Digital Press Briefing with Dr. John MacArthur, Regional Director, CDC Southeast Asia Regional Office, and Dr. Bill Davis, CDC Regional Influenza Program Director

MODERATOR:  Greetings from the U.S. Department of State’s Asia Pacific Media Hub.  I would like to welcome journalists to today’s on-the-record briefing with Dr. John MacArthur, Regional Director of CDC Southeast Asia Regional Office, and Dr. Bill Davis, Regional Influenza Program Director of CDC Thailand.  The speakers will discuss the recent Southeast Asia Regional Influenza Workshop hosted in Bangkok, Thailand; CDC’s public health partnerships across Southeast Asia; and regional efforts to prevent, detect, and respond to avian influenza.

With that, let’s get started.  Dr. MacArthur, I’ll turn it over to you for your opening remarks.

DR MACARTHUR:  Thank you, Katie.  This is Dr. MacArthur.  It’s a pleasure to speak with you today about the importance of public health events such as the Regional Influenza Workshop for Southeast Asia, which bring together experts from across the region to continue improving our efforts to protect the health of the people in our countries, the region, and across the world.

The CDC has worked in Southeast Asia for more than 70 years.  We’ve responded to many emerging infectious diseases together, such as the Nipah virus, SARS, multiple avian influenza outbreaks, and of course COVID-19.  Each response has demonstrated a long-known truth that a disease threat anywhere is a disease threat everywhere, and we must all work together to stop diseases at their source and to prevent them from spreading.  These disease outbreaks have also given us opportunities to advance our collaborations, to learn with one another how to better prevent, detect, and respond, and reinforce our collective fight against disease threats.

There’s no doubt that we have come a long way since the first global detection of H5N1.  Together we have learned how important it is to lean forward on prevention efforts to contain the circulation of these viruses.  The Avian Influenza Workshop we co-hosted this week is a prime example of CDC continuing to do just that.  We understand we cannot be complacent in our efforts and practices, and that it is critical to strengthen global health security measures even further to prepare for the next global health crisis.  CDC continues to stand firm in its longstanding commitment to work with the ASEAN member states to strengthen and enhance our collaboration across a broad range of mutual interests, including not only prevention and control of avian influenza, but also malaria, HIV, and other public health threats.

Specifically, we continue to harmonize and strengthen disease surveillance efforts through programs like the Field Epidemiology Training Program to bolster emergency response, to public health emergency management fellowship programs, and strengthening emergency operations centers across the region to build sustainable regional laboratory networks through lab leadership training and new diagnostic capacity building and jointly address One Health, border health, and migrant population health across Southeast Asia.

Thank you for the opportunity to bring attention to our cooperation with partners in the region aimed to improve the health of the people in Southeast Asia.  We look forward to many more years of partnership to protect the health of all nations and improve health security in the region and around the world.

MODERATOR:  Thank you, Dr. MacArthur.  I’ll now turn it over to Dr. Davis for opening remarks.  Dr. Davis, over to you.

DR DAVIS:  Thanks.  Good morning, everyone.  I’m Dr. Bill Davis.  I’m pleased to be here today to discuss the timeliness and importance of this Workshop on Avian Influenza.  After several years of focusing much of our effort on protecting against COVID-19, we cannot forget about preparedness for other diseases like influenza.  The workshop is being held against a backdrop of increasing highly pathogenic avian influenza A(H5N1) infections among wild birds and poultry around the globe.  There have been 11 human cases of H5N1 reported across the globe since 2022, including five in Southeast Asia.

While avian influenza remains a low risk for the general population and there have been no documented cases of person-to-person transmission since these outbreaks began, it’s critical that we remain vigilant.  CDC has worked with partners in Asia for many years to build surveillance and epidemiology capacity for both seasonal influenza and novel influenza, including avian influenza.

CDC regularly engages in influenza prevention and control activities at the human-animal interface, including conducting routine surveillance for influenza viruses at live bird markets in the region.  CDC also places a focus on rapid response to human infections with avian influenza, and we’ve been supporting partners in Southeast Asia to do this for nearly two decades.  Most recently, CDC supported partners in Cambodia to respond to two human infections with avian influenza.  The Cambodian Government led the outbreak response, with the U.S. CDC providing technical support.  The investigation found that these infections were most likely from exposure to infected poultry and not human-to-human transmission.

As H5N1 viruses continue to spread widely among wild birds and poultry, additional human cases may be identified in other countries.  The successful response in Cambodia highlighted not only the importance of strong global partnerships, but also of robust surveillance networks across the region.  This workshop in Bangkok brings partners together from across the region to share best practices so that we continue – so that we can continue to build preparedness and response capacity for novel influenza.

We convened 110 people from eight countries across Asia as well as global partners, including partners from the U.S. Government, the World Health Organization, Food and Agriculture Organization, and the World Organization for Animal Health.  We hope that this workshop, paired with continued partnerships in the region, will allow the region to be better prepared to detect and respond to cases of avian influenza.

Thank you.

MODERATOR:  Thank you, Dr. Davis.  We will now turn to the question-and-answer portion of today’s briefing.  Our first question was submitted in advance and it comes from Mohammad Al Amin at the Daily Manab Zamin in Bangladesh, who asks:  “How much at risk of avian influenza is Bangladesh and what should Bangladesh do to avoid it?”

DR DAVIS:  Sure.  This is Dr. Bill Davis.  I can take that question.  So we know that since H5N1 was first detected over 20 years ago that human infections with H5N1 have been rare, and the current H5N1 outbreak in poultry and birds continues to be mostly an animal health issue.  However, people with specific exposures to wild birds or poultry should take precautions around birds.  The CDC believes that the risk to the U.S. public remains low; however, globally members of the public should defer to their respective ministry of health for additional guidance on prevention and level of risk within their specific country.

I will say that CDC has been working with partners in the region to support a couple of key activities to respond to avian influenza, which would be surveillance and to support rapid response, rapid detection of human cases and response to those cases.  And specifically in Bangladesh, we’ve supported IEDCR, the Ministry of Health and Family Welfare, on surveillance and we’ve also supported the research institute ICDDR,B on surveillance of live bird markets and surveillance in wild migratory birds as well as to test some interventions to help reduce transmission in live bird markets.  We’ve had these partnerships for a long time, and we value our partners in Bangladesh.

Thank you.

MODERATOR:  All right.  Thank you, Dr. Davis.  Our next question came in from Sarah Newey from the Telegraph’s global health security desk.  “Is Southeast Asia at a higher risk of a human avian influenza spillover?  And what do you consider the risk of a human epidemic or pandemic?”  Over to you.

DR DAVIS:  Thanks.  This is Dr. Bill Davis.  I think I can take this one too.  So CDC has been monitoring – as I mentioned, we’ve been monitoring H5N1 for over two decades, and we’ve been monitoring detections in poultry, in farmed poultry and wild birds, and also in humans.  And the viruses that we obtained from these surveillance activities from us and our partners we’re able to sequence so we can understand the properties of the virus.

And so the current – in the current outbreak of H5N1 virus, we’ve seen an increase in cases in poultry and in wild birds in Asia, in Europe, and more recently in North and in South America, and also in Southeast Asia.  But we know from sequencing these viruses that we’ve seen no changes in the genetic sequence that would make the virus more likely to infect humans or more likely to be spread from humans to humans.

I think the risk we’re talking about with human infections comes from the fact that there’s a lot more birds infected with H5N1, and so there’s more exposures between humans and infected birds.  So this is probably why we’ve seen a few more cases in Southeast Asia than we have in recent years.  Over.

MODERATOR:  All right.  Our next question is – comes from the live queue.  We have Feng Lifei from the China Science Daily based in Beijing, China.  Feng Lifei, you should be able to unmute yourself now.

QUESTION:  Thank you.  Do you hear me?

MODERATOR:  Yes, we do.

QUESTION:  Okay.  My question is, do we have some vaccines for bird flu now?  And I learned that not only in – not only in Southeast Asia, but also in Brazil, we have bird flu in a very large region.  So is that possible that maybe this circle – this bird flu may have a – may spread global?  That’s my question.  Thank you.

DR DAVIS:  Yeah.  So this is Dr. Bill Davis again.  I think I can – I think I can take that one.  So as I mentioned, H5N1 bird flu, we first detected it in wild birds all the way back in 1996, and it has continued to circulate around the globe since then.  And as some people might remember, 15 to 20 years ago there was an increase in circulation, especially in Southeast Asia, and there were a lot of poultry-infected and also a lot of human cases at that time as well.  And so the virus has been slowly changing all this time, and so there’s a new mutation in the virus, and we call that type of virus – that type of H5N1 virus clade 2.3.4.4b, in case you’ve seen that.  This emerged in 2022, and this virus appears well adapted to spread efficiently among wild birds and poultry.

And so we think this is why we’ve seen an increase in bird and in wild bird and in farmed bird infections since about 2022, and we’ve tracked the spread globally.  It was first detected in Asia and Europe, like I mentioned.  It’s being spread between countries mostly through migratory bird pathways.  The U.S. had a lot of detections in the last year and it has spread to South America, and as you mentioned, in Brazil.

To answer your vaccine question, so there are vaccines for H5N1 that are being used in poultry as we speak, and it’s up to different countries’ national policies on whether or not they implement those.  Those vaccines are very effective in controlling the disease in poultry.  There are currently no vaccines for humans for H5N1, although I will say because we’ve been working for such a long time on H5N1 and there’s been good collaboration globally between countries in sharing surveillance data and sharing virus sequence, sharing characterizations of the virus, we – there are some candidate vaccine viruses made for H5N1 that could be further tested and could be potentially used for humans, if needed.  Over.

MODERATOR:  Thank you, Dr. Davis.  Our next question will come from the live queue, from Jonathan Landreth of The China Project based in New York.  Jonathan, you should be able to unmute yourself now.

QUESTION:  Good evening or good morning.  This is Jonathan Landreth from New York.  The first question I’d asked is, what was the major takeaway from the recent Southeast Asia Regional Influenza Workshop in Bangkok?  What contributions were made by delegates from the People’s Republic of China?  And who were those delegates by name, if you remember, please?

DR DAVIS:  Sure, I can answer that question as well.  So at the workshop, we had about 110 participants from health, animal health, and environment ministries from eight countries in the region, I think as I’d mentioned, including WHO, FAO, World Organization for Animal Health, and U.S. Government agencies.  And in total, people from 14 countries participated.  And the workshop covered the best practices and state-of-the-art techniques and surveillance in lab.  Countries shared data on surveillance systems and findings on avian influenza viruses.  And I think the workshop strengthened already-strong relationships between everyone attending.

In terms of take-homes, I think there are several take-homes.  I think one – I think what we saw was from country presentations on surveillance and on their responses to human detections of H5N1 infection, that things have improved a lot over time, and I think this is really an indication of CDC’s work in the region supporting partners for nearly 20 years on rapid response, on surveillance, on lab testing, starting from PCR several years ago and through the COVID pandemic, really advances in sequencing technologies and rapidly sequencing viruses and getting those sequences shared.

To answer your question on China, there was participation from China.  We had presentations from the China CDC, two presentations from them, including one in the plenary session and a presentation from the agriculture ministry on surveillance in human cases.  And I don’t have the names of the participants in front of me, or else I would share them.

Thanks.

MODERATOR:  All right.  Our next question came in via the Q&A tab, and it comes from Feng Lifei of China Science Daily in Beijing, who asks:  “Do you have any other suggestions for ordinary people to protect themselves from the virus?”  Over to you.

DR DAVIS:  Sure, yeah.  I think I’ll take this one again.  And so we do – so the CDC has guidelines, which apply – because the CDC’s jurisdiction is within the U.S. and we’re supporting countries to do work – other countries to do work in their countries, but we can’t really influence their guidelines.

But generally what we tell people is when possible, people should avoid contact with wild birds and observe them only from a distance.  Wild birds can be infected with H5N1 virus, and even if they don’t look sick.  And people should be especially careful about unprotected contact with sick poultry or with dying poultry.  And I think what we have seen based on the limited number of human cases that we have responded to and have investigated over the last two decades is that really, one of the really high risks is if you have a sick or dead chicken and the family decides or a person decides to slaughter it and prepare it for cooking.  That’s an extremely – slaughtering a chicken is an extremely high-risk event for H5N1 transmission.

So I think that would be our recommendations.

MODERATOR:  All right.  Our next question comes from Sarah Newey of the Telegraph in – based in Bangkok, Thailand, who asks:  “What do you see as the major gaps in Southeast Asia’s avian influenza response?”

DR DAVIS:  So this is Dr. Bill Davis again, and I’ll take this one.  I think historically and in the – when H5N1 was first detected over 20 years ago, even globally, not just in Southeast Asia, our surveillance systems were not as robust as they are today, and rather than seeing gaps today what I’ve seen is a lot of advancement in the region.  And I think that was really clear during this recent workshop.  We had presentations from eight countries who attended.  They talked about their current surveillance that they’re doing for H5N1 in poultry.  Several countries who have had human cases of H5N1 presented on their response and investigation of those cases.  And I think what it shows is that we have – our partnerships are paying off, and we’ve trained people over 20 years in rapid response teams and lab techniques, advanced sequencing techniques these days, and also in surveillance.  So we’re getting a good handle on what’s happening to the virus.

I think we can continue to work on sharing data between countries and sharing data with the WHO and international organizations because the faster data is shared, the faster we can respond to things.  But I think, in all, we’ve seen a lot of progress over the years in cooperation and coordinating response to these.

MODERATOR:  Thank you, Dr. Davis.  Our next question comes from Michelle Cortez from Bloomberg based in Hong Kong, who asks:  “What do you make of asymptomatic surveillance that has detected H5N1 in two people who worked in the poultry industry in the UK?  Should this be done more widely, and do you think asymptomatic spread is a current problem?”  Over to our speakers.

DR DAVIS:  Thanks, and that’s a great question.  I have to say I probably know as much about those cases in the UK as you do, because I haven’t been in conversations with the responders to that.  But I am familiar with this idea that you’re talking about where the person would have no symptoms and they would have virus detected from a nasal swab.  I think one thing that could cause this is actually not an infection, but it seems improbable but we’ve seen this in a lot of human cases, which is what we call environmental contamination of the nose.  So the virus is actually in the nose, which is not surprising because the person is breathing through their nose and there’s a lot of air transmitting through there, and so if you stick a swab in the nose you’ll find a virus in there.

But CDC labs actually in the last year recently developed a technique to differentiate between a virus that’s just sitting in the nose compared with virus that’s replicating in the human.  And so it has to do with – this is getting a little technical, but it has to do with detecting the amount of positive strands of RNA, the ratio of those, the amount you detect of positive-stranded RNA with negative-stranded RNA.

But I don’t want to get into details, but let me just say what we think is that a lot of these – or not a lot, but we think that it’s possible to have people with environmental contamination in the nose, so they’re not infected and they’re not asymptomatic, and they’re probably not spreading the virus.  So we know that you can be infected with influenza – human influenza –and asymptomatic.  But what we really have – there have been few human cases of this and we really haven’t detected much of it yet.

And so I think it’s an important point to raise that we have – because there have been limited human cases, we don’t have a whole lot of data on how the infection goes in humans, especially with new variant viruses or new clades of viruses.  And so I think that’s why it’s important that we maintain our strong partnerships in the region, and so when there is a human case we’re able to run technical assistance, not only in the response and making sure human-to-human transmission is not happening and stopping the spread of the virus, but also to learn as much as we can about the human cases that are detected.  This is going to help us prepare responses in the future if we understand the virus better.  Over.

MODERATOR:  Great.  Our next question goes to Dominique Patton with Reuters based in Beijing, who asks:  “Hello.  We haven’t seen any outbreaks of H5N1 being reported in birds in China, which I presume is due to the fact that China vaccinates its poultry against the virus.  However, we regularly see human infections with other variants of avian influenza, especially H5N6, and many are fatal.  Are you aware of efforts to try to improve surveillance of these other strains and do you believe the risk of these is growing, or is this just a continuing risk?”  Over to our speakers.

DR DAVIS:  Yeah, thanks, that’s a great question.  So I’ll first address surveillance of other strains.  So when we talk about surveillance – and I’m talking about the surveillance in poultry and in wild birds here – the way that’s done is you can go into a bird market or you can go to a wetland where there’s a lot of wild birds, and you can take a swab of the bird – similar how you would do with a human, like how we’re all familiar with SARS-CoV-2 – to swab the bird.  You can swab the environments.  And there’s even methods now you can do air sampling to detect virus that’s been aerosolized.

And so when they bring those samples in for testing, they do not just test for H5N1; they test for multiple avian influenza viruses, including H5N6.  And so when we talk about surveillance, we’re talking about surveillance for a broad spectrum of viruses.

Perhaps you could remind me about the other parts of that question.

MODERATOR:  Absolutely.  So human infections from other strains, aware of efforts to improve surveillance of these other strains, and do you believe the risk of these is growing or is this just a continuing risk?

DR DAVIS:  Yeah.  So surveillance for other strains is going on.  I can say that a lot of countries have their own tools to assess risks for viruses and the WHO also has a tool for that.  The WHO tool is called T-I-P-R-A, TIPRA.  And so that looks at, for a particular virus – not just a virus but a clade of that virus – what’s the global spread in birds, what’s the global – how many human cases have there been, what do we understand about sequences of that virus that might indicate greater risk of infecting humans or spreading between humans.  And so a panel of experts assesses all these categories of the virus to determine if this should be a high-risk virus or not.

So risk assessments are ongoing.  I think what’s really important when it comes to risk assessments is the data inputs on these, because there are so many viruses and so many different clades of these viruses.  There’s not always enough data to really inform a risk assessment, and you’re basing your assessment on limited data.  So it’s important for countries to work together, and it’s important for CDC and other organizations to work with countries and develop strong partnerships for surveillance, because when we do surveillance, we get viruses from birds and we can sequence them and learn more about them, and to respond to human cases so we can learn about how disease progresses in humans, which we have sometimes a limited understanding of with where there are very few human cases.

And so I think it’s a great thing about the workshop that we had this week with all these participants here to share data from their countries, to figure out the best practices on how to do surveillance, how to do more advanced lab techniques, and how to do rapid response to cases to get data on this.

Thanks.

MODERATOR:  All right.  We’re near the end of our time, so if we have any closing remarks, Dr. MacArthur, I’ll turn it back over to you first.

DR MACARTHUR:  Thanks, Katie.  And I just want to thank Dr. Davis, our subject matter expert, for fielding all of the questions, but he’s the right person that you guys want to hear from.

I just want to say some things about changes in the region.  Really over the last 50 years or so, the Asia region has undergone changes leading to dynamic economic growth, and this really has happened from a switch from agrarian-based economies to one that is more industrial, and thus people are moving more into urban regions and putting people closer and closer together.  Our protein sources have shifted from traditional backyard farms to live bird markets, often in high-population centers, and this has provided fertile conditions for animal diseases to spill over and infect humans, thus causing new human diseases.  Asia is really a hotbed of emerging infectious diseases.  It’s estimated that 75 percent of new diseases, new viruses come from animals into humans, and over the last 25 years Asia has seen such new viruses as Nipah, SARS, multiple avian influenza strains, and of course COVID-19.  And I’ll say even the Zika virus that dramatically affected the health of people in South America was of Asian lineage.

CDC is working closely with partners throughout the region because one thing I think all of us can agree on is that diseases know no borders and that we are stronger when we work together.  So the Regional Avian Influenza Workshop that Dr. Davis discussed today is just one example of what we’re doing in the region, working with ASEAN and working with member states throughout Asia, the United Nations agencies.  A few weeks ago we held a regional training for countries to identify what are the priority diseases that pass from animals to humans.  Next week in Singapore we’ll be hosting an ASEAN-U.S. Infection Prevention Task Force so that people in the health care settings but also in the field can protect themselves from getting infected with these new diseases.  We’ve got programs looking at building leaders for the emergency operations centers to train disease detectives to better do – excuse me – the disease investigations and contact tracing, and to develop leaders in the laboratory.

So these are just a few examples of what CDC is doing with partner countries throughout Asia to try to ensure that they have the capacity to prevent, detect, and respond to public health emergencies.

Over to you, Katie.

MODERATOR:  Thank you, Dr. MacArthur.  I’ll now turn it over to Dr. Davis.  Dr. Davis, if you have any last words.

DR DAVIS:  Sure, thanks.  So you know, all of our countries are working individually to address the risks of avian influenza, but we know we can best fight this as partners.  And this is why we wanted to gather in Bangkok this week.  We wanted to share best practices in epidemiologic and laboratory surveillance for avian influenza viruses so we can strengthen the region’s readiness to respond to pandemic threats.  It’s in the best interest of everyone that we work together to address the threat of avian influenza.

CDC and partners have been working on H5N1 since it was first detected in the ’90s; we worked side by side to respond and investigate human cases of H5N1 in the early 2000s; and we’ll continue to work with partners globally and in Southeast Asia to track the virus and investigate outbreaks today.  We’ll maintain strong partnerships with ministries of health, ministries of agriculture, and environment ministries in Southeast Asia and globally so we can continue to address the threats of H5N1 and other threats to public health.

Thank you.

MODERATOR:  Thank you, Dr. Davis.  That’s all the time we have for today.  Thank you for your questions, and thanks to Dr. MacArthur and Dr. Davis for joining us.  We will provide a transcript of this briefing to participating journalists as soon as it is available.  We’d also love to hear your feedback, and you can contact us at any time at AsiaPacMedia@state.gov.  Thanks again for your participation, and we hope you can join us for another briefing soon.