The CDC study provides the largest window to date into how the bird virus first detected in March in dairy cows may be spreading to people. It suggests that the virus has infected more humans than the 46 farmworkers identified in the U.S. as of Thursday. Nearly all were in contact with infected dairy cows or infected poultry.

CDC officials said the study suggests asymptomatic workers who engage in jobs that put them at high risk for exposure at poultry and dairy farms might be at heightened risk. The CDC had recommended testing be limited to workers who had symptoms after exposure to infected animals.