WHO

Human infection with avian influenza A(H5N6) virus – China

Between 30 December 2015 and 2 January 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 2 additional laboratory-confirmed cases of human infection with avian influenza A(H5N6) virus.

Details of the cases

• The first case is a 26-year-old female from Baoan District, Shenzhen City, with onset date of 24 December. The patient was admitted to hospital on 27 December and is now in critical condition.
• The second case is a 40-year-old female from Duanzhou District, Zhaoqing City, with onset date of 22 December. The patient was admitted to hospital on 28 December and is now in critical condition.

Public health response

The Chinese Government has taken the following surveillance and control measures:

• making every effort to treat the patient; collecting and testing the specimens of the patient, carrying out viral isolation and whole genome sequencing and comparison;
• conducting epidemiological investigation; tracing, managing and observing the close contacts of the patient;
• strengthening surveillance of unexplained pneumonia and routine sentinel surveillance of influenza; strengthening the etiological surveillance of influenza/avian influenza virus.

WHO risk assessment

WHO continues to closely monitor the influenza A(H5N6) situation and conduct risk assessments. So far, the overall risk associated with avian influenza A(H5N6) viruses has not changed.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, or contact with animals in live bird markets, or entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.

CDC

What is the current situation?

According to the World Health Organization, 667 cases and 229 deaths from H7N9 flu have been reported globally from March 2013 through October 14, 2015, most from the mainland of China. Cases have been confirmed in the following administrative areas of China: Anhui, Beijing, Fujian, Guangdong, Guangxi, Guizhou, Hebei, Henan, Hubei, Hunan, Jiangsu, Jiangxi, Jilin, Shandong, Shanghai, Xinjiang, and Zhejiang. Smaller numbers of cases have been identified in travelers from Hong Kong, Taiwan, Malaysia, and Canada.

CDC advises people traveling to China to avoid contact with poultry (including poultry markets and farms), birds, and their droppings. There are no recommendations against travel to China.

What is avian influenza A (H7N9)?

Avian influenza A (H7N9) is an influenza (flu) virus found in birds that does not normally infect humans. However, in spring of 2013, China began reporting infections with the virus in people. Most of these infections have been associated with contact with infected poultry or contaminated environments (such as poultry markets) in China. Early symptoms are consistent with seasonal flu and may include fever, cough, sore throat, muscle aches and fatigue, loss of appetite, and runny or stuffy nose. However, infection with this virus often causes severe respiratory illness and, in some cases, death (see http://www.cdc.gov/flu/avianflu/h7n9-virus.htm).

What can travelers do to protect themselves?

There is no vaccine to prevent H7N9 flu.

• Do not touch birds, pigs, or other animals.
  • Don’t touch animals, whether they are alive or dead.
  • Avoid live bird or poultry markets.
  • Avoid other markets or farms with animals (wet markets).

• Eat food that is fully cooked.
  • Eat meat and poultry that is fully cooked (not pink) and served hot.
  • Eat hard-cooked eggs (not runny).
  • Don’t eat or drink dishes that include blood from any animal.
  • Don’t eat food from street vendors.

• Practice hygiene and cleanliness.
  • Wash your hands often.
  • If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol.
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.
• If you feel sick and think you may have avian flu after visiting China:

• Talk to your doctor or nurse if you feel seriously ill, especially if you have a fever, cough, or shortness of breath.
  • Tell them about your travel to China.
  • For more information about medical care abroad, see Getting Health Care Abroad(http://wwwnc.cdc.gov/travel/page/getting-health-care-abroad).
• Avoid contact with other people while you are sick.

Clinician information

Clinicians should consider the possibility of avian influenza A (H7N9) virus infection in people presenting with respiratory illness within 10 days of travel to China, particularly if the patient reports exposure to birds or poultry markets. Although most H7N9 cases have resulted in severe respiratory illness in adults, infection may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness of unknown etiology may identify human cases of avian influenza A or new cases of variant influenza (such as human infections caused by influenza viruses from pigs) in the United States. Patients with H7N9 are expected to have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction (RT-PCR testing) that will be unsubtypeable by most assays. Nonmolecular rapid test results may be variable. Clinicians who suspect avian influenza A (H7N9) should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours.

Additional information

• Avian Influenza A (H7N9) Virus (CDC)
• Avian Influenza Travel Health Disease Page(http://wwwnc.cdc.gov/travel/diseases/avian-bird-flu)
• Human infection with influenza A (H7N9) in China—update (WHO)
• Frequently Asked Questions on human infection with influenza A (H7N9) virus, China (WHO).