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Published Date: 2018-10-16 12:35:02
Subject: PRO/AH/EDR> Avian influenza, human (19): human-animal interface, WHO
Archive Number: 20181016.6093180
AVIAN INFLUENZA, HUMAN (19): HUMAN-ANIMAL INTERFACE, WHO
********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 21 Sep 2018
Source: WHO, Influenza (avian and other zoonotic) [summ., edited]
http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_21_09_2018_.pdf


Influenza at the human-animal interface
Summary and assessment (21 Jul-21 Sep 2018)
-------------------------------------------
- New infections: Since the previous update, new human infections with avian influenza A(H5N6) and A(H9N2) viruses, and influenza A(H1N2) variant viruses were reported.
- Risk assessment: The overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the likelihood of sustained human-to-human transmission of these viruses remains low. Further human infections with viruses of animal origin are expected.
- Risk management: Selection of new candidate vaccine viruses (CVVs) for zoonotic influenza for influenza pandemic preparedness purposes was done during a recent WHO consultation.
- IHR compliance: All human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005). This includes any influenza A virus that has demonstrated the capacity to infect a human and its heamagglutinin gene (or protein) is not a mutated form of those, that is, A(H1) or A(H3), circulating widely in the human population. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.

Avian influenza viruses -- current situation:
Avian influenza A(H5) viruses
-----------------------------
Since the last update on 20 Jul 2018, one new laboratory-confirmed human case of influenza A(H5N6) virus infection was reported to WHO. A 42-year-old male resident of Guangxi Zhuang Autonomous Region, China, developed symptoms on 10 Aug 2018. He initially sought outpatient care but was later admitted to hospital and was diagnosed and treated for pneumonia. The patient had exposure to live poultry before illness onset. Infection with an avian influenza A(H5N6) virus was confirmed and samples collected from the local live bird markets the patient visited tested positive for influenza A(H5) viruses. No further human cases were reported among his close contacts.

A total of 20 laboratory-confirmed cases of human infection with influenza A(H5N6) virus have been reported to WHO from China since 2014.

According to reports received by the World Organisation for Animal Health (OIE), various influenza A(H5) subtypes continue to be detected in birds in Africa, Europe and Asia. Influenza A(H5N6) viruses have recently been detected in parts of Europe and Asia, however these A(H5N6) viruses are different from the A(H5N6) influenza viruses which have infected humans in China.

Risk assessment
1. What is the likelihood that additional human cases of infection with avian influenza A(H5) viruses will occur?
Most human cases were exposed to A(H5) viruses through contact with infected poultry or contaminated environments, including live poultry markets. Since the viruses continue to be detected in animals and environments, further human cases can be expected.
2. What is the likelihood of human-to-human transmission of avian influenza A(H5) viruses?
Even though small clusters of A(H5) virus infections have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this and other A(H5) viruses have not acquired the ability of sustained transmission among humans, thus the likelihood is low.
3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?
Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as evidence suggests these viruses have not acquired the ability to transmit easily among humans.

Avian influenza A(H7N9) viruses
-------------------------------
According to reports from mainland and the Hong Kong Special Administrative Region China and those received by the World Organisation for Animal Health (OIE), A(H7N9) avian influenza viruses continue to be detected in China but at lower levels compared to previous years. A nationwide domestic poultry vaccination campaign began in 2017.

Overall, the risk assessment has not changed.

Overall risk management recommendations:
- WHO does not advise special traveler screening at points of entry or restrictions with regard to the current situation of influenza viruses at the human-animal interface. For recommendations on safe trade in animals from countries affected by these influenza viruses, refer to OIE guidance.
- WHO advises that travelers to countries with known outbreaks of animal influenza should avoid farms, contact with animals in live animal markets, entering areas where animals may be slaughtered, or contact with any surfaces that appear to be contaminated with animal faeces.
Travelers should also wash their hands often with soap and water. Travelers should follow good food safety and good food hygiene practices.
- Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health, especially over the coming winter months. Continued vigilance is needed within affected and neighbouring areas to detect infections in animals and humans. Collaboration between the animal and human health sectors is essential. As the extent of virus circulation in animals is not clear, epidemiological and virological surveillance and the follow-up of suspected human cases should remain high.
- All human infections caused by a new subtype of influenza virus are notifiable under theInternational Health Regulations (IHR, 2005). State Parties to the IHR (2005) are required toimmediately notify WHO of any laboratory-confirmed case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic. Evidence of illness is not required for this report.
- It is critical that influenza viruses from animals and people are fully characterized in appropriate animal or human health influenza reference laboratories. Under WHO's Pandemic Influenza Preparedness (PIP) Framework, Member States are expected to share their influenza viruses with pandemic potential on a regular and timely basis with the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of public health laboratories. The viruses are used by the public health laboratories to assess the risk of pandemic influenza and to develop candidate vaccine viruses.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[HealthMap/ProMED-mail map of China: http://healthmap.org/promed/p/355

Related links:
- WHO human-animal interface web page
http://www.who.int/influenza/human_animal_interface/en/
- Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO
http://www.who.int/influenza/human_animal_interface/H5N1_cumulative_table_archives/en/
- Avian influenza A(H7N9) information
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/
- WHO: avian influenza food safety issues
http://www.who.int/foodsafety/areas_work/zoonose/avian/en/
World Organisation of Animal Health (OIE) web page: avian influenza portal
http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/
Food and Agriculture Organization of the UN (FAO) webpage: avian influenza
http://www.fao.org/avianflu/en/index.html
OFFLU [OIE-FAO global network of expertise on animal influenza]
http://www.offlu.net
- Mod.UBA]

See Also

Avian influenza, human (14): human-animal interface, WHO 20180809.5955870
Avian influenza, human (11): human-animal interface, WHO 20180612.5851799
Avian influenza, human (10): human-animal interface, WHO 20180325.5702642
Avian influenza, human (09): China (JS), H7N4 20180224.5648329
Avian influenza, human (08): Yemen, RFI 20180222.5642403
Avian influenza, human (07): China (JS) H7N4, 1st report 20180214.5628629
Avian influenza, human (06): China (GD) H7N9 20180213.5625277
Avian influenza, human (05): human-animal interface, WHO 20180205.5606724
Avian influenza, human (04): Iraq (SD), NOT 20180123.5576564
Avian influenza, human (03): Iraq (SD) 20180122.5576560
Avian influenza, human (02): Iraq, H5N8 susp, RFI 20180119.5570128
Avian influenza, human (01): China (FJ) H5N6 20180109.5546265
2017
---
Avian influenza, human (82): human-animal interface, WHO 20171227.5523467
Avian influenza, human (81): China (YN) H7N9 20171204.5481306
Avian Influenza, human (80): China (GX) H5N6 20171121.5457466
Avian influenza, human (79): Asia, silent spread 20171118.5452196
Avian influenza, human (78): human-animal interface, WHO 20171115.5445134
Avian influenza, human (77): China, H7N9, WHO 20171108.5426416
Avian influenza, human (75): China, H7N9, pandemic potential 20171022.5395570
Avian influenza, human (74): Indonesia, H5N1 20171016.5383526
Avian influenza, human (73): Indonesia, H5N1, preventing human exposure, RFI 20170929.5347871
Avian influenza, human (72): Indonesia, H5N1, RFI 20170919.5326997
Avian influenza, human (71): China, H7N9, WHO update 20170916.5318278
Avian influenza, human (70): China, H7N9 20170911.5306399
Avian influenza, human (60): WHO, human-animal interface 20170629.5138971
Avian influenza, human (50): China, H7N9 20170509.5019418
Avian influenza, human (41): China, H7N9, WHO 20170406.4945768
Avian influenza, human (30): China, H7N9 20170307.4885433
Avian influenza, human (20): China (SC, YN, BJ), H7N9, death toll 20170215.4841682
Avian influenza, human (10): Indonesia (LA) RFI 20170123.4785841
Avian influenza, human (01): China (JX), H7N9 20170102.4736553
2016
---
Avian influenza, human (72): China (HK) H7N9, fatal 20161229.4727495
Avian influenza, human (68): China, H7N9 20161218.4705001
Avian influenza, human (67): WHO, H5N6, H7N9, risk assessment 20161212.4689184
Avian influenza, human (66): China (GD) H7N9 20161210.4689085
Avian influenza, human (65): China (HN) H5N6 20161123.4646005
Avian influenza, human (64): China (ZJ,JS) H7N9 20161114.4624064
Avian influenza, human (60): China (JX) H9N2 20160912.4481431
Avian influenza, human (58): China, H7N9, update, WHO 20160820.4422893
Avian influenza, human (57): China, H7N9, WHO update 20160727.4370565
.................................................uba/mj/jhPublished Date: 2018-10-16 12:35:02

Subject: PRO/AH/EDR> Avian influenza, human (19): human-animal interface, WHO
Archive Number: 20181016.6093180
AVIAN INFLUENZA, HUMAN (19): HUMAN-ANIMAL INTERFACE, WHO
********************************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Fri 21 Sep 2018
Source: WHO, Influenza (avian and other zoonotic) [summ., edited]
http://www.who.int/influenza/human_animal_interface/Influenza_Summary_IRA_HA_interface_21_09_2018_.pdf


Influenza at the human-animal interface
Summary and assessment (21 Jul-21 Sep 2018)
-------------------------------------------
- New infections: Since the previous update, new human infections with avian influenza A(H5N6) and A(H9N2) viruses, and influenza A(H1N2) variant viruses were reported.
- Risk assessment: The overall public health risk from currently known influenza viruses at the human-animal interface has not changed, and the likelihood of sustained human-to-human transmission of these viruses remains low. Further human infections with viruses of animal origin are expected.
- Risk management: Selection of new candidate vaccine viruses (CVVs) for zoonotic influenza for influenza pandemic preparedness purposes was done during a recent WHO consultation.
- IHR compliance: All human infections caused by a new influenza subtype are required to be reported under the International Health Regulations (IHR, 2005). This includes any influenza A virus that has demonstrated the capacity to infect a human and its heamagglutinin gene (or protein) is not a mutated form of those, that is, A(H1) or A(H3), circulating widely in the human population. Information from these notifications is critical to inform risk assessments for influenza at the human-animal interface.

Avian influenza viruses -- current situation:
Avian influenza A(H5) viruses
-----------------------------
Since the last update on 20 Jul 2018, one new laboratory-confirmed human case of influenza A(H5N6) virus infection was reported to WHO. A 42-year-old male resident of Guangxi Zhuang Autonomous Region, China, developed symptoms on 10 Aug 2018. He initially sought outpatient care but was later admitted to hospital and was diagnosed and treated for pneumonia. The patient had exposure to live poultry before illness onset. Infection with an avian influenza A(H5N6) virus was confirmed and samples collected from the local live bird markets the patient visited tested positive for influenza A(H5) viruses. No further human cases were reported among his close contacts.

A total of 20 laboratory-confirmed cases of human infection with influenza A(H5N6) virus have been reported to WHO from China since 2014.

According to reports received by the World Organisation for Animal Health (OIE), various influenza A(H5) subtypes continue to be detected in birds in Africa, Europe and Asia. Influenza A(H5N6) viruses have recently been detected in parts of Europe and Asia, however these A(H5N6) viruses are different from the A(H5N6) influenza viruses which have infected humans in China.

Risk assessment
1. What is the likelihood that additional human cases of infection with avian influenza A(H5) viruses will occur?
Most human cases were exposed to A(H5) viruses through contact with infected poultry or contaminated environments, including live poultry markets. Since the viruses continue to be detected in animals and environments, further human cases can be expected.
2. What is the likelihood of human-to-human transmission of avian influenza A(H5) viruses?
Even though small clusters of A(H5) virus infections have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this and other A(H5) viruses have not acquired the ability of sustained transmission among humans, thus the likelihood is low.
3. What is the likelihood of international spread of avian influenza A(H5) viruses by travellers?
Should infected individuals from affected areas travel internationally, their infection may be detected in another country during travel or after arrival. If this were to occur, further community level spread is considered unlikely as evidence suggests these viruses have not acquired the ability to transmit easily among humans.

Avian influenza A(H7N9) viruses
-------------------------------
According to reports from mainland and the Hong Kong Special Administrative Region China and those received by the World Organisation for Animal Health (OIE), A(H7N9) avian influenza viruses continue to be detected in China but at lower levels compared to previous years. A nationwide domestic poultry vaccination campaign began in 2017.

Overall, the risk assessment has not changed.

Overall risk management recommendations:
- WHO does not advise special traveler screening at points of entry or restrictions with regard to the current situation of influenza viruses at the human-animal interface. For recommendations on safe trade in animals from countries affected by these influenza viruses, refer to OIE guidance.
- WHO advises that travelers to countries with known outbreaks of animal influenza should avoid farms, contact with animals in live animal markets, entering areas where animals may be slaughtered, or contact with any surfaces that appear to be contaminated with animal faeces.
Travelers should also wash their hands often with soap and water. Travelers should follow good food safety and good food hygiene practices.
- Due to the constantly evolving nature of influenza viruses, WHO continues to stress the importance of global surveillance to detect virological, epidemiological and clinical changes associated with circulating influenza viruses that may affect human (or animal) health, especially over the coming winter months. Continued vigilance is needed within affected and neighbouring areas to detect infections in animals and humans. Collaboration between the animal and human health sectors is essential. As the extent of virus circulation in animals is not clear, epidemiological and virological surveillance and the follow-up of suspected human cases should remain high.
- All human infections caused by a new subtype of influenza virus are notifiable under theInternational Health Regulations (IHR, 2005). State Parties to the IHR (2005) are required toimmediately notify WHO of any laboratory-confirmed case of a recent human infection caused by an influenza A virus with the potential to cause a pandemic. Evidence of illness is not required for this report.
- It is critical that influenza viruses from animals and people are fully characterized in appropriate animal or human health influenza reference laboratories. Under WHO's Pandemic Influenza Preparedness (PIP) Framework, Member States are expected to share their influenza viruses with pandemic potential on a regular and timely basis with the Global Influenza Surveillance and Response System (GISRS), a WHO-coordinated network of public health laboratories. The viruses are used by the public health laboratories to assess the risk of pandemic influenza and to develop candidate vaccine viruses.

--
Communicated by:
ProMED-mail
<promed@promedmail.org>

[HealthMap/ProMED-mail map of China: http://healthmap.org/promed/p/355

Related links:
- WHO human-animal interface web page
http://www.who.int/influenza/human_animal_interface/en/
- Cumulative number of confirmed human cases of avian influenza A(H5N1) reported to WHO
http://www.who.int/influenza/human_animal_interface/H5N1_cumulative_table_archives/en/
- Avian influenza A(H7N9) information
http://www.who.int/influenza/human_animal_interface/influenza_h7n9/en/
- WHO: avian influenza food safety issues
http://www.who.int/foodsafety/areas_work/zoonose/avian/en/
World Organisation of Animal Health (OIE) web page: avian influenza portal
http://www.oie.int/animal-health-in-the-world/web-portal-on-avian-influenza/
Food and Agriculture Organization of the UN (FAO) webpage: avian influenza
http://www.fao.org/avianflu/en/index.html
OFFLU [OIE-FAO global network of expertise on animal influenza]
http://www.offlu.net
- Mod.UBA]

See Also

Avian influenza, human (14): human-animal interface, WHO 20180809.5955870
Avian influenza, human (11): human-animal interface, WHO 20180612.5851799
Avian influenza, human (10): human-animal interface, WHO 20180325.5702642
Avian influenza, human (09): China (JS), H7N4 20180224.5648329
Avian influenza, human (08): Yemen, RFI 20180222.5642403
Avian influenza, human (07): China (JS) H7N4, 1st report 20180214.5628629
Avian influenza, human (06): China (GD) H7N9 20180213.5625277
Avian influenza, human (05): human-animal interface, WHO 20180205.5606724
Avian influenza, human (04): Iraq (SD), NOT 20180123.5576564
Avian influenza, human (03): Iraq (SD) 20180122.5576560
Avian influenza, human (02): Iraq, H5N8 susp, RFI 20180119.5570128
Avian influenza, human (01): China (FJ) H5N6 20180109.5546265
2017
---
Avian influenza, human (82): human-animal interface, WHO 20171227.5523467
Avian influenza, human (81): China (YN) H7N9 20171204.5481306
Avian Influenza, human (80): China (GX) H5N6 20171121.5457466
Avian influenza, human (79): Asia, silent spread 20171118.5452196
Avian influenza, human (78): human-animal interface, WHO 20171115.5445134
Avian influenza, human (77): China, H7N9, WHO 20171108.5426416
Avian influenza, human (75): China, H7N9, pandemic potential 20171022.5395570
Avian influenza, human (74): Indonesia, H5N1 20171016.5383526
Avian influenza, human (73): Indonesia, H5N1, preventing human exposure, RFI 20170929.5347871
Avian influenza, human (72): Indonesia, H5N1, RFI 20170919.5326997
Avian influenza, human (71): China, H7N9, WHO update 20170916.5318278
Avian influenza, human (70): China, H7N9 20170911.5306399
Avian influenza, human (60): WHO, human-animal interface 20170629.5138971
Avian influenza, human (50): China, H7N9 20170509.5019418
Avian influenza, human (41): China, H7N9, WHO 20170406.4945768
Avian influenza, human (30): China, H7N9 20170307.4885433
Avian influenza, human (20): China (SC, YN, BJ), H7N9, death toll 20170215.4841682
Avian influenza, human (10): Indonesia (LA) RFI 20170123.4785841
Avian influenza, human (01): China (JX), H7N9 20170102.4736553
2016
---
Avian influenza, human (72): China (HK) H7N9, fatal 20161229.4727495
Avian influenza, human (68): China, H7N9 20161218.4705001
Avian influenza, human (67): WHO, H5N6, H7N9, risk assessment 20161212.4689184
Avian influenza, human (66): China (GD) H7N9 20161210.4689085
Avian influenza, human (65): China (HN) H5N6 20161123.4646005
Avian influenza, human (64): China (ZJ,JS) H7N9 20161114.4624064
Avian influenza, human (60): China (JX) H9N2 20160912.4481431
Avian influenza, human (58): China, H7N9, update, WHO 20160820.4422893
Avian influenza, human (57): China, H7N9, WHO update 20160727.4370565
.................................................uba/mj/jhProMED logo
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