Avian influenza viruses and human health.

Influenza A viruses cause natural infections of humans, some other mammals and birds. Few of the 16 haemagglutinin and nine neuraminidase subtype combinations have been isolated from mammals, but all subtypes have been isolated from birds. In the 20th century, there were four pandemics of influenza as a result of the emergence of antigenically different strains in humans: 1918 (H1N1), 1957 (H2N2), 1968 (H3N2) and 1977 (H1N1). Influenza A viruses contain eight distinct RNA genes and reassortment of these can occur in mixed infections with different viruses. The 1957 and 1968 pandemic viruses differed from the preceding viruses in humans by the substitution of genes that came from avian viruses, suggesting they arose by genetic reassortment of viruses of human and avian origin. Up to 1995, there had been only three reports of avian influenza viruses infecting humans, in 1959, 1977 and 1981 (all H7N7), but, since 1996, there have been regular reports of natural infections of humans with avian influenza viruses: in England in 1996 (H7N7), Hong Kong 1997 (H5N1), 1999 (H9N2), and 2003 (H5N1), in The Netherlands 2003 (H7N7), Canada 2004 (H7N3), Vietnam 2004 (H5N1) and Thailand 2004 (H5N1). The H5N1 virus is alarming because 51 (64 %) of the 80 people confirmed as infected since 1997 have died.