05:07am Friday 03 April 2020

Estimates reveal low population immunity to new bird flu virus H7N9 in humans

The study used a new, high-throughput method that allows blood samples to be analysed for antibodies to multiple human and animal influenza viruses at the same time and is easier to standardise than previous techniques. However, the assay is yet to be validated clinically for the H7N9 virus, and the researchers caution that the results must be interpreted with care.

Since the first case of H7N9 infection in humans was reported in February 2013, there have been 131 confirmed cases and 36 deaths, all in China apart from one case in Taiwan. All of the infections seem to have come from infected poultry and there is no evidence of sustained transmission between people.

One of the first key pieces of information that officials need when considering how best to respond to the threat of a pandemic is how much, if any, immunity the human population has to this virus. This helps to predict where the virus is likely to affect first and how likely it is to spread further. Having this knowledge also helps to understand the risks of severe infection, as well as helping to target protective measures such as where to direct antiviral medication.

Researchers at the Wellcome Trust Oxford University Clinical Research Unit (OUCRU) in Vietnam tested 1723 blood samples collected in southern Vietnam for the presence of antibodies to five different bird flu viruses, including one from the H7 subtype. The presence of antibodies would be an indication of past exposure to these particular strains of flu. They used a new technique, developed by their research collaborators at the National Institute of Public Health of the Netherlands, which is faster and easier to use than previous methods.

The results reveal that although there were more antibodies to the H7 subtype of flu virus than that to any of the H5 subtypes tested, antibodies to all five bird flu viruses were much rarer than those to human flu viruses. This suggests that people living in this particular area of Vietnam have had very little or no exposure to H7, similar to other bird flu viruses. As this population of people would be expected to be among the first to be affected in the event of a pandemic, these findings have important implications for pandemic preparedness plans in this area.

Dr Maciej Boni, a Sir Henry Dale Fellow at the OUCRU and first author of the study, explains: “H7N9 is a virus that until now has only infected birds so it’s not surprising that we don’t find much evidence of humans having been exposed to it. It is reassuring that in Vietnam we don’t see any evidence that the current outbreaks represent a tip-of-the iceberg observation of widespread H7N9 infection in people. On the other hand, the low antibody levels indicate that there is likely to be very little immunity to this virus.”

Around half of the samples were taken from an urban environment, Ho Chi Minh City, and half from a rural area, the nearby Khanh Hoa province. The team found no difference in the level of immunity to bird flu viruses between these two populations, even though people living in rural areas are more likely to live in close proximity to poultry.

“It has been suggested that people who live in closer proximity to chickens and other birds will have higher levels of immunity to bird flu viruses simply because their exposure is likely to be greater. However we find no evidence for this. Our findings would suggest that both rural and urban populations should be treated the same when considering how best to respond to the threat of an outbreak,” added Dr Boni.

Professor Jeremy Farrar, Director of the Wellcome Trust Major Overseas Programme in Vietnam and the OUCRU Hospital for Tropical Diseases, explains: “This is the first study to give us information about the level of antibodies and potentially human immunity to this new bird flu virus, H7N9 in the region. But we need to interpret the findings cautiously; these assays are relatively new and we need to understand how they correspond to existing assays and how they reflect past infection and true human immunity.

“We know that antibodies are very important for immunity to other flu viruses but at this stage, we still don’t know what level of antibody measured using this assay would provide protection against this novel strain. Further studies will be needed to understand the clinical relevance of these new assays, how they compare with classic techniques and what the apparent absence of antibodies to these viruses in the human population means. However these new techniques do allow for much higher throughput of samples, ease of use and once validated may allow much more rapid assessment of the spread of infection and levels of population immunity than do traditional assays.”

The study, which was carried out in collaboration with scientists at the National Institute for Public Health and the Environment (RIVM) in the Netherlands, is published online this week in the Journal of Infectious Diseases.

Professor Marion Koopmans, who is Head of Virology at the RIVM and senior author of the study, said: “We developed this technique exactly to be used in the current situation: we wanted a standardised test that allowed us to rapidly compare antibodies to the new virus with those to influenza viruses that we already know are common in people.

“The level of immunity to a new virus is one of the important questions during any emerging disease outbreak. We need only one drop of blood, so that tests can also be run when only small sample volumes are available, for instance when testing children. For outbreak investigations, testing of animals may be needed, and we are currently working on that. To do the clinical validation studies, we need blood samples from patients (and animals) with confirmed H7N9, and we hope to be able to do that soon through collaborations with other groups working on H7N9.”

Image: A representation of the influenza virus. Credit: Anna Tanczos/Wellcome Images.



Jen Middleton
Senior Media Officer, Wellcome Trust
020 7611 7262
[email protected]


Notes to Editors


Boni M et al. Population level antibody estimates to novel influenza A/H7N9. Journal of Infectious Diseases 17 May 2013 [epub].


About the Wellcome Trust
The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in human and animal health. It supports the brightest minds in biomedical research and the medical humanities. The Trust’s breadth of support includes public engagement, education and the application of research to improve health. It is independent of both political and commercial interests.


About the Wellcome Trust Oxford University Clinical Research Unit
The Oxford University Clinical Research Unit (OUCRU-VN) in Vietnam. Established in 1991 with support from the Hospital for Tropical Diseases (HTD) in Ho Chi Minh City, the Health Services of Ho Chi Minh City and the Wellcome Trust, OUCRU-VN has developed strong links not only with HTD, but also other hospitals in Ho Chi Minh City, Hanoi and other regions of Vietnam.


About the University of Oxford’s Medical Sciences Division
The University of Oxford’s Medical Sciences Division is one of the largest biomedical research centres in Europe, with over 2,500 people involved in research and more than 2,800 students. The University is rated the best in the world for medicine, and it is home to the UK’s top-ranked medical school.




From the genetic and molecular basis of disease to the latest advances in neuroscience, Oxford is at the forefront of medical research. It has one of the largest clinical trial portfolios in the UK and great expertise in taking discoveries from the lab into the clinic. Partnerships with the local NHS Trusts enable patients to benefit from close links between medical research and healthcare delivery.




A great strength of Oxford medicine is its long-standing network of clinical research units in Asia and Africa, enabling world-leading research on the most pressing global health challenges such as malaria, TB, HIV/AIDS and flu. Oxford is also renowned for its large-scale studies which examine the role of factors such as smoking, alcohol and diet on cancer, heart disease and other conditions.

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