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