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Epidemiological Risk Factors for Animal Influenza A Viruses Overcoming Species Barriers

Abstract

Drivers and risk factors for Influenza A virus transmission across species barriers are poorly understood, despite the ever present threat to human and animal health potentially on a pandemic scale. Here we review the published evidence for epidemiological risk factors associated with influenza viruses transmitting between animal species and from animals to humans. A total of 39 papers were found with evidence of epidemiological risk factors for influenza virus transmission from animals to humans; 18 of which had some statistical measure associated with the transmission of a virus. Circumstantial or observational evidence of risk factors for transmission between animal species was found in 21 papers, including proximity to infected animals, ingestion of infected material and potential association with a species known to carry influenza virus. Only three publications were found which presented a statistical measure of an epidemiological risk factor for the transmission of influenza between animal species. This review has identified a significant gap in knowledge regarding epidemiological risk factors for the transmission of influenza viruses between animal species.

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Notes

  1. FAO EMPRES-i compiles and displays information from numerous sources (FAO representatives or country missions, FAO reports, OIE, official government sources, European Commission, FAO reference centres, laboratories and FAO collaborators) to provide full and accurate information on the animal disease situation worldwide.

References

  • Aguirre-Ezkauriatza EJ, Karlsson EA, Freiden P, Schultz-Cherry S, Flores-Gutierrez SGH, and Zertuche-Guerra MI (2012). Seroepidemiological Survey of Equine Influenza a H3N8 in Horses from the Eastern Region of the United States-Mexico Border. Journal of Animal and Veterinary Advances 11:2250-2255.

    Article  Google Scholar 

  • Ai J, Huang Y, Xu K, Ren D, Qi X, Ji H, et al. (2013). Case-control study of risk factors for human infection with influenza A(H7N9) virus in Jiangsu Province, China, 2013. Eurosurveillance 18:4-9.

    Article  Google Scholar 

  • Alexander DJ, and Brown IH (2000). Recent zoonoses caused by influenza A viruses. Revue Scientifique Et Technique De L Office International Des Epizooties 19:197-225.

    Article  CAS  Google Scholar 

  • Amirsalehy H, Nili H, and Mohammadi A (2012). Can dogs carry the global pandemic candidate avian influenza virus H9N2? Australian Veterinary Journal 90:341-345.

    Article  CAS  PubMed  Google Scholar 

  • Anthony SJ, St. Leger JA, Pugliares K, Ip HS, Chan JM, Carpenter ZW, et al. (2012). Emergence of fatal avian influenza in New England harbor seals. mBio 3:e00166–12

  • Biswas PK, Rahman MH, Das A, Ahmed SSU, Giasuddin M, and Christensen JP (2011). Risk for Highly Pathogenic Avian Influenza H5N1 Virus Infection in Chickens in Small-Scale Commercial Farms, in a High-Risk Area, Bangladesh, 2008. Transboundary and Emerging Diseases 58:519-525.

    Article  CAS  PubMed  Google Scholar 

  • Blair PJ, Putnam SD, Krueger WS, Chum C, Wierzba TF, Heil GL, et al. (2013). Evidence for avian H9N2 influenza virus infections among rural villagers in Cambodia. Journal of Infection and Public Health 6:69-79.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bos MEH, Beest DEt, van Boven M, Holle MR-DRvB, Meijer A, Bosman A, et al. (2010). High Probability of Avian Influenza Virus (H7N7) Transmission from Poultry to Humans Active in Disease Control on Infected Farms. Journal of Infectious Diseases 201:1390-1396.

    Article  PubMed  Google Scholar 

  • Bowman AS, Nelson SW, Page SL, Nolting JM, Killian ML, Sreevatsan S, et al. (2014a). Swine-to-Human Transmission of Influenza A(H3N2) Virus at Agricultural Fairs, Ohio, USA, 2012. Emerging Infectious Diseases 20:1472-1480.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Bowman AS, Workman JD, Nolting JM, Nelson SW, and Slemons RD (2014b). Exploration of risk factors contributing to the presence of influenza A virus in swine at agricultural fairs. Emerging Microbes & Infections 3:e5.

    Article  Google Scholar 

  • Burnell FJ, Holmes MA, Roiko AH, Lowe JB, Heil GL, White SK, et al. (2014). Little evidence of human infection with equine influenza during the 2007 epizootic, Queensland, Australia. Journal of Clinical Virology 59:100-103.

    Article  PubMed  Google Scholar 

  • Buxton Bridges C LW, Hu-Primmer J, Sims L, Fukuda K, Mak KH, Rowe T, Thompson WW, Conn L, Lu X, Cox NJ, Katz JM (2002). Risk of Influenza A (H5N1) Infection Among Poultry Workers, Hong Kong 1997-1998. Journal of Infectious Diseases 185:1005-1010.

    Article  Google Scholar 

  • Callan RJ, G. Early, H. Kida and V.S. Hinshaw (1995). The appearance of H3 influenza viruses in seals. Journal of General Virology 76:199-203.

    Article  CAS  PubMed  Google Scholar 

  • Chen J-M, Chen J-W, Dai J-J, and Sun Y-X (2007). A survey of human cases of H5NI avian influenza reported by the WHO before June 2006 for infection control. American Journal of Infection Control 35:467-469.

    Article  PubMed  Google Scholar 

  • Chowell G, Simonsen L, Towers S, Miller MA, and Viboud C (2013). Transmission potential of influenza A/H7N9, February to May 2013, China. Bmc Medicine 11:214.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cowling BJ, Jin L, Lau EHY, Liao Q, Wu P, Jiang H, et al. (2013). Comparative epidemiology of human infections with avian influenza A H7N9 and H5N1 viruses in China: a population-based study of laboratory-confirmed cases. Lancet 382:129-137.

    Article  PubMed  PubMed Central  Google Scholar 

  • Crispe E, Finlaison DS, Hurt AC, and Kirkland PD (2011). Infection of dogs with equine influenza virus: evidence for transmission from horses during the Australian outbreak. Australian Veterinary Journal 89:27-28.

    Article  PubMed  Google Scholar 

  • Daly JM, A. S. Blunden et al. (2008). Transmission of Equine Influenza Virus to English Foxhounds. Emerging Infectious Diseases 14:461-464.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dinh PN, Long HT, Tien NTK, Hien NT, Mai LTQ, Phong LH, et al. (2006). Risk factors for human infection with avian influenza A H5N1, Vietnam, 2004. Emerging Infectious Diseases 12:1841-1847.

    Article  PubMed  PubMed Central  Google Scholar 

  • Ducatez MF, Webster RG, and Webby RJ (2008). Animal influenza epidemiology. Vaccine 26:D67-D69.

    Article  PubMed  PubMed Central  Google Scholar 

  • Dudley JP (2008). Public health and epidemiological considerations for avian influenza risk mapping and risk assessment. Ecology and Society 13:21.

    Article  Google Scholar 

  • FAO (2006). Review of free-ranging duck farming systems in Northern Vietnam and assessment of their implication in the spreading of highly pathogenic (H5N1) strain of avian influenza (HPAI). Agronomes et Veterinaires sans Frontieres. Food and Agriculture Organisation of the United Nations.

  • FAO (2012). EMPRES-i Global Animal Disease Information System, EMPRES Animal Health, Animal Health Service, Animal Production and Health Division. Food and Agriculture Organization of the United Nations, Rome. Available at http://empres-i.fao.org.

  • Feng H-x, Liu Y-y, Song Q-q, Ling Z-s, Zhang F-x, Zhu Y-l, et al. (2014). Interspecies transmission of canine influenza virus H5N2 to cats and chickens by close contact with experimentally infected dogs. Veterinary Microbiology 170:414-417.

    Article  Google Scholar 

  • Freidl GS, Meijer A, de Bruin E, de Nardi M, Munoz O, Capua I, et al. (2014). Influenza at the animal–human interface: a review of the literature for virological evidence of human infection with swine or avian influenza viruses other than A(H5N1). Eurosurveillance 19.

  • Fuller T, Havers F, Xu C, Fang L, Cao W, Shu Y, et al. (2014). Identifying areas with a high risk of human infection with the avian influenza A (H7N9) virus in East Asia. Journal of Infection 69:174-181.

    Article  PubMed  PubMed Central  Google Scholar 

  • Geraci JR, D.J. St Aubin et al. (1982). Mass mortality of harbor seals: Pneumonia associated with Influenza A virus. Science 215:1129-1131.

    Article  CAS  PubMed  Google Scholar 

  • Gerloff NA, Kremer JR, Charpentier E, Sausy A, Olinger CM, Weicherding P, et al. (2011). Swine Influenza Virus Antibodies in Humans, Western Europe, 2009. Emerging Infectious Diseases 17:403-411.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gong Z, Lv H, Ding H, Han J, Sun J, Chai C, et al. (2014). Epidemiology of the avian influenza A (H7N9) outbreak in Zhejiang Province, China. BMC Infectious Diseases 14:244.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gray GC, McCarthy T, Capuano AW, Setterquist SF, Alavanja MC, and Lynch CF (2008). Evidence for avian influenza A infections among Iowa’s agricultural workers. Influenza and Other Respiratory Viruses 2:61-69.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guan Y, Farooqui A, Zhu H, Dong W, Wang J, and Kelvin DJ (2013). H7N9 Incident, immune status, the elderly and a warning of an influenza pandemic. Journal of Infection in Developing Countries 7:302-307.

    Article  PubMed  Google Scholar 

  • Hill AA, Dewé T, Kosmider R, Von Dobschuetz S, Munoz O, Hanna A, et al. (2015). Modelling the species jump: towards assessing the risk of human infection from novel avian influenzas. R Soc Open Sci 2:150173.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hinshaw VS, W. J. Bean et al. (1986). Characterization of two Influenza A viruses from a pilot whale. Journal of Virology 58:655-656.

    CAS  PubMed  PubMed Central  Google Scholar 

  • Karasin AI, I. H. Brown et al. (2000). Isolation and characterization of H4N6 Avian Influenza viruses from Pigs with Pneumonia in Canada. Journal of Virology 74:9322-9327.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kayali G, Ortiz EJ, Chorazy ML, and Gray GC (2010). Evidence of Previous Avian Influenza Infection among US Turkey Workers. Zoonoses and Public Health 57:265-272.

    Article  CAS  PubMed  Google Scholar 

  • Keawcharoen J, K. Oraveerakul et al. (2004). Avian Influenza H5N1 in Tigers and Leopards. Emerging Infectious Diseases 10:2189-2191.

    Article  PubMed  PubMed Central  Google Scholar 

  • Khan MSI, Akbar SMF, Hossain ST, Mahatab M, Hossain MM, and Idrus Z (2012). Possible Route of Transmission of Highly Pathogenic Avian Influenza Virus Type H5N1 in Family Poultry at Rural Bangladesh. Pakistan Veterinary Journal 32:112-116.

    Google Scholar 

  • Kirkland PD, Finlaison DS, Crispe E, and Hurt AC (2010). Influenza Virus Transmission from Horses to Dogs, Australia. Emerging Infectious Diseases 16:699-702.

    Article  PubMed  PubMed Central  Google Scholar 

  • Klingeborn B, L. Englund et al. (1985). An Avian Influenza A virus killing a mammalian species - the mink Archives of Virology 86:347-351.

    Article  CAS  PubMed  Google Scholar 

  • Klopfleisch R, P. U. Wolf, C. Wolf et al. (2007a). Encephalitis in a Stone Marten (Martes foina) after Natural Infection with Highly Pathogenic Avian Influenza Virus Subtype H5N1. Journal of Comparative Pathology 137:155-159.

    Article  CAS  PubMed  Google Scholar 

  • Klopfleisch R, P. U. Wolf, W. Uhl et al. (2007b). Distribution of Lesions and Antigen of Highly Pathogenic Avian Influenza Virus A/Swan/Germany/R65/06 (H5N1) in Domestic Cats after Presumptive Infection by Wild Birds. Veterinary Pathology 44:261-268.

    Article  CAS  PubMed  Google Scholar 

  • Krueger WS, Khuntirat B, Yoon I, Blair PJ, Chittagarnpitch M, Putnam SD, et al. (2013). Prospective study of avian influenza virus infections among rural Thai villagers. Plos One 8:e72196.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Kuiken T, Rimmelzwaan G, van Riel D, van Amerongen G, Baars M, Fouchier R, et al. (2004). Avian H5N1 influenza in cats. Science 306:241.

    Article  CAS  PubMed  Google Scholar 

  • Kumar SC, Naveen R, Srinand S, Joseph B, Prashanth A, Belani KG, et al. (2013). Knowledge, attitudes, and poultry-handling practices of poultry workers in relation to avian influenza in India. Indian Journal of Occupational and Environmental Medicine 17:16-21.

    Article  PubMed  PubMed Central  Google Scholar 

  • Lam T, Wang J, Shen Y, Zhou B, Duan L, Cheung C, et al. (2013). The genesis and source of the H7N9 influenza viruses causing human infections in China. Nature (London) 502:241-244.

    Article  CAS  Google Scholar 

  • Li Q, Zhou L, Zhou M, Chen Z, Li F, Wu H, et al. (2014) Epidemiology of human infections with avian influenza A(H7N9) virus in China. The New England Journal of Medicine 370:520–532

  • Liu B, Havers F, Chen E, Yuan Z, Yuan H, Ou J, et al. (2014). Risk factors for Influenza A (H7N9) Disease - China, 2013. Clinical Infectious Diseases 59:787-794.

    Article  PubMed  Google Scholar 

  • Lohiniva A-L, Dueger E, Talaat M, Refaey S, Zaki A, Horton KC, et al. (2013). Poultry rearing and slaughtering practices in rural Egypt: an exploration of risk factors for H5N1 virus human transmission. Influenza and Other Respiratory Viruses 7:1251-1259.

    Article  PubMed  Google Scholar 

  • Minh PQ, Schauer B, Stevenson M, Jones G, Morris RS, and Noble A (2009). Association Between Human Cases and Poultry Outbreaks of Highly Pathogenic Avian Influenza in Vietnam From 2003 to 2007: A Nationwide Study. Transboundary and Emerging Diseases 56:311-320.

    Article  CAS  PubMed  Google Scholar 

  • Mounts AW, Kwong H, Izurieta HS, Ho YY, Au TK, Lee M, et al. (1999). Case-control study of risk factors for avian influenza A (H5N1) disease, Hong Kong, 1997. Journal of Infectious Diseases 180:505-508.

    Article  CAS  PubMed  Google Scholar 

  • Munoz O, De Nardi M, van der Muelen K, Van Reeth K, Koopmans M, Harris K, et al. (2015). Genetic adaptation of influenza A viruses in domestic animals and their potential role in interspecies transmission a literature review. Ecohealth.

  • Myers KP, Olsen CW, and Gray GC (2007). Cases of swine influenza in humans: A review of the literature. Clinical Infectious Diseases 44:1084-1088.

    Article  PubMed  PubMed Central  Google Scholar 

  • Olsen CW, Brammer L, Easterday BC, Arden N, Belay E, Baker I, et al. (2002). Serologic evidence of H1 swine influenza virus infection in swine farm residents and employees. Emerging Infectious Diseases 8:814-819.

    Article  PubMed  PubMed Central  Google Scholar 

  • Panahi S, Mosleh N, and Hasiri MA (2014). Evaluation of the transmission potential and infectivity of H9N2 avian influenza virus in dogs fed infected chicken carcasses. Bulgarian Journal of Veterinary Medicine 17:223-230.

    Google Scholar 

  • Ramirez-Martinez LA, Contreras-Luna M, Luz Jdl, Manjarrez ME, Rosete DP, Rivera-Benitez JF, et al. (2013). Evidence of transmission and risk factors for influenza A virus in household dogs and their owners. Influenza and Other Respiratory Viruses 7:1292-1296.

    Article  PubMed  PubMed Central  Google Scholar 

  • Reperant LA, Rimmelzwaan GF, and Kuiken T (2009). Avian influenza viruses in mammals. Revue Scientifique Et Technique-Office International Des Epizooties 28:137-159.

    Article  CAS  Google Scholar 

  • Smallman-Raynor M, and Cliff AD (2007). Avian influenza A (H5N1) age distribution in humans. Emerging Infectious Diseases 13:510-512.

    Article  PubMed  Google Scholar 

  • Songserm T, Amonsin A, Jam-On R, Sae-Heng N, Meemak N, Pariyothorn N, et al. (2006). Avian influenza H5N1 in naturally infected domestic cat. Emerging Infectious Diseases 12:681-683.

    Article  PubMed  PubMed Central  Google Scholar 

  • Suarez DL (2000). Evolution of avian influenza viruses. Veterinary Microbiology 74:15-27.

    Article  CAS  PubMed  Google Scholar 

  • Suarez DL (2010). Avian influenza: our current understanding. Animal Health Research Reviews 11 19-33.

    Article  PubMed  Google Scholar 

  • Suarez DL, Woolcock PR, Bermudez AJ, and Senne DA (2002). Isolation from turkey breeder hens of a reassortant H1N2 influenza virus with swine, human, and avian lineage genes. Avian Diseases 46:111-121.

    Article  CAS  PubMed  Google Scholar 

  • Sun LS, Wang LF, Ning ZY, Hong ML, Zheng Y, He SY, et al. (2014). Lack of Evidence of Avian-to-Cat Transmission of Avian H5 subtype Influenza Virus among Cats in Southern China. Pakistan Veterinary Journal 34:535-537.

    Google Scholar 

  • Thanawongnuwech R, Amonsin A, Tantilertcharoen R, Damrongwatanapokin S, Theamboonlers A, Payungporn S, et al. (2005). Probable tiger-to-tiger transmission of avian influenza H5N1. Emerging Infectious Diseases 11:699-701.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tong S, Zhu X, Li Y, Shi M, Zhang J, and Bourgeois M (2013). New World Bats Harbor Diverse Influenza A Viruses. PLoS Pathogens 9:e1003657.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tong S, Li Y, Rivailler P, Conrardy C, Alvarez Castillo DA, Chen L-M, et al. (2012). A distinct lineage of influenza A virus from bats. Proceedings of the National Academy of Sciences of the United States of America 109:4269-4274.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Tseng WC, Li HA, Huang WC, and Liang LH (2010). Potential number of human cases of H5N1 avian influenza in Egypt. Public Health 124:452-459.

    Article  PubMed  Google Scholar 

  • Van Kerkhove MD, Ly S, holl D, Guitian J, Mangtani P, Ghani AC, et al. (2008). Frequency and patterns of contact with domestic poultry and potential risk of H5N1 transmission to humans living in rural Cambodia. Influenza and Other Respiratory Viruses 2:155-163.

    Article  PubMed  PubMed Central  Google Scholar 

  • Van Reeth K (2007). Avian and swine influenza viruses: our current understanding of the zoonotic risk. Veterinary Research 38:243-260.

    Article  PubMed  Google Scholar 

  • Van Reeth K (2013). Influenza pandemics: does the greater threat come from pigs, not birds? Pig Journal 69:17-24.

    Google Scholar 

  • Van Reeth K, De Vleeschauwer A, Kyriakis CS, and Pensaert M (2007). Influenza in birds, pigs and humans: how strong is the species barrier? Journal of the Hellenic Veterinary Medical Society 58:208-219.

    Google Scholar 

  • Vong S, Ly S, Van Kerkhove MD, Achenbach J, Holl D, Buchy P, et al. (2009). Risk Factors Associated with Subclinical Human Infection with Avian Influenza A (H5N1) Virus-Cambodia, 2006. Journal of Infectious Diseases 199:1744-1752.

    Article  PubMed  Google Scholar 

  • Wang N, Zou W, Yang Y, Guo X, Hua Y, Zhang Q, et al. (2012). Complete genome sequence of an H10N5 avian influenza virus isolated from pigs in central China. Journal of Virology 86:13865-13866.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Wang XY, Chai CL, Li FD, He F, Yu Z, Wang XX, et al. (2015). Epidemiology of human infections with avian influenza A(H7N9) virus in the two waves before and after October 2013 in Zhejiang province, China. Epidemiology and Infection 143:1839-1845.

    Article  CAS  PubMed  Google Scholar 

  • Xin L, Bai T, Zhou JF, Chen YK, Li XD, Zhu WF, et al. (2015). Seropositivity for Avian Influenza H6 Virus among Humans, China. Emerging Infectious Diseases 21:1267-1269.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Yassine HM, Khatri M, Lee C-W, and Saif YM (2011). Potential role of viral surface glycoproteins in the replication of H3N2 triple reassortant influenza A viruses in swine and turkeys. Veterinary Microbiology 148:175-182.

    Article  CAS  PubMed  Google Scholar 

  • Yingst SL, M. D. Saad et al. (2006). Qinghai-like H5N1 from Domestic Cats, Northern Iraq. Emerging Infectious Diseases 12:1295-1297.

    Article  PubMed  PubMed Central  Google Scholar 

  • Yoon KJ, Schwartz K, Sun D, Zhang JQ, and Hildebrandt H (2012). Naturally occurring influenza A virus subtype H1N2 infection in a Midwest United States mink (Mustela vison) ranch. Journal of Veterinary Diagnostic Investigation 24:388-391.

    Article  PubMed  Google Scholar 

  • Zhang K, Zhang Z, Yu Z, Li L, Cheng K, Wang T, et al. (2013). Domestic cats and dogs are susceptible to H9N2 avian influenza virus. Virus Research 175:52-57.

    Article  CAS  PubMed  Google Scholar 

  • Zhou H, He S-y, Sun L, He H, Ji F, Sun Y, et al. (2015). Serological evidence of avian influenza virus and canine influenza virus infections among stray cats in live poultry markets, China. Veterinary Microbiology 175:369-373.

    Article  PubMed  Google Scholar 

  • Zhou L, Liao Q, Dong L, Huai Y, Bai T, Xiang N, et al. (2009). Risk Factors for Human Illness with Avian Influenza A (H5N1) Virus Infection in China. Journal of Infectious Diseases 199:1726-1734.

    Article  PubMed  PubMed Central  Google Scholar 

  • Zhou P, Zhu W, Gu H, Fu X, Wang L, Zheng Y, et al. (2014). Avian influenza H9N2 seroprevalence among swine farm residents in China. Journal of Medical Virology 86:597-600.

    Article  PubMed  Google Scholar 

  • Zhuang QY, Wang S, Wu M, Liu S, Jiang W, Hou GY, et al. (2013). Epidemiological and risk analysis of the H7N9 subtype influenza outbreak in China at its early stage. Chinese Science Bulletin 58:3183-3187.

    Article  CAS  Google Scholar 

  • Zohari S, Neimanis A, Härkönen T, Moraeus C, and JF. V (2014). Avian influenza A(H10N7) virus involvement in mass mortality of harbour seals (Phoca vitulina) in Sweden, March through October 2014. Eurosurveillance 19:20967.

    Article  PubMed  Google Scholar 

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Acknowledgements

This work was conducted within the framework of the FLURISK project, supported by the European Food Safety Authority. The sole responsibility of this review lies with the authors and the European Food Safety Authority shall not be considered responsible for any use that may be made of the information contained herein.

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Correspondence to Andrew C. Breed.

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Dennis J. Alexander: Retired from APHA, Weybridge.

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Harris, K.A., Freidl, G.S., Munoz, O.S. et al. Epidemiological Risk Factors for Animal Influenza A Viruses Overcoming Species Barriers. EcoHealth 14, 342–360 (2017). https://doi.org/10.1007/s10393-017-1244-y

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Keywords

  • Influenza
  • Avian influenza
  • Zoonosis
  • Epidemiology
  • Risk factor
  • Transmission