What is it about?
The Veterans Health Administration (VHA) mobilized and adapted its established national infrastructure to enhance influenza surveillance during 2024–2025 highly pathogenic avian influenza (HPAI) A(H5N1) panzootic. VHA's Public Health Reference Laboratory (PHRL) expanded capacity for H5 subtyping and whole genome sequencing (WGS) to support detection. Although challenges in decentralizing testing remain, the framework of this approach could be implemented in future public health response efforts.
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Why is it important?
We highlight the complexity and resources necessary for epidemiologic and laboratory surveillance of H5N1 within a large, national health system during a recognized panzootic. While challenges in decentralizing testing remain, the framework of this approach could be implemented in future public health response efforts. Although H5 influenza has not yet been observed among Veterans within VHA, the ongoing risk warrants continued vigilance and monitoring.
Perspectives
Using enhanced passive surveillance and monitoring, molecular assays, and sequencing, we established a multipronged strategy to surveil for H5N1 influenza across the VHA network. Although H5N1 influenza was not detected in this cohort, this study highlights the complexity, resources necessary and lessons learned from scaling surveillance for novel influenza detection within a national healthcare system. This can be beneficial for other health systems or jurisdictions wishing to scale and perform similar surveillance. Moving forward, it will be important to strategically decentralize influenza A subtyping, by expanding H3/H1 subtyping capacity in VAMC clinical laboratories or developing other timely internal processes to automatically reflex positive influenza A results to a subtyping assay.
Dr. Cynthia Lucero-Obusan
U.S. Department of Veterans Affairs
Read the Original
This page is a summary of: Activating laboratory surveillance response to the threat of H5N1 influenza in the Veterans Health Administration, 2024–25, Frontiers in Public Health, July 2026, Frontiers,
DOI: 10.3389/fpubh.2026.1869020.
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