1. Introduction
Since 2006, when highly pathogenic avian influenza (HPAI) H5 viruses from the goose/Guangdong (gs/GD) lineage first caused deaths in wild birds and poultry in Germany, numerous epidemics associated with H5 HPAI virus of the same lineage have been recorded in different years. In autumn 2020, the introduction of HPAI viruses (H5N8 and H5N5) subsequently triggered the largest HPAI epidemic ever recorded in Germany and had a severe impact on wild bird populations and the poultry production sector [
1]. For the first time, the epidemic did not completely fade out during the summer months in Europe, with ongoing detections in wild birds throughout 2021 [
2]. Although the H5 HPAI viruses of 2016/2017 and 2020 (to date) belong to the same clade of 2.3.4.4b, they are not directly phylogenetically linked and probably display separate introductions to Germany ([
3,
4]).
In Germany, the reporting of suspicion and confirmation of notifiable animal diseases to a central database, the German animal disease notification system (Tierseuchen-nachrichtensystem, TSN, [
5]), is mandatory. The database is hosted by the Federal Research Institute for Animal Health (Friedrich-Loeffler-Institut, FLI, [
6]).
More than 1000 cases in wild birds and a total of 245 outbreaks in poultry and captive birds were recorded in TSN between November 2020 and May 2021. Within a short period between late March and early April, over 100 new outbreaks occurred in poultry, all due to the secondary spread of the virus. Originating from a poultry farm in the district of Paderborn (North Rhine-Westphalia), H5N8 HPAIV spread mainly to small holdings in Baden-Württemberg and Thuringia through the distribution of live poultry via trade routes [
7].
According to the current legislation, outbreak investigation in case of notifiable animal diseases, such as HPAI, has to be carried out by the veterinary authority of the respective district. Support by the outbreak investigation unit of the FLI may be sought.
Here, the outbreak of HPAI in the district of Paderborn was investigated by the respective veterinary authority in conjunction with the FLI involving classical outbreak investigation on the farm with interviewing and assessment of the documentation, analysis of the TSN database, molecular analysis, and a modeling approach of the disease spread on the farm.
The presented study unravels contact patterns in a complex epidemiological scenario of an outbreak on a farm raising laying hens for travel trade with an unprecedented number of secondary outbreaks. Special emphasis was put on the determination of the herd incubation period, which is of utmost importance for contact tracing in disease control.
3. Discussion
In outbreak investigations, the determination of the most likely time of disease introduction into the outbreak farm is of utmost importance. The latter defines the relevant time span of tracing-back (where did the disease come from) and tracing-on (where did it go to) and is thus crucial for successful disease control. Usually, the time of disease introduction is deduced from the onset of clinical symptoms or positive test results and the incubation period. The applied incubation period is then often an individual incubation period, i.e., the time elapsing from infection to clinical (or laboratory) evidence in individual specimens similar to observations made in experiments. It is widely accepted that the so-called herd incubation period is different, i.e., longer, than the individual incubation period. Especially in larger herds, symptoms, or losses of the initially infected animals, particularly if they were only mild, may be missed or misinterpreted as background losses due to unknown reasons or non-regulated animal diseases. When larger cohorts of infected animals reach the stage of clinical disease or die after initial unnoticed spread, the dramatic course of disease and a massive increase in the rate of losses may lead to an underestimation of the time that has elapsed since the disease was introduced. This is particularly true if only the individual incubation period determined in experimental infections is applied to assess the most likely period of disease introduction. Underestimating the herd incubation period and assuming a period of introduction that starts after the true time of introduction will jeopardize the success of practical disease control, since events of potential spread may be missed in the epidemiological outbreak analysis. Moreover, the increase of scientific knowledge concerning potential routes of disease introduction is curtailed.
The presented outbreak investigation offered the unique opportunity to gain insight into possible herd incubation periods of H5N8 HPAI. Based on the highly dynamic development of disease in the affected flock and the losses and considering the (individual) incubation period of three to five days as indicated by the Food and Agriculture Organization (FAO, [
9]), a disease introduction around day -5 (
Figure 4) was first suspected. Yet, a smallholder (farm B,
Figure 1) that had received 150 chickens from outbreak farm A on day -14, the first day of trade, had suffered an outbreak of HPAI. Farm B had housed the chickens indoors in a closed mobile stable that was stocked for the first time with no other source of birds than farm A. We cannot completely rule out that farms A and B may have been infected by chance almost simultaneously and independently, e.g., through indirect contact with infected wild birds. This is unlikely, however, since there were no other outbreaks near farm B at this time and there were hardly any reports on HPAI in wild birds in the region where farm B is situated. Thus, it seems more likely that the outbreaks were directly linked, supported by the close genetic relationship of virus genomes isolated from the two farms. The dynamics of the documented losses on farms A and B were similar, but unusual losses were apparently detected a few days earlier on farm B than on farm A. This can potentially be explained by the fact that small holdings are sometimes easier to monitor for disease and losses.
As shown in
Table 2 and
Figure 4, the probability that the batch of chickens delivered from farm A to farm B on day -14 was infected was low, but the risk was not negligible. The veterinary authority of the district where farm B is situated reported that the disease developed slowly in the holding. A private practitioner had been consulted on day -5 and treated the flock against respiratory disease. Early infection of farm A is also supported by the tracing of two secondary outbreaks in Saxony (SN), which received birds from a batch that had left farm A on day -12. Since these outbreaks are geographically closely related to many secondary outbreaks derived from the branch farm A
1 in Thuringia (
Figure 1), it might be assumed that the outbreaks in SN were also related to branch farm A
1, though according to the records farm A
1 had received a batch of chickens from farm A for the first time on day -5 in the relevant period. Yet, investigations of the veterinary authority of the respective district in SN seem to confirm that the chickens had originated from a batch directly distributed by farm A and that these birds had left the farm on day -12. The probability of infection of this batch was also low, mirrored by the fact that only two of 29 holdings supplied with chickens from this batch subsequently experienced HPAI outbreaks. However, the fact that the virus from one of the outbreak farms (D) in SN was genetically more closely related to the virus from the branch farm A
1 than from farm A may contradict the scenario outlined above. Maybe the chickens destined for SN were actually channeled through branch farm A
1. There was at least one unconfirmed statement in the interviews of farm personnel indicating that some chickens from index farm A were already relocated to branch farm A
1 on day -12.
The probabilities of batch infection calculated for the days prior to disease confirmation on farm A (
Table 2,
Figure 4) support the findings of the epidemiological outbreak investigations in respect to the batches. All batches with a calculated probability of 100% of infection with HPAI led to secondary outbreaks. A batch that originated from day -3 did not transmit disease, although the probability of infection was high but not 100%. This batch comprised only of a small number of chickens (25,
Table 2).
The two federal states affected most as far as contacts with farm A and resulting secondary outbreaks are concerned were BW and TH. In the latter federal state, the proportion of secondary outbreaks relative to the experienced contacts was considerably lower than in BW, probably because the farms in this state mainly received chickens from a batch that left farm A on day -12, when the percentage of infected birds was still low on farm A (
Table 2). On the contrary, many secondary outbreaks in BW were due to sales tours supplying many small holders with chickens from the batches of the days -2 and even -1, i.e., the day before the outbreak was suspected on index farm A.
The modeling of disease spread conducted for the 19-week-old laying hens on farm A served mainly as an orientation. The losses modeled for the days close to the confirmation date of the outbreak were considerably higher than the observed losses (
Figure 4), although conservative assumptions were made for the model parameters. The latent period (time span from infection to infectiousness) was set to two days according to findings of [
11] for laying hens infected with HPAI, subtype H5N8, in 2014. Data of [
12] referring to the year 2016 imply, however, that the latent period may be as short as one day. The time span from infection to death was chosen as 4.5 days, i.e., the latent period plus an infectious period of 2.5 days based on a literature review of [
13] concerning the situation in the year 2014. The investigations of [
12] in the year 2016 suggest a markedly shorter infectious period. Concerning the secondary attack rate, the lowest value estimated by [
13] for a laying hen farm (4.4) was used, although values up to 34.4 were found.
Thus, the use of parameter values less favorable for a slow spread of disease in the model would have further increased the discrepancies between the modeled and the observed losses, rendering an actual disease introduction into farm A considerably later than day -14 more likely. It also must be taken into account that HPAI isolates may be genetically related, even if farms A and B were independently infected via wild birds, if only limited virus passaging had occurred. Moreover, the attribution of outbreaks to the early batches that had left the index farm A might be spurious and the suspected secondary outbreaks could in fact have been caused by contact to infected wild birds. Yet, we consider this much less likely.
Although it is a matter of probabilities, the presented investigation seems to hint towards the possibility of a slow spread of HPAI in a chicken farm. The secondary attack rate might be lower than 4.4 on average and the herd incubation period (flock-level) as long as 14 days. These findings support the specification of the flock-level incubation period (14 days) of HPAI independent of the subtype as detailed in the Terrestrial Animal Health Code of the World Organization for Animal Health (OIE, [
14]). It should be noted, however, that [
13], who estimated the time span from disease introduction to detection of H5N8 for five laying hen farms, found flock-level incubation periods as short as 5.9 days on average, but with a maximum at 14.8 days for one particular farm.
The described outbreak occurred on a farm that sold young laying hens to poultry holders in many German federal states, also to small holders on sales tours. This business model implies the risk of a wide, distance-independent spread of HPAI if the farm of origin is infected, but disease not yet suspected. According to the relevant German legislation in force at the time of the outbreak [
15], the veterinary authority may demand a clinical examination carried out by a veterinarian not earlier than four days prior to the sale of the chickens on sales tours. However, this is difficult to implement for practical reasons and the risk remains that chickens may not yet show symptoms when examined. In any case, an exact documentation of sales with precise contact data of all customers irrespective of the number of birds sold is mandatory to allow proper tracing of contacts and disease control in case of an outbreak.
The information collated in the course of the outbreak investigations reported here may be used to improve prevention measures for HPAI spread through travel trade of poultry. It also emphasizes the importance of determining the herd (or flock) incubation time for HPAI in poultry holdings as precisely as possible.
4. Materials and Methods
The federal states of Germany are the competent authorities for animal disease control according to European Union and German national legislation. They have delegated these duties to the district veterinary offices in the affected federal states. The epidemiological investigation on outbreak farm A and the tracing of contacts were thus carried out by an official veterinarian of the district veterinary office of Paderborn, partly assisted by an epidemiologist of the Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health. The veterinary authorities of the districts where the contact holdings were situated investigated these contacts. Information on outbreaks (primary and secondary) was submitted to the German Disease Notification System (Tierseuchennachrichtensystem, TSN, [
5]).
TSN was developed and is continuously advanced and maintained by the Federal Research Institute for Animal Health [
6]. It comprises an online component mainly for disease notification and software for disease control management. The competent local veterinary authorities are obliged to notify animal diseases via this system if they are notifiable or reportable according to the relevant European community or national legislation. The database of the notification system may be queried, and data may be downloaded by entitled and registered users.
Network analysis and visualization was carried out employing the software R [
10] with the package igraph [
16]. Outbreak data (HPAI in poultry) from the time interval 1 March to 12 July 2021 were downloaded from the TSN database as a csv-file and read into R. Among the information that has to be provided with the notification is a statement on the epidemiological status of the affected holding, i.e., primary (index) versus secondary outbreak, and in the latter case, the registration number of the traced source of infection. The registration number of the outbreaks and of the identified source of infection were used to analyze the data with igraph [
16].
The penside rapid test (FASTest
® AIV Ag, Megacor Diagnostik GmbH, Hörbranz, Austria) for influenza A was carried out according to the manufacturer’s recommendations [
17]. Tracheal swabs were immersed in 1 mL of buffer diluent, the eluate was mixed and 280 µL was transferred to a test tube. A dipstick was added to the test tube and results were read after 20 min. Positive samples containing avian influenza virus type A antigens (subtypes H1–H15) react in the conjugate pad area of the dipstick with mobile monoclonal anti-AIV antibodies (anti-AIV mAbs), which are bound to colloidal gold particles. Migrating (“lateral flow”) along the nitrocellulose membrane, these specific antigen-antibody complexes are bound by fixed anti-AIV mAbs producing a pink-purple test line.
Confirmatory Polymerase Chain Reaction (PCR) testing of samples was conducted by matrix gene-based real-time reverse-transcription quantitative PCR (RT-qPCR) to screen for influenza A positive samples from the holding [
18]. Subsequently, the latter samples were tested in a clade 2.3.4.4b HP H5 specific RT-qPCR [
19] and additionally in a N8 specific RT-qPCR to confirm the H5N8 HPAI subtype.
Full-genome sequencing of AIV-positive samples was executed as previously described [
20] via a nanopore-based multiplexed amplification method with the Rapid Barcoding Kit (SQK-RBK004, ONT) using a R9.4.1 flow cell on a Mk1C MinION platform (Oxford Nanopore Technologies, ONT, Oxford, UK) directed according to the manufacturer’s instructions. Live basecalling of the raw data with Guppy (v.4.3.4, ONT) was followed by a demultiplexing, quality check, and trimming step to remove low quality, primer, and short (<50 bp) sequences. Full-genome consensus sequences were generated in a map-to-reference approach utilizing MiniMap2 [
21]. Polishing of the final genome sequences was done in Geneious Prime (Biomatters, New Zealand). The coding sequences of the eight segments were concatenated and maximum likelihood (ML) trees thereof were generated with RAxML [
22] utilizing the GTR GAMMA model with rapid bootstrapping and search for the best scoring ML tree together with 1000 bootstrap replicates. The results of ML analysis were used for time-scaled Bayesian phylogenetic interference calculation with BEAST (V1.10.4) software package [
23] using a GTR GAMMA substitution model, an uncorrelated relaxed clock with a lognormal distribution and coalescent constant population tree models. Chain lengths were set to 50 million iterations and convergence was checked via Tracer (V1.7.1). Time-scaled summary maximum clade credibility trees (MCC) with 10% for the post burn-in posterior were created using TreeAnnotator (V1.10.4) and visualized with FigTree (V1.4.4) showing posterior confidence values at each branch.
To get an impression of the within-farm spread of HPAI on index farm A (i.e., in the compartment with 19-week-old hens), a simple SIR model (susceptible, infectious, removed, [
24]) was implemented in R [
10]. It was assumed that a single chicken was infected on day -14 (
Figure 4). It was further assumed that a chicken becomes infectious two days post infection (latent period according to [
11]) and that all infected chickens die after four to five days [
13]. Dead chicken left the status “infectious” in the model. The infectious period was thus set to 2.5 days. The secondary attack rate per day and chicken with the status “infectious” was modeled using a Poisson distribution with an average number of events of λ = 4.4 [
13]. The simulation was run with 1000 iterations, the mean of infected and dead chickens per day was calculated and rounded. Results are presented in
Table 2 and
Figure 4, respectively.
To assess the probability of infection of a batch of chicken at the day when it left the index farm, the number of chickens included in the batches was determined from all deliveries originating from the specific batch, be it through direct delivery to a single customer, during sales tours or after relocation to the branch farm with subsequent distribution. The number of infected birds on the respective day was derived from the model describing the spread of disease within the affected compartment with 19-week-old chicken on farm A (
Table 2). The probability of a batch to be infected and thus at least one secondary outbreak was calculated as the probability of at least one infected bird to be present in a batch according to the following equation
with n
inf denoting the number of infected chickens in the farm compartment, N the population size, and n the size of the batch.