Epidemiology and Evolutionary Dynamics of High Pathogenicity Avian Influenza (HPAI) H5N1 in Bangladesh.

Understanding disease clustering and transmission patterns improves the prevention and control of disease. Herein, we described the epizootic characteristics and spatiotemporal dynamics of High Pathogenicity Avian Influenza (HPAI) H5N1 outbreaks as well as clade diversity and phylodynamics of H5N1 over time and across host species in Bangladesh. We used Moran's I, Geary's C, Getis-Ord Gi, and a space-time permutation model to analyze the spatiotemporal patterns of H5N1 outbreaks. We used Bayesian phylogenetic analysis to generate a time-scaled maximum clade credibility (MCC) tree. Our study revealed nine HPAI H5N1 epizootic waves between 2007 and 2020 that invariably peaked in the wintertime. After vaccination of poultry against H5N1 was introduced in 2012, the incidence of HPAI H5N1 outbreaks and poultry mortality decreased significantly over time. Nonetheless, our research revealed that the virus continued circulating unabatedly in Bangladesh. The various spatiotemporal analyses were identified up to nine space-time clusters across Bangladesh, with the most significant clustering and hotspots of H5N1 outbreaks in and around the district of Dhaka. Since 2007, four H5N1 clades have been detected in Bangladesh, with only clade 2.3.2.1a continuing to circulate since 2011, which was followed up by the reassorted clade 2.3.2.1a in 2012. The HA gene of the H5N1 clade 2.3.2.1a has been reassorted into at least nine subgroups (R1-R9). After 2016, the first eight groups disappeared, with only the R9 group remaining. Spatiotemporal patterns and phylodynamics of H5N1 outbreaks are crucial for developing targeted and appropriate HPAI control and prevention measures. We recommended intensive monitoring of biosecurity measures and disease records in high-priority areas, along with assessing vaccine efficacy to better control HPAI outbreaks in Bangladesh.