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Article

Antibodies to Highly Pathogenic A/H5Nx (Clade 2.3.4.4) Influenza Viruses in the Sera of Vietnamese Residents

1
State Research Center of Virology and Biotechnology “Vector”, Rospotrebnadzor, Koltsovo, Novosibirsk 630559, Russia
2
Department Natural Sciences, Novosibirsk State University, Novosibirsk 630090, Russia
3
Russian-Vietnamese Tropical Research and Technology Centre, Hanoi 650000, Vietnam
*
Author to whom correspondence should be addressed.
Pathogens 2021, 10(4), 394; https://doi.org/10.3390/pathogens10040394
Submission received: 9 February 2021 / Revised: 18 March 2021 / Accepted: 23 March 2021 / Published: 25 March 2021
(This article belongs to the Special Issue Characterization of Antibody Responses to Virus Infections in Humans)

Abstract

:
To cause a pandemic, an influenza virus has to overcome two main barriers. First, the virus has to be antigenically new to humans. Second, the virus has to be directly transmitted from humans to humans. Thus, if the avian influenza virus is able to pass the second barrier, it could cause a pandemic, since there is no immunity to avian influenza in the human population. To determine whether the adaptation process is ongoing, analyses of human sera could be conducted in populations inhabiting regions where pandemic virus variant emergence is highly possible. This study aimed to analyze the sera of Vietnamese residents using hemagglutinin inhibition reaction (HI) and microneutralization (MN) with A/H5Nx (clade 2.3.4.4) influenza viruses isolated in Vietnam and the Russian Federation in 2017–2018. In this study, we used sera from 295 residents of the Socialist Republic of Vietnam collected from three groups: 52 samples were collected from households in Nam Dinh province, where poultry deaths have been reported (2017); 96 (2017) and 147 (2018) samples were collected from patients with somatic but not infectious diseases in Hanoi. In all, 65 serum samples were positive for HI, at least to one H5 virus used in the study. In MN, 47 serum samples neutralizing one or two viruses at dilutions of 1/40 or higher were identified. We postulate that the rapidly evolving A/H5Nx (clade 2.3.4.4) influenza virus is possibly gradually adapting to the human host, insofar as healthy individuals have antibodies to a wide spectrum of variants of that subtype.

1. Introduction

Humanity has acquired knowledge to control most anthroponotic infections, such as measles, poliomyelitis, smallpox, and mumps. However, recently, problems related to zoonotic human infections have emerged. Since the natural reservoirs of these pathogens are unlimited, they are difficult or often impossible to control.
Influenza A virus belongs to the genus Alphainfluenzaviruses of the Orthomyxoviridae family and has a segmented genome consisting of single-stranded RNA segments of negative polarity [1]. Influenza A viruses are divided into subtypes (serotypes) based on the genetic and antigenic characteristics of its two surface glycoproteins, hemagglutinin (HA) and neuraminidase (NA). The nomenclature of these viruses is based on a combination of the HA (H1–H18) and NA (N1–N11) subtypes. Wild waterfowl are a natural reservoir for all influenza A subtypes [2], except for H17N10 and H18N11, which were recently found in bats [3,4]. Influenza A viruses can also be detected in a wide variety of hosts including humans, swine, horses, dogs, cats, and sea mammals.
Pandemic influenza A virus appears in the human population every 10–30 years. There is currently no immunity to these viruses; therefore, the resultant pandemics cause high morbidity and often high mortality. It is supposed that pandemic influenza A viruses emerge because of the reassortment of viruses in humans and animals or the adaptation of zoonotic viruses to humans [5].
Reassortment occurs when two strains of influenza A virus coinfect one cell and can cause procreation of the new reassortant virus, which contains a new set of genes [6]. The influenza pandemics in 1957 and 1968 were caused by reassortant viruses containing genes of influenza A viruses of humans and birds [7]. The first pandemic of the 21st century was caused by a virus that emerged after multiple reassortments of human-, avian-, and swine-origin influenza A viruses [8].
The views on the cause of the 1918 pandemic (the so-called “Spanish flu”) differ among experts. Some support the idea that the virus was directly introduced into the human population (without reassortment), while others believe that the pandemic virus emerged after multiple genome reassortments of avian and mammalian, and possibly swine and/or human, viruses that had emerged during the years preceding the pandemic of 1918 [9].
Regardless of the exact mechanism of the emergence of a new virus variant, there may be a certain period before the pandemic begins that is needed by the virus for optimal adaptation to the human host [10].
If this assumption is correct, then an understanding of whether the adaptation process is ongoing is possible by analyzing antibody levels in the sera of human populations inhabiting regions where the emergence of pandemic virus variants is most likely.
The objective of this research was to analyze the sera of Vietnamese residents using the hemagglutinin inhibition (HI) test and virus microneutralization (MN) with avian influenza viruses isolated in Vietnam and the Russian Federation in 2017–2018.

2. Results

For sera analyses, we selected influenza A virus strains that were isolated from poultry in Vietnam in 2018 and poultry and wild birds in Russia in 2017–2018. These strains were selected based on a phylogenetic analysis, which revealed a high degree of identity between the strains isolated in Russia and Vietnam (Figure 1). It was determined that the A/chicken/Nghe An/27VTC/2018 (H5N6), A/chicken/Nghe An/01VTC/2018 (H5N6), and A/common gull/Saratov/1676/2018 (H5N6) strains belonged to the genetic clade 2.3.4.4h. At that time, the strain A/chicken/Kostroma/1718/2017 (H5N2) was selected for comparison as a representative of clade 2.3.4.4b, which circulated widely in Eurasia. The study of antigenic properties is consistent with the phylogenetic analysis. Data are presented in Table 1.
As shown in Table 1, the A/chicken/NgheAn/27VTC/2018 (H5N6) and A/chicken/NgheAn/01VTC/2018 (H5N6) viruses cross-reacted with sera against A/common gull/Saratov/1676/2018 (H5N6) as effectively as the homological virus (the reciprocal of the titer in the HI test is 320). Vietnamese strains did not react with other ferret reference sera obtained against the A/H5N6 viruses isolated in Russia.
For the analysis of sera against influenza virus subtype A/H5, we selected the following viruses: low pathogenic A/chicken/Kostroma/1718/2017 (H5N2) virus (LPAI) and highly pathogenic A/common gull/Saratov/1676/2018, A/chicken /Nghe An/01VTC/2018, and A/chicken/Nghe An/27VTC/2018 (H5N6) viruses (HPAI).
The sera were tested using the HI test with human vaccine viruses, highly and lowly pathogenic viruses of the A/H5 subtype, highly pathogenic A/H7N9 virus, and lowly pathogenic A/H9N2 virus.
Testing with vaccine strains showed that antibodies with significant titers (40 and higher) to the A/Michigan/45/2015 (H1N1pdm09) virus were detected in 29 samples (14, 2, and 13 from three groups, respectively). Antibodies to the A/Singapore/INFIMH-16-0019/2016 (H3N2) vaccine virus were detected in 55 samples (14, 6, and 35 from each group, respectively) (data not shown).
None of the tested serum samples reacted in HI or MN with A/Anhui/1/2013 (H7N9) virus at dilutions of 1:40 or higher. Four samples had a titer of 20 in the HI test, but not in MN. Fifty-seven samples reacted with the A/chicken/Primorsky Krai/03/2018 (H9N2) virus in the HI test, of which 0, 1, and 56 samples were from the three groups, respectively (data not shown).
The results of the sera analyses in HI and MN for A/H5Nx (2.3.4.4.) avian influenza viruses are presented in Table 2. Data are presented only for samples that were positive in at least one study.
As shown in Table 2, only one serum from the first group reacted in the HI test with one of the viruses, A/chicken/Kostroma/1718/2017 (H5N2) 2.3.4.4. Seven serum samples from the second group reacted in the HI test with one or two A/H5 viruses. The largest number of positive serum samples was in the third group: 55 samples reacted in the HI test and two samples in MN with the A/chicken/NgheAn/01VTC/2018 (H5N6) virus, 59 serum samples were positive in the HI test and only one in MN with A/chicken/Kostroma/1718/2017 (H5N2) virus, 51 serum samples in HI and 47 in MN with A/chicken/NgheAn/27VTC/2018 (H5N6) virus, and 54 serum samples were positive in HI and 27 in MN with the A/common gull/Saratov/1676/2018 (H5N6) virus.

3. Discussion

The first documented outbreak of human infection with the avian influenza A/H5 virus occurred in Hong Kong in 1997. Since then, A(H5N1) has caused diseases in 861 people, and 455 cases were fatal (data up to 20 September 2020). In Vietnam, 127 confirmed cases of human infection with the A(H5N1) virus were detected between 2003 and 2014, 64 of which were fatal. No human cases of highly pathogenic avian influenza A/H5 have been reported in Vietnam since 2015 [11]. However, outbreaks in poultry and wild birds have been reported in Vietnam to date, including those caused by the most rapidly evolving H5N6 subtype [12].
Today, HPAI H5N6 is one of the few subtypes of the avian influenza virus that can infect humans [13]. Studies have shown that the H5N6 virus originated from a common precursor strain of the clade 2.3.4.4 subtype H5 as a result of reassortment with the A/duck/Guangxi/2281/2007 (H6N6) strain [13,14,15,16]. However, there is evidence that the origin of the H5N6 viruses followed other evolutionary paths [17]. According to one of the hypotheses, this virus appeared in the period from 2010 to 2012 as a result of reassortment of the H5N2 virus of clade 2.3.4.4 with the A/duck/Guangxi/2281/2007 (H6N6) strain, followed by reassortment of the six internal genes with the H5N1 influenza virus of clade 2.3.2.1c isolated from chickens [14]. The H5N6 virus, the so-called “reassortant A”, which developed along this pathway, circulates in Xinjiang, Jilin, and Northern China [14,15,18]. In 2013, the virus spread to Western China, where it caused outbreaks in Sichuan, Vietnam, and Laos [14,19].
Another variant of the H5N6 influenza virus, named “reassortant B,” appeared in 2013 because of reassortment of H6N6 viruses with H5N8 viruses in clade 2.3.4.4 and subsequent resorting of genes with H5N1 viruses in clade 2.3.2.1c [14]. This virus also circulated in China, Vietnam, and Laos. Two years later, reassortant B underwent repeated reassortment with an influenza virus of the H9N2 subtype, resulting in a new variant of the H5N6 virus, reassortant C. The circulation of this variant was reported in the Yunnan and Guangdong provinces of China [17,18]. Regardless of the evolutionary way in which these reassortants emerged, it is known that all of them caused infectious diseases among humans [14,15,16]. Since 2014, H5N6 viruses (2.3.4.4) have caused 27 human infections, resulting in 15 deaths in China [20]. Most human cases are associated with A or B reassortants.
In 2014, H5N6 spread across Laos and Vietnam, resulting in huge economic losses due to outbreaks in poultry [18,21]. In 2016, H5N6 caused several outbreaks in Japan, Myanmar, and the Republic of Korea [14,15,21]. In 2017, outbreaks of H5N6 were reported in Taiwan and the Philippines. In addition, with wild migratory birds, HPAI H5N6 was introduced into Europe during this time. Outbreaks were reported in Greece, Germany, the Netherlands, and Switzerland [14,15,16,17,22]. To date, H5N6 circulation is limited to Asia and Europe.
In addition to influenza viruses of the A/H5 subtype, the H6, H7, H9, and H10 viruses also have pandemic potential, since there is confirmed evidence that they can cross the interspecies barrier and infect humans [23]. For example, highly pathogenic A(H7N9) viruses caused 1568 confirmed human cases, 616 of which were fatal (data up to 20 September 2020) [24].
To cause a pandemic, the virus has to overcome two main obstacles. First, the pathogen must be antigenically new to humans to ensure that herd immunity does not impede the rapid spread of the virus. Second, the virus must be effectively transmitted from person to person [25]. Thus, if the avian influenza virus is able to pass the second barrier, it could cause a pandemic, since there is no immunity to avian influenza virus in the human population.
Vietnam is considered one of the hotspots for the emergence of influenza viruses with epidemic and pandemic potential [26]. A/H5 highly pathogenic avian influenza viruses have been endemic in Vietnamese poultry for over a decade and a half. It has been shown that in the northern provinces of Vietnam, more than 30% of poultry have antibodies to the influenza A/H5 virus [26]. The Global Influenza Surveillance and Response System (GISRS) tracks the emergence of viruses with pandemic potential. Within the framework of GISRS, this work is being carried out at the WHO Reference Laboratory for H5 on the basis of the State Research Center of VB “Vector” of Rospotrebnadzor [27] and in the Socialist Republic of Vietnam [28,29,30].
However, during the adaptation process, virus variants may not cause clinical manifestations and may remain unnoticed during monitoring activities. It is even more difficult to detect the adaptation of lowly pathogenic avian influenza viruses to humans. In such cases, adaptation can be assessed by analyzing sera collected from residents of areas with a high risk of avian influenza.
In the present study, we investigated the sera of Vietnamese residents using MN and HI with highly pathogenic, lowly pathogenic, and vaccine influenza A viruses H5N2, H5N6, H7N9, H9N2, A/H1N1pdm09, and A/H3N2 subtypes. The analyses showed that only 10% of sera had significant titers in the HI test with the A/H1N1pdm09 vaccine virus and close to 20% with the A/H3N2 vaccine virus. This indicates a low level of population immunity against seasonal influenza, which represents a serious risk, since the probability of human infection with a seasonal and highly pathogenic influenza virus is increasing, and this event could lead to the emergence of a reassortant virus with new antigenic features and the ability to be transmitted from person to person.
In the tested sera, we did not find significant titers of antibodies against the A/Anhui/1/2013 (H7N9) virus; only four serum samples out of 295 had a titer of 1:20 in HI, but not in MN. With the A/chicken/PrimorskyKrai/03/2018 (H9N2) virus, 57 serum samples were positive. This is consistent with previous data on the wide circulation of the A(H9N2) virus in Vietnam, especially in live poultry markets [31], and relatively high antibody levels to this virus serotype in human sera [28]. Current concerns about H9N2 viruses are related to their ability to reassort with other avian influenza viruses, resulting in highly and lowly pathogenic viruses that can cross species barriers and infect humans [32].
Among all investigated viruses of the A/H5 subtype, only two viruses, A/chicken/Nghe An/27VTC/2018 (H5N6) 2.3.4.4 and A/common gull/Saratov/1676/2018 (H5N6) 2.3.4.4, had a significant number of positive serum samples in HI and MN. For other viruses, we found mostly anti-hemagglutination antibodies, but not neutralizing virus in cell cultures. However, the absence of neutralizing antibodies does not mean that humans have not been infected. Thus, Li et al. showed that after mice were infected with wildtype A/H7N9 virus, all animals after 14 days had high titers of HI antibodies in their sera, but not virus-neutralizing antibodies. At the same time, the recombinant virus, which contained genes for internal proteins from the PR8 strain, and the HA and NA genes from A/H7N9, induced significantly higher antibody levels in sera, detected in both HI and MN. The authors concluded that internal proteins of the A/H7N9 virus can influence the humoral immune response of the host [33].
We analyzed all sera in the HI test with horse, goose, and turkey red blood cells and demonstrated the highest titers with horse red blood cells, in accordance with [34]. It is not clear why, in the present study, many serum samples from the third group reacted with different A/H5 viruses in HI (but not in MN). Thus, 45 serum samples were positive in the HI test and all were included in the study of A/H5 viruses. At the same time, these viruses in most cases did not react in HI with heterologous ferret reference sera. However, antibodies may appear because of human infection with various A/H5 pathogens. However, in our opinion, it is highly probable that the presence of antibodies to different A/H5 viruses in the same serum samples can be explained by the fact that A/H5 viruses induce in humans (but not in ferrets) a wide range of anti-H5 cross-reactive antibodies. This may be because of frequent human contact with various virus subtypes, while, to obtain a reference serum, animals that do not have antibodies to any influenza virus are selected.
To understand this phenomenon and, more importantly, the process of avian influenza virus adaptation to humans, it is necessary to continue studies of the circulation of viruses in domestic and wild birds, as well as the sera of people living in “hotspot” regions of pandemic potential virus emergence. From the results of the present research, we can postulate that the rapidly evolving A/H5Nx influenza viruses (clade 2.3.4.4) are gradually adapting to human hosts, in so far as healthy individuals have neutralizing and anti-hemagglutinating antibodies to a wide range of viruses of this subtype. The number and profiles of serum samples tested in this work were limited, so our results may be misleading; thus, we cannot say with confidence that the process of adaptation of H5 avian viruses to humans is underway. Nevertheless, our results allow us to make such an assumption.
It should be noted that in the human population, there are diseases that are caused by pathogens that previously circulated only among animals: SARS, the Middle East respiratory syndrome, coronavirus disease 2019 (COVID-19), acquired immune deficiency syndrome, and pandemics caused by Chikungunya and Zika viruses [35]. It is believed that, in the future, new viruses that are pathogenic to humans will emerge, owing to the presence of an unlimited natural reservoir of animal viruses. One of the most dangerous among them includes highly pathogenic influenza viruses. It is possible that pandemics similar to the Spanish flu will emerge [36]. Therefore, it is important to conduct comprehensive surveillance of avian and mammalian influenza viruses, including monitoring human sera for the presence of antibodies to animal influenza viruses.

4. Materials and Methods

Sera. The blood serum research was approved by the Ethics Committee IRB 00001360, affiliated with SRC VB Vector (No.2 d.d. Protocol, May 2008). The study used blood sera collected from residents of the Socialist Republic of Vietnam; 52 samples (No 1-52) were collected from private households in Nam Dinh province, where poultry deaths have been reported (2017) [37]; 96 samples (No 53-148) were collected in Hanoi from healthy donors (2017), and 147 samples (No 200-346) were collected from patients with non-communicable diseases in hospitals in Hanoi (2018). Blood samples were collected, on condition of anonymity, from individuals of different age groups: 18–55 years (90%), 56–64 years (8%) and 65 years and older (2%).
Before HI testing, sera were treated with receptor-destroying enzyme and hemadsorbed on horse RBCs, before MN sera were heat-inactivated for 30 min at 56 °C, as described by [34,38].
Viruses. A/Michigan/45/2015 (H1N1) pdm09 and A/Singapore/INFIMH-16-0019/2016 (H3N2) vaccine influenza viruses were kindly provided by the WHO Collaborating Center in Atlanta, United States. The WHO Collaborating Center in Beijing, China, kindly provided the A/Anhui/01/2013 (H7N9) virus. Virus A/chicken/Kostroma/1718/2017 (H5N2) [39], virus A/common gull/Saratov/1676/2018 (H5N6) [40,41], A/chicken/PrimorskyKrai/03/2018 (H9N2), A/chicken/NgheAn/01VTC/2018 (H5N6), and A /chicken/NgheAn/27VTC/2018 (H5N6) were isolated by the authors. A maximum-likelihood tree based on the Hasegawa–Kishino–Yano model was built using MEGA 6.06 software (http://www.megasoftware.net/, accessed on 5 March 2021) with 1000 bootstrap replicates.
HI test and MN. The hemagglutination inhibition (HI) test and microneutralization (MN) method were performed as described by [38,41]. Horse, goose, and turkey red blood cells were used in HI tests. Highest titers were obtained with horse red blood cells. Each serum was tested three times in the HI test with horse red blood cells, and the results differed by no more than 2 times. A lower value was taken for the serum titer. Sera from recovered ferrets infected with analyzed virus strain were used as a positive control. Negative control was represented by sera of non-immune ferrets and human sera without antibodies to avian influenza virus.

Funding

The study was conducted at the expense of targeted subsidies by order of the Government of the Russian Federation of July 13, 2019 No. 1536-r. and by State Assignment no. 1/21 and no. 3/21 (SRC VB “Vector”).

Author Contributions

Conceptualization, T.I., A.K. and A.R.; Formal analysis, V.M. and T.K.S.; Investigation, O.P., A.M., T.T.N. and B.T.L.A.; Methodology, V.M. and T.K.S.; Project administration, A.K. and A.R.; Supervision, A.K. and R.M.; Writing—original draft, T.I.; Writing—review and editing, T.I. and A.R. All authors have read and agreed to the published version of the manuscript.

Institutional Review Board Statement

The blood serum research was approved by the Ethics Committee IRB 00001360, affiliated with SRC VB Vector (No.2 d.d. Protocol, May 2008).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

Data sharing is not applicable to this article.

Conflicts of Interest

The authors declare no conflict of interest.

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Figure 1. The phylogenetic tree for HA of A(H5Nx) influenza viruses. Viruses used in this study are indicated by rhombs. Candidate vaccine viruses are indicated by circles (according to WHO recommendations https://www.who.int/influenza/vaccines/virus/characteristics_virus_vaccines/en/, accessed on 5 March 2021).
Figure 1. The phylogenetic tree for HA of A(H5Nx) influenza viruses. Viruses used in this study are indicated by rhombs. Candidate vaccine viruses are indicated by circles (according to WHO recommendations https://www.who.int/influenza/vaccines/virus/characteristics_virus_vaccines/en/, accessed on 5 March 2021).
Pathogens 10 00394 g001
Table 1. HI test of H5Nx clade 2.3.4.4 viruses with ferret reference antisera and horse red blood cells.
Table 1. HI test of H5Nx clade 2.3.4.4 viruses with ferret reference antisera and horse red blood cells.
VirusSubtypeCladeReverse Titer with Antisera
A/duck/England/36254/
2014
A/Northern Pintail/WA/40964/2014A/Sichuan/26221/2014 RG42AA/gyrfalcon/WA/41088/2014 RG43AA/great crested grebe/Tyva/34/2016A/wigeon/Sakha/1/2014A/chicken/SergiyevPosad/
38/2017
A/chicken/Kostroma/1718/
2017
A/common gull/Saratov/1676/2018A/chicken/Nghe An/27VTC/2018
A/duck/England/36254/2014H5N82.3.4.4c640512051206401280128012802560NANA
A/Northern Pintail/WA/40964/2014H5N22.3.4.4c3205120256025606406401601280<20<20
A/Sichuan/26221/2014 RG42AH5N62.3.4.4a640512051203206403203201280<20NA
A/gyrfalcon/WA/41088/2014 RG43AH5N82.3.4.4c640512012805120128012803201280<20<20
A/great crested grebe/Tyva/34/2016H5N82.3.4.4b32051202560256012806406401280<20<20
A/wigeon/Sakha/1/2014H5N82.3.4.4c64010,240256051206406406402560<20<20
A/chicken/SergiyevPosad/38/2017H5N82.3.4.4b1602560256025603206401601280<20<20
A/chicken/Kostroma/1718/2017H5N22.3.4.4b32010,240256025606406403205120<20<20
A/common gull/Saratov/1676/2018H5N62.3.4.4h<20<2080<20<20<20<20<2032080
A/chicken/NgheAn/27VTC/2018H5N62.3.4.4h<203204020<20<20<20<2032080
A/chicken/NgheAn/01VTC/2018H5N62.3.4.4hNA64080<20<20<20<20<20320160
A/chicken/Vietnam/NCVD-15A59/2015H5N62.3.4.4f32010,2402560256064064016064040<20
HI titers of sera with a homologous viruses are highlighted in bold.
Table 2. MN and HI test of human sera with H5 avian influenza viruses.
Table 2. MN and HI test of human sera with H5 avian influenza viruses.
Human Serum SampleGroupA/chicken/
NgheAn/01VTC/
2018 (H5N6)
2.3.4.4
A/chicken/
Kostroma/
1718/
2017 (H5N2)
2.3.4.4
A/chicken/
NgheAn/27VTC/2018 (H5N6)
2.3.4.4
A/common Gull/Saratov/1676/2018 (H5N6)
2.3.4.4
HIMNHIMNHIMNHIMN
201 ≥160
562 40
60240
822 40
100240 40
105280
128240 40
1342 40
2003≥160 ≥160 ≥16016016080
20338080160 16080≥16080
2093≥16080160 ≥160160≥160160
2123≥160 160 8080≥160160
2133≥160 160 16080≥16080
2143≥160 160 16080≥16080
221380 ≥160 8080≥160160
222340 160 40808080
2313 40
2323 40
235380 160 160320≥16080
237380 ≥160 160320≥160160
239380 160 4080160160
2403≥160 ≥160 16080≥160320
2413≥160 160 16080≥160320
250380 ≥160 8080160160
251340 160
2553≥160 ≥160 ≥16080≥160320
2573≥160 ≥160 808080160
2583≥160 ≥160 16080≥160160
2593≥160 ≥160 160160≥160160
2683≥160 ≥160 80160≥16080
270380 ≥160 408080
2713≥160 ≥160 80160≥16080
2723≥160 ≥160 80160≥160
273380 ≥160 8080≥160320
274380 ≥160 8080≥16080
2753≥160 ≥160 ≥160160≥160
277340 40
2783≥160 160 80160≥16080
2813≥160 ≥160 80160160
2833≥160 80 8080≥160
2843≥160 ≥160 ≥160160≥160
2853 ≥160 ≥160320≥160
2863≥160 ≥160 80160≥160
2873≥160 80 8080≥160
2883 80 40 ≥160
2893≥160 ≥160 160160≥160
290380 80 808080
291380 160 16080≥160
292380 ≥160 16080≥160
293380 160 8080≥160
294380 ≥160 8080≥160
295380 160 8080≥160
296380 160 40 40
297340 40 40
298340 80
299380 80 8016080
300380 80 8016080
303340 80 40 80
304340 80 160
307340 80 40160
308380 80 808080160
309340 ≥160 408040
310340 80 40 40
334380 80808016040
335380 80 801608080
338380 80 801604080
339380 80 8016080
Total number of positive sera 59265151475427
Reciprocal serum titers are shown for the selected sera positive in HI and MN simultaneously at least for one virus. The positive serum in MN ≥ 40, the positive serum in HI test ≥ 40. Each serum was tested three times in HI test with horse red blood cells; the results differed by no more than 2 times, and a lower value was taken for the serum titer. Sera from recovered ferrets infected with analyzed virus strain were used as a positive control. Negative control was represented by sera of non-immune ferrets and human sera without antibodies to avian influenza virus. Negative control titer in all tests > 20, positive control titer from 320 to 640.
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Ilyicheva, T.; Marchenko, V.; Pyankova, O.; Moiseeva, A.; Nhai, T.T.; Lan Anh, B.T.; Sau, T.K.; Kuznetsov, A.; Ryzhikov, A.; Maksyutov, R. Antibodies to Highly Pathogenic A/H5Nx (Clade 2.3.4.4) Influenza Viruses in the Sera of Vietnamese Residents. Pathogens 2021, 10, 394. https://doi.org/10.3390/pathogens10040394

AMA Style

Ilyicheva T, Marchenko V, Pyankova O, Moiseeva A, Nhai TT, Lan Anh BT, Sau TK, Kuznetsov A, Ryzhikov A, Maksyutov R. Antibodies to Highly Pathogenic A/H5Nx (Clade 2.3.4.4) Influenza Viruses in the Sera of Vietnamese Residents. Pathogens. 2021; 10(4):394. https://doi.org/10.3390/pathogens10040394

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Ilyicheva, Tatyana, Vasily Marchenko, Olga Pyankova, Anastasia Moiseeva, Tran Thi Nhai, Bui Thi Lan Anh, Trinh Khac Sau, Andrey Kuznetsov, Alexander Ryzhikov, and Rinat Maksyutov. 2021. "Antibodies to Highly Pathogenic A/H5Nx (Clade 2.3.4.4) Influenza Viruses in the Sera of Vietnamese Residents" Pathogens 10, no. 4: 394. https://doi.org/10.3390/pathogens10040394

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