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Second Identified Human Infection With the Avian Influenza Virus H10N3: A Case Report
... The H10N3 subtype of avian influenza A virus has been circulating among waterfowl and poultry in East and South Asia for decades, with rare instances of human infection (Wisedchanwet et al., 2011). The first recorded human cases of Avian-Origin Influenza A (H10N3) virus occurred in Jiangsu, China, in April 2021 (Qi et al., 2022), followed by a second case reported in Zhejiang in June 2022 (Zhang et al., 2023). ...
... The symptoms observed in the patient infected with H10N3 in this case closely resemble those documented in the two previously known cases of H10N3 infection. Notably, all cases resulted in severe pneumonia in the affected patients (Qi et al., 2022;Zhang et al., 2023). ...
In recent years, the avian influenza virus has emerged as a significant threat to both human and public health. This study focuses on a patient infected with the H10N3 subtype of avian influenza virus, admitted to the Third People’s Hospital of Kunming City on March 6, 2024. Metagenomic RNA sequencing and polymerase chain reaction (PCR) analysis were conducted on the patient’s sputum, confirming the H10N3 infection. The patient presented severe pneumonia symptoms such as fever, expectoration, chest tightness, shortness of breath, and cough. Phylogenetic analysis of the Haemagglutinin (HA) and neuraminidase (NA) genes of the virus showed that the virus was most closely related to a case of human infection with the H10N3 subtype of avian influenza virus found in Zhejiang Province, China. Analysis of amino acid mutation sites identified four mutations potentially hazardous to human health. Consequently, this underscores the importance of continuous and vigilant monitoring of the dynamics surrounding the H10N3 subtype of avian influenza virus, utilizing advanced genomic surveillance techniques.
... In uenza A (H10N3) virus occurred in Jiangsu, China, in April 2021 8 , followed by a second case reported in Zhejiang in June 2022 9 . Importantly, no instances of human-to-human transmission were detected in either case. ...
... The symptoms observed in the patient infected with H10N3 in this case closely resemble those documented in the two previously known cases of H10N3 infection. Notably, all cases resulted in severe pneumonia in the affected patients 8, 9 . In light of our ndings, the identi cation of HA-Q226L, PB2-D701N, PA-S409N, and M2-S31N mutations in the protein of the Yunnan H10N3 virus strain underscores the potential for increased harm posed by H10N3 in humans. ...
In recent years, the avian influenza virus has emerged as a significant threat to both human and public health. Despite this, only two cases of human infection with the H10N3 strain have been documented. Here, we present the initial instance of human infection with avian influenza virus H10N3 in Yunnan Province, Southwest China. The patient, a previously healthy 51-year-old male, presented with recurrent fever peaking at 39℃, accompanied by symptoms such as cough, expectoration, chest tightness, and shortness of breath. Diagnosis revealed severe pneumonia, type I respiratory failure, and infection with avian influenza virus H10N3. Additionally, the patient experienced complications from Candida albicans and Staphylococcus epidermidis infections. Following treatment with appropriate antiviral drugs and antibiotics, the patient's condition improved. Molecular analysis of the viral strain identified four mutations potentially hazardous to human health. This underscores the importance of continuous and vigilant monitoring of the dynamics surrounding the H10N3 subtype of avian influenza virus.
... Кроме того, в другой китайской провинции, Юньнань, в 2024 г. отмечен третий в мире случай заболевания человека гриппом A(H10N3) [48] (первые два случая также зарегистрированы в КНР в 2021 и 2022 гг. [49]). Широкое распространение вирусов гриппа A(H10Nx), их частая реассортация с вирусами других подтипов, продолжающиеся случаи среди людей и тот факт, что они не подлежат уведомлению по стандартам Всемирной организации здоровья животных [50], требуют от научного сообщества проактивного реагирования. ...
The aim of the work was to analyze the circulation of the most epidemiologically significant variants of the avian influenza virus in the world and across Russia in 2024. The global situation on highly pathogenic avian influenza remained tense in 2024. The disease affected 68 countries, resulting in the death or culling of about 19 million poultry. In addition, there was a large number of influenza A(H5N1) virus detections in wild and domestic mammals, predominantly in the United States. Those included outbreaks on dairy farms that affected herds throughout the year, encompassing more than 900 dairy farms in 16 states by the year’s end and causing infection of 40 farm workers in four states. The A(H5N1) viruses detected in farm workers contained mammalian adaptation mutations. In total, more than 100 human infections with zoonotic variants of influenza virus were reported in 2024, with influenza A(H5N1) virus detected in 81 cases. Apart from outbreaks of A(H5N1), other influenza virus variants, such as A(H5N6), A(H5N8), A(H5N5), A(H5N2), were circulating worldwide. Outbreaks among poultry caused by different subtypes of influenza A(H7) virus were also reported in a number of countries. In Russia, the situation on highly pathogenic influenza virus in 2024 was less tense. All detected influenza A(H5N1) viruses belonged to clade 2.3.4.4b and were genetically similar to the vaccine strains recommended by WHO. Isolated strains were antigenically similar to a reference strain A/goose/Tyumen/359- 13/2021(H5N1), which had HA1 sequence identical to the vaccine strain A/Astrakhan/3212/2020(H5N8). In addition, an influenza A(H9N2) virus was isolated in 2024. The study of this strain showed that it belongs to the clade Y439 and does not contain mutations associated with increased pathogenicity and drug resistance.
... 11 Subsequently, the novel reassortant H10N8 AIV resulted in the first human infection in late 2013 and two more cases in early 2014 in Jiangxi Province, China; 12 all three patients developed severe pneumonia, and two of them died. Further, one human infection with novel H10N3 AIVs was first reported in Jiangsu Province, China, in 2021, 13 and the second confirmed human case was identified in Zhejiang Province in 2022; 14 both patients developed severe pneumonia but recovered after treatment. Moreover, almost all patients infected with H10N3/N8/N7 AIVs had direct or indirect exposure to live poultry or visited LPMs, 15 highlighting the risk of interspecies transmission from poultry to humans. ...
... 2025, 26,1977 2 of 15 H10N3 virus was first reported to infect humans in 2021 in China [15]. To date, four human cases have been documented globally, with the most recent case reported in Guangxi Zhuang Autonomous Region, China, in December 2024 [15][16][17]. Our previous studies have demonstrated that the novel H10N3 virus exhibits high affinity for human-type receptors, high pathogenicity in mice, and efficient transmission between mammals through respiratory droplets [5, 18,19]. ...
The novel H10N3 avian influenza virus (AIV) has infected four individuals since 2021 and caused severe respiratory damage, posing a significant threat to public health. However, its pathogenic mechanisms remain poorly understood. Our findings revealed that H10N3 infection induces severe lung damage and causes death in mice, even at low doses. The elevated levels of multiple pro-inflammatory factors in the bronchoalveolar lavage fluid were significantly increased during infection, displaying hallmarks of a cytokine storm. Transcriptome sequencing further revealed systematic activation of inflammation-related pathways, predicting that viral infection induces multiple forms of programmed cell death, including apoptosis, pyroptosis, and necroptosis. Protein-level validation showed that the activation of key cell death markers, including Caspase-3, GSDMD, and MLKL, significantly increased as the infection progressed, with their dynamic changes correlating strongly with the expression pattern of viral proteins. This study elucidates the central role of the synergistic effect between the cytokine storm and multiple cell death pathways in H10N3 pathogenesis. These findings not only advance our understanding of the pathogenic mechanisms of AIVs but also provide a critical theoretical basis for the development of targeted therapeutic strategies.
... This subtype is able to rapidly reassort with circulating poultry strains and goes undetected due to its low pathogenicity in chickens. In recent years, the occurrence of H10Ny subtype AIVs infecting humans has become more frequent, including subtypes H10N8 (2013) (16), H10N3 (2021) (5,17), and H10N5 (2023) (8), which now pose a newly recognized threat to public health security. The first reported human case of H10N3 infection occurred in Jiangsu, China, in 2021 (5). ...
Following two human infections with the H10N3 avian influenza virus (AIV) in 2021 and 2022, a third case was discovered in Yunnan, China, in 2024, raising concerns about the potential for future pandemics. Recent studies have indicated that novel H10N3 viruses are highly pathogenic in mice and can be transmitted between guinea pigs via respiratory droplets without prior adaptation. However, the biological characteristics of novel H10N3 in poultry have not been fully elucidated. Our findings revealed that H10 subtype AIVs are predominantly prevalent in waterfowl. Notably, H10N8 and H10N3 viruses that have infected humans were primarily isolated from chickens. For the first time, double basic hemagglutinin cleavage sites (motif PEIKQGR↓GL) were identified in novel H10N3 AIVs, which exhibit enhanced replication in chickens, and can be transmitted between chickens through direct contact and respiratory droplets. Animal experimental studies demonstrated that ducks are also susceptible to H10N3 viruses and that the virus is transmissible through direct contact, suggesting a greater risk of transmission and recombination. Serological studies conducted among poultry workers suggest that while the human population was largely naïve to H10N3 infection, sporadic and undetected human infections did occur, indicating a potential increasing trend. These data further emphasize the growing threat to public health posed by zoonotic H10N3 subtype AIVs.
IMPORTANCE
Exposure to poultry in live poultry markets (LPMs) is strongly associated with human infection with avian influenza viruses (AIVs), with chickens being the most common species found in these markets in China. The prevalence of AIVs in chickens, therefore, increases the risk of human infection. Notably, the main host of the novel H10N3 virus has shifted from waterfowl to chickens, and the virus can be transmitted between chickens via respiratory droplets, posing a potential risk of a pandemic within poultry populations. The novel H10N3 virus also remains sensitive to ducks and can be transmitted through direct contact, which means a greater risk of transmission and recombination. Significantly, the human population remains largely naïve to H10N3 infection, but sporadic seropositivity among poultry workers indicates previous exposure to H10 subtype AIVs. Therefore, a comprehensive surveillance of the novel H10N3 viruses in poultry is imperative. Effective control of the virus within poultry populations could significantly reduce the risk of emerging human infections.
... The influenza A(H10N3) virus, A/Jiangsu/428/ 2021/H10N3 (JS428), was isolated from the patient. In 2022, another human case of influenza A(H10N3) virus was reported in Zhejiang Province [17]. Both cases developed severe pneumonia after infection and were eventually discharged. ...
Subtype H10 viruses are known to infect humans in Africa, Oceania, and Asia. In 2021, 2022, and recently in April 2024, a novel H10N3 subtype avian influenza virus was found cause human infection with severe pneumonia. Herein, we comprehensively studied the phylogenetic evolution and biological characteristics of the newly emerged influenza A(H10N3) virus. We found that the human isolated H10N3 virus was generated in early 2019 in domestic poultry. The viruses bound to salic acid α2, 3 receptors, indicating their insufficient ability to infect humans. Although a low pathogenic avian influenza virus, the human isolated H10N3 virus exhibited robust pathogenicity in both BALB/c and C57BL/6 mice, with MLD50 1000 times higher than a homologous environmental isolate. The human isolated H10N3 also showed respiratory droplet transmissibility in ferrets. Considering the continuous circulation in avian populations and repeated transmission to humans, strengthened surveillance of H10 subtype viruses in poultry should be put into effect.
... Interestingly, the patient had not visited a live poultry market or interacted with poultry. Similarly, another case of LPAI-H10N3 infection in a patient was reported in China in June 2022 [3,22]. In January 2024, LPAI-H10N5 coinfection with seasonal human H3N2 virus was detected in a patient in China. ...
Background and Aim
Free-grazing duck (FGD) raising is a unique domestic duck production system that is widely practiced in several Asian countries, including Thailand. FGD is a significant reservoir for influenza A viruses (IAVs). In this study, we genetically characterized IAV-H10N6 and IAV-H10N7 isolated from avian influenza surveillance in FGDs in Thailand.
Materials and Methods
We collected 640 swab samples from 29 FGD flocks located in 6 provinces of Thailand. IAVs were isolated from swab samples using egg inoculation. Hemagglutination test-positive samples were then subjected to IAV detection. Viral RNA was subjected to IAV detection using real-time reverse-transcription polymerase chain reaction (rRT-PCR) specific to matrix (M) gene. IAV subtypes were identified using the RT-PCR assay specific to all hemagglutinin and neuraminidase subtypes. Whole-genome sequencing of IAVs was performed to genetically characterize IAV-H10N6 and IAV-H10N7.
Results
Our results showed that 41 (6.41%) samples tested positive for IAV using rRT-PCR specific to the M gene. Among these, only two IAVs were subtypes as IAV-H10N6 and IAV-H10N7 and were subjected to whole-genome sequencing. IAV-H10N6 and IAV-H10N7 belonged to the Eurasian lineage and did not show any evidence of reassortment from the North American lineage. The viruses exhibited low-pathogenic characteristics and preferred binding to avian-type receptors. Genetic analysis revealed no mutations in PB2 and M genes, unlike human IAV-H10N3 and IAV-H10N8, which exhibited increased virulence in mammals.
Conclusion
IAV-H10N6 and IAV-H10N7 viruses have less potential as zoonotic viruses. However, IAV in FGDs should be monitored for novel reassortant or zoonotic viruses. This study provides information on the genetic characteristics and diversity of IAV-H10N6 and IAV-H10N7 that are circulated in FGDs in Thailand.
... Our report meticulously describes the first case of human-infected avian influenza H10N3 virus since the end of the COVID-19 pandemic. Similar to the onset of the first two globally reported cases [5,8], human infection with the H10N3 virus initially presents with common symptoms of respiratory disease, such as fever, cough, shortness of breath, and fatigue. These symptoms could be easily overlooked, leading to delayed treatment. ...
Background
On March 16th 2024, the first case of Human infection with avian influenza H10N3 since the end of the global COVID-19 Pandemic was reported in Kunming, China. To enhance comprehension of the source of infection and risk factors of the H10N3 virus infection, this case report summarizes the clinical features, epidemiological investigation, and laboratory test results. Provides recommendations for the prevention and control of Human infection with avian influenza H10N3.
Case presentation
A 51-year-old male with a history of COVID-19 infection and a smoking habit of 30 years, worked in livestock breeding and was exposed to sick and dead poultry before falling ill with fever and chills on 28th February 2024. A week later, he was diagnosed with severe pneumonia, influenza, and respiratory failure by the Third People's Hospital of Kunming(KM-TPH). He was discharged on 17th April and none of his 6 close contacts showed any symptoms of illness. Environmental samples taken from the epidemic spot revealed that peacock feces tested positive for avian influenza sub-type H9 and waterfowl specimens showed positive results for avian influenza sub-type H5. Gene sequencing conducted on positive specimens from the patient's respiratory tract by the Chinese Centre for Disease Control and Prevention (CCDC) showed a high degree of similarity (98.6–99.5%) with the strain responsible for the second global case of human infected with H10N3 (reported from Zhejiang, China 2022).
Conclusions
According to the available epidemiological information, there is limited evidence to suggest that H10N3 viruses are excessively lethal. However, adaptive site mutations have been observed in the H10N3 isoform of mammals. While it is unlikely that the H10N3 virus will spread among humans, the possibility of additional cases cannot be entirely ruled out. Symptoms of human infection with H10N3 avian influenza are similar to those of common respiratory infections, which may result in them being overlooked during initial clinical consultations. Therefore, it is essential to improve surveillance of the H10 sub-type of avian influenza and to increase the awareness of hospital-related workers of cases of pneumonia of unknown origin.
... Other LPAI viruses, such as the novel avian influenza A(H10N3) virus, have been frequently isolated in poultry in China in recent years [14,15] and have caused zoonotic infection in at least three confirmed human cases [16,17]. The first recorded human case of influenza A(H10N3) virus infection was a 41-year-old man with a medical history of hypertension and diabetes, who visited a live-poultry market (LPM) in Jiangsu Province, China, one week prior to becoming ill. ...
The H10 subtype avian influenza virus (AIV), an important zoonotic pathogen, is widely prevalent in host species (wild fowl) and continues to infect humans, imposing a huge threat to public health. Thus, the H10 subtype AIV is considered a potential pandemic strain and has drawn the attention of scholars worldwide. Therefore, a fast, sensitive, and economical detection method for H10 subtype AIV needs to be developed for the surveillance and prevention of this infection. Quantum dot fluorescent microsphere‐based immunochromatographic strip (QDFM‐ICS) has a great application prospect in the rapid detection of the virus. In this study, two monoclonal antibodies (1E8 and 2G9) were generated by immunizing mice with the purified hemagglutinin (HA) protein, and QDFM‐ICS was designed to detect the H10 subtype influenza antigen. We illustrated that the limit of detection (LOD) of QDFM‐ICS for the HA titer and purified HA protein of the H10 subtype AIV was 0.125 per 80 μL of the sample and 4 ng/mL, respectively. The specificity of QDFM‐ICS was 100%, which indicated that mAb 2G9 specifically bound to the H10 subtype influenza antigen without cross‐reacting with other subtype AIVs. The method has good reproducibility. Additionally, the results of preliminary tests on clinical samples showed high consistency between QDFM‐ICS and real‐time reverse transcription‐polymerase chain reaction. The QDFM‐ICS has simple analysis steps and can produce objective results within 15 min. Hence, it can be suggested that QDFM‐ICS can be used to monitor and prevent the infection caused by H10 subtype AIVs.
What is known about this topic?
H10 avian influenza viruses circulate in wild birds and can reassort with other subtypes. H10N8 and H10N3 have previously caused sporadic human infections in China.
What is added by this report?
This report documents the first human case of co-infection with avian-origin H10N5 and seasonal H3N2 influenza viruses. Epidemiological investigations identified H10N5 in environmental samples linked to the patient, but no transmission to close contacts occurred.
What are the implications for public health practice?
Enhanced surveillance of avian influenza in live poultry markets and poultry populations is crucial for thoroughly characterizing the epidemiology, transmission, and pathogenesis of H10N5 viruses. Strengthening assessments of outbreak control measures is essential to guide effective management.
Background:
On March 16th 2024, the first case of Human infection with avian influenza H10N3 since the end of the global COVID-19 Pandemic was reported in Kunming, China. To enhance comprehension of the source of infection and risk factors of the H10N3 virus infection, this case report summarizes the clinical features, epidemiological investigation, and laboratory test results. Provides recommendations for the prevention and control of Human infection with avian influenza H10N3.
Case presentation:
A 51-year-old male with a history of COVID-19 infection and a smoking habit of 30 years, worked in livestock breeding and was exposed to sick and dead poultry before falling ill with fever and chills on 28th February 2024. A week later, he was diagnosed with severe pneumonia, influenza, and respiratory failure by the Third People's Hospital of Kunming(KM-TPH). He was discharged on 17th April and none of his 6 close contacts showed any symptoms of illness. Environmental samples taken from the epidemic spot revealed that peacock feces tested positive for avian influenza sub-type H9 and waterfowl specimens showed positive results for avian influenza sub-type H5. Gene sequencing conducted on positive specimens from the patient's respiratory tract by the Chinese Centre for Disease Control and Prevention (CCDC) showed a high degree of similarity (98.6-99.5%) with the strain responsible for the second global case of human infected with H10N3 (reported from Zhejiang, China 2022).
Conclusions:
According to the available epidemiological information, there is limited evidence to suggest that H10N3 viruses are excessively lethal. However, adaptive site mutations have been observed in the H10N3 isoform of mammals. While it is unlikely that the H10N3 virus will spread among humans, the possibility of additional cases cannot be entirely ruled out. Symptoms of human infection with H10N3 avian influenza are similar to those of common respiratory infections, which may result in them being overlooked during initial clinical consultations. Therefore, it is essential to improve surveillance of the H10 sub-type of avian influenza and to increase the awareness of hospital-related workers of cases of pneumonia of unknown origin.
In 1918, a strain of influenza A virus caused a human pandemic resulting in the deaths of 50 million people. A century later, with the advent of sequencing technology and corresponding phylogenetic methods, we know much more about the origins, evolution and epidemiology of influenza epidemics. Here we review the history of avian influenza viruses through the lens of their genetic makeup: from their relationship to human pandemic viruses, starting with the 1918 H1N1 strain, through to the highly pathogenic epidemics in birds and zoonoses up to 2018. We describe the genesis of novel influenza A virus strains by reassortment and evolution in wild and domestic bird populations, as well as the role of wild bird migration in their long-range spread. The emergence of highly pathogenic avian influenza viruses, and the zoonotic incursions of avian H5 and H7 viruses into humans over the last couple of decades are also described. The threat of a new avian influenza virus causing a human pandemic is still present today, although control in domestic avian populations can minimize the risk to human health.
This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.
Pandemic influenza is a constant global threat to human health. In particular, the pandemic potential of novel avian influenza viruses such as the H10N7 and H10N8 avian strains, which recently managed to cross the species barrier from birds to humans, are always of great concern as we are unlikely to have any prior immunity. Human and avian isolates of H10 influenza display the ability to rapidly adapt to replication in mammalian hosts. Fortunately, so far there is no evidence of efficient human-to-human transmission of any avian influenza virus. This review examines all of the available clinical and biological data for H10 influenza viruses with an emphasis on hemagglutinin as it is a major viral antigen that determines host range and immunity. The available glycan binding data on the influenza H10 hemagglutinin are discussed in a structure-recognition perspective. Importantly, this review raises the question of whether the emerging novel avian H10 influenza viruses truly represents a threat to global health that warrants close monitoring.
Human infections with different avian influenza viruses-eg, H5N1, H9N2, and H7N9-have raised concerns about pandemic potential worldwide. We report the first human infection with a novel reassortant avian influenza A H10N8 virus.
We obtained and analysed clinical, epidemiological, and virological data from a patient from Nanchang City, China. Tracheal aspirate specimens were tested for influenza virus and other possible pathogens by RT-PCR, viral culture, and sequence analyses. A maximum likelihood phylogenetic tree was constructed.
A woman aged 73 years presented with fever and was admitted to hospital on Nov 30, 2013. She developed multiple organ failure and died 9 days after illness onset. A novel reassortant avian influenza A H10N8 virus was isolated from the tracheal aspirate specimen obtained from the patient 7 days after onset of illness. Sequence analyses revealed that all the genes of the virus were of avian origin, with six internal genes from avian influenza A H9N2 viruses. The aminoacid motif GlnSerGly at residues 226-228 of the haemagglutinin protein indicated avian-like receptor binding preference. A mixture of glutamic acid and lysine at residue 627 in PB2 protein-which is associated with mammalian adaptation-was detected in the original tracheal aspirate samples. The virus was sensitive to neuraminidase inhibitors. Sputum and blood cultures and deep sequencing analysis indicated no co-infection with bacteria or fungi. Epidemiological investigation established that the patient had visited a live poultry market 4 days before illness onset.
The novel reassortant H10N8 virus obtained is distinct from previously reported H10N8 viruses. The virus caused human infection and could have been associated with the death of a patient.
Emergency Research Project on human infection with avian influenza H7N9 virus, the National Basic Research Program of China, and the National Mega-projects for Infectious Diseases.