Asian lineage H5N6 Since 2014, HPAI A(H5N6) has been responsible for widespread outbreaks in birds across China, Japan and South East Asia and in 2018 significant outbreaks have been reported from Mainland China, Japan, South Korea, Taiwan, Hong Kong and Vietnam. The Philippines has also reported H5N6 in poultry. The virus is highly pathogenic in birds and has been isolated from both poultry and wild birds. In April 2014, the World Health Organization (WHO) first reported a case of human infection with avian influenza A(H5N6) from China. As of 3 November 2021, a total of 50 human cases of infection with avian influenza A(H5N6) have been reported internationally and at least 25 cases were fatal. Apart from one case in Laos, all cases have occurred in mainland China. Seven of these cases were in children and the remaining 43 were adult cases. The majority of human cases of HPAI A(H5N6) in mainland China are known to have had contact with birds or their environments or exposure to suspected contaminated meat prior to becoming ill, and there is currently no evidence of human-to-human transmission. WHO considers that the H5 avian influenza viruses have not acquired the ability to transmit easily among humans and therefore the risk of sustained human-to-human transmission is low at present.