The evolving situation of the dairy cow H5N1 highly pathogenic avian influenza (HPAI) outbreaks (clade 2.3.4.4b) first identified in the USA in early 2024 has stimulated consideration of avian influenza pandemic preparedness.1 Recent experience during the SARS-CoV-2 pandemic demonstrated that early mobilisation of laboratory resources for rapid diagnostic testing is crucial for an effective response. Assessment of laboratory bio-risk in dealing with samples containing viruses with pandemic potential, is a key but frequently overlooked consideration, which has often been performed cursorily either due to lack of resources, understanding or time. The capability to conduct a thorough laboratory biosafety risk assessment is a critical component of avian influenza preparedness.
World Health Organisation (WHO) through their Global Influenza Surveillance and Response System (GISRS) and the World Organisation of Animal Health (WOAH) associated laboratories have essential roles in characterising newly emerging avian Influenza viruses. Many of these activities involve manipulation of high viral load samples (virus isolates, neutralising antibody assays, viral antigenic characterisation and phenotypic antiviral susceptibility testing). The first imported human case of HPAI H5N1 (clade 2.3.4.4a) in Australia2 revealed common bio-risk challenges faced by reference and clinical laboratories, due to (i) lack of clinical or epidemiological information provided to the laboratory by the requesting clinician and (ii) possible high viral loads in clinical samples. This specimen was handled within our own institution and was referred without sufficient clinical information to inform risk. The influenza A subtype was revealed only after significant handling of the specimen during both diagnostic and reference work. This incident suggests the risk of laboratory acquired infection extends to frontline diagnostic laboratories.