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Emergence of a Novel Influenza A(H7N9) Virus July 2013 Europe’s journal on infectious disease epidemiology, prevention and control Special edition: Emergence of a novel influenza A(H7N9) virus July 2013 • This issue presents papers on early epidemiological and virological aspects concerning the novel reassortant avian influenza A(H7N9) virus causing human disease in China in 2013 and the implications for public health. www.eurosurveillance.org Editorial team Editorial advisors Based at the European Centre for Albania: Alban Ylli, Tirana Disease Prevention and Control (ECDC), Austria: Reinhild Strauss, Vienna 171 83 Stockholm, Sweden Belgium: Koen De Schrijver, Antwerp Telephone number Belgium: Sophie Quoilin, Brussels +46 (0)8 58 60 11 38 or +46 (0)8 58 60 11 36 Bosnia and Herzogovina: Nina Rodić Vukmir, Banja Luka Fax number Bulgaria: Mira Kojouharova, Sofia +46 (0)8 58 60 12 94 Croatia: To be nominated Cyprus: To be nominated E-mail Czech Republic: Bohumir Križ, Prague [email protected] Denmark: Peter Henrik Andersen, Copenhagen Editor-in-chief England and Wales: TBC, London Ines Steffens Estonia: Kuulo Kutsar, Tallinn Finland: Outi Lyytikäinen, Helsinki Scientific editors France: Judith Benrekassa, Paris Kathrin Hagmaier Germany: Jamela Seedat, Berlin Williamina Wilson Greece: Rengina Vorou, Athens Karen Wilson Hungary: Ágnes Csohán, Budapest Assistant editors Iceland: Haraldur Briem, Reykjavik Alina Buzdugan Ireland: Lelia Thornton, Dublin Ingela Söderlund Italy: Paola De Castro, Rome Associate editors Kosovo (under UNSCR 1244/99): Lul Raka, Pristina Andrea Ammon, Stockholm, Sweden Latvia: Jurijs Perevoščikovs, Riga Tommi Asikainen, Frankfurt, Germany Lithuania: Milda Zygutiene, Vilnius Mike Catchpole, London, United Kingdom Luxembourg: Thérèse Staub, Luxembourg Denis Coulombier, Stockholm, Sweden The FYR of Macedonia: Elisaveta Stikova, Skopje Christian Drosten, Bonn, Germany Malta: Tanya Melillo Fenech, Valletta Karl Ekdahl, Stockholm, Sweden Montenegro: Dragan Laušević, Podgorica Johan Giesecke, Stockholm, Sweden Netherlands: Paul Bijkerk, Bilthoven Herman Goossens, Antwerp, Belgium Norway: Hilde Klovstad, Oslo David Heymann, London, United Kingdom Poland: Malgorzata Sadkowska-Todys, Warsaw Heath Kelly, Melbourne, Australia Portugal: Isabel Marinho Falcão, Lisbon Irena Klavs, Ljubljana, Slovenia Romania: Daniela Pitigoi, Bucharest Karl Kristinsson, Reykjavik, Iceland Serbia: Tatjana Pekmezovic, Belgrade Daniel Lévy-Bruhl, Paris, France Slovakia: Lukáš Murajda, Martin Richard Pebody, London, United Kingdom Slovenia: Alenka Kraigher, Ljubljana Panayotis T. Tassios, Athens, Greece Spain: Elena Rodríguez Valín, Madrid Hélène Therre, Paris, France Sweden: Christer Janson, Stockholm Henriette de Valk, Paris, France Turkey: Fehmaniz Temel, Ankara Sylvie van der Werf, Paris, France United Kingdom: Norman MacDonald, Glasgow European Commission: Paolo Guglielmetti, Luxembourg Design / Layout World Health Organization Regional Office for Europe: Nedret Fabrice Donguy / Arne Haeger Emiroglu, Copenhagen www.eurosurveillance.org © Eurosurveillance, 2013 Contents Avian influenza A(H7N9) virus EDITORIAL A novel reassortant avian influenza A(H7N9) virus in China – what are the implications for Europe 2 A Nicoll et al. RAPID COMMUNICATION PERSPECTIVES Genetic analysis of novel avian A(H7N9) influenza Outbreak with a novel avian influenza A(H7N9) viruses isolated from patients in China, February to virus in China - scenarios and triggers for assessing April 2013 7 risks and planning responses in the European T Kageyama et al. Union, May 2013 58 Surveillance of avian influenza A(H7N9) virus C Schenk et al. infection in humans and detection of the first imported human case in Taiwan, 3 April to 10 May LETTER 2013 22 YC Lo et al. Virus-host interactions and the unusual age and sex distribution of human cases of influenza A(H7N9) Preliminary inferences on the age-specific in China, April 2013 64 seriousness of human disease caused by avian DM Skowronski et al. influenza A(H7N9) infections in China, March to April 2013 26 BJ Cowling et al. Epidemiological link between exposure to poultry and all influenza A(H7N9) confirmed cases in Huzhou city, China, March to May 2013 32 J Han et al. A comparison of rapid point-of-care tests for the detection of avian influenza A(H7N9) virus, 2013 38 C Baas et al. Guiding outbreak management by the use of influenza A(H7Nx) virus sequence analysis 43 M Jonges et al. Specific detection by real-time reverse- transcription PCR assays of a novel avian influenza A(H7N9) strain associated with human spillover infections in China 51 VM Corman et al. © istockphoto.com, © Eurosurveillance Illustration of lungs, phylogenetic tree www.eurosurveillance.org 1 Editorials A novel reassortant avian influenza A(H7N9) virus in China – what are the implications for Europe A Nicoll ([email protected])1, N Danielsson1 1. European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden Citation style for this article: Nicoll A, Danielsson N. A novel reassortant avian influenza A(H7N9) virus in China – what are the implications for Europe. Euro Surveill. 2013;18(15):pii=20452. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=2045 Article submitted on 10 April 2013 / published on 11 April 2013 As of 10 April 2013, 33 human cases infected with a Following the detection of the first cases, the Chinese novel influenza A(H7N9) virus have been laboratory CDC has rapidly made specific polymerase chain reac- confirmed in Shanghai, Anhui, Jiangsu and Zhejiang tion (PCR) test kits for the new A(H7N9) viruses avail- provinces in China (Figure1). This case count came able to provincial and local laboratories across China after on 31 March 2013, the Chinese authorities had to ensure timely testing of suspected cases. Since announced the identification of a novel influenza A then individual human cases are being confirmed and virus, an A(H7H9) virus, in three people in Shanghai made public daily by the Chinese authorities at pro- and Anhui province. Two men in Shanghai, 87 and 27 vincial level in the four affected provinces. More cases years old, respectively, had become ill with influenza- are being detected with onset dates since late March like (ILI) symptoms and progressed to severe lower (Figure 2). While this could simply reflect increasing respiratory tract infections within a week in mid to late awareness among clinicians and public health authori- February, and died from acute respiratory distress syn- ties and that testing became available more widely, drome hereafter [1,2]. The two had no epidemiological close monitoring is necessary to detect changes in link and no known exposure to evidently sick animals. transmission patterns, especially human-to-human One of them was a pork butcher. The third case was transmission and cases appearing in China beyond the a 35-year-old woman from Anhui province, adjacent to four provinces. Shanghai, who also became ill with ILI with symptom onset on 9 March followed by severe respiratory dis- While the novel A(H7N9) virus has been detected in ease and death. birds and environmental specimens at a bird markets in Shanghai and the other affected provinces, the The detection of these cases was possible because of source of infection in most of the cases still remains to a well-functioning surveillance system with a labora- be determined [6 ]. It is equally unclear how the virus is tory component through which the initially non-sub- introduced into the markets. Nevertheless, China has typeable influenza A viruses were sent to the World stepped up vigilance and intensified human and animal Health Organization (WHO) Influenza Collaborating surveillance [7]. It has also implemented public health Centre at the Chinese Center for Disease Control and measures that include the closure of some live poultry Prevention (CDC) in Beijing for sequencing. Upon labo- and bird markets and culling of birds [8]. ratory identification of the new viruses, the responsi- ble Chinese authorities notified the cases as required A striking feature is that human cases are sporadic and in the International Health Regulations (IHR) to WHO very few possible clusters have been detected. They and other member states [3]. are being investigated by the Chinese authorities. So far, there has been no documented sustained human- Moreover, researchers from the Chinese CDC posted to-human transmission and there is no clear indication the genetic information of the viruses on the publicly of such transmission even though the virus has genetic accessible GISAID website [4]. The viruses were not markers that are known to be associated with improved genetically identical, indicating they had been circu- replication of avian influenza viruses in mammals [4,5]. lating for some time over a wide region [5]. The same type of viruses were reported by Chinese veterinary When compared with A(H5N1) viruses, animal-to- authorities from 4 April onward in different species of human transmissibility seems to be higher for influenza poultry and environmental samples from live bird mar- A(H7N9). It is noteworthy that the timeframe during kets in Shanghai [6]. The sequences of the veterinary which cases have been identified is very different from and environmental specimens were also posted on the that of human cases of influenza A(H5N1) detected in GISAID site by the Chinese national veterinary labora- China of late. Between January 2010 and March 2013, tory in Harbin [3]. only seven human A(H5N1) cases were reported, five 2 www.eurosurveillance.org
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