A recent report in ProMED documented a March 2024 case of H5N1 influenza in a child with the infection acquired in India.  The patient was treated with oseltamivir with ICU supportive therapy for severe respiratory infection before recovery.

Genome sequencing of the isolate was conducted by the WHO Collaborating Center for Reference and Research on Influenza in Melbourne, VIC, Australia.  The hemagglutinin sequence was 98 percent homologous with A/duck/Bangladesh/46162/2020 and was classified as clade 2.3.2.1a, distinct from HA2.3.4.4b the predominant strain in the ongoing avian panornitic. The neuraminidase sequence was 98 percent homologous with A /chicken/Bangladesh/18-B-569/2022.

An investigation failed to disclose the source of infection during the stay in India.  Contact tracing failed to demonstrate infection among contacts of the child after return to Australia.

As per the comments of public health physician, Dr. Finn Romanes, the case demonstrates the need to characterize influenza strains isolated from patients, especially visitors and returnees from areas known to be infected with potentially zoonotic strains of influenza A.  Australia has an active program of promoting seasonal influenza vaccination for travelers and for farm and plant workers in contact with poultry and swine.

It is considered essential that all persons coming into contact with live poultry or in processing plants should be vaccinated annually with the available seasonal multivalent product.  Although this will not provide protection against H5N1, immunity will limit the possibility of genetic reassortment that may occur if an infected worker comes into contact with a flock exposed to H5 or H7 avian influenza virus.

The emergence of bovine influenza-H5N1 demonstrates the need for dairy workers to receive seasonal vaccination and to be provided with PPE.