Predicting disease severity and viral spread of h5n1 influenza virus in ferrets in the context of natural exposure routes

Kathryn M. Edenborough, Suzanne Lowther, Karen Laurie, Manabu Yamada, Fenella Long, John Bingham, Jean Payne, Jennifer Harper, Jessica Haining, Rachel Arkinstall, Brad Gilbertson, Deborah Middleton, Lorena E. Brown

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7 Citations (Scopus)


Although avian H5N1 influenza virus has yet to develop the capacity for human-to-human spread, the severity of the rare cases of human infection has warranted intensive follow-up of potentially exposed individuals that may require antiviral prophylaxis. For countries where antiviral drugs are limited, the World Health Organization (WHO) has developed a risk categorization for different levels of exposure to environmental, poultry, or human sources of infection. While these take into account the infection source, they do not account for the likely mode of virus entry that the individual may have experienced from that source and how this could affect the disease outcome. Knowledge of the kinetics and spread of virus after natural routes of exposure may further inform the risk of infection, as well as the likely disease severity. Using the ferret model of H5N1 infection, we compared the commonly used but artificial inoculation method that saturates the total respiratory tract (TRT) with virus to upper respiratory tract (URT) and oral routes of delivery, those likely to be encountered by humans in nature. We show that there was no statistically significant difference in survival rate with the different routes of infection, but the disease characteristics were somewhat different. Following URT infection, viral spread to systemic organs was comparatively delayed and more focal than after TRT infection. By both routes, severe disease was associated with early viremia and central nervous system infection. After oral exposure to the virus, mild infections were common suggesting consumption of virus-contaminated liquids may be associated with seroconversion in the absence of severe disease.

Original languageEnglish
Pages (from-to)1888-1897
Number of pages10
JournalJournal of Virology
Issue number4
Publication statusPublished - 28 Jan 2016
Externally publishedYes

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