Global & Disaster Medicine

Archive for the ‘H7N9’ Category

Among all influenza viruses assessed using CDC’s Influenza Risk Assessment Tool (IRAT), the Asian lineage avian influenza A(H7N9) virus (Asian H7N9), first reported in China in March 2013,* is ranked as the influenza virus with the highest potential pandemic risk

Kile JC, Ren R, Liu L, et al. Update: Increase in Human Infections with Novel Asian Lineage Avian Influenza A(H7N9) Viruses During the Fifth Epidemic — China, October 1, 2016–August 7, 2017. MMWR Morb Mortal Wkly Rep 2017;66:928–932. DOI: http://dx.doi.org/10.15585/mmwr.mm6635a2.

The figure above is a map showing the geographic distribution of Asian lineage avian influenza A(H7N9) virus infections of humans reported to the World Health Organization in China during A) epidemic 5 (during October 1, 2016–August 7, 2017) and B) epidemics 1–4 (during March 2013–September 30, 2016).

Confirmed Asian lineage avian influenza A(H7N9) virus infections of humans reported to the World Health Organization (N = 1,557),* by month of illness onset — China,† February 19, 2013–August 7, 2017

 

 

The figure above is a histogram showing confirmed Asian lineage avian influenza A(H7N9) virus infections of humans reported to the World Health Organization (N = 1,557), by month of illness onset in China during February 19, 2013–August 7, 2017.

Geographic distribution of Asian lineage avian influenza A(H7N9) virus infections of humans reported to the World Health Organization — China,* A) epidemic 5 (October 1, 2016–August 7, 2017) and B) epidemics 1–4 (March 2013–September 30, 2016)


Five additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China.

WHO

Human infection with avian influenza A(H7N9) virus – China

Disease outbreak news
19 July 2017

On 19 June 2017, the National Health and Family Planning Commission of China (NHFPC) notified WHO of five additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China. On 24 June 2017, the NHFPC notified WHO of 10 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China. On 30 June 2017, the NHFPC notified WHO of six additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus in China.

Details of the case patients

On 19 June 2017, the NHFPC reported five laboratory-confirmed human cases of infection with avian influenza A(H7N9) virus in China. Onset dates ranged from 25 April to 6 June 2017. Of these five cases, one was female. The median age was 55 years (range 41 to 68 years). The case patients were reported from Beijing (1), Guangxi (1), Guizhou (1), Hunan (1), and Zhejiang (1). At the time of notification, there was one death. Four cases were diagnosed as having severe pneumonia. Three cases were reported to have had exposure to poultry or live poultry market, and two had no known poultry exposure. No case clustering was reported.

On 24 June 2017, the NHFPC reported 10 laboratory-confirmed human cases of infection with avian influenza A(H7N9) virus in China. Onset dates ranged from 5 to 19 June 2017. All cases were male. The median age was 53.5 years (range 31 to 79 years). The cases were reported from Anhui (1), Beijing (2), Guizhou (1), Hebei (1), Inner Mongolia (1), Jiangsu (1), Sichuan (2), and Tianjin (1). This is the first case reported in Inner Mongolia since the virus emerged in 2013 although two cases were recently reported from Shaanxi province but who had likely exposure in Inner Mongolia. At the time of notification, there were two deaths. Eight cases were diagnosed as having either pneumonia (4) or severe pneumonia (4). Nine cases were reported to have had exposure to poultry or live poultry market, and one had no known poultry exposure.

One cluster with two cases was reported and both cases are from Panzhihua City, Sichuan Province, and had exposure to the same live poultry market. The cluster includes:

  • A 79-year-old male, who had symptom onset on 12 June 2017 and was admitted to hospital with severe pneumonia on 15 June 2017, then died on the 21 June 2017. He was living on an upper floor of the live poultry market and passed regularly through the market.
  • A 48-year-old male, who had symptom onset on 7 June 2017 and was admitted to hospital with severe pneumonia on 11 June 2017. He is a seller of poultry at the same live poultry market.

On 30 June 2017, the NHFPC reported six laboratory-confirmed human cases of infection with avian influenza A(H7N9) virus in China. Onset dates ranged from 11 to 23 June 2017. Three cases were male. The median age was 37.5 years (range 4 to 72 years). The cases were reported from Guizhou (1), Shanxi (1), and Yunnan (4) provinces. At the time of notification no associated deaths were reported. Four cases were diagnosed as having either pneumonia (1) or severe pneumonia (3). Two mild cases, identified through ILI surveillance, were reported: one in a child with exposure to market poultry and one in an adult. Five cases were reported to have had exposure to poultry or live poultry market, and one had no known poultry exposure. These are the first cases reported with exposure to the virus in Yunnan province. Previous cases reported from Yunnan province had likely exposure in a neighbouring province.

One cluster with two cases was reported, which include:

  • A 33-year-old female from Wenshan, Yunnan Province had symptom onset on 17 June 2017 and was admitted to hospital with severe pneumonia on the same day. She had no apparent exposure to live poultry.
  • Her sister-in-law, a 42-year-old female also from Wenshan, Yunnan Province, visited her in the hospital, developed mild symptoms on 21 June and was hospitalized on 24 June 2017. Investigation of the case revealed that she ran a shop near a live poultry market and bought live poultry from the market on a daily basis before her symptom onset. The investigation concluded that the likely source of her infection was exposure to the virus from visiting live poultry markets.

To date, a total of 1554 laboratory-confirmed human infections with avian influenza A(H7N9) virus have been reported through IHR notification since early 2013.

Public health response

The Chinese government at national and local level is taking preventive measures which include:

  • Continuing to guide the provinces to strengthen assessment, and prevention and control measures.
  • Continuing to strengthen control measures focusing on hygienic management of live poultry markets and cross-regional transportation.
  • Conducting detailed source investigations to inform effective prevention and control measures.
  • Continuing to detect and treat human infections with avian influenza A(H7N9) early to reduce mortality.
  • Continuing to carry out risk communication and issue information notices to provide the public with guidance on self-protection.
  • Strengthening virology surveillance to better understand levels of virus contamination in the environment as well as mutations, in order to provide further guidance for prevention and control.

WHO risk assessment

The number of human infections with avian influenza A(H7N9) virus and the geographical distribution in the fifth epidemic wave (i.e. onset since 1 October 2016) is greater than earlier waves. This suggests that the virus is spreading, and emphasizes that further intensive surveillance and control measures in both human and animal health sector are crucial.

According to the epidemiological curve, the number of reported cases on a weekly basis seems to have peaked in early February and is slowly decreasing. The peak in cases this year corresponds to the timing of the peak in cases in previous years.

Most human cases are exposed to avian influenza A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, and live poultry vending continues, further human cases can be expected. Additional sporadic human cases of avian influenza A(H7N9) in other provinces in China that have not yet reported human cases are also expected. Similarly, sporadic human cases of avian influenza A(H7N9) detected in countries bordering China would not be unexpected. Although small clusters of cases of human infection with avian influenza A(H7N9) virus have been reported including those involving patients in the same ward, current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore the likelihood of further community level spread is considered low.

Close analysis of the epidemiological situation and further characterization of the most recent viruses are critical to assess associated risk and to adjust risk management measures in a timely manner.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid, if possible, poultry farms, contact with animals in live poultry markets, 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, and 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 in 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 influenza-like illness (ILI) and to carefully review any unusual patterns, ensure reporting of human infections under the IHR 2005, and continue national health preparedness actions.


12 H7N9 avian flu cases reported from China’s mainland from Jun 2 through Jun 8.

Government of Hong Kong

CHP notified of human cases of avian influenza A(H7N9) in Mainland

*******************************************************

     The Centre for Health Protection (CHP) of the Department of Health today (June 9) is monitoring a notification from the National Health and Family Planning Commission that 12 additional human cases of avian influenza A(H7N9) were recorded from June 2 to 8, and strongly urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The eight male and four female patients, aged from 4 to 68, had onset from May 20 to June 3. Three of them are from Beijing, two each from Anhui, Chongqing and Henan, and one each from Jiangsu, Shaanxi and Shandong. Two cases reported in Beijing were likely infected in Hebei and Shanxi while the case reported in Shaanxi was likely infected in Inner Mongolia Autonomous Region. Among them, nine were known to have exposure to poultry, poultry markets or mobile stalls.

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchase of live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

While local surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

The CHP’s Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below while handling poultry:

  • Avoid touching poultry, birds, animals or their droppings;
  • When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
  • Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
  • Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
  • Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.


The public may visit the CHP’s pages for more information: the avian influenza page, the weekly Avian Influenza Reportglobal statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

Ends/Friday, June 9, 2017
Issued at HKT 18:41

 


H7N9 in China, Update: Another 23 human infections with Asian H7N9 bird flu, bringing the total number of such infections during the current (fifth) epidemic to 688.

CDC

More Human Infections Reported as CDC Prepares to Ship New Candidate Vaccine Virus

May 23, 2017 — Today the World Health Organization (WHO) reported another 23 human infections with Asian H7N9 bird flu, bringing the total number of such infections during the current (fifth) epidemic to 688. This is the largest epidemic of Asian H7N9 human infections in China since this virus emerged to infect people in 2013. CDC has completed development of a new Asian H7N9 candidate vaccine virus (CVV) that is matched to a recently emerged lineage of Asian H7N9 viruses which have predominated during the fifth epidemic and which could be used to make vaccine if one were needed.

CDC has been monitoring the Asian H7N9 situation closely since 2013 and taken routine preparedness measures, including previously developing three candidate vaccine viruses. Besides an increase in the number of infections being reported during the current epidemic and an increase in the geographic areas in China where human infections with Asian H7N9 are being reported, the epidemiology of H7N9 virus infections in humans does not appear to have changed. Most human infections with Asian H7N9 continue to be associated with exposure to poultry and there is no sustained person-to-person spread of this virus, however, there have been some changes in recent Asian H7N9 viruses identified that are of public health concern.

Most recent viruses belong to a lineage of Asian H7N9 called Yangtze River Delta. Antigenic analysis of some viruses belonging to the Yangtze River Delta lineage has showed reduced cross-reactivity with previously produced CVVs, suggesting that stockpiled vaccine made with earlier CVVs will not protect against the Yangtze River Delta lineage viruses now circulating. Also, based on publically available genetic data, about 10% of viruses from the 5th epidemic have markers indicating reduced susceptibility (resistance) to one or more neuraminidase inhibitor antiviral medications, which are the only currently recommended treatment for avian influenza infections in people.

The new CDC CVV was derived from a low pathogenic avian influenza A/Hunan/2650/2016-like virus and was made using reverse genetics. Creating a candidate vaccine virus is a multistep process that takes months to complete. At this time, CDC is coordinating shipping of the new Asian H7N9 CVV to various manufacturers. Information about the availability of the CVV was posted on the WHO website on Friday, May 18, 2017 at http://www.who.int/influenza/vaccines/virus/candidates_reagents/a_h7n9/en/.

The cumulative number of human infections with Asian H7N9 viruses reported by WHO between 2013 and May 23, 2017, was 1,486. During the first four epidemics, most human infections occurred between December and March. While new infections continue to be reported, the number of new infections being reported each week has declined since the peak of activity during January of the current epidemic.

More information about Asian H7N9 is available at https://www.cdc.gov/flu/avianflu/h7n9-virus.htm(https://www.cdc.gov/flu/avianflu/h7n9-virus.htm) and http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/.


China: 16 new H7N9 cases, 2 fatal

WHO

Human infection with avian influenza A(H7N9) virus – China

Disease outbreak news
18 May 2017

On 5 May 2017, the National Health and Family Planning Commission of China (NHFPC) notified WHO of 24 additional laboratory-confirmed human infections with avian influenza A(H7N9) virus in China.

Details of the cases

Onset dates ranged from 14 to 29 April 2017. Of these 24 case patients, nine were female. The median age was 56.5 years (range 25 to 82 years). The case patients were reported from Anhui (1), Beijing (1), Chongqing (2), Gansu (1), Guangxi (1), Hebei (7), Henan (1), Hubei (1), Hunan (1), Jiangsu (1), Sichuan (6) and Shaanxi (1). This is the first case reported in Shaanxi since the virus emerged in 2013.

At the time of notification, there were nine deaths, 13 case patients were diagnosed as having either pneumonia (2) or severe pneumonia (11), and two case patients were still being investigated. Nineteen case patients were reported to have had exposure to poultry or live poultry market, and two had no known poultry exposure. The exposure history was still being investigated for three case patients. No case clustering was reported.

To date, a total of 1463 laboratory-confirmed human infections with avian influenza A(H7N9) virus have been reported through IHR notification since early 2013.

Public health response

Considering the increase in the number of human infections since December 2016, the Chinese government at national and local levels is taking further measures which include:

  • Strengthening risk assessment and guidance on prevention and control focusing on the most affected and newly affected areas;
  • Continuing to strengthen control measures focusing on hygienic management of live poultry markets and cross-regional transportation;
  • Conducting detailed source investigations to inform effective prevention and control measures;
  • Continuing to detect and treat human infections with avian influenza A(H7N9) early to reduce mortality;
  • Continuing to carry out risk communication and issue information notices to provide the public with guidance on self-protection; and
  • Strengthening virology surveillance to better understand levels of virus contamination in the environment as well as mutations, in order to provide further guidance for prevention and control.

WHO risk assessment

The number of human infections with avian influenza A(H7N9) and the geographical distribution in the fifth epidemic wave (i.e. onset since 1 October 2016) is greater than in earlier waves. This suggests that the virus is spreading, and emphasizes that further intensive surveillance and control measures in both the human and animal health sector are crucial.

Most case patients are exposed to avian influenza A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, and live poultry vending continues, further human infections can be expected. Although small clusters of human infection with avian influenza A(H7N9) virus have been reported including those involving patients in the same ward, current epidemiological and virologic evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore the likelihood of further community level spread is considered low.

Close analysis of the epidemiological situation and further characterization of the most recent viruses are critical to assess associated risk and to adjust risk management measures in a timely manner.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid, if possible, poultry farms, contact with animals in live poultry markets, 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, and 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 in 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 influenza-like illness (ILI) and to carefully review any unusual patterns, ensure reporting of human infections under the IHR 2005, and continue national health preparedness actions.


China: New H7N9 avian flu infections late into the season, with 24 cases reported over the past week, including at least one from a province that had never reported one before.

Hong Kong


China’s H7N9 cases are rising again, partly related to a recent spurt of local infections in Beijing

CHP

China


Hong Kong’s Centre for Health Protection’s weekly update of H7N9 avian flu in mainland China: 14 new cases, 2 of them fatal. 

H7N9 in China

The Centre for Health Protection (CHP) of the Department of Health today (April 14) received notification of 14 additional human cases of avian influenza A(H7N9), including two deaths, from the National Health and Family Planning Commission, and strongly urged the public to maintain strict personal, food and environmental hygiene both locally and during travel, particularly in Easter.

The eleven male and three female patients, aged from 39 to 81, had onset from March 27 to April 11, including three from Sichuan, two each from Henan, Shandong and Xizang, and one each from Anhui, Beijing, Hunan, Tianjin and Zhejiang. Among them, 13 had exposure to poultry, poultry markets or mobile stalls.

Travellers to the Mainland or other affected areas must avoid visiting wet markets, live poultry markets or farms. They should be alert to the presence of backyard poultry when visiting relatives and friends. They should also avoid purchase of live or freshly slaughtered poultry, and avoid touching poultry/birds or their droppings. They should strictly observe personal and hand hygiene when visiting any place with live poultry.

Travellers returning from affected areas should consult a doctor promptly if symptoms develop, and inform the doctor of their travel history for prompt diagnosis and treatment of potential diseases. It is essential to tell the doctor if they have seen any live poultry during travel, which may imply possible exposure to contaminated environments. This will enable the doctor to assess the possibility of avian influenza and arrange necessary investigations and appropriate treatment in a timely manner.

While local surveillance, prevention and control measures are in place, the CHP will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments.

The CHP’s Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.

The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.

The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below while handling poultry:

  • Avoid touching poultry, birds, animals or their droppings;
  • When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
  • Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
  • Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
  • Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.

The public may visit the CHP’s pages for more information: the avian influenza page, the weekly Avian Influenza Reportglobal statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

Ends/Friday, April 14, 2017
Issued at HKT 19:10

China: The reported H7N9 human infections during the 5th epidemic represent a significant increase compared with the first 4 epidemics.

MMWR

Increase in Human Infections with Avian Influenza A(H7N9) Virus During the Fifth Epidemic — China, October 2016–February 2017

On March 3, 2017, this report was posted online as an MMWR Early Release.

A. Danielle Iuliano, PhD1; Yunho Jang, PhD1; Joyce Jones, MS1; C. Todd Davis, PhD1; David E. Wentworth, PhD1; Timothy M. Uyeki, MD1; Katherine Roguski, MPH1; Mark G. Thompson, PhD1; Larisa Gubareva, PhD1; Alicia M. Fry, MD1; Erin Burns, MA1; Susan Trock, DVM1; Suizan Zhou, MPH2; Jacqueline M. Katz, PhD1; Daniel B. Jernigan, MD1 (View author affiliations)

During March 2013–February 24, 2017, annual epidemics of avian influenza A(H7N9) in China resulted in 1,258 avian influenza A(H7N9) virus infections in humans being reported to the World Health Organization (WHO) by the National Health and Family Planning Commission of China and other regional sources (1). During the first four epidemics, 88% of patients developed pneumonia, 68% were admitted to an intensive care unit, and 41% died (2). Candidate vaccine viruses (CVVs) were developed, and vaccine was manufactured based on representative viruses detected after the emergence of A(H7N9) virus in humans in 2013. During the ongoing fifth epidemic (beginning October 1, 2016),* 460 human infections with A(H7N9) virus have been reported, including 453 in mainland China, six associated with travel to mainland China from Hong Kong (four cases), Macao (one) and Taiwan (one), and one in an asymptomatic poultry worker in Macao (1). Although the clinical characteristics and risk factors for human infections do not appear to have changed (2,3), the reported human infections during the fifth epidemic represent a significant increase compared with the first four epidemics, which resulted in 135 (first epidemic), 320 (second), 226 (third), and 119 (fourth epidemic) human infections (2). Most human infections continue to result in severe respiratory illness and have been associated with poultry exposure. Although some limited human-to-human spread continues to be identified, no sustained human-to-human A(H7N9) transmission has been observed (2,3).

CDC analysis of 74 hemagglutinin (HA) gene sequences from A(H7N9) virus samples collected from infected persons or live bird market environments during the fifth epidemic, which are available in the Global Initiative on Sharing All Influenza Data (GISAID) database (4,5), indicates that A(H7N9) viruses have diverged into two distinct genetic lineages. Available fifth epidemic viruses belong to two distinct lineages, the Pearl River Delta and Yangtze River Delta lineage, and ongoing analyses have found that 69 (93%) of the 74 HA gene sequences to date have been Yangtze River Delta lineage viruses. Preliminary antigenic analysis of recent Yangtze River Delta lineage viruses isolated from infections detected in Hong Kong indicate reduced cross-reactivity with existing CVVs, whereas viruses belonging to the Pearl River Delta lineage are still well inhibited by ferret antisera raised to CVVs. These preliminary data suggest that viruses from the Yangtze River Delta lineage are antigenically distinct from earlier A(H7N9) viruses and from existing CVVs. In addition, ongoing genetic analysis of neuraminidase genes from fifth epidemic viruses indicate that approximately 7%–9% of the viruses analyzed to date have known or suspected markers for reduced susceptibility to one or more neuraminidase inhibitor antiviral medications. The neuraminidase inhibitor class of antiviral drugs is currently recommended for the treatment of human infection with A(H7N9) virus. Antiviral resistance can arise spontaneously or emerge during the course of treatment. Many of the A(H7N9) virus samples collected from human infections in China might have been collected after antiviral treatment had begun.

Although all A(H7N9) viruses characterized from the previous four epidemics have been low pathogenic avian influenza viruses, analysis of human (three) and environmental (seven) samples from the fifth epidemic demonstrate that these viruses contain a four–amino acid insertion in a host protease cleavage site in the HA protein that is characteristic of highly pathogenic avian influenza (HPAI) viruses. Chinese authorities are investigating and monitoring closely for outbreaks of HPAI A(H7N9) among poultry.

Since April 2013, the Influenza Risk Assessment Tool has been used by CDC to assess the risk posed by certain novel influenza A viruses. Although the current risk to the public’s health from A(H7N9) viruses is low, among the 12 novel influenza A viruses evaluated with this tool, A(H7N9) viruses have the highest risk score and are characterized as posing moderate–high potential pandemic risk (6). Experts from the World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS) met in Geneva, Switzerland, February 27–March 1, 2017, to review available epidemiologic and virologic data related to influenza A(H7N9) viruses to evaluate the need to produce additional CVVs to maximize influenza pandemic preparedness. Two additional H7N9 CVVs were recommended for development: a new CVV derived from an A/Guangdong/17SF003/2016-like virus (HPAI), which is a highly pathogenic virus from the Yangtze River Delta lineage; and a new CVV derived from A/Hunan/2650/2016-like virus, which is a low pathogenic virus also from the Yangtze River Delta lineage (1). At this time, CDC is preparing a CVV derived from an A/Hunan/2650/2016-like virus using reverse genetics. Further preparedness measures will be informed by ongoing analysis of genetic, antigenic, and epidemiologic data and how these data impact the risk assessment. CDC will continue to work closely with the Chinese Center for Disease Control and Prevention to support the response to this epidemic. Guidance for U.S. clinicians who might be evaluating patients with possible H7N9 virus infection and travelers to China is available online (https://www.cdc.gov/flu/avianflu/h7n9-virus.htm).

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Acknowledgments

Eduardo Azziz-Baumgartner, Stephen A. Burke, Douglas Jordan, CDC; Ying Song, Carolyn Greene, CDC, Beijing, China; National Influenza Center, CDC, Beijing, China; Prevention and Public Health Emergency Center, CDC, Beijing, China; Taiwan CDC, Taipei, Taiwan; Centre for Health Protection, Department of Health, Hong Kong SAR, China.

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Corresponding author: A. Danielle Iuliano, aiuliano@cdc.gov, 404-639-5106.

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1CDC; 2CDC, Beijing, China.

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* Epidemics refer to the seasonal increases in human infections; the fifth epidemic began on October 1, 2016.

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References

  1. World Health Organization. Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness, March 2017. Geneva, Switzerland: World Health Organization; 2017. http://www.who.int/influenza/vaccines/virus/201703_zoonotic_vaccinevirusupdate.pdf?ua=1
  2. Xiang N, Li X, Ren R, et al. Assessing change in avian influenza A(H7N9) virus infections during the fourth epidemic—China, September 2015–August 2016. MMWR Morb Mortal Wkly Rep 2016;65:1390–4. CrossRef PubMed
  3. Zhou L, Ren R, Yang L, et al. Sudden increase in human infection with avian influenza A(H7N9) virus in China, September–December 2016. Western Pac Surveill Response J 2017;8. CrossRef
  4. Elbe S, Buckland-Merrett G. Data, disease and diplomacy: GISAID’s innovative contribution to global health. Global Challenges 2017;1:33–46. CrossRef
  5. Federal Republic of Germany. The GISAID initiative. http://platform.gisaid.org/epi3/start
  6. CDC. Influenza risk assessment tool (IRAT). Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/flu/pandemic-resources/national-strategy/risk-assessment.htm

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Suggested citation for this article: Iuliano AD, Jang Y, Jones J, et al. Increase in Human Infections with Avian Influenza A(H7N9) Virus During the Fifth Epidemic — China, October 2016–February 2017. MMWR Morb Mortal Wkly Rep 2017;66:254–255. DOI: http://dx.doi.org/10.15585/mmwr.mm6609e2.


Trump & Deadly Disease

NY Times

  • “…..President Trump’s budget would cut funding for the National Institutes of Health by 18 percent.
  • It would cut the State Department and the United States Agency for International Development, a key vehicle for preventing and responding to outbreaks before they reach our shores, by 28 percent.
  • And the repeal of the Affordable Care Act would kill the billion-dollar Prevention and Public Health Fund, which provides funding for the Centers for Disease Control and Prevention to fight outbreaks of infectious disease.
  • (While the budget also calls for the creation of an emergency fund to respond to outbreaks, there is no indication that it would offset the other cuts, or where the money would come from.)
  • We are already witnessing an outbreak of influenza in birds — the H7N9 strain, in China — that could be the source for the next human pandemic. Since October, over 500 people have been infected; more than 34 percent have died. Most victims had contact with infected poultry, yet three recent clusters appear to be from person-to-person transmission. Will H7N9 mutate to become easily transmitted between humans? We don’t know. But without sufficient supplies of a vaccine, we are not prepared to stop it…….”

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