#Risk factors for #hospital admission and #mortality in patients with #influenza virus #infection: a systematic review and meta-analysis

 

Summary

Background

Identifying risk factors associated with hospital admission and mortality in patients with influenza is crucial for guiding clinical management and public health strategies. To support an update of WHO influenza clinical guidelines, this systematic review and meta-analysis assessed risk factors for hospital admission and all-cause mortality in patients with seasonal influenza.

Methods

We systematically searched Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, and Global Health for observational studies published from Jan 1, 2000, until Oct 30, 2025, that enrolled patients of any age with laboratory-confirmed seasonal influenza and reported an adjusted effect estimate for the association between at least one risk factor and hospital admission or all-cause mortality, or both. We conducted inverse-variance random-effects model meta-analyses to summarise the evidence and assessed the certainty of evidence using the GRADE approach. We registered the protocol with PROSPERO, CRD42024535669.

Findings

We identified 35 808 records, of which 63 studies enrolling 2 150 518 participants (mean age 3·6–87·9 years) were eligible. In patients with non-severe influenza, evidence with moderate or high certainty showed that older age (odds ratio 1·72 per 10-year increase for adults [95% CI 1·02–2·89]); cardiovascular disease (2·72 [1·24–5·94]); HIV, immunodeficiency, or immunosuppression (2·70 [1·55–4·70]); chronic respiratory disease (2·24 [1·90–2·64]); and any neurological disease (2·31 [1·65–3·24]) were major risk factors for hospital admission—pregnancy (1·88 [1·73–2·05]), diabetes (1·84 [1·26–2·67]), and malignancy (1·75 [1·12–2·75]) were additional risk factors for hospital admission. In patients with severe influenza, evidence with moderate or high certainty showed that secondary bacterial infection (4·13 [1·53–11·14]), malnutrition (3·29 [1·57–6·89]), sepsis (3·19 [2·08–4·89]), acute kidney injury (2·92 [1·11–7·73]), age 65 years or older (2·47 [2·21–2·75]), chronic cardiovascular disease (2·43 [1·16–5·09]), malignancy (2·21 [1·31–3·72]), and chronic neurological disease (2·08 [1·13–3·83]) were major risk factors for all-cause mortality—any liver disease (1·86 [1·35–2·58]); HIV, immunodeficiency, or immunosuppression (1·79 [1·51–2·13]), and chronic obstructive pulmonary disease (1·74 [1·37–2·20]) were additional risk factors for all-cause mortality.

Interpretation

Age 65 years or older, immunocompromised status, cardiovascular disease, neurological disease, and chronic respiratory disease are major risk factors for hospital admission in patients with non-severe seasonal influenza. Secondary bacterial infection, malnutrition, sepsis, acute kidney injury, age 65 years or older, chronic cardiovascular disease, malignancy, and chronic neurological disease are major risk factors for all-cause mortality in patients with severe seasonal influenza. Our findings support risk stratification and targeted prevention and treatment strategies for seasonal influenza.

Funding

WHO.

Source: 

Link: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(26)00195-5/abstract?rss=yes

____

Increased #receptor #binding and #spike #glycosylation, remodeled immune escape of surging #SARS-CoV-2 subvariant BA.3.2.2/RE.2.2/Cicada

 

Significance

SARS-CoV-2 evolved into distinct phylogenetic clades, generating a series of mutant strains. Notably, variants such as BA.1, BA.2.86, and BA.3.2 deserve special attention as they emerged abruptly at high detection frequencies during specific periods and harbored extensive mutations in the spike protein relative to contemporaneously prevalent strains, often accompanied by unique phenotypic characteristics. In this study, we primarily evaluated the structural and functional features of the BA.3.2.2 S protein, revealing its distinct traits in receptor binding, immune evasion, cross-species transmission, and glycosylation evolution. We observed constrained viral immune escape, as certain antibodies that were nonneutralizing against previously dominant subvariants exhibited neutralizing activity against recently emerged BA.3.2.2. These findings provide mechanistic insights for viral surveillance, vaccines, and therapeutics development.

Abstract

SARS-CoV-2 continues to evolve. The subvariant BA.3.2 (Cicada), a derivative of the Omicron BA.3 subtype first detected in late 2024, harbors multiple spike protein mutations, ORF7 and ORF8 deletions, and has recently evolved sublineages (BA.3.2.1 and BA.3.2.2), rendering it a critical target for epidemiological surveillance. The BA.3.2.2 sublineage, represented by RE.2.2, shows a marked upward trend in late 2025. Using surface plasmon resonance, we found that RE.2.2’s spike (S) protein receptor-binding domain (RBD) exhibits relatively high affinity for human receptor angiotensin-converting enzyme 2, with structural analysis identifying the R493Q reverse mutation as the key determinant. Pseudovirus infection and antibody neutralization assays demonstrated that RE.2.2 exhibited a distinct neutralization profile compared to contemporaneous dominant subvariants. Notably, several antibodies that previously lacked neutralizing activity (e.g., S2K146 and L4.65) to other subvariants regained neutralizing potency against RE.2.2, which was associated with key mutations including G446D. Profiling of RE.2.2 RBD binding to ACE2 orthologs across species showed no significant difference in species tropism from the representative Omicron BA.1. Importantly, RE.2.2 exhibits the newly emerged N-linked glycosylation at spike protein N529 (absent in all other subvariants), a modification potentially associated with immune evasion or spike protein conformational dynamics. In addition, we corroborated the “O-follow-N” glycosylation observation as previously reported, where O-linked glycans preferentially localize near N-glycosylation sites, implying coordinated glycan organization as an extra layer of spike regulation. These findings illuminate the evolutionary characteristics, functional changes, and the constrained virus immune escape of BA.3.2.2 (RE.2.2), providing critical insights into antibody development and variant surveillance.

Source: 

Link: https://www.pnas.org/doi/10.1073/pnas.2614163123

____

Increasing spatial scale of #analysis weakens and can mask the #dilution effect for #hantaviruses

 

Abstract

Despite its major implications for biodiversity conservation and public health, the generality of a protective effect of biodiversity on zoonotic pathogen transmission (i.e., the dilution effect) remains strongly debated. This controversy may partly arise from the diversity of analytical approaches used, but also from the spatial scales at which studies are conducted. Here, we explicitly test whether increasing the spatial scale of analysis affects the detection of the relationship between hantavirus infection prevalence and rodent species richness, using a global dataset spanning multiple regions. Although the association between species richness and infection prevalence remains negative across all spatial scales, we show that the magnitude of the dilution effect progressively weakens as spatial aggregation increases and can become statistically non-significant at coarse spatial resolutions. These results, which are consistent across world regions, indicate that the dilution effect is likely a general feature of hantavirus–rodent systems, but that its empirical detection is highly sensitive to the spatial scale of analysis. Our findings highlight how large-scale spatial aggregation can mask underlying ecological processes and emphasize the need to carefully match spatial scale to the biological mechanisms under investigation when testing biodiversity–disease relationships. Finally, we discuss the ecological and methodological mechanisms that may obscure dilution effects and outline why scale-explicit approaches are essential for robust inference in biodiversity-disease research.

Source: 

Link: https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007045

____

Divergent avian #strains drive an off-season #influenza A peak in municipal #wastewater

 

ABSTRACT

Wastewater sequencing is an increasingly valuable tool in tracking the spread of infectious disease agents across space and time in areas of dense human settlement. Among pathogens that can be readily detected by this approach is influenza A, which follows predictable patterns of prevalence through the winter months in North America. Here, we leverage routine surveillance of a municipal wastewater treatment plant in Northern California to describe an atypical, off-season spike in influenza A concentrations that rivals that of the winter respiratory virus season. Drawing upon metagenomic data generated through hybrid-capture sequencing, we assemble and subsequently characterize fragments of divergent influenza genomes that appear to derive predominantly from the avian H16 clade. These strains exhibit close evolutionary relationships to influenza isolated from migratory shorebirds, hinting at potential host species and mechanisms of geographic spread. Analysis of read abundances suggests that these avian strains dominate the pool of influenza circulating during the summer months, when typical human-infecting strains are essentially absent. Together, our results expand the value of wastewater sequencing to encompass sensitive tracking of outbreaks within animals in interface regions where human settlement abuts wildlands, increasing overall pandemic preparedness.

IMPORTANCE

Researchers now commonly search municipal wastewater for viral genetic material, which can indicate trends in the diversity and abundance of strains circulating in communities. Here, we show that under certain conditions, municipal wastewater can also capture the signatures of viruses circulating among animal populations, such as birds. Specifically, we draw on a targeted form of nucleic acid sequencing to discover a strain of influenza that is fairly genetically distinct from known relatives and may be circulating among shorebirds in Northern California. These findings both broaden the possible use cases of wastewater sequencing and provide new insights into avian viruses, some of which can jump host species to make other animals or people sick.

Source: 

Link: https://journals.asm.org/doi/10.1128/spectrum.02027-26

____

Pan - #Ebolavirus nanoparticle #vaccine provides protection in rodents from lethal #infection by #Zaire and #Sudan viruses

 

Abstract

Both Zaire ebolavirus (EBOV) and Sudan ebolavirus (SUDV) are members of the genus Ebolavirus and cause outbreaks marked by high fatality rates and repeated spillover from animal reservoirs. Filoviral glycoproteins (GPs) are the primary targets of neutralizing antibodies and form the basis of current vaccines. Here we describe the design, structural characterization, and evaluation of two-component self-assembling icosahedral I53-50 nanoparticles displaying prefusion EBOV or SUDV GP antigens, either individually or in cocktail and mosaic multivalent formats. EBOV-GP-I53-50 and SUDV-GP-I53-50 nanoparticles elicited strong homologous protection in mice and guinea pigs. In the mouse-adapted EBOV model (maEBOV), mosaic and cocktail formulations produced weak survival below that of the matched EBOV-GP-I53-50 GP immunogen. In contrast, in the gpaSUDV guinea pig model (gpSUDV), cocktail and mosaic nanoparticles elicited robust protection against gpSUDV, and detectable antibody responses to both SUDV and EBOV GPs. These findings demonstrate that multivalent GP-I53-50 nanoparticle immunogens can protect rodents from death, severe clinical signs of disease, and weight loss in relevant models. Together with the established clinical safety of the I53-50 platform, these results support continued efforts toward the development of a pan-ebolavirus vaccine.

Source: 

Link: https://www.nature.com/articles/s41467-026-76114-1

____

Elicitation of Potent #H5N1 - and #H7N9-Neutralizing #Antibody Responses in Rh. Macaques by Sequential Heterologous #Vaccination with #mRNA and Adenoviral Vectors Encoding Full-Length Hemagglutinins

 

Abstract

Highly pathogenic avian influenza (HPAI) represents an enormous pandemic risk amid the ongoing H5N1 panzootic. HPAI, defined by its high lethality in domestic poultry, includes the influenza A virus (IAV) H5N1 and H7N9 subtypes and has a 40–50% case fatality rate in humans. To facilitate the development of efficacious HPAI vaccination regimens and isolation of HPAI-neutralizing monoclonal antibodies (nmAbs) for prophylactic and therapeutic use, we performed a proof-of-concept pilot study wherein we developed an array of mRNA and adenovirus-vectored vaccines encoding HPAI hemagglutinins (HAs) and then assessed their immunogenicity in IAV-naïve Indian rhesus macaques (RMs). All RMs developed binding IgG recognizing both HPAI HAs. HPAI-nAbs were detected in RMs vaccinated with full-length HAs, but not in RMs vaccinated with HA stems alone. Potent HPAI neutralization activity was observed in two animals with serum ID50 titers of ~1:100,000 against H5N1 and ~1:50,000 against H7N9. Most RMs developed cross-reactive IgG recognizing the HAs of additional IAV subtypes, and HA-specific B cells were readily identifiable in vaccinee PBMCs by flow cytometric analysis. The results of our pilot study suggest that elicitation of potent HPAI-nAb responses is enhanced by vaccination with the HA head domain and that vaccination with the HA stem alone tends to elicit binding non-nAbs. Furthermore, use of our fluorophore-conjugated HA probes to identify HA-specific B cells could enable HPAI-nmAb isolation. Collectively, our findings could facilitate the development of novel vaccines and nmAb therapeutics leveraging the superior neutralization potency of HA head-specific Abs to prevent and treat HPAI infections in humans.

Source: 

Link: https://www.mdpi.com/1999-4915/18/9/981

____

Challenges in managing ruptured #ectopic #pregnancy complicated by hemorrhagic #shock in an #Ebola treatment unit in #DRC: first reported case

 

Abstract

Background: 

Ectopic pregnancy (EP) is an obstetric emergency; early diagnosis is critical for maternal survival. In resource-limited settings, such as Ebola treatment units (ETU), delayed diagnosis or management of EP often leads to rupture and life-threatening hemorrhagic shock.

Case presentation: 

We report the case of a pregnant woman in her 30s who was admitted to the ETU with suspected Ebola virus disease in the Democratic Republic of Congo (DRC). Her clinical presentation included fever and abdominal pain, which began 4 days before her admission. Thirteen months earlier, she had recovered from an Ebola infection. At admission, she presented with 8 weeks of amenorrhea and discrete pelvic pain. On vaginal examination, we noted a slightly enlarged uterus and palpated a small left adnexal mass. Laboratory exams confirmed malaria and pregnancy. Her EVD test was negative. Due to the absence of an ultrasound machine in the ETU, pelvic ultrasound was impossible. Supportive treatment was initiated. Nineteen hours after admission, the patient developed an acute surgical abdomen, with progressive left-sided pelvic pain, abdominal distension, and diffuse tenderness. A ruptured ectopic pregnancy was suspected and confirmed by diagnostic abdominal puncture, which revealed hemoperitoneum. She developed hemorrhagic shock. However, the ETU lacked an operating room, surgical equipment, and anesthetic drugs. Transfer to another ETU was not feasible due to the absence of a surgical-capable facility, while transfer to a community facility required at least a second negative EVD test 48 h after the first. We used an unused building that was part of the neighboring health center to perform an explorative laparotomy, which revealed an EP in the left tube with ampullary dislocation and active bleeding. We performed a left salpingectomy and homeostatic sutures. The real-time polymerase chain reaction (RT-PCR) tests for EVD performed at 48 and 72 h were negative. She had a normal postoperative course and was discharged from ETU to the community on the 14th day after surgery.

Conclusion: 

Ruptured ectopic pregnancy (REP) remains a life-threatening obstetric emergency that may occur in ETUs, where resources and treatment conditions are limited. To protect maternal health, ETUs should ensure not only proper care for Ebola infection but also adequate capacity for the timely diagnosis and management of obstetric complications.

Source: 

Link: https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2026.1848720/full

____

#Safety, humoral and cellular immune responses to a pre-pandemic adjuvanted #influenza #H5N8 #vaccine

 

Abstract

Highly pathogenic avian influenza (HPAI) A(H5) viruses can be transmitted from infected birds to various mammalian species, including humans. Avian influenza viruses (AIVs), members of the Orthomyxoviridae family, possess segmented RNA genomes prone to reassortment, favoring the emergence of novel genetic traits that may alter transmissibility, pathogenicity, and antigenicity. Although no sustained human-to-human transmission has been reported, the potential adaptation of these viruses poses a significant pandemic threat. This study aimed to evaluate the non-clinical safety, toxicity, and humoral immune responses induced by an adjuvanted H5 influenza vaccine in rats and rabbits, to support future clinical safety trials in humans. Male and female Wistar rats and New Zealand rabbits were observed for 14, 28, and 90 days after receiving two intramuscular doses of the H5N8 vaccine (15 μg HA/dose) formulated with the IB160 oil-in-water emulsion adjuvant. No systemic comorbidities, central nervous system alterations, or relevant clinical signs were observed. Hematological parameters remained within normal ranges, with total and differential leukocyte counts showing only minor fluctuations (<1% of total leukocytes). Mild biochemical variations in urea and hepatic transaminase levels were not correlated with histopathological alterations. The vaccine elicited a robust humoral response soon after immunization, with all groups reaching protective HAI-antibody titers. Although antibody levels declined over time, particularly in males, they remained significantly above baseline, indicating durable immunological memory. Furthermore, the vaccine induced a specific cellular immune response, confirmed by IL-2 and TNF production by antigen-specific T lymphocytes in splenic cell cultures after the booster dose. In conclusion, the H5N8 vaccine with the IB160 adjuvant was well tolerated locally and systemically, without compromising vital organ function. The safety and immunogenicity findings are consistent with expectations for adjuvanted influenza vaccines, demonstrating strong and durable humoral and cellular immune responses.

Source: 

Link: https://www.sciencedirect.com/science/article/abs/pii/S0264410X26008583?via%3Dihub

____

#Coronavirus Disease Research #References (AMEDEO, Sept. 5 '26)

 

BMJ

1. YANG YT
   Covid-19 vaccine study: scientific asylum should never have been necessary.
   BMJ. 2026;394:e100738.
   PubMed        
   
   

   
   Clin Infect Dis

2. TIPPETT A, Prasad PV, Begier E, Kim SS, et al
   Respiratory Syncytial Virus Hospitalizations in Adults >/=50 Years of Age and Those With Congestive Heart Failure or Chronic Obstructive Pulmonary Disease Exacerbations, 2018-2020.
   Clin Infect Dis. 2026;83:e416-e426.
   PubMed         Abstract available
   
   
3. GODWIN P, Shvachko V, Oppelt T, Wang CY, et al
   Retrospective Cohort Study Assessing Remdesivir Effectiveness in Hospitalized COVID-19 Patients With Renal or Hepatic Comorbidities.
   Clin Infect Dis. 2026 Sep 1:ciag534. doi: 10.1093.
   PubMed         Abstract available
   
   

   
   Int J Infect Dis

4. THUNDAKATTIL AV, Prabhu R, Prabhu G, Mani M, et al
   Mixing versus matching booster vaccines: A longitudinal humoral immune kinetics against Omicron in a Malaysian cohort.
   Int J Infect Dis. 2026 Sep 4:109103. doi: 10.1016/j.ijid.2026.109103.
   PubMed         Abstract available
   
   
5. JIN M, Xin H, Zhang J, Huang X, et al
   Epidemiological Characteristics of Scarlet Fever in Liaoning Province, China: A Pre- and Post-Pandemic Comparison, 2005-2024.
   Int J Infect Dis. 2026 Sep 4:109081. doi: 10.1016/j.ijid.2026.109081.
   PubMed         Abstract available
   
   
6. KIM JS, Park JH, Kim J, Lee YC, et al
   Non-invasive aspergillosis following COVID-19 exacerbates the severity of SARS-CoV-2 infection.
   Int J Infect Dis. 2026 Sep 3:109095. doi: 10.1016/j.ijid.2026.109095.
   PubMed         Abstract available
   
   
7. XUE M, Zhou Z, Chao Y, Li J, et al
   Influenza A-Associated Pulmonary Aspergillosis in Critically Ill Patients in the Post-COVID-19 Era: A Multicenter Cohort Study from China.
   Int J Infect Dis. 2026 Aug 29:109089. doi: 10.1016/j.ijid.2026.109089.
   PubMed         Abstract available
   
   

   
   Intensive Care Med

8. MEZA-FUENTES G, Delgado I, Vial PA, Godoy-Faundez A, et al
   Temporal trends in critical care burden and outcomes of Andes virus-associated hantavirus cardiopulmonary syndrome: a national Chilean cohort.
   Intensive Care Med. 2026 Sep 2. doi: 10.1007/s00134-026-08599.
   PubMed         Abstract available
   
   

   
   J Infect

9. LOUBET P, Roubille F, Launay O, Fourati S, et al
   Cardiovascular outcomes and acute human metapneumovirus infection in adults: A systematic literature review.
   J Infect. 2026;93:106843.
   PubMed         Abstract available
   
   
10. WALKER JL, Ribeiro S, Litt D, Patel T, et al
    Antenatal pertussis vaccine effectiveness in England remains high post COVID-19.
    J Infect. 2026;93:106836.
    PubMed         Abstract available
    
    

    
    J Med Virol

11. FERRENA A, Schlamp F, Tuen M, Duerr R, et al
    Durable Interferon-Linked Blood Signatures During COVID-19 Convalescence.
    J Med Virol. 2026;98:e71133.
    PubMed         Abstract available
    
    

    
    J Virol

12. HU L, Tian R, Gao L, Xu N, et al
    PEDV envelope protein promotes viral replication by remodeling host iron homeostasis via the TRIM28-KLF15-FPN axis.
    J Virol. 2026 Sep 2:e0123926. doi: 10.1128/jvi.01239.
    PubMed         Abstract available
    
    
13. DARNLEY JA, Waller SJ, French RK, Parata R, et al
    Divergent coronaviruses discovered in the virome of lamprey with reddening syndrome.
    J Virol. 2026 Sep 2:e0064526. doi: 10.1128/jvi.00645.
    PubMed         Abstract available
    
    

    
    JAMA

14. LIPSON RA, Senerth E, Watson MA, Saini H, et al
    COVID-19 Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season.
    JAMA. 2026 Sep 2. doi: 10.1001/jama.2026.18191.
    PubMed         Abstract available
    
    
15. SENERTH E, Sheikholeslamian SM, Sivakumaran K, Watson MA, et al
    Influenza Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season.
    JAMA. 2026 Sep 2. doi: 10.1001/jama.2026.18126.
    PubMed         Abstract available
    
    
16. ROTEN L, Maurhofer J, Krisai P, Breitenstein A, et al
    Pulmonary Vein Isolation Using Pulsed Field Ablation With vs Without Posterior Wall Isolation in Patients With Symptomatic Persistent Atrial Fibrillation: The PIFPAF-PFA Randomized Clinical Trial.
    JAMA. 2026 Aug 29:e2617598. doi: 10.1001/jama.2026.17598.
    PubMed         Abstract available
    
    

    
    Lancet Infect Dis

17. BADEN LR, Shah NS, Liu STH, Cohen J, et al
    Nirmatrelvir-ritonavir targeting viral persistence in post-COVID-19 condition (long COVID) in the USA (RECOVER-VITAL): a randomised, double-blind, placebo-controlled, phase 2 trial.
    Lancet Infect Dis. 2026 Aug 31:S1473-3099(26)00406.
    PubMed         Abstract available
    
    

    
    Nature

18. MAKIN S
    When do infections lead to long COVID? Scientists close in on triggers and treatments for post-viral syndromes.
    Nature. 2026;657:26-28.
    PubMed 

#Influenza and Other Respiratory Viruses Research #References (AMEDEO, Sept. 5 '26)

 

Antimicrob Agents Chemother

1. DE ANGELIS M, Gori Savellini G, Piselli E, Anichini G, et al
   Redox-sensitive factors as targets of thiol compounds to hinder SARS-CoV-2 replication and inflammatory response.
   Antimicrob Agents Chemother. 2026;70:e0051826.
   PubMed         Abstract available
   
   
2. JEENA N, Khan IA
   Targeting SARS-CoV-2 programmed -1 ribosomal frameshifting: structural dynamics and RNA-directed antiviral strategies.
   Antimicrob Agents Chemother. 2026;70:e0068726.
   PubMed         Abstract available
   
   
3. AVILA-PONCE DE LEON U, Esmaeili S, Owens K, Schiffer JT, et al
   Plasma concentrations of nirmatrelvir and molnupiravir required for inhibition of SARS-CoV-2 replication differ between rhesus macaques and humans.
   Antimicrob Agents Chemother. 2026 Aug 5:e0030726. doi: 10.1128/aac.00307.
   PubMed         Abstract available
   
   

   
   Antiviral Res

4. PU F, Guo Y, Pan X, Liu X, et al
   Dual-targeting engineered binding proteins block SARS-CoV-2 infection and complement activation.
   Antiviral Res. 2026;254:106515.
   PubMed         Abstract available
   
   
5. YURGELONIS I, Rai DK, Lee JT, Li Z, et al
   Antiviral activity of nirmatrelvir against contemporary SARS-CoV-2 variants.
   Antiviral Res. 2026;254:106517.
   PubMed         Abstract available
   
   

   
   Epidemiol Infect

6. NAQVI OH, Wendelboe AM, Beasley WH, Tyungu DL, et al
   Epidemiological characteristics of paediatric COVID-19 and influenza co-infections in the United States, 2020-2024 - CORRIGENDUM.
   Epidemiol Infect. 2026;154:e111.
   PubMed        
   
   

   
   J Infect Dis

7. ZHAO B, Zhang G, Wu J, Zhang W, et al
   Characterization of bronchiolitis and vaccine-induced enhanced respiratory disease in Syrian hamsters caused by respiratory syncytial virus infection.
   J Infect Dis. 2026 Mar 4:jiag136. doi: 10.1093.
   PubMed         Abstract available
   
   

   
   J Virol

8. BHAVSAR D, Civljak A, Bonnettaz B, Arunkumar GA, et al
   Broadly reactive antibodies against influenza B virus hemagglutinin neutralize and protect through distinct structural mechanisms.
   J Virol. 2026 Sep 4:e0080226. doi: 10.1128/jvi.00802.
   PubMed         Abstract available
   
   
9. LIU D, Zhang Y, Zhang M, Guo R, et al
   A neuraminidase-targeting nanobody as a therapeutic candidate against influenza A and B viruses.
   J Virol. 2026 Aug 31:e0087426. doi: 10.1128/jvi.00874.
   PubMed         Abstract available
   
   

   
   JAMA

10. SENERTH E, Sheikholeslamian SM, Sivakumaran K, Watson MA, et al
    Influenza Vaccine Effectiveness and Safety for the 2026-2027 Respiratory Season.
    JAMA. 2026 Sep 2. doi: 10.1001/jama.2026.18126.
    PubMed         Abstract available
    
    

    
    Pediatrics

11. CHAN OW, Cheng YT, Liu YH, Chou IJ, et al
    Anakinra in Severe RSV-Associated Autoinflammatory Encephalopathy With Delayed ADEM-Like Changes.
    Pediatrics. 2026;158:e2026076364.
    PubMed         Abstract available
    
    
12. PAYNE AB, Battan-Wraith S, Reese SE, Hathaway CA, et al
    Effectiveness of RSV Prevention Strategies in US Infants: 2024-2025.
    Pediatrics. 2026 Aug 4:e2026076089. doi: 10.1542/peds.2026-076089.
    PubMed         Abstract available
    
    
13. MIN J, Tam V, Jacoby SF, McDonald CC, et al
    Community Firearm Violence, Youth Depression, and Suicide Risk in Philadelphia: 2017-2024.
    Pediatrics. 2026;158:e2025075438.
    PubMed         Abstract available
    
    

    
    PLoS Comput Biol

14. FREEDMAN AS, Nielsen BF, Saad-Roy CM, Grenfell BT, et al
    Economic factors promoting vaccine nationalism in the face of viral evolution.
    PLoS Comput Biol. 2026;22:e1014466.
    PubMed         Abstract available
    
    

    
    PLoS Med

15. ELIAS KM, Mitchell A, Stadler E, Schlub TE, et al
    Neutralising antibodies and protection from progression to severe COVID-19: A meta-analysis.
    PLoS Med. 2026;23:e1005230.
    PubMed         Abstract available
    
    

    
    PLoS One

16. ADAMCZYK G, Jablonski A, Nowakowski PT, Ptaszek RT, et al
    Theodicy perspective as an effect of the interpenetration of mental and religious issues during the COVID-19 pandemic in Poland.
    PLoS One. 2026;21:e0355379.
    PubMed         Abstract available
    
    
17. JUNGMANN SM, Garbe Huedo SF, Jacobs KAS, Pothorn NK, et al
    Mental load in women and mothers: Causes of distress, personality traits, and psychopathology.
    PLoS One. 2026;21:e0356255.
    PubMed         Abstract available
    
    
18. MOUNADI N, Nour H, El Kouali M, Samadi A, et al
    Repositioning antiviral phytoconstituents as broad-spectrum inhibitors of influenza A neuraminidase and human metapneumovirus fusion protein.
    PLoS One. 2026;21:e0348517.
    PubMed         Abstract available
    
    
19. HAWKES BA, Hollister J, Porter C, Lyski ZL, et al
    Age-specific humoral immune response to SARS-CoV-2: A comparative analysis of antibody levels in children and adults after vaccination with primary series or infection.
    PLoS One. 2026;21:e0356178.
    PubMed         Abstract available
    
    
20. AVSAR FN, Kilicaslan N, Sahutoglu T
    Comparative associations of Anakinra and Tocilizumab initiation with in-hospital mortality in severe COVID-19: A single-center sequential cohort study.
    PLoS One. 2026;21:e0357671.
    PubMed         Abstract available
    
    
21. SEEGERT N, Gaulin M, Chaiyakunapruk N, Navarro-Sanchez F, et al
    The impact of state- versus county-level mask mandates on economic activity during the COVID-19 pandemic.
    PLoS One. 2026;21:e0332243.
    PubMed         Abstract available
    
    
22. HARDY MJ, Williams CK, Ladman BS, Pitesky ME, et al
    Using high frequency GPS data to assess wintering goose proximity to commercial poultry facilities on the Delmarva peninsula for avian influenza risk management and surveillance.
    PLoS One. 2026;21:e0355415.
    PubMed         Abstract available
    
    
23. KOPP J, Spies Rodriguez DC, Kunzi L, Puhan MA, et al
    Physical activity in post-COVID-19 condition: A cross-sectional study.
    PLoS One. 2026;21:e0357465.
    PubMed         Abstract available
    
    

    
    Proc Natl Acad Sci U S A

24. KARADAKIC R, Keating NL, Barnett ML
    Interpreting vaccine-associated survival differences in immune checkpoint inhibitor therapy.
    Proc Natl Acad Sci U S A. 2026;123:e2621501123.
    PubMed         Abstract available
    
    

    
    Vaccine

25. MOHAMMED H, Andraweera P, Marshall HS
    A cohort study to assess the safety and coverage of COVID-19, influenza, and pertussis vaccine in Australian pregnant women.
    Vaccine. 2026;91:129081.
    PubMed         Abstract available
    
    
26. SHEN AK, Tupps C, Bino S, Chipoya M, et al
    Investments in seasonal influenza vaccination programs pack a punch for pandemic preparedness.
    Vaccine. 2026;92:129098.
    PubMed         Abstract available
    
    
27. TRAN S, McClymont E, Blitz S, Barrett J, et al
    Self-reported reactogenicity after COVID-19 vaccination with and without influenza vaccine coadministration during pregnancy in Canada.
    Vaccine. 2026;92:129122.
    PubMed         Abstract available
    
    
28. MARIA DA, Martins IM, Porto GPM, Villas-Boas IM, et al
    Safety, humoral and cellular immune responses to a pre-pandemic adjuvanted influenza A (H5N8) vaccine.
    Vaccine. 2026;92:129049.
    PubMed         Abstract available
    
    
29. ZHENG Y, Qiao B, Gao Z, Zhang X, et al
    Development of a subunit vaccine candidate (RBD-HA trimer) provides dual protection against multi-subtype avian influenza viruses and QX-type infectious bronchitis virus.
    Vaccine. 2026;92:129121.
    PubMed         Abstract available
    
    
30. KORNUTA CA, Zhou G, Kane KP, Vliagoftis H, et al
    Mucosal adjuvant activity of a PAR-2-activating peptide enhances lymph node immune cell recruitment and promotes immune cell activation in a prime-boost influenza vaccination model.
    Vaccine. 2026;92:129110.
    PubMed         Abstract available
    
    

    
    Virology

31. BROGAARD L, Laybourn HA, Kristensen C, Welner S, et al
    Site-specific microRNA responses in lungs of pigs depend on the host-adaptation of H1N1 influenza A virus.
    Virology. 2026;624:111053.
    PubMed         Abstract available
    
    
32. SEKINE W, Kamiki H, Ishida H, Matsugo H, et al
    HA1-T138A and HA1-Q226L substitutions in H3N2 canine influenza virus contribute to binding to human-type alpha2,6-linked sialic acid receptors.
    Virology. 2026;625:111071.
    PubMed         Abstract available
    
    
33. OLDENSAND F, Rafati N, Van Hoef V, Lundkvist A, et al
    Single-cell transcriptomic landscape of avian influenza H9N2 virus infection in human and chicken cells.
    Virology. 2026;625:111070.
    PubMed         Abstract available
    

#Phylogenetic analysis of the 2025 #Ebola #outbreak in the #DRC

 

Abstract

On 4 September 2025, the Ministry of Public Health, Hygiene and Social Welfare officially declared the 16th Ebola disease outbreak in the Democratic Republic of the Congo (DRC). This outbreak ended on 1 December 2025 and occurred in Bulape Health Zone, Kasaï Province, an area with limited access to appropriate healthcare facilities and resources. Here, we describe the probable index patient and molecular investigations of samples obtained from six suspected patients from the initial outbreak phase. We identified Orthoebolavirus zairense (EBOV) in five samples from different patients. In addition, we performed whole-genome sequencing and generated four complete EBOV genomes. These genomes form a well-supported phylogenetic cluster with genomes from the 1976 Yambuku/Mayinga outbreak. This study suggests a likely new zoonotic spillover event from an as-yet unidentified natural reservoir. While the close relationship to 1976 EBOV Yambuku/Mayinga genomes is striking, this poses additional challenges on the comprehension of the animal reservoir species.

Source: 

Link: https://www.nature.com/articles/s41467-026-77542-9

____

Sex differences in #vaccine-induced #neuraminidase cross-recognition impact #H5N1 #dissemination to the lower respiratory tract in mice

 

Abstract

H5N1 vaccines have been poorly immunogenic in humans, creating a challenge for vaccine development. Seasonal influenza vaccines offer some cross-protection against H5N1, but there has been no consideration of whether protection differs between the sexes. We investigated sex differences in antibody responses following receipt of either beta-propiolactone inactivated whole virus H1N1 or H5N1 (LAIV backbone) vaccines in C57BL/6 mice. Using systems serology assays, vaccination induced strong homologous and heterologous antibody responses, with females generating greater IgG titers than males against whole virus H1N1 and H5N1, which was primarily mediated by greater IgG responses to neuraminidase (NA) than hemagglutinin (HA) protein. Cross-reactive H5N1 IgG titers were greater among H1N1-vaccinated females, and primarily mediated by greater N1-specific IgG titers. IgG2b and IgG2c were the primary antibody isotypes generated in response to these vaccines, with females having greater IgG2b titers and enhanced binding to FcγRIV for avian and human NA than males following either homologous or heterologous vaccination. Antibody-dependent complement deposition was measured as an FcR-mediated non-neutralizing response against HA and NA and was more robust among H1N1 and H5N1 vaccinated females than their male counterparts in response to homologous HA only. Vaccinated females tended to have greater neutralizing antibody titers than males against the homologous vaccine strain, 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 restricted virus to the upper respiratory tract and had lower pulmonary virus titers than males at 3 days post challenge. These findings highlight that sex differences in vaccine-induced NA-specific antibody responses are associated with differential respiratory dissemination of H5N1 and that sex should be considered in studies of vaccine-induced cross-reactive influenza immunity.

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

Richard Eliasberg Family Foundation

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.05.26.728011v3

____

Lessons Learned During 2024‒25 Highly Pathogenic Avian #Influenza #H5N1 Virus #Outbreak Response in #USA: Experience of State and Local Public Health Departments

 

Abstract

Objectives. 

To describe challenges and lessons learned during state and local health department responses to the 2024‒2025 highly pathogenic avian influenza A(H5N1) outbreaks.

Methods. 

We conducted semistructured interviews from August to November 2025 with Department of Health and Agriculture staff from states with confirmed or probable A(H5N1) human cases. We conducted 15 total interviews with 37 participants from 10 US states. Interview transcripts were inductively and deductively coded to identify generalizable lessons that might improve future outbreak response efforts.

Results. 

Key themes included difficulty accessing farms and reaching at-risk populations; lack of sufficient guidelines for proactively responding to zoonotic outbreaks that could have human health implications; the importance of maintaining preparedness planning, capacity, and infrastructure; and uncertainty around future capacity to respond to outbreaks because of resource constraints and changes in federal leadership.

Conclusions. 

Although this study focused on responses to A(H5N1) outbreaks, the findings are indicative of the nation’s overall readiness for biological threats. Prioritization of capacity building for infectious disease outbreaks, including robust health department funding to support continued disease surveillance, is critical to prevent more widespread transmission. 

(Am J Public Health. Published online ahead of print September 3, 2026:e1–e7. https://doi.org/10.2105/AJPH.2026.308656)

Source: 

Link: https://ajph.aphapublications.org/doi/10.2105/AJPH.2026.308656

____

Experimental #reproduction numbers disentangle #vaccine effects on susceptibility and infectiousness during #H5N1 #transmission in #geese

 

Abstract

Vaccination against high pathogenicity avian influenza virus (HPAIV) is increasingly used to protect poultry, but vaccine performance is commonly inferred from clinical protection and virus shedding rather than measured transmission. We asked whether reproduction numbers from controlled transmission experiments can quantify how vaccination changes susceptibility and infectiousness. Domestic geese were prime-boost vaccinated with an H5 clade 2.3.4.4b RNA-replicon vaccine and challenged with homologous HPAIV H5N1. Replicated seeder-sentinel groups represented transmission among unvaccinated animals, to vaccinated contacts, and from vaccinated breakthrough-infected animals. Vaccinated directly challenged geese remained clinically protected although all became RT-qPCR-positive. Estimated reproduction numbers were R0=4.7 (95% CI, 2.8-8.0) among unvaccinated geese, Rs=2.6 (1.6-4.5) for transmission to vaccinated contacts, Ri=3.7 (2.0-6.8) for transmission from vaccinated infected geese, and Rvacc=2.0 (0.8-4.9) for a fully vaccinated population. Vaccination reduced transmission but did not reduce the point estimate for Rvacc below one under these intensive exposure conditions. Vaccinated infected geese also shed substantially less viral RNA, whereas the estimated reduction in infectiousness was more modest, indicating that RNA shedding alone may not reliably predict transmission reduction. Experimental reproduction numbers therefore provide a direct population-level complement to conventional vaccine endpoints and separate effects on susceptibility from effects on onward transmission.

Competing Interest Statement

Christophe Cazaban is an employee of CEVA Santé Animale, which provided the experimental vaccine used in this study. The remaining authors declare no competing interests.

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.09.02.748824v1

____

Immunogenicity and #safety of seasonal #influenza #vaccine co-administered with other vaccines: a systematic review and meta-analysis

 

Abstract

Seasonal influenza remains a leading cause of global morbidity and mortality, highlighting the need for vaccination strategies that improve coverage and streamline vaccine delivery. In this systematic review and meta-analysis, we searched PubMed, Embase, Web of Science, Scopus, and the Cochrane Central Register of Controlled Trials for randomised controlled trials (RCTs), cohort, case-control, and cross-sectional studies, evaluating immunogenicity and safety of same-day co-administration of influenza vaccines with COVID-19 or other vaccines, compared with non-concomitant administration. Comparators included sequential administration, single vaccine administration or placebo-controlled delayed vaccination. Risk of bias was evaluated using the Cochrane Risk-of-Bias tool for Randomized Trials and Risk of Bias In Non-randomized Studies of Interventions; certainty of evidence was evaluated using Grading of Recommendations, Assessment, Development and Evaluation. Immunogenicity was assessed using geometric mean fold rise (GMFR) in antibody titres and seroprotection rate. Safety was assessed by adverse event (AE) incidence. 52 eligible studies were included. Influenza immunogenicity was comparable between the co-administration and non-concomitant comparator group across all strains (H1N1 GMFR ratio of means (ROM): 1.02 [95% CI: 0.95–1.10]; H3N2, 1.05 [95% CI: 0.97–1.13]; B strain, 1.01 [95% CI: 0.97–1.05]). Pooled risk ratio (RR) for seroprotection was 1.00 for all three strains with 95% CIs ranging from 0.99–1.01. GMFR for COVID-19 vaccines was modestly reduced under co-administration (ROM 0.84 [95% CI: 0.74–0.95]; p = 0.006). Serious AEs were more frequent in the co-administration group compared to the non-concomitant group (RR 1.41 [95% CI: 1.07–1.86]; p = 0.014; absolute risk difference: 1.56 percentage points). Overall, co-administration preserves influenza immunogenicity but modestly reduces COVID-19 vaccine GMFR. Although safety findings warrant cautious interpretation, the low absolute risk difference supports its feasibility as a strategy to streamline vaccination schedules and improve uptake.

Source: 

Link: https://www.nature.com/articles/s41541-026-01548-z

____

#Ring and #community #vaccination for #Bundibugyo virus #outbreak response: a stochastic network modelling study

 

Summary

Background

Vaccination with rVSV-ZEBOV is highly effective against Ebola virus, but protection against Bundibugyo virus (BDBV) is unproven. We evaluated the relative population impact and dose efficiency of a partially cross-protective hypothetical vaccine under operationally realistic constraints during a BDBV outbreak.

Methods

We developed a stochastic transmission model on a clustered household–community contact network with empirically realistic local structure, calibrated to 2026 DR Congo BDBV outbreak data. Time-varying effective reproduction numbers were estimated using a Bayesian renewal model. We evaluated case detection, isolation, contact tracing, reactive ring vaccination (Ring 1: direct contacts of the index case; Ring 2: contacts of contacts), and community vaccination (20–80% coverage). Base-case vaccine effectiveness was 45% and included post-exposure protection against disease and mortality. Primary outcomes were mortality and incidence reductions, total doses, and dose efficiency (doses per death averted) over 90 days, evaluated in a probabilistic sensitivity analysis with 10 000 matched stochastic replicates per strategy.

Findings

Compared with base operations alone (30% detection, 30% tracing), enhanced operations alone (70% detection, 80% tracing) reduced expected mortality by 81·6% (95% uncertainty interval 73·1–87·7). Reactive Ring 2 vaccination under base operations reduced mortality by 24·6% (18·0–29·6), requiring 35·1 doses per death averted. Added to enhanced operations, Ring 2 vaccination reduced mortality by 83·6% overall (76·4–89·0), an incremental benefit of 10·5% (6·2–15·6) beyond enhanced operations alone. Community vaccination at 20%, 40%, 60%, and 80% coverage reduced mortality by 44·7% (34·8–52·5), 67·4% (56·2–74·3), 79·8% (70·4–85·3), and 86·6% (79·2–90·4), respectively, requiring 53·8–111·4 doses per death averted.

Interpretation

Strengthened case finding, contact tracing, and isolation averted most deaths even without vaccination. Once these operations were strong, reactive ring vaccination added a modest further benefit, whereas rapid community vaccination produced the largest reductions in simulated scenarios but required substantially more doses. A partially protective BDBV vaccine's population-level value will depend principally on rapid, broad delivery.

Funding

Canadian Institutes of Health Research.

Translation

For the French translation of the abstract see Supplementary Materials section.

Source: 

Link: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(26)00464-0/fulltext

____

Early Action #Review of #Detection, Notification, and #Response Timeliness during Cross-Border #Bundibugyo Virus Disease #Outbreak, #Uganda, 2026

 

Abstract

Bundibugyo virus disease (BVD), an Ebola virus species with no licensed vaccine or therapeutic, reemerged in May 2026 as a cross-border outbreak in Uganda and the Democratic Republic of the Congo. During a 2-day workshop, July 8–9, 2026, we conducted an early action review of the outbreak response using the 7-1-7 framework (7 days to detect, 1 day to notify, 7 days to complete early response actions) to assess timeliness and identify bottlenecks and enablers across 9 response pillars. Uganda declared its outbreak on May 15, 2026; by July 8, the country had recorded 20 confirmed cases (15 imported, 5 locally transmitted) and a case-fatality rate of 15%. Uganda met all 3 targets: detection in 6 days, notification in <1 day, and response completion in 2 days. Low clinical suspicion, cross-border data-sharing gaps, fragmented digital systems, and delayed community engagement were common bottlenecks; strong leadership and coordination structures were most cited enablers.

Source: 

Link: https://wwwnc.cdc.gov/eid/article/32/10/26-1411_article

____

Immunogen selection and prior #immunity shape #antibody breadth following immunisation with avian #H5 #hemagglutinin

 

Abstract

Avian influenza A viruses pose a persistent zoonotic threat to humans owing to their expanding host range and high case fatality rates. In particular, viruses from the 2.3.4.4b clade of the H5 subtype have now been detected in over 60 mammalian species, raising serious pandemic concerns. Understanding immune recognition of the H5 hemagglutinin (HA) is therefore critical for effective vaccine design and pandemic preparedness. To understand the breadth of cross-recognition induced by different H5 strains, we selected genetically diverse H5 human isolates from 2003-2023 and assessed neutralising antibody responses elicited by adjuvanted recombinant HA protein-based vaccines in C57BL/6 mice. Neutralisation activity of sera was determined against seven H5 HA variants using pseudotyped viruses and a PR8-reassortant virus in micro-neutralisation assays. Our results showed a wide variety of cross-strain neutralisation across H5 HA antigen variants. The conventional vaccine strain A/Indonesia/05/2005 displayed narrow activity against emerging clade 2.3.4.4b viruses, whereas ancestral variants exhibited cross-neutralisation profiles showing a diversity of breath but with limited potency. Polyvalent H5 HA formulations and nanoparticle-displayed H5 HA platforms substantially broadened cross-neutralisation against diverse H5 strains. To examine the impact of pre-existing immunity on H5 vaccine immunogenicity in mouse models, mice were primed with either seasonal influenza infection or quadrivalent influenza vaccine (QIV) prior to H5 HA immunisation. QIV pre-vaccination, but not prior influenza infection, enhanced subsequent neutralizing responses towards A/Fujian-Sanyuan/21099/2017 (clade 2.3.4.4b) H5. Collectively, our results demonstrate that immunogen selection and prior immunity shape antibody breadth following immunisation with avian A(H5) hemagglutinin.

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.09.01.748495v1

____

#Genome-informed structural #analysis of #polymerase and glycoprotein #adaptation in #H5N1 clade 2.3.4.4b

 

Abstract

Importance

Understanding the molecular mechanisms driving H5N1 clade 2.3.4.4b is critical for pandemic preparedness.

Objective

To characterize the molecular drivers of viral fitness and mammalian adaptability in recent H5N1 viruses by integrating evolutionary dynamics with structural simulations.

Methods

This study analyzed 2,398 H5Nx genomes (2000–2024) through phylogenetic and selective pressure analyses. HA/NA structures were predicted with AlphaFold 3 and evaluated by AutoDock4 docking, whereas polymerase–ANP32A/B complexes were modeled using template-based methods and their binding free energies were estimated using MM/GBSA. Polymerase–ANP32E complexes were predicted with AlphaFold 3 and similarly evaluated by MM/GBSA. The binding affinities (ΔG) for the sialic acid (SA) receptors and human ANP32 proteins were quantified through molecular mechanics/generalized born surface area calculations.

Results

Clade 2.3.4.4b showed significant antigenic drift in the HA receptor binding site, reducing affinity for α2,3-SA and α2,6-SA receptors. On the other hand, the emergence of a full-length stalk N1 NA with second sialic acid-binding site mutations (e.g., N366S) compensated for reduced HA affinity by enhancing the NA binding stability. In the polymerase complex, both the PB2-627E/631L variant (−144.00 kcal/mol; unadjusted p = 0.0058) and the known mammalian-adaptive 627K/631M variant (−144.67 kcal/mol; unadjusted p = 0.0165) showed more favorable predicted human ANP32B binding free energies than the ancestral 627E/631M state (−136.46 kcal/mol).

Conclusions and Relevance

The co-occurrence of HA, NA, PB1, and PB2 signatures was associated with clade expansion and produced structural predictions consistent with altered receptor or ANP32 interactions; experimental validation is required before inferring effects on fitness or zoonotic risk.

Source: 

Link: https://vetsci.org/DOIx.php?id=10.4142/jvs.26088

____

The first high pathogenicity avian #influenza #H5N1 clade 2.3.4.4b incursions in Hunter New England region, NSW, #Australia, June–July 2026

 

Abstract

Two incursions of high pathogenicity avian influenza (HPAI) A(H5N1) clade 2.3.4.4b in vagrant birds were identified in the Hunter New England region of New South Wales, Australia on 28 June 2026 and 10 July 2026. These were the first detections of the virus in New South Wales and occurred shortly after the first Australian detection in June 2026. The Hunter New England Population Health Unit managed human contacts of the infected birds using a contact management system designed and purpose-built by the Unit. We report on the public health response and opportunities for improvement.

Source: 

Link: https://ojs.cdi.cdc.gov.au/index.php/cdi/article/view/3492

____