H5N1

Influenza A virus subtype H5N1 Genetic structure Infection Global spread in 2006 Social impact Pandemic

WHO pandemic phases Low risk New virus Self limiting Person to person Epidemic exists Pandemic exists

See Epidemiology of WHO-confirmed human cases of avian influenza A(H5N1) infection.

H5N1 flu refers to the transmission and infection of H5N1. H5N1 flu is a concern due to the global spread of H5N1 that constitutes a pandemic threat. This article is about the transmission of the H5N1 virus, infection by that virus, the resulting symptoms of that infection (having or coming down with influenza or more specifically avian flu or even more specifically H5N1 flu which can include pneumonia), and the medical response including treatment. Image File history File links Colorized_transmission_electron_micrograph_of_Avian_influenza_A_H5N1_viruses. ... Genera Influenzavirus A Influenzavirus B Influenzavirus C Isavirus Thogotovirus Influenzavirus A is a genus of a family of viruses called Orthomyxoviridae in virus classification. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... The H5N1 genetic structure is the structure of the H5N1 virus. ... The global spread of H5N1 in birds is considered a significant pandemic threat. ... Main article: Global spread of H5N1 Notes: Source WHO Confirmed Human Cases of H5N1 [T]he incidence of human cases peaked, in each of the three years in which cases have occurred, during the period roughly corresponding to winter and spring in the northern hemisphere. ... See Influenza pandemic for government preparation for an H5N1 pandemic H5N1 impact is the effect or influence of H5N1 in human society; especially the financial, political, social and personal responses to both actual and predicted deaths in birds, humans, and other animals. ... An influenza pandemic is a large scale epidemic of the influenza virus, such as the 1918 Spanish flu. ... An influenza pandemic is a large scale epidemic of the influenza virus, such as the 1918 Spanish flu. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... The global spread of H5N1 in birds is considered a significant pandemic threat. ... This article is about large epidemics. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Groups I: dsDNA viruses II: ssDNA viruses III: dsRNA viruses IV: (+)ssRNA viruses V: (-)ssRNA viruses VI: ssRNA-RT viruses VII: dsDNA-RT viruses A virus (Latin, poison) is a microscopic particle that can infect the cells of a biological organism. ... Influenza, commonly known as the flu, is an infectious disease of birds and mammals caused by an RNA virus of the family Orthomyxoviridae (the influenza viruses). ... For the current concern about the transmission of an avian flu to humans see Transmission and infection of H5N1. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ...

Infected birds pass on H5N1 through their saliva, nasal secretions, and feces. Other birds may pick up the virus through direct contact with these excretions or when they have contact with surfaces contaminated with this material. Because migratory birds are among the carriers of the H5N1 virus it may spread to all parts of the world. Past outbreaks of avian flu have often originated in crowded conditions in southeast and east Asia, where humans, pigs, and poultry live in close quarters. In these conditions a virus is more likely to mutate into a form that more easily infects humans. Saliva is the watery and usually somewhat frothy substance produced in the mouths of humans and some animals. ... Mucus is a slippery secretion of the lining of various membranes in the body (mucous membranes). ... Feces, faeces, or fæces (see spelling differences) is waste product from an animals digestive tract expelled through the anus (or cloaca) during defecation. ... Location of Southeast Asia Southeast Asia is a subregion of Asia. ... East Asia is a subregion of Asia that can be defined in either geographical or cultural terms. ... This article is about the pig genus. ... In biology, mutations are changes to the genetic material (either DNA or RNA). ...

The majority of H5N1 flu cases have been reported in southeast and east Asia. Once an outbreak is detected, local authorities often order a mass slaughter of birds or animals affected. If this is done promptly, an outbreak of avian flu may be prevented. However, the United Nations (UN) World Health Organization (WHO) has expressed concern that not all countries are reporting outbreaks as completely as they should. China, for example, is known to have initially denied past outbreaks of severe acute respiratory syndrome (SARS) and HIV, although there have been some signs of improvement regarding its openess in recent months, particularly with regard to H5N1. The United Nations (UN) is an international organization whose stated aims are to facilitate co-operation in international law, international security, economic development, social progress and human rights issues. ... The World Health Organization (WHO) is a specialized agency of the United Nations, acting as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... Severe acute respiratory syndrome or SARS is a respiratory disease in humans which is caused by the SARS coronavirus. ... Human immunodeficiency virus or HIV is a retrovirus that causes Acquired Immunodeficiency Syndrome (AIDS), a condition in which the immune system begins to fail, leading to life-threatening opportunistic infections. ...

H5N1 infections in humans are generally caused by bird to human transmission of the virus. Until May 2006, the WHO estimate of the number of human to human transmission had been "two or three cases". On May 24, 2006, Dr. Julie L. Gerberding, director of the United States Centers for Disease Control and Prevention in Atlanta, estimated that there had been "at least three." On May 30, Maria Cheng, a WHO spokeswoman, said there were "probably about half a dozen," but that no one "has got a solid number."^[1] A few isolated cases of suspected human to human transmission exist.^[2] with the latest such case in June 2006 (among members of a family in Sumatra).^[3] No pandemic strain of H5N1 has yet been found. The key point is that, at present, "the virus is not spreading efficiently or sustainably among humans."^[4] The World Health Organization (WHO) is a specialized agency of the United Nations, acting as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... Generally, regression is a move backwards; It is the opposite of progression. ... May 24 is the 144th day of the year in the Gregorian calendar (145th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ... This article is about the state capital of Georgia. ... May 30 is the 150th day of the year in the Gregorian calendar (151st in leap years). ... This article is about large epidemics. ...

There is also concern, although no definitive proof, that other animals — particularly cats — may be able to act as a bridge between birds and humans. So far several cats have been confirmed to have died from H5N1 and the fact that cats have regular close contact with both birds and humans means monitoring of H5N1 in cats will need to continue.

H5N1 vaccines for chickens exist and are sometimes used, although there are many difficulties that make deciding if it helps more or hurts more especially difficult. H5N1 pre-pandemic vaccines exist in quantities sufficient to inoculate a few million people^[5] and might be useful for priming to "boost the immune response to a different H5N1 vaccine tailor-made years later to thwart an emerging pandemic".^[6] H5N1 pandemic vaccines and technologies to rapidly create them are in the H5N1 clinical trials stage but can not be verified as useful until after there exists a pandemic strain. H5N1 clinical trials are clinical trials concerning H5N1 vaccine; which is to say they are investigations concerning H5N1 vaccine in humans intended to discover pharmacological effects and identify any adverse reactions. ...

Avian flu in birds

See also: Flu_vaccine#Flu vaccine for nonhumans

According to Avian Influenza by Timm C. Harder and Ortrud Werner: Model of Influenza Virus from NIH The flu vaccine is a vaccine to protect against the highly variable influenza virus. ...

Following an incubation period of usually a few days (but rarely up to 21 days), depending upon the characteristics of the isolate, the dose of inoculum, the species, and age of the bird, the clinical presentation of avian influenza in birds is variable and symptoms are fairly unspecific.^[7] Therefore, a diagnosis solely based on the clinical presentation is impossible. The symptoms following infection with low pathogenic AIV may be as discrete as ruffled feathers, transient reductions in egg production or weight loss combined with a slight respiratory disease.^[8] Some LP strains such as certain Asian H9N2 lineages, adapted to efficient replication in poultry, may cause more prominent signs and also significant mortality.^[9][10] In its highly pathogenic form, the illness in chickens and turkeys is characterised by a sudden onset of severe symptoms and a mortality that can approach 100% within 48 hours.^[11][12]

Poultry farming practices

Poultry farming practices have changed due to H5N1:

• killing millions of poultry
• vaccinating poultry against bird flu
• vaccinating poultry workers against human flu
• limiting travel in areas where H5N1 is found
• increasing farm hygiene
• reducing contact between livestock and wild birds
• reducing open-air wet markets
• limiting workers contact with cock fighting
• reducing purchases of live fowl
• improving veterinary vaccine availability and cost. ^[13]

For example, after nearly two years of using mainly culling to control the virus, the Vietnamese government in 2005 adopted a combination of mass poultry vaccination, disinfecting, culling, information campaigns and bans on live poultry in cities.^[14] Vaccination is the process of administering weakened or dead pathogens to a healthy person or animal, with the intent of conferring immunity against a targeted form of a related disease agent. ... Avian influenza (also known as bird flu) is a type of influenza virulent in birds. ... Human Flu refers to a subset of Orthomyxoviridae that create influenza in humans and are endemic in humans. ... Sheep are commonly bred as livestock. ... A live animal market, a common sight in many areas of the world and a source of influenza viruses and other infectious disease agents for human beings. ... This article or section does not cite its references or sources. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ...

Webster et al write

Transmission of highly pathogenic H5N1 from domestic poultry back to migratory waterfowl in western China has increased the geographic spread. The spread of H5N1 and its likely reintroduction to domestic poultry increase the need for good agricultural vaccines. In fact, the root cause of the continuing H5N1 pandemic threat may be the way the pathogenicity of H5N1 viruses is masked by cocirculating influenza viruses or bad agricultural vaccines."^[15]

Dr. Robert Webster explains: "If you use a good vaccine you can prevent the transmission within poultry and to humans. But if they have been using vaccines now [in China] for several years, why is there so much bird flu? There is bad vaccine that stops the disease in the bird but the bird goes on pooping out virus and maintaining it and changing it. And I think this is what is going on in China. It has to be. Either there is not enough vaccine being used or there is substandard vaccine being used. Probably both. It’s not just China. We can’t blame China for substandard vaccines. I think there are substandard vaccines for influenza in poultry all over the world." ^[16] In response to the same concerns, Reuters reports Hong Kong infectious disease expert Lo Wing-lok saying, "The issue of vaccines has to take top priority," and Julie Hall, in charge of the WHO's outbreak response in China, saying China's vaccinations might be masking the virus." ^[17] The BBC reported that Dr Wendy Barclay, a virologist at the University of Reading, UK said: "The Chinese have made a vaccine based on reverse genetics made with H5N1 antigens, and they have been using it. There has been a lot of criticism of what they have done, because they have protected their chickens against death from this virus but the chickens still get infected; and then you get drift - the virus mutates in response to the antibodies - and now we have a situation where we have five or six 'flavours' of H5N1 out there." ^[18]

Transmission

The spread of avian influenza in the eastern hemisphere.

According to the United Nations FAO: there is no denying the fact that wild water fowl most likely play a role in the avian influenza cycle and could be the initial source for AI viruses, which may be passed on through contact with resident water fowl or domestic poultry, particularly domestic ducks. The newly mutated virus could circulate within the domestic and possibly resident bird populations until HPAI arises. This new virus is pathogenic to poultry and possibly to the wild birds that it arose from. Wild birds found to have been infected with HPAI were either sick or dead. This could possibly affect the ability of these birds to carry HPAI for long distances. However, the findings in Qinghai Lake-China, suggest that H5N1 viruses could possibly be transmitted between migratory birds. Additionally, the new outbreaks of HPAI in poultry and wild birds in Russia, Kazakhstan, Western China and Mongolia may indicate that migratory birds probably act as carriers for the transport of HPAI over longer distances. Short distance transmission between farms, villages or contaminated local water bodies is likewise a distinct possibility. The AI virus has adapted to the environment in ways such as: 1) the use of water for survival and to spread 2) has evolved in a reservoir (ducks) strictly tied to water. The water in turn influences movement, social behaviour and migration patterns of water bird species. It is therefore of great importance to know the ecological strategy of influenza virus as well, in order to fully understand this disease and to control outbreaks when they occur. There remains a body of data and analysis missing on the collection and detection of HPAI viruses in wild birds. Finding HPAI viruses in wild birds may be a rare event, but if the contact with susceptible species occurs it can cause an outbreak at the local level or in distant areas. ^[19] For example, small birds like sparrows, starlings and pigeons can be infected with deadly H5N1 strains and they can carry the virus from chicken house to chicken house causing massive epidemics among the chickens.^[20] Image File history File links Avian_influenza_spread_map. ... Image File history File links Avian_influenza_spread_map. ... The United Nations (UN) is an international organization whose stated aims are to facilitate co-operation in international law, international security, economic development, social progress and human rights issues. ... Possible meanings: Faro Airport (Portugal) Federation of Astrobiology Organizations Financial Aid Office Food and Agriculture Organization This page expands a three-character combination which might be any or all of: an abbreviation, an acronym, an initialism, a word in English, or a word in another language. ... // Subfamilies Dendrocygninae Oxyurinae Anatinae Merginae Duck is the common name for a number of species in the Anatidae family of birds. ... Qinghai Lake from space, November 1994 Qinghai Lake or Lake Kokonor (Tibetan: mtsho khri sgir rgyal mo and Tso Ngonpo; The Blue Sea, Mongolian: Хөхнуур [Höhnuur], []; Chinese: 青海湖;, pinyin: Qīnghǎi Hú) is the largest and highest lake in China. ...

Prevention

The current method of prevention in animal populations is to destroy infected animals, as well as animals suspected of being infected. In southeast Asia, millions of domestic birds have been slaughtered to prevent the spread of the virus. World map showing the location of Asia. ...

The probability of a "humanized" form of H5N1 emerging through genetic recombination in the body of a human co-infected with H5N1 and another influenza virus type (a process called reassortment) could be reduced by influenza vaccination of those at risk for infection by H5N1. It is not clear at this point whether vaccine production and immunization could be stepped up sufficiently to meet this demand. Additionally, vaccination of only humans would not address the possibility or reassortment in pigs, cats, or other mammal hosts. For other meanings of this term, see gene (disambiguation). ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Reassortment is the exchange of DNA between viruses inside a host cell. ... Influenza, commonly known as the flu, is an infectious disease of birds and mammals caused by an RNA virus of the family Orthomyxoviridae (the influenza viruses). ... A vaccine is an antigenic preparation used to establish immunity to a disease. ...

If an outbreak of pandemic flu does occur, its spread might be slowed by increasing hygiene in aircraft, and by examining airline cabin air filters for presence of H5N1 virus. This article is about large epidemics. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Groups I: dsDNA viruses II: ssDNA viruses III: dsRNA viruses IV: (+)ssRNA viruses V: (-)ssRNA viruses VI: ssRNA-RT viruses VII: dsDNA-RT viruses A virus (Latin, poison) is a microscopic particle that can infect the cells of a biological organism. ...

The American Centers for Disease Control and Prevention advises travelers to areas of Asia where outbreaks of H5N1 have occurred to avoid poultry farms and animals in live food markets ^[21]. Travelers should also avoid surfaces that appear to be contaminated by feces from any kind of animal, especially poultry. The Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, is recognized as the leading United States agency for protecting the public health and safety of people. ...

There are several H5N1 vaccines for several of the avian H5N1 varieties. H5N1 continually mutates rendering them, so far for humans, of little use. While there can be some cross-protection against related flu strains, the best protection would be from a vaccine specifically produced for any future pandemic flu virus strain. Dr. Daniel Lucey, co-director of the Biohazardous Threats and Emerging Diseases graduate program at Georgetown University has made this point, "There is no H5N1 pandemic so there can be no pandemic vaccine." ^[22] However, "pre-pandemic vaccines" have been created; are being refined and tested; and do have some promise both in furthering research and preparedness for the next pandemic ^[23]. Vaccine manufacturing companies are being encouraged to increase capacity so that if a pandemic vaccine is needed, facilities will be available for rapid production of large amounts of a vaccine specific to a new pandemic strain. Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... This article is about large epidemics. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ... This article is about large epidemics. ... A vaccine is an antigenic preparation used to establish immunity to a disease. ...

It is not likely that use of antiviral drugs could prevent the evolution of a pandemic flu virus. ^[24] Antiviral drugs are a class of medication used specifically for treating viral infections. ...

Environmental survival

Avian flu virus can last indefinitely at a temperature dozens of degrees below freezing, as is found in the northern most areas that migratory birds frequent.

Heat kills H5N1 (i.e. inactivates the virus): Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ...

• Over 30 days at 0ºC (32.0ºF) (over one month at freezing temperature)
• 6 days at 37ºC (98.6ºF) (one week at human body temperature)
• 30 minutes 60ºC (140.0ºF) (half hour at a temperature that causes first and second degree burns in humans in ten seconds)^[25]

Inactivation of the virus also occurs under the following conditions:

• Acidic pH conditions
• Presence of oxidizing agents such as sodium dodecyl sulfate, lipid solvents, and B-propiolactone
• Exposure to disinfectants: formalin, iodine compounds ^[26]

An acid (often represented by the generic formula HA) is traditionally considered any chemical compound that, when dissolved in water, gives a solution with a pH of less than 7. ... The correct title of this article is . ... European Union Chemical hazard symbol for oxidizing agents Dangerous goods label for oxidising agents An oxidizing agent (also called an oxidant or oxidizer) is referred to as A chemical compound that readily transfers oxygen atoms or A substance that gains electrons in a redox chemical reaction. ... This article or section needs additional references or sources. ... For other uses, see Solvent (disambiguation). ... Disinfection The destruction of pathogenic and other kinds of microorganisms by physical or chemical means Disinfectants are chemical substances used to kill viruses and microbes (germs), such as bacteria and fungi. ... The chemical compound formaldehyde (also known by IUPAC nomenclature as methanal), is a gas with a strong pungent smell. ... General Name, Symbol, Number iodine, I, 53 Chemical series halogens Group, Period, Block 17, 5, p Appearance violet-dark gray, lustrous Atomic mass 126. ...

Incubation

The human incubation period of avian influenza A (H5N1) is 2 to 17 days^[27]. Once infected, the virus can spread by cell-to-cell contact, bypassing receptors. So even if a strain is very hard to initially catch, once infected, it spreads rapidly within a body.^[28]

Symptoms

Flu

Flu Flu season Flu vaccine Flu treatment Avian flu H5N1 flu Flu research Genome sequencing

See also Pneumonia.

Avian influenza HA bind alpha 2-3 sialic acid receptors while human influenza HA bind alpha 2-6 sialic acid receptors. Usually other differences also exist. There is as yet no human form of H5N1, so all humans who have caught it so far have caught avian H5N1. Image File history File links Flu_und_legende_color_c. ... Influenza, commonly known as the flu, is an infectious disease of birds and mammals caused by an RNA virus of the family Orthomyxoviridae (the influenza viruses). ... Flu season is mostly a colloquial term used to describe the regular outbreak in flu cases, or even cases of the common cold during the late fall or winter. ... Model of Influenza Virus from NIH The flu vaccine is a vaccine to protect against the highly variable influenza virus. ... This article is about flu treatment in humans for mild human flu, which includes both efforts to reduce symptoms and to battle the flu virus itself. ... For the current concern about the transmission of an avian flu to humans see Transmission and infection of H5N1. ... Flu research includes molecular virology, pathogenesis, host immune responses, and epidemiology. ... The Influenza Genome Sequencing Project is funded by the National Institute of Allergy and Infectious Diseases (NIAID) which is a component of the National Institutes of Health (NIH), which is an agency of the United States Department of Health and Human Services. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ... Sialic acid Sialic acid is a derivative of a nine-carbon monosaccharide, named from the Greek σιαλοσ (sialos) saliva. It is the negative charge of this chemical that is responsible for the slippery feel of saliva and mucins coating the body’s organs. ...

Human flu symptoms usually include fever, cough, sore throat, muscle aches, conjunctivitis and, in severe cases, severe breathing problems and pneumonia that may be fatal. The severity of the infection will depend to a large part on the state of the infected person's immune system and if the victim has been exposed to the strain before, and is therefore partially immune. No one knows if these or other symptoms will be the symptoms of a humanized H5N1 flu. Human Flu refers to a subset of Orthomyxoviridae that create influenza in humans and are endemic in humans. ... An analogue medical thermometer showing the temperature of 38. ... Also see Pharyngitis Sore Throat is a legendary British noisecore band, credited among others with inventing the genre Sore Throat formed in 1987 as a Crust Punk/ hardcore punk and grindcore act. ... Myalgia means muscle pain and is a symptom of many diseases and disorders. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ... A scanning electron microscope image of a single human lymphocyte. ...

Highly pathogenic H5N1 avian flu in a human is far worse, killing over 50% of humans that catch it. In one case, a boy with H5N1 experienced diarrhea followed rapidly by a coma without developing respiratory or flu-like symptoms. ^[29] Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... For the current concern about the transmission of an avian flu to humans see Transmission and infection of H5N1. ... Types 5-7 on the Bristol Stool Chart are often associated with diarrhea Diarrhea (in American English) or diarrhoea (in British English) is a generally unpleasant condition in which the sufferer has frequent watery, loose bowel movements (from the ancient Greek word διαρροή = leakage; literally meaning to run through). Acute infectious... Comatose redirects here. ...

There have been studies of the levels of cytokines in humans infected by the H5N1 flu virus. Of particular concern is elevated levels of tumor necrosis factor alpha (TNFα), a protein that is associated with tissue destruction at sites of infection and increased production of other cytokines. Flu virus-induced increases in the level of cytokines is also associated with flu symptoms including fever, chills, vomiting and headache. Tissue damage associated with pathogenic flu virus infection can ultimately result in death ^[30]. The inflammatory cascade triggered by H5N1 has been called a 'cytokine storm' by some, because of what seems to be a positive feedback process of damage to the body resulting from immune system stimulation. H5N1 type flu virus induces higher levels of cytokines than the more common flu virus types such as H1N1 ^[31] Other important mechanisms also exist "in the acquisition of virulence in avian influenza viruses" according to the CDC.^[32] Cytokines is a group of proteinaceous signalling compounds that like hormones and neurotransmitters are used extensively for inter-cell communication. ... In medicine, tumor necrosis factor alpha (TNFα, cachexin or cachectin) is an important cytokine involved in systemic inflammation and the acute phase response. ... A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Inflammation is the first response of the immune system to infection or irritation and may be referred to as the innate cascade. ... A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ... Imbibers of alcoholic drinks the unknown strange organisms were called yeast and they were the starting point of the image. ... A scanning electron microscope image of a single human lymphocyte. ... Genera Influenzavirus A Influenzavirus B Influenzavirus C Isavirus Thogotovirus Influenzavirus A is a genus of a family of viruses called Orthomyxoviridae in virus classification. ... CDC is an abbreviation which can mean any of the following: Canucks Dot Com Centers for Disease Control and Prevention Communicable Disease Control Community of Democratic Choice, a group of nine Eastern-European states Change data capture, in data warehousing Clock Domain Crossing, or simply clock-crossing in computing Cedar...

The NS1 protein of the highly pathogenic avian H5N1 viruses circulating in poultry and waterfowl in Southeast Asia is currently believed to be responsible for the enhanced proinflammatory cytokine response. H5N1 NS1 is characterized by a single amino acid change at position 92. By changing the amino acid from glutamic acid to aspartic acid, researchers were able to abrogate the effect of the H5N1 NS1. This single amino acid change in the NS1 gene greatly increased the pathogenicity of the H5N1 influenza virus. A representation of the 3D structure of myoglobin, showing coloured alpha helices. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Groups I: dsDNA viruses II: ssDNA viruses III: dsRNA viruses IV: (+)ssRNA viruses V: (-)ssRNA viruses VI: ssRNA-RT viruses VII: dsDNA-RT viruses A virus (Latin, poison) is a microscopic particle that can infect the cells of a biological organism. ... Ducks amongst other poultry The Poultry-dealer, after Cesare Vecellio. ... Falcated Duck at Slimbridge Wildfowl and Wetlands centre, Gloucestershire, England Wildfowl or waterfowl, also waterbirds, is the collective term for the approximately 147 species of swans, geese and ducks, classified in the order Anseriformes, family Anatidae. ... World map showing the location of Asia. ... Cytokines is a group of proteinaceous signalling compounds that like hormones and neurotransmitters are used extensively for inter-cell communication. ... Phenylalanine is one of the standard amino acids. ... Glutamic acid (Glu), also referred to as glutamate (the anion), is one of the 20 proteinogenic amino acids. ... Aspartic acid (Asp), also known as aspartate, the name of its anion, is one of the 20 natural proteinogenic amino acids which are the building blocks of proteins. ... Pathogenicity is the ability of an organism to cause disease in another organism. ...

In short, this one amino acid difference in the NS1 protein produced by the NS RNA molecule of the H5N1 virus is believed to be largely responsible for an increased pathogenicity (on top of the already increased pathogenicity of its hemagglutinin type which allows it to grow in organs other than lungs) that can manifest itself by causing a cytokine storm in a patient's body, often causing pneumonia and death. Ribonucleic acid (RNA) is a nucleic acid polymer consisting of nucleotide monomers. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Pathogenicity is the ability of an organism to cause disease in another organism. ... A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ... Pneumonia is an illness of the lungs and respiratory system in which the alveoli (microscopic air-filled sacs of the lung responsible for absorbing oxygen from the atmosphere) become inflamed and flooded with fluid. ... This article or section does not cite its references or sources. ...

Treatment

Neuraminidase inhibitors are a class of drugs that includes zanamivir and oseltamivir, the latter being licensed for prophylaxis treatment in the United Kingdom. Oseltamivir inhibits the influenza virus from spreading inside the user's body ^[24]. It is marketed by Roche as Tamiflu. This drug has become a focus for some governments and organizations trying to be seen as making preparations for a possible H5N1 pandemic. In August 2005, Roche agreed to donate three million courses of Tamiflu be deployed by the WHO to contain a pandemic in its region of origin. Although Tamiflu is patented, international law gives governments wide freedom to issue compulsory licenses for life-saving drugs. Zanamivir is a neuraminidase inhibitor used in the treatment of and prophylaxis of both influenza A and influenza B. Zanamivir was the first neuraminidase inhibitor commercially developed. ... Oseltamivir (INN) (IPA: ) is an antiviral drug used in the treatment and prophylaxis of both Influenzavirus A and Influenzavirus B. Like zanamivir, oseltamivir is a neuraminidase inhibitor. ... Prophylaxis refers to any medical or public health procedure whose purpose is to prevent, rather than treat or cure, disease. ... Hoffmann-La Roche, Ltd. ... Tamiflu manufactured by ROCHE active principle Oseltamivir Phosphate Drug Nomenclature Synonyms: GS-4104/002; Oseltamivir, fosfato de; Ro-64-0796/002 USAN: Oseltamivir Phosphate rINNM: Oseltamivir Phosphate erINNM: Fosfato de oseltamivir Chemical name: Ethyl (3R,4R,5S)-4-acetamido-5-amino-3-(1-ethylpropoxy)-1-cyclohexene-1-carboxylate phosphate (1... In a compulsory license, the government forces the holder of a patent, copyright, or other exclusive right to grant use to the state or others. ...

A second class of drugs, which include amantadine and rimantadine, target the M2 protein, but are ineffective against H5N1. Unlike zanamivir and oseltamivir, these drugs are inexpensive and widely available and the WHO had initially planned to use them in efforts to combat an H5N1 pandemic. However, the potential of these drugs was considerably lessened when it was discovered that farmers in China have been administering amantadine to poultry with government encouragement and support since the early 1990s, against international livestock regulations; the result has been that the strain of the virus now circulating in South East Asia is largely resistant to these medications and hence significantly more dangerous to humans^[33]. Amantadine, 1-aminoadamantane, is an antiviral drug that was approved by the FDA in 1976 for the treatment of influenza type A in adults. ... Rimantadine (systematic name 1-(1-aminoethyl)adamantane) is an orally administered medicine used to treat, and in rare cases prevent, Influenzavirus A infection. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ...

However, recent data suggest that some strains of H5N1 are susceptible to the older drugs. An analysis of more than 600 H5N1 viruses collected in Southeast Asia showed that most samples from China and Indonesia lacked genetic characteristics signaling resistance to amantadine, whereas most samples from Vietnam, Thailand, and Cambodia had those characteristics. The report was published by the Journal of Infectious Diseases. The new WHO guidelines were drawn up by an international group of clinicians with experience treating H5N1 patients, along with other experts, at a meeting in late March. The panel systematically reviewed and graded the evidence for the drugs' effectiveness. Since no results from controlled trials of medication use in H5N1 cases are available, "Overall, the quality of the underlying evidence for all recommendations was very low," the 138-page WHO report states. The evidence includes results of lab and animal studies and indirect evidence from studies of antiviral use in patients with seasonal influenza. The recommendations are classified as "strong" or "weak," depending on the quality of the relevant evidence. The WHO says that if a patient has a confirmed or strongly suspected H5N1 case and NIs are available, "Clinicians should administer oseltamivir treatment (strong recommendation); zanamivir might be used as an alternative (weak recommendation)." Oseltamivir comes in capsule form, whereas zanamivir is taken with an inhaler. The WHO says zanamivir has lower bioavailability outside the respiratory tract than oseltamivir, but it may be active against some strains of oseltamivir-resistant H5N1 virus.^[34]

Human mortality rate

Human Mortality from H5N1
As of February 3, 2007

Source WHO Confirmed Human Cases of H5N1

• The thin line represents average mortality of recent cases. The thicker line represents mortality averaged over all cases.
• According to WHO: "Assessment of mortality rates and the time intervals between symptom onset and hospitalization and between symptom onset and death suggests that the illness pattern has not changed substantially during the three years."[2]

A strain of H5N1 killed chickens in 1959 in Scotland and turkeys in 1991 in England.^[35] This strain was "highly pathogenic" (deadly to birds) but caused neither illness nor death in humans.^[36] "The precursor of the H5N1 influenza virus that spread to humans in 1997 was first detected in Guangdong, China, in 1996, when it caused a moderate number of deaths in geese and attracted very little attention." ^[37] In 1997, in Hong Kong, 18 humans were infected and 6 died in the first known case of H5N1 infecting humans. ^[38] H5N1 had evolved from a zero mortality rate to a 33% mortality rate. Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... February 3 is the 34th day of the year in the Gregorian Calendar. ... 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD (or CE) era. ... Image File history File links H5N1_Human_Mortality. ... The World Health Organization (WHO) is a specialized agency of the United Nations, acting as a coordinating authority on international public health, headquartered in Geneva, Switzerland. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... This article or section does not cite its references or sources. ... Motto: (Latin for No one provokes me with impunity)1 Anthem: Multiple unofficial anthems Capital Edinburgh Largest city Glasgow Official language(s) English, Gaelic, Scots 2 Government Constitutional monarchy  - Queen Queen Elizabeth II  - Prime Minister of the UK Tony Blair MP  - First Minister Jack McConnell MSP Unification    - by Kenneth I... Motto: (French for God and my right) Anthem: God Save the King/Queen Capital London (de facto) Largest city London Official language(s) English (de facto) Unification    - by Athelstan AD 927  Area    - Total 130,395 km² (1st in UK)   50,346 sq mi  Population    - 2006 est. ... Trinomial name Homo sapiens sapiens Linnaeus, 1758 Humans, or human beings, are bipedal primates belonging to the mammalian species Homo sapiens (Latin for wise man or knowing man) under the family Hominidae (the great apes). ... Guangdong, often spelt as Kwangtung, is a province on the south coast of the Peoples Republic of China. ... Other uses: Goose (disambiguation) Genera Anser Branta Chen Cereopsis † see also: Swan, Duck Anatidae Goose (plural geese) is the general English name for a considerable number of birds, belonging to the family Anatidae. ...

The first report, in the current wave of HPAI A(H5N1) outbreaks, was of an outbreak that began December 10, 2003 in the Republic of Korea and continued for fourteen weeks. This strain caused asymptomatic infections in humans and has died out, meaning that its low mortality level is no more relevant than the 1959 strain's low mortality rate in evaluating the mortality rate of existing HPAI A(H5N1) strains.^{[39] [40]} The apparently extinct strain that caused Vietnam's human deaths from H5N1 in 2003, 2004 and 2005 also had a much lower case mortality rate than the currently existing strains.^[40] Changes are occurring in H5N1 that are increasing its pathogenicity in mammals.^[41] December 10 is the 344th day (345th in leap years) of the year in the Gregorian calendar, 21 days before the next year. ... 2003 (MMIII) was a common year starting on Wednesday of the Gregorian calendar. ...

In 2005, when a markedly less-lethal strain in North Vietnam was responsible for most of the cases reported worldwide, only 42 of 97 people confirmed by the WHO to be infected with H5N1 died -- or 43%. From January 1, 2006 to December 29 2006, the case fatality ratio has been higher, with 79 deaths among 114 WHO-confirmed cases^[42]-- or 69%. This has been interpreted by some to mean that the virus itself is becoming more deadly over time. ^[43] The global case fatality ratio is, nonetheless, a crude summary of a complex situation with many contributing factors. In particular, if an influenza pandemic arises from one of the currently circulating pre-pandemic strains of Asian lineage HPAI A(H5N1), the mortality rates for the resulting human adapted pandemic strain cannot be predicted with any confidence. Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... January 1 is the first day of the calendar year in both the Julian and Gregorian calendars. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... An influenza pandemic is a large scale epidemic of the influenza virus, such as the 1918 Spanish flu. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... This article is about large epidemics. ...

H5N1 is currently much better adapted to birds than to other hosts, which is why the disease it causes is called a bird flu. No pandemic strain of H5N1 has yet been found. The precise nature and extent of the genetic alterations that might change one of the currently circulating avian flu strains into a human flu strain cannot be known in advance. While many of the current H5N1 strains circulating in birds can generate a dangerous cytokine storm in healthy adult humans ^[44][45], the ultimate pandemic strain might arise from a less-lethal strain, or its current level of lethality might be lost in the adaptation to a human host.^[46] Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... Aves redirects here. ... Avian influenza (also known as bird flu) is a type of influenza virulent in birds. ... This article is about large epidemics. ... For the current concern about the transmission of an avian flu to humans see Transmission and infection of H5N1. ... Human Flu refers to a subset of Orthomyxoviridae that create influenza in humans and are endemic in humans. ... A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ...

The global case fatality ratio looks only to the official tally of cases confirmed by the WHO. It takes no account of other cases, such as those appearing in press reports. Nor does it reflect any estimate of the global extent of mild, asymptomatic, or other cases which are undiagnosed, unreported by national governments to the WHO, or for any reason cannot be confirmed by the WHO. While the WHO's case count is clearly the most authoritative, these unavoidable limitations result in an unknown number of cases being omitted from it. The problem of overlooked but genuine cases is emphasized by occasional reports in which later serology reveals antibodies to the H5N1 infection in the blood of persons who were never known to have bird flu, and who then are confirmed by the WHO only retroactively as "cases." Press reports of such cases, often poultry handlers, have appeared in various countries. The largest number of asymptomatic cases was recently confirmed among Korean workers who had assisted in massive culls of H5N1-infected poultry.^[47] This relatively benign Korean strain of H5N1 has died out, and the remaining strains of H5N1 have a higher case fatality rate in humans. Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ...

Unconfirmed cases have a potentially huge impact on the case fatality ratio. This mathematical impact is well-understood by epidemiologists, and is easy to see in theory. For example, if for each confirmed case reported by the WHO we assume that there has been another mild and unreported case, the actual global number of cases would be double the current number of WHO-confirmed cases. The fatality ratio for H5N1 infections would then be calculated as the same number of deaths, but divided by a doubled number for total cases, resulting in a hypothetical death ratio of half the currently-reported fatality ratio. Such a result would indicate to epidemiologists that the world was confronting an H5N1 virus that is less-lethal than currently assumed, although possibly one that was more contagious and difficult to track. Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ...

A case-fatality ratio based on an accurate and all-inclusive count of cases would be invaluable, but unfortunately it is impossible to attain. The ability to diagnose every case of H5N1 as it arises does not exist. A few reported studies have attempted to gather preliminary data on this crucial statistic, by carrying out systematic blood testing of neighbors and contacts of fatal cases in villages where there had been confirmed H5N1 fatalities. This testing failed to turn up any overlooked mild cases. ^{[48] [49]} These methodical studies of contacts provide significant evidence that the high death rate among confirmed cases in the villages where these studies were carried out cannot be simply attributed to a wholesale failure to detect mild cases. Unfortunately, these studies are likely to remain too few and sketchy to define the complex situation worldwide regarding the lethality of the varying H5N1 clades. The testing and reporting necessary for mass serology studies to determine the incidence of overlooked cases for each existing clade and strain of H5N1 worldwide would be prohibitively costly.

Hence the precise allocation of infections by the various H5N1 clades across the spectrum including lethal, serious, mild, and asymptomatic cases is likely to remain unknown in both humans and the hundreds of other species it can infect. Scientists are very concerned about what we do know about H5N1; but even more concerned about the vast amount of important data that we don't know about H5N1 and its future mutations. Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ...

A case fatality ratio of over 50% provides a grim backdrop for the fact that the currently circulating H5N1 strains have certain genetic similarities with the Spanish Influenza pandemic virus. In that pandemic, 50 million to 100 million people worldwide were killed during about a year in 1918 and 1919 ^[50]. The highly lethal second and third waves of the 1918 Spanish flu evolved through time into a less virulent and more transmissible human form. Although the overall fatality rate for the Spanish Flu was at most 1% to 2% of the population, the lethal waves of the Spanish Flu are not reported to have emerged with anything like the over-50% case fatality ratio observed to date in human H5N1 infection. Unfortunately, a human H5N1 pandemic might emerge with initial lethality resembling that over-50% case fatality now observed in pre-pandemic H5N1 human cases, rather than with the still-high 1-2% seen with the Spanish Flu or with the lower rates seen in the two more recent influenza pandemics.^[51] The Spanish Flu Pandemic, also known as the Great Influenza Pandemic, the 1918 Flu Epidemic, and La Grippe, was an unusually severe and deadly strain of influenza, a viral infectious disease, that killed some 25 million to 40 million people (possibly significantly more) world-wide in 1918 and 1919. ...

Review of patient ages and outcomes reveals that H5N1 attacks are especially lethal in pre-adults and young adults, while older victims tend to have milder attacks and to survive. ^[52] This is consistent with the frequent development of a cytokine storm in the afflicted.^[53] Very few persons over 50 years of age died after suffering a H5N1 attack. Instead, the age-fatality curve of H5N1 influenza attacks in humans resembles that of the 1918 Spanish pandemic flu, and is the opposite of the mortality curve of seasonal flu strains, since seasonal influenza preferentially kills the elderly and does not kill by cytokine storm. A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ... A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ...

Another factor complicating any attempt to predict lethality of an eventual pandemic strain is that many human victims of the current H5N1 influenza have been blood relatives (but rarely^[54] spouses) of other victims. This data suggests that the victims' genetic susceptibility may have played a role in the human cases registered to date.^[55]

Planning reports

Governments and other organizations at many levels and in many places have produced "planning" reports that, among other things, have offered speculation on the mortality rate of an eventual H5N1 pandemic. One such report stated that "over half a million Americans could die and over 2.3 million could be hospitalized if a moderately severe strain of a pandemic flu virus hits the U.S."^[56]. No one knew if "moderately severe" was an accurate guess or not. A report entitled A Killer Flu?^[57] projected that, with an assumed (guessed) contraction rate of just 25%, and with a severity rate as low as that of the two lowest severity flu pandemics of the 1900s, a modern influenza A pandemic would cause 180 thousand deaths in the US, while a pandemic equaling the 1918 Spanish Flu in level of lethality would cause one million deaths in the US. Again, the report offered no evidence that an emerging H5N1 flu pandemic would be between these figures.^[58]

The current avian flu, in humans, is fatal in over 50% of confirmed cases. Yet early projections like those above have assumed that such a lethal avian strain would surely lose genes contributing to its lethality in humans as it made the adaptations necessary for ready transmission in the human population. This optimistic assumption cannot be relied on. As the WHO reported in November 2006, initial outbreaks of an H5N1 pandemic could rival the current lethality of over 50%.^[51] Further information necessary to make an accurate projection of initial lethality of an H5N1 pandemic does not exist, as no data was collected that could show the pre-pandemic virulence in any potential flu strain until after the last pandemic of the 20th Century. There is no basis for assuming that an H5N1 pandemic will emerge with only the far lower 1-2% lethality rate of the Spanish Flu, once assumed to be a worst case scenario. There exists no reliable prediction of the mortality rate of an H5N1 pandemic, and it would be irresponsible to confine planning to only optimistic assumptions out of step with the currently observed case fatality ratio.

Although marred by unrealistically low ranges of assumed mortality, the earlier planning reports nevertheless show convincingly that we are not prepared even for a pandemic as severe as the milder pandemics of the past century.^[59], let alone the much higher case fatality ratios seen more recently.

Scientific advances

Scientific advances may attenuate probable lethality. The genetic lethality potential of the initial flu pandemic strain is only one important factor in determining the ultimate outcome in number of human lives lost. Another factor that grows potentially more important with the passage of time is human preparation. For example, no flu vaccine specific to H5N1 could be produced when it emerged in Hong Kong in 1997, because it was lethal to eggs. Reverse DNA techniques have since made a vaccine possible, and several H5N1 vaccines have been tested and are in production in at least limited quantities. Vaccine development and production facilities are being ramped up, and possible pre-pandemic vaccines are being produced and studied. If a human pandemic does not emerge in the next few years, its eventual emergence may become almost a non-event if a very-effective pre-pandemic vaccine has prepared the population with sufficient herd immunity to blunt its lethality. Indeed, if there is sufficient immunity to stop it at the source, it will not become pandemic. An influenza pandemic is a large scale epidemic of the influenza virus, such as the 1918 Spanish flu. ... Model of Influenza Virus from NIH The flu vaccine is a vaccine to protect against the highly variable influenza virus. ... Influenza A virus subtype H5N1, also known as A(H5N1) or H5N1, is a subtype of the Influenza A virus that can cause illness in humans and many other animal species. ... The effectiveness of a vaccine depends, amongst other things, on the percentage of the population which has received it and is still within the period of protection offered by that vaccine. ...

As long as the likelihood of protecting the population continues to rise with the passage of time, that likelihood becomes an increasingly important factor in predicting the loss of lives and the amount of economic dislocation that will ultimately occur. In light of human potential to develop herd immunity via vaccination in advance of a pandemic strain, the time that it allows us to do so before it evolves may become as crucial or more crucial to the measure of damage it causes than its own lethality and contagiousness.

Notes and references

June 4 is the 155th day of the year in the Gregorian calendar (156th in leap years), with 210 days remaining. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... May 23 is the 143rd day of the year in the Gregorian calendar (144th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... Who can refer to: WHO, World Health Organization The Who, a British rock band The Guess Who, a Canadian rock band who (pronoun), an English language interrogative pronoun. ... June 6 is the 157th day of the year in the Gregorian calendar (158th in leap years), with 208 days remaining // 1508 - Maximilian I, Holy Roman Emperor, is defeated in Friulia by Venetian forces; he is forced to sign a three-year truce and cede several territories to Venice 1513... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... July 5 is the 186th day of the year (187th in leap years) in the Gregorian Calendar, with 179 days remaining. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... October 13 is the 286th day of the year (287th in leap years) in the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... June 16 is the 167th day of the year in the Gregorian calendar (168th in leap years), with 198 days remaining. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... April 28 is the 118th day of the year (119th in leap years) in the Gregorian Calendar, with 247 days remaining. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... Robert G. (Rob) Webster (born May 7, 1932), in Balclutha New Zealand, leading avian influenza expert, is the virologist who in 1957 was the first to announce a link between human flu and bird flu. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... December 30 is the 364th day of the year (365th in leap years) in the Gregorian Calendar, with 1 day remaining. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... March 19 is the 78th day of the year in the Gregorian calendar (79th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... August 21 is the 233rd day of the year (234th in leap years) in the Gregorian Calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... February 22 is the 53rd day of the year in the Gregorian Calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... March 24 is the 83rd day of the year in the Gregorian Calendar (84th in leap years). ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... October 27 is the 300th day of the year (301st in leap years) in the Gregorian Calendar, with 65 days remaining. ... Front of UPI Headquarters, Washington, D.C. UPI redirects here. ... November 28 is the 332nd day (333rd on leap years) of the year in the Gregorian Calendar. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... October 27 is the 300th day of the year (301st in leap years) in the Gregorian Calendar, with 65 days remaining. ... August 12 is the 224th day of the year (225th in leap years) in the Gregorian Calendar. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... Science is the journal of the American Association for the Advancement of Science (AAAS). ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... March 30 is the 89th day of the year in the Gregorian Calendar (90th in a leap year). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... October 27 is the 300th day of the year (301st in leap years) in the Gregorian Calendar, with 65 days remaining. ... January 28 is the 28th day of the year in the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... October 27 is the 300th day of the year (301st in leap years) in the Gregorian Calendar, with 65 days remaining. ... The University of Pittsburgh is a state-related, doctoral/research university in Pittsburgh, Pennsylvania. ... The National Institutes of Health (NIH) is the primary agency of the United States government responsible for medical research. ... January 13 is the 13th day of the year in the Gregorian calendar. ... This article is about the year 2000. ... January 10 is the 10th day of the year in the Gregorian calendar. ... 2001 (MMI) was a common year starting on Monday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 15 is the 258th day of the year (259th in leap years). ... September 29 is the 272nd day of the year (273rd in leap years) in the Gregorian calendar. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... The New England Journal of Medicine (NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society with the highest impact factor for a general medical journal. ... November 12 is the 316th day of the year (317th in leap years) in the Gregorian Calendar, with 49 days remaining. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... February 17 is the 48th day of the year in the Gregorian calendar. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... June 18 is the 169th day of the year in the Gregorian Calendar (170th in leap years), with 196 days remaining. ... 2005 (MMV) was a common year starting on Saturday of the Gregorian calendar. ... May 22 is the 142nd day of the year in the Gregorian calendar (143rd in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 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August 18 is the 230th day of the year (231st in leap years) in the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... December 29 is the 363rd day of the year (364th in leap years) in the Gregorian Calendar, with 2 days remaining. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... This article is about the date September 11 in general. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 10 is the 253rd day of the year (254th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... November 2 is the 306th day of the year (307th in leap years) in the Gregorian Calendar, with 59 days remaining. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... The H5N1 genetic structure is the structure of the H5N1 virus. ... September 21 is the 264th day of the year (265th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... August 23 is the 235th day of the year in the Gregorian Calendar (236th in leap years), with 130 days remaining. ... March 27 is the 86th day of the year in the Gregorian Calendar (87th in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... September 7 is the 250th day of the year (251st in leap years). ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... August 21 is the 233rd day of the year (234th in leap years) in the Gregorian Calendar. ... This article is about the date September 11 in general. ... 2006 (MMVI) was a common year starting on Sunday of the Gregorian calendar. ... 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See also

• Fujian flu
• Reporting disease cases
• Severe acute respiratory syndrome

See H5N1 flu and Flu for details about the illnesses and H5N1 and H3N2 for details about the causitive agents. ... Reporting disease cases refers to modern international human infectious disease surveillance. ... Severe acute respiratory syndrome or SARS is a respiratory disease in humans which is caused by the SARS coronavirus. ...

Further reading

Wikinews has news related to:

Category:Avian Flu

• WHO Avian influenza resource (updated).
• CDC Facts About Avian Influenza (Bird Flu) and Avian Influenza A (H5N1) Virus.
• FAO information on Avian Influenza - Latest news, Disease Card, Maps, Animations.
• Avian Influenza (Bird Flu): Agricultural and Wildlife Considerations. CIDRAP.
• Avian Influenza: Preparing for a Pandemic. American Family Physician.