Tuesday, May 17, 2022

CDC Adds Zoonotic Avian A/H5N1 Clade To IRAT List


The CDC monitors a (growing) number of novel influenza viruses with zoonotic potential on their  IRAT (Influenza Risk Assessment Tool)  website - that, using a variety of parameters - attempts to quantify their threat in two broad categories.
While IRAT can't predict which virus will become a pandemic strain (or when), it can help planners decide which viruses pose the greatest risks, so they can prioritize their efforts and investments.

In 2010 there were only 3 viruses on that list. By 2016 that number had grown to 11.  And in the 6 years since, it has more than doubled again (n=23).  A year ago, the CDC Added Zoonotic Avian A/H5N8 to their after 7 people in Russia were mildly infected with that virus.

In the past few days, with little fanfare, the CDC added the 23rd virus to this list; Avian A/H5N1 Clade, following reports of the first human infection emerged from the UK earlier this year.  This report was finalized in March, before the 1st Human HPAI H5 Infection was reported in the United States

The CDC ranks the Avian A/H1N1 virus's threat in the lower-middle of the pack, well below China's EA H1N1 swine-variant virus, or the far more virulent HPAI H5N6, or H7N9 viruses.  The CDC's summary follows:

Since January 2022, highly pathogenic avian influenza A(H5N1) virus clade has been detected in the United States in numerous wild bird species, including aquatic birds such as ducks, and in commercial and backyard domestic poultry in numerous states.

The A(H5N1) clade virus emerged in 2020, spreading across Europe, Asia, and Africa, in both wild aquatic birds and domestic poultry, and replacing the previously circulating A(H5N8) clade viruses by 2021. In 2022, the virus has been detected in more than 50 countries in these three regions and was first reported in migrating wild aquatic birds in the Americas in December 2021. First detections in the United States also were from migratory wild aquatic birds.

In January 2022, one asymptomatic human infection with this virus, with known repeated exposure to infected ducks in England, was reported to the World Health Organization.

Phylogenetic analysis of A(H5N1) clade viruses show high levels of genetic similarity to previously circulating A(H5Nx) clade viruses, with little to no evidence of mammalian adaptation. The hemagglutinin genes of circulating wild bird and poultry viruses show a high level of genetic similarity, with some genetic variability noted among the neuraminidase gene, which is wild bird adapted.

Previously recommended A(H5) candidate vaccine viruses are expected to be effective against A(H5N1) viruses currently circulating among wild birds and poultry. In addition, A(H5N1) virus genetic and phenotypic analysis suggests that they remain susceptible to available influenza antiviral medications.

Summary: A risk assessment of highly pathogenic avian influenza A(H5N1) virus clade, using A/American wigeon/South Carolina/AH0195145/2021 as the prototype strain, was conducted in March 2022. The overall estimated IRAT scores placed this virus in the moderate risk category, which ranges from 4.0 to 7.9. The average risk score for the estimated potential emergence of the virus was 4.4, in the lower range of the moderate risk category. The average risk score for the virus to potentially impact public health was 5.1, also in the lower range of the moderate risk category. The average confidence level in the available data of all 10 risk elements was 2.4 (range: 1.0-3.0). 

Of the 23 novel viruses on the IRAT list, 8 involve avian HPAI H5Nx viruses, although most of those (like today's H5N1 virus) fall into the moderate risk category.  As to whether they are capable of sparking a pandemic in humans, the jury is still out. 

And as we've discussed often over the past few years (see Are Influenza Pandemic Viruses Members Of An Exclusive Club?), the progression of human influenza pandemics over the past 130 years has been H2, H3, H1, H2, H3, H1, H1 . . . .

Simply put, novel H1, H2, and H3 flu viruses appear to have fewer barriers to overcome in order to jump to humans. That doesn't mean that an H5 or H7 virus can't adapt well enough to start a pandemic, only that we've never seen it happen (yet). 

So while our avian A/H5N1 clade virus is an unlikely candidate to spark a pandemic, we can't afford to ignore that possibility.