Wednesday, September 29, 2021

HK CHP Monitoring Another (Fatal) Human H5N6 Infection On the Mainland



China's summer of H5N6 continues with another (belated) report of a fatal H5N6 case from Guangxi Province involving a 26-year-old woman from Guilin, who fell ill in mid-August - was hospitalized on August 19th - and has subsequently died. 

While frustrating, it is not unusual for Mainland China to `slow roll' the release of bad news - particularly when it comes to novel virus outbreaks - which they tend to treat as national security issues.

This mindset led to the disastrous SARS-CoV cover-up of 2002-2003, chronic late reporting of H7N9 cases over the past decade (see Tracking H7N9: A Game Of Very Incomplete Information), and the delays in admitting they were dealing with a communicable disease outbreak in Wuhan in 2019. 

There was a period of time - right after the emergence of H7N9 in the spring of 2013 - when China seemed almost eager to share information about the disease and provided daily, detailed reports on outbreaks.  That window of openness began to erode in 2014 and 2015. 

Today's report - which comes via a notification from Hong Kong's CHP - increases to 21 the number of H5N6 cases reported in the last 10 months. To put that number in perspective, it took 6 years for the first 24 cases to be announced by China. 


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


The Centre for Health Protection (CHP) of the Department of Health is today (September 29) closely monitoring a human case 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 case involves a 26-year-old woman living in Guilin in Guangxi, who had contact with live domestic poultry before the onset of symptoms. She developed symptoms on August 14 and was admitted for treatment on August 19. The patient has passed away.

From 2014 to date, 45 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 or 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, September 29, 2021
Issued at HKT 17:00


This sudden uptick in cases - most of which have occurred over the summer months, normally a slow time for avian flu - has not gone unnoticed by China's CDC.  

Over the past month their CDC has published two detailed outbreak reports (see below) in their CCDC Weekly.  Both of which warn that HPAI H5N6 continues to mutate and reassort, and that its threat to public health is increasing. 

China CCDC Weekly: Genetic Characterization of Two Human A (H5N6) Viruses — Guangxi , China, 2021

CCDC Weekly: Outbreak Report - Five Independent Cases of Human Infection With HPAI H5N6 — Sichuan Province

While China's massive H5+H7 poultry vaccination campaign, launched in the summer of 2017,  has been a great success - particularly against H7N9 - this recent surge in H5N6 suggests that virus may now be spreading asymptomatically in vaccinated poultry (see OFID: Avian H5, H7 & H9 Contamination Before & After China's Massive Poultry Vaccination Campaign), increasing its risk of transmission to humans.

While H5N6 hasn't shown the ability to transmit efficiently from human-to-human, its high (roughly 50%) Case Fatality Rate - combined with its continual evolution - makes this virus one to watch.