Avian Flu Diary: Hong Kong Notified Of Human H5N6 Infection In Fujian Province

#13,036

Aside from the fact this is only the second human H5N6 infection we've seen reported in the past 12 months (see last November's HK CHP Notified Of Human H5N6 Infection In Guangxi Province), today's case is a bit unusual in that it is the first case reported from Fujian Province, and that the patient - a 3 year old girl - only suffered mild symptoms and has recovered.

Although complete details on all of the 18 cases reported to date by Chinese authorities are missing, we are aware of at least 10 fatalities (see FluTrackers H5N6 Cumulative Case List).

First stop, the Fujian PHFPC notification (bolding mine) - where this case was apparently picked up by routine lab surveillance - followed by Hong Kong's announcement of the case, after which I'll return with a bit more.

H5N6 influenza cases

Published: 2018-01-05

Into the winter and spring of influenza and other respiratory diseases after the high season, the province stepped up monitoring of flu, such as pneumonia of unknown causes. Recently, the provincial CDC in routine influenza surveillance detected from one case of influenza-like illness in a positive H5N6 influenza virus nucleic acid, detected by the Chinese Center for Disease Control review, combined with clinical and epidemiological findings of cases diagnosed province the first case of human infection with H5N6 influenza cases.

　　The patient is a 3 year old girl, now living Sanyuan District, Sanming City, on December 19, 2017 onset, mild symptoms, after outpatient treatment has been recovered, its close contacts with similar symptoms did not appear.

　　Experts believe judgments, cases are sporadic occurrences of this case, there is no evidence that the H5N6 flu virus may continue to spread from human to human, human to human infection and lower the risk of the spread, the public need not panic.

　　[Link] H5N6 influenza virus is not new and emerging viruses, H5N1 virus subtype it belongs avian influenza virus, highly pathogenic for poultry. People mainly through respiratory tract infections can also be in direct contact with infected poultry secretions or excreta by close contact with infected (such as poultry droppings, feathers, respiratory secretions, blood, etc.), or. Human infection with H5N6 virus after onset of, symptoms primarily flu-like symptoms, such as fever (over 38 ℃, up to 39 ℃ ~ 40 ℃), cough, sore throat, muscle pain, nasal congestion, runny nose and other symptoms.

　　Public H5N6 influenza prevention, the key is to try to avoid contact with live poultry and their secretions and excretions, especially to avoid contact with sick, dead poultry. At the same time, pay attention to personal hygiene, exercise, and to ensure proper nutrition, enhance immunity. When such occurs suspected symptoms should seek immediate medical attention and take the initiative to inform about a possible avian Dr. Shi Jiechu. (Committee Disease Control Department, Emergency Management Office)

CHP notified of human case of avian influenza A(H5N6) in Fujian

The Centre for Health Protection (CHP) of the Department of Health (DH) last night (January 5) received notification of an additional human case of avian influenza A(H5N6) in Fujian from the National Health and Family Planning Commission, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The case involved a three-year-old girl, who had contact with live poultry before the onset of symptoms. The patient had recovered after medical treatment and her close contacts remain asymptomatic.

"Based on the seasonal pattern of avian influenza viruses, their activity in the Mainland is expected to increase in winter. The public should avoid contact with poultry, birds and their droppings and should not visit live poultry markets and farms to prevent avian influenza," a spokesman for the CHP said.

From 2014 to date, 18 human cases of avian influenza A(H5N6) have been reported by the Mainland health authorities.

"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," the spokesman said.

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 purchasing 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 if 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 the eggs 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 Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.

Ends/Saturday, January 6, 2018
Issued at HKT 13:29

As with H5N1 and H7N9, while most cases we see are sick enough to be hospitalized, and a large percentage of those cases prove fatal, we are aware of a few `mild' to `moderate' cases of H5N6.

Since mild flu cases don't normally go to a hospital (and end up tested), we really don't know how often these mild or moderate flu cases fly under the surveillance radar.

While we haven't seen any evidence of human-to-human transmission of H5N6 (and only rarely with H5N1 and H7N9), each human infection does provide the virus another opportunity to better adapt to human physiology.

For more on the evolution of H5N6, you may wish to revisit yesterday's blog: