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Interpretation of molecular detection of avian influenza A virus in respiratory specimens collected from live bird market workers in Dhaka, Bangladesh: infection or contamination?
Hassan, Md Zakiul; Sturm-Ramirez, Katharine; Islam, Md Saiful; Afreen, Sadia; Rahman, Mohammed Ziaur; Kafi, Mohammad Abdullah Heel; Chowdhury, Sukanta; Khan, Salah Uddin; Rahman, Mustafizur; Nasreen, Sharifa; Davis, C. Todd; Levine, Min Z.; Rahman, Mahmudur; Luby, Stephen P.; Azziz-Baumgartner, Eduardo; Iuliano, A.D.; Uyeki, Timothy M.; Gurley, Emily S.
Journal Title
International Journal of Infectious Diseases
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2023-11
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136
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22
Publication End
28
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Abstract
Objectives: Interpreting real-time reverse transcription-polymerase chain reaction (rRT-PCR) results for human avian influenza A virus (AIV) detection in contaminated settings like live bird markets (LBMs) without serology or viral culture poses a challenge.
Methods: During February-March 2012 and November 2012-February 2013, we screened workers at nine LBMs in Dhaka, Bangladesh, to confirm molecular detections of AIV RNA in respiratory specimens with serology. We tested nasopharyngeal (NP) and throat swabs from workers with influenza-like illness (ILI) and NP, throat, and arm swabs from asymptomatic workers for influenza virus by rRT-PCR and sera for seroconversion and antibodies against HPAI A(H5N1) and A(H9N2) viruses.
Results: Among 1273 ILI cases, 34 (2.6%) had A(H5), 56 (4%) had A(H9), and six (0.4%) had both A(H5) and A(H9) detected by rRT-PCR. Of 192 asymptomatic workers, A(H5) was detected in eight (4%) NP and 38 (20%) arm swabs. Of 28 ILI cases with A(H5) or A(H9) detected, none had evidence of seroconversion, but one (3.5%) and 12 (43%) were seropositive for A(H5) and A(H9), respectively.
Conclusion: Detection of AIV RNA in respiratory specimens from symptomatic and asymptomatic LBM workers without evidence of seroconversion or virus isolation suggests environmental contamination, emphasizing caution in interpreting rRT-PCR results in high viral load settings.
Citation
Hassan MZ, Sturm-Ramirez K, Islam MS, Afreen S, Rahman MZ, Kafi MAH, Chowdhury S, Khan SU, Rahman M, Nasreen S, Davis CT, Levine MZ, Rahman M, Luby SP, Azziz-Baumgartner E, Iuliano AD, Uyeki TM, Gurley ES. Interpretation of molecular detection of avian influenza A virus in respiratory specimens collected from live bird market workers in Dhaka, Bangladesh: infection or contamination? Int J Infect Dis. 2023 Nov;136:22-28. doi: 10.1016/j.ijid.2023.08.020. Epub 2023 Aug 29. PMID: 37652093.