Ten of the U.S. cases were tied to exposure to infected poultry, nine were tied to sick or infected dairy cows, and one case in Missouri occurred in a person who had no known contact with infected animals, the U.S. Centers for Disease Control and Prevention said in a statement on Friday.

The CDC said all six of the cases in California appear to be caused by animal-to-human spread. So far, the infected workers had mild symptoms, which included eye redness or conjunctivitis. None were hospitalized.

The agency said it believes the immediate risk to the general public from bird flu remains low, but people with exposure to infected animals are at higher risk of infection.

Genetic sequencing of three virus samples from the California cases show they are closely related to those detected in dairy cattle, the CDC said.

Sequencing of the first two cases shows no changes in the virus to suggest it can spread more easily between people or that it is becoming resistant to antiviral medications, the agency added.

The California Department of Public Health said in a statement they are working closely with local public health laboratories and departments to provide health checks for exposed individuals and ensure testing and treatment are available as needed.

Of the six California cases, all occurred in workers exposed to the virus. California health officials said they expect additional cases to be identified among individuals who have regular contact with infected dairy cattle.

The state said it has received 5,000 additional doses of seasonal flu vaccine for farm workers from the CDC with the aim of reducing the risk of becoming infected with both bird flu and seasonal influenza.

Infections with both types of virus simultaneously could increase the risk of changes that could make bird flu spread more easily in people.

According to the U.S. Department of Agriculture, 298 dairy herds in 14 U.S. states have confirmed cases of H5 bird flu virus infections in dairy cows.

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The ongoing outbreak of bird flu has infected poultry flocks in nearly every U.S. state since 2022 and more than 170 dairy herds in 13 states since March, according to the U.S. Department of Agriculture.

Thirteen poultry and dairy farm workers have contracted the virus in Colorado, Michigan and Texas, according to the CDC. Nine of those cases were detected in July among workers killing chickens at two poultry farms with bird flu in Colorado.

The risk to the general public from bird flu is still low, CDC’s principal director Nirav Shah said on a call with reporters.

The CDC does not currently have any further human tests awaiting confirmation, though additional human cases in Colorado or elsewhere are possible, Shah added.

The Atlanta-based agency will allocate $5 million to organizations including the National Center for Farmworker Health to educate and train workers on protecting themselves from bird flu, and another $5 million to providing seasonal flu shots to farm workers, Shah said.

Though the seasonal flu vaccine does not provide protection from bird flu, the vaccine push could reduce the risk that workers become infected with the seasonal flu and bird flu at the same time, which could lead to flu virus mutations, Shah added.

“Preventing seasonal influenza for these workers, many of whom are also exposed to bird flu, may reduce risks of new strains of influenza emerging,” Shah said.

The CDC is hoping to vaccinate all of the nation’s approximately 200,000 livestock workers during this year’s flu shot season and is working with states to develop plans to reach the workers, Shah added.

The USDA believes it can stop the spread of bird flu among dairy cows and eventually eradicate the disease, Eric Deeble, an agency undersecretary, said on the call.

—Additional reporting for Reuters by Ahmed Aboulenein in Washington

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More than 120 dairy herds in 12 states have tested positive for bird flu since March, according to the U.S. Department of Agriculture. Federal officials have warned that further spread among dairy cows could heighten the risk of human infections.

The focus of additional testing is to ensure that pasteurization inactivates the virus, said Don Prater, acting director of the FDA’s Center for Food Safety and Applied Nutrition, on a call with reporters.

Prior FDA testing of 297 retail dairy samples came back negative for evidence of the virus.

The agency continues to strongly advise against consumption of raw milk products, Prater said.

More than 690 people who were exposed to infected or suspected infected animals have been monitored for flu symptoms, and 51 people who developed flu-like symptoms have been tested, Demetre Daskalakis, director of the U.S. Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, said on the press call.

Three dairy farm workers have tested positive for the virus with mild respiratory or conjunctivitis symptoms, and all have recovered.

The risk to the general public from bird flu remains low, federal officials have said, though it is higher for workers on dairy farms, who should wear personal protective equipment to reduce the risk of infection.

No cases of the disease have been reported in Canadian dairy cattle, however the Canadian Food Inspection Agency continues to monitor the milk supply.

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