Although it ultimately failed, a bill that would have authorized the creation of the VPA role was introduced in the Florida House of Representatives earlier this year. Additionally, Colorado State University’s College of Veterinary Medicine in Fort Collins is in the process of developing a VPA degree program called a master of veterinary clinical care. Based on an available curriculum draft, the program would encompass a mere 65 credit hours—which is about half the credit hours required by most doctorate in veterinary medicine (DVM/VMD) programs—and consists of 3 semesters of fully online lecture with no laboratory, a fourth semester of truncated basic clinical skills training, and a short internship/practicum.

Currently, there is no accredited national educational program, no national test, and no regulatory structure to ensure people filling the proposed midlevel position would deliver safe and effective care. Yet, the intent is that these VPAs would be diagnosing, prognosing, recommending treatment, and even performing surgery. Allowing an insufficiently trained individual to perform these skills endangers patients and clients across practice types and poses unacceptable risks for animal health and public health, in general.

Complicating the concept of a midlevel practitioner is federal law that limits prescribing and dispensing medications to a veterinarian—meaning that what an MLP could do for their patients would be severely limited. Some have suggested that MLPs could operate from protocols, but any veterinarian in practice knows that protocols only go so far; patients are unique and so are their needs. Any deviation from a protocol would require intervention by a properly trained and licensed veterinarian, creating unnecessary duplication, risks for patients when such intervention must be immediate, and likely confusion in care provision. Addressing this functional issue would require legislative and regulatory changes in all 50 states and at the federal level, take many years, and be incredibly costly. In addition, given that the proposed MLP would operate under a supervising veterinarian, that veterinarian would be liable for all actions of the MLP.

There also are many unknowns regarding how an MLP role would affect the veterinary workforce. Although proponents of this proposed role argue that it would help relieve workforce shortages, there is no evidence to suggest these individuals would be any more likely than veterinarians to practice in areas that are underserved. Looking to human health care, we have seen that the disincentives that keep physicians from practicing in such areas also dissuade midlevel practitioners from practicing there.

Concerns also have been expressed about the potential negative impacts an MLP program might have on existing educational programs awarding doctoral degrees in veterinary medicine, as well as the ongoing value of the DVM/VMD degree, given overlaps in the MLP’s responsibilities with these professionals. Faculty, staff, and resources at colleges of veterinary medicine are already in short supply and stretched thin, and adding yet another program to already overloaded plates doesn’t seem smart or sustainable. Something will have to give, particularly with 13 new proposed veterinary schools in the pipeline. There are also questions about how these programs might affect colleges of veterinary technology and their graduates.

Two recent surveys reaffirm these concerns. Results from both surveys indicate the proposed MLP role does not appear to serve a necessary or sustainable role in a veterinarian-led team.

The first survey, conducted by the American Association of Veterinary State Boards (AAVSB), aimed to determine whether a hypothetical midlevel role (termed advanced animal health care provider in the survey) was necessary and wanted by veterinary teams. Responses were received from nearly 14,000 veterinarians and veterinary technicians.

When given the opportunity to comment, respondents expressed concern about creating a new professional role when veterinary technicians currently are not being used to their full extent. Given the survey’s results, the AAVSB, whose members include licensing bodies in more than 60 US and Canadian jurisdictions, decided against pursuing a midlevel position at this time.

The second survey, conducted by Veterinary Management Groups, captured practice owner sentiments regarding the creation of a midlevel position. Respondents voiced a variety of concerns and criticisms, including the following:

The risks and potential complications that could be caused by nonveterinarians performing surgeries

The decline in quality of care that may result from improper diagnosis or potential malpractice

The push to create a midlevel position is driven by a desire to lower labor costs, rather than an actual need for the position.

Respondents’ suggested alternatives all touched on the better leveraging of veterinary technicians. These included increasing pay and support for credentialed veterinary technicians, expanding and enhancing veterinary technology specialty programs, and pushing for consistent title recognition and protection and licensure for credentialed veterinary technicians across states.

Pet owners agree: the midlevel practitioner is unneeded and dangerous

The above survey findings come on the heels of a 2023 survey of pet owner attitudes by the American Veterinary Medical Association (AVMA), which found little support for a midlevel position. Instead, pet owners voiced a strong preference for veterinarian-led care.

Indeed, most pet owners know that allowing someone other than a licensed veterinarian to diagnose, prognose, make treatment recommendations, prescribe, or perform surgery would jeopardize patient health and safety. They oppose delegating primary responsibility for care decisions to nonveterinarians.

Perhaps most importantly, as all 3 surveys confirmed, there is simply no clear need for a midlevel practitioner. Instead, we need to better leverage and support the talented team members we already have. This would mean increasing the number of veterinary technicians, veterinary technologists, and veterinary technician specialists in all types of practice; fully engaging them to the top of their degrees; and providing the pay and recognition they deserve.

Veterinarians need to trust and delegate more to veterinary technicians, and there’s plenty of opportunity to do so. Nearly 20% of veterinary technicians do not feel utilized to their fullest potential, according to a 2022 survey by the National Association of Veterinary Technicians in America.

 A top barrier to unlocking the full potential of veterinary technicians is a perceived lack of trust/confidence in the veterinary technician’s skillset by the veterinarian.

If your state is considering creating a veterinary midlevel practitioner or similar position, you can help maintain the integrity of credentialed veterinary technicians’ and veterinarians’ roles. Share this article with your state policymakers, point them to 

 for more information, and work with your state and local veterinary medical associations to build support for veterinary technicians and against proposed alternatives.

Optimal engagement of the full veterinary team—including credentialed veterinary technicians—can help veterinary practices see more patients and meet client demand, without compromising patient health and safety, food safety, and public health. A great starting point for understanding the breadth of your veterinary technicians’ abilities is the AVMA Committee on Veterinary Technician Education and Activities Essential and Recommended Skills List. It details more than 200 tasks that veterinary technician students must be able to complete in order to graduate from accredited educational programs. Find it at 

The AVMA also has continuing education webinars and other tools to help you fully engage your practice’s veterinary technicians. Go to 

AAVSB veterinary team survey: understanding the results. American Association of Veterinary State Boards. Accessed August 12, 2024. 

https://vmb.ca.gov/meetings/materials/20240724-25_6.pdf

2023 pet owner attitude survey: key findings. American Veterinary Medical Association. November 2023. Accessed July 17, 2024. https://www.avma.org/sites/default/files/2023-11/AVMA-2023-Pet-Owner-Attitude-Survey-For%20Release-20231101.pdf

Chart of the Month: pet owners prefer veterinarian-led care. American Veterinary Medical Association. January 18, 2024. Accessed July 17, 2024. 

https://www.avma.org/blog/chart-month-pet-owners-prefer-veterinarian-led-care

NAVTA 2022 demographic survey results: pay & education have increased; burnout & debt are still issues. National Association of Veterinary Technicians in America. Accessed July 17, 2024. https://drive.google.com/file/d/11pmYzIouybfL55YsduRbaZ1TtMD1i2DB/view

Articles

Proposals that would create a new midlevel practitioner (MLP) role raise serious concerns about the future of quality care for veterinary patients. Sometimes referred to as a veterinary professional associate (VPA), their duties would overlap those of a veterinarian and veterinary technician.

Proposed midlevel role poses unacceptable risks

Lauren Thielen, DVM, DABVP (Avian Practice) offered advice for avian specialists handling emergency cases

Advice for new exotic veterinarians 

What should new avian veterinarians know when it comes to handling emergency cases? Lauren Thielen, DVM, DABVP (Avian Practice) spoke with 

in late September 2024 to discuss her lectures presented at the Southwest Veterinary Symposium earlier this fall. In an earlier video, Thielen talked about one of the most common exotic animal medical emergencies—a 

, often mislabeled as gastrointestinal (GI) stasis.

In this video, Thielen offers advice to veterinarians who may be handling emergency cases with birds, providing guidance to those who may be new to the profession. She advises veterinarians to begin with an observational exam and cautions these specialists against ‘over-diagnosing’ their patients.

Lauren Thielen, DVM, DABVP (Avian Practice): 

To always, you know, start with an observational exam. And the reason, [which is] what I kind of tell my students, is because sometimes birds are just so sick that you… pick them up to examine them, and…they could die in that moment.

So, my biggest advice is always do an observational exam. Understand how sick the bird is, and if you need to give it 20, 30 minutes, I can promise you, you not examining that bird for 30 minutes isn't the reason [the bird] died. You know, sometimes just allowing their stress levels to come down, maybe giving them some oxygen—allowing them to really kind of catch their breath. You know, get them warm… get them in a warming incubator to try to get them as stable as humanly possible, so when you do pick them up, do your exam in like 5 seconds, and just… get the highlights and put it right back down, I think that's the best advice I can give people that are kind of just starting to see birds; so that way you can kind of understand, you know, what level [you are] dealing with, so you can go at the pace that the bird needs.

Bautista-Alejandre A. The potential risks of diagnosing rabbits with GI stasis. 

. October 4, 2024. Accessed October 29, 2024. 

https://www.dvm360.com/view/the-potential-risks-of-diagnosing-rabbits-with-gi-stasis

Videos

Vetlen Advanced Veterinary Devices announced the creation of its new device for delivering antibiotic medication directly to infected surgical and wound sites in canine and equine patients is now available. The new drug delivery device—Vetlen Pouch—offers a new method for delivering daily localized, high-dose antibiotic therapy for treating infected wounds in dogs and horses, according to a news release.

“Other options for administering local antibiotic therapy to canine and equine patients are currently limited to antibiotic powders and antibiotic-loaded beads—both of which lose their effectiveness long before full healing has occurred,” Stephanie Morley, DVM, president of Vetlen, said in a company release.

 “By contrast, Vetlen Pouch dispenses [the] antibiotic directly to the site of infection, delivering the right drug to the right place, for the right length of time. This enables patients to direct their energy toward healing both bone and soft tissues vs fighting infection, which promotes faster patient recovery.”

The Vetlen Pouch has a syringe-based replenishing system and was engineered for implantation at surgical or wound sites. It allows veterinarians to customize treatment based on the specific patient and pathogen being treated, according to Vetlen.

 Moreover, the medication can be adjusted as needed given the antibiotic is replenished every day. Once the therapy is complete, the device can be removed, similar to a surgical drain.

One or more pouches can be placed in wound sites, and the device allows for continuous medication delivery for up to 30 days. Although the device has been tested for local antibiotic therapy, the pouch can also dispense other small molecule medications under 2,000 g/mol that are water-soluble and approved for intramuscular or subcutaneous injection, according to Vetlen.

According to the company, comprehensive preclinical trials were carried out with the device to support FDA submissions. One trial involved comparing the Vetlen Pouch to systemic antibiotics and antibiotic-loaded beads for treating long bone open fractures in sheep infected with methicillin-resistant 

 “The pouches provided superior clinical results with study animals exhibiting healthier suture lines, improved bone outcomes, improved subdermal tissues, and significantly less bioburden,” wrote Vetlen in a new release.

The device, which was developed by Vetlen’s health sciences parent company,  Purgo Scientific, is initially being launched for veterinary use. However, there are plans for a human health version to follow.

Moreover, the US Food and Drug Administration (FDA) recently granted a breakthrough device designation to the parent technology.

 According to Vetlen, the recognition came as the device holds potential to address a significant unmet need in the treatment of difficult open fracture-related infections complicated by biofilms.

“We are excited to offer this kind of technology first in the veterinary market,” remarked Morley in a company statement.

 “We believe our breakthrough local antibiotic delivery technology will dramatically improve wound healing in veterinary medicine.” 

Veterinarians can now acquire 1 free Vetlen pouch for a limited time to gain clinical experience and understand the device’s potential, the company stated.

Additionally, the product can be purchased from the company website.

Innovative device for wound infection management now available for equine & canine patients. News release. Vetlen. October 8, 2024. Accessed October 29, 2024. [email]

The Vetlen Pouch can be placed in infected wound sites and can continuously deliver medication for up to 30 days

New device delivers antibiotics directly to wounds in dogs and horses

Burnout can affect any profession, but its impact on veterinary professionals and practices is particularly unique. To tackle it, we need to understand it thoroughly—and accept that burnout isn’t a “one-size-fits-all” problem that’s beyond our control.

Burnout is defined as “physical, emotional, or mental exhaustion, accompanied by decreased motivation, lowered performance, and negative attitudes towards oneself and others.” But burnout is nuanced and can manifest in different ways within the workplace. For veterinary professionals, it can manifest in 1 of 3 forms: overload burnout, under-challenge burnout, and neglect burnout. Each type hurts your practice in unique ways, compromising your team’s ability to function effectively, as well as your ability to deliver on your mission of animal care.

Veterinary medicine is a profession characterized by significant emotional and physical stress. A 2020 study by Merck revealed that 92% of veterinary professionals considered stress to be the most critical issue facing the profession.

 Burnout occurs when that stress becomes excessive and prolonged, leading to emotional, physical, and mental exhaustion.

Stress vs burnout: Understanding the difference

It's important to distinguish between stress and burnout. Stress is a natural response to external pressures, but burnout is the result of prolonged, unresolved stress. While stress may cause temporary discomfort, burnout leads to deeper emotional, physical, and mental exhaustion that requires intervention. Without proper management and structures in place, burnout can lead to devastating effects on both individual well-being and the overall health of your practice.

Burnout has far-reaching effects that can ripple through every aspect of your practice. Consider the following impacts:

 According to the American Animal Hospital Association (AAHA), turnover rates in veterinary practices were as high as 25% for veterinarians and technicians in 2023.

 This means 1 in 4 professionals are leaving or starting a new role, leading to disruptions in patient care and team stability.

Fatigued and disengaged team members are more prone to making errors or simply doing the bare minimum, which can harm both your patients and your practice’s reputation.

 Burnout can result in mood and attitude changes, leading to reduced empathy and poor communication with clients, further impacting client relationships.

Burnout can breed a toxic work environment, creating a dispirited team and hindering the overall success of your practice.

 Practices known for burnout often develop negative reputations, making it difficult to attract top talent.

While burnout is a real threat, it is not something that your team needs to handle on their own. The solution to burnout starts with the leadership team and must be addressed at the organizational level. There is no single cause of burnout, but several management shortcomings contribute to it. A practice lacking clear values, structure, and leadership is more susceptible to a burnout culture.

A healthy organization starts with a strong mission, core values, and a culture that everyone agrees upon. Practices with strong cultures and well-defined missions create environments where employees feel aligned with the values of the company.

According to a study by Glassdoor, the #1 most important factor in workplace satisfaction is how well employees feel they fit the mission, values, and culture of the company.

 This isn’t something that changes overnight — it takes intention, teamwork, and intentional effort to build a culture that supports wellness and reduces burnout.

Clear internal communication is critical to creating a cohesive and burnout-resistant practice. A study found that engaging employees around purpose, strategy, and values remains the number one priority for 51% of organizations. When communication breaks down,

 it leads to misalignment, loss of trust, increased stress, and ultimately, burnout.

As leaders, it's essential to set an example for communication. Ensure your leadership team is united in how they communicate expectations and foster a work environment where everyone feels supported and informed.

Preventing burnout in your practice requires a comprehensive strategy, including:

Align your team with your culture and mission:

 Foster a culture where everyone knows and is accountable to the mission. Clear behavior expectations help team members know what to expect from others.

 Establish protocols that everyone follows, ensuring staff is always clear on practice policies.

 If a team member isn’t aligned with your culture, coach them. If coaching fails, it may be time to part ways.

Maintain a professional and respectful environment:

 Kindness and respect should be nonnegotiables in your practice.

 Support employees through personal challenges by offering time off or workload adjustments as needed.

 Setting clear boundaries helps to protect your well-being and sets a precedent for your team to do the same.

We can’t eliminate stress, but we can prevent burnout

We may never completely get rid of stress in veterinary medicine, but we can significantly reduce burnout by building a practice environment that supports wellness, clear communication, and alignment with core values. As practice owners, it’s our responsibility to lead by example and provide the structure our teams need to thrive.

A Practice Owner’s Guide to Veterinary Burnout: Common Triggers & How to Overcome Them. GeniusVets. Accessed October 29, 2024. https://www.geniusvets.com/veterinary-marketing/blog/practice-owners-guide-veterinary-burnout-common-triggers-how-overcome

Significant Study on Veterinary Wellbeing Reveals Importance of Continued Focus on Personal and Professional Health and Well-Being Among Veterinarians. News release. Merck Animal Health. January 18, 2020. Accessed October 29, 2024. https://www.merck-animal-health-usa.com/newsroom/wellbeing-study-2020

Lederhouse C. Study: Fair pay, appreciation for work top factors in employee retention. American Veterinary Medical Association. Published March 4, 2024. https://www.avma.org/news/study-fair-pay-appreciation-work-top-factors-employee-retention

New Survey: Company Mission & Culture Matter More Than Salary | Glassdoor. Glassdoor. Published July 11, 2019. Accessed October 29, 2024. https://www.glassdoor.com/blog/mission-culture-survey/

Swift P. 20 Cutting Edge Employee Engagement Strategies for 2024. Cerkl. Published January 17, 2024. Accessed October 29, 2024. https://cerkl.com/blog/employee-engagement-strategie

Burnout is a word we hear a lot, especially in the veterinary industry. But do we really know what it is, let alone how to beat it?

What is the real solution to fatigue and burnout in the veterinary industry?

, commonly known as bird flu, has had an increase in human cases in the United States recently, particularly among poultry and dairy workers. H5N1 has primarily circulated in the Midwest, with these cases raising concerns about potential human transmission and broader public health implications. Understanding the current landscape of H5N1, including recent data and prevention strategies, is essential as health officials monitor the situation.

The CDC is monitoring influenza data at national, state, and local levels. As of October 9, 2024, 18 human cases of H5N1 have been reported in the US since 2022. Since February 2022, more than 15,500 individuals have been monitored after exposure to infected animals, with 590 tested for novel influenza A. Recently, approximately 6100 individuals have been monitored, including 3350 exposed to dairy cows and 2800 to birds and other animals.

Currently, CDC surveillance systems indicate no unusual flu activity related to H5N1. In the week ending October 19, 2024, public health laboratories reported no positive tests for novel influenza A, and wastewater monitoring detected H5 at only 1 out of 320 sites.

CDC continues to collaborate with the USDA, FDA, and state health officials using the One Health approach to monitor the situation. The agency has deployed a multilingual epidemiological field team to assist local health departments with outreach and surveillance efforts. To date, more than 5100 individuals exposed to potentially infected animals have been monitored, and more than 54,000 specimens have been tested for H5N1viruses.

Stay safe: Essential tips for protecting yourself from H5N1

, “The best way to prevent H5N1 bird flu is to avoid sources of exposure whenever possible. Recommended precautions include:

Avoid direct contact with wild birds and observe them only from a distance, if possible.

Avoid contact with wild or domestic birds that appear ill or have died. People should report sick birds or other animals or unusual bird or other animal deaths to the state or the federal government, either through their state veterinarian or by calling USDA's toll-free number at 

Avoid unprotected direct physical contact or close exposure with cattle and materials potentially infected or confirmed to be infected with HPAI A(H5N1) virus.

Do not touch surfaces or materials contaminated with saliva, mucous, or animal feces from wild or domestic birds or other animals with confirmed or suspected avian bird influenza A virus infection.

Do not eat or drink raw milk or products made with raw milk.

If you must have direct/close contact with infected or potentially infected birds or other animals, wear 

recommended personal protective equipment

 marked the 14th reported case this year and was the first without documented occupational exposure. Identified through seasonal flu surveillance, the patient was hospitalized but has since recovered. Experts suggest that transmission routes may include incidental contact with infected animals, indicating a need for further research into risk factors.

Meghan Davis, DVM, PhD, MPH, an associate professor at Johns Hopkins Bloomberg School of Public Health, discussed potential alternative transmission routes for avian influenza, highlighting the Missouri case as an example of variable exposure routes beyond direct animal contact. “What the case in Missouri really highlights is that the transmission routes are quite variable. It's not just occupational contact with live animals; it could also be from incidental contact with animals, and we don't yet fully recognize what those risk factors might be for people,” she said.

The serological testing methods used in the CDC's investigation of the Missouri H5N1 case included several assays. The primary method was the Microneutralization (MN) assay, which identifies influenza virus-specific antibodies in blood sera by measuring the ability of these antibodies to neutralize the virus. The Hemagglutinin Inhibition (HI) assay was employed to detect antibodies to the hemagglutinin of specific influenza viruses; this test assesses the ability of antibodies to agglutinate red blood cells, using multiple types of red blood cells for detection.

Another method used was the Multiplex Antibody Detection Assay (MIADA), which looks for antibody binding to multiple influenza antigen targets (28-plex) and measures total immunoglobulin responses, including IgG, IgM, and IgA. A Seasonal Influenza Serum Absorption step was included to remove antibodies against seasonal influenza viruses to reduce cross-reactivity, enhancing the specificity of the H5N1 testing.

The CDC also developed 2 Reverse Genetics (RG) viruses that mirrored the antigenic changes found in the H5N1 virus from the Missouri case. This allowed for precise serological testing. Together, these methods provided a comprehensive assessment of immune responses and potential previous exposure or infection with H5N1 in the individuals tested.

, the Department of Public Health confirmed 7 probable cases of H5N1 linked to dairy farm outbreaks. Most infections have occurred among farm workers, with mild symptoms reported.

To continue, the CDC confirmed H5 infections in two of four poultry cullers from 

 state, marking the state's first cases. Despite the confirmed cases, public health officials maintain that the risk to the public remains low, although those with occupational exposure to sick animals face a higher risk.

Despite the rise in cases, Davis said, “The good news, however, is that despite the human cases linked to poultry outbreaks and dairy cow infections primarily affecting workers, no human-to-human transmission has been identified yet. This is an important aspect to monitor closely.”

One Health: An approach bridging human, animal, and environmental Health

The One Health approach is a collaborative framework that recognizes the interconnectedness of human, animal, and environmental health. It advocates for a multidisciplinary strategy to address health challenges, particularly zoonotic diseases, by integrating expertise from fields like medicine, veterinary science, and environmental science to promote holistic solutions and sustainable ecosystems.

Davis is a proponent of the One Health approach. She said, “One Health is foundational to many infectious diseases that are zoonotic. What is recognized with highly pathogenic avian influenza is that it has been present for a considerable period. Like seasonal influenza in humans, there are influenza strains that predominantly affect birds. These include reservoirs—types of birds that carry the virus but don't get very sick themselves—such as waterfowl like ducks. On the other hand, there are birds that can become severely ill and die, including domestic poultry like broiler chickens, layer chickens (for meat and eggs), turkeys, and other species kept by humans.”

According to the CDC spokesperson, “CDC’s One Health approach recognizes the interconnection between people, animals, plants, and their shared environment, which is highly relevant in our surveillance and response strategies for H5N1.”

Current status of human vaccine developments for H5N1

According to the CDC’s October 11, 2024, update, the CDC has allocated more than 100,000 doses of seasonal flu vaccine for farm workers in 12 states with positive H5 cases to mitigate the risk of spread. Although the vaccine does not protect against H5N1, the CDC noted that it can reduce severe illness from seasonal flu as well as aid in the identification of potential H5N1 cases.

Additionally, the CDC is testing existing candidate vaccines for effectiveness against current H5N1 strains. Recent studies suggest that licensed adjuvanted H5N1 vaccines may generate cross-neutralizing antibodies against circulating variants, aiding in pandemic preparedness.

They are also genetic sequencing of the H5N1 viruses from infected individuals has shown no significant mutations associated with increased infectivity or reduced susceptibility to available antiviral treatments. This is important for understanding the current vaccine landscape, as it suggests that the current vaccines may still be relevant.

 in July 2024 found the stockpiled adjuvanted H5N1 vaccines demonstrate potential effectiveness against H5N1 clade 2.3.4.4b, highlighting their importance in pandemic preparedness efforts. The study assessed the binding, hemagglutination inhibition, and neutralizing antibody responses in adults vaccinated with three licensed H5N1 vaccines derived from earlier strains (A/Vietnam, clade 1; A/Indonesia, clade 2.1) with and without adjuvants.

Vaccination with the 2 adjuvanted H5N1 vaccines resulted in cross-reactive binding and cross-neutralizing antibodies against the HPAI clade 2.3.4.4b A/Astrakhan/3212/2020 virus. Seroconversion rates ranged from 60% to 95% after 2 doses of the AS03-adjuvanted A/Indonesia vaccine or 3 doses of the MF59-adjuvanted A/Vietnam vaccine.

 is the primary antiviral, prescribed at 75 mg twice daily for 5 days for outpatients, and should be given promptly to hospitalized patients, regardless of illness onset. For immunocompromised patients, combination therapy may help prevent antiviral resistance. Treatment should not be delayed while awaiting lab results, and duration may be extended for severely ill patients based on clinical judgment.

Intravenous peramivir is an alternative for those who cannot take oral medications, recommended for at least 5 days. Higher doses of oseltamivir have not shown additional benefits, so healthcare providers should consult CDC resources for dosing guidance. Treatment with antivirals like oseltamivir is recommended for suspected H5N1 cases. Healthcare providers are advised to start treatment without delay, even before laboratory confirmation. Monitoring for antiviral resistance, especially in hospitalized patients, is important.

The CDC H5N1 Science Agenda, summarizing key research issues related to the ongoing outbreak of H5N1 virus in dairy cows and other animals in the US.

Posting updated recommendations for agricultural fair organizers and people exhibiting animals at agricultural fairs on reducing the risk of novel influenza A viruses spreading between animals and people.

Supporting strategies to maximize protection of farm workers, including outreach in affected counties through Facebook, Instagram, Pandora, and digital displays, with resources in both English and Spanish.

Working with public health laboratories to monitor influenza virus testing and flu surveillance data using CDC's enhanced nationwide summer surveillance strategy, especially in areas where H5N1 viruses have been detected, for any unusual trends, including flu-like illness and influenza virus activity.”

Safety measures for veterinary professionals and clients

As avian influenza continues to rise as a threat to animals and the safety of veterinary professionals, it is becoming crucial for teams to understand the disease and how to protect patients, clients, and themselves—especially since avian influenza has now been transmitted to different species, including humans.

 In Spring 2024, Texas reported the detection of the disease in dairy farms and in other animals such as dolphins.

The CDC advises that it is currently unlikely humans can become infected through an infected stray, wild, feral, or domestic cat, but human infection can be possible if there is prolonged unprotected exposure to infected animals in individuals not wearing personal protective equipment.

“If you have an animal that has a fever, is lethargic, maybe [they are] having some discharge from the eyes or nose, coughing, trouble, breathing, wheezing, and especially an elevated body temperature, any of those flu-like symptoms will be things that you'll want to be thinking about as potential symptoms of avian influenza,” Kemba Marshall, MPH, DVM, DABVP (Avian), SHRM-CP, founder of Marshall Recruiting Consortium, explained.

“Now, specifically, let’s turn our attention towards backyard poultry. Chickens can do the same things, they can still cough, wheeze, and have discharged from the eyes and nose. Their comb, the skin that you see on the top of their head, you may see that become discolored. Affected laying hens may have an abnormally shaped eggs, which may be kind of lumpy, bumpy, or what we just call like a misshapen egg,” she continued.

Veterinary professionals who suspect that they have a case of avian influenza based on clinical signs, will need to run a polymerase chain reaction (PCR) test. Veterinary teams should wear personal protection equipment (PPE) for all suspect avian influenza cases and while collecting diagnostic samples. For testing, veterinary teams are encouraged to reach out to their state veterinarian prior to sample collection because state labs, which are part of the National Veterinary Diagnostic Laboratory, are often the only labs permitted to perform avian influenza testing. State labs should be contacted before any post-mortem samples are collected to ensure proper sampling techniques. As a reminder, carcass can be refrigerated or chilled but should never be frozen prior to diagnostic sample collection.

Nasal and ocular swabs, urine, and whole blood samples can be submitted to the appropriate diagnostic laboratory. If the suspected animal is deceased, veterinary teams should also submit a 1” x 2” section of brain.

 All samples should be fresh, refrigerated, and shipped in an insulated box with ice packs.

Marshall explained that biosecurity is the key to managing the virus on farms and amongst animals. She encourages anyone coming into your house or farm to wear clean clothing, hats, and shoes to avoid cross contamination and disease spread via fomites. If animals must be transported, it is important to thoroughly disinfect all shipping, handling, and transport areas and vehicles, especially for larger animals on the road for shows or competitions.

“Biosecurity also means we should be able to have a record and a log of every person that came to the fair, animal exhibition, or farm. We want to keep a record of who was there, how long they were there, and if that person had been to other farms that day or that week. Farms should have designated entry points, wheel or vehicle wash stations, and separate holding areas or pens for incoming and outgoing animals. All state ordinances and laws should be followed regarding intra and interstate health certificates” Marshall continued.

“We cannot understate the importance of PPE…. which includes gloves, goggles, gowns, and face masks. In addition, hand hygiene is critical and includes very frequent and thorough hand washing with soap and water. Individuals should be mindful of not handling animals or animal matter and then immediately handling their cell phones. Individuals should not be on their cell phones texting or making notes or anything like that, and then turn around and scroll on that same cell phone when you're eating your ham sandwich or drinking your coffee,” Marshall noted.

As avian influenza has now been detected in felines, it is recommended to use caution when letting cats go outside, especially if they live within an agricultural setting. The CDC also recommends feline owners who have interacted with animals or birds with unknown health status change their clothes and shoes before interacting with personal pets.

 For owners of potentially infected pets, veterinarians should refer them to their state's Department of Public Health and Environment in order to monitor human exposure and potential human disease transmission.

For veterinarians, it is recommended to use isolation and appropriate patient handling protocols for suspected infectious and/or zoonotic disease cases, including negative airflow if possible. Staff should contain and thoroughly disinfect any equipment used to treat the potentially infected patient. Staff should wear proper PPE and limit staff contact with animals in isolation facilities to the best of their abilities.

Navigating the risks: How H5N1 might cross into human populations

 contaminated with the droppings of infected animals may harbor the virus. Individuals who encounter contaminated water or who work in wastewater management could be at risk, especially if proper precautions are not taken.

Genetic testing in wastewater is increasingly used to track the spread of H5N1 in the US, particularly among dairy herds, raising public health concerns. While PCR testing is standard for virus detection, its specificity issues may miss some variants. Recent research found H5N1 in wastewater across nine Texas cities, suggesting animal rather than human sources. Individuals in close contact with infected animals or consuming unpasteurized milk face greater risk. Overall, wastewater testing is becoming essential for disease surveillance.

If poultry infected with avian influenza contaminates milk products, consuming unpasteurized or 

 could pose a risk of transmission. Pasteurization typically eliminates such viruses, but raw products carry a higher risk.

Health officials warn against consuming unpasteurized milk due to the H5N1 bird flu virus found in more than 140 US dairy herds and high levels in raw milk. The virus can remain infectious on milking equipment for several hours and in unpasteurized milk for at least 1 hour. The milking process, which involves automated equipment and manual cleaning, increases exposure risks for workers.

A historical perspective: Understanding avian influenza through the years

Avian flu can be traced back to northern Italy in 1878, when a contagious disease of poultry with a high mortality rate was described, and then referred to as “fowl plague.” It was eventually determined that the “fowl plague” described was caused by a virus, which in 1955 was determined to be a type A influenza virus. In 1971, influenza viruses were originally classified based on the antigenic properties of their structural and surface proteins nucleoprotein hemagglutinin and neuraminidase proteins, as well as the species of origin. In 1981, the name “fowl plague” was officially replaced with avian influenza at the First International Symposium of Avian Influenza.

According to Justin Brown, DVM, PhD, wildlife veterinarian and assistant teaching professor at Pennsylvania State University, the avian influenza virus has historically been most commonly detected within wild birds—mostly waterfowl, shorebirds, and gulls. However, this unique strain of the virus, H5N1 highly pathogenic avian influenza virus, has very unique properties that are very different from most avian influenza viruses, including the ability to infect and cause disease in a wide diversity of avian and mammal hosts.

“A wide diversity of avian influenza viruses circulate in wild birds without causing any outward signs of disease.Historically, when those have been low pathogenic and caused mild or no disease if they transmitted to chickens.However, if those low pathogenic avian influenza viruses were of the H5 or H7 subtype and spilled over into chickens, they could adapt to chickens and mutate to become highly pathogenic viruses that were associated with acute and high mortality.This historically has been a rare event.Once the virus adapts to chickens or related poultry species, these highly pathogenic avian influenza viruses have rarely transmitted back to wild birds.”

“This one-way spillover of avian influenza virus from a wild bird reservoir to poultry no longer explains what we are seeing with the H5N1 strains that are impacting the health of wild birds, poultry, and an increasing number of mammal species in multiple continents.This group of highly pathogenic avian influenza viruses was first isolated in China in 1997. Since then, these viruses have evolved into a group of viruses that differ genetically and biologically.Specifically, these H5N1 viruses have exhibited a unique ability to infect and cause disease in a wide range of bird and mammal hosts. As opposed to the historic “one-way” spillover events, some strains of this virus have re-adapted back to wild birds.What this means is that certain wild bird species can serve as reservoirs for the virus; this is very rare for a highly pathogenic avian influenza virus and makes control or eradication of the virus extremely difficult.

Brown also explained there are multiple routes for the virus to spread from wild birds, including direct contact with an infected bird (dead or alive) or contact with an infected birds feces (a common route that the virus is shed).Exposure to the virus through infected environmental samples has occurred and is possible.This often may be in habitats in which large numbers of infected birds are present and can contaminate the environment with virus, such as waterfowl habitat.

As the threat of infectious diseases continues to grow, veterinarians and animal health experts are facing an increasing challenge in managing species that may serve as reservoirs for transmission. Although the traditional focus for control of avian influenza has been on species like waterfowl and gulls, the list of potential infected bird or mammal species is expanding. This list includes wild and domestic felines. Brown stated that ensuring separation between naive host species and known reservoirs remains a key strategy.

“The real challenge is that we're seeing more and more species involved in the transmission and maintenance of H5N1, which includes highly susceptible species that are infected and die, as well as the species that are infected in the absence of outward disease.. Before we focused on the “high risk species”, such as ducks, gulls and shorebirds, for controlling the spread of avian influenza. Now our focus has to expand to new species that we’ve identified as reservoirs, and we have to continue to conduct research to identify new hosts involved in the epidemiology of this virus. This is critically important for understanding the risk of exposure to the virus and for preventing spillover into unique or atypical hosts like cats,” Brown explained.

“Over the last few years, we have seen increasing cases of H5N1 in wild and domestic carnivores and scavengers. Certainly species appear to be highly susceptible to infection and are likely to experience severe and fatal disease, including red foxes, domestic cats, and large felids. Presumably, the increasing cases we see in these animals is related to multiple factors, including a high susceptibility of the currently circulating strain and increased numbers of sick or dead infected animals on the landscape that are available to be scavenged.Understanding the wild and domestic animals that are most likely to be infected is an important step for preventing exposure in our highly susceptible companion animals, such as cats. In some systems, such outdoor cats, this may be more challenging,” he continued. 

With the rise in cases infecting novel species, Brown discussed that avian influenza has the potential to change the way veterinary teams look at sick patients in their clinics. In cats and other mammals, H5N1 virus infection can present with neurologic and/or respiratory signs. Unfortunately, this presentation is not specific to highly pathogenic avian influenza, and looks similar to many other more common diseases in domestic cats. However, with the cases in domestic cats, highly pathogenic avian influenza virus should be on the rule-out list for any cat exhibiting consistent clinical signs, particularly if there is a history of potential exposure to infected animals or their habitats.

“Avian influenza virus is widespread in wild birds and the virus is continuing to evolve. Influenza viruses have a unique ability to adapt and change, and this is particularly true for H5N1. Over the last 20 years, I can’t count the number of times we’ve said ‘well this is something new we haven't seen before’ .This massive ability to adapt and change makes avian influenza virus challenging to control or manage," he continued.

A lot of times, we learn about a pathogen in veterinary school or early in our careers, and then we retain the old textbook version in our mind. This won’t work with highly pathogenic avian influenza virus, because of how much the virus is changing.Rather, as practitioners or anyone in the animal health field, it is important that you keep a current understanding of the disease. Fortunately or unfortunately, it wouldn't surprise me if in 1, 2, [or] 3, years, the epidemiology of the highly pathogenic avian influenza virus outbreak in North American is quite different” Brown concluded.

As H5N1 poses a multifaceted threat to both animal and human health, ongoing research, surveillance, and public health preparedness strategies are essential. The adaptability of the virus calls for a proactive approach to disease management, ensuring a coordinated response to safeguard public health.

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Veterinary and public health officials share the important roles of surveillance and prevention strategies, insights on the virus's transmission pathways, historical context, the One Health approach, and highlights effective precautionary measures to mitigate H5N1 risks.