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While no foodborne infection has been reported in humans, this strain has infected at least 70 people, and milk from infected cows is known to be infected by ingestion of multiple other species. Investigation into the public health threat of this outbreak is warranted. This farm\u2010to\u2010table quantitative microbial risk assessment (QMRA) uses stochastic models to assess the risk of human infection from consumption of raw and pasteurized fluid cow's milk from the United States supply chains. These models were parameterized with literature emerging from this outbreak and then employed to estimate the H5N1 infection risk and evaluate multiple potential interventions aimed at reducing this risk. The median (5th and 95th percentiles) probabilities of infection per 240\u2010mL serving of pasteurized, farmstore\u2010purchased raw, or retail\u2010purchased raw milk were 7.66E\u221219 (2.39E\u221220, 4.02E\u221217), 1.56E\u22127 (6.67E\u221210, 1.28E\u22125), and 1.40E\u22127 (6.65E\u221210, 1.13E\u221205), respectively. Our results confirm that pasteurization is highly effective at reducing H5N1 infection risk. Scenario analysis revealed quantitative real\u2010time reverse transcriptase\u2010polymerase chain reaction (qrRT\u2010PCR) testing of bulk tank milk to be an effective method for numerically reducing risk from raw milk. In addition, we identify knowledge gaps related to the human H5N1 dose\u2012response by ingestion and raw milk consumption patterns. These findings emphasize the importance of mechanistic epidemiologic models for informing public health responses amidst outbreaks with foodborne potential and highlight the need for additional research into raw milk consumption patterns to better understand this exposure pathway.<\/jats:p>","DOI":"10.1111\/risa.70264","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:02:19Z","timestamp":1782219739000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Quantitative Microbial Risk Assessment of Human H5N1 Infection From Consumption of Fluid Cow's Milk"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4910-2131","authenticated-orcid":false,"given":"Katherine J.","family":"Koebel","sequence":"first","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ece","family":"Bulut","sequence":"additional","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel D.","family":"Alcaine","sequence":"additional","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aljo\u0161a","family":"Trm\u010di\u0107","sequence":"additional","affiliation":[{"name":"Department of Food Science College of Agriculture &amp; Life Sciences, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammed","family":"Nooruzzaman","sequence":"additional","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina M.","family":"Covaleda","sequence":"additional","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego G.","family":"Diel","sequence":"additional","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Ivanek","sequence":"additional","affiliation":[{"name":"Department of Population Medicine &amp; Diagnostic Sciences College of Veterinary Medicine, Cornell University  Ithaca New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"e_1_2_9_2_1","unstructured":"ACMSF.2012.ACMSF Approaches to Microbiological Risk Assessment: Discussion Paper\u2014Risk Assessment Outputs.UK Food Standards Agency."},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2006.10.051"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid2805.220318"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.21037\/jphe\u201022\u20101"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijfoodmicro.2018.06.001"},{"key":"e_1_2_9_7_1","doi-asserted-by":"crossref","unstructured":"Browne L. J.Jackson L.Adams andA.Wilson.2025.Updated Risk Assessment: Risk to UK Consumers From Highly Pathogenic Avian Influenza (HPAI) H5N1 B3.13 in US Dairy and Beef Products.Food Standards Agency.https:\/\/doi.org\/10.46756\/001c.128394.","DOI":"10.46756\/001c.128394"},{"key":"e_1_2_9_8_1","doi-asserted-by":"crossref","unstructured":"Bullock T. A. C.Pappas T. M.Uyeki et\u00a0al.2025. \u201cThe (Digestive) Path Less Traveled: Influenza A Virus and the Gastrointestinal Tract.\u201dmBio.16 no.9:e01017\u201325.https:\/\/doi.org\/10.1128\/mbio.01017\u201025.","DOI":"10.1128\/mbio.01017-25"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.3201\/eid3007.240508"},{"key":"e_1_2_9_10_1","doi-asserted-by":"crossref","unstructured":"Buzby J. C. H. 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