Pakistan-US Science and Technology Cooperation Program  Phase 6 (2015 Deadline) Targeted Surveillance of Avian Influenza in High Risk Groups of Avian and Human Population US partner: Richard Webby, St. Jude's Children Research Hospital Pak partner: Mamoona Chaudhry, University of Veterinary and Animal Sciences, Lahore Progress Reports 2016: Activities during this reporting period have concentrated primarily on training and preparation activities. The goals of this study are to better understand influenza viruses in animals and humans in Pakistan. Successful handling and identification of these viruses requires expert training and a skilled workforce. Training was provided in many aspects of diagnosis and handling of these viruses in the laboratory. Initial results from a group of viruses that were found in birds in Pakistan showed that they were very similar to those that had been previously characterized and that our planned screening procedures were targeting the appropriate types of viruses. 2017: During this reporting period good progress was made towards meeting the objectives set out in this research proposal. The objectives of the study are to understand the influenza virus activity at the human-poultry interfaces of Pakistan. To aid in achieving these goals information and training materials have been developed and used. A number of different poultry settings have been selected for inclusion in this project and these sites have been enrolled. At these sites, which includes backyard farms and poultry markets, samples from both poultry and people occupationally exposed to these birds have been collected. These samples have then been used to look for evidence of influenza viruses in the birds and their possible transmission to humans. To date, a number of samples have been collected and screened. Poultry in both backyards and markets have been shown to be infected with H9 influenza viruses; a virus common in poultry in many regions of the world and one previously shown to be circulating in Pakistan. No evidence was found for the circulation of the more troubling H5 and H7 viruses. Preliminary results from the human blood samples suggest that some individuals may have been previously exposed to the H9 viruses, but these results are being confirmed. No evidence for previous infection of H5 and H7 in humans has been found. 2018: The overall objectives of this project are to determine the prevalence of avian influenza viruses in poultry raised under different conditions in Pakistan and to determine if zoonotic transmission, i.e, poultry-to-human, can be detected, and if so with what frequency. Samples from poultry in backyard and live bird market settings were collected during this period and tested for the presence of avian influenza viruses. We tested these birds for three different influenza viruses, H5, H7, and H9. We found evidence for circulation of H9 viruses but not H5 or H7. In addition to sampling of poultry, we also sampled individuals who were occupationally exposed to them. We found evidence that some of these individuals may have been infected at some stage with the H9 viruses. These results are being confirmed through additional testing.