Jiangsu China Reports 1st Novel H7N4 Human Infection

Jiangsu Province - Credit Wikipedia

#13,146

It's been several years since we've seen a new novel flu subtype jump to a human host, but today we are learning of what appears to be the first recorded instance of an H7N4 infection detected in a patient in Jiangsu Province, China.

Although an HPAI H7N4 subtype sparked a minor outbreak in Chickens in NSW Australia in 1997, and this subtype has been reported elsewhere in the world (South Africa, Texas, etc.), this is likely a new reassortant virus.

Based on the past five years of bird flu activity in China - a reassorted H7N9 virus (see below) seems likely - but there are other H7Nx viruses out there, and so we'll have to wait for a full genetic analysis of this virus to know its origins. 

While it is possible this is a one-off infection, given the recent history of biologically fit novel zoonotic flu viruses emerging from China (H5N1, H7N9, H5N8, H5N6, H10N8, etc.) - and the apparent severity of this first case - this one bears watching.

Hopefully more detailed information will be forthcoming (perhaps even later today), but for now we have the following announcement from Hong Kong's CHP.   I'll return with a brief postscript:

CHP notified of human case of avian influenza A (H7N4) in Mainland

     The Centre for Health Protection (CHP) of the Department of Health (DH) today (February 14) received notification from the National Health and Family Planning Commission (NHFPC) that a human case of avian influenza A (H7N4) was confirmed from February 10 to 14, and reminded the public to maintain strict personal, food and environmental hygiene both locally and during travel.
 
     According to the NHFPC, this is the first case of human infection with avian influenza A (H7N4) in the world. The case involved a 68-year-old female patient living in Liyang in Changzhou of Jiangsu Province who developed symptoms on December 25, 2017. She was admitted to hospital for medical treatment on January 1 and was discharged on January 22. She had contact with live poultry before the onset of symptoms. All her close contacts did not have any symptoms during the medical surveillance period.
 
     According to a report from the Chinese Center for Disease Control and Prevention, upon analysis, the genes of the virus were determined to be of avian origin.
 
     "All novel influenza A infections, including H7N4, are notifiable infectious diseases in Hong Kong," the spokesman for the CHP said.
 
     "Based on the seasonal pattern, the activity of avian influenza viruses is expected to be higher in winter. 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," the spokesman reminded.
 
     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/Wednesday, February 14, 2018

Issued at HKT 18:43

It was not quite 5 years ago, early on the morning of March 31st, 2013, when we learned of a new avian influenza in China (see China: Two Deaths From H7N9 Avian Flu). A few hours later, in More Details Emerge On Shanghai H7N9 Case, we learned that the first known cases had been hospitalized in mid-February.

At the time, we had no idea whether this was going to be a flash in the pan, or if it would have `legs'.   H7 viruses had been known to infect humans previously (see A Brief History Of H7 Avian Flu Infections), but had most almost always  produced mild illnesses.

Not quite a month later, in WHO H7N9 Update – April 29th, the World Health Organization reported:

To date, a total of 126 laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus including 24 deaths have been reported to WHO. Contacts of the confirmed cases are being closely monitored. 

Since then, H7N9 has been viewed as a major pandemic contender, and at least 1,625 confirmed cases, and 621 deaths, have been attributed to the virus. Due to the limits of surveillance, testing, and reporting, the actual toll is likely much higher.

Once again we find ourselves looking at a new H7 avian flu subtype which has jumped to a human in Eastern China, and asking ourselves the same questions.

Is this a flash in the pan, or does it have legs?

Stay tuned.  This could get interesting.