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Health officials are scrambling to contain a major epidemic of bird flu in the Midwest that has decimated chicken and turkey flocks and caused egg prices nationwide to more than double.

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Almost 45 million chickens and turkeys have died from the disease as of Monday, most in Iowa and Minnesota, according to data from the U.S. Department of Agriculture. The current strain—HPAI H5—was first detected in December, and moved from the West Coast to the Midwest.

Once farmers detect the flu in their birds, they face the gruesome task of killing and disposing with the bodies of their entire flock. The Centers for Disease Control says the risk of this strain of bird flu transferring to humans is “low at this time.” But in Midwest communities with economies dominated by the poultry industry, there’s been a human cost.

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Kandiyohi County, Minnesota, is home to the largest number of turkey operations in the top turkey-producing state, and it’s become ground zero for Minnesota turkey deaths. Cal Ahrenholz, an accountant at Prinsburg Farmers Co-op in Kandiyohi, told Fusion that more than 90 percent of local farms have lost all their birds to the flu.

“We’ve never seen anything like this,” Ahrenholz, who’s been in the turkey farming business for 28 years, said. “It’s a sickening feeling…some birds, they look perfectly healthy and then they just start dying.”

Around the middle of April, Prinsburg farmers noticed a rise in deaths and became suspicious. By the time blood tests from a state laboratory came back positive for bird flu, Ahrenholz said, 80 to 90 percent of the farm’s birds had already died from the disease. Prinsburg lost its entire flock of 150,000 turkeys last month.

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The rest of the flock was crowded into a barn that was pumped full of suffocating foam, one of the methods of "poultry depopulation" recommended by the American Veterinary Medical Association because it is "as painless and stress-free as possible." A euthanization company helped dispose of the bodies.

WARNING: This is a graphic video of the foam killing process. It's not pleasant to watch.

After they’re dead, bird bodies are generally buried on-site, incinerated, put into a landfill or even composted in the barn they died in, Kevin Baskins, a spokesperson for the Iowa Department of Natural Resources, told Fusion.

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After farms have been hit, they’re disinfected and put under quarantine by the feds, preventing any poultry or poultry products moving in or out. While farmers receive indemnity payments from the USDA for cleanup costs and some of their losses, the quarantines can last two to three months.

In Kandiyohi, there’ve been layoffs and reduced hours for farm workers, Ahrenholz said. The Prinsburg co-op hopes to get more turkeys by the end of this month, and has put in increased biosecurity measures, such as disinfecting car tires when vehicles go on and off the farm and changing clothing when going into barns.

Outside of Iowa and Minnesota, the epidemic is having an impact in egg prices around the country, which have more than doubled in the last month.

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The midwest wholesale egg price has risen from $1.19 a dozen on May 5 to $2.62 a dozen on Wednesday, according to numbers from Urner Barry, the market report firm that is the recognized leader in reporting egg prices. Prices for the rest of the country are close behind.

“This is unprecedented, and it’s the highest it’s ever been,” Randy Pesciotta, an analyst with the firm, told Fusion. “The price on the shelf will certainly go up… if it hasn’t already.”

Even state fairs, a big deal in the Midwest, have been affected. The Iowa and Minnesota boards of health have both banned live poultry exhibits at their respective state fairs, and Minnesota banned all live poultry exhibits in the state, including all petting zoos, for the rest of the year.

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Instead of live birds, the Minnesota state fair will "feature interactive displays and presentations about Minnesota's poultry industry and its huge contribution to the state's economy," according to the fair’s website. Not quite as pettable.

While Illinois farms have avoided bird flu cases so far, the Illinois Department of Agriculture sent letters last month to 103 county fairs around the state urging them to practice “strict biosecurity measures,” the Springfield State Journal-Register reported this week. That doesn’t mean they’ll be awarding blue ribbons in hazmat suits, but fair officials will be expected to check all animals for signs of illness, prepare quarantine areas for sick animals, and consider laboratory tests on any animals that die during a fair.

Here's a map of the number of bird deaths by state since December 2014, either from the flu or from euthanization after a positive test result came back, based on data from the USDA:

Casey Tolan is a National News Reporter for Fusion based in New York City.