Avian influenza viruses in humans: lessons from past outbreaks

Br Med Bull. 2019 Dec 11;132(1):81-95. doi: 10.1093/bmb/ldz036.


Background: Human infections with avian influenza viruses (AIV) represent a persistent public health threat. The principal risk factor governing human infection with AIV is from direct contact with infected poultry and is primarily observed in Asia and Egypt where live-bird markets are common.

Areas of agreement: Changing patterns of virus transmission and a lack of obvious disease manifestations in avian species hampers early detection and efficient control of potentially zoonotic AIV.

Areas of controversy: Despite extensive studies on biological and environmental risk factors, the exact conditions required for cross-species transmission from avian species to humans remain largely unknown.

Growing points: The development of a universal ('across-subtype') influenza vaccine and effective antiviral therapeutics are a priority.

Areas timely for developing research: Sustained virus surveillance and collection of ecological and physiological parameters from birds in different environments is required to better understand influenza virus ecology and identify risk factors for human infection.

Keywords: highly pathogenic avian influenza virus; live-bird markets; pandemics; virus ecology; virus spillover; zoonotic viruses.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Animals
  • Antiviral Agents / therapeutic use
  • Birds
  • Disease Outbreaks
  • Disease Susceptibility
  • Humans
  • Influenza A virus / classification
  • Influenza Vaccines
  • Influenza in Birds / epidemiology*
  • Influenza in Birds / therapy
  • Influenza in Birds / transmission
  • Influenza, Human / epidemiology*
  • Influenza, Human / therapy
  • Influenza, Human / transmission
  • Risk Factors
  • Zoonoses / epidemiology
  • Zoonoses / therapy
  • Zoonoses / transmission


  • Antiviral Agents
  • Influenza Vaccines