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Serological evidence of human infections with highly pathogenic avian influenza A(H5N1) virus: a systematic review and meta-analysis

Serological evidence of human infections with highly pathogenic avian influenza A(H5N1) virus: a systematic review and meta-analysis
Serological evidence of human infections with highly pathogenic avian influenza A(H5N1) virus: a systematic review and meta-analysis

BACKGROUND: Highly pathogenic avian influenza A(H5N1) virus poses a global public health threat given severe and fatal zoonotic infections since 1997 and ongoing A(H5N1) virus circulation among poultry in several countries. A comprehensive assessment of the seroprevalence of A(H5N1) virus antibodies remains a gap and limits understanding of the true risk of A(H5N1) virus infection.

METHODS: We conducted a systematic review and meta-analysis of published serosurveys to assess the risk of subclinical and clinically mild A(H5N1) virus infections. We assessed A(H5N1) virus antibody titers and changes in titers among populations with variable exposures to different A(H5N1) viruses.

RESULTS: Across studies using the World Health Organization-recommended seropositive definition, the point estimates of the seroprevalence of A(H5N1) virus-specific antibodies were higher in poultry-exposed populations (range 0-0.6%) and persons exposed to both human A(H5N1) cases and infected birds (range 0.4-1.8%) than in close contacts of A(H5N1) cases or the general population (none to very low frequencies). Seroprevalence was higher in persons exposed to A(H5N1) clade 0 virus (1.9%, range 0.7-3.2%) than in participants exposed to other clades of A(H5N1) virus (range 0-0.5%) (p < 0.05). Seroprevalence was higher in poultry-exposed populations (range 0-1.9%) if such studies utilized antigenically similar A(H5N1) virus antigens in assays to A(H5N1) viruses circulating among poultry.

CONCLUSIONS: These low seroprevalences suggest that subclinical and clinically mild human A(H5N1) virus infections are uncommon. Standardized serological survey and laboratory methods are needed to fully understand the extent and risk of human A(H5N1) virus infections.

Influenza A(H5N1), Influenza in humans, Serological evidence
1741-7015
Chen, Xinhua
fa0fa23c-634a-460e-95d3-49be16a0ad42
Wang, Wei
3155280f-ff75-442d-91e5-67b74e9586c9
Wang, Yan
989d6a83-cb8f-48f9-a2c9-e45ba663bdd5
Lai, Shengjie
b57a5fe8-cfb6-4fa7-b414-a98bb891b001
Yang, Juan
a7a93a88-e671-435d-8845-9a32087cfe77
Cowling, Benjamin J
0c0bb95a-b3f1-45f7-8c77-abe9bf0ee576
Horby, Peter W
8f921e75-4605-4fb8-bb2c-be66fac6bb96
Uyeki, Timothy M
6333ed07-bca3-404c-bed3-b47a212afc9e
Yu, Hongjie
7921cb68-f4a2-4128-8406-eb0f6872bae7
Chen, Xinhua
fa0fa23c-634a-460e-95d3-49be16a0ad42
Wang, Wei
3155280f-ff75-442d-91e5-67b74e9586c9
Wang, Yan
989d6a83-cb8f-48f9-a2c9-e45ba663bdd5
Lai, Shengjie
b57a5fe8-cfb6-4fa7-b414-a98bb891b001
Yang, Juan
a7a93a88-e671-435d-8845-9a32087cfe77
Cowling, Benjamin J
0c0bb95a-b3f1-45f7-8c77-abe9bf0ee576
Horby, Peter W
8f921e75-4605-4fb8-bb2c-be66fac6bb96
Uyeki, Timothy M
6333ed07-bca3-404c-bed3-b47a212afc9e
Yu, Hongjie
7921cb68-f4a2-4128-8406-eb0f6872bae7

Chen, Xinhua, Wang, Wei, Wang, Yan, Lai, Shengjie, Yang, Juan, Cowling, Benjamin J, Horby, Peter W, Uyeki, Timothy M and Yu, Hongjie (2020) Serological evidence of human infections with highly pathogenic avian influenza A(H5N1) virus: a systematic review and meta-analysis. BMC Medicine, 18 (1), [377]. (doi:10.1186/s12916-020-01836-y).

Record type: Article

Abstract

BACKGROUND: Highly pathogenic avian influenza A(H5N1) virus poses a global public health threat given severe and fatal zoonotic infections since 1997 and ongoing A(H5N1) virus circulation among poultry in several countries. A comprehensive assessment of the seroprevalence of A(H5N1) virus antibodies remains a gap and limits understanding of the true risk of A(H5N1) virus infection.

METHODS: We conducted a systematic review and meta-analysis of published serosurveys to assess the risk of subclinical and clinically mild A(H5N1) virus infections. We assessed A(H5N1) virus antibody titers and changes in titers among populations with variable exposures to different A(H5N1) viruses.

RESULTS: Across studies using the World Health Organization-recommended seropositive definition, the point estimates of the seroprevalence of A(H5N1) virus-specific antibodies were higher in poultry-exposed populations (range 0-0.6%) and persons exposed to both human A(H5N1) cases and infected birds (range 0.4-1.8%) than in close contacts of A(H5N1) cases or the general population (none to very low frequencies). Seroprevalence was higher in persons exposed to A(H5N1) clade 0 virus (1.9%, range 0.7-3.2%) than in participants exposed to other clades of A(H5N1) virus (range 0-0.5%) (p < 0.05). Seroprevalence was higher in poultry-exposed populations (range 0-1.9%) if such studies utilized antigenically similar A(H5N1) virus antigens in assays to A(H5N1) viruses circulating among poultry.

CONCLUSIONS: These low seroprevalences suggest that subclinical and clinically mild human A(H5N1) virus infections are uncommon. Standardized serological survey and laboratory methods are needed to fully understand the extent and risk of human A(H5N1) virus infections.

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More information

Submitted date: 31 July 2020
Accepted/In Press date: 2 November 2020
Published date: 2 December 2020
Keywords: Influenza A(H5N1), Influenza in humans, Serological evidence

Identifiers

Local EPrints ID: 446157
URI: http://eprints.soton.ac.uk/id/eprint/446157
ISSN: 1741-7015
PURE UUID: 83a3c02b-96e6-4f9b-aa98-161df239f3ff
ORCID for Shengjie Lai: ORCID iD orcid.org/0000-0001-9781-8148

Catalogue record

Date deposited: 22 Jan 2021 17:31
Last modified: 28 Apr 2022 02:24

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Contributors

Author: Xinhua Chen
Author: Wei Wang
Author: Yan Wang
Author: Shengjie Lai ORCID iD
Author: Juan Yang
Author: Benjamin J Cowling
Author: Peter W Horby
Author: Timothy M Uyeki
Author: Hongjie Yu

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