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lli of Istituto Superiore di Sanit?in Rome and colleagues, noted that their work provides the first serologic evidence of transmission of low pathogenic strains of avian influenza virus to humans during an outbreak in domestic poultry. Previous reports of human infection in Asia, Canada, and the Netherlands have been associated, in contrast, with highly pathogenic strains. The investigators emphasized that their study probably underestimates the real infection rate of the two strains among exposed individuals, since blood samples were considered positive only if they repeatedly produced unequivocal positive results using several different serologic techniques. They commented, however, that very sensitive serologic techniques such as those developed in the study provide an efficient tool for preventing or controlling the spread of avian flu to humans.

The authors say their findings highlight the importance of improving disease surveillance not only during outbreaks of highly pathogenic avian flu, but also when less pathogenic strains are circulating. To forestall genetic exchange between human and avian strains, as in mixed infections, they emphasized that poultry workers should be systematically vaccinated, pointing out that such workers are identified as high-risk and included in the annual Italian vaccination campaign.

In an accompanying editorial, Frederick Hayden, MD, of the University of Virginia and Alice Croisier, MD, of the World Health Organization concluded, "The transmissibility of avian viruses may increase as the viruses adapt to humans. In affected countries, public education about simple precautionary measures for food preparation, poultry handling, and avoidance of contaminated water are essential until specific prevention measures such as vaccines become available."


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