Highly Pathogenic Avian Influenza A(H5N1) Virus Infection among Workers at Live Bird Markets, Bangladesh, 2009–2010 - Volume 21, Number 4—April 2015 - Emerging Infectious Disease journal - CDC

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Highly Pathogenic Avian Influenza A(H5N1) Virus Infection among Workers at Live Bird Markets, Bangladesh, 2009–2010 - Volume 21, Number 4—April 2015 - Emerging Infectious Disease journal - CDC

Volume 21, Number 4—April 2015

Research

Highly Pathogenic Avian Influenza A(H5N1) Virus Infection among Workers at Live Bird Markets, Bangladesh, 2009–2010

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• Methods
• Results
• Discussion
• Suggested Citation

Figures

• Figure

Tables

• Table 1
• Table 2
• Table 3

Technical Appendicies

• Technical Appendix 1
• Technical Appendix 2

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Sharifa Nasreen , Salah Uddin Khan, Stephen P. Luby, Emily S. Gurley, Jaynal Abedin, Rashid Uz Zaman, Badrul Munir Sohel, Mustafizur Rahman, Kathy Hancock, Min Z. Levine, Vic Veguilla, David Wang, Crystal Holiday, Eric Gillis, Katharine Sturm-Ramirez, Joseph S. Bresee, Mahmudur Rahman, Timothy M. Uyeki, Jacqueline M. Katz, and Eduardo Azziz-Baumgartner

Author affiliations: icddr,b, Dhaka, Bangladesh (S. Nasreen, S.U. Khan, S.P. Luby, E.S. Gurley, J. Abedin, R.U. Zaman, B.M. Sohel, M. Rahman, K. Sturm-Ramirez, E. Azziz-Baumgartner); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (S.P. Luby, K. Hancock, M.Z. Levine, V. Veguilla, D. Wang, C. Holiday, E. Gillis, K. Sturm-Ramirez, J.S. Bresee, T.M. Uyeki, J.M. Katz, E. Azziz-Baumgartner); Institute of Epidemiology, Disease Control and Research, Dhaka (M. Rahman)

Suggested citation for this article

Abstract

The risk for influenza A(H5N1) virus infection is unclear among poultry workers in countries where the virus is endemic. To assess H5N1 seroprevalence and seroconversion among workers at live bird markets (LBMs) in Bangladesh, we followed a cohort of workers from 12 LBMs with existing avian influenza surveillance. Serum samples from workers were tested for H5N1 antibodies at the end of the study or when LBM samples first had H5N1 virus–positive test results. Of 404 workers, 9 (2%) were seropositive at baseline. Of 284 workers who completed the study and were seronegative at baseline, 6 (2%) seroconverted (7 cases/100 poultry worker–years). Workers who frequently fed poultry, cleaned feces from pens, cleaned food/water containers, and did not wash hands after touching sick poultry had a 7.6 times higher risk for infection compared with workers who infrequently performed these behaviors. Despite frequent exposure to H5N1 virus, LBM workers showed evidence of only sporadic infection.

Human infections and deaths caused by highly pathogenic avian influenza A (H5N1) viruses in several countries (1); by A(H9N2) virus in Bangladesh (2); and by A(H7N2), A(H7N9), A(H9N2), and A(H10N8) viruses in China (3–5) reflect the persistent public health threat posed by different avian influenza A virus subtypes. Subtype H5N1 virus remains endemic among poultry in Bangladesh, China, Egypt, Indonesia, and Vietnam (6). Among these countries the first human cases of H5N1 virus were identified in China and Vietnam during 2003 (1). The seroprevalence of antibodies against H5N1 virus among poultry workers was 0%–4% in Bangladesh, China, Indonesia, and Vietnam during 2001–2009 (7–13); published data on seroprevalence among poultry workers in Egypt are not available. Beyond the countries where H5N1 is endemic, 0%–10% seroprevalence has been reported among poultry workers in Nigeria; South Korea; Thailand; and Hong Kong, China (14–17). The incidence of H5N1 virus infection among occupationally exposed populations has not been determined in countries where the virus is endemic or nonendemic.

In Bangladesh, a country with a population density of 964/km2 and 257 million poultry (18,19), H5N1 virus infection was first detected among poultry in 2007. By the end of 2013, the country had reported 549 outbreaks among poultry to the World Organisation for Animal Health (20). The first human case of H5N1 virus infection in Bangladesh was identified during 2008 (21). Live bird markets (LBMs) are often associated with poultry-to-human transmission of H5N1 virus (22). For example, butchering and exposure to sick poultry were associated with detection of H5 antibody among LBM workers in Hong Kong (17). In one study, workers from 16 LBMs in Bangladesh were rarely observed using personal protective equipment (PPE) or washing their hands during the handling of poultry, suggesting a high likelihood of exposures to H5N1 virus (23). Data are limited on the risk for avian influenza A virus infections among poultry workers in Bangladesh (7).

Seroprevalence studies among humans yield information about how many persons have serologic evidence of infection at a certain point and time, but they do not provide information about when people became infected or the risk for infection with prolonged exposures to contaminated animals or environments. Studies designed to estimate the rate of seroconversion of antibodies to H5N1 virus among poultry workers may also help elucidate the risks of poultry-to-human transmission of H5N1 virus in countries, such as Bangladesh, where H5N1 virus is endemic among poultry. Such information may help public health officials develop, prioritize, and reinforce prevention and control strategies. During 2009–2010, a total of 61 H5N1 outbreaks, resulting in the culling of 220,432 birds, were reported among poultry in Bangladesh (24); no human cases were identified during this period. We followed a cohort of LBM workers in Bangladesh to determine the seroprevalence of antibodies to H5N1 virus, the incidence of seroconversion, and risk factors for poultry-to-human transmission of H5N1 virus.

Dr. Nasreen works on respiratory infection research at the Centre for Communicable Diseases, icddr,b. Her research area of interest is infectious disease epidemiology, including prevention and control in low-income countries.

Acknowledgments

We thank the field staff and all study participants for their contribution to the study. We also acknowledge the contribution of Yaohui Bai for technical assistance and Dorothy Southern for providing support with the scientific writing and clarity of this manuscript. icddr,b acknowledges with gratitude the commitment of CDC to its research efforts.

This research study was funded by the CDC through their cooperative agreement with icddr,b (grant no. 1-U01-CI000298). icddr,b is thankful to the governments of Australia, Bangladesh, Canada, Sweden, and the United Kingdom for providing core/unrestricted support.

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Figure

• Figure. Enrollment and data for participants in a study of influenza A(H5N1) virus infection among workers at live bird markets (LBMs), Bangladesh, 2009–2010. ILI, influenza-like illness.

Tables

• Table 1. Characteristics of live bird market workers and nonpoultry workers, Bangladesh, 2009–2010
• Table 2. Characteristics of live bird market workers with evidence of seroconversion against avian influenza A(H5N1) virus, Bangladesh, 2009–2010
• Table 3. Risks for testing seropositive or seroconverting against avian influenza A(H5N1) virus among live bird market workers, Bangladesh 2009–2010

Technical Appendices

• Technical Appendix 1. Questionnaires administered to the poultry workers and nonpoultry workers during a study of avian influenza A(H5N1) virus infection among workers at live bird markets.  779 KB
• Technical Appendix 2. Workers’ baseline characteristics, exposure to poultry, and use of personal protective equipment; contribution of individual behaviors of poultry workers for each set of exposure behaviors; and timeline for... 52 KB

Suggested citation for this article: Nasreen S, Khan SU, Luby SP, Gurley ES, Abedin J, Zaman RU, et al. Highly pathogenic avian influenza A(H5N1) virus infection among workers at live bird markets, Bangladesh, 2009–2010. Emerg Infect Dis. 2015 Apr [date cited].http://dx.doi.org/10.3201/eid2104.141281

DOI: 10.3201/eid2104.141281