Control of highly pathogenic avian influenza through vaccination

The stamping-out strategy has been used to control highly pathogenic avian influenza viruses in many countries,driven by the belief that vaccination would not be successful against such viruses and fears that avian influenza virus in vaccinated birds would evolve more rapidly and pose a greater risk to humans.In this review,we summarize the successes in controlling highly pathogenic avian influenza in China and make suggestions regarding the requirements for vaccine selection and effectiveness.In addition,we present evidence that vaccination of poultry not only eliminates human infection with avian influenza virus,but also significantly reduces and abolishes some harmful characteristics of avian influenza virus.

Development and Assessment of Two Highly Pathogenic Avian Influenza(HPAI) H5N6 Candidate Vaccine Viruses for Pandemic Preparedness

Objective In China, 24 cases of human infection with highly pathogenic avian influenza(HPAI) H5 N6 virus have been confirmed since the first confirmed case in 2014. Therefore, we developed and assessed two H5 N6 candidate vaccine viruses(CVVs).Methods In accordance with the World Health Organization(WHO) recommendations, we constructed two reassortant viruses using reverse genetics(RG) technology to match the two different epidemic H5 N6 viruses. We performed complete genome sequencing to determine the genetic stability. We assessed the growth ability of the studied viruses in MDCK cells and conducted a hemagglutination inhibition assay to analyze their antigenicity. Pathogenicity attenuation was also evaluated in vitro and in vivo.Results The results showed that no mutations occurred in hemagglutinin or neuraminidase, and both CVVs retained their original antigenicity. The replication capacity of the two CVVs reached a level similar to that of A/Puerto Rico/8/34 in MDCK cells. The two CVVs showed low pathogenicity in vitro and in vivo, which are in line with the WHO requirements for CVVs.Conclusion We obtained two genetically stable CVVs of HPAI H5N6 with high growth characteristics,which may aid in our preparedness for a potential H5N6 pandemic.

Establishment of a Risk Assessment Framework for Analysis of the Spread of Highly Pathogenic Avian Influenza

To evaluate the risk of highly pathogenic avian influenza （HPAI） in China's Mainland, a risk assessment framework was built. Risk factors were determined by analyzing the epidemic data using the brainstorming method; the analytic hierarchy process was designed to weigh risk factors, and the integrated multicriteria analysis was used to evaluate the final result. The completed framework included the risk factor system, data standards for risk factors, weights of risk factors, and integrated assessment methods. This risk assessment framework can be used to quantitatively analyze the outbreak and spread of HPAI in China's Mainland.

Assessment of the Level of Knowledge of the Nature of Highly Pathogenic Avian Influenza Demonstrated by the Nigerian Veterinary Laboratory Staff Involved in HPAI Diagnosis in Nigeria

The study was designed to evaluate the level of knowledge of Nigerian Veterinary Laboratory Staff on the nature of Highly Pathogenic Avian Influenza (HPAI) disease using structured questionnaires. The study comprised the Staff of National Veterinary Research Institute (NVRI) and five reference Veterinary Teaching Hospitals (VTH) designated for HPAI diagnosis. A total of 69 questionnaires were distributed to the laboratory staff. Questions on the general nature of the disease such as the cause, signs, mode of transmission, methods of identification, lesions, control and prevention, etc. were asked. The results showed that 77.38% of the staff answered all the questions correctly indicating their considerable knowledge of the HPAI disease. Considerable percentage of the staff listed correctly the equipment used for serology (36.23%) and RT-PCR (31.88%). Interestingly only 13.04% of the staff listed correctly the equipment used in rapid tests despite the fact that they are simpler and recommended for all P2 laboratories. In conclusion, the veterinary laboratory staff assessed demonstrated a significant level of knowledge on HPAI diagnosis;however, most of their laboratories lack the structure, organization, funds and basic facilities required for effective HPAI diagnosis.

Characterization of Highly Pathogenic Avian Influenza H5N1 Viruses Isolated from Domestic Poultry in China

The highly pathogenic avian influenza （HPAI） H5N1 virus has caused several outbreaks in domestic poultry. Despite great efforts to control the spread of this virus, it continues to evolve and poses a substantial threat to public health because of a high mortality rate. In this study, we sequenced whole genomes of eight H5N1 avian influenza viruses isolated from domestic poultry in eastern China and compared them with those of typical influenza virus strains. Phylogenetic analyses showed that all eight genomes belonged to clade 2.3.2.1 and clade 7.2, the two main circulating clades in China. Viruses that clustered in clade 2.3.2.1 shared a high degree of homology with H5N1 isolates located in eastern Asian. Isolates that clustered in clade 7.2 were found to circulate throughout China, with an east-to-west density gradient. Pathogenicity studies in mice showed that these isolates replicate in the lungs, and clade 2.3.2.1 viruses exhibit a notably higher degree of virulence compared to clade 7.2 viruses. Our results contribute to the elucidation of the biological characterization and pathogenicity of HPAI H5N1 viruses.

Distribution of Avian Influenza A Viruses in Poultry-Related Environment and Its Association with Human Infection in Henan, 2016 to 2017

Objective To survey avian influenza A viruses(AIVs) in the environment and explore the reasons for the surge in human H7 N9 cases.Methods A total of 1,045 samples were collected from routine surveillance on poultry-related environments and 307 samples from human H7 N9 cases-exposed environments in Henan from 2016 to2017. The nucleic acids of influenza A(Flu A), H5, H7, and H9 subtypes were detected by real-time polymerase chain reaction.Results A total of 27 H7 N9 cases were confirmed in Henan from 2016 to 2017, 24 had a history of live poultry exposure, and 15 had H7 N9 virus detected in the related live poultry markets(LPMs). About 96%(264/275) Flu A positive-environmental samples were from LPMs. H9 was the main AIV subtype(10.05%) from routine surveillance sites with only 1 H7-positive sample, whereas 21.17% samples were H7-positive in H7 N9 cases-exposed environments. Samples from H7 N9 cases-exposed LPMs(47.56%)had much higher AIVs positive rates than those from routine surveillance sites(12.34%). The H7+H9 combination of mixed infection was 78.18%(43/55) of H7-positive samples and 41.34%(43/104) of H9-positive samples.Conclusion The contamination status of AIVs in poultry-related environments is closely associated with the incidence of human infection caused by AIVs. Therefore, systematic surveillance of AIVs in LPMs in China is essential for the detection of novel reassortant viruses and their potential for interspecies transmission.

The Evidence of Clade 7.1 Avian Influenza Virus (H5N1) in Qinghai Lake

The highly pathogenic influenza A virus subtype H5N1 spread throughout Asia since 2003, reached to Europe in 2005, and the Middle East, as well as Africa and caused a global concern for a potential pandemic threat last decade. A Clade 2.3.2 H5N1 virus became dominate in the Qinghai Lake region in 2009 with sporadic mammal cases of infection and transferred to Russia and Europe through wild migratory birds. Currently, HPAI H5N1 of clades 2.3.4, 2.3.2, and 7 are the dominant co-circulating H5N1 viruses in poultry in Asia. 2.3.2 Clade is dominant in wild birds through the world whereas there is no evident data about Clade 7 circulation in wild birds. We detected HPAI H5N1 virus of Clade 7.1 in Qinghai Lake, that closely related to Shanxi-like and Vietnam viruses co-circulating in poultry. This is the first report of Clade 7.1 H5N1 in wild birds. Based on phylogenetic analyses, the virus can be originated from Clade 7.1 virus gene pool that spread in Vietnam and Chinese poultry and could spread with migratory birds to Qinghai Lake. The Qinghai Lake continues to be significant hotspot for H5N1 surveillance since the regular outbreaks occurred there in wild birds and mammals. Based on these facts and findings, the related researchers should pay more attention to the Qinghai Lake basin as significant hotspot for H5N1 avian influenza surveillance since the regular H5N1 outbreaks occurred there in wild birds with sporadic mammal cases of infection.

Knowledge,attitudes and practices towards avian influenza A(H5N1) among Cambodian women:A cross-sectional study

Objective:To measure highly pathogenic avian influenza(HPAI)-related knowledge,attitudes, and practices(KAPs) among Cambodian women.Methods:This cross-sectional study selected 246 married women aged between 18-55 years who had backyard poultry and lived at least one year in the areas of the survey through multi-stage cluster sampling.An average score of correct answers was generated to evaluate respondents’ knowledge(Good/Poor).attitudes(Positive/ Negative),and practices(Good/Bad).Results:We reported that about half of the respondents had good knowledge and good practices and four-fifth of them had positive attitudes towards HPAl.Odds ratios(ORs) and 95%confidence intervals(CIs) were estimated through a logistic regression model to explore contributing factors that raise their KAP levels.Most of the sources were significant in increasing knowledge of the respondent,like television(OR=l.6.95%CI=1.0- 2.7),radio(OR=2.5.95%CI=l.3-4.9).leaflets/booklets(OR=2.1,95%CI=1.2-3.9),school students (OR=18.4.95%CI=2.4-142.9).village health volunteers(OR=4.5.95%CI=2.2-10.9) etc.Factors such as television(OR=3.7.95%CI=2.1-6.4).leaflets/booklets(OR=2.6,95%CI7=1.4-5.1).and public health staff(OR=2.2,95%CI=1.2-4.1) had similar influence on practices.Although,we found similar effect on raising the attitudes of the responded,it was not significant.Conclusions: We report a satisfactory level of positive attitudes,and moderate level of knowledge and practices related to HPAI among Cambodian women.Raising KAPs through television,radio and other medias may be more efficient than using usual information,education and communication materials to prevent HPAI.

Case report for human infection with a highly pathogenic avian influenza A(H5N6) virus in Beijing, China 2019

Bird infections with highly pathogenic avian influenza A(H5N6) viruses have been identified since 2014. With very limited occasion, the virus could sporadically spilled over to infect humans. It has been recognized that all human infections were within southern region of China's Mainland until the case reported here in Beijing in Aug. 2019. This was the first human case infected with highly pathogenic avian influenza A(H5N6) virus in northern China. The infection was confirmed by real-time RT-PCR assay. The whole genome sequences were obtained from clinical sample. Genetic characteristics of the virus were identified similar to those of previous avian influenza A(H5N6) viruses, retaining the main features of the avian influenza virus.

Assessment of vaccination strategies against highly pathogenic avian influenza in China

Vaccination for highly pathogenic avian influenza(HPAI)has been implemented in China for a decade,however,the virus is still present in poultry.A series of recombinant vaccines,Re-1 to Re-7,have been developed and used,and Re-8 will also be used in clinical settings to prevent the prevailing flu strains.The question remains,when can China eradicate the disease?Here,we review the epidemiology of H5 HPAI along with the development,usage and problems of vaccines.Further suggestions for controlling the disease in China are provided.

Highly pathogenic avian influenza H5N1 Clade 2.3.2.1c virus in migratory birds,2014–2015

A novel Clade 2.3.2.1c H5N1 reassortant virus caused several outbreaks in wild birds in some regions of China from late 2014 to 2015.Based on the genetic and phylogenetic analyses,the viruses possess a stable gene constellation with a Clade 2.3.2.1c HA,a H9N2-derived PB2 gene and the other six genes of Asian H5N1-origin.The Clade 2.3.2.1c H5N1 reassortants displayed a high genetic relationship to a human H5N1 strain(A/Alberta/01/2014).Further analysis showed that similar viruses have been circulating in wild birds in China,Russia,Dubai(Western Asia),Bulgaria and Romania(Europe),as well as domestic poultry in some regions of Africa.The affected areas include the Central Asian,East Asian-Australasian,West Asian-East African,and Black Sea/Mediterranean flyways.These results show that the novel Clade 2.3.2.1c reassortant viruses are circulating worldwide and may have gained a selective advantage in migratory birds,thus posing a serious threat to wild birds and potentially humans.

Adoption of HPAI biosecurity measures： The Chinese broiler industry

Highly pathogenic avian influenza （HPAI） contamination via wild birds and rodents poses a threat to food security and safety. As chicken meat comprises an increasing proportion of diet in China, it is useful to determine whether broiler farmers are adopting wild bird and rodent controls to minimize the risk of HPAI impacts on food supply. Our study surveyed a cross sectional sample of 331 Chinese broiler farmers in six provinces. We find that only 47% of farmers （mainly farmers with large herds） adopted control measures against wild birds and rodents, while 14% adopted no measures. Farm size was the biggest driver of adoption followed by proportion of farm revenue derived from broiler production. However, southern farmers were at a far greater probability of non-adoption. We suggest that assistance in the form of education/training programs and subsidized traps or baiting controls across smaller producers could help raise of the adoption level toward more effective HPAI control.

International chicken trade and increased risk for introducing or reintroducing highly pathogenic avian influenza A (H5N1) to uninfected countries

Every year billions of chickens are shipped thousands of miles around the globe in order to meet the ever increasing demands for this cheap and nutritious protein source.Unfortunately,transporting chickens internationally can also increase the chance for introducing zoonotic viruses,such as highly pathogenic avian influenza A(H5N1)to new countries.Our study used a retrospective analysis of poultry trading data from 2003 through 2011 to assess the risk of H5N1 poultry infection in an importing country.We found that the risk of infection in an importing country increased by a factor of 1.3(95%CI:1.1e1.5)for every 10-fold increase in live chickens imported from countries experiencing at least one H5N1 poultry case during that year.These results suggest that the risk in a particular country can be significantly reduced if imports from countries experiencing an outbreak are decreased during the year of infection or if biosecurity measures such as screening,vaccination,and infection control practices are increased.These findings show that limiting trade of live chickens or increasing infection control practices during contagious periods may be an important step in reducing the spread of H5N1 and other emerging avian influenza viruses.

Surveillance for highly pathogenic avian influenza in wild birds in the USA

As part of the USA’s National Strategy for Pandemic Influenza,an Interagency Strategic Plan for the Early Detection of Highly Pathogenic H5N1 Avian Influenza in Wild Migratory Birds was developed and implemented.From1April2006 through 31 March 2009,261946 samples fromwild birds and 101457 wild bird fecalsamples were collected in the USA;no highly pathogenic avian influenza was detected.The United States Department of Agriculture,and state and tribal cooperators accounted for 213115(81%)of the wild bird samples collected;31,27,21 and 21%of the samples were collected from theAtlantic,Pacific,Central and Mississippi flyways,respectively.More than 250 species of wild birds in all 50 states were sampled.The majority of wild birds(86%)were dabbling ducks,geese,swans and shorebirds.The apparent prevalence of low pathogenic avian influenza viruses during biological years 2007 and 2008 was 9.7 and 11.0%,respectively.The apparent prevalence of H5 and H7 subtypes across all species sampled were 0.5 and 0.06%,respectively.The pooled fecal samples(n=101539)positive for low pathogenic avian influenza were 4.0,6.7 and 4.7%for biological years 2006,2007 and 2008,respectively.The highly pathogenic early detection system for wild birds developed and implemented in the USA represents the largest coordinated wildlife disease surveillance system ever conducted.This effort provided evidence that wild birds in the USA were free of highly pathogenic avian influenza virus(given the expected minimum prevalence of 0.001%)at the 99.9%confidence level during the surveillance period.

The interaction of influenza H5N1 viral hemagglutinin with sialic acid receptors leads to the activation of human γδT cells

Highly pathogenic avian influenza H5N 1 epidemics are a significant public health hazard. Genetically engineered H5N 1 viruses with mammalian transmission activity highlight the potential risk of a human influenza H5N 1 pandemic. Understanding the underlying principles of the innate immune system in response to influenza H5N 1 viruses will lead to improved prevention and control of these potentially deadly viruses, γδT cells act as the first line of defense against microbial infection and help initiate adaptive immune responses during the early stages of viral infection. In this study, we investigated the molecular mechanisms of γδ T cells in response to influenza H5N1 viral infection, We found that recombinant hemagglutinin （rHA） derived from three different strains of influenza H5N 1 viruses elicited the activation of γδ T cells cultured in peripheral blood mononuclear cells （PBMCs）. Both the cell surface expression of CD69, an early activation marker on γδ T cells, and the production of interferon-y （IFN-y） were significantly increased. Notably, the rHA protein-induced γδ T-cell activation was not mediated by TCRγδ, NKG2D or pattern recognition receptors （PRRs） or NKp46 receptors. The interaction of rHA proteins with sialic acid receptors may play a critical role in γδ T-cell activation. Our data may provide insight into the mechanisms underlyingγδT-cell activation in response to infection with H5N1 viruses.

高致病性H5N1亚型人禽流感病毒性肺炎的影像学表现特点

目的探讨高致病性H5N1亚型人禽流感病毒性肺炎的影像学检查方法及胸部X线与CT影像表现特点。方法回顾性分析2006年6月深圳接诊的首例由卫生部确诊,并经过抢救治疗痊愈的高致病性H5N1亚型人禽流感病毒性肺炎患者的相关临床及影像学资料。结果胸部影像学特点是:①磨玻璃样影、大小片状影及肺实变影是人禽流感病毒性肺炎较早出现的影像表现;②病灶侵犯肺组织广泛,表现为多叶多段的两肺广泛受累;③病灶蔓延变化迅速;④肺实质、肺间质及胸膜受累可同时存在;⑤病灶吸收慢、迁延时间长,恢复期有肺纤维化的影像表现。结论影像学检查与诊断仍然是人禽流感病毒性肺炎的临床诊断、鉴别诊断、疗效评价及预后分析的重要手段。动态观察人禽流感病毒性肺炎的影像学变化及影像学表现特点,监测ARDS和肺部继发感染等并发症的发生,利于指导临床及时有效地进行治疗。

云南省首例人感染H9N2禽流感病例发现与应对

目的对云南省流感监测中发现的首例人感染H9N2禽流感病例进行调查分析,为进一步防治人禽流感疫情提供科学依据。方法对患者、密切接触者和活禽市场开展流行病学调查,并采集病例呼吸道标本和外环境标本进行实验室检测分析。结果病例有活禽市场暴露史,标本禽流感病毒核酸阳性结果表明,该病例为人感染H9N2禽流感确诊病例,未出现二代病例。病例暴露的活禽市场环境中存在大量禽流感病毒。结论医疗机构加强流感样病例监测和不明原因肺炎监测是及时发现人禽流感病例的重要手段。活禽交易市场定期消毒与休市是降低感染率的关键措施。

安徽省首例人感染H5N6禽流感病例的调查与分析

目的分析安徽省首例人感染H5N6禽流感病例发病与流行病学特征,为制定监测方案与防控措施提供科学依据。方法对人感染H5N6禽流感病例、密切接触者、感染来源进行流行病学调查,采集相关生物和环境标本进行实验室检测,应用描述性流行病学方法进行分析。结果安徽省首例人感染H5N6禽流感病例为单个散发病例,密切接触者无感染,早期临床表现无特异性,发病前一周有明确的病死禽接触史,病禽市场检出2份H5N6阳性标本。结论该病例为本地感染病例,感染来源与接触病死禽有关,未发现人传人的证据。

广州市首例人禽流感病例流行病学调查

[目的]探讨人禽流感的感染来源和传播途径。[方法]应用现场流行病学、血清学调查的方法,对病例和密切接触者进行访谈;采用荧光定量PCR检测禽流感病毒H5核酸、酶链免疫吸附试验及血凝抑制试验检测禽流感H5抗体。[结果]患者发病前1个月未离开过广州,发病前两周多次到过肉菜市场活动,并在活禽销售场所附近有过较长时间的逗留,无病、死禽的接触史;病情变化凶险,迅速进展为全肺炎和呼吸衰竭、多器官功能衰竭;发病d8、9气管吸取物检出禽流感病毒H5核酸;56名密切接触者经过医学观察未发现被感染。[结论]该病例为本地感染,感染来源可能与其市场活动有关,但感染途径、感染方式尚不祥;在潜伏期末和发病期间经密切接触未造成人与人的传播。

广州市人感染H7N9禽流感病毒高致病性变异株监测与基因进化分析

目的通过对广州市人感染H7N9禽流感病毒高致病性变异株基因变异和进化特点进行分析,掌握本地区H7N9病毒病原学特点,为疾病防控提供参考。方法选取2017年广州市人感染H7N9禽流感病毒阳性标本10份,提取核酸扩增HA、NA、M基因进行测序,通过生物信息学软件分析病毒重要蛋白突变情况和遗传进化特点。结果广州地区H7N9禽流感病毒基因同源性差异较大,大部分毒株基因与广东毒株同源性最高,部分毒株基因与河南、内蒙古等地毒株同源性最高。监测到5株病毒为H7N9禽流感病毒高致病性变异株,部分病毒出现了HA蛋白Q226L的突变,提示对人呼吸道上皮细胞SAα-2, 6Gal受体结合能力增加。HA蛋白和NA蛋白上糖基化位点均有一定的增加和缺失突变。HA、NA和M1蛋白上毒力相关位点均突变增强。M2蛋白均呈现耐药突变,同时监测到2株高致病性突变株出现对神经氨酸酶抑制剂的耐药突变。遗传进化结果显示,HA基因和NA基因在华南和华东分支均有分布,M1基因进化特点相对复杂,分别与华南地区H9N2、H7N9病毒,及北方地区的H7N9病毒重组。结论 2017年广州地区发现2株对达菲耐药的人感染H7N9禽流感病毒高致病性变异株。H7N9禽流感病毒在广州地区不断发生进化重组,具有遗传多样性和复杂性,提示高致病性耐药株有向华南以外地区传播的风险。