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Avian influenza (AI), or “bird flu,” is a contagious respiratory disease of animals caused by influenza viruses that typically infect birds. While AI viruses are characteristically species-specific, they can acquire the ability to infect humans. One AI virus, classified as the highly pathogenic H5N1, has affected more than 80 species of wild birds, led to the death or destruction of millions of domestic birds, and caused illness in hundreds of humans, killing more than half. Most humans have become ill with the H5N1 virus through close contact with infected birds. However, public health officials are concerned that the virus could develop into a form that could easily spread from human to human, creating an outbreak of illness that could rapidly spread around the world (a pandemic). In response, widespread efforts by national and international health organizations have been instituted to prepare for and to mitigate the potential impacts of a pandemic influenza outbreak, including attempts to use communication to alert and educate the public. Because of the potential threat to humans, news media often pay close attention to AI developments. To better understand the threat of AI, this entry explores the basic science of influenza, the impact of AI on wild and domestic birds and on humans, its potential to cause a pandemic, and what is being done in response.

Influenza Basics

The term influenza is thought to be derived from the Italian word for “influence.” Influenza viruses belong to the Orthomyxoviridae family of RNA viruses, which are classified into three groups, known as Types A, B, and C. Type A viruses cause infections in birds, humans, and some other mammals. Type B viruses typically infect only humans, while type C viruses, which are rare, infect both humans and pigs.

Influenza A viruses are further classified into subtypes based on structural proteins projecting from their surfaces like spikes. One type of spike contains the glycoprotein hemagglutinin (H), an enzyme that helps the virus attach to and penetrate host cells. The other type of spike contains the enzyme neuraminidase (N), which helps the virus enter the host cell and to exit after replication. There are 16 different types of H and 9 different types of N known, creating 144 possible combinations. Subtypes of viruses are identified by their particular combination of H and N proteins. According to the U.S. Centers for Disease Control and Prevention (CDC), human infections have been caused mainly by influenza A viruses containing the H1, H2, and H3 and N1 and N2 proteins, although only some subtypes (that is, H1N1, H1N2, and H3N2) are currently in general circulation among people.

Animals (including humans) can acquire protective immunities against influenza viruses by developing antibodies against these H and N proteins. Such antibodies are also the basis of influenza vaccines. However, mutations in viruses can cause chemical alterations in these proteins, yielding new strains of a virus that existing antibodies do not recognize. As a result, relatively minor variations (antigenic drift) in a virus can leave people vulnerable to getting the flu more than once. Consequently, influenza A and B viruses cause seasonal flu epidemics every year. Because viruses are constantly changing, there is no universally effective vaccine for influenza. Therefore, yearly seasonal flu vaccinations must be updated to match changes in the currently circulating flu viruses.

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