By Sara McCloskey

From spiraling egg prices, thousands of flocks being euthanized, and humans catching the illness – avian flu has made headlines for almost a year.

But how serious is it? And should we be worried?

As of late January 2025, cases of the avian flu, also known as bird flu or H5N1, have been documented in birds by the United States Department of Agriculture in every state as well as the territory of Puerto Rico and cases among dairy cows have been reported in 16 states. About 67 human cases have been reported and one death.

"I don't want to sound alarmist, but bird flu is certainly a public health threat,” said Gonzalo Bearman, M.D., chief of the Division of Infectious Diseases. "It is important that agencies, such as the Centers for Disease Control and Prevention and state health departments, continue to monitor the situation closely, provide updated epidemiology data, and provide guidance to health care workers and the public to keep us abreast of the situation.”

VCU Health News spoke with Bearman about the ongoing concerns about bird flu and who is most vulnerable when there is a widespread outbreak.

How can people get bird flu?

The virus is typically found in wild water birds and can spread to other animals, including humans, if they are exposed to mucous, saliva, or feces. That includes touching contaminated surfaces.

You can also be exposed to bird flu by eating undercooked or uncooked poultry, eggs, or consuming unpasteurized milk from a dairy cow. However, if the products are prepared properly, cooked thoroughly, or pasteurized, you’re safe.

Are there certain people who are more likely to catch this virus? If so, what special precautions should they take?

People who are around birds or other avian flu virus-infected animals are at greater risk of getting sick. This includes people who work in some of the following places, according to the Centers for Disease Control and Prevention:

• Farms, including backyard or hobby farms
• Zoos or other wild animal facilities  
• Veterinary hospitals or clinics
• Food processing facilities and slaughterhouses
• Dairy laboratories  
• Public health departments that may respond to cases

What are the symptoms of bird flu?  

There are a wide range of symptoms reported in people who have become sick from bird flu, including no symptoms to severe illness that can lead to death. The CDC notes that the most common sign reported among recent U.S. human cases is eye redness.  

Mild symptoms include:

• Mild fever or feeling feverish, although fever isn’t always present
• Cough
• Sore throat
• Runny or stuffy nose 
• Muscle or body aches
• Headaches and fatigue

Moderate to severe systems include:

• High fever
• Shortness of breath or trouble breathing
• Changes in consciousness
• Seizures

Less common symptoms include:

• Diarrhea
• Nausea
• Vomiting

At what point should I see a doctor because of my symptoms?

If you or someone you know begins to experience some of the more severe symptoms of bird flu noted above, you should seek medical attention.  

Either way, if you have any viral respiratory infection, consider getting evaluated by your primary care doctor. Most respiratory illnesses, including the flu, bird flu, and COVID-19, can be treated. So, it’s good to see a doctor and to get tested so you understand the diagnosis and the potential treatments.

Alarm bells – for any viral respiratory infection – should be going off and you should seek medical care if you or someone else begins to experience symptoms such as:

• Physical discomfort either from high fever and/or sore throat
• Trouble eating and drinking
• Shortness of breath or trouble breathing

When are people most contagious? And can I pass bird flu to another person?  

We’re not seeing cases of bird flu being transmitted person-to-person. But what we understand from studying the virus is that bird flu – while not as highly contagious between humans – is probably very similar to the influenza virus (flu) we see every year.

To suggest this means you're most infectious when you're symptomatic or in the first 24 hours prior to your symptoms. So, if you or someone you know is sick with a viral respiratory infection, whether it's bird flu or, more commonly, influenza, COVID-19, or RSV, then you should limit your contact with others. Don't go to work sick. Stay home. Isolate yourself.

If at all possible, you should seek medical attention. And why is that? It's not because you're dealing with a life-threatening illness. Most of the time, it's because with proper medical attention, the proper diagnosis can be made. We have very highly reliable tests that can tell us which virus is causing the infection. Once we know that, doctors can prescribe you the right treatment to make sure you’re feeling better sooner.  

How can I protect myself from the bird flu?

Avoid places where you can be exposed whenever possible. If you don’t work in the industries that come into close contact with these animals, you would most likely be exposed while hunting or visiting a site with a lot of birds and livestock.  

If you do come across an animal that might be exposed to bird flu – look at them from a distance. Wear personal protective equipment if you have to be in close contact with them. Do not touch surfaces or materials that may be contaminated, such as animal litter or bedding material.

Be sure to cook poultry, eggs, and beef to a safe internal temperature to kill bacteria and viruses. Use pasteurized milk and milk products; pasteurization kills bacteria and viruses like bird flu.

While bird flu mainly affects birds and cows, could this virus reach pandemic levels for people?

If you think about the history of influenza viruses, there are pandemics. So, it is possible. The majority of cases, of course, are birds and livestock, but there are cases documented in humans and bird flu can lead to severe illness, just like influenza.

The good news is that most bird flu is not transmissible from person-to-person like the more common flu. The bad news is that it doesn't take too many mutations in the virus to change from being lowly transmissible person-to-person to highly transmissible person-to-person.  

Why is that a concern? Essentially, we don't have a vaccine that's available for bird flu. We have a large potential population that is not immunized, either by prior infection and or vaccination, so there's a risk for outbreaks. And our antiviral medications may not be as good as they are for influenza, so bird flu does pose a public health threat. 

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