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A person in Texas became ill with bird flu after contact with infected dairy cattle, state officials reported Monday.
Its the first human case of the highly pathogenic strain of avian influenza in Texas, and its the second recorded in the U.S., according to the health alert state officials issued.
The risk to the general public is believed to be low; however, people with close contact with affected animals suspected of having avian influenza A(H5N1) have a higher risk of infection, the alert said.
The patients primary symptom was conjunctivitis, or eye redness, according to the alert.
State officials recommend that clinicians should consider the possibility of infection in people who have symptoms and a potential risk for exposure, including those who have had close contact with someone infected, contact with affected animals, or contact with unpasteurized milk from dairy farms with infections.
Symptoms can include a fever, cough, sore throat, runny or stuffy nose, headaches, fatigue, eye redness, shortness of breath, diarrhea, nausea, vomiting, or seizures. The illness can range from mild to severe, and health care providers who come across someone who may have the virus should immediately consult their local health department, according to the alert.
Because eye redness has been observed in these infections before, health care providers like optometrists and ophthalmologists should be aware of the potential of individuals presenting with conjunctivitis who have had exposure to affected animals, according to the alert.
The strain, novel avian influenza A(H5N1), started infecting dairy cattle in the Panhandle last week, in another blow to the Texas cattle industry after thousands were lost in historic Texas wildfires. Similar outbreaks were reported at dairies in Kansas and New Mexico.
Lauren Ancel Meyers, professor and director of the Center for Pandemic Decision Science at the University of Texas at Austin, said there is a lot of uncertainty at this point.
"On the positive side, it seems like this was a very mild case and it's the only case that's been identified so far," Meyers said. "But at the same time, it seems like there's quite a bit of this virus that has been detected in cattle populations. Anytime a virus jumps into a new species, especially a rapidly evolving virus like influenza we need to be approaching it with the utmost caution and vigilance to make sure we really understand the situation."
The U.S. Department of Agriculture said there is no safety concern to the commercial milk supply. Consumer health is also not at risk, the department said. The milk from impacted animals is being dumped or destroyed and will not enter the food supply.
Neelam Bohra is a 2023-24 New York Times disability reporting fellow, based at The Texas Tribune through a partnership with The New York Times and the National Center on Disability and Journalism, which is based at the Walter Cronkite School of Journalism and Mass Communication at Arizona State University.
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The largest producer of fresh eggs in the U.S. said Tuesday it had temporarily halted production at a Texas plant afterbird fluwas found in chickens, and officials said the virus had also been detected at a poultry facility in Michigan.
Ridgeland, Mississippi-based Cal-Maine Foods, Inc. said in a statement that approximately 1.6 million laying hens and 337,000 pullets, about 3.6% of its total flock, were destroyed after the infection, avian influenza, was found at a facility in Parmer County, Texas.
The plant is on the Texas-New Mexico border in the Texas Panhandle about 85 miles (137 kilometers) southwest of Amarillo and about 370 miles (595 kilometers) northwest of Dallas. Cal-Maine said it sells most of its eggs in the Southwestern, Southeastern, Midwestern and mid-Atlantic regions of the United States.
The Company continues to work closely with federal, state and local government officials and focused industry groups to mitigate the risk of future outbreaks and effectively manage the response, the statement said.
Cal-Maine Foods is working to secure production from other facilities to minimize disruption to its customers, the statement said.
The company said there is no known bird flu risk associated with eggs that are currently in the market and no eggs have been recalled.
Eggs that are properly handled and cooked are safe to eat,according to the U.S. Department of Agriculture.
The announcement by Cal-Maine comes a day afterstate health officials saida person had been diagnosed with bird flu after being in contact with cows presumed to be infected, and that the risk to the public remains low. The human case in Texas marks the first known instance globally of a person catching this version of bird flu from a mammal, federal health officials said.
In Michigan, Michigan State Universitys Veterinary Diagnostic Laboratory has detected bird flu in a commercial poultry facility in Ionia County, according to the Michigans Department of Agriculture and Rural Development.
The county is about 100 miles (161 kilometers) northwest of Detroit.
The department said it received confirmation of the disease Monday from the lab and that it is the fourth time since 2022 that the disease was detected at a commercial facility in Michigan.
Department spokesperson Jennifer Holton said Tuesday that state law prohibits the department from disclosing the type of poultry at the facility. The facility has been placed under quarantine and the department does not anticipate any disruptions to supply chains across the state, Holton said.
Dairy cows in Texas and Kansaswere reportedto be infected with bird flu last week and federal agriculture officials later confirmed infections in a Michigan dairy herd that had recently received cows from Texas. A dairy herd in Idaho has been added to the list after federal agriculture officials confirmed the detection of bird flu in them, according to a Tuesday press release from the USDA.
The Associated Press
The Associated Press
A person in Texas has been diagnosed with bird flu after close contact with dairy cows presumed to be infected, health officials said Apr. 1.
The persons only symptom is eye inflammation, and they are being treated with the antiviral drug Tamiflu (oseltamivir), Texas health officials said. The risk to the public remains low, they added.
This is the second person in the United States to test positive for H5N1 bird flu, and the first case linked to exposure to cattle, federal health officials said.
A previous human case of bird flu occurred in Colorado in 2022, in a person who had contact with infected poultry.
There is no evidence of person-to-person spread of the virus, Dr. Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention, told AP News.
Genetic tests carried out by the CDC on samples from the patient in Texas and infected cattle show that the virus lacks changes that would make it better able to infect mammals. There is also no sign that the virus has developed resistance to antiviral treatments, the CDC said.
The tests also suggest that the infection in the patient involves the eyes, but perhaps not the upper respiratory tract.
In late March, dairy cows in Kansas and Texas tested positive for bird flu. Since then, the outbreak has spread to additional herds in New Mexico and Ohio.
Federal agriculture officials emphasized that the food supply remains safe. Milk from sick cows is diverted or destroyed, and pasteurization kills any viruses or bacteria in milk.
Bird flu is a disease caused by an influenza virus that mainly infects birds.
These types of viruses, known as avian influenza A viruses, spread naturally among wild aquatic birds such as ducks and geese. From there, they can pass to chickens and other domesticated poultry.
There are two groups of these viruses: low pathogenic avian influenza (LPAI) and highly pathogenic avian influenza (HPAI).
The second group causes severe disease and high death rates in infected birds. This group includes the highly pathogenic avian influenza A (H5N1) virus aka H5N1 bird flu detected in cattle and the patient in Texas.
Certain bird flu viruses can spread to and infect mammals, including seals, bears, foxes, skunks, domestic cats and dogs, and humans.
People who are at risk are those who have direct and prolonged exposure with infected, ill or dead animals, or areas contaminated by infected birds or animals, said Dean Blumberg, MD, chief of pediatric infectious diseases at UC Davis Childrens Hospital.
It is rare for bird flu viruses to spread from an infected person to another person, but it has happened. In these cases, the virus has spread to only a few people, and often within a persons household, where there is prolonged, close contact.
Human-to-human transmission is extraordinarily rare, Blumberg told Healthline, and in fact there is no risk of sustained human-to-human transmission, so this [virus] poses no threat to the general public.
The federal government maintains a stockpile of vaccines, including ones that target H5N1 and H7N9 bird flu viruses. These could be mobilized if there are signs of human-to-human spread of the virus.
However, Blumberg said the chance of that happening right now is low.
It would be concerning if avian influenza evolved to be more easily transmitted among people, since [we have] little to no immunity to this virus, he said. However this has not happened since bird flu was first described almost 150 years ago.
Symptoms of bird flu in people range from mild to severe, and may include:
As of December 2023, 902 people have been infected with avian influenza H5N1 virus worldwide in 23 countries, reports the CDC. More than 50% of people died as a result of their infection.
However, the severity of the cases varied depending upon the genetic characteristics of the virus involved, ranging from causing no symptoms to leading to severe illness and death.
With only one human case in the recent outbreak associated with dairy cattle, it is too soon to know if all cases will be mild like the first one. Health officials are closely watching the situation.
To protect yourself and your pets from bird flu, the CDC recommends:
If you find a dead bird, check with your state health department, state veterinary diagnostic laboratory, or state wildlife agency to find out how to report it.
In addition, for those who work in the [animal] industry and do have contact with potentially infectious animals and environments, full personal protective equipment) should be used including goggles, N95 or equivalent, gown, gloves, hair and boot covers, said Blumberg.
The CDC also recommends that you get a seasonal flu vaccine. This wont protect you from bird flu, but will reduce your risk of getting seasonal flu and bird flu at the same time.
Health officials reported that a person in Texas has been diagnosed with bird flu after close contact with dairy cows presumed to be infected with the H5N1 bird flu virus.
The persons only symptom is eye inflammation. Tests by the CDC suggest that the infection in the patient may only involve the eyes, not the upper respiratory tract.
While bird flu virus is known to spread from wild and domesticated birds to mammals, including people, this is the first case in a person that involves exposure to infected cattle.
William Brangham:
That's right, Geoff.
This strain of bird flu, called H5N1, has been sickening bird flocks across America for a few years now. Millions have been killed to prevent further spread. Yesterday, the country's biggest egg producer halted productions when chickens at one of its facilities got sick.
But this virus has also been infecting mammals, most recently dairy cows, in five different states. This week, a person in Texas tested positive after working with cattle. He's had mild symptoms and is expected to recover.
For more on this virus, we are joined again by Jennifer Nuzzo. She runs the Pandemic Center at Brown University School of Public Health.
Jennifer Nuzzo, so good to have you back on the program.
Dr. Mandy Cohen, the head of the CDC, says the risk to humans from this virus is low, they're monitoring it, and there's no reason to worry at this point. Is that where you come down?
Dr. Jennifer Nuzzo, Brown University School of Public Health: So I think it's true that the risk to the general public is quite low, and I think it's also important that we continue to monitor this virus to make sure that doesn't change.
The one thing I do quite worry about is the risk to farmworkers, people who would be exposed to the sick animals, because we do know that exposure to sick animals can result in human infection. And we have already seen that now to date in two cases in the United States, the most recent one being in a worker that worked with sick cows.
So I do worry about protecting farmworkers. But for the general public, the risk of contracting this virus is currently low.
The risk to the general public remains low, but experts are concerned about the possibility of the H5N1 virus evolving and more easily spreading from birds to other mammals. Heres what to know about bird flu, its symptoms and treatment, and its risk to humans and pets.
The Centers for Disease Control and Prevention (CDC) issued a health alert Friday to inform health care centers and the public of a confirmed human infection of the bird flu.
A worker on a commercial dairy farm in Texas developed conjunctivitis, commonly known as pink eye, on March 27 and then tested positive for the “highly pathogenic avian influenza” (HPAI), the CDC said.
HPAI viruses have been reported in the Texas area’s dairy cattle and wild birds, but before this incident, there have been no previous reports on the spreading of HPAI from cows to humans.
The patient did not report any other symptoms and was not hospitalized. The person received antiviral treatment and is recovering, and the patient’s household members have not become sick, the CDC said.
“No additional cases of human infection with the HPAI A(H5N1) virus associated with the current infections in dairy cattle and birds in the United States, and no human-to-human transmission of HPAI A(H5N1) virus have been identified,” the CDC said.
The CDC said it tested the patient’s virus genome and sequences from cattle, wild birds and poultry. It found minor changes, and they both “lack changes that would make them better adapted to infect mammals.”
The Department of Agriculture has confirmed infections of dairy cattle herds in four states — Texas, Kansas, Michigan and New Mexico — with results in a fifth, Idaho, “presumed” to be positive. The CDC said the spread has likely been due to the movement of cattle across state lines.
States like Nebraska have issued temporary restrictions on cattle imports because of the bird flu.
The patient in Texas is the second person in the U.S. to test positive for the disease. The first person to test positive was a patient in Colorado in April 2022 who had contact with infected poultry.
The CDC said the risk remains low, but recommended people with jobs or recreational activities that could expose them to infected birds, cattle or other animals are at higher risk and should take precautions.
The virus historically has shown to be deadly, killing more than 50 percent of its human victims from 2003 to 2016. The current outbreak has spread to affect 82 million birds in 48 states, the worst outbreak of bird flu in U.S. history.
The recent bird flu infection in a dairy worker in Texas has public health officials on high alert, though experts say the virus hasn't become more contagious, either among cows or people.
Samples taken from the patient whose only symptom was pinkeye showed that the virus has not changed in ways that would make it easy for it to spread from human to human, and that currently available vaccines and medicines remain effective against it, according to the Centers for Disease Control and Prevention.
Our assessment of the risk of avian flu to the general public right now remains low, Dr. Nirav Shah, principal deputy director of the CDC, said in an interview Wednesday. However, make no mistake, we are taking this very seriously.
Upon learning from the U.S. Department of Agriculture last week that cows in a handful of dairy farms had tested positive for bird flu, the CDC contacted state health departments, asking them to work with farms to identify any person who may be showing symptoms.
The case that we found in Texas, we found it because we went to look for it. We knew to look for it, Shah said.
This current form of bird flu, a strain called H5N1, has been circulating in birds around the world since late 2021. It has infected and killed countless wild birds as well as led to the culling of tens of millions of birds on poultry farms across the United States.
The first human case in the U.S. was in 2022, in a prison inmate in Colorado who was working on a poultry farm. The case in Texas is the countrys second.
In a press briefing Wednesday, Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said the agency is in close contact with the CDC.
Any case of H5N1 is concerning because it is highly dangerous to humans, although it has never been shown to be easily transmissible between people, Tedros said.
While the two U.S. cases have both been mild, H5N1 infections outside the country have had a high mortality rate. Four cases in Cambodia were reported in February; one patient died. In 2023, there were six cases in Cambodia, four of which were fatal.
Bird flu is a respiratory virus. In severe cases in humans, it can cause pneumonia, according to the CDC. Symptoms can include fever, cough, sore throat, runny nose, body aches, headaches, fatigue and shortness of breath or difficulty breathing.
Cases can also be mild: In the 2022 case in Colorado, the man experienced a few days of fatigue.
The only symptom that the Texas patient developed was conjunctivitis, or pinkeye, and the person is recovering, according to the CDC. The agency is not aware that any of the persons close contacts have developed flu-like symptoms, Shah said.
Still, what makes this particular case different is the link to cows; the fear is that the virus will mutate in a way that allows it to spread more easily among mammals and possibly humans.
I dont think that this news means that a flu pandemic is imminent, said Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan.
I think that this means that we are getting yet another early warning signal that if H5N1 has enough opportunities to get into mammals, its going to do what viruses always do and its going to continue to adapt, to growing in them, because that is what viruses do.
Cows were likely exposed to the virus from some sort of interaction with a bird.
It could have been with bird feces. It could have been with a dead bird, Shah said.
Samples of the virus taken from the Texas patient as well as from a handful of infected cows have been sequenced.
Rasmussen said that the genetic sequencing of samples taken from cows showed that the virus was much more closely related to birds, suggesting it hadnt been transmitting in cows for very long and hadnt had the chance to mutate to spread more efficiently among them.
The virus sample taken from the patient had one additional mutation thats linked to spread in mammals. Shah said that the change has been seen in numerous other situations, going back 20 plus years and is not associated with sustained spread between people.
The mutation is only one of a constellation of these different mutations that have been associated with mammal to mammal transmission, Rasmussen said. So it really doesnt look like this is thoroughly adapted to mammal to mammal transmission, so thats good news.
On the other hand, she said, its still really early days. Weve only just appreciated that the extent of infection in cattle might be really, really underestimated. So theres a lot more research, I think, that we need to do to try to figure out how common this is in cattle and other people might potentially be at risk.
One of the big questions that will be key to preventing further spread, whether among cows or from cows to people, is understanding how cows themselves transmit the virus.
In birds, Rasmussen said, the virus grows in the gastrointestinal tract. Other birds get sick if they come into contact with infected saliva, mucous or feces.
Humans can get sick if they touch something with the virus on it and then touch their mouth, eyes or nose, the CDC says. They can also breathe it in if theyre in an area with a lot of virus particles in dust or droplets. According to Rasmussen, the virus can bind to receptors deep in humans lungs, but not higher up in the respiratory tract, like the nose or mouth, which makes it hard to spread from human to human.
It can also bind to receptors in the eyes. That the Texas patients symptom was pinkeye suggests that they didnt get it by inhalation, they got it from direct contact with cattle and then maybe from rubbing their eyes or something like that, she added.
Its unclear how cows are infected and shed the virus, though. Its really, really hard to try to assess what the risks are to people around cows, if we dont know where most of that virus is coming from on the cows, Rasmussen said.
Pasteurized milk is safe to drink, according to the Food and Drug Administration, because the process kills the virus.
Whats more, any milk from an affected cow is thrown out before it can enter the milk supply, another step in keeping it safe, Shah said.
Sara G. Miller is the health editor for NBC News, Health & Medical Unit.
Marina Kopf
Marina Kopf is an associate producer with the NBC News Health and Medical Unit.
Cases of eggs from Cal-Maine Foods, Inc., await to be handed out by the Mississippi Department of Agriculture and Commerce employees at the Mississippi State Fairgrounds in Jackson, Miss., on Aug. 7, 2020. Rogelio V. Solis/AP hide caption
Cases of eggs from Cal-Maine Foods, Inc., await to be handed out by the Mississippi Department of Agriculture and Commerce employees at the Mississippi State Fairgrounds in Jackson, Miss., on Aug. 7, 2020.
Cal-Maine Foods, Inc., the largest producer of fresh eggs in the U.S., has temporarily halted production at one of its facilities in Texas after detecting bird flu there, the company announced Tuesday.
The company says it "depopulated" about 1.6 million laying hens and 337,000 pullets, or about 3.6% of its flock, as a result of the outbreak.
Bird flu also known as highly pathogenic avian influenza, or HPAI is a highly contagious virus typically spread by wild birds that is extremely deadly to avian populations. Human infections are rare.
Commercial farms sometimes euthanize part of their flock during bird flu outbreaks to limit the spread of the disease, according to the Environmental Protection Agency.
Mississippi-based Cal-Maine Foods said it was "working to secure production from other facilities to minimize disruption to its customers."
But it's possible that the depopulation at the Texas location could lead to higher egg prices at the grocery store, says Amy Hagerman, an associate professor of agricultural economics at Oklahoma State University.
"Any time you have an outbreak of highly pathogenic avian influenza in a large poultry producer like this, it has the potential to impact the market, because you're taking a large number of egg-laying birds out of production all at once," Hagerman says.
The illnesses at Cal-Maine Foods come amid an outbreak of bird flu among livestock at multiple dairy farms across the U.S.
The USDA's Animal and Plant Health Inspection Service confirmed Tuesday that it had detected bird flu in dairy herds in Texas, Kansas, Michigan, New Mexico and Idaho.
Also, the Texas Department of State Health Services announced earlier this week that a person contracted bird flu through an outbreak of the disease among dairy cattle. It was only the second time in the U.S. a person was confirmed to have HPAI A, also known as H5N1.
Though the cattle appear to be experiencing only mild illnesses, bird flu is very deadly to avian populations, and poultry producers may depopulate large groups to prevent the disease from spreading.
Hagerman says the poultry industry tries to move quickly when an outbreak occurs, attempting to eradicate the virus from barns before bringing in new, healthy birds.
"But at least temporarily, you see that sharp decline in the total eggs laid and as a result you see a price increase usually at the grocery store," she says.
How much of an increase would depend on how many flocks contract bird flu at the same time and how many birds are taken out of production, Hagerman adds.
She also says the outbreak could lead to fewer cartons for sale and render some food items that contain eggs temporarily unavailable, but emphasized that she believed, "We're not going back to no-eggs-on-the-shelf levels of restricted supply."
The CDC says the likelihood of someone getting bird flu by eating contaminated eggs is very low, and that a person cannot contract it from eggs that are cooked and stored properly.
Officials say the rapid onset of symptoms in sick birds, combined with federal surveillance programs and other testing of poultry, make it unlikely that eggs from an infected bird enter the human food supply.
Bird flu outbreaks among dairy cows in multiple states, and at least one infection in farmworker in Texas, have incited fears that the virus may be the next infectious threat to people.
The influenza virus, called H5N1, is highly pathogenic, meaning it has the ability to cause severe disease and death. But while its spread among cows was unexpected, people can catch the virus only from close contact with infected animals, not from one another, federal officials said.
Its really about folks who are in environments where they may be interacting with cattle that are infected with this virus, said Dr. Demetre Daskalakis, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention.
The risk for most everyone else is very low, he added. Right now, our risk assessment hasnt changed, but if it does change, were going be pretty quick and pretty transparent about that.
Avian influenza is often fatal in birds, but none of the infected cows have died so far. The only symptom in the patient in Texas was conjunctivitis, or pink eye, which was also reported in people infected during other bird flu outbreaks.
The C.D.C. and other agencies in the United States and elsewhere have tracked H5N1 for years to monitor its evolution. Federal agencies have stockpiled vaccines and drugs to be used in a possible bird flu outbreak.
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A poultry facility in Michigan and egg producer in Texas both reported outbreaks of avian flu this week. The latest developments on the virus also include infected dairy cows and the first known instance of a human catching bird flu from a mammal.
Although health officials say the risk to the public remains low, there is rising concern, emerging in part from news that the largest producer of fresh eggs in the U.S. reported an outbreak.
Here are some key things to know about the disease.
Dr. Mandy Cohen, the director of the Centers for Disease Control and Prevention, told The Associated Press on Wednesday that the agency is taking bird flu seriously, but stressed that the virus has already been well studied.
The fact that it is in cattle now definitely raises our concern level, Cohen said, noting that it means farmworkers who work with cattle and not just those working with birds may need to take precautions.
The good news is that its not a new strain of the virus, Cohen added. This is known to us and weve been studying it, and frankly, weve been preparing for avian flu for 20 years.
Some flu viruses mainly affect people, but others chiefly occur in animals. Avian viruses spread naturally in wild aquatic birds like ducks and geese, and then to chickens and other domesticated poultry.
The bird flu virus drawing attention today Type A H5N1 was first identified in 1959. Like other viruses, it has evolved over time, spawning newer versions of itself.
Since 2020, the virus has been spreading among more animal species including dogs, cats, skunks, bears and even seals and porpoises in scores of countries.
In the U.S., this version of the bird flu has been detected in wild birds in every state, as well as commercial poultry operations and backyard flocks. Nationwide, tens of millions of chickens have died from the virus or been killed to stop outbreaks from spreading.
Last week, U.S. officials said it had been found in livestock. As of Tuesday, it had been discovered in dairy herds in five states Idaho, Kansas, Michigan, New Mexico and Texas according to the U.S. Department of Agriculture.
This bird flu was first identified as a threat to people during a 1997 outbreak in Hong Kong. In the past two decades, nearly 900 people have been diagnosed globally with bird flu and more than 460 people have died, according to the World Health Organization.
There have been only two cases in the U.S., and neither were fatal.
In 2022, a prison inmate in a work program caught it while killing infected birds at a poultry farm in Montrose County, Colorado. His only symptom was fatigue, and he recovered.
This week, Texas health officials announced that a person who had been in contact with cows had been diagnosed with bird flu. Their only reported symptom was eye redness.
Symptoms are similar to that of other flus, including cough, body aches and fever. Some people dont have noticeable symptoms, but others develop severe, life-threatening pneumonia.
The vast majority of infected people have gotten it directly from birds, but scientists are on guard for any sign of spread among people.
There have been a few instances when that apparently happened most recently in 2007 in Asia. In each cluster, it spread within families from a sick person in the home.
U.S. health officials have stressed that the current public health risk is low and that there is no sign that bird flu is spreading person to person.
While its too early to quantify the potential economic impact of a bird flu outbreak, many of these latest developments are concerning, particularly the transmission of the virus from one species to another, said Daren Detwiler, a food safety and policy expert at Northeastern University.
We dont have a magic forcefield, an invisible shield that protects land and water runoff from impacting other species, Detwiler said. There is a concern in terms of how this might impact other markets, the egg market, the beef market.
If the outbreak is not quickly contained, consumers could ultimately see higher prices, and if it continues to spread, some industries could experience reputational strain, possibly affecting the export industry, Detwiler added.
The egg industry already is experiencing some tightening of supply following detections of bird flu late in 2023 and in early January, coupled with the busy Easter season, where Americans typically consume an average of 3 billion eggs, said Marc Dresner, a spokesperson for the American Egg Board.
Still, even with the outbreak in Texas and the nearly 2 million birds that were killed there, Dresner said there are an estimated 310 million egg laying hens in the U.S. and wholesale egg prices are down about 25% from a February peak.
Associated Press reporters Jonathan Poet in Philadelphia and Mike Stobbe and videojournalist Sharon Johnson in Atlanta contributed to this report.
