Evidence map›Paper›PMID 42494546›Full record

ReviewOne health (Amsterdam, Netherlands)2026

Mapping Reported Modes of Transmission of Highly Pathogenic Avian Influenza A (H5N1) to Humans: A Scoping Review.

Nicole Billias, Victoria D'Alessandro, Dimitra V Pouliopoulou, Jessica J Wong, Erin Miller, Jessica P Hopkins, Eleni C Boutsikari, Lauren E Cipriano, Tiago da Veiga Pereira, Jennie Johnstone and 6 more

Abstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in One health (Amsterdam, Netherlands), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Avian influenza overview June-August 2026.EFSA journal. European Food Safety Authority · 2026
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Nicole BilliasSchool of Physical Therapy, Western University, London, Ontario, Canada.
Victoria D'AlessandroSchool of Physical Therapy, Western University, London, Ontario, Canada.
Dimitra V PouliopoulouSchool of Physical Therapy, Western University, London, Ontario, Canada.
Jessica J WongSchool of Physical Therapy, Western University, London, Ontario, Canada.
Erin MillerSchool of Physical Therapy, Western University, London, Ontario, Canada.
Jessica P HopkinsDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Eleni C BoutsikariDepartment of Preventive Medicine, Epidemiology & Medical Statistics, National and Kapodistrian University of Athens Medical School, Athens, Greece.
Lauren E CiprianoRichard Ivey School of Business, Western University, London, Ontario, Canada.
Tiago da Veiga PereiraNuffield Department of Population Health, University of Oxford, Oxford, UK.
Jennie JohnstoneDepartment of Medicine, University of Toronto, Toronto, Ontario, Canada.
Saverio StrangesDepartment of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.
J Scott WeeseOntario Veterinary College, University of Guelph, Guelph, Ontario, Canada.
Joy C MacDermidSchool of Physical Therapy, Western University, London, Ontario, Canada.
Kieran L QuinnDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
David N FismanDalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
Pavlos BobosSchool of Physical Therapy, Western University, London, Ontario, Canada.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background: Highly Pathogenic Avian Influenza A (subtype H5N1) poses a threat to human health, and its pandemic potential emphasizes the need to better understand detailed reported transmission pathways to humans. Existing literature is outdated or lacks detailed, comprehensive analysis of the range of transmission routes and how the virus may enter the human body. Objective: To comprehensively map all reported H5N1 transmission pathways to humans, as well as viral entry routes. Methods: CINAHL, Embase, MEDLINE, Scopus, PubMed, grey literature, and reference lists (of included studies) were searched up to October 29th, 2025, with no language restrictions. Observational studies and grey literature reporting H5N1 transmission evidence to humans were included. Two reviewers conducted duplicate screening independently (two of three reviewers per record). One reviewer completed data extraction, which was cross-verified for accuracy by a second. Findings were summarized narratively. Results: 120 sources met inclusion criteria (70 studies, 50 grey literature). Reported H5N1 transmission pathways were classified into animal-to-human (109 of 120 sources, 90.8%; including poultry-to-human in 100 sources [83.3%] and cattle-to-human in nine sources [7.5%]), environment-to-human (32 of 120 sources, 26.7%), and human-to-human (14 of 120 sources, 11.7%). Reported transmission pathways were further classified as direct or indirect contact, synthesized, and linked to suspected routes of human entry, including mucosal entry (eyes, nose, mouth), inhalation of aerosols or droplets, ingestion, and percutaneous exposure. Entry routes are biologically plausible and do not imply relative likelihood or causal attribution. Conclusions: There are multiple reported pathways of H5N1 exposure, and a single pathway may involve multiple ways to infect humans. Further research is needed to determine causal mechanisms, identify specific risk factors and measures of association, and strengthen evidence-based prevention strategies.

Indexed as

Avian InfluenzaH5N1Influenza ATransmission

Identifiers

PMID42494546
PMCPMC13393788

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.