Influenza

Flu, Grippe, Avian Influenza, Grippe Aviaire, Fowl Plague, Swine Influenza, Hog Flu, Pig Flu, Equine Influenza, Canine Influenza
Last Updated: December 29, 2009

Importance
Influenza viruses are RNA viruses in the family Orthomyxoviridae that can affect birds and mammals including humans. Influenza B and C viruses are maintained only in human populations, although they are isolated occasionally from other mammals. 1-9 Influenza A viruses can affect many species, with the vast majority of these viruses occurring among birds. Waterfowl and shorebirds seem to the reservoir hosts for avian influenza viruses, which are usually carried asymptomatically in these populations.1,10-17 Avian influenza viruses can also become established among poultry, causing two forms of disease. Low pathogenicity avian influenza (LPAI) viruses, the form usually carried in wild birds, generally cause asymptomatic infections, mild respiratory disease or decreased egg production in poultry.11,13,14,18,19 Some LPAI viruses can mutate in poultry populations to become high pathogenicity avian influenza (HPAI) viruses. HPAI viruses cause a severe illness that can kill up to 90-100% of a flock.10,11,13 A few influenza A viruses have become adapted to mammals including humans, swine, horses and dogs, and circulate in these populations. These viruses are called human influenza A viruses, swine influenza viruses, equine influenza viruses and canine influenza viruses, respectively. In the mammalian species to which they are adapted, influenza viruses cause respiratory disease with high morbidity but low mortality rates. More severe cases can occur in conjunction with other diseases or debilitation, as well as in infancy or old age. Influenza A viruses that circulate in birds and mammals are occasionally transmitted from one species to another. In most cases, these infections do not spread efficiently; they remain limited to an individual or a small group, and soon disappear from the novel host population.1-4,11,20-24 However, some of these viruses can become adapted to a new species and cause outbreaks, epidemics or pandemics. 1,2,16,20,25-32 One equine influenza virus recently began circulating in dog populations, becoming the first canine influenza virus.28-30 Similarly, avian influenza viruses have caused or contributed to past pandemics in humans and pigs. 2,20,27,31 Avian and swine influenza viruses, which are the only animal influenza viruses known to recurrently affect humans, are of the greatest concern as zoonotic agents. The effects of avian influenza viruses on people are highly variable. Although many human infections are limited to conjunctivitis or mild respiratory disease, some viruses can cause severe disease and death.2,11,12,15,26,33-41 Currently, HPAI H5N1 avian influenza viruses seem to be the greatest threat to people, as well as to poultry. These viruses first emerged in the late 1990s. They have since become established among birds in Asia, have spread to other geographic regions, and continue to threaten new areas.11,12,42 As of December 2009, H5N1 viruses have been responsible for approximately 450 human infections, generally as the result of close contact with poultry; about 60% of all laboratory confirmed cases have been fatal.43 Asian lineage H5N1 viruses have also caused disease in housecats, several species of large felids, palm civets, raccoon dogs, stone martens, a dog and a mink. 9,11,44-55 Some of these infections were fatal. In addition, H5N1 viruses have been detected in pigs and pikas, and experimental infections have been established in a variety of species including foxes, ferrets, rodents and rabbits.34,51,56-58,58-70 Unusually, numerous deaths have been reported in wild birds, which are rarely affected by avian influenza viruses.11,12,51,54,7173 There are fears that an Asian lineage H5N1 strain could eventually become adapted to humans, possibly resulting in a severe human pandemic. Other avian influenza viruses can also undergo cross-species transmission. H9N2 (LPAI) viruses, which have become endemic in poultry in parts of Asia and the Middle East, may be of particular concern.36,74,75 These viruses have caused outbreaks among poultry in many countries,75-77 and it has been recently recognized that some isolates share internal genes with H5N1 viruses.74,78,79 H9N2 viruses have been detected in pigs with respiratory disease and fatal paralysis in China. 74 Antibodies to H9N2 viruses, as well as rare clinical cases, have also been reported in humans. 3638,74,74,80,81 As of December 2009, known human H9N2 infections have been relatively mild, and fatal cases have not been reported.36-38,74 Swine influenza virus infections also occur sporadically among people. Most of these cases have been relatively mild and some may have been asymptomatic, but
© 2009

Author: Anna Rovid Spickler, DVM, PhD

INFL_H2009_2010

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Influenza
severe illnesses and a few deaths have been reported.1-3,2124,82-94 Swine influenza viruses are usually not welladapted to humans, and little or no person-to-person transmission usually occurs.1,2,22,24,89 Nevertheless, these viruses appear to have been responsible for the first human pandemic of the 21st century. In April 2009, a novel virus with the subtype H1N1 began circulating in people.93,95,96 The genetic analysis of this virus suggests that it originated from North American and Eurasian swine influenza viruses that reassorted.97-99 The novel H1N1 virus has also been transmitted from people to animals. Pigs are susceptible to this virus, and sporadic outbreaks have been reported among swine herds in a number of countries.100-116 Outbreaks have also been reported in turkey flocks, and a few cases have been recognized in pet ferrets, cats and dogs, as well as in a cheetah in a zoo.117-129 may contain some genes from one parent virus and some genes from the other.20 Reassortment between different strains results in the periodic emergence of novel strains. Reassortment between subtypes can result in the emergence of a new subtype. Reassortment can also occur between avian, swine, equine, canine and human influenza A viruses. This type of reassortment can result in a „hybrid‟ virus with, for example, both avian and human influenza virus proteins. An abrupt change in the subtypes found in a host species is called an „antigenic shift.‟ Antigenic shifts can result from three mechanisms: 1) genetic reassortment between subtypes, 2) the direct transfer of a whole virus from one host species into another, or 3) the re-emergence of a virus that was found previously in a species but is no longer in circulation.1,2 For example, human viruses can continue to circulate in pigs and could re-emerge into the human population.2 Antigenic drift and antigenic shifts result in the periodic emergence of novel influenza viruses. By evading the immune response, these viruses can cause influenza epidemics and pandemics.
Avian influenza viruses

Etiology
Viruses in the family Orthomyxoviridae cause influenza. There are three genera of influenza viruses: influenzavirus A, influenzavirus B and influenzavirus C.130 Separate viral species are not recognized within these genera; the members of each genus belong to the three species “influenza A virus,” “influenza B virus” or “influenza C virus,” respectively.130 These viruses are also called type A, type B and type C influenza viruses. Influenza A viruses Influenza A viruses include avian, swine, equine and canine influenza viruses, as well as the human influenza A viruses. Influenza A viruses are classified into subtypes based on two surface antigens, the hemagglutinin (H) and neuraminidase (N) proteins. There are 16 hemagglutinin antigens (H1 to H16) and nine neuraminidase antigens (N1 to N9).11,13,19,23 These two proteins are involved in cell attachment and release from cells, and are also major targets for the immune response.2,20,131 Wild birds carry most of the known hemagglutinin and neuraminidase antigens, but some, such as H14 and H15, are uncommon and seem to occur only in limited geographic areas.17 Only limited subtypes are found in each species of mammal.3 Influenza A viruses are also classified into strains. Strains of influenza viruses are described by their type, host, place of first isolation, strain number (if any), year of isolation, and antigenic subtype.1,3 [e.g., the prototype strain of the H7N7 subtype of equine influenza virus, first isolated in Czechoslovakia in 1956, is A/eq/Prague/56 (H7N7).] For human strains, the host is omitted.
Antigenic shift and drift in influenza A viruses

Influenza A viruses change frequently. Strains evolve as they accumulate point mutations during virus replication; this process is sometimes called „antigenic drift.‟3 A more abrupt change can occur during genetic reassortment. Reassortment is possible whenever two different influenza viruses infect a cell simultaneously; when the new viruses (the „progeny‟) are assembled, they
Last Updated: December 2009 © 2009

Avian influenza viruses circulate in a variety of domesticated and wild birds.1,11,14,17,34 They are also isolated occasionally from mammals including humans.1,9,11,25,26,35,37,44-53,55-57,132,133 Avian influenza viruses are classified as either high pathogenicity (HPAI) or low pathogenicity (LPAI) viruses, based on the genetic features of the virus and the severity of disease in experimentally inoculated chickens.11,13,19 Although there are exceptions (e.g., viruses that fit the genetic description of HPAI viruses but cause mild illness), HPAI viruses usually cause severe disease in poultry, while LPAI infections are generally much milder. To date, all HPAI viruses have contained the H5 or H7 hemagglutinin; subtypes that contained other hemagglutinins have been found only in the LPAI form.12,18,19 H5 and H7 LPAI viruses can evolve into high pathogenicity strains, typically while they are circulating among poultry.11,12,15 When a subtype has become established and circulates for a time, numerous variants may occur in the population. For example, multiple genotypes and a number of clades of Asian lineage H5N1 viruses are currently found among poultry.11,40,42,134,135 In wild species, avian influenza viruses are especially common among birds that live in wetlands and other aquatic environments.17 Waterfowl (order Anseriformes) and shorebirds (order Charadriiformes) seem to be the natural reservoirs for influenza A viruses, and carry all of the known subtypes, usually in the LPAI form. 1,12-17,23 Important reservoir hosts include ducks, geese, swans, gulls, terns and waders.17 The LPAI viruses found in wild birds can be divided into Eurasian and American lineages.17 Although viruses occasionally cross between these two geographic regions, this is uncommon.17 The predominant subtypes in wild ducks change periodically. 1 H3, H4 and H6 are detected most often in North

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Influenza
American and northern European wild ducks, but nearly all hemagglutinin and neuraminidase antigens can be found.17 Waders (families Charadriidae and Scolopacidae) seem to have a wider variety of hemagglutinin/ neuraminidase combinations than ducks. In the eastern U.S., H1 through H12 (LPAI) viruses have been isolated from these birds; H1, H2, H5, H7 and H9-H12 viruses are particularly common.17 Gulls are often infected with H13 LPAI viruses, which are rare in other avian species.17 They can also carry H16 viruses.17 Most, though not all, infections in wild waterfowl and shorebirds are asymptomatic.1,2,11,12,136,137 Limited information is available on the subtypes found in other species of birds. Subtypes that have been detected in ratites include H3N2, H4N2, H4N6, H5N1, H5N2, H5N9, H7N1, H7N3, H9N2, H10N1, H10N4 and H10N7.18,51,138-140 Isolates from cage birds usually contain H3 or H4; however, infections with high pathogenicity subtypes containing H7 or H5 can also occur.18,51,60,71,141,142 Very few avian influenza viruses were found in wild passerine birds, pigeons and doves in one survey.143
Swine influenza viruses

Swine influenza viruses mainly affect pigs, but they can cause disease in turkeys.1,3 Outbreaks have also been described recently in ferrets and mink.91,144 Other species may also be infected, although this seems to be rare. One H1N1 swine influenza virus, which was avirulent for both poultry and pigs, was isolated from a duck in Hong Kong, and experimental infections have been reported in calves.145,146 The most common subtypes currently found in pigs are H1N1, H1N2 and H3N2; however, the situation is complex, as two or more viruses of each subtype are circulating in swine populations.2,16,20,147 One H1N1 virus found in North America is the „classical‟ H1N1 swine influenza virus. This virus, the first influenza virus known to have infected pigs, was first detected in swine populations in 1918.1,2,16,20 Reassortant H1N1 viruses, which contain the same neuraminidase and hemagglutinin as the classical H1N1 virus, but have internal proteins from triple reassortant H3N2 viruses (see below), have recently become prominent among pigs in North America.148-150 An „avian-like‟ H1N1 virus circulates mainly in European pigs.2,16,20 This virus seems to be an avian influenza virus that was transmitted whole to pigs.16,20,151 It has, in some locations, replaced the classical H1N1 virus.16,20 A different „avian-like‟ H1N1 virus has been detected, together with the classical H1N1 virus, among pigs in Asia.9,16 Other variants have also been found. For example, H1N1 reassortant viruses consisting of classical swine influenza virus genes and a human PB1 polymerase gene have been detected in pigs in Canada152 and a wholly human lineage H1N1 virus was reported from pigs in China in 2007.153 In North America, some of the most important swine influenza viruses are the triple reassortant H3N2 viruses.
Last Updated: December 2009 © 2009

These viruses first emerged in U.S. pigs in the late 1990s, mainly in the Midwest,20,34,152,154,155 and they have been detected in Canada since 2005.89,144,156 The North American H3N2 triple reassortant viruses contain hemagglutinin and neuraminidase proteins from a human influenza virus, and internal proteins from the classical swine influenza virus, an avian influenza virus and a human influenza virus.154 The particular combination of internal genes carried by these viruses is known as the triple reassortant internal gene (TRIG) cassette. This cassette seems to be especially efficient in generating swine influenza virus recombinants with new hemagglutinin and neuraminidase genes, including some from human influenza viruses.149,150 Viruses with this cassette have had increased antigenic drift compared to other swine influenza viruses.149 H3N2 viruses also occur in Europe and Asia, but these viruses seem to be the result of reassortment between a human H3N2 virus, circulating there in pigs since the 1970s, and the H1N1 „avian-like‟ virus.2 The European H3N2 viruses contain human H3 and N2 proteins, and internal proteins from the avian virus.2 In China, H3N2 viruses that have been detected include double reassortants that contain human H3 and N2 and internal genes from avian influenza viruses, and triple reassortants with human H3 and N2 and internal gene segments from both swine and avian influenza viruses.157 Some wholly human-like H3N2 viruses have also been found among pigs in China.157 The H1N2 virus in the U.S. is a reassortant of the classical H1N1 swine influenza virus and the North American triple reassortant H3N2 virus.2 Other variants have also been detected. Some H1N2 viruses isolated from Canadian pigs contained neuraminidase and hemagglutinin genes from two different human influenza viruses, the polymerase gene from human H1N2 viruses, and other internal genes from classical H1N1 swine influenza viruses.152 The H1N2 virus in Europe is a reassortant of a human H1N1 virus and the „human-like‟ European H3N2 virus.2,16 In China, both the H1N2 swine influenza virus from North America, and apparent reassortants between the H1N1 classical swine influenza virus and North American H3N2 human influenza viruses have been reported.158 Other novel reassortants of swine influenza viruses continue to be discovered.159,160 New subtypes have also been found in some swine populations. The novel subtype H3N1 has recently been isolated from pigs in the U.S.161,162 This subtype appears to contain genes from human, swine and avian influenza viruses.161,162 A different H3N1 influenza virus, containing human and swine influenza virus genes, has been found in Korea163 and an H3N1 virus which may be a novel reassortant between H3N2 and H1N1 swine influenza viruses has been reported in Italy.164 An H2N3 virus isolated from pigs with respiratory disease in the U.S. contained genes from avian and swine influenza viruses.165 An avian H9N2 virus has been reported from

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Influenza
outbreaks of respiratory disease and paralysis in pigs in southeastern China, and may circulate in swine populations there.74 This subtype appears to contain neuraminidase and hemagglutinin genes from avian H9N2 viruses and internal genes from an H5N1 virus (Sw/SD/2/03) that also infects pig populations in the area.74 Avian (LPAI) H5N2 and avian/swine H5N2 reassortant viruses have been isolated from pigs in Korea.166 The avian H5N2 virus appears to have been circulating among pigs since 2006.166
The novel H1N1 virus of swine origin

Swine influenza viruses are occasionally found in humans.1-4,21-24,82-94,144 In most cases, these viruses are poorly adapted to humans, and little or no person-toperson transmission occurs. 1,2,22,24,89 In 2009, a novel H1N1 virus, which seems to have originated from one or more swine influenza viruses, emerged in human populations.97-99 This virus appears to be a reassortant between North American and Eurasian swine influenza viruses; it contains a hemagglutinin gene that is most closely related to swine influenza viruses in North America, a neuraminidase gene that is related to swine influenza viruses in Eurasia, and internal genes from two or more swine influenza viruses including the North American triple reassortant H3N2 viruses and a Eurasian virus.97-99 Similarly to some of the swine influenza viruses described above, the parental swine influenza viruses include some gene segments that originally came from avian and human influenza viruses. 98,99 In 2009, the novel H1N1 virus was the dominant influenza virus being transmitted in human populations in most parts of the world.167 It has also been transmitted to animals, including pigs, apparently from infected humans. 100117,119-129

This virus appears to be an avian influenza virus. A related virus caused influenza in a few hundred horses the following year but there were no deaths. The avian-like virus continued to circulate in horses in China for at least five years without further fatalities. One equine H3N8 virus recently jumped into dogs in North America.28,29,173 Equine influenza viruses can also infect dogs without becoming established in canine populations. A limited outbreak with an equine H3N8 (American lineage) virus was reported among foxhounds in the U.K. in 2002,32 and equine H3N8 viruses were shown to infect dogs asymptomatically during close contact with horses in an experimental study.174 Infections with equine H3N8 viruses have been reported among pigs in China.175
Canine influenza viruses

An H3N8 canine influenza virus has been reported in canine populations in a number of U.S. states. 30,176-183 This virus appears to be an equine influenza virus (Florida sublineage) that recently jumped species, and it bears a close resemblance to an isolate seen in horses in Wisconsin in 2004; however, the canine influenza virus has diverged genetically from equine influenza viruses.28-30 An H3N2 virus, isolated during an outbreak of canine respiratory disease in Korea in 2007, has the potential to become a second canine influenza virus.133 There is evidence that this virus may have been transmitted between dogs during the outbreak, and dog-to-dog transmission occurs readily in experimentally infected dogs.133,184 The H3N2 virus seems to have originated in birds.133 It contains gene segments that may have come from several different avian viruses.133 At least three different isolates of this virus have been recovered.133
Human influenza A viruses

Equine influenza viruses

Equine influenza viruses mainly infect horses and other Equidae (i.e., donkeys, mules and zebras).1,25,168,169 The two subtypes known to circulate in equine populations and cause disease are H7N7 (equine virus 1) and H3N8 (equine virus 2).1,3,25 There is less antigenic drift in these viruses than human influenza A viruses. 3,25 H7N7 equine influenza viruses have become extinct or are present at only very low levels in most parts of the world where surveillance is conducted.1,25,170 In contrast, H3N8 viruses circulate widely. H3N8 viruses have diverged into distinct Eurasian and American evolutionary lineages.171,172 The American lineage contains the classical American lineage (also called the Kentucky lineage), the Florida sublineage (originally called the Florida lineage) and the South American lineage.172 Some viruses of the American lineage (Florida sublineage) have also become established in Europe and Asia.171,172 In 1989, a novel strain of equine influenza [A/eq/Jilin/89 (H3N8)] caused a serious epidemic, with high morbidity and mortality rates, in Chinese horses. 25,170
Last Updated: December 2009 © 2009

Human influenza A viruses are mainly found in people, but they can also infect ferrets and sometimes swine.1,3,5,16,152,153,185-188 Experimental infections have been reported in raccoons.189 Human viruses can also replicate, to a limited extent, in the nasal epithelium of experimentally infected horses.170 H1N1, H1N2 and H3N2 viruses are currently in general circulation in humans.11,190 H1N2 viruses were first seen in human populations in 2001, probably as a result of genetic reassortment between the H3N2 and H1N1 viruses.190,191 H2N2 viruses circulated in the human population between 1957 and 1968.1 A novel H1N1 virus (see above) emerged in human populations in 2009. Human influenza viruses change frequently as the result of antigenic drift, and occasionally as the result of antigenic shift. Epidemics occur every few years, due to small changes in the influenza viruses.2,192 Human pandemics, resulting from antigenic shifts, were most recently reported in 1918, 1957, 1968 and 2009.

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14 HPAI viruses have been eradicated from domesticated poultry in most developed nations. These viruses can cause epidemics. In the U.11 Each strain is antigenically stable.32.208 As of December 2009.168-170.180 Infections were first reported in the general canine population in Florida. viruses of the B/Yamagata/16/88 lineage circulated to a very limited extent in Asia.9.201 Until recently. some Asian lineage H5N1 HPAI viruses are also circulating in wild bird populations in Eurasia.S.193 and a variety of mammals have been infected experimentally. Arizona.214 H3N8 infections were reported from dogs in Australia during an equine influenza outbreak in 2007.11 Although some countries (e.1. palm civets. these were also equine viruses that did not become Influenza A viruses are occasionally isolated from outbreaks or isolated cases in other species of mammals. including the detection of viral nucleic acids by RT-PCR.1.9. several species of large felids.215 These cases appear to have been caused by H3N8 equine influenza viruses that did not become established in the canine population.3.203 Recent evidence suggests that reassortment occurs frequently between different strains of influenza C viruses. been responsible for pandemics.1.201 However..205. and are mainly associated with disease in people.131. mink.S.9 and swine influenza viruses have caused outbreaks in mink and ferrets.206 Avian influenza (LPAI) viruses also occur worldwide in wild birds and poultry.91.197 Influenza B viruses are categorized into lineages rather than subtypes. ferrets.45.S.132 Unpublished research suggests that some raccoons in Japan have antibodies to H5N1 viruses.67-69.213.16 Although the subtypes of the swine influenza viruses found in the U.11. the B/Victoria/2/87 lineage predominated in human populations.9.44.190 Until recently. is patchy. the Middle East and Africa. Iowa.25.189.10. reindeer and deer. However. and Europe are the same. this epizootic is ongoing and worldwide eradication is not expected in the short term. cetaceans and mink. and it has been reported from Africa.213 There is no evidence that the canine influenza virus is currently circulating outside the U.189. HPAI H5N1 viruses spread into domesticated or wild birds in other regions of Asia as well as into parts of Europe.178.198 In the 1990s. raccoon dogs.214 Limited serological evidence also suggests that some U. Arkansas.203.1. but the virus later spread to other states.S.198 This lineage emerged in various parts of the world in 2001. any species other than birds.200 Influenza C viruses Influenza C viruses circulate in human populations.K. all countries in Europe) eradicate these viruses whenever they occur in domesticated birds. Equine influenza occurs in nearly all countries with substantial numbers of horses.12. Europe and parts of Asia. humans. but they have not. 169 Only a few countries such as New Zealand and Iceland are known to be free from this disease.9. swine. and influenza B viruses were said not to undergo antigenic shifts.202 Influenza C viruses have also been found in animals.170 The H3N8 canine influenza virus has been reported in the U.7173. wild bird surveillance has not detected these viruses in North America or New Zealand. In 2004-2006. foxes. and are circulating in. 11. a nationwide epidemic of influenza C was reported in Japan between January and July 2004.212 The H3N8 subtype is widespread in horse populations.192. infections with equine influenza viruses are occasionally reported among dogs in other regions. yak.131.192.K. are found worldwide.193 With the possible exception of H5N1 viruses in pikas.198. and accumulates few changes over time.2.57 there is currently no evidence that influenza viruses have become adapted to.g. dogs and horses. pigs. and can infect housecats.25. Colorado. they had never been linked to large-scale epidemics. Influenza B viruses Influenza B viruses are known to circulate only in human populations. they are actually different viruses (see „Etiology‟). foxhounds were exposed to an H3N8 virus in 2003.1.199 Recent evidence suggests that recombination between these two lineages is resulting in antigenic shifts.60-64. but later disappeared from that region.211 This disease is common in North and South America. Texas. in some cases. They are also classified into strains. rabbits and macaques.170 The H7N7 subtype is either extinct or present at very low levels.12 From 2003 to 2007. 4.5.1-8 Influenza C viruses are not classified into subtypes. including the novel H1N1 virus that entered human populations in 2009.204 Last Updated: December 2009 © 2009 page 5 of 46 .1 They have also been found occasionally in animals.168.11 Unusually. Alabama.10. and it is now co-circulating with the B/Victoria/2/87 lineage.181-183. though it occurs more slowly than in influenza A viruses.210 Swine influenza viruses are enzootic in most areas that have dense populations of pigs.32.Influenza Influenza A viruses in other species Geographic Distribution Human influenza viruses.34.177.207. Kansas. The Asian lineage H5N1 HPAI outbreak began among poultry in Southeast Asia in 2003.209.213 The distribution of this virus in the U. infections were seen in racing greyhounds in a number of states including Florida. the Pacific. Avian influenza viruses have infected pinnipeds. stone martens.51-58. West Virginia.1.199. to date.11 Influenza B viruses undergo antigenic drift.1. sheep.144 Antibodies to influenza viruses have been detected in other species including raccoons.1. it caused an outbreak or was detected serologically in an area.177. goats.. Rhode Island and Massachusetts.9 The Asian lineage H5N1 avian influenza viruses appear to have an unusually wide host range. cattle. dogs. rodents. that reptiles and amphibians can be infected with influenza viruses. but they are classified into strains. an equine H3N8 virus was responsible for an outbreak of respiratory disease in a foxhound kennel in 2002.4. pikas.47-49.194-196 There are also some indications.

In one study. and swimming in contaminated water is theoretically a source of exposure.45. either directly or on fomites.217.216.15 Avian influenza viruses have also been found in the yolk and albumen of eggs from hens infected with HPAI viruses.17. and for at least 20 days at 28-30°C (82-86oF). leopards and tigers in zoos.1.226 LPAI viruses are reported to persist in distilled water for more than 100 days at 28°C (82°F) and 200 days at 17°C (63°F). at least in some wild birds. two weeks at 20°C (68°F). as well as infected poultry or fomites.41 Ingestion of H5N1 viruses has been reported in naturally infected housecats. although their importance in transmitting these viruses to Last Updated: December 2009 © 2009 The survival of avian influenza viruses in the environment is influenced by temperature.3. avian influenza viruses are shed in the feces as well as in saliva and nasal secretions. Similarly.224 HPAI H5N2 viruses have also been detected recently in some asymptomatic wild ducks and geese in Africa.1.216 One recent study suggested that H5 and H7 HPAI viruses may survive for shorter periods in water than LPAI viruses.147.227 These viruses could survive for up to 32 days at 15-20°C (59-68oF). which are often transmitted between birds in feces. Close contact with dead or sick birds seems to be the principal way this virus is spread to humans.216 Various avian influenza viruses were reported to survive for four weeks at 18°C (64°F).17 Fecal transmission is facilitated by the persistence of avian influenza viruses in aquatic environments for prolonged periods.17 Once they are introduced into poultry. LPAI viruses were reported to survive for at least 44 or 105 days in feces.12.216 A few studies have examined virus persistence in feces. these viruses reassort and/or mutate to produce HPAI viruses. Fomites can be important in transmission and flies may act as mechanical vectors.6°F). but the current evidence suggests this is very rare.12. Once an avian influenza virus has entered a poultry flock.226 They appear to survive best at low temperatures and in fresh or brackish water rather than salt water.208. if it occurs at all. the disease could be introduced into flocks by migratory waterfowl or shorebirds.49.1. however. pH.219 This suggests that. the H3N2 influenza virus has been reported only from dogs in Korea. the Asian lineage HPAI H5N1 strains appear to occur regularly in wild birds.11.63.16. other felids and dogs. swine influenza viruses were inactivated in untreated pig slurry in 1-2. LPAI viruses (H7N2) persisted for up to two weeks in feces and on cages. which can fly long distances.190-192 Close contact and closed environments favor transmission.213 As of December 2009. 30°C (86°F) or 37°C (98.15. Transmission is best understood for the Asian lineage H5N1 (HPAI) viruses.13 The feces contain large amounts of virus.188 Transmission of avian influenza viruses among birds In birds.226 These viruses. and fecal-oral transmission is the predominant means of spread for LPAI viruses in wild bird populations.11.227 In other studies.17.207.222 In countries where HPAI has been eradicated from domesticated poultry.Influenza adapted to dogs. ferrets.192 There is little information on the survival of mammalian influenza viruses in water or organic material.220 Although infected eggs are unlikely to hatch. broken eggs could transmit the virus to other chicks in the incubator. as well page 6 of 46 .216 Mammalian influenza viruses (which are shed in respiratory secretions) are relatively labile.73.11. may persist for relatively long periods in aquatic environments. but a few cases may have resulted from indirect exposure via contaminated feces.3. it can spread on the farm by both the fecal–oral route and aerosols.216. experimentally infected cats. due to the close proximity of the birds. particularly at low temperatures. pigs.225 Survival of influenza viruses in the environment Transmission Transmission of mammalian influenza viruses In mammals.221.1.66. mice and foxes.25. but can persist for several hours in dried mucus. salinity and the presence of organic material.217 Avian influenza viruses might survive indefinitely when frozen. it is possible that is might play a role in some species. In ferrets. but they were inactivated more quickly when mixed with chicken manure.2. may exchange viruses with other populations at staging. 17 Wild birds usually carry only the low pathogenicity form of avian influenza viruses.13. however.217 Respiratory transmission of LPAI viruses is thought to be unimportant in most wild birds. these strains may no longer be transmitted primarily by the fecal-oral route. and rarely in humans.216. they still persisted in fresh water for 100 days or more at 17°C (63°F) and for approximately 26-30 days at 28°C (82°F).12. particularly those that live on land.73 Fecal-cloacal transmission might also be possible. It might also be possible for LPAI viruses to be shed in eggs.17 Some recent isolates of Asian lineage H5N1 (HPAI) viruses have been found in higher quantities in respiratory secretions than the feces. However. stopover or wintering sites.5 hours at 50-55°C (122-131°F).133 poultry is controversial.65.13.13.12.12. 228 Routes of transmission of avian influenza viruses to mammals Some avian influenza viruses can be transmitted to mammals by direct or indirect contact. influenza viruses are transmitted in aerosols created by coughing and sneezing. and by contact with nasal discharges.217.218.229 One Asian lineage H5N1 infection occurred in a dog that had eaten infected duck carcasses. In one study. and 9 weeks at 5°C (41°F).223. in utero transmission can occur with high viremia after experimental infection.13 Migrating birds.3.216 These viruses also remained viable for at least 35 days in peptone water at 4°C (39°F).217.49.

58. together with viral proteins that are well adapted to the new host‟s cells.4.133. it may be found in the urine of some mammals.Influenza as some housecats. many new viruses originate in Asia. which had been recovered from cats.196. but fecal shedding has not been reported.66. This has happened occasionally with whole viruses that jump to new hosts.20.34 This results in an increased opportunity for virus reassortment.27. avian influenza viruses have affected mink.3.2. 189 These raccoons could transmit this virus to uninfected raccoons. 230 Experimental studies suggest that Asian lineage H5N1 viruses can be transmitted to mammals by the respiratory.11 Reassortment can occur in the new host‟s own cells. the virus eventually disappeared from the novel host population.63 Infected housecats in an animal shelter probably ingested contaminated feces from a swan while they were grooming.46. these viruses have changed and differentiated into a number of strains and clades.235 Although reassortment can occur anywhere.66.132 Infected raccoon dogs in China were fed chicken carcasses.9. the virus is usually poorly adapted to the new host population and often affects only one or a few individuals. limited transmission and cross-species jumps Ordinarily. In most of the cases mentioned above. all routes have not been reported in each species. and might have acquired the H5N1 virus from this source.69 Infected foxes can excrete this virus in both respiratory secretions and feces. but aerosol transmission could not be ruled out. 70 Fecal shedding of Asian lineage H5N1 virus may also be possible in humans: this virus has been recovered from a child with diarrhea.53. H5N1 avian influenza viruses isolated from healthy ducks in southern China acquired the ability to replicate and cause lethal disease in page 7 of 46 . swine influenza viruses circulate only among pigs. seals and pigs.11. were apparently infected when they ate raw birds.189 Transmission of influenza viruses between species – sporadic cases.65 Cats appear to shed these viruses from the intestinal tract as well as the respiratory tract.68 In one experiment.63.20 Occasionally.11.16. The canine influenza virus.11.229 There are other human cases where ingestion probably occurred. however.11. human and avian influenza viruses. but additional routes of exposure also existed. a variety of species including ducks are kept in close proximity to each other and to humans. they have been called „mixing vessels‟ for the formation of new viruses. particularly a pig.231 In addition. swine influenza viruses have caused outbreaks in ferrets. (See „Etiology‟ for a description of some of these viruses. Some evidence also suggests that the H1N1 virus.53. It is. oral and intraocular routes.50. Raccoons that were intranasally inoculated with LPAI H4N8 viruses shed virus from the respiratory but not the digestive tract. Asian lineage H5N1 viruses have been found in respiratory secretions.135 An early study showed that.26.69 In experimentally infected dogs. the strongest evidence for oral transmission is that two people became infected with an Asian lineage H5N1 virus after eating uncooked duck blood. a high dose of the virus.55 In humans. is a good example. 58.65 Pigs and foxes can also be infected by feeding them H5N1-infected poultry. and equine influenza viruses have infected dogs. was probably an intact avian virus that became adapted to humans.40. from 1999 to 2002.20 Many outbreaks end without permanent adaptation of the virus to the species.2.147 For this reason.28. and human influenza viruses among people.11. For example.42.45. but pigs are known to shed it only from the respiratory tract. was used to inoculate the cattle. In rural China and other regions. as well as by intranasal or intratracheal inoculation.134.31 Dissemination is more likely if the new virus reassorts with a virus that is already adapted to the species. equine influenza viruses among the Equidae.20 Pigs have receptors that can bind swine. Although these viruses occasionally infect species other than their normal host. Infections have been established in cats by intratracheal inoculation with Asian lineage H5N1 viruses and by feeding them H5N1-infected chicks. Repeated reassortment between human. avian and swine influenza viruses has resulted in a wide variety of novel swine influenza viruses that contain segments originating from two or more species.48. however. however.1. which jumped from horses to dogs. which caused the deadly 1918 „Spanish flu‟ pandemic. horses. After intraocular inoculation of mice and ferrets with H7 and H5N1 (HPAI) isolates.2.12.67. quail cells have also been shown to bind both human and avian influenza viruses. cattle excreted small amounts of H5N1 viruses from the respiratory tract after intranasal inoculation.16. mink and turkeys.234 There are few detailed reports of mammalian infections with avian LPAI viruses.32. there are grave concerns about the possibility that these viruses might become adapted to these species. one of these viruses may cause an outbreak.25.91.) Recently. viral antigens and nucleic acids were detected in the fetus of a woman who died of an Asian lineage H5N1 infection.23. Over the decade that H5N1 viruses have been circulating among birds.1. efficient transmission requires a novel hemagglutinin and/or neuraminidase protein to evade the immune response. Last Updated: December 2009 © 2009 avian influenza viruses among birds.233 Transplacental transmission of avian influenza viruses is not well studied in mammals.232.144 Generally.3.9 The eye might act as an entry point for some HPAI viruses. Transmission of Asian lineage H5N1 viruses between mammals Because Asian lineage H5N1 avian influenza viruses can cause fatal disease in humans and other mammals.1. possible for a virus to become established in the new species.20 It could also occur in an intermediate host.12. the viruses could be detected in the respiratory tract and caused systemic disease.

7% in poultry workers.34.15.38 Swine influenza viruses in humans Two of the last four human pandemics appear to have been the result of reassortment between avian and human influenza viruses. have been associated with disease in Chinese pigs. or to three dogs in contact with infected cats.12 In 2007.23.243 Experimental infections.245 How often swine influenza viruses infect people is unknown. 15. an Asian lineage H5N1 virus with the ability to bind human receptors was isolated from a person in Thailand.57 In humans.2. there is recent evidence that Asian lineage H5N1 viruses might have become established among some pika populations in China. antibodies to H4. with any of the viruses currently circulating in bird populations. No sustained person-toperson transmission has been reported.240-242 These antibodies may be more common among people who are exposed to free-range or backyard poultry than workers in poultry confinement facilities. depending on the geographic area. with the possible exception of pikas.74. H10 and H11 viruses have been found in healthy people.36.236 Whether this modification would allow the virus to be transmitted more efficiently from person to person is unknown.1. accompanied in some cases by mild respiratory signs and other influenza symptoms. little or no host-to-host transmission has been seen in mammals. these viruses have not become adapted to people.35 The virus subtype was H7N7.11.67 However.7% of farmers and other poultry workers.81.5% of the human populations studied have antibodies to H9 viruses.11.50. only rare cases of limited person-toperson spread have been documented. have been established in human volunteers inoculated with some subtypes including H4N8.132 In one study.94.2.34. an Asian lineage H5N1 virus was not transmitted to one dog or three cats in contact with four experimentally infected dogs.80.74. With rare exceptions. these viruses do not seem to cause severe clinical signs in these animals. but viruses may also spread to people through another host.11.21-24. Sustained person-to-person transmission has never been reported. Avian influenza viruses in humans Asian lineage H5N1 avian influenza viruses have been responsible for nearly 450 confirmed clinical cases in humans. it is difficult to determine whether these viruses are more likely to infect humans than other subtypes.Influenza mice.20 The 1957 H2N2 („Asian flu‟) virus contained avian hemagglutinin.20 The H3N2 „Hong Kong flu‟ virus of 1968 had two new proteins from an avian virus – the new hemagglutinin and an internal protein – but kept the neuraminidase and remaining proteins from the H2N2 virus. which circulate among poultry in parts of Asia and the Middle East.36 Some serological evidence suggests that poultry workers. neuraminidase and an internal protein. and clinical illness is typically severe 12. and these cases occurred after close.9294.58. H9. H7 and H9 avian influenza viruses are documented occasionally in people.41 (thus more likely to be diagnosed).75 Humans can also be infected with H9N2 viruses. as of December 2009.244 Most of these infections occur after direct contact with pigs.11. after contact with infected poultry. Surveys in China report that from 0% to 4.5%. they may not be Last Updated: December 2009 © 2009 page 8 of 46 .34. veterinarians and hunters may be regularly exposed to avian influenza viruses of various subtypes.74 H9N2 (LPAI) viruses. or in experimentally infected pigs. and may have been eliminated by infection control measures. H6. was then transmitted to a laboratory technician who developed respiratory signs. and 1.37 In general. Infections with swine influenza viruses are reported sporadically in humans.37. 2.62 As of December 2009. If most infections resemble human influenza.5% of poultry retailers. and five other proteins from a human H1N1 strain. during a 2003 outbreak in the Netherlands.2.242.236 This particular isolate was found only once.80.80 Another survey reported seroprevalences of 0% to 1. H7.63 No animal-toanimal transmission was reported in asymptomatic cats infected by exposure to a sick swan. the overall seroprevalence was 4.12.3% of the general population were seropositive.11.6-5.38. however.12. prolonged contact.20 Illnesses caused by H5.81 In one study. H5.81 Symptomatic infections have occasionally been reported in H9N2-virus infected humans.82-90. Limited transmission of Asian lineage H5N1 viruses has been reported among zoo tigers and experimentally infected housecats. which had infected a turkey herd.38 Most of these infections have resulted from direct contact with infected poultry or fomites. Some currently circulating H9N2 viruses might undergo relatively frequent cross-species transmission. For example. three family members of poultry workers were also infected.43 Because exposure to these viruses can be high in some human populations.2. an H1N1 swine influenza virus.12 Zoonotic influenza viruses reported in humans Infections with avian or swine influenza viruses are reported periodically in humans. to date.12. H10N7 and H6N1. to date. these cases appear to be clinically indistinguishable from human influenza virus infections.11.38.

192 More severe syndromes. it may range from two to eight days and could be as long as 17 days. the most extensive person-to-person transmission was reported in 1976. 70% ethanol. when swine influenza in humans became reportable in the U.117. but in some cases. oxidizing agents. phenols.104.12 In most cases.190192 Infections with the novel H1N1 virus circulating in humans usually become apparent in two to seven days.190-192 Diarrhea. the symptoms may last up to two weeks or longer. and that it might have been circulating among pigs in an unknown location for years before it emerged in humans.216.131.98 There is no evidence that pigs are playing an significant role in the spread of this virus among people. acids.22 This virus remained limited to the base and did not spread to the surrounding community.131. rhinitis. transverse myelitis.190.256-258 In one recent study. five family members of an infected laboratory worker became ill.103. formaldehyde).130.191 In addition. influenza A has been associated with encephalopathy. who remained asymptomatic. Reye syndrome. there are few reports on their clinical features.192 Because influenza C viruses are difficult to isolate. vomiting and otitis media are common in children.204.99 As of December 2009.190. headache.190. can be seen in some individuals. chills.188 Nausea.201. as well as by ionizing radiation or low pH (pH 2).1. quaternary ammonium compounds. Serological evidence and one experiment in volunteers suggest that humans might be susceptible to equine viruses. 12 cases were reported to the CDC.21.21 One college student transmitted the virus to his roommate.3. weakness.12 Limited data from Asian lineage H5N1 infections suggest that.252 Equine influenza viruses and canine influenza viruses in humans aldehydes (glutaraldehyde. pericarditis and myositis. 1. this swine population has not been found.227 Avian influenza viruses seem to be more resistant to high temperatures and low pH than mammalian influenza viruses.S.216.249. which may include fever.23. approximately one case was reported to the Centers for Disease Control and Prevention (CDC) every 1-2 years.191 In young children. including pneumonia.190-192 Secondary bacterial or viral infections may also occur. In Czechoslovakia.21 Similarly.131.1.246-248 Although many swine influenza virus infections seem to be limited to a single person.250 Genetic analysis suggests that this virus was probably transmitted to people very recently.255 The incubation period for avian influenza in humans is difficult to determine.113.119-129.9 Infections in Humans Incubation Period The incubation period for seasonal human influenza is short. the initial signs may mimic bacterial sepsis. but more severe cases with lower respiratory signs including bronchitis or pneumonia can also occur.130. some recent descriptions suggest that clinical cases may be indistinguishable from influenza A or B. and febrile seizures can occur in severe cases. causing a pandemic. most infections appear after one to four days. for this virus.131.254. the first symptoms occur in two to five days.192. sometimes cases are followed by a few infections among close contacts.188.. In 2009. sneezing. the There are no published reports of equine or canine influenza viruses causing disease in humans after natural exposure.253 They can also be inactivated by heat of 56°C (133°F) for a minimum of 60 minutes (or higher temperatures for shorter periods).1 Disinfection Influenza viruses are susceptible to a wide variety of disinfectants including sodium hypochlorite. especially those with chronic respiratory or heart disease.191 Most people recover in one to seven days. 3.40 The World Health Organization (WHO) currently suggests using an incubation period of seven days for field investigations and monitoring patient contacts.131. New Jersey became seropositive to a swine influenza virus.93 From December 2005 through February 2009.93 Recent serological evidence suggests that swine influenza infections might occur regularly in people who have contact with pigs.1. abdominal pain and photophobia are also possible.1.190.12 Clinical Signs Seasonal human influenza Uncomplicated infections with human influenza A or B viruses are usually characterized by upper respiratory symptoms.2. myocarditis.000 people on a military base in Fort Dix.203.22 Until 2009.98. a novel H1N1 virus with genes of swine origin became established in human populations. anorexia.240. Last Updated: December 2009 © 2009 page 9 of 46 . These viruses are mainly thought to cause mild upper respiratory disease in children and young adults. and it is not known how humans acquired the novel H1N1 virus.1. several health care workers developed influenza symptoms after exposure to a pregnant woman with swine influenza in Wisconsin. povidone-iodine and lipid solvents.190.192.108. myalgia. sore throat and a nonproductive cough.2. Before 2005.206.251 but people might be involved in disseminating the virus to pigs and other animals.Influenza investigated and recognized as zoonoses. when approximately 500 of 12.

hoarseness of the voice and crackles during inspiration.264. a patient from Thailand exhibited only fever and diarrhea.12 Many patients develop lower respiratory tract disease shortly after the first signs.260.264 Multiple organ failure may be seen.257 This study also documented lower respiratory tract signs including pneumonia and bronchiolitis in a few patients. kidney disease. all six people recovered.38 In 2002.255.34 The symptoms included fever.259 Serious disease was most common in children less than two years of age.12 Most patients deteriorate rapidly.260. the novel H1N1 virus causes a relatively mild illness. Healthy children and adults.167. the symptoms may include chest pain.262 Most people have a self-limiting illness.12. headache.260.167.255. 347 total (suspected and confirmed) and 89 confirmed human infections were associated with an H7N7 HPAI outbreak among poultry in the Netherlands. particularly among children.167.33.205.260. in some cases.40 The respiratory secretions and sputum are sometimes bloodtinged.15. 256 Gastrointestinal symptoms including diarrhea and vomiting have been reported in some patients.205. tachypnea.40 Heart failure. In 2003. very young age or pregnancy increase the risk of severe disease.12.11.271 In some patients.271 Milder cases have been reported occasionally. coinfections with gastrointestinal pathogens were present in some but not all cases. Six unrelated H9N2 infections associated with acute respiratory disease were also reported from mainland China in 1998-99.11.38 The illnesses were mild and both children recovered.11.33-35. who would not be expected to have a high risk of complications.11. two patients from southern Vietnam had acute encephalitis without symptoms to indicate respiratory involvement. avian influenza (LPAI H9N2) was confirmed in two children with upper respiratory signs. as well as those with chronic medical conditions.34 One of the two people died.12.271 Respiratory signs are not always present at diagnosis.256.12 Some infections have been limited to conjunctivitis and/or typical influenza symptoms.255.260 Severe primary viral pneumonia and/or acute respiratory distress syndrome occur in a small percentage of cases. the first eighteen H5N1 infections in people were reported during an HPAI outbreak among poultry in Hong Kong. the novel H1N1 virus can also exacerbate chronic medical conditions.255. and disseminated intravascular coagulation can occur.40. and their condition rapidly becomes serious. severe respiratory distress and viral pneumonia.38 Asian lineage H5N1 viruses LPAI viruses. sore throat.264. but no testing was done. wheezing and/or otitis in some individuals. abdominal pain and vomiting in Hong Kong. which resembles the disease caused by other human influenza viruses. or gastrointestinal symptoms such as diarrhea.261. especially respiratory diseases such as asthma or chronic obstructive pulmonary disease.34.268 Avian influenza infections in humans Infections with avian influenza viruses have occasionally been reported in humans.12.258 A study from Spain reported high fever and lower respiratory tract illness.265 Like other influenza viruses.12 Eighteen people were hospitalized and six died. No other cases were found. arthralgia.266 Underlying health conditions.167. in a few infants. Novel H1N1 virus of swine origin In most people.11. 12. there may also be mucosal bleeding.260-262 Vomiting and diarrhea have been reported in a significant number of cases.267-270 A significant number of serious or fatal cases have been reported in healthy children or young adults. dyspnea.40. sore throat and cough and.12.11.12. In 1999.205.39 Asymptomatic infections with Asian lineage H5N1 viruses seem to be rare. and some cases may be complicated by secondary bacterial infections. sore throat and rhinorrhea were reported in four infected children in Cuba. severe enough to require hospitalization.12.257 Some influenza C infections may be asymptomatic. antibodies to an avian H7N2 virus were found in one person after an LPAI outbreak among poultry in Virginia. and may be fatal.12.261.38 High fever and upper respiratory symptoms resembling human seasonal influenza tend to be the initial signs.38. have been affected. were serious or fatal.41 The following human infections with Asian lineage H5N1 and other avian influenza viruses were reported between 1997 and 2009: In 1997.267.167.39 One H5N1 infection in a child with upper respiratory signs and an uncomplicated recovery after antibiotic treatment was recognized only by routine virus surveillance. pharyngitis.35 Most cases occurred in The Asian lineage H5N1 HPAI viruses appear to cause more severe disease than other HPAI viruses or Last Updated: December 2009 © 2009 page 10 of 46 . and recover within a week.38. bronchitis or bronchiolitis.259 Fever and cough were the most common signs in 14 patients from France. often progressing to respiratory failure within 24 hours. Another family member died of a respiratory illness while in China.15. but 29 of 179 children were hospitalized with more serious illnesses such as pneumonia. cough and rhinorrhea. 12 Similarly. other cases.11 In 2003.2. encephalitis and multiorgan dysfunction are common in the later stages. with rhinitis. vomiting and abdominal pain.260.265. fever.Influenza most common clinical signs were fever.2.40. cough. two HPAI H5N1 infections were reported in a Hong Kong family that had traveled to China.257 Fever. especially those caused by Asian lineage H5N1 viruses.34.262-265 Patients who become severely ill usually begin to deteriorate 3-5 days after the onset of the symptoms.

35 In 2003. All of the infections were associated with an H7N3 virus outbreak in poultry.26.11 The person. In 1980.2. mild dehydration and cough.240. was hospitalized but recovered.82 Serological evidence of possible infection was found in five contacts. while viruses from most of the other individuals had not. The virus isolated from the fatal case had accumulated a significant number of mutations.23. 11 In 2008. an H1N1 virus infection with influenza symptoms including diarrhea occurred in a young boy.11.2. It should be kept in mind that severe or fatal cases are more likely to be investigated than mild illnesses that resemble human seasonal influenza. As of December 11 2009. an LPAI H7N2 infection with respiratory signs was reported in a patient in New York. a mild LPAI H9N2 virus infection was reported in a 9-month-old child in Hong Kong. an H9N2 virus was found in a 2-monthold infant in China. Swine influenza virus infections in humans Serological evidence suggests that swine influenza virus infections might occur regularly among people who are occupationally exposed. coughing and muscle aches. including one who died of pneumonia.244 Serological evidence suggests that approximately 500 people on the fort had been infected by person-to-person spread.21. New Jersey in 1976.1. In 2004.36 The symptoms included mild fever. while other H7 viruses from milder human cases in North America were significantly less virulent.43 In 2007. 445 confirmed human cases had been reported to WHO.22 There was no evidence of spread to his family. but the infection did not spread further. An H1N1 swine influenza virus was isolated from five recruits with respiratory disease.21 page 11 of 46 .35 In 78 of the confirmed cases. but three family members also became ill. and died shortly after giving birth. (This virus is not the same virus involved in the swine-origin H1N1 pandemic of 2009.35 Two people had influenza symptoms such as fever.23 Reported swine influenza infections include the following cases.35 This virus also caused severe or fatal infections in experimentally infected ferrets and mice. an H1N1 swine influenza virus was isolated from a pregnant woman with viral pneumonia in Wisconsin. A localized outbreak was reported at Fort Dix. it is not known whether the symptoms caused by these viruses differ significantly from human influenza.11 One virus was LPAI. Five had both conjunctivitis and influenza-like illnesses. Several health care workers developed influenzasymptoms after exposure. From 2004 to 2008. Ten other infections were suspected but not confirmed.37 Last Updated: December 2009 © 2009 In 2009.196 Cases of conjunctivitis have been reported after contact with HPAI H7N7 avian viruses in infected seals.85 The farmer had been in contact with pigs showing signs of respiratory disease. who recovered. In 2003.88 She apparently became infected while attending an agricultural fair.35 His initial symptoms included a persistent high fever and headache but no signs of respiratory disease. In 1988. an H9N2 LPAI infection was confirmed in a child in Hong Kong. conjunctivitis was the only sign of infection. Swine influenza virus (H1N1) was isolated from an immunocompromised child with fulminant pneumonia who died in 1982. an H9N2 virus infection was reported in a 3-year-old child with a fever. Both people recovered after treatment with an antiviral drug.1. two cases of conjunctivitis and flu-like symptoms were confirmed in poultry workers in Canada.22 There was evidence that his roommate had been infected but remained asymptomatic.36 The child was hospitalized but recovered. cough and rhinorrhea in Hong Kong.37 She was hospitalized but recovered. There is no indication in the report that this case was more severe than the previously reported infections.22 Other people on the base may also have been ill with the same infection. 11. the other was HPAI. who had serious underlying medical conditions. sporadic human illness and deaths were associated with widespread outbreaks of Asian lineage H5N1 high pathogenicity avian influenza among poultry. these cases included both conjunctivitis and upper respiratory symptoms.12.) A self-limiting illness with influenza symptoms was reported in a college student infected with an H1N1 virus in 1979. In 1986. an H1N1 virus caused severe viral pneumonia in a 29-year-old swine farmer in the Netherlands. 263 cases were fatal.246-248 Because few infections with swine influenza viruses have been described.”) The single death occurred in an otherwise healthy veterinarian who developed acute respiratory distress syndrome and other complications. (Four cases were classified as “other.Influenza poultry workers.

1 Human volunteers inoculated with an equine virus became ill. the estimated period of communicability is from 1 day before the symptoms appear. In 1993.‟ Twenty of the 37 civilian patients were previously healthy. fever and myalgia. Last Updated: December 2009 © 2009 Centers for Disease Control and Prevention (CDC). A recent literature review summarized 49 cases of swine influenza that had been documented in scientific journals as of April 2006 (including many of the cases described above).153. coughing. and one case was thought to have been transmitted from person to person.24 He recovered without complications. an Asian H1N2 swine influenza virus was isolated in the Philippines from a 25-yearold man with symptoms of influenza including high fever. and one additional case identified in an ongoing survey of swine influenza among farmers. 11 human infections with triple reassortant H1N1 swine influenza viruses were reported to the U. and there was no evidence that the virus had infected others.190. In November 2008. No one who had been in contact with the caretaker became ill.192 Young children can shed virus for up to six days before. 190. Equine and canine influenza virus infections in humans Antibodies to equine H3N8 viruses have been reported in humans. but all of the gene segments were of swine influenza virus origin.190. an H1N1 swine influenza virus caused severe viral pneumonia in a 5-year-old child who lived on a pig farm in the Netherlands. Communicability Human influenza viruses are readily transmitted from person to person. and only one person was seropositive. others had immunosuppressive conditions including cancer and pregnancy.89 The virus.87 The physician who treated her reported an influenza-like illness shortly afterward. and 10 or more days after they become ill. The infected individual was given antiviral drugs. the other 37 were described as „cases in civilians. Two children were hospitalized for dehydration. dizziness and occasional vomiting. a recombinant swine influenza virus was recovered from a farm worker with influenza symptoms in Canada. but lived on a communal farm.187 For the novel (2009 pandemic) H1N1 virus. Four of 7 household members and 4 of 46 other people on the farm had antibodies to this virus. Two patients. but was not tested for the virus. In 2005.90 The child was hospitalized but recovered.191 Humans have transmitted influenza viruses to ferrets and occasionally to swine. a healthy young laboratory animal caretaker in Maryland died of pneumonia caused by an H1N1 influenza virus.1. but recovered. a 26-year-old previously healthy woman and a 48-year-old woman with asthma and a history of smoking. Most patients recovered. acute respiratory disease or pneumonia. He had no direct contact with animals. human and avian influenza viruses. but recovered without other complications. Nine of the patients had a history of contact with pigs. All cases were described in the literature as upper respiratory disease. and are infectious for 3-5 days after the initial signs. but seven deaths were reported. Between 2005 and February 2009. to as long as 7 days after their page 12 of 46 . an Asian H1N1 swine influenza virus was isolated from a 4-year-old boy in Thailand with rhinorrhea. One patient had three family members with suspected but unconfirmed swine influenza virus infections.84 The symptoms included fever. Other workers on the farm were treated prophylactically and did not become ill. vomiting.3. Four cases involved H3N2 viruses.S. myalgia. The virus appeared to be a reassortant. and virus could be isolated for up to 10 days. Infected adults usually begin to shed influenza A viruses the day before the symptoms appear.Influenza In 1991. headache.85 In 2004. In 2007. experienced severe illness with pneumonia and respiratory failure. There was no evidence of person-to-person transmission.21 Thirteen of the cases were from the outbreak at Fort Dix. No other potential cases were associated with this infection. was a triple reassortant H3N2 virus with genes from swine.83 He had close contact with pigs in a research facility. and recovered uneventfully. In 2005. diarrhea.86 This case was diagnosed only because the physician participated in an influenza surveillance program and collected a laboratory sample for virus identification.185. the remainder were H1N1. sore throat. self-limited case of H1N1 swine influenza was reported from a 50year-old woman who worked on a swine farm in Spain. which was also found in sick pigs on the farm.1 There are no reports of clinical cases caused by natural exposure to equine influenza viruses or canine influenza viruses. a mild. an H3N2 swine influenza virus was isolated from an infant with respiratory disease in Canada.24 The child recovered without complications.191 Severely immunocompromised individuals may remain infectious for weeks to months. shortness of breath and conjunctivitis.

with identification by hemagglutination and neuraminidase inhibition tests or by RT-PCR.S. however.119-129.190. antigen detection or virus isolation from respiratory and throat swab samples. if treatment is begun within the first 48 hours.93. Drug resistance develops rapidly in viruses exposed to amantadine or rimantadine.40 Serology has been used for surveillance.110. The current immunofluorescence or rapid antigen tests for human influenza cannot distinguish other human influenza viruses from the novel H1N1 virus.131. Avian influenza viruses can be identified by RTPCR.190.277Treatment usually results in milder symptoms and recovery.274. turkeys.22. samples that test positive by PCR or antigen tests are confirmed by the CDC. or infections that have an elevated risk of complications.191 RT-PCR techniques are also available.276 Treatment Supportive care for uncomplicated influenza in humans includes fluids and rest.108. but does not detect the hemagglutinins in common human influenza viruses suggests a novel. including the use of antiviral drugs. The viruses can be isolated in cell lines or chicken embryos.S.131.2.40 Virus isolation is done at World Health Organization (WHO) H5 Reference Laboratories.131. human influenza viruses circulating in the U.113. at most. influenza virus.are used to treat influenza. The microneutralization assay is the most reliable test for detecting antibodies to avian influenza viruses.1.272 Atypical prolonged shedding up to 28 days (by PCR) has been reported in healthy adults with severe or relatively severe cases.40 RT-PCR is usually the primary test for infection with Asian lineage H5N1 viruses. New Jersey. and Canada exhibited high resistance to amantadine and rimantadine.191 Commercial rapid diagnostic test kits can provide a diagnosis within 30 minutes. have been reported in humans infected with avian influenza viruses.191 Testing must be done to determine each individual virus‟s drug susceptibility. felids and dogs have apparently been infected from human contacts.202 Infections with the novel H1N1 virus can be confirmed by RT-PCR or virus isolation from respiratory secretions.277 Laboratory studies have shown that influenza viruses can also become resistant to zanamivir and oseltamivir. and no cases of sustained transmission. may occur.000 people.277 Zanamivir and oseltamivir are effective for both influenza A and influenza B.191 Infections can also be diagnosed by serology.93. which contained 12.93. zanamivir and oseltamivir . 249 One study presented at a recent conference found that viral nucleic acids could be detected by reverse transcription polymerase chain reaction (RT-PCR) assays in children for 1 to 13 days after they became febrile. may be treated with antiviral drugs.190-192. 275 Last Updated: December 2009 © 2009 page 13 of 46 .272 Children and people who are immunocompromised might be infectious for longer.179.277 The novel (swine origin) H1N1 virus circulating among humans in 2009 is resistant to amantadine and rimantadine (adamantanes).11. were infected or exposed. possibly zoonotic. however.82 There are two known outbreaks with more extensive spread.190.94 Approximately 500 people on the base.35 Fecal shedding of the Asian lineage H5N1 virus has been documented in a child with diarrhea.278-280 Oseltamivir-resistant isolates of this virus have been reported sporadically.190 During the 2006-2008 flu seasons.191.191.21. including neuropsychiatric events. Swine herds.275 Serology is currently used mainly in epidemiology and research.261.191 RT-PCR or culture can be used for the diagnosis of influenza C. the virus did not spread to the surrounding community.275 Samples should be collected as soon as possible after the onset of illness..167.104.273 Humans can transmit the novel H1N1 virus to animals as well as people.277 Amantadine and rimantadine (adamantanes) are active against human influenza A viruses.190-192.11.131.281 Diagnostic Tests Human influenza A and influenza B infections can be diagnosed by virus isolation or by the detection of antigens or nucleic acids.191.234 Swine influenza viruses have typically been transmitted only to a few close contacts.190.38.280.11.22 The other is the 2009 H1N1 pandemic in humans.278 Current recommendations for the treatment of infections with the novel H1N1 virus.22.103. Four drugs amantadine. this appears to be less common than resistance to adamantanes.274.1.252 Rare cases of probable person-to-person transmission. More severe cases. but they are currently uncommon. and may emerge during treatment.249 People may shed this virus for as long as they are ill. and in some cases. 231 Transmission of this virus across the placenta may also be possible.1. and virus could be isolated for 1 to 7 days. but it is usually sensitive to oseltamivir and zanamivir.11.131. ferrets.277 Side effects. rimantadine. Antigens can be detected in respiratory secretions by immunofluorescence or enzyme-linked immunosorbent assays (ELISAs). Serological tests include complement fixation.131.2.117. for 2-3 days after the fever has resolved. hemagglutination inhibition and immunodiffusion.277 The CDC recommends that these two drugs be avoided until the circulating strains become susceptible again. one day sooner.40 In the U. are available on the CDC and WHO Web sites (see Internet Resources). on average. One was a localized outbreak among recruits infected with an H1N1 virus at a military base in Fort Dix. RT-PCR and antigen testing of avian influenza viruses must be carried out in Biosafety Level (BSL) 2 laboratory conditions. a rising titer must be seen.Influenza onset.190.1.40 Enhanced BSL 3+ laboratory conditions are needed for the isolation of H5N1 HPAI viruses.40 An influenza test that is positive for influenza A.

nose or mouth.292 Prevention Preventative measures for seasonal human influenza viruses An annual vaccine is available for influenza A and B. communities or non-healthcare occupational settings. as well as frequent hand washing.190. people may be monitored. in meat).290 The CDC has published specific guidelines for self-isolation and treatment.131 It contains the viral strains that are most likely to produce epidemics during the following winter. the CDC recommends that these two drugs be avoided in the U. including frequent hand washing.amantadine. anyone who has a flu-like illness should avoid contact with this species. rimantadine and oseltamivir . people at an increased risk for complications should consider avoiding crowded conditions or close contact with others.93. Preventative measures for swine influenza viruses occurring in pigs Good hygiene and sanitation. people who are ill should avoid contact with these animals.287 In other cases. To protect ferrets from infection with human influenza.277 Other preventative measures include the avoidance of contact with people with symptomatic disease.283 There appears to be little or no cross-reactivity with the H1N1 strains in the current seasonal human influenza vaccine.1°C).11.263.191. as well as recommendations for infection control measures in health care settings (see Internet Resources).11 Although resistance to zanamivir and oseltamivir has also been reported in H5N1 viruses.131.40.292. There is no indication that any swine influenza virus can be acquired by eating well-cooked pork.S.. particularly if it is given early.Influenza Oseltamivir appears to increase the chance of survival in patients infected with Asian lineage H5N1 viruses.285 but vaccines for the novel H1N1 virus became available in Fall 2009. as influenza viruses have been transmitted occasionally to or from this species. vaccine types.191 Three antiviral drugs .187 If contact is unavoidable.190.286 Antiviral drugs may be used for prophylaxis in some high risk populations after exposure.g.can be used for prophylaxis in high-risk populations such as the elderly or immunocompromised.261. but they may be used voluntarily by individuals at risk for complications. cats (both housecats and other felines) and dogs.12.291 Face masks and respirators are no longer recommended in homes. particularly turkeys. Because infections with seasonal human influenza viruses cannot be distinguished clinically from infections with the novel (pandemic) H1N1 virus. the prevention of crosscontamination of foods or surfaces used for food preparation. the avoidance of unnecessary hand contact with the eyes.40 These viruses are resistant to amantadine and rimantadine.289.191.284 Last Updated: December 2009 © 2009 page 14 of 46 .271.249.282 Further testing. good hygiene and the use of face masks and/or other measures that prevent accidental droplet transmission from coughs and sneezes may be helpful. can help prevent human infections with swine influenza viruses.284 To protect others. it is currently uncommon. Preventative measures for the novel H1N1 virus circulating in humans Preventative measures are similar to those for seasonal human influenza.249.190 The vaccine is given in the fall before the flu season. and it is updated annually. and recombination can occur between human and swine influenza viruses. seeking medical care). and the use of hot soapy water to wash contaminated surfaces would be protective if any viruses survived long enough to reach consumers.277 Due to the high resistance of currently circulating viruses to amantadine and rimantadine.291 People who remain home should minimize contact with others in the household during their illness. as well as hand washing and other hygiene measures.93. Where limited quantities of these vaccines are available. Details on vaccine efficacy. 211 Ordinary food safety precautions including hand washing before and after handling raw meat. and include the avoidance of close contact (approximately 6 feet) with people who have flu-like illnesses. and recommendations for vaccination in specific population groups are available from the CDC.284 To prevent virus transmission to pigs.249. gloves and other personal protective equipment also reduce exposure. particularly on the optimum dose and duration of treatment.190. Protective clothing. anyone with an undiagnosed flu-like illness should also avoid unnecessary close contact with species susceptible to the latter virus. is still needed. until the influenza strains become susceptible again. and by cooking pork to an internal temperature of 160°F (71.288 The CDC currently recommends that anyone infected with the novel H1N1 virus and anyone who has an undiagnosed flu-like illness limit contact with others. ferrets. and other common sense hygiene measures.290.287 The CDC Web site has detailed information on the current recommendations. Care should also be taken to avoid spreading the virus to other animals.12. and treated at the first sign of disease. and stay home except for necessities (for instance. and they are not ordinarily expected to occur outside these tissues (e.1. the mouth and nose should be covered when coughing or sneezing.292 Influenza viruses are also killed by sanitizing cutting boards with 1 tbsp bleach in a gallon of water.287 In areas where infections with the novel H1N1 virus are common. swine influenza viruses replicate in the lungs and upper respiratory tract. Avoidance of contact with swine should also be considered.40. specific risk groups may be targeted first for vaccination.293 In pigs.157.

but can occur. Until recently. an influenza virus usually becomes established in the population and circulates for years. and these birds could be the initial source of infection in an area.295 If birds or contaminated surfaces are touched.11 In addition. coveralls.190.295 The hands.295 Dead or diseased wildlife should be reported to state. uncomplicated infections with human influenza viruses are rarely fatal in healthy individuals.296 Respirators and other protective equipment may be advisable during close contact with an infected individual.191 Over 90% of these deaths occur in the elderly. the hands should be washed with soap and water before eating.” epidemics in temperate regions usually do not begin until after school starts in the fall. the World Health Organization recommends prophylaxis with antiviral drugs in people who cull birds infected with Asian lineage H5N1 HPAI viruses.11 Eggs should be cooked until the whites and yolks are both firm. 296.000 deaths were reported in the U. as well as equipment and surfaces.3 years.297 Morbidity and Mortality Seasonal human influenza Although the morbidity rate for seasonal influenza is high.131 Epidemics in tropical regions are not usually seasonal. In areas where H5N1 viruses might be present in domesticated poultry.0075% between the ages of 50 and 64.191 Immunity to the viral surface antigens (the hemagglutinin and neuraminidase) reduces the risk of infection and severity of disease.11 Cutting boards and utensils should be washed with soap and hot water.11 Poultry should be cooked to a temperature of at least 74°C (165ºF).2. influenza appears first among schoolaged children.11. and those who are immunosuppressed. Antibodies offer limited or no protection against other virus types or subtypes. and they should always wear rubber or latex gloves while handling and cleaning wild birds.202 Influenza C infections seem to be most serious in very young Last Updated: December 2009 © 2009 page 15 of 46 .191 Pandemics.11.295 If an avian influenza pandemic occurs in humans.131. people in contact with infected birds should be vaccinated against human influenza. and an epidemic of influenza B every 3-4 years. crowded conditions and close contact with other people should be avoided.295 Hunters should not handle or eat sick game.1% in those over 65.20 Approximately 500. in 2004.1. these vaccines are stockpiled by the government and will be distributed by public health officials if they are needed.131 During epidemics. gloves and respirators.11.190. people with respiratory or cardiac disease. smoking.20. poultry farms and live bird markets should be avoided. and intensive care procedures were less effective. Sanitary precautions and cooking methods recommended to destroy Salmonella and other poultry pathogens are sufficient to kill avian influenza viruses. additional precautions will be necessary.20.20 Although a new virus may spread among a population before the “flu season. After a pandemic.0004 . 1957.11 Less is known about influenza C than influenza A or B. drinking.S. young children (particularly infants). a pandemic or as sporadic cases. these viruses were thought to cause only sporadic cases of influenza and minor localized outbreaks.0.2. Wild birds should be observed from a distance. which last occurred in 1918.131 It should be noted that antiviral drugs and antibiotics were not available at the time.1.131 During a typical epidemic.11.190 Human influenza can occur as a localized outbreak. an epidemic.1.131 During influenza pandemics. 296 In addition.S.192 Infections are more severe in the elderly.1.2 In North America.294 Avian influenza vaccines for humans are not commercially available in the U. then spreads to preschool children and adults.20 They are also discouraged from having contact with sick birds while suffering flu symptoms.294 In the U.1. 0.1.191 In the most severe pandemic. and an estimated 20-50 million deaths worldwide.191 Deaths are rare in children. close contact is discouraged. in 1918.201 However. are caused by antigenic shifts in influenza A viruses..20 H5N1 vaccines have also been developed.11 Precautions should also be taken when handling raw meat and eggs.12 People working with infected birds should follow good hygiene practices and wear appropriate protective clothing such as boots (or shoe covers). should be thoroughly washed after dressing the carcass.192 Since 1968.1. cancellation of social events and voluntary quarantines of infected individuals can limit the spread of disease. tribal or federal natural resource agencies.188. the morbidity and mortality rates may increase dramatically in all age groups.131.20. and 0. During a pandemic.0006% in persons under 50 years old.190 The estimated mortality rate from seasonal influenza is 0. 1968 and 2009. an epidemic of influenza A usually occurs every 1.16. the morbidity rate was 25-40% and the case fatality rate 2-5%.20 The outbreak usually lasts for three to six weeks. the type A (H3N2) viruses have caused the most serious outbreaks with the highest mortality rates.12. infection control measures such as good hygiene.12 To prevent reassortment between human and avian influenza viruses.131.131. a nationwide influenza C epidemic was reported in Japan.16.11 Avian influenza viruses can be carried in wild birds.11 The hands should be washed thoroughly with soap and warm water after handling poultry products.295 All game should be cooked thoroughly.Influenza Preventative measures for avian influenza viruses Controlling avian influenza epidemics in poultry decreases the risk of exposure for humans.1 Antigenic drift is usually responsible for small-scale epidemics and localized outbreaks.S.190. 15% to 40% of the population may be infected. or rubbing the eyes.192.190-192 Influenza-related deaths are usually the result of pneumonia or the exacerbation of a cardiopulmonary condition or other chronic disease.

259 however. Because the virus emerged in April.206.262.21.262. In a series of 11 infections with North American triple reassortant Last Updated: December 2009 © 2009 page 16 of 46 . 1.302-304 In June.269 The mortality rate in the Southern Hemisphere was relatively low.265 In Taiwan. severe or fatal cases have also been reported among some young.264.84 Most sporadic cases of swine influenza have been relatively mild and some may have been asymptomatic. at least twelve additional cases thought to be swine influenza were reported.269 In Victoria.307 The reported percentage of hospitalized patients who have had no significant preexisting conditions ranges from approximately 24% to 59%.205.240.307 The impact of the novel H1N1 virus has been greater among indigenous people in both the Northern and Southern Hemispheres.167.167. more than 622.22. previously healthy individuals.1.269 Although the vast majority of cases have been mild and uncomplicated. this occurred first in the Southern Hemisphere.2. depending on the country and the conditions that are defined as predisposing.21.95.2.3% of those infected were hospitalized. this underestimates the number of cases.8 per 100.306.267-270.246-248 Swine influenza infections have been reported among farm workers.167.266 The risk of severe illness has been greatest in children under the age of 2 years (especially infants under a year of age).307.21. who are not ordinarily expected to be at high risk.310 and this group has had lower morbidity rates than expected.298-301 2009 pandemic: Novel H1N1 virus of swine origin Morbidity and mortality information for the novel H1N1 virus are still preliminary.268. and serological evidence of infection was found in approximately 500 of 12. a human pandemic was declared. but they are more likely to have severe symptoms if they become ill.265.256.302-304 This was followed by the identification of the virus among travelers in other countries. and those who are obese. 85% of these critically ill patients survived.2.264.260.269 Transmission of the novel H1N1 virus appears to have declined normally after the flu season in the temperate regions of the Southern Hemisphere. one had secondary bacterial infection. but some severe illnesses and a few deaths have been reported.82-90 During the outbreak at the Fort Dix military base.0 to 31.93.205.000 people on the base. however.000 population. one person died of pneumonia.23.22. with hospitalization and mortality rates that were 3-7 times greater than in non-indigenous groups. and an additional 12% were between the ages of two and five.82. individual countries reported mortality rates from 0 to 36.1 per million population. In one study.83 The health status of one person was not known. the overall mortality rate from influenza was lower than in previous years. with less than 1 death per 100.265.1. then by the recognition of sustained person-to-person transmission outside Mexico.305 Because many countries no longer count or report individual cases.307 HIV infection was linked to more severe illness in South Africa. other probable cases were suspected. and a meat packer. particular those that are mild. However. people with underlying health conditions such as chronic respiratory disease.167 Unusually. with 20% of hospitalized patients transferred to an intensive care unit (ICU).260. and two were immunosuppressed by cancer.257. serological studies suggest that a large percentage of the population is exposed to influenza C viruses in childhood.260.264.22.269 but data from other countries suggest that this is not necessarily the case among HIV-infected individuals who are receiving antiretroviral drugs. serological evidence suggests that exposure may be relatively common among people who work with pigs.250 As of November 27 2009. but severe illness was seen in some high risk groups. 279 The autumn flu season in the Northern Hemisphere has been very active in the initial stages.269 A small number of H1N1 infections may be asymptomatic. most (75%) in people who had other health issues. viral pneumonia has been a significant concern with this virus. The initial outbreak with this virus occurred in Mexico in April.255.96.22.279.260.284. visitors at agricultural fairs or livestock shows. like other human influenza viruses. 21. and 0. some cardiovascular conditions or immunosuppression.259 Symptomatic influenza C infections are reported less often than illnesses caused by influenza A or B viruses. 30% of the children hospitalized with severe infections were less than two years old.279.167.800 deaths attributed to this virus had been reported to the World Health Organization. Australia.24.249.306 In New South Wales. the mortality rate among 91 hospitalized patients was approximately 10%.000 cases and 7. and one had extensive involvement of the abdominal organs.Influenza children. of 37 other cases reported in the literature.305.21 Infections not associated with swine contact have included instances of limited person-to-person transmission and some published cases with no known connection to swine.308 Some older people may have some immunity to the novel H1N1 virus.1.2. which begins in the autumn. one was pregnant. the reported hospitalization rates from various countries ranged from 2.95.265 In Victoria. Australia.21 Four of these patients had primary viral pneumonia.279.264. laboratory workers.269 Peru reported 8381 confirmed cases and 143 deaths. approximately 5% of the population is thought to have become ill.279. During the flu season in the Southern Hemisphere.306 Secondary bacterial infections have also contributed to some severe cases and deaths. pregnant women.309.269 Zoonotic swine influenza The overall prevalence of swine influenza virus infections in humans is unknown.000 population in most countries.96.206.305 Cases were reported in both the Northern and Southern Hemispheres during the initial stage of the outbreak.21 Two patients who died were described as previously healthy. six cases were fatal. the novel H1N1 virus has been transmitted most widely during the traditional flu season.267.244 One review reported that.

starlings.71. storks and herons (order Ciconiiformes). raccoon dogs and captive palm civets (Chrotogale owstoni).136 Disease can also occur in passeriform birds.240-242. Zoonotic avian influenza The severity of avian influenza varies with the virus isolate.71. cats. cranes. pinnipeds and cetaceans.55.208. goshawks.33-38. H9. two children were hospitalized for dehydration.311-313 A few milder cases have been documented.271. Wang2009 /id] Whether these antibodies result from productive infections.11.Influenza H1N1 swine influenza viruses between 2005 and 2009.36-38. dogs. Avian influenza viruses Avian influenza viruses mainly infect birds. but some strains can also infect and/or cause disease in mammals. emus and passerine birds.12. Many H5N1 viruses have been isolated from birds in the order Anseriformes.43 Higher or lower case fatality rates have been reported in smaller series. as of December 11.224 Symptomatic infections with Asian lineage H5N1 viruses have also been reported in mammals including captive tigers (Panthera tigris). mynahs. A single death was reported in an otherwise healthy veterinarian who became infected with an H7N7 virus.60.67.71. was 59%. Oriental magpie robins (Copsychus saularis). orioles.54.11. horses.11.43 The overall case fatality rate. shrikes. budgerigars (order Psittaciformes). munias. Influenza viruses Asian lineage H5N1 viruses can infect and/or cause disease in many species of birds in addition to poultry.40 From 2003 through December 11 2009. 3.57.317 Asian lineage H5N1 viruses have also been found in a variety of birds that appeared healthy. such as the Asian lineage H5N1 viruses or an H5N3 virus isolated from terns in the 1960s. owls (order Strigiformes). wood ducks. During an H7N3 LPAI outbreak in Italy in 2003. terns. no seropositive individuals were identified in serum samples collected during H7N1 epidemics from 1999-2002. guineafowl and peafowl (order Galliformes). lions (Panthera leo) and Asiatic golden cats (Catopuma temminckii).25. jackdaws.26. Japanese white-eye (Zosterops japonicus) and magpies.11. antibodies to H4.38.314 In other studies. partridges. particularly among children. a dog.314 Interestingly.207. depending on the subtype and strain of the virus.34.9. crakes. Peiris2009 /id. were reported to WHO. kites. exposure to antigens or crossreactions with human influenza viruses remains to be determined. only individual cases or limited outbreaks have been reported in others. ravens.39 One H5N1 infection in a child with upper respiratory signs and an uncomplicated recovery after antibiotic treatment was recognized only by routine virus surveillance. Cong2007 /id. mesias. cormorants and pelicans (order Pelecaniformes). hornbills (order Coraciiformes) and flamingos (order Phoenicopteriformes).44-53.142.136. H6.1. Eurasian tree sparrows (Passer montanus). farmed ostriches.12. varying with the country and the clade of the virus.16 Poultry can develop serious or mild disease.51. there was no apparent difference in the prevalence of the H5N1 virus between waterfowl and other birds.4455 Asymptomatic infections have been reported in some Last Updated: December 2009 © 2009 page 17 of 46 . appear to be the natural reservoir hosts.73.137.39 The prevalence of human infections with Asian lineage H5N1 viruses is unknown.61-63.8% of poultry workers tested developed antibodies to H7 viruses. H5.11.9. eagles.72.319 Symptomatic or fatal infections have also been reported in pheasants. swans and geese) and Charadriiformes (shore birds. gulls and terns). 51. Jia2009 /id.2. and buzzards/ vultures (order Falconiformes).11 Most patients infected with these viruses have been young and have had no predisposing conditions.51. H10 and H11 avian influenza viruses have been found in poultry workers.34. H7. jungle fowl. falcons.38.138-142.196 Waterfowl and shorebirds.41 Human disease has also been reported occasionally after infection with various H7 viruses and H9N2 viruses.11. which tend to carry these viruses asymptomatically. crows.71. egrets. quail.12. leopards (Panthera pardus).84 All of the patients in this study recovered. kestrels.26. moorhens.58. stone martens (Mustela foina). and they have not been-fatal.315-318 Host range of the Asian lineage H5N1 avian influenza viruses Infections in Animals Species Affected Influenza A viruses Influenza A viruses can cause disease in birds and many mammals including swine.54. species that can be affected include finches. unrecognized infections.51.16. however. ferrets. as well as housecats.13.51. 263 of them fatal. mink. bustards.69. pigeons (order Columbiformes).35 Some isolates may also cause asymptomatic or mild.194. veterinarians and waterfowl hunters. A few isolates.74 Most infections with H7 viruses have been limited to conjunctivitis. coots and sultans (order Gruiformes). house sparrows (Passer domesticus). grebes (order Podicipediformes). clouded leopards (Neofelis nebulos). but influenza symptoms have also been seen. and severe illnesses were reported in a previously healthy 26year-old woman and a 48-year-old woman with asthma and a history of smoking. Particularly severe infections have been reported with Asian lineage H5N1 (HPAI) viruses. emus (order Struthioniformes). particularly the families Anatidae (ducks.65. watercocks.74 The reported infections with H9N2 viruses have resembled human influenza. can also cause serious disease in other avian species including gulls.224 In a recent study from Thailand. red-billed leiothrix (Leiothrix lutea). circulate in some of these species. a wild mink (Mustela vison). 445 laboratory confirmed human H5N1 avian virus infections.1. asymptomatic infections seem to be rare.

189 Novel H1N1 virus of swine origin In ferrets.9Antibodies to influenza A viruses have been reported in sea lions and porpoises.9. H4.324-327 In 1984. foxes.3 Outbreaks have been described recently in ferrets and mink. and they can be infected experimentally with avian LPAI H4N8 viruses and human H3N2 viruses. and other species may also be susceptible to infection and/or disease. crocodiles. which was avirulent for both poultry and pigs.S. H3N3. H7N7.1. and an H3N2 virus isolated from cattle caused an illness resembling influenza in calves.9 Influenza B viruses Influenza B viruses can cause disease in humans.32.196. and H1N3.29 An H3N2 virus has been reported in dogs in Korea.1. serological evidence of infection or exposure has been reported in cats.194. rodents. dogs.28.58. an H10N4 virus was isolated from mink during an epidemic in Sweden.9 This virus is thought to have been of avian origin. but the animals remained asymptomatic despite shedding virus.262. sheep. pigs.1. clinical cases or outbreaks have been reported in animals infected with human influenza viruses.5 The novel (swine origin) H1N1 virus circulating in humans has infected pigs and turkeys.213 Recently.144 One H1N1 swine influenza virus. and influenza A viruses have been detected by RT-PCR in caimans. H4 and H10 viruses. closely related to avian viruses. canine influenza virus infections have not been reported in other species. H7N7.322 and an H1N1 swine influenza virus. 175 Experimental infections have been established in cattle. yak.4.9 Raccoons in the U. and dogs. H13N2 and H13N9 viruses have been isolated from whales.126-129 Experimental infections have been established in ferrets. chickens exposed to infected pigs did not become infected.133. and Asian lineage H5N1 viruses have been recovered from populations of apparently healthy wild pikas. cattle and birds. and H3N8 and H4N6 avian influenza viruses have been established in mink.146 Experimental infections have been reported in calves.9.1.1.238. an H3N8 equine influenza virus jumped into dogs.152.189 Unpublished research suggests that some raccoons in Japan have antibodies to H5N1 viruses.5. 9 Serological evidence of infection with influenza A viruses has also been reported from some other mammals including cattle.125.193 Experimental infections have been established in housecats. H3.119122. alligators. infections with equine H3N8 viruses were reported among pigs in China.60-70 Cattle can be experimentally infected with viruses isolated from cats. 9 Antibodies to influenza A viruses have been reported in reptiles and amphibians including snakes.262.153 Experimental infections have been established in horses and raccoons.185-188 They can also infect pigs.56. cynomolgus macaques and rabbits.91 Experimental infections with avian.197 Serological evidence of infection has been found in pigs.100-118.322 In one experiment. H1N1 swine influenza virus.5.232.165.9 There is evidence that some of these viruses were avian. and have been reported in dogs.1.59 Unpublished research suggests that some raccoons in Japan also have antibodies to H5N1 viruses.170.321] A few clinical cases have also been reported in pet ferrets. ferrets and seals. a cheetah in a zoo.Influenza housecats. alligators and crocodiles.2. dogs and swine. including humans.58.34. and antibodies to equine H3N8 viruses have been detected in dogs and humans. goats. ferrets.1. toads and frogs. An H3N2 swine influenza virus caused a recent outbreak in mink.119-124. To date.310. H3.320.51.173 The new H3N8 canine influenza viruses have diverged genetically from the viruses found among horses.310. horses and seals. and these viruses have also been isolated from pigs and a horse.1.30 and circulate only in dogs.91.25.144 Experimental infections with H1N1 and H3N2 human influenza viruses. cats.29. dogs.168. and viruses have been isolated rarely from pigs in China.215 Clinical cases have also been reported in dogs exposed to infected horses.174.174. H3N8 equine influenza virus. swine and equine influenza viruses have also been established in this species.328 Influenza A infections have been reported sporadically in cetaceans.70 The currently circulating H5N1 strains are continuing to evolve. dogs and humans. H8N4 and H11N4 viruses.145 Human influenza viruses Human seasonal influenza A viruses mainly cause disease in people and ferrets.57. H7. becoming the first canine influenza virus.9 Mink can also be infected with H5N3. caimans. was isolated from a duck in Hong Kong.184 Swine influenza viruses Swine influenza viruses mainly affect pigs. 9 Human influenza viruses have been isolated from some of these species.132 During outbreaks in poultry.193 Influenza A viruses can infect pinnipeds and cetaceans.1. suggest that influenza B infections in swine are sporadic and do not spread to other pigs. human and equine influenza viruses. but they can also cause disease in turkeys.169 Recently. reindeer and deer.323 Last Updated: December 2009 © 2009 page 18 of 46 . donkeys and mules.328 Serological studies from the U. Equine and canine influenza viruses Influenza viruses in other species Equine influenza viruses mainly affect horses.9 Antibodies to H1.1. H8 and H12 viruses have also been found in these animals. H6.185-188 the novel (swine origin) H1N1 virus.K. but they can also occur in zebras. H4N5 and H4N6 viruses. have serological evidence of infection with H1.32.3. have been isolated from seals. mice and cynomolgus macaques (Macaca fascicularis).170.

13.147.13 The incubation period for mammalian influenza viruses is also short.25.19 Sudden death of large numbers of birds is a common presentation. blood-tinged oral and nasal discharges.3.13-15 However. the most common signs are sinusitis. lacrimation. ecchymoses on the shanks and feet. mimicking high pathogenicity avian influenza.317 Incubation Period In poultry. respiratory signs.73.343 There are few descriptions of the clinical signs in other domesticated birds.14 A 21-day incubation period. and died rapidly. respiratory distress and/or neurological signs were seen.219. and in some cases.7.8 Clinical signs tend to be minimal in ducks and geese infected with avian influenza viruses. with decreased feed and water consumption. depression and neurological signs. the clinical signs included weakness.168.6. but most cases appear in 2-3 days.170. including most HPAI viruses.54 In other cases. it is also possible for an HPAI virus to be isolated from gallinaceous birds showing mild signs consistent with LPAI. The clinical signs usually appear within 1-3 days in horses.19 In addition.136 Most infected gulls died. and ruffled feathers. which remained asymptomatic. there can be coughing. 1.18.13. and all of the birds died within five days of inoculation.330 The incubation period for H3N8 canine influenza can be two to five days.343 Symptomatic infections with H5N1 viruses have also been reported in experimentally infected gulls and passerine or psittacine birds.71-73.13-15.1. within a few hours.54.14. ruffled feathers.137.54 Swans have been severely affected by H5N1 viruses. another recovered completely.319 Experimental infections with H5N1 viruses resulted in severe neurological disease in some mute swans and sudden death in others.18.19 Last Updated: December 2009 © 2009 page 19 of 46 . some recent H5N1 isolates have caused severe acute disease with neurological signs and high mortality rates in domesticated ducks.18 Decreased egg production. One gull that recovered had a persistent head tilt.5. northern pintails (Anas acuta). anorexia.11-13. Ostriches that were experimentally infected with an HPAI H7N1 virus developed mild depression and hemorrhagic diarrhea. severe weakness and neurological signs. but some indigenous North American ducks including mallards (Anas platyrhynchos). pigs or seals.140 Green diarrhea was the only sign of illness in ostriches inoculated with an LPAI virus of the same subtype.329 although incubation periods up to 5 days have been reported in some horses. or somewhat increased flock mortality rates may be seen. and sudden death may occur with few other signs.3. extreme lethargy. fever first appeared at 24 hours in experimentally infected dogs.19 Most of the flock usually dies. diarrhea and increased mortality. but some strains can cause illness and death. decreased egg production. respiratory signs. loss of egg pigmentation and deformed or shell-less eggs.136.54. and starlings. blue-winged teals (Anas crecca) and redheads (Aythya americana) remained asymptomatic when inoculated with one of these strains.136.13. can occur if the birds are concurrently infected with other viruses or there are other exacerbating factors.201 These viruses can cause disease in experimentally infected dogs.11. which takes into account the transmission dynamics of the virus. decreased fertility or hatchability of the eggs. turkeys and other gallinaceous birds. and green to white diarrhea may also be seen. Anorexia and depression occurred in experimentally infected zebra finches. none of these signs is pathognomonic.140 Avian influenza is often subclinical in wild birds. dark green diarrhea. grebes and mergansers also seem to be highly susceptible to these viruses. these birds are generally found dead.331 LPAI viruses usually cause subclinical infections or mild illness in poultry. often fatal infections. while some birds shed virus subclinically.332-342 More severe disease. a cross between wild and domesticated ducks) or wood ducks (Aix sponsa) resulted in drowsiness.142. edema of the head.142 In another study.142 House finches and budgerigars developed anorexia. lethargy.344 Diving ducks.1. comb and wattle. the incubation period can be a few hours to a week.10.323. These viruses can cause serious infections in some species of birds on a farm while leaving others unaffected. with death within 12 days.13.140 High mortality is occasionally seen in young ostriches infected with either LPAI or HPAI viruses. H5N1 infections were mild in house sparrows.72 However.13 Because a virus can be defined as HPAI based on its genetic composition.13 The clinical signs are variable.3.1-4.3.184 Clinical Signs Avian influenza HPAI viruses usually cause severe disease in poultry. In ducks. The birds can be markedly depressed.1 Serological evidence of infection has been found in pigs. domestica.142 In one study.13 Sinusitis. cloudy eyes. misshapen eggs.17.3.12. is used for an avian population in the context of disease control.143 Experimental infections with H5N1 viruses in call ducks (Anas platyrhyncha var.1.72.137 Some captive wild birds infected with these viruses have died suddenly.136.137. decreased feed and water consumption.3.60.4.317 Laughing gulls (Larus atricilla) developed severe neurological disease. sneezing. house sparrows but not starlings had severe. incoordination and torticollis.136.178.213 Little is known about H3N2 influenza virus in dogs. and other clinical signs began 2-8 days after inoculation.253. neurological disease.319 Strains known to cause fatal illness include some of the currently circulating Asian lineage H5N1 viruses.13. dogs and horses. 1.13 Systemic signs. without apparent clinical signs.Influenza Influenza C viruses Influenza C viruses have been isolated from humans and swine. which experienced only mild depression and survived.60. cyanosis of the head. may be noted in chickens. however.

in canaries and a siskin141 and an H5N3 HPAI virus caused an outbreak with a high mortality rate among South African terns in the 1960s.168 Secondary bacterial infections prolong recovery.9. One cat had fever.9 A wild stone marten was also found with neurological signs.132 In experimentally infected housecats.58 In another study. 168.318 Other influenza viruses in birds Turkeys infected with swine influenza viruses may develop respiratory disease.1 The virus could be isolated for up to five days. with evidence of interstitial pneumonia.48. pleuritis or purpura hemorrhagica.70 Equine influenza Equine influenza usually spreads rapidly in a group of animals.3.47 One of the latter cats was apparently well up to 24 hours before its death. and died the following day. mice and cattle. leopards and Asiatic golden cats were lethargic and had decreased appetites without respiratory signs for 5-7 days.60 Experimental infections have been established in foxes. Mild respiratory signs including cough. lung lesions were reported at necropsy.46.169. followed by a deep. conjunctivitis.25.1.54 Other mammals may also be affected by Asian lineage H5N1 viruses. anorexia. apathy and anorexia.55 Captive palm civets had neurological signs.25. protrusion of the third eyelid. but recovered. and lung lesions were much less severe than those caused by swine influenza viruses.68 Fatal respiratory disease was reported in infected raccoon dogs.25.253 Young foals without maternal antibodies can develop rapidly fatal viral pneumonia. The most common presentation seen with H3N8 viruses is relatively mild and resembles kennel cough. asymptomatic infections were reported in housecats that had been accidentally exposed to a sick.169.67 Fatal infections have also been reported in some captive tigers and leopards.65.61.66 The clinical signs in severe cases included high fever.177.25. convulsions and ataxia.253 In severely affected animals. the first sign is usually a high fever.253 Animals with partial immunity can have milder.25. the clinical signs included fever.25. an initial (usually low grade) fever is followed by a persistent cough and sometimes a purulent Last Updated: December 2009 © 2009 page 20 of 46 . infections in mice varied with the isolate and the route of inoculation (respiratory or intragastric).330 Other clinical signs may include a serous to mucopurulent nasal discharge. extreme lethargy.253.66 Similarly. however.168. H5N1-infected swan.9 HPAI H5N1 viruses have been isolated from wild pikas.330 Equine influenza is sometimes complicated by secondary bacterial infections.50 Some of these animals exhibited respiratory distress.229 Cattle inoculated with high titers of H5N1 viruses isolated from infected cats remained asymptomatic but could transiently shed virus.28. ferrets. 47. and enteritis (spasmodic impaction colic) has been reported in some epidemics.168 Death in adult horses usually results from bacterial pneumonia. dry cough. Canine influenza (H3N8) Canine influenza is an emerging disease in dogs. diarrhea and neurological signs.253 Other influenza viruses in horses Horses experimentally infected with human influenza virus (H3N2 „Hong Kong‟) developed a mild febrile illness.55 Other raccoon dogs on the same farm had died with respiratory signs and/or diarrhea before the virus was found. 47 In contrast. lethargy. there was no evidence that the pika population was seriously affected. the syndromes ranged from very mild upper respiratory infections to severe. myalgia.253 Interstitial myocarditis can occur during or after the infection.253.57 Asian lineage H5N1 infections in pigs appear to be mild or asymptomatic. serosanguineous nasal discharge. depression.213 In this form.3 Avian H5N1 influenza in mammals Both symptomatic and subclinical Asian lineage H5N1 virus infections have been seen in felids.11. some Asian lineage H5N1 strains caused slight and transient weight loss. photophobia. 25 Sequelae may include chronic pharyngitis.53 little is known about the clinical signs after natural exposure in this species.67.330 Postinfection encephalopathy has also been reported in foals. have decreased egg production.168. the pathogenicity varied with the specific isolate and the route of inoculation (intranasal or intragastric). with panting and lethargy.66 One group reported that miniature pigs were resistant to infection.253. weight loss. high fever and neurological signs before death. fatal disease.46 During an outbreak in Cambodia. fever and transient anorexia were observed in some experimentally infected pigs.69 In ferrets. Although fatal infections have been reported in some housecats. A dog that ate infected poultry developed a high fever. convalescence can take up to six months.179.168.330 There may be edema of the legs and scrotum.9 Some infections in palm civets were fatal.253 Loss of eyesight has also been reported. although no naturally infected animals have been reported. however.Influenza Other subtypes can also be pathogenic to some wild birds. tigers.1.63.48 and a few infected housecats were found dead.168. dyspnea and death. chronic bronchiolitis and emphysema. respiratory disease. captive lions.330 Healthy adult horses usually recover within 1-3 weeks. inappetence. encephalitis and hepatitis at necropsy.3. Some infected foxes developed fever but no other clinical signs. atypical infections with little or no coughing or fever.49 Experimentally infected dogs have been asymptomatic or developed only transient fever and conjunctivitis.25. or produce abnormal eggs.45.61. In naïve horses. An H7N1 (HPAI) virus caused conjunctivitis.25.176. but the cough may persist longer. with a high mortality rate. 1. but other clinical signs were not seen. corneal opacity and enlarged submandibular lymph nodes.1. dyspnea.

188 Infections with the novel 2009 H1N1 (swine origin) virus have also been reported after contact with humans.123 Although some animals apparently had milder cases. weight loss and labored breathing. coughing.100-111. purulent nasal discharge and coughing. which was used to infect dogs via close contact with horses.32 The disease. and the clinical signs included sneezing. and radiological evidence of pneumonia.108.28.124 and a dog in the U.346 Diarrhea was reported in some experimentally infected animals. nasal discharge and weakness.321. depression.147 Some outbreaks are more severe than others. sneezing. and severe dyspnea.123. miniature pigs remained asymptomatic although they shed the virus.2. The clinical signs may include fever. but one died.187. decreased appetite. 129 There is little information on cases in dogs. sneezing. was ill with clinical signs of lethargy. and swine influenza viruses can circulate in pigs with few or no clinical signs.213 Asymptomatic seroconversion also occurs. anorexia. anorexia. coughing and anorexia.322 Influenza viruses in ferrets Ferrets are susceptible to human influenza viruses.122 Several ferrets recovered.127 An infected cheetah developed lethargy. in another. and severe pathological changes were seen in the lungs.174 The only known outbreak of H3N2 canine influenza was characterized by severe respiratory disease with fever.178.30. conjunctivitis and/or abortions may also be seen.2.323.113-116.213 Some dogs have been found dead peracutely with evidence of hemorrhages in the respiratory tract.119. page 21 of 46 .211 Coughing can occur in the later stages of the disease. fever.184 The clinical signs in dogs experimentally infected with influenza C virus included nasal discharge and conjunctivitis.117.323 In one study.213 Lethargy and anorexia are common. coughing and nasal discharges occurred in experimentally inoculated dogs. lethargy.114-116. coughing. which was diagnosed as bronchointerstitial pneumonia. but does not seem to be prominent in pets. listlessness.122 A single outbreak caused by a swine influenza virus has been reported in ferrets. crusting of the nose and eyes.185.119.128 Respiratory disease has been reported in naturally infected ferrets.125 Upper or lower respiratory signs including sneezing and coughing in some cases.. nasal discharge.128 The dog in the U. with little sneezing.122 In experimentally infected ferrets. was hospitalized and treated with supportive care including antibiotics. but the novel H1N1 virus was isolated from sick animals in China. with no mortality or other clinical signs.91 Some severely affected animals died.S. which may include fever.120.111. but one death was reported.108. the clinical signs included fever.111 Experimentally infected pigs developed mild disease.107.1-4.310 Infected turkey flocks reported in Chile and Canada experienced only decreased egg production and reduced quality of the eggs.129 The illness lasted for several weeks in some animals.4. but recovered.3 H9N2 influenza viruses in pigs An avian H9N2 virus caused respiratory disease and paralysis in pigs in southeastern China.1 Swine influenza Swine influenza is an acute upper respiratory disease characterized by a variety of clinical signs. and recovered.186.127. 103. and the clinical signs have resembled those caused by other swine influenza viruses.149 Complications may include secondary bacterial or viral infections. nasal discharge and ruffled fur were reported in one study.173. this syndrome has been seen in racing greyhounds. 133 Four of five pet dogs seen at veterinary clinics died.91 The virus was a triple reassortant H1N1 swine influenza virus.32 Asymptomatic infections were reported in an experimental study with a Japanese H3N8 (Florida sublineage) isolate. sneezing.105.185. and pneumonia in others. have been described in cats.74 Novel H1N1 virus of swine origin in mammals A number of swine herds have been infected with the novel H1N1 virus circulating in humans.2. was characterized by coughing.178 More severely affected dogs exhibit a high fever with an increased respiratory rate and other signs of pneumonia or bronchopneumonia.321 The illness has been mild.2.28 Other influenza viruses in dogs In the U. sneezing. potentially fatal bronchopneumonia is occasionally seen. anorexia.178 The nasal discharge appears to resolve with antibiotics. which persisted for 10 days.262 and lethargy and weight loss. an H3N8 equine influenza (American lineage) virus caused a limited outbreak among foxhounds in 2002.120.211 Sneezing. The clinical signs (see previous section) appeared to be similar to those caused by human seasonal influenza viruses.147.30.188 The infection is not usually fatal in adult animals. sneezing and fever as the most prominent signs. sometimes progressing to loss of consciousness. which generally recover in five days to two weeks.32 One dog died and several were euthanized. nasal discharge.103. nasal discharge.28.16. lethargy. with nasal discharge. weakness and decreased Last Updated: December 2009 © 2009 appetite have been reported. lethargy and weakness. sneezing.Influenza nasal discharge. suggesting that secondary bacterial infections may be important in this disease.133.123.252 Abortions or diarrhea have also been seen in some herds. fever and coughing.S.129 Some cats with respiratory disease did not have a fever. one cat became dyspneic and severely ill but recovered with medical care. anorexia and a cough.K.1.119.118 Decreased egg production was also reported in a turkey flock in the U.30.345 Coughing. 133 Fever. and two cats died.179.103.113.147 Severe.4.177. with little or no mortality.114.213 The clinical signs can last for up to a month regardless of treatment.100.188 More severe or fatal disease can be seen in neonates.110.S.

329 Influenza B infections have been reported in some stranded seals. Cats can shed these viruses from the intestinal tract as well as the respiratory tract. H5N1 viruses have been detected only in respiratory secretions. lethargy.53.66 Influenza in mink In 1984. Chickens can begin shedding avian influenza viruses as soon as 1-2 days after infection. Raccoons that were experimentally infected with an avian LPAI H4N8 virus shed this virus in respiratory secretions but not from the digestive tract. anorexia. and usually shed these viruses for 4-5 days or less after the onset of clinical signs.66. and could infect other raccoons in contact. the recent isolation of H5N1 viruses from pikas suggests that these viruses may be maintained in this population. but whether clinical signs occur is unknown. dyspnea and neurological signs. nasal discharge.326 In one study. Limited animal-to-animal transmission seems to occur. with sneezing and shivering.189 Raccoons that were experimentally infected with avian LPAI H4N8 or human H3N2 viruses shed these viruses but remained asymptomatic.329 A white or bloody nasal discharge was seen in some animals. an H10N4 avian influenza virus caused an epidemic on 33 mink farms in Sweden.66 Some of these infections were fatal.3.196 Although most viruses caused relatively mild illness with fever. pigs. Experimental infections with these viruses were milder or asymptomatic. asymptomatic cats appeared to shed Asian lineage H5N1 viruses only sporadically. respiratory signs.57 A recent study suggests that raccoons may be able to transmit some influenza viruses.9 The clinical signs included anorexia. developed rhinitis. severe weight loss.16.227 Turkeys may excrete some avian influenza viruses for up to 72 days.50 Horizontal transmission of Asian lineage H5N1 viruses has not been reported inexperimentally infected dogs. and ducks can shed these viruses for up to 30 days.132 Limited animal-to-animal transmission was reported among tigers in a zoo.253 Animals that have been infected with influenza viruses from other species may or may not transmit the virus.9. 66-68 but in experimentally infected foxes. fatal disease. 189 According to yet unpublished research. antibodies to H5N1 viruses have also been found among raccoons in Japan.196.326 Experimental Asian lineage H5N1 virus infections in ferrets ranged from very mild upper respiratory infections to severe.25.67 Experimentally infected cats shed Asian lineage H5N1 viruses by the third day postinoculation.226.61.189 page 22 of 46 . but ferrets have been infected experimentally with a few of these viruses. 189 The H3N2 virus was not transmitted to uninfected raccoons. difficulty maneuvering and Last Updated: December 2009 © 2009 sloughing skin. and developed no other clinical signs. however. incoordination.132 Horizontal transmission was not observed in this instance.94.65 In contrast. the pathogenicity varied with the specific isolate and the route of inoculation (intranasal or intragastric).Influenza Natural infections with avian influenza viruses have not been documented.66 The clinical signs in severe cases included high fever. 2.63.226 Pigs may begin excreting swine influenza viruses within 24 hours of infection.94 Horses begin excreting equine influenza viruses during the incubation period. with increased mortality particularly on ranches where the mink were co-infected with other pathogens. H4 and H10 viruses has been reported in wild raccoons. ferrets inoculated with influenza viruses from various species.69 As of December 2009. but did not have an elevated temperature. and many mink died. these viruses were found in both respiratory secretions and feces.144 Influenza in raccoons Serological evidence of infection with H1. and nasal and ocular discharges.61.61. Mink naturally infected with a Canadian H3N2 swine influenza virus had respiratory signs including pneumonia. sustained or prolonged transmission of Asian lineage H5N1 viruses has not been reported in any of these mammals. and shedding for as long as 36 days has been reported in experimentally infected birds.58. under some conditions. with the currently circulating Asian lineage H5N1 viruses. naturally infected. ferrets infected with an H7N3 (LPAI) virus had only a transient elevation in temperature. However. foxes or cattle. sneezing. but minimal intestinal shedding was also reported. weight loss. and for less than two weeks. virus shedding has been described. anorexia.65.222 Most chickens shed LPAI influenza viruses for only a week. suggesting that co-infections may have increased the severity of the clinical signs. including birds.66-69 In experimentally infected dogs and pigs.26.324 Animals inoculated with avian H7 (LPAI and HPAI) viruses from recent outbreaks developed illness of varying severity.9 Communicability Influenza viruses are readily transmitted between animals in the species to which they are adapted. coughing. diarrhea. H3. dyspnea and subcutaneous emphysema of the neck.226 Waterfowl are often infected subclinically.193 Influenza in marine mammals Influenza A viruses have been associated with outbreaks of pneumonia in seals and disease in a pilot whale. the inoculation of an HPAI H7 virus from a fatal case in a Dutch veterinarian resulted in severe disease with fever.324.1.329 The viruses appeared to be of avian origin. transient weight loss and respiratory signs. but a minority of the flock can excrete the virus in feces for up to two weeks. and were able to infect sentinel cats in close contact.61. the signs were nonspecific and included extreme emaciation.16.147 Shedding up to four months has been documented in one pig.26 Clinical signs in seals included weakness.9 In the single known case in a whale.189 Raccoons that were inoculated with a human H3N2 virus shed virus mainly from respiratory secretions.196 In another experiment. extreme lethargy.1. diarrhea and neurological signs. and typically shed the viruses for 7-10 days.

53 The lungs were also affected in experimentally infected cats. especially when there is acute high morbidity in the flock.13.2. hemorrhagic. Experimentally infected wood ducks had multiple petechial hemorrhages in the pancreas. and congestion of the spleen.14. severe pulmonary congestion and edema. and less frequently.347 There may be subcutaneous edema on the head and neck. fluid (which may contain blood) in the nares and oral cavity. and in the intestinal mucosa.13 A study of the 2003 H7N7 outbreak in the Netherlands suggested that the occurrence of peritonitis. edema of the wattles and/or neck.13.13. subepicardial hemorrhages. perirenal tissue and/or diaphragm.142 Low pathogenicity avian influenza Rhinitis and catarrhal to purulent sinusitis are often seen in young birds infected with LPAI viruses. the tracheal lesions may be limited to excess mucoid exudate.4 The airways are often dilated and filled with mucopurulent exudate. with areas of necrosis.10. conjunctivitis. with multiple to coalescing foci of pulmonary consolidation. 47. heart.13. or petechial hemorrhages in the proventriculus may be particularly suggestive of an HPAI infection.13 Congestion and inflammation may also occur in the trachea. Asian lineage H5N1infected pigs had mild to minimal gross lung lesions.13 The ovary can be hemorrhagic in laying hens.58 In one study.14 Hemorrhagic tracheitis can be seen in some birds.49 Pulmonary lesions including interstitial pneumonia have been noted in some experimentally infected pigs. but they are usually more extensive in the ventral regions. thymus. and severe hemorrhagic pancreatitis have been reported in naturally infected cats. in these birds. the sinuses may be swollen.136 In naturally infected swans. 319 Pancreatic lesions alone or no gross lesions have also been seen in some swans.4 The bronchial and mediastinal lymph nodes are typically edematous but not congested.13 The oviduct may also be edematous.48.348 Mild or absent gross lesions were reported in experimentally infected zebra finches.4 Lesions may be found throughout the lungs. house finches and budgerigars despite high mortality rates in these species. apex of the heart. on serosal surfaces and on the peritoneum.65 These lesions were similar whether the cats were infected intratracheally or by the ingestion of infected chicks.14 Lower respiratory tract lesions such as pneumonia are usually Last Updated: December 2009 © 2009 seen only in birds with secondary bacterial infections. and in one cat. cerebrum and pancreas. congested and/or cyanotic.14. as well as enlarged mandibular and/ or retropharyngeal lymph nodes. dark red to purplered. and they may exude fluid when cut.4 Other parts of the lungs may be pale and emphysematous. The peritoneal cavity often contains yolk from ruptured ova.14 Avian H5N1 influenza viruses in mammals Pulmonary edema.13.347 In other cases.14 Some birds may have signs of acute renal failure and visceral urate deposition. liver and lymph nodes.347 Postmortem lesions have occasionally been described in wild birds infected with Asian lineage H5N1 viruses. with mild to moderate bronchiolitis and alveolitis detected on histopathologic examination. the liver lesions were accompanied by generalized icterus. renal and splenic congestion.14.13 The ovaries may be hemorrhagic or degenerated. In one study. tracheitis.65 Petechial hemorrhages occurred in the liver of some cats. with exudates in the lumen. stomach. petechial hemorrhages were found in the ventriculus. edema and diffuse subcutaneous hemorrhages on the feet and shanks. and sharply demarcated. the gross lesions are mainly those of a viral pneumonia. pneumonia. as well as serous or serofibrinous pleuritis.Influenza Post Mortem Lesions Click to view images High pathogenicity avian influenza The lesions in chickens and turkeys are highly variable and resemble those found in other systemic avian diseases. 69 Swine influenza In uncomplicated infections.13.63. which may cause severe airsacculitis and peritonitis. multifocal hepatic necrosis. with involuted and degenerated ova.347 Hemorrhages may also be seen on the mucosa and in the glands of the proventriculus.2. and they can sometimes be found in the muscles.2 Affected parts of the lungs are depressed and consolidated. may also be seen.347 Birds that die peracutely and young birds may have few or no lesions. in others.13 The kidneys can be severely congested and are sometimes plugged with urate deposits.2. lymph nodes. the lungs.46 Bloody nasal discharge. and can cause severe air sacculitis and peritonitis.4 Severe pulmonary edema. swelling and hemorrhages of the conjunctivae.13 Petechiae may be noted throughout the abdominal fat. and the comb and wattle are often edematous.65 In naturally infected tigers and leopards. kidney and liver were reported in a naturally infected dog. 4 Some strains of swine influenza viruses produce more marked lesions page 23 of 46 . 66 Experimentally infected foxes also developed lesions mainly in the lung. one study reported that the most consistent lesions were multifocal hemorrhagic necrosis in the pancreas. hemorrhages in the intestinal serosa. cats infected by ingestion also had enlarged tonsils with multifocal petechial hemorrhages. cerebral. and pulmonary congestion and edema. the gross lesions included severe pulmonary consolidation and multifocal hemorrhages in multiple organs including the lung.13 The lungs may be reddened from hemorrhages and congestion.136 More extensive lesions were reported in experimentally infected laughing gulls. beneath the lining of the gizzard. intestines. 69 More severe lesions were seen in foxes inoculated intratracheally than in animals fed infected birds. and some of these animals also had histopathologic evidence of encephalitis and myocarditis.13 Yolk may be present in the abdominal cavity. and congestion.

173.28. 133. hemagglutination inhibition and ELISAs are useful as supplemental tests. brain. and cranioventral lung consolidation was rarely seen. some serological tests may underestimate the prevalence of H5N1 infections. but hemagglutination inhibition tests are subtype specific and may miss some infections. the World Organization for Animal Health (OIE) recommended that antigen detection tests be used to identify avian influenza only in flocks and not in individual birds.213 In animals that were inoculated with Korean H3N2 viruses isolated from dogs.14.19 Real-time RT-PCR is the method of choice for diagnosis in many laboratories.13. but there was no evidence of severe hemorrhagic pneumonia. bronchiolitis and hemorrhagic alveolitis has been reported.323 Salpingitis. 19 Some rapid tests. tracheal and/ or cloacal swabs in live birds. and organ samples (trachea. intestine.2 Generalized lymphadenopathy.349 These tests can also distinguish some subtypes. hemagglutination. 253 Severe necrotizing myocarditis. there may be tracheitis. Diagnostic Tests Avian influenza Avian influenza can be diagnosed by a variety of techniques including virus isolation.1 Novel H1N1 virus of swine origin Typical swine influenza lesions in the lungs.329 In a single case in a whale. In experimentally infected puppies with this form.19 The virus can be identified as an influenza A virus with agar gel immunodiffusion (AGID) or ELISAs. air sacs.g. AGID tests are not reliable for detecting avian influenza in ducks or geese. together with genetic tests to identify characteristic patterns in the hemagglutinin. and are often accompanied by enlargement of the lymph nodes of the head. mediastinum and pleural cavity.19 Oropharyngeal.26.213 Hemorrhagic lesions are not always present in fatal cases.329 Acute interstitial pneumonia was seen in mink infected with a swine influenza virus. and can replace virus isolation in some cases. which are most often seen in young foals. focal areas of pulmonary discoloration and pervasive discoloration of the liver. kidney.19 These viruses can be recovered from oropharyngeal.28. serology can be valuable for surveillance and to demonstrate freedom from infection.173 The lungs may exhibit signs of severe pneumonia.173. bronchitis and bronchiolitis have been reported in fatal cases. Feces can be substituted in small birds if cloacal samples are not practical (e.349 Serological tests including agar gel immunodiffusion. including a diffusely non-collapsed parenchyma. AGID tests can recognize all avian influenza subtypes in poultry.13.330 Ventral edema of the trunk and lower limbs can also occur.349 As of 2008.19 Virulence tests in susceptible birds. were evaluated and compared in a recent review. and can be dark red to black.13. as well as catarrhal or hemorrhagic enteritis.133.253.184 Mild to moderate thickening of the alveolar septa was also seen. 117 Equine influenza The gross lesions are typically those of an upper respiratory infection (including nasal discharge). hepatic congestion and pulmonary consolidation were reported in one outbreak of severe disease in swine. and severe interstitial or bronchointerstitial pneumonia.25.14.13. Avian influenza viruses are subtyped with specific antisera in AGID or hemagglutination and neuraminidase inhibition tests.9 The gross lesions in ferrets inoculated with zoonotic avian H7 viruses ranged from mild pulmonary lesions to widespread hemorrhages.253 Canine influenza In dogs that die of canine influenza (H3N8).. the bronchial lymph nodes were edematous. lungs.13.Influenza than others.136 Swine influenza Last Updated: December 2009 © 2009 page 24 of 46 . hemagglutinating activity indicates the presence of influenza virus. suppurative secondary bacterial pneumonia may be seen alone.19 Although most gallinaceous birds and other susceptible birds die before developing antibodies.14.19 Virus isolation is performed in embryonated eggs.213 There is limited information on the lesions found in mild cases. pneumonia with necrotizing bronchitis. have been reported with some strains.173.170. and severe multilobular bronchiolitis and alveolitis. multifocal to coalescing reddish consolidation was found in the lungs. peritonitis and interrupted follicular development were the only lesions reported in turkeys.19.196 The extent of the lesions varied with the isolate.30 Fibrinous pleuritis may also be noted.170.133 Influenza in other mammals In seals infected with avian influenza viruses.13 In wild birds. in some cases. cannot be collected without harming the bird). rubbery texture and areas of bronchiopneumonia were reported in pigs experimentally infected with the novel H1N1 virus.213 The most severely affected puppies had small focal areas of pulmonary hemorrhage scattered throughout the lungs. the lungs were hemorrhagic and a hilar lymph node was greatly enlarged.19 RT-PCR assays can identify avian influenza viruses in clinical samples. including various PCR assays.253 Interstitial pneumonia. spleen. liver and heart) are tested in dead birds.19.184 The histopathologic lesions included severe multilobular or diffuse necrotizing tracheobronchitis. bronchitis. bronchiolitis. hemorrhages may be found in the lungs.213 On histological examination.184 No lesions were found outside the respiratory tract.13. tracheal and cloacal swabs (or intestinal contents).19 Viral antigens can be detected with ELISAs including rapid tests. are used to differentiate LPAI from HPAI viruses.

the detection of viral antigens or nucleic acids. dogs and.169 The most commonly used serological tests in horses are the hemagglutination inhibition test and a single-radial hemolysis (SRH) test.3. birds. Treatment Animals with influenza are usually treated with supportive care and rest. 213 Virus neutralization (microneutralization test) can also be done. and serology.11 Prevention Vaccines Influenza vaccines are available for pigs.350 The H3N8 canine influenza virus has been isolated in both embryonated eggs and cell cultures (MDCK cells) 213. Influenza vaccines may change periodically to reflect the current subtypes and strains in a geographic area.19. or the detection of nucleic acids by RT-PCR. the indirect fluorescent antibody test and virus neutralization. peak virus shedding is thought to occur during the first 24 to 48 hours of fever.147 Other antigen detection tests include immunohistochemistry on fixed tissue samples. is most often used. they seem to be particularly important in the treatment of canine influenza. nasal epithelial cells or bronchoalveolar lavage.2.147 Immunofluorescent techniques can detect antigens in fresh lung tissue. using paired serum samples.350 RT-PCR is the most reliable method to detect the virus directly. probably because the amount of virus shed is low. swine and equine viruses display less antigenic drift than human viruses. 213 Acute and convalescent titers should be submitted if possible.13.213. samples should be collected within the first 3-5 days after the onset of clinical signs. 133 In experimentally infected dogs. horses. and ELISAs.25 In the U.4. 24-48 hours after the onset of illness.169 Ideally.19 HPAI vaccines are not used routinely in the U. in some countries.. or most other countries.213. avian influenza vaccines are used most often in turkeys and are intended only to prevent infection by LPAI viruses.25.169 Equine influenza viruses can be isolated from nasopharyngeal swabs or nasal and tracheal washes.25.147.147 Swine influenza viruses are often recovered in Madin–Darby canine kidney cells. 133 Serology is expected to be useful.25.168.2.10.213 Little is known about testing for Korean H3N2 viruses in dogs.3.14.213 However.169 Equine influenza can also be diagnosed retrospectively by serology.147 RT-PCR assays are used to detect viral RNA. Antigen-capture ELISA tests do not seem to be reliable in individual dogs. these tests may be able to detect H3N8 canine influenza during outbreaks at kennels or other large facilities.213.3. Uncommonly used serological tests in swine include agar gel immunodiffusion.25.147 These viruses can be isolated from lung tissues at necropsy.14.168. which is subtype specific. Some H3N2 viruses were isolated from nasal swabs taken from dogs during an outbreak. these viruses were shed in nasal secretions from one to six days after inoculation.350 Because canine influenza is an emerging disease. whenever possible. nations may consider vaccination as a preventative or adjunct control measure during an outbreak.g.25. ferrets have been treated with amantadine as well as antihistamines. but this test is usually too cumbersome for routine use. antibiotics and other supportive therapy. however.353 Avian vaccines are usually autogenous or from viruses of the same subtype or page 25 of 46 .147 Equine influenza Equine influenza may tentatively be diagnosed based on the clinical signs.350 Hemagglutination inhibition is the most commonly used serological test. virus recovery should be attempted in both embryonated eggs and cell cultures.S. but only during the early stages of disease before antibodies develop.2 ELISA kits are available.169.185 Antiviral drugs could also be of use in valuable horses. but virus isolation fails to detect the virus in many infected dogs that do not die of the disease. most dogs are not expected to have pre-existing titers to the canine influenza virus.213.169 Canine influenza At this time.2. and from nasal or pharyngeal swabs taken from acutely ill pigs. 213 This test can be used on nasal swabs Last Updated: December 2009 © 2009 from live animals or lung tissue samples at necropsy.25. 213.2. but the disease is usually milder if it occurs..2.28.213.2. the detection of viral antigens (e.177.4.352 The vaccines do not always prevent infection or virus shedding. single titers are still considered to be less useful.168. by ELISA).177.147 Serology on paired samples can diagnose swine influenza retrospectively.1.4. and these vaccines are changed less often.S.Influenza Swine influenza can be diagnosed by virus isolation.351 Poultry flocks infected with HPAI viruses are depopulated and are not treated. 133 RT-PCR can also detect this virus.2.147 It may not detect new viruses.179 Antiviral drugs are not generally given to most animals.168.253 Antibiotics may be used to control secondary bacterial infections.25. serology and RT-PCR are the most reliable methods for detecting H3N8 canine influenza. prolonged recovery and more severe disease have been associated with increased stress. Mammalian influenza viruses can be isolated in embryonated chicken eggs or cell cultures.4. the disease is confirmed by virus isolation.350 In experimental infections.147 Recovery is best from an animal with a fever. nasal swabs have been more likely to yield virus than nasopharyngeal swabs.4.3. In general. however.350 Virus isolation may also be successful in some dogs.4 The hemagglutination inhibition test.168 In horses. but other cell types can also be used. In horses.213 The H3N8 canine influenza virus can be found in lung tissue samples taken post-mortem. however.147 Isolated viruses can be subtyped with hemagglutination inhibition and neuraminidase inhibition tests or RT-PCR.168 As in swine.

In mammals. quarantines and isolation of infected animals help prevent virus dissemination. and the public should be restricted from entering swine operations. 283 In domesticated poultry (particularly chickens).283 The reason for the seasonality is unknown. good surveillance and movement controls are critical in a vaccination campaign. but outbreaks with high pathogenicity H5 and H7 viruses are also seen occasionally.355.94 Infected swine herds can be cleared of influenza viruses by depopulation. Because vaccines may allow birds to shed virus while remaining asymptomatic. Rest decreases virus shedding in horses.170.10.354.10-12. particularly birds and humans.2.13. Low pathogenicity forms occur most often. prolong recovery and result in complications such as pneumonia.119-124.357 Other preventative measures Poultry can be infected by contact with newly introduced birds or fomites. Strict hygiene is necessary to prevent virus transmission on fomites.16.16. good hygiene. 3. cats and dogs should be kept indoors whenever possible. may be helpful.11.Influenza hemagglutinin type.360 Once a herd of swine has been infected with a swine influenza virus. good biosecurity is important.15 Illegal poultry movements may be of primary importance in transmission in some regions.10.3.168 Pigs should also be protected from the influenza viruses found in other species.140 Symptomatic infections are unusual in wild birds.2.16. however. cleaning and disinfection.15 In addition. and people with influenza should avoid contact with this species.11 Seasonality has been reported in the current H5N1 epidemic. up to 90-100%. depopulation. in a number of countries.H5 vaccines.11 The outbreak is managed by quarantine.147. but it may be the result of multiple factors such as increased virus survival in the cold.51. During outbreaks of H5N1 avian influenza.10. these infections are reportable to the OIE.127-129 Eradication and prevention of virus transmission during outbreaks During an outbreak of influenza among mammals.353. Because H5 and H7 LPAI viruses can mutate to become HPAI viruses.187 If contact is unavoidable. particularly waterfowl and shorebirds.216 Mammals should not be fed poultry or other birds that may be infected with the avian influenza viruses.12 Asian lineage H5N1 viruses have also been isolated sporadically from other dead birds. USDA approval. as well as by contact with wild birds.18. some of the Asian lineage H5N1 viruses have caused outbreaks with high mortality rates. Avian influenza Avian influenza outbreaks occur in most countries including the U.330 Secondary bacterial infections can exacerbate the clinical signs. good management can decrease the severity of disease.356 Vaccination may place selection pressures on avian influenza viruses.13 Any surviving birds are usually in poor condition.11.54. Poultry should not be returned to the farm from live bird markets or other slaughter channels. this virus has tended to reemerge during colder temperatures in the Northern Hemisphere. include inactivated whole virus and recombinant fowlpox. swine workers who are ill should avoid contact with pigs.25 Infected facilities should be cleaned and disinfected after the outbreak.15. in the case of H5 and H7 vaccines.15 Keeping flocks indoors is often recommended in areas where the H5N1 virus has been isolated from wild birds.1.45 They should also kept from contact with potentially infected flocks and wild birds. influenza is usually introduced into a facility in a new animal. The use of these vaccines requires the approval of the state veterinarian and. as well as the use of face masks and/or other measures to prevent droplet transmission from coughs and sneezes.358.19 Morbidity and Mortality The severity of an influenza virus infection varies with the dose and strain of virus and the host‟s immunity. however.359 The risk of infection can be decreased by all-in/ all-out flock management.353-355 Methods used to recognize infections with field viruses in vaccinated flocks include “DIVA” (differentiating vaccinated from infected animals) strategies.25.319 High mortality rates have been reported in some but not page 26 of 46 .25 Good hygiene can keep the virus from spreading on fomites.73 In April 2005. high pathogenicity avian influenza has very high morbidity and mortality rates. low mortality rates and rapid recovery.73. and might eventually result in the evolution of vaccine-resistant isolates.13.3. an outbreak that began at Qinghai Lake in central China resulted in the death of more than 6000 migratory wild birds.12.4.168 Similarly to birds. outbreaks of high pathogenicity avian influenza are controlled by eradication. and the use of sentinel birds. and by preventing any contact with wild birds or their water sources.4. LPAI viruses usually result in mild or asymptomatic infections. and surveillance around the affected flocks. To prevent human influenza viruses from entering a herd.168. In poultry. and are being controlled similarly in many countries. Felids (including housecats and a cheetah) and dogs have Last Updated: December 2009 © 2009 also been infected with the novel H1N1 virus from humans. and wild bird movements.72.13.1.S. but may also mimic HPAI viruses. including waterfowl. uncomplicated infections are usually associated with high morbidity rates.94 Ferrets can be infected by human influenza viruses (including the novel H1N1 virus). In pigs and horses. the virus usually persists in the herd and causes periodic outbreaks.71.1-4.94 Isolation of newly acquired animals can decrease the risk of transmission to the rest of the herd.12.19 Currently licensed vaccines in the U.S. strict hygiene and biosecurity measures are necessary to prevent virus transmission on fomites.19 High mortality is occasionally seen in young ostriches infected with either LPAI or HPAI viruses. increased poultry trade during winter festivals.2-4.

94 Influenza epidemics can occur if a virus infects a population without immunity to the virus. the severity of the clinical signs varied with the specific isolate and the route of inoculation (intranasal or intragastric). and can survive in a few carrier animals for up to four months.94 In a newly infected herd. antibodies to these viruses were found in 8 of 11 cats and 160 of 629 dogs.66 However.132 Few of these cats shed virus.S.66 and miniature pigs were resistant to infection in one study.54 Asymptomatic or mild infections have been reported in experimentally infected dogs.201 In the U.361 Some infections with Asian lineage H5N1 viruses have been fatal. and none became ill despite the presence of other viral and bacterial infections.107.58 However. fatal cases were reported among captive tigers and leopards in Thailand.1 Novel H1N1 virus of swine origin The H1N1 virus circulating in humans appears to cause mild disease in pigs.56 and these viruses have been isolated rarely from pigs in China.346 Decreased egg production may be the main effect in turkeys. In one study..68 In experimentally infected ferrets and mice. a similar study found antibodies to the type C viruses in 19% of pigs.66 Interestingly. and thousands of the infections were fatal.K. but little or no mortality has been seen.16. there is no evidence that HPAI H5N1 viruses are causing significant illness among infected pikas in China.310.55.8.61.1-6. 147 In the 1918 epizootic. B and C viruses.1. and four died.59 In contrast.3. asymptomatic infections were reported in cats exposed to an infected swan in an animal shelter. 49.94 Many infections in endemically infected herds are subclinical. blue-winged teal and redhead ducks inoculated with the same viral strains did not become ill.Influenza all experimentally infected wild birds.108. typical signs of influenza may occur in only 25% to 30% of the pigs. severe disease does not seem to occur in this species.16. the mortality rate was 66-100% in house sparrows.2.345. secondary infections or cold weather. all six laughing gulls infected with recent strains of H5N1 became severely ill.103. but captive leopards.65 In contrast.16 Approximately 10% of the pigs were seropositive for influenza C viruses. In an unpublished study from Thailand. In a turkeys flock in Chile. Fatal cases were reported in some naturally infected housecats.111116.1. but all house sparrows experienced mild disease and survived.28 In Japan.48.9. deaths have been reported in housecats. 317 Avian H5N1 influenza in mammals Asian lineage H5N1 viruses have been reported in a variety of mammalian species. millions of pigs developed influenza. 24. pigs can be infected with human influenza A. but no deaths were seen in starlings.63.50. and high stress levels in this population.45-50. but one death was reported in a naturally infected dog.16.1.9.5. a dog.2.2 Viruses may also infect the herd with few or no clinical signs.2.136 Morbidity and mortality rates in passerine and psittacine birds have varied with the species. A serological study conducted in Vietnam found that a low percentage of pigs (0. but only sporadic infections with the human influenza B viruses were found.1. and some experimentally infected cats exhibited severe disease and high mortality rates.46. stress.94 Annual outbreaks are often seen.16 In addition.4.108.58.16 In the epidemic form.25%) had been exposed to H5N1 influenza viruses in 2004.16 High seroprevalence rates to swine influenza viruses have also been reported in other countries.16. Experimental infections also suggest that the clinical signs may be mild in this species.107. or if the infection is exacerbated by factors such as poor husbandry.8 Swine influenza viruses are usually introduced into a herd in an infected animal.147 In uncomplicated cases.321 Experimental studies support this view. the morbidity rate was page 27 of 46 .1. no antibodies were detected in 171 cats from areas of Austria and Germany where infections had been reported in wild birds. northern pintail.57 and Asian lineage H5N1 viruses isolated from Indonesian pigs were less virulent in mice than isolates from poultry. deaths have not been reported among experimentally infected pigs.94 Maternal antibodies decrease the severity of disease in young pigs.53. In one study.53. the case fatality rate has ranged from less than 1% to 4%. raccoon dogs.102-104.323.4.56 Although Asian lineage H5N1 viruses have been reported in pigs. mortality rates approached 100% in zebra finches.67. 61.3. palm civets and experimentally infected ferrets9.142 In a study with a different Asian lineage H5N1 virus. Approximately 25-33% of 6-7 month-old finishing pigs and 45% of breeding pigs have antibodies to the classical swine H1N1 virus in the U.252. Mallard. it usually persists in the herd.16.1. tigers. Morbidity rates from less than 1% to as high as 90% have been reported.47.132 Similarly. up to 100% of the animals may become ill but most animals recover within 3-7 days if there are no secondary bacterial infections or other complications.58 Asian lineage H5N1 viruses have also been detected in swine in Last Updated: December 2009 © 2009 Indonesia. a study found antibodies to both swine and human influenza viruses in 14% of all pigs.1. occur mainly during the colder months.136 Four of six infected wood ducks also became severely ill while two others remained asymptomatic. both mild and severe cases have been reported in several of these species. there are no reports of severe illness among swine. house finches and budgerigars. some large felids. the virus spreads rapidly in pigs of all ages. and in temperate regions.136 Three of the sick ducks died and one recovered.2.60 Swine influenza Influenza is a major cause of acute respiratory disease in finishing pigs.4 Once the virus has been introduced.2. Asiatic golden cats and lions at a wildlife rescue center in Cambodia all recovered after an illness lasting 5-7 days. and all starlings remained asymptomatic.

25 Avian influenza viruses have rarely been reported in horses. races and other events where horses congregate. The H3N2 virus has been reported from outbreaks at three veterinary hospitals and a kennel in South Korea.125 A few cats. is not yet known. a survey found antibodies to the H3N8 virus in only one of 225 dogs in 2006. however.119-124.170 The virus appeared to be an avian influenza virus.S.121.Influenza 61%. if it exists at all.178 In kennels.123.25 Unless there are complications. 133 Cases were described in a miniature schnauzer. Canine influenza Canine H3N8 influenza was first reported in racing greyhounds and.179 Higher case fatality rates have been reported in small groups of greyhounds.S. H3N8 canine influenza has been seen in a variety of breeds at veterinary clinics and animal shelters in several states.213 Although this disease was first reported in 2004. 25 In populations that have been previously exposed.25 Deaths are rare in adult horses. severe disease is more likely in dogs that are in poor condition or are concurrently exposed to other pathogens.119.000 animals and killed several hundred.S.28 High case fatality rates are not expected in most canine populations. donkeys and zebras. turkey flock. healthy adult horses usually recover within 1-3 weeks.179.000 mink.262.25.30.177.213 At one Florida greyhound racetrack.168.1. most of the population is expected to be fully susceptible.322 Equine influenza In horses.118 Although a slight increase in flock mortality occurred in the latter case.330 In horses. The avian-like virus continued to circulate in horses for at least five years without further fatalities.122 Two infected cats died.310.330 In 1987.28. as well as 13 dogs of unknown breed at an animal shelter.178.1.364 This dog was a greyhound that had come from a racetrack in Florida. in Canada.177. the infection rate may reach 100%.213 Most dogs are expected to develop the less severe form of the disease.9 In an outbreak caused by a triple reassortant H1N1 swine influenza virus in ferrets. it may have been unrelated to the H1N1 infection.168. Similarly. the overall mortality rate is thought to be 1-5%. the case fatality rate was 36%.25.25. but no deaths were seen. in naïve populations. It had no recent history of respiratory disease.168.176. the morbidity rate was 8% and the mortality rate was 0.329 and they may be more severe if the animals are co-infected with other pathogens.120. and may have been infected there.183. influenza outbreaks are not as seasonal as they are in pigs or humans.1 Explosive epidemics in seals are thought to be exacerbated by high population densities and unseasonably warm temperatures. animals in poor condition. the case fatality rate was estimated to be 20% in one outbreak with an H7N7 virus. tracheal clearance rates can be depressed for up to a month after infection. 91 In seals. and some cats apparently had milder cases. or that the illness might last longer. although coughing can persist.9 Internet Resources page 28 of 46 . In 1989. One study suggests that canine influenza is rare.213 The prevalence of this disease in the U.213 In dogs with severe disease. but one died.170 The morbidity rate was at least 80% and the mortality rate was 20-35%. and required hospitalization and supportive care. pet ferrets and dogs have been infected naturally with the novel H1N1 virus. appeared to be confined to this breed.362 Decreased egg production and no mortality were reported in a U. and clinical signs can occur in 60-80% of the dogs infected. a Yorkshire terrier and two Jindo dogs ( a Korean breed of hunting dog).213 All dogs regardless of breed or age are now considered to be susceptible. and are usually the result of secondary bacterial infections.179. a cocker spaniel.133 Only one of the five dogs seen at veterinary clinics survived.179. an equine influenza epidemic in India affected more than 27. egg production dropped by approximately 80%. another developed severe illness with dyspnea but recovered with medical care. an avian H10N4 virus caused an outbreak on Swedish mink farms. ferrets and nonhuman primates suggest that this virus might cause more severe lung pathology and/or clinical signs than seasonal human H1N1 viruses.117 Egg production in this flock dropped from 70% to 31%.1. cases are seen mainly in young and newly introduced animals.253. In the province of Ontario. Influenza in other mammals In 1984.28.25. a more severe form with pneumonia may occur in a minority. and recover. a novel strain of equine influenza [A/eq/Jilin/89 (H3N8)] caused a serious epidemic in Chinese horses.129 An infected dog in the U.363 More recently. 170 Widespread epidemics can be seen.25 Most outbreaks are associated with sales. at first.177.3. Because dogs have not been exposed to the canine influenza virus before. was ill with pneumonia. 178.25.330 Higher mortality rates have been reported in foals.28. new evidence suggests that the H3N8 virus may Last Updated: December 2009 © 2009 have been circulating in U.25. with a mortality rate of 3%. and 4% in an outbreak with an H4N5 virus.127-129 Several ferrets recovered. but recovered. crowding and transportation are typical risk factors for disease.1.1 The morbidity rate was nearly 100%. with morbidity rates of 60-90% or greater.253 The H3N8 viruses usually cause more severe disease than the H7N7 viruses. It affected 33 farms and killed 3.181.1.128 Experimental studies in mice.173. however.S.180. greyhound populations as early as 1999.6%. The fate of the dogs in the animal shelter was not stated. in affected turkey flocks in Canada.25 Close contact with other horses. A related virus caused influenza in a few hundred horses the following year but there were no deaths.

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