These scenarios are neither predictive nor exhaustive, but provide some example trajectories which highlight strengths and weaknesses of different detection systems. The scenarios assume sustained human transmission with a reproduction number (R) of 1.2 to 2.0. The clinical severity of a human influenza A(H5N1) outbreak is highly unpredictable and variations of infection-fatality rate ( IFR) (0.25%, 2.5%, 5%) and options for the age profile of clinically severe disease have been provided. The surveillance approaches tested are also generic examples of different systems and are not exact equivalents of current UK respiratory surveillance. Since publication of the previous technical briefing, a further 2 mammalian genomes have been generated from samples collected during the 2022 to 2023 season, including one genome from samples collected during the die-off in captive bush dogs from November 2022. Both genomes were found to be the AIV09 genotype that has been predominant in the UK since October 2022. Unlike the first mammalian sequence from 2023, these sequences do contain the PB2 E627K mutation. This mutation has been observed in other mammalian H5N1 sequences. All other mutations within these additional mammalian H5N1 genomes (including in the PB2 and haemagglutinin ( HA) proteins) have been previously detected in avian and mammalian sequences. Additional work is currently ongoing to further investigate the bush dog die-off. International surveillance data of non-avian A(H5N1) detection continues to show spillover into mammalian species, though mammalian surveillance varies internationally. There are no new outbreaks with confirmed mammalian transmission since those reported in the last technical briefing, although some investigations continue. Data reported in the technical briefing is as of 15 March 2023 (or as specified in the text) to allow time for analysis.

Peanut butter is not a significant source of the fat-soluble vitamins A, D or K, but it is a good source of vitamin E. Two tablespoons provide 14% of the RDI ( 1). Information is also collected by HPTs using surveillance forms, as described in technical briefing 1, with caveats on completeness and lag. Between 1 October 2022 and 15 March 2023, information was returned for 261 (43%) out of 607 incidents this season and 3,226 exposure events documented (individuals may be recorded in more than one event if they are exposed multiple times). Perfect for both first-time powerboaters and those with boating experience, the PB2 is a comprehensive, functional course which teaches and consolidates the RYA principles of sailing. Guiding you through our practical courses are our highly experienced RYA instructors who deliver high impact, high quality teaching either on a small group or individual basis. This is the most common wrought grade of the metal. It contains around 5% tin to ensure good corrosion resistance. In addition there is approximate 0.4% phosphorous to improve things like resistance to wear, stiffness and mechanical strength.Surveillance forms are completed by UKHSA HPTs for each confirmed setting (includes both poultry and wild bird settings). This includes the follow-up of exposed persons and details of exposure. Data is enhanced with laboratory records for respiratory testing held by UKHSA. In scenario 1, the infection-fatality rate ( IFR) is around 0.25%, similar to that of coronavirus (COVID-19) in autumn 2021, though considerably higher than the overall severity of the 2009 H1N1 outbreak (0.01% IFR) ( Riley and colleagues, 2011; Wong and colleagues, 2013). There are very few studies with estimates of an infection-hospitalisation rate ( IHR), and for this scenario it has been set at 1%. There are confirmed mammalian infections reported from multiple other countries, including multiple species in the USA, a cat in France, and a large outbreak in farmed mink in Spain. The available genomes from the mink include a different PB2 mutation to that seen in UK mammals. While both the original and chocolate flavors of PB2 contain small quantities of added sugar and salt, other brands of powdered peanut butter may offer sugar- and salt-free versions. Summary

Scenarios of early human transmission have been developed by UKHSA and reviewed by the Technical Group and the Scientific Pandemic Influenza group on Modelling ( SPI-M). The scenarios are designed to assess the likely time to detection of an emerging influenza virus through different surveillance approaches and can also be used to provide the basis to assess the potential impact of pharmaceutical and non-pharmaceutical interventions in the very early stages of an outbreak. PB102 is useful for a number of applications because it is suitable for cold forming but also has good weldability and is excellent for brazing and soldering. It is commonly used for marine and offshore hardware as well as electrical components, fasteners and even decorative components. Phosphor Bronze SAE660Since most of the fats have been removed from PB2, it is likely that powdered peanut butter is no longer a good source of vitamin E. International surveillance data of human cases of avian influenza is reported by the World Health Organization under the International Health Regulations and routinely collated by UKHSA. Authors of this report With a lower R (and hence longer doubling time) it may take twice as long to detect an avian influenza case using lower coverage community testing, as it does to detect when testing hospital admissions. Therefore, there may be substantial numbers of infections in the community by the time the first case is detected. APHA have recently updated GISAID with additional H5 sequences, including the sequence obtained from the bush dog investigation (EPI_ISL_17257532). This brings the total number of publicly available UK H5 genomes for 2020 to 2023, to 594. 2.2 Haemagglutinin ( HA) genomic diversity There was one case of influenza A(H5N1) reported from Vietnam, however clade information is unavailable.