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Downloadable PDF: A Discussion on H5N1 Avian Flu
Q&A Forum from this Webinar
with Dr. Tim Uyeki
Q: Can you clarify the information on wastewater surveillance? Does it reflect human sources or both animal and human sources for influenza. How will you tell the difference if disease is asymptomatic?
A: Wastewater surveillance that detects influenza A viruses cannot distinguish detection of seasonal influenza A virus infections of humans from influenza A virus infections of animals (wild birds, poultry, pigs, cows, cow milk, other infected mammals). Wastewater surveillance that detects A(H5) cannot distinguish detection of A(H5) viruses from infected animals or cow milk or a few human infections and cannot identify the source, so any signal needs to be investigated. There are poultry outbreaks of H5N1, wild bird detections, and H5N1 viruses are highly concentrated in the raw milk of infected cows.
Wastewater surveillance is only one component of a bundle of influenza surveillance platforms and tools.
Q: Any ideas on conducting human challenge studies on H5 vaccines for efficacy?
A: This has not been done. H5N1 virus challenge studies in vaccinated animal models (mice, ferrets) have been used.
Q: Since we see alpha 2,3 receptors in human conjunctiva do you think this could serve as a viable conduit to the mutations mentioned needed to overcome the alpha 2,6 receptor difference.
A: Yes, H5N1 viruses can infect conjunctival tissues because conjunctival tissues have abundant alpha 2,3 sialic acid linked receptors; virus can potentially enter the upper respiratory tract via the nasolacrimal duct and might establish infection because there are some alpha 2,3 receptors in the upper respiratory tract – it is not 100% alpha 2,6 receptor distribution. That might not result in a receptor tropism switch, however. The main issue is that H5N1 viruses need to establish infection in the lower respiratory tract where alpha 2,3 receptors are most prevalent.
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