#Genetic and #biological characterization of a #duck-origin clade 2.3.4.4b #H5N6 avian #influenza virus reveals partial #mammalian #adaptation

 

Highlights

• Duck-origin H5N6 virus A/Duck/Jiangsu/628/2022 shares high homology with the human strain A/Yangzhou/125/2022.

• The 628 strain shows mammalian adaptation markers: HA mutations enhance human receptors affinity and NA mutations reduce sensitivity to neuraminidase inhibitors.

• Limited airborne transmission but detectable droplet-mediated spread suggests increased mammalian transmission risk.

Abstract

Clade 2.3.4.4b H5Nx highly pathogenic avian influenza viruses (HPAIVs) have caused extensive outbreaks in poultry worldwide. H5 HPAIVs have caused sporadic but severe human infections in China, representing a persistent zoonotic threat. Here, we identified a duck-origin H5N6 HPAIV (A/Duck/Jiangsu/628/2022) through routine surveillance and assessed its biological characteristics and mammalian pathogenesis. Phylogenetic analysis revealed > 98% nucleotide identity between strain 628 and the concurrent human H5N6 strain A/Yangzhou/125/2022. Molecular characterization identified multiple mammalian adaptation markers: hemagglutinin substitutions (S137A, T160A, T192I) associated with enhanced human receptor binding; neuraminidase mutations (I117T, D198N) linked to reduced neuraminidase inhibitor susceptibility; and polymerase complex changes (PB1-D622G, PA-K142Q) conferring increased mammalian cell replication. In vitro studies demonstrated that 628 virus replicated more efficiently in mammalian than in avian cells and exhibited dual receptor-binding specificity. Mouse pathogenicity assays revealed moderate virulence with progressive lung pathology. Critically, transmission experiments confirmed both direct contact and airborne transmission capabilities of 628 in guinea pigs. These findings demonstrate that circulating H5N6 viruses have acquired partial mammalian adaptation while retaining avian fitness, significantly elevating pandemic potential. Enhanced surveillance of wild bird populations, poultry farms, and live poultry markets is urgently needed to develop effective prevention and control strategies.

Source: 

Link: https://www.sciencedirect.com/science/article/abs/pii/S037811352600146X?via%3Dihub

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#Surveillance and cross-species #transmission #assessment of #H3NX avian #influenza viruses isolated in #Guangdong province, #China from 2023 to 2025

 

Abstract

Continued influenza surveillance remains important, especially given that the emergence of novel subtypes or reassorted influenza viruses with pandemic potential continues to be a worldwide threat. In particular, virus circulating in birds can facilitate interspecies transmission to humans. In this study, we conducted systematic surveillance of H3 subtype avian influenza virus (AIVs) in domestic poultry and wild birds throughout Guangdong Province from 2023 to 2025. A total of 21 strains of H3 subtype AIVs were isolated, and phylogenetic analyses and risk assessment of their internal gene segments revealed genetic evidence of reassortment events, indicating a close genetic relationship with highly pathogenic avian influenza viruses (HPAIVs). ZJ1722, ZJ1542 and SZ837 showed dual-receptor binding ability and robust replication in mammalian cells, which coincided with amino acid mutations in the HA protein associated with human receptor binding. Although the H3NX viruses isolated in this study failed to cause lethality in mice, they efficiently replicated in the nasal turbinate and lungs of mice without prior adaptation. This study highlights the paramount importance of sustained, subtype-specific surveillance targeting H3NX avian influenza viruses coupled with timely risk characterization and assessment. Proactive containment of H3NX avian influenza virus (AIV) transmission has vital implications for safeguarding the sustainability of the poultry industry and protecting global human public health, given the inherent zoonotic potential and evolutionary plasticity of this H3 subtype, which could drive future spillover events.

Source: 

Link: https://www.sciencedirect.com/science/article/pii/S0032579126004918?via%3Dihub

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#Taiwan: First locally acquired #human case of novel avian #H7 #influenza virus has been detected (MoH, edited)

 

The Taiwan Centers for Disease Control (CDC) announced today (March 2nd) the first locally transmitted case of novel H7 subtype avian influenza in Taiwan. 

The patient is a man in his 70s from central Taiwan who works in poultry farming and has a history of chronic illness. 

He developed symptoms of runny nose, cough, and body aches on March 20th and sought medical attention at a hospital on March 22nd due to fever. 

He was admitted to the hospital on the same day. 

Imaging examination revealed pneumonia. 

Based on clinical symptoms, test results, and the patient's contact history, the doctor reported the case as a novel H7 avian influenza and administered antiviral medication. 

Further testing and gene sequencing by the CDC confirmed the virus as H7 subtype avian influenza. 

Sequence analysis showed that this H7 belongs to the Eurasian lineage and is similar to the H7 subtype avian influenza viruses monitored in wild birds (mainly ducks and anadidae) in Taiwan over the years. 

However, it is different from the H7N9 subtype avian influenza virus that circulated in mainland China from 2013 to 2019, and is a low-pathogenic avian influenza virus. 

This morning, the CDC convened a meeting with agricultural authorities and relevant medical and veterinary experts to discuss the case and, based on the test results, confirmed it as a case of novel H7 avian influenza in humans. 

The patient's condition has improved and they are continuing isolation and treatment. 

The Centers for Disease Control (CDC) stated that after the first locally transmitted case of H7 subtype novel influenza A was detected in Taiwan, health and agricultural authorities immediately launched a joint epidemic prevention operation to carry out relevant investigations and prevention measures. 

Health authorities, with the assistance of epidemiologists and the Health Bureau, conducted on-site epidemiological investigations at the patient's residence, poultry farm, and hospital. 

Currently, 33 close contacts are under health monitoring and management, and 3 have been given preventative medication based on risk assessment. 

Tests were conducted on 6 family members, all of whom tested negative. 

Agricultural authorities immediately implemented movement restrictions at the poultry farm, and animal testing results were negative for avian influenza virus. 

To clarify the source of infection, today's expert meeting resolved to request the farm to expand testing at nearby poultry farms and to cooperate with wild bird associations to collect droppings from surrounding wild birds. 

Furthermore, the CDC will continue to cooperate with the farm to obtain the gene sequence of the H7 virus detected in Taiwan for further comparison. 

Health and agricultural authorities will continue to strengthen surveillance of humans and animals, including respiratory viruses and influenza/novel coronavirus pneumonia surveillance in medical institutions, active surveillance of poultry farms and migratory birds, and will cooperate with farmers to promote personal protective measures for poultry farmers and public health education. 

They have also contacted duck farming associations to distribute 40,000-50,000 masks free of charge to duck farmers. 

The Centers for Disease Control (CDC) pointed out that, based on current epidemiological investigations and test results, the genetic analysis of this case shows a low-pathogenic avian influenza virus, without any mutations increasing the risk of avian-to-human transmission, and it remains a common avian virus. 

The initial assessment is that this case is an isolated incident. 

Considering the patient's improved condition after treatment, the lack of mutations increasing the risk of avian-to-human transmission in the preliminary genetic analysis, the negative test results at the poultry farm, and the absence of any other family members showing symptoms after the patient's onset, the risk is assessed as controllable, and there is no immediate risk of the outbreak expanding. 

However, to understand the potential risks of this case, they will continue to track the symptoms and test results of contacts, further analyze the virus and trace possible sources of infection, and have activated a joint working group on the risk assessment of zoonotic infectious diseases between agriculture and health authorities to conduct a comprehensive risk assessment. 

The Taiwan Centers for Disease Control (CDC) will notify the World Health Organization (WHO) today through the IHR contact window in accordance with the International Health Regulations (IHR).

According to surveillance data, since the novel influenza A virus was classified as a Category 5 notifiable infectious disease in Taiwan in 2014, a total of 5 sporadic cases have been reported. Besides this case, the others were reported in 2017 (H7N9, imported from outside China), 2021 (H1N2v), 2022 (H1N2v), and 2023 (H1N2v). In addition, there were 4 confirmed cases of H7N9 imported from outside China in 2013-2014; none of the contacts were infected.

The CDC explained that the H7N9 sequence in today's reported case is only closely related to one other human case, H7N4, reported in Jiangsu, China in 2018. The case involves a 68-year-old woman with a history of coronary heart disease and hypertension. She developed symptoms such as cough, weakness, and muscle aches on December 25, 2017, and was hospitalized for pneumonia on January 1, 2018, and discharged on January 22 after recovery. Prior to the onset of illness, the patient had contact with live poultry. Her close contacts did not develop any suspected symptoms during the observation period. The virus remains avian and has not shown resistance to existing antiviral drugs.

The Centers for Disease Control (CDC) reminds workers involved in poultry and livestock farming to implement self-protection measures during operations and to conduct thorough disinfection after work to reduce the risk of infection with the novel influenza A. If symptoms of acute respiratory infection or conjunctivitis appear, seek medical attention immediately and proactively inform healthcare professionals of your occupational history of contact with animals to facilitate early diagnosis. The public is advised to implement the "5 Dos and 6 Don'ts" epidemic prevention principles in daily life:

"5 Dos": Cook meat and eggs thoroughly with soap; wash hands thoroughly with soap; if symptoms appear, wear a mask, seek medical attention immediately, and inform the doctor of your occupation and contact history; those who have long-term contact with poultry and livestock should get vaccinated against influenza; maintain a balanced diet and exercise appropriately.

"6 Don'ts": Don't eat raw poultry, eggs, or poultry products; don't smuggle or buy meat of unknown origin; don't touch or feed poultry and livestock; don't release or discard poultry and livestock indiscriminately; don't mix poultry and livestock with other poultry and livestock; and don't go to places with poor air circulation or crowded places.

For related information, please visit the Taiwan Centers for Disease Control website (https://www.cdc.gov.tw/) or call the toll-free epidemic prevention hotline 1922 (or 0800-001922).

Source: 

Link: https://www.cdc.gov.tw/Bulletin/Detail/bZE85LXA9ZGdCvEJKZe6Cg?typeid=9

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#Mpox - cMulti-country external #situation #report no. 64, published 26 March 2026 (#WHO, summary)

 

{Excerpt}

Highlights

• Transmission of mpox continues mostly within sexual networks, affecting both women and men, followed by household transmission, and in some historically endemic areas, affecting all age groups. 

- All clades of monkeypox virus (MPXV) continue to circulate. 

- Unless mpox outbreaks are rapidly contained and human-to-human transmission is interrupted, there is a risk of sustained community transmission in all settings. 

• In February 2026, 46 countries across all WHO regions reported a total of 1184 confirmed mpox cases, including four deaths (case fatality ratio [CFR] 0.3%). 

- Of these cases, 58.6% were reported in the WHO African Region. 

• Four WHO regions – the Region of the Americas and the African, South-East Asian and Western Pacific regions – reported a decline in confirmed cases in February, compared to January 2026, while the European Region reported an increase in confirmed cases. 

- The Eastern Mediterranean Region reported the same monthly case count in January and February 2026.

• Seventeen countries in Africa reported active transmission of mpox in the last six weeks (1 February – 15 March 2026), with 907 confirmed cases, including seven deaths (CFR 0.8%). 

- Countries reporting the highest number of cases in this period are Madagascar, the Democratic Republic of the Congo, Kenya, Burundi, and Liberia. 

• Three countries, Argentina, Austria, and the Central African Republic, have reported mpox due to clade Ib MPXV for the first time. 

• Outside Africa, community transmission of clade Ib MPXV continues in the WHO European Region, with Austria, Belgium, Portugal, Spain, and the United Kingdom of Great Britain and Northern Ireland reporting community transmission, including in sexual networks of men who have sex with men.  

• This report provides an update on mpox outbreak transmission dynamics across different clades and settings. 

• On 7 April 2026, World Health Day, WHO will join a One Health summit convened by the Government of France. 

- The Summit will foster international and interdisciplinary dialogue to highlight the interdependence of human, animal, plant and ecosystem health, and the need for coordinated, science-based approaches to address shared health threats, including for emergency response. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report--64---26-march-2026

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Rapid #risk #assessment, acute event of potential public health concern: #Diphtheria, #Africa Region (#WHO, March 20 '26)

{Summary)

Risk statement

-- This WHO Rapid Risk Assessment (RRA, v2) aims to assess the risk of diphtheria at the regional level, considering the public health impact, the risk of geographical spread and the risk of insufficient control capacities with available resources. 

-- Diphtheria is a major public health problem in the WHO African Region (AFR) despite significant efforts on immunization in the past decades (e.g. introduction of DTP vaccine in the Expanded Program on Immunisation in 1974). 

-- Between 2000 and 2024, 75 789 diphtheria suspected cases were reported across the Region with an average 3 500 cases per year.    

-- Between the beginning of 2025 and as of 1 March 2026, over 29 000 suspected diphtheria cases with 1 420 deaths (CFR 4.9%) have been reported across these eight countries: Algeria, Chad, Guinea, Mali, Mauritania, Niger, Nigeria and South. 

-- This represents a 67% increase in the number of suspected cases (11 749 additional cases) and a 59.4% increase in the number of deaths (529 additional deaths) reported since the last WHO RRA (v1) conducted in October 2025, Nigeria continues to account for the majority of suspected cases (62.6%) and deaths (66%) in the Region. 

-- Of the 18 130 total confirmed cases (clinically compatible, laboratory-confirmed and epidemiologically linked) across the eight affected countries, 752 (4%) cases were recorded as laboratory-confirmed: Algeria (8), Chad (1), Guinea (48), Mali (66), Mauritania (12), Niger (313), Nigeria (211) and South Africa (93).     

-- Case data trends from 2026 have been difficult to interpret, with extremely delayed case reporting from countries (both to the national and regional levels), and instances of under-reporting also being notified, particularly from humanitarian settings. 

-- However, a lower number of cases are being consistently reported than earlier in the outbreak and thus it appears that new cases continue to decline or plateau, as seen in half of the affected countries (Chad, Mali, Mauritania, and Nigeria).    

-- Since the first WHO RRA (v1) conducted in October 2025, the regional CFR remains around 5%. 

-- While Guinea continues to report among the highest CFRs in the region at 19%, South Africa’s CFR has increased since the last WHO RRA (v1) to 19%.  

-- Children aged 5–14 yrs (57%) and females (63%) are the most affected; where information is available on the vaccination status of cases, most cases are unvaccinated, under-vaccinated, or with unknown vaccination status.   

-- While the overall risk was previously assessed as “HIGH” at the regional level in October 2025, it is now considered “MODERATE” due to:  

• Overall declining trend in number of weekly cases regionally, with country-specific trends also declining in half of the affected countries (Chad, Mali, Mauritania and Nigeria), and only sporadic cases reported from South Africa. 

• Strengthened coordination of public health response through the activation of an Incident Management System (IMS) in most of the affected countries. A joint Regional Office for Africa (AFRO) and WHO headquarters (HQ) IMS structure was activated to support the regional coordination of the response, with high-level ministerial commitment to controlling the outbreaks in the affected countries.  

• Implementation of immunization activities as part of the outbreak response in most of the affected countries. 

• Strengthening of surveillance, case management, community sensitization, through capacity building activities, and the provision of diphtheria antitoxin (DAT), antibiotics, laboratory supplies, etc.  

-- Nonetheless, some challenges continue to prevent the effective containment of these outbreaks:  

• The complex humanitarian situation in many of the affected countries continues to contribute to poor access to immunization and healthcare services for internally displaced persons (IDPs), nomads, miners, and migrants. Unsanitary living conditions (in displacement camps) are also favouring the transmission of diphtheria. These increase the exposure risk of vulnerable groups (particularly women and children) to diseases.   

• Limited laboratory confirmation due to lack of reagents, sample transportation challenges and limited available of laboratory capacity.  

• In most of the affected countries, the annual coverage for routine diphtheria vaccination remains below the national targets thereby contributing to the resurgence of cases and outbreaks.  

• Global scarcity of DAT for the treatment of affected persons. 

• High internal and cross-border movements of susceptible individuals (unvaccinated or not fully vaccinated). 

• Persistent funding challenges across most affected countries exacerbated by the current challenging international funding landscape.  

-- The overall risk at the global level remains ‘’LOW’’ due to: 

- The global risk of diphtheria outbreaks from the ongoing multi-country diphtheria outbreak in the African region is assessed as low, given the existence of routine immunization programs in most countries. 

- Nonetheless, the risk posed by international travel of susceptible populations from the WHO African Region cannot be overlooked, highlighting the need to strengthen risk communication, demand generation and reactive immunisation, as well as the need for enhanced data sharing and surveillance globally. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment---diphtheria--african-region-v.2

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Rapid #Risk #Assessment, Acute Event of Potential Public Health Concern: #Nipah Virus #Infection - Global (#WHO, Mar. 6 '26, summary)

 

{Summary}

Risk Statement  

-- This Rapid Risk Assessment (RRA) evaluates the global public health risk posed by Nipah virus (NiV), considering the distinct epidemiological profiles of 

- i) enzootic countries, where recurrent zoonotic spillover and limited human‑to‑human transmission continue to occur, and 

- ii) non‑enzootic regions, where the risk remains primarily associated with infected travellers or importation of infected livestock. 

-- The assessment considers the ecological and seasonal drivers of spillover, the constrained efficiency of human‑to‑human transmission, and the capacity of health and community systems to detect, confirm, and rapidly contain outbreaks. 

-- Given that NiV has not demonstrated sustained transmission beyond outbreak settings and no human cases have ever been reported outside Asia, the global risk is largely determined by localized outbreaks in endemic areas and the very low likelihood of onward transmission following importation. 

-- NiV activity remains geographically limited, with human cases occurring primarily in the South-East Asia Region with limited outbreaks in the Western Pacific Region. 

-- The epidemiological profile of NiV is characterized by low frequency, localized outbreaks, occurring predominantly in Bangladesh and India, with additional historical events reported in Malaysia, Singapore, and the Philippines. 

-- Bangladesh has reported sporadic cases almost annually since 2001, largely associated with consumption of raw date palm sap, following a well‑defined seasonal pattern between December and April. 

-- India reported its first outbreak in 2001 and has documented near-annual cases in Kerala since 2018 with sporadic cases reported in West Bengal. 

-- In 2025, eight laboratory‑confirmed cases were detected across Bangladesh (four) and India (four). 

-- As of March 2026, three sporadic cases have been reported in the two countries, two in India and one in Bangladesh. 

-- Malaysia (1998–1999), Singapore (1999), and the Philippines (2014) experienced outbreaks previously but have not reported any additional NiV events recently. 

-- Although NiV has a high case‑fatality ratio (40–75%), transmission remains limited in scale, typically arising from isolated spillover events linked to fruit bats, contaminated fruits or fruit products, or occasionally infected livestock. 

-- Human‑to‑human transmission has been documented, particularly in Bangladesh and India. However, sustained community transmission or multi‑country spread has never been observed. 

KEY RISK FACTORS 

{1.} Risk to Enzootic Countries  

• Sporadic zoonotic spillover events occur due to contact with infected bats or consumption of contaminated fruits or fruit products.  

• Serological evidence of NiV circulation beyond affected areas in Bangladesh and India (Kerala and West Bengal), suggest that spillover could potentially occur in other areas where infected bats are present. 

• Human‑to‑human transmission, although documented, is limited to close contacts and has not resulted in widespread community transmission. 

• The case‑fatality ratio is high; however, the total number of reported cases remains low. 

• Health care settings may amplify transmission when infection prevention and control (IPC) measures are insufficient.  

• Spillover from other susceptible animal hosts (pigs, horses) cannot be ruled out, nor the risk of importation through infected livestock, though probably very low.  

{2.} Risk to Non‑Enzootic Regions (reservoirs may be present; no human cases to date) 

• Risk is primarily associated with an infected traveller. 

• No human NiV transmission has ever been reported outside affected Asian countries. 

• In settings without established animal reservoirs or intermediate hosts, onward transmission following importation is unlikely and would require close, prolonged contact. 

• Historical spread via movement of infected animals (e.g., pigs exported from Malaysia to Singapore in 1999) demonstrates that animal trade–related spillover is possible, however current evidence suggests that the risk under present animal‑health and trade practices is likely very low.  

{3.} Risk to Countries Without Known Bat Reservoirs (reservoirs absent; no human cases) 

• Importation via travellers (and, exceptionally, livestock) may occur and while secondary transmission is possible it is unlikely, given the absence of established animal reservoirs and the need for close contact for human‑to‑human spread. 

{4.} Risk to Travellers 

• Travellers to affected areas face a very low but non‑zero risk, particularly if they have direct exposure to fruit bats, consume contaminated food products, or come into contact with other infected animals, including pigs or horses. 

• Returning infected travellers pose a limited risk of onward transmission due to low NiV transmissibility. 

{5.} Risk Determinants 

• Ecological presence of Pteropodidae bats in enzootic countries.  

• Presence of potential intermediary hosts that could transmit to humans (e.g., pigs, horses).  

• Cultural and dietary practices (e.g., consumption of raw date palm sap). 

• Exposure in health care settings with inadequate IPC measures. 

• Limited awareness among communities and health workers. 

• Close, unprotected contact with sick/deceased individuals, including local practice traditions. 

{6.} Response Capacity 

• Countries with recurring outbreaks have strengthened their surveillance systems, diagnostics, and clinical management capacity. 

• No licensed vaccines or specific antiviral treatments are currently available; however, several vaccine and therapeutics candidates are in development, supported by CEPI and WHO‑aligned research priorities.  

• Rapid case isolation and contact tracing remain effective measures in preventing wider spread. 

{7.} Confidence in Available Information 

-- Overall confidence is moderate, due to: 

• Under‑detection of sporadic spillover events in rural areas. 

• Ongoing uncertainty about the full geographic distribution of bat reservoirs and potential intermediate hosts.  

-- Based on current evidence, characterized by rare outbreaks, limited human‑to‑human transmission, no sustained global spread, and improving response capacity, the overall global public health risk posed by NiV is assessed as Low with a Moderate level of confidence in the available information.  

-- This rapid risk assessment will be updated as new epidemiological, clinical, or virological information becomes available. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment---nipah-virus---global---version-1

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Fatal #human #H3N8 #influenza virus has a moderate #pandemic #risk

 

Abstract

In China, low pathogenic avian influenza (LPAI) H3N8 virus is widespread among chickens and has recently caused three zoonotic infections, with the last one in 2023 being fatal. Here we evaluated the relative pandemic risk of this 2023 zoonotic H3N8 influenza virus, utilizing our previously published decision tree. Serological analysis indicated that a large proportion of the human population does not have any cross-neutralizing antibodies against this H3N8 strain. LPAI H3N8 displayed a dual affinity for α2–3 and α2–6 sialic acids and replicated efficiently in human bronchial epithelial cells. Furthermore, we observed H3N8 transmission via direct contact but not aerosols to ferrets with pre-existing H3N2 immunity. Although pre-existing H3N2 immunity resulted in a shortened disease course in ferrets, it did not reduce disease severity or replication in the respiratory tract. This study suggests that this zoonotic H3N8 strain has moderate pandemic potential and emphasizes the continued need for avian influenza surveillance.

Author summary

Low pathogenic avian influenza (LPAI) viruses circulate widely amongst birds and are a major public health concern for their ability to cross over to other species, including humans. Here we characterize the pandemic potential of an H3N8 LPAI virus that caused a lethal human infection. While this strain was only able to transmit by direct contact, we found that it did exhibit some human adaptations, and pre-existing immunity did not reduce replication or pathogenesis, suggesting that it is a moderate pandemic risk and needs to be monitored given the potential public health threat.

Source: 

Link: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1013586

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#Mpox Multi-country external #situation #report no. 63, published 24 February 2026 (#WHO, summary)

 

Highlights   

• Transmission of mpox continues in sexual networks, affecting both women and men, and in some historically endemic areas. 

- All clades of monkeypox virus (MPXV) continue to circulate. 

- Unless mpox outbreaks are rapidly contained and human-to-human transmission is interrupted, there is a risk of sustained community transmission. 

• In January 2026, 50 countries across all WHO regions reported a total of 1334 new confirmed mpox cases, including three deaths (case fatality ratio [CFR] 0.2%). 

- Of these cases, 66% were reported in the African Region. 

• Four regions observed a decline in confirmed cases in January, compared to December 2025, while the European Region reported an increase in confirmed cases.

• Twenty countries in Africa reported active transmission of mpox in the last six weeks (5 January – 15 February 2026), with 1142 confirmed cases, including four deaths (CFR 0.4%). 

- Countries reporting the highest number of cases in this period are the Democratic Republic of the Congo, Guinea, Madagascar, Liberia and Ghana. 

• One country, Comoros, and one territory, La Réunion (Overseas Department of France), have reported mpox due to clade Ib MPXV for the first time.   

• Outside Africa, reports of community transmission of clade Ib MPXV continue in France, Portugal and Spain, including in sexual networks of men who have sex with men.  

• WHO conducted a global mpox rapid risk assessment in February 2026; the overall global public health risk associated with the mpox multi-country outbreak was assessed as moderate. 

• India has reported a case of mpox with the clade Ib /IIb recombinant MPXV. 

- The strain sequenced is closely related to the first clade Ib / IIb recombinant strain reported by the United Kingdom of Great Britain and Northern Ireland in December 2025. 

- As both cases are travel-related, these case reports suggest wider transmission of the recombinant strain, implicating four countries in three WHO regions. 

(...)

Source: 

Link: https://www.who.int/publications/m/item/multi-country-outbreak-of-mpox--external-situation-report--63---24-february-2026

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#MPOX, Multi-Country: Rapid #risk #assessment, 7 February 2026, v6 (#WHO, Feb. 18 '26)

 

{Excerpt}

Overall Global Risk Statement  

-- This global rapid risk assessment (RRA) aims to assess the current public health risk associated with the 2024 upsurge of mpox in in Africa, in the context of the continuing global reporting of mpox cases in other regions since 2022, with a focus on updates since the previous RRA in September 2025.    

Global overview 

-- As of 28 January 2026, the monkeypox virus (MPXV) continues to spread globally, causing both localized and extended mpox outbreaks driven by various MPXV clades (Ia, Ib, IIa, and IIb) in diverse settings. 

-- Furthermore, recombination of MPXV clades has been documented, with two cases of a recombinant clade Ib/IIb MPXV strain reported in recent months.  

-- Globally, from 1 January 2022 to 31 December 2025 (latest global data available), 143 countries and territories across all WHO regions have reported 177 848 confirmed cases, including 477 deaths (case fatality ratio [CFR] – 0.3%). 

-- This marks an increase of five additional reporting countries (Kuwait, Mali, Madagascar, Namibia and Senegal), along with an additional 19 423 confirmed cases and 78 deaths since the last RRA in September 2025. 

-- Since the last RRA, an average of 616 new confirmed mpox cases per week have been reported across all affected countries.

-- In addition, in January 2026, the Comoros and the French departments of Mayotte and la Réunion have reported cases linked to travel to Madagascar.  

-- Previous versions of this RRA have categorized risk based on MPXV clade. However, in absence of substantial data suggesting differences in the mode of transmission between different MPXV clades, and with relatively limited data suggesting higher case fatality for clade Ia MPXV compared to other clades, this version of the RRA assesses the risk for three population groups:

- global risk for individuals with multiple sexual partners, 

- local risk for children in mpox historically endemic areas, and 

- global risk for all other individuals.   

Individuals with multiple sexual partners – global risk  

-- Since the start of the global mpox outbreak in 2022, sexual activity in linked sexual networks has been the primary driver of sustained transmission and geographic spread, particularly in newly affected areas. 

-- In Europe and the Americas, up to 96% of cases were among men who have sex with men driven by spread among individuals with multiple sexual partners in a short space of time and frequent partner change. 

-- While sexual behavior data for cases in newly affected African countries remain limited, the contribution of sexual transmission to the introduction, spread and establishment of mpox in communities has been recognized across all affected settings, as in the most recent outbreak in Madagascar. 

-- In several countries, transmission has involved sex workers and their clients, and sexual networks with frequent and multiple partner change.  

-- Sexual contact infection likely occurs during pre-symptomatic or less apparent stages of infection, the duration of which can vary between individuals. 

-- People with few or mild genital lesions might not even recognise the infection. 

-- Although the secondary attack rate for sexual contact is high (estimated at 16-73%), for the epidemic to spread it requires networks characterised by frequent partner change and high rates of partner turnover over short timeframe (days to few weeks). 

-- This pattern was observed during the initial spread of clade IIb among communities of men who have sex with men, as well as in more recent MPXV clade Ib oubtreaks driven – in part – by key populations such as female sex workers and their clients. 

-- We therefore consider within this group of multiple sexual partners, individuals with frequent partner change, and those who may engage in at-risk sexual behaviour, such as people who buy sex.  

(...)

Source: 

Link: https://www.who.int/publications/m/item/who-rapid-risk-assessment---mpox--global-v.6

____

#Mpox: #recombinant virus with genomic elements of clades Ib and IIb - Global (#WHO, Feb. 16 '26)

 

Situation at a glance

Recombination of monkeypox virus (MPXV) strains has been documented in recent months, with two cases of a recombinant strain comprising clade Ib and IIb MPXV reported. 

Recombination is a known natural process that can occur when two related viruses infecting the same individual exchange genetic material, producing a new virus. 

The first case was detected in the United Kingdom of Great Britain and Northern Ireland (hereafter “United Kingdom”), with travel history to a country in South-East Asia, and the second in India, with travel history to a country in the Arabian Peninsula. 

Detailed analysis of the virus genomes shows that the two individuals fell ill several weeks apart with the same recombinant strain, suggesting that there may be further cases than are currently reported. 

Both cases had similar clinical presentation to that observed for other clades. 

Neither patient experienced severe outcomes. 

Contact tracing for both cases in the reporting countries has been completed; no secondary cases were detected. 

Based on available information, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.

Description of the situation

In December 2025, the United Kingdom detected the first reported case of a clade Ib/IIb MPXV recombinant strain.​​ After classification of this case and posting in a public database as a novel MPXV recombinant strain, a case of mpox detected in India in September 2025 was retrospectively reclassified as a closely-related recombinant strain based on sequencing data. To date, these are the only known cases of this recombinant virus.  

Case detected in the United Kingdom of Great Britain and Northern Ireland 

The case was identified following testing of a vesicular swab from a traveler who had returned from a country in the Asia Pacific region in October 2025. 

During laboratory confirmation, the virus was initially typed as clade Ib MPXV by qPCR. 

Subsequent whole genome sequencing revealed that the MPXV strain identified was distinct from other known clade Ib MPXV strains with phylogenetic analysis indicating that the genome had regions similar to both clade Ib and clade IIb MPXV reference sequences, suggesting that it is an inter-clade recombinant. 

To confirm this unusual finding, sequencing was repeated on the original extract from the primary sample, a fresh extract from the same primary sample, a second swab collected from the patient at the same time, and a cultured isolate derived from the initial swab. 

This repeat sequencing yielded identical viral genome sequences from the two clinical swabs and the cultured isolate, supporting the initial findings of a new recombinant strain, and showing that it can replicate and presents potential for onward transmission. 

This strain is a recombinant MPXV, containing genetic elements from both clade Ib and clade IIb MPXV. 

A small number of contacts were identified and followed up in the United Kingdom; none developed any clinical features of mpox. 

Health worker contacts had worn full personal protective equipment (PPE) during provision of medical care to the patient. 

The authorities of the United Kingdom continue to investigate the significance of this recombinant MPXV strain through phenotypic characterization studies. 

Case detected in India

On 13 January 2026, the National IHR Focal Point (NFP) of India notified WHO of a mpox case with an inter‑clade recombinant MPXV which was, upon whole-genome sequencing, found to have genomic elements of clades Ib and IIb MPXV.

The recombinant virus was found in samples from a man with mpox who had presented for care in September 2025. The patient had reported recent travel from a country in the Arabian Peninsula, where he resides as an overseas worker.

He developed symptoms on 1 September 2025, while still abroad. After his return to India, real‑time PCR confirmed MPXV infection on 11 September 2025. 

Clade differentiation PCR performed on 15 September 2025 initially identified this virus as clade II MPXV. Initial genomic sequencing analysis suggested features consistent with clade IIb MPXV. However, following the update of the global Nextclade database on 16 December 2025, which included the recombinant clade Ib/IIb MPXV strain reported by the United Kingdom, the virus from the patient in India was reclassified as belonging to the recombinant strain. 

Recombination analysis demonstrated mosaic patterns containing genomic regions derived from both parent clades.

Following the initial diagnosis, the patient was hospitalized, did not experience any medical complications, and fully recovered, testing negative for MPXV on 29 September 2025. The case reported no close contacts in India, and no known secondary cases were identified following this introduction of the recombinant clade Ib/IIb MPXV in India.

Full or near‑full genome retrieval (>99%) from both the sample and a sample-derived virus isolate enabled phylogenetic analysis showing >99.9% similarity to the recombinant strain detected in the United Kingdom. 

A total of 34 recombinant tracts were observed in the sequence reported by India, while 28 recombinant tracts were observed in the sequence reported by the United Kingdom; 16 recombinant tracts were common to both strains.  

This case in India therefore represents the earliest known detection of this recombinant strain globally, having preceded the event reported in the United Kingdom.

Consistent with the case reported in the United Kingdom, clinical presentation was consistent with cases due to clade I or clade II MPXV (non-recombinant MPXV) infection.

Epidemiology

Mpox is an infectious disease caused by the MPXV, which is part of the genus Orthopoxvirus, that includes the variola virus, the causative agent for smallpox. 

There are two known clades of MPXV: clade I (previously called the Congo Basin clade), which includes subclades Ia and Ib; and clade II (previously called the West Africa clade), which includes subclades IIa and clade IIb. 

Subclades Ia and Ib were defined after the emergence of subclade Ib in the South Kivu province of the Democratic Republic of the Congo in 2023, and subclade Ia encompasses all other strains of clade I that are not Ib.

As reported here, there have also been two cases of the clade Ib/IIb recombinant strain, detected in the UK and in India.

Mpox spreads among humans through direct close physical contact with an infected person, including sexual contact. 

Transmission can also occur through indirect contact (with contaminated materials), through infectious respiratory particles in limited cases, and from mother to child (vertical transmission).

Historically mpox was primarily characterized by zoonotic transmission, with outbreaks occurring in tropical rainforest regions of East, Central and West Africa, and occasional exportation of cases to other areas. 

In the context of zoonotic transmission, which continues to occur in historically endemic areas, MPXV is transmitted to humans through direct contact with infected wild animals (e.g., through hunting, trapping, or petting), and possibly through processing and consuming infected wild game or their body parts and fluids. 

To date, animal-to-human transmission has always been documented in or linked to known endemic regions of Africa. 

All other outbreaks in Africa or in other parts of the world are to date presumed to be due to human-to-human transmission, until proven otherwise. 

Symptoms of mpox in humans include: 

- swollen lymph nodes, 

- fever, and 

- a skin rash and/or mucosal lesions that may initially resemble those of other illnesses such as chickenpox (caused by the varicella virus), or sexually transmitted infections such as herpes or syphilis if the rash or lesions appear in the genital or anal region. 

The ongoing  global outbreak has shown that mpox can also present with few lesions, and asymptomatic infection can occur.​ The contribution of pre- and asymptomatic infection to transmission remains poorly understood. 

Public health response

WHO Response:

WHO maintains global mpox surveillance and continues to provide response guidance and support for all countries, including access to diagnostics and vaccines through multi-partner coordination including through the Access and Allocation Mechanism for mpox. WHO and partners are establishing the longer-term International Coordinating Group for mpox vaccine provision (ICG) to further accelerate timely outbreak response and ensure sustainable support for the future. Furthermore, WHO continues to evaluate available rapid diagnostic tests for field use.

Response measures in the United Kingdom:

The United Kingdom Health Security Agency (UKHSA) continues to work closely with the National Health Service England, public health agencies in Scotland, Wales and Northern Ireland, and is monitoring the situation in the United Kingdom and undertaking public health actions in accordance with the Mpox control: UK strategy 2025 to 2026 .

Public health information was made available to health care providers and the public. Contact tracing was completed in line with national guidance. Contacts were given appropriate health advice, offered vaccination, and monitored for symptoms.

All suspected mpox cases in the UK are tested using Orthopoxvirus-generic, MPXV-generic, and MPXV-specific PCR as primary testing, with clade differentiation assays performed on any positive samples. All samples identified as clade Ib, and selected samples identified as clade IIb cases undergo whole genome sequencing through Illumina-based workflows.

Response measures in India:

Public health measures, including contact tracing and monitoring, were implemented to prevent onward transmission. No secondary case was detected.

All suspected mpox cases in India are tested using Orthopoxvirus‑generic and MPXV‑specific PCR with clade differentiation assays. Positive cases undergo whole genome sequencing through Illumina‑based workflows.

WHO risk assessment

Mpox outbreaks must be considered in their local context, with meaningful involvement of affected communities, to ensure an in-depth understanding of the epidemiology, modes of transmission, risk factors for severe disease, viral reservoir and evolution, and relevance of strategic approaches and countermeasures for prevention and control.   

Multiple strains of MPXV are circulating through interconnected sexual networks across many countries and settings. Co-infection with different strains, that could lead to emergence of recombinant virus strains, while rare, can be expected. The case in India was infected with the same recombinant Ib/IIb MPXV strain detected in the United Kingdom. 

Symptom onset in the case reported in India occurred more than two months earlier than the case in the United Kingdom, and the great degree of similarity between their sequences suggests a common evolutionary history. This information has two important implications: i) the origin of the recombinant strain remains unknown; and ii) transmission of this recombinant virus already involves at least four countries in three WHO regions, and is therefore likely to be more widespread than currently documented.

For the cases in the United Kingdom and India, the initial clade differentiation PCR results indicated clade Ib and IIb MPXV, respectively. Thus, clade differentiation PCR assays alone may not reliably identify recombinant MPXV strains, and genomic sequencing is likely to be required for their detection.   

Due to the small number of cases found to date, conclusions about transmissibility or clinical characterization of mpox due to recombinant strains would be premature, and it remains essential to maintain vigilance regarding this development.

In light of the limited information available on this recombinant MPXV strain, the overall WHO public health risk assessment for mpox remains unchanged: the risk is assessed as moderate for men who have sex with men with new and/or multiple partners and for sex workers or others with multiple casual sexual partners, and low for the general population without specific risk factors.

All countries should remain alert to the possibility of MPXV genetic recombination. The public health risk posed by any newly detected recombinant strain should be assessed on a case-by-case basis, considering available epidemiological, clinical and genomic information.

WHO advice

Based on the information available, WHO recommends maintaining epidemiological surveillance, laboratory and genomic sequencing capacity for mpox, case management, infection prevention and control (IPC) measures, vaccination for people at risk, locally relevant risk communication and community engagement, and public health guidance for mpox.   

All recommendations are made in the context of ongoing transmission of clades Ib and IIb MPXV in key populations at risk in all WHO regions, including undetected or pre- and asymptomatic infections, as well as unreported cases. They additionally apply to settings where clades Ia and IIa MPXV continue to spread through a mix of zoonotic and human-to-human contact. There is likely to be wider circulation of this emerging recombinant strain of MPXV since at least September 2025 than reflected by the two cases documented and linked to four countries in three WHO regions. 

WHO advises Member States to:  

- maintain mpox surveillance and rapid reporting, including prompt IHR notification of any unusual events and imported cases in line with the WHO Standing Recommendations issued under the IHR (2005) and extended to August 2026; 

- continue to carry out genomic sequencing of all laboratory specimens from confirmed cases in early outbreak settings, and a representative sample of at least 10% of laboratory specimens from confirmed cases in settings experiencing community transmission, as per WHO guidance;  

- carry out targeted sample characterization for specific situations of interest, especially for cases who report recent travel to locations with clade I MPXV circulation or to locations which provide opportunities for sex tourism, prioritizing sequencing for cases in key populations at risk and for imported, unusual, or severe cases, and sharing sequences rapidly in public databases;  

- ensure quality case management and robust IPC practices and strengthen vaccination strategies, including ensuring access to mpox vaccines for key populations at risk;  

- continue to advance integration of HIV/STI and mpox health services to ensure early HIV testing and care for any person with suspected or confirmed mpox and rapid initiation or resumption of antiretroviral therapy in people living with HIV as needed for any person with mpox; 

- strive to eliminate human-to-human transmission of mpox where MPXV circulation remains low and ensure the maintenance of capacity for prompt outbreak response;  

- continue to provide information to travelers who may be at risk.

WHO recommends that no restrictions be applied for travel to, or trade with, the countries named in this report, based on the information available on the event reported here.  

Further information

1) World Health Organization. Mpox: fact sheet. 26 August 2024. Available from: http://www.who.int/news-room/fact-sheets/detail/monkeypox 

2) World Health Organization. Global mpox trends. Available from: https://worldhealthorg.shinyapps.io/mpx_global/ 

3) World Health Organization. Multi-country outbreak of mpox: external situation report no. 62. 23 January 2026. Available from: Multi-country outbreak of mpox, External situation report #62

4) World Health Organization. Fifth meeting of the International Health Regulations (2005) Emergency Committee regarding the upsurge of mpox 2024. 30 October 2025. Available from: https://www.who.int/news/item/30-10-2025-fifth-meeting-of-the-international-health-regulations-(2005)-emergency-committee-regarding-the-upsurge-of-mpox-2024

5) World Health Organization. Standing recommendations for mpox issued by the Director-General of the World Health Organization in accordance with the International Health Regulations (2005). 21 August 2023. Available from: https://www.who.int/publications/m/item/standing-recommendations-for-mpox-issued-by-the-director-general-of-the-world-health-organization-(who)-in-accordance-with-the-international-health-regulations-(2005)-(ihr) 

6) World Health Organization. Extension of standing recommendations for mpox to August 2026, by the Director-General of WHO. 21 August 2025. Available from: https://www.who.int/publications/m/item/extension-of-standing-recommendations-for-mpox-by-the-director-general-of-who 

7) World Health Organization. Clinical management and infection prevention and control for mpox: living guideline. May 2025. Available from: https://www.who.int/publications/i/item/B09434 

8) World Health Organization. WHO recommends rapid treatment initiation for people living with HIV and mpox. 16 July 2025. Available from: https://www.who.int/news/item/16-07-2025-who-recommends-rapid-treatment-initiation-for-people-living-with-hiv-and-mpox 

9) World Health Organization. WHO mpox multi-country rapid risk assessment, version 5. 13 October 2025. Available from: https://www.who.int/publications/m/item/who-rapid-risk-assessment---mpox--global-v.5 

10) World Health Organization. Strategic framework for enhancing prevention and control of mpox (2024–2027). 24 May 2024. Available from: https://www.who.int/publications/i/item/9789240092907 

11) World Health Organization. Guidance on use of Smallpox and mpox vaccines, including WHO Position paper on mpox vaccines and other resources to support countries. 23 August 2024 https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/smallpox-and-mpox  

12) World Health Organization. Frequently Asked Questions (FAQ) on use of fractional dosing with intradermal administration of mpox MVA-BN vaccine in the context of vaccine supply-constrained outbreak response. 19 June 2025. https://www.who.int/publications/m/item/frequently-asked-questions-(faq)-on-use-of-fractional-dosing-with-intradermal-administration-of-mpox-mva-bn-vaccine-in-the-context-of-vaccine-supply-constrained-outbreak-response  

13) World Health Organization. LC16m8 (live-attenuated freeze-dried vaccinia) smallpox and mpox vaccine. Interim guidance. 22 April 2025. Available from:  https://iris.who.int/server/api/core/bitstreams/9b10eb01-fbfd-4f9f-81b7-9c29ddbcc560/content

14) World Health Organization. Prequalification of Smallpox and Mpox vaccine (Live Modified Vaccinia Virus Ankara), 2024 September 13. Available from:  https://extranet.who.int/prequal/vaccines/p/imvanexr

15) World Health Organization. Emergency use listing of LC16m8. 2024 November 19. Available from: https://extranet.who.int/prequal/vaccines/lc16-kmb

16) UK Health Security Agency, Institute of Ecology and Evolution, University of Edinburgh; Inter-clade recombinant mpox virus detected in England in a traveller recently returned from Asia. 7 December 2025: https://virological.org/t/inter-clade-recombinant-mpox-virus-detected-in-england-in-a-traveller-recently-returned-from-asia/1015  

17) UK Health Security Agency, Mpox outbreak: epidemiological overview. 11 December 2025: https://www.gov.uk/government/publications/monkeypox-outbreak-epidemiological-overview/mpox-outbreak-epidemiological-overview-11-december-2025   

Source: 

Link: https://www.who.int/emergencies/disease-outbreak-news/item/2026-DON595

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New contagious #skin #disease detected in #horses in #Sweden (State Veterinary Medical Institute, Feb. 11 '26)

 

A horse in Jönköping County and one in Norrbotten County, both of which had blisters and sores on the skin on their legs, were found to be infected with a smallpox virus called equine parapoxvirus or horse parapoxvirus. It is an infection that has not previously been detected in the country.

The equine parapoxvirus was detected in our neighboring country Finland for the first time in 2021. The State Veterinary Institute, SVA, has performed DNA analysis of the virus in the Swedish cases and it turned out to be the same type as in Finland. The virus has caused outbreaks in several Finnish stables with severe skin inflammation on the horses' legs, so-called mug or rasp.

The typical symptom of parapoxvirus is small blisters (pox) that burst into round sores. The virus is transmitted by direct contact but also via equipment, clothing, hands and objects. Sick horses should be kept isolated from other horses. Use disposable gloves and special clothing when handling.   

– This is a new infection that has probably not yet gained a real foothold in Sweden. We have gone back and analyzed previously submitted skin samples from around 80 horses with skin problems in recent years. However, none of these carried parapoxvirus, says Gittan Gröndahl, state veterinarian at SVA.

Humans can also be infected with the horse parapoxvirus and get blisters/pox and sores on the skin. In Finland, a few horse grooms have had problems, but no human cases were reported from the two Swedish stables with sick horses. If someone gets pox or sores after visiting a sick horse, a doctor should be contacted.

– Our assessment is that the risk of further spread of infection is low at present. However, if there are signs of contagious foot and mouth disease, or if there are blisters or typical round wounds in the horse, virus samples should be taken. Keep in mind the risk of infection, and always use disposable gloves when handling wounds in horses, says Gittan Gröndahl.

Samples from suspected cases can be sent for analysis to SVA.

How is equine parapoxvirus transmitted?

· In direct contact between horses

· Indirectly via equipment, clothing, hands and objects

· People can also get blisters (pox) that burst into sores on the skin.

· There is no vaccine.

Think about hygiene

· Use disposable gloves when handling the horse's wounds, even small wounds.

· Wash your hands thoroughly before and after handling wounds.

· Do not share equipment between horses and stables and be careful with hygiene routines

· Contact a doctor if you develop smallpox or sores on skin that has been in contact with a sick horse.

Source: 

Link: https://www.sva.se/aktuellt/nyhetsarkiv/webbnyheter/ny-smittsam-hudsjukdom-paavisad-hos-haestar-i-sverige/

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Efficient #replication of #influenza D virus in the #human #airway underscores zoonotic potential

 

Abstract

Influenza D virus (IDV), primarily found in livestock species, has demonstrated cross-species transmission potential, yet its threat to humans remains poorly understood. Here, we curated a panel of IDV isolates collected during field surveillance from 2011 to 2020 from swine and cattle to assess their ability to infect human airway cells as a proxy for zoonotic threat assessment. Using lung epithelial cell lines, primary well-differentiated airway epithelial cultures, and precision-cut lung slices, we demonstrated that IDV efficiently propagates in cells and tissues from the human respiratory tract, reaching titers comparable to human influenza A virus (IAV). Infection kinetics in primary porcine airway cultures and respiratory tissues mirrored those from human, suggesting similar infectivity across species. To define host responses to IDV infection, we evaluated innate immune sensing and downstream interferon signaling in human respiratory cells. IDV infection resulted in markedly reduced activation of interferon regulatory factor (IRF) signaling and diminished induction of interferon lambda 1 and interferon-stimulated genes compared to IAV, indicating inefficient activation of innate immune sensing pathways. However, IDV replication was potently restricted in interferon-pretreated cells, demonstrating sensitivity to interferon-mediated antiviral effector mechanisms once an antiviral state was established. Together, these findings show that IDV can efficiently infect the human airway while limiting innate immune sensing, a feature that may facilitate zoonotic spillover. Our study highlights the need for enhanced surveillance of IDV at the animal-human interface and provides a foundation for further investigation into its biology and potential for causing human infection and disease.

Competing Interest Statement

The author E.M.K. is currently employed by AbbVie Inc. The author was not affiliated with AbbVie Inc at the time of experiment design, data acquisition, or analysis.

Funder Information Declared

United States Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA), 2025-39601-44639

The Enterprise for Research, Innovation, and Knowledge at The Ohio State University

Centers of Excellence for Influenza Research and Response, National Institute of Allergy and Infectious Diseases, National Institutes of Health (NIH), Department of Health and Human Services, HHSN272201400006C, 75N93021C00016

National Institutes of Health, T35 5T35OD010977

National Institutes of Health, P30 CA016058

Source: 

Link: https://www.biorxiv.org/content/10.64898/2026.02.07.704474v1

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