{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T06:02:15Z","timestamp":1785391335297,"version":"3.55.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The Veterans Health Administration (VHA) mobilized and adapted its established national infrastructure to enhance influenza surveillance during 2024\u20132025 highly pathogenic avian influenza (HPAI) A(H5N1) panzootic. Additionally, VHA's Public Health Reference Laboratory (PHRL) expanded capacity for H5 subtyping and whole genome sequencing (WGS) to support detection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Routine influenza surveillance was enhanced with customized queries to identify cases in high-risk counties with reported H5N1 detected in animals. In coordination with VHA clinical laboratories, select samples were sent to PHRL. PHRL subtyped specimens received, which included hospitalized cases. Demographics of influenza A cases in VHA were compared with those residing in high-risk \u201csurveilled\u201d counties (with reported H5N1 detection in animals) and those whose specimens were sent to PHRL for H5 subtyping.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>From 4\/1\/2024-5\/31\/2025, we identified 40,406 positive influenza A VHA cases (12.5% with local subtyping performed), including 5,348 cases from \u201csurveilled\u201d counties. A total of 1,155 specimens were received by PHRL for H5 subtyping and 180 completed WGS. Cases from \u201csurveilled\u201d counties had fewer females, fewer in 50\u201369 age group and more of Hispanic ethnicity compared to other influenza A cases. No H5N1 was detected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We highlight the complexity and resources necessary for epidemiologic and laboratory surveillance of H5N1 within a large, national health system during a recognized panzootic. Additional resources for decentralized influenza A subtyping at local VA clinical laboratories are needed as centralized subtyping and WGS at PHRL was not comprehensive. Although H5 influenza has not yet been observed among Veterans within VHA, the ongoing risk warrants continued vigilance and monitoring.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1869020","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T05:38:32Z","timestamp":1785389912000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Activating laboratory surveillance response to the threat of H5N1 influenza in the Veterans Health Administration, 2024\u201325"],"prefix":"10.3389","volume":"14","author":[{"given":"Cynthia","family":"Lucero-Obusan","sequence":"first","affiliation":[{"name":"Office of Public Health, US Department of Veterans Affairs, Veterans Health Administration","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joyce S.","family":"Chung","sequence":"additional","affiliation":[{"name":"Office of Public Health, US Department of Veterans Affairs, Veterans Health Administration","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gina","family":"Oda","sequence":"additional","affiliation":[{"name":"Office of Public Health, US Department of Veterans Affairs, Veterans Health Administration","place":["Washington, DC, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Connor","family":"Edson","sequence":"additional","affiliation":[{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs, Veterans Health Administration, Palo Alto","place":["CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aarthi","family":"Chary","sequence":"additional","affiliation":[{"name":"Office of Public Health, US Department of Veterans Affairs, Veterans Health Administration","place":["Washington, DC, United States"]},{"name":"Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford","place":["CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Holodniy","sequence":"additional","affiliation":[{"name":"Office of Public Health, US Department of Veterans Affairs, Veterans Health Administration","place":["Washington, DC, United States"]},{"name":"National Public Health Reference Laboratory, US Department of Veterans Affairs, Veterans Health Administration, Palo Alto","place":["CA, United States"]},{"name":"Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford","place":["CA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e0294424","DOI":"10.1128\/mbio.02944-24","article-title":"mGem: Transmission and exposure risks of dairy cow H5N1 influenza virus","volume":"16","author":"Campbell","year":"2025","journal-title":"MBio."},{"key":"B2","doi-asserted-by":"publisher","first-page":"101100","DOI":"10.1016\/j.lana.2025.101100","article-title":"Enhancing the response to avian influenza in the US and globally","volume":"46","author":"Bartlett","year":"2025","journal-title":"Lancet Reg Health Am."},{"key":"B3","unstructured":"CDC A(H5N1) Bird Flu Response\n          \n          2025"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1425","DOI":"10.3201\/eid3007.240717","article-title":"Avian influenza A(H5N1) virus among dairy cattle, Texas, USA","volume":"30","author":"Oguzie","year":"2024","journal-title":"Emerg Infect Dis"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1335","DOI":"10.3201\/eid3007.240508","article-title":"Highly pathogenic Avian influenza A(H5N1) clade 2","volume":"30","author":"Burrough","year":"2024","journal-title":"Emerg Infect Dis."},{"key":"B6","doi-asserted-by":"publisher","first-page":"2028","DOI":"10.1056\/NEJMc2405371","article-title":"Highly pathogenic Avian influenza A(H5N1) virus infection in a dairy farm worker","volume":"390","author":"Uyeki","year":"2024","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"501","DOI":"10.15585\/mmwr.mm7321e1","article-title":"Outbreak of highly pathogenic Avian Influenza A(H5N1) viruses in U","volume":"73","author":"Garg","year":"2024","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"B8","doi-asserted-by":"publisher","first-page":"127","DOI":"10.15585\/mmwr.mm7408a1","article-title":"Human cases of highly pathogenic Avian Influenza A(H5N1) - 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