After a going more than a year without reporting any human infections with avian H5N6, since mid-December (see China: Jiangsu Province Reports Fatal Human H5N6 Infection) China has reported a half dozen cases (including today's announced case).
While almost certainly an undercount, this brings the official number of human H5N6 infections reported by China since 2014 to 30.
As with other recent cases, we are learning about this one several weeks after the fact, and in this case via an announcement by Hong Kong's CHP.
CHP closely monitors human case of avian influenza A(H5N6) in Guangxi
The Centre for Health Protection (CHP) of the Department of Health (DH) is today (March 22) closely monitoring a human case of avian influenza A(H5N6) in Guangxi, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
The case involved a 50-year-old man living in Hechi in Guangxi. He developed symptoms on February 16, and was admitted for treatment on February 17 due to severe pneumonia. The patient passed away on March 2.
From 2014 to date, 30 human cases of avian influenza A(H5N6) have been reported by Mainland health authorities.
"All novel influenza A infections, including H5N6, are notifiable infectious diseases in Hong Kong," a spokesman for the CHP 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 public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below when handling poultry:
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.
- 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 most recent risk assessment on HPAI H5 viruses from the World Health Organization reads:
Public health risk assessment for human infection with avian influenza A(H5) viruses
Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected.
With continued incidence of avian influenza due to existing and new influenza A(H5) viruses in poultry, there is a need to remain vigilant in the animal and public health sectors. Community awareness of the potential dangers for human health is essential to prevent infection in humans. Surveillance should be continued to detect human cases and early changes in transmissibility and infectivity of the viruses.
For more information on confirmed cases of human infection with avian influenza A(H5) virus reported to WHO, visit: http://www.who.int/influenza/human_animal_interface/en/ For information on monthly risk assessments on Avian Influenza, visit: http://www.who.int/influenza/human_animal_interface/HAI_Risk_Assessment/en/
Up until the middle of 2017 China was a hotbed of both H5 and H7 avian flu viruses, and had been reporting literally hundreds of human infections (mostly H7) each year for nearly a half a decade. H7N9 was, by far, the most worrisome of the viruses, but HPAI H5N6 was growing in stature as well.
In the summer of 2017, following a disastrous spring surge in H7N9 infections and the emergence of an HPAI strain, China's MOA Ordered a new H5+H7 Poultry Vaccine Deployed Nationwide.
While previous poultry vaccination programs in China (and elsewhere) had yielded varying levels of success, China's dramatic drop in human infections, poultry outbreaks and virus detection from routine surveillance has been nothing short of remarkable (see OFID: Avian H5, H7 & H9 Contamination Before & After China's Massive Poultry Vaccination Campaign)
China's H7N9 epidemic in poultry and in humans was quickly halted, and over the next three years, only a handful of human H5N6 cases were reported. HPAI H5 outbreaks in poultry, while not completely eliminated, were also greatly reduced.
Whether coincidental - or due to China's vaccination campaign - globally HPAI H5 went into a steep decline in 2017, and only started to show signs of renewed life about a year ago. In addition to seeing a resurgence in human H5N6 cases, HPAI H5Nx viruses (H5N8, H5N5, H5N3, etc.) have sparked large epizootics in both Europe and Asia over the past 6 months.
All of which means that our very much welcomed lull in avian flu activity - which began in the summer of 2017 - appears to be over.