H5N1 potential threats

Influenza A viruses circulating among poultry have the potential to

recombine with human influenza A viruses and become more
transmissible among humans. - If HPAI Asian H5N1 viruses gain the ability
for efficient and sustained transmission among humans, an influenza
pandemic could result, with potentially high rates of illness and death
worldwide.

H5N1 can attack the lower respiratory tract, which leads to a severe, life-
threatening form of pneumonia, but it’s somewhat less able to bind in the
upper respiratory tract and lead to lots of secretions that lead to
transmission.

1. High Mortality Rate - H5N1 has a high mortality rate in humans, with reported rates
exceeding 50%. This means that if the virus were to become more easily transmissible
between humans, it could result in a significant number of severe illnesses and
deaths.
2. Pandemic Potential - H5N1 has the potential to recombine with human
influenza A viruses and become more transmissible among humans.
If HPAI Asian H5N1 viruses gain the ability for efficient and sustained
transmission among humans, an influenza pandemic could result,
with potentially high rates of illness and death worldwide , putting a
strain on healthcare systems and causing social and economic disruption.
3. Antiviral resistance - Over time, the H5N1 virus may develop resistance to antiviral
medications such as oseltamivir (Tamiflu), which are commonly used to treat
influenza infections. This could make it more difficult to manage and control the
spread of the virus.
4. Limited vaccine effectiveness - Developing an effective vaccine against H5N1 can be
challenging due to its high genetic variability. Vaccines need to be regularly updated
to match the evolving strains of the virus. In the event of a pandemic, there may be
delays in producing and distributing a sufficient amount of vaccine to protect the
population.
5. Global economic impact - A widespread outbreak of H5N1 could have significant
economic consequences. Trade restrictions on poultry products and other animals
may be imposed, affecting the agriculture and food industries. Travel restrictions and
reduced consumer confidence could also impact tourism and international trade.
6. Overburdened healthcare systems - In the event of an outbreak, healthcare systems
may be overwhelmed by the large number of people seeking medical attention.
 Hospitals and clinics may face shortages of staff, equipment, and beds, making it
challenging to provide adequate care to all those affected.

Descriptive Epidemiology

What - The morphology of influenza A (H5N1) is basically that of an orthomyxovirus as it is a subtype

of the type A influenza virus. The typical virion is enveloped, spherical (100 nm), with a nucleocapsid
of helical symmetry surrounding a minus sense single stranded 8 segmented RNA (Figure). The
envelope is internally lined by a matrix protein (M) and externally with glycoprotein peplomers-rod
shaped haemagglutinin (HA) which are homotrimers of class I membrane glycoproteins and
mushroom shaped neuraminidase (NA) molecules which are tetramers of a class II membrane
protein.

Based on the variation on HA and NA molecules there exists 15 HA and 9 NA subtypes of influenza A
virus. The avian strains differ from human strains in that they have all the 15 subtypes of HA in
contrast to only three in case of humans. The virulent avian influenza H5N1 strains differ from other
avian strains in that, there lies a link between HA cleavage and degree of virulence. In virulent strains
the HAs contain multiple basic aminoacids at the cleavage site, which are cleaved intracellularly by
endogenous proteases. In contrast, in case of avirulent avian strains as well as non-avian influenza A
viruses, the HAs lack the basic aminoacid residues, hence not subjected to cleavage by such
proteases. Moreover, all types of influenza A viruses are antigenically labile, well adapted to evade
host defences and lack mechanisms for “proof reading”; hence constant, permanent and small
changes in antigenic composition are very common, which is known as antigenic drift. Another
important characteristic of great public health concern is antigenic shift which results from
reassortment of genetic material from different species resulting in variability of HA spikes, keeping
the basic structure of the virus constant.
The name H5N1 refers to the subtypes of surface antigens present on
the virus: hemagglutinin type 5 and neuraminidase type 1.

Symptoms
It usually takes 3 to 5 days for the first symptoms to appear after
you've been infected.
The main symptoms of bird flu can appear very quickly and include:

 a very high temperature or feeling hot or shivery

 aching muscles
 headache
 a cough or shortness of breath
Within days of symptoms appearing, it's possible to develop more
severe complications such as pneumonia and acute respiratory
distress syndrome.
When
H5N1, or avian influenza, can potentially infect birds throughout the year. However,
outbreaks of H5N1 in birds often coincide with the cooler months and the start of
the migratory bird season. During colder seasons, migratory birds can carry and
spread the virus over long distances, contributing to the spread of H5N1 to new
regions.

Where

H5N1 outbreaks can occur in various regions around the world

1. Poultry farming areas: Regions with a high density of poultry farms, especially
those with inadequate biosecurity measures, can be more susceptible to H5N1
outbreaks. Close proximity between infected and susceptible birds increases
the risk of transmission.

2. Live bird markets: Markets where live birds are sold can be hotspots for the
spread of H5N1. These markets often have large concentrations of live birds
from different sources, providing an environment where the virus can easily
spread among susceptible birds and potentially to humans.
3. Migratory bird pathways: Migratory birds, such as waterfowl, play a role in the
global dissemination of H5N1. Locations along their migratory routes, such as
wetlands or bird sanctuaries, may be more susceptible to H5N1 introductions
and outbreaks as infected birds can shed the virus into the environment.

Who
H5N1, or avian influenza, primarily affects birds, but when it infects humans, it can cause
severe illness. The following groups are generally considered more vulnerable to H5N1
infection:

1. Individuals with direct exposure to infected birds: People who work with live
poultry, such as poultry farmers, poultry market workers, and veterinarians, are
at an increased risk of H5N1 infection. Direct contact with infected birds or
exposure to contaminated environments in these occupations can lead to
transmission.
2. Individuals with weak immune systems: People with weakened immune
systems, such as those with underlying health conditions, the elderly, and
young children, may be more susceptible to severe H5N1 infections. These
individuals may have reduced ability to fight off the virus and are at a higher
risk of complications.

References

Britannica. (2023). Poultry farming [Photograph]. https://www.britannica.com/topic/poultry-farming

Current Affairs. (2021). Kazhuveli wetland declared as 16th bird sanctuary of tamil nadu
[Photograph]. https://currentaffairs.adda247.com/bird-sanctuary-kazhuveli-wetland/

Food and Agriculture Organization of the United Nations. (2015). Biosecurity guide for live poultry
markets [Photograph]. https://www.fao.org/3/i5029e/i5029e.pdf

Guo, J., Chen, J., Li, Y., Li, Y., Deng, G., Shi, J., Liu, L., Chen, H., & Li, X. (2022). SUMOylation of matrix
protein M1 and filamentous morphology collectively contribute to the replication and virulence of
highly pathogenic H5N1 avian influenza viruses in mammals. Journal of Virology, 96(4), e0163021.
https://doi.org/10.1128/JVI.01630-21

Indian Express. (2020). Innovative solutions: How poultry farming is alleviating farm distress in Kerala
[Photograph]. https://indianexpress.com/article/governance/innovative-solutions-how-poultry-
farming-is-alleviating-farm-distress-in-kerala-6225141/

Ministry of Health. (2018). Highly pathogenic avian influenza. https://www.health.govt.nz/our-

work/diseases-and-conditions/communicable-disease-control-manual/highly-pathogenic-avian-
influenza#casedef

Shutterstock. (n.d.) Socially vulnerable pictogram set [Pictogram].

https://www.shutterstock.com/image-vector/socially-vulnerable-pictogram-set-765595588

Te Ara - the Encyclopedia of New Zealand. (2023). Bird migration - The phenomenon of migration
[Photograph]. http://www.TeAra.govt.nz/en/photograph/7208/godwits-in-flight

Thailand Medical News. (2023). H5N1 Avian Flu [Pictograph].

https://www.thailandmedical.news/news/h5n1-avian-flu-news-preparing-for-an-imminent-
outbreak-what-prophylactics,-drugs-and-supplements-work-part-1
Parums D. V. (2023). Editorial: Global surveillance of highly pathogenic avian
influenza viruses in poultry, wild birds, and mammals to prevent a human
influenza pandemic. Medical Science Monitor: International Medical Journal of
Experimental and Clinical Research, 29, 1-3.
https://doi.org/10.12659/MSM.939968
Tian, H., Zhou, S., Dong, L., Van Boeckel, T. P., Cui, Y., Newman, S. H., ... & Xu, B. (2015). Avian
influenza H5N1 viral and bird migration networks in Asia. Proceedings of the National Academy of
Sciences, 112(1), 172-177.