Background: H5N2 avian influenza virus infection of humans has not been reported thus far. The first H5N2 avian influenza infection of poultry in Japan occurred in Ibaraki. Methods: The subjects were workers at 35 chicken farms in Ibaraki Prefecture, where the H5N2 virus or antibody was isolated from chickens. None of the subjects exhibited influenza symptoms. The H5N2-neutralizing antibody titers of the first and second paired sera samples were compared. To investigate the possible factors for this increase, the H5N2-neutralizing antibody titer (1:40 or more) was calculated for the second samples. A logistic regression analysis was performed to examine the association of these factors with H5N2-neutralizing antibody positivity. Results: We performed Wilcoxon matched-pairs signed-ranked test on data collected from 257 subjects, and determined that the H5N2 antibody titers of the second paired sera samples were significantly higher than those of the first samples (P < 0.001). The H5N2 antibody titers of paired sera of 13 subjects without a history of seasonal influenza vaccination within the previous 12 months increased 4-fold or more. The percentage of antibody positivity was 32% for subjects with a history of seasonal influenza vaccination (28% of all subjects) and 13% for those without a history of the same. The adjusted odds ratio of H5N2-neutralizing antibody positivity was 4.6 (95% confidence interval: 1.6-13.7) for those aged over 40 and 3.1 (95% confidence interval: 1.6-6.1) for those with a history of seasonal influenza vaccination within the previous 12 months. Conclusion: The results suggest that this may have been the first avian influenza H5N2 infection of poultry to affect humans. A history of seasonal influenza vaccination might be associated with H5N2-neutralizing antibody positivity.
The inhabitants living in a specific region of Kizaki area in Kamisu-town, Ibaraki Prefecture exhibited uncommon clinical central nervous system symptoms. A graphite furnace atomic absorption spectrophotometer detected markedly elevated concentration of arsenic (4.5 ppm) in their drinking well water. Further investigation using HPLC, GC/MS and HPLC/ICP/MS demonstrated that the structures of the arsenic were bis(diphenylarsine)oxide (BDPAO), diphenylarsinic acid (DPAA) and phenylarsonic acid (PAA), compounds that can be derived from the chemical warfare agents, diphenylchloroarsine (DA) and diphenylcyanoarsine (DC). The predominant form of the arsenic compound in the well water was DPAA (maximum 15 ppm), so that it was calculated that the inhabitants ingested 11-30 mg of DPAA daily. This is the first report of inhabitants that were injured by drinking well water contaminated with organic arsenic compounds that were likely derived from chemical weapons.