The Delaware Division of Public Health DPH is forwarding this Health Alert from the Centers for Disease Control and Prevention CDC with minor revisions to reflect the recent rise in confirmed cases of Novel Influenza A H7N9. For information from the Division of Public Health, contact the immunization program at 1-800-282-8672.
As of April 8, 2013, Chinese public health officials have reported 21 cases of human infection with a novel avian influenza A H7N9 virus from four different provinces in China. Most patients were hospitalized with severe respiratory illness, and six persons have died. These are the first human infections identified with an avian influenza A H7N9 virus infection. Previous data as of April 4, 2013 when the total count was fourteen indicate that six cases were from Shanghai, one from Anhui Province, four from Jiangsu Province, and three from Zhejiang Province. Also as of April 4, 2013, thirteen cases were in adults aged 27 through 87 years, and one case was in a child aged 4 years; all cases had illness onset from February 19 through March 31, 2013. Age breakdown is not yet available for the 7 most recent confirmed cases.
No person-to-person transmission or epidemiologic link between any of the cases has been identified. We are aware of reports of possible sources of infection but these have not been confirmed. We are investigating and will provide that information when it is available. Preliminary functional data of the isolated viruses from the first 3 cases suggest that they are likely susceptible to neuraminidase inhibitors. Investigations by Chinese public health officials are ongoing.
These cases are a reminder that novel A influenza viruses can infect and cause severe respiratory illness in humans. Novel influenza A viruses are influenza viruses that are different from currently circulating human influenza A virus subtypes and include influenza viruses from predominantly avian and swine origin. In recent years, human infections with highly pathogenic avian influenza A H5N1 virus in several Asian countries and Egypt, highly pathogenic avian influenza A H7N3 virus in Mexico, and variant influenza A H3N2v viruses in the United States have been reported http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6136a4.htm , http://www.who.int/influenza/human_animal_interface/EN_GIP_20130312CumulativeNumberH5N1cases.pdf , http://emergency.cdc.gov/HAN/han00325.asp. The clinical presentation of human infection with avian influenza A viruses varies considerably--from mild illness, including conjunctivitis, fever, and cough, to severe illness, including fulminant pneumonia leading to death in cases of H5N1 and in these recent cases of H7N9 virus infections. To date there has been no evidence of person-to-person transmission of influenza A H7N9 viruses.
At this time, no cases of human infection with avian influenza A H7N9 viruses have been detected in the United States. Rapid detection and characterization of novel influenza viruses remain a critical component of national efforts to prevent further cases, evaluate clinical illness associated with them, and assess any ability for these viruses to spread among humans. As a result, clinicians are reminded to consider influenza as a possible diagnosis when evaluating patients with acute respiratory illnesses, including pneumonia, even outside of the typical influenza season.
Clinicians should consider the possibility of novel influenza A H7N9 virus infection in persons with respiratory illness and an appropriate travel or exposure history. Although the majority of novel influenza A H7N9 cases have resulted in severe respiratory illness in adults, infection with this virus may cause mild illness in some and may cause illness in children as well. When performing influenza diagnostic testing in patients with respiratory illness for whom an etiology has not been confirmed, clinicians may identify human cases of avian influenza A virus infection or new cases of variant influenza in the United States. Patients with novel influenza A H7N9 virus infections should have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction RT-PCR testing but be unsubtypeable.
Suspected infections with novel influenza A H7N9 viruses in the United States should be reported to CDC within 24 hours of initial detection, and state health departments should notify CDC promptly of all patients under investigation for possible novel influenza A virus infection.
The Centers for Disease Control and Prevention CDC protects people’s health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.
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