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

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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)

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.