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Incidence of asymptomatic human influenza A(H5N1) virus infection

When virologists Fouchier and Kawaoka were isolating avian influenza H5N1 viruses that could transmit among ferrets by aerosol, there was consternation from some quarters that such viruses might escape from the laboratory and cause a pandemic in humans. Part of the fear came from the fact that the case fatality ratio for human infections with the H5N1 virus exceeds 50%. This number could be substantially higher than the lethality ratio, which is the number of symptomatic cases divided by the total number of infections. Divining the latter number has been difficult. Results of a meta-analysis published in 2012 suggest that H5N1 seropositivity approaches 1-2% in certain populations. Others have concluded that these studies are flawed, clouded by false positives and cross-reacting antigens. Recently two additional studies have been published that contribute to this discussion.

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