{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T13:35:29Z","timestamp":1785418529557,"version":"3.56.0"},"reference-count":18,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["ASM Case Rep"],"published-print":{"date-parts":[[2026,1,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>Current U.S. surveillance for highly pathogenic avian influenza A(H5N1) in humans prioritizes individuals with known animal exposures, potentially missing community-acquired infections. To address this gap, we implemented universal H5 subtyping of all influenza A-positive respiratory samples collected within our hospital system, regardless of patient exposure history. Between August 2024 and April 2025, we subtyped 4,488 influenza A-positive samples and identified two cases positive for H5 RNA in Alameda County, California, USA. The first case was a 14-month-old girl with mild respiratory symptoms and no H5N1 exposure risks; sequencing of the sample revealed an H5 gene closely related to clade 2.3.4.4b, genotype B3.13 viruses circulating in U.S. dairies. The second case was a 79-year-old male, also with no known exposures, whose sample reproducibly tested positive with a high cycle threshold value but could not be confirmed by public health laboratories. Both patients had evidence of co-infection with other common respiratory viruses. These findings, while requiring cautious interpretation due to low virus levels and the presence of potential confounding factors, highlight limitations in exposure-based testing and demonstrate the potential for cryptic H5N1 circulation. This report underscores that broader, geographically targeted surveillance may be a critical tool for early detection of potential community transmission of pandemic-capable pathogens.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/asmcr.00165-25","type":"journal-article","created":{"date-parts":[[2025,12,10]],"date-time":"2025-12-10T13:30:26Z","timestamp":1765373426000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["One confirmed and one potential human case of influenza A(H5N1) detected through an expanded subtyping protocol"],"prefix":"10.1128","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8288-576X","authenticated-orcid":true,"given":"Grant P.","family":"Higerd-Rusli","sequence":"first","affiliation":[{"name":"Department of Pathology, Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abraar","family":"Karan","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7881-3605","authenticated-orcid":true,"given":"Seth A.","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingrid E. A.","family":"Morante","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/019wqcg20","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Virology Laboratory, Stanford Health Care","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"ChunHong","family":"Huang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malaya K.","family":"Sahoo","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/019wqcg20","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Virology Laboratory, Stanford Health Care","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew M.","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford University School of Medicine","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8751-4810","authenticated-orcid":true,"given":"Benjamin A.","family":"Pinsky","sequence":"additional","affiliation":[{"name":"Department of Pathology, Stanford University School of Medicine","place":["Stanford, USA"]},{"name":"Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine","place":["Stanford, USA"]},{"id":[{"id":"https:\/\/ror.org\/019wqcg20","id-type":"ROR","asserted-by":"publisher"}],"name":"Clinical Virology Laboratory, Stanford Health Care","place":["Stanford, USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/jvi.02209-24"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41591-025-03599-6"},{"key":"e_1_3_4_4_2","unstructured":"CDC. 2024. CDC A(H5N1) bird flu response update June 14 2024. Avian Influenza Bird Flu. Available from: https:\/\/web.archive.org\/web\/20240615000929\/https:\/\/www.cdc.gov\/bird-flu\/spotlights\/h5n1-response-06142024.html"},{"key":"e_1_3_4_5_2","unstructured":"CDC. 2025. H5 Bird Flu: current situation. Avian Influenza Bird Flu. Available from: https:\/\/web.archive.org\/web\/20250818004001\/https:\/\/www.cdc.gov\/bird-flu\/situation-summary\/index.html. Retrieved 19 Apr 2025."},{"key":"e_1_3_4_6_2","unstructured":"CDC. 2025. CDC A(H5N1) bird flu response update March 19 2025. Avian Influenza Bird Flu. Available from: https:\/\/web.archive.org\/web\/20250320093403\/https:\/\/www.cdc.gov\/bird-flu\/spotlights\/h5n1-response-03192025.html"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7433a2"},{"key":"e_1_3_4_8_2","unstructured":"CDC. 2025. U.S. influenza surveillance: purpose and methods. FluView. Available from: https:\/\/web.archive.org\/web\/20250131061341\/https:\/\/www.cdc.gov\/fluview\/overview\/index.html"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2024.105723"},{"key":"e_1_3_4_10_2","unstructured":"CDC. 2025. Interim guidance on specimen collection and testing for patients with suspected infection with novel influenza a viruses associated with severe disease or with the potential to cause severe disease in humans. Avian Influenza Bird Flu. Available from: https:\/\/web.archive.org\/web\/20250212002013\/https:\/\/www.cdc.gov\/bird-flu\/php\/severe-potential\/index.html. Retrieved 11 Feb 2025."},{"key":"e_1_3_4_11_2","unstructured":"CDC. 2024. Highly pathogenic avian influenza A(H5N1) virus in animals: interim recommendations for prevention monitoring and public health investigations. Avian Influenza Bird Flu. Available from: https:\/\/web.archive.org\/web\/20241118104102\/https:\/\/www.cdc.gov\/bird-flu\/prevention\/hpai-interim-recommendations.html. Retrieved 2 Oct 2024."},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid3008.240785"},{"key":"e_1_3_4_13_2","unstructured":"World Health Organization. 2021. Information for molecular diagnosis of influenza virus. Available from: https:\/\/web.archive.org\/web\/20250427151540\/https:\/\/www.who.int\/teams\/global-influenza-programme\/laboratory-network\/quality-assurance\/eqa-project\/information-for-molecular-diagnosis-of-influenza-virus. Retrieved 27 Apr 2025."},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00859-21"},{"key":"e_1_3_4_15_2","unstructured":"CDC. 2025. Technical update: summary analysis of the genetic sequence of a highly pathogenic avian Influenza A(H5N1) virus identified in a child in California. Avian Influenza Bird Flu. Available from: https:\/\/web.archive.org\/web\/20250210104623\/https:\/\/www.cdc.gov\/bird-flu\/spotlights\/h5n1-response-12092024.html. Retrieved 11 Feb 2025."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7408a1"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00066-22"},{"key":"e_1_3_4_18_2","unstructured":"CDC. 2024. Novel Influenza A virus infections 2024 case definition. 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