igration routes of Asian birds. A) Distribution and migration routes of bar-headed geese (courtesy of P. Leader). B) The Asia-Pacific region contains >240 species of migratory birds. The 3 flyways run primarily in a north-south direction, overlapping and extending from Australia/New Zealand to India, Central Asia, and Siberia. The outbreak of highly pathogenic (HP) H5N1 in migratory waterfowl at Qinghai Lake, China, affected primarily bar-headed geese (Anser indicus); however, other species, including gulls and ducks, were affected (16,17). The outbreak started in early May 2005, and by June >5,000 birds had died. The birds exhibited neurologic signs, inability to stand, diarrhea, and death. Systemic infection was detected in all organs tested. C) Bar-headed goose infected with HP H5N1 influenza virus. D) Immunostain of goose pancreas, using H5 monoclonal antibodies (magnification ×400). (C and D, courtesy of H. Chen). Countries shown in red have had outbreaks of HP H5N1 since 2004. The geographic range of H5N1 may be extended by bar-headed geese or by ducks that are less susceptible to lethal infection.

Emergence of H5N1 influenza virus and control options. A nonpathogenic H5 influenza virus is believed to have spread to domestic ducks and geese, then to domestic chickens. In chickens, the H5 virus became highly pathogenic before it was transferred back to domestic ducks and geese. The highly pathogenic H5 virus reassorted its genome with those of other influenza viruses in aquatic birds, and the resulting viruses spread to domestic poultry farms, humans, and occasionally to pigs. These viruses acquired mutations in their PB2, HA, NA, and NS genes that made them lethal to domestic and wild waterfowl and humans. Solid lines, transmission demonstrated; dotted lines, transmission postulated but not demonstrated. Multiple opportunities exist for control of highly pathogenic avian influenza: 1) prevent contact between wild and domestic poultry by use of screened poultry houses and treated water; 2) prevent contact between domestic waterfowl and gallinaceous poultry by use of screened houses and treated water and by exclusion of waterfowl from "wet markets"; 3) eradicate H5/H7 influenza viruses from gallinaceous poultry by culling or the use of vaccines that prevent disease and transmission; 4) prevent contact between poultry, pigs, and humans and make vaccines and antiviral drugs available.