Chapter V. Transmission of Influenza A Viruses Between Animals and People

Influenza A viruses have infected many different animals, including ducks, chickens, pigs, whales, horses, and seals. However, certain subtypes of influenza A virus are specific to certain species, except for birds, which are hosts to all known subtypes of influenza A. Subtypes that have caused widespread illness in people either in the past or currently are H3N2, H2N2, H1N1, and H1N2. H1N1 and H3N2 subtypes also have caused outbreaks in pigs, and H7N7 and H3N8 viruses have caused outbreaks in horses.

Influenza A viruses normally seen in one species sometimes can cross over and cause illness in another species. For example, until 1998, only H1N1 viruses circulated widely in the U.S. pig population. However, in 1998, H3N2 viruses from humans were introduced into the pig population and caused widespread disease among pigs. Most recently, H3N8 viruses from horses have crossed over and caused outbreaks in dogs.

Avian influenza A viruses may be transmitted from animals to humans in two main ways:

1. Directly from birds or from avian virus-contaminated environments to people.

2. Through an intermediate host, such as a pig.

Influenza A viruses have eight separate gene segments. The segmented genome allows influenza A viruses from different species to mix and create a new influenza A virus if viruses from two different species infect the same person or animal. For example, if a pig were infected with a human influenza A virus and an avian influenza A virus at the same time, the new replicating viruses could mix existing genetic information (reassortment) and produce a new virus that had most of the genes from the human virus, but a hemagglutinin and/or neuraminidase from the avian virus. The resulting new virus might then be able to infect humans and spread from person to person, but it would have surface proteins (hemagglutinin and/or neuraminidase) not previously seen in influenza viruses that infect humans.

This type of major change in the influenza A viruses is known as antigenic shift. Antigenic shift results when a new influenza A subtype to which most people have little or no immune protection infects humans. If this new virus causes illness in people and can be transmitted easily from person to person, an influenza pandemic can occur.

It is possible that the process of genetic reassortment could occur in a human who is co-infected with avian influenza A virus and a human strain of influenza A virus. The genetic information in these viruses could reassort to create a new virus with a hemagglutinin from the avian virus and other genes from the human virus. Theoretically, influenza A viruses with a hemagglutinin against which humans have little or no immunity that have reassorted with a human influenza virus are more likely to result in sustained human-to-human transmission and pandemic influenza. Therefore, careful evaluation of influenza viruses recovered from humans who are infected with avian influenza is very important to identify reassortment if it occurs.

Although it is unusual for people to get influenza virus infections directly from animals, sporadic human infections and outbreaks caused by certain avian influenza A viruses and pig influenza viruses have been reported. (For more information see Avian Influenza Infections in Humans.) These sporadic human infections and outbreaks, however, rarely result in sustained transmission among humans.

Avian H5N1 Flu in Humans is Currently Very Limited and Not a Pandemic

• Human H5N1 influenza infection was first recognized in 1997 when this virus infected 18 people in Hong Kong, causing 6 deaths.
• The World Health Organization is tracking the number of human cases of the H5N1virus. See http://www.pandemicflu.gov/#map, for a map showing the nations with confirmed human cases and the number of cases.
• Currently, close contact with infected poultry has been the primary source for human infection. Though rare, there have been isolated reports of human-to-human transmission of the virus.
• Genetic studies confirm that the influenza A virus H5N1 mutates rapidly. Should it adapt to allow easy human-to-human transmission, a pandemic could ensue - it has not done so to date.
• At this time, it is uncertain whether the currently circulating H5N1 virus will lead to a global disease outbreak in humans - a pandemic.
• The reported symptoms of avian influenza in humans have ranged from typical influenza-like symptoms (e.g. fever, cough, sore throat, and muscle aches) to eye infections (conjunctivitis), acute respiratory distress, viral pneumonia and other severe, life-threatening complications.