#Asymptomatic #Human #Infections With Avian #Influenza #H5N1 Virus Confirmed by Molecular and Serologic Testing - A Scoping Review

 

Key Points

-- Question:  Have asymptomatic infections with highly pathogenic avian influenza A(H5N1) virus been reported in humans?

-- Findings: This scoping review of published reports through August 25, 2025, identified 10 reports of 18 cases of asymptomatic infection with A(H5N1) virus, including 2 cases with molecular and serologic confirmation and 16 cases with molecular confirmation alone. Symptom ascertainment methods varied among reported cases.

-- Meaning:  Asymptomatic human avian influenza A(H5N1) virus infections have been infrequently reported, with most lacking serologic confirmation; prospective surveillance studies with serial respiratory and serum sampling and detailed symptom monitoring for persons with high-risk exposures could provide data to inform future public health responses.

Abstract

Importance  

Since 1997, more than 1000 infections with highly pathogenic avian influenza A(H5N1) virus among humans have been reported globally. Given ongoing A(H5N1) outbreaks in animals, understanding the frequency of A(H5N1) virus infections among asymptomatic persons can inform public health risk assessments and infection prevention guidance.

Objective  

To identify and characterize reported cases of asymptomatic A(H5N1) virus infection among humans with confirmation by both molecular testing of 1 or more respiratory specimens and 1 or more serum specimens meeting World Health Organization criteria (molecularly and serologically confirmed [MSC]) or molecular confirmation (MC) alone.

Evidence Review  

MEDLINE, Embase, Global Health, Cochrane, Scopus, Virtual Health Library, and Europe PubMed Central were searched for publication through August 25, 2025. Articles for full-text screening were evaluated by 2 investigators. Studies published through August 25, 2025, were included if they reported a confirmed A(H5N1) virus infection that met MSC or MC criteria and had a full-text report in English. Articles were excluded if they reported results from A(H5N1) serologic testing alone, serosurveys, or other immunologic studies.

Findings  

Of 1567 unique reports that underwent title or abstract screening, 42 were selected for full-text screening, of which 10 met inclusion criteria (3 reports about 2 MSC cases and 7 reports about 16 MC cases). The 2 MSC cases occurred among adults in Pakistan and Vietnam who were identified by investigations of household contacts of index A(H5N1) case patients; 1 case patient also had exposure to A(H5N1) virus–infected chickens as the possible infection source and 1 is thought to have been infected through human-to-human transmission. Neither MSC case patient used personal protective equipment. Of 16 reported MC cases (14 adults, 2 children), 11 were identified by enhanced surveillance of persons exposed to A(H5N1) virus–infected poultry (8 in Bangladesh, 2 in Spain, and 1 in the UK) and the remaining 5 MC cases (3 in Vietnam, 2 in Cambodia) were identified by investigations of household contacts of index A(H5N1) case patients.

Conclusions and Relevance  

Asymptomatic human infections with A(H5N1) virus have been infrequently reported, with most cases identified through enhanced surveillance or household contact investigations of persons with known exposure. Robust data collection is needed from persons with possible asymptomatic A(H5N1) virus infection to inform future public health responses.

Source: JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2840680

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Updated #Evidence for #Covid19, #RSV, and #Influenza #Vaccines for 2025–2026

 

Abstract

Background

Changes in the vaccine advisory process in the United States have disrupted immunization guidance, which reinforces the need for independent evidence review to inform decisions regarding immunization for respiratory viruses during the 2025–2026 season.

Methods

We conducted a systematic review of U.S.-licensed immunizations against coronavirus disease 2019 (Covid-19), respiratory syncytial virus (RSV), and influenza. We searched databases on PubMed/MEDLINE, Embase, and Web of Science for updates of the most recent review by the Advisory Committee on Immunization Practices (ACIP) Evidence-to-Recommendations for each disease, which was performed during the 2023–2024 period. Outcomes included vaccine efficacy and effectiveness against hospitalization, other clinical end points, and safety.

Results

Of 17,263 identified references, 511 studies met the inclusion criteria. Covid-19 mRNA vaccines against the XBB.1.5 subvariant had pooled vaccine effectiveness against hospitalization of 46% (95% confidence interval [CI], 34 to 55; from cohort studies) and 50% (95% CI, 43 to 57; from case–control studies) among adults and 37% (95% CI, 29 to 44) among immunocompromised adults. In a case–control study, vaccines against the KP.2 subvariant showed an effectiveness of 68% (95% CI, 42 to 82). Maternal RSV vaccination (for infant protection), nirsevimab for infants, and RSV vaccines in adults who were 60 years of age or older showed vaccine effectiveness of 68% or more against hospitalization. Influenza vaccination had a pooled vaccine effectiveness of 48% (95% CI, 39 to 55) in adults between the ages of 18 and 64 years and 67% (95% CI, 58 to 75) in children against hospitalization. Safety profiles were consistent with previous evaluations. The diagnosis of myocarditis associated with Covid-19 vaccines occurred at rates of 1.3 to 3.1 per 100,000 doses in male adolescents, with lower risk associated with longer dosing intervals. The RSVpreF vaccine was associated with 18.2 excess cases of Guillain–Barré syndrome per million doses in older adults; a significant association with preterm birth was not observed when the vaccine was administered at 32 to 36 weeks’ gestation.

Conclusions

Ongoing peer-reviewed evidence supports the safety and effectiveness of immunizations against Covid-19, RSV, and influenza during the 2025–2026 season. (Funded by the Center for Infectious Disease Research and Policy and the Alumbra Innovations Foundation.)

Source: The New England Journal of Medicine, https://www.nejm.org/doi/full/10.1056/NEJMsa2514268?query=TOC

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#Influenza A Virus detection in Bulk Tank and Pen Level #Milk from #Dairies Affected by Highly Pathogenic Avian Influenza #H5N1

 

Abstract

Highly pathogenic avian influenza virus H5N1 has been infecting dairy herds in the U.S. since its initial incursion into cows in early 2024. Although national strategies have aimed to detect affected herds, the best way to surveil herds for the H5N1 virus has not been formally studied and we also do not understand herd-level patterns of infection. To understand infection patterns of H5N1 in dairy herds over time, we conducted early surveillance of non-affected farms in California in the Fall of 2024 in an observational study. Daily bulk tank milk (BTM) samples were submitted from each herd and tested for influenza A (IAV) via rRt-PCR. In a subset of herds, IAV testing of multiple excretion types from cattle of different classes and pen-level daily milk was also completed soon after BTM detection. Daily detections of IAV occurred in BTM for a minimum of 33 days, with some herds continuing to have detection beyond a 75-day window. BTM Ct nadirs were seen between 1-3 weeks of detection. In herds that were tested, virus was detected in the milk from all pens of cattle within a very short time frame after BTM detection, or prior to the initiation of pen level sampling. A very low percentage (2.8%) of individual cow samples tested positive for IAV when collected soon after BTM detection, and although the virus was found in all excretion types, a majority of positive samples were from milk. This suggests that BTM may be the best early indicator of herd infection, and that movement of the virus to all lactating pens of cattle after herd incursion is relatively quick. These results also suggest that surveillance strategies with a long interval between BTM testing days may miss herds with short infection windows. Because most herds experienced test days where some submitted BTM samples had virus detected while others did not, and virus was detected in pen level milk samples when the BTM from the herd had become test negative, this work also highlights the necessity of studying the test sensitivity of IAV rRt-PCR detection in aggregate milk samples.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

This project was completed using Federal funds provided through the United States Department of Agriculture, Cooperative Agreement 25-9419-0731 and the National Institute of Allergy and Infectious Diseases, National Institutes of Health, Department of Health and Human Services, under Contract No. 75N93021C00016.

Source: MedRxIV, https://www.medrxiv.org/content/10.1101/2025.10.26.25338833v1

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#UK - High pathogenicity avian #influenza #H5N1 viruses (#poultry) (Inf. with) - Immediate notification

 

{England, Suffolk} Turkey fattening unit. 

Source: WOAH, https://wahis.woah.org/#/in-review/6954

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Evaluation of #therapeutic effect of #baloxavir marboxil against high pathogenicity avian #influenza virus infection in #duck model

 

Abstract

Since 2020, high pathogenicity avian influenza virus (HPAIV) infections in wild birds have been frequently reported. Because HPAIV infection has occasionally caused outbreaks in captive rare birds, application of antiviral drugs for treatment purposes against them has been considered from the perspective of conservation medicine. In this study, the therapeutic efficacy of baloxavir marboxil (BXM) was evaluated using a duck model to help establish the post-infection treatment for rare birds. Sixteen four-week-old ducks were divided into four groups and intranasally inoculated with the HPAIV strain A/crow/Hokkaido/0103B065/2022 (H5N1). BXM was orally administered once daily at doses of 12.5, 2.5, 0.5, and 0 mg/kg to each of the four groups from 2 to 6 days post-infection. Blood samples were collected at 2, 8, and 24 hours after the initial BXM administration to measure the plasma concentrations of its active form, baloxavir acid (BXA). All ducks were monitored until 14 days post-infection, and their oral and cloacal swabs were collected for virus recovery. All eight ducks administered with 12.5 or 2.5 mg/kg of BXM survived, demonstrating a significant reduction in virus recovery compared to the 0 mg/kg group. Pharmacokinetic/pharmacodynamic (PK/PD) analysis of BXA suggested that parameters such as Cmax and AUC0–24hr were correlated with the suppression of virus shedding. These findings demonstrated that BXM administration within 48 hours post-HPAIV infection in ducks effectively reduced mortality and virus shedding. The comparison of PK parameters may help estimate efficient BXM dosing strategies in rare birds.

Competing Interest Statement

This study was supported by a collaborative research project between Hokkaido University and Shionogi & Co., Ltd. M.S., R.D.O, H.O., and T.S. are employees of Shionogi & Co., Ltd. M.M. is a former employee of Shionogi & Co., Ltd. These affiliations did not influence the study design, data collection, analysis, or interpretation. The remaining authors declare no competing interests.

Funder Information Declared

Environmental Restoration and Conservation Agency, JPMEERF20254004

Japan Science and Technology Agency, JPMJSP2119

Japan Agency for Medical Research and Development, https://ror.org/004rtk039, JP223fa627005, JP24wm000125008

Source: BioRxIV, https://www.biorxiv.org/content/10.1101/2025.10.24.684283v1

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Latest #update on Clade Ib #mpox - #UKHSA reminds eligible groups to come forward for mpox #vaccination.

 

Last updated 27 October 2025

Latest update

UKHSA is aware of small numbers of locally-acquired cases of clade Ib mpox in the USA, Spain, Italy, the Netherlands and Portugal which have no connection to countries with known clade Ib mpox transmission.  

This suggests there is now community transmission of clade Ib mpox globally. Most of the new cases identified in Europe and the USA have been in gay, bisexual and other men who have sex with men, a population in which clade Ib mpox transmission has not previously been observed.  

Mpox is usually a mild infection, and clade Ia and Ib mpox are no longer classified as a high-consequence infectious disease (HCID). However, it can be severe in some cases. 

The UK has a routine mpox vaccination programme in place for eligible groups, including those who:  

-- have multiple sexual partners  

-- have group sex  

-- visit sex-on-premises venues  

Studies show that the vaccine is around 75 to 80% effective in protecting people against clade II mpox. Although there are no studies on vaccine effectiveness against clade Ib mpox, vaccine protection is expected. A high proportion of people in eligible groups in the UK have already had the vaccine.  

To check if you are eligible or to book an appointment, visit Mpox vaccine - NHS.   

Common symptoms of mpox include: 

-- a skin rash or 

-- pus-filled lesions which can last 2 to 4 weeks. 

-- It can also cause fever, headaches, muscle aches, back pain, low energy and swollen lymph nodes.  

Dr Katy Sinka, Head of Sexually Transmitted Infections at UKHSA:  

''The ways in which we are seeing mpox continue to spread globally is a reminder to come forward for the vaccine, if you are eligible.  

''Although mpox infection is mild for many, it can be severe.  

''Getting vaccinated is a proven effective way to protect yourself against severe disease, so please make sure to get the jab if you are eligible.  

''It is important to remain alert to the risks from this unpleasant illness. Anyone who thinks they may have mpox should contact NHS 111 for advice on what to do.

UKHSA has robust mechanisms in place to investigate suspected cases of mpox of all clade types, irrespective of travel history, with regular updates on confirmed UK cases of mpox.  

UKHSA has today published a technical assessment on mpox to reflect the latest epidemiology. 

Further information about symptoms is available on the NHS website.  

Dr Will Nutland, Director at The Love Tank said:  

''Mpox hasn’t been making headlines for more than a year but these cases show that mpox has not gone away. Routine availability of mpox vaccination, through NHS sexual health clinics, provides an effective way of protecting against mpox. The Love Tank continues to work alongside NHS colleagues to ensure that vaccination programmes continue to reach those who most need them, including in community settings.

Prof. Matt Phillips, President of the British Association for Sexual Health and HIV said:  

''We encourage anyone who is eligible for the vaccine against mpox to talk to their local sexual health clinic and arrange to be vaccinated.   

''These cases are a reminder both that mpox has not gone away, and of the importance of vaccine programmes in reducing the impact of mpox infection.

Richard Angell OBE, Chief Executive, Terrence Higgins Trust said: 

''The last outbreak of mpox hit the gay, bi and other men who have sex with men community disproportionately hard. While it is described as ‘mild’, those who have the mpox rash around their face and body, including in intimate and sensitive areas, will tell you how unpleasant and painful it is.  

''In 2022, we were not prepared for the MPOX outbreak and the tools available were hard to mobilise – this time we have a government-funded vaccine programme available to gay and bi men and it is strongly encouraged for those who have multiple partners, take part in sex parties or visit sex on premises venues.  

''With Winter Pride season soon upon us across Europe, those travelling to these events would be wise to get vaccinated, at least once, if not twice. Those who have had 2 mpox jabs should have protection. Anyone experiencing a rash after sex should seek out a sexual health clinic or call THT Direct on 0808 802 1221.

(...)

Source: United Kingdom Health Security Agency, https://www.gov.uk/government/news/ukhsa-detects-first-case-of-clade-ib-mpox

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#Germany - #Influenza A #H5N1 viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

A wild bird from Gruidae Spp. in Saarland Region.

Source WOAH, https://wahis.woah.org/#/in-review/6940

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An evolutionary approach to identify #mammalian adaptive #mutations in the avian #influenza #polymerase complex

 

Abstract

Avian influenza viruses (AIVs) are a global public health risk; human infection is typically associated with high mortality. While the relationship between several mammalian adaptive mutations and host factors have been described, it is unknown whether additional uncharacterised mutations lead to adaptation. Here, we combine phylogenetic analysis and complementary experimental methods to quantify the impact of novel mutations that emerge at the avian-mammal interface. We constructed phylogenetic trees of mammalian and avian influenza sequences for the polymerase (PA, PB1, PB2) and nucleoprotein (NP) segments and identified potential avian to mammal spillover events. We found >6500 mutations across the polymerase and NP, including known signatures of mammalian adaptation such as PB2 E627K and D701N which occurred independently in mammals 143 and 56 times respectively. We selected 95 mutations which were mostly undescribed and emerged independently multiple times in a range of species and subtypes. Using a minigenome assay in an avian H5N1 backbone to measure the effect of these mutations in human cells we identified PA P28S, NP I425V and G485R as novel mutations leading to polymerase adaptation. In addition, to determine the mechanism of adaptive mutations, we measured polymerase activity in cells lacking a key host factor, ANP32, and cells overexpressing host restriction factors MxA and BTN3A3. Our combined approach revealed novel mammalian adaptive mutations and demonstrated the benefit of combining phylogenetic and molecular approaches in validating novel adaptive mutations.

Competing Interest Statement

The authors have declared no competing interest.

Funder Information Declared

Royal Society, https://ror.org/03wnrjx87, 231225

Academy of Medical Sciences, https://ror.org/00c489v88, Springboard Grant 1049

Source: BioRxIV, https://www.biorxiv.org/content/10.1101/2025.10.27.684835v1

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#Sweden - High pathogenicity avian #influenza #H5N1 viruses (#poultry) (Inf. with) - Immediate notification

 

A protection zone (3km) and a surveillance zone (10 km) have been put in place around the infected farm and all other restrictions and necessary measures according to Regulation (EU) 2016/429 and (EU) 2020/687.

{Tomelilla} Fattening turkeys. The turkeys were reported showing clinical signs of increased mortality 24 October and were euthanasia was finalized 26 October. A protection zone (3 km) and a surveillance zone (10 km) have been put in place around the infected farm and all other restrictions and necessary measures according to Regulation (EU) 2016/429 and EU DR 2020/687 are applied.

Source: WOAH, https://wahis.woah.org/#/in-review/6939

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#Germany - #Influenza A #H5N1 viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

 

{Di Frank Liebig - Archiv Frank Liebig, CC BY-SA 3.0 de, https://commons.wikimedia.org/w/index.php?curid=56812600}

Wild birds belonging to the Gruidae Species in Berlin Region.

Source: WOAH, https://wahis.woah.org/#/in-review/6938

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#Israel - #Influenza A #H5N1 viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

 

{By Charles J. Sharp - Own work, from Sharp Photography, sharpphotography.co.uk, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=66151818}

A wild Great Wild Pelican in Ha Zafon Region.

Source: WOAH, https://wahis.woah.org/#/in-review/6936

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#Lithuania - #Influenza A #H5N1 viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

Wild Mute Swans in Klaipedos, Vilniaus, Panevezio Regions.

Source: WOAH, https://wahis.woah.org/#/in-review/6923

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#Germany - High pathogenicity avian #influenza #H5N1 viruses (#poultry) (Inf. with) - Immediate notification

{Baden-Württemberg] Turkeys for fattening (1200), ducks for fattening (2400), geese for fattening (1200), broilers (6500), laying hens (4000).

Source: WOAH, https://wahis.woah.org/#/in-review/6927

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#Luxembourg - #Influenza A #H5N1 viruses of high pathogenicity (Inf. with) (non-poultry including wild birds) (2017-) - Immediate notification

{By Andreas Trepte - Own work, CC BY-SA 2.5, https://commons.wikimedia.org/w/index.php?curid=39163967}

Wild Common Cranes.

Source: WOAH, https://wahis.woah.org/#/in-review/6918

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Terracotta Head of a Man, Ancient Greek Painting and Sculpture (ca. 600 BC)

 Public Domain.

Source: WikiArt, https://www.wikiart.org/en/ancient-greek-painting/terracotta-head-of-a-man--600

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History of Mass Transportation: The FS RAL60 Metric Gauge Autorail

 

Di Smiley.toerist - Opera propria, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7690411

Source: Wikipedia, https://it.wikipedia.org/wiki/Automotrice_FS_RALn_60

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History of Mass Transportation: The Henschel Steam Locomotive No. 2000

 

By Henschel & Sohn Cassel - https://orka.bibliothek.uni-kassel.de/viewer/fullscreen/02008090546707/1/, Public Domain, https://commons.wikimedia.org/w/index.php?curid=164392169

Source: Wikipedia, https://en.wikipedia.org/wiki/Henschel_%26_Son

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Joint #FAO / #WHO / #WOAH Rapid #Risk #Assessment of Rift Valley fever (#RVF) in #Senegal and #Mauritania: Implications for Public Health and Animal Health (Oct. 24 '25)

 

{Excerpt}

Risk statement

This risk assessment is based on the current epidemiological and epizootic situation of Rift Valley fever (RVF) in Senegal and Mauritania, from 20 September through 8 October 2025.

The risk assessment was conducted separately for each country. However, the findings indicate that the level of risk is the same for both countries across all levels, for both human and animal health.  

During this period, Senegal reported 119 confirmed human RVF cases, including 16 deaths, resulting in a case fatality rate (CFR) of 13.4%. Cases were recorded across eight health districts in three regions of Senegal, with the majority in Saint-Louis Region with 110 cases (92%) followed by Louga (four cases) and Matam (one case). 

The affected districts in Saint-Louis Region: Podor, Richard-Toll, Dagana, and Saint-Louis are located along the northern border with Mauritania along the Senegal River.  

The most affected age groups were 15- 35 years, accounting for 69 cases (58%), and 35-60 years with 34 cases (29%), with 77 % of cases occurring in males. 

Hemorrhagic symptoms were reported in 22 cases (18%) of which 13 resulted in death.  

Animal infections resulting in abortions and livestock mortality were also reported. 

On 23 September, 1122 blood samples and four abortion samples were collected from small ruminant herds in villages where human cases were reported. 

Of these, 36 samples tested positive across six herds. 

By 30 September, a total of 27 confirmed animal cases, two deaths have been reported to the World Organisation for Animal Health (WOAH) through the World Animal Health Information System (WAHIS). 

As of that date, five animal outbreaks have been confirmed in Saint-Louis Region, with four additional outbreaks expected to be included in a forthcoming follow-up report currently in draft.  

RVF is endemic in Senegal, with previous outbreaks affecting both humans and animals. 

The last confirmed human case before this outbreak occurred in January 2025 in Touba, located in the Diourbel region, while the last recorded human case in Saint-Louis region occurred in 2022.   

Between 27 September and 5 October 2025, Mauritania reported 17 confirmed human RVF cases, including eight deaths, resulting in a CFR of 47%. 

Cases were recorded across seven districts in five regions (wilayas), three of which have international borders: Assaba which borders Mali to the south, Brakna and Trarza both bordering Senegal along the Senegal River. 

Of 66 samples tested, the positivity rate was 25.7%.  

Multiple active outbreaks in animals have also been reported. According to the Ministry of Animal Resources of Mauritania, as of 6 October, 17 outbreaks across eight regions, with 86 out of 307 samples testing positive. 

The first animal cases, involving goats and camels, were reported in August 2025. A total of 39 clinical animal cases (including 16 deaths in two dromedaries and 14 goats) were reported in Aioun, Hodh-Gharbi region and Timbedra, Hodh-Charghi region, both are located in southeastern Mauritania near the Mali border, and in Maghta Lahjar, Brakna region, in central Mauritania.  

In Brakna region alone, 233 animal cases and 55 deaths have been reported to WOAH by 3 October 2025. 

Affected animals include sheep, goats, camels and cattle.  

RVF is endemic in Mauritania. The last major outbreak occurred in 2022, with 47 confirmed human cases, including 23 deaths (CFR 49%), mostly among animal breeders in nine of 15 regions. 

The virus also affected animals such as cattle, camels, and small ruminants, with sample positivity rates of around 24% tested during that outbreak period.  

The current outbreak in Senegal and Mauritania is unusual in both its magnitude and severity. It involves multiple districts in border regions, particularly along the Senegal River, increasing the risk of cross-border transmission between Senegal and Mauritania. 

In Mauritania, the outbreak also extends to eastern regions bordering Mali, raising concerns about potential regional spread beyond the Senegal River basin.  

A notably high proportion of severe and haemorrhagic cases has been reported. In Senegal, 18% of confirmed human cases presented with haemorrhagic symptoms, with 13 cases resulting in death.  

The situation is particularly concerning in Mauritania, where the CFR has reached 47%, reflecting both the severity of illness and potential gaps in early detection and clinical management. 

Further information is needed to better understand the factors contributing to this high fatality rate. 

Possible contributing factors include delayed access to adequate care, shortage of essential medical products and supplies and underreporting of mild cases, which may result in disproportionate detection of severe cases. However, additional factors should also be investigated.  

(...)

Source: World Health Organization, https://www.who.int/publications/m/item/joint-fao-who-woah-rapid-risk-assessment-of-rift-valley-fever-(rvf)-in-senegal-and-mauritania--implications-for-public-health-and-animal-health

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