title: Evidence for H5 avian influenza infection in Zhejiang province, China, 2010-2012: a cross-sectional study.
abstract: BACKGROUND
  The first outbreak of H5N1 highly-pathogenic avian influenza (HPAI) virus associated with several human deaths occurred in 1997 in Hong-Kong, China. While H5N1 virus infection in poultry workers has been studied in some detail, little is known about the environmental risk factors of the H5 avian influenza virus infection in China.
  
  
  METHODS
  A cross-sectional study was performed to evaluate the environmental load of H5 viruses in poultry-contaminated environments and to explore potential risk factors associated with infection in poultry workers between October 2010 and March 2012. Serum and environmental samples were collected in Zhejiang province, China. The hemagglutination inhibition (HI) assay was used to analyze human sera for antibodies against H5N1 virus [A/Hubei/1/2010 (H5N1) and A/Anhui/1/2005 (H5N1)]. All participants were interviewed with a standardized questionnaire to collect information on exposure to poultry. H5 Avian influenza virus in the environmental samples was detected by real time RT-PCR.
  
  
  RESULTS
  One hundred and five of 3,453 environmental samples (3.0%) tested positive for H5 avian influenza virus. Fifty-five of 1,169 subjects (4.7%) tested seropositive for anti-H5N1 antibodies. A statistically significant difference in H5 virus detection rate was found among the different environments sampled (<0.001), with the highest showed in live bird markets (68.6%). Detection rate varied according to the source of samples, sewage (9.5%), drinking water (19.0%), feces (19.0%), cage surface (25.7%), and slaughtering chopping boards (15.2%), respectively. Direct or close contact with poultry (OR =5.20, 95% CI, 1.53-17.74) and breeding numerous poultry (OR =3.77, 95% CI, 1.72-8.73) were significantly associated with seroprevalence of antibodies to avian influenza virus A (H5N1).
  
  
  CONCLUSIONS
  The number of birds bred more than 1,000 and direct or close contact with poultry in the workplace or the environment would be a potential risk of H5N1 infection.
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: Lian-Hong
authors.initials: LH
authors.lastname: Li
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: Zhao
authors.initials: Z
authors.lastname: Yu
authors.affiliation: First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China.
authors.forename: Wen-Sen
authors.initials: WS
authors.lastname: Chen
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: She-Lan
authors.initials: SL
authors.lastname: Liu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: Ye
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: Yan-Jun
authors.initials: YJ
authors.lastname: Zhang
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: En-Fu
authors.initials: EF
authors.lastname: Chen
authors.affiliation: Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou 310051, China;
authors.forename: Jun-Fen
authors.initials: JF
authors.lastname: Lin
keywords: Avian influenza virus; environment; occupational exposure; risk factors