On 12 July 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 7 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus, including 4 deaths.

Onset dates range from 26 May to 23 June. The cases range in age from 52 to 68 years, with a median age of 61 years. Of these 7 cases, 4 (57%) are male. The majority (5 cases, 71%) reported exposure to live poultry, slaughtered poultry or live poultry markets. One case has no history of exposure to poultry and the remaining case worked in a market where live poultry is sold. No human to human transmission was reported.

Cases were reported from 6 provinces and municipalities: Tianjin (2), Anhui (1), Beijing (1), Jiangsu (1), Liaoning (1) and Zhejiang (1).

Public health response

The Chinese Government has taken the following surveillance and control measures:

• strengthening outbreak surveillance and situation analysis;
• reinforcing all efforts on medical treatment; and
• conducting risk communication with the public and dissemination of information.

WHO risk assessment

Most human cases are exposed to the A(H7N9) virus through contact with infected poultry or contaminated environments, including live poultry markets. Since the virus continues to be detected in animals and environments, further human cases can be expected. Although small clusters of human cases with influenza A(H7N9) viruses have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that this virus has not acquired the ability of sustained transmission among humans. Therefore, community level spread of this virus is considered unlikely for the time being.

Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and/or its transmission behaviour to humans as it may have a serious public health impact.

WHO advice

WHO advises that travellers to countries with known outbreaks of avian influenza should avoid poultry farms, contact with animals in live bird markets, entering areas where poultry may be slaughtered, or contact with any surfaces that appear to be contaminated with faeces from poultry or other animals. Travellers should also wash their hands often with soap and water. Travellers should follow good food safety and good food hygiene practices.

WHO does not advise special screening at points of entry with regard to this event, nor does it currently recommend any travel or trade restrictions. As always, a diagnosis of infection with an avian influenza virus should be considered in individuals who develop severe acute respiratory symptoms while travelling or soon after returning from an area where avian influenza is a concern.

WHO encourages countries to continue strengthening influenza surveillance, including surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns, in order to ensure reporting of human infections under the IHR (2005), and continue national health preparedness actions.