InfluenzaViruses

Types,Subtypes,andStrains
Therearethreetypesofinfluenzaviruses:A,B,andC.OnlyinfluenzaAvirusesarefurtherclassifiedby
subtypeonthebasisofthetwomainsurfaceglycoproteinshemagglutinin(HA)andneuraminidase(NA).
InfluenzaAsubtypesandBvirusesarefurtherclassifiedbystrains.

HumanInfluenzaVirusesandAvianInfluenzaAViruses
HumanscanbeinfectedwithinfluenzatypesA,B,andCviruses.SubtypesofinfluenzaAthatare
currentlycirculatingamongpeopleworldwideincludeH1N1,H1N2,andH3N2viruses.
WildbirdsarethenaturalhostforallknownsubtypesofinfluenzaAviruses.Typically,wildbirdsdonot
becomesickwhentheyareinfectedwithavianinfluenzaAviruses.However,domesticpoultry,suchas
turkeysandchickens,canbecomeverysickanddiefromavianinfluenza,andsomeavianinfluenzaA
virusesalsocancauseseriousdiseaseanddeathinwildbirds.

LowPathogenicversusHighlyPathogenicAvianInfluenzaAViruses
AvianinfluenzaAvirusstrainsarefurtherclassifiedaslowpathogenic(LPAI)orhighlypathogenic(HPAI)
onthebasisofspecificmoleculargeneticandpathogenesiscriteriathatrequirespecifictesting.Mostavian
influenzaAvirusesareLPAIvirusesthatareusuallyassociatedwithmilddiseaseinpoultry.Incontrast,
HPAIvirusescancausesevereillnessandhighmortalityinpoultry.Morerecently,someHPAIviruses
(e.g.,H5N1)havebeenfoundtocausenoillnessinsomepoultry,suchasducks.LPAIviruseshavethe
potentialtoevolveintoHPAIvirusesandthishasbeendocumentedinsomepoultryoutbreaks.Avian
influenzaAvirusesofthesubtypesH5andH7,includingH5N1,H7N7,andH7N3viruses,havebeen
associatedwithHPAI,andhumaninfectionwiththeseviruseshaverangedfrommild(H7N3,H7N7)to
severeandfataldisease(H7N7,H5N1).HumanillnessduetoinfectionwithLPAIviruseshasbeen
documented,includingverymildsymptoms(e.g.,conjunctivitis)toinfluenzalikeillness.ExamplesofLPAI
virusesthathaveinfectedhumansincludeH7N7,H9N2,andH7N2.
Ingeneral,directhumaninfectionwithavianinfluenzavirusesoccursveryinfrequently,andhasbeen
associatedwithdirectcontact(e.g.,touching)infectedsickordeadinfectedbirds(domesticpoultry).

HowInfluenzaVirusesChange:DriftandShift
Influenzavirusesaredynamicandarecontinuouslyevolving.Influenzavirusescanchangeintwodifferent
ways:antigenicdriftandantigenicshift.Influenzavirusesarechangingbyantigenicdriftallthetime,but
antigenicshifthappensonlyoccasionally.InfluenzatypeAvirusesundergobothkindsofchanges
influenzatypeBviruseschangeonlybythemoregradualprocessofantigenicdrift.
Antigenicdriftreferstosmall,gradualchangesthatoccurthroughpointmutationsinthetwogenesthat
containthegeneticmaterialtoproducethemainsurfaceproteins,hemagglutinin,andneuraminidase.
Thesepointmutationsoccurunpredictablyandresultinminorchangestothesesurfaceproteins.
Antigenicdriftproducesnewvirusstrainsthatmaynotberecognizedbyantibodiestoearlierinfluenza
strains.Thisprocessworksasfollows:apersoninfectedwithaparticularinfluenzavirusstraindevelops
antibodyagainstthatstrain.Asnewervirusstrainsappear,theantibodiesagainsttheolderstrainsmight
notrecognizethe"newer"virus,andinfectionwithanewstraincanoccur.Thisisoneofthemainreasons
whypeoplecanbecomeinfectedwithinfluenzavirusesmorethanonetimeandwhyglobalsurveillanceis
November18,2005

Page1of3

InfluenzaViruses
(continuedfrompreviouspage)
criticalinordertomonitortheevolutionofhumaninfluenzavirusstainsforselectionofwhichstrains
shouldbeincludedintheannualproductionofinfluenzavaccine.Inmostyears,oneortwoofthethree
virusstrainsintheinfluenzavaccineareupdatedtokeepupwiththechangesinthecirculatinginfluenza
viruses.Forthisreason,peoplewhowanttobeimmunizedagainstinfluenzaneedtobevaccinatedevery
year.
Antigenicshiftreferstoanabrupt,majorchangetoproduceanovelinfluenzaAvirussubtypeinhumans
thatwasnotcurrentlycirculatingamongpeople(seemoreinformationbelowunderInfluenzaTypeAand
ItsSubtypes).Antigenicshiftcanoccureitherthroughdirectanimal(poultry)tohumantransmissionor
throughmixingofhumaninfluenzaAandanimalinfluenzaAvirusgenestocreateanewhumaninfluenza
Asubtypevirusthroughaprocesscalledgeneticreassortment.Antigenicshiftresultsinanewhuman
influenzaAsubtype.Aglobalinfluenzapandemic(worldwidespread)mayoccurifthreeconditionsare
met:
AnewsubtypeofinfluenzaAvirusisintroducedintothehumanpopulation.
Theviruscausesseriousillnessinhumans.
Theviruscanspreadeasilyfrompersontopersoninasustainedmanner.

Types,Subtypes,andStrains
InfluenzaTypeAandItsSubtypes
InfluenzatypeAvirusescaninfectpeople,birds,pigs,horses,andotheranimals,butwildbirdsarethe
naturalhostsfortheseviruses.InfluenzatypeAvirusesaredividedintosubtypesandnamedonthebasis
oftwoproteinsonthesurfaceofthevirus:hemagglutinin(HA)andneuraminidase(NA).Forexample,an
H7N2virusdesignatesaninfluenzaAsubtypethathasanHA7proteinandanNA2protein.Similarlyan
H5N1virushasanHA5proteinandanNA1protein.Thereare16knownHAsubtypesand9knownNA
subtypes.ManydifferentcombinationsofHAandNAproteinsarepossible.OnlysomeinfluenzaA
subtypes(i.e.,H1N1,H1N2,andH3N2)arecurrentlyingeneralcirculationamongpeople.Othersubtypes
arefoundmostcommonlyinotheranimalspecies.Forexample,H7N7andH3N8virusescauseillnessin
horses,andH3N8alsohasrecentlybeenshowntocauseillnessindogs.
OnlyinfluenzaAvirusesinfectbirds,andallknownsubtypesofinfluenzaAvirusescaninfectbirds.
However,therearesubstantialgeneticdifferencesbetweentheinfluenzaAsubtypesthattypicallyinfect
birdsandthosethatinfectbothpeopleandbirds.ThreeprominentsubtypesoftheavianinfluenzaA
virusesthatareknowntoinfectbothbirdsandpeopleare:
InfluenzaAH5
NinepotentialsubtypesofH5areknown.H5infections,suchasHPAIH5N1virusescurrentlycirculatingin
AsiaandEurope,havebeendocumentedamonghumansandsometimescausesevereillnessordeath.
InfluenzaAH7
NinepotentialsubtypesofH7areknown.H7infectioninhumansisrarebutcanoccuramongpersons
whohavedirectcontactwithinfectedbirds.Symptomsmayincludeconjunctivitisand/orupperrespiratory
symptoms.H7viruseshavebeenassociatedwithbothLPAI(e.g.,H7N2,H7N7)andHPAI(e.g.,H7N3,
H7N7),andhavecausedmildtosevereandfatalillnessinhumans.
InfluenzaAH9
NinepotentialsubtypesofH9areknowninfluenzaAH9hasrarelybeenreportedtoinfecthumans.
However,thissubtypehasbeendocumentedonlyinalowpathogenicform.

InfluenzaTypeB
InfluenzaBvirusesareusuallyfoundonlyinhumans.UnlikeinfluenzaAviruses,thesevirusesarenot
classifiedaccordingtosubtype.InfluenzaBvirusescancausemorbidityandmortalityamonghumans,but
November18,2005
Page2of3

InfluenzaViruses
(continuedfrompreviouspage)
ingeneralareassociatedwithlesssevereepidemicsthaninfluenzaAviruses.AlthoughinfluenzatypeB
virusescancausehumanepidemics,theyhavenotcausedpandemics.

InfluenzaTypeC
InfluenzatypeCvirusescausemildillnessinhumansanddonotcauseepidemicsorpandemics.These
virusesarenotclassifiedaccordingtosubtype.

Strains
InfluenzaBvirusesandsubtypesofinfluenzaAvirusarefurthercharacterizedintostrains.Thereare
manydifferentstrainsofinfluenzaBvirusesandofinfluenzaAsubtypes.Newstrainsofinfluenzaviruses
appearandreplaceolderstrains.Thisprocessoccursthroughantigenicdrift.Whenanewstrainofhuman
influenzavirusemerges,antibodyprotectionthatmayhavedevelopedafterinfectionorvaccinationwith
anolderstrainmaynotprovideprotectionagainstthenewstrain.Therefore,theinfluenzavaccineis
updatedonayearlybasistokeepupwiththechangesininfluenzaviruses.

Formoreinformation,visithttp://www.cdc.gov/flu/avian,
orcallCDCat800CDCINFO(EnglishandSpanish)or8882326348(TTY).
November18,2005

Page3of3