Although the effective transmission of the H5N1 virus from humans to humans has yet to be further observed, humans are at increased risk of a pandemic caused by H5N1. In order to fully evaluate the seroprevalence and risk factor of highly pathogenic avian influenza A (H5N1) virus infection among in mainland China, we performed a systematic review and meta‐analysis. In this review, we searched literature on the seroprevalence of H5N1 infection among humans in mainland China from 1 January 1997 to 20 October 2018 in English and Chinese databases, including PubMed, Google scholar, Cochrane library, Clinical Trial, VIP, CNKI and WanFang database. We made a selection according to the title and the abstract of paper, and then, we excluded duplicated literature, and data incomplete literature according to the exclusion criteria we formulated. Finally, we extracted how many humans have H5N1 infection from the obtained studies to establish the seroprevalence of H5N1 infection among humans in mainland China. A total of 56 studies (including data of 35,159 humans) were compliant with our criteria. In China, the overall seroprevalence of H5N1 infection among humans was 2.45% (862/35,159), while the seroprevalence of H5N1 infection among humans from central China was 7.32% (213/2,911), higher than those in other regions of China. The seroprevalence of H5N1 infection was associated with test method, sampling time and demographic characteristics of humans. However, there was no significant difference in the effect of gender on the seroprevalence of H5N1 among humans in China. The purpose of this review was to better understand the real infection rate of H5N1 virus among humans and evaluate the potential risk factors for the zoonotic spread of H5N1 virus to humans. Sufficient epidemiological data are important to explore and understand the prevalent status of AIVs throughout the country and to disease control.

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Wild birds are natural hosts of avian influenza viruses (AIV) and can transmit viruses to poultry and other species. To monitor the prevalence of AIV antibodies, 211 eggs from wild Mallards ( Anas platyrhynchos) and 177 from wild White-winged Terns ( Chlidonias leucopterus) were collected from Zhalong Wetland and Xianghai Wetland in northeastern Republic of China from April to September, 2016. A hemagglutinin inhibition test detected the presence of H1, H3, H5, and H7 subtype-specific antibodies. The prevalences of AIV antibodies of subtypes H1 and H3 were relatively high while the prevalences of H5 and H7 AIV subtype antibody were low. In Zhalong Wetland, the prevalence of H1 AIV subtype antibody in Mallards was the highest, with a percentage of 11.0%. Prevalence of all AIV subtype-specific antibodies in Mallards was higher than those in White-winged Terns.

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