Since 2020, global outbreaks of avian influenza subtype H5N1 have been occurring, with cases reported from every continent as of May 2024. [1] [2] [3] [4] In late 2023, H5N1 was discovered in the Antarctic for the first time, raising fears of imminent spread throughout the region, potentially leading to a "catastrophic breeding failure" among animals that had not previously been exposed to avian influenza viruses. [5] The main virus involved in the global outbreak is classified as H5N1 clade 2.3.4.4b, however genetic diversification with other clades such as 2.3.2.1c has seen the virus evolve in ability to cause significant outbreaks in a broader range of species including mammals. [6] [7] [8]
Highly pathogenic H5N1 | |
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Countries that have reported deaths of poultry or wild birds linked to highly pathogenic H5N1 infection as of March 2023. | |
Countries that have reported human cases of highly pathogenic H5N1 infection. |
H5N6 and H5N8 viruses with the H5-2.3.4.4b hemagglutinin (HA) gene became prominent globally among poultry in 2018–2020. [7] In 2020, reassortment (genetic "swapping") between these H5-2.3.4.4b poultry viruses and N1 wild bird viruses led to the emergence of a H5N1 with a H5-2.3.4.4b gene. The virus then spread across Europe, detected there in autumn, before spreading to Africa and Asia. [1] It continues to swap genes with local flu viruses as it travels the globe. [9] : (fig.1)
In May 2021, H5N1 was detected in wild red foxes in the Netherlands. [10] It was later detected in December in Estonia in wild foxes. [1] [11]
In January 2022, an infection in an eighty-year-old man was reported, who raised ducks in England. [1] Also in January, infections were reported from the United States in wild birds. [1] In February, infections were reported from commercial poultry centres in the U.S., and Peru reported infections in sea lions. [1] [12] The virus continued to spread further, infecting additional species of mammals. In October, a mink farm in northwest Spain was affected. [1] In December, a HPAI H5N1 subtype of clade 2.3.4.4b was found in a captive Asian black bear and in wild and captive birds in a wildlife park in France. [13]
A human case of H5N1 was reported in the U.S. in April, "though this detection may have been the result of contamination of the nasal passages with the virus rather than actual infection." [1] [14] In September, Spain reported a human case; this was followed by a second case in November, in a person who worked at the same poultry farm as the first. Both were asymptomatic. [1] [15] In November, China reported a human case, infected due to contact with poultry. The case died from their infection. [1]
H5N1 was first detected in the islands of the Antarctic region in October 2023, via a brown skua on Bird Island, near South Georgia. Within several months, hundreds of elephant seals were found dead, as well as fur seals, kelp gulls and further brown skua. [16]
In December 2023, conservation officials confirmed that a polar bear had died of H5N1 near Alaska's northernmost city, Utqiagvik. [16]
In February 2023, Cambodia reported the death of a girl due to H5N1 infection after developing symptoms on 16 February. [17] [18] The girl's father also tested positive for the virus. The World Health Organization (WHO) described the situation as "worrying" and urged "heightened vigilance". [19] [20] [21] Further sequencing determined that at least one of the two cases was from an older H5N1 clade, 2.3.2.1c, which had circulated as a common H5N1 strain in Cambodia for many years, rather than the more recent clade 2.3.4.4b, which had caused mass poultry deaths since 2020. This older clade had jumped to humans in the past yet hadn't previously resulted in any known human-to-human transmission. [22]
On March 1, 2023, as Taiwan raised its travel alert for Cambodia, the WHO and the U.S. Center for Disease and Control and Prevention (CDC), in concert with Cambodian authorities, determined that both of the individuals had been infected through direct contact with poultry. [23] [24]
In late February 2023, Argentina confirmed a case of H5N1 in industrial poultry, in the Rio Negro province. Avian product exports were suspended as a result. [25]
In March 2023, H5N1 was detected in black-necked swan populations in Carlos Anwandter Nature Sanctuary, Chile and Uruguay. [26] [27] In Uruguay the death of ten swans found in the locality of Estación Tapia was attributed to flu. [27] Previously in Uruguay ten hens had died because of the flu in El Monarca, Montevideo. [27]
In late March 2023, Chile detected H5N1 in a 53 year-old man who had severe symptoms. [28] The patient survived but had to stay on a ventilator. The virus was determined to be in the 2.3.4.4b lineage.[ citation needed ]
In September 2023, Uruguay reported upwards of 400 seals and sea lions found dead of H5N1 on the nation's Atlantic coastline and along the River Plate. [29]
According to a 2024 paper, a large outbreak of H5N1 killed 70% of elephant seal pups born in the 2023 breeding season. In surveyed areas of Península Valdés, Argentina, seal mortality rates exceed 96%. [6] A February 2024 article reports that the outbreak in South America has, since 2022, killed at least 600,000 wild birds and 50,000 mammals. [6]
On April 1 a domestic dog in Oshawa, Canada was tested positive for H5N1. [30]
On May 22, Brazil declared an 180-day "animal health emergency" in response to eight cases of H5N1 found in wild birds. Although Brazil's major poultry-producing regions are in the country's south and the infections were found in Espirito Santo state and Rio de Janeiro state, Brazil, as the world's largest exporter of chicken meat, created an emergency operations center to plan for and mitigate potential further spread of H5N1. [31]
A cluster of five human infections of H5N1 occurred in Cambodia in late January and early February. All patients had recent contact with sick poultry. One patient died. Sequencing of two of the patients indicate that they were infected by clade 2.3.2.1c, which is not the same same as the 2.3.4.4b clade virus that is causing global outbreaks in the US and beyond. [32] A person in Vietnam died of H5N1 infection around the same time. [33] It remains unreported which clade of H5 virus the patient in Vietnam was infected by. However, an April 2024 statement from the FAO reports that recent (~2023) reassortment in the Greater Mekong Subregion has produced viruses that carry internal genes from the new 2.3.4.4b virus but the H5 gene from the old 2.3.2.1c lineage. The FAO also states that the new type of virus is implicate in human cases, but it does not specify which. [34]
On April 5, the Philippines reported a H5N1 outbreak on a poultry farm in Leyte, which killed 4,475 birds. Earlier in the year, the Philippines Department of Agriculture temporarily banned poultry exports from several countries including Japan, Belgium, and France. [35]
On April 18, a H5N1 outbreak was detected in ducks in two parts in Alappuzha district, Kerala. The disease was confirmed in a lab for ducks reared in the area. The District Collector has decided to initiate the process of culling domestic birds within a 1 kilometre radius from the epicentre of the outbreak. [36] As of May 9, district officials have culled 60,232 birds in Alappuzha. Farmers were compensated ₹100 per ducklings and chicks, ₹200 per older bird, and ₹5 per egg destroyed. [37]
On May 18, Chinese authorities confirm 275 cases of bird flu in dead Pallas's gulls and other wild birds in two counties in Qinghai province. [38]
The US CDC continues to report "widespread" occurrence in wild birds, "sporadic outbreaks" in poultry flocks, and "sporadic infections" as of March 2024. [39] As of March 8, 2024, the United States Department of Agriculture's (USDA) Animal and Plant Health Inspection Service (APHIS) had recorded around 20 mammal species confirmed as being able to be infected by H5N1. [40] Also in March 2024, H5N1 was confirmed to have infected farmed goats and cows in the USA. [41] [42]
On April 2, a dairy worker in Texas became infected and strong indications of cow-to-cow spread were evident as cow herds in five different states became ill. [43] A few days later on April 4, H5N1 was confirmed to have spread to several additional dairy herds in six US states including Texas, along with Idaho, Kansas, New Mexico, Ohio and Michigan. Scientists deemed these to be either cow-to-cow transmission or spillover from wild birds. [44] [45] [46] On April 11, H5N1 was found in dairy cattle herds in North Carolina and South Dakota. [47] [48]
On April 10, researchers found several cases of HPAI H5N1 in animals in New York City, including three Canada geese, a red-tailed hawk, a peregrine falcon, and a chicken. [49] [50] Scientists have also found cases of H5N1 of clade 2.3.4.4b in common bottlenose dolphins from Florida. [51]
On April 26, the FDA reported the virus had spread to cow herds in nine states, including Colorado, with one in five U.S commercial milk samples testing positive for traces of bird flu. [52] [53] H5N1 was found to be present at high levels in the mammary glands of affected cows, and cats that consumed unpasteurized milk from symptomatic cows displayed a high mortality rate from severe systemic influenza infection. [54] More than half the cats on one farm died after drinking raw milk from infected cows. [55]
On May 10, The Biden administration announced it will provide nearly $200 million to help contain the current outbreak. The US Department of Agriculture pledged $98 million at a split of $28,000 per dairy farm, while the Department of Health and Human Services (HHS) will provide $101 million split between the FDA and the US Centers for Disease Control and Prevention (CDC). [56]
On May 22 in Michigan, a farmworker was infected with the bird flu due to their regular exposure to infected dairy cows. The person had mild symptoms and recovered. [57] It was shown that H5N1 can persist on milking equipment, which provides a probable transmission route for cow-to-cow and cow-to-human spread. [58]
H5N1 was detected in dead birds on the Antarctic mainland for the first time in February 2024. [59] In February, scientists found H5N1 in 12 Antarctic skua seabirds carcasses on Beak Island. Additional cases have also been found at Hope Bay and on the Devil and Paulet islands. In March, scientists detected the virus in nine Adélie penguins and one Antarctic cormorant. [60]
In May 2024, H5N1 was detected for the first time in Australia after a human child who had returned to the country from India tested positive. The child was infected with the South Asian 2.3.2.1a clade of H5N1 and had severe symtoms but recovered. [61] [62]
H5-2.3.4.4b can be prevented by vaccination in chickens. The H5-Re14 (2.3.4.4b) strain used in updated vaccines since 2022 is a reasonably good match for the new virus. [9]
In May 2024, a study was published in Emerging Infectious Diseases reporting that subclade 2.3.4.4b H5N1 HPIAV strains that circulated in North America during 2022–2023 were poorly adapted to dogs. The authors suggest that effective risk communication with hunting dog owners could be an inexpensive and effective strategy to reduce the potential for spillover to dogs, and monitoring hunting dogs for IAV could be a useful addition to existing surveillance efforts. [63]
Influenza A virus (IAV) is a pathogen that causes the flu in birds and some mammals, including humans. It is an RNA virus whose subtypes have been isolated from wild birds. Occasionally, it is transmitted from wild to domestic birds, and this may cause severe disease, outbreaks, or human influenza pandemics.
Avian influenza, also known as avian flu or bird flu, is a disease caused by the influenza A virus (IAV) which primarily affects birds but can sometimes affect mammals including humans. Wild aquatic birds are the primary host of Influenza A virus (IAV), which is endemic in many bird populations.
Influenza A virus subtype H5N1 (A/H5N1) is a subtype of the influenza A virus, which causes influenza (flu), predominantly in birds. It is enzootic in many bird populations, and also panzootic. A/H5N1 virus can also infect mammals which have been exposed to infected birds; in these cases symptoms are frequently severe or fatal.
Singapore has taken a series of measures against avian influenza and the potential threat of a pandemic.
The global spread of H5N1 influenza in birds is considered a significant pandemic threat. While other H5N1 influenza strains are known, they are significantly different on a genetic level from a recent, highly pathogenic, emergent strain of H5N1, which was able to achieve hitherto unprecedented global spread in 2008. The H5N1 strain is a fast-mutating, highly pathogenic avian influenza virus (HPAI) found in multiple bird species. It is both epizootic and panzootic. Unless otherwise indicated, "H5N1" in this timeline refers to the recent highly pathogenic strain of H5N1.
Transmission and infection of H5N1 from infected avian sources to humans has been a concern since the first documented case of human infection in 1997, due to the global spread of H5N1 that constitutes a pandemic threat.
H5 N2 is a subtype of the species Influenzavirus A. The subtype infects a wide variety of birds, including chickens, ducks, turkeys, falcons, and ostriches. Affected birds usually do not appear ill, and the disease is often mild as avian influenza viral subtypes go. Some variants of the subtype are much more pathogenic than others, and outbreaks of "high-path" H5N2 result in the culling of thousands of birds in poultry farms from time to time. It appears that people who work with birds can be infected by the virus, but suffer hardly any noticeable health effects. Even people exposed to the highly pathogenic H5N2 variety that killed ostrich chicks in South Africa only seem to have developed conjunctivitis, or a perhaps a mild respiratory illness. There is no evidence of human-to-human spread of H5N2. On November 12, 2005 it was reported that a falcon was found to have H5N2.
H5N8 is a subtype of the influenza A virus and is highly lethal to wild birds and poultry. H5N8 is typically not associated with humans. However, seven people in Russia were found to be infected in 2021, becoming the first documented human cases.
H5N1 genetic structure is the molecular structure of the H5N1 virus's RNA.
Disease surveillance is an epidemiological practice by which the spread of disease is monitored in order to establish patterns of progression. The main role of disease surveillance is to predict, observe, and minimize the harm caused by outbreak, epidemic, and pandemic situations, as well as increase knowledge about which factors contribute to such circumstances. A key part of modern disease surveillance is the practice of disease case reporting.
The global spread of H5N1 in birds is considered a significant pandemic threat.
The global spread of H5N1 in birds is considered a significant pandemic threat.
The global spread of H5N1 in birds is considered a significant pandemic threat.
Fujian flu refers to flu caused by either a Fujian human flu strain of the H3N2 subtype of the Influenza A virus or a Fujian bird flu strain of the H5N1 subtype of the Influenza A virus. These strains are named after Fujian, a coastal province in Southeast China.
Human mortality from H5N1 or the human fatality ratio from H5N1 or the case-fatality rate of H5N1 is the ratio of the number of confirmed human deaths resulting from confirmed cases of transmission and infection of H5N1 to the number of those confirmed cases. For example, if there are 100 confirmed cases of humans infected with H5N1 and 50 die, then there is a 50% human fatality ratio. H5N1 flu is a concern due to the global spread of H5N1 that constitutes a pandemic threat. The majority of H5N1 flu cases have been reported in southeast and east Asia. The case-fatality rate is central to pandemic planning. Estimates of case-fatality (CF) rates for past influenza pandemics have ranged from to 2-3% for the 1918 pandemic to about 0.6% for the 1957 pandemic to 0.2% for the 1968 pandemic. As of 2008, the official World Health Organization estimate for the case-fatality rate for the outbreak of H5N1 avian influenza was approximately 60%. Public health officials in Ontario, Canada argue that the true case-fatality rate could be lower, pointing to studies suggesting it could be 14-33%, and warned that it was unlikely to be as low as the 0.1–0.4% rate that was built into many pandemic plans.
The global spread of H5N1 in birds is considered a significant pandemic threat.
A H5N1 vaccine is an influenza vaccine intended to provide immunization to influenza A virus subtype H5N1.
Influenza A virus subtype H7N9 (A/H7N9) is a bird flu strain of the species Influenza virus A. Avian influenza A H7 viruses normally circulate amongst avian populations with some variants known to occasionally infect humans. An H7N9 virus was first reported to have infected humans in March 2013, in China. Cases continued to be reported throughout April and then dropped to only a few cases during the summer months. At the closing of the year, 144 cases had been reported of which 46 had died. It is known that influenza tends to strike during the winter months, and the second wave, which began in October, was fanned by a surge in poultry production timed for Lunar New Year feasts that began at the end of January. January 2014 brought a spike in reports of illness with 96 confirmed reports of disease and 19 deaths. As of April 11, 2014, the outbreak's overall total was 419, including 7 in Hong Kong, and the unofficial number of deaths was 127.
H5N6 is a subtype of the species Influenza A virus. Infected birds shed the virus in their saliva, mucous, and feces. The virus was first detected in poultry in 2013, since then spreading among wild bird populations and poultry around the world. Humans can be infected through unprotected contact with infected birds or contaminated surfaces. The virus transmits by getting into a person's eyes, nose, mouth, and through inhalation. Human infections are rare. Since 2014, at least 87 cases have occurred in humans. 29 people have died. A spike in human cases was reported in 2021. There have been no confirmed cases of human-to-human transmission. Some infections have been identified where no direct contact with infected birds or contaminated surfaces has been known to had occurred. Only one infected woman has said that she never came into any contact with poultry.