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From molecular evolution to the school health room: the role of community-based public health nurses (helsesykepleiere) in one health communication on cross-species influenza transmission in Norway.

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Title: From molecular evolution to the school health room: the role of community-based public health nurses (helsesykepleiere) in one health communication on cross-species influenza transmission in Norway.
Authors: Klein J; Department of Nursing and Health Sciences, Faculty of Health and Social Sciences, University of South-Eastern Norway, Porsgrunn, Norway.
Source: Frontiers in cellular and infection microbiology [Front Cell Infect Microbiol] 2026 Sep 22; Vol. 16, pp. 1965045. Date of Electronic Publication: 2026 Sep 22 (Print Publication: 2026).
Publication Type: Journal Article; Review
Language: English
Journal Info: Publisher: Frontiers Media SA Country of Publication: Switzerland NLM ID: 101585359 Publication Model: eCollection Cited Medium: Internet ISSN: 2235-2988 (Electronic) Linking ISSN: 22352988 NLM ISO Abbreviation: Front Cell Infect Microbiol Subsets: MEDLINE
Imprint Name(s): Original Publication: Lausanne : Frontiers Media SA
MeSH Terms: Influenza, Human*/transmission , Influenza, Human*/epidemiology , Influenza, Human*/prevention & control , Influenza, Human*/virology , Orthomyxoviridae Infections*/transmission , Orthomyxoviridae Infections*/epidemiology , One Health* , Evolution, Molecular*, Norway/epidemiology ; Influenza A Virus, H5N1 Subtype/genetics ; Influenza in Birds/transmission ; Influenza in Birds/virology ; Influenza in Birds/epidemiology ; Zoonoses/transmission ; Viral Zoonoses/transmission ; Humans ; Animals ; Schools
Abstract: Highly pathogenic avian influenza (HPAI) A(H5N1) clade 2.3.4.4b viruses have undergone an unprecedented expansion of host range since 2021, moving from wild birds and poultry into dairy cattle, domestic cats, and other mammals, with sporadic human infections in Europe and North America (Food and Agriculture Organization et al., 2025a; Rolfes et al., 2025). This expansion is underpinned by well-characterised molecular mechanisms of influenza A virus evolution - antigenic drift, gene segment reassortment, and receptor-binding adaptation - that shape the frequency and direction of cross-species spillover (McDonald et al., 2016; Steel and Lowen, 2017; Man et al., 2026). Norwegian wild-bird and mammalian surveillance data document recurrent incursions of clade 2.3.4.4b viruses, and international risk assessments continue to describe low, but non-zero, human risk concentrated among individuals with close animal contact (World Health Organization, 2025-2026; Ytrehus et al; European Food Safety Authority et al., 2025a). Translating this fast-moving virological and epidemiological evidence into everyday protective behavior for children, adolescents, and families remains an underdeveloped link in pandemic preparedness, compounded by documented gaps in adolescent One Health literacy (Zucca et al., 2021). This mini review synthesizes current literature on the molecular basis of influenza cross-species transmission, the Norwegian epidemiological and One Health governance context, and established child- and family-oriented risk-communication frameworks, to argue that Norway's community-based public health nurses (helsesykepleiere) - who deliver near-universal, statutorily mandated contact with children and families through the helsestasjon- and skolehelsetjeneste - occupy a distinctive but underused position as One Health communication nodes (Helsedirektoratet, 2021). I outline a practical three-tier framework for translating zoonotic-influenza science into age-appropriate household guidance, critically appraise the feasibility, workload, training, and governance implications of this role, and identify priority gaps for future empirical and implementation research.
(Copyright © 2026 Klein.)
Competing Interests: The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
References: Emerg Infect Dis. 2025 Dec;31(12):2297-2301. (PMID: 41490523)
J Am Vet Med Assoc. 2025 Aug 08;263(11):1355-1363. (PMID: 40780258)
Front Public Health. 2021 Mar 30;9:658876. (PMID: 33869135)
Immunohorizons. 2025 Dec 5;9(SI):. (PMID: 41388280)
Nat Rev Microbiol. 2016 Jul;14(7):448-60. (PMID: 27211789)
Adv Genet (Hoboken). 2026 Jan 11;7(1):e00051. (PMID: 41531488)
Nat Med. 2025 Nov;31(11):3889-3898. (PMID: 40712649)
EFSA J. 2025 Oct 27;23(10):e9702. (PMID: 41158675)
Eur J Clin Microbiol Infect Dis. 2025 Aug;44(8):1817-1833. (PMID: 40369349)
Commun Earth Environ. 2026;7(1):135. (PMID: 41657975)
MMWR Morb Mortal Wkly Rep. 2025 Mar 13;74(8):127-133. (PMID: 40080512)
Annu Rev Virol. 2017 Sep 29;4(1):105-121. (PMID: 28548881)
Biol Open. 2012 Apr 15;1(4):385-90. (PMID: 23213428)
Sci Rep. 2022 May 21;12(1):8588. (PMID: 35597789)
Cold Spring Harb Perspect Med. 2021 Jul 1;11(7):. (PMID: 32839251)
MMWR Morb Mortal Wkly Rep. 2026 May 07;75(17):215-220. (PMID: 42096344)
Paediatr Child Health. 2022 May 03;27(Suppl 1):S1-S3. (PMID: 35620559)
Contributed Indexing: Keywords: H5N1; avian influenza; cross-species transmission; health literacy; helsesykepleier; nordic public health; one health; pandemic preparedness
Entry Date(s): Date Created: 20261007 Date Completed: 20261007 Latest Revision: 20261008
Update Code: 20261008
PubMed Central ID: PMC13639862
DOI: 10.3389/fcimb.2026.1965045
PMID: 42840841
Database: MEDLINE
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  Data: From molecular evolution to the school health room: the role of community-based public health nurses (helsesykepleiere) in one health communication on cross-species influenza transmission in Norway.
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  Data: <searchLink fieldCode="JN" term="%22101585359%22">Frontiers in cellular and infection microbiology</searchLink> [Front Cell Infect Microbiol] 2026 Sep 22; Vol. 16, pp. 1965045. <i>Date of Electronic Publication: </i>2026 Sep 22 (<i>Print Publication: </i>2026).
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  Data: <i>Original Publication</i>: Lausanne : Frontiers Media SA
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  Data: <searchLink fieldCode="MM" term="%22Influenza%2C+Human%22">Influenza, Human*</searchLink>/<searchLink fieldCode="MM" term="%22Influenza%2C+Human+transmission%22">transmission</searchLink> <br /><searchLink fieldCode="MM" term="%22Influenza%2C+Human%22">Influenza, Human*</searchLink>/<searchLink fieldCode="MM" term="%22Influenza%2C+Human+epidemiology%22">epidemiology</searchLink> <br /><searchLink fieldCode="MM" term="%22Influenza%2C+Human%22">Influenza, Human*</searchLink>/<searchLink fieldCode="MM" term="%22Influenza%2C+Human+prevention+%26+control%22">prevention & control</searchLink> <br /><searchLink fieldCode="MM" term="%22Influenza%2C+Human%22">Influenza, Human*</searchLink>/<searchLink fieldCode="MM" term="%22Influenza%2C+Human+virology%22">virology</searchLink> <br /><searchLink fieldCode="MM" term="%22Orthomyxoviridae+Infections%22">Orthomyxoviridae Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Orthomyxoviridae+Infections+transmission%22">transmission</searchLink> <br /><searchLink fieldCode="MM" term="%22Orthomyxoviridae+Infections%22">Orthomyxoviridae Infections*</searchLink>/<searchLink fieldCode="MM" term="%22Orthomyxoviridae+Infections+epidemiology%22">epidemiology</searchLink> <br /><searchLink fieldCode="MM" term="%22One+Health%22">One Health*</searchLink> <br /><searchLink fieldCode="MM" term="%22Evolution%2C+Molecular%22">Evolution, Molecular*</searchLink><br /><searchLink fieldCode="MH" term="%22Norway%22">Norway</searchLink>/<searchLink fieldCode="MH" term="%22Norway+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Influenza+A+Virus%2C+H5N1+Subtype%22">Influenza A Virus, H5N1 Subtype</searchLink>/<searchLink fieldCode="MH" term="%22Influenza+A+Virus%2C+H5N1+Subtype+genetics%22">genetics</searchLink> ; <searchLink fieldCode="MH" term="%22Influenza+in+Birds%22">Influenza in Birds</searchLink>/<searchLink fieldCode="MH" term="%22Influenza+in+Birds+transmission%22">transmission</searchLink> ; <searchLink fieldCode="MH" term="%22Influenza+in+Birds%22">Influenza in Birds</searchLink>/<searchLink fieldCode="MH" term="%22Influenza+in+Birds+virology%22">virology</searchLink> ; <searchLink fieldCode="MH" term="%22Influenza+in+Birds%22">Influenza in Birds</searchLink>/<searchLink fieldCode="MH" term="%22Influenza+in+Birds+epidemiology%22">epidemiology</searchLink> ; <searchLink fieldCode="MH" term="%22Zoonoses%22">Zoonoses</searchLink>/<searchLink fieldCode="MH" term="%22Zoonoses+transmission%22">transmission</searchLink> ; <searchLink fieldCode="MH" term="%22Viral+Zoonoses%22">Viral Zoonoses</searchLink>/<searchLink fieldCode="MH" term="%22Viral+Zoonoses+transmission%22">transmission</searchLink> ; <searchLink fieldCode="MH" term="%22Humans%22">Humans</searchLink> ; <searchLink fieldCode="MH" term="%22Animals%22">Animals</searchLink> ; <searchLink fieldCode="MH" term="%22Schools%22">Schools</searchLink>
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Highly pathogenic avian influenza (HPAI) A(H5N1) clade 2.3.4.4b viruses have undergone an unprecedented expansion of host range since 2021, moving from wild birds and poultry into dairy cattle, domestic cats, and other mammals, with sporadic human infections in Europe and North America (Food and Agriculture Organization et al., 2025a; Rolfes et al., 2025). This expansion is underpinned by well-characterised molecular mechanisms of influenza A virus evolution - antigenic drift, gene segment reassortment, and receptor-binding adaptation - that shape the frequency and direction of cross-species spillover (McDonald et al., 2016; Steel and Lowen, 2017; Man et al., 2026). Norwegian wild-bird and mammalian surveillance data document recurrent incursions of clade 2.3.4.4b viruses, and international risk assessments continue to describe low, but non-zero, human risk concentrated among individuals with close animal contact (World Health Organization, 2025-2026; Ytrehus et al; European Food Safety Authority et al., 2025a). Translating this fast-moving virological and epidemiological evidence into everyday protective behavior for children, adolescents, and families remains an underdeveloped link in pandemic preparedness, compounded by documented gaps in adolescent One Health literacy (Zucca et al., 2021). This mini review synthesizes current literature on the molecular basis of influenza cross-species transmission, the Norwegian epidemiological and One Health governance context, and established child- and family-oriented risk-communication frameworks, to argue that Norway's community-based public health nurses (helsesykepleiere) - who deliver near-universal, statutorily mandated contact with children and families through the helsestasjon- and skolehelsetjeneste - occupy a distinctive but underused position as One Health communication nodes (Helsedirektoratet, 2021). I outline a practical three-tier framework for translating zoonotic-influenza science into age-appropriate household guidance, critically appraise the feasibility, workload, training, and governance implications of this role, and identify priority gaps for future empirical and implementation research.<br /> (Copyright © 2026 Klein.)
– Name: Abstract
  Label: Competing Interests
  Group: Ab
  Data: The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
– Name: Ref
  Label: References
  Group: RefInfo
  Data: Emerg Infect Dis. 2025 Dec;31(12):2297-2301. (PMID: <searchLink fieldCode="PM" term="%2241490523%22">41490523)</searchLink><br />J Am Vet Med Assoc. 2025 Aug 08;263(11):1355-1363. (PMID: <searchLink fieldCode="PM" term="%2240780258%22">40780258)</searchLink><br />Front Public Health. 2021 Mar 30;9:658876. (PMID: <searchLink fieldCode="PM" term="%2233869135%22">33869135)</searchLink><br />Immunohorizons. 2025 Dec 5;9(SI):. (PMID: <searchLink fieldCode="PM" term="%2241388280%22">41388280)</searchLink><br />Nat Rev Microbiol. 2016 Jul;14(7):448-60. (PMID: <searchLink fieldCode="PM" term="%2227211789%22">27211789)</searchLink><br />Adv Genet (Hoboken). 2026 Jan 11;7(1):e00051. (PMID: <searchLink fieldCode="PM" term="%2241531488%22">41531488)</searchLink><br />Nat Med. 2025 Nov;31(11):3889-3898. (PMID: <searchLink fieldCode="PM" term="%2240712649%22">40712649)</searchLink><br />EFSA J. 2025 Oct 27;23(10):e9702. (PMID: <searchLink fieldCode="PM" term="%2241158675%22">41158675)</searchLink><br />Eur J Clin Microbiol Infect Dis. 2025 Aug;44(8):1817-1833. (PMID: <searchLink fieldCode="PM" term="%2240369349%22">40369349)</searchLink><br />Commun Earth Environ. 2026;7(1):135. (PMID: <searchLink fieldCode="PM" term="%2241657975%22">41657975)</searchLink><br />MMWR Morb Mortal Wkly Rep. 2025 Mar 13;74(8):127-133. (PMID: <searchLink fieldCode="PM" term="%2240080512%22">40080512)</searchLink><br />Annu Rev Virol. 2017 Sep 29;4(1):105-121. (PMID: <searchLink fieldCode="PM" term="%2228548881%22">28548881)</searchLink><br />Biol Open. 2012 Apr 15;1(4):385-90. (PMID: <searchLink fieldCode="PM" term="%2223213428%22">23213428)</searchLink><br />Sci Rep. 2022 May 21;12(1):8588. (PMID: <searchLink fieldCode="PM" term="%2235597789%22">35597789)</searchLink><br />Cold Spring Harb Perspect Med. 2021 Jul 1;11(7):. (PMID: <searchLink fieldCode="PM" term="%2232839251%22">32839251)</searchLink><br />MMWR Morb Mortal Wkly Rep. 2026 May 07;75(17):215-220. (PMID: <searchLink fieldCode="PM" term="%2242096344%22">42096344)</searchLink><br />Paediatr Child Health. 2022 May 03;27(Suppl 1):S1-S3. (PMID: <searchLink fieldCode="PM" term="%2235620559%22">35620559)</searchLink>
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        Text: English
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      – SubjectFull: Norway epidemiology
        Type: general
      – SubjectFull: Influenza A Virus, H5N1 Subtype genetics
        Type: general
      – SubjectFull: Influenza in Birds transmission
        Type: general
      – SubjectFull: Influenza in Birds virology
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      – SubjectFull: Influenza, Human transmission
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      – SubjectFull: Influenza, Human epidemiology
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      – SubjectFull: Influenza, Human prevention & control
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      – SubjectFull: Influenza, Human virology
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