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Between 10 and 13 October 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. The four cases are from the same compound in Riyadh city. Contact tracing of household and healthcare contacts is ongoing for these cases.View the full article

Between 8 October and 16 October 2015, the National IHR Focal Points of Brazil and Colombia notified PAHO/WHO of cases of Zika virus infection. In May 2015, the public health authorities of Brazil confirmed autochthonous transmission of Zika virus in the northeastern part of the country. As of 8 October, autochthonous cases of Zika virus had been detected in 14 states: Alagoas, Bahia, Ceará, Maranhão, Mato Grosso, Pará, Paraná, Paraíba, Pernambuco, Piauí, Rio de Janeiro, Rio Grande do Norte, Roraima, and São Paulo.View the full article

The Ministry of Health and Social Welfare (MOHSW) of the United Republic of Tanzania has notified WHO of new foci of cholera outbreaks in the country. As of 13 October, 13 regions have been affected, namely Dar es Salaam, Morogoro, Pwani, Kigoma, Kilimanjaro, Iringa, Dodoma, Geita, Mara, Singida, Shinyaga, Mwanza and Zanzibar. As of 19 October, the cumulative number of cases is 4,835 cases, including 68 deaths. The region of Dar es Salam accounts for 72% of all reported cases (3,460). Zanzibar has reported 140 cases. The national task force led by the MOHSW continues to carry out activities aimed at controlling the outbreak. Water sanitation measures have been implemented alongside health education campaigns. The MOHSW, WHO, the US Centers for Disease Control (CDC) and the Field Epidemiology Program have joined forces to enhance surveillance and ensure a timely, coordinated response to alerts from the field.View the full article

On 14 October 2015, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 2 additional laboratory-confirmed cases of human infection with avian influenza A (H7N9) virus. The cases are a 55-year-old female and a 53-year-old male, with onset dates of 18 September and 21 September, respectively. Both cases had exposure to poultry and live poultry markets. No epidemiological link between the cases was reported. The cases were reported from 2 municipalities (Huzhou city and Jinhua city) in Zhejiang province.View the full article

WHO has received notification from the National IHR Focal Point of Iraq of additional laboratory-confirmed cases of cholera. As of 8 October, a total of 1,263 laboratory-confirmed cases of Vibrio cholerae 01 Inaba were reported. These cases were reported from at least 15 governorates of the country – These are Babylon (469 cases), Baghdad (304 cases), Qadisiyyah (146 cases), Muthanna (155 cases), Basra (61 cases), Wassit (41 cases), Karbala (33 case), Najaf (32 cases), Thi-qar (6 cases), Maysan (6 cases), Diyala (2 cases), Duhok (2 cases), Erbil (2 cases), Kirkuk (2 cases), Salah al-din (1 case) and Suleimaniyah (1 case).View the full article

Between 27 September and 1 October 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 1 additional case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. A 38-year-old, non-national male from Riyadh city developed symptoms on 21 September and, on 28 September, was admitted to hospital. The patient, who has no comorbidities, tested positive for MERS-CoV on 30 September. Currently, he is in stable condition in a negative pressure isolation room on a ward. Investigation of history of exposure to the known risk factors in the 14 days prior to the onset of symptoms is ongoing. Contact tracing of household and healthcare contacts is ongoing.View the full article

On 8 October 2015, the National IHR Focal Point of the Lao People’s Democratic Republic (PDR) notified WHO of one confirmed type 1 vaccine-derived poliovirus (VDPV) case. In Lao PDR, one case of circulating vaccine-derived poliovirus type 1 (cVDPV1) was confirmed, with onset of paralysis on 7 September. The patient was 8 years old when he died on 11 September. View the full article

On 7 October 2015, the National IHR Focal Point of Jordan notified WHO of 1 additional case of Middle East respiratory syndrome coronavirus (MERS-CoV). A 53-year-old male from Amman city developed symptoms on 26 September and sought health care at a hospital, where he was treated symptomatically and sent home. On 29 September, as symptoms worsened, the patient returned to the hospital, where he was admitted to an isolation room. The patient was discharged on 1 October. On the same day, as his conditions did not improve, he visited a second healthcare facility, where he was treated symptomatically and sent home. On 3 October, as his condition deteriorated, the patient sought medical care and was admitted to a third health care facility. He tested positive for MERS-CoV on 6 October. Currently, the patient is in stable condition in ICU. He does not have comorbid conditions but is a smoker. The patient is a contact of a laboratory-confirmed MERS-CoV case reported to WHO on 21 September (see DON published on 1 October – case no. 2). He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Contact tracing of household and healthcare contacts is ongoing.View the full article

Between 21 and 23 September 2015, the National IHR Focal Point of Jordan notified WHO of 4 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. Contact tracing of household and healthcare contacts is ongoing for these cases.View the full article

Between 20 and 26 September 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 6 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. Contact tracing of household and healthcare contacts is ongoing for these cases. View the full article

On 15 September 2015, WHO received a notification from the IHR National Focal Point of Iraq of laboratory-confirmation of cholera in at least five governorates. As of 23 September 2015, a total of 120 stool samples have been tested positive at the Central Public Health Laboratory of Baghdad for Vibrio cholerae 01 Inaba. Laboratory-confirmed cases have so far been reported from at-least five Governorates of the country- Baghdad Babylon, Najaf, Qadisiyyah, and Muthanna. The preliminary investigation revealed contaminated water source as the cause of this current outbreak. View the full article

Between 12 and 18 September 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 13 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death. Contact tracing of household and healthcare contacts is ongoing for these cases. View the full article

Volume 22, Number 1—January 2016DispatchAvian Influenza A(H7N9) Virus Infection in 2 Travelers Returning from China to Canada, January 20151Danuta M. Skowronski , Catharine Chambers, Reka Gustafson, Dale B. Purych, Patrick Tang, Nathalie Bastien, Mel Krajden, and Yan LiAuthor affiliations: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada (D.M. Skowronski, C. Chambers, P. Tang, M. Krajden); University of British Columbia, Vancouver (D.M. Skowronski, R. Gustafson, D.B. Purych, P. Tang, M. Krajden); Vancouver Coastal Health Authority, Vancouver (R. Gustafson); LifeLabs Medical Laboratories, Surrey, British Columbia, Canada (D.B. Purych); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (N. Bastien, Y. Li); University of Manitoba, Winnipeg (Y. Li)Main Article Table 2Antibody titers to influenza A/Anhui/1/2013(H7N9) in an anonymized population serosurvey, Lower Mainland, British Columbia, Canada, May 2013* Age group, yNo. patients†Median age, y% FemaleMean GMT (95% CI)‡No. (%, 95% CI)§With titer >10With titer >20<104944750010–1948166750020–2949276950030–3950349050040–4950466050050–5949554950060–695065.5565.3 (4.9–5.7)3 (6.0, 0.0–12.6)1 (2.0, 0–5.9)¶70–7950754250080–895083405.4 (5–5.9)4 (8.0, 0.5–15.5)1 (2.0, 0–5.9)¶>905192735.3 (4.9–5.6)3 (5.9, 0.0–12.4)1 (2.0, 0–5.8)¶All49650595.1 (5–5.2)10 (0.9, 0.2–1.7)#3 (0.3, −0.1 to0.7)#*Titers were measured by hemagglutination inhibition assay by using horse erythrocytes as previously described (6); assays were conducted at the National Microbiology Laboratory, Canada’s influenza reference laboratory in July 2013. GMT, geometric mean titer. †Serum samples were collected in May 2013; 5 samples had insufficient serum and were excluded from the analyses (8). ‡Titers were assessed in duplicate. Titers <10 were assigned a value of 5. GMT of duplicate titers derived as individual titers and group GMTs derived by age and overall. §No patients had a titer >40. ¶Further assessed by microneutralization (MN) assay, according to procedures described by the Centers for Disease Control and Prevention (Atlanta, GA, USA); available by request. MN titers for all 3 samples were <10. #Age-standardized (direct method) to the 2013 Fraser Valley and Greater Vancouver, British Columbia, Canada, population projections (BC Stats, 2013:http://www.bcstats.gov.bc.ca/StatisticsBySubject/Demography/PopulationProjections.aspx). Main Article 1Preliminary results from this study were presented at the CACMID-AMMI Canada 2014 Annual Conference, April 3–5, 2014, Victoria, British Columbia, Canada The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. http://wwwnc.cdc.gov/eid/article/22/1/15-1330-t2

Volume 22, Number 1—January 2016DispatchAvian Influenza A(H7N9) Virus Infection in 2 Travelers Returning from China to Canada, January 20151Danuta M. Skowronski , Catharine Chambers, Reka Gustafson, Dale B. Purych, Patrick Tang, Nathalie Bastien, Mel Krajden, and Yan LiAuthor affiliations: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada (D.M. Skowronski, C. Chambers, P. Tang, M. Krajden); University of British Columbia, Vancouver (D.M. Skowronski, R. Gustafson, D.B. Purych, P. Tang, M. Krajden); Vancouver Coastal Health Authority, Vancouver (R. Gustafson); LifeLabs Medical Laboratories, Surrey, British Columbia, Canada (D.B. Purych); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (N. Bastien, Y. Li); University of Manitoba, Winnipeg (Y. Li)Main Article Table 1Antibody titers to avian influenza A(H7N9) virus and recent human influenza A(H3N2) and A(H1N1)pdm09 virus strains for 2 persons with virologically confirmed H7N9 virus infection and for an HCW contact, British Columbia, Canada, January 2015* Person, date of specimen collectionDuplicate inverse HI titers and GMT for influenza antibodyA/British Columbia/1/2015(H7N9)† A/Switzerland/9715293/2013(H3N2)‡§ A/California/07/2009(H1N1)‡¶Titer 1Titer 2GMTTiter 1Titer 2GMTTiter 1Titer 2GMTIndex patient# January 26202020 101010 101010March 580160113101010101010Second patient# January 26204028 101010 101010March 5160160160202020202020HCW contact** January 27<10<10<10 404040 202020May 1<10<10<10 404040 202020*The 2 H7N9 virus–infected persons were a married couple; the woman was the index patient, and the man was the second patient. GMT, geometric mean titer; HCW, healthcare worker; HI, hemagglutination inhibition. †Assay was conducted by using homologous H7N9 virus isolated from the index patient (Global Initiative on Sharing Avian Influenza Data accession no. EPI_ISL_171342); the virus was antigenically equivalent to influenza A/Anhui/1/2013(H7N9), which was used in the population serosurvey reported inTable 2. The HI assay was conducted by using horse erythrocytes, as previously described (6). ‡Assay was conducted by using viruses of each human influenza A H1 and H3 subtype to which strains identified globally during the 2014–15 influenza season were considered antigenically related (see http://www.who.int/influenza/vaccines/virus/recommendations/2015_16_north/en/). Titers were measured according to standard assay protocols of the National Microbiology Laboratory, Canada’s influenza reference laboratory. §Assay was conducted by using guinea pig erythrocytes and in the presence of oseltamivir carboxylate to address potential neuraminidase-mediated binding of influenza A(H3N2) viruses to erythrocytes. ¶Assay was conducted by using turkey erythrocytes. #Received neither the 2013–14 nor 2014–15 influenza vaccine nor prior pneumococcal vaccine. **Received the 2013–14 and the 2014–15 influenza vaccines. Main Article 1Preliminary results from this study were presented at the CACMID-AMMI Canada 2014 Annual Conference, April 3–5, 2014, Victoria, British Columbia, Canada The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. http://wwwnc.cdc.gov/eid/article/22/1/15-1330-t1

http://wwwnc.cdc.gov/eid/article/22/1/15-1330_article

ReferencesLam TT, Zhou B, Wang J, Chai Y, Shen Y, Chen X, Dissemination, divergence and establishment of H7N9 influenza viruses in China. Nature.2015;522:102–5 . DOIPubMedEuropean Centre for Disease Prevention and Control. Human infection with avian influenza A(H7N9) virus. Fourth update, February 2, 2015 [cited 2015 Jul 23]. http://ecdc.europa.eu/en/publications/Publications/RRA-Influenza-A-H7N9-update-four.pdfTo KKW, Chan JFW, Chen H, Li L, Yuen K-Y. The emergence of influenza A H7N9 in human beings 16 years after influenza A H5N1: a tale of two cities. Lancet Infect Dis. 2013;13:809–21. DOIPubMedSkowronski DM, Li Y, Tweed SA, Tam TWS, Petric M, David ST, Protective measures and human antibody response during an avian influenza H7N3 outbreak in poultry in British Columbia, Canada. CMAJ. 2007;176:47–53. DOIPubMedEuropean Centre for Disease Prevention and Control. Risk assessment guidelines for infectious diseases transmitted on aircraft (RAGIDA)—influenza. 2014 [cited 2015 Sep 6]. http://ecdc.europa.eu/en/publications/Publications/influenza-RAGIDA-2014.pdfCenters for Disease Control and Prevention. Modified hemagglutination-inhibition (HI) assay using horse RBCS for serologic detection of antibodies to H7 subtype avian influenza virus in human sera. Version 1 [cited 2015 July 23].https://consise.tghn.org/site_media/media/articles/160713_Modified_Hemagglutination_Inhibition_Assay_Using_Horse_RBCs.pdf.Skowronski DM, Janjua NZ, De Serres G, Purych D, Gilca V, Scheifele DW, Cross-reactive and vaccine-induced antibody to an emerging swine-origin variant of influenza A virus subtype H3N2 (H3N2)v. J Infect Dis. 2012;206:1852–61. DOIPubMedSkowronski DM, Chambers C, Sabaiduc S, Janjua NZ, Li G, Petric M, Pre- and postpandemic estimates of 2009 pandemic influenza A(H1N1) seroprotection to inform surveillance-based incidence by age, during the 2013–2014 epidemic in Canada. J Infect Dis. 2015;211:109–14.DOIPubMedGao H-N, Lu H-Z, Cao B, Du B, Shang H, Gan J-H, Clinical findings in 111 cases of influenza A (H7N9) virus infection. N Engl J Med.2013;368:2277–85. DOIPubMedZhang A, Huang Y, Tian D, Lau EH, Wan Y, Liu X, Kinetics of serological responses in influenza A(H7N9)-infected patients correlate with clinical outcome in China, 2013. Euro Surveill. 2013;18:20657 .PubMedYang S, Chen Y, Cui D, Yao H, Lou J, Huo Z, Avian-origin influenza A(H7N9) infection in influenza A(H7N9)–affected areas of China: a serological study. J Infect Dis. 2014;209:265–9. DOIPubMedGuo L, Zhang X, Yu X, Chen L, Zhou H, Gao X, Human antibody responses to avian influenza A(H7N9) virus, 2013. Emerg Infect Dis.2014;20:192–200. DOIPubMedChen Z, Liu H, Lu J, Luo L, Li K, Liu Y, Asymptomatic, mild, and severe influenza A(H7N9) virus infection in humans, Guangzhou, China. Emerg Infect Dis. 2014;20:1535–40. DOIPubMedIp DK, Liao Q, Wu P, Gao Z, Cao B, Feng L, Detection of mild to moderate influenza A/H7N9 infection by China's national sentinel surveillance system for influenza-like illness: case series. BMJ. 2013;346:f3693. DOIPubMedPabbaraju K, Tellier R, Wong S, Li Y, Bastien N, Tang JW. Full-genome analysis of avian influenza A(H5N1) virus from a human, North America, 2013.Emerg Infect Dis. 2014;20:887–91 . DOIPubMedTablesTable 1. Antibody titers to avian influenza A(H7N9) virus and recent human influenza A(H3N2) and A(H1N1)pdm09 virus strains for 2 persons with virologically confirmed H7N9 virus infection and for an HCW contact, British...Table 2. Antibody titers to influenza A/Anhui/1/2013(H7N9) in an anonymized population serosurvey, Lower Mainland, British Columbia, Canada, May 2013 Suggested citation for this article: Skowronski DM, Chambers C, Gustafson R, Purych DB, Tang P, Bastien N, et al. Avian influenza A(H7N9) virus infection in 2 travelers returning from China to Canada, January 2015. Emerg Infect Dis. 2016 Jan [date cited]. http://dx.doi.org/10.3201/eid2201.151330 DOI: 10.3201/eid2201.151330 1Preliminary results from this study were presented at the CACMID-AMMI Canada 2014 Annual Conference, April 3–5, 2014, Victoria, British Columbia, Canada Table of Contents – Volume 22, Number 1—January 2016

AcknowledgmentsWe acknowledge the 2 patients and healthcare worker, who generously shared their experiences. We also thank Suzana Sabaiduc for assistance with manuscript preparation. Funding in support of the population serosurvey was provided by the Michael Smith Foundation for Health Research (grant OT-GIA-00012091). D.P. was previously a shareholder with BC Biomedical Laboratories, which contributed anonymized serum included in serosurveys, but he did not receive direct compensation for contributions to this analysis. M.K. has received research grants from Roche, Merck, Gen-Probe, Boerhinger Ingelheim, and Siemens.

ConclusionsThe onset of ILI in 2 BC patients 5–6 days after observing poultry in China is consistent with the median 5-day incubation period reported elsewhere for H7N9 virus (9) and with common-source acquisition of the virus in Fujian. However, we cannot rule out other unrecognized exposures or person-to-person transmission between the couple. Continued RT-PCR detection in respiratory specimens 2 weeks after ILI onset has been documented (9) but does not necessarily signify ongoing shedding of infectious virus. Although previous case series have reported inconsistent antibody responses to H7N9 virus, often with low avidity and potentially correlated with clinical outcome (10–12), both BC case-patients with typical outpatient ILI demonstrated seroconversion. Reported human cases of H7N9 infection have mostly been in older men, and two thirds have been categorized as severe (2,3,9). Mild illness has occasionally been reported in children (2,13,14), but, as exemplified by the BC cases, adults can also experience milder infection. Imported cases of novel influenza are less likely to be recognized if they are mild. In that regard, identification of H7N9 virus in an outpatient setting was adventitious. Travel history triggered specimen collection by the HCW, and identification of nonsubtypeable influenza by the provincial laboratory prompted further investigation and public health notification. Despite broad susceptibility and instances of household or familial transmission, H7N9 virus has not demonstrated easy person-to-person spread. Poultry exposure remains the major risk factor for human H7N9 infection (2,3,9). Primary prevention messages should emphasize to travelers that they avoid exposure to poultry and uncooked poultry products while visiting affected areas. As illustrated by a prior imported case of avian influenza A(H5N1) virus to Alberta, Canada, however, such exposures may not always be recognized or avoidable (15). Screening should therefore begin with travel history in the 2 weeks before onset of acute respiratory illness. Patients should be encouraged to volunteer recent travel histories, and HCWs should elicit information regarding travel to affected areas. Public health and laboratory partners should be notified of suspect cases, as appropriate, during the diagnostic work-up, so that emerging pathogen screening, risk assessment, and advice can be guided in a timely manner. Dr. Skowronski is an epidemiologist at the British Columbia Centre for Disease Control, where she is responsible for surveillance, rapid response research, and policy advice related to influenza and other emerging or reemerging respiratory pathogens. Her primary research interests are influenza molecular and immunoepidemiology and influenza vaccine effectiveness and safety evaluation.

The StudyA married couple, both 56 years of age, from British Columbia (BC), Canada, traveled in Hong Kong (December 29, 2014–January 3, 2015, and January 6–7); Taipei, Taiwan (January 3–6); and Fujian Province, China (January 7–11), returning home on January 12. They recalled seeing live poultry and copious droppings while visiting Fujian on January 8 but recollected no other poultry contact. Around January 3–7, the previously healthy woman experienced mild cough, sore throat, and hoarseness. She recovered, but influenza-like illness (ILI), including fever, cough, myalgia, and fatigue, developed on January 14. On January 15, she sought outpatient care. A healthcare worker (HCW) collected a nasal swab specimen, which was sent to the BC Public Health Microbiology and Reference Laboratory (BC-PHMRL), where most influenza testing is centralized in BC. On January 16, the sample tested positive for influenza A virus by reverse transcription PCR (RT-PCR), and the HCW was informed; the next business day (January 19), the patient was prescribed oseltamivir. For surveillance purposes, BC-PHMRL conducts subtyping of all detected influenza A viruses. Despite a high virus titer (cycle threshold [Ct] 23.43), the specimen could not be subtyped for human influenza H1 or H3 virus by matrix gene–based RT-PCR. Further subtyping using RT-PCR–based targets for the hemagglutinin gene indicated an H7 virus. Sequence analysis of a matrix gene fragment showed 99% identity with H7N9 and H9N2 viruses, the latter of which is known to have donated internal genes to H7N9 virus (1,3). On January 23, BC-PHMRL notified public health authorities of a presumptive diagnosis of H7N9 virus infection in the woman (index case), and on January 26, Canada’s National Microbiology Laboratory (NML) confirmed the diagnosis by RT-PCR. On January 13, a day before the woman became ill, her husband, who had a history of asthma, had onset of ILI symptoms (fever, productive cough, chest pain, dyspnea, headache, myalgia, and fatigue) and visited the same HCW. The HCW prescribed doxycycline but did not collect a specimen. On January 19, after his wife received a diagnosis of influenza, the man was prescribed oseltamivir. A throat swab specimen collected from him on January 23 was RT-PCR–positive for influenza A (Ct 29.79). On January 29, NML confirmed H7N9 virus infection. Neither patient experienced conjunctivitis, which has been reported with H7N7 and H7N3 infections (3,4), and both recovered in self-isolation at home. Follow-up respiratory specimens were still positive by RT-PCR on January 26 (day 12 after ILI onset for the woman [Ct 36.82]; day 13 for the man [Ct33.80]) and on January 28 (day 15 after ILI onset) for the man (Ct 30.21). The HCW remained asymptomatic; however, because of the patients’ travel history, the HCW began oseltamivir prophylaxis after learning the index patient had laboratory-confirmed influenza. Throat swab specimens collected from the HCW on January 26 were influenza RT-PCR–negative. Approximately 20 other close contacts of the patients were placed under 10-day surveillance (from last exposure), including 1 who received oseltamivir prophylaxis. All contacts remained asymptomatic. Passengers on the flight taken by the patients while they were asymptomatic were not included in active surveillance because >10 days had elapsed (5); however, media communications included flight details and public health advice. Virus cultures in Madin-Darby canine kidney cells were attempted with all patient samples; only the woman’s January 15 sample was culture-positive for influenza virus (A/British Columbia/1/2015[H7N9]). Phylogenetic analysis of the hemagglutinin and neuraminidase genes showed that the strain clustered with 2014 and 2015 H7N9 human isolates from Jiangsu, Zhejiang, and Fujian Provinces, China, and 2014 chicken isolates from Jiangxi, China, belonging to clade W2-C (1). Similar to genomes of previous human H7N9 isolates, the genome of the patient’s isolate showed clinically relevant markers: substitutions G186V (H3 numbering), Q226L, and T160L in the hemagglutinin for increased human receptor affinity; substitution E627K in polymerase basic 2 for mammalian replication; substitutions S31N and V27I in matrix 2 for amantadine resistance; deletion in the neuraminidase stalk (positions 69–73); and neuraminidase inhibitor susceptibility (3). Antibody titers to H7N9 and recent human influenza A(H3N2) and A(H1N1)pdm09 strains in paired serum samples from the case-patients and HCW were measured by hemagglutination inhibition assay at NML (Table 1) (6). At ≈7 weeks after ILI onset, the case-patients showed seroconversion (>4-fold antibody rise) to H7N9 virus; the HCW had no detectable H7N9 antibody (Table 1). As part of population risk assessment, we also previously measured hemagglutination inhibition antibody titers to H7N9 virus in anonymized residual serum samples collected and banked from patients attending community-based laboratory test sites in 2010 (n = 1,116; ≈100 samples/10-year age group) (7) and 2013 (n = 496; ≈50 samples/10-year age group) (8) across the same BC region to which the couple returned. The assessment was conducted as described (7,8) and approved by the University of British Columbia Research Ethics Board. Results showed broad population serosusceptibility to H7N9 virus: 5% (10/201) of serum samples collected from patients >60 years of age in 2013 had low-level titers (>10 but <40), but no other samples had detectable H7N9 virus antibody (Table 2). Three samples with titers >20 showed titers <10 by microneutralization assay (Table 2).

Volume 22, Number 1—January 2016DispatchAvian Influenza A(H7N9) Virus Infection in 2 Travelers Returning from China to Canada, January 20151On This PageThe StudyConclusionsSuggested CitationTablesTable 1Table 2DownloadsRIS[TXT - 2 KB]Danuta M. Skowronski , Catharine Chambers, Reka Gustafson, Dale B. Purych, Patrick Tang, Nathalie Bastien, Mel Krajden, and Yan LiAuthor affiliations: British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada (D.M. Skowronski, C. Chambers, P. Tang, M. Krajden); University of British Columbia, Vancouver (D.M. Skowronski, R. Gustafson, D.B. Purych, P. Tang, M. Krajden); Vancouver Coastal Health Authority, Vancouver (R. Gustafson);LifeLabs Medical Laboratories, Surrey, British Columbia, Canada (D.B. Purych); Public Health Agency of Canada, Winnipeg, Manitoba, Canada (N. Bastien, Y. Li); University of Manitoba, Winnipeg (Y. Li)Suggested citation for this article AbstractIn January 2015, British Columbia, Canada, reported avian influenza A(H7N9) virus infection in 2 travelers returning from China who sought outpatient care for typical influenza-like illness. There was no further spread, but serosurvey findings showed broad population susceptibility to H7N9 virus. Travel history and timely notification are critical to emerging pathogen detection and response. Since February 2013, >600 human cases of avian influenza A(H7N9) infection have been reported from eastern China, where the virus is considered enzootic in poultry (1). Travel-associated cases have previously been reported in Asia (2); however, in January 2015, Canada reported 2 travel-associated cases, which are described here.

On 19 September 2015, the National IHR Focal Point of Kuwait notified WHO of 1 additional fatal case of Middle East respiratory syndrome coronavirus (MERS-CoV) infection. A 78-year-old male from Kuwait city developed symptoms on 8 September and, on 13 September, was admitted to hospital. The patient, who had comorbidities, tested positive for MERS-CoV on 14 September. The patient owned dromedary camels and had a history of frequent contact with them. He had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient passed away on 19 September. Contact tracing of household and healthcare contacts is ongoing for this case.View the full article

Between 7 and 10 August 2015, the National IHR Focal Point of Jordan notified WHO of 5 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 2 deaths. Contact tracing of household and healthcare contacts is ongoing for these cases.View the full article