Like bird flu ravaged by birds and dairy cattle across the United States, Georgia became the latest state to detect the virus in a commercial poultry flock, and on Friday it halted all poultry sales to mitigate further spread of the disease. Nationally, egg prices are rising – if you can find them at all in your local grocery store.

The ongoing outbreak in animals has also resulted in at least 67 human cases of bird flu, with all but one causing mild illness. Earlier this month, a person in Louisiana died after being hospitalized with severe bird flu in December. This is the country’s first recorded death attributed to H5N1.

The US previously licensed three H5N1 vaccines for humans, but they are not commercially available. The government has bought millions of doses for the national stockpile in case it is needed. But even as the outbreak spread, federal health officials under President Joe Biden were reluctant to deploy them. Experts say the decision comes down to risk, and currently the risk of H5N1 remains low. Rolling out a vaccine to farm workers and others at higher risk of infection would be a more targeted tactic, but even that measure may be premature. Now, with a change in federal health leadership looming as President Donald Trump begins his second term, the decision rests with the new administration.

“Right now, from the standpoint of severity and ease of transmission, it doesn’t seem like a necessity to get a vaccine out to protect people,” said William Schaffner, a physician and professor of preventive medicine at the Vanderbilt University in Tennessee.

So far, no person-to-person spread of H5N1 has been identified, but health officials are monitoring the virus for any genetic changes that would make transmission among people more likely. Most bird flu infections are related to exposure to animals. Of the 67 known human cases in the US, 40 have been linked to sick dairy cattle and 23 are associated with poultry farms and slaughter operations. In the other four cases, the exact source is not known.

In the US, human cases have been mild, with many of them causing only conjunctivitis. In some cases, people had mild respiratory symptoms. Aside from the Louisiana patient, all of the individuals who tested positive for H5N1 recovered quickly and never required hospitalization. Historically, however, H5N1 has been fatal in about 50 percent of cases. Since 2003, a total of 954 cases of human H5N1 have been reported to the World Health Organization, and about half of them have died. Egypt, Indonesia, Vietnam, Cambodia and China reported the highest number of deaths from human bird flu.

Those numbers come with some caveats. For one, many of those deaths occurred in places where people live very close to the sick poultry. “In those circumstances, the thinking is that they probably got a very large dose of the virus,” says Schaffner.

Moreover, the case fatality rate – the proportion of infected people who die from the disease – takes into account only known cases, and some cases of H5N1 undoubtedly go undetected in part because bird flu symptoms are similar to other respiratory viruses. In the US, language barriers among farm workers, a lack of testing and a reluctance among workers to report being sick are also factors. “We’re probably missing more cases than we’re detecting, and we’re much more likely to detect a case that’s severe,” said Shira Doron, chief infection control officer for Tufts Medicine in Boston and hospital epidemiologist at Tufts Medical Center.