Report, a group of researchers from the CDC, the Ohio Department of Health and the American Assn. of Bovine Practitioners, reported the results of an analysis they conducted on 150 bovine, or cow, veterinarians from 46 states and Canada.\nThey found that three of them had antibodies for the H5N1 bird flu virus in their blood. However, none of the infected vets recalled having any symptoms \u2014 including conjunctivitis, or pink eye, the most commonly reported symptom in human cases.\nThe three vets also reported to investigators that they had not worked with cattle or poultry known to be infected with the virus. In one case, a vet reported having practiced only in Georgia (on dairy cows) and South Carolina (on poultry) \u2014 two states that have not reported H5N1 infections in dairy cows.\nSeema Lakdawala, a microbiologist at Emory University in Atlanta \u2014 who was not involved in the research \u2014 said she was surprised that only 2% of the veterinarians surveyed tested positive for the antibodies, considering another CDC study showed that 17% of dairy workers sampled had been infected. But she said she was even more surprised that none of them had known they were infected or that they had worked with infected animals.\n\u201cThese surprising results indicate that serum surveillance studies are important to inform risk of infections that are going undiagnosed,\u201d she said. \u201cVeterinarians are on the front line of the outbreak, and increased biosafety practices like respiratory and eye protection should reduce their exposure risk.\u201d\nJennifer Nuzzo, director of the Pandemic Center at Brown University, described the study as a \u201cgood and bad news story.\u201d\n\u201cOn one hand, we see concerning evidence that there may be more H5N1 outbreaks on farms than are being reported,\u201d she said. \u201cOn the other hand, I\u2019m reassured that there isn\u2019t evidence that infections among vets have been widespread. This means there\u2019s more work that can and should be done to prevent the virus from spreading to more farms and sickening workers.\u201d\nThe analysis was conducted in September 2024. At that time, there had been only four human cases reported, and the infection was believed to be restricted to dairy cattle in 14 states. Since then, 68 people have been infected \u2014 40 working with infected dairy cows \u2014 and the virus is reported have infected herds in 16 states.\nJohn Korslund, a retired U.S. Department of Agriculture scientist, said in an email that finding H5N1 antibodies in the blood of veterinarians was an interesting \u201cbut very imprecise way to measure state cattle incidence.\u201d But it underscored \u201cthat humans ARE susceptible to subclinical infections and possible reassortment risks, which we already knew, I guess.\u201d\nReassortment occurs when a person or animal is infected with more than one influenza virus, allowing the two to mingle and exchange \u201chardware,\u201d potentially creating a new, more virulent strain.\nMore important, he said, the D1.1 version of the strain \u2014 which has been detected in Nevada dairy cattle and one person living in the state \u2014 is \u201cchanging the landscape. ... [P]eople may be more more susceptible (or not) with a greater potential for severeness (or not).\u201d\n\u201cI\u2019m confident that we\u2019ll find it in other states. Its behavior and transmissibility within and between cattle herds is still pretty much a black box,\u201d he said.",
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+ "title": "Bird flu: First death from H5N1 strain reported in US",
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+ "text": "The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred.\nThe patient had been taken to hospital after contracting a major strain of bird flu, known as H5N1.\nLouisiana health department said they were over the age of 65, and had other underlying health conditions.\nIt said their public health investigation had not found evidence of person-to-person transmission, or any other cases.\nBird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. In very rare cases, it can also infect humans.\nThe state's health department added the person had contracted bird flu after being exposed to a personal flock of birds and wild birds.\n\"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,\" it said.\nThere have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC).",
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+ "text": "Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Bird migration has resulted in outbreaks of the avian flu in domestic and wild birds.\nThe H5N1 virus is the major strain circulating among wild birds worldwide, and emerged in China in the late 1990s.\nAlthough infection of humans is very rare, it occurs via transmission from birds.\nAlmost all cases of infection in people have been associated with close contact to infected dead or live birds, or contaminated environments.\nSince 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died.\nThere has been no sustained human-to-human transmission.\nLast month, the CDC said the Louisiana patient had been infected with the D1.1variant of the virus, which has recently been detected in North America.\nA 13-year-old girl in Canada was taken to hospital with the same D1.1 variant in November 2024, according to a paper published in The New England Journal of Medicine.\nIt is different to the B3.13 variant, which - during the past year - has been on the rise among cows in the US.\nIn September 2024, a person in Missouri recovered from bird flu after being treated in hospital.",
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+ "text": "According to the WHO, symptoms of a H5N1 infection include a cough, sore throat, fever (often over 38C), muscle aches and general feelings of malaise.\nPeople with the virus may also display other non-respiratory symptoms such as conjunctivitis.\nThe WHO added that H5N1 has also been detected in people without symptoms who had contact with infected animals or their environments.\nWhile the risk to humans is low, the constantly evolving virus is monitored for all changes, including the potential to become easily transmissible from person to person.",
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+ "text": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic.\nThe severe case involves a resident of southwestern Louisiana who was reported as presumptively positive for infection last Friday. The infected patient \u201cis experiencing severe respiratory illness related to H5N1 infection and is currently hospitalized in critical condition,\u201d according to Emma Herrock, a spokesperson for the Louisiana Department of Health, who said that the patient is over the age of 65 and has underlying medical conditions but that further updates on their condition will not be given at this time due to patient confidentiality.\nRead More: What Are the Symptoms of Bird Flu?\nIt is the 61st case of human H5N1 bird flu infection in the country since April this year. But the CDC said the overall risk of the pathogen to the public remains low, and no related deaths have been reported in the U.S. so far.\nHere\u2019s what to know.",
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+ "text": "The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins.\nOf the 60 other cases, 58 were linked to commercial agriculture\u201437 from dairy herds and 21 from poultry farms and culling. The sources of exposure for the two other U.S. human cases remain unknown.",
+ "chunk_type": "prose",
+ "heading": "What caused the severe infection?",
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+ "text": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California, with all but one exposed to cattle. In response, Governor Gavin Newsom on Dec. 18 declared a state of emergency.\nThe CDC said that such a \u201csevere\u201d infection as was found in Louisiana was expected given cases in other countries. In Vietnam, a patient who died in March after a diagnosis of \u201csevere pneumonia, severe sepsis, and acute respiratory distress syndrome\u201d was found with an H5N1 infection, according to the World Health Organization. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.\nRead More: The Bird Flu Virus Is One Mutation Away from Getting More Dangerous\nAccording to Mark Mulligan, Director of the Vaccine Center and the Division of Infectious Diseases and Immunology at New York University Grossman School of Medicine, the general population faces \u201cno immediate threat.\u201d Those who are in contact with birds and animals\u2014especially those who work on dairy farms and cattle farms\u2014are at greatest risk. Currently, no person to person spread of the virus has been detected.\n\u201cRight now we have to let the experts do surveillance, do sequencing of the virus to see if we're seeing any changes that portend any significant difference,\u201d says Mulligan.",
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+ "text": "According to the CDC, symptoms of the bird flu can vary. Many of the cases in the U.S. included symptoms resembling conjunctivitis-like eye issues, including eye redness, discomfort, and discharge.\nSome cases also included both respiratory classic flu-like symptoms, including cough, headache, runny nose, fever, sore throat, body aches, fatigue, shortness of breath, and pneumonia, according to the CDC.\nRead More: What Are the Symptoms of Bird Flu?",
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+ "text": "The CDC issued a number of protective measures, including largely avoiding direct contact with wild birds and other suspected infected animals as well as their bodily excretions. People who work with cattle and poultry on affected farms have a greater risk of infection, and are thus advised to monitor any possible symptoms of infection.\nThe CDC also recommends that those who work with poultry or other animals use the correct personal protective equipment (PPE)\u2014including coveralls, boots, and more\u2014which should be provided by employers.\nVirologist and professor at John Hopkins University Andy Pekosz says that the severe case in Louisiana provides a reminder of an easy way to stay safe: stay away from dead animals. \u201cYou see a dead animal, if you're exposed to dead animals, stay away,\u201d he says. \u201cIn many ways, it is the least likely way someone can get exposed, but in some ways, it's also one of the more preventable ways.\u201d\nProperly cooked poultry and poultry products are safe, and the CDC says that while unpasteurized (raw) milk from infected cows can pose risks to humans, it\u2019s not yet known if avian influenza viruses can be transmitted through its consumption.\nBoth Mulligan and Pekosz say it is also important to get the seasonal human influenza vaccine. They say if there were to be a case of a person with simultaneous bird flu and human flu infection, it could lead to a \u201creassortment\u201d and thus a virus that could be more easily spread.\n\u201cWe know that has happened before, because the 1957 influenza pandemic and the 1968 influenza pandemic both were a result of a human and a bird influenza virus exchanging genetic material,\u201d Pekosz says. \u201cWe know that the flu vaccines are not perfect, but they do a good job of reducing infection.\u201d\nThe CDC currently has a program to offer seasonal vaccines to farm workers in high risk scenarios in certain states.",
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+ "text": "\u2022 L.A. Fires Show Reality of 1.5\u00b0C of Warming\n\u2022 Behind the Scenes of The White Lotus Season Three\n\u2022 How Trump 2.0 Is Already Sowing Confusion\n\u2022 Bad Bunny On Heartbreak and New Album\n\u2022 How to Get Better at Doing Things Alone\n\u2022 We\u2019re Lucky to Have Been Alive in the Age of David Lynch\n\u2022 The Motivational Trick That Makes You Exercise Harder\n\u2022 Column: All Those Presidential Pardons Give Mercy a Bad Name\nContact us at letters@time.com",
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+ "text": "A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States.\nThe agency said Wednesday that the person was exposed to sick and dead birds in backyard flocks; this is the first US bird flu case linked to a backyard flock.\n\u201cIt is believed that the patient that was reported by Louisiana had exposure to sick or dead birds on their property. These are not commercial poultry, and there was no exposure to dairy cows or their related products,\u201d said Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC.\nFederal officials declined to answer questions about the patient\u2019s symptoms or their current condition. They instead referred all inquiries about the case to the Louisiana Department of Health, which is leading the investigation.\nAccording to state officials, the patient is experiencing severe respiratory illness related to H5N1 and is hospitalized in critical condition. The person is older than 65 and has underlying medical conditions that increased their risk of flu complications, the Louisiana Department of Health said in an email to CNN.\nThis virus, D1.1, is the same type found in recent human cases in Canada and Washington state and detected in wild birds and poultry in the United States. It\u2019s different from B3.13, the type detected in dairy cows, some poultry outbreaks and other cases in humans across the United States.\nThe CDC said it\u2019s working on additional genomic sequencing of samples from the patient, who is from southwestern Louisiana, and the investigation into the patient\u2019s exposure is still underway.\nBird flu has been linked with severe human illness and death in other countries, but no person-to-person spread has been detected.\n\u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the agency said in a statement.\nIn California, Gov. Gavin Newsom declared a state of emergency Wednesday over the continued spread of H5N1 bird flu in that state.",
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+ "text": "\u2022 Sign up here to get The Results Are In with Dr. Sanjay Gupta every Friday from the CNN Health team.\nNewsom said the measure was necessary because, despite intense efforts to contain it, the virus had spread beyond the Central Valley to four dairies in the southern part of the state.\n\u201cThis proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,\u201d he said in a news release. \u201cWhile the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus.\u201d\nThe emergency declaration will give state agencies greater flexibility with staffing and free up more funding for the response.\nOf the 61 confirmed human cases of bird flu in the US this year, 34 have been in California. Nearly all of those have been in dairy farm workers, according to the CDC.\nThe Louisiana case shows that precautions should be taken by people with backyard chicken flocks, hunters and other bird enthusiasts, the CDC said.\n\u201cThe cases across the US are a constellation of spillovers,\u201d said Dr. Rebecca Christofferson, a virologist at Louisiana State University\u2019s School of Veterinary Medicine. Experts still don\u2019t understand exactly how these spillovers are happening and the specific factors that increase a person\u2019s risk.\n\u201cIt\u2019s just kind of a black box at the moment that a lot of people are trying to answer these questions on,\u201d Christofferson said.\nThe CDC says the best approach is to avoid exposure. Infected birds can shed viruses in their saliva, mucus and feces, and other animals may shed them in their respiratory secretions and bodily fluids, including unpasteurized milk from cows.\n\u201cPeople who work with or have recreational exposure to infected animals are at higher risk of infection, and it\u2019s extremely important that they follow CDC recommended precautions when around infected or potentially infected animals, a message that we will continue to magnify given recent cases,\u201d Daskalakis said.",
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+ "text": "\u2022 Share via\nThe fate of a Canadian teenager who was infected with H5N1 bird flu in early November, and subsequently admitted to an intensive care unit, has finally been revealed: She has fully recovered.\nBut genetic analysis of the virus that infected her body showed ominous mutations that researchers suggest potentially allowed it to target human cells more easily and cause severe disease \u2014 a development the study authors called \u201cworrisome.\u201d\nThe case was published Tuesday in a special edition of the New England Journal of Medicine that explored H5N1 cases from 2024 in North America. In one study, doctors and researchers who worked with the Canadian teenager published their findings. In the other, public health officials from across the U.S. \u2014 from the Centers for Disease Control and Prevention, as well as state and local health departments \u2014 chronicled the 46 human cases that occurred between March and October.\nThere have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024.\nIn the case of the 13-year-old Canadian child, the girl was admitted to a local emergency room on Nov. 4 having suffered from two days of conjunctivitis (pink eye) in both eyes and one day of fever. The child, who had a history of asthma, an elevated body-mass index and Class 2 obesity, was discharged that day with no treatment.\nOver the next three days, she developed a cough and diarrhea and began vomiting. She was taken back to the ER on Nov. 7 in respiratory distress and with a condition called hemodynamic instability, in which her body was unable to maintain consistent blood flow and pressure. She was admitted to the hospital.\nOn Nov. 8, she was transferred to a pediatric intensive care unit at another hospital with respiratory failure, pneumonia in her left lower lung, acute kidney injury, thrombocytopenia (low platelet numbers) and leukopenia (low white blood cell count).\nShe tested negative for the predominant human seasonal influenza viruses \u2014 but had a high viral loads of influenza A, which includes the major human seasonal flu viruses, as well as H5N1 bird flu. This finding prompted her caregivers to test for bird flu; she tested positive.\nAs the disease progressed over the next few days, she was intubated and put on extracorporeal membrane oxygenation (ECMO) \u2014 a life support technique that temporarily takes over the function of the heart and lungs for patients with severe heart or lung conditions.\nShe was also treated with three antiviral medications, including oseltamivir (brand name Tamiflu), amantadine (Gocovri) and baloxavir (Xofluza).\nBecause of concerns about the potential for a cytokine storm \u2014 a potentially lethal condition in which the body releases too many inflammatory molecules \u2014 she was put on a daily regimen of plasma exchange therapy, in which the patient\u2019s plasma is removed in exchange for donated, health plasma.\nAs the days went by, her viral load began to decrease; on Nov. 16, eight days after she\u2019d been admitted, she tested negative for the virus.\nThe authors of the report noted, however, that the viral load remained consistently higher in her lower lungs than in her upper respiratory tract \u2014 suggesting that the disease may manifest in places not currently tested for it (like the lower lungs) even as it disappears from those that are tested (like the mouth and nose).\nShe fully recovered and was discharged sometime after Nov. 28, when her intubation tube was removed.\nGenetic sequencing of the virus circulating in the teenager showed it was similar to the one circulating in wild birds, the D1.1 version. It\u2019s a type of H5N1 bird flu that is related, but distinct, from the type circulating in dairy cows and is responsible for the vast majority of human cases reported in the U.S. \u2014 most of which were acquired via dairy cows or commercial poultry. This is also the same version of the virus found in a Louisiana patient who experienced severe disease, and it showed a few mutations that researchers say increases the virus\u2019 ability to replicate in human cells.\nIn the Louisiana case, researchers from the CDC suggested the mutations arose as it replicated in the patient and were were not likely present in the wild.\nIrrespective of where and when they occurred, said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I., \u201cit is worrisome because it indicates that the virus can change in a person and possibly cause a greater severity of symptoms than initial infection.\u201d\nIn addition, said Nuzzo \u2014 who was not involved in the research \u2014 while there\u2019s evidence these mutations occurred after the patients were infected, and therefore not circulating in the environment \u201cit increases worries that some people may experience more severe infection than other people. Bottom line is that this is not a good virus to get.\u201d",
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+ "title": "WHO Influenza at the human-animal interface (monthly risk assessment)",
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+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "750289852c7a48c9af12bd274e1577cf",
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+ "title": "Bird flu infections in dairy cows are more widespread than we thought, according to a new CDC study - Los Angeles Times",
+ "snippet": "At that time, there had only been four human cases reported, and the infection was believed to be restricted to dairy cattle in 14 states. Since then, 68 people have been infected \u2014 40 working with infected dairy cows \u2014 and the virus is reported have infected herds in 16 states. John Korslund, a retired U.S. Department of Agriculture scientist, said in an email that finding H5N1 antibodies in the blood of veterinarians was an interesting \u201cbut very imprecise way to measure state cattle incidence.\u201d But it underscored \u201cthat humans ARE susceptible to subclinical infections and possible reassortment risks, which we already knew, I guess.\u201d",
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+ "result_id": "214c1516437c42e58fdb85df008e8376",
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+ "snippet": "Bird flu: First death from H5N1 strain reported in US First bird flu-related death reported in US The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred. Bird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. There have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC). What is bird flu? Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Since 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died. About the BBC",
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+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "860356a83f6549fc95c5d4cbe368bd72",
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+ "canonical_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer",
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+ "snippet": "\u2018Severe\u2019 Bird Flu in the U.S.: Latest Updates | TIME TIME 2030 What to Know About Bird Flu in the U.S. After CDC Announces First \u2018Severe\u2019 Human Case What to Know About Bird Flu in the U.S. After CDC Announces First \u2018Severe\u2019 Human Case The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic. It is the 61st case of human H5N1 bird flu infection in the country since April this year. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.",
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+ ],
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+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "e4c37fd63de344a9bf6f7f83cdfaa4c9",
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+ "url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "canonical_url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
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+ "snippet": "America\u2019s first severe case of bird flu confirmed in Louisiana | CNN CNN10 CNN 5 Things About CNN There have been 61 reported human cases of H5 bird flu in the United States since April. A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States. \u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the CDC said in a statement. There have been 61 reported human cases of H5 bird flu in the United States since April, mostly among dairy and poultry workers.",
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+ "extraction_mode": "html",
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+ "source_id": null,
+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "b9c596e3e55d479f8e96b9168503830c",
+ "question_id": "q1",
+ "url": "https://www.latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
+ "canonical_url": "https://latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
+ "domain": "latimes.com",
+ "title": "\u2018Worrisome\u2019 mutations found in H5N1 bird flu virus isolated from Canadian teenager - Los Angeles Times",
+ "snippet": "'Worrisome' mutations found in H5N1 bird flu virus in Canadian teen - Los Angeles Times But genetic analysis of the virus that infected her body showed ominous mutations that researchers suggest potentially allowed it to target human cells more easily and cause severe disease \u2014 a development the study authors called \u201cworrisome.\u201d There have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024. She tested negative for the predominant human seasonal influenza viruses \u2014 but had a high viral loads of influenza A, which includes the major human seasonal flu viruses, as well as H5N1 bird flu. L.A. County health officials warn pet owners to avoid raw cat food after feline dies of bird flu",
+ "published_date": "2025-01-01T00:03:00+00:00",
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+ ],
+ "extraction_priority": 10,
+ "extraction_mode": "html",
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+ "source_id": null,
+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ }
+]
\ No newline at end of file
diff --git a/data/runs_ab_no_history/q1/traj_20250217/forecast.json b/data/runs_ab_no_history/q1/traj_20250217/forecast.json
new file mode 100644
index 0000000..9b90f2b
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250217/forecast.json
@@ -0,0 +1,156 @@
+{
+ "question_id": "q1",
+ "options": [
+ "70-100",
+ "100-150",
+ "150-200",
+ "200+"
+ ],
+ "distributions": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "probabilities": {
+ "70-100": 0.9696517924061445,
+ "100-150": 0.02625833811431085,
+ "150-200": 0.0033220710153221583,
+ "200+": 0.00076779846422236
+ }
+ }
+ ],
+ "records": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "70-100",
+ "probability": 0.9696517924061445,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "100-150",
+ "probability": 0.02625833811431085,
+ "forecast_version": null
+ },
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+ "forecast_source": "bioscancast",
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+ ],
+ "ok": true,
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+ "base_rate": 0.1,
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+ "H5N1 has been detected in several states, indicating potential wider spread.",
+ "Historical global case count shows potential for significant outbreaks."
+ ],
+ "drivers_down": [
+ "Only 9 cases confirmed by January 2025 indicates slow progression.",
+ "Most US cases have been linked to commercial agriculture, not community spread.",
+ "Limited time until February 2025 for a dramatic increase in cases."
+ ],
+ "why_might_be_wrong": "The base rate and global data might inadequately capture the local dynamics and public health responses in the US.",
+ "rationale": "The base rate from historical data suggests a low probability of high case numbers. With only 9 cases confirmed by January 2025, the likelihood of reaching 70 cases by February 28, 2025, is low. Factors like the recent increase in cases and potential for wider spread push the probability slightly up. However, the time frame is short, and most cases are linked to agriculture, limiting potential for rapid increase, making lower case counts more likely.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 42
+ },
+ {
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+ 0.02
+ ],
+ "ok": true,
+ "reference_class": "Historical outbreaks of H5N1 in the US and globally",
+ "base_rate": 0.05,
+ "drivers_up": [
+ "Recent increase in cases from 61 in December 2024 to 68 in September 2024 suggests potential for further spread.",
+ "Past reports indicate H5N1 infections in multiple states, not just confined to one area, which could facilitate wider spread."
+ ],
+ "drivers_down": [
+ "The cumulative number of cases reported as of January 2025 is only 9, suggesting a significant slowing of new cases compared to late 2024.",
+ "Containment and control measures may have been enacted following the sudden increase in cases, reducing further spread."
+ ],
+ "why_might_be_wrong": "The forecast might be wrong if there is a sudden outbreak or if the virus adapts, leading to a significant increase in cases before the target date.",
+ "rationale": "With only 9 confirmed cases reported as of January 2025 and the historical base rate of substantial outbreaks being low, it is unlikely that the number of cases will reach the higher thresholds by February 28, 2025. Despite a surge in cases in late 2024, the current evidence does not suggest a continued rapid increase. Therefore, the probability of remaining in the lowest range (70-100 cases) is highest.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 43
+ },
+ {
+ "probabilities": [
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+ ],
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+ "base_rate": 0.05,
+ "drivers_up": [
+ "Recent increase in cases from 9 to 68 in a short period, indicating a possible outbreak.",
+ "High number of cases in California suggests localized spread.",
+ "Confirmed human-to-human transmission in recent cases could lead to more cases."
+ ],
+ "drivers_down": [
+ "Historically low human-to-human transmission of H5N1 globally.",
+ "Containment measures typically effective in the US to prevent large outbreaks.",
+ "Current case count is still low compared to thresholds."
+ ],
+ "why_might_be_wrong": "Unexpected changes in transmission dynamics or containment failures could lead to a rapid increase in cases.",
+ "rationale": "Given the recent increase in cases to 68 and localized clusters, there is a potential for more cases, but given historical transmission patterns and the containment capabilities of the US, it is unlikely to exceed 100 cases. Therefore, the highest probability is assigned to the 70-100 range.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 44
+ }
+ ],
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+ "ins-b831a7252894",
+ "ins-5ededcaf4bdd",
+ "ins-f8af3289f09f",
+ "ins-b1f5c93ea05b",
+ "ins-031f36115918"
+ ],
+ "budget_summary": {
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+ "calls": 3
+ }
+ }
+ },
+ "notes": []
+}
\ No newline at end of file
diff --git a/data/runs_ab_no_history/q1/traj_20250217/insight.json b/data/runs_ab_no_history/q1/traj_20250217/insight.json
new file mode 100644
index 0000000..fca7de1
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250217/insight.json
@@ -0,0 +1,445 @@
+{
+ "records": [
+ {
+ "id": "ins-031f36115918",
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+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 67.0,
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+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": null,
+ "event_date_precision": null,
+ "summary": "Total confirmed cases of A(H5) virus in the US since 2022.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:39:16.363769+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-5fda5c04014a45c6aa6a2957c95fd4a5",
+ "chunk_id": "doc-5fda5c04014a45c6aa6a2957c95fd4a5-c3",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "To date, 67 people have tested positive for A(H5) virus in the United States since 2022"
+ }
+ ]
+ },
+ {
+ "id": "ins-b831a7252894",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
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+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-09-01T00:00:00",
+ "event_date_precision": "month",
+ "summary": "As of September 2024, there had been 68 human cases reported, with 40 working with infected dairy cows.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:39:21.097283+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-750289852c7a48c9af12bd274e1577cf",
+ "chunk_id": "doc-750289852c7a48c9af12bd274e1577cf-c0",
+ "source_url": "https://www.latimes.com/environment/story/2025-02-13/cdc-study-h5n1-bird-flu-in-dairy-cows-more-widespread-than-thought",
+ "quote": "At that time, there had been only four human cases reported, and the infection was believed to be restricted to dairy cattle in 14 states."
+ }
+ ]
+ },
+ {
+ "id": "ins-5ededcaf4bdd",
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+ "surveillance_method": null,
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+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed H5N1 cases in the US since 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:39:23.043115+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-214c1516437c42e58fdb85df008e8376",
+ "chunk_id": "doc-214c1516437c42e58fdb85df008e8376-c0",
+ "source_url": "https://www.bbc.com/news/articles/cqx85y07jz9o",
+ "quote": "There have been 66 confirmed cases of H5N1 bird flu in the US since 2024"
+ },
+ {
+ "document_id": "doc-b9c596e3e55d479f8e96b9168503830c",
+ "chunk_id": "doc-b9c596e3e55d479f8e96b9168503830c-c0",
+ "source_url": "https://www.latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
+ "quote": "There have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024."
+ }
+ ]
+ },
+ {
+ "id": "ins-c9e19f76cc5c",
+ "question_id": "q1",
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+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human infections in the U.S. for the year, with a significant number in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:39:25.348970+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-860356a83f6549fc95c5d4cbe368bd72",
+ "chunk_id": "doc-860356a83f6549fc95c5d4cbe368bd72-c2",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California"
+ }
+ ]
+ },
+ {
+ "id": "ins-0360c1acd31e",
+ "question_id": "q1",
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+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
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\ No newline at end of file
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+ "snippet": "Related news USDA reports reveal biosecurity risks at H5N1-affected dairy farms USDA reports more H5N1 detections in mice and cats Study shows 'not surprising' fatal spread of avian flu in ferrets Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow H5 influenza wastewater dashboard launches Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho This week's top reads USDA reports more H5N1 detections in mice and cats Officials reported 36 more detections in mice, as well as 4 more H5N1 positives in cats. Main navigation Studies find little to no immunity to H5N1 avian flu virus in Americans solarseven / iStock The American population has little to no pre-existing immunity to the H5N1 avian flu virus circulating on dairy and poultry farms, according to preliminary findings from ongoing testing by the Centers for Disease Control and Prevention (CDC). Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Also, the Iowa Department of Agriculture and Land Stewardship, in two separate statements, has reported three more outbreaks in dairy herds, two more in\u00a0Sioux County and one in\u00a0Plymouth County, both in the northwestern part of the state. The vaccine was developed by Seqirus UK, Ltd. Dairy herd outbreaks top 100; virus infects more poultry The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has\u00a0confirmed 6 more H5N1 outbreaks in dairy herds, lifting the US total to 102.",
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+ "snippet": "CDC is collaborating with the U.S. Department of Agriculture, the Food and Drug Administration, the Administration for Strategic Preparedness and Response, the Health Resources and Services Administration, the National Institute of Allergy and Infectious Diseases, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. One week earlier, the U.S. Department of Agriculture had reported a multistate outbreak of A(H5N1) viruses in dairy cows.\u00a7 A(H5N1) viruses were also detected in barn cats, birds, and other animals (e.g., one raccoon and two opossums) that lived in and around human habitations and that died on affected farms.\u00b6 Genetic sequencing of the A(H5N1) virus from infected cattle and the farm worker** identified clade 2.3.4.4b; this clade has been detected in U.S. wild birds, commercial poultry, backyard flocks, and other animals since January 2022 (2). Top Discussion CDC is collaborating with the U.S. Department of Agriculture, FDA, ASPR, the Health Resources and Services Administration, NIAID, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. CDC considers the current risk to the U.S. public from A(H5N1) viruses to be low; however, persons with exposure to infected animals or contaminated materials, including raw cow\u2019s milk, are at higher risk for A(H5N1) virus infection and should take recommended precautions, including using recommended personal protective equipment, self-monitoring for illness symptoms, and, if they are symptomatic, seeking prompt medical evaluation for influenza testing and antiviral treatment if indicated. Top Corresponding author: Shikha Garg, sgarg1@cdc.gov. Top 1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; 2One Health Office, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Office of Public Health Data, Surveillance, and Technology, CDC; 4National Center for Immunization and Respiratory Diseases, CDC; 5Administration for Strategic Preparedness and Response, Washington, DC. ",
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+ "snippet": "International avian flu developments In global developments: Related news Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow H5 influenza wastewater dashboard launches Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho Study confirms infection in mice fed H5N1-contaminated raw milk USDA expands support for H5N1 response to more dairy producers Michigan reports H5 avian flu in dairy farm worker This week's top reads Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow Minnesota and Iowa report infected dairy herds. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation Study shows 'not surprising' fatal spread of avian flu in ferrets Vital Hil/iStock Late last week the Centers for Disease Control and Prevention (CDC) published a study showing that the current strain of H5N1 (A/Texas/37/2024) avian flu was fatal in six ferrets used as part of an experimental infection study. Household spread in pet ferrets In related news, a study out of Poland described the first documented cases of natural H5N1 cases in five pet ferrets, which occurred at the same time the country saw an uptick of H5 cases in cats in 2023. \" In Iowa, which confirmed high-path avian flu in dairy cattle last week, officials from the Iowa Department of Agriculture and Land Stewardship are requesting resources from the USDA and announcing additional response measures, including providing compensation for culled dairy cattle at a fair market value and compensation for lost milk production at a minimum of 90% of fair market value. ",
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+ "snippet": "Related news USDA experiments suggest H5N1 not viable in properly cooked ground beef CDC launches new influenza A wastewater dashboard; states report more H5N1 in dairy herds Wastewater testing finds H5N1 avian flu in 9 Texas cities Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows This week's top reads Wastewater testing finds H5N1 avian flu in 9 Texas cities Wastewater detections began in early March, and so far sequencing hasn't found any mutations linked to human adaptation. Main navigation Michigan reports 3 more H5N1 outbreaks in dairy herds sarahluv/Flickr cc The Michigan Department of Agriculture and Rural Development (MDRAD) today reported three more H5N1 avian flu outbreaks in dairy herds, noting that it will send results to the US Department of Agriculture (USDA) National Veterinary Services Laboratory (NVSL) for confirmation. CDC boosts flu surveillance, starts pandemic review Meanwhile, in its latest update on its response to the H5N1 outbreaks in dairy herds, the CDC said it is developing a plan for enhanced surveillance over the summer, which will include increasing the number of flu specimens tested and subtyped at public health laboratories. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. In other developments, the Food and Drug Administration (FDA) recently detailed its next steps for monitoring the virus in that nation's milk supply and the Centers for Disease Control and Prevention (CDC) posted an update on its response steps, which includes an evaluation of the dairy outbreak virus with its Influenza Risk Assessment Tool (IRAT). ",
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+ "snippet": "Bird flu outbreaks are rising among California dairy herds - Los Angeles Times California reports a total of eight H5N1 bird flu outbreaks among dairy herds The number of California dairy herds reported to have outbreaks of H5N1 bird flu has grown to eight. The number of California dairy herds reported to have outbreaks of H5N1 bird flu has grown to eight. \u201cBovine vaccines may prove to be an important tool to eventually help eliminate the virus from the nation\u2019s dairy cattle herd, but developing a vaccine requires many steps and it will take time to test, approve, and distribute a successful vaccine,\u201d he said. Three more California dairy herds infected with H5N1 bird flu H5N1 bird flu infections suspected in California dairy herds",
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+ "snippet": "Related news Wastewater testing finds H5N1 avian flu in 9 Texas cities Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows Case report bolsters evidence for H5N1 avian flu spread from cow to Texas dairy worker USDA genome study sheds light on H5N1 avian flu spillover to cows, but data gaps remain This week's top reads Wastewater testing finds H5N1 avian flu in 9 Texas cities Wastewater detections began in early March, and so far sequencing hasn't found any mutations linked to human adaptation. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. A wastewater dashboard; states report more H5N1 in dairy herds Smederevac/iStock The Centers for Disease Control and Prevention (CDC) today unveiled a new influenza A wastewater tracker, part of its surveillance for H5N1 avian influenza, as three states reported more detections in dairy herds. H5N1 detected in 4 more dairy herds In other developments, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today reported four more H5N1 detections in dairy herds, raising the total to 46. A wastewater dashboard; states report more H5N1 in dairy herds The tracker will help with surveillance, but it doesn't distinguish the influenza A subtype or determine the source of the virus. ",
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+ "snippet": "It\u2019s important to keep that experience in mind, he told STAT Monday, as the H5N1 bird flu virus now spreads among dairy cattle in the U.S. Farrar stressed that the social context is key in responding to disease threats like H5N1, noting that a similar reluctance among dairy farmers to report outbreaks or allow testing of their workers is adding to the challenges in assessing how much transmission is occurring and the risk it poses to people. Home Don't miss out Subscribe to STAT+ today, for the best life sciences journalism in the industry WHO\u2019s top scientist learned a hard lesson about H5N1 two decades ago: Stopping it takes more than biology By Helen Branswell May 7, 2024 Jeremy Farrar, now the World Health Organization\u2019s chief scientist, was working in Vietnam 20 years ago when the H5N1 virus started to spread across Asia \u2014 at that point in poultry. advertisement \u201cYou can\u2019t just take the virus and the biological surveillance and divorce it from the environment and the social construct that it\u2019s happening in,\u201d Farrar said in an interview from WHO headquarters in Geneva. Trending Recommended Recommended Stories STAT\u2019s Casey Ross and Bob Herman named 2024 Pulitzer Prize finalists STAT Plus: Endo Health ordered to pay more than $1.5 billion in opioid criminal case advertisement STAT Plus: Brain biopsies on \u2018vulnerable\u2019 patients at Mount Sinai set off alarm bells at FDA, documents show STAT Sign up for Morning Rounds Understand how science, health policy, and medicine shape the world every day While he believes the risk of a human flu pandemic triggered by the H5N1 virus is low, should it happen, the social context will also be crucial, Farrar continued.",
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+ "snippet": "In other H5N1 developments: Related news USDA reports more H5N1 detections in mice and cats Study shows 'not surprising' fatal spread of avian flu in ferrets Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow H5 influenza wastewater dashboard launches Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho Study confirms infection in mice fed H5N1-contaminated raw milk This week's top reads Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow Minnesota and Iowa report infected dairy herds. Yesterday, the Iowa Department of Agriculture and Land Stewardship reported the state's third outbreak in a dairy herd, which affected a second location in Sioux County. Updates on human investigations, vaccine production Responding to questions about Michigan's second case-patient in a dairy worker, who, unlike the other previous patients, had respiratory symptoms, Nirav Shah, JD, MD, principal deputy director for the Centers for Disease Control and Prevention (CDC), said the polymerase chain reaction cycle threshold\u00a0 (Ct) value for the patient's sample was high, suggesting a lower amount of viral RNA in the sample. Main navigation USDA reports reveal biosecurity risks at H5N1-affected dairy farms Naked King/iStock Shared equipment and shared personnel working on multiple dairy farms are some of the main risk factors for ongoing spread of highly pathogenic H5N1 avian flu in dairy cows, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said today in a pair of new epidemiologic reports. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. One of the reports is an overview based on the results of questionnaires from affected dairy herds, and the other is a deep dive into the dairy cow and poultry outbreaks in Michigan, the state hit hardest by outbreaks in dairy cows, which now number at least 94. ",
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+ "snippet": "May 13, 2024 More to Read Experts blast CDC over failure to test sewage for signs of H5N1 bird flu virus May 10, 2024 Federal government \u2018believes\u2019 virus found in grocery store milk is safe for consumption April 24, 2024 Avian flu outbreak raises a disturbing question: Is our food system built on poop? April 18, 2024 Follow Us Susanne Rust is an award-winning investigative reporter specializing in environmental issues. Climate & Environment A rare songbird\u2019s epic journey from the edge of extinction back to the L.A. River Opinion Opinion: Florida just picked the wrong kind of meat to ban Subscribe for unlimited accessSite Map Follow Us MORE FROM THE L.A. TIMES More From the Los Angeles Times Climate & Environment Wildfire weather is increasing in California and much of the U.S., report finds California Climate change is central to both Pope Francis and Newsom. However, there have been a few cases in which it appears the virus may have spread between mammals, including on European fur farms, on a few South American beaches where elephant seals came to roost, and now among dairy cattle in the United States. Climate & Environment Despite H5N1 bird flu outbreaks in dairy cattle, raw milk enthusiasts are uncowed Despite warnings of H5N1 bird flu outbreaks among dairy cattle, raw milk enthusiasts say they will continue to drink unpasteurized milk. ",
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+ "snippet": "Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation HHS advances plan to produce 4.8 million H5N1 vaccine doses Response (ASPR) at the US Department of Health and Human Services (HHS) said officials are moving forward with a plan to produce 4.8 million doses of H5N1 avian flu vaccine for pandemic preparedness. \" Surveillance study describes incidence of multidrug-resistant infections in US children A surveillance\u00a0study found that carbapenem-resistant Enterobacterales (CRE) infections occur less frequently than extended-spectrum beta-lactamase\u2013producing Enterobacterales (ESBL-E) infections in US children, researchers reported today in Emerging Infectious Diseases. HHS advances plan to produce 4.8 million H5N1 vaccine doses Officials have identified a fill-and-finish opening on a production line at a vaccine company partner and said the activity won't disrupt the supply of seasonal flu vaccine. Led by researchers with the Centers for Disease Control and Prevention's Emerging Infections Program (EIP), the surveillance study analyzed CRE incidence in children in 10 states from 2016 through 2020 and ESBL-E incidence in children in six states from 2019 through 2020.",
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+ "snippet": "Research Professional | Pivot-RP South Africa steps up bird flu monitoring in humans Image:\u00a0AMISOM Public Information, via Flickr Move comes as global concern grows in the wake of infections in US dairy workers South Africa is stepping up efforts to detect avian influenza in humans following growing global concern about spillover infections from animals. Pandemic potential Concerns are growing globally around avian influenza, with three dairy workers in the US having caught the virus from dairy cattle since April this year. \u201cThis surveillance system will be set up in collaboration with veterinary and animal health colleagues,\u201d Sibongile Walaza, head of epidemiology in the institute\u2019s Centre for Respiratory Diseases and Meningitis, told Research Professional News. No time for complacency Last year, an outbreak of H5N1 in South African poultry farms decimated the country\u2019s poultry stocks and disrupted egg production in the country. The stepped-up surveillance system due to be operational later this year will document human cases associated with outbreaks in poultry, wild birds or other animals, the country\u2019s National Institute for Communicable Diseases has confirmed. ",
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+ "snippet": "In addition to being the first case not linked to contact with a sick animal, Missouri officials said that the case was the first detected using the state's flu surveillance system, rather than protocol specifically tailored to detect H5N1 cases related to the recent outbreak in livestock like dairy cows and poultry. The latest infection makes Missouri the fourth U.S. state with a human case this year. The following map created by Newsweek shows that all of this year's human H5N1 cases have been limited to Colorado, Texas, Michigan and Missouri: No cases of human-to-human transmission have ever been detected in the U.S. In humans, bird flu can range in severity from no symptoms to mild symptoms like eye infections or upper respiratory illness.",
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+ "snippet": "Hologic to Contribute to H5N1 Bird Flu Test Development via Agreement Issued by CDC - BioSpace Hologic to Contribute to H5N1 Bird Flu Test Development via Agreement Issued by CDC H5N1 bird flu, also known as avian influenza A (H5N1), continues to spread among wild birds worldwide and is causing outbreaks in poultry and dairy cows in the U.S., with several recent cases identified in humans who work with these animals.1 Illness from the virus in the U.S. has been mild but severe illness in other countries has been associated with this virus.2 To prepare for if the current outbreak worsens, Hologic will work with the CDC to develop reagents that may be used for H5N1 testing.",
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+ "snippet": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms This infection, tied to an ongoing outbreak in cows, is the first in the U.S. to cause respiratory symptoms, but not the first H5N1 case in the world to do so. Related: H5N1: What to know about the bird flu cases in cows, goats and people \"This is the first human case of H5 in the United States to report more typical symptoms of acute respiratory illness associated with influenza virus infection, including A(H5N1) viruses,\" the CDC reported. H5N1 bird flu has spread to human from cow in 2nd probable case, CDC reports H5N1: What to know about the bird flu cases in cows, goats and people China lands Chang'e 6 sample-return probe on far side of the moon Live Science is part of Future US Inc, an international media group and leading digital publisher. \u201421-year-old student dies of H5N1 bird flu in Vietnam \u20141st polar bear death from bird flu spells trouble for species \u2014China reported 1st human death from H3N8 bird flu, WHO says With that possibility in mind, the CDC continues to closely monitor for unusual flu activity across the country. A third human case of bird flu has been linked to the ongoing outbreak in cows on U.S. dairy farms \u2014 and this one came with respiratory symptoms, such as cough, the Centers for Disease Control and Prevention (CDC) reported May 30. ",
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+ "snippet": "CDC Confirms Third Case of H5N1 Avian Flu in the US The US Centers for Disease Control and Prevention (CDC) confirmed a third case of H5N1 avian flu in the United States on Thursday, marking the second case in Michigan alone. \u201cThird Case of H5N1 Avian Flu Confirmed in the US, CDC Urges Vigilance and Personal Protective Equipment\u201d USDA Announces Funding to Combat H5N1 Outbreak in US Livestock In a recent development, H5N1 was detected in the muscle of a dairy cow intended for beef consumption. Concerns Over Respiratory Symptoms \u201cThis is the first time in the US outbreak a person with H5N1 has displayed respiratory symptoms, unlike the previous two cases with only conjunctivitis, commonly known as \u2018pink eye,\u2019\u201d said Dr. Nirav Shah, principal deputy director of the CDC, during a press briefing. CDC Urges Use of Personal Protective Equipment Despite Summer Heat Dr. Shah emphasized the importance of using personal protective equipment for workers in close contact with animals, despite the challenges posed by hot summer weather. According to the CDC, only 39 individuals have been tested for H5N1 during the 2024 outbreak in the United States.",
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+ "snippet": "Severe case of H5N1 bird flu detected in US, CDC confirms | Fox News Fox News FOX News Go Fox News The U.S. Centers for Disease Control and Prevention said on Wednesday that a patient has been hospitalized with a severe case of H5N1 infection in Louisiana, marking the first known instance of a severe human illness linked to the bird flu virus in the United States. The CDC said that partial viral genome data from the infected patient shows that the virus belongs to the D1.1 genotype, recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. Fox News Health FOX News Go Fox News",
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+ "snippet": "California egg prices jump 70% due to bird flu outbreaks A sign posted in store coolers at Whole Foods on Ocean Avenue in San Francisco reads, \u201cFor now, we\u2019re limiting purchases to 3 cartons per customer.\u201d Egg prices have spiked 70% amid a nationwide dairy shortage spurred by the outbreak of H5N1 avian flu, commonly known as bird flu. The price hike, highlighted in the U.S. Department of Agriculture\u2019s December egg markets report, owes largely to a series of highly pathogenic avian influenza outbreaks that have decimated the state\u2019s poultry flocks. With the U.S. egg-laying flock expected to dip below 300 million hens \u2014 its lowest point since the 2022 bird flu crisis \u2014 the nation\u2019s egg production is unlikely to return to normal levels until mid-2025, assuming no additional outbreaks occur.",
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+ "snippet": "NMPF annual meeting spotlights dairy vigilance on H5N1, advances on milk pricing NMPF annual meeting spotlights dairy vigilance on H5N1, advances on milk pricing U.S. dairy farmers are remaining resilient in the face of H5N1 influenza outbreaks while advancing in policy areas including nutrition and milk pricing, said NMPF Chairman Randy Mooney at the organization\u2019s annual meeting held in Phoenix Oct. 21-23. Underpinning the entire industry is USDA\u2019s plan for Federal Milk Marketing Order modernization, which is likely to resemble a proposal released in July that incorporated key NMPF principles and would be voted on by dairy farmers early next year. \u201cDairy farmers and their cooperatives have developed and embraced a robust biosecurity program through the National Dairy FARM Program,\u201d NMPF\u2019s Emily Yeiser Stepp said.",
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+ "snippet": "Such rapid viral transmission started after the emergence of a new genotype of H5N1 viruses belonging to clade 2.3.4.4b, which infected wild birds from Europe to Africa, North America, South America, and the Antarctic. The article provides information on the acquisition of key adaptive mutations that enabled 2.3.4.4b H5N1 viruses to sustain mammal-to-mammal transmission. The authors have collected this information from three real-world settings: the 2022-2023 H5N1 outbreaks on European fur farms, the 2023 South American marine mammal-adapted virus, and the 2024 US dairy cattle outbreak. Genetic sequencing of H5N1 viruses from South American marine mammals identified the same known mammalian adaptations (PB2 D701N and Q591K) and other distinctive mutations absent in birds, supporting mammal-to-mammal transmission. Retrieved on September 25, 2024 from https://www.news-medical.net/news/20240925/H5N1-bird-flu-is-mutating-fast-and-jumping-to-mammals-could-the-next-pandemic-be-here.aspx. . https://www.news-medical.net/news/20240925/H5N1-bird-flu-is-mutating-fast-and-jumping-to-mammals-could-the-next-pandemic-be-here.aspx. News-Medical, viewed 25 September 2024, https://www.news-medical.net/news/20240925/H5N1-bird-flu-is-mutating-fast-and-jumping-to-mammals-could-the-next-pandemic-be-here.aspx.",
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+ "snippet": "The USDA said on Monday the virus has been confirmed in 33 dairy herds in eight states since it was first identified on March 25. A dairy worker in Texas apparently contracted bird flu on the job and was treated for conjunctivitis early this month. Bird flu virus susceptible to antiviral meds used against seasonal flu, says CDC The USDA said on Monday the virus has been confirmed in 33 dairy herds in eight states since it was first identified on March 25. Testing has confirmed that antiviral medications used against the seasonal flu would be effective against the H5N1 bird flu virus that also infects dairy cattle, said the\u00a0Centers for Disease Control. Authorities say risk of H5N1 to the public is low, and surveillance would continue to see if the virus was evolving to spread more easily. Wild birds are believed to spread HPAI, so animal welfare officials urge farmers to adopt strong biosecurity measures, such as keeping wild birds away from their stock, limiting access by outsiders to their farms, and using foot baths to sanitize boots before entering barns. ",
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+ "text": "This map is updated each weekday to depict the number of new confirmed cases in livestock in the last 30 days and the cumulative number of confirmed cases in livestock by State.\nFor information related to the National Milk Testing Strategy, visit Testing.\nUsers may need to refresh the page to see the latest map and table data. To refresh the page, hold down the SHIFT key and click the Reload Page button in the upper left corner of your browser. You can also use SHIFT+F5 on your keyboard.",
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+ "text": "\u2022 H5 bird flu is widespread in wild birds worldwide and is causing outbreaks in poultry and U.S. dairy cows with several recent human cases in U.S. dairy and poultry workers.\n\u2022 While the current public health risk is low, CDC is watching the situation carefully and working with states to monitor people with animal exposures.\n\u2022 CDC is using its flu surveillance systems to monitor for H5 bird flu activity in people.",
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+ "text": "When a case tests positive for H5 at a public health laboratory but testing at CDC is not able to confirm H5 infection, per Council of State and Territorial Epidemiologists (CSTE) guidance, a case is reported as probable.\nConfirmed and probable cases are typically updated by 5 PM EST on Mondays (for cases confirmed by CDC on Friday, Saturday, or Sunday), Wednesdays (for cases confirmed by CDC on Monday or Tuesday), and Fridays (for cases confirmed by CDC on Wednesday and Thursday). Affected states may report cases more frequently.",
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+ "text": "\u2022 12,064 wild birds detected as of 2/18/2025 | Full Report\n\u2022 51 jurisdictions with bird flu in wild birds\n\u2022 162,586,638 poultry affected as of 2/18/2025 | Full Report\n\u2022 51 jurisdictions with outbreaks in poultry\n\u2022 972 dairy herds affected as of 2/18/2025 | Full Report\n\u2022 16 states with outbreaks in dairy cows\nThese data will be updated daily, Monday through Friday, after 4 p.m. to reflect any new data.\nCumulative data on wild birds have been collected since January 20, 2022. Cumulative data on poultry have been collected since February 8, 2022. Cumulative data on humans in the U.S. have been collected since April 28, 2022. Cumulative data on dairy cattle have been collected since March 25, 2024.",
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+ "text": "Birds are the natural hosts for avian influenza viruses. Avian influenza refers to an infectious disease of birds caused by infection with avian influenza viruses. Avian influenza viruses can also infect non-avian species including wild and domestic (including companion and farmed) terrestrial and marine mammals. Avian influenza viruses primarily spread from infected birds to humans through close contact with birds or contaminated environments, such as in backyard poultry farm settings and at markets where birds are sold.\nThere have also been limited reports of transmission from other infected animals to humans.\nSwine influenza is a respiratory disease of pigs caused by influenza A viruses. Most swine influenza viruses do not cause disease in humans, but some countries have reported cases of human infection from certain swine influenza viruses. Close proximity to infected pigs or visiting locations where pigs are exhibited has been reported for most human cases, but some limited human-to-human transmission has occurred.\nJust like birds and pigs, other animals such as horses and dogs, can be infected with their own influenza viruses (canine influenza viruses, equine influenza viruses, etc.).\nDive in\nTechnical guidance",
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+ "text": "\u2022\nNew human cases 1 2 : From 13 December 2024 to 20 January 2025, the detection of influenza\nA(H5) virus in five humans, influenza A(H9N2) virus in two humans, and influenza A(H10N3) virus\nin one human were reported officially. Additionally, five human cases of infection with influenza\nA(H5) viruses were detected.\n\u2022\nCirculation of influenza viruses with zoonotic potential in animals: High pathogenicity avian\ninfluenza (HPAI) events in poultry and non-poultry continue to be reported to the World\nOrganisation for Animal Health (WOAH). 3 The Food and Agriculture Organization of the United\nNations (FAO) also provides a global update on avian influenza viruses with pandemic potential. 4\n\u2022\nRisk assessment 5 : Based on information available at the time of the risk assessment, the overall\npublic health risk from currently known influenza viruses at the human-animal interface has not\nchanged remains low. Sustained human to human transmission has not been reported from\nthese events and the occurrence of sustained human-to-human transmission of these viruses is\ncurrently considered unlikely. Although human infections with viruses of animal origin are\ninfrequent, they are not unexpected at the human-animal interface.\n\u2022\nIHR compliance: All human infections caused by a new influenza subtype are required to be\nreported under the International Health Regulations (IHR, 2005). 6 This includes any influenza A\nvirus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or\nprotein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human\npopulation. Information from these notifications is critical to inform risk assessments for\ninfluenza at the human-animal interface.\nAvian influenza viruses in humans\nCurrent situation:\nSince the last risk assessment of 12 December 2024, influenza A(H5) virus has been detected in nine\nhumans in the United States of America (USA) and one laboratory-confirmed human case of A(H5N1)\ninfection was reported to WHO from Cambodia.\n1 This summary and assessment covers information confirmed during this period and may include information\nreceived outside of this period.\n2 For epidemiological and virological features of human infections with animal influenza viruses not reported in\nthis assessment, see the reports on human cases of influenza at the human-animal interface published in the\nWeekly Epidemiological Record here .\n3 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n4 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .\n5 World Health Organization (2012). Rapid risk assessment of acute public health events. World Health\nOrganization. Available at: https://iris.who.int/handle/10665/70810 .\n6 World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all\ncircumstances under the International Health Regulations (2005). Case definitions for the four diseases\nrequiring notification in all circumstances under the International Health Regulations (2005).",
+ "chunk_type": "prose",
+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "2\nA(H5), USA\nOn 14 December 2024, the USA notified WHO of one laboratory-confirmed human case of infection\nwith influenza A(H5) in an adult aged over 65 years from the state of Louisiana. The patient, with\nunderlying conditions, developed symptoms and sought care at an emergency department in early\nDecember 2024. Due to worsening symptoms, the patient returned to the emergency department a\nfew days later, was hospitalized in critical condition with pneumonia, and started on antiviral\ntreatment. Unfortunately, the patient passed away. No household contacts of the case tested\npositive for influenza viruses. The individual owned backyard poultry and had noted deaths in\ndomestic and wild birds on the property prior to symptom onset. A(H5N1) viruses were detected in\npoultry on the property.\nThe viruses identified in two clinical samples from the patent were identified as influenza A(H5N1)\nviruses belonging to the clade 2.3.4.4b and the genotype D1.1. Deep sequencing of the genetic\nsequences from the two clinical specimens were compared to A(H5N1) virus sequences from dairy\ncows, wild birds, poultry and other human cases in the USA and Canada. The hemagglutinin (HA)\ngene sequences of the viruses from the clinical specimens are closely related to other D1.1 viruses\nrecently detected in wild birds and poultry in the Louisiana and other parts of the USA and in recent\nhuman cases detected in Canada and the USA, as well as to existing influenza A(H5N1) candidate\nvaccine viruses. 7\nSome changes in the HA gene segment of one of the clinical specimens from the patient were\ndetected at a low frequency. These changes have rarely been identified in specimens from previous\nhuman infections with A(H5N1) viruses and were not detected in specimens from the poultry on the\nproperty of the patient. It is possible that these changes arise during viral replication in the infected\nhuman cases. No changes in the polymerase genes associated with adaptation to mammals were\nidentified. No changes associated with known or suspected markers of reduced susceptibility to\nantiviral drugs were identified. 8 , 9 , 10\nBetween 20 and 21 December 2024, the USA notified WHO of two additional laboratory-confirmed\nhuman case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin. The\ncases developed symptoms in December 2024 and reported their illness to public health officials as\npart of active monitoring. The cases were not hospitalized and have recovered. Both cases were\nexposed to influenza A(H5N1) while working at poultry facilities.\nOn 15 January 2025, the USA notified WHO of one additional laboratory-confirmed human case of\ninfection with influenza A(H5) from the state of California. The case occurred in a child less than 18\nyears old with no known contact with influenza A(H5N1) virus-infected animals or humans. The\ninvestigation into the source of infection and contact monitoring around this case was ongoing at\nthe time of reporting, and thus far, no human-to-human transmission has been identified. Additional\n7 WHO. Zoonotic influenza: candidate vaccine viruses and potency testing reagents. Available at:\nhttps://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations/zoonotic-\ninfluenza-viruses-and-candidate-vaccine-viruses .\n8 US CDC. CDC Confirms First Severe Case of H5N1 Bird Flu in the United States, 18 Dec 2024. Available at:\nhttps://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html .\n9 US CDC. Genetic Sequences of Highly Pathogenic Avian Influenza A(H5N1) Viruses Identified in a Person in\nLouisiana, 26 Dec 2024. Available at: https://www.cdc.gov/bird-flu/spotlights/h5n1-response-12232024.html .\n10 US CDC. First H5 Bird Flu Death Reported in United States, 6 Jan 2025. Available at:\nhttps://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html .",
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+ "text": "3\nanalysis including genetic sequencing of the virus from the specimen from this case was underway at\nthe time of reporting. 11\nFive additional cases of influenza A(H5) were detected in California in individuals aged over 18 years\nwho worked at commercial dairy cattle farms in areas where highly pathogenic avian influenza\n(HPAI)(H5N1) viruses had been detected in cows. The individuals had mild symptoms. 12 , 13\nLow pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds\nin the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and\nbackyard flocks in 48 states, impacting over 100 million birds. To date, 67 people have tested\npositive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in\n2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy\ncattle, except for two cases where the exposure source could not be identified. 14 To date, no human-\nto-human transmission of influenza A(H5) virus has been identified in the USA. A(H5N1) virus\ninfections in dairy cattle and wild and domestic birds continue to be reported in the USA. 15\nA(H5N1), Cambodia\nOn 10 January 2025, Cambodia notified WHO of one case of human infection with influenza A(H5N1)\nin a 28-year-old male from Kampong Cham Province. The case had onset of fever, sore throat and\nchest pain on 1 January 2025. He sought care at two private local clinics and after his condition did\nnot improve, he traveled to Phnom Penh and was hospitalized due to shortness of breath on 7\nJanuary at a national hospital, which is a severe acute respiratory infection (SARI) sentinel site. The\ncase was isolated upon admission and provided oseltamivir and symptomatic treatment before\npassing away on 10 January. Nasopharyngeal (NP) and oropharyngeal (OP) swab specimens tested\npositive on 9 January for influenza A(H5N1) by real-time reverse transcription-polymerase chain\nreaction (rt-PCR) at the National Institute of Public Health of Cambodia. The Institut Pasteur du\nCambodge (IPC) confirmed the results on 10 January. Sequence analysis of HA gene shows the virus\nbelongs to clade 2.3.2.1c and is closely related to those viruses circulating among birds in Cambodia\nin 2024. Phylogenetic and molecular analysis is ongoing.\nAccording to the early investigation, the case was a guard of a farm in the village where he lived and\nraised poultry for family consumption. There were reports of sick poultry in his farm and samples\nfrom the poultry on the farm have been collected. No further cases were detected among the\ncontacts of the case.\nAccording to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in\nwild and domestic birds in the Americas, Asia and Europe. Infections in non-human mammals are\n11 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 2, ending January 11, 2025.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2025-week-02.html.\n12 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 50, ending December 14, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-50.html .\n13 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 51, ending December 21, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-51.html .\n14 United States Centers for Disease Control and Prevention. H5 Bird Flu: Current Situation. Available at:\nhttps://www.cdc.gov/bird-flu/situation-\nsummary/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbird-flu%2Fphp%2Favian-flu-\nsummary%2Findex.html .\n15 United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock,\n19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-\ndetections/livestock .",
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+ "text": "4\nalso reported, including in marine and land mammals. 16 A list of bird and mammalian species\naffected by HPAI A(H5) viruses is maintained by FAO. 17\nRisk Assessment for avian influenza A(H5) viruses:\n1. What is the current global public health risk of additional human cases of infection with avian\ninfluenza A(H5) viruses?\nMost human cases so far have been infections in people exposed to A(H5) viruses, for example,\nthrough contact with infected poultry or contaminated environments, including live poultry markets,\nand occasionally infected mammals and contaminated environments. While the viruses continue to\nbe detected in animals and related environments humans are exposed to, further human cases\nassociated with such exposures are expected but unusual. The impact for public health if additional\ncases are detected is minimal. The current overall global public health risk of additional human cases\nis low.\n2. What is the likelihood of sustained human-to-human transmission of currently circulating avian\ninfluenza A(H5) viruses?\nNo sustained human-to-human transmission has been identified associated with the recent reported\nhuman infections with avian influenza A(H5). There has been no reported human-to-human\ntransmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007\nand the years prior, small clusters of A(H5) virus infections in humans were reported, including some\ninvolving health care workers, where limited human-to-human transmission could not be excluded;\nhowever, sustained human-to-human transmission was not reported.\nAvailable evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to\nefficiently transmit between people, therefore the likelihood of sustained human-to-human\ntransmission is thus currently considered unlikely at this time.\n3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community-\nlevel spread is considered unlikely as current evidence suggests these viruses have not acquired the\nability to transmit easily among humans.\nA(H9N2), China\nSince the last risk assessment of 12 December 2024, two human cases of infection with A(H9N2)\ninfluenza viruses were notified to WHO from China (Table 1). Both cases were detected through\ninfluenza-like illness (ILI) surveillance, were mild and have recovered. Both cases had a history of\nexposure to live poultry markets prior the onset of symptoms. No further cases were detected\namong contacts of the cases. Influenza A(H9) virus was detected in the poultry-related environments\nassociated with these cases.\n16 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n17 Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential/bird-species-affected-by-h5nx-hpai/en .",
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+ "text": "Onset date\tReporting province\tAge (years)\tGender\tHospitalization date\n27 Nov 2024\tHubei\t8\tFemale\tNot hospitalized\n13 Dec 2024\tChongqing\t1\tFemale\t14 Dec 2024",
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+ "text": "5",
+ "chunk_type": "prose",
+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
+ "page_number": 5,
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+ "text": "Onset date\nReporting province\nAge (years)\nGender\nHospitalization date\n27 Nov 2024\nHubei\n8\nFemale\nNot hospitalized\n13 Dec 2024\nChongqing\n1\nFemale\n14 Dec 2024\nRisk Assessment for avian influenza A(H9N2):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H9N2) viruses?\nMost human cases follow exposure to the A(H9N2) virus through contact with infected poultry or\ncontaminated environments. Most human infections of A(H9N2) to date have resulted in mild\nclinical illness in most cases. Nearly 130 human infections with A(H9N2) cases have been reported to\ndate since 2003, and six of these have been severe or fatal and three of these were known to have\nunderlying medical conditions. Since the virus is endemic in poultry in multiple continues in Africa\nand Asia 18 , further human cases associated with exposure to infected poultry are expected but\nremain unusual. The impact to public health if additional cases are detected is minimal. The overall\nglobal public health risk of additional human cases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H9N2)\nviruses?\nAt the present time, no sustained human-to-human transmission has been identified associated with\nthe event described above. Current evidence suggests that influenza A(H9N2) viruses from these\ncases have not acquired the ability of sustained transmission among humans, therefore sustained\nhuman-to-human transmission is thus currently considered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely as current evidence suggests the A(H9N2) virus subtype has not\nacquired the ability to transmit easily among humans.\nA(H10N3), China\nSince the last risk assessment of 12 December 2024, one human case of infection with A(H10N3)\ninfluenza viruses were notified to WHO from China on 3 January 2025. A 23-year-old female from\nGuangxi Zhuang Autonomous Region, with an underlying condition, had symptom onset on 12\nDecember 2024. She was admitted to hospital on 19 December with severe pneumonia and treated\nwith oseltamivir. Initially, she was in critical condition but has improved. A clinical sample collected\non 22 December tested positive for influenza A and influenza A(H10N3) was confirmed a on 26\nDecember. Prior to symptom onset, the patient worked at a supermarket and was exposed to freshly\nslaughtered poultry. No family members have developed symptoms at the time of reporting. All\nclose contacts tested negative for influenza A(H10N3). All environmental samples collected from\nvarious locations tested negative for influenza A(H10N3).\nThis is the fourth case of human A(H10N3) virus infection detected in China and globally to date.\n18 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .",
+ "chunk_type": "prose",
+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "6\nRisk Assessment for avian influenza A(H10N3):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H10N3) viruses?\nHuman infections with avian influenza A(H10) viruses have been detected and reported previously.\nThe extent of circulation and epidemiology of these viruses in birds is unclear. Avian influenza\nA(H10N3) viruses with different genetic characteristics have been detected previously in migratory\nand other wild birds since the 1970s. As long as the virus continues to circulate in birds, further\nhuman cases can be expected but remain unusual. The impact to public health if additional sporadic\ncases are detected is minimal. The overall global public health risk of additional sporadic human\ncases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H10N3)\nviruses?\nNo sustained human-to-human transmission has been identified associated with the event described\nAbove or past events with human cases of influenza A(H10N3) viruses. Current epidemiologic and\nvirologic evidence suggests that contemporary influenza A(H10N3) viruses assessed by the Global\nInfluenza Surveillance and response System (GISRS) have not acquired the ability of sustained\ntransmission among humans, therefore sustained human-to-human transmission is thus currently\nconsidered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H10N3) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely based on current limited evidence.\nOverall risk management recommendations:\nSurveillance and investigations\n\u2022\nDue to the constantly evolving nature of influenza viruses, WHO continues to stress the\nimportance of global strategic surveillance in animals and humans to detect virologic,\nepidemiologic and clinical changes associated with circulating influenza viruses that may affect\nhuman (or animal) health. Continued vigilance is needed within affected and neighbouring areas\nto detect infections in animals and humans. Close collaboration with the animal health and\nenvironment sectors is essential to understand the extent of the risk of human exposure and to\nprevent and control the spread of animal influenza.\n\u2022\nAs the extent of influenza virus circulation in animals is not clear, epidemiologic and virologic\nsurveillance and the follow-up of suspected human cases should continue systematically.\nGuidance on investigation of non-seasonal influenza and other emerging acute respiratory\ndiseases has been published on the WHO website.\n\u2022\nCountries should increase avian influenza surveillance in domestic and wild birds, enhance\nsurveillance for early detection in cattle populations in countries where HPAI is known to be\ncirculating, include HPAI as a differential diagnosis in non-avian species, including cattle and\nother livestock populations, with high risk of exposure to HPAI viruses; monitor and investigate\ncases in non-avian species, including livestock, report cases of HPAI in all animal species,\nincluding unusual hosts, to WOAH and other international organizations, share genetic\nsequences of avian influenza viruses in publicly available databases, implement preventive and\nearly response measures to break the HPAI transmission cycle among animals through\nmovement restrictions of infected livestock holdings and strict biosecurity measures in all",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "7\nholdings, employ good production and hygiene practices when handing animal products, and\nprotect persons in contact with suspected/infected animals. 19\n\u2022\nWhen there has been human exposure to a known outbreak of an influenza A virus in domestic\npoultry, wild birds or other animals \u2013 or when there has been an identified human case of\ninfection with such a virus \u2013 enhanced surveillance in potentially exposed human populations\nbecomes necessary. Enhanced surveillance should consider the health care seeking behaviour of\nthe population, and could include a range of active and passive health care and/or community-\nbased approaches, including: enhanced surveillance in local influenza-like illness (ILI)/SARI\nsystems, active screening in hospitals and of groups that may be at higher occupational risk of\nexposure, and inclusion of other sources such as traditional healers, private practitioners and\nprivate diagnostic laboratories.\n\u2022\nVigilance for the emergence of novel influenza viruses of pandemic potential should be\nmaintained at all times including during a non-influenza emergency. In the context of the co-\ncirculation of SARS-CoV-2 and influenza viruses, WHO has updated and published practical\nguidance for integrated surveillance .\nNotifying WHO\n\u2022\nAll human infections caused by a new subtype of influenza virus are notifiable under the\nInternational Health Regulations (IHR, 2005). 20 State Parties to the IHR (2005) are required to\nimmediately notify WHO of any laboratory-confirmed 5 21 case of a recent human infection caused\nby an influenza A virus with the potential to cause a pandemic 6 22 . Evidence of illness is not\nrequired for this report.\n\u2022\nWHO published the case definition for human infections with avian influenza A(H5) virus\nrequiring notification under IHR (2005): https://www.who.int/teams/global-influenza-\nprogramme/avian-influenza/case-definitions .\nVirus sharing and risk assessment\n\u2022\nIt is critical that these influenza viruses from animals or from people are fully characterized in\nappropriate animal or human health influenza reference laboratories. Under WHO\u2019s Pandemic\nInfluenza Preparedness (PIP) Framework, Member States are expected to share influenza viruses\nwith pandemic potential on a timely basis 23 with a WHO Collaborating Centre for influenza of\nGISRS. The viruses are used by the public health laboratories to assess the risk of pandemic\ninfluenza and to develop candidate vaccine viruses.\n\u2022\nThe Tool for Influenza Pandemic Risk Assessment (TIPRA) provides an in-depth assessment of\nrisk associated with some zoonotic influenza viruses \u2013 notably the likelihood of the virus gaining\nhuman-to-human transmissibility, and the impact should the virus gain such transmissibility.\nTIPRA maps relative risk amongst viruses assessed using multiple elements. The results of TIPRA\ncomplement those of the risk assessment provided here, and those of prior TIPRA analyses will\nbe published at http://www.who.int/teams/global-influenza-programme/avian-influenza/tool-\nfor-influenza-pandemic-risk-assessment-(tipra) .\n19 World Organisation for Animal Health. Statement on High Pathogenicity Avian Influenza in Cattle, 6\nDecember 2024. Available at: https://www.woah.org/en/high-pathogenicity-avian-influenza-hpai-in-cattle/ .\n20 World Health Organization. Case definitions for the four diseases requiring notification in all\ncircumstances under the International Health Regulations (2005).\n21 World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza\n(2011). Available at: https://apps.who.int/iris/handle/10665/44518\n22 World Health Organization. Pandemic influenza preparedness framework for the sharing of influenza viruses\nand access to vaccines and other benefits, 2 nd edition. Available at: https://iris.who.int/handle/10665/341850\n23 World Health Organization. Operational guidance on sharing influenza viruses with human pandemic\npotential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework (2017). Available at:\nhttps://apps.who.int/iris/handle/10665/25940",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "8\nRisk reduction\n\u2022\nGiven the observed extent and frequency of avian influenza in poultry, wild birds and some wild\nand domestic mammals, the public should avoid contact with animals that are sick or dead from\nunknown causes, including wild animals, and should report dead birds and mammals or request\ntheir removal by contacting local wildlife or veterinary authorities.\n\u2022\nEggs, poultry meat and other poultry food products should be properly cooked and properly\nhandled during food preparation. Due to the potential health risks to consumers, raw milk\nshould be avoided. WHO advises consuming pasteurized milk. If pasteurized milk isn\u2019t available,\nheating raw milk until it boils makes it safer for consumption.\n\u2022\nWHO has published practical interim guidance to reduce the risk of infection in people exposed\nto avian influenza viruses.\nTrade and travellers\n\u2022\nWHO advises that travellers to countries with known outbreaks of animal influenza should avoid\nfarms, contact with animals in live animal markets, entering areas where animals may be\nslaughtered, or contact with any surfaces that appear to be contaminated with animal excreta.\nTravelers should also wash their hands often with soap and water. All individuals should follow\ngood food safety and hygiene practices.\n\u2022\nWHO does not advise special traveller screening at points of entry or restrictions with regards to\nthe current situation of influenza viruses at the human-animal interface. For recommendations\non safe trade in animals and related products from countries affected by these influenza viruses,\nrefer to WOAH guidance.\nLinks:\nWHO Human-Animal Interface web page\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza\nWHO Influenza (Avian and other zoonotic) fact sheet\nhttps://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)\nWHO Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nhttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.2\nWHO Public health resource pack for countries experiencing outbreaks of influenza in animals:\nhttps://www.who.int/publications/i/item/9789240076884\nCumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus\nAvian Influenza A(H7N9) Information\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-influenza-a-( h7n9 )-\nvirus\nWorld Organisation of Animal Health (WOAH) web page: Avian Influenza\nhttps://www.woah.org/en/home/\nFood and Agriculture Organization of the United Nations (FAO) webpage: Avian Influenza\nhttps://www.fao.org/animal-health/avian-flu-qa/en/\nOFFLU\nhttp://www.offlu.org/",
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+ "title": "Bird flu: First death from H5N1 strain reported in US",
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+ "text": "The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred.\nThe patient had been taken to hospital after contracting a major strain of bird flu, known as H5N1.\nLouisiana health department said they were over the age of 65, and had other underlying health conditions.\nIt said their public health investigation had not found evidence of person-to-person transmission, or any other cases.\nBird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. In very rare cases, it can also infect humans.\nThe state's health department added the person had contracted bird flu after being exposed to a personal flock of birds and wild birds.\n\"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,\" it said.\nThere have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC).",
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+ "text": "Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Bird migration has resulted in outbreaks of the avian flu in domestic and wild birds.\nThe H5N1 virus is the major strain circulating among wild birds worldwide, and emerged in China in the late 1990s.\nAlthough infection of humans is very rare, it occurs via transmission from birds.\nAlmost all cases of infection in people have been associated with close contact to infected dead or live birds, or contaminated environments.\nSince 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died.\nThere has been no sustained human-to-human transmission.\nLast month, the CDC said the Louisiana patient had been infected with the D1.1variant of the virus, which has recently been detected in North America.\nA 13-year-old girl in Canada was taken to hospital with the same D1.1 variant in November 2024, according to a paper published in The New England Journal of Medicine.\nIt is different to the B3.13 variant, which - during the past year - has been on the rise among cows in the US.\nIn September 2024, a person in Missouri recovered from bird flu after being treated in hospital.",
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+ "heading": "First bird flu-related death reported in US > What is bird flu?",
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+ "text": "According to the WHO, symptoms of a H5N1 infection include a cough, sore throat, fever (often over 38C), muscle aches and general feelings of malaise.\nPeople with the virus may also display other non-respiratory symptoms such as conjunctivitis.\nThe WHO added that H5N1 has also been detected in people without symptoms who had contact with infected animals or their environments.\nWhile the risk to humans is low, the constantly evolving virus is monitored for all changes, including the potential to become easily transmissible from person to person.",
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+ "text": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic.\nThe severe case involves a resident of southwestern Louisiana who was reported as presumptively positive for infection last Friday. The infected patient \u201cis experiencing severe respiratory illness related to H5N1 infection and is currently hospitalized in critical condition,\u201d according to Emma Herrock, a spokesperson for the Louisiana Department of Health, who said that the patient is over the age of 65 and has underlying medical conditions but that further updates on their condition will not be given at this time due to patient confidentiality.\nRead More: What Are the Symptoms of Bird Flu?\nIt is the 61st case of human H5N1 bird flu infection in the country since April this year. But the CDC said the overall risk of the pathogen to the public remains low, and no related deaths have been reported in the U.S. so far.\nHere\u2019s what to know.",
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+ "text": "The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins.\nOf the 60 other cases, 58 were linked to commercial agriculture\u201437 from dairy herds and 21 from poultry farms and culling. The sources of exposure for the two other U.S. human cases remain unknown.",
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+ "text": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California, with all but one exposed to cattle. In response, Governor Gavin Newsom on Dec. 18 declared a state of emergency.\nThe CDC said that such a \u201csevere\u201d infection as was found in Louisiana was expected given cases in other countries. In Vietnam, a patient who died in March after a diagnosis of \u201csevere pneumonia, severe sepsis, and acute respiratory distress syndrome\u201d was found with an H5N1 infection, according to the World Health Organization. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.\nRead More: The Bird Flu Virus Is One Mutation Away from Getting More Dangerous\nAccording to Mark Mulligan, Director of the Vaccine Center and the Division of Infectious Diseases and Immunology at New York University Grossman School of Medicine, the general population faces \u201cno immediate threat.\u201d Those who are in contact with birds and animals\u2014especially those who work on dairy farms and cattle farms\u2014are at greatest risk. Currently, no person to person spread of the virus has been detected.\n\u201cRight now we have to let the experts do surveillance, do sequencing of the virus to see if we're seeing any changes that portend any significant difference,\u201d says Mulligan.",
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+ "text": "According to the CDC, symptoms of the bird flu can vary. Many of the cases in the U.S. included symptoms resembling conjunctivitis-like eye issues, including eye redness, discomfort, and discharge.\nSome cases also included both respiratory classic flu-like symptoms, including cough, headache, runny nose, fever, sore throat, body aches, fatigue, shortness of breath, and pneumonia, according to the CDC.\nRead More: What Are the Symptoms of Bird Flu?",
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+ "text": "The CDC issued a number of protective measures, including largely avoiding direct contact with wild birds and other suspected infected animals as well as their bodily excretions. People who work with cattle and poultry on affected farms have a greater risk of infection, and are thus advised to monitor any possible symptoms of infection.\nThe CDC also recommends that those who work with poultry or other animals use the correct personal protective equipment (PPE)\u2014including coveralls, boots, and more\u2014which should be provided by employers.\nVirologist and professor at John Hopkins University Andy Pekosz says that the severe case in Louisiana provides a reminder of an easy way to stay safe: stay away from dead animals. \u201cYou see a dead animal, if you're exposed to dead animals, stay away,\u201d he says. \u201cIn many ways, it is the least likely way someone can get exposed, but in some ways, it's also one of the more preventable ways.\u201d\nProperly cooked poultry and poultry products are safe, and the CDC says that while unpasteurized (raw) milk from infected cows can pose risks to humans, it\u2019s not yet known if avian influenza viruses can be transmitted through its consumption.\nBoth Mulligan and Pekosz say it is also important to get the seasonal human influenza vaccine. They say if there were to be a case of a person with simultaneous bird flu and human flu infection, it could lead to a \u201creassortment\u201d and thus a virus that could be more easily spread.\n\u201cWe know that has happened before, because the 1957 influenza pandemic and the 1968 influenza pandemic both were a result of a human and a bird influenza virus exchanging genetic material,\u201d Pekosz says. \u201cWe know that the flu vaccines are not perfect, but they do a good job of reducing infection.\u201d\nThe CDC currently has a program to offer seasonal vaccines to farm workers in high risk scenarios in certain states.",
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+ "text": "\u2022 L.A. Fires Show Reality of 1.5\u00b0C of Warming\n\u2022 Behind the Scenes of The White Lotus Season Three\n\u2022 How Trump 2.0 Is Already Sowing Confusion\n\u2022 Bad Bunny On Heartbreak and New Album\n\u2022 How to Get Better at Doing Things Alone\n\u2022 We\u2019re Lucky to Have Been Alive in the Age of David Lynch\n\u2022 The Motivational Trick That Makes You Exercise Harder\n\u2022 Column: All Those Presidential Pardons Give Mercy a Bad Name\nContact us at letters@time.com",
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+ "text": "Most human cases of bird flu in North America have been mild, a fact that\u2019s underscored by a new study of the first 46 confirmed human H5N1 infections in the United States this year. But the case of an ill Canadian teen stands out because of its severity and because the source of exposure remains a mystery.\nWith the number of cases continuing to grow, leaders from the National Institutes of Health are calling for more action to tackle the bird flu outbreak.\nThe teenager, who was hospitalized with H5N1 infection in November, became critically ill and spent almost two weeks hooked up to machines that took over for her failing heart, lungs and kidneys, according to a report published Tuesday in the New England Journal of Medicine.\nThe 13-year-old had asthma and obesity but was otherwise in good health before catching H5N1. She recovered after aggressive treatment with a combination of three antiviral drugs, according to the report.\n\u201cShe had multiorgan failure and was horribly ill,\u201d said Dr. Megan Ranney, an emergency medicine physician and dean of the Yale School of Public Health, who was not involved with the girl\u2019s care.\nThe teen was treated with extracorporeal membrane oxygenation, or ECMO, in which machines take over the work of the heart and lungs to give the body a chance to recover. She also had continuous dialysis to help remove toxins from her blood because her kidneys weren\u2019t working, as well as plasma exchange, in which machines separate the clear part of the blood from blood cells so harmful substances can be removed.\n\u201cWere those extraordinary treatment modalities not available, she likely would not have lived,\u201d Ranney said.\nHealth officials in British Columbia closed their investigation into the case late last month after being unable to find the virus in any of the household pets, nearby animals, or soil or water samples. Close monitoring of people who were around the teen determined that no one else caught the virus from her. At the time, it wasn\u2019t clear whether she had recovered.\nThe new report on the teen\u2019s case \u201cclearly shows that a child who was otherwise generally healthy became sick and then got very, very ill in a matter of days. This is a very worrisome outcome that we should be much more concerned about happening with other infections,\u201d said Dr. Jennifer Nuzzo, who directs the Pandemic Center at Brown University. She was not involved in the case.\nThe teen was infected with a newer variant of the H5N1 virus, D1.1, which is carried by wild birds. This variant has played a role in some infections of poultry workers in Washington, which were mild, and a recent human infection in Louisiana, which was severe.\nIn both severe infections \u2013 the teen\u2019s and the case in Louisiana \u2013 the virus has shown changes that mean it might be adapting to humans, a finding that has put infectious disease experts on high alert since it increases the possibility of human-to-human spread.\n\u201cFor this reason, we should be much more aggressive in conducting environmental surveillance for H5N1 to track the virus and to prevent people from becoming infected,\u201d Nuzzo said.\nThe report of the first 46 human cases, also published Tuesday in the New England Journal of Medicine by researchers at the US Centers for Disease Control and Prevention, shows that most were exposed to infected animals or to raw milk.\nEye redness, or conjunctivitis, was the most common symptom in these farmworker infections, showing up in 42 of 46 cases (93%). Almost half of the workers had fevers, and more than a third reported respiratory symptoms. The average duration of illness was about four days.\nThe article also acknowledges that the official number of cases is an undercount. Although the CDC says there have been 66 confirmed cases in the US this year, recent testing on dairy farms found that 7% of workers had evidence of recent H5N1 infection in their blood.\nIn a commentary that accompanied the two studies, Dr. Jeanne Marrazzo, who directs the National Institute of Allergy and Infectious Diseases, says the mutations found in the virus isolated from the Canadian teen highlight an \u201curgent need for vigilant surveillance and assessment of the threat of human-to-human transmission.\u201d\nSurveillance has been hampered because of incomplete reporting of animal infections, she wrote. The US Department of Agriculture hasn\u2019t been submitting critical details like the exact dates when animals have gotten sick or precise locations that help scientists track the evolution of a virus over time.\nTaken together, she writes, the new reports of human cases show that the pace of human H5N1 infections has been accelerating. There have also been an increasing number of people with respiratory symptoms, like breathing problems or coughing, linked to their infections.\nAlthough the overall number of human infections related to H5N1 has been low, the continued drip, drip, drip of human and animal detections is not a good sign.",
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+ "text": "\u2022 Sign up here to get The Results Are In with Dr. Sanjay Gupta every Friday from the CNN Health team.\n\u201cThis kind of repetitive, persistent opportunity for passage from one species to another, from one anatomic space to another, that\u2019s what that\u2019s what influenza thrives on to mutate,\u201d Marrazzo told CNN. \u201cThis virus doesn\u2019t miss a beat.\u201d\nShe and co-author Dr. Michael Ison, who is chief of the Respiratory Diseases Branch at NIAID, call for better cooperation between human and animal disease investigators, complete reporting of data from animal infections so scientists can better track how the virus is spreading, development of countermeasures like vaccines and antiviral medication, and more precautions to prevent infection, such as increased use of recommended personal protective equipment and education about the risks of being around sick animals.\n\u201cThe risk is really going to come when this gets better at obviously infecting humans, and then we are faced with potential for human-to-human transmission,\u201d Marrazzo said.",
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+ "text": "A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States.\nThe agency said Wednesday that the person was exposed to sick and dead birds in backyard flocks; this is the first US bird flu case linked to a backyard flock.\n\u201cIt is believed that the patient that was reported by Louisiana had exposure to sick or dead birds on their property. These are not commercial poultry, and there was no exposure to dairy cows or their related products,\u201d said Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC.\nFederal officials declined to answer questions about the patient\u2019s symptoms or their current condition. They instead referred all inquiries about the case to the Louisiana Department of Health, which is leading the investigation.\nAccording to state officials, the patient is experiencing severe respiratory illness related to H5N1 and is hospitalized in critical condition. The person is older than 65 and has underlying medical conditions that increased their risk of flu complications, the Louisiana Department of Health said in an email to CNN.\nThis virus, D1.1, is the same type found in recent human cases in Canada and Washington state and detected in wild birds and poultry in the United States. It\u2019s different from B3.13, the type detected in dairy cows, some poultry outbreaks and other cases in humans across the United States.\nThe CDC said it\u2019s working on additional genomic sequencing of samples from the patient, who is from southwestern Louisiana, and the investigation into the patient\u2019s exposure is still underway.\nBird flu has been linked with severe human illness and death in other countries, but no person-to-person spread has been detected.\n\u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the agency said in a statement.\nIn California, Gov. Gavin Newsom declared a state of emergency Wednesday over the continued spread of H5N1 bird flu in that state.",
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+ "text": "\u2022 Sign up here to get The Results Are In with Dr. Sanjay Gupta every Friday from the CNN Health team.\nNewsom said the measure was necessary because, despite intense efforts to contain it, the virus had spread beyond the Central Valley to four dairies in the southern part of the state.\n\u201cThis proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,\u201d he said in a news release. \u201cWhile the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus.\u201d\nThe emergency declaration will give state agencies greater flexibility with staffing and free up more funding for the response.\nOf the 61 confirmed human cases of bird flu in the US this year, 34 have been in California. Nearly all of those have been in dairy farm workers, according to the CDC.\nThe Louisiana case shows that precautions should be taken by people with backyard chicken flocks, hunters and other bird enthusiasts, the CDC said.\n\u201cThe cases across the US are a constellation of spillovers,\u201d said Dr. Rebecca Christofferson, a virologist at Louisiana State University\u2019s School of Veterinary Medicine. Experts still don\u2019t understand exactly how these spillovers are happening and the specific factors that increase a person\u2019s risk.\n\u201cIt\u2019s just kind of a black box at the moment that a lot of people are trying to answer these questions on,\u201d Christofferson said.\nThe CDC says the best approach is to avoid exposure. Infected birds can shed viruses in their saliva, mucus and feces, and other animals may shed them in their respiratory secretions and bodily fluids, including unpasteurized milk from cows.\n\u201cPeople who work with or have recreational exposure to infected animals are at higher risk of infection, and it\u2019s extremely important that they follow CDC recommended precautions when around infected or potentially infected animals, a message that we will continue to magnify given recent cases,\u201d Daskalakis said.",
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+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "ca39d86abd714a8b87e57f67704ae75a",
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+ "title": "WHO Influenza at the human-animal interface (monthly risk assessment)",
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+ ],
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+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "adab909dde1f4b70bdc1ce79da0b0b2e",
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+ "snippet": "Bird flu: First death from H5N1 strain reported in US First bird flu-related death reported in US The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred. Bird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. There have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC). What is bird flu? Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Since 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died. About the BBC",
+ "published_date": "2025-01-07T16:25:05+00:00",
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+ },
+ {
+ "result_id": "5cd3a0baec254366ad4006888d6ea4f3",
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+ "snippet": "\u2018Severe\u2019 Bird Flu in the U.S.: Latest Updates | TIME TIME 2030 What to Know About Bird Flu in the U.S. After CDC Announces First \u2018Severe\u2019 Human Case What to Know About Bird Flu in the U.S. After CDC Announces First \u2018Severe\u2019 Human Case The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic. It is the 61st case of human H5N1 bird flu infection in the country since April this year. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.",
+ "published_date": "2024-12-19T08:00:00+00:00",
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+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "20ed0309167f4011ab343c6293c859ea",
+ "question_id": "q1",
+ "url": "https://edition.cnn.com/2024/12/31/health/human-h5n1-bird-flu-cases/index.html",
+ "canonical_url": "https://edition.cnn.com/2024/12/31/health/human-h5n1-bird-flu-cases/index.html",
+ "domain": "edition.cnn.com",
+ "title": "As pace and severity of human H5N1 cases accelerate, NIH leaders call for more action on bird flu - CNN International",
+ "snippet": "As pace and severity of human H5N1 cases accelerate, NIH leaders call for more action on bird flu | CNN CNN10 About CNN Most human cases of bird flu in North America have been mild, a fact that\u2019s underscored by a new study of the first 46 confirmed human H5N1 infections in the United States this year. She and co-author Dr. Michael Ison, who is chief of the Respiratory Diseases Branch at NIAID, call for better cooperation between human and animal disease investigators, complete reporting of data from animal infections so scientists can better track how the virus is spreading, development of countermeasures like vaccines and antiviral medication, and more precautions to prevent infection, such as increased use of recommended personal protective equipment and education about the risks of being around sick animals. CNN10 About CNN",
+ "published_date": "2024-12-31T22:12:00+00:00",
+ "file_type": null,
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+ ],
+ "extraction_priority": 8,
+ "extraction_mode": "html",
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+ "source_id": null,
+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "a4e5988661f244a18ec5ca0a116df8af",
+ "question_id": "q1",
+ "url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "canonical_url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "domain": "amp.cnn.com",
+ "title": "United States\u2019 first severe case of bird flu confirmed in Louisiana - CNN",
+ "snippet": "America\u2019s first severe case of bird flu confirmed in Louisiana | CNN CNN10 CNN 5 Things About CNN There have been 61 reported human cases of H5 bird flu in the United States since April. A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States. \u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the CDC said in a statement. There have been 61 reported human cases of H5 bird flu in the United States since April, mostly among dairy and poultry workers.",
+ "published_date": "2024-12-18T16:26:00+00:00",
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+ "extraction_priority": 9,
+ "extraction_mode": "html",
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+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ }
+]
\ No newline at end of file
diff --git a/data/runs_ab_no_history/q1/traj_20250220/forecast.json b/data/runs_ab_no_history/q1/traj_20250220/forecast.json
new file mode 100644
index 0000000..12a53fe
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250220/forecast.json
@@ -0,0 +1,153 @@
+{
+ "question_id": "q1",
+ "options": [
+ "70-100",
+ "100-150",
+ "150-200",
+ "200+"
+ ],
+ "distributions": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "probabilities": {
+ "70-100": 0.9781017233253921,
+ "100-150": 0.020290419640909687,
+ "150-200": 0.0012341043083096267,
+ "200+": 0.0003737527253887142
+ }
+ }
+ ],
+ "records": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "70-100",
+ "probability": 0.9781017233253921,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "100-150",
+ "probability": 0.020290419640909687,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "150-200",
+ "probability": 0.0012341043083096267,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "200+",
+ "probability": 0.0003737527253887142,
+ "forecast_version": null
+ }
+ ],
+ "samples": [
+ {
+ "probabilities": [
+ 0.9,
+ 0.08,
+ 0.01,
+ 0.01
+ ],
+ "ok": true,
+ "reference_class": "Past H5N1 outbreaks in the US and globally",
+ "base_rate": 0.05,
+ "drivers_up": [
+ "The US has reported 67 cumulative cases since 2022, indicating some level of transmission.",
+ "Recent reports indicate new cases are still being detected."
+ ],
+ "drivers_down": [
+ "The cumulative number of cases is still relatively low, at 67 cases since 2022, suggesting limited spread.",
+ "No evidence of large-scale outbreaks or exponential growth in case numbers.",
+ "Most cases are linked to commercial agriculture, which might be easier to contain."
+ ],
+ "why_might_be_wrong": "There might be under-reporting or delays in reporting new cases, especially close to the target date.",
+ "rationale": "The base rate for H5N1 transmission to humans is low, given historical data and current case numbers. Despite the recent cases in the US, the evidence does not indicate a rapid increase or large-scale outbreak. Most cases are tied to commercial agriculture, suggesting containment efforts may limit further spread. Given the current case count of 67 and the lack of evidence for accelerating transmission, it's reasonable to predict that the count will remain below 100 by February 28, 2025.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 42
+ },
+ {
+ "probabilities": [
+ 0.7,
+ 0.2,
+ 0.08,
+ 0.02
+ ],
+ "ok": true,
+ "reference_class": "H5N1 outbreaks in the US",
+ "base_rate": 0.1,
+ "drivers_up": [
+ "Recent increase in cases, with 67 confirmed cases since 2022",
+ "High concentration of cases in states like California, indicating potential for further spread"
+ ],
+ "drivers_down": [
+ "The historically low number of human cases of H5N1 globally since 2003",
+ "Limited human-to-human transmission observed, with most cases linked to agriculture"
+ ],
+ "why_might_be_wrong": "The forecast could be off due to potential underreporting or sudden changes in transmission dynamics.",
+ "rationale": "The base rate of H5N1 cases has been low historically. However, there has been a notable increase recently, with 67 cases reported in the US since 2022. The clustering of cases in specific states suggests some potential for further spread. Still, the lack of widespread human-to-human transmission and the linkage of many cases to agriculture suggest that an exponential increase is unlikely. Given the current case count of 67 and the limited time until the target date, the probability of reaching over 70 cases is moderate, but exceeding 100 cases seems unlikely.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 43
+ },
+ {
+ "probabilities": [
+ 0.85,
+ 0.1,
+ 0.03,
+ 0.02
+ ],
+ "ok": true,
+ "reference_class": "H5N1 outbreaks in the US",
+ "base_rate": 0.1,
+ "drivers_up": [
+ "Recent increase in confirmed cases from December 2024 indicates ongoing transmission.",
+ "High concentration of cases in California suggests potential for localized outbreaks."
+ ],
+ "drivers_down": [
+ "No evidence of widespread community transmission in the US.",
+ "Most cases linked to commercial agriculture, where mitigation measures can be applied."
+ ],
+ "why_might_be_wrong": "Unexpected outbreaks or changes in the virus's transmissibility could lead to a higher case count than forecasted.",
+ "rationale": "As of January 2025, the cumulative number of confirmed H5N1 cases in the US is 9. The recent trend shows a significant rise from earlier months, suggesting the possibility of more cases. However, the base rate of H5N1 cases historically remains low in the US. Given the current evidence and typical patterns of H5N1 outbreaks, the probability of reaching above 100 cases by late February 2025 is low. Therefore, the most likely outcome is the 70-100 range.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 44
+ }
+ ],
+ "baseline_rationale": null,
+ "evidence_record_ids": [
+ "ins-febdb43b6415",
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+ "ins-e46c87abcc12",
+ "ins-6a03580ff1d4",
+ "ins-6d15fa32c492",
+ "ins-5719fdb51002",
+ "ins-b91740d5241b",
+ "ins-d71f805fc1b3",
+ "ins-6a03a30ebbef",
+ "ins-0603684c784c"
+ ],
+ "budget_summary": {
+ "total_input_tokens": 5994,
+ "total_output_tokens": 737,
+ "total_tokens": 6731,
+ "per_model": {
+ "gpt-4o-2024-08-06": {
+ "input_tokens": 5994,
+ "output_tokens": 737,
+ "calls": 3
+ }
+ }
+ },
+ "notes": []
+}
\ No newline at end of file
diff --git a/data/runs_ab_no_history/q1/traj_20250220/insight.json b/data/runs_ab_no_history/q1/traj_20250220/insight.json
new file mode 100644
index 0000000..364e1e2
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250220/insight.json
@@ -0,0 +1,445 @@
+{
+ "records": [
+ {
+ "id": "ins-0603684c784c",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 67.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": null,
+ "event_date_precision": null,
+ "summary": "Total confirmed cases of A(H5) virus in the US since 2022.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:43:49.000306+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-ca39d86abd714a8b87e57f67704ae75a",
+ "chunk_id": "doc-ca39d86abd714a8b87e57f67704ae75a-c3",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "To date, 67 people have tested positive for A(H5) virus in the United States since 2022"
+ }
+ ]
+ },
+ {
+ "id": "ins-b91740d5241b",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 66.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed H5N1 cases in the US since 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:43:53.002178+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-adab909dde1f4b70bdc1ce79da0b0b2e",
+ "chunk_id": "doc-adab909dde1f4b70bdc1ce79da0b0b2e-c0",
+ "source_url": "https://www.bbc.com/news/articles/cqx85y07jz9o",
+ "quote": "There have been 66 confirmed cases of H5N1 bird flu in the US since 2024"
+ },
+ {
+ "document_id": "doc-20ed0309167f4011ab343c6293c859ea",
+ "chunk_id": "doc-20ed0309167f4011ab343c6293c859ea-c0",
+ "source_url": "https://edition.cnn.com/2024/12/31/health/human-h5n1-bird-flu-cases/index.html",
+ "quote": "the CDC says there have been 66 confirmed cases in the US this year"
+ }
+ ]
+ },
+ {
+ "id": "ins-ae60784a837e",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 34.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human infections in the U.S. for the year, with a significant number in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:43:55.566145+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-5cd3a0baec254366ad4006888d6ea4f3",
+ "chunk_id": "doc-5cd3a0baec254366ad4006888d6ea4f3-c2",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California"
+ }
+ ]
+ },
+ {
+ "id": "ins-6a03580ff1d4",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.5,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
+ "count_basis": "unknown",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "first known case of infection in the U.S. to have links to sick and dead birds in backyard flocks",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:43:56.393499+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-5cd3a0baec254366ad4006888d6ea4f3",
+ "chunk_id": "doc-5cd3a0baec254366ad4006888d6ea4f3-c1",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "the first known case of infection in the U.S. to have those origins."
+ }
+ ]
+ },
+ {
+ "id": "ins-6d15fa32c492",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.5,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 60.0,
+ "metric_unit": "cases",
+ "count_basis": "unknown",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "includes 60 other cases linked to commercial agriculture",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:43:56.393568+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-5cd3a0baec254366ad4006888d6ea4f3",
+ "chunk_id": "doc-5cd3a0baec254366ad4006888d6ea4f3-c1",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the 60 other cases, 58 were linked to commercial agriculture"
+ }
+ ]
+ },
+ {
+ "id": "ins-d71f805fc1b3",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 61.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed human cases of bird flu in the US this year, with 34 in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:44:00.052844+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-a4e5988661f244a18ec5ca0a116df8af",
+ "chunk_id": "doc-a4e5988661f244a18ec5ca0a116df8af-c1",
+ "source_url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "quote": "Of the 61 confirmed human cases of bird flu in the US this year, 34 have been in California."
+ }
+ ]
+ },
+ {
+ "id": "ins-5719fdb51002",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-14T00:00:00",
+ "event_date_precision": "day",
+ "summary": "One laboratory-confirmed human case of infection with influenza A(H5) reported from Louisiana.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:43:51.177209+00:00",
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+ "snippet": "International avian flu developments In global developments: Related news Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow H5 influenza wastewater dashboard launches Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho Study confirms infection in mice fed H5N1-contaminated raw milk USDA expands support for H5N1 response to more dairy producers Michigan reports H5 avian flu in dairy farm worker This week's top reads Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow Minnesota and Iowa report infected dairy herds. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation Study shows 'not surprising' fatal spread of avian flu in ferrets Vital Hil/iStock Late last week the Centers for Disease Control and Prevention (CDC) published a study showing that the current strain of H5N1 (A/Texas/37/2024) avian flu was fatal in six ferrets used as part of an experimental infection study. Household spread in pet ferrets In related news, a study out of Poland described the first documented cases of natural H5N1 cases in five pet ferrets, which occurred at the same time the country saw an uptick of H5 cases in cats in 2023. \" In Iowa, which confirmed high-path avian flu in dairy cattle last week, officials from the Iowa Department of Agriculture and Land Stewardship are requesting resources from the USDA and announcing additional response measures, including providing compensation for culled dairy cattle at a fair market value and compensation for lost milk production at a minimum of 90% of fair market value. ",
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+ "snippet": "Severe case of H5N1 bird flu detected in US, CDC confirms | Fox News Fox News FOX News Go Fox News The U.S. Centers for Disease Control and Prevention said on Wednesday that a patient has been hospitalized with a severe case of H5N1 infection in Louisiana, marking the first known instance of a severe human illness linked to the bird flu virus in the United States. The CDC said that partial viral genome data from the infected patient shows that the virus belongs to the D1.1 genotype, recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. Fox News Health FOX News Go Fox News",
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+ "snippet": "California egg prices jump 70% due to bird flu outbreaks A sign posted in store coolers at Whole Foods on Ocean Avenue in San Francisco reads, \u201cFor now, we\u2019re limiting purchases to 3 cartons per customer.\u201d Egg prices have spiked 70% amid a nationwide dairy shortage spurred by the outbreak of H5N1 avian flu, commonly known as bird flu. The price hike, highlighted in the U.S. Department of Agriculture\u2019s December egg markets report, owes largely to a series of highly pathogenic avian influenza outbreaks that have decimated the state\u2019s poultry flocks. With the U.S. egg-laying flock expected to dip below 300 million hens \u2014 its lowest point since the 2022 bird flu crisis \u2014 the nation\u2019s egg production is unlikely to return to normal levels until mid-2025, assuming no additional outbreaks occur.",
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+ "snippet": "Footer Links My Account Connect with CBC Contact CBC Audience Relations, CBC P.O. Box 500 Station A Toronto, ON Canada, M5W 1E6 Toll-free (Canada only): 1-866-306-4636 About CBC Services Accessibility \" Corrections ABOUT THE AUTHOR Senior Health & Medical Reporter Lauren Pelley covers health and medical science for CBC News, including the global spread of infectious diseases, Canadian health policy, pandemic preparedness, and the crucial intersection between human health and climate change. Lawrence Goodridge, director of the Canadian Research Institute for Food Safety and a professor at the University of Guelph, said his team started tracking influenza in Ontario wastewater a few months ago to study trends in human infections, and are now pivoting to see if any H5N1 shows up. With cases confirmed in dozens of herds across nine states \u2014 and roughly 300 people being tested or monitored for symptoms after the detection of one human case \u2014 the U.S. Centers for Disease Control and Prevention (CDC) is aiming to launch an online dashboard for wastewater monitoring as soon as Friday. At a handful of sites, the agency has already spotted spikes of influenza A, of which H5N1 is a subtype, and is investigating the source, the CDC's wastewater team lead Amy Kirby told Reuters. ",
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+ "title": "NMPF annual meeting spotlights dairy vigilance on H5N1, advances on milk pricing - Feedstuffs",
+ "snippet": "NMPF annual meeting spotlights dairy vigilance on H5N1, advances on milk pricing NMPF annual meeting spotlights dairy vigilance on H5N1, advances on milk pricing U.S. dairy farmers are remaining resilient in the face of H5N1 influenza outbreaks while advancing in policy areas including nutrition and milk pricing, said NMPF Chairman Randy Mooney at the organization\u2019s annual meeting held in Phoenix Oct. 21-23. Underpinning the entire industry is USDA\u2019s plan for Federal Milk Marketing Order modernization, which is likely to resemble a proposal released in July that incorporated key NMPF principles and would be voted on by dairy farmers early next year. \u201cDairy farmers and their cooperatives have developed and embraced a robust biosecurity program through the National Dairy FARM Program,\u201d NMPF\u2019s Emily Yeiser Stepp said.",
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+ "title": "H5N1 bird flu is mutating fast and jumping to mammals - could the next pandemic be here? - News-Medical.Net",
+ "snippet": "Such rapid viral transmission started after the emergence of a new genotype of H5N1 viruses belonging to clade 2.3.4.4b, which infected wild birds from Europe to Africa, North America, South America, and the Antarctic. The article provides information on the acquisition of key adaptive mutations that enabled 2.3.4.4b H5N1 viruses to sustain mammal-to-mammal transmission. The authors have collected this information from three real-world settings: the 2022-2023 H5N1 outbreaks on European fur farms, the 2023 South American marine mammal-adapted virus, and the 2024 US dairy cattle outbreak. Genetic sequencing of H5N1 viruses from South American marine mammals identified the same known mammalian adaptations (PB2 D701N and Q591K) and other distinctive mutations absent in birds, supporting mammal-to-mammal transmission. Retrieved on September 25, 2024 from https://www.news-medical.net/news/20240925/H5N1-bird-flu-is-mutating-fast-and-jumping-to-mammals-could-the-next-pandemic-be-here.aspx. . https://www.news-medical.net/news/20240925/H5N1-bird-flu-is-mutating-fast-and-jumping-to-mammals-could-the-next-pandemic-be-here.aspx. News-Medical, viewed 25 September 2024, https://www.news-medical.net/news/20240925/H5N1-bird-flu-is-mutating-fast-and-jumping-to-mammals-could-the-next-pandemic-be-here.aspx.",
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+ "title": "WHO Influenza at the human-animal interface (monthly risk assessment)",
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+ "text": "\u2022\nNew human cases 1 2 : From 13 December 2024 to 20 January 2025, the detection of influenza\nA(H5) virus in five humans, influenza A(H9N2) virus in two humans, and influenza A(H10N3) virus\nin one human were reported officially. Additionally, five human cases of infection with influenza\nA(H5) viruses were detected.\n\u2022\nCirculation of influenza viruses with zoonotic potential in animals: High pathogenicity avian\ninfluenza (HPAI) events in poultry and non-poultry continue to be reported to the World\nOrganisation for Animal Health (WOAH). 3 The Food and Agriculture Organization of the United\nNations (FAO) also provides a global update on avian influenza viruses with pandemic potential. 4\n\u2022\nRisk assessment 5 : Based on information available at the time of the risk assessment, the overall\npublic health risk from currently known influenza viruses at the human-animal interface has not\nchanged remains low. Sustained human to human transmission has not been reported from\nthese events and the occurrence of sustained human-to-human transmission of these viruses is\ncurrently considered unlikely. Although human infections with viruses of animal origin are\ninfrequent, they are not unexpected at the human-animal interface.\n\u2022\nIHR compliance: All human infections caused by a new influenza subtype are required to be\nreported under the International Health Regulations (IHR, 2005). 6 This includes any influenza A\nvirus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or\nprotein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human\npopulation. Information from these notifications is critical to inform risk assessments for\ninfluenza at the human-animal interface.\nAvian influenza viruses in humans\nCurrent situation:\nSince the last risk assessment of 12 December 2024, influenza A(H5) virus has been detected in nine\nhumans in the United States of America (USA) and one laboratory-confirmed human case of A(H5N1)\ninfection was reported to WHO from Cambodia.\n1 This summary and assessment covers information confirmed during this period and may include information\nreceived outside of this period.\n2 For epidemiological and virological features of human infections with animal influenza viruses not reported in\nthis assessment, see the reports on human cases of influenza at the human-animal interface published in the\nWeekly Epidemiological Record here .\n3 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n4 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .\n5 World Health Organization (2012). Rapid risk assessment of acute public health events. World Health\nOrganization. Available at: https://iris.who.int/handle/10665/70810 .\n6 World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all\ncircumstances under the International Health Regulations (2005). Case definitions for the four diseases\nrequiring notification in all circumstances under the International Health Regulations (2005).",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "2\nA(H5), USA\nOn 14 December 2024, the USA notified WHO of one laboratory-confirmed human case of infection\nwith influenza A(H5) in an adult aged over 65 years from the state of Louisiana. The patient, with\nunderlying conditions, developed symptoms and sought care at an emergency department in early\nDecember 2024. Due to worsening symptoms, the patient returned to the emergency department a\nfew days later, was hospitalized in critical condition with pneumonia, and started on antiviral\ntreatment. Unfortunately, the patient passed away. No household contacts of the case tested\npositive for influenza viruses. The individual owned backyard poultry and had noted deaths in\ndomestic and wild birds on the property prior to symptom onset. A(H5N1) viruses were detected in\npoultry on the property.\nThe viruses identified in two clinical samples from the patent were identified as influenza A(H5N1)\nviruses belonging to the clade 2.3.4.4b and the genotype D1.1. Deep sequencing of the genetic\nsequences from the two clinical specimens were compared to A(H5N1) virus sequences from dairy\ncows, wild birds, poultry and other human cases in the USA and Canada. The hemagglutinin (HA)\ngene sequences of the viruses from the clinical specimens are closely related to other D1.1 viruses\nrecently detected in wild birds and poultry in the Louisiana and other parts of the USA and in recent\nhuman cases detected in Canada and the USA, as well as to existing influenza A(H5N1) candidate\nvaccine viruses. 7\nSome changes in the HA gene segment of one of the clinical specimens from the patient were\ndetected at a low frequency. These changes have rarely been identified in specimens from previous\nhuman infections with A(H5N1) viruses and were not detected in specimens from the poultry on the\nproperty of the patient. It is possible that these changes arise during viral replication in the infected\nhuman cases. No changes in the polymerase genes associated with adaptation to mammals were\nidentified. No changes associated with known or suspected markers of reduced susceptibility to\nantiviral drugs were identified. 8 , 9 , 10\nBetween 20 and 21 December 2024, the USA notified WHO of two additional laboratory-confirmed\nhuman case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin. The\ncases developed symptoms in December 2024 and reported their illness to public health officials as\npart of active monitoring. The cases were not hospitalized and have recovered. Both cases were\nexposed to influenza A(H5N1) while working at poultry facilities.\nOn 15 January 2025, the USA notified WHO of one additional laboratory-confirmed human case of\ninfection with influenza A(H5) from the state of California. The case occurred in a child less than 18\nyears old with no known contact with influenza A(H5N1) virus-infected animals or humans. The\ninvestigation into the source of infection and contact monitoring around this case was ongoing at\nthe time of reporting, and thus far, no human-to-human transmission has been identified. Additional\n7 WHO. Zoonotic influenza: candidate vaccine viruses and potency testing reagents. Available at:\nhttps://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations/zoonotic-\ninfluenza-viruses-and-candidate-vaccine-viruses .\n8 US CDC. CDC Confirms First Severe Case of H5N1 Bird Flu in the United States, 18 Dec 2024. Available at:\nhttps://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html .\n9 US CDC. Genetic Sequences of Highly Pathogenic Avian Influenza A(H5N1) Viruses Identified in a Person in\nLouisiana, 26 Dec 2024. Available at: https://www.cdc.gov/bird-flu/spotlights/h5n1-response-12232024.html .\n10 US CDC. First H5 Bird Flu Death Reported in United States, 6 Jan 2025. Available at:\nhttps://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html .",
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+ "text": "3\nanalysis including genetic sequencing of the virus from the specimen from this case was underway at\nthe time of reporting. 11\nFive additional cases of influenza A(H5) were detected in California in individuals aged over 18 years\nwho worked at commercial dairy cattle farms in areas where highly pathogenic avian influenza\n(HPAI)(H5N1) viruses had been detected in cows. The individuals had mild symptoms. 12 , 13\nLow pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds\nin the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and\nbackyard flocks in 48 states, impacting over 100 million birds. To date, 67 people have tested\npositive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in\n2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy\ncattle, except for two cases where the exposure source could not be identified. 14 To date, no human-\nto-human transmission of influenza A(H5) virus has been identified in the USA. A(H5N1) virus\ninfections in dairy cattle and wild and domestic birds continue to be reported in the USA. 15\nA(H5N1), Cambodia\nOn 10 January 2025, Cambodia notified WHO of one case of human infection with influenza A(H5N1)\nin a 28-year-old male from Kampong Cham Province. The case had onset of fever, sore throat and\nchest pain on 1 January 2025. He sought care at two private local clinics and after his condition did\nnot improve, he traveled to Phnom Penh and was hospitalized due to shortness of breath on 7\nJanuary at a national hospital, which is a severe acute respiratory infection (SARI) sentinel site. The\ncase was isolated upon admission and provided oseltamivir and symptomatic treatment before\npassing away on 10 January. Nasopharyngeal (NP) and oropharyngeal (OP) swab specimens tested\npositive on 9 January for influenza A(H5N1) by real-time reverse transcription-polymerase chain\nreaction (rt-PCR) at the National Institute of Public Health of Cambodia. The Institut Pasteur du\nCambodge (IPC) confirmed the results on 10 January. Sequence analysis of HA gene shows the virus\nbelongs to clade 2.3.2.1c and is closely related to those viruses circulating among birds in Cambodia\nin 2024. Phylogenetic and molecular analysis is ongoing.\nAccording to the early investigation, the case was a guard of a farm in the village where he lived and\nraised poultry for family consumption. There were reports of sick poultry in his farm and samples\nfrom the poultry on the farm have been collected. No further cases were detected among the\ncontacts of the case.\nAccording to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in\nwild and domestic birds in the Americas, Asia and Europe. Infections in non-human mammals are\n11 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 2, ending January 11, 2025.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2025-week-02.html.\n12 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 50, ending December 14, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-50.html .\n13 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 51, ending December 21, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-51.html .\n14 United States Centers for Disease Control and Prevention. H5 Bird Flu: Current Situation. Available at:\nhttps://www.cdc.gov/bird-flu/situation-\nsummary/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbird-flu%2Fphp%2Favian-flu-\nsummary%2Findex.html .\n15 United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock,\n19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-\ndetections/livestock .",
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+ "text": "4\nalso reported, including in marine and land mammals. 16 A list of bird and mammalian species\naffected by HPAI A(H5) viruses is maintained by FAO. 17\nRisk Assessment for avian influenza A(H5) viruses:\n1. What is the current global public health risk of additional human cases of infection with avian\ninfluenza A(H5) viruses?\nMost human cases so far have been infections in people exposed to A(H5) viruses, for example,\nthrough contact with infected poultry or contaminated environments, including live poultry markets,\nand occasionally infected mammals and contaminated environments. While the viruses continue to\nbe detected in animals and related environments humans are exposed to, further human cases\nassociated with such exposures are expected but unusual. The impact for public health if additional\ncases are detected is minimal. The current overall global public health risk of additional human cases\nis low.\n2. What is the likelihood of sustained human-to-human transmission of currently circulating avian\ninfluenza A(H5) viruses?\nNo sustained human-to-human transmission has been identified associated with the recent reported\nhuman infections with avian influenza A(H5). There has been no reported human-to-human\ntransmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007\nand the years prior, small clusters of A(H5) virus infections in humans were reported, including some\ninvolving health care workers, where limited human-to-human transmission could not be excluded;\nhowever, sustained human-to-human transmission was not reported.\nAvailable evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to\nefficiently transmit between people, therefore the likelihood of sustained human-to-human\ntransmission is thus currently considered unlikely at this time.\n3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community-\nlevel spread is considered unlikely as current evidence suggests these viruses have not acquired the\nability to transmit easily among humans.\nA(H9N2), China\nSince the last risk assessment of 12 December 2024, two human cases of infection with A(H9N2)\ninfluenza viruses were notified to WHO from China (Table 1). Both cases were detected through\ninfluenza-like illness (ILI) surveillance, were mild and have recovered. Both cases had a history of\nexposure to live poultry markets prior the onset of symptoms. No further cases were detected\namong contacts of the cases. Influenza A(H9) virus was detected in the poultry-related environments\nassociated with these cases.\n16 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n17 Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential/bird-species-affected-by-h5nx-hpai/en .",
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+ "text": "Onset date\tReporting province\tAge (years)\tGender\tHospitalization date\n27 Nov 2024\tHubei\t8\tFemale\tNot hospitalized\n13 Dec 2024\tChongqing\t1\tFemale\t14 Dec 2024",
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+ "text": "5",
+ "chunk_type": "prose",
+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "Onset date\nReporting province\nAge (years)\nGender\nHospitalization date\n27 Nov 2024\nHubei\n8\nFemale\nNot hospitalized\n13 Dec 2024\nChongqing\n1\nFemale\n14 Dec 2024\nRisk Assessment for avian influenza A(H9N2):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H9N2) viruses?\nMost human cases follow exposure to the A(H9N2) virus through contact with infected poultry or\ncontaminated environments. Most human infections of A(H9N2) to date have resulted in mild\nclinical illness in most cases. Nearly 130 human infections with A(H9N2) cases have been reported to\ndate since 2003, and six of these have been severe or fatal and three of these were known to have\nunderlying medical conditions. Since the virus is endemic in poultry in multiple continues in Africa\nand Asia 18 , further human cases associated with exposure to infected poultry are expected but\nremain unusual. The impact to public health if additional cases are detected is minimal. The overall\nglobal public health risk of additional human cases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H9N2)\nviruses?\nAt the present time, no sustained human-to-human transmission has been identified associated with\nthe event described above. Current evidence suggests that influenza A(H9N2) viruses from these\ncases have not acquired the ability of sustained transmission among humans, therefore sustained\nhuman-to-human transmission is thus currently considered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely as current evidence suggests the A(H9N2) virus subtype has not\nacquired the ability to transmit easily among humans.\nA(H10N3), China\nSince the last risk assessment of 12 December 2024, one human case of infection with A(H10N3)\ninfluenza viruses were notified to WHO from China on 3 January 2025. A 23-year-old female from\nGuangxi Zhuang Autonomous Region, with an underlying condition, had symptom onset on 12\nDecember 2024. She was admitted to hospital on 19 December with severe pneumonia and treated\nwith oseltamivir. Initially, she was in critical condition but has improved. A clinical sample collected\non 22 December tested positive for influenza A and influenza A(H10N3) was confirmed a on 26\nDecember. Prior to symptom onset, the patient worked at a supermarket and was exposed to freshly\nslaughtered poultry. No family members have developed symptoms at the time of reporting. All\nclose contacts tested negative for influenza A(H10N3). All environmental samples collected from\nvarious locations tested negative for influenza A(H10N3).\nThis is the fourth case of human A(H10N3) virus infection detected in China and globally to date.\n18 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .",
+ "chunk_type": "prose",
+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "6\nRisk Assessment for avian influenza A(H10N3):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H10N3) viruses?\nHuman infections with avian influenza A(H10) viruses have been detected and reported previously.\nThe extent of circulation and epidemiology of these viruses in birds is unclear. Avian influenza\nA(H10N3) viruses with different genetic characteristics have been detected previously in migratory\nand other wild birds since the 1970s. As long as the virus continues to circulate in birds, further\nhuman cases can be expected but remain unusual. The impact to public health if additional sporadic\ncases are detected is minimal. The overall global public health risk of additional sporadic human\ncases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H10N3)\nviruses?\nNo sustained human-to-human transmission has been identified associated with the event described\nAbove or past events with human cases of influenza A(H10N3) viruses. Current epidemiologic and\nvirologic evidence suggests that contemporary influenza A(H10N3) viruses assessed by the Global\nInfluenza Surveillance and response System (GISRS) have not acquired the ability of sustained\ntransmission among humans, therefore sustained human-to-human transmission is thus currently\nconsidered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H10N3) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely based on current limited evidence.\nOverall risk management recommendations:\nSurveillance and investigations\n\u2022\nDue to the constantly evolving nature of influenza viruses, WHO continues to stress the\nimportance of global strategic surveillance in animals and humans to detect virologic,\nepidemiologic and clinical changes associated with circulating influenza viruses that may affect\nhuman (or animal) health. Continued vigilance is needed within affected and neighbouring areas\nto detect infections in animals and humans. Close collaboration with the animal health and\nenvironment sectors is essential to understand the extent of the risk of human exposure and to\nprevent and control the spread of animal influenza.\n\u2022\nAs the extent of influenza virus circulation in animals is not clear, epidemiologic and virologic\nsurveillance and the follow-up of suspected human cases should continue systematically.\nGuidance on investigation of non-seasonal influenza and other emerging acute respiratory\ndiseases has been published on the WHO website.\n\u2022\nCountries should increase avian influenza surveillance in domestic and wild birds, enhance\nsurveillance for early detection in cattle populations in countries where HPAI is known to be\ncirculating, include HPAI as a differential diagnosis in non-avian species, including cattle and\nother livestock populations, with high risk of exposure to HPAI viruses; monitor and investigate\ncases in non-avian species, including livestock, report cases of HPAI in all animal species,\nincluding unusual hosts, to WOAH and other international organizations, share genetic\nsequences of avian influenza viruses in publicly available databases, implement preventive and\nearly response measures to break the HPAI transmission cycle among animals through\nmovement restrictions of infected livestock holdings and strict biosecurity measures in all",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "7\nholdings, employ good production and hygiene practices when handing animal products, and\nprotect persons in contact with suspected/infected animals. 19\n\u2022\nWhen there has been human exposure to a known outbreak of an influenza A virus in domestic\npoultry, wild birds or other animals \u2013 or when there has been an identified human case of\ninfection with such a virus \u2013 enhanced surveillance in potentially exposed human populations\nbecomes necessary. Enhanced surveillance should consider the health care seeking behaviour of\nthe population, and could include a range of active and passive health care and/or community-\nbased approaches, including: enhanced surveillance in local influenza-like illness (ILI)/SARI\nsystems, active screening in hospitals and of groups that may be at higher occupational risk of\nexposure, and inclusion of other sources such as traditional healers, private practitioners and\nprivate diagnostic laboratories.\n\u2022\nVigilance for the emergence of novel influenza viruses of pandemic potential should be\nmaintained at all times including during a non-influenza emergency. In the context of the co-\ncirculation of SARS-CoV-2 and influenza viruses, WHO has updated and published practical\nguidance for integrated surveillance .\nNotifying WHO\n\u2022\nAll human infections caused by a new subtype of influenza virus are notifiable under the\nInternational Health Regulations (IHR, 2005). 20 State Parties to the IHR (2005) are required to\nimmediately notify WHO of any laboratory-confirmed 5 21 case of a recent human infection caused\nby an influenza A virus with the potential to cause a pandemic 6 22 . Evidence of illness is not\nrequired for this report.\n\u2022\nWHO published the case definition for human infections with avian influenza A(H5) virus\nrequiring notification under IHR (2005): https://www.who.int/teams/global-influenza-\nprogramme/avian-influenza/case-definitions .\nVirus sharing and risk assessment\n\u2022\nIt is critical that these influenza viruses from animals or from people are fully characterized in\nappropriate animal or human health influenza reference laboratories. Under WHO\u2019s Pandemic\nInfluenza Preparedness (PIP) Framework, Member States are expected to share influenza viruses\nwith pandemic potential on a timely basis 23 with a WHO Collaborating Centre for influenza of\nGISRS. The viruses are used by the public health laboratories to assess the risk of pandemic\ninfluenza and to develop candidate vaccine viruses.\n\u2022\nThe Tool for Influenza Pandemic Risk Assessment (TIPRA) provides an in-depth assessment of\nrisk associated with some zoonotic influenza viruses \u2013 notably the likelihood of the virus gaining\nhuman-to-human transmissibility, and the impact should the virus gain such transmissibility.\nTIPRA maps relative risk amongst viruses assessed using multiple elements. The results of TIPRA\ncomplement those of the risk assessment provided here, and those of prior TIPRA analyses will\nbe published at http://www.who.int/teams/global-influenza-programme/avian-influenza/tool-\nfor-influenza-pandemic-risk-assessment-(tipra) .\n19 World Organisation for Animal Health. Statement on High Pathogenicity Avian Influenza in Cattle, 6\nDecember 2024. Available at: https://www.woah.org/en/high-pathogenicity-avian-influenza-hpai-in-cattle/ .\n20 World Health Organization. Case definitions for the four diseases requiring notification in all\ncircumstances under the International Health Regulations (2005).\n21 World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza\n(2011). Available at: https://apps.who.int/iris/handle/10665/44518\n22 World Health Organization. Pandemic influenza preparedness framework for the sharing of influenza viruses\nand access to vaccines and other benefits, 2 nd edition. Available at: https://iris.who.int/handle/10665/341850\n23 World Health Organization. Operational guidance on sharing influenza viruses with human pandemic\npotential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework (2017). Available at:\nhttps://apps.who.int/iris/handle/10665/25940",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "8\nRisk reduction\n\u2022\nGiven the observed extent and frequency of avian influenza in poultry, wild birds and some wild\nand domestic mammals, the public should avoid contact with animals that are sick or dead from\nunknown causes, including wild animals, and should report dead birds and mammals or request\ntheir removal by contacting local wildlife or veterinary authorities.\n\u2022\nEggs, poultry meat and other poultry food products should be properly cooked and properly\nhandled during food preparation. Due to the potential health risks to consumers, raw milk\nshould be avoided. WHO advises consuming pasteurized milk. If pasteurized milk isn\u2019t available,\nheating raw milk until it boils makes it safer for consumption.\n\u2022\nWHO has published practical interim guidance to reduce the risk of infection in people exposed\nto avian influenza viruses.\nTrade and travellers\n\u2022\nWHO advises that travellers to countries with known outbreaks of animal influenza should avoid\nfarms, contact with animals in live animal markets, entering areas where animals may be\nslaughtered, or contact with any surfaces that appear to be contaminated with animal excreta.\nTravelers should also wash their hands often with soap and water. All individuals should follow\ngood food safety and hygiene practices.\n\u2022\nWHO does not advise special traveller screening at points of entry or restrictions with regards to\nthe current situation of influenza viruses at the human-animal interface. For recommendations\non safe trade in animals and related products from countries affected by these influenza viruses,\nrefer to WOAH guidance.\nLinks:\nWHO Human-Animal Interface web page\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza\nWHO Influenza (Avian and other zoonotic) fact sheet\nhttps://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)\nWHO Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nhttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.2\nWHO Public health resource pack for countries experiencing outbreaks of influenza in animals:\nhttps://www.who.int/publications/i/item/9789240076884\nCumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus\nAvian Influenza A(H7N9) Information\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-influenza-a-( h7n9 )-\nvirus\nWorld Organisation of Animal Health (WOAH) web page: Avian Influenza\nhttps://www.woah.org/en/home/\nFood and Agriculture Organization of the United Nations (FAO) webpage: Avian Influenza\nhttps://www.fao.org/animal-health/avian-flu-qa/en/\nOFFLU\nhttp://www.offlu.org/",
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+ "title": "Bird flu: First death from H5N1 strain reported in US",
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+ "text": "The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred.\nThe patient had been taken to hospital after contracting a major strain of bird flu, known as H5N1.\nLouisiana health department said they were over the age of 65, and had other underlying health conditions.\nIt said their public health investigation had not found evidence of person-to-person transmission, or any other cases.\nBird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. In very rare cases, it can also infect humans.\nThe state's health department added the person had contracted bird flu after being exposed to a personal flock of birds and wild birds.\n\"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,\" it said.\nThere have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC).",
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+ "text": "Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Bird migration has resulted in outbreaks of the avian flu in domestic and wild birds.\nThe H5N1 virus is the major strain circulating among wild birds worldwide, and emerged in China in the late 1990s.\nAlthough infection of humans is very rare, it occurs via transmission from birds.\nAlmost all cases of infection in people have been associated with close contact to infected dead or live birds, or contaminated environments.\nSince 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died.\nThere has been no sustained human-to-human transmission.\nLast month, the CDC said the Louisiana patient had been infected with the D1.1variant of the virus, which has recently been detected in North America.\nA 13-year-old girl in Canada was taken to hospital with the same D1.1 variant in November 2024, according to a paper published in The New England Journal of Medicine.\nIt is different to the B3.13 variant, which - during the past year - has been on the rise among cows in the US.\nIn September 2024, a person in Missouri recovered from bird flu after being treated in hospital.",
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+ "text": "According to the WHO, symptoms of a H5N1 infection include a cough, sore throat, fever (often over 38C), muscle aches and general feelings of malaise.\nPeople with the virus may also display other non-respiratory symptoms such as conjunctivitis.\nThe WHO added that H5N1 has also been detected in people without symptoms who had contact with infected animals or their environments.\nWhile the risk to humans is low, the constantly evolving virus is monitored for all changes, including the potential to become easily transmissible from person to person.",
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+ "title": "\u2018Severe\u2019 Bird Flu in the U.S.: Latest Updates",
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+ "text": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic.\nThe severe case involves a resident of southwestern Louisiana who was reported as presumptively positive for infection last Friday. The infected patient \u201cis experiencing severe respiratory illness related to H5N1 infection and is currently hospitalized in critical condition,\u201d according to Emma Herrock, a spokesperson for the Louisiana Department of Health, who said that the patient is over the age of 65 and has underlying medical conditions but that further updates on their condition will not be given at this time due to patient confidentiality.\nRead More: What Are the Symptoms of Bird Flu?\nIt is the 61st case of human H5N1 bird flu infection in the country since April this year. But the CDC said the overall risk of the pathogen to the public remains low, and no related deaths have been reported in the U.S. so far.\nHere\u2019s what to know.",
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+ "text": "The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins.\nOf the 60 other cases, 58 were linked to commercial agriculture\u201437 from dairy herds and 21 from poultry farms and culling. The sources of exposure for the two other U.S. human cases remain unknown.",
+ "chunk_type": "prose",
+ "heading": "What caused the severe infection?",
+ "page_number": null,
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+ "text": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California, with all but one exposed to cattle. In response, Governor Gavin Newsom on Dec. 18 declared a state of emergency.\nThe CDC said that such a \u201csevere\u201d infection as was found in Louisiana was expected given cases in other countries. In Vietnam, a patient who died in March after a diagnosis of \u201csevere pneumonia, severe sepsis, and acute respiratory distress syndrome\u201d was found with an H5N1 infection, according to the World Health Organization. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.\nRead More: The Bird Flu Virus Is One Mutation Away from Getting More Dangerous\nAccording to Mark Mulligan, Director of the Vaccine Center and the Division of Infectious Diseases and Immunology at New York University Grossman School of Medicine, the general population faces \u201cno immediate threat.\u201d Those who are in contact with birds and animals\u2014especially those who work on dairy farms and cattle farms\u2014are at greatest risk. Currently, no person to person spread of the virus has been detected.\n\u201cRight now we have to let the experts do surveillance, do sequencing of the virus to see if we're seeing any changes that portend any significant difference,\u201d says Mulligan.",
+ "chunk_type": "prose",
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+ "text": "According to the CDC, symptoms of the bird flu can vary. Many of the cases in the U.S. included symptoms resembling conjunctivitis-like eye issues, including eye redness, discomfort, and discharge.\nSome cases also included both respiratory classic flu-like symptoms, including cough, headache, runny nose, fever, sore throat, body aches, fatigue, shortness of breath, and pneumonia, according to the CDC.\nRead More: What Are the Symptoms of Bird Flu?",
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+ "text": "The CDC issued a number of protective measures, including largely avoiding direct contact with wild birds and other suspected infected animals as well as their bodily excretions. People who work with cattle and poultry on affected farms have a greater risk of infection, and are thus advised to monitor any possible symptoms of infection.\nThe CDC also recommends that those who work with poultry or other animals use the correct personal protective equipment (PPE)\u2014including coveralls, boots, and more\u2014which should be provided by employers.\nVirologist and professor at John Hopkins University Andy Pekosz says that the severe case in Louisiana provides a reminder of an easy way to stay safe: stay away from dead animals. \u201cYou see a dead animal, if you're exposed to dead animals, stay away,\u201d he says. \u201cIn many ways, it is the least likely way someone can get exposed, but in some ways, it's also one of the more preventable ways.\u201d\nProperly cooked poultry and poultry products are safe, and the CDC says that while unpasteurized (raw) milk from infected cows can pose risks to humans, it\u2019s not yet known if avian influenza viruses can be transmitted through its consumption.\nBoth Mulligan and Pekosz say it is also important to get the seasonal human influenza vaccine. They say if there were to be a case of a person with simultaneous bird flu and human flu infection, it could lead to a \u201creassortment\u201d and thus a virus that could be more easily spread.\n\u201cWe know that has happened before, because the 1957 influenza pandemic and the 1968 influenza pandemic both were a result of a human and a bird influenza virus exchanging genetic material,\u201d Pekosz says. \u201cWe know that the flu vaccines are not perfect, but they do a good job of reducing infection.\u201d\nThe CDC currently has a program to offer seasonal vaccines to farm workers in high risk scenarios in certain states.",
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+ "text": "\u2022 L.A. Fires Show Reality of 1.5\u00b0C of Warming\n\u2022 Behind the Scenes of The White Lotus Season Three\n\u2022 How Trump 2.0 Is Already Sowing Confusion\n\u2022 Bad Bunny On Heartbreak and New Album\n\u2022 How to Get Better at Doing Things Alone\n\u2022 We\u2019re Lucky to Have Been Alive in the Age of David Lynch\n\u2022 The Motivational Trick That Makes You Exercise Harder\n\u2022 Column: All Those Presidential Pardons Give Mercy a Bad Name\nContact us at letters@time.com",
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+ "heading": "What caused the severe infection? > More Must-Reads from TIME",
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+ "source_url": "https://www.latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
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+ "text": "\u2022 Share via\nThe fate of a Canadian teenager who was infected with H5N1 bird flu in early November, and subsequently admitted to an intensive care unit, has finally been revealed: She has fully recovered.\nBut genetic analysis of the virus that infected her body showed ominous mutations that researchers suggest potentially allowed it to target human cells more easily and cause severe disease \u2014 a development the study authors called \u201cworrisome.\u201d\nThe case was published Tuesday in a special edition of the New England Journal of Medicine that explored H5N1 cases from 2024 in North America. In one study, doctors and researchers who worked with the Canadian teenager published their findings. In the other, public health officials from across the U.S. \u2014 from the Centers for Disease Control and Prevention, as well as state and local health departments \u2014 chronicled the 46 human cases that occurred between March and October.\nThere have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024.\nIn the case of the 13-year-old Canadian child, the girl was admitted to a local emergency room on Nov. 4 having suffered from two days of conjunctivitis (pink eye) in both eyes and one day of fever. The child, who had a history of asthma, an elevated body-mass index and Class 2 obesity, was discharged that day with no treatment.\nOver the next three days, she developed a cough and diarrhea and began vomiting. She was taken back to the ER on Nov. 7 in respiratory distress and with a condition called hemodynamic instability, in which her body was unable to maintain consistent blood flow and pressure. She was admitted to the hospital.\nOn Nov. 8, she was transferred to a pediatric intensive care unit at another hospital with respiratory failure, pneumonia in her left lower lung, acute kidney injury, thrombocytopenia (low platelet numbers) and leukopenia (low white blood cell count).\nShe tested negative for the predominant human seasonal influenza viruses \u2014 but had a high viral loads of influenza A, which includes the major human seasonal flu viruses, as well as H5N1 bird flu. This finding prompted her caregivers to test for bird flu; she tested positive.\nAs the disease progressed over the next few days, she was intubated and put on extracorporeal membrane oxygenation (ECMO) \u2014 a life support technique that temporarily takes over the function of the heart and lungs for patients with severe heart or lung conditions.\nShe was also treated with three antiviral medications, including oseltamivir (brand name Tamiflu), amantadine (Gocovri) and baloxavir (Xofluza).\nBecause of concerns about the potential for a cytokine storm \u2014 a potentially lethal condition in which the body releases too many inflammatory molecules \u2014 she was put on a daily regimen of plasma exchange therapy, in which the patient\u2019s plasma is removed in exchange for donated, health plasma.\nAs the days went by, her viral load began to decrease; on Nov. 16, eight days after she\u2019d been admitted, she tested negative for the virus.\nThe authors of the report noted, however, that the viral load remained consistently higher in her lower lungs than in her upper respiratory tract \u2014 suggesting that the disease may manifest in places not currently tested for it (like the lower lungs) even as it disappears from those that are tested (like the mouth and nose).\nShe fully recovered and was discharged sometime after Nov. 28, when her intubation tube was removed.\nGenetic sequencing of the virus circulating in the teenager showed it was similar to the one circulating in wild birds, the D1.1 version. It\u2019s a type of H5N1 bird flu that is related, but distinct, from the type circulating in dairy cows and is responsible for the vast majority of human cases reported in the U.S. \u2014 most of which were acquired via dairy cows or commercial poultry. This is also the same version of the virus found in a Louisiana patient who experienced severe disease, and it showed a few mutations that researchers say increases the virus\u2019 ability to replicate in human cells.\nIn the Louisiana case, researchers from the CDC suggested the mutations arose as it replicated in the patient and were were not likely present in the wild.\nIrrespective of where and when they occurred, said Jennifer Nuzzo, director of the Pandemic Center at Brown University in Providence, R.I., \u201cit is worrisome because it indicates that the virus can change in a person and possibly cause a greater severity of symptoms than initial infection.\u201d\nIn addition, said Nuzzo \u2014 who was not involved in the research \u2014 while there\u2019s evidence these mutations occurred after the patients were infected, and therefore not circulating in the environment \u201cit increases worries that some people may experience more severe infection than other people. Bottom line is that this is not a good virus to get.\u201d",
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new file mode 100644
index 0000000..c6222b7
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+ "snippet": "Bird flu: First death from H5N1 strain reported in US First bird flu-related death reported in US The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred. Bird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. There have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC). What is bird flu? Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Since 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died. About the BBC",
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+ "snippet": "\u2018Severe\u2019 Bird Flu in the U.S.: Latest Updates | TIME TIME 2030 What to Know About Bird Flu in the U.S. After CDC Announces First \u2018Severe\u2019 Human Case What to Know About Bird Flu in the U.S. After CDC Announces First \u2018Severe\u2019 Human Case The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic. It is the 61st case of human H5N1 bird flu infection in the country since April this year. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.",
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+ "extraction_priority": 7,
+ "extraction_mode": "html",
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+ "source_id": null,
+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ },
+ {
+ "result_id": "ad0a8fe44ac74067bf72756185d98061",
+ "question_id": "q1",
+ "url": "https://www.latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
+ "canonical_url": "https://latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
+ "domain": "latimes.com",
+ "title": "\u2018Worrisome\u2019 mutations found in H5N1 bird flu virus isolated from Canadian teenager - Los Angeles Times",
+ "snippet": "'Worrisome' mutations found in H5N1 bird flu virus in Canadian teen - Los Angeles Times But genetic analysis of the virus that infected her body showed ominous mutations that researchers suggest potentially allowed it to target human cells more easily and cause severe disease \u2014 a development the study authors called \u201cworrisome.\u201d There have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024. She tested negative for the predominant human seasonal influenza viruses \u2014 but had a high viral loads of influenza A, which includes the major human seasonal flu viruses, as well as H5N1 bird flu. L.A. County health officials warn pet owners to avoid raw cat food after feline dies of bird flu",
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+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ }
+]
\ No newline at end of file
diff --git a/data/runs_ab_no_history/q1/traj_20250224/forecast.json b/data/runs_ab_no_history/q1/traj_20250224/forecast.json
new file mode 100644
index 0000000..5636578
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250224/forecast.json
@@ -0,0 +1,153 @@
+{
+ "question_id": "q1",
+ "options": [
+ "70-100",
+ "100-150",
+ "150-200",
+ "200+"
+ ],
+ "distributions": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "probabilities": {
+ "70-100": 0.9835928913625247,
+ "100-150": 0.012312603857545758,
+ "150-200": 0.0029955097501227815,
+ "200+": 0.0010989950298066595
+ }
+ }
+ ],
+ "records": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "70-100",
+ "probability": 0.9835928913625247,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "100-150",
+ "probability": 0.012312603857545758,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "150-200",
+ "probability": 0.0029955097501227815,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "200+",
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+ "forecast_version": null
+ }
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+ ],
+ "ok": true,
+ "reference_class": "H5N1 outbreaks in the US",
+ "base_rate": 0.1,
+ "drivers_up": [
+ "Recent increase in H5N1 cases in the US suggests higher transmission rate.",
+ "High concentration of cases in California, a populous state, which could lead to more cases if containment is not effective.",
+ "Historical global data shows H5N1 can have significant outbreaks."
+ ],
+ "drivers_down": [
+ "Currently only 9 confirmed cases in January 2025, which is far from the lower threshold of 70 for the options given.",
+ "Previous cases have been linked to specific agricultural settings rather than widespread community transmission, suggesting limited spread.",
+ "Global H5N1 cases historically have not resulted in large numbers in the US."
+ ],
+ "why_might_be_wrong": "There could be a sudden outbreak or misreporting that significantly increases the number of confirmed cases beyond current trends.",
+ "rationale": "As of January 2025, there are 9 confirmed cases of H5N1 in the US, with a history of sporadic cases rather than a large outbreak. The base rate for large outbreaks is low in the US, and while recent trends suggest an increase in cases, it is unlikely to reach the thresholds of 70+ cases given the current containment strategies and the nature of transmission being limited mostly to agricultural settings. However, unpredictability in viral transmission or reporting could lead to unexpected results.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 42
+ },
+ {
+ "probabilities": [
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+ 0.1,
+ 0.03,
+ 0.02
+ ],
+ "ok": true,
+ "reference_class": "Cumulative human H5N1 cases in the US in recent years",
+ "base_rate": 0.01,
+ "drivers_up": [
+ "Recent increase in confirmed cases from 61 to 67 within a short period suggests a rising trend.",
+ "High transmission potential due to connections with commercial agriculture."
+ ],
+ "drivers_down": [
+ "Only 9 new cases reported from January 15 to January 20, 2025, suggesting a slowdown.",
+ "Historical base rates of H5N1 in humans are generally low globally and in the US.",
+ "No evidence of a significant outbreak or change in virus transmissibility."
+ ],
+ "why_might_be_wrong": "A sudden outbreak or change in virus transmissibility could lead to a rapid increase in cases.",
+ "rationale": "The base rate of H5N1 cases in the US is low, with only 67 cases since 2022. Recent data show a slowing trend in reported cases, with only 9 new cases in January 2025. While there is a potential for increased transmission linked to commercial agriculture, the lack of a major outbreak and low historical incidence suggest that reaching any of the higher brackets is unlikely. Thus, the probability is weighted heavily towards the lower range of 70-100 cases.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 43
+ },
+ {
+ "probabilities": [
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+ 0.05,
+ 0.03,
+ 0.02
+ ],
+ "ok": true,
+ "reference_class": "Past H5N1 outbreaks in the United States",
+ "base_rate": 0.1,
+ "drivers_up": [
+ "Significant increase in cases from 2024 to early 2025, indicating potential for further growth.",
+ "Presence of H5N1 in multiple states suggesting wider spread."
+ ],
+ "drivers_down": [
+ "Current cumulative confirmed cases are only at 9, far from the lowest option threshold of 70.",
+ "H5N1 generally has low human-to-human transmission rates.",
+ "Previous cases in 2024 were largely linked to commercial agriculture, a specific source that can be controlled."
+ ],
+ "why_might_be_wrong": "The rate of new cases could accelerate unexpectedly due to changes in the virus's transmission dynamics or human behavior, leading to a larger outbreak than anticipated.",
+ "rationale": "The current cumulative number of confirmed cases is only 9, which is far below the threshold for the lowest option (70-100). While there has been a recent increase in cases, the total is still quite low, and H5N1 typically does not spread easily between humans. Additionally, many of the past cases were linked to specific agricultural exposure, suggesting that control measures could limit further spread. Given the low base rate and current numbers, the probability of reaching 70 cases by the target date is very low.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 44
+ }
+ ],
+ "baseline_rationale": null,
+ "evidence_record_ids": [
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+ "ins-52804af640ac",
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+ "ins-5623220d5ccb",
+ "ins-b726026b1cac",
+ "ins-5cf522e4c6ee",
+ "ins-b844d077e306",
+ "ins-76b4e3e66d49",
+ "ins-72990952deef"
+ ],
+ "budget_summary": {
+ "total_input_tokens": 5223,
+ "total_output_tokens": 837,
+ "total_tokens": 6060,
+ "per_model": {
+ "gpt-4o-2024-08-06": {
+ "input_tokens": 5223,
+ "output_tokens": 837,
+ "calls": 3
+ }
+ }
+ },
+ "notes": []
+}
\ No newline at end of file
diff --git a/data/runs_ab_no_history/q1/traj_20250224/insight.json b/data/runs_ab_no_history/q1/traj_20250224/insight.json
new file mode 100644
index 0000000..4c6ff56
--- /dev/null
+++ b/data/runs_ab_no_history/q1/traj_20250224/insight.json
@@ -0,0 +1,355 @@
+{
+ "records": [
+ {
+ "id": "ins-72990952deef",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 67.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": null,
+ "event_date_precision": null,
+ "summary": "Cumulative total of confirmed cases since 2022, with all but one occurring in 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:51:01.607665+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-08a9d1af007d4a9291e6f2dd1b49f4c8",
+ "chunk_id": "doc-08a9d1af007d4a9291e6f2dd1b49f4c8-c3",
+ "source_url": "https://web.archive.org/web/20250221235638id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "To date, 67 people have tested positive for A(H5) virus in the United States since 2022"
+ }
+ ]
+ },
+ {
+ "id": "ins-b844d077e306",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 66.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed H5N1 cases in the US since 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:51:05.839265+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-1a54af62de424fda94562938c4fc1b73",
+ "chunk_id": "doc-1a54af62de424fda94562938c4fc1b73-c0",
+ "source_url": "https://www.bbc.com/news/articles/cqx85y07jz9o",
+ "quote": "There have been 66 confirmed cases of H5N1 bird flu in the US since 2024"
+ },
+ {
+ "document_id": "doc-ad0a8fe44ac74067bf72756185d98061",
+ "chunk_id": "doc-ad0a8fe44ac74067bf72756185d98061-c0",
+ "source_url": "https://www.latimes.com/environment/story/2024-12-31/worrisome-mutations-found-in-h5n1-bird-flu-virus-isolated-from-canadian-teenager",
+ "quote": "There have been a total of 66 reported human cases of H5N1 bird flu in the U.S. in 2024."
+ }
+ ]
+ },
+ {
+ "id": "ins-79ad3241b13f",
+ "question_id": "q1",
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+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 34.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Confirmed human infections recorded in the U.S. this year, with 34 cases reported, mostly in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:51:07.905811+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-e4c0f772f7bb40fbb2cb232f0db01285",
+ "chunk_id": "doc-e4c0f772f7bb40fbb2cb232f0db01285-c2",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California"
+ }
+ ]
+ },
+ {
+ "id": "ins-5623220d5ccb",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.5,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
+ "count_basis": "unknown",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
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+ "snippet": "It\u2019s important to keep that experience in mind, he told STAT Monday, as the H5N1 bird flu virus now spreads among dairy cattle in the U.S. Farrar stressed that the social context is key in responding to disease threats like H5N1, noting that a similar reluctance among dairy farmers to report outbreaks or allow testing of their workers is adding to the challenges in assessing how much transmission is occurring and the risk it poses to people. Home Don't miss out Subscribe to STAT+ today, for the best life sciences journalism in the industry WHO\u2019s top scientist learned a hard lesson about H5N1 two decades ago: Stopping it takes more than biology By Helen Branswell May 7, 2024 Jeremy Farrar, now the World Health Organization\u2019s chief scientist, was working in Vietnam 20 years ago when the H5N1 virus started to spread across Asia \u2014 at that point in poultry. advertisement \u201cYou can\u2019t just take the virus and the biological surveillance and divorce it from the environment and the social construct that it\u2019s happening in,\u201d Farrar said in an interview from WHO headquarters in Geneva. Trending Recommended Recommended Stories STAT\u2019s Casey Ross and Bob Herman named 2024 Pulitzer Prize finalists STAT Plus: Endo Health ordered to pay more than $1.5 billion in opioid criminal case advertisement STAT Plus: Brain biopsies on \u2018vulnerable\u2019 patients at Mount Sinai set off alarm bells at FDA, documents show STAT Sign up for Morning Rounds Understand how science, health policy, and medicine shape the world every day While he believes the risk of a human flu pandemic triggered by the H5N1 virus is low, should it happen, the social context will also be crucial, Farrar continued.",
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+ "snippet": "In other H5N1 developments: Related news USDA reports more H5N1 detections in mice and cats Study shows 'not surprising' fatal spread of avian flu in ferrets Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow H5 influenza wastewater dashboard launches Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho Study confirms infection in mice fed H5N1-contaminated raw milk This week's top reads Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow Minnesota and Iowa report infected dairy herds. Yesterday, the Iowa Department of Agriculture and Land Stewardship reported the state's third outbreak in a dairy herd, which affected a second location in Sioux County. Updates on human investigations, vaccine production Responding to questions about Michigan's second case-patient in a dairy worker, who, unlike the other previous patients, had respiratory symptoms, Nirav Shah, JD, MD, principal deputy director for the Centers for Disease Control and Prevention (CDC), said the polymerase chain reaction cycle threshold\u00a0 (Ct) value for the patient's sample was high, suggesting a lower amount of viral RNA in the sample. Main navigation USDA reports reveal biosecurity risks at H5N1-affected dairy farms Naked King/iStock Shared equipment and shared personnel working on multiple dairy farms are some of the main risk factors for ongoing spread of highly pathogenic H5N1 avian flu in dairy cows, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said today in a pair of new epidemiologic reports. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. One of the reports is an overview based on the results of questionnaires from affected dairy herds, and the other is a deep dive into the dairy cow and poultry outbreaks in Michigan, the state hit hardest by outbreaks in dairy cows, which now number at least 94. ",
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+ "snippet": "May 30Another human case of bird flu has been detected in a dairy farm worker in Michigan\u2014though the cases aren\u2019t connected\u2014and this is the first person in the U.S. to report respiratory symptoms connected to bird flu, though their symptoms are \u201cresolving,\u201d according to the Centers for Disease Control and Prevention. Toddler Infected With Another Strain\u2014Second Human Case In India Topline Here\u2019s the latest news about a global outbreak of H5N1 bird flu that started in 2020, and recently spread among cattle in U.S. states and marine mammals across the world, which has health officials closely monitoring it and experts concerned the virus could mutate and eventually spread to humans, where it has proven rare but deadly. May 14The Centers for Disease Control and Prevention released influenza A waste water data for the weeks ending in April 27 and May 4, and found several states like Alaska, California, Florida, Illinois and Kansas had unusually high levels, though the agency isn\u2019t sure if the virus came from humans or animals, and isn\u2019t able to differentiate between influenza A subtypes, meaning the H5N1 virus or other subtypes may have been detected. May 1The Food and Drug Administration confirmed dairy products are still safe to consume, announcing it tested grocery store samples of products like infant formula, toddler milk, sour cream and cottage cheese, and no live traces of the bird flu virus were found, although some dead remnants were found in some of the food\u2014though none in the baby products. June 5A new study examining the 2023 bird flu outbreak in South America that killed around 17,400 elephant seal pups and 24,000 sea lions found the disease spread between the animals in several countries, the first known case of transnational virus mammal-to-mammal bird flu transmission. ",
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+ "snippet": "\u201cThe fact that you can go into a supermarket and 30% to 40% of those samples test positive, that suggests there\u2019s more of the virus around than is currently being recognized,\u201d said Richard Webby, an influenza virologist who has been analyzing the samples at St. Jude\u2019s Children\u2019s Research Hospital in Memphis, Tenn., where he heads the WHO Collaborating Center for Studies on the Ecology of Influenza in Animals. Trending Recommended Recommended Stories STAT Plus: Amid layoffs and a hit to earnings, Bristol\u2019s new CEO shares his vision for the future STAT Plus: Takeda is fourth big company to leave BIO since December advertisement STAT Plus: Taking stock of the frenzied push into autoimmune disease STAT Plus: Medicare official says breakthrough device reimbursement rule coming in early summer STAT \u201cBoth of these data \u2014 the milk data and the genetic data that shows this has been around since December of last year \u2014 suggests that the outbreak is probably much bigger than we know,\u201d said Angie Rasmussen, a virologist who studies emerging zoonotic pathogens at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada. Home Don't miss out Subscribe to STAT+ today, for the best life sciences journalism in the industry Early tests of H5N1 prevalence in milk suggest U.S. bird flu outbreak in cows is widespread By Megan Molteni April 25, 2024 Andrew Bowman, a veterinary epidemiologist at Ohio State University, had a hunch. Genetic testing found viral RNA in 58 samples, he told STAT. advertisement The researchers expect additional lab studies currently underway to show that those samples don\u2019t contain live virus with the capability to cause human infections, meaning that the risk of pasteurized milk to consumer health is still very low.",
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+ "snippet": "The first study on the H5N1 bird flu outbreak from the Centers for Disease Control and Prevention to make it to publication under the Trump administration came out Thursday. In the new study, researchers analyzed blood samples collected from 150 veterinarians who worked with cattle around the country and found that three of them had antibodies to the H5N1 virus, indicating recent infections. Tracking human infections in the dairy industry has been an ongoing challenge throughout the bird flu outbreak. Even though the new CDC research turned up a \"low\" number of past human infections,\" it's not actually clear \"how many participants were truly exposed,\" says Gray.",
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+ "snippet": "California egg prices jump 70% due to bird flu outbreaks A sign posted in store coolers at Whole Foods on Ocean Avenue in San Francisco reads, \u201cFor now, we\u2019re limiting purchases to 3 cartons per customer.\u201d Egg prices have spiked 70% amid a nationwide dairy shortage spurred by the outbreak of H5N1 avian flu, commonly known as bird flu. The price hike, highlighted in the U.S. Department of Agriculture\u2019s December egg markets report, owes largely to a series of highly pathogenic avian influenza outbreaks that have decimated the state\u2019s poultry flocks. With the U.S. egg-laying flock expected to dip below 300 million hens \u2014 its lowest point since the 2022 bird flu crisis \u2014 the nation\u2019s egg production is unlikely to return to normal levels until mid-2025, assuming no additional outbreaks occur.",
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+ "text": "This map is updated each weekday to depict the number of new confirmed cases in livestock in the last 30 days and the cumulative number of confirmed cases in livestock by State.\nFor information related to the National Milk Testing Strategy, visit Testing.\nUsers may need to refresh the page to see the latest map and table data. To refresh the page, hold down the SHIFT key and click the Reload Page button in the upper left corner of your browser. You can also use SHIFT+F5 on your keyboard.",
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+ "text": "\u2022\nNew human cases 1 2 : From 13 December 2024 to 20 January 2025, the detection of influenza\nA(H5) virus in five humans, influenza A(H9N2) virus in two humans, and influenza A(H10N3) virus\nin one human were reported officially. Additionally, five human cases of infection with influenza\nA(H5) viruses were detected.\n\u2022\nCirculation of influenza viruses with zoonotic potential in animals: High pathogenicity avian\ninfluenza (HPAI) events in poultry and non-poultry continue to be reported to the World\nOrganisation for Animal Health (WOAH). 3 The Food and Agriculture Organization of the United\nNations (FAO) also provides a global update on avian influenza viruses with pandemic potential. 4\n\u2022\nRisk assessment 5 : Based on information available at the time of the risk assessment, the overall\npublic health risk from currently known influenza viruses at the human-animal interface has not\nchanged remains low. Sustained human to human transmission has not been reported from\nthese events and the occurrence of sustained human-to-human transmission of these viruses is\ncurrently considered unlikely. Although human infections with viruses of animal origin are\ninfrequent, they are not unexpected at the human-animal interface.\n\u2022\nIHR compliance: All human infections caused by a new influenza subtype are required to be\nreported under the International Health Regulations (IHR, 2005). 6 This includes any influenza A\nvirus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or\nprotein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human\npopulation. Information from these notifications is critical to inform risk assessments for\ninfluenza at the human-animal interface.\nAvian influenza viruses in humans\nCurrent situation:\nSince the last risk assessment of 12 December 2024, influenza A(H5) virus has been detected in nine\nhumans in the United States of America (USA) and one laboratory-confirmed human case of A(H5N1)\ninfection was reported to WHO from Cambodia.\n1 This summary and assessment covers information confirmed during this period and may include information\nreceived outside of this period.\n2 For epidemiological and virological features of human infections with animal influenza viruses not reported in\nthis assessment, see the reports on human cases of influenza at the human-animal interface published in the\nWeekly Epidemiological Record here .\n3 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n4 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .\n5 World Health Organization (2012). Rapid risk assessment of acute public health events. World Health\nOrganization. Available at: https://iris.who.int/handle/10665/70810 .\n6 World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all\ncircumstances under the International Health Regulations (2005). Case definitions for the four diseases\nrequiring notification in all circumstances under the International Health Regulations (2005).",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "2\nA(H5), USA\nOn 14 December 2024, the USA notified WHO of one laboratory-confirmed human case of infection\nwith influenza A(H5) in an adult aged over 65 years from the state of Louisiana. The patient, with\nunderlying conditions, developed symptoms and sought care at an emergency department in early\nDecember 2024. Due to worsening symptoms, the patient returned to the emergency department a\nfew days later, was hospitalized in critical condition with pneumonia, and started on antiviral\ntreatment. Unfortunately, the patient passed away. No household contacts of the case tested\npositive for influenza viruses. The individual owned backyard poultry and had noted deaths in\ndomestic and wild birds on the property prior to symptom onset. A(H5N1) viruses were detected in\npoultry on the property.\nThe viruses identified in two clinical samples from the patent were identified as influenza A(H5N1)\nviruses belonging to the clade 2.3.4.4b and the genotype D1.1. Deep sequencing of the genetic\nsequences from the two clinical specimens were compared to A(H5N1) virus sequences from dairy\ncows, wild birds, poultry and other human cases in the USA and Canada. The hemagglutinin (HA)\ngene sequences of the viruses from the clinical specimens are closely related to other D1.1 viruses\nrecently detected in wild birds and poultry in the Louisiana and other parts of the USA and in recent\nhuman cases detected in Canada and the USA, as well as to existing influenza A(H5N1) candidate\nvaccine viruses. 7\nSome changes in the HA gene segment of one of the clinical specimens from the patient were\ndetected at a low frequency. These changes have rarely been identified in specimens from previous\nhuman infections with A(H5N1) viruses and were not detected in specimens from the poultry on the\nproperty of the patient. It is possible that these changes arise during viral replication in the infected\nhuman cases. No changes in the polymerase genes associated with adaptation to mammals were\nidentified. No changes associated with known or suspected markers of reduced susceptibility to\nantiviral drugs were identified. 8 , 9 , 10\nBetween 20 and 21 December 2024, the USA notified WHO of two additional laboratory-confirmed\nhuman case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin. The\ncases developed symptoms in December 2024 and reported their illness to public health officials as\npart of active monitoring. The cases were not hospitalized and have recovered. Both cases were\nexposed to influenza A(H5N1) while working at poultry facilities.\nOn 15 January 2025, the USA notified WHO of one additional laboratory-confirmed human case of\ninfection with influenza A(H5) from the state of California. The case occurred in a child less than 18\nyears old with no known contact with influenza A(H5N1) virus-infected animals or humans. The\ninvestigation into the source of infection and contact monitoring around this case was ongoing at\nthe time of reporting, and thus far, no human-to-human transmission has been identified. Additional\n7 WHO. Zoonotic influenza: candidate vaccine viruses and potency testing reagents. Available at:\nhttps://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations/zoonotic-\ninfluenza-viruses-and-candidate-vaccine-viruses .\n8 US CDC. CDC Confirms First Severe Case of H5N1 Bird Flu in the United States, 18 Dec 2024. Available at:\nhttps://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html .\n9 US CDC. Genetic Sequences of Highly Pathogenic Avian Influenza A(H5N1) Viruses Identified in a Person in\nLouisiana, 26 Dec 2024. Available at: https://www.cdc.gov/bird-flu/spotlights/h5n1-response-12232024.html .\n10 US CDC. First H5 Bird Flu Death Reported in United States, 6 Jan 2025. Available at:\nhttps://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html .",
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+ "text": "3\nanalysis including genetic sequencing of the virus from the specimen from this case was underway at\nthe time of reporting. 11\nFive additional cases of influenza A(H5) were detected in California in individuals aged over 18 years\nwho worked at commercial dairy cattle farms in areas where highly pathogenic avian influenza\n(HPAI)(H5N1) viruses had been detected in cows. The individuals had mild symptoms. 12 , 13\nLow pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds\nin the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and\nbackyard flocks in 48 states, impacting over 100 million birds. To date, 67 people have tested\npositive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in\n2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy\ncattle, except for two cases where the exposure source could not be identified. 14 To date, no human-\nto-human transmission of influenza A(H5) virus has been identified in the USA. A(H5N1) virus\ninfections in dairy cattle and wild and domestic birds continue to be reported in the USA. 15\nA(H5N1), Cambodia\nOn 10 January 2025, Cambodia notified WHO of one case of human infection with influenza A(H5N1)\nin a 28-year-old male from Kampong Cham Province. The case had onset of fever, sore throat and\nchest pain on 1 January 2025. He sought care at two private local clinics and after his condition did\nnot improve, he traveled to Phnom Penh and was hospitalized due to shortness of breath on 7\nJanuary at a national hospital, which is a severe acute respiratory infection (SARI) sentinel site. The\ncase was isolated upon admission and provided oseltamivir and symptomatic treatment before\npassing away on 10 January. Nasopharyngeal (NP) and oropharyngeal (OP) swab specimens tested\npositive on 9 January for influenza A(H5N1) by real-time reverse transcription-polymerase chain\nreaction (rt-PCR) at the National Institute of Public Health of Cambodia. The Institut Pasteur du\nCambodge (IPC) confirmed the results on 10 January. Sequence analysis of HA gene shows the virus\nbelongs to clade 2.3.2.1c and is closely related to those viruses circulating among birds in Cambodia\nin 2024. Phylogenetic and molecular analysis is ongoing.\nAccording to the early investigation, the case was a guard of a farm in the village where he lived and\nraised poultry for family consumption. There were reports of sick poultry in his farm and samples\nfrom the poultry on the farm have been collected. No further cases were detected among the\ncontacts of the case.\nAccording to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in\nwild and domestic birds in the Americas, Asia and Europe. Infections in non-human mammals are\n11 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 2, ending January 11, 2025.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2025-week-02.html.\n12 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 50, ending December 14, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-50.html .\n13 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 51, ending December 21, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-51.html .\n14 United States Centers for Disease Control and Prevention. H5 Bird Flu: Current Situation. Available at:\nhttps://www.cdc.gov/bird-flu/situation-\nsummary/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbird-flu%2Fphp%2Favian-flu-\nsummary%2Findex.html .\n15 United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock,\n19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-\ndetections/livestock .",
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+ "text": "4\nalso reported, including in marine and land mammals. 16 A list of bird and mammalian species\naffected by HPAI A(H5) viruses is maintained by FAO. 17\nRisk Assessment for avian influenza A(H5) viruses:\n1. What is the current global public health risk of additional human cases of infection with avian\ninfluenza A(H5) viruses?\nMost human cases so far have been infections in people exposed to A(H5) viruses, for example,\nthrough contact with infected poultry or contaminated environments, including live poultry markets,\nand occasionally infected mammals and contaminated environments. While the viruses continue to\nbe detected in animals and related environments humans are exposed to, further human cases\nassociated with such exposures are expected but unusual. The impact for public health if additional\ncases are detected is minimal. The current overall global public health risk of additional human cases\nis low.\n2. What is the likelihood of sustained human-to-human transmission of currently circulating avian\ninfluenza A(H5) viruses?\nNo sustained human-to-human transmission has been identified associated with the recent reported\nhuman infections with avian influenza A(H5). There has been no reported human-to-human\ntransmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007\nand the years prior, small clusters of A(H5) virus infections in humans were reported, including some\ninvolving health care workers, where limited human-to-human transmission could not be excluded;\nhowever, sustained human-to-human transmission was not reported.\nAvailable evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to\nefficiently transmit between people, therefore the likelihood of sustained human-to-human\ntransmission is thus currently considered unlikely at this time.\n3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community-\nlevel spread is considered unlikely as current evidence suggests these viruses have not acquired the\nability to transmit easily among humans.\nA(H9N2), China\nSince the last risk assessment of 12 December 2024, two human cases of infection with A(H9N2)\ninfluenza viruses were notified to WHO from China (Table 1). Both cases were detected through\ninfluenza-like illness (ILI) surveillance, were mild and have recovered. Both cases had a history of\nexposure to live poultry markets prior the onset of symptoms. No further cases were detected\namong contacts of the cases. Influenza A(H9) virus was detected in the poultry-related environments\nassociated with these cases.\n16 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n17 Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential/bird-species-affected-by-h5nx-hpai/en .",
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+ "text": "Onset date\tReporting province\tAge (years)\tGender\tHospitalization date\n27 Nov 2024\tHubei\t8\tFemale\tNot hospitalized\n13 Dec 2024\tChongqing\t1\tFemale\t14 Dec 2024",
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+ "text": "5",
+ "chunk_type": "prose",
+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "Onset date\nReporting province\nAge (years)\nGender\nHospitalization date\n27 Nov 2024\nHubei\n8\nFemale\nNot hospitalized\n13 Dec 2024\nChongqing\n1\nFemale\n14 Dec 2024\nRisk Assessment for avian influenza A(H9N2):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H9N2) viruses?\nMost human cases follow exposure to the A(H9N2) virus through contact with infected poultry or\ncontaminated environments. Most human infections of A(H9N2) to date have resulted in mild\nclinical illness in most cases. Nearly 130 human infections with A(H9N2) cases have been reported to\ndate since 2003, and six of these have been severe or fatal and three of these were known to have\nunderlying medical conditions. Since the virus is endemic in poultry in multiple continues in Africa\nand Asia 18 , further human cases associated with exposure to infected poultry are expected but\nremain unusual. The impact to public health if additional cases are detected is minimal. The overall\nglobal public health risk of additional human cases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H9N2)\nviruses?\nAt the present time, no sustained human-to-human transmission has been identified associated with\nthe event described above. Current evidence suggests that influenza A(H9N2) viruses from these\ncases have not acquired the ability of sustained transmission among humans, therefore sustained\nhuman-to-human transmission is thus currently considered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely as current evidence suggests the A(H9N2) virus subtype has not\nacquired the ability to transmit easily among humans.\nA(H10N3), China\nSince the last risk assessment of 12 December 2024, one human case of infection with A(H10N3)\ninfluenza viruses were notified to WHO from China on 3 January 2025. A 23-year-old female from\nGuangxi Zhuang Autonomous Region, with an underlying condition, had symptom onset on 12\nDecember 2024. She was admitted to hospital on 19 December with severe pneumonia and treated\nwith oseltamivir. Initially, she was in critical condition but has improved. A clinical sample collected\non 22 December tested positive for influenza A and influenza A(H10N3) was confirmed a on 26\nDecember. Prior to symptom onset, the patient worked at a supermarket and was exposed to freshly\nslaughtered poultry. No family members have developed symptoms at the time of reporting. All\nclose contacts tested negative for influenza A(H10N3). All environmental samples collected from\nvarious locations tested negative for influenza A(H10N3).\nThis is the fourth case of human A(H10N3) virus infection detected in China and globally to date.\n18 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .",
+ "chunk_type": "prose",
+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "6\nRisk Assessment for avian influenza A(H10N3):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H10N3) viruses?\nHuman infections with avian influenza A(H10) viruses have been detected and reported previously.\nThe extent of circulation and epidemiology of these viruses in birds is unclear. Avian influenza\nA(H10N3) viruses with different genetic characteristics have been detected previously in migratory\nand other wild birds since the 1970s. As long as the virus continues to circulate in birds, further\nhuman cases can be expected but remain unusual. The impact to public health if additional sporadic\ncases are detected is minimal. The overall global public health risk of additional sporadic human\ncases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H10N3)\nviruses?\nNo sustained human-to-human transmission has been identified associated with the event described\nAbove or past events with human cases of influenza A(H10N3) viruses. Current epidemiologic and\nvirologic evidence suggests that contemporary influenza A(H10N3) viruses assessed by the Global\nInfluenza Surveillance and response System (GISRS) have not acquired the ability of sustained\ntransmission among humans, therefore sustained human-to-human transmission is thus currently\nconsidered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H10N3) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely based on current limited evidence.\nOverall risk management recommendations:\nSurveillance and investigations\n\u2022\nDue to the constantly evolving nature of influenza viruses, WHO continues to stress the\nimportance of global strategic surveillance in animals and humans to detect virologic,\nepidemiologic and clinical changes associated with circulating influenza viruses that may affect\nhuman (or animal) health. Continued vigilance is needed within affected and neighbouring areas\nto detect infections in animals and humans. Close collaboration with the animal health and\nenvironment sectors is essential to understand the extent of the risk of human exposure and to\nprevent and control the spread of animal influenza.\n\u2022\nAs the extent of influenza virus circulation in animals is not clear, epidemiologic and virologic\nsurveillance and the follow-up of suspected human cases should continue systematically.\nGuidance on investigation of non-seasonal influenza and other emerging acute respiratory\ndiseases has been published on the WHO website.\n\u2022\nCountries should increase avian influenza surveillance in domestic and wild birds, enhance\nsurveillance for early detection in cattle populations in countries where HPAI is known to be\ncirculating, include HPAI as a differential diagnosis in non-avian species, including cattle and\nother livestock populations, with high risk of exposure to HPAI viruses; monitor and investigate\ncases in non-avian species, including livestock, report cases of HPAI in all animal species,\nincluding unusual hosts, to WOAH and other international organizations, share genetic\nsequences of avian influenza viruses in publicly available databases, implement preventive and\nearly response measures to break the HPAI transmission cycle among animals through\nmovement restrictions of infected livestock holdings and strict biosecurity measures in all",
+ "chunk_type": "prose",
+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "7\nholdings, employ good production and hygiene practices when handing animal products, and\nprotect persons in contact with suspected/infected animals. 19\n\u2022\nWhen there has been human exposure to a known outbreak of an influenza A virus in domestic\npoultry, wild birds or other animals \u2013 or when there has been an identified human case of\ninfection with such a virus \u2013 enhanced surveillance in potentially exposed human populations\nbecomes necessary. Enhanced surveillance should consider the health care seeking behaviour of\nthe population, and could include a range of active and passive health care and/or community-\nbased approaches, including: enhanced surveillance in local influenza-like illness (ILI)/SARI\nsystems, active screening in hospitals and of groups that may be at higher occupational risk of\nexposure, and inclusion of other sources such as traditional healers, private practitioners and\nprivate diagnostic laboratories.\n\u2022\nVigilance for the emergence of novel influenza viruses of pandemic potential should be\nmaintained at all times including during a non-influenza emergency. In the context of the co-\ncirculation of SARS-CoV-2 and influenza viruses, WHO has updated and published practical\nguidance for integrated surveillance .\nNotifying WHO\n\u2022\nAll human infections caused by a new subtype of influenza virus are notifiable under the\nInternational Health Regulations (IHR, 2005). 20 State Parties to the IHR (2005) are required to\nimmediately notify WHO of any laboratory-confirmed 5 21 case of a recent human infection caused\nby an influenza A virus with the potential to cause a pandemic 6 22 . Evidence of illness is not\nrequired for this report.\n\u2022\nWHO published the case definition for human infections with avian influenza A(H5) virus\nrequiring notification under IHR (2005): https://www.who.int/teams/global-influenza-\nprogramme/avian-influenza/case-definitions .\nVirus sharing and risk assessment\n\u2022\nIt is critical that these influenza viruses from animals or from people are fully characterized in\nappropriate animal or human health influenza reference laboratories. Under WHO\u2019s Pandemic\nInfluenza Preparedness (PIP) Framework, Member States are expected to share influenza viruses\nwith pandemic potential on a timely basis 23 with a WHO Collaborating Centre for influenza of\nGISRS. The viruses are used by the public health laboratories to assess the risk of pandemic\ninfluenza and to develop candidate vaccine viruses.\n\u2022\nThe Tool for Influenza Pandemic Risk Assessment (TIPRA) provides an in-depth assessment of\nrisk associated with some zoonotic influenza viruses \u2013 notably the likelihood of the virus gaining\nhuman-to-human transmissibility, and the impact should the virus gain such transmissibility.\nTIPRA maps relative risk amongst viruses assessed using multiple elements. The results of TIPRA\ncomplement those of the risk assessment provided here, and those of prior TIPRA analyses will\nbe published at http://www.who.int/teams/global-influenza-programme/avian-influenza/tool-\nfor-influenza-pandemic-risk-assessment-(tipra) .\n19 World Organisation for Animal Health. Statement on High Pathogenicity Avian Influenza in Cattle, 6\nDecember 2024. Available at: https://www.woah.org/en/high-pathogenicity-avian-influenza-hpai-in-cattle/ .\n20 World Health Organization. Case definitions for the four diseases requiring notification in all\ncircumstances under the International Health Regulations (2005).\n21 World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza\n(2011). Available at: https://apps.who.int/iris/handle/10665/44518\n22 World Health Organization. Pandemic influenza preparedness framework for the sharing of influenza viruses\nand access to vaccines and other benefits, 2 nd edition. Available at: https://iris.who.int/handle/10665/341850\n23 World Health Organization. Operational guidance on sharing influenza viruses with human pandemic\npotential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework (2017). Available at:\nhttps://apps.who.int/iris/handle/10665/25940",
+ "chunk_type": "prose",
+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "8\nRisk reduction\n\u2022\nGiven the observed extent and frequency of avian influenza in poultry, wild birds and some wild\nand domestic mammals, the public should avoid contact with animals that are sick or dead from\nunknown causes, including wild animals, and should report dead birds and mammals or request\ntheir removal by contacting local wildlife or veterinary authorities.\n\u2022\nEggs, poultry meat and other poultry food products should be properly cooked and properly\nhandled during food preparation. Due to the potential health risks to consumers, raw milk\nshould be avoided. WHO advises consuming pasteurized milk. If pasteurized milk isn\u2019t available,\nheating raw milk until it boils makes it safer for consumption.\n\u2022\nWHO has published practical interim guidance to reduce the risk of infection in people exposed\nto avian influenza viruses.\nTrade and travellers\n\u2022\nWHO advises that travellers to countries with known outbreaks of animal influenza should avoid\nfarms, contact with animals in live animal markets, entering areas where animals may be\nslaughtered, or contact with any surfaces that appear to be contaminated with animal excreta.\nTravelers should also wash their hands often with soap and water. All individuals should follow\ngood food safety and hygiene practices.\n\u2022\nWHO does not advise special traveller screening at points of entry or restrictions with regards to\nthe current situation of influenza viruses at the human-animal interface. For recommendations\non safe trade in animals and related products from countries affected by these influenza viruses,\nrefer to WOAH guidance.\nLinks:\nWHO Human-Animal Interface web page\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza\nWHO Influenza (Avian and other zoonotic) fact sheet\nhttps://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)\nWHO Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nhttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.2\nWHO Public health resource pack for countries experiencing outbreaks of influenza in animals:\nhttps://www.who.int/publications/i/item/9789240076884\nCumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus\nAvian Influenza A(H7N9) Information\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-influenza-a-( h7n9 )-\nvirus\nWorld Organisation of Animal Health (WOAH) web page: Avian Influenza\nhttps://www.woah.org/en/home/\nFood and Agriculture Organization of the United Nations (FAO) webpage: Avian Influenza\nhttps://www.fao.org/animal-health/avian-flu-qa/en/\nOFFLU\nhttp://www.offlu.org/",
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+ "title": "Bird flu: First death from H5N1 strain reported in US",
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+ "text": "The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred.\nThe patient had been taken to hospital after contracting a major strain of bird flu, known as H5N1.\nLouisiana health department said they were over the age of 65, and had other underlying health conditions.\nIt said their public health investigation had not found evidence of person-to-person transmission, or any other cases.\nBird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. In very rare cases, it can also infect humans.\nThe state's health department added the person had contracted bird flu after being exposed to a personal flock of birds and wild birds.\n\"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,\" it said.\nThere have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC).",
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+ "text": "Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Bird migration has resulted in outbreaks of the avian flu in domestic and wild birds.\nThe H5N1 virus is the major strain circulating among wild birds worldwide, and emerged in China in the late 1990s.\nAlthough infection of humans is very rare, it occurs via transmission from birds.\nAlmost all cases of infection in people have been associated with close contact to infected dead or live birds, or contaminated environments.\nSince 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died.\nThere has been no sustained human-to-human transmission.\nLast month, the CDC said the Louisiana patient had been infected with the D1.1variant of the virus, which has recently been detected in North America.\nA 13-year-old girl in Canada was taken to hospital with the same D1.1 variant in November 2024, according to a paper published in The New England Journal of Medicine.\nIt is different to the B3.13 variant, which - during the past year - has been on the rise among cows in the US.\nIn September 2024, a person in Missouri recovered from bird flu after being treated in hospital.",
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+ "text": "According to the WHO, symptoms of a H5N1 infection include a cough, sore throat, fever (often over 38C), muscle aches and general feelings of malaise.\nPeople with the virus may also display other non-respiratory symptoms such as conjunctivitis.\nThe WHO added that H5N1 has also been detected in people without symptoms who had contact with infected animals or their environments.\nWhile the risk to humans is low, the constantly evolving virus is monitored for all changes, including the potential to become easily transmissible from person to person.",
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+ "title": "\u2018Severe\u2019 Bird Flu in the U.S.: Latest Updates",
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+ "text": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic.\nThe severe case involves a resident of southwestern Louisiana who was reported as presumptively positive for infection last Friday. The infected patient \u201cis experiencing severe respiratory illness related to H5N1 infection and is currently hospitalized in critical condition,\u201d according to Emma Herrock, a spokesperson for the Louisiana Department of Health, who said that the patient is over the age of 65 and has underlying medical conditions but that further updates on their condition will not be given at this time due to patient confidentiality.\nRead More: What Are the Symptoms of Bird Flu?\nIt is the 61st case of human H5N1 bird flu infection in the country since April this year. But the CDC said the overall risk of the pathogen to the public remains low, and no related deaths have been reported in the U.S. so far.\nHere\u2019s what to know.",
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+ "text": "The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins.\nOf the 60 other cases, 58 were linked to commercial agriculture\u201437 from dairy herds and 21 from poultry farms and culling. The sources of exposure for the two other U.S. human cases remain unknown.",
+ "chunk_type": "prose",
+ "heading": "What caused the severe infection?",
+ "page_number": null,
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+ "text": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California, with all but one exposed to cattle. In response, Governor Gavin Newsom on Dec. 18 declared a state of emergency.\nThe CDC said that such a \u201csevere\u201d infection as was found in Louisiana was expected given cases in other countries. In Vietnam, a patient who died in March after a diagnosis of \u201csevere pneumonia, severe sepsis, and acute respiratory distress syndrome\u201d was found with an H5N1 infection, according to the World Health Organization. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.\nRead More: The Bird Flu Virus Is One Mutation Away from Getting More Dangerous\nAccording to Mark Mulligan, Director of the Vaccine Center and the Division of Infectious Diseases and Immunology at New York University Grossman School of Medicine, the general population faces \u201cno immediate threat.\u201d Those who are in contact with birds and animals\u2014especially those who work on dairy farms and cattle farms\u2014are at greatest risk. Currently, no person to person spread of the virus has been detected.\n\u201cRight now we have to let the experts do surveillance, do sequencing of the virus to see if we're seeing any changes that portend any significant difference,\u201d says Mulligan.",
+ "chunk_type": "prose",
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+ "text": "According to the CDC, symptoms of the bird flu can vary. Many of the cases in the U.S. included symptoms resembling conjunctivitis-like eye issues, including eye redness, discomfort, and discharge.\nSome cases also included both respiratory classic flu-like symptoms, including cough, headache, runny nose, fever, sore throat, body aches, fatigue, shortness of breath, and pneumonia, according to the CDC.\nRead More: What Are the Symptoms of Bird Flu?",
+ "chunk_type": "prose",
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+ "text": "The CDC issued a number of protective measures, including largely avoiding direct contact with wild birds and other suspected infected animals as well as their bodily excretions. People who work with cattle and poultry on affected farms have a greater risk of infection, and are thus advised to monitor any possible symptoms of infection.\nThe CDC also recommends that those who work with poultry or other animals use the correct personal protective equipment (PPE)\u2014including coveralls, boots, and more\u2014which should be provided by employers.\nVirologist and professor at John Hopkins University Andy Pekosz says that the severe case in Louisiana provides a reminder of an easy way to stay safe: stay away from dead animals. \u201cYou see a dead animal, if you're exposed to dead animals, stay away,\u201d he says. \u201cIn many ways, it is the least likely way someone can get exposed, but in some ways, it's also one of the more preventable ways.\u201d\nProperly cooked poultry and poultry products are safe, and the CDC says that while unpasteurized (raw) milk from infected cows can pose risks to humans, it\u2019s not yet known if avian influenza viruses can be transmitted through its consumption.\nBoth Mulligan and Pekosz say it is also important to get the seasonal human influenza vaccine. They say if there were to be a case of a person with simultaneous bird flu and human flu infection, it could lead to a \u201creassortment\u201d and thus a virus that could be more easily spread.\n\u201cWe know that has happened before, because the 1957 influenza pandemic and the 1968 influenza pandemic both were a result of a human and a bird influenza virus exchanging genetic material,\u201d Pekosz says. \u201cWe know that the flu vaccines are not perfect, but they do a good job of reducing infection.\u201d\nThe CDC currently has a program to offer seasonal vaccines to farm workers in high risk scenarios in certain states.",
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+ "text": "\u2022 L.A. Fires Show Reality of 1.5\u00b0C of Warming\n\u2022 Behind the Scenes of The White Lotus Season Three\n\u2022 How Trump 2.0 Is Already Sowing Confusion\n\u2022 Bad Bunny On Heartbreak and New Album\n\u2022 How to Get Better at Doing Things Alone\n\u2022 We\u2019re Lucky to Have Been Alive in the Age of David Lynch\n\u2022 The Motivational Trick That Makes You Exercise Harder\n\u2022 Column: All Those Presidential Pardons Give Mercy a Bad Name\nContact us at letters@time.com",
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+ "text": "A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States.\nThe agency said Wednesday that the person was exposed to sick and dead birds in backyard flocks; this is the first US bird flu case linked to a backyard flock.\n\u201cIt is believed that the patient that was reported by Louisiana had exposure to sick or dead birds on their property. These are not commercial poultry, and there was no exposure to dairy cows or their related products,\u201d said Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC.\nFederal officials declined to answer questions about the patient\u2019s symptoms or their current condition. They instead referred all inquiries about the case to the Louisiana Department of Health, which is leading the investigation.\nAccording to state officials, the patient is experiencing severe respiratory illness related to H5N1 and is hospitalized in critical condition. The person is older than 65 and has underlying medical conditions that increased their risk of flu complications, the Louisiana Department of Health said in an email to CNN.\nThis virus, D1.1, is the same type found in recent human cases in Canada and Washington state and detected in wild birds and poultry in the United States. It\u2019s different from B3.13, the type detected in dairy cows, some poultry outbreaks and other cases in humans across the United States.\nThe CDC said it\u2019s working on additional genomic sequencing of samples from the patient, who is from southwestern Louisiana, and the investigation into the patient\u2019s exposure is still underway.\nBird flu has been linked with severe human illness and death in other countries, but no person-to-person spread has been detected.\n\u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the agency said in a statement.\nIn California, Gov. Gavin Newsom declared a state of emergency Wednesday over the continued spread of H5N1 bird flu in that state.",
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+ "text": "\u2022 Sign up here to get The Results Are In with Dr. Sanjay Gupta every Friday from the CNN Health team.\nNewsom said the measure was necessary because, despite intense efforts to contain it, the virus had spread beyond the Central Valley to four dairies in the southern part of the state.\n\u201cThis proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,\u201d he said in a news release. \u201cWhile the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus.\u201d\nThe emergency declaration will give state agencies greater flexibility with staffing and free up more funding for the response.\nOf the 61 confirmed human cases of bird flu in the US this year, 34 have been in California. Nearly all of those have been in dairy farm workers, according to the CDC.\nThe Louisiana case shows that precautions should be taken by people with backyard chicken flocks, hunters and other bird enthusiasts, the CDC said.\n\u201cThe cases across the US are a constellation of spillovers,\u201d said Dr. Rebecca Christofferson, a virologist at Louisiana State University\u2019s School of Veterinary Medicine. Experts still don\u2019t understand exactly how these spillovers are happening and the specific factors that increase a person\u2019s risk.\n\u201cIt\u2019s just kind of a black box at the moment that a lot of people are trying to answer these questions on,\u201d Christofferson said.\nThe CDC says the best approach is to avoid exposure. Infected birds can shed viruses in their saliva, mucus and feces, and other animals may shed them in their respiratory secretions and bodily fluids, including unpasteurized milk from cows.\n\u201cPeople who work with or have recreational exposure to infected animals are at higher risk of infection, and it\u2019s extremely important that they follow CDC recommended precautions when around infected or potentially infected animals, a message that we will continue to magnify given recent cases,\u201d Daskalakis said.",
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+ "text": "Weekly / May 30, 2024 / 73(21);501\u2013505\nOn May 24, 2024, this report was posted online as an MMWR Early Release.\nShikha Garg, MD1; Carrie Reed, DSc1; C. Todd Davis, PhD 1; Timothy M. Uyeki, MD1; Casey Barton Behravesh, DVM, DrPH2; Krista Kniss, MPH1; Alicia Budd, MPH1; Matthew Biggerstaff, ScD1; Jennifer Adjemian, PhD3; John R. Barnes, PhD1; Marie K. Kirby, PhD1; Colin Basler, DVM2; Christine M. Szablewski, DVM1; Malia Richmond-Crum, MPH1; Erin Burns, MA1; Brandi Limbago, PhD4; Demetre C. Daskalakis, MD4; Kimberly Armstrong, PhD5; David Boucher, PhD5; Tom T. Shimabukuro, MD1; Michael A. Jhung, MD1; Sonja J. Olsen, PhD1; Vivien Dugan, PhD1 (View author affiliations)",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024",
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+ "text": "What is already known about this topic?\nInfluenza A(H5) virus infection was detected in two U.S. farm workers during a multistate outbreak of A(H5N1) viruses in dairy cows; these are the first known instances of presumed cow-to-human transmission of avian influenza A viruses.\nWhat is added by this report?\nApproximately 350 exposed farm workers are being monitored; one of the two cases was identified via daily, active monitoring. Surveillance has identified no unusual influenza activity trends in the United States. A(H5) candidate vaccine viruses are available, and laboratory analyses indicate that A(H5N1) viruses circulating in cows and other animals are susceptible to FDA-approved antivirals.\nWhat are the implications for public health practice?\nCurrent risk to the U.S. public from A(H5N1) viruses is low; however, persons exposed to infected animals or contaminated materials, including raw cow\u2019s milk, are at higher risk and should take precautions and self-monitor for illness. A One Health (human, animal, and environmental) approach is critical to preparing for circumstances that could increase risk to human health.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Summary",
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+ "text": "On April 1, 2024, the Texas Department of State Health Services reported that a dairy farm worker had tested positive for highly pathogenic avian influenza A(H5N1) virus after exposure to presumably infected dairy cattle; CDC confirmed these laboratory findings. A(H5N1) viruses were found in high concentrations in unpasteurized (raw) milk from infected cows. CDC is collaborating with the U.S. Department of Agriculture, the Food and Drug Administration, the Administration for Strategic Preparedness and Response, the Health Resources and Services Administration, the National Institute of Allergy and Infectious Diseases, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. Activities include monitoring of exposed persons, conducting syndromic and laboratory surveillance, planning epidemiologic investigations, and evaluating medical countermeasures. As of May 22, 2024, approximately 350 farm workers with exposure to dairy cattle or infected raw cow\u2019s milk had been monitored. These monitoring efforts identified a second human A(H5) case with conjunctivitis in Michigan, which was reported on May 22, 2024. CDC considers the current risk to the U.S. public from A(H5N1) viruses to be low; however, persons with exposure to infected animals or contaminated materials, including raw cow\u2019s milk, are at higher risk for A(H5N1) virus infection and should take recommended precautions, including using recommended personal protective equipment, self-monitoring for illness symptoms, and, if they are symptomatic, seeking prompt medical evaluation for influenza testing and antiviral treatment if indicated. Pasteurization inactivates A(H5N1) viruses, and the commercial milk supply is safe for consumption; however, all persons should avoid consuming raw milk or products produced from raw milk. Importantly, the risk to the public might change based on whether A(H5N1) viruses acquire genetic changes that increase their transmissibility to and among humans, which could increase the risk of an influenza pandemic.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Abstract",
+ "page_number": null,
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+ },
+ {
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+ "text": "On April 1, 2024, the Texas Department of State Health Services reported, after confirmation by CDC, that a commercial dairy farm worker tested positive by real-time reverse transcription\u2013polymerase chain reaction (RT-PCR) for highly pathogenic avian influenza (HPAI) A(H5N1) virus infection after exposure to dairy cattle presumed to be infected with A(H5N1) viruses*,\u2020; CDC confirmed laboratory findings through RT-PCR and sequencing (1). The patient only experienced conjunctivitis without other signs or symptoms, was instructed to isolate, was treated with oseltamivir, and recovered. No illness was identified among the patient\u2019s household members, all of whom received oseltamivir postexposure prophylaxis. One week earlier, the U.S. Department of Agriculture had reported a multistate outbreak of A(H5N1) viruses in dairy cows.\u00a7 A(H5N1) viruses were also detected in barn cats, birds, and other animals (e.g., one raccoon and two opossums) that lived in and around human habitations and that died on affected farms.\u00b6 Genetic sequencing of the A(H5N1) virus from infected cattle and the farm worker** identified clade 2.3.4.4b; this clade has been detected in U.S. wild birds, commercial poultry, backyard flocks, and other animals since January 2022 (2). On May 22, 2024, the Michigan Department of Health and Human Services reported an A(H5) case in a dairy farm worker on a farm confirmed to have A(H5N1) virus in cattle; this person was enrolled in an active text-based monitoring program and reported only eye symptoms.\u2020\u2020 The investigation into this second case is ongoing. These two cases are the first known instances of presumed cow-to-human spread of an avian influenza A virus.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Identification of Two Human Cases of Influenza A(H5) Virus Infection",
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+ "text": "Although first reported in March 2024, A(H5N1) virus infection of U.S. dairy cows might have been occurring since December 2023, according to preliminary data (3). As of May 22, 2024, infected dairy cows had been identified in 52 dairy cattle herds in nine states\u00a7\u00a7 (Colorado, Idaho, Kansas, Michigan, New Mexico, North Carolina, Ohio, South Dakota, and Texas). Signs in cattle were nonspecific and included decreased milk production, reduced rumination, and thickened (colostrum-like) milk consistency; some cows also had clear nasal discharge. High A(H5N1) virus levels have also been found in unpasteurized (raw) milk from infected cows(4).",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Influenza A(H5N1) Viruses in U.S. Dairy Cattle",
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+ "text": "From 1997 through late April 2024, a total of 909 sporadic human A(H5N1) cases were reported worldwide from 23 countries; 52% of human cases have been fatal (2); of the 909 cases, 26 human A(H5N1) cases have been reported from eight countries, including seven deaths, since 2022. Since these numbers were last updated, two additional human A(H5) cases have been detected including the case from Michigan and one case in Australia. Nearly all reported human A(H5N1) cases had reported recent exposure to poultry. In the United States, three human A(H5) cases have been identified to date; all patients had mild illness, were not hospitalized, and fully recovered. The first occurred in April 2022 in a person from Colorado with direct exposure to infected poultry, who only reported fatigue,\u00b6\u00b6 and the second and third occurred in dairy farm workers with conjunctivitis referenced in this report.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Human Cases of Influenza A(H5N1) Worldwide",
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+ "text": "Activities implemented using a One Health*** approach to respond to this outbreak\u2020\u2020\u2020 include monitoring for infections in exposed persons, conducting syndromic and laboratory surveillance, planning for epidemiologic investigations, and assessing performance of existing medical countermeasures including diagnostic tests, vaccines, and therapeutics. To assess A(H5N1) virus pathogenesis, severity, and transmissibility in an animal model of infection, CDC is also conducting laboratory experiments in ferrets.\nThis activity was reviewed by CDC, deemed not research, and was conducted consistent with applicable federal law and CDC policy.\u00a7\u00a7\u00a7 Ferret studies were approved by the CDC Institutional Animal Care and Use Committee.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > U.S. Outbreak Response Activities",
+ "page_number": null,
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+ {
+ "chunk_id": "doc-970f74dceb574b14a7b0fe450b6c8773-c7",
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+ "text": "In 2014, CDC began monitoring persons exposed to infected poultry when HPAI A(H5) viruses were first detected in poultry and wild birds in North America (5). Recommendations are to monitor persons exposed to infected birds, poultry, or other animals for 10 days after their last exposure and to test symptomatic persons for influenza A viruses by RT-PCR assay using H5-specific primers and probes, in coordination with state or local health departments (6).\nDuring February 2022\u2013May 2024, approximately 9,400 persons in 52 jurisdictions have been monitored. As of May 22, 2024, approximately 350 farm workers had been or were currently being monitored for illness after exposure to infected cows or infected raw cow\u2019s milk; the number of persons monitored continues to increase; data are updated weekly.\u00b6\u00b6\u00b6 Monitoring is performed either through direct daily contact by state or local health departments or by providing persons with information on how to self-monitor and where to seek testing and possible treatment should they experience symptoms. The most recent human A(H5) case was identified through active, daily monitoring of exposed farm workers using a text-based illness monitoring program in Michigan (7).",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Monitoring of Persons Exposed to Influenza A(H5) Viruses",
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+ "text": "CDC\u2019s influenza surveillance systems**** collect information to track trends in influenza activity and detect changes in circulating influenza viruses, including detection of novel influenza A viruses year-round. Human cases of novel influenza A virus infection have been nationally notifiable since 2007; every identified case is investigated and reported to CDC.\nThrough approximately 300 clinical laboratories, CDC monitors changes in the percentage of influenza tests with positive results in clinical settings. The National Syndromic Surveillance Program collects data from emergency departments and other health care settings, facilitating the detection of unusual trends in influenza diagnoses, including in jurisdictions where A(H5N1) viruses have been identified in animals.\nCDC\u2019s National Wastewater Surveillance System\u2020\u2020\u2020\u2020 complements other existing human influenza surveillance systems in monitoring influenza trends. These monitoring methods detect influenza A viruses but do not distinguish subtypes of influenza A, meaning that current wastewater testing can detect A(H5N1) viruses but cannot distinguish them from other influenza A viruses or determine the source of the influenza A viruses (e.g., humans versus animals or animal products). Together, these systems provide visibility into U.S. influenza activity. As of May 18, 2024, no indicators of unusual human influenza activity, including A(H5N1 virus), had been detected in humans through these systems.\nCDC\u2019s molecular diagnostic assays are used at more than 100 public health laboratories in all 50 states and other U.S. jurisdictions to detect seasonal and novel influenza A viruses; nine centers also perform genetic sequencing for virus characterization. Statistical methods are used to determine the number of specimens needed to have 95% confidence that at least one novel influenza A virus among all influenza positive specimens per week would be detected given varying influenza prevalence; the number varies by timing during the season. Each state\u2019s contribution is proportional to its population and has been set as a national weekly goal for public health laboratory testing.\u00a7\u00a7\u00a7\u00a7",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > National Surveillance Activities",
+ "page_number": null,
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+ "text": "Multiple efforts are underway to enhance influenza surveillance activities through the spring and summer as part of this response. CDC is working with commercial laboratories to increase submission of influenza-positive test specimens to public health laboratories to increase the number of specimens available for virus subtyping. Approximately 140,000 of these H5-specific tests are already prepositioned at the state and local level, and another 750,000 tests are available for distribution if needed. CDC also continues to collaborate with manufacturers of commercial diagnostic tests with the goal of having an A(H5N1) test that is widely available if needed. Surveillance for laboratory-confirmed, influenza-associated hospitalizations will also continue during the spring and summer through the Influenza Hospitalization Surveillance Network (FluSurv-NET), which typically conducts surveillance during October 1\u2013April 30 of each influenza season. As well, CDC is working with state and local public health partners, with outreach to providers and clinics, to increase awareness about A(H5N1) so that influenza is considered in patients with conjunctivitis or respiratory illness after exposures, including agricultural fair attendance, that might increase the risk of novel influenza A virus infection.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Spring and Summer Activities",
+ "page_number": null,
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+ "text": "As a World Health Organization Collaborating Center, and in partnership with the Administration for Strategic Preparedness and Response (ASPR), CDC regularly develops novel influenza A candidate vaccine viruses (CVVs) for pandemic preparedness. Antigenic characterization of the A(H5N1) virus isolated from the Texas farm worker (A/Texas/37/2024) with ferret antisera produced against existing CVVs confirmed two clade 2.3.4.4b A(H5) CVVs have good cross-reactivity to this virus. Under the National Pre-Pandemic Influenza Vaccine Stockpile (NPIVS) program, ASPR has shared these CVVs with Food and Drug Administration (FDA)\u2013licensed pandemic influenza vaccine manufacturers and has completed initial production of bulk antigen. ASPR is also supporting clinical evaluation of safety and immunogenicity of vaccines using antigen manufactured from one of these CVVs, influenza A/Astrakhan/3212/2020\u2013like virus vaccine, in combination with different adjuvants that are stockpiled under the NPIVS. The clinical study (NCT05874713)\u00b6\u00b6\u00b6\u00b6 testing cell-based antigen combined with MF59 adjuvant, according to the AUDENZ-licensed manufacturing process, has completed enrollment. The egg-based antigen, produced according to the Q-PAN-licensed process, combined with AS03 adjuvant clinical study (NCT05975840)***** is also fully enrolled. ASPR is planning additional clinical studies for combining egg-based antigen with both AS03 and MF59 adjuvants with enrollment expected to start in late summer 2024. If needed, and dependent upon FDA review and regulatory action allowing use, these vaccines could be the first allotment of vaccines used while additional manufacturing, starting with the stockpiled antigens and adjuvants, ramps up for full-scale production.\nFour FDA-approved antiviral drugs (baloxavir marboxil, oseltamivir, peramivir, and zanamivir) are recommended for influenza treatment in the United States.\u2020\u2020\u2020\u2020\u2020 CDC has conducted phenotypic testing of antiviral susceptibility and found that the A(H5N1) virus isolated from the Texas farm worker is susceptible to baloxavir marboxil (Xofluza, Genentech) and to neuraminidase inhibitors, including oseltamivir (generic or Tamiflu, Genentech). Oral oseltamivir treatment is recommended for persons with confirmed or suspected A(H5N1) virus infection.\u00a7\u00a7\u00a7\u00a7\u00a7 Oral oseltamivir is also recommended for postexposure prophylaxis (using twice daily treatment dosing) of close contacts (e.g., household members) of a confirmed A(H5N1) case. Observational studies of patients infected with older and different clades of A(H5N1) viruses, (i.e., not the current clade 2.3.4.4b viruses identified in the United States) have found that starting oseltamivir treatment within 2 days of symptom onset was significantly associated with survival benefit compared with no treatment or later initiation of oseltamivir treatment after symptom onset (8,9). All four antivirals are available in the Strategic National Stockpile and in many state-managed stockpiles, both of which can be deployed to assist with supply chain constraints should they arise.\nThe National Institute of Allergy and Infectious Diseases (NIAID) continues to investigate the efficacy of novel direct-acting antiviral medications and host-targeted molecules as well as broadly neutralizing antibodies and more targeted monoclonal antibodies aimed at A(H5N1) viral-specific surface antigens that could protect from death or severe respiratory disease.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Medical Countermeasures",
+ "page_number": null,
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+ "text": "To better ascertain and define the risk to humans, CDC is working with states to plan epidemiologic investigations in collaboration with affected farms and health and agricultural partners at local, state, and federal levels. Important public health questions might be addressed through in-depth studies with specimen collection and surveys (Box). CDC conducted a similar study in response to poultry outbreaks of A(H5N1) in 2022 (10).",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Investigation and Findings > Epidemiologic Investigations",
+ "page_number": null,
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+ "text": "CDC is collaborating with the U.S. Department of Agriculture, FDA, ASPR, the Health Resources and Services Administration, NIAID, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. Substantial challenges to identifying and interviewing persons exposed to cattle infected with A(H5N1) viruses for illness monitoring or epidemiologic studies exist. Workers exposed to A(H5N1) viruses might represent socioeconomically vulnerable, or otherwise hard-to-reach populations, including those who live in rural or remote areas; or they might be migrant, transient, or undocumented workers. Further, persons might not be aware of the risks or potential signs and symptoms associated with exposure; dairy farmers and the dairy industry have not previously been major partners in outreach about avian influenza. Recommendations for worker protection have been recently updated\u00b6\u00b6\u00b6\u00b6\u00b6 and disseminated.\nOnce exposed persons are identified, defining exposure periods is also difficult. A(H5N1) disease is widespread in poultry, and mortality is high. Rapid depopulation of affected flocks facilitates monitoring of exposed workers because it creates a finite 10-day monitoring window after exposure. In contrast, illness in cows can last for 2\u20134 weeks, and the duration of infectious virus shedding in cows is unknown. In addition, A(H5N1) virus infection has been identified in some cows without signs of illness; thus, some workers might be unaware of their exposure. Recent testing did not detect live, infectious A(H5N1) viruses in retail dairy samples; however, identification of A(H5N1) viral fragments in approximately one in five retail milk samples from across the country (4) suggests that A(H5N1) virus infections of cattle might be widespread. Therefore, monitoring of exposed or potentially exposed persons and animals might be protracted and resource-intensive.\nInterpretation of surveillance data can be challenging given that A(H5N1) virus infections might manifest signs and symptoms similar to those associated with infections caused by other pathogens. During periods of low U.S. influenza virus circulation (e.g., spring and summer), syndromic and wastewater surveillance might more readily identify unusual signals in influenza-related symptoms or activity. However, using these systems to detect novel influenza A virus infection trends in the fall and winter, once seasonal influenza A virus circulation increases, will likely be complicated. Interpretation of wastewater data are further limited by the inability to distinguish between human and animal source material.\nCurrently circulating A(H5N1) viruses do not have the ability to easily bind to receptors that are most prevalent in the human upper respiratory tract and therefore are not easily transmissible to and between humans (2). However, because of the widespread global prevalence of A(H5N1) viruses in birds and other animals, continued sporadic human infections are anticipated. Further, if a novel influenza A virus acquires the ability to infect and be transmitted easily between persons in a sustained manner, an influenza pandemic could occur. Thus, investigation of every novel influenza A virus case in humans and comprehensive worldwide surveillance is critical to public health preparedness efforts.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Discussion",
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+ "text": "CDC considers the current health risk to the U.S. public from A(H5N1) viruses to be low. However, persons who have job-related or recreational exposure to infected birds, poultry, dairy cattle, or other infected animals or contaminated materials, including raw cow\u2019s milk, are at increased risk for infection; these persons should take appropriate precautions, including using recommended personal protective equipment, self-monitoring for illness symptoms (6), and seeking prompt medical evaluation if they are symptomatic, including influenza testing and antiviral treatment if indicated. FDA has confirmed that pasteurization inactivates A(H5N1) viruses, and that the commercial milk supply is safe for consumption (4); however, all persons should avoid consuming raw milk or products produced from raw milk. A coordinated and comprehensive One Health response to this ongoing outbreak of A(H5N1) virus infections in dairy cows, poultry, and other animals is needed to identify and prepare for any developments that indicate an increase in the risk to public health.",
+ "chunk_type": "prose",
+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Discussion > Implications for Public Health Practice",
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+ "text": "Haley C. Boswell, Ramona Byrkit, Ann Carpenter, Phillippa Chadd, Kevin Chatham-Stephens, Anton Chesnokov, Peter Daly, Juan A. De La Cruz; Han Di, Sascha R. Ellington, Julia C. Frederick, Eric Gogstad, William Gregg, Lisa A. Grohskopf, Larisa Gubareva, Norman Hassell, Mary Hill, Margaret Honein, Yunho Jang, Douglas E. Jordan, Aaron Kite-Powell, Rebecca Kondor, Kristine Lacek, Brian Lee, Brianna Lewis, Jimma Liddell, Rochelle Medford, Alexandra Mellis, Megin Nichols, Elizabeth Pusch, Katie Reinhart, Laird J. Ruth, Rebecca Sabo, Michael Sheppard, George Sims, Sean Stapleton, James Stevens, Jonathan Yoder, Natalie M. Wendling, CDC; Michael Ison, National Institutes of Health.\nCorresponding author: Shikha Garg, sgarg1@cdc.gov.\n1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; 2One Health Office, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Office of Public Health Data, Surveillance, and Technology, CDC; 4National Center for Immunization and Respiratory Diseases, CDC; 5Administration for Strategic Preparedness and Response, Washington, DC.\nAll authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.\n\u2020 https://emergency.cdc.gov/han/2024/han00506.asp\n\u00b6 https://wahis.woah.org/#/in-review/4451?fromPage=event-dashboard-url\n** https://www.cdc.gov/flu/avianflu/spotlights/2023-2024/h5n1-analysis-texas.htm\n\u2020\u2020 https://www.michigan.gov/mdhhs/inside-mdhhs/newsroom/2024/05/22/influenza-a-detection\n\u00a7\u00a7 https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-detections/livestock\n\u00b6\u00b6 https://www.cdc.gov/media/releases/2022/s0428-avian-flu.html\n*** https://www.cdc.gov/one-health/about/index.html\n\u2020\u2020\u2020 https://www.cdc.gov/flu/avianflu/what-cdc-doing-h5n1.htm\n\u00a7\u00a7\u00a7 45 C.F.R. part 46.102(l)(2), 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq.\n\u00b6\u00b6\u00b6 https://www.cdc.gov/flu/avianflu/h5-monitoring.html\n**** https://www.cdc.gov/flu/weekly/index.htm\n\u2020\u2020\u2020\u2020 https://www.cdc.gov/nwss/wastewater-surveillance/Flu-A-data.html\n\u00a7\u00a7\u00a7\u00a7 https://www.aphl.org/aboutAPHL/publications/Documents/ID-Influenza-Right-Size-Roadmap-Edition2.pdf\n\u00b6\u00b6\u00b6\u00b6 https://www.clinicaltrials.gov/study/NCT05874713?term=NCT05874713&rank=1\n***** https://www.clinicaltrials.gov/study/NCT05975840?term=NCT05975840&rank=1\n\u2020\u2020\u2020\u2020\u2020 https://www.cdc.gov/flu/professionals/antivirals/index.htm\n\u00a7\u00a7\u00a7\u00a7\u00a7 https://www.cdc.gov/flu/avianflu/novel-av-treatment-guidance.htm\n\u00b6\u00b6\u00b6\u00b6\u00b6 https://www.cdc.gov/flu/avianflu/h5/worker-protection-ppe.htm",
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+ "heading": "Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024 > Discussion > Acknowledgments",
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+ "text": "\u2022 Uyeki TM, Milton S, Abdul Hamid C, et al. Highly pathogenic avian influenza A(H5N1) virus infection in a dairy farm worker. N Engl J Med 2024. Epub May 3, 2024. https://doi.org/10.1056/nejmc2405371 PMID:38700506\n\u2022 CDC. Influenza (flu): technical report: highly pathogenic avian influenza A(H5N1) viruses. Atlanta, GA: US Department of Health and Human Services, CDC; 2024. https://www.cdc.gov/flu/avianflu/spotlights/2023-2024/h5n1-technical-report_april-2024.htm\n\u2022 Nguyen T, Hutter C, Markin A, et al. Emergence and interstate spread of highly pathogenic avian influenza A(H5N1) in dairy cattle. bioRxiv [Preprint posted online May 1, 2024]. https://doi.org/10.1101/2024.05.01.591751\n\u2022 Food and Drug Administration. Updates of highly pathogenic avian influenza (HPAI). Silver Spring, MD: US Department of Health and Human Services, Food and Drug Administration; 2024. Accessed May 7, 20204. https://www.fda.gov/food/alerts-advisories-safety-information/updates-highly-pathogenic-avian-influenza-hpai\n\u2022 Olsen SJ, Rooney JA, Blanton L, et al. Estimating risk to responders exposed to avian influenza A H5 and H7 viruses in poultry, United States, 2014\u20132017. Emerg Infect Dis 2019;25:1011\u20134. https://doi.org/10.3201/eid2505.181253 PMID:30741630\n\u2022 CDC. Influenza (flu): highly pathogenic avian influenza A(H5N1) virus in animals: interim recommendations for prevention, monitoring, and public health investigations. Atlanta, GA: US Department of Health and Human Services, CDC; 2024. https://www.cdc.gov/flu/avianflu/hpai/hpai-interim-recommendations.html\n\u2022 Stewart RJ, Rossow J, Eckel S, et al. Text-based illness monitoring for detection of novel influenza A virus infections during an influenza A (H3N2)v virus outbreak in Michigan, 2016: surveillance and survey. JMIR Public Health Surveill 2019;5:e10842. https://doi.org/10.2196/10842 PMID:31025948\n\u2022 Kandun IN, Tresnaningsih E, Purba WH, et al. Factors associated with case fatality of human H5N1 virus infections in Indonesia: a case series. Lancet 2008;372:744\u20139. https://doi.org/10.1016/s0140-6736(08)61125-3 PMID:18706688\n\u2022 Adisasmito W, Chan PK, Lee N, et al. Effectiveness of antiviral treatment in human influenza A(H5N1) infections: analysis of a global patient registry. J Infect Dis 2010;202:1154\u201360 https://doi.org/10.1086/656316 PMID:20831384\n\u2022 Kniss K, Sumner KM, Tastad KJ, et al. Risk for infection in humans after exposure to birds infected with highly pathogenic avian influenza A(H5N1) virus, United States, 2022. Emerg Infect Dis 2023;29:1215\u20139. https://doi.org/10.3201/eid2906.230103 PMID:37095080",
+ "chunk_type": "prose",
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+ "text": "1. Is there evidence of influenza A(H5N1) virus infections in human populations?\n2. If human illness is identified, what is the clinical spectrum of illness?\n3. What are the rates of asymptomatic human infection with influenza A(H5N1) virus?\n4. What are the routes of exposure to influenza A(H5N1) virus on farms and dairies, and what is the risk for zoonotic transmission?\n5. What behaviors, including use of personal protective equipment, are associated with human infection or protection from infection with influenza A(H5N1) virus?\nSuggested citation for this article: Garg S, Reed C, Davis CT, et al. Outbreak of Highly Pathogenic Avian Influenza A(H5N1) Viruses in U.S. Dairy Cattle and Detection of Two Human Cases \u2014 United States, 2024. MMWR Morb Mortal Wkly Rep 2024;73:501\u2013505. DOI: http://dx.doi.org/10.15585/mmwr.mm7321e1.\nMMWR and Morbidity and Mortality Weekly Report are service marks of the U.S. Department of Health and Human Services. Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services. References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.\nAll HTML versions of MMWR articles are generated from final proofs through an automated process. This conversion might result in character translation or format errors in the HTML version. Users are referred to the electronic PDF version (https://www.cdc.gov/mmwr) and/or the original MMWR paper copy for printable versions of official text, figures, and tables.\nQuestions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.",
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+ "snippet": "CDC is collaborating with the U.S. Department of Agriculture, the Food and Drug Administration, the Administration for Strategic Preparedness and Response, the Health Resources and Services Administration, the National Institute of Allergy and Infectious Diseases, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. One week earlier, the U.S. Department of Agriculture had reported a multistate outbreak of A(H5N1) viruses in dairy cows.\u00a7 A(H5N1) viruses were also detected in barn cats, birds, and other animals (e.g., one raccoon and two opossums) that lived in and around human habitations and that died on affected farms.\u00b6 Genetic sequencing of the A(H5N1) virus from infected cattle and the farm worker** identified clade 2.3.4.4b; this clade has been detected in U.S. wild birds, commercial poultry, backyard flocks, and other animals since January 2022 (2). Top Discussion CDC is collaborating with the U.S. Department of Agriculture, FDA, ASPR, the Health Resources and Services Administration, NIAID, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. CDC considers the current risk to the U.S. public from A(H5N1) viruses to be low; however, persons with exposure to infected animals or contaminated materials, including raw cow\u2019s milk, are at higher risk for A(H5N1) virus infection and should take recommended precautions, including using recommended personal protective equipment, self-monitoring for illness symptoms, and, if they are symptomatic, seeking prompt medical evaluation for influenza testing and antiviral treatment if indicated. Top Corresponding author: Shikha Garg, sgarg1@cdc.gov. Top 1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; 2One Health Office, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Office of Public Health Data, Surveillance, and Technology, CDC; 4National Center for Immunization and Respiratory Diseases, CDC; 5Administration for Strategic Preparedness and Response, Washington, DC. ",
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+ ],
+ "why_might_be_wrong": "Under-reporting or delays in case detection and reporting could mean actual figures could be higher than currently known.",
+ "rationale": "As of the latest data in January 2025, there are 67 confirmed cases in the US. The increase from December to January was 6 cases, which suggests a slowdown in new cases. Given the base rate of similar outbreaks and the drivers up and down, it's reasonable to expect the number of confirmed cases to be in the 70-100 range by February 28, 2025. The strong healthcare infrastructure in the US should help contain the spread, but the presence of the virus in commercial agriculture remains a risk factor.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 43
+ },
+ {
+ "probabilities": [
+ 0.39999999999999997,
+ 0.19999999999999998,
+ 0.19999999999999998,
+ 0.19999999999999998
+ ],
+ "ok": true,
+ "reference_class": "Cumulative human cases of H5N1 in the US over a similar time frame.",
+ "base_rate": 0.2,
+ "drivers_up": [
+ "Recent increase in cases suggests a trend towards higher reporting.",
+ "Previous months have shown a sharp increase, suggesting potential for continued spread.",
+ "Seasonal factors may contribute to a further increase in cases, as influenza viruses tend to spread more in certain weather conditions."
+ ],
+ "drivers_down": [
+ "The recent cumulative number of cases is only 9, far from the lowest option threshold of 70.",
+ "Control measures and public health interventions may reduce the spread.",
+ "The window until February 28, 2025, is short for a significant case increase."
+ ],
+ "why_might_be_wrong": "Unexpected outbreaks or inaccuracies in reporting could rapidly change case numbers.",
+ "rationale": "The recent evidence shows a cumulative total of 9 cases, which is significantly below the threshold for 70-100 cases, the lowest option. Despite a recent increase, the short time frame until February 28, 2025, makes it unlikely to reach even the lowest option threshold. Control measures and natural limitations on spread also suggest slower growth. Thus, the probability of reaching any of the listed options is extremely low.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 44
+ }
+ ],
+ "baseline_rationale": null,
+ "evidence_record_ids": [
+ "ins-098b4eaf5143",
+ "ins-bfd7147c04e1",
+ "ins-9673ff309cf6",
+ "ins-9bc33a10a1a9",
+ "ins-de3b9b382709",
+ "ins-fbe6644f1352",
+ "ins-8d3de449989e",
+ "ins-446bf4906d24",
+ "ins-b6ab7ed8251a",
+ "ins-b488ea400552",
+ "ins-56d2c848e6c0",
+ "ins-a6c09bc8ca4d",
+ "ins-69f9a7baa251",
+ "ins-e810d7258c41",
+ "ins-28774fa009a8",
+ "ins-c970251da78c",
+ "ins-e7a2be6db26c"
+ ],
+ "budget_summary": {
+ "total_input_tokens": 6609,
+ "total_output_tokens": 804,
+ "total_tokens": 7413,
+ "per_model": {
+ "gpt-4o-2024-08-06": {
+ "input_tokens": 6609,
+ "output_tokens": 804,
+ "calls": 3
+ }
+ }
+ },
+ "notes": []
+}
\ No newline at end of file
diff --git a/data/runs_ab_with_history/q1/traj_20250217/insight.json b/data/runs_ab_with_history/q1/traj_20250217/insight.json
new file mode 100644
index 0000000..ba8359b
--- /dev/null
+++ b/data/runs_ab_with_history/q1/traj_20250217/insight.json
@@ -0,0 +1,529 @@
+{
+ "records": [
+ {
+ "id": "ins-e7a2be6db26c",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 67.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": null,
+ "event_date_precision": null,
+ "summary": "Cumulative total of confirmed human cases of A(H5) virus in the US since 2022.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:45.688513+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-a91fce0340f74993b3ace471797f84fa",
+ "chunk_id": "doc-a91fce0340f74993b3ace471797f84fa-c3",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "To date, 67 people have tested positive for A(H5) virus in the United States since 2022"
+ }
+ ]
+ },
+ {
+ "id": "ins-e810d7258c41",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 66.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed H5N1 cases in the US since 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:49.709192+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-63ae00041a224378aa30a3ad43bb7b7d",
+ "chunk_id": "doc-63ae00041a224378aa30a3ad43bb7b7d-c0",
+ "source_url": "https://www.bbc.com/news/articles/cqx85y07jz9o",
+ "quote": "There have been 66 confirmed cases of H5N1 bird flu in the US since 2024"
+ }
+ ]
+ },
+ {
+ "id": "ins-de3b9b382709",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 34.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human infections in the U.S. for the year, with a majority in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:51.913200+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-aa69aaaf8d8d441281a07c239c037281",
+ "chunk_id": "doc-aa69aaaf8d8d441281a07c239c037281-c2",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California"
+ }
+ ]
+ },
+ {
+ "id": "ins-8d3de449989e",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.5,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
+ "count_basis": "unknown",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "first known case of H5N1 infection in the U.S. linked to sick and dead birds in backyard flocks.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:52.703139+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-aa69aaaf8d8d441281a07c239c037281",
+ "chunk_id": "doc-aa69aaaf8d8d441281a07c239c037281-c1",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "the first known case of infection in the U.S. to have those origins."
+ }
+ ]
+ },
+ {
+ "id": "ins-446bf4906d24",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.5,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 60.0,
+ "metric_unit": "cases",
+ "count_basis": "unknown",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "total of 60 cases reported, with 58 linked to commercial agriculture.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:52.703712+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-aa69aaaf8d8d441281a07c239c037281",
+ "chunk_id": "doc-aa69aaaf8d8d441281a07c239c037281-c1",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the 60 other cases, 58 were linked to commercial agriculture"
+ }
+ ]
+ },
+ {
+ "id": "ins-28774fa009a8",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 61.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed human cases of bird flu in the US this year, with 34 in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:54.628895+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-449e8f83e1404fd3b410fc900dc9e221",
+ "chunk_id": "doc-449e8f83e1404fd3b410fc900dc9e221-c1",
+ "source_url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "quote": "Of the 61 confirmed human cases of bird flu in the US this year, 34 have been in California."
+ }
+ ]
+ },
+ {
+ "id": "ins-b6ab7ed8251a",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-14T00:00:00",
+ "event_date_precision": "day",
+ "summary": "One laboratory-confirmed human case of infection with influenza A(H5) reported from Louisiana.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:47.772112+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-a91fce0340f74993b3ace471797f84fa",
+ "chunk_id": "doc-a91fce0340f74993b3ace471797f84fa-c2",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "the USA notified WHO of one laboratory-confirmed human case of infection with influenza A(H5) in an adult aged over 65 years from the state of Louisiana."
+ }
+ ]
+ },
+ {
+ "id": "ins-9673ff309cf6",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 2.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-21T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Two additional laboratory-confirmed human cases of infection with influenza A(H5) reported from Iowa and Wisconsin.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:47.772550+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-a91fce0340f74993b3ace471797f84fa",
+ "chunk_id": "doc-a91fce0340f74993b3ace471797f84fa-c2",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "the USA notified WHO of two additional laboratory-confirmed human case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin."
+ }
+ ]
+ },
+ {
+ "id": "ins-bfd7147c04e1",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2025-01-15T00:00:00",
+ "event_date_precision": "day",
+ "summary": "One additional laboratory-confirmed human case of infection with influenza A(H5) reported from California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:47.772877+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-a91fce0340f74993b3ace471797f84fa",
+ "chunk_id": "doc-a91fce0340f74993b3ace471797f84fa-c2",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "the USA notified WHO of one additional laboratory-confirmed human case of infection with influenza A(H5) from the state of California."
+ }
+ ]
+ },
+ {
+ "id": "ins-098b4eaf5143",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States of America",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 9.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2025-01-20T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human cases of influenza A(H5) virus in the US since the last risk assessment.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:45.903814+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-a91fce0340f74993b3ace471797f84fa",
+ "chunk_id": "doc-a91fce0340f74993b3ace471797f84fa-c1",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "influenza A(H5) virus has been detected in nine humans in the United States of America (USA)"
+ }
+ ]
+ },
+ {
+ "id": "ins-c970251da78c",
+ "question_id": "q1",
+ "event_type": "other",
+ "confidence": 0.5,
+ "location": "Global",
+ "iso_country_code": null,
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 954.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2003-01-01T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Since 2003, the WHO has counted 954 confirmed human cases of bird flu, of which about half have died.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:49.858968+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-63ae00041a224378aa30a3ad43bb7b7d",
+ "chunk_id": "doc-63ae00041a224378aa30a3ad43bb7b7d-c1",
+ "source_url": "https://www.bbc.com/news/articles/cqx85y07jz9o",
+ "quote": "Since 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died."
+ }
+ ]
+ },
+ {
+ "id": "ins-9bc33a10a1a9",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 61.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-19T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human H5N1 cases since April 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:51.781642+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-aa69aaaf8d8d441281a07c239c037281",
+ "chunk_id": "doc-aa69aaaf8d8d441281a07c239c037281-c0",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "It is the 61st case of human H5N1 bird flu infection in the country since April this year."
+ }
+ ]
+ },
+ {
+ "id": "ins-a6c09bc8ca4d",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 3.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-04-30T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Three human A(H5) cases have been identified to date; all patients had mild illness, were not hospitalized, and fully recovered.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:56.873087+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-970f74dceb574b14a7b0fe450b6c8773",
+ "chunk_id": "doc-970f74dceb574b14a7b0fe450b6c8773-c5",
+ "source_url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7321e1.htm",
+ "quote": "In the United States, three human A(H5) cases have been identified to date; all patients had mild illness, were not hospitalized, and fully recovered."
+ }
+ ]
+ },
+ {
+ "id": "ins-69f9a7baa251",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 2.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-04-01T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Two confirmed human cases of H5N1 reported in dairy farm workers in the U.S.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:56.755679+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-970f74dceb574b14a7b0fe450b6c8773",
+ "chunk_id": "doc-970f74dceb574b14a7b0fe450b6c8773-c3",
+ "source_url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7321e1.htm",
+ "quote": "the Texas Department of State Health Services reported, after confirmation by CDC, that a commercial dairy farm worker tested positive"
+ }
+ ]
+ },
+ {
+ "id": "ins-56d2c848e6c0",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 2.0,
+ "metric_unit": "cases",
+ "count_basis": "unknown",
+ "time_window": "unknown",
+ "surveillance_method": "syndromic and laboratory surveillance",
+ "data_quality": null,
+ "event_date": "2024-05-22T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Two confirmed human cases of A(H5N1) reported in the U.S. as of May 22, 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:11:56.872685+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-970f74dceb574b14a7b0fe450b6c8773",
+ "chunk_id": "doc-970f74dceb574b14a7b0fe450b6c8773-c2",
+ "source_url": "https://www.cdc.gov/mmwr/volumes/73/wr/mm7321e1.htm",
+ "quote": "a second human A(H5) case with conjunctivitis in Michigan, which was reported on May 22, 2024."
+ }
+ ]
+ },
+ {
+ "id": "ins-b488ea400552",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 2.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
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+ "snippet": "CDC is collaborating with the U.S. Department of Agriculture, the Food and Drug Administration, the Administration for Strategic Preparedness and Response, the Health Resources and Services Administration, the National Institute of Allergy and Infectious Diseases, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. One week earlier, the U.S. Department of Agriculture had reported a multistate outbreak of A(H5N1) viruses in dairy cows.\u00a7 A(H5N1) viruses were also detected in barn cats, birds, and other animals (e.g., one raccoon and two opossums) that lived in and around human habitations and that died on affected farms.\u00b6 Genetic sequencing of the A(H5N1) virus from infected cattle and the farm worker** identified clade 2.3.4.4b; this clade has been detected in U.S. wild birds, commercial poultry, backyard flocks, and other animals since January 2022 (2). Top Discussion CDC is collaborating with the U.S. Department of Agriculture, FDA, ASPR, the Health Resources and Services Administration, NIAID, and state and local public health and animal health officials using a coordinated One Health approach to identify and prepare for developments that could increase the risk to human health. CDC considers the current risk to the U.S. public from A(H5N1) viruses to be low; however, persons with exposure to infected animals or contaminated materials, including raw cow\u2019s milk, are at higher risk for A(H5N1) virus infection and should take recommended precautions, including using recommended personal protective equipment, self-monitoring for illness symptoms, and, if they are symptomatic, seeking prompt medical evaluation for influenza testing and antiviral treatment if indicated. Top Corresponding author: Shikha Garg, sgarg1@cdc.gov. Top 1Influenza Division, National Center for Immunization and Respiratory Diseases, CDC; 2One Health Office, National Center for Emerging and Zoonotic Infectious Diseases, CDC; 3Office of Public Health Data, Surveillance, and Technology, CDC; 4National Center for Immunization and Respiratory Diseases, CDC; 5Administration for Strategic Preparedness and Response, Washington, DC. ",
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+ "snippet": "In a study published May 29, the CDC estimated that there was a 72% to 77% chance that current surveillance would detect one human case of H5N1 in an emergency room or urgent care clinic monthly, provided the person had symptoms similar in severity to a case of seasonal flu, and there were at least 100 cases of H5N1 in the population. The data, released Monday by the nonprofit WastewaterSCAN network, showed detections of the H5 protein portion of the flu virus in sewage from 14 water treatment plants in five states, mostly in Texas and Michigan, suggesting that an ongoing outbreak in dairy cattle may largely be confined to states that have already been identified as having affected herds. \u201cWhile these findings indicate that existing flu surveillance systems are likely to detect at least one novel influenza case before the virus has spread widely, CDC is asking that health care providers remain vigilant for signs and symptoms of influenza virus infection over the summer and maintain high rates of testing,\u201d the agency said in a news release.\u00a0 \u201cIn the case of Amarillo in Texas, for example, they had a dairy processing plant that was making processed dairy products, and their waste stream discharges into the wastewater treatment plant because milk, raw milk from the local area, was coming into that plant with H5N1,\u201d Boehm said. But when asked to estimate whether one thousand, tens of thousands or hundreds of thousands of cows had been affected, Deeble said he could not, underscoring the large degree of uncertainty involved in understanding the scope of the outbreak. ",
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+ "snippet": "Breaking Bird Flu (H5N1) Explained: Finland Will Start Vaccinating Humans In A Global First Topline Here\u2019s the latest news about a global outbreak of H5N1 bird flu that started in 2020, and recently spread among cattle in U.S. states and marine mammals across the world, which has health officials closely monitoring it and experts concerned the virus could mutate and eventually spread to humans, where it has proven rare but deadly. May 30Another human case of bird flu has been detected in a dairy farm worker in Michigan\u2014though the cases aren\u2019t connected\u2014and this is the first person in the U.S. to report respiratory symptoms connected to bird flu, though their symptoms are \u201cresolving,\u201d according to the Centers for Disease Control and Prevention. May 14The Centers for Disease Control and Prevention released influenza A waste water data for the weeks ending in April 27 and May 4, and found several states like Alaska, California, Florida, Illinois and Kansas had unusually high levels, though the agency isn\u2019t sure if the virus came from humans or animals, and isn\u2019t able to differentiate between influenza A subtypes, meaning the H5N1 virus or other subtypes may have been detected. May 1The Food and Drug Administration confirmed dairy products are still safe to consume, announcing it tested grocery store samples of products like infant formula, toddler milk, sour cream and cottage cheese, and no live traces of the bird flu virus were found, although some dead remnants were found in some of the food\u2014though none in the baby products. June 5A new study examining the 2023 bird flu outbreak in South America that killed around 17,400 elephant seal pups and 24,000 sea lions found the disease spread between the animals in several countries, the first known case of transnational virus mammal-to-mammal bird flu transmission. ",
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+ "snippet": "Related news USDA experiments suggest H5N1 not viable in properly cooked ground beef CDC launches new influenza A wastewater dashboard; states report more H5N1 in dairy herds Wastewater testing finds H5N1 avian flu in 9 Texas cities Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows This week's top reads Wastewater testing finds H5N1 avian flu in 9 Texas cities Wastewater detections began in early March, and so far sequencing hasn't found any mutations linked to human adaptation. Main navigation Michigan reports 3 more H5N1 outbreaks in dairy herds sarahluv/Flickr cc The Michigan Department of Agriculture and Rural Development (MDRAD) today reported three more H5N1 avian flu outbreaks in dairy herds, noting that it will send results to the US Department of Agriculture (USDA) National Veterinary Services Laboratory (NVSL) for confirmation. CDC boosts flu surveillance, starts pandemic review Meanwhile, in its latest update on its response to the H5N1 outbreaks in dairy herds, the CDC said it is developing a plan for enhanced surveillance over the summer, which will include increasing the number of flu specimens tested and subtyped at public health laboratories. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. In other developments, the Food and Drug Administration (FDA) recently detailed its next steps for monitoring the virus in that nation's milk supply and the Centers for Disease Control and Prevention (CDC) posted an update on its response steps, which includes an evaluation of the dairy outbreak virus with its Influenza Risk Assessment Tool (IRAT). ",
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+ "snippet": "Related news USDA reports reveal biosecurity risks at H5N1-affected dairy farms USDA reports more H5N1 detections in mice and cats Study shows 'not surprising' fatal spread of avian flu in ferrets Man dies after H5N2 avian flu in Mexico; Minnesota reports first case in dairy cow H5 influenza wastewater dashboard launches Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho This week's top reads USDA reports more H5N1 detections in mice and cats Officials reported 36 more detections in mice, as well as 4 more H5N1 positives in cats. Main navigation Studies find little to no immunity to H5N1 avian flu virus in Americans solarseven / iStock The American population has little to no pre-existing immunity to the H5N1 avian flu virus circulating on dairy and poultry farms, according to preliminary findings from ongoing testing by the Centers for Disease Control and Prevention (CDC). Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Also, the Iowa Department of Agriculture and Land Stewardship, in two separate statements, has reported three more outbreaks in dairy herds, two more in\u00a0Sioux County and one in\u00a0Plymouth County, both in the northwestern part of the state. The vaccine was developed by Seqirus UK, Ltd. Dairy herd outbreaks top 100; virus infects more poultry The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) has\u00a0confirmed 6 more H5N1 outbreaks in dairy herds, lifting the US total to 102.",
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+ "snippet": "Related news H5N1 strikes dairy herd in Michigan, large poultry farm in Colorado Animal experiments shed more light on behavior of H5N1 from dairy cows CDC confirms 4th human case of H5N1 avian flu as more dairy herds in Colorado hit HHS awards Moderna $176 million to develop mRNA H5 avian flu vaccine More evidence pasteurization inactivates H5N1 avian flu virus in milk USDA spells out financial assistance to offset H5N1-linked milk losses Scientists expand H5N1 testing in dairy products, launch human serology study Experiments show H5N1 risk to dairy cows not exclusive to subtype infecting US herds This week's top reads CDC confirms 4th human case of H5N1 avian flu as more dairy herds in Colorado hit The infected farm worker is from Colorado, which has had the most affected dairy herds in the past month. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation H5N1 confirmed in 5 more US dairy herds, more cats Khaligo/iStock The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today added five more dairy herds in three states to its list of H5N1 avian flu outbreak confirmations. H5N1 confirmed in 5 more US dairy herds, more cats The additional cat detections are from 2 states battling the virus in cows: Minnesota and Michigan. More cat and wild-bird positives In related developments, APHIS confirmed H5N1 detections in three more domestic cats, two from Minnesota and one from Michigan, raising the total since 2022 to 33. ",
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+ "snippet": "In other developments: Related news Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows Case report bolsters evidence for H5N1 avian flu spread from cow to Texas dairy worker USDA genome study sheds light on H5N1 avian flu spillover to cows, but data gaps remain FDA finds no live H5N1 avian flu virus in sour cream or cottage cheese, will assess raw milk This week's top reads Study: HHS's COVID vaccine campaign saved $732 billion in averted infections, costs Researchers say the campaign encouraged 22 million Americans to complete their primary COVID-19 vaccine series, preventing nearly 2.6 million infections. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation Wastewater testing finds H5N1 avian flu in 9 Texas cities varius-studios/ iStock Researchers who sequenced viruses from wastewater samples from 10 Texas cities found H5N1 avian flu virus in 9 of them, sometimes at levels that rivaled seasonal flu. On X, Mike Tisza, PhD, the first author of the study and assistant professor of virology and microbiology at Baylor, said it's still not clear where the viruses came from, but the evidence tilts toward an animal source, because the researchers didn't see any mutations with known links to human adaptation. Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals Monitoring of about 70 farm workers found no symptoms, and the state's wastewater sampling pilot has found no flu rise. ",
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+ "title": "HHS advances plan to produce 4.8 million H5N1 vaccine doses - University of Minnesota Twin Cities",
+ "snippet": "Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation HHS advances plan to produce 4.8 million H5N1 vaccine doses Response (ASPR) at the US Department of Health and Human Services (HHS) said officials are moving forward with a plan to produce 4.8 million doses of H5N1 avian flu vaccine for pandemic preparedness. \" Surveillance study describes incidence of multidrug-resistant infections in US children A surveillance\u00a0study found that carbapenem-resistant Enterobacterales (CRE) infections occur less frequently than extended-spectrum beta-lactamase\u2013producing Enterobacterales (ESBL-E) infections in US children, researchers reported today in Emerging Infectious Diseases. HHS advances plan to produce 4.8 million H5N1 vaccine doses Officials have identified a fill-and-finish opening on a production line at a vaccine company partner and said the activity won't disrupt the supply of seasonal flu vaccine. Led by researchers with the Centers for Disease Control and Prevention's Emerging Infections Program (EIP), the surveillance study analyzed CRE incidence in children in 10 states from 2016 through 2020 and ESBL-E incidence in children in six states from 2019 through 2020.",
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+ "snippet": "In addition to being the first case not linked to contact with a sick animal, Missouri officials said that the case was the first detected using the state's flu surveillance system, rather than protocol specifically tailored to detect H5N1 cases related to the recent outbreak in livestock like dairy cows and poultry. The latest infection makes Missouri the fourth U.S. state with a human case this year. The following map created by Newsweek shows that all of this year's human H5N1 cases have been limited to Colorado, Texas, Michigan and Missouri: No cases of human-to-human transmission have ever been detected in the U.S. In humans, bird flu can range in severity from no symptoms to mild symptoms like eye infections or upper respiratory illness.",
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+ "snippet": "Flu cases 2025: Levels have increased to highest in 15 years, CDC says Flu cases surge to highest levels in 15 years, CDC says There are 12 states in the U.S. that have \"'very high\" flu activity, according to the CDC. For the first time this flu season, overall levels of the respiratory illness have reached \"very high\" activity despite a decrease in COVID-19 infections in recent months, according to the CDC. One of the states where flu levels are growing is Kentucky, where the probability of an influenza epidemic is growing\u00a0by 92.45%, the CDC said. The CDC still considers the\u00a0general population at \"low\" risk\u00a0for catching bird flu, but one 65-year-old Louisiana resident with complicating health conditions did die from the disease.",
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+ "title": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms - Livescience.com",
+ "snippet": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms This infection, tied to an ongoing outbreak in cows, is the first in the U.S. to cause respiratory symptoms, but not the first H5N1 case in the world to do so. Related: H5N1: What to know about the bird flu cases in cows, goats and people \"This is the first human case of H5 in the United States to report more typical symptoms of acute respiratory illness associated with influenza virus infection, including A(H5N1) viruses,\" the CDC reported. H5N1 bird flu has spread to human from cow in 2nd probable case, CDC reports H5N1: What to know about the bird flu cases in cows, goats and people China lands Chang'e 6 sample-return probe on far side of the moon Live Science is part of Future US Inc, an international media group and leading digital publisher. \u201421-year-old student dies of H5N1 bird flu in Vietnam \u20141st polar bear death from bird flu spells trouble for species \u2014China reported 1st human death from H3N8 bird flu, WHO says With that possibility in mind, the CDC continues to closely monitor for unusual flu activity across the country. A third human case of bird flu has been linked to the ongoing outbreak in cows on U.S. dairy farms \u2014 and this one came with respiratory symptoms, such as cough, the Centers for Disease Control and Prevention (CDC) reported May 30. ",
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+ "snippet": "The Centers for Disease Control and Prevention and the Food and Drug Administration will use the funding to detect and track the virus, called H5N1, that\u2019s been spreading in wild birds, poultry and domestic cows, according to a statement Friday. This is a subscriber only feature Subscribe Now to get daily updates on WhatsApp Open Demat Account and Get Best Offers Start Investing in Stocks, Mutual Funds, IPOs, and more I'm interested in opening a Trading and Demat Account and am comfortable with the online account opening process. US Health Officials to Spend $100 Million on Bird Flu Surveillance US health officials are putting more than $100 million toward ramping up surveillance of bird flu in cattle and people amid rising concerns that the outbreak has spread more widely than reported. While just one H5N1 infection has been recorded in a person in the US so far, scientists have cautioned that virus has the potential to mutate into something far more transmissible and dangerous. One in five milk samples contains fragments of the avian flu virus, the agency said in April, but pasteurization kills it. Tests for live virus in eggs have been negative, the FDA said.",
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+ "text": "This map is updated each weekday to depict the number of new confirmed cases in livestock in the last 30 days and the cumulative number of confirmed cases in livestock by State.\nFor information related to the National Milk Testing Strategy, visit Testing.\nUsers may need to refresh the page to see the latest map and table data. To refresh the page, hold down the SHIFT key and click the Reload Page button in the upper left corner of your browser. You can also use SHIFT+F5 on your keyboard.",
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+ "text": "\u2022 H5 bird flu is widespread in wild birds worldwide and is causing outbreaks in poultry and U.S. dairy cows with several recent human cases in U.S. dairy and poultry workers.\n\u2022 While the current public health risk is low, CDC is watching the situation carefully and working with states to monitor people with animal exposures.\n\u2022 CDC is using its flu surveillance systems to monitor for H5 bird flu activity in people.",
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+ "text": "When a case tests positive for H5 at a public health laboratory but testing at CDC is not able to confirm H5 infection, per Council of State and Territorial Epidemiologists (CSTE) guidance, a case is reported as probable.\nConfirmed and probable cases are typically updated by 5 PM EST on Mondays (for cases confirmed by CDC on Friday, Saturday, or Sunday), Wednesdays (for cases confirmed by CDC on Monday or Tuesday), and Fridays (for cases confirmed by CDC on Wednesday and Thursday). Affected states may report cases more frequently.",
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+ "text": "\u2022 12,064 wild birds detected as of 2/18/2025 | Full Report\n\u2022 51 jurisdictions with bird flu in wild birds\n\u2022 162,586,638 poultry affected as of 2/18/2025 | Full Report\n\u2022 51 jurisdictions with outbreaks in poultry\n\u2022 972 dairy herds affected as of 2/18/2025 | Full Report\n\u2022 16 states with outbreaks in dairy cows\nThese data will be updated daily, Monday through Friday, after 4 p.m. to reflect any new data.\nCumulative data on wild birds have been collected since January 20, 2022. Cumulative data on poultry have been collected since February 8, 2022. Cumulative data on humans in the U.S. have been collected since April 28, 2022. Cumulative data on dairy cattle have been collected since March 25, 2024.",
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+ "text": "Birds are the natural hosts for avian influenza viruses. Avian influenza refers to an infectious disease of birds caused by infection with avian influenza viruses. Avian influenza viruses can also infect non-avian species including wild and domestic (including companion and farmed) terrestrial and marine mammals. Avian influenza viruses primarily spread from infected birds to humans through close contact with birds or contaminated environments, such as in backyard poultry farm settings and at markets where birds are sold.\nThere have also been limited reports of transmission from other infected animals to humans.\nSwine influenza is a respiratory disease of pigs caused by influenza A viruses. Most swine influenza viruses do not cause disease in humans, but some countries have reported cases of human infection from certain swine influenza viruses. Close proximity to infected pigs or visiting locations where pigs are exhibited has been reported for most human cases, but some limited human-to-human transmission has occurred.\nJust like birds and pigs, other animals such as horses and dogs, can be infected with their own influenza viruses (canine influenza viruses, equine influenza viruses, etc.).\nDive in\nTechnical guidance",
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+ "text": "Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nInfluenza Investigations & Studies (Unity Studies)",
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+ "text": "Clinical care of severe acute respiratory infections \u2013 Tool kit\nGuidelines for the clinical management of severe illness from influenza virus infections",
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+ "text": "Five keys to safer food manual",
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+ "text": "Training materials",
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+ "text": "\u2022\nNew human cases 1 2 : From 13 December 2024 to 20 January 2025, the detection of influenza\nA(H5) virus in five humans, influenza A(H9N2) virus in two humans, and influenza A(H10N3) virus\nin one human were reported officially. Additionally, five human cases of infection with influenza\nA(H5) viruses were detected.\n\u2022\nCirculation of influenza viruses with zoonotic potential in animals: High pathogenicity avian\ninfluenza (HPAI) events in poultry and non-poultry continue to be reported to the World\nOrganisation for Animal Health (WOAH). 3 The Food and Agriculture Organization of the United\nNations (FAO) also provides a global update on avian influenza viruses with pandemic potential. 4\n\u2022\nRisk assessment 5 : Based on information available at the time of the risk assessment, the overall\npublic health risk from currently known influenza viruses at the human-animal interface has not\nchanged remains low. Sustained human to human transmission has not been reported from\nthese events and the occurrence of sustained human-to-human transmission of these viruses is\ncurrently considered unlikely. Although human infections with viruses of animal origin are\ninfrequent, they are not unexpected at the human-animal interface.\n\u2022\nIHR compliance: All human infections caused by a new influenza subtype are required to be\nreported under the International Health Regulations (IHR, 2005). 6 This includes any influenza A\nvirus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or\nprotein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human\npopulation. Information from these notifications is critical to inform risk assessments for\ninfluenza at the human-animal interface.\nAvian influenza viruses in humans\nCurrent situation:\nSince the last risk assessment of 12 December 2024, influenza A(H5) virus has been detected in nine\nhumans in the United States of America (USA) and one laboratory-confirmed human case of A(H5N1)\ninfection was reported to WHO from Cambodia.\n1 This summary and assessment covers information confirmed during this period and may include information\nreceived outside of this period.\n2 For epidemiological and virological features of human infections with animal influenza viruses not reported in\nthis assessment, see the reports on human cases of influenza at the human-animal interface published in the\nWeekly Epidemiological Record here .\n3 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n4 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .\n5 World Health Organization (2012). Rapid risk assessment of acute public health events. World Health\nOrganization. Available at: https://iris.who.int/handle/10665/70810 .\n6 World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all\ncircumstances under the International Health Regulations (2005). Case definitions for the four diseases\nrequiring notification in all circumstances under the International Health Regulations (2005).",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "2\nA(H5), USA\nOn 14 December 2024, the USA notified WHO of one laboratory-confirmed human case of infection\nwith influenza A(H5) in an adult aged over 65 years from the state of Louisiana. The patient, with\nunderlying conditions, developed symptoms and sought care at an emergency department in early\nDecember 2024. Due to worsening symptoms, the patient returned to the emergency department a\nfew days later, was hospitalized in critical condition with pneumonia, and started on antiviral\ntreatment. Unfortunately, the patient passed away. No household contacts of the case tested\npositive for influenza viruses. The individual owned backyard poultry and had noted deaths in\ndomestic and wild birds on the property prior to symptom onset. A(H5N1) viruses were detected in\npoultry on the property.\nThe viruses identified in two clinical samples from the patent were identified as influenza A(H5N1)\nviruses belonging to the clade 2.3.4.4b and the genotype D1.1. Deep sequencing of the genetic\nsequences from the two clinical specimens were compared to A(H5N1) virus sequences from dairy\ncows, wild birds, poultry and other human cases in the USA and Canada. The hemagglutinin (HA)\ngene sequences of the viruses from the clinical specimens are closely related to other D1.1 viruses\nrecently detected in wild birds and poultry in the Louisiana and other parts of the USA and in recent\nhuman cases detected in Canada and the USA, as well as to existing influenza A(H5N1) candidate\nvaccine viruses. 7\nSome changes in the HA gene segment of one of the clinical specimens from the patient were\ndetected at a low frequency. These changes have rarely been identified in specimens from previous\nhuman infections with A(H5N1) viruses and were not detected in specimens from the poultry on the\nproperty of the patient. It is possible that these changes arise during viral replication in the infected\nhuman cases. No changes in the polymerase genes associated with adaptation to mammals were\nidentified. No changes associated with known or suspected markers of reduced susceptibility to\nantiviral drugs were identified. 8 , 9 , 10\nBetween 20 and 21 December 2024, the USA notified WHO of two additional laboratory-confirmed\nhuman case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin. The\ncases developed symptoms in December 2024 and reported their illness to public health officials as\npart of active monitoring. The cases were not hospitalized and have recovered. Both cases were\nexposed to influenza A(H5N1) while working at poultry facilities.\nOn 15 January 2025, the USA notified WHO of one additional laboratory-confirmed human case of\ninfection with influenza A(H5) from the state of California. The case occurred in a child less than 18\nyears old with no known contact with influenza A(H5N1) virus-infected animals or humans. The\ninvestigation into the source of infection and contact monitoring around this case was ongoing at\nthe time of reporting, and thus far, no human-to-human transmission has been identified. Additional\n7 WHO. Zoonotic influenza: candidate vaccine viruses and potency testing reagents. Available at:\nhttps://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations/zoonotic-\ninfluenza-viruses-and-candidate-vaccine-viruses .\n8 US CDC. CDC Confirms First Severe Case of H5N1 Bird Flu in the United States, 18 Dec 2024. Available at:\nhttps://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html .\n9 US CDC. Genetic Sequences of Highly Pathogenic Avian Influenza A(H5N1) Viruses Identified in a Person in\nLouisiana, 26 Dec 2024. Available at: https://www.cdc.gov/bird-flu/spotlights/h5n1-response-12232024.html .\n10 US CDC. First H5 Bird Flu Death Reported in United States, 6 Jan 2025. Available at:\nhttps://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html .",
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+ "text": "3\nanalysis including genetic sequencing of the virus from the specimen from this case was underway at\nthe time of reporting. 11\nFive additional cases of influenza A(H5) were detected in California in individuals aged over 18 years\nwho worked at commercial dairy cattle farms in areas where highly pathogenic avian influenza\n(HPAI)(H5N1) viruses had been detected in cows. The individuals had mild symptoms. 12 , 13\nLow pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds\nin the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and\nbackyard flocks in 48 states, impacting over 100 million birds. To date, 67 people have tested\npositive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in\n2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy\ncattle, except for two cases where the exposure source could not be identified. 14 To date, no human-\nto-human transmission of influenza A(H5) virus has been identified in the USA. A(H5N1) virus\ninfections in dairy cattle and wild and domestic birds continue to be reported in the USA. 15\nA(H5N1), Cambodia\nOn 10 January 2025, Cambodia notified WHO of one case of human infection with influenza A(H5N1)\nin a 28-year-old male from Kampong Cham Province. The case had onset of fever, sore throat and\nchest pain on 1 January 2025. He sought care at two private local clinics and after his condition did\nnot improve, he traveled to Phnom Penh and was hospitalized due to shortness of breath on 7\nJanuary at a national hospital, which is a severe acute respiratory infection (SARI) sentinel site. The\ncase was isolated upon admission and provided oseltamivir and symptomatic treatment before\npassing away on 10 January. Nasopharyngeal (NP) and oropharyngeal (OP) swab specimens tested\npositive on 9 January for influenza A(H5N1) by real-time reverse transcription-polymerase chain\nreaction (rt-PCR) at the National Institute of Public Health of Cambodia. The Institut Pasteur du\nCambodge (IPC) confirmed the results on 10 January. Sequence analysis of HA gene shows the virus\nbelongs to clade 2.3.2.1c and is closely related to those viruses circulating among birds in Cambodia\nin 2024. Phylogenetic and molecular analysis is ongoing.\nAccording to the early investigation, the case was a guard of a farm in the village where he lived and\nraised poultry for family consumption. There were reports of sick poultry in his farm and samples\nfrom the poultry on the farm have been collected. No further cases were detected among the\ncontacts of the case.\nAccording to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in\nwild and domestic birds in the Americas, Asia and Europe. Infections in non-human mammals are\n11 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 2, ending January 11, 2025.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2025-week-02.html.\n12 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 50, ending December 14, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-50.html .\n13 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 51, ending December 21, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-51.html .\n14 United States Centers for Disease Control and Prevention. H5 Bird Flu: Current Situation. Available at:\nhttps://www.cdc.gov/bird-flu/situation-\nsummary/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbird-flu%2Fphp%2Favian-flu-\nsummary%2Findex.html .\n15 United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock,\n19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-\ndetections/livestock .",
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+ "text": "4\nalso reported, including in marine and land mammals. 16 A list of bird and mammalian species\naffected by HPAI A(H5) viruses is maintained by FAO. 17\nRisk Assessment for avian influenza A(H5) viruses:\n1. What is the current global public health risk of additional human cases of infection with avian\ninfluenza A(H5) viruses?\nMost human cases so far have been infections in people exposed to A(H5) viruses, for example,\nthrough contact with infected poultry or contaminated environments, including live poultry markets,\nand occasionally infected mammals and contaminated environments. While the viruses continue to\nbe detected in animals and related environments humans are exposed to, further human cases\nassociated with such exposures are expected but unusual. The impact for public health if additional\ncases are detected is minimal. The current overall global public health risk of additional human cases\nis low.\n2. What is the likelihood of sustained human-to-human transmission of currently circulating avian\ninfluenza A(H5) viruses?\nNo sustained human-to-human transmission has been identified associated with the recent reported\nhuman infections with avian influenza A(H5). There has been no reported human-to-human\ntransmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007\nand the years prior, small clusters of A(H5) virus infections in humans were reported, including some\ninvolving health care workers, where limited human-to-human transmission could not be excluded;\nhowever, sustained human-to-human transmission was not reported.\nAvailable evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to\nefficiently transmit between people, therefore the likelihood of sustained human-to-human\ntransmission is thus currently considered unlikely at this time.\n3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community-\nlevel spread is considered unlikely as current evidence suggests these viruses have not acquired the\nability to transmit easily among humans.\nA(H9N2), China\nSince the last risk assessment of 12 December 2024, two human cases of infection with A(H9N2)\ninfluenza viruses were notified to WHO from China (Table 1). Both cases were detected through\ninfluenza-like illness (ILI) surveillance, were mild and have recovered. Both cases had a history of\nexposure to live poultry markets prior the onset of symptoms. No further cases were detected\namong contacts of the cases. Influenza A(H9) virus was detected in the poultry-related environments\nassociated with these cases.\n16 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n17 Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential/bird-species-affected-by-h5nx-hpai/en .",
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+ "text": "Onset date\tReporting province\tAge (years)\tGender\tHospitalization date\n27 Nov 2024\tHubei\t8\tFemale\tNot hospitalized\n13 Dec 2024\tChongqing\t1\tFemale\t14 Dec 2024",
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+ "text": "Onset date\nReporting province\nAge (years)\nGender\nHospitalization date\n27 Nov 2024\nHubei\n8\nFemale\nNot hospitalized\n13 Dec 2024\nChongqing\n1\nFemale\n14 Dec 2024\nRisk Assessment for avian influenza A(H9N2):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H9N2) viruses?\nMost human cases follow exposure to the A(H9N2) virus through contact with infected poultry or\ncontaminated environments. Most human infections of A(H9N2) to date have resulted in mild\nclinical illness in most cases. Nearly 130 human infections with A(H9N2) cases have been reported to\ndate since 2003, and six of these have been severe or fatal and three of these were known to have\nunderlying medical conditions. Since the virus is endemic in poultry in multiple continues in Africa\nand Asia 18 , further human cases associated with exposure to infected poultry are expected but\nremain unusual. The impact to public health if additional cases are detected is minimal. The overall\nglobal public health risk of additional human cases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H9N2)\nviruses?\nAt the present time, no sustained human-to-human transmission has been identified associated with\nthe event described above. Current evidence suggests that influenza A(H9N2) viruses from these\ncases have not acquired the ability of sustained transmission among humans, therefore sustained\nhuman-to-human transmission is thus currently considered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely as current evidence suggests the A(H9N2) virus subtype has not\nacquired the ability to transmit easily among humans.\nA(H10N3), China\nSince the last risk assessment of 12 December 2024, one human case of infection with A(H10N3)\ninfluenza viruses were notified to WHO from China on 3 January 2025. A 23-year-old female from\nGuangxi Zhuang Autonomous Region, with an underlying condition, had symptom onset on 12\nDecember 2024. She was admitted to hospital on 19 December with severe pneumonia and treated\nwith oseltamivir. Initially, she was in critical condition but has improved. A clinical sample collected\non 22 December tested positive for influenza A and influenza A(H10N3) was confirmed a on 26\nDecember. Prior to symptom onset, the patient worked at a supermarket and was exposed to freshly\nslaughtered poultry. No family members have developed symptoms at the time of reporting. All\nclose contacts tested negative for influenza A(H10N3). All environmental samples collected from\nvarious locations tested negative for influenza A(H10N3).\nThis is the fourth case of human A(H10N3) virus infection detected in China and globally to date.\n18 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "6\nRisk Assessment for avian influenza A(H10N3):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H10N3) viruses?\nHuman infections with avian influenza A(H10) viruses have been detected and reported previously.\nThe extent of circulation and epidemiology of these viruses in birds is unclear. Avian influenza\nA(H10N3) viruses with different genetic characteristics have been detected previously in migratory\nand other wild birds since the 1970s. As long as the virus continues to circulate in birds, further\nhuman cases can be expected but remain unusual. The impact to public health if additional sporadic\ncases are detected is minimal. The overall global public health risk of additional sporadic human\ncases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H10N3)\nviruses?\nNo sustained human-to-human transmission has been identified associated with the event described\nAbove or past events with human cases of influenza A(H10N3) viruses. Current epidemiologic and\nvirologic evidence suggests that contemporary influenza A(H10N3) viruses assessed by the Global\nInfluenza Surveillance and response System (GISRS) have not acquired the ability of sustained\ntransmission among humans, therefore sustained human-to-human transmission is thus currently\nconsidered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H10N3) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely based on current limited evidence.\nOverall risk management recommendations:\nSurveillance and investigations\n\u2022\nDue to the constantly evolving nature of influenza viruses, WHO continues to stress the\nimportance of global strategic surveillance in animals and humans to detect virologic,\nepidemiologic and clinical changes associated with circulating influenza viruses that may affect\nhuman (or animal) health. Continued vigilance is needed within affected and neighbouring areas\nto detect infections in animals and humans. Close collaboration with the animal health and\nenvironment sectors is essential to understand the extent of the risk of human exposure and to\nprevent and control the spread of animal influenza.\n\u2022\nAs the extent of influenza virus circulation in animals is not clear, epidemiologic and virologic\nsurveillance and the follow-up of suspected human cases should continue systematically.\nGuidance on investigation of non-seasonal influenza and other emerging acute respiratory\ndiseases has been published on the WHO website.\n\u2022\nCountries should increase avian influenza surveillance in domestic and wild birds, enhance\nsurveillance for early detection in cattle populations in countries where HPAI is known to be\ncirculating, include HPAI as a differential diagnosis in non-avian species, including cattle and\nother livestock populations, with high risk of exposure to HPAI viruses; monitor and investigate\ncases in non-avian species, including livestock, report cases of HPAI in all animal species,\nincluding unusual hosts, to WOAH and other international organizations, share genetic\nsequences of avian influenza viruses in publicly available databases, implement preventive and\nearly response measures to break the HPAI transmission cycle among animals through\nmovement restrictions of infected livestock holdings and strict biosecurity measures in all",
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+ "text": "7\nholdings, employ good production and hygiene practices when handing animal products, and\nprotect persons in contact with suspected/infected animals. 19\n\u2022\nWhen there has been human exposure to a known outbreak of an influenza A virus in domestic\npoultry, wild birds or other animals \u2013 or when there has been an identified human case of\ninfection with such a virus \u2013 enhanced surveillance in potentially exposed human populations\nbecomes necessary. Enhanced surveillance should consider the health care seeking behaviour of\nthe population, and could include a range of active and passive health care and/or community-\nbased approaches, including: enhanced surveillance in local influenza-like illness (ILI)/SARI\nsystems, active screening in hospitals and of groups that may be at higher occupational risk of\nexposure, and inclusion of other sources such as traditional healers, private practitioners and\nprivate diagnostic laboratories.\n\u2022\nVigilance for the emergence of novel influenza viruses of pandemic potential should be\nmaintained at all times including during a non-influenza emergency. In the context of the co-\ncirculation of SARS-CoV-2 and influenza viruses, WHO has updated and published practical\nguidance for integrated surveillance .\nNotifying WHO\n\u2022\nAll human infections caused by a new subtype of influenza virus are notifiable under the\nInternational Health Regulations (IHR, 2005). 20 State Parties to the IHR (2005) are required to\nimmediately notify WHO of any laboratory-confirmed 5 21 case of a recent human infection caused\nby an influenza A virus with the potential to cause a pandemic 6 22 . Evidence of illness is not\nrequired for this report.\n\u2022\nWHO published the case definition for human infections with avian influenza A(H5) virus\nrequiring notification under IHR (2005): https://www.who.int/teams/global-influenza-\nprogramme/avian-influenza/case-definitions .\nVirus sharing and risk assessment\n\u2022\nIt is critical that these influenza viruses from animals or from people are fully characterized in\nappropriate animal or human health influenza reference laboratories. Under WHO\u2019s Pandemic\nInfluenza Preparedness (PIP) Framework, Member States are expected to share influenza viruses\nwith pandemic potential on a timely basis 23 with a WHO Collaborating Centre for influenza of\nGISRS. The viruses are used by the public health laboratories to assess the risk of pandemic\ninfluenza and to develop candidate vaccine viruses.\n\u2022\nThe Tool for Influenza Pandemic Risk Assessment (TIPRA) provides an in-depth assessment of\nrisk associated with some zoonotic influenza viruses \u2013 notably the likelihood of the virus gaining\nhuman-to-human transmissibility, and the impact should the virus gain such transmissibility.\nTIPRA maps relative risk amongst viruses assessed using multiple elements. The results of TIPRA\ncomplement those of the risk assessment provided here, and those of prior TIPRA analyses will\nbe published at http://www.who.int/teams/global-influenza-programme/avian-influenza/tool-\nfor-influenza-pandemic-risk-assessment-(tipra) .\n19 World Organisation for Animal Health. Statement on High Pathogenicity Avian Influenza in Cattle, 6\nDecember 2024. Available at: https://www.woah.org/en/high-pathogenicity-avian-influenza-hpai-in-cattle/ .\n20 World Health Organization. Case definitions for the four diseases requiring notification in all\ncircumstances under the International Health Regulations (2005).\n21 World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza\n(2011). Available at: https://apps.who.int/iris/handle/10665/44518\n22 World Health Organization. Pandemic influenza preparedness framework for the sharing of influenza viruses\nand access to vaccines and other benefits, 2 nd edition. Available at: https://iris.who.int/handle/10665/341850\n23 World Health Organization. Operational guidance on sharing influenza viruses with human pandemic\npotential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework (2017). Available at:\nhttps://apps.who.int/iris/handle/10665/25940",
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+ "text": "8\nRisk reduction\n\u2022\nGiven the observed extent and frequency of avian influenza in poultry, wild birds and some wild\nand domestic mammals, the public should avoid contact with animals that are sick or dead from\nunknown causes, including wild animals, and should report dead birds and mammals or request\ntheir removal by contacting local wildlife or veterinary authorities.\n\u2022\nEggs, poultry meat and other poultry food products should be properly cooked and properly\nhandled during food preparation. Due to the potential health risks to consumers, raw milk\nshould be avoided. WHO advises consuming pasteurized milk. If pasteurized milk isn\u2019t available,\nheating raw milk until it boils makes it safer for consumption.\n\u2022\nWHO has published practical interim guidance to reduce the risk of infection in people exposed\nto avian influenza viruses.\nTrade and travellers\n\u2022\nWHO advises that travellers to countries with known outbreaks of animal influenza should avoid\nfarms, contact with animals in live animal markets, entering areas where animals may be\nslaughtered, or contact with any surfaces that appear to be contaminated with animal excreta.\nTravelers should also wash their hands often with soap and water. All individuals should follow\ngood food safety and hygiene practices.\n\u2022\nWHO does not advise special traveller screening at points of entry or restrictions with regards to\nthe current situation of influenza viruses at the human-animal interface. For recommendations\non safe trade in animals and related products from countries affected by these influenza viruses,\nrefer to WOAH guidance.\nLinks:\nWHO Human-Animal Interface web page\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza\nWHO Influenza (Avian and other zoonotic) fact sheet\nhttps://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)\nWHO Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nhttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.2\nWHO Public health resource pack for countries experiencing outbreaks of influenza in animals:\nhttps://www.who.int/publications/i/item/9789240076884\nCumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus\nAvian Influenza A(H7N9) Information\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-influenza-a-( h7n9 )-\nvirus\nWorld Organisation of Animal Health (WOAH) web page: Avian Influenza\nhttps://www.woah.org/en/home/\nFood and Agriculture Organization of the United Nations (FAO) webpage: Avian Influenza\nhttps://www.fao.org/animal-health/avian-flu-qa/en/\nOFFLU\nhttp://www.offlu.org/",
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+ "text": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic.\nThe severe case involves a resident of southwestern Louisiana who was reported as presumptively positive for infection last Friday. The infected patient \u201cis experiencing severe respiratory illness related to H5N1 infection and is currently hospitalized in critical condition,\u201d according to Emma Herrock, a spokesperson for the Louisiana Department of Health, who said that the patient is over the age of 65 and has underlying medical conditions but that further updates on their condition will not be given at this time due to patient confidentiality.\nRead More: What Are the Symptoms of Bird Flu?\nIt is the 61st case of human H5N1 bird flu infection in the country since April this year. But the CDC said the overall risk of the pathogen to the public remains low, and no related deaths have been reported in the U.S. so far.\nHere\u2019s what to know.",
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+ "text": "The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins.\nOf the 60 other cases, 58 were linked to commercial agriculture\u201437 from dairy herds and 21 from poultry farms and culling. The sources of exposure for the two other U.S. human cases remain unknown.",
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+ "heading": "What caused the severe infection?",
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+ "text": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California, with all but one exposed to cattle. In response, Governor Gavin Newsom on Dec. 18 declared a state of emergency.\nThe CDC said that such a \u201csevere\u201d infection as was found in Louisiana was expected given cases in other countries. In Vietnam, a patient who died in March after a diagnosis of \u201csevere pneumonia, severe sepsis, and acute respiratory distress syndrome\u201d was found with an H5N1 infection, according to the World Health Organization. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.\nRead More: The Bird Flu Virus Is One Mutation Away from Getting More Dangerous\nAccording to Mark Mulligan, Director of the Vaccine Center and the Division of Infectious Diseases and Immunology at New York University Grossman School of Medicine, the general population faces \u201cno immediate threat.\u201d Those who are in contact with birds and animals\u2014especially those who work on dairy farms and cattle farms\u2014are at greatest risk. Currently, no person to person spread of the virus has been detected.\n\u201cRight now we have to let the experts do surveillance, do sequencing of the virus to see if we're seeing any changes that portend any significant difference,\u201d says Mulligan.",
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+ "text": "According to the CDC, symptoms of the bird flu can vary. Many of the cases in the U.S. included symptoms resembling conjunctivitis-like eye issues, including eye redness, discomfort, and discharge.\nSome cases also included both respiratory classic flu-like symptoms, including cough, headache, runny nose, fever, sore throat, body aches, fatigue, shortness of breath, and pneumonia, according to the CDC.\nRead More: What Are the Symptoms of Bird Flu?",
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+ "text": "The CDC issued a number of protective measures, including largely avoiding direct contact with wild birds and other suspected infected animals as well as their bodily excretions. People who work with cattle and poultry on affected farms have a greater risk of infection, and are thus advised to monitor any possible symptoms of infection.\nThe CDC also recommends that those who work with poultry or other animals use the correct personal protective equipment (PPE)\u2014including coveralls, boots, and more\u2014which should be provided by employers.\nVirologist and professor at John Hopkins University Andy Pekosz says that the severe case in Louisiana provides a reminder of an easy way to stay safe: stay away from dead animals. \u201cYou see a dead animal, if you're exposed to dead animals, stay away,\u201d he says. \u201cIn many ways, it is the least likely way someone can get exposed, but in some ways, it's also one of the more preventable ways.\u201d\nProperly cooked poultry and poultry products are safe, and the CDC says that while unpasteurized (raw) milk from infected cows can pose risks to humans, it\u2019s not yet known if avian influenza viruses can be transmitted through its consumption.\nBoth Mulligan and Pekosz say it is also important to get the seasonal human influenza vaccine. They say if there were to be a case of a person with simultaneous bird flu and human flu infection, it could lead to a \u201creassortment\u201d and thus a virus that could be more easily spread.\n\u201cWe know that has happened before, because the 1957 influenza pandemic and the 1968 influenza pandemic both were a result of a human and a bird influenza virus exchanging genetic material,\u201d Pekosz says. \u201cWe know that the flu vaccines are not perfect, but they do a good job of reducing infection.\u201d\nThe CDC currently has a program to offer seasonal vaccines to farm workers in high risk scenarios in certain states.",
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+ "text": "\u2022 L.A. Fires Show Reality of 1.5\u00b0C of Warming\n\u2022 Behind the Scenes of The White Lotus Season Three\n\u2022 How Trump 2.0 Is Already Sowing Confusion\n\u2022 Bad Bunny On Heartbreak and New Album\n\u2022 How to Get Better at Doing Things Alone\n\u2022 We\u2019re Lucky to Have Been Alive in the Age of David Lynch\n\u2022 The Motivational Trick That Makes You Exercise Harder\n\u2022 Column: All Those Presidential Pardons Give Mercy a Bad Name\nContact us at letters@time.com",
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+ "text": "A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States.\nThe agency said Wednesday that the person was exposed to sick and dead birds in backyard flocks; this is the first US bird flu case linked to a backyard flock.\n\u201cIt is believed that the patient that was reported by Louisiana had exposure to sick or dead birds on their property. These are not commercial poultry, and there was no exposure to dairy cows or their related products,\u201d said Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC.\nFederal officials declined to answer questions about the patient\u2019s symptoms or their current condition. They instead referred all inquiries about the case to the Louisiana Department of Health, which is leading the investigation.\nAccording to state officials, the patient is experiencing severe respiratory illness related to H5N1 and is hospitalized in critical condition. The person is older than 65 and has underlying medical conditions that increased their risk of flu complications, the Louisiana Department of Health said in an email to CNN.\nThis virus, D1.1, is the same type found in recent human cases in Canada and Washington state and detected in wild birds and poultry in the United States. It\u2019s different from B3.13, the type detected in dairy cows, some poultry outbreaks and other cases in humans across the United States.\nThe CDC said it\u2019s working on additional genomic sequencing of samples from the patient, who is from southwestern Louisiana, and the investigation into the patient\u2019s exposure is still underway.\nBird flu has been linked with severe human illness and death in other countries, but no person-to-person spread has been detected.\n\u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the agency said in a statement.\nIn California, Gov. Gavin Newsom declared a state of emergency Wednesday over the continued spread of H5N1 bird flu in that state.",
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+ "text": "\u2022 Sign up here to get The Results Are In with Dr. Sanjay Gupta every Friday from the CNN Health team.\nNewsom said the measure was necessary because, despite intense efforts to contain it, the virus had spread beyond the Central Valley to four dairies in the southern part of the state.\n\u201cThis proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,\u201d he said in a news release. \u201cWhile the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus.\u201d\nThe emergency declaration will give state agencies greater flexibility with staffing and free up more funding for the response.\nOf the 61 confirmed human cases of bird flu in the US this year, 34 have been in California. Nearly all of those have been in dairy farm workers, according to the CDC.\nThe Louisiana case shows that precautions should be taken by people with backyard chicken flocks, hunters and other bird enthusiasts, the CDC said.\n\u201cThe cases across the US are a constellation of spillovers,\u201d said Dr. Rebecca Christofferson, a virologist at Louisiana State University\u2019s School of Veterinary Medicine. Experts still don\u2019t understand exactly how these spillovers are happening and the specific factors that increase a person\u2019s risk.\n\u201cIt\u2019s just kind of a black box at the moment that a lot of people are trying to answer these questions on,\u201d Christofferson said.\nThe CDC says the best approach is to avoid exposure. Infected birds can shed viruses in their saliva, mucus and feces, and other animals may shed them in their respiratory secretions and bodily fluids, including unpasteurized milk from cows.\n\u201cPeople who work with or have recreational exposure to infected animals are at higher risk of infection, and it\u2019s extremely important that they follow CDC recommended precautions when around infected or potentially infected animals, a message that we will continue to magnify given recent cases,\u201d Daskalakis said.",
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+ "title": "Avian Influenza A(H5N1)- Cambodia",
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+ "text": "On 20 August 2024, the IHR NFP of the Kingdom of Cambodia notified WHO of one case of human infection with influenza A(H5N1) in a 15-year-old with no underlying medical conditions, from Prey Veng Province. The child had an onset of fever on 11 August 2024. On 17 August, the patient was hospitalized in Phnom Penh at a severe acute respiratory infection (SARI) sentinel site. On admission, the patient presented with a fever, cough, sore throat, and difficulty breathing, and on the same day, treatment with oseltamivir was initiated. Nasopharyngeal and oropharyngeal swab specimens were collected on 17 August, and the patient died on 20 August.\nSwab specimens collected on 17 August arrived at the National Institute of Public Health of Cambodia on 19 August and tested positive for influenza A(H5N1) by quantitative reverse transcription polymerase chain reaction (RT-qPCR) on 20 August. The results were confirmed by the Institut Pasteur du Cambodge (IPC) the same day. The sample was successfully sequenced, and phylogenetic analysis of the haemagglutinin (HA) gene showed the virus to be H5 clade 2.3.2.1c, similar to the viruses circulating in Cambodia and Southeast Asia since 2013-2014. However, its internal genes belong to H5 clade 2.3.4.4b viruses. This novel reassortant influenza A(H5N1) virus has been detected in human cases reported in Cambodia since late 2023.\nAccording to early investigations, there were reports of dead poultry in the village about five days before the patient\u2019s onset of illness. The patient's family was given some of these chickens for consumption and the girl was exposed to the chicken while preparing food.\nThe Cambodian Communicable Disease and Control Department (CDC), Ministry of Health, and local Rapid Response Team conducted further investigations. Six close contacts were identified, and oseltamivir was provided to them. All close contacts are being monitored and are asymptomatic. Further investigations and response measures are ongoing for public and animal health and the environment. Test results for samples collected from chickens and ducks from the village are pending.\nAvian influenza A(H5N1) was detected for the first time in Cambodia in December 2003, initially affecting wild birds. From then until 2014, sporadic human cases were reported due to transmission from poultry to humans, either directly or indirectly through contaminated environments. Between 2014 and 2022, there were no reports of human infection with A(H5N1) viruses. However, the re-emergence of human infections with A(H5N1) viruses in Cambodia was reported in February 2023; six cases were reported that year. This case is one of 10 human cases of influenza A(H5N1) infection reported in Cambodia in 2024. Two of the 10 cases were fatal, and nine involved persons under 18 years of age. From 2003 to the present, 72 cases of human infection with influenza A(H5N1), including 43 deaths (CFR 59.7%), have been reported in the country.",
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+ "text": "Animal influenza viruses normally circulate in animals but can also infect humans. Infections in humans have primarily been acquired through direct contact with infected animals or contaminated environments. Depending on the original host, influenza A viruses can be classified as avian influenza, swine influenza, or other types of animal influenza viruses.\nAvian influenza virus infections in humans may cause disease ranging from mild upper respiratory tract infection to severe disease and death. Conjunctivitis, gastrointestinal symptoms, encephalitis and encephalopathy have all been reported. There have also been several detections of A(H5N1) virus in asymptomatic persons who had exposure to infected birds.\nLaboratory tests are required to diagnose human infection with avian influenza. WHO periodically updates technical guidance protocols for the detection of zoonotic influenza using molecular methods, e.g., RT-PCR. Evidence suggests that some antiviral drugs, notably neuraminidase inhibitors (oseltamivir, zanamivir), can reduce the duration of viral replication and improve prospects of survival in some cases.\nFrom 2003 to 20 August 2024, 903 cases of human infections with avian influenza A(H5N1), including 464 deaths (CFR 51.4%), have been reported to WHO from 24 countries. Almost all of these cases have been linked to close contact with infected live or dead birds, or contaminated environments.",
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+ "text": "The Ministry of Health's national and sub-national rapid response teams have been deployed to conduct further investigations and respond to this avian influenza outbreak. Response measures are being implemented in coordination with the local authorities, the Ministry of Environment, and the Ministry of Agriculture, Forestry, and Fisheries.\n\u2022 Investigations are ongoing to identify the presence of the disease in animals and sources of transmission, detect suspected animal and human cases, and prevent community transmission.\n\u2022 Close contacts are being monitored and provided with oseltamivir treatment as prophylaxis.\n\u2022 Health education campaigns are being conducted in affected villages.\n\u2022 Stamping-out measures are being implemented, including culling of poultry, safe disposal of carcasses and potentially contaminated materials, and cleaning and disinfection.\nWHO has provided technical assistance to the investigation and response, including efforts to increase public awareness and adoption of preventive behaviours, and raise clinical suspicion of avian influenza amongst healthcare providers to support early detection and strengthen clinical management of cases. WHO continues to collaborate with partners to ensure coordinated actions for a One Health response.",
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+ "text": "From 2003 to 20 August 2024, a total of 903 human cases of infection of influenza A(H5N1) have been reported globally to WHO from 24 countries, including this case. Almost all cases of human infection with avian influenza A(H5N1) have been linked to close contact with A(H5N1)-infected live or dead birds or mammals, or contaminated environments.\nAvailable epidemiological and virological evidence suggests that A(H5N1) viruses have not acquired the capacity for sustained transmission among humans. Therefore, the likelihood of sustained human-to-human spread is low at present. Since the virus continues to circulate in poultry, particularly in rural areas in Cambodia, further sporadic human cases can be expected.\nCurrently, based on available information, WHO assesses the overall public health risk posed by this virus to be low. The risk assessment will be reviewed as needed if additional information becomes available.\nClose analysis of the epidemiological situation, further characterization of the most recent influenza A(H5N1) viruses in both human and poultry populations, and serological investigations are critical to assess associated risks to public health and promptly adjust risk management measures.\nVaccines against seasonal influenza viruses will not protect humans against infections with influenza A(H5N1) viruses. Candidate vaccines to prevent influenza A(H5) infection in humans have been developed for pandemic preparedness in some countries. WHO continues to update the list of zoonotic influenza candidate vaccine viruses (CVV), which are selected twice a year at the WHO consultation on influenza virus vaccine composition. The list of such CVVs is available on the WHO website, at the reference below. In addition, the genetic and antigenic characterization of contemporary zoonotic influenza viruses is published here.",
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+ "text": "This event does not change WHO recommendations on public health measures and influenza surveillance.\nThe public should avoid contact with high-risk environments, such as live animal markets/farms and live poultry or surfaces that might be contaminated by poultry droppings. Additionally, maintaining good hand hygiene through frequent hand washing with soap or using alcohol-based hand sanitizer is recommended.\nThe general public and at-risk individuals should immediately report instances of illness or unexpected deaths in animals to veterinary authorities. Handling sick or unexpectedly dead poultry including slaughtering, butchering, and preparing such poultry for consumption, should be avoided.\nAny person exposed to potentially infected animals or contaminated environments who feels unwell should seek healthcare promptly and inform their healthcare provider of their possible exposure.\nWHO does not recommend special traveler screening at points of entry or other restrictions due to the current situation of influenza viruses at the human-animal interface.\nStates Parties to the International Health Regulations (2005) are required to immediately notify WHO of any laboratory-confirmed case of a human infection caused by a new subtype of influenza virus. Evidence of illness is not required for this notification.",
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+ "text": "\u2022 Global influenza programme, human-animal interface: https://www.who.int/teams/global-influenza-programme/avian-influenza\n\u2022 World Health Organization. Practical interim guidance to reduce the risk of infection in people exposed to avian influenza viruses: https://iris.who.int/handle/10665/378626\n\u2022 World Health Organization. Risk assessments and summaries of influenza at the human-animal interface: https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary\n\u2022 World Health Organization Western Pacific. Avian Influenza Weekly Update: https://www.who.int/westernpacific/emergencies/surveillance/avian-influenza\n\u2022 World Health Organization. Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases: https://www.who.int/publications-detail-redirect/WHO-WHE-IHM-GIP-2018.2\n\u2022 World Health Organization. Summary of Key Information Practical to Countries Experiencing Outbreaks of A(H5N1) and Other Subtypes of Avian Influenza: https://apps.who.int/iris/rest/bitstreams/1031911/retrieve\n\u2022 World Health Organization. Maintaining surveillance of influenza and monitoring SARS-CoV-2 adapting Global Influenza surveillance and Response System (GISRS) and sentinel systems during the COVID-19 pandemic: https://www.who.int/publications/i/item/maintaining-surveillance-of-influenza-and-monitoring-sars-cov-2-adapting-global-influenza-surveillance-and-response-system-(gisrs)-and-sentinel-systems-during-the-covid-19-pandemic\n\u2022 World Health Organization. Case definitions for the four diseases requiring notification in all circumstances under the International Health Regulations (2005): https://www.who.int/publications/m/item/case-definitions-for-the-four-diseases-requiring-notification-to-who-in-all-circumstances-under-the-ihr-(2005)\n\u2022 Food and Agriculture Organization of the United Nations. Evidence-based risk management along the livestock production and market chain: Cambodia: https://www.fao.org/publications/card/en/c/CA7319EN/(link is external)(link is external)(link is external)\n\u2022 Disease Outbreak News. Avian Influenza A (H5N1) - Cambodia: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON501\n\u2022 Food and Agriculture Organization of the United Nations. Animal Production and Health Division (NSA) https://www.fao.org/agriculture/animal-production-and-health/en(link is external)\n\u2022 World Health Organization. Addressing the low-risk perception of avian flu in Cambodia: https://www.who.int/westernpacific/news-room/feature-stories/item/addressing-the-low-risk-perception-of-avian-flu-in-cambodia Citable reference: World Health Organization (2 September 2024). Disease Outbreak News; Avian Influenza A (H5N1) in Cambodia Available at: https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON533",
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+ "title": "Avian Influenza A(H5N1) - Cambodia - World Health Organization (WHO)",
+ "snippet": "On 20 August 2024, the World Health Organization (WHO) was notified by the country\u2019s International Health Regulations (IHR) National Focal Point (NFP) of a laboratory-confirmed case of human infection with avian influenza A(H5N1) virus (clade 2.3.2.1c) in a 15-year-old child in the Kingdom of Cambodia. From 2003 to 20 August 2024, 903 cases of human infections with avian influenza A(H5N1), including 464 deaths (CFR 51.4%), have been reported to WHO from 24 countries. Close analysis of the epidemiological situation, further characterization of the most recent influenza A(H5N1) viruses in both human and poultry populations, and serological investigations are critical to assess associated risks to public health and promptly adjust risk management measures.",
+ "published_date": "2024-09-02T17:03:45+00:00",
+ "file_type": null,
+ "relevance_score": 0.391304347826087,
+ "credibility_score": 1.0,
+ "final_score": 0.6621262656343061,
+ "source_tier": "official",
+ "is_official_domain": true,
+ "selection_reasons": [
+ "official_domain",
+ "has_publication_date",
+ "passed_heuristic_threshold"
+ ],
+ "extraction_priority": 8,
+ "extraction_mode": "html",
+ "expected_value": "medium",
+ "source_id": null,
+ "region": "us",
+ "question_text": "How many confirmed human cases of H5N1 will be reported in the US by February 28, 2025, according to the US dashboard?"
+ }
+]
\ No newline at end of file
diff --git a/data/runs_ab_with_history/q1/traj_20250220/forecast.json b/data/runs_ab_with_history/q1/traj_20250220/forecast.json
new file mode 100644
index 0000000..cca5c71
--- /dev/null
+++ b/data/runs_ab_with_history/q1/traj_20250220/forecast.json
@@ -0,0 +1,154 @@
+{
+ "question_id": "q1",
+ "options": [
+ "70-100",
+ "100-150",
+ "150-200",
+ "200+"
+ ],
+ "distributions": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "probabilities": {
+ "70-100": 0.9978743860813621,
+ "100-150": 0.0019075990590898026,
+ "150-200": 0.00016069748614622954,
+ "200+": 5.731737340189762e-05
+ }
+ }
+ ],
+ "records": [
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "70-100",
+ "probability": 0.9978743860813621,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "100-150",
+ "probability": 0.0019075990590898026,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "150-200",
+ "probability": 0.00016069748614622954,
+ "forecast_version": null
+ },
+ {
+ "question_id": "q1",
+ "forecast_source": "bioscancast",
+ "option": "200+",
+ "probability": 5.731737340189762e-05,
+ "forecast_version": null
+ }
+ ],
+ "samples": [
+ {
+ "probabilities": [
+ 0.933,
+ 0.048,
+ 0.013,
+ 0.006
+ ],
+ "ok": true,
+ "reference_class": "Past H5N1 outbreaks in the United States and globally",
+ "base_rate": 0.933,
+ "drivers_up": [
+ "The cumulative number of cases has reached 67, indicating some spread.",
+ "There was a recent increase in cases from 61 to 67 over a short period."
+ ],
+ "drivers_down": [
+ "Base rate for H5N1 outbreaks in the US is historically low.",
+ "H5N1 has limited human-to-human transmission capabilities compared to other influenza viruses.",
+ "The recent uptick in cases is relatively small in absolute numbers."
+ ],
+ "why_might_be_wrong": "There could be an unexpected large-scale outbreak or underreporting of cases leading to a higher actual number than predicted.",
+ "rationale": "The cumulative confirmed cases of H5N1 in the US have reached 67, with a recent small uptick in cases. Despite this, H5N1 historically has limited human-to-human transmission, and the base rate for outbreaks in the US remains low. Given these factors, it is most likely that the total reported cases by February 28, 2025, will remain within the 70-100 range. Any substantial increase would be unexpected based on historical patterns and current transmission characteristics.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 42
+ },
+ {
+ "probabilities": [
+ 0.95,
+ 0.03,
+ 0.01,
+ 0.01
+ ],
+ "ok": true,
+ "reference_class": "H5N1 outbreaks in the US",
+ "base_rate": 0.95,
+ "drivers_up": [
+ "Recent uptick in cases, with a cumulative total of 67 cases as of mid-February 2025.",
+ "Historically low human-to-human transmission of H5N1 limits rapid spread."
+ ],
+ "drivers_down": [
+ "No significant increase in cases reported between mid-January and mid-February 2025.",
+ "Strong public health measures and awareness may limit further spread.",
+ "Historically, H5N1 has shown limited capability for sustained human-to-human transmission."
+ ],
+ "why_might_be_wrong": "An unexpected outbreak or change in the virus transmissibility could lead to a rapid increase in cases beyond the base rate.",
+ "rationale": "As of February 2025, the cumulative confirmed human cases of H5N1 in the US is 67. Given the historical transmission patterns of H5N1, where human-to-human transmission is rare, and the lack of significant increase in cases recently, it's unlikely that the number will surpass 100 by February 28, 2025. Thus, the probability of remaining in the 70-100 range is high, with smaller probabilities for higher numbers.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 43
+ },
+ {
+ "probabilities": [
+ 0.933,
+ 0.048,
+ 0.013,
+ 0.006
+ ],
+ "ok": true,
+ "reference_class": "H5N1 outbreaks in the US",
+ "base_rate": 0.933,
+ "drivers_up": [
+ "Recent increase in confirmed cases to 67 by mid-February 2025 indicates potential for more cases.",
+ "H5N1 is a zoonotic virus with potential for human transmission, primarily in areas with high bird-human interaction."
+ ],
+ "drivers_down": [
+ "Historically low base rates of H5N1 cases in humans in the US.",
+ "Limited human-to-human transmission of H5N1 compared to other influenza viruses.",
+ "Current surveillance and control measures in place in the US reduce likelihood of rapid spread."
+ ],
+ "why_might_be_wrong": "H5N1 could mutate to become more easily transmissible between humans, leading to a sudden increase in cases that current surveillance might not catch immediately.",
+ "rationale": "The base rate of H5N1 cases in the US has historically been low, and although there has been a recent increase to 67 cases, the transmission dynamics of H5N1 suggest limited human-to-human spread. Surveillance and control measures are likely to contain further spread, making a large jump in cases unlikely by the target date. Therefore, it is reasonable to predict that confirmed cases will remain in the 70-100 range.",
+ "model": "gpt-4o-2024-08-06",
+ "seed": 44
+ }
+ ],
+ "baseline_rationale": null,
+ "evidence_record_ids": [
+ "ins-3f61179552e1",
+ "ins-b98c3ee6ebdc",
+ "ins-d55b420f88e6",
+ "ins-e8d6a74cd91d",
+ "ins-0c46a1b83e3c",
+ "ins-3c6bddb54123",
+ "ins-77a12428355c",
+ "ins-46bed2e91d43",
+ "ins-1ad18630365d",
+ "ins-b514cf2d804f",
+ "ins-362af5c8a89f",
+ "ins-8af42bb3249e",
+ "ins-fc7f78ebceab"
+ ],
+ "budget_summary": {
+ "total_input_tokens": 7164,
+ "total_output_tokens": 787,
+ "total_tokens": 7951,
+ "per_model": {
+ "gpt-4o-2024-08-06": {
+ "input_tokens": 7164,
+ "output_tokens": 787,
+ "calls": 3
+ }
+ }
+ },
+ "notes": []
+}
\ No newline at end of file
diff --git a/data/runs_ab_with_history/q1/traj_20250220/insight.json b/data/runs_ab_with_history/q1/traj_20250220/insight.json
new file mode 100644
index 0000000..401014e
--- /dev/null
+++ b/data/runs_ab_with_history/q1/traj_20250220/insight.json
@@ -0,0 +1,409 @@
+{
+ "records": [
+ {
+ "id": "ins-fc7f78ebceab",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 67.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": null,
+ "event_date_precision": null,
+ "summary": "Cumulative total of confirmed cases since 2022, with all but one occurring in 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:14.577630+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-46640fdee37b4b72a14e965bd4af5e59",
+ "chunk_id": "doc-46640fdee37b4b72a14e965bd4af5e59-c3",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "To date, 67 people have tested positive for A(H5) virus in the United States since 2022"
+ }
+ ]
+ },
+ {
+ "id": "ins-0c46a1b83e3c",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 34.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Confirmed human infections recorded in the U.S. this year, with 34 cases reported, mostly in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:18.404272+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-33633ea86ca34fed954ee36e2ea039ea",
+ "chunk_id": "doc-33633ea86ca34fed954ee36e2ea039ea-c2",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California"
+ }
+ ]
+ },
+ {
+ "id": "ins-1ad18630365d",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "US",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 61.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "year",
+ "summary": "Cumulative total of confirmed human cases of bird flu in the US this year, with 34 in California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:20.775375+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-6eddfdfec1dd4fb1893315648a2e8718",
+ "chunk_id": "doc-6eddfdfec1dd4fb1893315648a2e8718-c1",
+ "source_url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "quote": "Of the 61 confirmed human cases of bird flu in the US this year, 34 have been in California."
+ }
+ ]
+ },
+ {
+ "id": "ins-77a12428355c",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-14T00:00:00",
+ "event_date_precision": "day",
+ "summary": "One laboratory-confirmed human case of infection with influenza A(H5) reported from Louisiana.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:16.573426+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-46640fdee37b4b72a14e965bd4af5e59",
+ "chunk_id": "doc-46640fdee37b4b72a14e965bd4af5e59-c2",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "the USA notified WHO of one laboratory-confirmed human case of infection with influenza A(H5) in an adult aged over 65 years from the state of Louisiana."
+ }
+ ]
+ },
+ {
+ "id": "ins-d55b420f88e6",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 2.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-20T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Two additional laboratory-confirmed human cases of infection with influenza A(H5) reported from Iowa and Wisconsin.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:16.573823+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-46640fdee37b4b72a14e965bd4af5e59",
+ "chunk_id": "doc-46640fdee37b4b72a14e965bd4af5e59-c2",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "the USA notified WHO of two additional laboratory-confirmed human case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin."
+ }
+ ]
+ },
+ {
+ "id": "ins-b98c3ee6ebdc",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "USA",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": null,
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2025-01-15T00:00:00",
+ "event_date_precision": "day",
+ "summary": "One additional laboratory-confirmed human case of infection with influenza A(H5) reported from California.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:16.574161+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-46640fdee37b4b72a14e965bd4af5e59",
+ "chunk_id": "doc-46640fdee37b4b72a14e965bd4af5e59-c2",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "the USA notified WHO of one additional laboratory-confirmed human case of infection with influenza A(H5) from the state of California."
+ }
+ ]
+ },
+ {
+ "id": "ins-3f61179552e1",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States of America",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 9.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2025-01-20T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human cases of influenza A(H5) virus in the US since the last risk assessment.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:14.732165+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-46640fdee37b4b72a14e965bd4af5e59",
+ "chunk_id": "doc-46640fdee37b4b72a14e965bd4af5e59-c1",
+ "source_url": "https://web.archive.org/web/20250205083524id_/https://www.who.int/teams/global-influenza-programme/avian-influenza/monthly-risk-assessment-summary",
+ "quote": "influenza A(H5) virus has been detected in nine humans in the United States of America (USA)"
+ }
+ ]
+ },
+ {
+ "id": "ins-e8d6a74cd91d",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "United States",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 61.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-19T00:00:00",
+ "event_date_precision": "day",
+ "summary": "Cumulative total of confirmed human H5N1 cases since April 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:18.707219+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-33633ea86ca34fed954ee36e2ea039ea",
+ "chunk_id": "doc-33633ea86ca34fed954ee36e2ea039ea-c0",
+ "source_url": "https://time.com/7203290/bird-flu-united-states-severe-case-h5n1-explainer/",
+ "quote": "It is the 61st case of human H5N1 bird flu infection in the country since April this year."
+ }
+ ]
+ },
+ {
+ "id": "ins-3c6bddb54123",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.85,
+ "location": "Louisiana",
+ "iso_country_code": "US",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 1.0,
+ "metric_unit": "cases",
+ "count_basis": "active",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-12-18T00:00:00",
+ "event_date_precision": "day",
+ "summary": "First severe case of H5N1 bird flu in the US, linked to backyard flock, patient hospitalized in critical condition.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:20.772548+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-6eddfdfec1dd4fb1893315648a2e8718",
+ "chunk_id": "doc-6eddfdfec1dd4fb1893315648a2e8718-c0",
+ "source_url": "https://amp.cnn.com/cnn/2024/12/18/health/severe-bird-flu-louisiana-first-us-case",
+ "quote": "A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States."
+ }
+ ]
+ },
+ {
+ "id": "ins-b514cf2d804f",
+ "question_id": "q1",
+ "event_type": "case_count",
+ "confidence": 0.5,
+ "location": "Cambodia",
+ "iso_country_code": "KH",
+ "pathogen": "h5n1",
+ "metric_name": "confirmed_cases",
+ "metric_value": 10.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "day",
+ "summary": "10 human cases of influenza A(H5N1) infection reported in Cambodia in 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:25.998309+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-92a5cade3af5474ea198fe03d7dcded7",
+ "chunk_id": "doc-92a5cade3af5474ea198fe03d7dcded7-c0",
+ "source_url": "https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON533",
+ "quote": "This case is one of 10 human cases of influenza A(H5N1) infection reported in Cambodia in 2024."
+ }
+ ]
+ },
+ {
+ "id": "ins-362af5c8a89f",
+ "question_id": "q1",
+ "event_type": "death_count",
+ "confidence": 0.5,
+ "location": "Cambodia",
+ "iso_country_code": "KH",
+ "pathogen": "h5n1",
+ "metric_name": "deaths",
+ "metric_value": 2.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "day",
+ "summary": "2 of the 10 cases were fatal in Cambodia in 2024.",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:25.998752+00:00",
+ "notes": null,
+ "sources": [
+ {
+ "document_id": "doc-92a5cade3af5474ea198fe03d7dcded7",
+ "chunk_id": "doc-92a5cade3af5474ea198fe03d7dcded7-c0",
+ "source_url": "https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON533",
+ "quote": "Two of the 10 cases were fatal"
+ }
+ ]
+ },
+ {
+ "id": "ins-8af42bb3249e",
+ "question_id": "q1",
+ "event_type": "death_count",
+ "confidence": 0.5,
+ "location": "Cambodia",
+ "iso_country_code": "KH",
+ "pathogen": "h5n1",
+ "metric_name": "deaths",
+ "metric_value": 43.0,
+ "metric_unit": "cases",
+ "count_basis": "cumulative",
+ "time_window": "unknown",
+ "surveillance_method": null,
+ "data_quality": null,
+ "event_date": "2024-01-01T00:00:00",
+ "event_date_precision": "day",
+ "summary": "43 deaths reported in Cambodia from 2003 to present due to influenza A(H5N1).",
+ "model": "gpt-4o-mini",
+ "extracted_at": "2026-07-14T23:20:26.012396+00:00",
+ "notes": null,
+ "sources": [
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+ "snippet": "Related news USDA experiments suggest H5N1 not viable in properly cooked ground beef CDC launches new influenza A wastewater dashboard; states report more H5N1 in dairy herds Wastewater testing finds H5N1 avian flu in 9 Texas cities Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows This week's top reads Wastewater testing finds H5N1 avian flu in 9 Texas cities Wastewater detections began in early March, and so far sequencing hasn't found any mutations linked to human adaptation. Main navigation Michigan reports 3 more H5N1 outbreaks in dairy herds sarahluv/Flickr cc The Michigan Department of Agriculture and Rural Development (MDRAD) today reported three more H5N1 avian flu outbreaks in dairy herds, noting that it will send results to the US Department of Agriculture (USDA) National Veterinary Services Laboratory (NVSL) for confirmation. CDC boosts flu surveillance, starts pandemic review Meanwhile, in its latest update on its response to the H5N1 outbreaks in dairy herds, the CDC said it is developing a plan for enhanced surveillance over the summer, which will include increasing the number of flu specimens tested and subtyped at public health laboratories. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. In other developments, the Food and Drug Administration (FDA) recently detailed its next steps for monitoring the virus in that nation's milk supply and the Centers for Disease Control and Prevention (CDC) posted an update on its response steps, which includes an evaluation of the dairy outbreak virus with its Influenza Risk Assessment Tool (IRAT). ",
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+ "snippet": "Bird flu, measles top 2025 concerns for Canada\u2019s chief public health officer - Ladysmith Chemainus Chronicle News As we enter 2025, Dr. Theresa Tam has her eye on H5N1 bird flu, an emerging virus that had its first human case in Canada this year. At the same time, Canada\u2019s chief public health officer is closely monitoring measles \u2014 a virus that was eliminated in this country more than two decades ago, but is making an accelerated resurgence. \u201cWhat I am particularly concerned about is that this virus has demonstrated the capability of a whole range of clinical outcomes, from asymptomatic infection \u2026 all the way to rare cases of severe illness,\u201d said Tam in a year-end interview on Dec. 18. News",
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+ "snippet": "\u201cThe more people you have on the ground that help us to generate the data now and understand what\u2019s happening, the better this is for us and also for the wildlife,\u201d said Christine Marizzi, a co-author of the study and director of community science for BioBus, the mobile research lab working with students. Scientists get creative in monitoring bird flu outbreak \u2013 by testing feces With second human case of H5N1 reported, CDC launches dashboard to monitor wastewater, and recruits students to help Amid widespread gaps in US testing for H5N1, a type of bird flu, and as a second case among humans has been detected, scientists are turning to more creative ways of monitoring the outbreak \u2013 especially in human and animal feces. The dashboard helps identify hotspots in the US where flu A is surging \u2013 and, since flu rates among people are low this time of year, such a surge can alert scientists and the public to potential outbreaks of H5N1. \u201cI\u2019m really pleased to see that they\u2019re sharing the data that they have,\u201d said Marc Johnson, a professor at the University of Missouri School of Medicine and the lab lead for wastewater surveillance in Missouri. Dairy cow infections are usually detected by testing their milk, since the udders have proven to have high concentrations of the flu virus \u2013 but in other animals that aren\u2019t lactating, it might be difficult to know where to test the animal to get accurate results.",
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+ "snippet": "\" Editor\u2019s Picks Traces of H5N1 bird flu virus found in some milk, pasteurized dairy: FDA Avian flu hits dairy producing cattle farms Largest US egg producer temporarily halts production due to avian flu at Texas facility To further ensure the safety of other milk-derived products for the youngest population, the FDA said it \"tested samples of retail powdered infant formula and powdered milk products marketed as toddler formula,\" all of which came back negative, \"indicating no detection of viral fragments or virus. \"We are looking to grow H5N1 virus stock from the one human case in Texas to use for additional laboratory experiments to learn how the virus reproduces in both human and cows,\" he said, which will ultimately help the CDC \"assess the severity of illness and transmissibility of the virus under different scenarios. How the CDC is monitoring H5N1 bird flu, local testing of those exposed In the course of this investigation, the CDC said Wednesday local public health partners had monitored over 100 people, and if anyone presents with symptoms, the next step is to conduct local testing. The agency said at the time it had \"confirmed one human HPAI A(H5N1) infection that had exposure to dairy cattle in Texas that were presumed to be infected with the virus,\" adding that it was \"working with state health departments to continue to monitor workers who may have been in contact with infected or potentially infected birds/animals and test those people who develop symptoms. The CDC said it is monitoring flu surveillance data, \"especially in areas where H5N1 viruses have been detected in dairy cattle or other animals for any unusual trends in flu-like illness, flu or conjunctivitis,\" Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC, said in his update Wednesday. ",
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+ "snippet": "Related news Wastewater testing finds H5N1 avian flu in 9 Texas cities Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows Case report bolsters evidence for H5N1 avian flu spread from cow to Texas dairy worker USDA genome study sheds light on H5N1 avian flu spillover to cows, but data gaps remain This week's top reads Wastewater testing finds H5N1 avian flu in 9 Texas cities Wastewater detections began in early March, and so far sequencing hasn't found any mutations linked to human adaptation. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. A wastewater dashboard; states report more H5N1 in dairy herds Smederevac/iStock The Centers for Disease Control and Prevention (CDC) today unveiled a new influenza A wastewater tracker, part of its surveillance for H5N1 avian influenza, as three states reported more detections in dairy herds. H5N1 detected in 4 more dairy herds In other developments, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today reported four more H5N1 detections in dairy herds, raising the total to 46. A wastewater dashboard; states report more H5N1 in dairy herds The tracker will help with surveillance, but it doesn't distinguish the influenza A subtype or determine the source of the virus. ",
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+ "snippet": "Bird Flu Outbreak: Map Reveals Confirmed US Human Cases - Newsweek Less than a month after reporting its first human case of bird flu, California has confirmed that 16 people have now been infected with the disease, and a Newsweek map shows how the numbers compare with the rest of the U.S. Nationwide, the total number of people infected with the avian influenza H5N1 in 2024 now stands at 36. \"The current bird flu situation in the U.S. is quite disturbing and odd,\" Jeremy Rossman, senior lecturer in virology at the University of Kent, U.K, previously told Newsweek when California reported its first cases among farmworkers.",
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+ "snippet": "May 30Another human case of bird flu has been detected in a dairy farm worker in Michigan\u2014though the cases aren\u2019t connected\u2014and this is the first person in the U.S. to report respiratory symptoms connected to bird flu, though their symptoms are \u201cresolving,\u201d according to the Centers for Disease Control and Prevention. Toddler Infected With Another Strain\u2014Second Human Case In India Topline Here\u2019s the latest news about a global outbreak of H5N1 bird flu that started in 2020, and recently spread among cattle in U.S. states and marine mammals across the world, which has health officials closely monitoring it and experts concerned the virus could mutate and eventually spread to humans, where it has proven rare but deadly. May 14The Centers for Disease Control and Prevention released influenza A waste water data for the weeks ending in April 27 and May 4, and found several states like Alaska, California, Florida, Illinois and Kansas had unusually high levels, though the agency isn\u2019t sure if the virus came from humans or animals, and isn\u2019t able to differentiate between influenza A subtypes, meaning the H5N1 virus or other subtypes may have been detected. May 1The Food and Drug Administration confirmed dairy products are still safe to consume, announcing it tested grocery store samples of products like infant formula, toddler milk, sour cream and cottage cheese, and no live traces of the bird flu virus were found, although some dead remnants were found in some of the food\u2014though none in the baby products. June 5A new study examining the 2023 bird flu outbreak in South America that killed around 17,400 elephant seal pups and 24,000 sea lions found the disease spread between the animals in several countries, the first known case of transnational virus mammal-to-mammal bird flu transmission. ",
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+ "snippet": "In other developments: Related news Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows Case report bolsters evidence for H5N1 avian flu spread from cow to Texas dairy worker USDA genome study sheds light on H5N1 avian flu spillover to cows, but data gaps remain FDA finds no live H5N1 avian flu virus in sour cream or cottage cheese, will assess raw milk This week's top reads Study: HHS's COVID vaccine campaign saved $732 billion in averted infections, costs Researchers say the campaign encouraged 22 million Americans to complete their primary COVID-19 vaccine series, preventing nearly 2.6 million infections. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation Wastewater testing finds H5N1 avian flu in 9 Texas cities varius-studios/ iStock Researchers who sequenced viruses from wastewater samples from 10 Texas cities found H5N1 avian flu virus in 9 of them, sometimes at levels that rivaled seasonal flu. On X, Mike Tisza, PhD, the first author of the study and assistant professor of virology and microbiology at Baylor, said it's still not clear where the viruses came from, but the evidence tilts toward an animal source, because the researchers didn't see any mutations with known links to human adaptation. Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals Monitoring of about 70 farm workers found no symptoms, and the state's wastewater sampling pilot has found no flu rise. ",
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+ "snippet": "In other avian flu developments: Related news Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho Study confirms infection in mice fed H5N1-contaminated raw milk USDA expands support for H5N1 response to more dairy producers Michigan reports H5 avian flu in dairy farm worker Australia reports imported human H5N1 avian flu case and unrelated high-path poultry outbreak Survey: States and territories able to test for highly pathogenic H5N1 This week's top reads Alpacas infected with H5N1 avian flu in Idaho In other developments, H5N1 was detected in feral cats in New Mexico and more dairy herds in affected states. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Iowa disaster proclamation Governor Reynolds yesterday announced the disaster proclamation for highly pathogenic avian flu in Cherokee County, the same day the Iowa Department of Agriculture and Land Stewardship\u00a0reported an outbreak at a commercial turkey farm in the county. Main navigation H5 influenza wastewater dashboard launches Luke Jones/Flickr cc WastewaterSCAN, a national wastewater monitoring system based at Stanford University in partnership with Emory University, today launched an\u00a0H5 avian influenza wastewater dashboard today, which shows detections at about a dozen locations, mostly in Texas and Michigan. Second dairy farm worker infected with H5 avian flu in Michigan Unlike similar earlier cases in the United States, the newly reported patient had respiratory symptoms. ",
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+ "snippet": "Related news H5N1 strikes dairy herd in Michigan, large poultry farm in Colorado Animal experiments shed more light on behavior of H5N1 from dairy cows CDC confirms 4th human case of H5N1 avian flu as more dairy herds in Colorado hit HHS awards Moderna $176 million to develop mRNA H5 avian flu vaccine More evidence pasteurization inactivates H5N1 avian flu virus in milk USDA spells out financial assistance to offset H5N1-linked milk losses Scientists expand H5N1 testing in dairy products, launch human serology study Experiments show H5N1 risk to dairy cows not exclusive to subtype infecting US herds This week's top reads CDC confirms 4th human case of H5N1 avian flu as more dairy herds in Colorado hit The infected farm worker is from Colorado, which has had the most affected dairy herds in the past month. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation H5N1 confirmed in 5 more US dairy herds, more cats Khaligo/iStock The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today added five more dairy herds in three states to its list of H5N1 avian flu outbreak confirmations. H5N1 confirmed in 5 more US dairy herds, more cats The additional cat detections are from 2 states battling the virus in cows: Minnesota and Michigan. More cat and wild-bird positives In related developments, APHIS confirmed H5N1 detections in three more domestic cats, two from Minnesota and one from Michigan, raising the total since 2022 to 33. ",
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+ "snippet": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic. It is the 61st case of human H5N1 bird flu infection in the country since April this year. The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.",
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+ "snippet": "U.S. and California health officials confirmed two new cases of H5N1\u00a0bird flu\u00a0in dairy farm workers in the state on Friday, bringing the total of infected dairy workers in that state to six, and the total of human cases nationwide this year to 20. Health officials in the U.S. and California confirmed two more cases of H5N1 bird flu in dairy farm workers in the state on Friday. Six dairy workers in California have now contracted the virus, and the total number of human cases of bird flu nationwide is now at 20. California health officials said they expect additional cases to be identified among individuals who have regular contact with infected dairy cattle.",
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+ "snippet": "CDC Confirms First \u2018Severe\u2019 Case of H5N1 Bird Flu in U.S. The U.S. has seen 61 confirmed human cases to date. The CDC has declared the first \u201csevere\u201d case of H5N1 bird flu in the U.S., according to a press release published Wednesday. The CDC launched a bird flu tracker online that breaks down the confirmed cases in humans, as well as the U.S. states where they\u2019ve been identified, and the animal believed to have been the source of the infection. ScienceHealth Canada\u2019s First Human Case of H5 Bird Flu Leaves Teen in Critical Condition -------------------------------------------------------------------------- British Columbia health officials have yet to identify a likely source of the infection, though none of the teen's contacts have tested positive for the virus so far.",
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+ "snippet": "November 16, 2005 \u2013 The World Health Organization confirms two human cases of bird flu in China, including a female poultry worker who died from the H5N1 strain. February 2022 \u2013 The USDA confirms that wild birds and domestic poultry in the United States have tested positive for the H5N1 strain of avian flu. The animals that tested positive were on a farm in Idaho where poultry had tested positive for the virus and were culled in May. November 22, 2024 \u2013 The CDC announces a case of H5 bird flu has been confirmed in a child in California. December 18, 2024 \u2013 The CDC confirms a patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the first such case in the US.",
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+ "title": "Have the flu or know someone with it? Flu cases surge to highest levels in 15 years, CDC says - Democrat & Chronicle",
+ "snippet": "Flu cases 2025: Levels have increased to highest in 15 years, CDC says Flu cases surge to highest levels in 15 years, CDC says There are 12 states in the U.S. that have \"'very high\" flu activity, according to the CDC. For the first time this flu season, overall levels of the respiratory illness have reached \"very high\" activity despite a decrease in COVID-19 infections in recent months, according to the CDC. One of the states where flu levels are growing is Kentucky, where the probability of an influenza epidemic is growing\u00a0by 92.45%, the CDC said. The CDC still considers the\u00a0general population at \"low\" risk\u00a0for catching bird flu, but one 65-year-old Louisiana resident with complicating health conditions did die from the disease.",
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+ "title": "Third Case of H5N1 Avian Flu Confirmed in the US, CDC Urges Vigilance and Personal Protective Equipment - Global Village space",
+ "snippet": "CDC Confirms Third Case of H5N1 Avian Flu in the US The US Centers for Disease Control and Prevention (CDC) confirmed a third case of H5N1 avian flu in the United States on Thursday, marking the second case in Michigan alone. \u201cThird Case of H5N1 Avian Flu Confirmed in the US, CDC Urges Vigilance and Personal Protective Equipment\u201d USDA Announces Funding to Combat H5N1 Outbreak in US Livestock In a recent development, H5N1 was detected in the muscle of a dairy cow intended for beef consumption. Concerns Over Respiratory Symptoms \u201cThis is the first time in the US outbreak a person with H5N1 has displayed respiratory symptoms, unlike the previous two cases with only conjunctivitis, commonly known as \u2018pink eye,\u2019\u201d said Dr. Nirav Shah, principal deputy director of the CDC, during a press briefing. CDC Urges Use of Personal Protective Equipment Despite Summer Heat Dr. Shah emphasized the importance of using personal protective equipment for workers in close contact with animals, despite the challenges posed by hot summer weather. According to the CDC, only 39 individuals have been tested for H5N1 during the 2024 outbreak in the United States.",
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+ "snippet": "Teen Hospitalized for Bird Flu Shows 'Worrisome' Change in People - Newsweek A Canadian teen who contracted the H5N1 bird flu in early November has fully recovered after a prolonged battle with the disease. However, genetic analysis of the virus that infected her revealed alarming mutations that could potentially enhance the virus's ability to target human cells and cause severe illness. With 66 human cases reported in the U.S. in 2024, experts are increasingly worried about the virus's evolving potential and its implications for future outbreaks. A Canadian teen who contracted H5N1 bird flu in November 2024 has fully recovered, but genetic analysis revealed concerning mutations in the virus that could increase its ability to target human cells and cause more severe disease.",
+ "rank": 5,
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+ "snippet": "Inside Medicine DEFCON 3 for H5N1. Inside Medicine DEFCON 3 for H5N1. All told, I think a severe case of H5N1 coming on the cusp of the forthcoming peak of flu season merits an increase in our threat assessment of the overall situation. As I outlined in the Slate piece, I\u2019m worried about the possibility of a novel variant of H5N1 emerging from a coinfection\u2014that is, a single person getting seasonal flu and bird flu at the same time, which is a recipe for a potentially horrific flu pandemic. At some point, the federal government should also consider increasing our supplies of H5N1 vaccines and consider administering them to high-risk individuals like farmworkers (in whom most of the US cases have been detected so far). Inside Medicine DEFCON 3 for H5N1.",
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+ "snippet": "Severe case of H5N1 bird flu detected in US, CDC confirms | Fox News Fox News FOX News Go Fox News The U.S. Centers for Disease Control and Prevention said on Wednesday that a patient has been hospitalized with a severe case of H5N1 infection in Louisiana, marking the first known instance of a severe human illness linked to the bird flu virus in the United States. The CDC said that partial viral genome data from the infected patient shows that the virus belongs to the D1.1 genotype, recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. Fox News Health FOX News Go Fox News",
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+ "title": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms - Livescience.com",
+ "snippet": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms This infection, tied to an ongoing outbreak in cows, is the first in the U.S. to cause respiratory symptoms, but not the first H5N1 case in the world to do so. Related: H5N1: What to know about the bird flu cases in cows, goats and people \"This is the first human case of H5 in the United States to report more typical symptoms of acute respiratory illness associated with influenza virus infection, including A(H5N1) viruses,\" the CDC reported. H5N1 bird flu has spread to human from cow in 2nd probable case, CDC reports H5N1: What to know about the bird flu cases in cows, goats and people China lands Chang'e 6 sample-return probe on far side of the moon Live Science is part of Future US Inc, an international media group and leading digital publisher. \u201421-year-old student dies of H5N1 bird flu in Vietnam \u20141st polar bear death from bird flu spells trouble for species \u2014China reported 1st human death from H3N8 bird flu, WHO says With that possibility in mind, the CDC continues to closely monitor for unusual flu activity across the country. A third human case of bird flu has been linked to the ongoing outbreak in cows on U.S. dairy farms \u2014 and this one came with respiratory symptoms, such as cough, the Centers for Disease Control and Prevention (CDC) reported May 30. ",
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+ "text": "This map is updated each weekday to depict the number of new confirmed cases in livestock in the last 30 days and the cumulative number of confirmed cases in livestock by State.\nFor information related to the National Milk Testing Strategy, visit Testing.\nUsers may need to refresh the page to see the latest map and table data. To refresh the page, hold down the SHIFT key and click the Reload Page button in the upper left corner of your browser. You can also use SHIFT+F5 on your keyboard.",
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+ "text": "\u2022 H5 bird flu is widespread in wild birds worldwide and is causing outbreaks in poultry and U.S. dairy cows with several recent human cases in U.S. dairy and poultry workers.\n\u2022 While the current public health risk is low, CDC is watching the situation carefully and working with states to monitor people with animal exposures.\n\u2022 CDC is using its flu surveillance systems to monitor for H5 bird flu activity in people.",
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+ "text": "When a case tests positive for H5 at a public health laboratory but testing at CDC is not able to confirm H5 infection, per Council of State and Territorial Epidemiologists (CSTE) guidance, a case is reported as probable.\nConfirmed and probable cases are typically updated by 5 PM EST on Mondays (for cases confirmed by CDC on Friday, Saturday, or Sunday), Wednesdays (for cases confirmed by CDC on Monday or Tuesday), and Fridays (for cases confirmed by CDC on Wednesday and Thursday). Affected states may report cases more frequently.",
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+ "text": "\u2022 12,064 wild birds detected as of 2/18/2025 | Full Report\n\u2022 51 jurisdictions with bird flu in wild birds\n\u2022 162,801,168 poultry affected as of 2/21/2025 | Full Report\n\u2022 51 jurisdictions with outbreaks in poultry\n\u2022 973 dairy herds affected as of 2/21/2025 | Full Report\n\u2022 16 states with outbreaks in dairy cows\nThese data will be updated daily, Monday through Friday, after 4 p.m. to reflect any new data.\nCumulative data on wild birds have been collected since January 20, 2022. Cumulative data on poultry have been collected since February 8, 2022. Cumulative data on humans in the U.S. have been collected since April 28, 2022. Cumulative data on dairy cattle have been collected since March 25, 2024.",
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+ "text": "Birds are the natural hosts for avian influenza viruses. Avian influenza refers to an infectious disease of birds caused by infection with avian influenza viruses. Avian influenza viruses can also infect non-avian species including wild and domestic (including companion and farmed) terrestrial and marine mammals. Avian influenza viruses primarily spread from infected birds to humans through close contact with birds or contaminated environments, such as in backyard poultry farm settings and at markets where birds are sold.\nThere have also been limited reports of transmission from other infected animals to humans.\nSwine influenza is a respiratory disease of pigs caused by influenza A viruses. Most swine influenza viruses do not cause disease in humans, but some countries have reported cases of human infection from certain swine influenza viruses. Close proximity to infected pigs or visiting locations where pigs are exhibited has been reported for most human cases, but some limited human-to-human transmission has occurred.\nJust like birds and pigs, other animals such as horses and dogs, can be infected with their own influenza viruses (canine influenza viruses, equine influenza viruses, etc.).\nDive in\nTechnical guidance",
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+ "text": "Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nInfluenza Investigations & Studies (Unity Studies)",
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+ "text": "Clinical care of severe acute respiratory infections \u2013 Tool kit\nGuidelines for the clinical management of severe illness from influenza virus infections",
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+ "text": "Five keys to safer food manual",
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+ "text": "Training materials",
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+ "text": "\u2022\nNew human cases 1 2 : From 13 December 2024 to 20 January 2025, the detection of influenza\nA(H5) virus in five humans, influenza A(H9N2) virus in two humans, and influenza A(H10N3) virus\nin one human were reported officially. Additionally, five human cases of infection with influenza\nA(H5) viruses were detected.\n\u2022\nCirculation of influenza viruses with zoonotic potential in animals: High pathogenicity avian\ninfluenza (HPAI) events in poultry and non-poultry continue to be reported to the World\nOrganisation for Animal Health (WOAH). 3 The Food and Agriculture Organization of the United\nNations (FAO) also provides a global update on avian influenza viruses with pandemic potential. 4\n\u2022\nRisk assessment 5 : Based on information available at the time of the risk assessment, the overall\npublic health risk from currently known influenza viruses at the human-animal interface has not\nchanged remains low. Sustained human to human transmission has not been reported from\nthese events and the occurrence of sustained human-to-human transmission of these viruses is\ncurrently considered unlikely. Although human infections with viruses of animal origin are\ninfrequent, they are not unexpected at the human-animal interface.\n\u2022\nIHR compliance: All human infections caused by a new influenza subtype are required to be\nreported under the International Health Regulations (IHR, 2005). 6 This includes any influenza A\nvirus that has demonstrated the capacity to infect a human and its haemagglutinin gene (or\nprotein) is not a mutated form of those, i.e. A(H1) or A(H3), circulating widely in the human\npopulation. Information from these notifications is critical to inform risk assessments for\ninfluenza at the human-animal interface.\nAvian influenza viruses in humans\nCurrent situation:\nSince the last risk assessment of 12 December 2024, influenza A(H5) virus has been detected in nine\nhumans in the United States of America (USA) and one laboratory-confirmed human case of A(H5N1)\ninfection was reported to WHO from Cambodia.\n1 This summary and assessment covers information confirmed during this period and may include information\nreceived outside of this period.\n2 For epidemiological and virological features of human infections with animal influenza viruses not reported in\nthis assessment, see the reports on human cases of influenza at the human-animal interface published in the\nWeekly Epidemiological Record here .\n3 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n4 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .\n5 World Health Organization (2012). Rapid risk assessment of acute public health events. World Health\nOrganization. Available at: https://iris.who.int/handle/10665/70810 .\n6 World Health Organization. Case definitions for the 4 diseases requiring notification to WHO in all\ncircumstances under the International Health Regulations (2005). Case definitions for the four diseases\nrequiring notification in all circumstances under the International Health Regulations (2005).",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "2\nA(H5), USA\nOn 14 December 2024, the USA notified WHO of one laboratory-confirmed human case of infection\nwith influenza A(H5) in an adult aged over 65 years from the state of Louisiana. The patient, with\nunderlying conditions, developed symptoms and sought care at an emergency department in early\nDecember 2024. Due to worsening symptoms, the patient returned to the emergency department a\nfew days later, was hospitalized in critical condition with pneumonia, and started on antiviral\ntreatment. Unfortunately, the patient passed away. No household contacts of the case tested\npositive for influenza viruses. The individual owned backyard poultry and had noted deaths in\ndomestic and wild birds on the property prior to symptom onset. A(H5N1) viruses were detected in\npoultry on the property.\nThe viruses identified in two clinical samples from the patent were identified as influenza A(H5N1)\nviruses belonging to the clade 2.3.4.4b and the genotype D1.1. Deep sequencing of the genetic\nsequences from the two clinical specimens were compared to A(H5N1) virus sequences from dairy\ncows, wild birds, poultry and other human cases in the USA and Canada. The hemagglutinin (HA)\ngene sequences of the viruses from the clinical specimens are closely related to other D1.1 viruses\nrecently detected in wild birds and poultry in the Louisiana and other parts of the USA and in recent\nhuman cases detected in Canada and the USA, as well as to existing influenza A(H5N1) candidate\nvaccine viruses. 7\nSome changes in the HA gene segment of one of the clinical specimens from the patient were\ndetected at a low frequency. These changes have rarely been identified in specimens from previous\nhuman infections with A(H5N1) viruses and were not detected in specimens from the poultry on the\nproperty of the patient. It is possible that these changes arise during viral replication in the infected\nhuman cases. No changes in the polymerase genes associated with adaptation to mammals were\nidentified. No changes associated with known or suspected markers of reduced susceptibility to\nantiviral drugs were identified. 8 , 9 , 10\nBetween 20 and 21 December 2024, the USA notified WHO of two additional laboratory-confirmed\nhuman case of infection with influenza A(H5) in an adult from the states of Iowa and Wisconsin. The\ncases developed symptoms in December 2024 and reported their illness to public health officials as\npart of active monitoring. The cases were not hospitalized and have recovered. Both cases were\nexposed to influenza A(H5N1) while working at poultry facilities.\nOn 15 January 2025, the USA notified WHO of one additional laboratory-confirmed human case of\ninfection with influenza A(H5) from the state of California. The case occurred in a child less than 18\nyears old with no known contact with influenza A(H5N1) virus-infected animals or humans. The\ninvestigation into the source of infection and contact monitoring around this case was ongoing at\nthe time of reporting, and thus far, no human-to-human transmission has been identified. Additional\n7 WHO. Zoonotic influenza: candidate vaccine viruses and potency testing reagents. Available at:\nhttps://www.who.int/teams/global-influenza-programme/vaccines/who-recommendations/zoonotic-\ninfluenza-viruses-and-candidate-vaccine-viruses .\n8 US CDC. CDC Confirms First Severe Case of H5N1 Bird Flu in the United States, 18 Dec 2024. Available at:\nhttps://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html .\n9 US CDC. Genetic Sequences of Highly Pathogenic Avian Influenza A(H5N1) Viruses Identified in a Person in\nLouisiana, 26 Dec 2024. Available at: https://www.cdc.gov/bird-flu/spotlights/h5n1-response-12232024.html .\n10 US CDC. First H5 Bird Flu Death Reported in United States, 6 Jan 2025. Available at:\nhttps://www.cdc.gov/media/releases/2025/m0106-h5-birdflu-death.html .",
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+ "text": "3\nanalysis including genetic sequencing of the virus from the specimen from this case was underway at\nthe time of reporting. 11\nFive additional cases of influenza A(H5) were detected in California in individuals aged over 18 years\nwho worked at commercial dairy cattle farms in areas where highly pathogenic avian influenza\n(HPAI)(H5N1) viruses had been detected in cows. The individuals had mild symptoms. 12 , 13\nLow pathogenicity and high pathogenicity avian influenza (HPAI) viruses have been detected in birds\nin the United States. Since 2022, the HPAI A(H5) virus has been detected in commercial and\nbackyard flocks in 48 states, impacting over 100 million birds. To date, 67 people have tested\npositive for A(H5) virus in the United States since 2022, with all but one of these cases occurring in\n2024. All cases have been associated with exposure to either A(H5N1)-infected poultry or dairy\ncattle, except for two cases where the exposure source could not be identified. 14 To date, no human-\nto-human transmission of influenza A(H5) virus has been identified in the USA. A(H5N1) virus\ninfections in dairy cattle and wild and domestic birds continue to be reported in the USA. 15\nA(H5N1), Cambodia\nOn 10 January 2025, Cambodia notified WHO of one case of human infection with influenza A(H5N1)\nin a 28-year-old male from Kampong Cham Province. The case had onset of fever, sore throat and\nchest pain on 1 January 2025. He sought care at two private local clinics and after his condition did\nnot improve, he traveled to Phnom Penh and was hospitalized due to shortness of breath on 7\nJanuary at a national hospital, which is a severe acute respiratory infection (SARI) sentinel site. The\ncase was isolated upon admission and provided oseltamivir and symptomatic treatment before\npassing away on 10 January. Nasopharyngeal (NP) and oropharyngeal (OP) swab specimens tested\npositive on 9 January for influenza A(H5N1) by real-time reverse transcription-polymerase chain\nreaction (rt-PCR) at the National Institute of Public Health of Cambodia. The Institut Pasteur du\nCambodge (IPC) confirmed the results on 10 January. Sequence analysis of HA gene shows the virus\nbelongs to clade 2.3.2.1c and is closely related to those viruses circulating among birds in Cambodia\nin 2024. Phylogenetic and molecular analysis is ongoing.\nAccording to the early investigation, the case was a guard of a farm in the village where he lived and\nraised poultry for family consumption. There were reports of sick poultry in his farm and samples\nfrom the poultry on the farm have been collected. No further cases were detected among the\ncontacts of the case.\nAccording to reports received by WOAH, various influenza A(H5) subtypes continue to be detected in\nwild and domestic birds in the Americas, Asia and Europe. Infections in non-human mammals are\n11 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 2, ending January 11, 2025.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2025-week-02.html.\n12 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 50, ending December 14, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-50.html .\n13 US CDC. Weekly US Influenza Surveillance Report: Key Updates for Week 51, ending December 21, 2024.\nAvailable at: https://www.cdc.gov/fluview/surveillance/2024-week-51.html .\n14 United States Centers for Disease Control and Prevention. H5 Bird Flu: Current Situation. Available at:\nhttps://www.cdc.gov/bird-flu/situation-\nsummary/index.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fbird-flu%2Fphp%2Favian-flu-\nsummary%2Findex.html .\n15 United States Department of Agriculture. Highly Pathogenic Avian Influenza (HPAI) Detections in Livestock,\n19 July 2024. Available at: https://www.aphis.usda.gov/livestock-poultry-disease/avian/avian-influenza/hpai-\ndetections/livestock .",
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+ "text": "4\nalso reported, including in marine and land mammals. 16 A list of bird and mammalian species\naffected by HPAI A(H5) viruses is maintained by FAO. 17\nRisk Assessment for avian influenza A(H5) viruses:\n1. What is the current global public health risk of additional human cases of infection with avian\ninfluenza A(H5) viruses?\nMost human cases so far have been infections in people exposed to A(H5) viruses, for example,\nthrough contact with infected poultry or contaminated environments, including live poultry markets,\nand occasionally infected mammals and contaminated environments. While the viruses continue to\nbe detected in animals and related environments humans are exposed to, further human cases\nassociated with such exposures are expected but unusual. The impact for public health if additional\ncases are detected is minimal. The current overall global public health risk of additional human cases\nis low.\n2. What is the likelihood of sustained human-to-human transmission of currently circulating avian\ninfluenza A(H5) viruses?\nNo sustained human-to-human transmission has been identified associated with the recent reported\nhuman infections with avian influenza A(H5). There has been no reported human-to-human\ntransmission of A(H5N1) viruses since 2007, although there may be gaps in investigations. In 2007\nand the years prior, small clusters of A(H5) virus infections in humans were reported, including some\ninvolving health care workers, where limited human-to-human transmission could not be excluded;\nhowever, sustained human-to-human transmission was not reported.\nAvailable evidence suggests that influenza A(H5) viruses circulating have not acquired the ability to\nefficiently transmit between people, therefore the likelihood of sustained human-to-human\ntransmission is thus currently considered unlikely at this time.\n3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community-\nlevel spread is considered unlikely as current evidence suggests these viruses have not acquired the\nability to transmit easily among humans.\nA(H9N2), China\nSince the last risk assessment of 12 December 2024, two human cases of infection with A(H9N2)\ninfluenza viruses were notified to WHO from China (Table 1). Both cases were detected through\ninfluenza-like illness (ILI) surveillance, were mild and have recovered. Both cases had a history of\nexposure to live poultry markets prior the onset of symptoms. No further cases were detected\namong contacts of the cases. Influenza A(H9) virus was detected in the poultry-related environments\nassociated with these cases.\n16 World Organisation for Animal Health (WOAH). Avian influenza. Global situation. Available at:\nhttps://www.woah.org/en/disease/avian-influenza/#ui-id-2 .\n17 Food and Agriculture Organization of the United Nations. Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential/bird-species-affected-by-h5nx-hpai/en .",
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+ "text": "Onset date\tReporting province\tAge (years)\tGender\tHospitalization date\n27 Nov 2024\tHubei\t8\tFemale\tNot hospitalized\n13 Dec 2024\tChongqing\t1\tFemale\t14 Dec 2024",
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+ "text": "5",
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+ "heading": "Influenza at the human-animal interface\nSummary and risk assessment, from 13 December 2024 to 20 January 2025 1",
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+ "text": "Onset date\nReporting province\nAge (years)\nGender\nHospitalization date\n27 Nov 2024\nHubei\n8\nFemale\nNot hospitalized\n13 Dec 2024\nChongqing\n1\nFemale\n14 Dec 2024\nRisk Assessment for avian influenza A(H9N2):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H9N2) viruses?\nMost human cases follow exposure to the A(H9N2) virus through contact with infected poultry or\ncontaminated environments. Most human infections of A(H9N2) to date have resulted in mild\nclinical illness in most cases. Nearly 130 human infections with A(H9N2) cases have been reported to\ndate since 2003, and six of these have been severe or fatal and three of these were known to have\nunderlying medical conditions. Since the virus is endemic in poultry in multiple continues in Africa\nand Asia 18 , further human cases associated with exposure to infected poultry are expected but\nremain unusual. The impact to public health if additional cases are detected is minimal. The overall\nglobal public health risk of additional human cases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H9N2)\nviruses?\nAt the present time, no sustained human-to-human transmission has been identified associated with\nthe event described above. Current evidence suggests that influenza A(H9N2) viruses from these\ncases have not acquired the ability of sustained transmission among humans, therefore sustained\nhuman-to-human transmission is thus currently considered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H9N2) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely as current evidence suggests the A(H9N2) virus subtype has not\nacquired the ability to transmit easily among humans.\nA(H10N3), China\nSince the last risk assessment of 12 December 2024, one human case of infection with A(H10N3)\ninfluenza viruses were notified to WHO from China on 3 January 2025. A 23-year-old female from\nGuangxi Zhuang Autonomous Region, with an underlying condition, had symptom onset on 12\nDecember 2024. She was admitted to hospital on 19 December with severe pneumonia and treated\nwith oseltamivir. Initially, she was in critical condition but has improved. A clinical sample collected\non 22 December tested positive for influenza A and influenza A(H10N3) was confirmed a on 26\nDecember. Prior to symptom onset, the patient worked at a supermarket and was exposed to freshly\nslaughtered poultry. No family members have developed symptoms at the time of reporting. All\nclose contacts tested negative for influenza A(H10N3). All environmental samples collected from\nvarious locations tested negative for influenza A(H10N3).\nThis is the fourth case of human A(H10N3) virus infection detected in China and globally to date.\n18 Food and Agriculture Organization of the United Nations (FAO). Global Avian Influenza Viruses with Zoonotic\nPotential situation update. Available at: https://www.fao.org/animal-health/situation-updates/global-aiv-with-\nzoonotic-potential .",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "6\nRisk Assessment for avian influenza A(H10N3):\n1. What is the global public health risk of additional human cases of infection with avian influenza\nA(H10N3) viruses?\nHuman infections with avian influenza A(H10) viruses have been detected and reported previously.\nThe extent of circulation and epidemiology of these viruses in birds is unclear. Avian influenza\nA(H10N3) viruses with different genetic characteristics have been detected previously in migratory\nand other wild birds since the 1970s. As long as the virus continues to circulate in birds, further\nhuman cases can be expected but remain unusual. The impact to public health if additional sporadic\ncases are detected is minimal. The overall global public health risk of additional sporadic human\ncases is low.\n2. What is the likelihood of sustained human-to-human transmission of avian influenza A(H10N3)\nviruses?\nNo sustained human-to-human transmission has been identified associated with the event described\nAbove or past events with human cases of influenza A(H10N3) viruses. Current epidemiologic and\nvirologic evidence suggests that contemporary influenza A(H10N3) viruses assessed by the Global\nInfluenza Surveillance and response System (GISRS) have not acquired the ability of sustained\ntransmission among humans, therefore sustained human-to-human transmission is thus currently\nconsidered unlikely.\n3. What is the likelihood of international spread of avian influenza A(H10N3) virus by travellers?\nShould infected individuals from affected areas travel internationally, their infection may be\ndetected in another country during travel or after arrival. If this were to occur, further community\nlevel spread is considered unlikely based on current limited evidence.\nOverall risk management recommendations:\nSurveillance and investigations\n\u2022\nDue to the constantly evolving nature of influenza viruses, WHO continues to stress the\nimportance of global strategic surveillance in animals and humans to detect virologic,\nepidemiologic and clinical changes associated with circulating influenza viruses that may affect\nhuman (or animal) health. Continued vigilance is needed within affected and neighbouring areas\nto detect infections in animals and humans. Close collaboration with the animal health and\nenvironment sectors is essential to understand the extent of the risk of human exposure and to\nprevent and control the spread of animal influenza.\n\u2022\nAs the extent of influenza virus circulation in animals is not clear, epidemiologic and virologic\nsurveillance and the follow-up of suspected human cases should continue systematically.\nGuidance on investigation of non-seasonal influenza and other emerging acute respiratory\ndiseases has been published on the WHO website.\n\u2022\nCountries should increase avian influenza surveillance in domestic and wild birds, enhance\nsurveillance for early detection in cattle populations in countries where HPAI is known to be\ncirculating, include HPAI as a differential diagnosis in non-avian species, including cattle and\nother livestock populations, with high risk of exposure to HPAI viruses; monitor and investigate\ncases in non-avian species, including livestock, report cases of HPAI in all animal species,\nincluding unusual hosts, to WOAH and other international organizations, share genetic\nsequences of avian influenza viruses in publicly available databases, implement preventive and\nearly response measures to break the HPAI transmission cycle among animals through\nmovement restrictions of infected livestock holdings and strict biosecurity measures in all",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "7\nholdings, employ good production and hygiene practices when handing animal products, and\nprotect persons in contact with suspected/infected animals. 19\n\u2022\nWhen there has been human exposure to a known outbreak of an influenza A virus in domestic\npoultry, wild birds or other animals \u2013 or when there has been an identified human case of\ninfection with such a virus \u2013 enhanced surveillance in potentially exposed human populations\nbecomes necessary. Enhanced surveillance should consider the health care seeking behaviour of\nthe population, and could include a range of active and passive health care and/or community-\nbased approaches, including: enhanced surveillance in local influenza-like illness (ILI)/SARI\nsystems, active screening in hospitals and of groups that may be at higher occupational risk of\nexposure, and inclusion of other sources such as traditional healers, private practitioners and\nprivate diagnostic laboratories.\n\u2022\nVigilance for the emergence of novel influenza viruses of pandemic potential should be\nmaintained at all times including during a non-influenza emergency. In the context of the co-\ncirculation of SARS-CoV-2 and influenza viruses, WHO has updated and published practical\nguidance for integrated surveillance .\nNotifying WHO\n\u2022\nAll human infections caused by a new subtype of influenza virus are notifiable under the\nInternational Health Regulations (IHR, 2005). 20 State Parties to the IHR (2005) are required to\nimmediately notify WHO of any laboratory-confirmed 5 21 case of a recent human infection caused\nby an influenza A virus with the potential to cause a pandemic 6 22 . Evidence of illness is not\nrequired for this report.\n\u2022\nWHO published the case definition for human infections with avian influenza A(H5) virus\nrequiring notification under IHR (2005): https://www.who.int/teams/global-influenza-\nprogramme/avian-influenza/case-definitions .\nVirus sharing and risk assessment\n\u2022\nIt is critical that these influenza viruses from animals or from people are fully characterized in\nappropriate animal or human health influenza reference laboratories. Under WHO\u2019s Pandemic\nInfluenza Preparedness (PIP) Framework, Member States are expected to share influenza viruses\nwith pandemic potential on a timely basis 23 with a WHO Collaborating Centre for influenza of\nGISRS. The viruses are used by the public health laboratories to assess the risk of pandemic\ninfluenza and to develop candidate vaccine viruses.\n\u2022\nThe Tool for Influenza Pandemic Risk Assessment (TIPRA) provides an in-depth assessment of\nrisk associated with some zoonotic influenza viruses \u2013 notably the likelihood of the virus gaining\nhuman-to-human transmissibility, and the impact should the virus gain such transmissibility.\nTIPRA maps relative risk amongst viruses assessed using multiple elements. The results of TIPRA\ncomplement those of the risk assessment provided here, and those of prior TIPRA analyses will\nbe published at http://www.who.int/teams/global-influenza-programme/avian-influenza/tool-\nfor-influenza-pandemic-risk-assessment-(tipra) .\n19 World Organisation for Animal Health. Statement on High Pathogenicity Avian Influenza in Cattle, 6\nDecember 2024. Available at: https://www.woah.org/en/high-pathogenicity-avian-influenza-hpai-in-cattle/ .\n20 World Health Organization. Case definitions for the four diseases requiring notification in all\ncircumstances under the International Health Regulations (2005).\n21 World Health Organization. Manual for the laboratory diagnosis and virological surveillance of influenza\n(2011). Available at: https://apps.who.int/iris/handle/10665/44518\n22 World Health Organization. Pandemic influenza preparedness framework for the sharing of influenza viruses\nand access to vaccines and other benefits, 2 nd edition. Available at: https://iris.who.int/handle/10665/341850\n23 World Health Organization. Operational guidance on sharing influenza viruses with human pandemic\npotential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework (2017). Available at:\nhttps://apps.who.int/iris/handle/10665/25940",
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+ "heading": "Table 1. Human cases of influenza A(H9N2) reported to WHO from China from to 13 December\n2024 to 20 January 2025.",
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+ "text": "8\nRisk reduction\n\u2022\nGiven the observed extent and frequency of avian influenza in poultry, wild birds and some wild\nand domestic mammals, the public should avoid contact with animals that are sick or dead from\nunknown causes, including wild animals, and should report dead birds and mammals or request\ntheir removal by contacting local wildlife or veterinary authorities.\n\u2022\nEggs, poultry meat and other poultry food products should be properly cooked and properly\nhandled during food preparation. Due to the potential health risks to consumers, raw milk\nshould be avoided. WHO advises consuming pasteurized milk. If pasteurized milk isn\u2019t available,\nheating raw milk until it boils makes it safer for consumption.\n\u2022\nWHO has published practical interim guidance to reduce the risk of infection in people exposed\nto avian influenza viruses.\nTrade and travellers\n\u2022\nWHO advises that travellers to countries with known outbreaks of animal influenza should avoid\nfarms, contact with animals in live animal markets, entering areas where animals may be\nslaughtered, or contact with any surfaces that appear to be contaminated with animal excreta.\nTravelers should also wash their hands often with soap and water. All individuals should follow\ngood food safety and hygiene practices.\n\u2022\nWHO does not advise special traveller screening at points of entry or restrictions with regards to\nthe current situation of influenza viruses at the human-animal interface. For recommendations\non safe trade in animals and related products from countries affected by these influenza viruses,\nrefer to WOAH guidance.\nLinks:\nWHO Human-Animal Interface web page\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza\nWHO Influenza (Avian and other zoonotic) fact sheet\nhttps://www.who.int/news-room/fact-sheets/detail/influenza-(avian-and-other-zoonotic)\nWHO Protocol to investigate non-seasonal influenza and other emerging acute respiratory diseases\nhttps://www.who.int/publications/i/item/WHO-WHE-IHM-GIP-2018.2\nWHO Public health resource pack for countries experiencing outbreaks of influenza in animals:\nhttps://www.who.int/publications/i/item/9789240076884\nCumulative Number of Confirmed Human Cases of Avian Influenza A(H5N1) Reported to WHO\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-a-h5n1-virus\nAvian Influenza A(H7N9) Information\nhttps://www.who.int/teams/global-influenza-programme/avian-influenza/avian-influenza-a-( h7n9 )-\nvirus\nWorld Organisation of Animal Health (WOAH) web page: Avian Influenza\nhttps://www.woah.org/en/home/\nFood and Agriculture Organization of the United Nations (FAO) webpage: Avian Influenza\nhttps://www.fao.org/animal-health/avian-flu-qa/en/\nOFFLU\nhttp://www.offlu.org/",
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+ "text": "The first bird-flu related death has been reported in the US, according to the Louisiana department of health, where the death occurred.\nThe patient had been taken to hospital after contracting a major strain of bird flu, known as H5N1.\nLouisiana health department said they were over the age of 65, and had other underlying health conditions.\nIt said their public health investigation had not found evidence of person-to-person transmission, or any other cases.\nBird flu is a disease caused by a virus that infects birds and sometimes other animals, such as foxes, seals and otters. In very rare cases, it can also infect humans.\nThe state's health department added the person had contracted bird flu after being exposed to a personal flock of birds and wild birds.\n\"While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,\" it said.\nThere have been 66 confirmed cases of H5N1 bird flu in the US since 2024, according to the Centers for Disease Control and Prevention (CDC).",
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+ "text": "Bird flu is a disease caused by a virus that infects birds, and sometimes other animals. Bird migration has resulted in outbreaks of the avian flu in domestic and wild birds.\nThe H5N1 virus is the major strain circulating among wild birds worldwide, and emerged in China in the late 1990s.\nAlthough infection of humans is very rare, it occurs via transmission from birds.\nAlmost all cases of infection in people have been associated with close contact to infected dead or live birds, or contaminated environments.\nSince 2003, the World Health Organization (WHO) has counted 954 confirmed human cases of bird flu, of which about half have died.\nThere has been no sustained human-to-human transmission.\nLast month, the CDC said the Louisiana patient had been infected with the D1.1variant of the virus, which has recently been detected in North America.\nA 13-year-old girl in Canada was taken to hospital with the same D1.1 variant in November 2024, according to a paper published in The New England Journal of Medicine.\nIt is different to the B3.13 variant, which - during the past year - has been on the rise among cows in the US.\nIn September 2024, a person in Missouri recovered from bird flu after being treated in hospital.",
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+ "text": "According to the WHO, symptoms of a H5N1 infection include a cough, sore throat, fever (often over 38C), muscle aches and general feelings of malaise.\nPeople with the virus may also display other non-respiratory symptoms such as conjunctivitis.\nThe WHO added that H5N1 has also been detected in people without symptoms who had contact with infected animals or their environments.\nWhile the risk to humans is low, the constantly evolving virus is monitored for all changes, including the potential to become easily transmissible from person to person.",
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+ "title": "\u2018Severe\u2019 Bird Flu in the U.S.: Latest Updates",
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+ "text": "The Centers for Disease Control and Prevention (CDC) confirmed on Wednesday the United States\u2019 first \u201csevere\u201d human case of H5N1 avian influenza\u2014or bird flu, a zoonotic infection which has stoked fears of becoming the next global pandemic.\nThe severe case involves a resident of southwestern Louisiana who was reported as presumptively positive for infection last Friday. The infected patient \u201cis experiencing severe respiratory illness related to H5N1 infection and is currently hospitalized in critical condition,\u201d according to Emma Herrock, a spokesperson for the Louisiana Department of Health, who said that the patient is over the age of 65 and has underlying medical conditions but that further updates on their condition will not be given at this time due to patient confidentiality.\nRead More: What Are the Symptoms of Bird Flu?\nIt is the 61st case of human H5N1 bird flu infection in the country since April this year. But the CDC said the overall risk of the pathogen to the public remains low, and no related deaths have been reported in the U.S. so far.\nHere\u2019s what to know.",
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+ "text": "The CDC, in its Dec. 18 announcement, said that while an investigation is underway, the patient was found to have links to sick and dead birds in backyard flocks, making it the first known case of infection in the U.S. to have those origins.\nOf the 60 other cases, 58 were linked to commercial agriculture\u201437 from dairy herds and 21 from poultry farms and culling. The sources of exposure for the two other U.S. human cases remain unknown.",
+ "chunk_type": "prose",
+ "heading": "What caused the severe infection?",
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+ "text": "Of the human infections recorded in the U.S. this year, 34, or more than half, were in California, with all but one exposed to cattle. In response, Governor Gavin Newsom on Dec. 18 declared a state of emergency.\nThe CDC said that such a \u201csevere\u201d infection as was found in Louisiana was expected given cases in other countries. In Vietnam, a patient who died in March after a diagnosis of \u201csevere pneumonia, severe sepsis, and acute respiratory distress syndrome\u201d was found with an H5N1 infection, according to the World Health Organization. The U.S. appears to be leading in H5N1 infections across the world this year, according to CDC data on bird flu cases reported to the WHO.\nRead More: The Bird Flu Virus Is One Mutation Away from Getting More Dangerous\nAccording to Mark Mulligan, Director of the Vaccine Center and the Division of Infectious Diseases and Immunology at New York University Grossman School of Medicine, the general population faces \u201cno immediate threat.\u201d Those who are in contact with birds and animals\u2014especially those who work on dairy farms and cattle farms\u2014are at greatest risk. Currently, no person to person spread of the virus has been detected.\n\u201cRight now we have to let the experts do surveillance, do sequencing of the virus to see if we're seeing any changes that portend any significant difference,\u201d says Mulligan.",
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+ "text": "According to the CDC, symptoms of the bird flu can vary. Many of the cases in the U.S. included symptoms resembling conjunctivitis-like eye issues, including eye redness, discomfort, and discharge.\nSome cases also included both respiratory classic flu-like symptoms, including cough, headache, runny nose, fever, sore throat, body aches, fatigue, shortness of breath, and pneumonia, according to the CDC.\nRead More: What Are the Symptoms of Bird Flu?",
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+ "text": "The CDC issued a number of protective measures, including largely avoiding direct contact with wild birds and other suspected infected animals as well as their bodily excretions. People who work with cattle and poultry on affected farms have a greater risk of infection, and are thus advised to monitor any possible symptoms of infection.\nThe CDC also recommends that those who work with poultry or other animals use the correct personal protective equipment (PPE)\u2014including coveralls, boots, and more\u2014which should be provided by employers.\nVirologist and professor at John Hopkins University Andy Pekosz says that the severe case in Louisiana provides a reminder of an easy way to stay safe: stay away from dead animals. \u201cYou see a dead animal, if you're exposed to dead animals, stay away,\u201d he says. \u201cIn many ways, it is the least likely way someone can get exposed, but in some ways, it's also one of the more preventable ways.\u201d\nProperly cooked poultry and poultry products are safe, and the CDC says that while unpasteurized (raw) milk from infected cows can pose risks to humans, it\u2019s not yet known if avian influenza viruses can be transmitted through its consumption.\nBoth Mulligan and Pekosz say it is also important to get the seasonal human influenza vaccine. They say if there were to be a case of a person with simultaneous bird flu and human flu infection, it could lead to a \u201creassortment\u201d and thus a virus that could be more easily spread.\n\u201cWe know that has happened before, because the 1957 influenza pandemic and the 1968 influenza pandemic both were a result of a human and a bird influenza virus exchanging genetic material,\u201d Pekosz says. \u201cWe know that the flu vaccines are not perfect, but they do a good job of reducing infection.\u201d\nThe CDC currently has a program to offer seasonal vaccines to farm workers in high risk scenarios in certain states.",
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+ "text": "A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States.\nThe agency said Wednesday that the person was exposed to sick and dead birds in backyard flocks; this is the first US bird flu case linked to a backyard flock.\n\u201cIt is believed that the patient that was reported by Louisiana had exposure to sick or dead birds on their property. These are not commercial poultry, and there was no exposure to dairy cows or their related products,\u201d said Dr. Demetre Daskalakis, director of the National Center for Immunization and Respiratory Diseases at the CDC.\nFederal officials declined to answer questions about the patient\u2019s symptoms or their current condition. They instead referred all inquiries about the case to the Louisiana Department of Health, which is leading the investigation.\nAccording to state officials, the patient is experiencing severe respiratory illness related to H5N1 and is hospitalized in critical condition. The person is older than 65 and has underlying medical conditions that increased their risk of flu complications, the Louisiana Department of Health said in an email to CNN.\nThis virus, D1.1, is the same type found in recent human cases in Canada and Washington state and detected in wild birds and poultry in the United States. It\u2019s different from B3.13, the type detected in dairy cows, some poultry outbreaks and other cases in humans across the United States.\nThe CDC said it\u2019s working on additional genomic sequencing of samples from the patient, who is from southwestern Louisiana, and the investigation into the patient\u2019s exposure is still underway.\nBird flu has been linked with severe human illness and death in other countries, but no person-to-person spread has been detected.\n\u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the agency said in a statement.\nIn California, Gov. Gavin Newsom declared a state of emergency Wednesday over the continued spread of H5N1 bird flu in that state.",
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+ "text": "\u2022 Sign up here to get The Results Are In with Dr. Sanjay Gupta every Friday from the CNN Health team.\nNewsom said the measure was necessary because, despite intense efforts to contain it, the virus had spread beyond the Central Valley to four dairies in the southern part of the state.\n\u201cThis proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,\u201d he said in a news release. \u201cWhile the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus.\u201d\nThe emergency declaration will give state agencies greater flexibility with staffing and free up more funding for the response.\nOf the 61 confirmed human cases of bird flu in the US this year, 34 have been in California. Nearly all of those have been in dairy farm workers, according to the CDC.\nThe Louisiana case shows that precautions should be taken by people with backyard chicken flocks, hunters and other bird enthusiasts, the CDC said.\n\u201cThe cases across the US are a constellation of spillovers,\u201d said Dr. Rebecca Christofferson, a virologist at Louisiana State University\u2019s School of Veterinary Medicine. Experts still don\u2019t understand exactly how these spillovers are happening and the specific factors that increase a person\u2019s risk.\n\u201cIt\u2019s just kind of a black box at the moment that a lot of people are trying to answer these questions on,\u201d Christofferson said.\nThe CDC says the best approach is to avoid exposure. Infected birds can shed viruses in their saliva, mucus and feces, and other animals may shed them in their respiratory secretions and bodily fluids, including unpasteurized milk from cows.\n\u201cPeople who work with or have recreational exposure to infected animals are at higher risk of infection, and it\u2019s extremely important that they follow CDC recommended precautions when around infected or potentially infected animals, a message that we will continue to magnify given recent cases,\u201d Daskalakis said.",
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+ "snippet": "America\u2019s first severe case of bird flu confirmed in Louisiana | CNN CNN10 CNN 5 Things About CNN There have been 61 reported human cases of H5 bird flu in the United States since April. A patient in Louisiana has been hospitalized with a severe case of H5N1 bird flu, the US Centers for Disease Control and Prevention said, the first such case in the United States. \u201cThis case does not change CDC\u2019s overall assessment of the immediate risk to the public\u2019s health from H5N1 bird flu, which remains low,\u201d the CDC said in a statement. There have been 61 reported human cases of H5 bird flu in the United States since April, mostly among dairy and poultry workers.",
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new file mode 100644
index 0000000..5771a4f
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+++ b/data/runs_ab_with_history/q1/traj_20250224/insight.json
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diff --git a/data/runs_ab_with_history/q1/traj_20250224/question.json b/data/runs_ab_with_history/q1/traj_20250224/question.json
new file mode 100644
index 0000000..82b7bda
--- /dev/null
+++ b/data/runs_ab_with_history/q1/traj_20250224/question.json
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+ "snippet": "In other avian flu developments: Related news Avian flu infects more dairy cows in Michigan Second dairy farm worker infected with H5 avian flu in Michigan Alpacas infected with H5N1 avian flu in Idaho Study confirms infection in mice fed H5N1-contaminated raw milk USDA expands support for H5N1 response to more dairy producers Michigan reports H5 avian flu in dairy farm worker Australia reports imported human H5N1 avian flu case and unrelated high-path poultry outbreak Survey: States and territories able to test for highly pathogenic H5N1 This week's top reads Alpacas infected with H5N1 avian flu in Idaho In other developments, H5N1 was detected in feral cats in New Mexico and more dairy herds in affected states. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Iowa disaster proclamation Governor Reynolds yesterday announced the disaster proclamation for highly pathogenic avian flu in Cherokee County, the same day the Iowa Department of Agriculture and Land Stewardship\u00a0reported an outbreak at a commercial turkey farm in the county. Main navigation H5 influenza wastewater dashboard launches Luke Jones/Flickr cc WastewaterSCAN, a national wastewater monitoring system based at Stanford University in partnership with Emory University, today launched an\u00a0H5 avian influenza wastewater dashboard today, which shows detections at about a dozen locations, mostly in Texas and Michigan. Second dairy farm worker infected with H5 avian flu in Michigan Unlike similar earlier cases in the United States, the newly reported patient had respiratory symptoms. ",
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+ "snippet": "Related news H5N1 strikes dairy herd in Michigan, large poultry farm in Colorado Animal experiments shed more light on behavior of H5N1 from dairy cows CDC confirms 4th human case of H5N1 avian flu as more dairy herds in Colorado hit HHS awards Moderna $176 million to develop mRNA H5 avian flu vaccine More evidence pasteurization inactivates H5N1 avian flu virus in milk USDA spells out financial assistance to offset H5N1-linked milk losses Scientists expand H5N1 testing in dairy products, launch human serology study Experiments show H5N1 risk to dairy cows not exclusive to subtype infecting US herds This week's top reads CDC confirms 4th human case of H5N1 avian flu as more dairy herds in Colorado hit The infected farm worker is from Colorado, which has had the most affected dairy herds in the past month. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation H5N1 confirmed in 5 more US dairy herds, more cats Khaligo/iStock The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today added five more dairy herds in three states to its list of H5N1 avian flu outbreak confirmations. H5N1 confirmed in 5 more US dairy herds, more cats The additional cat detections are from 2 states battling the virus in cows: Minnesota and Michigan. More cat and wild-bird positives In related developments, APHIS confirmed H5N1 detections in three more domestic cats, two from Minnesota and one from Michigan, raising the total since 2022 to 33. ",
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+ "snippet": "In other developments: Related news Feds announces assistance for US farmers affected by H5N1 avian flu Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals USDA reports more H5N1 detections in poultry, wild birds With H5N1 avian flu silently spreading in US cattle, wastewater testing could be key Studies yield more clues about H5N1 avian flu susceptibility, spread in dairy cows Case report bolsters evidence for H5N1 avian flu spread from cow to Texas dairy worker USDA genome study sheds light on H5N1 avian flu spillover to cows, but data gaps remain FDA finds no live H5N1 avian flu virus in sour cream or cottage cheese, will assess raw milk This week's top reads Study: HHS's COVID vaccine campaign saved $732 billion in averted infections, costs Researchers say the campaign encouraged 22 million Americans to complete their primary COVID-19 vaccine series, preventing nearly 2.6 million infections. Our underwriters Unrestricted financial support provided by Help make CIDRAP's vital work possible Help make CIDRAP's vital work possible Contact Us CIDRAP - Center for Infectious Disease Research & Policy Research and Innovation Office, University of Minnesota, Minneapolis, MN Email us \u00a9 2024 Regents of the University of Minnesota. Main navigation Wastewater testing finds H5N1 avian flu in 9 Texas cities varius-studios/ iStock Researchers who sequenced viruses from wastewater samples from 10 Texas cities found H5N1 avian flu virus in 9 of them, sometimes at levels that rivaled seasonal flu. On X, Mike Tisza, PhD, the first author of the study and assistant professor of virology and microbiology at Baylor, said it's still not clear where the viruses came from, but the evidence tilts toward an animal source, because the researchers didn't see any mutations with known links to human adaptation. Colorado officials probe source of H5N1 in cows as USDA confirms more infected mammals Monitoring of about 70 farm workers found no symptoms, and the state's wastewater sampling pilot has found no flu rise. ",
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+ "title": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms - Livescience.com",
+ "snippet": "Latest human H5N1 bird flu case in US is 1st to cause respiratory symptoms This infection, tied to an ongoing outbreak in cows, is the first in the U.S. to cause respiratory symptoms, but not the first H5N1 case in the world to do so. Related: H5N1: What to know about the bird flu cases in cows, goats and people \"This is the first human case of H5 in the United States to report more typical symptoms of acute respiratory illness associated with influenza virus infection, including A(H5N1) viruses,\" the CDC reported. H5N1 bird flu has spread to human from cow in 2nd probable case, CDC reports H5N1: What to know about the bird flu cases in cows, goats and people China lands Chang'e 6 sample-return probe on far side of the moon Live Science is part of Future US Inc, an international media group and leading digital publisher. \u201421-year-old student dies of H5N1 bird flu in Vietnam \u20141st polar bear death from bird flu spells trouble for species \u2014China reported 1st human death from H3N8 bird flu, WHO says With that possibility in mind, the CDC continues to closely monitor for unusual flu activity across the country. A third human case of bird flu has been linked to the ongoing outbreak in cows on U.S. dairy farms \u2014 and this one came with respiratory symptoms, such as cough, the Centers for Disease Control and Prevention (CDC) reported May 30. ",
+ "rank": 3,
+ "retrieved_at": "2026-07-14T23:24:39.992439+00:00",
+ "published_date": "2024-06-03T19:09:13+00:00",
+ "file_type": null,
+ "language": null,
+ "source_id": null,
+ "is_official_domain": false,
+ "source_tier": "unknown",
+ "domain_score": 0.2,
+ "keyword_overlap_score": 0.0,
+ "freshness_score": 0.273972602739726,
+ "duplicate_cluster_id": null,
+ "retrieval_reason": "latest_data",
+ "contains_aggregator_forecast": false,
+ "search_stage_score": 0.3330494341870161,
+ "published_date_source": "backend",
+ "cutoff_applied": "2025-02-24T00:00:00+00:00"
+ },
+ {
+ "id": "5bb9225ea86845cf893a9cfceb5dc85c",
+ "question_id": "q1",
+ "query_id": "7fd736cd485e4c399e000c03863031bc",
+ "engine": "tavily",
+ "url": "https://www.foxnews.com/health/first-severe-case-bird-flu-detected-us-cdc-confirms",
+ "canonical_url": "https://foxnews.com/health/first-severe-case-bird-flu-detected-us-cdc-confirms",
+ "domain": "foxnews.com",
+ "title": "First severe case of bird flu detected in US, CDC confirms - Fox News",
+ "snippet": "Severe case of H5N1 bird flu detected in US, CDC confirms | Fox News Fox News FOX News Go Fox News The U.S. Centers for Disease Control and Prevention said on Wednesday that a patient has been hospitalized with a severe case of H5N1 infection in Louisiana, marking the first known instance of a severe human illness linked to the bird flu virus in the United States. The CDC said that partial viral genome data from the infected patient shows that the virus belongs to the D1.1 genotype, recently detected in wild birds and poultry in the United States and in recent human cases in British Columbia, Canada, and Washington state. Fox News Health FOX News Go Fox News",
+ "rank": 9,
+ "retrieved_at": "2026-07-14T23:24:39.993952+00:00",
+ "published_date": "2024-12-18T16:59:00+00:00",
+ "file_type": null,
+ "language": null,
+ "source_id": null,
+ "is_official_domain": false,
+ "source_tier": "unknown",
+ "domain_score": 0.2,
+ "keyword_overlap_score": 0.0,
+ "freshness_score": 0.8164383561643835,
+ "duplicate_cluster_id": null,
+ "retrieval_reason": "latest_data",
+ "contains_aggregator_forecast": false,
+ "search_stage_score": 0.3148322414135398,
+ "published_date_source": "backend",
+ "cutoff_applied": "2025-02-24T00:00:00+00:00"
+ }
+]
\ No newline at end of file
diff --git a/requirements.txt b/requirements.txt
index 86323fa..cf9dfae 100644
--- a/requirements.txt
+++ b/requirements.txt
@@ -10,4 +10,5 @@ docling[chunking]>=2.90,<3.0 # TableFormer-based refinement for borderless / mer
tiktoken>=0.7,<1.0 # Approximate token counting (cl100k_base encoding)
openai>=1.0,<2.0 # OpenAI API client (used by filtering stage LLM calls)
pycountry>=24.0 # ISO 3166-1 country name → alpha-2 lookup (insight stage location resolution)
+TableauScraper>=0.1.29,<1.0 # Tableau workbook extraction for dashboard-backed custom scrapers
pytest>=8.0,<9.0 # Testing
diff --git a/scripts/run_historical_trajectory.py b/scripts/run_historical_trajectory.py
index dff087a..f08f60f 100644
--- a/scripts/run_historical_trajectory.py
+++ b/scripts/run_historical_trajectory.py
@@ -123,6 +123,11 @@ def _parse_args(argv: List[str]) -> argparse.Namespace:
)
p.add_argument("--no-baseline", action="store_true", help="Skip the retrieval-free baseline.")
p.add_argument("--no-cache", action="store_true", help="Disable the search-stage cache.")
+ p.add_argument(
+ "--no-history-context",
+ action="store_true",
+ help="Disable prior-run forecast/insight context during forecasting.",
+ )
p.add_argument(
"--max-input-tokens", type=int, default=None,
help="Override InsightConfig.max_input_tokens_per_run.",
@@ -181,6 +186,8 @@ def _run_one_cutoff(
orch_argv.append("--no-baseline")
if args.no_cache:
orch_argv.append("--no-cache")
+ if args.no_history_context:
+ orch_argv.append("--no-history-context")
if args.max_input_tokens is not None:
orch_argv += ["--max-input-tokens", str(args.max_input_tokens)]
if args.verbose: