<table><tbody><tr><td></td><td></td><td>Amur leopard (Panthera pardus)</td><td>USA</td><td>2021-2022</td><td>(USDA, online)</td></tr><tr><td></td><td>Procyonidae</td><td>Raccoon (Procyon lotor)</td><td>USA</td><td>2021-2022</td><td>(WOAH, online-b)</td></tr><tr><td></td><td>Mephitidae</td><td>Skunks (Mephitis mephitis)</td><td>Canada; USA</td><td>2021-2022; 2022-2023</td><td>(CTV News, online; USDA, online; WOAH, online-b)</td></tr><tr><td></td><td>Phocidae</td><td>Grey seals (Halichoerus grypus)</td><td>USA; Canada</td><td>2021-2022</td><td>(AMMI, 2022; WOAH, online-b)</td></tr><tr><td></td><td></td><td>Harbour seals (Phoca vitulina)</td><td>USA; Canada</td><td>2021-2022</td><td>(WOAH, online-b)</td></tr><tr><td></td><td>Ursidae</td><td>American black bear (Ursus americanus)</td><td>Canada</td><td>2021-2022; 2022-2023</td><td>(Healthy Wildlife, online; KTOO, online; WOAH, online-b)</td></tr><tr><td></td><td></td><td>Brown bear (Ursus arctos)</td><td>USA</td><td>2022-2023</td><td>(Kiniradio, online)</td></tr><tr><td>Artiodactyla</td><td>Suidae</td><td>Domestic pigs (Sus scrofa), serological detection<sup>a</sup></td><td>Italy</td><td>2021-2022</td><td>EURL</td></tr><tr><td>Didelphimorphia</td><td>Dedelphidae</td><td>Virginia opossum (Didelphis virginiana)</td><td>USA</td><td>2021-2022; 2022-2023</td><td>(USDA, online; WOAH, online-b)</td></tr><tr><td rowspan="2">Cetacea</td><td>Phocoenidae</td><td>Porpoise (Phocoena phocoena)</td><td>Sweden</td><td>2021-2022</td><td>(SVA, online-a)</td></tr><tr><td>Delphinidae</td><td>Bottlenose dolphin (Tursiops truncatus)</td><td>USA</td><td>2021-2022</td><td>(UFHealth, online; WOAH, online-b)</td></tr><tr><td></td><td></td><td>White-sided dolphin (Lagenorhynchus acutus)</td><td>Canada</td><td>2022-2023</td><td>(Avian Flu Diary, online-a)</td></tr></tbody></table>

(a) Serological detection in a HPAI outbreak in a backyard poultry
<table><tbody><tr><td></td><td></td><td>Amur leopard (Panthera pardus)</td><td>USA</td><td>2021-2022</td><td>(USDA, online)</td></tr><tr><td></td><td>Procyonidae</td><td>Raccoon (Procyon lotor)</td><td>USA</td><td>2021-2022</td><td>(WOAH, online-b)</td></tr><tr><td></td><td>Mephitidae</td><td>Skunks (Mephitis mephitis)</td><td>Canada; USA</td><td>2021-2022; 2022-2023</td><td>(CTV News, online; USDA, online; WOAH, online-b)</td></tr><tr><td></td><td>Phocidae</td><td>Grey seals (Halichoerus grypus)</td><td>USA; Canada</td><td>2021-2022</td><td>(AMMI, 2022; WOAH, online-b)</td></tr><tr><td></td><td></td><td>Harbour seals (Phoca vitulina)</td><td>USA; Canada</td><td>2021-2022</td><td>(WOAH, online-b)</td></tr><tr><td></td><td>Ursidae</td><td>American black bear (Ursus americanus)</td><td>Canada</td><td>2021-2022; 2022-2023</td><td>(Healthy Wildlife, online; KTOO, online; WOAH, online-b)</td></tr><tr><td></td><td></td><td>Brown bear (Ursus arctos)</td><td>USA</td><td>2022-2023</td><td>(Kiniradio, online)</td></tr><tr><td>Artiodactyla</td><td>Suidae</td><td>Domestic pigs (Sus scrofa), serological detection<sup>a</sup></td><td>Italy</td><td>2021-2022</td><td>EURL</td></tr><tr><td>Didelphimorphia</td><td>Dedelphidae</td><td>Virginia opossum (Didelphis virginiana)</td><td>USA</td><td>2021-2022; 2022-2023</td><td>(USDA, online; WOAH, online-b)</td></tr><tr><td rowspan="2">Cetacea</td><td>Phocoenidae</td><td>Porpoise (Phocoena phocoena)</td><td>Sweden</td><td>2021-2022</td><td>(SVA, online-a)</td></tr><tr><td>Delphinidae</td><td>Bottlenose dolphin (Tursiops truncatus)</td><td>USA</td><td>2021-2022</td><td>(UFHealth, online; WOAH, online-b)</td></tr><tr><td></td><td></td><td>White-sided dolphin (Lagenorhynchus acutus)</td><td>Canada</td><td>2022-2023</td><td>(Avian Flu Diary, online-a)</td></tr></tbody></table>

(a) Serological detection in a HPAI outbreak in a backyard poultry
## 4.4. Prevention and control measures applied in Europe, 3 September to 18 November 2022 (ToR 3)

The description of the control and prevention measures applied in the affected Member States on HPAI outbreaks occurred from 3 September to 18 November 2022 is presented in Annex B, thanks to the countries that were willing to collaborate with EFSA and kindly provided the information reported here. Outbreaks that occurred before 3 September 2022 have been described in the previous EFSA report (EFSA et al., 2022b).

## 4.5. The avian influenza situation in other countries not reporting via ADIS, 10 September to 2 December 2022 (ToR 4)

An overview of the HPAI detections notified from other countries not reporting via ADIS but via the WOAH or national authorities from 10 September to 2 December 2022 is presented in Table 6 and Figure 12. For the purposes of this report, only findings of avian influenza viruses occurring in countries that are considered to be of epidemiological interest for the EU/EEA or of public health relevance are described.

<table><caption>**Table 6:** Number of HPAI detections in non-European countries, by virus subtype and country, from 10 September to 2 December 2022</caption><thead><tr><th rowspan="2">Region</th><th rowspan="2">Country</th><th colspan="4">Domestic birds (344)</th><th colspan="3">Wild birds (50)</th><th rowspan="2">Total</th></tr><tr><th>A(H5N1)</th><th>A(H5N2)</th><th>A(H5N4)</th><th>A(Not typed)</th><th>A(H5N1)</th><th>A(H5N2)</th><th>A(Not typed)</th></tr></thead><tbody><tr><td rowspan="4">Africa (14)</td><td>Algeria</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td>Nigeria</td><td>7</td><td></td><td></td><td></td><td></td><td></td><td></td><td>7</td></tr><tr><td>Reunion</td><td>2</td><td></td><td></td><td></td><td></td><td></td><td></td><td>2</td></tr><tr><td>South Africa</td><td>3</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td>4</td></tr><tr><td rowspan="6">Americas (320)</td><td>Canada</td><td>93</td><td></td><td></td><td></td><td></td><td></td><td></td><td>93</td></tr><tr><td>Colombia</td><td>18</td><td></td><td></td><td></td><td>1</td><td></td><td></td><td>19</td></tr><tr><td>Ecuador</td><td></td><td></td><td></td><td>1</td><td></td><td></td><td></td><td>1</td></tr><tr><td>Mexico</td><td>4</td><td></td><td></td><td></td><td>2</td><td></td><td></td><td>6</td></tr><tr><td>Peru</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td><td>1</td></tr><tr><td>United States of America</td><td>188</td><td></td><td>1</td><td></td><td>10</td><td></td><td></td><td>199</td></tr><tr><td>Venezuela</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td rowspan="6">Asia (55)</td><td>Chinese Taipei</td><td></td><td>1</td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td>Hong Kong</td><td></td><td></td><td></td><td></td><td>2</td><td></td><td></td><td>2</td></tr><tr><td>India</td><td>2</td><td></td><td></td><td></td><td></td><td></td><td></td><td>2</td></tr><tr><td>Israel</td><td>2</td><td></td><td></td><td></td><td></td><td></td><td></td><td>2</td></tr><tr><td>Japan</td><td>12</td><td></td><td></td><td></td><td>31</td><td>1</td><td></td><td>44</td></tr><tr><td>Korea (Rep. of)</td><td>3</td><td></td><td></td><td></td><td></td><td></td><td></td><td>3</td></tr><tr><td>Vietnam</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td>Europe (5)</td><td>Russia</td><td>3</td><td></td><td></td><td></td><td>2</td><td></td><td></td><td>5</td></tr><tr><td colspan="2">Total</td><td>340</td><td>2</td><td>1</td><td>1</td><td>48</td><td>1</td><td>1</td><td>394</td></tr></tbody></table>

Source: WOAH-WAHIS (data extraction carried out on 2 December 2022).
## 4.4. Prevention and control measures applied in Europe, 3 September to 18 November 2022 (ToR 3)

The description of the control and prevention measures applied in the affected Member States on HPAI outbreaks occurred from 3 September to 18 November 2022 is presented in Annex B, thanks to the countries that were willing to collaborate with EFSA and kindly provided the information reported here. Outbreaks that occurred before 3 September 2022 have been described in the previous EFSA report (EFSA et al., 2022b).

## 4.5. The avian influenza situation in other countries not reporting via ADIS, 10 September to 2 December 2022 (ToR 4)

An overview of the HPAI detections notified from other countries not reporting via ADIS but via the WOAH or national authorities from 10 September to 2 December 2022 is presented in Table 6 and Figure 12. For the purposes of this report, only findings of avian influenza viruses occurring in countries that are considered to be of epidemiological interest for the EU/EEA or of public health relevance are described.

<table><caption>**Table 6:** Number of HPAI detections in non-European countries, by virus subtype and country, from 10 September to 2 December 2022</caption><thead><tr><th rowspan="2">Region</th><th rowspan="2">Country</th><th colspan="4">Domestic birds (344)</th><th colspan="3">Wild birds (50)</th><th rowspan="2">Total</th></tr><tr><th>A(H5N1)</th><th>A(H5N2)</th><th>A(H5N4)</th><th>A(Not<br>typed)</th><th>A(H5N1)</th><th>A(H5N2)</th><th>A(Not<br>typed)</th></tr></thead><tbody><tr><td rowspan="4">Africa (14)</td><td>Algeria</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td>Nigeria</td><td>7</td><td></td><td></td><td></td><td></td><td></td><td></td><td>7</td></tr><tr><td>Reunion</td><td>2</td><td></td><td></td><td></td><td></td><td></td><td></td><td>2</td></tr><tr><td>South Africa</td><td>3</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td>4</td></tr><tr><td rowspan="6">Americas (320)</td><td>Canada</td><td>93</td><td></td><td></td><td></td><td></td><td></td><td></td><td>93</td></tr><tr><td>Colombia</td><td>18</td><td></td><td></td><td></td><td>1</td><td></td><td></td><td>19</td></tr><tr><td>Ecuador</td><td></td><td></td><td></td><td>1</td><td></td><td></td><td></td><td>1</td></tr><tr><td>Mexico</td><td>4</td><td></td><td></td><td></td><td>2</td><td></td><td></td><td>6</td></tr><tr><td>Peru</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td><td>1</td></tr><tr><td>United States of America</td><td>188</td><td></td><td>1</td><td></td><td>10</td><td></td><td></td><td>199</td></tr><tr><td>Venezuela</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td rowspan="7">Asia (55)</td><td>Chinese Taipei</td><td></td><td>1</td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td>Hong Kong</td><td></td><td></td><td></td><td></td><td>2</td><td></td><td></td><td>2</td></tr><tr><td>India</td><td>2</td><td></td><td></td><td></td><td></td><td></td><td></td><td>2</td></tr><tr><td>Israel</td><td>2</td><td></td><td></td><td></td><td></td><td></td><td></td><td>2</td></tr><tr><td>Japan</td><td>12</td><td></td><td></td><td></td><td>31</td><td>1</td><td></td><td>44</td></tr><tr><td>Korea (Rep. of)</td><td>3</td><td></td><td></td><td></td><td></td><td></td><td></td><td>3</td></tr><tr><td>Vietnam</td><td>1</td><td></td><td></td><td></td><td></td><td></td><td></td><td>1</td></tr><tr><td>Europe (5)</td><td>Russia</td><td>3</td><td></td><td></td><td></td><td>2</td><td></td><td></td><td>5</td></tr></tbody><tfoot><tr><td colspan="2">Total</td><td>340</td><td>2</td><td>1</td><td>1</td><td>48</td><td>1</td><td>1</td><td>394</td></tr></tfoot></table>

Source: WOAH-WAHIS (data extraction carried out on 2 December 2022).
<figure><img src="image_15.png" /></figure>

Author: EFSA
Data sources: ADIS, WOAH
Date updated: 02/12/2022

<caption>**Figure 12:** Geographical distribution, based on available geocoordinates, of highly pathogenic avian influenza virus detections reported in domestic birds (893) and wild birds (663) by virus type, from 10 September to 2 December 2022</caption>

### 4.5.1. Avian influenza A(H3N8)

#### 4.5.1.1. Human infections with A(H3N8)

No new cases have been reported due to infection with A(H3N8) since the last report (EFSA et al., 2022a). Two human infections with avian influenza A(H3N8) reassortant virus were reported for the first time in a 4-year-old child with critical conditions in April 2022 (WHO, 2022b) and a 5-year-old child in May 2022, both in China (The Government of the Hong Kong Special Administrative Region Press Releases, 2022b). Both children had been exposed to live poultry before the onset of symptoms. A preliminary FAO/WOAH/WHO Joint Rapid Risk Assessment ranks the risk for A(H3N8) as low for human health (FAO, 2022).

### 4.5.2. HPAI A(H5)

#### 4.5.2.1. Human infections with A(H5)

In October 2022, a human infection with avian influenza A(H5) without NA-type was reported in Vietnam in a five-year-old girl from Phu Tho, the first case of avian influenza in Vietnam since 2014 (WHO, 2022a; VNExpress, online). The girl developed symptoms on 5 October 2022 and was hospitalised in critical condition on 7 October 2022. Prior to symptoms' onset she had exposure to sick poultry and other domestic birds. All of the 65 identified contacts tested negative for influenza A(H5).

### 4.5.3. HPAI A(H5N1)

#### 4.5.3.1. Domestic birds and wild animals

*Detections*

Outbreaks of HPAI A(H5N1) in Africa were detected on poultry farms in previously affected regions (Nigeria, South Africa), but also the first time ever on the island Reunion in the Indian Ocean and returned to Algeria after 18 months of absence (Figure 13). Furthermore, South Africa detected the Eurasian lineage serotype HPAI A(H5N2) on a medium-sized poultry farm in the long-time affected
<figure><img src="image_15.png" /></figure>

Author: EFSA
Data sources: ADIS, WOAH
Date updated: 02/12/2022

<caption>**Figure 12:** Geographical distribution, based on available geocoordinates, of highly pathogenic avian influenza virus detections reported in domestic birds (893) and wild birds (663) by virus type, from 10 September to 2 December 2022</caption>

### 4.5.1. Avian influenza A(H3N8)

#### 4.5.1.1. Human infections with A(H3N8)

No new cases have been reported due to infection with A(H3N8) since the last report (EFSA et al., 2022a). Two human infections with avian influenza A(H3N8) reassortant virus were reported for the first time in a 4-year-old child with critical conditions in April 2022 (WHO, 2022b) and a 5-year-old child in May 2022, both in China (The Government of the Hong Kong Special Administrative Region Press Releases, 2022b). Both children had been exposed to live poultry before the onset of symptoms. A preliminary FAO/WOAH/WHO Joint Rapid Risk Assessment ranks the risk for A(H3N8) as low for human health (FAO, 2022).

### 4.5.2. HPAI A(H5)

#### 4.5.2.1. Human infections with A(H5)

In October 2022, a human infection with avian influenza A(H5) without NA-type was reported in Vietnam in a five-year-old girl from Phu Tho, the first case of avian influenza in Vietnam since 2014 (WHO, 2022a; VNExpress, online). The girl developed symptoms on 5 October 2022 and was hospitalised in critical condition on 7 October 2022. Prior to symptoms' onset she had exposure to sick poultry and other domestic birds. All of the 65 identified contacts tested negative for influenza A(H5).

### 4.5.3. HPAI A(H5N1)

#### 4.5.3.1. Domestic birds and wild animals

*Detections*

Outbreaks of HPAI A(H5N1) in Africa were detected on poultry farms in previously affected regions (Nigeria, South Africa), but also the first time ever on the island Reunion in the Indian Ocean and returned to Algeria after 18 months of absence (Figure 13). Furthermore, South Africa detected the Eurasian lineage serotype HPAI A(H5N2) on a medium-sized poultry farm in the long-time affected
province KwaZulu-Natal. Contrary to the last report, no wild bird cases from Africa were reported to the WOAH. Although the number of outbreaks in Asia has slightly decreased compared to the last report (68 vs 55), the number of countries has doubled (6 vs 3). India, Israel, Korea and Vietnam detected HPAI A(H5N1) on several poultry farms of medium size during the current reporting period. Japan notified several cases in wild birds of various species (e.g., northern pintail, greater white-fronted goose, hooded crane, white-naped crane, peregrine falcon) to the WOAH in addition to outbreaks in poultry farms of all sizes. Furthermore, a black-faced spoonbill and an undetermined wild bird were tested positive for HPAI A(H5N1) in Hongkong. Russia reported outbreaks of HPAI A(H5N1) and HPAI A(H5Nx) in poultry farms and in wild birds (e.g., rock dove, corvids) from eastern provinces neighbouring the Pacific Ocean (Figure 13). The outbreak in Canada and the USA continues with a large number of HPAI A(H5N1) cases on farms of all sizes and one HPAI A(H5N4) case in previously affected regions (Figure 14). Furthermore, several wild bird species were affected, for example blue-winged teal, Canada goose, cackling goose, Forster's tern, black-crowned night heron, glossy ibis and western gull. In addition, the USA detected HPAI A(H5N1) virus in several mammal species, the red fox (Vulpes vulpes), striped skunk (Mephitis mephitis), Virginia opossum (Didelphis virginiana) and American black bear (Ursus americanus) (Table 5). For the first time ever, the Eurasian lineage of HPAI A(H5N1) spread to Central and South America. First reports from Colombia of outbreaks in backyard poultry farms and wild birds (e.g. helmeted guineafowl, yellow-crowned amazon, scarlet macaw) in a wildlife reserve were reported to WOAH in October 2022. In the following month Mexico detected HPAI A(H5N1) in captive birds (e.g. mallards, snow goose, northern goshawk, Cooper's hawk) and several wild waterfowl (mallards and lesser scaup). In Ecuador, an outbreak with HPAI A(H5Nx) was reported in a commercial laying hen farm on 28 November 2022. On the coasts of Venezuela, Peru, and Chile thousands of Peruvian pelicans, in which HPAI A(H5N1) was detectable, have died since the beginning of November (ProMed, online-a, b; Tribune, online) (Figure 14).

<figure><img src="image_16.png" /></figure>

Author: EFSA
Data sources: ADIS, WOAH
Date updated: 02/12/2022

Red and dark grey symbols indicate outbreaks that occurred between 10 September and 2 December 2022, light red and light grey symbols indicate outbreaks that occurred between 2 December 2021 and 9 September 2022.

<caption>**Figure 13:** Geographical distribution, based on available geocoordinates, of HPAI A(H5N1) and A(H5Nx) virus detections reported in domestic birds (circles) and wild birds (stars) (7,384)</caption>
province KwaZulu-Natal. Contrary to the last report, no wild bird cases from Africa were reported to the WOAH. Although the number of outbreaks in Asia has slightly decreased compared to the last report (68 vs 55), the number of countries has doubled (6 vs 3). India, Israel, Korea and Vietnam detected HPAI A(H5N1) on several poultry farms of medium size during the current reporting period. Japan notified several cases in wild birds of various species (e.g., northern pintail, greater white-fronted goose, hooded crane, white-naped crane, peregrine falcon) to the WOAH in addition to outbreaks in poultry farms of all sizes. Furthermore, a black-faced spoonbill and an undetermined wild bird were tested positive for HPAI A(H5N1) in Hongkong. Russia reported outbreaks of HPAI A(H5N1) and HPAI A(H5Nx) in poultry farms and in wild birds (e.g., rock dove, corvids) from eastern provinces neighbouring the Pacific Ocean (Figure 13). The outbreak in Canada and the USA continues with a large number of HPAI A(H5N1) cases on farms of all sizes and one HPAI A(H5N4) case in previously affected regions (Figure 14). Furthermore, several wild bird species were affected, for example blue-winged teal, Canada goose, cackling goose, Forster's tern, black-crowned night heron, glossy ibis and western gull. In addition, the USA detected HPAI A(H5N1) virus in several mammal species, the red fox (Vulpes vulpes), striped skunk (Mephitis mephitis), Virginia opossum (Didelphis virginiana) and American black bear (Ursus americanus) (Table 5). For the first time ever, the Eurasian lineage of HPAI A(H5N1) spread to Central and South America. First reports from Colombia of outbreaks in backyard poultry farms and wild birds (e.g. helmeted guineafowl, yellow-crowned amazon, scarlet macaw) in a wildlife reserve were reported to WOAH in October 2022. In the following month Mexico detected HPAI A(H5N1) in captive birds (e.g. mallards, snow goose, northern goshawk, Cooper's hawk) and several wild waterfowl (mallards and lesser scaup). In Ecuador, an outbreak with HPAI A(H5Nx) was reported in a commercial laying hen farm on 28 November 2022. On the coasts of Venezuela, Peru, and Chile thousands of Peruvian pelicans, in which HPAI A(H5N1) was detectable, have died since the beginning of November (ProMed, online-a, b; Tribune, online) (Figure 14).

<figure><img src="image_16.png" /></figure>

Author: EFSA
Data sources: ADIS, WOAH
Date updated: 02/12/2022

Red and dark grey symbols indicate outbreaks that occurred between 10 September and 2 December 2022, light red and light
grey symbols indicate outbreaks that occurred between 2 December 2021 and 9 September 2022.

<caption>**Figure 13:** Geographical distribution, based on available geocoordinates, of HPAI A(H5N1) and A(H5Nx) virus detections reported in domestic birds (circles) and wild birds (stars) (7,384)</caption>
<figure><img src="image_17.png" /></figure>

Red symbols indicate outbreaks that occurred between 10 September and 2 December 2022, light red symbols indicate outbreaks that occurred between 2 December 2021 and 9 September 2022.

<caption>**Figure 14:** Geographical distribution, based on available geocoordinates, of HPAI A(H5N1) and A(H5Nx) virus detections reported in domestic birds (circles) and wild birds (stars) (1,038)</caption>

#### 4.5.3.2. Human infections due to A(H5N1)

Three new detections of avian influenza A(H5N1) have been reported in two poultry workers in Spain and one lethal case in China over the reporting period (ECDC, 2022b, a; Sanidad, 2022; WHO, 2022a, online-a). In 2022, two detections in people involved in culling operations were reported in September and October from Spain, both people were asymptomatic and were tested as routine surveillance following a confirmation of an influenza A(H5N1) outbreak in one commercial poultry facility. One lethal case was reported from China in October with severe pneumonia and exposure history to culling sick chicken (WHO, 2022a; CHP, online). Since 2003, and as of 17 November 2022, 867 laboratory-confirmed cases of human infection with avian influenza A(H5N1) virus, including 456 deaths, have been reported from 21 countries, including one EU country (Spain) (ECDC, 2022b, a; WHO, 2022a) (WHO, 2022b) (Figure 15).
<figure><img src="image_17.png" /></figure>

Red symbols indicate outbreaks that occurred between 10 September and 2 December 2022, light red symbols indicate outbreaks that occurred between 2 December 2021 and 9 September 2022.

<caption>**Figure 14:** Geographical distribution, based on available geocoordinates, of HPAI A(H5N1) and A(H5Nx) virus detections reported in domestic birds (circles) and wild birds (stars) (1,038)</caption>

#### 4.5.3.2. Human infections due to A(H5N1)

Three new detections of avian influenza A(H5N1) have been reported in two poultry workers in Spain and one lethal case in China over the reporting period (ECDC, 2022b, a; Sanidad, 2022; WHO, 2022a, online-a). In 2022, two detections in people involved in culling operations were reported in September and October from Spain, both people were asymptomatic and were tested as routine surveillance following a confirmation of an influenza A(H5N1) outbreak in one commercial poultry facility. One lethal case was reported from China in October with severe pneumonia and exposure history to culling sick chicken (WHO, 2022a; CHP, online). Since 2003, and as of 17 November 2022, 867 laboratory-confirmed cases of human infection with avian influenza A(H5N1) virus, including 456 deaths, have been reported from 21 countries, including one EU country (Spain) (ECDC, 2022b, a; WHO, 2022a) (WHO, 2022b) (Figure 15).
<figure><img src="image_18.png" /></figure>

Source: WHO and ECDC line list (WHO, 2021d, b, online-e).

<caption>**Figure 15:** Distribution of confirmed human cases of A(H5N1) by year and country of reporting, 2003 to 28 November 2022 (868)</caption>

### 4.5.4. HPAI A(H5N2) and A(H5N5)

#### 4.5.4.1. Domestic and wild birds

*Detections*

In the current reporting period, Taiwan reported no new outbreaks of the Taiwanese lineage HPAI A(H5N5) to the WOAH. However, one outbreak of the Taiwanese lineage HPAI A(H5N2) in a backyard poultry farm were detected in October 2022. The Taiwanese lineages of HPAI A(H5N2) and HPAI A(H5N5) (clade 2.3.4.4) differed from the Eurasian HPAI A(H5N2) and A(H5N5) lineages (Li et al., 2020); the latter belonging to clade 2.3.4.4b, which has been detected, with different genotypes, in Egypt and Russia as well as in Asian countries between 2016 and 2019 (EFSA et al., 2019) and in Bulgaria in 2020. As in the previous reporting period, no wild bird cases were reported between 10 September and 2 December 2022 (Figure 16).
<figure><img src="image_18.png" /></figure>

Source: WHO and ECDC line list (WHO, 2021d, b, online-e).

<caption>**Figure 15:** Distribution of confirmed human cases of A(H5N1) by year and country of reporting, 2003 to 28 November 2022 (868)</caption>

### 4.5.4. HPAI A(H5N2) and A(H5N5)

#### 4.5.4.1. Domestic and wild birds

*Detections*

In the current reporting period, Taiwan reported no new outbreaks of the Taiwanese lineage HPAI A(H5N5) to the WOAH. However, one outbreak of the Taiwanese lineage HPAI A(H5N2) in a backyard poultry farm were detected in October 2022. The Taiwanese lineages of HPAI A(H5N2) and HPAI A(H5N5) (clade 2.3.4.4) differed from the Eurasian HPAI A(H5N2) and A(H5N5) lineages (Li et al., 2020); the latter belonging to clade 2.3.4.4b, which has been detected, with different genotypes, in Egypt and Russia as well as in Asian countries between 2016 and 2019 (EFSA et al., 2019) and in Bulgaria in 2020. As in the previous reporting period, no wild bird cases were reported between 10 September and 2 December 2022 (Figure 16).
<figure><img src="image_19.png" /></figure>

Purple symbols indicate HPAI A(H5N2) virus detections between 10 September and 2 December 2022, light purple symbols indicate HPAI A(H5N2) virus detections between 2 December 2021 and 9 September 2022, light blue symbols indicate HPAI A(H5N5) virus detections between 2 December 2021 and 9 September 2022.

<caption>**Figure 16:** Geographical distribution, based on available geocoordinates, of HPAI A(H5N2) and HPAI A(H5N5) virus detections reported in domestic birds (circles) and wild birds (stars) in Taiwan (38)</caption>

### 4.5.5. HPAI A(H5N6)

#### 4.5.5.1. Domestic and wild birds

*Detections*

No new outbreaks of the zoonotic reassortment of HPAI A(H5N6) clade 2.3.4.4c were detected within the relevant time period for this report. New human cases of A(H5N6) from China in the current reporting period might suggest underreporting of poultry outbreaks in the Asian region.

#### 4.5.5.2. Human infections due to A(H5N6)

One new patient infected with avian influenza A(H5N6) and hospitalised with severe pneumonia following exposure to backyard poultry has been reported from China since the last EFSA report (WHO, 2022a, c). Since 2014, and as of 17 November 2022, 82 laboratory-confirmed human infections with avian influenza A(H5N6) viruses have been reported from China (81 cases) and Laos (1), 33 of the patients died (CHP, 2022a) (Figure 17). Twelve of these 33 deaths due to A(H5N6) had been reported between 2014 and 2017 (Jiang et al., 2017) and at least 17 deaths occurred in the most recent period 2018–2021 (ECDC line list; please refer to Appendix B.2). A household cluster with two infections was observed in a couple preparing a duck purchased from a live-bird market for meal (The Government of the Hong Kong Special Administrative Region Press Releases, 2022a; BNO, online; GovMO, online). The overall case fatality ratio of A(H5N6) in humans is estimated to be 42% (limitation: case reports might not have been a complete or lacking updated information).
<figure><img src="image_19.png" /></figure>

Purple symbols indicate HPAI A(H5N2) virus detections between 10 September and 2 December 2022, light purple symbols indicate HPAI A(H5N2) virus detections between 2 December 2021 and 9 September 2022, light blue symbols indicate HPAI A(H5N5) virus detections between 2 December 2021 and 9 September 2022.

<caption>**Figure 16:** Geographical distribution, based on available geocoordinates, of HPAI A(H5N2) and HPAI A(H5N5) virus detections reported in domestic birds (circles) and wild birds (stars) in Taiwan (38)</caption>

### 4.5.5. HPAI A(H5N6)

#### 4.5.5.1. Domestic and wild birds

*Detections*

No new outbreaks of the zoonotic reassortment of HPAI A(H5N6) clade 2.3.4.4c were detected within the relevant time period for this report. New human cases of A(H5N6) from China in the current reporting period might suggest underreporting of poultry outbreaks in the Asian region.

#### 4.5.5.2. Human infections due to A(H5N6)

One new patient infected with avian influenza A(H5N6) and hospitalised with severe pneumonia following exposure to backyard poultry has been reported from China since the last EFSA report (WHO, 2022a, c). Since 2014, and as of 17 November 2022, 82 laboratory-confirmed human infections with avian influenza A(H5N6) viruses have been reported from China (81 cases) and Laos (1), 33 of the patients died (CHP, 2022a) (Figure 17). Twelve of these 33 deaths due to A(H5N6) had been reported between 2014 and 2017 (Jiang et al., 2017) and at least 17 deaths occurred in the most recent period 2018–2021 (ECDC line list; please refer to Appendix B.2). A household cluster with two infections was observed in a couple preparing a duck purchased from a live-bird market for meal (The Government of the Hong Kong Special Administrative Region Press Releases, 2022a; BNO, online; GovMO, online). The overall case fatality ratio of A(H5N6) in humans is estimated to be 42% (limitation: case reports might not have been a complete or lacking updated information).
<figure><img src="image_20.png" /></figure>

Source: ECDC line list (please refer to Appendix B.2).

<caption>**Figure 17:** Number of human cases due to A(H5N6) infection by year of onset, 2014 to 28 November 2022 (N = 82)</caption>

### 4.5.6. HPAI A(H5N8)

#### 4.5.6.1. Domestic and wild birds

*Detections*

No outbreaks of HPAI A(H5N8) in poultry or wild birds were notified outside Europe between 10 September and 2 December 2022.

### 4.5.7. HPAI-LPAI A(H7N9)

#### 4.5.7.1. Domestic and wild birds

*Detection*

No LPAI or HPAI A(H7N9) cases have been notified to WOAH-WAHIS in poultry or wild birds within the relevant time period for this report. The last case was reported from Shandong province, China, in October 2020. The nationwide A(H7N9) vaccination campaigns for poultry, except for poultry in avian influenza-free zones and export farms, started extensively in September 2017 (FAO, online).

#### 4.5.7.2. Human infections due to A(H7N9)

No human cases due to avian influenza A(H7N9) have ever been reported from Europe and no human case has been reported globally since 2019 (WHO, 2020b, d). Since February 2013, in total, 1,568 human cases have been reported from outside Europe, including at least 615 deaths (39%) (WHO, 2019a, b; CHP, 2021a). The last case was reported in March 2019. Of all human cases, 32 had been infected with HPAI virus A(H7N9), and 13 of them were fatal, according to the Chinese National Influenza Center (Chinese National Influenza Center et al., 2018).
<figure><img src="image_20.png" /></figure>

Source: ECDC line list (please refer to Appendix B.2).

<caption>**Figure 17:** Number of human cases due to A(H5N6) infection by year of onset, 2014 to 28 November 2022 (N = 82)</caption>

### 4.5.6. HPAI A(H5N8)

#### 4.5.6.1. Domestic and wild birds

*Detections*

No outbreaks of HPAI A(H5N8) in poultry or wild birds were notified outside Europe between 10 September and 2 December 2022.

### 4.5.7. HPAI-LPAI A(H7N9)

#### 4.5.7.1. Domestic and wild birds

*Detection*

No LPAI or HPAI A(H7N9) cases have been notified to WOAH-WAHIS in poultry or wild birds within the relevant time period for this report. The last case was reported from Shandong province, China, in October 2020. The nationwide A(H7N9) vaccination campaigns for poultry, except for poultry in avian influenza-free zones and export farms, started extensively in September 2017 (FAO, online).

#### 4.5.7.2. Human infections due to A(H7N9)

No human cases due to avian influenza A(H7N9) have ever been reported from Europe and no human case has been reported globally since 2019 (WHO, 2020b, d). Since February 2013, in total, 1,568 human cases have been reported from outside Europe, including at least 615 deaths (39%) (WHO, 2019a, b; CHP, 2021a). The last case was reported in March 2019. Of all human cases, 32 had been infected with HPAI virus A(H7N9), and 13 of them were fatal, according to the Chinese National Influenza Center (Chinese National Influenza Center et al., 2018).
4.5.8. LPAI A(H9N2)

4.5.8.1. Domestic and wild birds

Detection

As mentioned in previous EFSA reports, A(H9N2) is the most commonly detected non-notifiable subtype of influenza virus in poultry in Asia, the Middle East and Africa (Zecchin et al., 2017; Bonfante et al., 2018; Chrzastek et al., 2018; Xu et al., 2018; Zhu et al., 2018; Awuni et al., 2019; Kariithi et al., 2019). These regions remained LPAI (H9N2) endemic at least until 2 December 2022.

4.5.8.2. Human infections due to A(H9N2)

One new case of human infection with avian influenza A(H9N2) has been reported in China since the previous report (CHP, 2022b; WHO, 2022a). Since 1998, and as of 17 November 2022, 115 laboratory-confirmed human infections with avian influenza A(H9N2) virus, including two deaths, have been reported globally. Infections were reported from China (101), Egypt (4), Bangladesh (3), Cambodia (2), India (1), Oman (1), Pakistan (1) and Senegal (1) (ECDC line list; please refer to Appendix B.2) (Figure 18). Exposure to live or slaughtered poultry or contaminated environment has been reported. The age group mostly affected by A(H9N2) infections in humans was children under 10 years of age, who developed mild symptoms (WHO, 2020c; CHP, 2021b; ECDC, 2021a) (ECDC line list; please refer to Appendix B.2) (Figure 19).

<figure><img src="image_21.png" /></figure>

Source: ECDC line list.

<caption>**Figure 18:** Distribution of confirmed human cases of A(H9N2) by reporting country, 1998 to 28 November 2022 (115)</caption>
4.5.8. LPAI A(H9N2)

4.5.8.1. Domestic and wild birds

Detection

As mentioned in previous EFSA reports, A(H9N2) is the most commonly detected non-notifiable subtype of influenza virus in poultry in Asia, the Middle East and Africa (Zecchin et al., 2017; Bonfante et al., 2018; Chrzastek et al., 2018; Xu et al., 2018; Zhu et al., 2018; Awuni et al., 2019; Kariithi et al., 2019). These regions remained LPAI (H9N2) endemic at least until 2 December 2022.

4.5.8.2. Human infections due to A(H9N2)

One new case of human infection with avian influenza A(H9N2) has been reported in China since the previous report (CHP, 2022b; WHO, 2022a). Since 1998, and as of 17 November 2022, 115 laboratory-confirmed human infections with avian influenza A(H9N2) virus, including two deaths, have been reported globally. Infections were reported from China (101), Egypt (4), Bangladesh (3), Cambodia (2), India (1), Oman (1), Pakistan (1) and Senegal (1) (ECDC line list; please refer to Appendix B.2) (Figure 18). Exposure to live or slaughtered poultry or contaminated environment has been reported. The age group mostly affected by A(H9N2) infections in humans was children under 10 years of age, who developed mild symptoms (WHO, 2020c; CHP, 2021b; ECDC, 2021a) (ECDC line list; please refer to Appendix B.2) (Figure 19).

<figure><img src="image_21.png" /></figure>

Source: ECDC line list.

<caption>**Figure 18:** Distribution of confirmed human cases of A(H9N2) by reporting country, 1998 to 28 November 2022 (115)</caption>
<figure><img src="image_22.png" /></figure>

Source: ECDC line list.

<caption>**Figure 19:** and sex distribution of confirmed human cases of A(H9N2) by age group, 1998 to 28 November 2022 (115)</caption>

### 4.5.9. Human infections due to A(H10N3) and A(H10N8)

No new detections of any avian influenza A(H10) virus in humans have been reported during this reporting period. In June 2021, the first human case of A(H10N3) was detected in China (NHCGovCN, online). China reported a second infection in 2022. Both patients were adults between 30 to 45 years of age with unknown exposure to birds or poultry. To date, there were three people infected with influenza A(H10N8) between November 2013 and February 2014, two of whom died (Parry, 2014; GovHK, online). Both adults were above 55 years of age in China and reported exposure to live poultry/poultry market before onset of symptoms.

### 4.6. Scientific analysis of avian influenza spread from non-EU/EEA countries and within the EU/EEA

Since Autumn 2021, HPAI A(H5N1) virus subtype has been circulating in wild birds in Europe, indicating a persistent circulation of this virus in Europe. In the 2021-2022 epidemiological year, the high infection pressure due to the sustained circulation of the virus in the wild reservoir resulted in frequent introductions of the virus into domestic bird populations across Europe. In several countries (e.g., France, Italy, Hungary), devastating epidemics occurred in areas with high poultry densities due to the rapid spread of the infection between poultry establishments.

The epidemic observed in the 2021-2022 HPAI epidemiological year in Europe was the largest in history, involving 37 countries and with a total of 2,520 HPAI outbreaks in poultry and 50 million birds culled in the affected establishments, 227 detections in captive birds, and 3,867 detections in wild birds. The overall number of detections was 1.7 times higher than in the 2020-2021 epidemiological year, and 2.4 times higher than in the 2016-2017 epidemiological year.

A novel aspect of the 2021-2022 epidemic was the extensive spread of HPAI to colony-breeding seabirds (Figure 5C). This has resulted in high mortality rates and purported population-level effects in some species (Wille et al. 2022) documented confirmed or probable cases of HPAI affecting seabirds inhabiting geographic areas extending latitudinally from Alaska to South Africa, including approximately 19 seabird species in the EU and 16 in Canada. Reports include high mortality among breeding colonies of Caspian Terns in the US, Great Skuas in Scotland, Sandwich Terns in the Netherlands and Northern Gannets and Common Murres in Canada and in the UK. Regarding the link between wild birds and
<figure><img src="image_22.png" /></figure>

Source: ECDC line list.

<caption>**Figure 19:** and sex distribution of confirmed human cases of A(H9N2) by age group, 1998 to 28 November 2022 (115)</caption>

### 4.5.9. Human infections due to A(H10N3) and A(H10N8)

No new detections of any avian influenza A(H10) virus in humans have been reported during this reporting period. In June 2021, the first human case of A(H10N3) was detected in China (NHCGovCN, online). China reported a second infection in 2022. Both patients were adults between 30 to 45 years of age with unknown exposure to birds or poultry. To date, there were three people infected with influenza A(H10N8) between November 2013 and February 2014, two of whom died (Parry, 2014; GovHK, online). Both adults were above 55 years of age in China and reported exposure to live poultry/poultry market before onset of symptoms.

### 4.6. Scientific analysis of avian influenza spread from non-EU/EEA countries and within the EU/EEA

Since Autumn 2021, HPAI A(H5N1) virus subtype has been circulating in wild birds in Europe, indicating a persistent circulation of this virus in Europe. In the 2021-2022 epidemiological year, the high infection pressure due to the sustained circulation of the virus in the wild reservoir resulted in frequent introductions of the virus into domestic bird populations across Europe. In several countries (e.g., France, Italy, Hungary), devastating epidemics occurred in areas with high poultry densities due to the rapid spread of the infection between poultry establishments.

The epidemic observed in the 2021-2022 HPAI epidemiological year in Europe was the largest in history, involving 37 countries and with a total of 2,520 HPAI outbreaks in poultry and 50 million birds culled in the affected establishments, 227 detections in captive birds, and 3,867 detections in wild birds. The overall number of detections was 1.7 times higher than in the 2020-2021 epidemiological year, and 2.4 times higher than in the 2016-2017 epidemiological year.

A novel aspect of the 2021-2022 epidemic was the extensive spread of HPAI to colony-breeding seabirds (Figure 5C). This has resulted in high mortality rates and purported population-level effects in some species (Wille et al. 2022) documented confirmed or probable cases of HPAI affecting seabirds inhabiting geographic areas extending latitudinally from Alaska to South Africa, including approximately 19 seabird species in the EU and 16 in Canada. Reports include high mortality among breeding colonies of Caspian Terns in the US, Great Skuas in Scotland, Sandwich Terns in the Netherlands and Northern Gannets and Common Murres in Canada and in the UK. Regarding the link between wild birds and
poultry, it is pertinent that the shape of the epidemic curve in poultry in 2021-2022 resembled that in waterfowl, but not that in seabirds (Figure 5C). This suggests that waterfowl are more involved than seabirds in the incursion of HPAI virus into poultry establishments, likely because the habitat of waterfowl is more likely to overlap with the location of poultry establishments than seabird colony sites.

In the current reporting period, from 10 September to 2 December 2022, primary HPAI outbreaks due to direct or indirect contact with infected wild birds frequently occurred in poultry in several European countries (e.g., France, Germany, Italy, The Netherlands) without an extensive secondary spread of the virus. Indeed, these countries reported, until now, only a limited number of secondary infections, whereas various secondary HPAI outbreaks were detected in commercial poultry in Hungary. Primary outbreaks were often identified in farms without outdoor access and poultry production systems (e.g., breeders) with high biosecurity standards were also affected.

The biosecurity measures implemented along the poultry production chain did not seem effective in preventing all introductions of the HPAI A(H5N1) virus into poultry farms, especially in some poultry production systems (e.g., ducks, turkeys, and layers). In this situation, there is a high risk of serious epidemics in densely populated poultry areas. To mitigate the risk of further spread of the infection, adequate early detection and rapid control of HPAI outbreaks should be ensured.

The patterns of HPAI virus introduction into the different poultry production systems should be investigated and identified. Appropriate risk mitigation measures should be rapidly defined and implemented. The overall structure and organization of the affected poultry production systems should also be scrutinised, especially in countries where severe epidemics have repeatedly occurred in recent years. Based on a risk assessment, competent authorities and poultry producers should identify the stages of the poultry production process where: biosecurity standards need to be improved; poultry production systems need to be reorganized.

Taking into account the epidemiology of the disease, critical points for HPAI control should be identified, and appropriate corrective actions should be implemented to mitigate the HPAI risk.

In the coming months, the sustained and increasing infection pressure on poultry establishments will challenge the effectiveness of applied biosecurity measures. Stringent biosecurity must constantly be in place to reduce the HPAI risk posed by infected wild birds.

Based on the available genetic data, to date no new virus incursions seem to have occurred in Europe with the wild bird fall migration. Most of the genetically characterized A(H5N1) viruses collected since September 2022 belong to three genotypes that have been circulating in Europe in the summer months. The virus retains a high propensity to reassort with LPAI viruses, likely as a consequence of its extensive circulation in wild birds, and eight new reassortant viruses have been detected in Europe in the last three months. All the new genotypes seem to have originated through local reassortment events with viruses circulating in the European wild bird population, and each of them has been identified in one or few viruses, in a single European country or at most in two European countries, rather than having emerged in other geographic areas and introduced in Europe through migratory birds. The low number of sequences of the latest A(H5N1) viruses deposited in public sequence repository from non-European countries (e.g. Asiatic countries) does not allow to confirm this hypothesis.

Since October 2020, 13 European countries have reported infections of HPAI A(H5) viruses of clade 2.3.4.4b in multiple mammalian species, including red foxes, harbour seals, grey seals, a Eurasian otter, a lynx, a harbour porpoise, domestic pigs, a European badger, a European polecat, a ferret, farmed mink. The last reported infection in a wild mammal (red fox) was detected in Ireland in the month of September. In October, Spain reported an A(H5N1) outbreak in a large mink farm, which represents the first identification in Europe of a A(H5N1) virus infection in farmed American mink (*Neovison vison*). Increased mortality among the animals and mink-to-mink transmission with spread across the farm through animal contact but also likely through aerosol after possible introduction of the virus through infected wild birds to the open-housed farm were observed. The characterized viruses from mink belong to a genotype that has been circulating mainly in sea birds in northern Europe during the summer; however, compared to the viruses detected in birds, the mink A(H5N1) virus contains a mutation in the polymerase protein that favours virus replication in mammals.

As well as in Europe, several HPAI A(H5N1) mammalian cases have recently been reported also in an American black bear, striped skunks, red foxes, a Virginia opossum and an Amur leopard in the USA.
poultry, it is pertinent that the shape of the epidemic curve in poultry in 2021-2022 resembled that in waterfowl, but not that in seabirds (Figure 5C). This suggests that waterfowl are more involved than seabirds in the incursion of HPAI virus into poultry establishments, likely because the habitat of waterfowl is more likely to overlap with the location of poultry establishments than seabird colony sites.

In the current reporting period, from 10 September to 2 December 2022, primary HPAI outbreaks due to direct or indirect contact with infected wild birds frequently occurred in poultry in several European countries (e.g., France, Germany, Italy, The Netherlands) without an extensive secondary spread of the virus. Indeed, these countries reported, until now, only a limited number of secondary infections, whereas various secondary HPAI outbreaks were detected in commercial poultry in Hungary. Primary outbreaks were often identified in farms without outdoor access and poultry production systems (e.g., breeders) with high biosecurity standards were also affected.

The biosecurity measures implemented along the poultry production chain did not seem effective in preventing all introductions of the HPAI A(H5N1) virus into poultry farms, especially in some poultry production systems (e.g., ducks, turkeys, and layers). In this situation, there is a high risk of serious epidemics in densely populated poultry areas. To mitigate the risk of further spread of the infection, adequate early detection and rapid control of HPAI outbreaks should be ensured.

The patterns of HPAI virus introduction into the different poultry production systems should be investigated and identified. Appropriate risk mitigation measures should be rapidly defined and implemented. The overall structure and organization of the affected poultry production systems should also be scrutinised, especially in countries where severe epidemics have repeatedly occurred in recent years. Based on a risk assessment, competent authorities and poultry producers should identify the stages of the poultry production process where: biosecurity standards need to be improved; poultry production systems need to be reorganized.

Taking into account the epidemiology of the disease, critical points for HPAI control should be identified, and appropriate corrective actions should be implemented to mitigate the HPAI risk.

In the coming months, the sustained and increasing infection pressure on poultry establishments will challenge the effectiveness of applied biosecurity measures. Stringent biosecurity must constantly be in place to reduce the HPAI risk posed by infected wild birds.

Based on the available genetic data, to date no new virus incursions seem to have occurred in Europe with the wild bird fall migration. Most of the genetically characterized A(H5N1) viruses collected since September 2022 belong to three genotypes that have been circulating in Europe in the summer months. The virus retains a high propensity to reassort with LPAI viruses, likely as a consequence of its extensive circulation in wild birds, and eight new reassortant viruses have been detected in Europe in the last three months. All the new genotypes seem to have originated through local reassortment events with viruses circulating in the European wild bird population, and each of them has been identified in one or few viruses, in a single European country or at most in two European countries, rather than having emerged in other geographic areas and introduced in Europe through migratory birds. The low number of sequences of the latest A(H5N1) viruses deposited in public sequence repository from non-European countries (e.g. Asiatic countries) does not allow to confirm this hypothesis.

Since October 2020, 13 European countries have reported infections of HPAI A(H5) viruses of clade 2.3.4.4b in multiple mammalian species, including red foxes, harbour seals, grey seals, a Eurasian otter, a lynx, a harbour porpoise, domestic pigs, a European badger, a European polecat, a ferret, farmed mink. The last reported infection in a wild mammal (red fox) was detected in Ireland in the month of September. In October, Spain reported an A(H5N1) outbreak in a large mink farm, which represents the first identification in Europe of a A(H5N1) virus infection in farmed American mink (*Neovison vison*). Increased mortality among the animals and mink-to-mink transmission with spread across the farm through animal contact but also likely through aerosol after possible introduction of the virus through infected wild birds to the open-housed farm were observed. The characterized viruses from mink belong to a genotype that has been circulating mainly in sea birds in northern Europe during the summer; however, compared to the viruses detected in birds, the mink A(H5N1) virus contains a mutation in the polymerase protein that favours virus replication in mammals.

As well as in Europe, several HPAI A(H5N1) mammalian cases have recently been reported also in an American black bear, striped skunks, red foxes, a Virginia opossum and an Amur leopard in the USA.
The continuous detection of HPAI viruses in wild and domestic mammals, the rapid acquisition of viral mutations associated with mammalian adaptation after transmission to mammals, as well as the sporadic human infections with HPAI A(H5Nx) viruses of clade 2.3.4.4b, including the two human cases recently reported in Spain, are all factors that highlight the need to intensify surveillance in mammals and humans, particularly in high-risk areas with an intensive viral circulation.

Worldwide, HPAI A(H5) virus continues to be reported in poultry and wild birds in Russia, Asia and North America, and since October 2022 has been increasingly reported from Central and South America. For the first time ever, the Eurasian lineage of HPAI A(H5N1) and A(H5Nx) were detected in poultry, captive and wild birds in Mexico, Colombia, Ecuador, Peru and Venezuela. The spread in Central and South America seems to continue from north to south with unforeseeable consequences.

## 4.7. Monitoring, diagnosis of human infections and public health, occupational health and safety measures for infection prevention and control in the EU/EEA

### 4.7.1. Occupational health and safety measures

There is an extensive set of regulations to protect workers from health and safety risks and in accordance with occupational health and safety legislation, employers have responsibilities<fnref n="8" />. Employers' responsibilities include the implementation of appropriate preventive measures after a workplace risk assessment, taking into account all risks, including the risks from unintentional exposure to biological agents, in agreement with the health or safety committee or with workers' representatives. This includes prioritising technical and organisational measures over personal measures, the obligation to consult, inform and train workers and the need to provide appropriate health surveillance. Employers should periodically revise their workplace risk assessment and ensure that all necessary technical, organisational, maintenance and hygiene measures are taken to prevent the infection of workers.

When there is a potential risk of exposure to these viruses from infected birds (whether in an agricultural or other setting), the workplace risk assessment should be revised by the employer and appropriate measures should be taken. These measures may include physical distancing, enhanced ventilation, dust- and aerosol-avoiding measures (for example when cleaning and handling litter) and using appropriate PPE, when the above-mentioned collective measures do not sufficiently protect workers. Work clothing and street clothing should be stored separately and a separation of potentially contaminated areas from clean areas should be ensured (black/white areas) and appropriate hygiene measures applied. In agricultural settings, care should be taken to avoid contamination of domestic areas, for example through contaminated work clothing. Appropriate PPE should be provided by employers and properly stored and disposed of, and workers should be trained in its use. The employer should provide the possibility for storing work clothing and street clothing separately. Specific measures should be set out for culling operations and for the handling of dead animals and waste.

At premises where workers may be exposed to the above-mentioned viruses (e.g. establishments, slaughterhouses), for example when directly exposed to birds, their products or droppings, which may potentially be infected or contaminated with avian influenza viruses, stricter measures should be applied. To reduce the risk of infection with zoonotic influenza viruses, workers should be protected from direct physical contact with sick or dead animals or their remains (e.g. sick birds, poultry carcasses, poultry faeces or litter, surfaces and water that might be contaminated with excretions in the case of infected or dead birds). At poultry farms, it should be ensured that living areas are not contaminated, and working and living areas should be strictly separated. Good hand hygiene practice (proper use of gloves, hand-washing, and use of waterless hand sanitisers) is important and helps prevent infections and keep the virus from spreading. Showering at the worksite or at a nearby decontamination station at the end of the work shift and leaving all contaminated clothing and equipment at work should be facilitated by the employer. Workers must receive training and instructions on appropriate working practices, the application of the technical, organisational and decontamination measures, the use of PPE, and how to

<footnote n="8">⁸ An extensive body of occupational safety and health (OSH) legislation applies to the protection of workers. Employers' obligations are set out in the OSH framework Directive 89/391/EC and its daughter directives, in particular directive 2000/54/EC 000 on the protection of workers from risks related to exposure to biological agents at work. These Directives are minimum requirements and are implemented in national regulations. There may be specific guidance for poultry workers in the Member states and they may also include requirements for appropriate health surveillance for instance.</footnote>
The continuous detection of HPAI viruses in wild and domestic mammals, the rapid acquisition of viral mutations associated with mammalian adaptation after transmission to mammals, as well as the sporadic human infections with HPAI A(H5Nx) viruses of clade 2.3.4.4b, including the two human cases recently reported in Spain, are all factors that highlight the need to intensify surveillance in mammals and humans, particularly in high-risk areas with an intensive viral circulation.

Worldwide, HPAI A(H5) virus continues to be reported in poultry and wild birds in Russia, Asia and North America, and since October 2022 has been increasingly reported from Central and South America. For the first time ever, the Eurasian lineage of HPAI A(H5N1) and A(H5Nx) were detected in poultry, captive and wild birds in Mexico, Colombia, Ecuador, Peru and Venezuela. The spread in Central and South America seems to continue from north to south with unforeseeable consequences.

## 4.7. Monitoring, diagnosis of human infections and public health, occupational health and safety measures for infection prevention and control in the EU/EEA

### 4.7.1. Occupational health and safety measures

There is an extensive set of regulations to protect workers from health and safety risks and in accordance with occupational health and safety legislation, employers have responsibilities<fnref n="8" />. Employers' responsibilities include the implementation of appropriate preventive measures after a workplace risk assessment, taking into account all risks, including the risks from unintentional exposure to biological agents, in agreement with the health or safety committee or with workers' representatives. This includes prioritising technical and organisational measures over personal measures, the obligation to consult, inform and train workers and the need to provide appropriate health surveillance. Employers should periodically revise their workplace risk assessment and ensure that all necessary technical, organisational, maintenance and hygiene measures are taken to prevent the infection of workers.

When there is a potential risk of exposure to these viruses from infected birds (whether in an agricultural or other setting), the workplace risk assessment should be revised by the employer and appropriate measures should be taken. These measures may include physical distancing, enhanced ventilation, dust- and aerosol-avoiding measures (for example when cleaning and handling litter) and using appropriate PPE, when the above-mentioned collective measures do not sufficiently protect workers. Work clothing and street clothing should be stored separately and a separation of potentially contaminated areas from clean areas should be ensured (black/white areas) and appropriate hygiene measures applied. In agricultural settings, care should be taken to avoid contamination of domestic areas, for example through contaminated work clothing. Appropriate PPE should be provided by employers and properly stored and disposed of, and workers should be trained in its use. The employer should provide the possibility for storing work clothing and street clothing separately. Specific measures should be set out for culling operations and for the handling of dead animals and waste.

At premises where workers may be exposed to the above-mentioned viruses (e.g. establishments, slaughterhouses), for example when directly exposed to birds, their products or droppings, which may potentially be infected or contaminated with avian influenza viruses, stricter measures should be applied. To reduce the risk of infection with zoonotic influenza viruses, workers should be protected from direct physical contact with sick or dead animals or their remains (e.g. sick birds, poultry carcasses, poultry faeces or litter, surfaces and water that might be contaminated with excretions in the case of infected or dead birds). At poultry farms, it should be ensured that living areas are not contaminated, and working and living areas should be strictly separated. Good hand hygiene practice (proper use of gloves, hand-washing, and use of waterless hand sanitisers) is important and helps prevent infections and keep the virus from spreading. Showering at the worksite or at a nearby decontamination station at the end of the work shift and leaving all contaminated clothing and equipment at work should be facilitated by the employer. Workers must receive training and instructions on appropriate working practices, the application of the technical, organisational and decontamination measures, the use of PPE, and how to

<footnote n="8">⁸ An extensive body of occupational safety and health (OSH) legislation applies to the protection of workers. Employers' obligations are set out in the OSH framework Directive 89/391/EC and its daughter directives, in particular directive 2000/54/EC 000 on the protection of workers from risks related to exposure to biological agents at work. These Directives are minimum requirements and are implemented in national regulations. There may be specific guidance for poultry workers in the Member states and they may also include requirements for appropriate health surveillance for instance.</footnote>
put on, use, take off, and dispose of it. Employers should ensure that there are proper waste storage and disposal facilities in closed containers. Workers should be informed of any emergency measures and know to whom they should report any incident that could cause the spread of the virus.

In the event of an outbreak, the occupational safety and health authorities may be consulted on the appropriate preventive measures to take. Ideally, occupational safety and health authorities should be notified of any such outbreaks – e.g. by the public health authorities.

Employers must keep a record of any workers that may have been exposed to the viruses and offer health surveillance as appropriate, according to national requirements. If self-isolation is advised, employers should set out clear procedures clarifying how workers should self-isolate, the duration of isolation and any health surveillance they should undergo. Employers should seek advice from the occupational health services and/or occupational physician on any measures and also recommend health surveillance for any other potentially infected workers. The confidentiality of sensitive medical data should however be respected and maintained. Workers should be able to return to work safely and clear procedures should be developed by employers to ensure this.

### 4.7.2. Monitoring and options for public health measures

Surveillance and options for public health measures have been outlined in previous reports (EFSA et al., 2021b) and remain valid.

### 4.7.3. Diagnosis

People in the EU presenting with severe acute respiratory or influenza-like infection and a history of exposure to poultry or wild birds will require careful investigation, management and infection control. Neurological symptoms have also been observed in mammals infected with avian influenza viruses. Should transmission to humans occur, also other non-respiratory symptoms might possibly occur, and clinicians should consider testing for influenza severely ill patients presenting with respiratory but also with other unusual e.g. neurological symptoms. Appropriate samples for influenza tests should be rapidly taken and processed from patients with relevant exposure history within 10-14 days preceding the symptom onset. If positive specimens cannot be subtyped, those should be shared with the national reference laboratory (National Influenza Centres; NICs).

With routine diagnostic laboratory assays, human infection with A(H5Nx) viruses should be detected as positive for influenza A virus, and negative for influenza B, A(H1), A(H1)pdm09 and A(H3) viruses and therefore classified as unsubtypable influenza A virus, if no specific A(H5) diagnostic test is performed. Such unsubtypable influenza A virus isolates or clinical samples that cannot be subtyped should be sent to NICs, and further to a WHO Collaborating Centre for Reference.

If testing of asymptomatic workers is conducted, also follow-up investigations should be in place if exposed people are testing positive to monitor the case and close contacts, to confirm the infection or to identify a contamination or amplification of low-level virus material.

The confirmation of a true avian influenza infection in a person following a positive PCR should include repeated testing to exclude a false-positive signal, subsequent virus sequencing to produce full-length genomes for further analysis, virus cultivation, and material should be shared with reference laboratories and WHO-CCs for virus characterisation as outlined in the guidance document about testing and detection of zoonotic influenza virus infections in humans in the EU/EEA, and occupationally safety and health measures for those exposed at work (ECDC, 2022c). Also, serological investigations are needed to identify seroconversion for case ascertainment. However, for some virus positivity findings it might be challenging to confirm or rule out a true infection. More work needs to be performed globally to develop criteria how to address such inconclusive results. Reference viruses and sera against these reference viruses need to be developed, constantly updated and provided to the countries to investigate transmission events and confirm infections serologically. This is also needed to conduct larger studies in population groups exposed to avian influenza viruses and also potentially infected birds such as poultry workers, cullers but also slaughterhouse workers, to support risk assessments.

ECDC jointly with EFSA, EU-OSHA and the EURL published a separate document that provides guidance for the testing of humans for zoonotic influenza viruses. The document describes different exposed groups at risk and raises awareness about the possibility of atypical presentations in humans similar to
put on, use, take off, and dispose of it. Employers should ensure that there are proper waste storage and disposal facilities in closed containers. Workers should be informed of any emergency measures and know to whom they should report any incident that could cause the spread of the virus.

In the event of an outbreak, the occupational safety and health authorities may be consulted on the appropriate preventive measures to take. Ideally, occupational safety and health authorities should be notified of any such outbreaks – e.g. by the public health authorities.

Employers must keep a record of any workers that may have been exposed to the viruses and offer health surveillance as appropriate, according to national requirements. If self-isolation is advised, employers should set out clear procedures clarifying how workers should self-isolate, the duration of isolation and any health surveillance they should undergo. Employers should seek advice from the occupational health services and/or occupational physician on any measures and also recommend health surveillance for any other potentially infected workers. The confidentiality of sensitive medical data should however be respected and maintained. Workers should be able to return to work safely and clear procedures should be developed by employers to ensure this.

### 4.7.2. Monitoring and options for public health measures

Surveillance and options for public health measures have been outlined in previous reports (EFSA et al., 2021b) and remain valid.

### 4.7.3. Diagnosis

People in the EU presenting with severe acute respiratory or influenza-like infection and a history of exposure to poultry or wild birds will require careful investigation, management and infection control. Neurological symptoms have also been observed in mammals infected with avian influenza viruses. Should transmission to humans occur, also other non-respiratory symptoms might possibly occur, and clinicians should consider testing for influenza severely ill patients presenting with respiratory but also with other unusual e.g. neurological symptoms. Appropriate samples for influenza tests should be rapidly taken and processed from patients with relevant exposure history within 10-14 days preceding the symptom onset. If positive specimens cannot be subtyped, those should be shared with the national reference laboratory (National Influenza Centres; NICs).

With routine diagnostic laboratory assays, human infection with A(H5Nx) viruses should be detected as positive for influenza A virus, and negative for influenza B, A(H1), A(H1)pdm09 and A(H3) viruses and therefore classified as unsubtypable influenza A virus, if no specific A(H5) diagnostic test is performed. Such unsubtypable influenza A virus isolates or clinical samples that cannot be subtyped should be sent to NICs, and further to a WHO Collaborating Centre for Reference.

If testing of asymptomatic workers is conducted, also follow-up investigations should be in place if exposed people are testing positive to monitor the case and close contacts, to confirm the infection or to identify a contamination or amplification of low-level virus material.

The confirmation of a true avian influenza infection in a person following a positive PCR should include repeated testing to exclude a false-positive signal, subsequent virus sequencing to produce full-length genomes for further analysis, virus cultivation, and material should be shared with reference laboratories and WHO-CCs for virus characterisation as outlined in the guidance document about testing and detection of zoonotic influenza virus infections in humans in the EU/EEA, and occupationally safety and health measures for those exposed at work (ECDC, 2022c). Also, serological investigations are needed to identify seroconversion for case ascertainment. However, for some virus positivity findings it might be challenging to confirm or rule out a true infection. More work needs to be performed globally to develop criteria how to address such inconclusive results. Reference viruses and sera against these reference viruses need to be developed, constantly updated and provided to the countries to investigate transmission events and confirm infections serologically. This is also needed to conduct larger studies in population groups exposed to avian influenza viruses and also potentially infected birds such as poultry workers, cullers but also slaughterhouse workers, to support risk assessments.

ECDC jointly with EFSA, EU-OSHA and the EURL published a separate document that provides guidance for the testing of humans for zoonotic influenza viruses. The document describes different exposed groups at risk and raises awareness about the possibility of atypical presentations in humans similar to
what has been recently observed in other mammals with severe infection of the brain, i.e. encephalitis or meningoencephalitis (ECDC, 2022c).

### 4.7.4. Reporting

Human infections with avian influenza viruses are notifiable under EU legislation within 24 hours through the Early Warning and Response System (EWRS) according to EU Decision 1082/2013/EU<fnref n="9" />. Reporting is also required through the International Health Regulations (IHR) notification system (WHO, 2017): 'Each State Party shall notify WHO, by the most efficient means of communication available, by way of the National IHR Focal Point, and within 24 hours of assessment of public health information, of all events that may constitute a public health emergency of international concern within its territory according to the decision instrument, and any health measure implemented in response to those events.'

Information should also be shared with local OSH authorities.

### 4.7.5. Sharing of sequences

The timely characterisation of viruses and the sharing of sequence information remain crucial for the monitoring of virus evolution and for virus vaccine development. Sharing of sequence data through the GISAID EpiFlu (GSAID, online) or other sequence databases and of virus isolates with WHO Collaborating Centres are important for public health assessment, improvement of diagnostics and the development of candidate vaccines. Sharing of influenza viruses occurs through the Global Influenza Surveillance and Response System (GISRS) (WHO, online-b).

### 4.7.6. Candidate vaccine viruses

Candidate vaccine viruses (CVV) developed, under development or proposed are listed at WHO (WHO, 2021b).

## 4.8. ECDC risk assessment for the general public in the EU/EEA

Avian influenza A(H5Nx) clade 2.3.4.4 viruses have caused large outbreaks in birds and poultry since 2014. ECDC has published a Threat Assessment Brief on 24 February 2021 (ECDC, 2021b).

During this reporting period, Spain reported the first detections of avian influenza A(H5N1) virus in two workers exposed to infected poultry before and during culling activities during an outbreak in a farm (ECDC, 2022a, b; Sanidad, 2022; WHO, online-a). Virus load in the sample was low and the full virus could not be sequenced suggesting a contamination rather than an active infection with virus replication in the person (ECDC, 2022a; Sanidad, 2022). Spanish authorities are routinely testing all workers involved in culling and cleaning activities during avian influenza virus outbreaks in poultry farms and workers are required to wear personal protective equipment including FFP2 masks during these activities. None of the workers had experienced any symptom. Preliminary results from serological investigation showed no evidence of seroconversion of at least one of the workers indicating no systemic infection but rather exposure and amplification of low-level viral RNA. Similar reports of avian influenza detections in workers exposed to avian influenza infected birds or the environment during culling operations without any clinical symptoms and with limited information and evidence of a systemic viral infection add challenges to the situational and overall risk assessment.

The risk assessment is based on the likelihood of infection and disease severity: the likelihood of infection is related to direct unprotected exposure to infected wild birds or poultry (or other mammals infected with avian influenza virus such as foxes and seals) and is considered low for the general population and low to medium for people occupationally exposed to infected birds or other potentially infected mammals. The disease severity has been described as asymptomatic or very mild in human infected with recent A(H5N1) or A(H5N8) viruses circulating in Europe related to different detections in humans involved in culling activities (see Table 4), therefore the impact based on severity has been considered low but with high uncertainty due to the high diversity of circulating avian influenza viruses. The recent human A(H5N1) infection and infections with A(H5N6) in China have shown a high level of

<footnote n="9">⁹ Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. OJ L 262, 27.9.2012, pp. 263-319.</footnote>
what has been recently observed in other mammals with severe infection of the brain, i.e. encephalitis or meningoencephalitis (ECDC, 2022c).

### 4.7.4. Reporting

Human infections with avian influenza viruses are notifiable under EU legislation within 24 hours through the Early Warning and Response System (EWRS) according to EU Decision 1082/2013/EU<fnref n="9" />. Reporting is also required through the International Health Regulations (IHR) notification system (WHO, 2017): 'Each State Party shall notify WHO, by the most efficient means of communication available, by way of the National IHR Focal Point, and within 24 hours of assessment of public health information, of all events that may constitute a public health emergency of international concern within its territory according to the decision instrument, and any health measure implemented in response to those events.'

Information should also be shared with local OSH authorities.

### 4.7.5. Sharing of sequences

The timely characterisation of viruses and the sharing of sequence information remain crucial for the monitoring of virus evolution and for virus vaccine development. Sharing of sequence data through the GISAID EpiFlu (GSAID, online) or other sequence databases and of virus isolates with WHO Collaborating Centres are important for public health assessment, improvement of diagnostics and the development of candidate vaccines. Sharing of influenza viruses occurs through the Global Influenza Surveillance and Response System (GISRS) (WHO, online-b).

### 4.7.6. Candidate vaccine viruses

Candidate vaccine viruses (CVV) developed, under development or proposed are listed at WHO (WHO, 2021b).

## 4.8. ECDC risk assessment for the general public in the EU/EEA

Avian influenza A(H5Nx) clade 2.3.4.4 viruses have caused large outbreaks in birds and poultry since 2014. ECDC has published a Threat Assessment Brief on 24 February 2021 (ECDC, 2021b).

During this reporting period, Spain reported the first detections of avian influenza A(H5N1) virus in two workers exposed to infected poultry before and during culling activities during an outbreak in a farm (ECDC, 2022a, b; Sanidad, 2022; WHO, online-a). Virus load in the sample was low and the full virus could not be sequenced suggesting a contamination rather than an active infection with virus replication in the person (ECDC, 2022a; Sanidad, 2022). Spanish authorities are routinely testing all workers involved in culling and cleaning activities during avian influenza virus outbreaks in poultry farms and workers are required to wear personal protective equipment including FFP2 masks during these activities. None of the workers had experienced any symptom. Preliminary results from serological investigation showed no evidence of seroconversion of at least one of the workers indicating no systemic infection but rather exposure and amplification of low-level viral RNA. Similar reports of avian influenza detections in workers exposed to avian influenza infected birds or the environment during culling operations without any clinical symptoms and with limited information and evidence of a systemic viral infection add challenges to the situational and overall risk assessment.

The risk assessment is based on the likelihood of infection and disease severity: the likelihood of infection is related to direct unprotected exposure to infected wild birds or poultry (or other mammals infected with avian influenza virus such as foxes and seals) and is considered low for the general population and low to medium for people occupationally exposed to infected birds or other potentially infected mammals. The disease severity has been described as asymptomatic or very mild in human infected with recent A(H5N1) or A(H5N8) viruses circulating in Europe related to different detections in humans involved in culling activities (see Table 4), therefore the impact based on severity has been considered low but with high uncertainty due to the high diversity of circulating avian influenza viruses. The recent human A(H5N1) infection and infections with A(H5N6) in China have shown a high level of

<footnote n="9">⁹ Commission Implementing Decision of 8 August 2012 amending Decision 2002/253/EC laying down case definitions for reporting communicable diseases to the Community network under Decision No 2119/98/EC of the European Parliament and of the Council. OJ L 262, 27.9.2012, pp. 263-319.</footnote>
severity, which has not been observed elsewhere related to clade 2.3.4.4b viruses and further analyses e.g. sequence and virus characterisation data are needed to better understand differences and similarities of the viruses causing severe or no illness globally. There are no indications so far that viruses differ antigenically from developed candidate vaccine viruses of previously circulating A(H5) viruses in Europe.

The risk of human transmission due to avian influenza viruses of the currently circulating clade 2.3.4.4b in Europe is assessed as *low* for the general population and *low to moderate* for people occupationally or otherwise HPAI virus exposed. The recent detection of A(H5N1) in asymptomatic workers in Spain does not alter this assessment. Further information about the severe A(H5N1) case in China is needed for the assessment.

Sporadic transmission of uncommon avian influenza viruses such as A(H3N8) and A(H10N3) reported in 2022 have been observed before e.g. for A(H6N1), A(H7N4), A(H10N8) and is therefore not an unexpected event. This does not alter the assessment that avian influenza virus transmission to humans is a rare event and the risk is considered very low for viruses adapted to avian species. Viruses currently circulating in bird populations in Europe are considered to be avian-adapted viruses. However, the detection of viruses carrying markers for mammalian adaptation, and correlated with increased replication and virulence in mammals, is of concern. The additional reports of transmission events to and between mammals, e.g. mink, seals, foxes and other carnivores as well as seroepidemiological evidence of transmission to wild boar and domestic pigs, associated with evolutionary processes including mammalian adaptation are of concern and need to be closely followed up. People involved and exposed to these animals need to be followed up to identify early any transmission between humans. Also outbreaks in mink farms showing adaptation processes to mammals with mutations associated with enhanced polymerase activity need to be carefully monitored and workers exposed during such outbreaks monitored for at least 10-14 days actively or passively and immediately tested and isolated should they develop symptoms e.g. fever, conjunctivitis, diarrhoea, respiratory, neurological, or other atypical symptoms.

Direct and unprotected exposure to possibly infected poultry or wild birds and their products including blood, remains limited to mostly occupationally exposed groups of people in the EU/EEA countries. Also, other groups of people such as backyard farmers or wild bird hunters with possible exposure to infected poultry or wild birds should be made aware of the potential risk of transmission and appropriately protected. Such unprotected exposure to infected backyard birds was the source of infection in the recent human A(H5N1) infection in the United Kingdom (GovUK, online-a; WHO, online-d). Workers in close contact to potentially infected mammals such as mink, foxes or other wildlife e.g. at rehabilitation centres or in areas with high level of avian influenza outbreaks in wild birds, should also be informed about possible avian influenza infections and should be appropriately protected when having to handle such animals. If they develop symptoms after exposure, they should consult a practitioner, inform about the exposure and get tested for avian influenza virus.

The use of antiviral pre-and postexposure should be considered for exposed people and in particular for possible cases of avian influenza infection according to national guidelines.

The uncertainty of this risk assessment is high due to the high variability of the avian influenza viruses of clade 2.3.4.4 with many reassorted subtypes and genetic lineages co-circulating in Europe and globally. Reassortment events will continue and zoonotic transmission of avian influenza viruses cannot be fully excluded in general when avian influenza viruses are present in birds. People should avoid touching sick or dead birds or their droppings and should wear PPE when in direct contact. Workers should be protected following an updated workplace risk assessment and preventive measures should be set accordingly<fnref n="10" />. Additionally the use of personal protective equipment and measures for people exposed to birds infected with avian influenza viruses will minimise any residual risk. Follow-up measures and testing should be initiated as described above.

The risk of travel-related importation of human avian influenza cases from countries where the viruses are detected in poultry or wild birds is *very low*. Sporadic human cases infected with A(H9N2) LPAI or A(H5N6) HPAI viruses outside Europe underline the risk of transmission whenever people are exposed to infected birds.

<footnote n="10">¹⁰ Council Directive 2005/94/EC of 20 December 2005 on Community measures for the control of avian influenza and repealing Directive 92/40/EEC. OJ L 10, 14.1.2006, p. 16-65.</footnote>
severity, which has not been observed elsewhere related to clade 2.3.4.4b viruses and further analyses e.g. sequence and virus characterisation data are needed to better understand differences and similarities of the viruses causing severe or no illness globally. There are no indications so far that viruses differ antigenically from developed candidate vaccine viruses of previously circulating A(H5) viruses in Europe.

The risk of human transmission due to avian influenza viruses of the currently circulating clade 2.3.4.4b in Europe is assessed as *low* for the general population and *low to moderate* for people occupationally or otherwise HPAI virus exposed. The recent detection of A(H5N1) in asymptomatic workers in Spain does not alter this assessment. Further information about the severe A(H5N1) case in China is needed for the assessment.

Sporadic transmission of uncommon avian influenza viruses such as A(H3N8) and A(H10N3) reported in 2022 have been observed before e.g. for A(H6N1), A(H7N4), A(H10N8) and is therefore not an unexpected event. This does not alter the assessment that avian influenza virus transmission to humans is a rare event and the risk is considered very low for viruses adapted to avian species. Viruses currently circulating in bird populations in Europe are considered to be avian-adapted viruses. However, the detection of viruses carrying markers for mammalian adaptation, and correlated with increased replication and virulence in mammals, is of concern. The additional reports of transmission events to and between mammals, e.g. mink, seals, foxes and other carnivores as well as seroepidemiological evidence of transmission to wild boar and domestic pigs, associated with evolutionary processes including mammalian adaptation are of concern and need to be closely followed up. People involved and exposed to these animals need to be followed up to identify early any transmission between humans. Also outbreaks in mink farms showing adaptation processes to mammals with mutations associated with enhanced polymerase activity need to be carefully monitored and workers exposed during such outbreaks monitored for at least 10-14 days actively or passively and immediately tested and isolated should they develop symptoms e.g. fever, conjunctivitis, diarrhoea, respiratory, neurological, or other atypical symptoms.

Direct and unprotected exposure to possibly infected poultry or wild birds and their products including blood, remains limited to mostly occupationally exposed groups of people in the EU/EEA countries. Also, other groups of people such as backyard farmers or wild bird hunters with possible exposure to infected poultry or wild birds should be made aware of the potential risk of transmission and appropriately protected. Such unprotected exposure to infected backyard birds was the source of infection in the recent human A(H5N1) infection in the United Kingdom (GovUK, online-a; WHO, online-d). Workers in close contact to potentially infected mammals such as mink, foxes or other wildlife e.g. at rehabilitation centres or in areas with high level of avian influenza outbreaks in wild birds, should also be informed about possible avian influenza infections and should be appropriately protected when having to handle such animals. If they develop symptoms after exposure, they should consult a practitioner, inform about the exposure and get tested for avian influenza virus.

The use of antiviral pre-and postexposure should be considered for exposed people and in particular for possible cases of avian influenza infection according to national guidelines.

The uncertainty of this risk assessment is high due to the high variability of the avian influenza viruses of clade 2.3.4.4 with many reassorted subtypes and genetic lineages co-circulating in Europe and globally. Reassortment events will continue and zoonotic transmission of avian influenza viruses cannot be fully excluded in general when avian influenza viruses are present in birds. People should avoid touching sick or dead birds or their droppings and should wear PPE when in direct contact. Workers should be protected following an updated workplace risk assessment and preventive measures should be set accordingly<fnref n="10" />. Additionally the use of personal protective equipment and measures for people exposed to birds infected with avian influenza viruses will minimise any residual risk. Follow-up measures and testing should be initiated as described above.

The risk of travel-related importation of human avian influenza cases from countries where the viruses are detected in poultry or wild birds is *very low*. Sporadic human cases infected with A(H9N2) LPAI or A(H5N6) HPAI viruses outside Europe underline the risk of transmission whenever people are exposed to infected birds.

<footnote n="10">¹⁰ Council Directive 2005/94/EC of 20 December 2005 on Community measures for the control of avian influenza and repealing Directive 92/40/EEC. OJ L 10, 14.1.2006, p. 16-65.</footnote>
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## References

Adlhoch C, Baldinelli F, Fusaro A and Terregino C, 2021. Avian influenza, a new threat to public health in Europe? *Clin Microbiol Infect.* doi: 10.1016/j.cmi.2021.11.005

Alkie TN, Lopes S, Hisanaga T, Xu W, Suderman M, Koziuk J, Fisher M, Redford T, Lung O, Joseph T, Himsworth CG, Brown IH, Bowes V, Lewis NS and Berhane Y, 2022. A threat from both sides: Multiple introductions of genetically distinct H5 HPAI viruses into Canada via both East Asia-Australasia/Pacific and Atlantic flyways. *Virus Evol*, 8:veac077. doi: 10.1093/ve/veac077

Ärzteblatt D, online. Bird flu virus detected in dead seals.

Avian Flu Diary, online. Canada Reports (Fatal) H5N1 Infection In A White-Sided Dolphin.

Avian Flu Diary, online. Two Reports On HPAI H5N8 Infecting Marine Mammals (Denmark & Germany).

Awuni JA, Bianco A, Dogbey OJ, Fusaro A, Yingar DT, Salviato A, Ababio PT, Milani A, Bonfante F and Monne I, 2019. Avian influenza H9N2 subtype in Ghana: virus characterization and evidence of co-infection. *Avian Pathology*, 48:470-476. doi: 10.1080/03079457.2019.1624687

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Galicia Xd, online. La Xunta detecta un foco de influenza aviar en una explotación de visones en la provincia de A Coruña.

GovHK (The Government of Hong Kong Special Administrative News), online. 75-year-old man in Jiangxi dies of H10N8 infection.

GovUK (UK Health Security Agency), online. Human case of avian flu detected in UK.

GovUK (UK Health Security Agency), online. Influenza of avian origin in UK seal populations: qualitative assessment of the risk to the UK human population.

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Herve S, Schmitz A, Briand FX, Gorin S, Queguiner S, Niqueux E, Paboeuf F, Scoizec A, Le Bouquin-Leneveu S, Eterradossi N and Simon G, 2021. Serological Evidence of Backyard Pig Exposure to Highly Pathogenic Avian Influenza H5N8 Virus during 2016-2017 Epizootic in France. Pathogens, 10. doi: 10.3390/pathogens10050621

Isoda N, Onuma M, Hiono T, Sobolev I, Lim HY, Nabeshima K, Honjyo H, Yokoyama M, Shestopalov A and Sakoda Y, 2022. Detection of New H5N1 High Pathogenicity Avian Influenza Viruses in Winter 2021-2022 in the Far East, Which Are Genetically Close to Those in Europe. Viruses, 14. doi: 10.3390/v14102168

Jiang H, Wu P, Uyeki TM, He J, Deng Z, Xu W, Lv Q, Zhang J, Wu Y, Tsang TK, Kang M, Zheng J, Wang L, Yang B, Qin Y, Feng L, Fang VJ, Gao GF, Leung GM, Yu H and Cowling BJ, 2017. Preliminary Epidemiologic Assessment of Human Infections With Highly Pathogenic Avian Influenza A(H5N6) Virus, China. Clinical Infectious Diseases, 65:383-388. doi: 10.1093/cid/cix334

Kariithi HM, Welch CN, Ferreira HL, Pusch EA, Ateya LO, Binepal YS, Apopo AA, Dulu TD, Afonso CL and Suarez DL, 2019. Genetic characterization and pathogenesis of the first H9N2 low pathogenic avian influenza viruses isolated from chickens in Kenyan live bird markets. Infection, Genetics and Evolution:104074. doi: 10.1016/j.meegid.2019.104074

Kiniradio, online. Brown Bear Cub in Alaska tests positive for Avian Influenza.

KTOO, online. First bear with bird flu in US was cub in Glacier Bay.

Lee EK, Lee YN, Kye SJ, Lewis NS, Brown IH, Sagong M, Heo GB, Kang YM, Cho HK, Kang HM, Cheon SH, Lee M, Park BK, Kim YJ and Lee YJ, 2018. Characterization of a novel reassortant H5N6 highly pathogenic avian influenza virus clade 2.3.4.4 in Korea, 2017. Emerging Microbes & Infections, 7:103. doi: 10.1038/s41426-018-0104-3
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NHCGovCN (National Health Commission of the People's Republic of China), online. One case of human infection with H10N3 avian influenza was detected in Jiangsu Province.

Outbreak News, online. Denmark reports 1st highly pathogenic avian influenza case in harbor seal.

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Pulit-Penaloza J, Belser J, Brock N, Thakur PB, Tumpey T and Maines T, 2022. Pathogenesis and Transmissibility of North American Highly Pathogenic Avian Influenza A(H5N1) Virus in Ferrets. Emerging Infectious Disease journal, 28:1913. doi: 10.3201/eid2809.220879

Puryear W, Sawatzki K, Hill N, Foss A, Stone JJ, Doughty L, Walk D, Gilbert K, Murray M, Cox E, Patel P, Mertz Z, Ellis S, Taylor J, Fauquier D, Smith A, DiGiovanni RA, van de Guchte A, Gonzalez-Reiche AS, Khalil Z, van Bakel H, Torchetti MK, Lenoch JB, Lantz K and Runstadler J, 2022. Outbreak of Highly Pathogenic Avian Influenza H5N1 in New England Seals. bioRxiv:2022.2007.2029.501155. doi: 10.1101/2022.07.29.501155

Pyankova OG, Susloparov IM, Moiseeva AA, Kolosova NP, Onkhonova GS, Danilenko AV, Vakalova EV, Shendo GL, Nekeshina NN, Noskova LN, Demina JV, Frolova NV, Gavrilova EV, Maksyutov RA and Ryzhikov AB, 2021. Isolation of clade 2.3.4.4b A(H5N8), a highly pathogenic avian influenza virus, from a worker during an outbreak on a poultry farm, Russia, December 2020. Eurosurveillance, 26:2100439.

Rijks JM, Leopold MF, Kuhn S, In 't Veld R, Schenk F, Brenninkmeijer A, Lilipaly SJ, Ballmann MZ, Kelder L, de Jong JW, Courtens W, Slaterus R, Kleyheeg E, Vreman S, Kik MJL, Grone A, Fouchier RAM, Engelsma M, de Jong MCM, Kuiken T and Beerens N, 2022. Mass Mortality Caused by Highly Pathogenic Influenza A(H5N1) Virus in Sandwich Terns, the Netherlands, 2022. Emerg Infect Dis, 28:2538-2542. doi: 10.3201/eid2812.221292

Sanidad Md, 2022. Primera detección de gripe aviar A(H5N1) en humanos en España. 13 pp.

Schülein A, Ritzmann M, Christian J, Schneider K and Neubauer-Juric A, 2021. Exposure of wild boar to Influenza A viruses in Bavaria: Analysis of seroprevalences and antibody subtype specificity before and after the panzootic of highly pathogenic avian influenza viruses A (H5N8). Zoonoses and Public Health, n/a.

Shin D, Siebert U, Lakemeyer J, Grilo M, Pawliczka I, Wu N, Valentin-Weigand P, Haas L and Herrler G, 2019. Highly Pathogenic Avian Influenza A(H5N8) Virus in Gray Seals, Baltic Sea. Emerging Infectious Diseases, 25:2295-2298. doi: 10.3201/eid2512.181472

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SSI (Staten Serum Insitut), online. Bird flu in Danish seals.

SVA (National Veterinary Institute Sweden), online. First case of bird flu confirmed in porpoises.
Li YT, Chen CC, Chang AM, Chao DY and Smith GJD, 2020. Co-circulation of both low and highly pathogenic avian influenza H5 viruses in current poultry epidemics in Taiwan. Virus Evol, 6:veaa037.
doi: 10.1093/ve/veaa037

Liang Y, Hjulsager CK, Seekings AH, Warren CJ, Lean FZX, Nunez A, James J, Thomas SS, Banyard AC, Slomka MJ, Brown IH and Larsen LE, 2022. Pathogenesis and infection dynamics of high pathogenicity avian influenza virus (HPAIV) H5N6 (clade 2.3.4.4b) in pheasants and onward transmission to chickens. Virology, 577:138-148. doi: 10.1016/j.virol.2022.10.009

NHCGovCN (National Health Commission of the People's Republic of China), online. One case of human infection with H10N3 avian influenza was detected in Jiangsu Province.

Outbreak News, online. Denmark reports 1st highly pathogenic avian influenza case in harbor seal.

Parry J, 2014. H10N8 avian flu virus claims its first known human casualty. BMJ, 348:g1360. doi: 10.1136/bmj.g1360

ProMed, online. Avian influenza (226): Americas (Peru) pelican, HPAI H5N1, Archive Number: 20221202.8707032.

ProMed, online. Avian influenza (231): Americas (Chile) wild bird, HPAI H5N1, Archive Number: 20221209.8707163.

Pulit-Penaloza J, Belser J, Brock N, Thakur PB, Tumpey T and Maines T, 2022. Pathogenesis and Transmissibility of North American Highly Pathogenic Avian Influenza A(H5N1) Virus in Ferrets. Emerging Infectious Disease journal, 28:1913. doi: 10.3201/eid2809.220879

Puryear W, Sawatzki K, Hill N, Foss A, Stone JJ, Doughty L, Walk D, Gilbert K, Murray M, Cox E, Patel P, Mertz Z, Ellis S, Taylor J, Fauquier D, Smith A, DiGiovanni RA, van de Guchte A, Gonzalez-Reiche AS, Khalil Z, van Bakel H, Torchetti MK, Lenoch JB, Lantz K and Runstadler J, 2022. Outbreak of Highly Pathogenic Avian Influenza H5N1 in New England Seals. bioRxiv:2022.2007.2029.501155. doi: 10.1101/2022.07.29.501155

Pyankova OG, Susloparov IM, Moiseeva AA, Kolosova NP, Onkhonova GS, Danilenko AV, Vakalova EV, Shendo GL, Nekeshina NN, Noskova LN, Demina JV, Frolova NV, Gavrilova EV, Maksyutov RA and Ryzhikov AB, 2021. Isolation of clade 2.3.4.4b A(H5N8), a highly pathogenic avian influenza virus, from a worker during an outbreak on a poultry farm, Russia, December 2020. Eurosurveillance, 26:2100439.

Rijks JM, Leopold MF, Kuhn S, In 't Veld R, Schenk F, Brenninkmeijer A, Lilipaly SJ, Ballmann MZ, Kelder L, de Jong JW, Courtens W, Slaterus R, Kleyheeg E, Vreman S, Kik MJL, Grone A, Fouchier RAM, Engelsma M, de Jong MCM, Kuiken T and Beerens N, 2022. Mass Mortality Caused by Highly Pathogenic Influenza A(H5N1) Virus in Sandwich Terns, the Netherlands, 2022. Emerg Infect Dis, 28:2538-2542. doi: 10.3201/eid2812.221292

Sanidad Md, 2022. Primera detección de gripe aviar A(H5N1) en humanos en España. 13 pp.

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SVA (National Veterinary Institute Sweden), online. Highly pathogenic bird flu - the past season and the infection situation for the coming season.

The Government of the Hong Kong Special Administrative Region Press Releases, online. CHP closely monitors human case of avian influenza A(H5N6) in Mainland.

The Government of the Hong Kong Special Administrative Region Press Releases, online. CHP notified of human case of avian influenza A(H3N8) in Mainland.

Tribune O, online. Bird Flu Virus Detected in Pelicans in Eastern Venezuela.

UFHealth (University of Florida Helath), online. A first: Avian influenza detected in American dolphin.

USDA (U.S. Department of Agriculture), online. 2022 Detections of Highly Pathogenic Avian Influenza in Mammals.

VNExpress, online. Vietnam records first human case of bird flu in 8 years.

Wille M, Avery-Gomm S, Caliendo V, Camphuysen K, Humphreys E, Lang A, Philip E, Ramey A, Rijks J, Robertson G, Roberts L, 2022. High pathogenicity avian influenza represents an unprecedented conservation challenge for globally declining seabird populations. Response to: Editorial, Protect wildlife from livestock diseases (Thijs Kuiken & Ruth Cromie), Science 6 Oct 2022, Vol 378, Issue 6615, p. 5 DOI: 10.1126/science.adf0956

WHO (World Health Organization), 2017. Operational Guidance on Sharing Influenza Viruses with Human Pandemic Potential (IVPP) under the Pandemic Influenza Preparedness (PIP) Framework. Geneva, WHO. 20 pp.

WHO (World Health Organization), 2019a. Avian Influenza Weekly Update Number 713. Geneva, WHO. 3 pp.

WHO (World Health Organization), 2019b. Influenza at the human-animal interface - Summary and assessment, from 25 June 2019 to 27 September 2019. Geneva, WHO. 3 pp.

WHO (World Health Organization), 2020a. Antigenic and genetic characteristics of zoonotic influenza A viruses and development of candidate vaccine viruses for pandemic preparedness. Geneva, WHO. 15 pp.

WHO (World Health Organization), 2020b. Influenza at the human-animal interface - Summary and assessment, from 21 January to 28 February 2020. Geneva. 4 pp.

WHO (World Health Organization), 2020c. Influenza at the human-animal interface; Summary and assessment, from 9 August to 1 October 2021. Geneva. 7 pp.

WHO (World Health Organization), 2020d. Influenza at the human-animal interface; Summary and assessment, from 28 February to 8 May 2020. Geneva. 3 pp.

WHO (World Health Organization), 2021a. Antigenic and genetic characteristics of zoonotic influenza A viruses and development of candidate vaccine viruses for pandemic preparedness. Geneva. 15 pp.

WHO (World Health Organization), 2021b. Cumulative number of confirmed human cases for avian influenza A(H5N1) reported to WHO, 2003-2021 (22 June 2021). Geneva, WHO. 4 pp.

WHO (World Health Organization), 2021c. Influenza at the human-animal interface; Summary and assessment, from 22 May to 22 June 2021. Geneva. 7 pp.

WHO (World Health Organization), 2021d. Influenza at the human-animal interface; Summary and assessment, from 23 June to 8 August 2021. Geneva. 13 pp.

WHO (World Health Organization), 2021e. Influenza at the human-animal interface; Summary and assessment, from 30 January to 15 April 2021. Geneva. 7 pp.

WHO (World Health Organization), 2022a. Influenza at the human-animal interface; Summary and assessment, from 6 October to 11 November 2022. Geneva. 6 pp.

WHO (World Health Organization), 2022b. Influenza at the human-animal interface; Summary and assessment, from 8 April to 13 May 2022. Geneva. 6 pp.
WHO (World Health Organization), 2022c. Influenza at the human-animal interface; Summary and assessment, from 30 August to 5 October 2022. Geneva. 5 pp.

WHO (World Health Organization), online. Avian Influenza A (H5N1) - Spain.

WHO (World Health Organization), online. Global Influenza Surveillance and Response System (GISRS).

WHO (World Health Organization), online. Human infection with avian influenza A (H5N8) - Russian Federation.

WHO (World Health Organization), online. Human infection with avian influenza A(H5) virus.

WHO (World Health Organization), online. Human infection with avian influenza A(H5N1) – India.

WHO (World Health Organization), online. Influenza A (H5) - United Kingdom of Great Britain and Northern Ireland.

WOAH (World Organization for Animal Health), 2022. High pathogenicity avian influenza (HPAI) - Situation report 15/11/2022. Paris. 5 pp.

WUR (Wageningen University Research), online. Bird flu (H5N1) detected in a fox with neurological symptoms.

Xu C, Ye H, Qiu W, Lin H, Chen Y, Zhang H and Liao M, 2018. Phylogenetic classification of hemagglutinin gene of H9N2 avian influenza viruses isolated in China during 2012–2016 and evaluation of selected candidate vaccine strains. Poultry Science, 97:3023-3030. doi: 10.3382/ps/pey154

Yang ZY, Wei CJ, Kong WP, Wu L, Xu L, Smith DF and Nabel GJ, 2007. Immunization by avian H5 influenza hemagglutinin mutants with altered receptor binding specificity. Science, 317:825-828. doi: 10.1126/science.1135165

Zecchin B, Minoungou G, Fusaro A, Moctar S, Ouedraogo-Kabore A, Schivo A, Salviato A, Marciano S and Monne I, 2017. Influenza A(H9N2) Virus, Burkina Faso. Emerging Infectious Diseases, 23:2118-2119. doi: 10.3201/eid2312.171294

Zhu C, Hu C, Gui B, Chen Q, Zhang S and He G, 2018. Genetic characteristics of H9N2 avian influenza viruses isolated from free-range poultry in Eastern China, in 2014-2015. Poultry Science, 97:3793-3800. doi: 10.3382/ps/pey187
WHO (World Health Organization), 2022c. Influenza at the human-animal interface; Summary and assessment, from 30 August to 5 October 2022. Geneva. 5 pp.

WHO (World Health Organization), online. Avian Influenza A (H5N1) - Spain.

WHO (World Health Organization), online. Global Influenza Surveillance and Response System (GISRS).

WHO (World Health Organization), online. Human infection with avian influenza A (H5N8) - Russian Federation.

WHO (World Health Organization), online. Human infection with avian influenza A(H5) virus.

WHO (World Health Organization), online. Human infection with avian influenza A(H5N1) - India.

WHO (World Health Organization), online. Influenza A (H5) - United Kingdom of Great Britain and Northern Ireland.

WOAH (World Organization for Animal Health), 2022. High pathogenicity avian influenza (HPAI) - Situation report 15/11/2022. Paris. 5 pp.

WUR (Wageningen University Research), online. Bird flu (H5N1) detected in a fox with neurological symptoms.

Xu C, Ye H, Qiu W, Lin H, Chen Y, Zhang H and Liao M, 2018. Phylogenetic classification of hemagglutinin gene of H9N2 avian influenza viruses isolated in China during 2012–2016 and evaluation of selected candidate vaccine strains. Poultry Science, 97:3023-3030. doi: 10.3382/ps/pey154

Yang ZY, Wei CJ, Kong WP, Wu L, Xu L, Smith DF and Nabel GJ, 2007. Immunization by avian H5 influenza hemagglutinin mutants with altered receptor binding specificity. Science, 317:825-828. doi: 10.1126/science.1135165

Zecchin B, Minoungou G, Fusaro A, Moctar S, Ouedraogo-Kabore A, Schivo A, Salviato A, Marciano S and Monne I, 2017. Influenza A(H9N2) Virus, Burkina Faso. Emerging Infectious Diseases, 23:2118-2119. doi: 10.3201/eid2312.171294

Zhu C, Hu C, Gui B, Chen Q, Zhang S and He G, 2018. Genetic characteristics of H9N2 avian influenza viruses isolated from free-range poultry in Eastern China, in 2014-2015. Poultry Science, 97:3793-3800. doi: 10.3382/ps/pey187
Abbreviations

<table><tr><td>ADIS</td><td>Animal Disease Information System</td></tr><tr><td>ADNS</td><td>Animal Disease Notification System</td></tr><tr><td>ECDC</td><td>European Centre for Disease Prevention and Control</td></tr><tr><td>EEA</td><td>European Economic Area</td></tr><tr><td>EFSA</td><td>European Food Safety Authority</td></tr><tr><td>EU</td><td>European Union</td></tr><tr><td>EURL</td><td>European Union Reference Laboratory</td></tr><tr><td>EWRS</td><td>Early Warning and Response System</td></tr><tr><td>FAO</td><td>Food and Agriculture Organization</td></tr><tr><td>GISRS</td><td>Global Influenza Surveillance and Response System</td></tr><tr><td>HPAI</td><td>Highly pathogenic avian influenza</td></tr><tr><td>IHR</td><td>International Health Regulations</td></tr><tr><td>IRAT</td><td>Influenza Risk Assessment Tool</td></tr><tr><td>IVPP</td><td>Influenza Viruses with Human Pandemic Potential</td></tr><tr><td>LPAI</td><td>Low pathogenic avian influenza</td></tr><tr><td>NRL</td><td>National Reference Laboratory</td></tr><tr><td>OSH</td><td>Occupational safety and health</td></tr><tr><td>PCR</td><td>Polymerase chain reaction</td></tr><tr><td>PIP</td><td>Pandemic Influenza Preparedness</td></tr><tr><td>PPE</td><td>Personal protective equipment</td></tr><tr><td>RA</td><td>Risk assessment</td></tr><tr><td>SSI</td><td>Statens Serum Institut</td></tr><tr><td>ToR</td><td>Term of Reference</td></tr><tr><td>WAHIS</td><td>World Animal Health System</td></tr><tr><td>WOAH</td><td>World Organisation for Animal Health</td></tr><tr><td>WHO</td><td>World Health Organization</td></tr><tr><td>WUR</td><td>Wageningen University Research</td></tr></table>
Abbreviations

<table><tr><td>ADIS</td><td>Animal Disease Information System</td></tr><tr><td>ADNS</td><td>Animal Disease Notification System</td></tr><tr><td>ECDC</td><td>European Centre for Disease Prevention and Control</td></tr><tr><td>EEA</td><td>European Economic Area</td></tr><tr><td>EFSA</td><td>European Food Safety Authority</td></tr><tr><td>EU</td><td>European Union</td></tr><tr><td>EURL</td><td>European Union Reference Laboratory</td></tr><tr><td>EWRS</td><td>Early Warning and Response System</td></tr><tr><td>FAO</td><td>Food and Agriculture Organization</td></tr><tr><td>GISRS</td><td>Global Influenza Surveillance and Response System</td></tr><tr><td>HPAI</td><td>Highly pathogenic avian influenza</td></tr><tr><td>IHR</td><td>International Health Regulations</td></tr><tr><td>IRAT</td><td>Influenza Risk Assessment Tool</td></tr><tr><td>IVPP</td><td>Influenza Viruses with Human Pandemic Potential</td></tr><tr><td>LPAI</td><td>Low pathogenic avian influenza</td></tr><tr><td>NRL</td><td>National Reference Laboratory</td></tr><tr><td>OSH</td><td>Occupational safety and health</td></tr><tr><td>PCR</td><td>Polymerase chain reaction</td></tr><tr><td>PIP</td><td>Pandemic Influenza Preparedness</td></tr><tr><td>PPE</td><td>Personal protective equipment</td></tr><tr><td>RA</td><td>Risk assessment</td></tr><tr><td>SSI</td><td>Statens Serum Institut</td></tr><tr><td>ToR</td><td>Term of Reference</td></tr><tr><td>WAHIS</td><td>World Animal Health System</td></tr><tr><td>WOAH</td><td>World Organisation for Animal Health</td></tr><tr><td>WHO</td><td>World Health Organization</td></tr><tr><td>WUR</td><td>Wageningen University Research</td></tr></table>
# Appendix A – Terms of Reference

## A.1. Background and Terms of Reference as provided by the requestor

Avian influenza is an infectious viral disease in birds, including domestic poultry. Infections with avian influenza viruses in poultry cause two main forms of that disease that are distinguished by their virulence. The low pathogenic (LPAI) form generally only causes mild symptoms, while the highly pathogenic (HPAI) form results in very high mortality rates in most poultry species. That disease may have a severe impact on the profitability of poultry farming.

Avian influenza is mainly found in birds, but under certain circumstances infections can also occur in humans even though the risk is generally very low.

More than a decade ago, it was discovered that virus acquired the capability to be carried by wild birds over long distances. This occurred for the HPAI of the subtype A(H5N1) from South East and Far East Asia to other parts of Asia, Europe and Africa as well as to North America. In the current epidemic the extent of the wild bird involvement in the epidemiology of the disease is exceptional.

Since late October 2016 up to early February 2017, highly pathogenic avian influenza (HPAI) of the subtype A(H5N8) has been detected in wild migratory birds or captive birds on the territory of 21 Member States, namely Austria, Belgium, Bulgaria, Croatia, Czechia, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and the United Kingdom. In 17 Member States the virus has spilled over to poultry holdings leading also to lateral spread between holdings in a few Member States, in particular in those with a high density of duck and geese holdings where the poultry cannot sufficiently be protected against contacts with wild birds. A second HP AI subtype A(H5N5) has been detected in wild birds and recently also in poultry holdings in Germany.

The number of infected migratory wild birds found dead and the geographical extent of these findings are posing an immense threat for virus introduction into poultry or captive birds holdings as demonstrated by the high number of outbreaks (~700 as of 08/02/2017).

In the event of an outbreak of avian influenza, there is a risk that the disease agent might spread to other holdings where poultry or other captive birds are kept. As a result it may spread from one Member State to other Member States or to third countries through trade in live birds or their products.

There is knowledge, legislation¹¹, technical and financial tools in the EU to effectively deal with outbreaks of avian influenza in poultry and captive birds. However, the very wide virus spread by wild birds and the increased risk of direct or indirect virus introduction into poultry or captive bird holdings has led to the largest HPAI epidemic in the EU so far. This situation calls for a reflection and evaluation how preparedness, risk assessment, early detection and control measures could be improved.

The Commission and Member States are therefore in need of an epidemiological analysis based on the data collected from the disease affected Member States. The use of the EFSA Data Collection Framework is encouraged given it promotes the harmonisation of data collection. Any data that is available from neighbouring third countries should be used as well, if relevant.

Therefore, in the context of Article 31 of Regulation (EC) No. 178/2002¹², EFSA should provide the technical and scientific assistance to the Commission based on the following Terms of Reference (TOR):

1) Analyse the epidemiological data on highly pathogenic avian influenza (HPAI) and low pathogenic avian influenza (LPAI), where co-circulating or linked within the same epidemic, from HPAI disease affected Member States.

<footnote n="12">¹² Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety. OJ L 31, 1.2.2002, pp. 1–24.</footnote>
# Appendix A – Terms of Reference

## A.1. Background and Terms of Reference as provided by the requestor

Avian influenza is an infectious viral disease in birds, including domestic poultry. Infections with avian influenza viruses in poultry cause two main forms of that disease that are distinguished by their virulence. The low pathogenic (LPAI) form generally only causes mild symptoms, while the highly pathogenic (HPAI) form results in very high mortality rates in most poultry species. That disease may have a severe impact on the profitability of poultry farming.

Avian influenza is mainly found in birds, but under certain circumstances infections can also occur in humans even though the risk is generally very low.

More than a decade ago, it was discovered that virus acquired the capability to be carried by wild birds over long distances. This occurred for the HPAI of the subtype A(H5N1) from South East and Far East Asia to other parts of Asia, Europe and Africa as well as to North America. In the current epidemic the extent of the wild bird involvement in the epidemiology of the disease is exceptional.

Since late October 2016 up to early February 2017, highly pathogenic avian influenza (HPAI) of the subtype A(H5N8) has been detected in wild migratory birds or captive birds on the territory of 21 Member States, namely Austria, Belgium, Bulgaria, Croatia, Czechia, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, the Netherlands, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden and the United Kingdom. In 17 Member States the virus has spilled over to poultry holdings leading also to lateral spread between holdings in a few Member States, in particular in those with a high density of duck and geese holdings where the poultry cannot sufficiently be protected against contacts with wild birds. A second HP AI subtype A(H5N5) has been detected in wild birds and recently also in poultry holdings in Germany.

The number of infected migratory wild birds found dead and the geographical extent of these findings are posing an immense threat for virus introduction into poultry or captive birds holdings as demonstrated by the high number of outbreaks (~700 as of 08/02/2017).

In the event of an outbreak of avian influenza, there is a risk that the disease agent might spread to other holdings where poultry or other captive birds are kept. As a result it may spread from one Member State to other Member States or to third countries through trade in live birds or their products.

There is knowledge, legislation¹¹, technical and financial tools in the EU to effectively deal with outbreaks of avian influenza in poultry and captive birds. However, the very wide virus spread by wild birds and the increased risk of direct or indirect virus introduction into poultry or captive bird holdings has led to the largest HPAI epidemic in the EU so far. This situation calls for a reflection and evaluation how preparedness, risk assessment, early detection and control measures could be improved.

The Commission and Member States are therefore in need of an epidemiological analysis based on the data collected from the disease affected Member States. The use of the EFSA Data Collection Framework is encouraged given it promotes the harmonisation of data collection. Any data that is available from neighbouring third countries should be used as well, if relevant.

Therefore, in the context of Article 31 of Regulation (EC) No. 178/2002¹², EFSA should provide the technical and scientific assistance to the Commission based on the following Terms of Reference (TOR):

1) Analyse the epidemiological data on highly pathogenic avian influenza (HPAI) and low pathogenic avian influenza (LPAI), where co-circulating or linked within the same epidemic, from HPAI disease affected Member States.

<footnote n="12">¹² Regulation (EC) No 178/2002 of the European Parliament and of the Council of 28 January 2002 laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety. OJ L 31, 1.2.2002, pp. 1–24.</footnote>
2) Analyse the temporal and spatial pattern of HPAI and LPAI as appropriate in poultry, captive birds and wild birds, as well the risk factors involved in the occurrence, spread and persistence of the HPAI virus in and at the interface of these avian populations.

3) Based on the findings from the points above, describe the effect of prevention and control measures.

4) Provide for regular quarterly reports updating on the avian influenza situation within the Union and worldwide, in particular with a view to describe the evolution of virus spread from certain regions towards the EU. In case of significant changes in the epidemiology of avian influenza, these reports could be needed more frequently. These reports should in particular closely follow the developments of zoonotic avian influenza viruses (such as HPAI A(H5N6) and LPAI A(H7N9)) in collaboration with the European Centre for Disease Prevention and Control (ECDC).

## A.2. Interpretation of the Terms of Reference

In reply to ToR 1 and ToR 2, this scientific report gives an overview of the HPAI and LPAI outbreaks in poultry, captive and wild birds detected in Europe from 10 September to 2 December 2022 and reported by Member States and neighbouring countries to the ADIS or WOAH-WAHIS. Member States where avian influenza outbreaks have occurred in poultry have submitted additional epidemiological data to EFSA, that have been used to analyse the characteristics of the affected poultry establishments.

It was not possible to collect data for a risk factor analysis on the occurrence and persistence of HPAI virus within the EU. Risk factor analysis requires not only case-related information, but also data on the susceptible population (e.g. location of establishments, population structure), which should be collected in a harmonised manner across the EU. Limitations in data collection, reporting and analysis were explained in the first avian influenza overview report (EFSA et al., 2017).

If HPAI outbreaks in poultry are detected in the EU, a description of the applied prevention and control measures (ToR 3) is given in the overview document provided by representatives from the affected Member States and attached as an Annex B. Information was collected for outbreaks that occurred from 3 September to 18 November 2022. The main topics covered are increasing awareness, release and repeal of housing orders, strengthening biosecurity, preventive culling, implementation of a regional standstill, bans on hunting and derogations from restriction zone implementation after a risk assessment.

Monitoring of the avian influenza situation in other countries (ToR 4) is based on data reported to WOAH-WAHIS. The description focuses only on findings of avian influenza viruses occurring in countries that are considered to be of epidemiological interest for the EU/EEA and the UK or of public health relevance, specifically on HPAI A(H5N1), HPAI A(H5N2), HPAI A(H5N5), HPAI A(H5N6), HPAI A(H5N8), HPAI/LPAI A(H7N9) and LPAI A(H9N2). The background and epidemiology, detections, phenotypic and genetic characterisations are described based on information from confirmed human, poultry and wild bird cases that occurred from 10 September and 2 December 2022. Possible actions for preparedness in the EU are discussed.

This report mainly describes information that has become available since the publication of the EFSA report for the period June to September 2022 (EFSA et al., 2022a) and that might affect the interpretation of risks related to avian influenza introduction and/or spread in Europe.
2) Analyse the temporal and spatial pattern of HPAI and LPAI as appropriate in poultry, captive birds and wild birds, as well the risk factors involved in the occurrence, spread and persistence of the HPAI virus in and at the interface of these avian populations.

3) Based on the findings from the points above, describe the effect of prevention and control measures.

4) Provide for regular quarterly reports updating on the avian influenza situation within the Union and worldwide, in particular with a view to describe the evolution of virus spread from certain regions towards the EU. In case of significant changes in the epidemiology of avian influenza, these reports could be needed more frequently. These reports should in particular closely follow the developments of zoonotic avian influenza viruses (such as HPAI A(H5N6) and LPAI A(H7N9)) in collaboration with the European Centre for Disease Prevention and Control (ECDC).

## A.2. Interpretation of the Terms of Reference

In reply to ToR 1 and ToR 2, this scientific report gives an overview of the HPAI and LPAI outbreaks in poultry, captive and wild birds detected in Europe from 10 September to 2 December 2022 and reported by Member States and neighbouring countries to the ADIS or WOAH-WAHIS. Member States where avian influenza outbreaks have occurred in poultry have submitted additional epidemiological data to EFSA, that have been used to analyse the characteristics of the affected poultry establishments.

It was not possible to collect data for a risk factor analysis on the occurrence and persistence of HPAI virus within the EU. Risk factor analysis requires not only case-related information, but also data on the susceptible population (e.g. location of establishments, population structure), which should be collected in a harmonised manner across the EU. Limitations in data collection, reporting and analysis were explained in the first avian influenza overview report (EFSA et al., 2017).

If HPAI outbreaks in poultry are detected in the EU, a description of the applied prevention and control measures (ToR 3) is given in the overview document provided by representatives from the affected Member States and attached as an Annex B. Information was collected for outbreaks that occurred from 3 September to 18 November 2022. The main topics covered are increasing awareness, release and repeal of housing orders, strengthening biosecurity, preventive culling, implementation of a regional standstill, bans on hunting and derogations from restriction zone implementation after a risk assessment.

Monitoring of the avian influenza situation in other countries (ToR 4) is based on data reported to WOAH-WAHIS. The description focuses only on findings of avian influenza viruses occurring in countries that are considered to be of epidemiological interest for the EU/EEA and the UK or of public health relevance, specifically on HPAI A(H5N1), HPAI A(H5N2), HPAI A(H5N5), HPAI A(H5N6), HPAI A(H5N8), HPAI/LPAI A(H7N9) and LPAI A(H9N2). The background and epidemiology, detections, phenotypic and genetic characterisations are described based on information from confirmed human, poultry and wild bird cases that occurred from 10 September and 2 December 2022. Possible actions for preparedness in the EU are discussed.

This report mainly describes information that has become available since the publication of the EFSA report for the period June to September 2022 (EFSA et al., 2022a) and that might affect the interpretation of risks related to avian influenza introduction and/or spread in Europe.
# Appendix B – Data and Methodologies

## B.1. Data on animals

### B.1.1. Overview of avian influenza outbreaks in Europe (ToR 1 and ToR 2)

Data on the avian influenza outbreaks that occurred in Europe from 10 September and 2 December 2022 submitted by Member States to the ADIS (European Commission, online) were taken into account for this report. Data extraction was carried on 5 December 2022. The WOAH's World Animal Health Information Database (WOAH, online-c) was consulted to complement the information for European countries not reporting HPAI notifications to ADIS. In addition, HPAI-affected European countries were asked to provide more detailed epidemiological data directly to EFSA on the avian influenza outbreaks that occurred in poultry during the same period. Wild bird species have been categorised according to Table B1, and the common and scientific name of wild bird species described in this report in relation to Europe is reported in Table B2. The public GISAID's EpiFlu Database was accessed to download newly released avian influenza sequences. A descriptive analysis of the data collected is reported in Section 4.1 and 4.2. The PDFs of the SCOPAFF presentations are available on the European Commission website (European Commission, online)

<table><caption>**Table B1.** Categorisation of the wild bird species detected as HPAI virus-positive between 1 October 2016 and 2 December 2022</caption><thead><tr><td>Raptor</td><td>Waterfowl</td><td>Colony-breeding sea birds</td><td>Other wild bird species</td></tr></thead><tbody><tr><td>Accipitridae</td><td>Anatidae</td><td>Arctic tern</td><td>Anambra waxbill</td></tr><tr><td>Accipitriformes</td><td>Anatinae</td><td>Atlantic puffin</td><td>Ardeidae</td></tr><tr><td>Bald eagle</td><td>Anserinae</td><td>Auk</td><td>Calidris</td></tr><tr><td>Bearded vulture</td><td>Barnacle goose</td><td>Black guillemot</td><td>Carrion crow</td></tr><tr><td>Common barn-owl</td><td>Bean goose</td><td>Black-headed gull</td><td>Charadriidae</td></tr><tr><td>Common kestrel</td><td>Black swan</td><td>Caspian gull</td><td>Ciconiidae</td></tr><tr><td>Eagles</td><td>Bufflehead</td><td>Common murre</td><td>Columbidae</td></tr><tr><td>Eurasian buzzard</td><td>Brent goose</td><td>Common tern</td><td>Common coot</td></tr><tr><td>Eurasian eagle-owl</td><td>Canada goose</td><td>Cormorants and shags</td><td>Common crane</td></tr><tr><td>Eurasian sparrowhawk</td><td>Common eider</td><td>crowned cormorant</td><td>Common moorhen</td></tr><tr><td>Falcons and caracaras</td><td>Common goldeneye</td><td>Dalmatian pelican</td><td>common pheasant</td></tr><tr><td>Golden eagle</td><td>Common pochard</td><td>European herring gull</td><td>Common raven</td></tr><tr><td>Griffon vulture</td><td>Common shelduck</td><td>Glaucous gull</td><td>Common redshank</td></tr><tr><td>Gyrfalcon</td><td>Common teal</td><td>Great black-backed gull</td><td>Common ringed plover</td></tr><tr><td>Hen harrier</td><td>Cygnus</td><td>Great ne</td><td>Common starling</td></tr><tr><td>Kites, hawks and eagles</td><td>Duck</td><td>Great skua</td><td>Common woodpigeon</td></tr><tr><td>Lanner falcon</td><td>Egyptian goose</td><td>Grey-headed gull</td><td>Corvids, jays and magpies</td></tr><tr><td>Little owl</td><td>Eurasian wigeon</td><td>Gulls, terns and skimmers</td><td>Cranes</td></tr><tr><td>Merlin</td><td>Ferruginous duck</td><td>Lesser black-backed gull</td><td>Curlew sandpiper</td></tr><tr><td>Montagu's harrier</td><td>Gadwall</td><td>Little auk</td><td>Dunlin</td></tr><tr><td>Northern goshawk</td><td>Garganey</td><td>Manx shearwater</td><td>Eurasian blackbird</td></tr><tr><td>Northern long-eared owl</td><td>Goosander</td><td>Mediterranean gull</td><td>Eurasian bullfinch</td></tr><tr><td>Osprey</td><td>Goose</td><td>Mew gull</td><td>Eurasian collared-dove</td></tr><tr><td>Peregrine falcon</td><td>Greater scaup</td><td>Northern fulmar</td><td>Eurasian curlew</td></tr><tr><td>Red kite</td><td>Greater white-fronted goose</td><td>Northern gannet</td><td>Eurasian jackdaw</td></tr><tr><td>Rough-legged buzzard</td><td>Greylag goose</td><td>Pelecanidae</td><td>Eurasian jay</td></tr><tr><td>Short-eared owl</td><td>Lesser white-fronted goose</td><td>Razorbill</td><td>Eurasian magpie</td></tr><tr><td>Spotted harrier</td><td>Mallard</td><td>Ring-billed gull</td><td>Eurasian oystercatcher</td></tr><tr><td>Strigidae</td><td>Muscovy duck</td><td>Sandwich tern</td><td>Eurasian spoonbill</td></tr><tr><td>Strigiformes</td><td>Mute swan</td><td>Silver gull</td><td>Eurasian woodcock</td></tr></tbody></table>
# Appendix B – Data and Methodologies

## B.1. Data on animals

### B.1.1. Overview of avian influenza outbreaks in Europe (ToR 1 and ToR 2)

Data on the avian influenza outbreaks that occurred in Europe from 10 September and 2 December 2022 submitted by Member States to the ADIS (European Commission, online) were taken into account for this report. Data extraction was carried on 5 December 2022. The WOAH's World Animal Health Information Database (WOAH, online-c) was consulted to complement the information for European countries not reporting HPAI notifications to ADIS. In addition, HPAI-affected European countries were asked to provide more detailed epidemiological data directly to EFSA on the avian influenza outbreaks that occurred in poultry during the same period. Wild bird species have been categorised according to Table B1, and the common and scientific name of wild bird species described in this report in relation to Europe is reported in Table B2. The public GISAID's EpiFlu Database was accessed to download newly released avian influenza sequences. A descriptive analysis of the data collected is reported in Section 4.1 and 4.2. The PDFs of the SCOPAFF presentations are available on the European Commission website (European Commission, online)

<table><caption>**Table B1.** Categorisation of the wild bird species detected as HPAI virus-positive between 1 October 2016 and 2 December 2022</caption><thead><tr><td>Raptor</td><td>Waterfowl</td><td>Colony-breeding sea birds</td><td>Other wild bird species</td></tr></thead><tbody><tr><td>Accipitridae</td><td>Anatidae</td><td>Arctic tern</td><td>Anambra waxbill</td></tr><tr><td>Accipitriformes</td><td>Anatinae</td><td>Atlantic puffin</td><td>Ardeidae</td></tr><tr><td>Bald eagle</td><td>Anserinae</td><td>Auk</td><td>Calidris</td></tr><tr><td>Bearded vulture</td><td>Barnacle goose</td><td>Black guillemot</td><td>Carrion crow</td></tr><tr><td>Common barn-owl</td><td>Bean goose</td><td>Black-headed gull</td><td>Charadriidae</td></tr><tr><td>Common kestrel</td><td>Black swan</td><td>Caspian gull</td><td>Ciconiidae</td></tr><tr><td>Eagles</td><td>Bufflehead</td><td>Common murre</td><td>Columbidae</td></tr><tr><td>Eurasian buzzard</td><td>Brent goose</td><td>Common tern</td><td>Common coot</td></tr><tr><td>Eurasian eagle-owl</td><td>Canada goose</td><td>Cormorants and shags</td><td>Common crane</td></tr><tr><td>Eurasian sparrowhawk</td><td>Common eider</td><td>crowned cormorant</td><td>Common moorhen</td></tr><tr><td>Falcons and caracaras</td><td>Common goldeneye</td><td>Dalmatian pelican</td><td>common pheasant</td></tr><tr><td>Golden eagle</td><td>Common pochard</td><td>European herring gull</td><td>Common raven</td></tr><tr><td>Griffon vulture</td><td>Common shelduck</td><td>Glaucous gull</td><td>Common redshank</td></tr><tr><td>Gyrfalcon</td><td>Common teal</td><td>Great black-backed gull</td><td>Common ringed plover</td></tr><tr><td>Hen harrier</td><td>Cygnus</td><td>Great ne</td><td>Common starling</td></tr><tr><td>Kites, hawks and eagles</td><td>Duck</td><td>Great skua</td><td>Common woodpigeon</td></tr><tr><td>Lanner falcon</td><td>Egyptian goose</td><td>Grey-headed gull</td><td>Corvids, jays and magpies</td></tr><tr><td>Little owl</td><td>Eurasian wigeon</td><td>Gulls, terns and skimmers</td><td>Cranes</td></tr><tr><td>Merlin</td><td>Ferruginous duck</td><td>Lesser black-backed gull</td><td>Curlew sandpiper</td></tr><tr><td>Montagu's harrier</td><td>Gadwall</td><td>Little auk</td><td>Dunlin</td></tr><tr><td>Northern goshawk</td><td>Garganey</td><td>Manx shearwater</td><td>Eurasian blackbird</td></tr><tr><td>Northern long-eared owl</td><td>Goosander</td><td>Mediterranean gull</td><td>Eurasian bullfinch</td></tr><tr><td>Osprey</td><td>Goose</td><td>Mew gull</td><td>Eurasian collared-dove</td></tr><tr><td>Peregrine falcon</td><td>Greater scaup</td><td>Northern fulmar</td><td>Eurasian curlew</td></tr><tr><td>Red kite</td><td>Greater white-fronted goose</td><td>Northern gannet</td><td>Eurasian jackdaw</td></tr><tr><td>Rough-legged buzzard</td><td>Greylag goose</td><td>Pelecanidae</td><td>Eurasian jay</td></tr><tr><td>Short-eared owl</td><td>Lesser white-fronted goose</td><td>Razorbill</td><td>Eurasian magpie</td></tr><tr><td>Spotted harrier</td><td>Mallard</td><td>Ring-billed gull</td><td>Eurasian oystercatcher</td></tr><tr><td>Strigidae</td><td>Muscovy duck</td><td>Sandwich tern</td><td>Eurasian spoonbill</td></tr><tr><td>Strigiformes</td><td>Mute swan</td><td>Silver gull</td><td>Eurasian woodcock</td></tr></tbody></table>
<table><caption>**Table B2.** Common and scientific name of the wild bird species detected as HPAI virus-positive between 1 October 2016 and 2 December 2022</caption><tr><td>Tawny owl</td><td>Nene</td><td>Sulidae</td><td>European greenfinch</td></tr><tr><td>True owls</td><td>Northern shoveler</td><td>Western gull</td><td>Finches</td></tr><tr><td>Ural owl</td><td>Pink-footed goose</td><td>Yellow-legged gull</td><td>Great Blue heron</td></tr><tr><td>Western marsh-harrier</td><td>Tufted duck</td><td></td><td>Great crested grebe</td></tr><tr><td>White-tailed sea-eagle</td><td>Whooper swan</td><td></td><td>Great white egret</td></tr><tr><td></td><td></td><td></td><td>Green sandpiper</td></tr><tr><td></td><td></td><td></td><td>Grey heron</td></tr><tr><td></td><td></td><td></td><td>Grey plover</td></tr><tr><td></td><td></td><td></td><td>Guineafowl</td></tr><tr><td></td><td></td><td></td><td>Haematopodidae</td></tr><tr><td></td><td></td><td></td><td>Hooded crow</td></tr><tr><td></td><td></td><td></td><td>House sparrow</td></tr><tr><td></td><td></td><td></td><td>Little egret</td></tr><tr><td></td><td></td><td></td><td>Little grebe</td></tr><tr><td></td><td></td><td></td><td>Northern bald ibis</td></tr><tr><td></td><td></td><td></td><td>Northern lapwing</td></tr><tr><td></td><td></td><td></td><td>Passeridae</td></tr><tr><td></td><td></td><td></td><td>Pheasants and allies</td></tr><tr><td></td><td></td><td></td><td>Pied avocet</td></tr><tr><td></td><td></td><td></td><td>Rallidae</td></tr><tr><td></td><td></td><td></td><td>Red knot</td></tr><tr><td></td><td></td><td></td><td>Rock dove</td></tr><tr><td></td><td></td><td></td><td>Rook</td></tr><tr><td></td><td></td><td></td><td>Ruddy turnstone</td></tr><tr><td></td><td></td><td></td><td>Sanderling</td></tr><tr><td></td><td></td><td></td><td>Semipalmated sandpiper</td></tr><tr><td></td><td></td><td></td><td>Snipe</td></tr><tr><td></td><td></td><td></td><td>Song thrush</td></tr><tr><td></td><td></td><td></td><td>Turdidae</td></tr><tr><td></td><td></td><td></td><td>Western grebe</td></tr><tr><td></td><td></td><td></td><td>Western sandpiper</td></tr><tr><td></td><td></td><td></td><td>Western water rail</td></tr><tr><td></td><td></td><td></td><td>Whimbrel</td></tr><tr><td></td><td></td><td></td><td>White stork</td></tr><tr><td></td><td></td><td></td><td>White-rumped sandpiper</td></tr></table>

<table><thead><tr><td>Common name</td><td>Scientific name</td><td>Common name</td><td>Scientific name</td></tr></thead><tbody><tr><td>Anambra waxbill</td><td>Estrilda poliopareia</td><td>Common goldeneye</td><td>Bucephala lingula</td></tr><tr><td>Arctic tern</td><td>Sterna paradisaea</td><td>Common kestrel</td><td>Falco tinnunculus</td></tr><tr><td>Atlantic puffin</td><td>Fratercula arctica</td><td>Common moorhen</td><td>Gallinula chloropus</td></tr><tr><td>Bald eagle</td><td>Haliaeetus leucocephalus</td><td>Common murre</td><td>Uria aalge</td></tr><tr><td>Barnacle goose</td><td>Branta leucopsis</td><td>common pheasant</td><td>Phasianus colchicus</td></tr><tr><td>Bean goose</td><td>Anser fabalis</td><td>Common pochard</td><td>Aythya ferina</td></tr><tr><td>Bearded vulture</td><td>Gypaetus barbatus</td><td>Common raven</td><td>Corvus corax</td></tr><tr><td>Black guillemot</td><td>Cephus grylle</td><td>Common redshank</td><td>Tringa totanus</td></tr><tr><td></td><td></td><td>Common ringed plover</td><td>(Charadrius hiaticula)</td></tr><tr><td>Black swan</td><td>Cygnus atratus</td><td>Common shelduck</td><td>Tadorna tadorna</td></tr></tbody></table>
<table><caption>**Table B2.** Common and scientific name of the wild bird species detected as HPAI virus-positive between 1 October 2016 and 2 December 2022</caption><tr><td>Tawny owl</td><td>Nene</td><td>Sulidae</td><td>European greenfinch</td></tr><tr><td>True owls</td><td>Northern shoveler</td><td>Western gull</td><td>Finches</td></tr><tr><td>Ural owl</td><td>Pink-footed goose</td><td>Yellow-legged gull</td><td>Great Blue heron</td></tr><tr><td>Western marsh-harrier</td><td>Tufted duck</td><td></td><td>Great crested grebe</td></tr><tr><td>White-tailed sea-eagle</td><td>Whooper swan</td><td></td><td>Great white egret</td></tr><tr><td></td><td></td><td></td><td>Green sandpiper</td></tr><tr><td></td><td></td><td></td><td>Grey heron</td></tr><tr><td></td><td></td><td></td><td>Grey plover</td></tr><tr><td></td><td></td><td></td><td>Guineafowl</td></tr><tr><td></td><td></td><td></td><td>Haematopodidae</td></tr><tr><td></td><td></td><td></td><td>Hooded crow</td></tr><tr><td></td><td></td><td></td><td>House sparrow</td></tr><tr><td></td><td></td><td></td><td>Little egret</td></tr><tr><td></td><td></td><td></td><td>Little grebe</td></tr><tr><td></td><td></td><td></td><td>Northern bald ibis</td></tr><tr><td></td><td></td><td></td><td>Northern lapwing</td></tr><tr><td></td><td></td><td></td><td>Passeridae</td></tr><tr><td></td><td></td><td></td><td>Pheasants and allies</td></tr><tr><td></td><td></td><td></td><td>Pied avocet</td></tr><tr><td></td><td></td><td></td><td>Rallidae</td></tr><tr><td></td><td></td><td></td><td>Red knot</td></tr><tr><td></td><td></td><td></td><td>Rock dove</td></tr><tr><td></td><td></td><td></td><td>Rook</td></tr><tr><td></td><td></td><td></td><td>Ruddy turnstone</td></tr><tr><td></td><td></td><td></td><td>Sanderling</td></tr><tr><td></td><td></td><td></td><td>Semipalmated sandpiper</td></tr><tr><td></td><td></td><td></td><td>Snipe</td></tr><tr><td></td><td></td><td></td><td>Song thrush</td></tr><tr><td></td><td></td><td></td><td>Turdidae</td></tr><tr><td></td><td></td><td></td><td>Western grebe</td></tr><tr><td></td><td></td><td></td><td>Western sandpiper</td></tr><tr><td></td><td></td><td></td><td>Western water rail</td></tr><tr><td></td><td></td><td></td><td>Whimbrel</td></tr><tr><td></td><td></td><td></td><td>White stork</td></tr><tr><td></td><td></td><td></td><td>White-rumped sandpiper</td></tr></table>

<table><thead><tr><td>Common name</td><td>Scientific name</td><td>Common name</td><td>Scientific name</td></tr></thead><tbody><tr><td>Anambra waxbill</td><td>Estrilda poliopareia</td><td>Common goldeneye</td><td>Bucephala lingula</td></tr><tr><td>Arctic tern</td><td>Sterna paradisaea</td><td>Common kestrel</td><td>Falco tinnunculus</td></tr><tr><td>Atlantic puffin</td><td>Fratercula arctica</td><td>Common moorhen</td><td>Gallinula chloropus</td></tr><tr><td>Bald eagle</td><td>Haliaeetus leucocephalus</td><td>Common murre</td><td>Uria aalge</td></tr><tr><td>Barnacle goose</td><td>Branta leucopsis</td><td>common pheasant</td><td>Phasianus colchicus</td></tr><tr><td>Bean goose</td><td>Anser fabalis</td><td>Common pochard</td><td>Aythya ferina</td></tr><tr><td>Bearded vulture</td><td>Gypaetus barbatus</td><td>Common raven</td><td>Corvus corax</td></tr><tr><td>Black guillemot</td><td>Cephus grylle</td><td>Common redshank</td><td>Tringa totanus</td></tr><tr><td></td><td></td><td>Common ringed plover</td><td>(Charadrius hiaticula)</td></tr><tr><td>Black swan</td><td>Cygnus atratus</td><td>Common shelduck</td><td>Tadorna tadorna</td></tr></tbody></table>
<table><thead><tr><td>Common name</td><td>Scientific name</td><td>Common name</td><td>Scientific name</td></tr></thead><tbody><tr><td>Black-headed gull</td><td>Larus ridibundus</td><td>Common starling</td><td>Sturnus vulgaris</td></tr><tr><td>Brent goose</td><td>Branta bernicla</td><td>Common teal</td><td>Anas crecca</td></tr><tr><td>Bufflehead</td><td>Bucephala albeola</td><td>Common tern</td><td>Sterna hirundo</td></tr><tr><td>Calidris</td><td>Calidris spp.</td><td>Common woodpigeon</td><td>Columba palumbus</td></tr><tr><td>Canada goose</td><td>Branta canadensis</td><td>Crowned cormorant</td><td>Microcarbo coronatus</td></tr><tr><td>Carrion crow</td><td>Corvus corone</td><td>Curlew sandpiper</td><td>Calidris ferruginea</td></tr><tr><td>Caspian gull</td><td>Larus cachinnans</td><td>Dalmatian pelican</td><td>Pelecanus crispus</td></tr><tr><td>Common barn-owl</td><td>Tyto alba</td><td>Dunlin</td><td>Calidris alpina</td></tr><tr><td>Common coot</td><td>Fulica atra</td><td>Egyptian goose</td><td>Alopochen aegyptiaca</td></tr><tr><td>Common crane</td><td>Grus grus</td><td>Eurasian blackbird</td><td>Turdus merula</td></tr><tr><td>Common eider</td><td>Somateria mollissima</td><td>Mew gull</td><td>Larus canus</td></tr><tr><td>Eurasian bullfinch</td><td>Pyrrhula pyrrhula</td><td>Mediterranean gull</td><td>Larus melanocephalus</td></tr><tr><td>Eurasian buzzard</td><td>Buteo buteo</td><td>Merlin</td><td>Falco columbarius</td></tr><tr><td>Eurasian collared-dove</td><td>Streptopelia decaocto</td><td>Montagu's harrier</td><td>Circus pygargus</td></tr><tr><td>Eurasian curlew</td><td>Numenius arquata</td><td>Muscovy duck</td><td>Cairina moschata</td></tr><tr><td>Eurasian eagle-owl</td><td>Bubo bubo</td><td>Mute swan</td><td>Cygnus olor</td></tr><tr><td>Eurasian jackdaw</td><td>Corvus monedula</td><td>Nene</td><td>Branta bernicla</td></tr><tr><td>Eurasian jay</td><td>Garrulus glandarius</td><td>Northern bald ibis</td><td>Geronticus eremita</td></tr><tr><td>Eurasian magpie</td><td>Pica pica</td><td>Northern fulmar</td><td>Fulmarus glacialis</td></tr><tr><td>Eurasian oystercatcher</td><td>Haematopus ostralegus</td><td>Northern gannet</td><td>Morus bassanus</td></tr><tr><td>Eurasian sparrowhawk</td><td>Accipiter nisus</td><td>Northern goshawk</td><td>Accipiter gentilis</td></tr><tr><td>Eurasian spoonbill</td><td>Platalea leucorodia</td><td>Northern lapwing</td><td>Vanellus vanellus</td></tr><tr><td>Eurasian wigeon</td><td>Mareca penelope</td><td>Northern long-eared Owl</td><td>Asio otus</td></tr><tr><td>Eurasian woodcock</td><td>Scolopax rusticola</td><td>Northern Pintail</td><td>Anas acuta</td></tr><tr><td>European greenfinch</td><td>Chloris chloris</td><td>Northern shoveler</td><td>Spatula clypeata</td></tr><tr><td>European herring gull</td><td>Larus argentatus</td><td>Osprey</td><td>Pandion haliaetus</td></tr><tr><td>Ferruginous duck</td><td>Aythya nyroca</td><td>Peregrine falcon</td><td>Falco peregrinus</td></tr><tr><td>Finches</td><td>Fringillidae</td><td>Pied avocet</td><td>Recurvirostra avosetta</td></tr><tr><td>Gadwall</td><td>Mareca strepera</td><td>Pink-footed goose</td><td>Anser brachyrhynchus</td></tr><tr><td>Garganey</td><td>Spatula querquedula</td><td>Razorbill</td><td>Alca torda</td></tr><tr><td>Glaucous gull</td><td>Larus hyperboreus</td><td>Red-breasted goose</td><td>Branta ruficollis</td></tr><tr><td>Golden eagle</td><td>Aquila chrysaetos</td><td>Red kite</td><td>Milvus milvus</td></tr><tr><td>Goosander</td><td>Mergus merganser</td><td>Red knot</td><td>Calidris canutus</td></tr><tr><td>Great black-backed gull</td><td>Larus marinus</td><td>Red-legged partridge</td><td>Alectoris rufa</td></tr><tr><td>Great blue heron</td><td>Ardea herodias</td><td>Ring-billed gull</td><td>Larus delawarensis</td></tr><tr><td>Great cormorant</td><td>Phalacrocorax carbo</td><td>Rock dove</td><td>Columba livia</td></tr><tr><td>Great crested grebe</td><td>Podiceps cristatus</td><td>Rook</td><td>Corvus frugilegus</td></tr><tr><td>Great skua</td><td>Catharacta skua</td><td>Rough-legged buzzard</td><td>Buteo lagopus</td></tr><tr><td>Greater Flamingo</td><td>Phoenicopterus roseus</td><td>Ruddy turnstone</td><td>Arenaria interpres</td></tr><tr><td>Great white egret</td><td>Ardea alba</td><td>Sanderling</td><td>Calidris alba</td></tr><tr><td>Greater scaup</td><td>Aythya marila</td><td>Sandwich tern</td><td>Thalasseus sandvicensis</td></tr><tr><td>Great spotted woodpecker</td><td>Dendrocopos major</td><td>Semipalmated sandpiper</td><td>Calidris pusilla</td></tr><tr><td>Greater white-fronted goose</td><td>Anser albifrons</td><td>Short-eared owl</td><td>Asio flammeus</td></tr><tr><td>Green sandpiper</td><td>Tringa ochropus</td><td>Silver gull</td><td>Chroicocephalus novaehollandiae</td></tr></tbody></table>
<table><thead><tr><td>Common name</td><td>Scientific name</td><td>Common name</td><td>Scientific name</td></tr></thead><tbody><tr><td>Black-headed gull</td><td>Larus ridibundus</td><td>Common starling</td><td>Sturnus vulgaris</td></tr><tr><td>Brent goose</td><td>Branta bernicla</td><td>Common teal</td><td>Anas crecca</td></tr><tr><td>Bufflehead</td><td>Bucephala albeola</td><td>Common tern</td><td>Sterna hirundo</td></tr><tr><td>Calidris</td><td>Calidris spp.</td><td>Common woodpigeon</td><td>Columba palumbus</td></tr><tr><td>Canada goose</td><td>Branta canadensis</td><td>Crowned cormorant</td><td>Microcarbo coronatus</td></tr><tr><td>Carrion crow</td><td>Corvus corone</td><td>Curlew sandpiper</td><td>Calidris ferruginea</td></tr><tr><td>Caspian gull</td><td>Larus cachinnans</td><td>Dalmatian pelican</td><td>Pelecanus crispus</td></tr><tr><td>Common barn-owl</td><td>Tyto alba</td><td>Dunlin</td><td>Calidris alpina</td></tr><tr><td>Common coot</td><td>Fulica atra</td><td>Egyptian goose</td><td>Alopochen aegyptiaca</td></tr><tr><td>Common crane</td><td>Grus grus</td><td>Eurasian blackbird</td><td>Turdus merula</td></tr><tr><td>Common eider</td><td>Somateria mollissima</td><td>Mew gull</td><td>Larus canus</td></tr><tr><td>Eurasian bullfinch</td><td>Pyrrhula pyrrhula</td><td>Mediterranean gull</td><td>Larus melanocephalus</td></tr><tr><td>Eurasian buzzard</td><td>Buteo buteo</td><td>Merlin</td><td>Falco columbarius</td></tr><tr><td>Eurasian collared-dove</td><td>Streptopelia decaocto</td><td>Montagu's harrier</td><td>Circus pygargus</td></tr><tr><td>Eurasian curlew</td><td>Numenius arquata</td><td>Muscovy duck</td><td>Cairina moschata</td></tr><tr><td>Eurasian eagle-owl</td><td>Bubo bubo</td><td>Mute swan</td><td>Cygnus olor</td></tr><tr><td>Eurasian jackdaw</td><td>Corvus monedula</td><td>Nene</td><td>Branta bernicla</td></tr><tr><td>Eurasian jay</td><td>Garrulus glandarius</td><td>Northern bald ibis</td><td>Geronticus eremita</td></tr><tr><td>Eurasian magpie</td><td>Pica pica</td><td>Northern fulmar</td><td>Fulmarus glacialis</td></tr><tr><td>Eurasian oystercatcher</td><td>Haematopus ostralegus</td><td>Northern gannet</td><td>Morus bassanus</td></tr><tr><td>Eurasian sparrowhawk</td><td>Accipiter nisus</td><td>Northern goshawk</td><td>Accipiter gentilis</td></tr><tr><td>Eurasian spoonbill</td><td>Platalea leucorodia</td><td>Northern lapwing</td><td>Vanellus vanellus</td></tr><tr><td>Eurasian wigeon</td><td>Mareca penelope</td><td>Northern long-eared Owl</td><td>Asio otus</td></tr><tr><td>Eurasian woodcock</td><td>Scolopax rusticola</td><td>Northern Pintail</td><td>Anas acuta</td></tr><tr><td>European greenfinch</td><td>Chloris chloris</td><td>Northern shoveler</td><td>Spatula clypeata</td></tr><tr><td>European herring gull</td><td>Larus argentatus</td><td>Osprey</td><td>Pandion haliaetus</td></tr><tr><td>Ferruginous duck</td><td>Aythya nyroca</td><td>Peregrine falcon</td><td>Falco peregrinus</td></tr><tr><td>Finches</td><td>Fringillidae</td><td>Pied avocet</td><td>Recurvirostra avosetta</td></tr><tr><td>Gadwall</td><td>Mareca strepera</td><td>Pink-footed goose</td><td>Anser brachyrhynchus</td></tr><tr><td>Garganey</td><td>Spatula querquedula</td><td>Razorbill</td><td>Alca torda</td></tr><tr><td>Glaucous gull</td><td>Larus hyperboreus</td><td>Red-breasted goose</td><td>Branta ruficollis</td></tr><tr><td>Golden eagle</td><td>Aquila chrysaetos</td><td>Red kite</td><td>Milvus milvus</td></tr><tr><td>Goosander</td><td>Mergus merganser</td><td>Red knot</td><td>Calidris canutus</td></tr><tr><td>Great black-backed gull</td><td>Larus marinus</td><td>Red-legged partridge</td><td>Alectoris rufa</td></tr><tr><td>Great blue heron</td><td>Ardea herodias</td><td>Ring-billed gull</td><td>Larus delawarensis</td></tr><tr><td>Great cormorant</td><td>Phalacrocorax carbo</td><td>Rock dove</td><td>Columba livia</td></tr><tr><td>Great crested grebe</td><td>Podiceps cristatus</td><td>Rook</td><td>Corvus frugilegus</td></tr><tr><td>Great skua</td><td>Catharacta skua</td><td>Rough-legged buzzard</td><td>Buteo lagopus</td></tr><tr><td>Greater Flamingo</td><td>Phoenicopterus roseus</td><td>Ruddy turnstone</td><td>Arenaria interpres</td></tr><tr><td>Great white egret</td><td>Ardea alba</td><td>Sanderling</td><td>Calidris alba</td></tr><tr><td>Greater scaup</td><td>Aythya marila</td><td>Sandwich tern</td><td>Thalasseus sandvicensis</td></tr><tr><td>Great spotted woodpecker</td><td>Dendrocopos major</td><td>Semipalmated sandpiper</td><td>Calidris pusilla</td></tr><tr><td>Greater white-fronted goose</td><td>Anser albifrons</td><td>Short-eared owl</td><td>Asio flammeus</td></tr><tr><td>Green sandpiper</td><td>Tringa ochropus</td><td>Silver gull</td><td>Chroicocephalus novaehollandiae</td></tr></tbody></table>
<table><thead><tr><td>Common name</td><td>Scientific name</td><td>Common name</td><td>Scientific name</td></tr></thead><tbody><tr><td>Grey heron</td><td>Ardea cinerea</td><td>Song thrush</td><td>Turdus philomelos</td></tr><tr><td>Grey plover</td><td>Pluvialis squatarola</td><td>Spotted harrier</td><td>Circus assimilis</td></tr><tr><td>Grey-headed gull</td><td>Larus cirrocephalus</td><td>Tawny owl</td><td>Strix aluco</td></tr><tr><td>Greylag goose</td><td>Anser anser</td><td>Tufted duck</td><td>Aythya fuligula</td></tr><tr><td>Griffon vulture</td><td>Gyps fulvus</td><td>Ural owl</td><td>Strix uralensis</td></tr><tr><td>Guineafowl</td><td>Numididae</td><td>western grebe</td><td>Aechmophorus occidentalis</td></tr><tr><td>Gyrfalcon</td><td>Falco rusticolus</td><td>Western gull</td><td>Larus occidentalis</td></tr><tr><td>Hen harrier</td><td>Circus cyaneus</td><td>Western marsh-harrier</td><td>Circus aeruginosus</td></tr><tr><td>Hooded crow</td><td>Corvus coronus</td><td>Western sandpiper</td><td>Calidris mauri</td></tr><tr><td>House sparrow</td><td>Passer domesticus</td><td>Western water Rail</td><td>Rallus aquaticus</td></tr><tr><td>Lanner falcon</td><td>Falco biarmicus</td><td>Whimbrel</td><td>Numenius phaeopus</td></tr><tr><td>Lesser black-backed gull</td><td>Larus fuscus</td><td>White stork</td><td>Ciconia ciconia</td></tr><tr><td>Lesser white-fronted goose</td><td>Anser erythropus</td><td>White-rumped sandpiper</td><td>Calidris fuscicollis</td></tr><tr><td>Little auk</td><td>Alle alle</td><td>White-tailed eagle</td><td>Haliaeetus albicilla</td></tr><tr><td>Little egret</td><td>Egretta garzetta</td><td>Whooper swan</td><td>Cygnus cygnus</td></tr><tr><td>Little grebe</td><td>Tachybaptus ruficollis</td><td>Yellow-legged gull</td><td>Larus michahellis</td></tr><tr><td>Little owl</td><td>Athene noctua</td><td></td><td></td></tr><tr><td>Mallard</td><td>Anas platyrhynchos</td><td></td><td></td></tr><tr><td>Manx shearwater</td><td>Puffinus puffinus</td><td></td><td></td></tr></tbody></table>

### B.1.1.1. Literature review on phenotypic characterisation of HPAI viruses circulating in the EU

Information on the phenotypic characterisation of AI viruses circulating in the EU was extracted from the scientific literature by performing a literature review.

**Review question** Update on the phenotypic characterisation of HPAI viruses circulating in the EU in domestic and wild birds within the last 2 years.

**Search** The PubMed database was searched using subject index terms and free-text terms combined with the appropriate Boolean operators. Scientific articles added to the database from 6 September to 1 December 2022 were searched; the search was run on 14 November and 2 December 2022.

**Relevance criteria** Scientific articles added to the database from 6 September to 1 December 2022 and reporting information on the presence or absence of clinical signs or pathological changes or mortality due to HPAI infection with viruses circulating within the last 2 years in the EU in domestic or wild birds.

**Eligibility criteria** Host species all domestic birds or wild birds present in the EU; the virus subtype should be reported; for experimental studies only, the age of the infected animals should be reported (at least as juvenile/adult).

**Results** The search retrieved 135 papers. The articles were subsequently screened against the relevance and eligibility criteria. Seven of the screened papers were finally taken into consideration in the description of the phenotypic characterisation of HPAI viruses circulating in the EU in domestic and wild birds in the reporting period.

The search protocol and the results can be consulted at https://doi.org/10.5281/zenodo.7446257.

### B.1.2. Overview of avian influenza outbreaks in other countries not reporting via ADNS (ToR 4)

Data from WOAH-WAHIS (WOAH, online-c) on HPAI A(H5N1), HPAI A(H5N2), HPAI A(H5N5), A(H5N6), A(H5N8), HPAI and LPAI A(H7N9) in domestic and wild birds were used to describe and to map the geographical distribution of avian influenza detections in domestic and wild birds in Africa, the Americas, Asia and Europe based on the observation dates. Data were retrieved on 5 December 2022 and
<table><thead><tr><td>Common name</td><td>Scientific name</td><td>Common name</td><td>Scientific name</td></tr></thead><tbody><tr><td>Grey heron</td><td>Ardea cinerea</td><td>Song thrush</td><td>Turdus philomelos</td></tr><tr><td>Grey plover</td><td>Pluvialis squatarola</td><td>Spotted harrier</td><td>Circus assimilis</td></tr><tr><td>Grey-headed gull</td><td>Larus cirrocephalus</td><td>Tawny owl</td><td>Strix aluco</td></tr><tr><td>Greylag goose</td><td>Anser anser</td><td>Tufted duck</td><td>Aythya fuligula</td></tr><tr><td>Griffon vulture</td><td>Gyps fulvus</td><td>Ural owl</td><td>Strix uralensis</td></tr><tr><td>Guineafowl</td><td>Numididae</td><td>western grebe</td><td>Aechmophorus occidentalis</td></tr><tr><td>Gyrfalcon</td><td>Falco rusticolus</td><td>Western gull</td><td>Larus occidentalis</td></tr><tr><td>Hen harrier</td><td>Circus cyaneus</td><td>Western marsh-harrier</td><td>Circus aeruginosus</td></tr><tr><td>Hooded crow</td><td>Corvus coronus</td><td>Western sandpiper</td><td>Calidris mauri</td></tr><tr><td>House sparrow</td><td>Passer domesticus</td><td>Western water Rail</td><td>Rallus aquaticus</td></tr><tr><td>Lanner falcon</td><td>Falco biarmicus</td><td>Whimbrel</td><td>Numenius phaeopus</td></tr><tr><td>Lesser black-backed gull</td><td>Larus fuscus</td><td>White stork</td><td>Ciconia ciconia</td></tr><tr><td>Lesser white-fronted goose</td><td>Anser erythropus</td><td>White-rumped sandpiper</td><td>Calidris fuscicollis</td></tr><tr><td>Little auk</td><td>Alle alle</td><td>White-tailed eagle</td><td>Haliaeetus albicilla</td></tr><tr><td>Little egret</td><td>Egretta garzetta</td><td>Whooper swan</td><td>Cygnus cygnus</td></tr><tr><td>Little grebe</td><td>Tachybaptus ruficollis</td><td>Yellow-legged gull</td><td>Larus michahellis</td></tr><tr><td>Little owl</td><td>Athene noctua</td><td></td><td></td></tr><tr><td>Mallard</td><td>Anas platyrhynchos</td><td></td><td></td></tr><tr><td>Manx shearwater</td><td>Puffinus puffinus</td><td></td><td></td></tr></tbody></table>

### B.1.1.1. Literature review on phenotypic characterisation of HPAI viruses circulating in the EU

Information on the phenotypic characterisation of AI viruses circulating in the EU was extracted from the scientific literature by performing a literature review.

**Review question** Update on the phenotypic characterisation of HPAI viruses circulating in the EU in domestic and wild birds within the last 2 years.

**Search** The PubMed database was searched using subject index terms and free-text terms combined with the appropriate Boolean operators. Scientific articles added to the database from 6 September to 1 December 2022 were searched; the search was run on 14 November and 2 December 2022.

**Relevance criteria** Scientific articles added to the database from 6 September to 1 December 2022 and reporting information on the presence or absence of clinical signs or pathological changes or mortality due to HPAI infection with viruses circulating within the last 2 years in the EU in domestic or wild birds.

**Eligibility criteria** Host species all domestic birds or wild birds present in the EU; the virus subtype should be reported; for experimental studies only, the age of the infected animals should be reported (at least as juvenile/adult).

**Results** The search retrieved 135 papers. The articles were subsequently screened against the relevance and eligibility criteria. Seven of the screened papers were finally taken into consideration in the description of the phenotypic characterisation of HPAI viruses circulating in the EU in domestic and wild birds in the reporting period.

The search protocol and the results can be consulted at https://doi.org/10.5281/zenodo.7446257.

### B.1.2. Overview of avian influenza outbreaks in other countries not reporting via ADNS (ToR 4)

Data from WOAH-WAHIS (WOAH, online-c) on HPAI A(H5N1), HPAI A(H5N2), HPAI A(H5N5), A(H5N6), A(H5N8), HPAI and LPAI A(H7N9) in domestic and wild birds were used to describe and to map the geographical distribution of avian influenza detections in domestic and wild birds in Africa, the Americas, Asia and Europe based on the observation dates. Data were retrieved on 5 December 2022 and
extracted by EFSA. Reproduced with permission. WOAH bears no responsibility for the integrity or accuracy of the data contained herein, but not limited to, any deletion, manipulation, or reformatting of data that may have occurred beyond its control

## B.2. Data on humans

The numbers of human cases caused by infection with avian influenza viruses were collected by ECDC. Multiple sources are scanned regularly as part of Epidemic Intelligence activities at ECDC to collect information on laboratory-confirmed human cases. Data were extracted and line lists developed to collect case-based information on virus type, date of disease onset, country of reporting, country of exposure, sex, age, exposure, clinical information (hospitalisation, severity) and outcome. All cases included in the line list and mentioned in the document have been laboratory-confirmed. Data are continuously checked for double entries and validity. The data on human cases cover the full period of time since the first human case was reported. Therefore, data on human cases refer to different time periods and are included irrespective of whether there have been any new human cases during the reporting period.
extracted by EFSA. Reproduced with permission. WOAH bears no responsibility for the integrity or accuracy of the data contained herein, but not limited to, any deletion, manipulation, or reformatting of data that may have occurred beyond its control

## B.2. Data on humans

The numbers of human cases caused by infection with avian influenza viruses were collected by ECDC. Multiple sources are scanned regularly as part of Epidemic Intelligence activities at ECDC to collect information on laboratory-confirmed human cases. Data were extracted and line lists developed to collect case-based information on virus type, date of disease onset, country of reporting, country of exposure, sex, age, exposure, clinical information (hospitalisation, severity) and outcome. All cases included in the line list and mentioned in the document have been laboratory-confirmed. Data are continuously checked for double entries and validity. The data on human cases cover the full period of time since the first human case was reported. Therefore, data on human cases refer to different time periods and are included irrespective of whether there have been any new human cases during the reporting period.
## List of Annexes

The annexes are available on the EFSA Knowledge Junction community on Zenodo at:

https://doi.org/10.5281/zenodo.7426549

The annexes contain the following information:

### Annex A – Characteristics of the HPAI A(H5Nx)-positive poultry establishments

The Annex contains a table with the characteristics of the HPAI A(H5Nx)-positive poultry establishments by affected EU Member State from 3 September to 18 November 2022. In addition, the Netherlands reported on the characteristics of the HPAI A(H5Nx)-positive poultry establishments affected before 3 September that were not included in the previous published report; those information are also included in Annex A.

### Annex B – Applied prevention and control measures on avian influenza

The Annex contains an overview of specific prevention and control measures applied in Belgium, Bulgaria, Croatia, Denmark, France, Germany, Hungary, Ireland, Italy, Moldova, Norway, the Netherlands, Poland, Portugal and Spain, from 3 September to 18 November 2022 in relation to HPAI outbreaks in poultry.

### Annex C – Data on wild birds

The Annex contains tables and plots on HPAI virus detections in wild birds in Europe.
## List of Annexes

The annexes are available on the EFSA Knowledge Junction community on Zenodo at:

https://doi.org/10.5281/zenodo.7426549

The annexes contain the following information:

### Annex A – Characteristics of the HPAI A(H5Nx)-positive poultry establishments

The Annex contains a table with the characteristics of the HPAI A(H5Nx)-positive poultry establishments by affected EU Member State from 3 September to 18 November 2022. In addition, the Netherlands reported on the characteristics of the HPAI A(H5Nx)-positive poultry establishments affected before 3 September that were not included in the previous published report; those information are also included in Annex A.

### Annex B – Applied prevention and control measures on avian influenza

The Annex contains an overview of specific prevention and control measures applied in Belgium, Bulgaria, Croatia, Denmark, France, Germany, Hungary, Ireland, Italy, Moldova, Norway, the Netherlands, Poland, Portugal and Spain, from 3 September to 18 November 2022 in relation to HPAI outbreaks in poultry.

### Annex C – Data on wild birds

The Annex contains tables and plots on HPAI virus detections in wild birds in Europe.