HK CHP Monitoring 2 More H5N6 Infections On The Mainland (Guangxi & Sichaun)

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After a roughly 3-year global decline in reported avian flu cases, the uptick in human H5N6 infections in China - which began last November - continues, with 2 more cases from July reported today from Hong Kong's CHP.

Although the 1st H5N6 human infection was reported in Sichuan province in 2014, no other cases had been reported there for 7 years - until May of this year, that is.  Over the past 90 days we've seen 5 additional cases reported in Sichuan Province. 

First today's announcement from Hong Kong's CHP, after which I'll return with a postscript. 

CHP closely monitors two human cases of avian influenza A(H5N6) in Mainland
 
The Centre for Health Protection (CHP) of the Department of Health is today (August 6) closely monitoring two 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 involves a 61-year-old woman living in Guilin in Guangxi, who had prior exposure to a live poultry market before the onset of symptoms. She developed symptoms on July 6, and was admitted for treatment on July 9. The patient is in stable condition.

The second case involves a 65-year-old woman living in Yibin City in Sichuan Province, who had contact with dead poultry before onset. She developed symptoms on July 13, and was admitted for treatment on the same day. The patient is in critical condition.

From 2014 to date, 37 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, August 6, 2021

Issued at HKT 18:35

Summer typically signifies the nadir of avian flu transmission, which makes this recent spate of human H5N6  infections in China worth noting.  This summer we've also seen  India's first human H5 infection in an 11 y.o. boy (fatal), and last winter we saw the first documented infection of humans from H5N8 (in Russia). 

In May, the  CDC Added Zoonotic Avian A/H5N8 To Their IRAT List, and over the winter we saw the biggest HPAI H5 epizootic in Europe since their historic outbreak of 2016-17. 

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.

We are now only a couple of months away from the start of the fall-winter `avian flu season' in the Northern hemisphere, as migratory birds begin their southbound migration from high latitudes. 

While no one can predict what this year's migration will bring, nations around the globe will be on heightened alert once again this fall, as we wait to see what has evolved over the summer.

Stay tuned.