10 Feb 2015

Imported avian influenza A (H7N9): Canada

First cases of influenza A (H7N9) infection in humans in North America
On 30 January 2015, health officials in British Columbia confirmed that two individuals have tested positive for influenza A (H7N9). The cases became ill a day apart from each other after returning from a trip to China. Cases were diagnosed through routine testing while attending a general practice with mild flu symptoms; they did not require hospitalisation. These are the first documented cases of influenza A (H7N9) infection in humans in North America. The avian influenza (H7N9) virus causing illness in people in China has not been identified in birds in Canada [1-2].

About influenza A (H7N9)

Since the notification of a novel reassortant influenza A(H7N9) virus on 31 March 2013, a total of 488 laboratory confirmed cases of human infection with avian influenza A (H7N9) virus, including 185 deaths, have been reported. As 4 February 2015, the vast majority were in China [3]. In addition, on 4 February, China notified WHO of an additional 83 cases including 19 deaths with onset dates between 20 December 2014 and 27 January 2015 [4].

In February 2014, a human infection with avian influenza A (H7N9) was detected in a Malaysian traveller to China [3].

Advice for travellers

Although there is no evidence of sustained human-to-human transmission, you are advised to follow special precautions to minimise the potential exposure if you are planning to visit China, (including Hong Kong SAR and Taiwan):

  • Avoid visiting live bird and animal markets (including ‘wet’ markets) and poultry farms
  • Avoid contact with surfaces contaminated with animal faeces
  • Avoid untreated bird feathers and other animal and bird waste
  • Do not eat or handle undercooked or raw poultry, egg or duck dishes
  • Do not pick up or touch dead or dying birds
  • Do not attempt to bring any  poultry products back to the UK
  • Exercise good personal hygiene with regular hand washing with soap and use of alcohol-based hand rubs.
You are advised to seek medical advice promptly if you become ill with respiratory symptoms within ten days of a trip to China, (including Hong Kong SAR and Taiwan), should seek medical advice from their GP or NHS 111.

Advice for Healthcare Professionals

Chinese New Year is 19 February and it is possible there will be increased travel to and from China in the next three to four weeks. Healthcare professionals should be alert to the possibility of avian influenza in travellers presenting with a severe respiratory illness within ten days of returning from China (including Hong Kong SAR and Taiwan).  Public Health England (PHE) has published avian influenza algorithms and guidance  [5].

The level of risk in those who come to the UK from, or return from China, Hong Kong SAR or Taiwan and meet the case definition for a “case under investigation” is very low but warrants testing for H7N9 [5].

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