The patient, who has not been identified, was hospitalized with the virus on Dec. 18 after exposure to a combination of backyard chickens and wild birds, Louisiana health officials had said.

The patient was over age 65 and had underlying medical conditions, the officials said.

Nearly 70 people in the U.S. have contracted bird flu since April, most of them farmworkers, as the virus has circulated among poultry flocks and dairy herds, according to the U.S. Centers for Disease Control and Prevention.

Federal and state officials have said the risk to the general public remains low.

The ongoing bird flu outbreak, which began in poultry in 2022, has killed nearly 130 million wild and domestic poultry and has sickened 917 dairy herds, according to the CDC and the U.S. Department of Agriculture.

The CDC has said genomic data of the virus taken from the Louisiana person showed it belongs to the D1.1 genotype related to other D1.1 viruses recently detected in wild birds and poultry in the U.S., as well as in recent human cases in British Columbia, Canada, and Washington state. It is different from the B3.13 genotype circulating in U.S. dairy cows.

“While the current public health risk for the general public remains low, people who work with birds, poultry or cows, or have recreational exposure to them, are at higher risk,” the Louisiana state health department said in a statement.

The CDC did not immediately respond to a request for comment.

Most U.S. bird flu cases reported this year have been mild, with symptoms including conjunctivitis, or pink eye.

“Though H5N1 cases in the U.S. have been uniformly mild, the virus does have the capacity to cause severe disease and death in certain cases,” said Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security. The Louisiana patient was at high risk from influenza given their age and underlying conditions, he added.

The death is not surprising given that bird flu has killed people in other countries, said Gail Hansen, a veterinary and public health consultant.

“I hate to have the death of somebody be a wake-up call,” she said. “But if that’s what it takes, hopefully that will make people look at bird flu a little more carefully and say this really is a public health issue we need to be looking at more closely.”

—Reporting by Jasper Ward, Katharine Jackson, and Leah Douglas in Washington and Tom Polansek and Julie Steenhuysen in Chicago.

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Scientists and government officials hope the research will guide efforts to contain the virus and reduce exposure to humans. Respiratory spread could give the virus more opportunity to evolve, they said.

Scientists have so far suspected the virus spreads among animals and humans through contact with infected milk or aerosolized milk droplets, or from exposure to infected birds or poultry.

The Michigan Department of Agriculture and Rural Development is working with Michigan State University and the U.S. Department of Agriculture (USDA) to plan research on farms to evaluate respiratory spread, Tim Boring, the department’s director, said in an interview.

“This is an area of concern that we’re building out and looking more into,” Boring said. The research is a high priority and will be important to guiding the state’s public policy, he said.

The USDA did not respond to a request for comment.

Bird flu has been reported in more than 80 dairy herds across 11 states since late March.

The exact mechanics of the spread of the virus are still unclear, though there is evidence of spread to cows from wild birds and other cows.

The virus has been identified mainly in milk, but also in nasal swabs at lesser levels, said Zelmar Rodriguez, a dairy veterinarian and assistant professor in Michigan State University’s College of Veterinary Medicine who has researched affected farms.

“If it’s present in the nose when the cow is shedding (virus), it’s potentially transmitted through air,” he said.

Any change in how the virus is transmitting gives it the opportunity to evolve, said Richard Webby, a St. Jude Children’s Research Hospital virologist who studies flu in animals and birds for the World Health Organization.

“We certainly don’t want that,” Webby said.

But for the virus to be a more significant threat to human health, it would need to undergo further genetic mutations, Webby said.

The third dairy worker to contract avian flu, who lives in Michigan, reported respiratory symptoms, including coughing. Flu experts said the worker was most likely infected through close contact with milk through splashes or aerosolized droplets.

Respiratory symptoms have often been seen in prior human bird flu infections. The first two U.S. workers known to be infected during this outbreak only reported symptoms of conjunctivitis, or pink eye.

The U.S. Centers for Disease Control and Prevention (CDC) said the latest case does not change its assessment that bird flu is a low risk to the general public, and that it has not seen evidence of human-to-human transmission.

The worker with respiratory symptoms was still recovering as of a few days ago, said Natasha Bagdasarian, Michigan’s chief medical executive, in an interview.

Michigan aims to begin its study of blood samples looking for evidence of prior bird flu infection among farm workers this month, Bagdasarian said.

Reuters reported on May 30 that the state and CDC would be conducting the study to understand the prevalence of human illness and whether any dairy workers had previously contracted the virus.

“We have folks from the CDC who are in the state right now,” Bagdasarian said. “We’ve been working really closely and collaboratively with them, our protocols are in place

—Additional reporting for Reuters by Tom Polansek in East Lansing, Michigan

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The infection was the second human case in Michigan, which has confirmed more cases of bird flu in dairy cattle than any other state. It also expands the symptoms for human cases, after the two workers who previously tested positive experienced only conjunctivitis, or pink eye, and recovered.

The U.S. Centers for Disease Control and Prevention (CDC) said the latest case does not change its assessment that bird flu is a low risk to the general public.

Meanwhile, Michigan will soon begin testing dairy farm workers for signs of prior infection with avian flu, a county health official told Reuters.

“We have not seen signs of sustained human-to-human transmission,” Dr. Natasha Bagdasarian, Michigan’s chief medical executive, said in a statement.

The ongoing outbreak of avian flu in dairy cattle has affected 67 herds in nine states since March, according to CDC data.

The third worker to test positive reported upper respiratory tract symptoms including cough without fever, and eye discomfort with watery discharge, the CDC said.

The patient was given antiviral treatment, is isolating at home, and the symptoms are resolving, CDC said. Household contacts of the patient have not developed symptoms and are being monitored for illness, the agency added.

The worker was employed at a different farm than the previous human case Michigan reported on May 22, the state said.

CDC reported the first human case connected to dairy cattle in Texas on April 1. None of the three human cases are associated with the others, the agency said.

“Even though there were respiratory symptoms present in this individual, it was still a mild case,” said Dr. Amesh Adalja, an infectious disease expert at the Johns Hopkins Center for Health Security. “This underscore the risk that is particular to dairy farm workers.”

CDC officials have been eager to test blood samples of farm workers for signs of prior infection to help understand the scope of the bird flu outbreak.

Michigan county and state officials will collaborate with the CDC on the testing effort, said Chad Shaw, health officer and environmental health director with the Ionia County Health Department in Michigan. Details of the plan for testing have not been previously reported.

Ionia County has reported avian flu infections in four dairy cattle herds and four poultry flocks, according to state data.

The goal of the testing is to discern how the virus is spreading from farm to farm, including whether humans have carried the virus asymptomatically, Shaw said, adding that he did not know when the testing would begin or how many workers would be tested.

A CDC spokesperson confirmed the testing and said the agency will be providing technical assistance to the state, which is coordinating the effort.

Testing for prior infection is important for determining how widespread the virus is among humans, said Michael Osterholm, a bird flu expert at the University of Minnesota. Widespread exposure could increase the chances that the virus will mutate to become more easily transmissible in humans.

If testing shows very few infections, he said, that would be an indication that “the barrier is still substantial for this virus to jump to humans.”

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The U.S. CDC urged farmers, workers, and emergency responders to wear appropriate protective gear when in direct or close physical contact with sick birds, livestock, feces, raw milk or contaminated surfaces.

The warning coincides with a letter published online in a letter to the New England Journal of Medicine detailing the case of a dairy worker who was infected with the virus in March and developed an eye infection known as conjunctivitis.

Infection of the bird virus is rare in humans, and the dairy worker’s case represents only the second known infection in the United States. It follows a concerning spread of the virus in a variety of mammal species, raising concerns that widespread exposure in people could cause the virus to spread more easily in people and spark a global pandemic.

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The FDA released results from tests of products including sour cream and cottage cheese, after reporting last week that preliminary results from testing showed pasteurization kills the virus in milk and baby formula.

The U.S. Department of Agriculture (USDA) has confirmed bird flu in 36 dairy herds in nine states since late March. One Texas dairy worker tested positive for the virus.

The FDA said it has looked at 297 total retail samples of dairy products, and the results released on Wednesday represent tests of a group of 201 of those samples.

“It is a pretty good body of results,” Donald Prater, acting director of the FDA’s Center for Food Safety and Applied Nutrition, said on a call with reporters that also included officials from the U.S. Centers for Disease Control and Prevention (CDC) as well as the USDA.

“There are probably a few more products that we would look at just so that we make sure that we’ve got a good national sample,” Prater added.

CDC official Dr. Demetre Daskalakis said that 25 people had been tested so far for bird flu and that no additional positive cases had been found.

The agency tested a sample of the virus taken from the farm worker who was infected with H5N1 and found that all three commercially available antiviral flu treatments are effective against it. The worker’s only symptom was conjunctivitis, commonly known as pink eye.

Currently approved antiviral drugs include Roche’s Tamiflu as well as a generic versions, GSK’s Relenza and BioCryst Pharmaceuticals’ Rapivab.

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The surgery, performed by a team at the University of Maryland Medicine, is among the first to demonstrate the feasibility of a pig-to-human heart transplant, a field made possible by new gene-editing tools.

If proven successful, scientists hope pig organs could help alleviate shortages of donor organs.

“This was a breakthrough surgery and brings us one step closer to solving the organ shortage crisis. There are simply not enough donor human hearts available to meet the long list of potential recipients,” Dr. Bartley Griffith, who surgically transplanted the pig heart into the patient, said in a statement.

“We are proceeding cautiously, but we are also optimistic that this first-in-the-world surgery will provide an important new option for patients in the future,” Griffith added.

For 57-year-old David Bennett of Maryland, the heart transplant was his last option.

“It was either die or do this transplant. I want to live. I know it’s a shot in the dark, but it’s my last choice,” Bennett said a day before his surgery, according to a statement released by the university.

To move ahead with the experimental surgery, the university obtained an emergency authorization from the U.S. Food and Drug Administration on New Year’s Eve through its compassionate use program.

“The FDA used our data and data on the experimental pig to authorize the transplant in an end-stage heart disease patient who had no other treatment options,” said Dr. Muhammad Mohiuddin, who heads the university’s program on xenotransplantation — transplanting animal organs into humans.

About 110,000 Americans are currently waiting for an organ transplant, and more than 6,000 patients die each year before getting one, according to organdonor.gov.

Bennett’s genetically modified pig heart was provided by Revivicor, a regenerative medicine company based in Blacksburg, Virginia. On the morning of the surgery, the transplant team removed the pig’s heart and placed it into a special device to preserve its function until the surgery.

Pigs have long been a tantalizing source of potential transplants because their organs are so similar to humans. A hog heart at the time of slaughter, for example, is about the size of an adult human heart.

Other organs from pigs being researched for transplantation into humans include kidneys, liver and lungs.

Prior efforts at pig-to-human transplants have failed because of genetic differences that caused organ rejection or viruses that posed an infection risk.

Scientists have tackled that problem by editing away potentially harmful genes.

In the heart implanted in Bennett, three genes previously linked with organ rejection were “knocked out” of the donor pig, and six human genes linked with immune acceptance were inserted into the pig genome.

Researchers also deleted a pig gene to prevent excessive growth of the pig heart tissue.

The work was funded in part with a US$15.7 million research grant to evaluate Revivicor’s genetically-modified pig hearts in baboon studies.

In addition to the genetic changes to the pig heart, Bennett received an experimental anti-rejection drug made by Kiniksa Pharmaceuticals based in Lexington, Mass.

— Julie Steenhuysen is a Reuters health and science correspondent in Chicago.

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Routine pig-human organ transplants are years away, but recent scientific advances are breaking down barriers that frustrated prior attempts to use pigs as a ready supply of replacement parts for sick or injured people, making it an attractive new market.

“Our bread and butter has always been the bacon, sausage, fresh pork — very much a food-focused operation,” Courtney Stanton, vice-president of Smithfield’s new bioscience unit, told Reuters in an exclusive interview.

“We want to signal to the medical device and science communities that this is an area we’re focused on — that we’re not strictly packers,” she said.

Smithfield, the $14 billion subsidiary of China’s WH Group , in its first move has joined a public-private tissue engineering consortium funded by an $80 million grant from the U.S. Department of Defense (all figures US$). Smithfield is the only pork producer, joining health-care companies including Abbott Laboratories, Medtronic and United Therapeutics Corp.

Transplants are used for people diagnosed with organ failure and who have no other treatment options. Transplants from animals could help close a critical gap to help those in need. The United Network for Organ Sharing estimates that, on average, 22 people die each day while waiting for a transplant.

Smithfield already harvests materials for medical use from the 16 million hogs it slaughters each year. The company owns more than 51 per cent of its farms and hopes to sell directly to researchers and health-care companies, which now typically buy from third parties.

Stanton said the U.S. market for pork byproducts used for medical, pet food and non-food purposes stands at more than $100 billion, and that excludes any potential market for animal-to-human transplants, known as xenotransplants.

Smithfield has deals in the works to supply pig organs to two entities, though Stanton would not disclose the names.

“It’s just a huge potential space, and to be at the leading edge and focused on building those relationships is critical,” she said.

Hog hearts

Pigs have long been a tantalizing source of transplants because their organs are so similar to humans. A hog heart at the time of slaughter, for example, is about the size of an adult human heart.

Other organs from pigs being researched for transplantation into humans include kidney, liver and lungs.

Prior efforts at pig-to-human transplants have failed because of genetic differences that caused organ rejection or viruses that posed an infection risk. Swiss drugmaker Novartis AG folded its $1 billion xenotransplantation effort in 2001 because of safety concerns about pig viruses that could be passed to humans.

George Church, a Harvard Medical School genetics professor and researcher, tackled that problem two years ago, using a new gene-editing tool known as CRISPR to trim away potentially harmful virus genes that have impeded the use of pig organs for transplants in humans.

Church has since formed a company named eGenesis Bio to develop humanized pigs that do not provoke a rejection response or transfer viruses to people. The company last month raised $38 million in venture funding.

Eventually, Church said, the process could enable researchers to harvest a dozen different organs and tissues from a single pig.

Church estimates the first transplants involving humanized pig organs could occur in a clinical trial later this year, but these would only be used on people too sick to receive human organs.

Genome pioneer Craig J. Venter’s Synthetic Genomics Inc. has been working for two years with United Therapeutics on editing the pig genome and mixing in human cells to overcome the complex issues involved in immune rejection.

“It’s not like changing a couple genes and you’ve got it solved,” Venter said.

Stanton would not rule out breeding genetically modified animals, but said Smithfield’s first ventures will likely involve whole pig organs that go through decellularization — a process in which existing cells are washed away and replaced with human cells.

Miromatrix Medical Inc, of Eden Prairie, Minnesota, for example, is using whole pig livers to make a surgical mesh used in hernia repair and breast reconstruction, and it is working toward developing replacement livers, hearts and kidneys.

Church welcomes the involvement of a big pork producer. “Even though we’ve got companies like eGenesis that would make the first pigs, you still need someone who will breed them and do it to scale,” he said.

— Reporting for Reuters by Julie Steenhuysen and Michael Hirtzer in Chicago.

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The federal government sprang into action on Friday after confirmation that the virus had hit an Indiana turkey farm, alerting other states to the danger and putting workers who might have been exposed to the virus under surveillance.

Last year’s outbreak led to the deaths of more than 48 million chickens and turkeys, either killed by the virus or culled to contain it. No cases were reported in humans.

Strains similar to the new virus, known as H7N8, have on rare occasions made people ill and the U.S. Department of Agriculture (USDA), U.S. Centers for Disease Control and Prevention (CDC) and state officials aim to reduce the risk of human infection.

They also want to blunt the impact on the poultry industry, which suffered billions of dollars in losses in last year’s outbreak. Egg supplies shrank and prices surged to record highs.

“We are hopeful that as we respond very quickly to this virus that we can get it contained and hopefully not see an extensive outbreak like we did last year,” said T.J. Myers, an associate deputy administrator for USDA’s Animal and Plant Health Inspection Service.

Even if the response is fast, the government’s ability to contain the disease is far from certain. Officials have never dealt with this strain before, and wild birds are thought to spread the disease to farms through feces dropped from the air, making infections difficult to prevent.

U.S. officials have taken to heart lessons from last year’s outbreak, when USDA workers could not always kill infected flocks fast enough to contain the virus. Workers are now trying to cull sick flocks within 24 hours of diagnoses, following a goal the agency set in the autumn.

Most turkeys at the infected farm were killed within a day, but it was 29 hours before all were dead, said Denise Derrer, spokeswoman for the Indiana State Board of Animal Health.

No human infections associated with the new strain have ever been reported, according to USDA.

Especially deadly to poultry

Still, people who interacted with infected turkeys were quickly placed under a new monitoring plan developed in response to last year’s outbreak, Michael Jhung, a medical officer at the CDC, told Reuters. The agency also plans to conduct lab tests and animal studies of the virus.

Similar H7 viruses — which share the same surface proteins — have caused problems in people ranging from mild, flu-like symptoms to serious respiratory illness, Jhung said.

“We know very little about this particular virus because we haven’t seen it, but we want to take as many precautions as we can to prevent any human infections,” he said.

There is always uncertainty around any new strain of influenza because the virus acquires mutations passing from host to host.

The Indiana flock appears to have become infected when a less dangerous form of the virus in the area mutated, said John Clifford, USDA’s chief veterinarian.

Limited genetic data from preliminary diagnostic tests last week showed this H7N8 virus originated from North America, while last year’s strains had roots in Europe and Asia, government officials said.

North American viruses have typically posed less of a threat to humans than viruses from the Asian avian H5N1 lineage, said Carol Cardona, an avian flu expert at the University of Minnesota.

Viruses in the H5N1 lineage “are super bad guys,” Cardona said. Still, outbreaks of North American viruses in Pennsylvania in 1983 and British Columbia in 2000 were “devastating and difficult” for poultry, she added.

The new strain found in the U.S., like these previous viruses, is considered highly pathogenic, meaning it is especially deadly to poultry.

Mobilizing personnel, equipment

In Indiana, USDA quickly deployed personnel and equipment to assist the state with culling birds and testing nearby flocks, said Bret Marsh, Indiana’s state veterinarian.

Marsh alerted other states about the new virus outbreak on an emergency conference call in the early hours on Friday.

“We realize that if it’s indeed of wild bird origin, they know no boundaries so we want to make sure that everyone is properly informed,” Marsh told reporters.

Bird flu cost the U.S. poultry industry an estimated US$3.3 billion in 2015 as farmers had to destroy infected flocks and halt production for months. Importers also cut back on trade in the $5.7 billion poultry and egg export market, and some have already limited shipments because of this new outbreak.

U.S. negotiators have worked with trading partners in the past year to focus restrictions on infected counties or states, instead of blocking shipments from the entire country, said Toby Moore, spokesman for the USA Poultry and Egg Export Council. That could minimize the economic burden of outbreaks.

Farmers also have strengthened cleaning and security practices in a bid to keep out the virus, with many requiring workers to change their shoes before entering barns and barring delivery trucks from getting too close to poultry houses.

“In the poultry business, there’s a positive determination that this new strain not have any chance at proving what it might be able to do,” said Keith Williams, a spokesman for the National Turkey Federation, a trade group.

— Tom Polansek and Julie Steenhuysen report on agriculture and health issues respectively for Reuters from Chicago.

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The government guidelines, which are issued every five years, are a roadmap for U.S. dietary policy. Some groups suggested the recommendations should have better reflected the World Health Organization’s view that processed meat can cause cancer.

Kari Hamerschlag, senior program manager with the advocacy group Friends of the Earth, said in a statement that the new guidelines by the U.S. Department of Health and Human Services and the U.S. Department of Agriculture ignored strong scientific evidence presented by the agencies’ own advisory committee on the need for Americans to eat less meat for health, food security and environmental reasons.

“The administration has clearly put the financial interests of the meat industry over the weight of the science and the health of the American people,” Hamerschlag said.

Other health advocates lauded the guidelines, which aim to reduce obesity and prevent chronic diseases such as Type 2 diabetes, hypertension and heart disease.

“If Americans ate according to that advice, it would be a huge win for the public’s health,” said Michael F. Jacobson, president of the Center for Science in the Public Interest.

Health and Human Services Secretary Sylvia Burwell said the recommendations were based on the latest scientific evidence, input from the public and other factors. For the first time, she said, they did not include a specific limit on dietary cholesterol consumption.

The North American Meat Institute, an industry group that represents companies including Cargill, Tyson Foods and Kraft Heinz, said the recommendations were an “affirmation of meat and poultry nutrition.”

World Health Organization experts, however, said in October that eating processed meats such as hot dogs, sausages and bacon can cause colorectal cancer in humans, and that red meat is also a likely cause of the disease. Meat companies rejected the findings.

Meat producers were pleased that the guidelines did not address the environmental impact of raising livestock, said Dave Warner, spokesman for the National Pork Producers Council.

“The advisory committee had talked about reducing consumption of processed meats and it doesn’t talk about that either,” he said.

The American Cancer Society expressed dismay that the guidelines did not take a stronger stand on the need to reduce meat consumption.

“The science on the link between cancer and diet is extensive. By omitting specific diet recommendations, such as eating less red and processed meat, these guidelines miss a critical and significant opportunity to reduce suffering and death from cancer,” said Dr. Richard Wender of the American Cancer Society.

The guidelines were more specific on sugar, encouraging Americans to keep consumption of added sugar, sweeteners added in the production process, below 10 per cent of daily caloric intake, while consuming more fruit and vegetables. In the past, the government has offered less specific recommendations on limiting sugar consumption.

The advice would translate to a sharp reduction in the consumption of sugary drinks, snacks and sweets for many Americans. Teenagers age 14-18 on average consume about 17 per cent of their calories in added sugar, according to the guidelines.

Those aged 14 and younger were advised to consume less than 2,300 milligrams of sodium per day.

A USDA website provides more information about added sugars. They do not include naturally occurring sugars such as those consumed as part of milk and fruits.

— Reporting for Reuters by Julie Steenhuysen and Tom Polansek in Chicago and Caroline Humer and Chris Prentice in New York.

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