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In regions endemic for poultry infection, low anti-H5 micro-NT titres (R428 in vivo of a low anti-H5 antibody titre may represent previous H5N1 exposure, suggesting that ICU patients with severe CAP have a similar seroprevalence with respect to H5N1 as has been identified for the general population in this same geographical region. Several plausible hypotheses can be generated to explain the low anti-H5 micro-NT titres among the CAP cases in our study. First, these low titres may represent cross-reactivity with circulating antibodies from prior human influenza virus infection [1,6]. Second, they may be due to mild or asymptomatic www.selleckchem.com/products/jq1.html H5N1 infection, as not all H5N1 infections result in marked antibody responses [11]. Third, they may reflect a decrease in antibody titres over time [12]. Finally, they may represent infections E-64 with another virus variant, given that the micro-NT assay is highly sensitive and strain specific, and was performed with test virus from the first (KAN-1) and the last (PT) human H5N1 cases in Thailand. There are some limitations that are worth noting. First, the small sample size may not have permitted us to identify other potential factors associated with low anti-H5 micro-NT titres. Given that follow-up was limited to 14?days after clinical manifestation of CAP, we were not able to assess whether these low titres reflected a decrease in antibody titres over time. Although it is plausible that low anti-H5 titres result from either ��false-positive�� test findings or cross-reactivity with circulating antibodies from prior human influenza virus infection or prior influenza vaccination, it remains intriguing that all six participants with low anti-H5 micro-NT titres had both positive acute-phase and positive convalescence-phase sera when tested against two different H5N1 strains, and all had extensive poultry exposure. Additionally, in all six cases the results of haemagglutination inhibition tests for antibody to seasonal influenza virus were negative, suggesting a lower likelihood of cross-reactivity between influenza subtypes.