July 19, 2025

Bird Flu

The Impact of Highly Pathogenic Avian Influenza H5N1 Virus Infection on Dairy Cows
Authors looked at the impact of H5N1 virus infection on an affected dairy herd in Ohio. Clinical disease, which lasted for about three weeks, was recorded in 20.0% (777/3,876) of the adult cows. Milk losses of ~900 kg per cow were recorded in affected cows during a 60 day-post-outbreak period. Seroprevalence was 89.4% (570/637) in the herd, with 76.1% (485/637) of seropositive animals being subclinically infected. Clinically affected cows presented an increased risk of death (6 times) and of premature herd removal (3.6 times) when compared to non-clinical cows. Economic losses due to decreased milk production, mortality, and early herd removal were estimated at $950 per clinically affected cow for a total cost of ~$737,500 for the herd during the observation period. Results demonstrate a production impact lasting at least 60 days post-clinical diagnosis and major financial consequences of HPAI H5N1 virus infection to dairy farms. 53 of 777 sick cows (6.8%) died or were euthanized within, on average, 13.6 days after diagnosis, while another 245 (31.6%) were culled within 20.6 days after diagnosis. Relative to uninfected cows, sick cows were at a sixfold increased risk for death (relative risk [RR], 6.0) and a more than triple the risk of being removed from the herd (RR, 3.6).

RSV

Systematic Review and Expert Consensus on the Use of Long-acting Monoclonal Antibodies for Prevention of Respiratory Syncytial Virus Disease: ARMADA (Advancing RSV Management And Disease Awareness) Taskforce
The ARMADA Taskforce – an international, multidisciplinary expert panel – undertook a systematic review to develop LAmAbs consensus recommendations for RSV disease prevention in children. The Taskforce recommends LAmAbs for all infants aged <8 months in the absence of maternal RSV vaccination, preterm infants (<37 weeks’ gestational age) aged <12 months, and children <24 months with high-risk conditions. Seasonal LAmAb administration is recommended, although in RSV endemic countries decisions should be made locally concerning administration year-round or with peak RSV incidences.

COVID: Early Viral Phase

Drug Treatments for Mild or Moderate Covid-19: Systematic Review and Network Meta-analysis
Authors state, “The current evidence supports two stages of COVID-19 disease, an early phase marked by viral replication (non-severe disease) and a later inflammatory phase (severe disease). The different pathogenesis and resulting severity of symptoms at each of these stages suggest different interventions are most effective at certain stages of the disease. Consequently, our systematic review and network meta-analysis now addresses patients with mild or moderate COVID-19 (also known as non-severe COVID-19) separate from those with severe COVID-19. In this publication, we compare the effects of drug treatments for mild or moderate COVID-19. A separate publication will compare the effects of drug treatments for severe or critical COVID-19, and together these two publications replace our previous living systematic review of COVID-19 of all severities.” They ultimately looked at 259 trials enrolling 166,230 patients, 187 (72%) for this analysis. Compared with standard care, two drugs probably reduce hospital admission: nirmatrelvir-ritonavir (25 fewer per 1,000 (95% confidence interval 28 fewer to 20 fewer), moderate certainty) and remdesivir (21 fewer per 1,000 (28 fewer to 7 fewer), moderate certainty). Molnupiravir and systemic corticosteroids may reduce hospital admission (low certainty). Drugs for prophylaxis and antibody based treatments are addressed separately.

Extended Nirmatrelvir–ritonavir Treatment Durations for Immunocompromised Patients with COVID-19 (EPIC-IC): A Placebo-controlled, Randomised, Double-blind, Phase 2 Trial
This placebo-controlled, randomised, double-blind, phase 2 trial enrolled non-hospitalised, immunocompromised individuals aged 12 years or older with symptomatic COVID-19 from 73 sites across nine countries. Participants were randomly assigned (1:1:1) to receive 300 mg nirmatrelvir and 100 mg ritonavir orally twice per day for 5, 10, or 15 days. The primary endpoint was proportion of randomly assigned and dosed participants with sustained nasopharyngeal SARS-CoV-2 RNA concentrations below the lower limit of quantification (2·0 log10 copies per mL) from days 15 to 44. Secondary endpoints included the incidence of viral rebound after the end of treatment up to day 44. Safety, a secondary endpoint, was assessed in all randomly assigned participants who received at least one dose of nirmatrelvir–ritonavir. No difference was observed between the three treatment durations in the primary endpoint. Extending nirmatrelvir–ritonavir treatment beyond 5 days resulted in a nominal improvement in the frequency of viral rebound and was generally well tolerated.