Zoonotic Influenza Surveillance in Belgium

Study Overview
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Brief Summary
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The project aims at implementing a more pro-active surveillance of potential transmission of influenza viruses to humans (zoonotic transmission). Clinical surveillance of influenza in humans and avian species is well organized and has been operating for decades, but currently there is no pro-active systematic surveillance of potential transmission of animal (avian or swine) influenza viruses to humans, only follow-up of people showing clinical symptoms. People working with potentially infected animals have the highest risk. Moreover, they can represent the first steps in a pandemic: if the virus adapts to humans, infected workers could potentially spread the virus to other people. Currently, highly pathogenic clade2.3.4.4b H5 avian influenza viruses are continuously circulating in wild birds in Belgium and the number of introduction in poultry farms has raised, increasing the contact opportunities with high viral concentrations. Several reports of suspected human infection have been made by different countries. In addition, the virus was detected in sick non-human mammals. The large circulation in wild birds thus represents an increase risk of spill-over to mammalian species, including humans, (by contact directly with wild birds, or via outbreaks in poultry). This increased opportunity for accidental spillover to new host species increases the chances for the avian virus to adapt to mammals, including humans. Likewise, there have also been an increased number of human cases of swine influenza reported by several European countries. A pro-active surveillance aiming at also detecting asymptomatic infections would allow an early detection of transmission that could help to prevent a new pandemic. As a piloting approach during this specific project, some dedicated sentinel networks among at-risk workers will be initiated: people in poultry farms involved with the management of outbreaks of highly pathogenic avian influenza; people working at bird (or more generally wild life) rehabilitation centres or poultry farms; veterinarians working in pig farms/slaughterhouses.

Official Title
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Active Surveillance of Influenza Virus Zoonotic Transmission Events: a Pilot Study in Belgium

Conditions
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Influenza, Human

Intervention / Treatment
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* Diagnostic Test: respiratory specimen
* Diagnostic Test: serum


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: worker or volunteer of one of the targeted groups at one of the selected sites and accepting to take part in the study to have regular contacts with animals within job/activity framework being committed to take the regular samples Exclusion Criteria: - people who had a broken nose might have difficulties to perform self-swabbing

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Avian Influenza Outbreak Farms<br>People involved in outbreak management, ranging from poultry farm owners and their family to inspectors through veterinarians and cullers/cleaners, will be invited to take part in the study at the earliest step possible after outbreak detection. Self sampling by nasopharyngeal swab will be requested every 2 days during 2 weeks. | Diagnostic Test: respiratory specimen<br>* participants will perform self-sampling with a nasopharyngeal swab<br>Diagnostic Test: serum<br>* participants will be invited to get a blood sample taken by a general practitioner or to perform a self sampling of capillary blood<br>|
| Poultry Farm Sentinel Network<br>People working in poultry farms and in contact with animals will be invited to join the cohort. Self sampling by nasopharyngeal swab will be requested every 2 weeks for the whole duration of the study. anticipated: 15 | Diagnostic Test: respiratory specimen<br>* participants will perform self-sampling with a nasopharyngeal swab<br>|
| Wild bird/life Rehabilitation Centre Sentinel Network<br>People working in wild bird/life rehabilitation centers and in contact with animals will be invited to join the cohort. Self sampling by nasopharyngeal swab will be requested every 2 weeks for the whole duration of the study. anticipated: 25 | Diagnostic Test: respiratory specimen<br>* participants will perform self-sampling with a nasopharyngeal swab<br>|
| Pig Industry Veterinarian Sentinel Network<br>Veterinarians working in the pig industry and in contact with animals will be invited to join the cohort. Self sampling by nasopharyngeal swab will be requested every 2 weeks for the whole duration of the study. anticipated: 15 | Diagnostic Test: respiratory specimen<br>* participants will perform self-sampling with a nasopharyngeal swab<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of sentinel participants positive for a non-seasonal influenza virus | result of RT-qPCR test to detect and characterize non-influenza viruses | every 2 weeks through study completion (December 2024) | 
| Number of outbreak participants positive for a non-seasonal influenza virus | result of RT-qPCR test to detect and characterize non-influenza viruses | every 2 days during 2 weeks after enrollment | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of outbreak participants with seroconversion against a non-seasonal influenza virus | result of inhibition of haemagglutination or seroneutralisation assay | at enrollment and about 4 weeks after |