Health Alert
TESTING TRAVELERS RETURNING FROM CHINA FOR AVIAN INFLUENZA A (H7N9) VIRUS INFECTION

Summary

The Centers for Disease Control and Prevention (CDC) has alerted state health agencies of increasing concerns regarding human transmission of avian influenza following the report of the fifth annual epidemic of avian influenza A (H7N9) virus in mainland China. The Delaware Division of Public Health (DPH) is providing this health advisory to ensure that Delaware health care providers are aware of the emerging threat among travelers returning from China.

Health care providers should consider H7N9 virus infection as a possible cause among travelers returning from China with severe respiratory illness, especially if they have had exposure to poultry. January 28, 2017 was the Chinese Lunar New Year which is typically associated with increased travel to and from China.

Background

Since 2013, China has had annual epidemics of human infections with avian influenza A (H7N9) virus. The fifth annual epidemic is underway. From Sept. 1, 2016 to Jan. 15, 2017, 225 human H7N9 infections were reported in mainland China, including 51 deaths. Four infections were reported in Hong Kong and two in Macao among travelers returning from mainland China, bringing the total number of cases since 2013 to 1,035 with 371 deaths. Most infected people have had exposure to poultry.

At this time, no change in the epidemiologic characteristic of human H7N9 infections has been observed, including the proportion of reported cases occurring in people exposed to poultry or the number and size of clusters of human cases identified when compared to previous annual epidemics. Symptoms have started with high fever and cough. Cases may progress to very serious illness, including severe pneumonia, acute respiratory distress syndrome (ARDS), septic shock and multi-organ failure leading to death.

Prevention and control measures are being implemented in China, Hong Kong, and Macao to reduce the risk of virus transmission. CDC is working with China CDC to provide assistance as needed and monitoring the situation closely.

According to the CDC, the spread of avian influenza A viruses from one ill person to another has been reported very rarely, and has been limited, inefficient and not sustained. However, because of the possibility that avian influenza A viruses could change and gain the ability to spread easily between people, monitoring for human infection and person-to-person transmission is extremely important for public health.

Additional Information

For guidance conducting investigations of human infections with avian influenza A (H7N9) viruses, see Interim Guidance on Case Definitions for Investigations of Human Infection with avian influenza A (H7N9) virus in the United States https://www.cdc.gov/flu/avianflu/h7n9/case-definitions.htm

Refer to the following web pages for more information related to CDC’s recommendations for specimen collection, testing, infection control, and treatment for H7N9:

• Interim Guidance for Specimen Collection, Processing, and Testing for Patients with Suspected Infection with Novel Influenza A Viruses Associated with Severe Disease in Humans
  https://www.cdc.gov/flu/avianflu/h7n9/specimen-collection.htm
• Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease
  https://www.cdc.gov/flu/avianflu/novel-flu-infection-control.htm
• Interim Guidance on the Use of Antiviral Medications for Treatment of Human Infections with Novel Influenza A Viruses Associated with Severe Human Disease
  https://www.cdc.gov/flu/avianflu/novel-av-treatment-guidance.htm

Reporting

Questions about this Health Advisory, requests for laboratory testing, and reports of suspected cases can be directed to DPH at 888-295-5156. This number is operational 24/7 including for emergencies during non-business hours.

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