First reported case of #Andes #hantavirus cardiopulmonary syndrome treated with a combination of #favipiravir, #ribavirin, icatibant and baricitinib

 

ABSTRACT

Objectives

To describe the first documented case of Andes virus (ANDV) hantavirus cardiopulmonary syndrome (HCPS) in Spain and the first worldwide use of a therapeutic regime including two antivirals (favipiravir and ribavirin) and two host-directed drugs (baricitinib and icatibant).

Methods

A 69-year-old Spanish man, repatriated following a multinational ANDV outbreak aboard a cruise ship, was managed in a high-level isolation unit. Diagnosis was established by RT-PCR and serology while he was still asymptomatic as part of protocol-driven screening. Under compassionate-use authorisation and written informed consent, the patient received ribavirin (initially intravenous, then switched to oral on day +4), oral favipiravir, subcutaneous icatibant, and oral baricitinib, with serial clinical, laboratory, and radiological monitoring.

Results

Hypoxaemia, bilateral B-lines, thrombocytopenia, lymphopenia, and hyponatraemia developed within 24 hours after diagnosis. The combination regimen was initiated on day 0, and baricitinib was added on day +1, coinciding with the need for high-flow nasal oxygen. Sustained clinical, laboratory, and radiological recovery occurred from day +2 onwards, without progression to invasive ventilation or vasopressors. Mild diarrhoea attributed to ribavirin led to its discontinuation on day +5, shortly after the IV-to-oral switch. Severe recurrent diarrhoea on day +8, attributed to favipiravir, prompted its withdrawal before completion of the planned 10-day course; baricitinib was completed on day +10.

Conclusions

This sentinel case of imported HCPS in non-endemic Europe was managed with, to our knowledge, the first reported combined antiviral and host-directed regimen for this syndrome and the first reported use of favipiravir in a patient with hantavirus infection. The favourable outcome supports prospective evaluation of antiviral combinations and adjunctive immunomodulation within international preparedness protocols.

Source: 

Link: https://www.clinicalmicrobiologyandinfection.org/article/S1198-743X(26)00310-1/fulltext

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#Bundibugyo #ebolavirus #outbreak in #DRC and #Uganda: rapid #assessment from the #ESCMID Emerging Infections Subcommittee

 

Introduction

The ongoing outbreak of Ebola virus disease (EVD) caused by Bundibugyo ebolavirus (BDBV) in the Democratic Republic of the Congo (DRC) and Uganda represents a major regional public health emergency with international implications. The World Health Organization (WHO) declared the event a Public Health Emergency of International Concern (PHEIC) on 17 May 2026, while clarifying that it did not meet the criteria for a pandemic emergency [1]. This distinction reflects the revised International Health Regulations framework, which allows WHO to distinguish a PHEIC from a pandemic emergency when an event is serious and internationally relevant but does not meet the additional criteria for a pandemic emergency.

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Source: 

Link: https://www.clinicalmicrobiologyandinfection.org/article/S1198-743X(26)00285-5/fulltext

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Beyond past #Ebola #outbreaks: delayed #detection, #preparedness gaps, and the #vaccine race during the 2026 #Bundibugyo virus outbreak

 

{Summary}

The 2026 Bundibugyo Public Health Emergency of International concern

What makes the current Ebola virus (EBOV) outbreak in the Democratic Republic of the Congo (DRC), caused by the Bundibugyo virus Diseases (Orthoebolavirus), different from previous Ebola outbreaks over the past five decades? This question has gained renewed urgency following the World Health Organization’s (WHO) declaration of the outbreak as a Public Health Emergency of International Concern (PHEIC) on May 17, 20261. This declaration occurred only two days after the Ministry of Public Health, Hygiene and Social Welfare, Democratic Republic of the Congo (DRC), and the Ministry of Health of Uganda declared an outbreak of Ebola Disease following the confirmation of Bundibugyo virus disease (BVD) in both countries1–3.

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Source: 

Link: https://www.ijidonline.com/article/S1201-9712(26)00478-9/fulltext

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#Outbreak at #Sea: The MV Hondius #Hantavirus #Cluster as a Sentinel for Global #Pandemic Readiness

 

{Summary}

The South Atlantic promises crystalline isolation. But the Dutch-flagged MV Hondius—an expedition vessel carrying 147 passengers and crew from 23 nations—harbored something else entirely between the Southern Cone and Antarctica [1, 2]. An invisible passenger. Epidemiologists trace this outbreak directly to dry land, theorizing the index case inhaled aerosolized rodent excreta during a Southern Cone bird-watching excursion [1].

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Source: 

Link: https://www.ijidonline.com/article/S1201-9712(26)00473-X/fulltext

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Sex differences in #vaccine-induced #neuraminidase cross-recognition and #protection against #H5N1 in mice

 

Abstract

Despite concerns about the spread and pandemic potential of H5N1, there is no commercial H5N1 vaccine. Seasonal influenza vaccines offer some cross-protection against H5N1, but to date there has been no consideration of whether protection differs between the sexes. We investigated immune responses and protection in adult male and female C57BL/6 mice following vaccination with either inactivated H1N1 or H5N1 (LAIV backbone) virus vaccines. Vaccination induced strong homologous antibody responses, with females generating greater total IgG than males against both H1N1 and H5N1 vaccine, which was primarily mediated by greater IgG responses to neuraminidase (NA) than hemagglutinin (HA) protein. IgG cross-recognition of H1N1 also was greater among H5N1 vaccinated females and was primarily caused by greater IgG responses to N1. IgG2b and IgG2c were the primary isotypes generated in response to these vaccines, with females having greater IgG2b responses and greater binding to FcγRIV for avian and human NA than males in response to both homologous and heterologous vaccination. Antibody-dependent complement deposition was measured as an FcR-mediated non-neutralizing response against HA and NA and was robust in both sexes. Vaccinated females had greater neutralizing antibody titers than males against the homologous vaccine virus, with limited cross-neutralizing antibodies detected in either sexes. Neuraminidase inhibition titers were greater in vaccinated females than males against the heterologous virus following H1N1 vaccination and against both the vaccine and heterologous viruses following H5N1 vaccination. When H1N1 and H5N1 vaccinated mice were challenged with a lethal dose of A/Texas/37/2024 H5N1, all H5N1 vaccinated mice were protected, regardless of sex. Among H1N1 vaccinated mice, while both sexes were protected against disease, H1N1 vaccinated females cleared virus faster than their male counterparts. These findings highlight that female-biased NA-specific antibodies result in greater cross-protection and should be considered in studies of influenza vaccines.

Competing Interest Statement

The authors have declared no competing interest.

Funder Information Declared

NIH/NIAID Johns Hopkins Center of Excellence for Influenza Research and Response, 75N93021C00045

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.05.26.728011v1

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Increased burden of #influenza #H1N1pdm09 in older adults following the #COVID19 #pandemic

 

Abstract

Of the two influenza A virus (IAV) subtypes circulating endemically in humans, A/H3N2 and A/H1N1pdm09, A/H3N2 has historically been the dominant driver of disease burden in older adults. Based on an analysis of publicly available global surveillance data from 2015 to 2025 (>300,000 subtyped, age-stratified infections), we report a substantially increased contribution of A/H1N1pdm09 to influenza morbidity in older adults since approximately 2022. Birth cohort-stratified analyses suggest elevated A/H1N1pdm09 burden among individuals born before 1955-1959, consistent with erosion of pre-existing immunity originally generated by exposure to historical A/H1N1 strains. Pooled estimates across datasets and analytical approaches indicate the increase in A/H1N1pdm09 burden rises with earlier birth year, ranging from 1.22-fold (95% CI 1.08-1.37) for the 1955-1959 birth cohort to 3.10-fold (95% CI 2.58-3.72) for the 1930-1934 cohort. These findings point to a substantial rise in the overall influenza burden among the most vulnerable age groups, with implications for vaccine policy, clinical management, and public health planning.

Competing Interest Statement

C.A.R. has received consulting fees from CSL Seqirus, Moderna, Pfizer, GSK, and Sanofi for advisory services unrelated to this work.

Source: 

Link: https://www.medrxiv.org/content/10.64898/2026.05.20.26353664v1

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#Hantavirus #infections: an emerging zoonotic #threat in the context of #ecological change

 

{Extract}

Dear Editor,

Hantaviruses, belonging to the family Hantaviridae, are increasingly recognized as significant zoonotic pathogens responsible for severe human diseases, including hemorrhagic fever with renal syndrome (HFRS) and hantavirus cardiopulmonary syndrome (HCPS). Although traditionally considered geographically confined, recent epidemiological data indicate a gradual expansion in the incidence and geographic distribution of hantavirus infections, raising concerns regarding their re-emergence as a global public health threat [1,2]. 

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Source: 

Link: https://www.sciencedirect.com/science/article/pii/S2052297526000673?via%3Dihub

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BNT162b2 #LP81 early #vaccine #effectiveness against #COVID19 emergency department, urgent care, and outpatient visits

 

Abstract

COVID-19 continues to cause substantial illness, particularly among older adults and individuals with underlying conditions. Updated vaccines are designed to better protect against the strains of the virus that are currently circulating. However, real-world evidence on the effectiveness of updated vaccines remains limited. Here we show the early vaccine effectiveness (VE) of the BNT162b2 LP.8.1-adapted COVID-19 vaccine against mild-to-moderate COVID-19 outcomes. We used a test-negative case-control design to estimate early VE of the BNT162b2 LP.8.1-adapted vaccine against COVID-19 emergency department/urgent care (ED/UC) and outpatient visits. Adult patients from the US Veterans Affairs Healthcare System with an acute respiratory infection (ARI) who underwent SARS-CoV-2 testing from September 10 to November 30, 2025, were included. VE was estimated using multivariable logistic regression adjusted for patient demographics and clinical characteristics. Among 34,455 ARI episodes, 10.7% were COVID-19 cases. A total of 1.2% of cases and 2.6% of controls received the BNT162b2 LP.8.1 vaccine, with a median time since vaccination of 29 days (interquartile range 20-–41). BNT162b2 LP.8.1 vaccine was effective during the early 2025–2026 respiratory virus season. VE was 57% (95% confidence interval [CI] 39–70%) against ED/UC visits and 54% (95% CI 15–75%) against outpatient visits. These findings inform shared decision-making in clinical practice and support the continued importance of COVID-19 vaccination in populations for whom it is recommended.

Source: 

Link: https://www.nature.com/articles/s41467-026-73798-3

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#Andes virus, #hantavirus infections, and the unresolved question of #transfusion #transmission

 

{Summary}

The May 2026 multinational outbreak of Andes virus infection linked to cruise ship travel has appropriately focused public health attention on case identification, quarantine, contact tracing, and prevention of secondary transmission. Although the US Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) have emphasized that the general public risk remains low, the outbreak is relevant to transfusion medicine because Andes virus (Orthohantavirus andesense, also known as Andes hantavirus) occupies an unusual position among hantaviruses. Hantaviruses are enveloped, negative-sense RNA viruses in the family Hantaviridae that are maintained primarily in rodent and other small mammal reservoirs. 

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Source: 

Link: https://www.trasci.com/article/S1473-0502(26)00087-X/abstract

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Assessing #Evidence to Guide Primary #Prevention of #Pathogen X

 

Abstract

Primary prevention includes interventions that prevent the initial occurrence of disease; in the context of pandemic origins, one class of primary preventative interventions involves reducing the risk of zoonotic pathogen spillover. Pandemics are rare events, therefore data on spillover events of known pandemic pathogens are also rare. In contrast, many zoonotic viruses spill over frequently but fail to spread efficiently between humans. We consider whether insights from frequent spillovers of poorly-spreading viruses should be used to inform primary prevention strategies aimed at viruses that spill over rarely but spread well human-to-human. We propose a set of principles to steer future research and guide deployment of preventative strategies. We believe that a precautionary approach, grounded in evidence from viruses that spill over frequently, offers the most practical empirical foundation for guiding primary spillover prevention.

Source: 

Link: https://wwwnc.cdc.gov/eid/article/32/6/26-0293_article

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Detection of Anti- #H5 #Antibodies in People with Exposure to Wild #Birds in Northern #Canada

 

Abstract

Using a commercially available H5 serology assay, we identified a 7.4% (n=5/68) anti-H5 seroreactivity rate among hunters in Northern Canada. All participants reported close contact with wild birds.

Competing Interest Statement

This study was performed outside of JK's duties and responsibilities with the Public Health Agency of Canada.

Source: 

Link: https://www.medrxiv.org/content/10.64898/2026.05.24.26353994v1

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Two #epidemics, one #genotype, different outcomes: evolutionary #changes of Avian #Influenza #H5N1, genotype EA-2024-DI

 

Abstract

Since 2020, high pathogenicity avian influenza H5Nx viruses of clade 2.3.4.4b have become enzootic in Europe, causing recurrent epidemic waves characterized by extensive reassortment events. Here, we describe the emergence of a single high-fitness genotype (EA-2024-DI) that has driven two consecutive waves, evolving into distinct sub-lineages. While its circulation is ongoing, during the 2025-2026 wave it caused an unprecedented number of cases in wild birds. Using phylodynamic analyses of a large dataset of genomic sequences, we compared the spatial diffusion and host transmission pattern of the EA-2024-DI sub-lineages across the three most recent epidemic waves (2023-2024, 2024-2025 and 2025-2026). We show that the genotype has persisted over time and has spread primarily through wild Anseriformes, but with a marked change in the transmission patterns between the different waves and a shift in the epicenter from Eastern to Central Europe, the latter having emerged as an important hub for virus diffusion throughout Europe. Our results reveal a recent increase in the frequency of viruses from wild and domestic mammals carrying mutations enhancing virus replication in mammalian hosts, highlighting the importance of proactive monitoring of this group of hosts to better understand its role in the virus ecology and evolution.

Competing Interest Statement

The authors have declared no competing interest.

Funder Information Declared

Funded by the European Union under grant agreement (101084171) - (Kappa-Flu). Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or REA. Neither the European Union nor the granting authority can be held responsible for them

Support for this work was provided by the European Union within the framework of the activities foreseen by the European Union Reference Laboratory for Avian Influenza and Newcastle Disease under grant agreement 101201937

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.05.25.727580v1

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The Q226H #Mutation in #Avian #H5N1 #Hemagglutinin Mediates a Path towards Structural #Adaptation in #Humans

 

Abstract

The global outbreak of highly pathogenic avian influenza (HPAI) A(H5N1) among birds and the spillover to mammals increases the risk for humans. A recent case in British Columbia with a clade 2.3.4.4b H5 virus infection revealed a mixture of 226Q/H in the receptor-binding site of hemagglutinin. While significant changes in pre-existing immunity by H1 or H3 polyclonal sera are not evident, we show that the Q226H mutation enables binding to human-type α2-6 sialic acid receptors. High-resolution cryo-EM structures provide a basis for the alteration in receptor preference and show that a possible path towards human adaptation also requires a conformational change of the bound α2-6-sialylated glycan. Continued surveillance for additional mutations that could enhance this phenotype is warranted.

Competing Interest Statement

The authors have declared no competing interest.

Funder Information Declared

Ministry of Technology and Innovation through Striving for Pandemic Preparedness—The Alberta Research Consortium

Canada Excellence Research Chair Program

Alberta Innovates Graduate Student Scholarship

Canada Biomedical Research Fund grant

Biosciences Research Infrastructure Fund grant

Natural Sciences and Engineering Research Council of Canada Discovery Grant

Natural Sciences and Engineering Research Council of Canada

Canada Foundation for Innovation

Alberta Innovation and Advanced Education Research Capacity Program

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.05.21.726965v1

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#Human #infection with #Andes #hantavirus: an #update for the general physician

 

Abstract

Orthohantaviruses are zoonotic RNA-viruses transmitted to humans through inhalation of aerosols contaminated by infected rodent excreta. Among hantavirus species, Andes virus (ANDV) owns unique capacity for sustained human-to-human transmission, occurring via respiratory droplets and prolonged close contact with symptomatic individuals, with a median reproductive number exceeding 2 and an incubation period ranging from 9 to 40 days.

ANDV infection can present with a wide range of clinical manifestations. Of them, the most feared is Hantavirus cardiopulmonary syndrome (HCPS), a severe condition characterised by acute respiratory failure, haemodynamic instability, acute kidney injury, hepatic involvement, and dysregulated cytokine release, with high lethality. Disease severity correlates with the degree of neutrophilia, leukocytosis, lymphopenia, thrombocytopenia, and elevated lactate dehydrogenase. No approved antiviral therapy or vaccine currently exists; management remains entirely supportive, centred on oxygen supplementation, haemodynamic stabilisation, and renal replacement therapy when indicated. Case fatality rates reached 32% in a 2018–2019 outbreak, with death occurring a mean of 6.7 days from symptom onset.

The April 2026 outbreak aboard the MV Hondius cruise ship — involving passengers of 23 nationalities, with 8 cases (6 confirmed, 2 suspected), and 3 deaths reported as of 11 May 2026 (CFR 38%) — exemplifies how a zoonotic pathogen with limited human-to-human transmissibility can rapidly achieve global reach in the era of mass international rtravel, underscoring the urgent need for clinician awareness, prompt contact tracing, and internationally coordinated outbreak preparedness.

Source: 

Link: https://www.ejinme.com/article/S0953-6205(26)00251-7/fulltext

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#Zoonotic #infections and genomic #evolution associated with novel #reassortants swine-origin #influenza A viruses in #Spain

 

Abstract

Influenza A virus (IAV) circulates widely in European pig populations and continues to diversify through frequent introductions from humans, followed by reassortment within swine. Spain represents a particularly dynamic ecological setting due to the coexistence of intensive white pig production, extensive Iberian pig systems, and abundant wild boar populations. This study provides an integrated analysis of IAV evolution and genomic diversity in swine in Spain between 2019 and 2022, expanding on previous surveillance from 2016 to 2019. Sampling across 24 provinces yielded 66 new whole genome sequences from Iberian and white pigs. We identified 18 genotypes, including 11 novel reassortants not detected in our previous survey. Several genotypes, such as H1huN2 G21 and G22, H3N2 G23, and the unusual H3N1 G12, were exclusive to the country. Some genotypes were detected across white pigs, Iberian pigs, and wild boar in Toledo and Badajoz, suggesting viral flow among swine populations. Phylogenetic analyses revealed ongoing introductions of H1N1pdm09 from humans into pigs, generating at least five reassortant genotypes (G10, G16 to G19). These lineages incorporated pandemic internal cassettes and, in some cases, human seasonal N2 segments, highlighting the continued role of humans as a source of viral incursions. Conversely, four zoonotic infections (H1N1v) detected in Spain between 2022 and 2026 were linked to genotypes circulating in white pigs, underscoring the bidirectional nature of IAV transmission at the human swine interface. Overall, this study demonstrates that Spain provides ecological conditions conducive to IAV diversification, reassortment, and zoonotic risk. The findings reinforce the need for sustained One Health surveillance.

Competing Interest Statement

The A.G.-S. laboratory has received research support from Avimex, Dynavax, Pharmamar, and Accurius, outside of the reported work within the last three years. A.G.-S. has consulting agreements for the following companies involving cash and/or stock within the last three years: Castlevax, Amovir, Vivaldi Biosciences, Contrafect, Avimex, Pagoda, Accurius, Applied Biological Laboratories, Pharmamar, CureLab Oncology, CureLab Veterinary, Virofend and Prosetta, outside of the reported work. A.G.-S. has been an invited speaker in meeting events within the last three years organized by Seqirus, Novavax and Hipra. A.G.-S. is inventor on patents and patent applications on the use of antivirals and vaccines for the treatment and prevention of virus infections and cancer, owned by the Icahn School of Medicine at Mount Sinai, New York, outside of the reported work. The rest of the authors report no conflicts of interest.

Funder Information Declared

Centre for Research on Influenza Pathogenesis and Transmission (CRIPT), one of the National Institute of Allergy and Infectious Diseases (NIAID) funded Centres of Excellence for Influenza Research and Response (CEIRR), contract #75N93021C00014

Intramural Research Program of the National Library of Medicine at the US National Institutes of Health

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.05.22.724525v1

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Connecting the #region during #crisis: a Community of Practice #response to the MV Hondius #hantavirus #outbreak

 

Abstract

This article describes the rapid activation of the Asia Pacific Health Security Action Framework Community of Practice following the MV Hondius hantavirus outbreak. It highlights regional knowledge-sharing, multidisciplinary engagement, preparedness activities, and the importance of timely communication and collaboration in strengthening readiness and response during emerging public health emergencies.

Source: 

Link: https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/1488

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#Hantavirus #seroprevalence and associated factors for exposure in south-central #Uganda

 

ABSTRACT

Orthohantaviruses are largely rodent-borne pathogens that can cause haemorrhagic fever with renal syndrome and hantavirus cardiopulmonary syndrome. In Uganda, the risk of human exposure is heightened by known rodent hosts, close human-rodent interaction in rural areas, and poor housing conditions. Despite this risk, data on human exposure remain scarce. This study sought to ascertain the seroprevalence of orthohantavirus exposure and identify associated factors with exposure among residents of the greater Masaka-Rakai region in Uganda. Seropositivity was assessed for orthohantavirus-specific IgG antibodies using commercial enzyme-linked immunosorbent assays. Logistic regression models were used to identify factors associated with seropositivity. Among 1,199 sera samples, orthohantavirus population-weighted seroprevalence was 7.4% (95% CI: 3.91–10.80). Males had a higher seroprevalence, while higher socioeconomic status was associated with a reduced burden of exposure to orthohantavirus. This study reports evidence of orthohantavirus exposure in Uganda, highlighting a previously underrecognized zoonotic risk in the region likely driven by close contact with rodent reservoirs and poor living conditions. The higher burden among males and lower-burden association with higher socioeconomic status, highlights the need for improved housing, rodent control, and integration of orthohantavirus surveillance into national public health programmes.

Source: 

Link: https://www.tandfonline.com/doi/full/10.1080/22221751.2026.2665002

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Clade 2.3.4.4b #H5N1 #HPAIV from Migratory #Birds in Beidaihe #Wetland, North #China

 

Abstract

During 2022–2024, a highly pathogenic avian influenza virus (HPAIV) H5N1 strain, designated A/Seagull/Hebei/qhd6/2024 (H5N1), was isolated from migratory birds in Beidaihe National Wetland Park, North China. Phylogenetic analyses revealed that its hemagglutinin (HA) gene belongs to the 2.3.4.4b clade, while the neuraminidase (NA) gene and internal genes clustered with strains originating from multiple continents, consistent with a transcontinental reassortment event. The virus also exhibited 90.1–98.1% nucleotide homology with human-derived H5N1 isolates. Molecular characterization identified key virulence-associated mutations, including the classic HPAIV HA cleavage site, HA-T160A (associated with enhanced human receptor-binding capacity), and NA-I117T (potentially linked to drug resistance). BALB/c mouse infection experiments confirmed systemic replication and high pathogenicity of strain qhd6, with a 50% lethal dose (LD50) of 0.95 log10EID50/mL. Antigenic analysis revealed good cross-reactivity with the widely used H5-Re14 vaccine strain. This study reports the identification, in Beidaihe National Wetland Park, of an HPAIV H5N1 strain whose genetic characteristics suggest intercontinental reassortment and indicate cross-species transmission risk. It clarifies the genetic characteristics and pathogenicity of this strain, providing an important theoretical and practical basis for precise surveillance, risk early warning, and comprehensive prevention and control of AIV at migratory bird stopover sites in North China.

Source: 

Link: https://www.mdpi.com/1999-4915/18/6/595

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