Genetic Characterization of Clade 2.3.2.1 Avian Influenza A(H5N1) Viruses, Indonesia, 2012

After reports of unusually high mortality rates among ducks on farms in Java Island, Indonesia, in September 2012, influenza A(H5N1) viruses were detected and characterized. Sequence analyses revealed all genes clustered with contemporary clade 2.3.2.1 viruses, rather than enzootic clade 2.1.3 viruses, indicating the introduction of an exotic H5N1 clade into Indonesia.

H ighly pathogenic avian influenza A(H5N1) virus has circulated in poultry in Indonesia since 2003 (1,2). The phylogeny of A(H5N1) viruses detected during 2003-2011 indicated all genes descended from 1 ancestral virus with a clade 2.1 hemagglutinin (HA) introduced into Indonesia before 2003 (3). These viruses became enzootic and evolved into second-, third-, and fourth-order HA clades, leading to the recent dominance of clade 2.1.3.2 viruses (4). Outbreaks in poultry typically caused high mortality rates among gallinaceous birds, especially layer, broiler, and native chickens. The virus seemed less pathogenic in aquatic birds (5). However, reports of duck deaths and a higher than usual mortality rate (100% in some outbreaks) in backyard farms in Central Java, Jogjakarta, and East Java Provinces, Indonesia, in September 2012 triggered a joint outbreak investigation by animal and public health authorities (6). We describe the genetic characteristics of viruses isolated from A(H5N1) infection outbreaks in these 3 provinces on Java Island, where a previously unrecognized clade was detected.

The Study
We investigated 9 small-holding duck farms that reported bird deaths during September 12-November 5, 2012 (6). Cloacal swab samples were collected from sick birds, placed in 1,000 µL of viral transport medium, and sent for testing at laboratories of the regional Ministry of Agriculture Disease Investigation Center, Jogjakarta. Seventeen A(H5N1)-positive samples were forwarded to the National Animal Health Laboratory, Indonesian Research Center for Veterinary Science (IRCVS), for virus isolation and genome sequencing.
In addition, IRCVS collected 122 cloacal swab samples from birds and 58 environmental swab samples (from defeathering machines) at 5 live-bird markets (LBMs) in East Java Province during November 5-8, 2012. RNA extracted from farm and LBM specimens was tested for influenza A matrix gene to identify presumptive A(H5N1)positive samples (7). Select positive samples were inoculated in 9-11-day-old embryonated, specific pathogen-free eggs. Allantoic fluid was harvested 36 h postinfection and tested for HA with chicken erythrocytes to confirm virus isolation (8).
Phylogenetic analysis revealed that A(H5N1) isolates from samples collected from duck farm outbreaks and an LBM were not related to isolates in long-established Indonesian clade 2.1; rather, the HA genes closely resembled those of clade 2.3.2.1 viruses recently found in Vietnam, China, and Hong Kong (Figure). Full-length HA genes showed 97%-98%-nt identity with recent viruses from Vietnam and clustered in a larger group containing viruses from many Asian regions during 2009-2012. The environmental sample from an East Java LBM shared >99% nt similarity with viruses from samples at duck farms, indicating spread of this A(H5N1) clade into the marketing chain. A poultry sample from the same district as the 2.3.2.1 virus was identified as clade 2.1.3.2 ( Figure), indicating likely cocirculation.   All 4 isolates exhibited the typical 20-aa deletion in the stalk region (residue 48-68) of the neuraminidase gene (NA). Although 1 sample had an Ile203Val substitution in the NA, which has been associated with reduced susceptibility to oseltamivir, no other markers of resistance in the NA or M2 were identified (Table 1). All 4 viruses had NS1 protein sequences with the typical deletion at position 80-84 and an intact H5N1 consensus PDZ binding motif (ESEV). A truncated form (57 aa) of the PB1-F2 protein was found in all viruses characterized. Although the functional consequences of this truncation are unknown, this represents a change from the typical full-length 90-aa protein found in most A(H5N1) viruses (13). All other amino acid residues and motifs of interest in the internal genes of the 4 viruses sequenced in this study represented avian consensus sequences.
Phylogenetic comparison of the NA and internal gene segments revealed ancestral origins of the new viruses similar to those of the HA gene (online Technical Appendix 1). Although partial nucleotide sequences from some genes were available for analysis (Table 1)

Conclusions
Detection of a novel clade of A(H5N1) virus in Indonesia marks a potential turning point in the molecular epidemiology of this virus. Indonesia has the highest number of human A(H5N1) infections because of ongoing outbreaks in poultry (14,15). Whether this new virus will become entrenched, as did clade 2.1.3 viruses over the past decade, remains to be seen, as do its effects on the incidence of human infection. Potential cocirculation of subtypes of 2 different clades warrants review of diagnostic methods and vaccination strategy to maximize effectiveness of disease control interventions. The lack of antigenic relatedness between the clade 2.3.2.1 and 2.1.3.2 viruses must be considered when evaluating A(H5N1) serologic diagnostic reagents used in Indonesia. This change also may have implications in selecting prepandemic candidate vaccine virus for the region. Furthermore,