Human Influenza A(H7N9) Virus Infection Associated with Poultry Farm, Northeastern China

Table

Ming Fan, Biao Huang, Ao Wang, Liquan Deng, Donglin Wu, Xinrong Lu, Qinglong Zhao, Shuang Xu, Fiona Havers, Yanhui Wang, Jing Wu, Yuan Yin, Bingxin Sun, Jianyi Yao, and Nijuan Xiang

Author affiliations: Jilin Provincial Center for Disease Control and Prevention, Jilin, China (M. Fan, B. Huang, A. Wang, L. Deng, D. Wu, X. Lu, Q. Zhao, S. Xu); Changchun Prefectural Center for Disease Control and Prevention, Jilin (Y. Wang, J. Wu, Y. Yin, B. Sun); Chinese Center for Disease Control and Prevention, Beijing, China (J. Yao, N. Xiang); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (F. Havers)

Abstract

We report on a case of human infection with influenza A(H7N9) virus in Jilin Province in northeastern China. This case was associated with a poultry farm rather than a live bird market, which may point to a new focus for public health surveillance and interventions in this evolving outbreak.

Thumbnail of Provinces in China in which human cases of infection with influenza A(H7N9) virus have been confirmed (gray shading). Jilin Province (dark shading), where the case described in this article occurred, shares borders with the Russian Federation and the Democratic People’s Republic of Korea (North Korea).

Figure 1. Provinces in China in which human cases of infection with influenza A(H7N9) virus have been confirmed (gray shading)Jilin Province (dark shading), where the case described in this article occurred, shares borders...

Since it was first reported in spring 2013 (1), influenza A(H7N9) virus has caused 436 confirmed human infections, resulting in 167 deaths as of July 8, 2014 (Chinese Center for Disease Control and Prevention [China CDC], unpub. data). Most cases have occurred in eastern and southern China and have been associated with exposure to poultry at live poultry markets (LPMs). We report a case of human H7N9 virus infection in Jilin Province in northeastern China, an area not contiguous with provinces in which human cases have been previously reported (Figure 1). Furthermore, this case was associated with a small-scale poultry farm, not an LPM.

The Case

On February 15, 2014, a 50-year-old man, owner of a small farm in Changchun, Jilin Province, experienced an isolated fever (axillary temperature 38.3°C). He had no history of underlying medical conditions. The man sought medical care that day at Jilin University Third Hospital and returned to the hospital on February 16, 17, and 19 with ongoing fever. Radiographic imaging showed evidence of pneumonia; he received intravenous administration of azithromycin and xiyanping, a traditional Chinese medicine. On February 19, the man sought care at Jilin University First Hospital, where throat swab samples were taken. The same day, testing of the samples at the local and provincial Centers for Disease Control and Prevention yielded positive results for influenza A(H7N9) virus by real-time reverse transcription PCR (RT-PCR); China CDC confirmed results the next day. Treatment with oseltamivir (150 mg 2×/d) and methylprednisolone (80 mg 2×/d) was initiated, and oxygen was administered by nasal cannula. The man recovered and was discharged from the hospital on March 7.

The man denied exposure to poultry other than on his farm, including to poultry on other farms or in LPMs. He reported no contact with persons who had similar symptoms before onset of his illness. As part of the case investigation, 68 close contacts of the case-patient were monitored for 7 days; 1 contact had influenza-like illness. Throat swab specimens were collected from this person on days 2 and 3 after symptom onset and tested for influenza A(H7N9) by using real-time RT-PCR; results were negative.

The virus from the case-patient’s specimens was isolated in egg culture and designated A/Jilin/10117/2014 (H7N9) (full sequence available from GISAID, accession no. EPI_ISL_161665). The isolate’s 8 genes were similar to those of the virus A/Anhui/ 02/2013 (H7N9) (GISAID accession no. EPI_ISL_141190); nucleotide/amino acid homology was 99.5%/99.6% for hemagglutinin, 99.2%/98.9% for neuraminidase, 99.3%/99.7% for polybasic 1, 96.4%/98.9% for polybasic 2, 97.9%/99.6% for polymerase acidic, 99.7%/99.6% for nucleoprotein, 97.7%/100.0% for matrix protein, and 99.5%/99.1% for nonstructural

Mr Fan is a chief physician in the Jilin Provincial Center for Disease Prevention and Control, Jilin, China. His research interests focus on epidemiology and infectious disease prevention and control.

Acknowledgments

We thank Sue Trock for reviewing this manuscript; Jian Zhao for map production; and Lei Yang, Dayan Wang, and Yuelong Shu for the virus sequencing and analysis of virus data. We also thank the colleagues involved in the field investigation, specimen collection and laboratory testing, logistical administration, and support in the response from China CDC, Jilin Provincial CDC, Changchun Prefectural CDC, Siping Prefectural CDC, Jilin Prefectural CDC, Liaoyuan Prefectural CDC, Jingyue, Luyuan, Chaoyang, and Changchun Economic & Technical Development Zone county CDCs in Changchun city, Gongzhuling county CDC in Siping City, and Dongfeng county CDC in Liaoyuan City, as well as the first cohort of the Jilin Field Epidemiology Training Program.

This work was supported by the China–US Collaborative Program on Emerging and Re-emerging Infectious Diseases and a grant from National Ministry of Science and Technology Emergency Research Project on human infection with avian influenza H7N9 virus (Epidemiology Research Project) (KJYJ-2013-01-02).

References

Gao R, Cao B, Hu Y, Feng Z, Wang D, Hu W, Human infection with a novel avian-origin influenza A (H7N9) virus. N Engl J Med. 2013;368:1888–97 .DOI PubMed
Mid-March 2014 national animal H7N9 avian flu monitoring report 2014 March 21, 2014 [cited 2014 Apr 2].http://www.moa.gov.cn/sjzz/syj/dwyqdt/jczt/201403/t20140321_3824954.htm
Yu X, Jin T, Cui Y, Pu X, Li J, Xu J, Influenza H7N9 and H9N2 viruses: coexistence in poultry linked to human H7N9 infection and genome characteristics. J Virol. 2014;88:3423–31 . DOI PubMed
Pantin-Jackwood MJ, Miller PJ, Spackman E, Swayne DE, Susta L, Costa-Hurtado M, Role of poultry in spread of novel H7N9 influenza virus in China.J Virol. 2014;88:5381–90. DOI PubMed
Liu D, Shi W, Shi Y, Wang D, Xiao H, Li W, Origin and diversity of novel avian influenza A H7N9 viruses causing human infection: phylogenetic, structural, and coalescent analyses. Lancet. 2013;381:1926–32 . DOI PubMed
Chen Y, Liang W, Yang S, Wu N, Gao H, Sheng J, Human infections with the emerging avian influenza A H7N9 virus from wet market poultry: clinical analysis and characterisation of viral genome. Lancet. 2013;381:1916–25. DOI PubMed
Song P, Xia J, Gao J, Xu L, Huang Y, Yao L, Measures to combat H7N9 virus infection in China: live poultry purchasing habits, poultry handling, and living conditions increase the risk of exposure to contaminated environments. Biosci Trends. 2013;7:168–71.
Yuan J, Tang X, Yang Z, Wang M, Zheng B. Enhanced disinfection and regular closure of wet markets reduced the risk of avian influenza A virus transmission. Clin Infect Dis. 2014;58:1037–8. DOI PubMed
Bao CJ, Cui LB, Zhou MH, Hong L, Gao GF, Wang H. Live-animal markets and influenza A (H7N9) virus infection. N Engl J Med. 2013;368:2337–9.DOI PubMed
Lee SS, Wong NS, Leung CC. Exposure to avian influenza H7N9 in farms and wet markets. Lancet. 2013;381:1815. DOI PubMed
Shi J, Deng G, Liu P, Zhou J, Guan L, Li W, Isolation and characterization of H7N9 viruses from live poultry markets—implication of the source of current H7N9 infection in humans. Chin Sci Bull. 2013;58:1857–63. DOI
Yu H, Wu JT, Cowling BJ, Liao Q, Fang VJ, Zhou S, Effect of closure of live poultry markets on poultry-to-person transmission of avian influenza A H7N9 virus: an ecological study. Lancet. 2014;383:541–8. DOI PubMed
Xiang N, Havers F, Chen T, Song Y, Tu W, Li L, Use of national pneumonia surveillance to describe influenza A(H7N9) virus epidemiology, China, 2004–2013. Emerg Infect Dis. 2013;19:1784–90. DOI PubMed
Han J, Jin M, Zhang P, Liu J, Wang L, Wen D, Epidemiological link between exposure to poultry and all influenza A(H7N9) confirmed cases in Huzhou city, China, March to May 2013. Euro Surveill. 2013;18:6–11 .PubMed