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Biological Health Threat (Human-Animal Infections) – Avian influenza: (HPAI) Guangdong Province, China

2017/08/13

AVIAN INFLUENZA, HUMAN (65): CHINA (GUANGDONG, H9N2, HUMAN-ANIMAL INTERFACE, WHO
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Published Date: 2017-08-12 10:57:57
Subject: PRO/AH/EDR> Avian influenza, human (65): China (GD) H9N2, human-animal interface, WHO
Archive Number: 20170812.5242688

In this update:
[1] China (Guangdong): H9N2
[2] WHO: human-animal interface

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[1] China (Guangdong): H9N2
Date: 10 Aug 2017
Source: Outbreak News Today [edited]

A 2-month old female child who lives in Guangdong province, China was confirmed positive for A(H9N2) influenza in June [2017], according to the World Health Organization (WHO), becoming the 3rd case in China this year [2017].

She had onset of influenza-like illness (ILI) on 28 Apr 2017. The patient was hospitalized on [9 Jun 2017]. A sample collected from the patient on [13 Jun 2017] as part of ILI [influenza-like illness] surveillance was laboratory-confirmed as positive for A(H9N2) influenza virus on [16 Jun 2017].

The patient was exposed to backyard poultry prior to illness. She has fully recovered. The 2 previous cases reported this year [2017] were in February and May in an 11-month-old child and a 32-year-old man, respectively.

In most human cases of avian influenza A(H9N2), the associated disease symptoms have been mild and there has been no evidence of human-to-human transmission. Influenza A(H9N2) viruses are enzootic in poultry populations in parts of Africa, Asia, and the Middle East.

Most human cases are exposed to the A(H9N2) virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness. Since the virus continues to be detected in poultry populations, further human cases can be expected.

[Byline: Robert Herriman]


Communicated by:
ProMED-mail
<promed@promedmail.org>

[Maps of China can be seen at http://www.sacu.org/maps/provmap.png and http://healthmap.org/promed/p/334. – Sr.Tech.Ed.MJ]

*****
[2] WHO: human-animal interface
Date: Tue 25 Jul 2017
Source: WHO, Influenza at the Human-Animal Interface (HAI) [summ., edited]

Summary [16 Jun to 25 Jul 2017]
——————————-
– New infections: since the previous update, new human infections with influenza A(H7N9), A(H9N2), and A(H3N2) variant viruses were reported.
– Risk assessment: the overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the likelihood of sustained human-to-human transmission of these viruses remains low. Further human infections with viruses of animal origin are expected.
– IHR compliance: all human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005). This includes any animal and non-circulating seasonal influenza viruses. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.

Avian influenza A(H5) viruses
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Current situation: since the last update on 15 Jun 2017, no new laboratory-confirmed human cases of influenza A(H5N1) virus infection were reported to WHO. Since 2003, a total of 859 laboratory-confirmed cases of human infection with avian influenza A(H5N1) virus, including 453 deaths, have been reported to WHO from 16 countries.
Influenza A(H5) subtype viruses have the potential to cause disease in humans and thus far, no human cases, other than those with influenza A(H5N1) and A(H5N6) viruses, have been reported to WHO. According to reports received by the World Organisation for Animal Health (OIE), various influenza A(H5) subtypes continue to be detected in birds in Africa, Europe and Asia.

Avian influenza A(H7N9) viruses
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Current situation: during this reporting period, 24 laboratory-confirmed human cases of influenza A(H7N9) virus infection were reported to WHO from China. Cases were reported with likely exposure in Yunnan province for the 1st time.

As of 25 Jul 2017, a total of 1557 laboratory-confirmed cases of human infection with avian influenza A(H7N9) viruses, including at least 605 deaths, have been reported to WHO. The number of human infections with avian influenza A(H7N9) viruses and the geographical distribution of human cases in the 5th epidemic wave (that is, onset since 1 Oct 2016) have been greater than in any earlier wave. This suggests that the virus has spread, and emphasizes that further intensive surveillance and control measures in both the human and animal health sectors are crucial. However, the number of reported confirmed cases has continued to decline over the past few weeks with only one case reported thus far with an onset of illness after 23 Jun 2017.

According to reports received by the Food and Agriculture Organization (FAO) on surveillance activities for avian influenza A(H7N9) viruses in China, positives among virological samples continue to be detected in poultry from live bird markets, commercial, and backyard farms. The agricultural authorities in China have also announced plans to commence vaccination of domestic poultry nation-wide against infection with avian influenza A(H7) viruses beginning in September 2017.

Risk assessment
—————
1. What is the likelihood that additional human cases of infection with avian influenza A(H7N9) viruses will occur? Most human cases are exposed to the 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, further human cases can be expected. Additional sporadic human cases of influenza A(H7N9) in other provinces in China that have not yet reported human cases are also expected.

2. What is the likelihood of human-to-human transmission of avian influenza A(H7N9) viruses? Even though small clusters of cases have been reported, including those involving healthcare workers, currently available epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans, thus the likelihood is low.

3. What is the risk of international spread of avian influenza A(H7N9) virus by travellers? Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as this virus has not acquired the ability to transmit easily among humans.

Avian influenza A(H9N2) viruses
——————————-
Current situation: on 30 Jun 2017, one case of human infection with avian influenza A(H9N2) virus was reported to WHO from China in a 2-month old female child who lives in Guangdong province, China. She had onset of influenza-like illness (ILI) on 28 Apr 2017. The patient was hospitalized on 9 Jun 2017. A sample collected from the patient on 13 Jun 2017 as part of ILI surveillance was laboratory-confirmed as positive for A(H9N2) influenza virus on 16 Jun 2017. The patient was exposed to backyard poultry prior to illness. The case has fully recovered.

Risk assessment
—————
1. What is the likelihood that additional human cases of infection with avian influenza A(H9N2) viruses will occur? Most human cases are exposed to the A(H9N2) virus through contact with infected poultry or contaminated environments. Human infection tends to result in mild clinical illness. Since the virus continues to be detected in poultry populations, further human cases can be expected.

2. What is the likelihood of human-to-human transmission of avian influenza A(H9N2) viruses? No case clusters have been reported. Currently available epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans, thus the likelihood is low.

3. What is the risk of international spread of avian influenza A(H9N2) virus by travellers? Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as this virus has not acquired the ability to transmit easily among humans.

Overall risk management recommendations
—————————————
– WHO does not advise special traveller screening at points of entry or restrictions with regard to the current situation of influenza viruses at the human-animal interface. For recommendations on safe trade in animals from countries affected by these influenza viruses, refer to OIE guidance.
– WHO advises that travellers to countries with known outbreaks of animal influenza should avoid farms, contact with animals in live animal markets, entering areas where animals may be slaughtered, or contact with any surfaces that appear to be contaminated with animal faeces. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.
– Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health. Continued vigilance is needed within affected and neighbouring areas to detect infections in animals and humans. As the extent of virus circulation in animals is not clear, epidemiological and virological surveillance and the follow-up of suspected human cases should remain high.
– All human infections caused by a new influenza subtype are notifiable under the International Health Regulations (IHR, 2005). State Parties to the IHR (2005) are required to immediately notify WHO of any laboratory-confirmed case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic. Evidence of illness is not required for this report.
– It is critical that influenza viruses from animals and people are fully characterized in appropriate animal or human health influenza reference laboratories and reported according to international standards. Under WHO’s Pandemic Influenza Preparedness (PIP) Framework, Member States are expected to share their influenza viruses with pandemic potential on a regular and timely basis with the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of public health laboratories. The viruses are used by the public health laboratories to assess the risk of pandemic influenza and to develop candidate vaccine viruses.


Communicated by:
ProMED-mail
<promed@promedmail.org>

[Important links shared in the report:
The complete document can be accessed at the URL above:
WHO human-animal interface web page
Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO
Avian influenza A(H7N9) information
WHO avian influenza food safety issues
World Organisation of Animal Health (OIE) webpage: web portal on avian influenza
Food and Agriculture Organization of the UN (FAO) webpage: Avian influenza
OFFLU (OIE-FAO global network of expertise on animal influenza)

According to this report, human cases of avian influenza A/H7N9 as well as A/H9N2 have been reported in China . The situations require continued surveillance and monitoring for the evolution and pandemic potential of these viruses – Mod.UBA]

See Also

Avian influenza, human (64): China (FJ) WHO update, H7N9 20170807.5231257
Avian influenza, human (63): China, H7N9, WHO update 20170720.5190748
Avian influenza, human (62): China, H7N9, cases, research 20170711.5160322
Avian influenza, human (61): CHINA, H7N9 20170703.5145932
Avian influenza, human (60): WHO, human-animal interface 20170629.5138971
Avian influenza, human (59): China, H7N9 20170624.5122881
Avian influenza, human (58): China, H7N9 20170618.5109575
Avian influenza, human (57): China, H7N9, WHO 20170611.5093273
Avian influenza, human (56): China, H7N9 20170606.5085514
Avian influenza, human (55): China, H7N9 20170603.5081255
Avian influenza, human (54): CHINA, H7N9, WHO 20170530.5069791
Avian influenza, human (53): China, H7N9 20170523.5052589
Avian influenza, human (52): China, H7N9 20170517.5041644
Avian influenza, human (51): China, H7N9 20170514.5030458
Avian influenza, human (50): China, H7N9 20170509.5019418
Avian influenza, human (49): China, H7N9 20170504.5012923
Avian influenza, human (48): China, H7N9 20170429.5000143
Avian influenza, human (47): China, H7N9, WHO 20170424.4989441
Avian influenza, human (46): WHO, human-animal interface 20170423.4986981
Avian influenza, human (45): China, H7N9 20170422.4982785
Avian influenza, human (44): China, H7N9, updates, pandemic potential 20170417.4968872
Avian influenza, human (43): China, H7N9 20170412.4962707
Avian influenza, human (42): China, H7N9 20170409.4959020
Avian influenza, human (41): China, H7N9, WHO 20170406.4945768
Avian influenza, human (39): China, H7N9 20170331.4935953
Avian influenza, human (38): China, H7N9 20170327.4926547
Avian influenza, human (37): China, H7N9, WHO update, control, genetics 20170324.4923674
Avian influenza, human (36): China, H7N9 20170320.4910882
Avian influenza, human (35): China, H7N9, WHO updates 20170317.4905430
Avian influenza, human (34): China (JX,CQ) H7N9 20170316.4898107
Avian influenza, human (32): China, H7N9 20170310.4890695
Avian influenza, human (30): China, H7N9 20170307.4885433
Avian influenza, human (29): China (SH, Mainland), H7N9, WHO assessment 20170304.4878682
Avian influenza, human (28): China (GX) Taiwan, H7N9, mutations 20170302.4874114
Avian influenza, human (27): Egypt (Fayoum) H5N1, RFI 20170227.4866795
Avian influenza, human (26): China (HE) H7N9 20170227.4866739
Avian influenza, human (25): China (SD, GX), H7N9 20170225.4863940
Avian influenza, human (24): China (JX), H7N9, control measures 20170224.4861044
Avian influenza, human (23): China, Taiwan, H7N9, WHO, genetic mutations 20170223.4858369
Avian influenza, human (22): China (GX, SD), H7N9, WHO updates, vaccine 20170222.4852285
Avian influenza, human (21): China (GZ) H7N9 20170219.4849594
Avian influenza, human (20): China (SC, YN, BJ), H7N9, death toll 20170215.4841682
Avian influenza, human (10): Indonesia (LA) RFI 20170123.4785841
Avian influenza, human (01): China (JX), H7N9 20170102.4736553

2016
—-
Avian influenza, human (72): China (HK) H7N9, fatal 20161229.4727495
Avian influenza, human (68): China, H7N9 20161218.4705001
Avian influenza, human (67): WHO, H5N6, H7N9, risk assessment 20161212.4689184
Avian influenza, human (66): China (GD) H7N9 20161210.4689085
Avian influenza, human (65): China (HN) H5N6 20161123.4646005
Avian influenza, human (64): China (ZJ,JS) H7N9 20161114.4624064
Avian influenza, human (60): China (JX) H9N2 20160912.4481431
Avian influenza, human (58): China, H7N9, update, WHO 20160820.4422893
Avian influenza, human (57): China, H7N9, WHO update 20160727.4370565
………………………………………….sb/uba/mj/msp/jh

Source:
A ProMED-mail post
ProMED-mail is a program of the International Society for Infectious Diseases


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