Yonsei Med J.  2007 Aug;48(4):586-594. 10.3349/ymj.2007.48.4.586.

Avian Influenza: Should China Be Alarmed?

• Su Z
• Xu H
• Chen J

• KMID: 2158162
• DOI: http://doi.org/10.3349/ymj.2007.48.4.586

Abstract

Avian influenza has emerged as one of the primary public health concern of the 21st century. Influenza strain H5N1 is capable of incidentally infecting humans and other mammals. Since their reemergence in 2003, highly pathogenic avian influenza A (H5N1) viruses have been transmitted from poultry to humans (by direct or indirect contact with infected birds) in several provinces of Mainland China, which has resulted in 22 cases of human infection and has created repercussions for the Chinese economy. People have been concerned whether a new pandemic will occur in the future. The eradication of pathogenic avian influenza viruses appears to be the most effective way to prevent an influenza pandemic. This paper will examine the features of H5N1, including incidence, infection, immunity, clinical management, prevention and control, and therapy in Mainland China.

Keyword

Avian influenza; H5N1; innate immune; adaptive immune; prevention; control

MeSH Terms

Adolescent
Adult
Animals
Birds
Child
China/epidemiology
Disease Outbreaks/prevention & control
Female
Humans
Incidence
*Influenza A Virus, H5N1 Subtype
Influenza in Birds/prevention & control
Influenza, Human/*epidemiology/immunology/therapy
Male
Zoonoses/epidemiology/transmission/virology

Figure

• 

  Fig. 1 Schematic diagram of avian influenza virus.

• 

  Fig. 2 Transmission route of H5N1.

Reference

1. Zhang M. Chinese economic loss USD 87,000,000,000 because for avian influenza Oriental Morning Post. 2005. Nov 22. Available from http://finance.sina.com.cn/g/20051122/07132136780.shtml. Chinese.

2. Lahariya C, Sharma AK, Pradhan SK. Avian flu and possible human pandemic. Indian Pediatr. 2006. 43:317–325.

3. Horimoto T, Kawaoka Y. Influenza: lessons from past pandemics, warnings from current incidents. Nat Rev Microbiol. 2005. 3:591–600.

4. Xu XY, Wang QH. Biology and epidemiology of avian influenza. Zhonghua Yi Xue Za Zhi. 2004. 84:353–354.

5. Liu JP. Avian influenza-a pandemic waiting to happen? J Microbiol Immunol Infect. 2006. 39:4–10.

6. Beijing Centers for Diseases Control and Prevention & Centers Preventive Medical Research. Schematic diagram of avian influenza subtypes virus. Xinhua News Agency. 2006. Feb 21. Aviable from http://news.sina.com.cn/c/p/2006-02-21/20219164152.shtml. Chinese.

7. Subbarao K, Klimov A, Katz J, Regnery H, Lim W, Hall H, et al. Characterization of an avian influenza A (H5N1) virus isolated from a child with a fatal respiratory illness. Science. 1998. 279:393–396.

8. Claas EC, Osterhaus AD, van Beek R, De Jong JC, Rimmelzwaan GF, Senne DA, et al. Human influenza A H5N1 virus related to a highly pathogenic avian influenza virus. Lancet. 1998. 351:472–477.

9. Chen H, Deng G, Li Z, Tian G, Li Y, Jiao P, et al. The evolution of H5N1 influenza viruses in ducks in southern China. Proc Natl Acad Sci U S A. 2004. 101:10452–10457.

10. Xing L. The Chinese avian influenza case presentd disperse and Ministry of Public Health asked to make careful obviate chinanews.com. 2006. April 28. Available from http://www.chinanews.com.cn//news/2006/2006-04-28/8/724249.shtml.Chinese.

11. The news office of State council. the Chinese avian influenza epidemic characteristics, prevention and control measures. 2006. Feb 5. Available from http:// www.wxhealth.com/qlg/q43.htm.Chinese.

12. Perez DR, Sorrell EM, Donis RO. Avian influenza: an omnipresent pandemic threat. Pediatr Infect Dis J. 2005. 24(11 Suppl):S208–S216.

13. Luo RP, Zhu YM, Xu ZY, Gao JP, Yu SJ. Report of the first human case of H5N1 avian influenza pneumonia in Human, China. Zhonghua Er Ke Za Zhi. 2006. 44:342–345. Chinese.

14. Yu HJ, Chen YX, Shu YL, Li JH, Gao ZC, Hu SX, et al. The first confirmed human case of avian influenza A (H5N1) in Mainland, China. Zhonghua Liu Xing Bing Xue Za Zhi. 2006. 27:281–287.

15. Ministry of Public Health. The bulletin of human avian influenza cases in mainland china. Available from http://news.tom.com/hot/qinliugan/.Chinese.

16. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO.world health organization. 2006. May 19. Available from http://www.who.int/csr/disease/avian_influenza/country/en/.Chinese.

17. Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis. 2003. 37:1094–1101.

18. Liao DJ, Song B. Review and Epidemiology of Avian Influenza [In Chinese]. J Vet Parasitol. 2004. 12:43–47.

19. Ungchusak K, Auewarakul P, Dowell SF, Kitphati R, Auwanit W, Puthavathana P, et al. Probable person-to-person transmission of avian influenza A (H5N1). N Engl J Med. 2005. 352:333–340.

20. Zhang CY, Wei JF, He SH. Adaptive evolution of the spike gene of SARS coronavirus: changes in positively selected sites at different epidemic groups. BMC Microbiol. 2006. 6:88.

21. Nash T. Roitt I, Brostoff J, Male D, editors. Immunity to viruses. Immunology. 2001. 6th ed. Harcourt Asia: Pte Ltd;236–237.

22. Sekellick MJ, Carra SA, Bowman A, Hopkins DA, Marcus PI. Transient resistance of influenza virus to interferon action attributed to random multiple packaging and activity of NS genes. J Interferon Cytokine Res. 2000. 20:963–970.

23. Engelhardt OG, Sirma H, Pandolfi PP, Haller O. Mx1 GTPase accumulates in distinct nuclear domains and inhibits influenza A virus in cells that lack promyelocytic leukaemia protein nuclear bodies. J Gen Virol. 2004. 85:2315–2326.

24. Suarez DL, Schultz-Cherry S. Immunology of avian influenza virus: a review. Dev Comp Immunol. 2000. 24:269–283.

25. Lipatov AS, Andreansky S, Webby RJ, Hulse DJ, Rehg JE, Krauss S, et al. Pathogenesis of Hong Kong H5N1 influenza virus NS gene reassortants in mice: the role of cytokines and B- and T-cell responses. J Gen Virol. 2005. 86:1121–1130.

26. Hsieh SM, Chang SC. Insufficient perforin expression in CD8+ T cells in response to hemagglutinin from avian influenza (H5N1) virus. J Immunol. 2006. 176:4530–4533.

27. Ko SY, Ko HJ, Chang WS, Park SH, Kweon MN, Kang CY. Alpha-Galactosylceramide can act as a nasal vaccine adjuvant inducing protective immune responses against viral infection and tumor. J Immunol. 2005. 175:3309–3317.

28. van Riel D, Munster VJ, de Wit E, Rimmelzwaan GF, Fouchier RA, Osterhaus AD, et al. H5N1 virus attachment to lower respiratory tract. Science. 2006. 312:399.

29. Tumpey TM, García-Sastre A, Taubenberger JK, Palese P, Swayne DE, Pantin-Jackwood MJ, et al. Pathogenicity of influenza viruses with genes from the 1918 pandemic virus: functional roles of alveolar macrophages and neutrophils in limiting virus replication and mortality in mice. J Virol. 2005. 79:14933–14944.

30. Seo SH, Webster RG. Cross-reactive, cell-mediated immunity and protection of chickens from lethal H5N1 influenza virus infection in Hong Kong poultry markets. J Virol. 2001. 75:2516–2525.

31. Cavanagh LL, Bonasio R, Mazo IB, Halin C, Cheng G, van der Velden AW, et al. Activation of bone marrow-resident memory T cells by circulating, antigen-bearing dendritic cells. Nat Immunol. 2005. 6:1029–1037.

32. Belz GT, Wilson NS, Smith CM, Mount AM, Carbone FR, Heath WR. Bone marrow-derived cells expand memory CD8+ T cells in response to viral infections of the lung and skin. Eur J Immunol. 2006. 36:327–335.

33. Belz GT, Smith CM, Eichner D, Shortman K, Karupiah G, Carbone FR, et al. Cutting edge: conventional CD8 alpha+ dendritic cells are generally involved in priming CTL immunity to viruses. J Immunol. 2004. 172:1996–2000.

34. Flynn KJ, Riberdy JM, Christensen JP, Altman JD, Doherty PC. In vivo proliferation of naive and memory influenza-specific CD8+ T cells. Proc Natl Acad Sci U S A. 1999. 96:8597–8602.

35. Jelley-Gibbs DM, Brown DM, Dibble JP, Haynes L, Eaton SM, Swain SL. Unexpected prolonged presentation of influen za antigens promotes CD4 T cell memory generation. J Exp Med. 2005. 202:697–706.

36. Jameson J, Cruz J, Terajima M, Ennis FA. Human CD8+ and CD4+ T lymphocyte memory to influenza A viruses of swine and avian species. J Immunol. 1999. 162:7578–7583.

37. Laudert E, Sivanandan V, Halvorson D. Effect of an H5N1 avian influenza virus infection on the immune system of mallard ducks. Avian Dis. 1993. 37:845–853.

38. Sakai K, Yada K, Sakabe G, Tani O, Miyaji K, Nakamura M, et al. Serological and virological studies of Newcastle disease and avian influenza in slaughter-age ostriches (Struthio camelus) in Japan. J Vet Med Sci. 2006. 68:491–494.

39. Rott R, Klenk HD, Nagai Y, Tashiro M. Influenza viruses, cell enzymes, and pathogenicity. Am J Respir Crit Care Med. 1995. 152:S16–S19.

40. Lipatov AS, Gitel'man AK, Govorkova EA, Smirnov IuA. Changes in biological and physico-chemical properties of avian influenza virus A hemagglutinin H2 during adaptation to a new host. Vopr Virusol. 1995. 40:208–211.

41. Matrosovich M, Zhou N, Kawaoka Y, Webster R. The surface glycoproteins of H5 influenza viruses isolated from humans, chickens, and wild aquatic birds have distinguishable properties. J Virol. 1999. 73:1146–1155.

42. Bender C, Hall H, Huang J, Klimov A, Cox N, Hay A, et al. Characterization of the surface proteins of influenza A (H5N1) viruses isolated from humans in 1997-1998. Virology. 1999. 254:115–123.

43. Stevens J, Blixt O, Tumpey TM, Taubenberger JK, Paulson JC, Wilson IA. Structure and receptor specificity of the hemagglutinin from an H5N1 influenza virus. Science. 2006. 312:404–410.

44. Il'iushina NA, Rudneva IA, Varich NL, Lipatov AS, Webster RG, Kaverin NV. Antigenic structure of influenza A virus subtype H5 hemagglutinin: mechanism of acquiring stability to monoclonal antibodies in escape-mutants. Mol Gen Mikrobiol Virusol. 2003. 1:40–45.

45. Chen H, Subbarao K, Swayne D, Chen Q, Lu X, Katz J, et al. Generation and evaluation of a high-growth reassortant H9N2 influenza A virus as a pandemic vaccine candidate. Vaccine. 2003. 21:1974–1979.

46. Chen Z, Matsuo K, Asanuma H, Takahashi H, Iwasaki T, Suzuki Y, et al. Enhanced protection against a lethal infuenza virus challenge by immunization with both hemagglutinin and neuraminidase-expressing DNAs. Vaccine. 1999. 17:653–659.

47. Frace AM, Klimov AI, Rowe T, Black RA, Katz JM. Modified M2 proteins produce heterotypic immunity against infuenza A virus. Vaccine. 1999. 17:2237–2244.

48. Liu W, Zou P, Ding J, Lu Y, Chen YH. Sequence comparison between the extracellular domain of M2 protein human and avian influenza A virus provides new information for bivalent influenza vaccine design. Microbes Infect. 2005. 7:171–177.

49. Renegar KB. Influenza virus infections and immunity: a review of human and animal models. Lab Anim Sci. 1992. 42:222–232.

50. World Health Organization Global Influenza Program Surveillance Network. Evolution of H5N1 avian influenza viruses in Asia. Emerg Infect Dis. 2005. 11:1515–1521.

51. Liu JP. Avian influenza--a pandemic waiting to happen? J Microbiol Immunol Infect. 2006. 39:4–10.

52. Fernandez-Sesma A, Marukian S, Ebersole BJ, Kaminski D, Park MS, Yuen T, et al. Influenza virus evades innate and adaptive immunity via the NS1 protein. J Virol. 2006. 80:6295–6304.

53. Perdue ML. Naturally occurring NS gene variants in an avian influenza virus isolate. Virus Res. 1992. 23:223–240.

54. Chen H, Smith GJ, Li KS, Wang J, Fan XH, Rayner JM, et al. Establishment of multiple sublineages of H5N1 influenza virus in Asia: implications for pandemic control. Proc Natl Acad Sci U S A. 2006. 103:2845–2850.

55. Henley E. The growing threat of avian influenza. J Fam Pract. 2005. 54:442–444.

56. Riedel S. Crossing the species barrier: the threat of an avian influenza pandemic. Proc (Bayl Univ Med Cent). 2006. 19:16–20.

57. Yu SY, Chen Q, Hu GF. Summary of Guangdong provincial seminar on avian influenza and influenza. Di Yi Jun Yi Da Xue Xue Bao. 2005. 25:1587–1588.

58. Normile D. Avian influenza. Chinese Ministry questions bird flu findings. Science. 2005. 309:364.

59. Yang YH. Pay enough attention to human infection with avian influenza virus. Zhonghua Er Ke Za Zhi. 2004. 42:246–247.

60. Chinese Ministry of Public Health. Diagnosis and treatment measures about human influenza A. 2005. Sep 5. Available from http://www.cintcm.com/qinliugan/index_qlg.htm.

61. How to prevent avian influenza of citizen. Shanghai Evening Post. 2004. Jan 29. Available from http://www.china.com.cn/chinese/zhuanti/qlg/487001.htm.Chinese.

62. Wei TB, Huang YT, Li KS. Influenza virus variation and prevention. Chin J Immunol. 2006. 22:16–19. Chinese.

63. Jin NY. Prevalence and preventive control of highly pathogenic avian influenza. Chin J Immunol. 2006. 22:5–12. Chinese.

64. Hang J. My country had successfully advanced development three kinds of new influenza vaccines. Xinhuanet. 2006. June 14. Chinese:

65. Cyranoski D. China steps up drive to vaccinate all domestic birds. Nature. 2005. 438:406.

66. Wood JM, Nicholson KG, Stephenson I, Zambon M, Newman RW, Major DL, et al. Experience with the clinical development of influenza vaccines for potential pandemics. Med Microbiol Immunol. 2002. 191:197–201.

67. The Chinese Center for Disease Control and Prevention. The project of human avian influenza's diaginosis and treatment. 2005 Revised edition. Available from http://www.chinacdc.net.cn/n272442/n272530/n273736/n273781/n305111/index.html.

68. Prevention and control of avian influenza in humans in China: achieving the national objectives of the WHO Global Influenza Preparedness Plan Weekly epidemiological record. 2006. 84:105–116. Available from http://www.who.int/wer.

69. Hu X. Speech at the International Conference on Avian Influenza. 2005. Geneva.

70. Leneva IA, Roberts N, Govorkova EA, Goloubeva OG, Webster RG. The neuraminidase inhibitor GS4104 (oseltamivir phosphate) is efficacious against A/Hong Kong/156/97 (H5N1) and A/Hong Kong/1074/99 (H9N2) influenza viruses. Antiviral Res. 2000. 48:101–115.

71. World Health Organization. Avian influenza (bird flu) fact sheet. 2006. Accessed on February 24. At http://www.who.int/mediacentre/factsheets/ avian_influenza/en/index.html.

72. Avian influenza A (H5N1). Weekly Epidemiol Rec. 2004. 79:65–70. (Also available at http://www.who.int/wer/2004/en/wer7907.pdf. (Accessed on February 24, 2006).

73. Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, Chunsuthiwat S, Sawanpanyalert P, Kijphati R, et al. Human disease from influenza A (H5N1), Thailand, 2004. Emerg Infect Dis. 2005. 11:201–209.

74. Aoki FY, Macleod MD, Paggiaro P, Carewicz O, El Sawy A, Wat C, et al. Early administration of oral oseltamivir increases the benefits of influenza treatment. J Antimicrob Chemother. 2003. 51:123–129.

75. Hedrick JA, Barzilai A, Behre U, Henderson FW, Hammond J, Reilly L, et al. Zanamivir for treatment of symptomatic influenza A and B infection in children five to twelve years of age: a randomized controlled trial. Pediatr Infect Dis J. 2000. 19:410–417.

76. Hughes JM. Twenty-first century plague; The story of SARS. J Clin Invest. 2006. 116:846.