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Malmberg JL, Miller M, Jennings-Gaines J, Allen SE. Mortality in Wild Turkeys (Meleagris gallopavo) Associated with Natural Infection with H5N1 Highly Pathogenic Avian Influenza Virus (HPAIV) Subclade 2.3.4.4. J Wildl Dis 2023; 59:767-773. [PMID: 37486883 DOI: 10.7589/jwd-d-22-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/27/2023] [Indexed: 07/26/2023]
Abstract
A Eurasian strain of H5N1 highly pathogenic avian influenza virus (HPAIV) was first detected in North America in December 2021 and has since been confirmed in numerous wild and domestic avian species. In April 2022, 41 Wild Turkeys (Meleagris gallopavo) were found dead in Johnson County, Wyoming, USA adjacent to a property with confirmed HPAIV in a backyard poultry flock. Oropharyngeal swabs were collected from 11 of the 41 turkeys and necropsy was performed on seven. Avian influenza virus RNA was detected in all 11 turkeys by real-time reverse-transcription PCR. Acute, multiorgan necrosis was observed grossly and identified in all seven turkeys evaluated by histopathology, most consistently in the lung, spleen, liver, gastrointestinal tract, and gonads. Lesions indicate high virulence of subclade 2.3.4.4b H5N1 HPAIV in Wild Turkeys, with infections presenting as clusters of acute mortality. Although documented cases of HPAIV in Wild Turkeys are rare, these findings signify a risk of spillback from domestic poultry, which may be heightened by the recent rise in backyard poultry ownership and the use of peridomestic habitat by wild birds. Additional research is needed to better understand the risk of disease transmission at the interface of Wild Turkeys and backyard poultry and the potential conservation and management implications of HPAIV in wild gallinaceous birds.
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Affiliation(s)
- Jennifer L Malmberg
- Department of Veterinary Sciences, University of Wyoming, 1174 Snowy Range Road, Laramie, Wyoming 82070, USA
- Wyoming State Veterinary Laboratory, 1174 Snowy Range Road, Laramie, Wyoming 82070, USA
- Current affiliation and address: National Wildlife Research Center, Wildlife Services, Animal and Plant Health Inspection Service, US Department of Agriculture, 4101 LaPorte Avenue, Fort Collins, Colorado 80521, USA
| | - Myrna Miller
- Department of Veterinary Sciences, University of Wyoming, 1174 Snowy Range Road, Laramie, Wyoming 82070, USA
- Wyoming State Veterinary Laboratory, 1174 Snowy Range Road, Laramie, Wyoming 82070, USA
| | - Jessica Jennings-Gaines
- Veterinary Services, Wildlife Health Laboratory, Wyoming Game and Fish Department, 1174 Snowy Range Road, Laramie, Wyoming 82070, USA
| | - Samantha E Allen
- Veterinary Services, Wyoming Game and Fish Department, 1212 South Adams Street, Laramie, Wyoming 82070, USA
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MacDonald AM, Johnson JB, Casalena MJ, Nemeth NM, Kunkel M, Blake M, Brown JD. Active and passive disease surveillance in wild turkeys (
Meleagris gallopavo
) from 2008 to 2018 in Pennsylvania, USA. WILDLIFE SOC B 2022. [DOI: 10.1002/wsb.1289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Amanda M. MacDonald
- Ontario Veterinary College, University of Guelph 419 Gordon Street Guelph ON N1G 2W1 Canada
| | - Joshua B. Johnson
- Pennsylvania Game Commission, 2001 Elmerton Avenue Harrisburg PA 17110‐9797 USA
| | - Mary Jo Casalena
- Pennsylvania Game Commission, 2001 Elmerton Avenue Harrisburg PA 17110‐9797 USA
| | - Nicole M. Nemeth
- Southeastern Cooperative Wildlife Disease Study, University of Georgia, 589 D. W. Brooks Drive Athens GA 30602 USA
| | - Melanie Kunkel
- Southeastern Cooperative Wildlife Disease Study, University of Georgia, 589 D. W. Brooks Drive Athens GA 30602 USA
| | - Mitchell Blake
- National Wild Turkey Federation, 770 Augusta Road, Edgefield, SC 29824 USA
| | - Justin D. Brown
- Department of Veterinary and Biomedical Sciences Pennsylvania State University, 115 Henning Building, University Park PA 16802 USA
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Hall JS, Grear DA, Krauss S, Seiler JP, Dusek RJ, Nashold SW, Webster RG. Highly pathogenic avian influenza virus H5N2 (clade 2.3.4.4) challenge of mallards age appropriate to the 2015 midwestern poultry outbreak. Influenza Other Respir Viruses 2021; 15:767-777. [PMID: 34323380 PMCID: PMC8542950 DOI: 10.1111/irv.12886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 06/16/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022] Open
Abstract
Background The 2015 highly pathogenic avian influenza virus (HPAIV) H5N2 clade 2.3.4.4 outbreak in upper midwestern U.S. poultry operations was not detected in wild birds to any great degree during the outbreak, despite wild waterfowl being implicated in the introduction, reassortment, and movement of the virus into North America from Asia. This outbreak led to the demise of over 50 million domestic birds and occurred mainly during the northward spring migration of adult avian populations. Objectives There have been no experimental examinations of the pathogenesis, transmission, and population impacts of this virus in adult wild waterfowl with varying exposure histories—the most relevant age class. Methods We captured, housed, and challenged adult wild mallards (Anas platyrhynchos) with HPAIV H5N2 clade 2.3.4.4 and measured viral infection, viral excretion, and transmission to other mallards. Results All inoculated birds became infected and excreted moderate amounts of virus, primarily orally, for up to 14 days. Cohoused, uninoculated birds also all became infected. Serological status had no effect on susceptibility. There were no obvious clinical signs of disease, and all birds survived to the end of the study (14 days). Conclusions Based on these results, adult mallards are viable hosts of HPAIV H5N2 regardless of prior exposure history and are capable of transporting the virus over short and long distances. These findings have implications for surveillance efforts. The capture and sampling of wild waterfowl in the spring, when most surveillance programs are not operating, are important to consider in the design of future HPAIV surveillance programs.
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Affiliation(s)
- Jeffrey S Hall
- United States Geological Survey, National Wildlife Health Center, Madison, WI, USA
| | - Daniel A Grear
- United States Geological Survey, National Wildlife Health Center, Madison, WI, USA
| | - Scott Krauss
- Infectious Disease Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - J Patrick Seiler
- Infectious Disease Department, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Robert J Dusek
- United States Geological Survey, National Wildlife Health Center, Madison, WI, USA
| | - Sean W Nashold
- United States Geological Survey, National Wildlife Health Center, Madison, WI, USA
| | - Robert G Webster
- Infectious Disease Department, St. Jude Children's Research Hospital, Memphis, TN, USA
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Delgado-Hernández B, Mugica L, Acosta M, Pérez F, Montano DDLN, Abreu Y, Ayala J, Percedo MI, Alfonso P. Knowledge, Attitudes, and Risk Perception Toward Avian Influenza Virus Exposure Among Cuban Hunters. Front Public Health 2021; 9:644786. [PMID: 34368040 PMCID: PMC8342762 DOI: 10.3389/fpubh.2021.644786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
A critical step for decreasing zoonotic disease threats is to have a good understanding of the associated risks. Hunters frequently handle potentially infected birds, so they are more at risk of being exposed to zoonotic avian pathogens, including avian influenza viruses (AIVs). The objective of the current study was to gain a better understanding of Cuban hunters' general hunting practices, focusing on their knowledge and risk perception on avian influenza. An anonymous and voluntary semi-structured questionnaire was designed and applied to 398 hunters. Multiple correspondence analyses found relationships with potential exposure of AIVs to people and domestic animals. The main associated risks factors identified were not taking the annual flu vaccine (60.1%) and not cleaning hunting knives (26.3%); Direct contact with water (32.1%), cleaning wild birds at home (33.2%); receiving assistance during bird cleaning (41.9%), keeping poultry at home (56.5%) and feeding domestic animals with wild bird leftovers (30.3%) were also identified as significant risk factors. The lack of use of some protective measures reported by hunters had no relationship with their awareness on avian influenza, which may imply a lack of such knowledge. The results evidenced that more effective risk communication strategies about the consequences of AIVs infecting human or other animals, and the importance of reducing such risks, are urgently needed.
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Affiliation(s)
- Beatriz Delgado-Hernández
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba
| | - Lourdes Mugica
- Bird Ecology Group, Biology Faculty, Havana University, Vedado, Cuba
| | - Martin Acosta
- Bird Ecology Group, Biology Faculty, Havana University, Vedado, Cuba
| | - Frank Pérez
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba.,Department of Veterinary Medicine, Faculty of Agricultural Sciences, University of Granma, Bayamo, Cuba
| | - Damarys de Las Nieves Montano
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba
| | - Yandy Abreu
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba
| | - Joel Ayala
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba
| | - María Irian Percedo
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba
| | - Pastor Alfonso
- Epidemiology Group, National Center for Animal and Plant Health (CENSA), World Organisation for Animal Health (OIE) Collaborating Center for the Reduction of the Risk of Disaster in Animal Health, San José de las Lajas, Cuba
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A Review of Avian Influenza A Virus Associations in Synanthropic Birds. Viruses 2020; 12:v12111209. [PMID: 33114239 PMCID: PMC7690888 DOI: 10.3390/v12111209] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/20/2020] [Accepted: 10/21/2020] [Indexed: 12/20/2022] Open
Abstract
Avian influenza A viruses (IAV) have received significant attention due to the threat they pose to human, livestock, and wildlife health. In this review, we focus on what is known about IAV dynamics in less common avian species that may play a role in trafficking IAVs to poultry operations. Specifically, we focus on synanthropic bird species. Synanthropic species, otherwise known as peridomestic, are species that are ecologically associated with humans and anthropogenically modified landscapes, such as agricultural and urban areas. Aquatic birds such as waterfowl and shorebirds are the species most commonly associated with avian IAVs, and are generally considered the reservoir or maintenance hosts in the natural ecology of these viruses. Waterfowl and shorebirds are occasionally associated with poultry facilities, but are uncommon or absent in many areas, especially large commercial operations. In these cases, spillover hosts that share resources with both maintenance hosts and target hosts such as poultry may play an important role in introducing wild bird viruses onto farms. Consequently, our focus here is on what is known about IAV dynamics in synanthropic hosts that are commonly found on both farms and in nearby habitats, such as fields, lakes, wetlands, or riparian areas occupied by waterfowl or shorebirds.
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Froberg T, Cuthbert F, Jennelle CS, Cardona C, Culhane M. Avian Influenza Prevalence and Viral Shedding Routes in Minnesota Ring-Billed Gulls ( Larus delawarensis). Avian Dis 2020; 63:120-125. [PMID: 31131567 DOI: 10.1637/11848-041718-reg.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/20/2018] [Indexed: 11/05/2022]
Abstract
Birds within the orders Charadriiformes (shorebirds, gulls) and Anseriformes (waterfowl) are reservoir hosts for avian influenza (AI) viruses, but their role in the transmission dynamics of AI viruses is unclear. To date, waterfowl have been the predominant focal species for most surveillance and epidemiological studies, yet gulls, in particular, have been shown to harbor reassortant AI viruses of both North American and Eurasian lineages and are underrepresented in North American surveillance efforts. To address this gap in surveillance, 1346 ring-billed gulls (Larus delawarensis) were sampled during spring and fall migrations and at three breeding sites in 2017 across Minnesota. Results indicate noticeable age-cohort dynamics in AI virus prevalence within ring-billed gulls in Minnesota. Immunologically naïve juveniles represented the cohort with the highest prevalence rate (57.8%). Regardless of age, more gulls had AI virus detected in oropharyngeal (OP) than in cloacal (CL) swabs. The high AI virus prevalence within ring-billed gulls, particularly in immunologically naïve birds, warrants further targeted surveillance efforts of ring-billed gulls and other closely related species.
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Affiliation(s)
- Todd Froberg
- Department of Fisheries, Wildlife, and Conservation Biology, University of Minnesota, Saint Paul, MN 55108
| | - Francesca Cuthbert
- Department of Fisheries, Wildlife, and Conservation Biology, University of Minnesota, Saint Paul, MN 55108
| | | | - Carol Cardona
- College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108
| | - Marie Culhane
- College of Veterinary Medicine, University of Minnesota, Saint Paul, MN 55108.,Corresponding author. E-mail:
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Yamaji R, Saad MD, Davis CT, Swayne DE, Wang D, Wong FYK, McCauley JW, Peiris JSM, Webby RJ, Fouchier RAM, Kawaoka Y, Zhang W. Pandemic potential of highly pathogenic avian influenza clade 2.3.4.4 A(H5) viruses. Rev Med Virol 2020; 30:e2099. [PMID: 32135031 PMCID: PMC9285678 DOI: 10.1002/rmv.2099] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 01/05/2023]
Abstract
The panzootic caused by A/goose/Guangdong/1/96‐lineage highly pathogenic avian influenza (HPAI) A(H5) viruses has occurred in multiple waves since 1996. From 2013 onwards, clade 2.3.4.4 viruses of subtypes A(H5N2), A(H5N6), and A(H5N8) emerged to cause panzootic waves of unprecedented magnitude among avian species accompanied by severe losses to the poultry industry around the world. Clade 2.3.4.4 A(H5) viruses have expanded in distinct geographical and evolutionary pathways likely via long distance migratory bird dispersal onto several continents and by poultry trade among neighboring countries. Coupled with regional circulation, the viruses have evolved further by reassorting with local viruses. As of February 2019, there have been 23 cases of humans infected with clade 2.3.4.4 H5N6 viruses, 16 (70%) of which had fatal outcomes. To date, no HPAI A(H5) virus has caused sustainable human‐to‐human transmission. However, due to the lack of population immunity in humans and ongoing evolution of the virus, there is a continuing risk that clade 2.3.4.4 A(H5) viruses could cause an influenza pandemic if the ability to transmit efficiently among humans was gained. Therefore, multisectoral collaborations among the animal, environmental, and public health sectors are essential to conduct risk assessments and develop countermeasures to prevent disease and to control spread. In this article, we describe an assessment of the likelihood of clade 2.3.4.4 A(H5) viruses gaining human‐to‐human transmissibility and impact on human health should such human‐to‐human transmission occur. This structured analysis assessed properties of the virus, attributes of the human population, and ecology and epidemiology of these viruses in animal hosts.
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Affiliation(s)
- Reina Yamaji
- Global Influenza Programme, Infectious Hazards Management, WHO Emergency Programme, WHO, Geneva, Switzerland
| | - Magdi D Saad
- Global Influenza Programme, Infectious Hazards Management, WHO Emergency Programme, WHO, Geneva, Switzerland
| | - Charles T Davis
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - David E Swayne
- Department of Agriculture, OIE Collaborating Centre for Research on Emerging Avian Diseases, U.S. National Poultry Research Center, Agricultural Research Service, Athens, Georgia, USA
| | - Dayan Wang
- National Institute for Viral Disease Control and Prevention, China
| | - Frank Y K Wong
- CSIRO Australian Animal Health Laboratory, Geelong, Australia
| | - John W McCauley
- WHO Collaborating Centre for Reference and Research on Influenza, Crick Worldwide Influenza Centre, The Francis Crick Institute, London, UK
| | - J S Malik Peiris
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Richard J Webby
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Ron A M Fouchier
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Yoshihiro Kawaoka
- Division of Virology, Department of Microbiology and Immunology, Institute of Medical Science, University of Tokyo, Tokyo, Japan.,Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA.,Department of Special Pathogens, International Research Center for Infectious Diseases, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Wenqing Zhang
- Global Influenza Programme, Infectious Hazards Management, WHO Emergency Programme, WHO, Geneva, Switzerland
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Lee DH, Torchetti MK, Hicks J, Killian ML, Bahl J, Pantin-Jackwood M, Swayne DE. Transmission Dynamics of Highly Pathogenic Avian Influenza Virus A(H5Nx) Clade 2.3.4.4, North America, 2014-2015. Emerg Infect Dis 2019; 24:1840-1848. [PMID: 30226167 PMCID: PMC6154162 DOI: 10.3201/eid2410.171891] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Eurasia highly pathogenic avian influenza virus (HPAIV) H5 clade 2.3.4.4 emerged in North America at the end of 2014 and caused outbreaks affecting >50 million poultry in the United States before eradication in June 2015. We investigated the underlying ecologic and epidemiologic processes associated with this viral spread by performing a comparative genomic study using 268 full-length genome sequences and data from outbreak investigations. Reassortant HPAIV H5N2 circulated in wild birds along the Pacific flyway before several spillover events transmitting the virus to poultry farms. Our analysis suggests that >3 separate introductions of HPAIV H5N2 into Midwest states occurred during March–June 2015; transmission to Midwest poultry farms from Pacific wild birds occurred ≈1.7–2.4 months before detection. Once established in poultry, the virus rapidly spread between turkey and chicken farms in neighboring states. Enhanced biosecurity is required to prevent the introduction and dissemination of HPAIV across the poultry industry.
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DETECTION OF LYMPHOPROLIFERATIVE DISEASE VIRUS IN CANADA IN A SURVEY FOR VIRUSES IN ONTARIO WILD TURKEYS (MELEAGRIS GALLOPAVO). J Wildl Dis 2019; 55:113-122. [DOI: 10.7589/2018-01-013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Wang XX, Cheng W, Yu Z, Liu SL, Mao HY, Chen EF. Risk factors for avian influenza virus in backyard poultry flocks and environments in Zhejiang Province, China: a cross-sectional study. Infect Dis Poverty 2018; 7:65. [PMID: 29914558 PMCID: PMC6006748 DOI: 10.1186/s40249-018-0445-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 05/30/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Human infection of avian influenza virus (AIV) remains a great concern. Although live poultry markets are believed to be associated with human infections, ever more infections have been reported in rural areas with backyard poultry, especially in the fifth epidemic of H7N9. However, limited information is available on backyard poultry infection and surrounding environmental contamination. METHODS Two surveillance systems and a field survey were used to collect data and samples in Zhejiang Province. In total, 4538 samples were collected by surveillance systems and 3171 from the field survey between May 2015 and May 2017, while 352 backyard poultry owners were interviewed in May 2017 by questionnaire to investigate factors influencing the prevalence of avian influenza A virus and other AIV subtypes. RT-PCR was used to test the nucleic acids of viruses. ArcGIS 10.1 software was used to generate maps. Univariate and logistic regression analyses were conducted to identify risk factors for AIV infection. RESULTS Of the 428 poultry premises observed by the surveillance system, 53 (12.38%) were positive for influenza A virus. Of the 352 samples from poultry premises observed by field survey, 13 (3.39%) were positive for influenza A virus. The prevalence of AIV was unevenly distributed and the dominant subtype differed among cities. Eastern (Shaoxing and Ningbo) and southern (Wenzhou) cities exhibited a higher prevalence of AIV (16.33, 8.94, and 7.30% respectively). Contamination of AIV subtypes was most severe in January, especially in 2016 (23.26%, 70/301). The positive rate of subtype H5/H7/H9 was 2.53% (115/4538). Subtype H5 was the least prevalent, while subtypes H7 and H9 had similar positivity rates (1.50 and 1.32% respectively). Poultry flocks and environmental samples had a similar prevalence of AIV (4.46% vs 5.06%). The type of live birds was a risk factor and the sanitary condition of the setting was a protective factor against influenza A contamination. CONCLUSIONS AIV subtypes were prevalent in backyard poultry flocks and surrounding environments in Zhejiang Province. The types of live birds and sanitary conditions of the environment were associated with influenza A contamination. These findings shine a light on the characteristics of contamination of AIV subtypes and emphasize the importance of reducing AIV circulation in backyard poultry settings.
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Affiliation(s)
- Xiao-Xiao Wang
- Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang 310051 People’s Republic of China
| | - Wei Cheng
- Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang 310051 People’s Republic of China
| | - Zhao Yu
- Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang 310051 People’s Republic of China
| | - She-Lan Liu
- Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang 310051 People’s Republic of China
| | - Hai-Yan Mao
- Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang 310051 People’s Republic of China
| | - En-Fu Chen
- Zhejiang Provincial Centre for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, Zhejiang 310051 People’s Republic of China
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