Photo Credit – FAO
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While there are myriad ways by which the next pandemic virus might emerge, one of the more obvious routes is via Live Bird Markets (LBMs), Live Animal Markets (LAMs), or Traditional Food Markets (TFMs), which often deal in live poultry and other animal species (including `bushmeat').Live bird markets (LBMs) have long been linked to human exposure to (and infection by) avian influenza viruses, so much so that in 2014, in CDC: Risk Factors Involved With H7N9 Infection, we looked at a case-control study that pretty much nailed visiting LBMs as the prime risk factor for infection.
Three years ago, in Zoonoses & Public Health: Aerosol Exposure of Live Bird Market Workers to Viable Influenza A/H5N1 and A/H9N2 Viruses, Cambodia, we looked at a study that documented high levels of H5 & H9 viruses in the air at a Cambodian LBM during the `high season' for avian flu, and more importantly, that a large percentage remained viable (and infectious).
While data is limited, numerous seroprevalence studies have shown higher rates of H5, H6, and H9 antibodies in poultry workers than in the general population (see EID Journal: Avian Influenza A Viruses among Occupationally Exposed Populations, China, 2014–2016).
Although we often think of this risk being largely limited to Asia, or the Middle East, or perhaps Africa, since H5N1's arrival in late 2021, the USDA has reported 54 outbreaks in live markets across the U.S. (in 6 states; NY, NJ, PA, FL, VA, CA). Of those, 62% (n=34) have been reported in the first 5 months of 2025, with the vast majority (n=23) coming from New York State.
Of course, HPAI isn't the only concern, the consumption and trade in `bushmeat' likely reintroduces dangerous pathogens (e.g. Ebola, Anthrax, Mpox, etc.) into the human population on a regular basis (see `Carrion’ Luggage & Other Ways To Import Exotic Diseases).
In 2005, the CDC’s EID Journal carried a perspective article warning on the dangers of bushmeat hunting by Nathan D. Wolfe, Peter Daszak, A. Marm Kilpatrick, and Donald S. Burke; Bushmeat Hunting, Deforestation, and Prediction of Zoonotic Disease.
The sale and consumption of raw or unpasteurized milk - quite common in many parts of the world - presents multiple disease risks. Between bacteria, viruses, parasites, and toxins, foodborne illnesses reportedly sicken 600 million people each year, killing 420,000.It describes how it may take multiple introductions of a zoonotic pathogen to man – over a period of years or decades – before it adapts well enough to human physiology to support human-to-human transmission.
Even modern manufacturing techniques, refrigeration, and rigorous hygiene standards can't guarantee the food we eat will be 100% safe (see CDC Outbreaks List), but they do go a long way in improving the odds.
Earlier this year the city of Shanghai (pop 25 million) banned the sale of live poultry, but earlier attempts to restrict or close LBMs in Asia have been met with steep resistance.
Often, when `legal' markets were shuttered during avian flu outbreaks, infected birds would be shipped to other (sometimes illicit) markets.
Due to its length, I've only provided the link a a few small excerpts.
The authors emphasize the importance of a `One Health' approach; integrating human, animal, and environmental health to improve market safety - and call for improved pathogen surveillance in TFMs - along with finding solutions tailored to local needs, rather than blanket bans.
Traditional food markets (TFMs) are dynamic and complex systems that play a vital role in societies across the globe. They provide fresh, affordable food, help preserve cultural traditions, and support the livelihoods of millions. However, these markets also present inherent risks associated with the trade of live animals and animal-derived products, including the emergence and spread of zoonotic diseases, which are underreport ed in these settings.
This review explores the dual role of TFMs as essential societal hubs and hotspots for zoonotic diseases, emphasizing the need for surveillance and targeted One Health research on pathogens in these environments. By assessing the health risks associated with the presence of specific animals and their pathogens in TFMs, this review lays the foundation for developing the evidence-based risk assessments and mitigation strategies needed to reduce zoonotic disease risk.
Enhancing the safety and sustainability of TFMs through integrated One Health approaches will be crucial for balancing the cultural and economic importance of TFMs with the need for increased global health security.
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Traditional food markets (TFMs) exist in diverse forms and are known by various names, including wet markets, live animal markets (LAMs), and informal markets. Regardless of their designation, they play a vital role in the livelihood of millions of individuals and provide affordable, fresh food to people worldwide. TFMs also serve as critical social and cultural spaces and can even be an attraction for tourists. These markets typically offer a wide range of products, including animal-derived foodstuffs, fresh produce, dried goods, and ready-to-eat meals. In some cases, live animals are housed and slaughtered on-site, contributing to negative perceptions that TFMs pose risks for zoonotic disease emergence (1).
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Despite these proposed interventions, significant challenges remain. Many TFMs operate within informal structures, lacking regulatory oversight, policy enforcement, and adequate investment in infrastructure. Moreover, data on the diversity and prevalence of zoonotic diseases in TFMs are limited, particularly in regions with high market activity but low surveillance capacity. Moving forward, a coordinated international effort is required to balance the economic and cultural importance of TFMs with public health and biosafety concerns. Strengthening global surveillance networks, fostering cross-sector collaboration, and incorporating innovative environmental monitoring technologies can enhance our ability to detect and respond to emerging threats. Future research should also prioritize underrepresented regions and pathogens to build a more comprehensive understanding of the risks associated with TFMs.
Ultimately, TFMs will continue to play a vital role in global food systems, but their sustainability and safety depend on integrating evidence-based strategies to mitigate zoonotic disease risks.