Estimating the risk of pandemic avian influenza

Outbreaks of highly pathogenic strains of avian influenza (HPAI) cause high mortality in avian populations worldwide. When spread from avian reservoirs to humans, HPAI infections cause mortality in about 50% of human infections. Cases of human-to-human transmission of HPAI are relatively rare, and have, to date, only been reported in situations of close contact. These transmissions have resulted in isolated clusters of human HPAI infections, but have not yet caused a pandemic. Given the large number of human H5N1 HPAI infections to date, none of which has resulted in a pandemic, we estimate an upper bound on the probability of H5N1 pandemic emergence. We use this estimate to provide the likelihood of observing such a pandemic over the next decade. We then develop a more accurate parameter-based estimate of the emergence probability and predict the likelihood that, through rare mutations, an H5N1 influenza pandemic will emerge over the same time span.