Avian influenza (H7N9) virus infection is a notifiable condition. Infection control measures, such as patient isolation, and standard, droplet, contact, and airborne precautions, are recommended.
Five annual epidemic waves of human cases occurred in China during 2013 to 2017, with the largest wave occurring in 2016 to 2017. No cases have been reported since 2019.
Reverse transcription polymerase chain reaction of respiratory tract samples at a designated public health laboratory is the recommended diagnostic test.
Treatment involves optimal supportive care, specialised intensive-care management, and prompt administration of antiviral therapy.
There is a high cumulative case-fatality proportion of approximately 39% among hospitalised patients with laboratory-confirmed infection.
The risk to public health is low; however, the pandemic potential of this virus is concerning. Case clusters of limited human-to-human transmission have been described, but there is no evidence of sustained transmission.
Avian influenza A viruses are generally confined to birds but have infected other mammals and some viruses have crossed the species barrier to sporadically infect humans. Highly pathogenic avian influenza (HPAI) A(H5N1) virus is capable of causing severe multi-system disease in birds, humans, and other mammals. Until 2017, Asian lineage A(H7N9) virus infections in birds were associated with only asymptomatic infection or mild illness (characterised as low-pathogenic avian influenza [LPAI]). In February 2017, the detection of Asian lineage HPAI A(H7N9) viruses was reported for the first time in the People’s Republic of China (hereafter referred to as China), in samples from human cases, and from poultry and their environments. Regardless of pathogenicity assessments in birds, Asian lineage LPAI A(H7N9) virus typically causes severe illness in infected humans.
Following the detection of Asian lineage LPAI A(H7N9) virus infection in humans in eastern China in March 2013, A(H7N9) viruses that are genetically similar to isolates from human cases were detected in poultry and environmental samples obtained from live animal markets in China. Investigations of isolated clusters of human infections where zoonotic transmission was thought to be unlikely suggest that human-to-human transmission may occur with Asian lineage LPAI A(H7N9) viruses, although transmission appears to be limited and non-sustainable to date.
History and exam
Key diagnostic factors
- influenza-like illness
- decreased breath sounds
Other diagnostic factors
- vomiting, diarrhoea
- altered mental status
- environmental exposure to Asian lineage A(H7N9) virus
- close contact with infected humans
- laboratory work with A(H7N9) virus
1st investigations to order
- FBC with differential
- chest x-ray
- pulse oximetry
- sputum Gram stain
- sputum and blood bacterial culture
- reverse transcription polymerase chain reaction (RT-PCR)
Investigations to consider
- viral culture
close contact of confirmed or probable case
suspected or probable or confirmed infection
- Coronavirus disease 2019 (COVID-19)
- Community-acquired pneumonia
- Atypical pneumonia
- Interim guidance on influenza antiviral chemoprophylaxis of persons exposed to birds with avian influenza A viruses associated with severe human disease or with the potential to cause severe human disease
- Guidelines for the clinical management of severe illness from influenza virus infections
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