Infokiri

Regarding the ongoing situation on Avian Influenza 1/2 European Centre for Disease Prevention and Control (ECDC) Gustav den III:s Boulevard 40, 169 73 Solna, Sweden Phone: +46 (0)8 58 60 10 00 - Fax: +46 (0)8 58 60 10 01

www.ecdc.europa.eu

ECDC Letter DIR

Regarding the ongoing situation on Avian Influenza

05 July 2024, Stockholm Dear Directors of the Coordinating Competent Bodies, dear colleagues, I would like to reach out to you with regards to the ongoing avian influenza situation in Europe and globally, inform you of ECDC’s ongoing activities and recommendations on this topic, and reconfirm our support to the Member States. In addition to our national partners in the Member States, ECDC continues to closely monitor avian influenza globally together with EFSA, and to closely collaborate with other relevant EU agencies such as EMA and EU OSHA , international organisations such as WHO, and at the global level through the network of major CDCs. Any new avian influenza event involving humans is regularly communicated through the Communicable Disease Threat Report (CDTR), and every three months a situational report on the global situation in animals and humans is published jointly with EFSA together with an updated assessment of risk for humans in the EU. As of today, based on the currently available evidence, ECDC continues to assess as low the risk of avian influenza for the general population in the EU and as low-to-moderate the risk for the occupationally or otherwise exposed individuals. The recently published joint ECDC/EFSA avian influenza monitoring report indicates a period of low circulation in the bird populations. However, recent events of widespread avian influenza infection of cattle in the US, with four infected symptomatic farm workers, raises additional concerns of potential further mammalian adaptation and risk of transmission to humans. For the moment the virus remains avian-like, but some point mutations showing initial adaptation to mammals have been observed. ECDC has been taking numerous initiatives in order to address this potential threat and has produced several guidance documents and reports in recent months on testing of exposed individuals, surveillance, outbreak investigation, public health options for response, and more. Based on the current situation, there is reason for increased awareness, however no reason for increased concern. ECDC considers of key importance to continue to raise awareness among healthcare professionals, both at primary and secondary care level regarding the possibility of encountering human cases of infection with the A(H5N1) virus. Among the general public, awareness raising actions are needed about the risk linked to contact with sick or dead animals. Additionally, in our recently updated surveillance guidance for the summer period, we recommend lowering the threshold for testing for avian influenza, including using a risk-based approach for exposed asymptomatic individuals. We also recommend testing for influenza all cases hospitalised due to symptoms compatible with avian influenza and to further investigate those influenza A-positive samples that are negative for seasonal influenza virus. Biosafety and personal protective measures in place at occupational and recreational sites with an increased risk of avian influenza remain in our view the best way to minimise the risk of spillover events to humans. These protective measures should be complied to the greatest extent possible.

Regarding the ongoing situation on Avian Influenza 2/2 European Centre for Disease Prevention and Control (ECDC) Gustav den III:s Boulevard 40, 169 73 Solna, Sweden Phone: +46 (0)8 58 60 10 00 - Fax: +46 (0)8 58 60 10 01

www.ecdc.europa.eu

Finally, enhanced surveillance and data sharing, healthcare systems readiness, availability of outbreak investigation and management protocols, as well as strengthening laboratory capacity and capabilities are crucial actions for public health preparedness. Stockpiling of available countermeasures including antivirals can also be considered. ECDC offers the Member States the opportunity to share specimens for further characterisation in case of avian influenza infections in humans through its contracted laboratory consortium Aurorae which provides ongoing support for influenza and SARS-CoV-2. ECDC also outsourced an External Quality Assurance scheme and a bioinformatics ring-trial on avian influenza with preliminary results expected before the Autumn. Ongoing interaction with the EU disease network is maintained through regular webinars and calls, often carried out jointly with EFSA and WHO in a One Health approach. ECDC is also working closely with EFSA on developing by the end of the year a Scientific Opinion on preparedness, prevention and control measures for zoonotic avian influenza, a technical report for a One Health outbreak investigation and management when human and animal populations are involved. In addition, we are jointly organising a simulation exercise involving Member States. I strongly believe that the close ongoing collaboration between ECDC and the Member States is key in order to address the risk posed by avian influenza and other cross-border threats to health to the EU. I look forward to working with you to make the EU a safer place. Sincerely yours,

Pamela Rendi-Wagner, ECDC Director

Relevant links to ECDC guidance documents and reports are highlighted in the text.

Regarding the ongoing situation on Avian Influenza 1/2 European Centre for Disease Prevention and Control (ECDC) Gustav den III:s Boulevard 40, 169 73 Solna, Sweden Phone: +46 (0)8 58 60 10 00 - Fax: +46 (0)8 58 60 10 01

www.ecdc.europa.eu

ECDC Letter DIR

Regarding the ongoing situation on Avian Influenza

05 July 2024, Stockholm Dear Directors of the Coordinating Competent Bodies, dear colleagues, I would like to reach out to you with regards to the ongoing avian influenza situation in Europe and globally, inform you of ECDC’s ongoing activities and recommendations on this topic, and reconfirm our support to the Member States. In addition to our national partners in the Member States, ECDC continues to closely monitor avian influenza globally together with EFSA, and to closely collaborate with other relevant EU agencies such as EMA and EU OSHA , international organisations such as WHO, and at the global level through the network of major CDCs. Any new avian influenza event involving humans is regularly communicated through the Communicable Disease Threat Report (CDTR), and every three months a situational report on the global situation in animals and humans is published jointly with EFSA together with an updated assessment of risk for humans in the EU. As of today, based on the currently available evidence, ECDC continues to assess as low the risk of avian influenza for the general population in the EU and as low-to-moderate the risk for the occupationally or otherwise exposed individuals. The recently published joint ECDC/EFSA avian influenza monitoring report indicates a period of low circulation in the bird populations. However, recent events of widespread avian influenza infection of cattle in the US, with four infected symptomatic farm workers, raises additional concerns of potential further mammalian adaptation and risk of transmission to humans. For the moment the virus remains avian-like, but some point mutations showing initial adaptation to mammals have been observed. ECDC has been taking numerous initiatives in order to address this potential threat and has produced several guidance documents and reports in recent months on testing of exposed individuals, surveillance, outbreak investigation, public health options for response, and more. Based on the current situation, there is reason for increased awareness, however no reason for increased concern. ECDC considers of key importance to continue to raise awareness among healthcare professionals, both at primary and secondary care level regarding the possibility of encountering human cases of infection with the A(H5N1) virus. Among the general public, awareness raising actions are needed about the risk linked to contact with sick or dead animals. Additionally, in our recently updated surveillance guidance for the summer period, we recommend lowering the threshold for testing for avian influenza, including using a risk-based approach for exposed asymptomatic individuals. We also recommend testing for influenza all cases hospitalised due to symptoms compatible with avian influenza and to further investigate those influenza A-positive samples that are negative for seasonal influenza virus. Biosafety and personal protective measures in place at occupational and recreational sites with an increased risk of avian influenza remain in our view the best way to minimise the risk of spillover events to humans. These protective measures should be complied to the greatest extent possible.

Regarding the ongoing situation on Avian Influenza 2/2 European Centre for Disease Prevention and Control (ECDC) Gustav den III:s Boulevard 40, 169 73 Solna, Sweden Phone: +46 (0)8 58 60 10 00 - Fax: +46 (0)8 58 60 10 01

www.ecdc.europa.eu

Finally, enhanced surveillance and data sharing, healthcare systems readiness, availability of outbreak investigation and management protocols, as well as strengthening laboratory capacity and capabilities are crucial actions for public health preparedness. Stockpiling of available countermeasures including antivirals can also be considered. ECDC offers the Member States the opportunity to share specimens for further characterisation in case of avian influenza infections in humans through its contracted laboratory consortium Aurorae which provides ongoing support for influenza and SARS-CoV-2. ECDC also outsourced an External Quality Assurance scheme and a bioinformatics ring-trial on avian influenza with preliminary results expected before the Autumn. Ongoing interaction with the EU disease network is maintained through regular webinars and calls, often carried out jointly with EFSA and WHO in a One Health approach. ECDC is also working closely with EFSA on developing by the end of the year a Scientific Opinion on preparedness, prevention and control measures for zoonotic avian influenza, a technical report for a One Health outbreak investigation and management when human and animal populations are involved. In addition, we are jointly organising a simulation exercise involving Member States. I strongly believe that the close ongoing collaboration between ECDC and the Member States is key in order to address the risk posed by avian influenza and other cross-border threats to health to the EU. I look forward to working with you to make the EU a safer place. Sincerely yours,

Pamela Rendi-Wagner, ECDC Director

Relevant links to ECDC guidance documents and reports are highlighted in the text.