Alarming case of avian influenza A (H5) in humans: call for urgent action in Ecuador

Avian influenza A (H5) is a subtype of the influenza A virus that primarily infects birds, but is also known to cause infections in humans. It can produce symptoms similar to the seasonal flu, such as temperature, coughing, and breathlessness, but it can also lead to more severe diseases, such as pneumonia, acute respiratory distress syndrome, and death. The primary objective of this study is to investigate a novel case of avian influenza A (H5)-related human illness that has been reported in Ecuador1. The study’s objectives include identifying potential risk factors for this viral infection in humans as well as the illness’ origin. The infection was first reported in a 9-year-old girl who lives in the remote Bolvar area of Ecuador. This case was discovered as part of sentinel surveillance for severe acute respiratory infections, and it was reported to the World Health Organization (WHO) by the Ecuador National Focal Point on January 9, 20232. H7N9 and H9N2, 2 other avian influenzas, have already infected humans and have the propensity to cause epidemics in case of rapid spread. The WHO reports that avian influenza subtypes H5N8, H5N6, H5N1, and H5N2 have been detected in various locations around the world2. In recent years, there has been an increase in reports of direct transmission of avian influenza viruses from birds to humans, culminating in various poultry outbreaks of influenza A (H5N1) in numerous Asian nations, with concomitant human illnesses. These discoveries have increased global alarm about these viruses’ pandemic potential2. Antiviral medicines and supportive treatment, such as oxygen therapy, are commonly used to treat avian influenza in people. The outcomes of the cases are varied and anomalous. To confirm the infection, laboratory tests, such as polymerase chain reaction and serology, are utilized. Polymerase chain reaction is a molecular method that detects the virus’s genetic material, whereas serology tests a patient’s blood for the existence of antibodies against the virus3. Contact tracing is also used to detect probable exposure sources. This entails locating and interviewing persons who have had intimate contact with sick patients, such as relatives or health care staff, to ascertain if they have been affected as well as identifying any possible areas of exposure4. Enhancing surveillance programs targeting commercial or backyard poultry and wild birds, in addition, to close monitoring of exposed individuals, such as workers in animal markets, animal farms, and areas of slaughtering, is crucial for early detection of animal-human transmission events and controlling the cycle of infection from the beginning. The great genetic diversity of the influenza virus and its constant evolution results in novel viruses that predispose immunologically naïve communities to severe infections and disastrous pandemics. The variety of novel influenzas viruses emphasizes the importance of identifying the epidemiological, virologic, and clinical changes in circulating viruses by the surveillance of severe acute respiratory infection and influenza syndrome (ILI), especially in areas of an animal outbreak or possible transmission. Once an active case is detected the responsible authorities should take a steady step toward direct isolation, identification of human and animal contacts, travel history, respiratory or other related symptoms, activity tracing, sending samples of confirmatory laboratory tests to the WHO Collaboration Centre, assessing disease severity, providing supportive and antiviral treatment, follow-up and notifying health care workers to take protective measures, apply standard infection prevention and control procedures, and use personal protective equipment. Authorities responsible for veterinarian services should trace the origin and movement of infected animals to locate areas of outbreak and investigate individuals who were in contact. Influenza surveillance recommendations by WHO are still applicable regardless of the newly reported case4 with the epidemiological, investigation, and virus characteristics of the confirmed positive case reported immediately to WHO International Health Regulations and the WHO Global Influenza Surveillance and Response System, while the details of suspected cases are shared with Global Influenza Surveillance and Response System1. WHO stated that the possibility of human-to-human transmission of this virus is low. Although no available proven vaccination prevents influenza viruses (H5), seasonal influenza vaccination has a role in preventing concomitant viral infection in healthy individuals especially those exposed to animals1. Strict instruction should be given to residents and travelers of areas with possible outbreaks to take preventative actions around animals at risk by avoiding live animal markets, farms, areas of slaughtering, surfaces contaminated with animal feces, mucous, or saliva, and ensure good hygiene and probably cooked food. Moreover, an occupation that necessitates contact with poultry should use protective equipment to prevent the spread of the virus. In addition, they should directly report any case of a sick or dead animal to the government5. The case fatality rate for A/H5N1 infections is >50%8. According to World Organization for Animal Health, there is a need to stop the spread of the virus in areas where outbreaks are common. Farmers suffer significant financial loss as a result, which will have an ongoing effect on their way of life. Since outbreaks were discovered in poultry and wild bird populations in late 2021–early 2022, the Centers for Disease Control and Prevention in the United States have been keeping an eye out for sickness among humans exposed to infected birds. The U.S. Department of Agriculture reported on July 5, 2022 that 40.09 million birds in 36 states have highly virulent avian influenza9. As influenza viruses are constantly changing, we emphasize the significance of global surveillance to identify and track virologic, epidemiological, and clinical changes linked to newly circulating or emerging influenza viruses that could disturb human well-being. We need an urgent call for action (Figs. 1 – 3).Figure 1: Common symptoms and transmission cycle pictorially.Figure 2: Measures to improve biosecurity through the food chain6.Figure 3: Measures for prevention and control of influenza viruses7.Ethical approval None. Sources of funding None. Author contributions Equal contributions of all authors Conflict of interest disclosures The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor None.