China Reports 3 Additional Human H5N6 Infections (1 Fatal, 2 in Critical Condition)

 
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In the spring of 2014 Sichuan China reported the first known human infection with an emerging HPAI H5N6 avian flu virus.  Over the next 6 years, another 25 widely scattered cases would be announced - all from Southern China - killing roughly half of the announced cases. 

Avian flu activity decreased sharply in China following their massive, nationwide, rollout of a new H5+H7 poultry vaccine over the summer of 2017, which effectively put an end to their H7N9 crisis. 

While H7N9 has yet to make a comeback, over the past year we've seen the return of H5 avian flu, not only in China, but around the world.  While this has primarily affected wild birds and poultry, starting in November of 2020 China began reporting scattered human infections with H5N6 again after a long respite. 

With today's addition, China will have reported 11 new H5N6 cases over the past 8 months - compared to just 25 in the previous 6 years.  Of particular note, Sichuan Province - the site of the first case - had gone 7 years without reporting another, but has now reported 4 cases since May.

First the announcement via Hong Kong's CHP, then I'll return with a postscript.

CHP closely monitors three human cases of avian influenza A(H5N6) in Mainland

The Centre for Health Protection (CHP) of the Department of Health is today (July 23) closely monitoring three human cases of avian influenza A(H5N6) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

The first case involved a 51-year-old woman living in Xuanhan in Sichuan Province, who had contact with live domestic poultry before the onset of symptoms. She developed symptoms on June 25, and was admitted for treatment on July 2. The patient passed away on July 4.  

The second case involved a 57-year-old man living in Kaijiang in Sichuan Province, who had contact with live domestic poultry before onset. He developed symptoms on June 22, and was admitted for treatment on July 5. The patient is in critical condition.

The third case involved a 66-year-old man living in Tongnan in Chongqing Municipality, who had contact with live domestic poultry before onset. He developed symptoms on June 23, and was admitted for treatment on June 30. The patient is in critical condition.

From 2014 to date, 35 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:

• 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/Friday, July 23, 2021
Issued at HKT 20:08

While China remains the world's hotspot for reported H5 human infections, earlier this week we saw India's first human H5 infection in an 11 y.o. boy (fatal), and since last fall Laos has reported both a human H5N1 and the first human H5N6 infection outside of China .

In February of 2021, Russia reported the first confirmed human infections with avian H5N8 (see Russian Media Reports 7 Human Infections With Avian H5N8), and in May the CDC Added Zoonotic Avian A/H5N8 To Their IRAT List. 

HPAI H5 is not only on the ascendent again, it continues to evolve and adapt, increasing its threat to public health.  While once we only really worried about H5N1, H5N8 and H5N6 are now considered zoonotic threats with pandemic potential. 

Last May, in  Science: Emerging H5N8 Avian Influenza Viruses, we looked at a review by two well-respected Chinese scientists (Weifeng Shi and George F. Gao)  on the evolution, and growing zoonotic threat, of avian H5N8, stating:

•  the  ". . . global spread of AIVs, particularly the H5N8 subtype, has become a major concern to poultry farming and wildlife security but, critically, also to global public health."
• And due to the ". . . long-distance migration of wild birds, the innate capacity for reassortment of AIVs, the increased human-type receptor binding capability, and the constant antigenic variation of HPAIVs  the authors warned that it was imperative that " . . . the global spread and potential risk of H5N8 AIVs to poultry farming, avian wildlife, and global public health are not ignored."

And in June, in V. Evolution: Genomic Evolution, Transmission Dynamics, and Pathogenicity of Avian H5N8 Viruses Emerging in China, 2020, we saw Chinese researchers describe the rapid rise in 2020 of an antigenically distinct H5N8 virus that is lethal to chickens and mice, that is similar to the Russian Zoonotic strain, and has shown signs of mammalian adaptation.

Last February, in China's Recent Resurgence Of Human HPAI H5N6 Infections, we looked at the recent uptick in HPAI H5 outbreaks in birds and poultry - and its occasional jumps to humans - which began in early 2020.   

Unfortunately, surveillance and reporting is less than optimal even when we aren't in a pandemic, but is undoubtedly even less robust today. In too many ways, we are still Flying Blind In the Age Of Pandemics & Emerging Infectious Diseases. 

While we aren't anywhere near the levels of avian flu human infections we we're seeing between 2003 and 2016, this recent uptick - particularly in the dead of summer - a time when avian flu activity would normally be expected to be at its nadir, is noteworthy. 

Whether this summer surge is a fluke, or a harbinger, remains to be seen.   Stay tuned.