#19,371
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.
Four 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).
In low and middle-income countries (LMICs) - where home refrigeration is less common - the ability to buy freshly killed poultry is often viewed as a necessity.
Larger, more modern cities like Hong Kong have gone to great lengths to regulate and restrict live bird markets, while early in 2025, Shanghai suspended Live Poultry Sales altogether.
During past avian flu outbreaks - when authorities ordered LBMs closed - clandestine and unregulated markets sometimes sprang up, which only exacerbated the problem.
The authors of the above mentioned J.Virology review are back today (with several other contributors) with a follow-up scoping review based on 87 studies published between 2017 and the end of 2025 that reported on public health outcomes, risk factors or control measures associated with TFMs in LMICs.
Most of these studies centered on TFMs in China and Bangladesh, and while avian flu was the primary focus, other public health risks (primarily bacterial zoonoses, e.g. Campylobacter spp, Salmonella spp, and multi-drug resistant E. coli) were also considered.
While the authors offer up a number of suggestions that may help reduce the risks, this is a complex and varied problem, and solutions will likely have to be tailored to each TFM.
Follow the link to read the review in its entirety.
Public health risks and control measures associated with live animal and animal product trade in traditional food markets in low- and middle-income countries: a scoping review
Author affiliations• Frida E Sparaciari1 2, Alfonso I Vargas Huaco3 4, Charifa Zemouri5, Anna Signe Fomsgaard1 2, Wei Ning Chen3 4, Cadhla Firth2 6, Paul F Horwood2 7, Erik Karlsson1 8
BMJ Public Health 2026;4:e006159. doi:10.1136/bmjph-2026-006159
Abstract
IntroductionTraditional food markets (TFMs) support food security and livelihoods in low- and middle-income countries (LMICs), but the trade of live animals and products of animal origin may facilitate zoonotic and foodborne disease transmission. Evidence on associated risks and control measures remains fragmented across pathogens, market types and interventions. This scoping review maps the literature on zoonotic and foodborne public health risks, risk factors and control measures related to the trade of live animals and animal products in TFMs in LMICs.
MethodsWeb of Science, PubMed and Scopus were searched on 24 April 2026 for primary, English-language studies published from 1 January 2017 to 31 December 2025. Eligible studies reported public health outcomes, risk factors or control measures associated with TFMs in LMICs. Reviewers screened titles/abstracts and full texts against predefined criteria, resolving disagreements by consensus. Data were charted and checked using a standardised pro forma; no methodological quality appraisal was conducted.
Results87 studies were included; 61 (70.1%) reported public health risks and 35 (40.2%) examined control measures, with 9 (10.3%) addressing both domains. Most studies were observational and focused on poultry markets and avian influenza viruses (AIVs), particularly at the human–market interface. Reported risks included occupational exposure among market workers, exposure among community members and contamination of animal products and market environments.
Common risk factors included poor hygiene, weak biosecurity, on-site slaughter, species mixing, inadequate waste management, prolonged animal holding and unsafe handling. Control measures included market closure, rest days, species separation, cleaning and disinfection, infrastructure improvements and policy-based interventions such as China’s ‘1110’ policy.
Across distinct studies, several measures were associated with lower pathogen detection or modelled infection estimates, whereas other findings were non-significant or inconsistent. Implementation was constrained by economic losses, limited infrastructure, weak enforcement, low awareness and poor adherence to protective practices.
ConclusionsTFMs are important human–animal–environment interfaces where zoonotic and foodborne risks arise from interacting biological, structural and behavioural factors. The findings from this scoping review provide a rationale for context-specific, multilevel One Health approaches combining infrastructure improvements, biosecurity, surveillance, regulation, compensation and vendor engagement. However, because most evidence was observational and concentrated on AIV-focused poultry markets, the effectiveness and generalisability of these approaches require further evaluation across diverse TFM settings.
What is already known on this topic
Traditional food markets are essential to food access and livelihoods in many low- and middle-income countries, but the trade of live animals and products of animal origin can create human–animal–environment interfaces where zoonotic and foodborne pathogens circulate. Existing evidence remains fragmented and is largely concentrated on avian influenza in poultry markets.
What this study adds
This scoping review maps 87 studies and uses a One Health framework to integrate evidence on public health risks, exposure pathways, human health outcomes and control-measure implementation in traditional food markets. It shows that risk is produced by interacting market infrastructure, hygiene, biosecurity, animal management and human practices, rather than by live animals or animal-origin products alone.
How this study might affect research, practice or policy
The findings suggest potential value in adaptive, context-specific One Health approaches rather than isolated technical controls. Policy and research should evaluate combinations of infrastructure, water, sanitation and hygiene, biosecurity, surveillance, vendor engagement, market regulation and livelihood-sensitive incentives, while expanding evaluation beyond avian influenza virus-focused poultry systems.
