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The CDC has confirmed the first severe human case of 

 in the US, involving a patient from Louisiana with a history of exposure to backyard poultry. This marks the first documented severe H5N1 infection in the country and follows global patterns of severe illness associated with poultry contact.

The patient is the first such case in the US to be severe enough for the person to be hospitalized. Thus far, all previous patients in confirmed cases have had mild symptoms not requiring hospitalization. The case was confirmed by the CDC on December 13, and the Louisiana Department of Health has not released additional information about the patient, citing privacy concerns.

UN, WHO address public health concern over avian flu transmission to humans

The patient’s infection was identified as the D11 genotype of the virus, which is commonly found in wild birds and has previously been linked to severe cases in regions like Canada and Washington state. Unlike the B313 strain, which has caused milder symptoms in dairy workers exposed to infected cattle, the D11 genotype appears to be more serious.

Genetic testing is ongoing to assess whether any mutations indicate increased danger or potential human-to-human spread, but no other related cases have been reported so far. The CDC continues to assess the risk as low to the public. It is important to note that although the D11 genotype appears to be more virulent, there has been no person-to-person transmission of the virus detected.

Jeanne Marrazzo, MD, MPH, director of the NIH's ational Institute of Allergy and Infectious Diseases (NIAID), recently 

about mutations and human-top human transmission. “The virus would still likely need to acquire additional mutations to acquire the ability to spread effectively among humans,” Marrazzo said.

With this first severe case, the US now has 61 confirmed human cases of H5N1. Last week there were 58 cases, with the overwhelming majority of cases confirmed in California. California Governor Gavin Newsom recently declared 

“This proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak. Building on California’s testing and monitoring system—the largest in the nation—we are committed to further protecting public health, supporting our agriculture industry, and ensuring that Californians have access to accurate, up-to-date information. While the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus,” Newsom said in a statement.

In California, there have been 34 human exposure incidents in the state overall and all but 1 of the cases have been linked to commercial agriculture and related operations. The one outstanding case was classified as having an unknown source. These figures reflect the overall exposure risk in the state tied to agricultural and animal operations.

The proclamation follows the detection of additional 

. While the risk to the public remains low, the declaration aims to provide state and local agencies with the resources and flexibility needed to respond swiftly and effectively.

For the Louisiana case, it has been determined that the patient had exposure to sick and dead birds in backyard flocks. This is the first case of avian infleunza in the US that has been linked to exposure to a backyard flock. A sporadic case of severe H5N1 bird flu illness in a person is not unexpected; avian influenza infection has previously been associated with severe human illness in other countries during 2024 and prior years, including illness resulting in death.

CDC Confirms First Severe Case of H5N1 Bird Flu in the United States. CDC press release. December 18, 2024. Accessed December 19, 2024.


https://www.cdc.gov/media/releases/2024/m1218-h5n1-flu.html

Governor Newsom takes proactive action to strengthen robust state response to Bird Flu. Published December 18, 2024. Accessed December 18, 2024. 

https://www.gov.ca.gov/2024/12/18/governor-newsom-takes-proactive-action-to-strengthen-robust-state-response-to-bird-flu/

Avian Influenza (Bird Flu). H5 Bird Flu: Current Situation. CDC. Updated December 17, 2024. Accessed December 18, 2024. 

https://www.cdc.gov/flu/avianflu/index.htm

Articles

The CDC has reported a case in Louisiana where the patient is hospitalized and had a history of exposure to backyard poultry

The first severe human case of avian influenza in the US is confirmed

 editorial team is counting down our Top 20 news stories and articles of the year, from January 1, 2024, to November 15, 2024. Rank was determined by measurable audience interest and engagement.

A spotlight is shining on 1 article each day through New Year’s Eve, when the No. 1 

 story of the year will be shared. The following article is No. 13 on this list:

written by By Jayme Hoffberg DVM, DACVECC, Board Certified Criticalist

Anaphylaxis is more than just an everyday allergic reaction and being prepared to recognize and treat these pets in a timely manner is crucial. Anaphylaxis is the systemic, immediate hypersensitivity reaction that is mostly caused by the Immunoglobulin E (IgE) mediated immunologic release of mediators from mast cells and basophils. The best way to differentiate an anaphylactic reaction from other simpler Type I hypersensitivity reactions is to characterize it as systemic hypersensitivity reaction involving at least 2 organ systems (dermatologic, respiratory, cardiovascular, and gastrointestinal (GI)).

Anecdotally, it would seem we are seeing more severe, life-threatening anaphylactic reactions in the last 5 years, which may also be due to our improved recognition of the disease. These are often some of the most severely and acutely ill patients we see in practice, and without timely and accurate identification and intervention, mortality can be very high.

There are numerous causes of allergic and anaphylactic reactions including insect bites and stings, vaccines, or other drugs though many of our patients will have an unknown trigger. In this article we are going to focus on IgE mediated type I hypersensitivity.

Our 2 main “bad boys” of anaphylaxis are the mast cell and the basophil. Both release histamine and mast cells will also release heparin. These 2 mediators are stored in granules preformed so there is prompt degranulation and release from the cells. This occurs when an antigen (an allergen) attaches to an IgE antibody on the surface of the cells. The release of these granules occurs within seconds to minutes. Then within 5-30 minutes there is downstream activation of the arachidonic acid cascade which releases prostaglandin, leukotrienes, and platelet activating factor. About 2-6 hours post stimulation, there is release of cytokines and chemokines such as interleukins and Tumor Necrosis Factor alpha (TNFalpha).

For information on this story, including identification of canine anaphylaxis and references, continue reading the full article: 

https://www.dvm360.com/view/navigating-canine-anaphylaxis

dvm360 is counting down the Top 20 news stories and articles from 2024 with this series of spotlights

2024 veterinary news in review: #13

The Innovator of the Month series, sponsored by Chewy Health, spotlights veterinary professionals who are driving positive change and inspiring their peers. By recognizing outstanding clinicians, technicians, and paraprofessionals, Chewy Health aims to highlight impactful initiatives and promote a brighter future for veterinary medicine.



Kwane Stewart, DVM, has practiced veterinary medicine in California for over 2 decades. During a 5-year tenure as a shelter veterinarian in an underfunded area of California, Dr. Stewart decided to embark on a new mission: providing free veterinary services to the pets of individuals experiencing homelessness. As Co-Founder and President of Project Street Vet, Dr. Stewart aims to expand the organization’s reach across major cities in the United States to provide free-of-charge check-ups, medication, and even food. With his personal motto of “no judgement, just help,” Dr. Stewart knows that there are myriad reasons why pet parents may not be in the position to afford health care for their pets. With access to care being an increasingly hot-button topic across the veterinary industry, Dr. Stewart is carving out a way to make obtaining that much-needed care easier.



Note: The following interview has been edited for brevity and clarity.

Can you introduce yourself and tell us about your work?

 I am Co-Founder and President of Project Street Vet, a 501c3 we established in 2020. Our mission is simple: we give free veterinary care to pets of people experiencing homelessness.

What was the pivotal moment or experience that inspired you to pursue Project Street Vet?

 There was a moment outside of a 7-Eleven where I randomly met this unhoused gentleman and his dog. His dog was suffering from a really bad skin condition. I treated the dog then saw the same man about a week and a half later, and the dog was transformed. I realized that, in those five minutes of care, I changed this dog's life and this man's life. That inspired me to do what I'm doing, and it’s been 13 or 14 years now.

What does success look like for you? How would that impact veterinary medicine, your practice, or community?

My dream is to be in the 15 largest cities. If we had a Project Street Vet team in those markets, we would account for about 75 percent of the homeless population in pets. It's an expansion that will probably take another two years. However, if I can reach that, we will have a serious footprint.

Can you share a specific example of how your innovation has positively impacted the veterinary community or success stories that demonstrate the effectiveness?

For many years it was just me, and now we've expanded to 8 cities and in those 8 cities I probably have 12 to 15 volunteer vets and maybe 30 to 35 veterinary techs. We have a little network and family of people doing the work. I think the biggest impact that I’ve noticed is a renewed belief in our purpose and what we're here to do. I spoke with someone who felt stuck in the mundane and had lost their desire and passion for the profession. I found that people who do this work for passion and not for pay are given a new lease on their career.

How has your work been received by the veterinary community and by pet owners or other stakeholders?

My work has been received with open arms and gratitude in ways that are hard to describe. It's very emotional and we have very personal interactions. It's not just the folks on the streets but the veterinarians and people who hear my story, or donate, or read the book. I'm building this beautiful network of people who are inspired to do more of this.

What are your plans for the future development of Project Street Vet?

It comes down to growth and expansion, we're on a tear. So, give me two years and check back with me.

What advice would you give other veterinarians or researchers who aspire to innovate in their field?

I think what drives vets, and I say this a lot, is the passion. You sometimes start to lose that in the race of building net wealth, or your practice, or staying afloat financially, or paying off your student loans. Then you start to lose that childhood part of you—the part that wanted to be a veterinarian. That seven-year-old boy in me dreamed of being a vet, and I sometimes realize I'm starting to stray from my very basic nature of helping animals.

In your opinion, what are the most pressing challenges facing the veterinary field today, and how can we work together to solve them?

A pressing challenge is access to care. I think if you ask any vet, that'll be in their top three challenges. There aren’t enough of us. The number of pet parents and pets in the country is outpacing the number of care providers. Unless we empower technicians or telemedicine as it becomes more popular, we're going to keep losing this battle and more and more pets aren't going to be seen to get the care they need.

Dr. Stewart closes out the 2024 Innovator of the Month series, which has brought forth some insightful conversations about advancing the veterinary field in more meaningful ways. Over the past five months, dvm360 has partnered with Chewy Health to celebrate these veterinary professionals who have combined compassion and innovation to make positive changes across access to care, affordability, practitioner burnout, and more. Creative new charities, products, and professional development programs are all included in this exciting series – Check out the other great innovators featured in 

Dr. Kwane Stewart’s mission is to provide free veterinary care to pets of individuals experiencing homelessness, which addresses critical access-to-care challenges in veterinary medicine.

Introducing dvm360 and Chewy Health’s December Innovator of the Month: Kwane Stewart, DVM, Co-Founder and President of Project Street Vet

Recent innovations and technology opportunities give veterinary teams a wealth of resources to streamline operations and improve efficiency, freeing up time to focus on what we do best: care for patients and assist clients. The important question is, are we taking full advantage of these opportunities? Results from a recent survey of veterinary practice owners by the American Veterinary Medical Association (AVMA) provide some important insights.

Many practices are using practice information management software (PIMS), electronic medical records software, and online pharmacies. Adoption has been slower for digital inventory management systems, online appointment scheduling, and telehealth.

Technology adoption rates also vary by practice type. For example, PIMS integrated communications software and online appointment scheduling are more common in companion animal practice than in mixed animal or equine practice.

To delve deeper into these findings, the AVMA asked practice owners whether they felt they were keeping up or falling behind when it came to using technology in their practice. Overall, 69% of owners said they were keeping up, 20% said they were falling behind, and the remainder said they didn’t know.

What reasons were given for falling behind? The most common reason was time constraints, followed by financial constraints and lack of interest.

Although these reasons need to be acknowledged, they don’t need to hold us back. Many digital tools are available to simplify or automate routine tasks and seamlessly incorporate technology into everyday practice. These tools provide solutions to specific problems that teams may be experiencing and opportunities to deliver what clients are demanding. Most of these tools, if not all, save more time in the long run than they take to incorporate. And as artificial intelligence continues to be integrated into technology solutions, the potential is immense for significant efficiency gains through responsible use of these capabilities. 

The good news is you don’t have to fully implement all available technologies right now to see results. In fact, a thoughtful, incremental approach can not only help overcome any hesitancy or resistance within your team but also prime your path toward sustained rewards.

Here are some tips to get started. If technology isn’t your thing, consider recruiting a technology enthusiast from your team to lead the charge.

Identify which types of digital tools or services your practice currently lacks. You can use the ones mentioned previously from the practice owners survey as a reference.

Talk with your team about pain points and frictions they are encountering in their daily roles and how these might be overcome.

Pick 1 tool that you think will address a problem or opportunity you’ve identified and would be easiest or least costly to implement. You’ll earn bonus points if the tool promises a quick win with potentially high impact, such as a ready-to-use online pharmacy or appointment scheduling platform or videoconferencing software for telemedicine visits.

Ask the vendor to highlight what the tool can do, the steps involved in implementation, and any ongoing support to help with training, technical issues, and updates.

Find out about the cost as well as the potential savings in both money and time you might expect with implementation. Several digital tools can substantially improve revenue streams or cut costs and time, with just a minor financial commitment. For tools that facilitate client communications, patient follow-up, or product sales, these benefits can be realized even if only a portion of clients take advantage.

Start with a small pilot project to discover how you and your team like the tool and its impacts on a specific area of your practice. Often, you can try things out for minimal expense, and within a week or two, you will know more about the technology than you could garner from a vendor’s pitch. If you like what you see, you can gradually expand the tool’s application to minimize disruption.

Another great way to overcome hesitancy is to learn about the experiences of other practices in implementing your chosen tool as well as any advice they have to offer, so you don’t need to start from scratch.

Check out the new AVMA Axon Tech Talk webinar series (avma.org/Axon), which focuses on technology and how it can be used to improve practices, processes, and productivity. Be sure to catch the episode “Online Ordering and Home Delivery.”

Find tips and real-life case studies on putting telemedicine services into practice

Practices that have already embraced digital technologies have growth opportunities as well. Quite often, the tools we’re already using have features we have yet to discover or use. Leveraging those features can offer a low-budget, high-impact boost.

For example, PIMS can be great for automating or facilitating a myriad of routine, often repetitive tasks. Are you taking advantage of all features, or do some go unused?

Although you could find out about a technology’s full capabilities by reading about the available features in the marketing or instructional materials, a quicker path might be to contact the vendor directly—for example, the PIMS company’s technology support team. Ask them to highlight what your practice could be doing with the tool.

Afterward, ask your team about their thoughts on the unused features and how those features might affect their work. (Discover how one practice did this, followed through, and reaped the rewards in the Tech Talk webinar “Boosting Productivity.”

In today’s busy practices, technology is a necessity, not a luxury. Among the many benefits are superior patient care, happier clients, smoother operations, and less stress on the team, not to mention financial gains. Indeed, research has shown that optimizing efficiency in companion animal practice can allow veterinary teams to accomplish more and reach more patients with their current contingent of staff.4 For more ideas on how technology can be used to achieve these goals, be sure to check out the Just One Thing series on the AVMA@Work blog (avma.org/Blog), featuring practical tips for veterinary practices that can be achieved in 15 minutes or less.

Doherty C, McKay C, Ouedraogo FB. 2024 AVMA Report on the Economic State of the Veterinary Profession. American Veterinary Medical Association. 2024. Accessed September 11, 2024. https://ebusiness.avma.org/ProductCatalog/product.aspx?ID=2157

Doherty C, Hayworth R. AVMA Tech Talk: online ordering and home delivery. American Veterinary Medical Association. Accessed October 18, 2024. https://axon.avma.org/local/catalog/view/product.php?productid=285

Doherty C, Boudreau L. AVMA Tech Talk: boosting productivity. American Veterinary Medical Association. Accessed October 18, 2024. https://axon.avma.org/local/catalog/view/product.php?productid=319

Ouedraogo FB, Weinstein P, Lefebvre SL. Increased efficiency could lessen the need for more staff in companion animal practice. 

. 2023;261(9):1357-1362. doi:10.2460/javma.23.03.0163

A practice can benefit in many ways by embracing and utilizing modern tools and resources

Take advantage of technology

, our host Adam Christman, DVM, MBA, welcomes Pam Hale, DVM, MBA, JM; George Melillo, VMD; and Keith True, DVM, MBA, to discuss a new group making its way to veterinary medicine: the New Order of Veterinary Leaders (NOVL) . The trio explains to Christman what the goals and aspirations of NOVL are and how they are using their years and successes as veterinarians and business professionals to provide support and encouragement to veterinarians through coaching and business training. 

 So barriers to ownership, obviously, what started probably 20 or 30 years ago, which sort of led to this growth in veterinary groups, is a lot of young DVMs coming out of school not wanting to get a loan to pay for a practice, considering the school loan debt that many of them have, and also the feeling of the need to learn more medicine before they enter into practice. Ownership, which we all do, coming out of school. Traditionally, what is it? Fifty-60, years ago, you might come out of school on a Friday and open up your own practice on a Monday or you would go in and work with Doc Joe for 5 or 6 years and start buying into the practice, but as we've grown into veterinary groups, we also need veterinarians that are in those important roles that help to give us agency. I know I've done some of my best work, even as a clinician, as a leader, as a regional medical director, when I've answered to another veterinarian, because we know that they can help us and they understand exactly what we go through each day. 

Don't get me wrong. I do believe we need our paraprofessionals around us—and paraprofessionals being those non DVMs—not just at our hospital level, but even at the corporate home office level. I think we need those [professionals] around us. But I do believe that veterinarians also should bring that most important part of what our profession needs, and that's the veterinary medical leadership and the business leadership, which I know, Dr True and Dr Melillo can talk to.

Podcasts

NOVL founders discuss its creation, and how it will empower veterinarians to pursue leadership and practice ownership opportunities. 

Introducing the New Order Of Veterinary Leaders

 story of the year will be shared. The following article is No. 14 on this list:

Spaying and neutering dogs: Myth vs reality

“Every lame animal that comes to your practice is not treated the exact same way; every animal hit by a car is not treated the same. I am going to try and convince you that spaying and neutering are no different in that respect: you should be taking each case and evaluating it separately. There is simply no cookie cutter answer to spaying and neutering dogs.” So began Bruce W Christensen, DVM, MS, DACT, founder of the Kokopelli Assisted Reproductive Services in Sacramento, California, in his session, “To spay or not to spay? And how? And when?” at the 2024 American Veterinary Medical Association (AVMA) Convention in Austin, Texas.

Christensen broke down the reasons for canine sterilization into 3 main categories: To prevent the contribution to the stray pet population; to halt undesirable behaviors; and to decrease the chance of contracting disease.

For the first case, overpopulation, although Christensen acknowledges the problem exists, he said, “keep in mind, there is also a variety of places people get their dogs from (ie, animal shelters, friend, breeder, etc.). “That should be considered when you are looking at the spaying or neutering,” Christensen said.

If, for example, the dog comes from a reputable breeder, that’s different than if the dog is coming from a shelter, which usually requires the dog is spayed or neutered before leaving the shelter. When coming from a breeder, said Christensen, almost always there is a discussion about spaying or neutering this animal. For breeders who, for example, sell a puppy that they consider great for future breeding, they might want to retain some coownership or breeding rights, with sterilization happening later in life for that dog. For other breeders, it might be in the contract that the adoptive family will spay or neuter this puppy at a certain point.

“You, as the veterinarian, should be aware that these conversations are happening, and if you are not on board with these decisions, then you should ask yourself why,” Christensen said.

For information on this story, including about the prevention of undesirable behaviors and decreasing the chance of contracting disease, continue reading the full article: 

https://www.dvm360.com/view/spaying-and-neutering-dogs-myth-v-reality