title: Global epidemiology of avian influenza A H5N1 virus infection in humans, 1997-2015: a systematic review of individual case data.
abstract: Avian influenza A H5N1 viruses have caused many, typically severe, human infections since the first human case was reported in 1997. However, no comprehensive epidemiological analysis of global human cases of H5N1 from 1997 to 2015 exists. Moreover, few studies have examined in detail the changing epidemiology of human H5N1 cases in Egypt, especially given the outbreaks since November, 2014, which have the highest number of cases ever reported worldwide in a similar period. Data on individual patients were collated from different sources using a systematic approach to describe the global epidemiology of 907 human H5N1 cases between May, 1997, and April, 2015. The number of affected countries rose between 2003 and 2008, with expansion from east and southeast Asia, then to west Asia and Africa. Most cases (67·2%) occurred from December to March, and the overall case-fatality risk was 483 (53·5%) of 903 cases which varied across geographical regions. Although the incidence in Egypt has increased dramatically since November, 2014, compared with the cases beforehand, there were no significant differences in the fatality risk, history of exposure to poultry, history of patient contact, and time from onset to hospital admission in the recent cases.
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; Department of Geography and Environment, University of Southampton, Southampton, UK; Flowminder Foundation, Stockholm, Sweden.
authors.forename: Shengjie
authors.initials: S
authors.lastname: Lai
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Qin
authors.affiliation: WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Cowling
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Ren
authors.affiliation: Department of Geography and Environment, University of Southampton, Southampton, UK.
authors.forename: Nicola A
authors.initials: NA
authors.lastname: Wardrop
authors.affiliation: Biological Control and Spatial Ecology, Université Libre de Bruxelles, Brussels, Belgium; Fonds National de la Recherche Scientifique, Brussels, Belgium.
authors.forename: Marius
authors.initials: M
authors.lastname: Gilbert
authors.affiliation: WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Tim K
authors.initials: TK
authors.lastname: Tsang
authors.affiliation: WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Wu
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Luzhao
authors.initials: L
authors.lastname: Feng
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Jiang
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Zhibin
authors.initials: Z
authors.lastname: Peng
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Jiandong
authors.initials: J
authors.lastname: Zheng
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Qiaohong
authors.initials: Q
authors.lastname: Liao
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: Sa
authors.initials: S
authors.lastname: Li
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Singapore Infectious Disease Initiative, Singapore.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Horby
authors.affiliation: Oxford University Clinical Research Unit, Wellcome Trust Major Overseas Programme, Ho Chi Minh City, Vietnam; Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; Singapore Infectious Disease Initiative, Singapore; International Severe Acute Respiratory and Emerging Infection Consortium, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Farrar
authors.affiliation: CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; Chinese Center for Disease Control and Prevention, Beijing, China.
authors.forename: George F
authors.initials: GF
authors.lastname: Gao
authors.affiliation: Department of Geography and Environment, University of Southampton, Southampton, UK; Flowminder Foundation, Stockholm, Sweden; Fogarty International Center, National Institutes of Health, Bethesda, MD, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Tatem
authors.affiliation: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China; School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. Electronic address: cfetpyhj@vip.sina.com.
authors.forename: Hongjie
authors.initials: H
authors.lastname: Yu
mesh_terms: D000818:Animals; D004196:Disease Outbreaks; D014943:Global Health; D006801:Humans; D015994:Incidence; D053124:Influenza A Virus, H5N1 Subtype / Q000472:pathogenicity; D005585:Influenza in Birds / Q000453:epidemiology* / Q000635:transmission; D007251:Influenza, Human / Q000453:epidemiology*; D011200:Poultry / Q000821:virology