Ahead of Print -Human Exposure to Live Poultry and Psychological and Behavioral Responses to Influenza A(H7N9), China - Volume 20, Number 8—August 2014 - Emerging Infectious Disease journal - CDC

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Ahead of Print -Human Exposure to Live Poultry and Psychological and Behavioral Responses to Influenza A(H7N9), China - Volume 20, Number 8—August 2014 - Emerging Infectious Disease journal - CDC

Volume 20, Number 8—August 2014

Research

Human Exposure to Live Poultry and Psychological and Behavioral Responses to Influenza A(H7N9), China

Article Contents

• Methods
• Results
• Discussion
• Acknowledgments
• References
• Figure 1
• Figure 2
• Figure 3
• Table 1
• Table 2
• Table 3
• Table 4
• Table 5
• Technical Appendix - 1.18 MB 
• Suggested Citation

Liping Wang1, Benjamin J. Cowling1, Peng Wu1, Jianxing Yu1, Fu Li, Lingjia Zeng, Joseph T. Wu, Zhongjie Li, Gabriel M. Leung, and Hongjie Yu 

Author affiliations: Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (L. Wang, J. Yu, F. Li, L. Zeng, Z. Li, H. Yu); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B.J. Cowling, P. Wu, J.T. Wu, G.M. Leung)

Suggested citation for this article

Abstract

To investigate human exposure to live poultry and changes in risk perception and behavior after the April 2013 influenza A(H7N9) outbreak in China, we surveyed 2,504 urban residents in 5 cities and 1,227 rural residents in 4 provinces and found that perceived risk for influenza A(H7N9) was low. The highest rate of exposure to live poultry was reported in Guangzhou, where 47% of those surveyed reported visiting a live poultry market >1 times in the previous year. Most (77%) urban respondents reported that they visited live markets less often after influenza A(H7N9) cases were first identified in China in March 2013, but only 30% supported permanent closure of the markets to control the epidemic. In rural areas, 48% of respondents reported that they raised backyard poultry. Exposure to live commercial and private poultry is common in urban and rural China and remains a potential risk factor for human infection with novel influenza viruses.

The novel influenza A(H7N9) virus was identified in early 2013; as of March 31, 2014, a total of 404 laboratory-confirmed cases of human infection had been reported. These cases included 394 in mainland China, 2 in Taiwan, 7 in Hong Kong, and 1 in Malaysia (1,2). Only 2 laboratory-confirmed cases were identified in the summer months (June–September 2013), but beginning in early October 2013, the virus reemerged and caused many new human infections (3,4).

Previously published studies have reported that most human infections appear to have occurred as a result of exposure to live poultry, particularly through visits to live poultry markets (LPMs) in urban areas (3,5–8). No published reports have detailed population exposure to live poultry and LPMs in influenza A(H7N9) virus–affected areas in China, and few data on live poultry exposure have been previously reported in areas in which the virus has not been detected (4,9,10). In addition, little information has been reported on how the population of China responded to the outbreak and the control measures that were implemented. To clarify responses to the influenza A(H7N9) outbreak in China, we investigated patterns in human exposure to live poultry in LPMs and at home, examined risk perception and behavioral responses in the population, and compared these parameters between urban and rural areas in China that were affected or unaffected by the virus.

Dr Wang is a director of the Branch of General Affairs on Infectious Disease, Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention. Her research interests include notifiable infectious diseases surveillance and related policy research.

Acknowledgments

We thank Hang Zhou and Zhibin Peng for questionnaire preparation and Qiaohong Liao, Hui Jiang, Xiang Ren, Vicky Fang, Michael Ni, and Hoi Wa Wong for technical assistance.

This study was funded by the US National Institutes of Health (Comprehensive International Program for Research on AIDS grant U19 AI51915); the China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases; and grants from the Ministry of Science and Technology, China (2012 ZX10004-201); the Harvard Center for Communicable Disease Dynamics from the National Institute of General Medical Sciences (grant no. U54 GM088558); the Research Fund for the Control of Infectious Disease, Food and Health Bureau, Government of the Hong Kong Special Administrative Region (grant no. HKU-13-06-01); and the Area of Excellence Scheme of the Hong Kong University Grants Committee (grant no. AoE/M-12/06). The funding bodies had no role in study design, data collection and analysis, preparation of the manuscript, or the decision to publish.

L.W., B.J.C., P.W., G.M.L., and H.Y. designed the study; L.W., J.Y., F.L., and L.Z. collected data; and L.W., B.J.C., P.W., and J.Y. analyzed data. L.W. and B.J.C. wrote the first draft of this article, and all authors contributed to review and revision of the report.

References

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Figures

• Figure 1. Geographic distribution of urban locations (red stars) and rural locations (blue triangles) selected for population survey to determine human exposure to live poultry and attitudes and behavior toward influenza...
• Figure 2. Flowcharts for recruitment of participants for telephone surveys and face-to-face interviews to determine human exposure to live poultry and attitudes and behavior toward influenza A(H7N9) in China, 2013A) Flowchart...
• Figure 3. Age- and sex-specific patterns in exposures to live poultry markets in 5 urban areas of China, 2013A) Chengdu; B) Guangzhou; C) Shanghai; D) Shenyang; E) Wuhan.

Tables

• Table 1. Sociodemographic characteristics of participants recruited for urban and rural surveys of influenza A(H7N9) awareness, China, 2013
• Table 2. Exposure to live poultry and attitudes toward closure of LPMs among participants recruited in urban areas for surveys related to influenza A(H7N9) awareness, by area, China, 2013
• Table 3. Risk perception related to influenza A(H7N9) among participants recruited for surveys in urban areas, by area, China, 2013
• Table 4. Risk perception related to influenza A(H7N9) and backyard poultry exposure among participants recruited for surveys in rural areas, by area, China, 2013
• Table 5. Factors associated with attitudes and behavior toward influenza A(H7N9) among survey respondents from urban areas who had visited a live poultry market during the previous year, China, 2013

Technical Appendix

• Technical Appendix. English and Chinese language versions of the questionnaire used for the telephone survey conducted in 5 cities in China to determine human exposure to live poultry and attitudes and... 1.18 MB 

Suggested citation for this article: Wang L, Cowling BJ, Wu P, Yu J, Li F, Zeng L, et al. Human exposure to live poultry and psychological and behavioral responses to influenza A(H7N9), China. Emerg Infect Dis [Internet]. 2014 Aug [date cited].http://dx.doi.org/10.3201/eid2008.131821

DOI: 10.3201/eid2008.131821

1These authors contributed equally to this article.