Rare bird flu makes the leap to humans: Is this the start of a new pandemic?

The same day Dr Ashley Bloomfield warned Kiwis the COVID-19 pandemic probably isn't even halfway done, China announced the first-ever case of a rare strain of bird flu infecting a human being

A 41-year-old man in the eastern province of Jiangsu fell ill in late April, a month later being diagnosed with H10N3 - an avian influenza virus that until now had never been seen in people.

The virus, a member of the influenza A family, is incredibly rare even in birds. First discovered in Hong Kong in 1979, only 160 cases have been reported. 

"They have the propensity to - as the name suggests - infect birds and cause influenza-like illness in birds, and every now and again there's what we call a spillover event," Massey University professor of veterinary public health Jackie Benschop told Newshub.

China is also where SARS-CoV-2, the virus behind the COVID-19 pandemic, emerged; it's also believed to have originated in an animal, likely a bat, before making the leap to humans some time in 2019. It's since killed at least 3.7 million people, with evidence the true death toll could be at least twice that. 

News that another zoonotic disease could be on the loose made headlines worldwide. The World Health Organization was quick to note "there is no indication of human-to-human transmission" at this time - but that's also what the agency said in the early days of the COVID-19 outbreak.

But unlike the SARS family, of which SARS-CoV-2 is just the second, scientists have seen a number of avian flu viruses infect humans before. 

"Given the reports, it seems very unlikely that this new H10N3 case is going to lead to a pandemic," said David Hayman, a doctoral supervisor at Massey's School of Veterinary Science.

"However, it is a reminder that there are many different viruses in nature and that people are infected by them frequently. The difficulty is it is hard to predict which new ones will continue to spread among people."

Avian flu viruses have made a number of jumps to humans in the past 20 years. The deadliest, to humans at least, is H5N1, which made the leap in 1997. While there have been only about 861 recorded cases, more than half of them died. Luckily, after more than two decades, H5N1 hasn't evolved the ability to transmit from person-to-person easily. It prefers to bind to cells found in birds' respiratory tracts that humans don't have; instead infecting cells in structures deep in our lungs, so aren't easily coughed or sneezed out. 

Ben Cowling, professor at the School of Public Health at the University of Hong Kong, told Reuters it wouldn't take much for H10N3 to evolve the ability to spread from person-to-person. Dr Benschop told Newshub the virus has a short genome which is highly segmented, making it "highly plastic, a real changeling", able to change its genetic code through a process called 'reassortment'

Of particular concern would be if H10N3 infected a person who already had a normal human influenza virus infection.

"These viruses, they use your own body cells to reproduce. If they happen to be in the same cell at the same time there could be reassortment with other viruses, or there could be mutations themselves. They're just not stable. They could either swap or they could add [genes]."

A worst-case scenario would be H10N3 taking on genes from a human flu virus that allows it to "be carried high up in the respiratory tract, up in the high part of your throat or your windpipe", Dr Benschop said, making it easily transmissible via coughs, sneezes or - like COVID-19 - even just breathing

H10N3 doesn't cause severe disease in poultry, which Dr Benschop means it's unlikely to pose the same mortality or morbidity concerns as COVID-19. The latter's mortality rate remains a mystery, but it's at least 10 times higher than typical influenza, and around half of patients who develop serious illness go on to suffer long-term effects. 

"There are both low and high pathogenic variants of the avian influenza virus. Generally the H1 or the H7 are highly pathogenic in poultry, and they've been quite nasty in people. There's always a possibility for one that's lowly pathogenic in poultry to mutate... but I think there is normally more concern when it's highly pathogenic in poultry, and this one is not the case."

The fact the case was detected, despite its rarity in birds, is a "really positive thing", she says.

"All we can act on is what's being reported. When something's reported... there's actually a surveillance system. People are reporting these things."

But there's still a chance others have been infected without realising it wasn't just a normal flu. 

"A reported case doesn't necessarily mean the first case - it's the first reported case."

"We need good surveillance and health care systems and to try to capture these events early to stop them spreading and to try to reduce the frequency of these events occurring in the first place," said Dr Hayman.

"This prevention includes practical things like biosecurity, but if we really want to reduce these events we should also look at more complex solutions like reducing our encroachment into spaces where wildlife live."

Dr Hayman recently contributed to a paper which pinpointed China as the likely source of the next zoonotic pandemic, citing its growing demand for meat, and intensive livestock practices, which involve keeping "a large number of animals - often immunosuppressed, with low genetic diversity and in poor conditions - in close proximity to one another".

Dr Benschop in the past looked into the deadly H5N1 strain, including looking at lots of pictures of the nation's notorious wet markets.

"There might be cases of birds on top of each other, perhaps quite near to other animals, mammals, and perhaps - because of the stress of transport - there's a lot of juices flowing around, a lot of droplets, the animals are coughing and sneezing and carrying on. I think it's a wee bit of a viral melting pot, right? ... 

"Anywhere where there's humans and animals mixing, or animals and animals mixing, one needs to be cautious."

The current flu vaccines would likely offer little cross-protection against avian influenza viruses, she said, but the usual measures - washing hands, sanitation, et cetera - would help keep it at bay. But that doesn't mean you shouldn't bother getting vaccinated anyway. 

"If there's anything going around, if you're otherwise vaccinated against everything else, then you've got a better chance of being well."