niman

Immediate notification report Report reference: REF OIE 23101, Report Date: 03/03/2017, Country : Greece Report Summary Name of sender of the report Mr Spiros Doudounakis Telephone (30-210) 883 64 20 Position Director, Fax (30-210) 212 57 19 Address 2 Acharnon Street ATHENS 10176 Email [email protected] Date submitted to OIE 03/03/2017 Animal type Terrestrial Date of report 03/03/2017 Disease Highly pathogenic avian influenza Date of start of the event 06/02/2017 Causal Agent Highly pathogenic avian influenza virus Date of confirmation of the event 02/03/2017 Serotype(s) H5N6 Diagnosis Laboratory (basic), Laboratory (advanced), Necropsy Reason New strain of a listed disease in the country Clinical signs Yes Country or zone the whole country Number of reported outbreaks submitted= 1, Draft= 0 Outbreak details Province Number of outbreaks District Sub-district Unit Type Location Latitude Longitude Start Date End Date: DYTIKI MAKEDONIA- (this report - submitted) - Backyard Village of Antigonos in Florina Prefecture 40.6392 21.7608 06/02/2017 Species Measuring units Susceptible Cases Deaths Destroyed Slaughtered Birds Animals 60 60 60 0 0 Affected Population Outbreak summary: Total outbreaks = 1 (Submitted) Species Susceptible Cases Deaths Destroyed Slaughtered Birds 60 60 60 0 0 Epidemiology Epidemiological comments This outbreak was mistakenly reported on 16/2/2017 as HPAI H5N8 instead of HPAI (H5) other than H5N8 and H5N1. Subsequent laboratory investigation confirmed HPAI H5N6 on 2/3/2017. All measures on holding were applied upon AI H5 confirmation on 9/02/2017 http://www.oie.int/wahis_2/temp/reports/en_imm_0000023101_20170303_172837.pdf

Isolate detail Isolate name: A/Anhui/60933/2016 Isolate ID: EPI_ISL_242896 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-12-19 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Anhui Patient age: 66 Year(s) Gender: Male Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Wang,Dayan; Zhou,Shumei; Li,Xiyan; Li,Xiaodan; Zhang,Ye; Bo,Hong; Shu,Yuelong Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A_ANHUI_60933_2016_DEC-PB2 2280 EPI888041 PB1 A_ANHUI_60933_2016_DEC-PB1 2274 EPI888042 PA A_ANHUI_60933_2016_DEC-PA 2151 EPI888040 HA A_ANHUI_60933_2016_DEC-HA 1683 EPI888044 NP A_ANHUI_60933_2016_DEC-NP 1497 EPI888037 NA A_ANHUI_60933_2016_DEC-NA 1398 EPI888043 MP A_ANHUI_60933_2016_DEC-MP 982 EPI888039 NS A_ANHUI_60933_2016_DEC-NS 838 EPI888038 Submitter information Submitter: Yang, Lei Submission Date: 2017-01-25 Last modifier: Yang, Lei Last modified: 2017-01-25 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Anhui/60934/2016 Isolate ID: EPI_ISL_242897 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-12-19 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Anhui Patient age: 37 Year(s) Gender: Female Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Wang,Dayan; Zhou,Shumei; Li,Xiyan; Li,Xiaodan; Zhang,Ye; Bo,Hong; Shu,Yuelong Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A_ANHUI_60934_2016_DEC-PB2 2280 EPI888049 PB1 A_ANHUI_60934_2016_DEC-PB1 2274 EPI888050 PA A_ANHUI_60934_2016_DEC-PA 2151 EPI888048 HA A_ANHUI_60934_2016_DEC-HA 1683 EPI888052 NP A_ANHUI_60934_2016_DEC-NP 1497 EPI888045 NA A_ANHUI_60934_2016_DEC-NA 1398 EPI888051 MP A_ANHUI_60934_2016_DEC-MP 982 EPI888047 NS A_ANHUI_60934_2016_DEC-NS 838 EPI888046 Submitter information Submitter: Yang, Lei Submission Date: 2017-01-25 Last modifier: Yang, Lei Last modified: 2017-01-25 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

References 1. World Health Organization. Antigenic and genetic characteristics of zoonotic influenza viruses and development of candidate vaccine viruses for pandemic preparedness, March 2017. Geneva, Switzerland: World Health Organization; 2017. http://www.who.int/influenza/vaccines/ virus/201703_zoonotic_vaccinevirusupdate.pdf?ua=1 2. Xiang N, Li X, Ren R, et al. Assessing change in avian influenza A(H7N9) virus infections during the fourth epidemic—China, September 2015– August 2016. MMWR Morb Mortal Wkly Rep 2016;65:1390–4. http:// dx.doi.org/10.15585/mmwr.mm6549a2 3. Zhou L, Ren R, Yang L, et al. Sudden increase in human infection with avian influenza A(H7N9) virus in China, September–December 2016. Western Pac Surveill Response J 2017;8. http://dx.doi.org/10.5365/ wpsar.2017.8.1.001 4. Elbe S, Buckland-Merrett G. Data, disease and diplomacy: GISAID’s innovative contribution to global health. Global Challenges 2017;1:33–46. http://dx.doi.org/10.1002/gch2.1018 5. Federal Republic of Germany. The GISAID initiative. http://platform. gisaid.org/epi3/start 6. CDC. Influenza risk assessment tool (IRAT). Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://www.cdc.gov/flu/ pandemic-resources/national-strategy/risk-assessment.htm

Acknowledgments Eduardo Azziz-Baumgartner, Stephen A. Burke, Douglas Jordan, CDC; Ying Song, Carolyn Greene, CDC, Beijing, China; National Influenza Center, CDC, Beijing, China; Prevention and Public Health Emergency Center, CDC, Beijing, China; Taiwan CDC, Taipei, Taiwan; Centre for Health Protection, Department of Health, Hong Kong SAR, China. 1CDC; 2CDC, Beijing, China. Corresponding author: A. Danielle Iuliano, [email protected], 404-639-5106.

During March 2013–February 24, 2017, annual epidemics of avian influenza A(H7N9) in China resulted in 1,258 avian influenza A(H7N9) virus infections in humans being reported to the World Health Organization (WHO) by the National Health and Family Planning Commission of China and other regional sources (1). During the first four epidemics, 88% of patients developed pneumonia, 68% were admitted to an intensive care unit, and 41% died (2). Candidate vaccine viruses (CVVs) were developed, and vaccine was manufactured based on representative viruses detected after the emergence of A(H7N9) virus in humans in 2013. During the ongoing fifth epidemic (beginning October 1, 2016),* 460 human infections with A(H7N9) virus have been reported, including 453 in mainland China, six associated with travel to mainland China from Hong Kong (four cases), Macao (one) and Taiwan (one), and one in an asymptomatic poultry worker in Macao (1). Although the clinical characteristics and risk factors for human infections do not appear to have changed (2,3), the reported human infections during the fifth epidemic represent a significant increase compared with the first four epidemics, which resulted in 135 (first epidemic), 320 (second), 226 (third), and 119 (fourth epidemic) human infections (2). Most human infections continue to result in severe respiratory illness and have been associated with poultry exposure. Although some limited human-to-human spread continues to be identified, no sustained human-to-human A(H7N9) transmission has been observed (2,3). CDC analysis of 74 hemagglutinin (HA) gene sequences from A(H7N9) virus samples collected from infected persons or live bird market environments during the fifth epidemic, which are available in the Global Initiative on Sharing All Influenza Data (GISAID) database (4,5), indicates that A(H7N9) viruses have diverged into two distinct genetic lineages. Available fifth epidemic viruses belong to two distinct lineages, the Pearl River Delta and Yangtze River Delta lineage, and ongoing analyses have found that 69 (93%) of the 74 HA gene sequences to date have been Yangtze River Delta lineage viruses. Preliminary antigenic analysis of recent Yangtze River Delta lineage viruses isolated from infections detected in Hong Kong indicate reduced cross-reactivity with existing CVVs, whereas viruses belonging to the Pearl River Delta lineage are still well inhibited by ferret antisera raised to CVVs. These preliminary data suggest that viruses from the Yangtze River Delta lineage are antigenically distinct from earlier A(H7N9) viruses and from existing CVVs. In addition, ongoing genetic analysis of neuraminidase genes from fifth epidemic viruses indicate that approximately 7%–9% of the viruses analyzed to date have known or suspected markers for reduced susceptibility to one or more neuraminidase inhibitor antiviral medications. The neuraminidase inhibitor class of antiviral drugs is currently recommended for the treatment of human infection with A(H7N9) virus. Antiviral resistance can arise spontaneously or emerge during the course of treatment. Many of the A(H7N9) virus samples collected from human infections in China might have been collected after antiviral treatment had begun. Although all A(H7N9) viruses characterized from the previous four epidemics have been low pathogenic avian influenza viruses, analysis of human (three) and environmental (seven) samples from the fifth epidemic demonstrate that these viruses contain a four–amino acid insertion in a host protease cleavage site in the HA protein that is characteristic of highly pathogenic avian influenza (HPAI) viruses. Chinese authorities are investigating and monitoring closely for outbreaks of HPAI A(H7N9) among poultry. Since April 2013, the Influenza Risk Assessment Tool has been used by CDC to assess the risk posed by certain novel influenza A viruses. Although the current risk to the public’s health from A(H7N9) viruses is low, among the 12 novel influenza A viruses evaluated with this tool, A(H7N9) viruses have the highest risk score and are characterized as posing moderate–high potential pandemic risk (6). Experts from the World Health Organization (WHO) Global Influenza Surveillance and Response System (GISRS) met in Geneva, Switzerland, February 27–March 1, 2017, to review available epidemiologic and virologic data related to influenza A(H7N9) viruses to evaluate the need to produce additional CVVs to maximize influenza pandemic preparedness. Two additional H7N9 CVVs were recommended for development: a new CVV derived from an A/Guangdong/17SF003/2016-like virus (HPAI), which is a highly pathogenic virus from the Yangtze River Delta lineage; and a new CVV derived from A/Hunan/2650/2016-like virus, which is a low pathogenic virus also from the Yangtze River Delta lineage (1). At this time, CDC is preparing a CVV derived from an A/Hunan/2650/2016-like virus using reverse genetics. Further preparedness measures will be informed by ongoing analysis of genetic, antigenic, and epidemiologic data and how these data impact the risk assessment. CDC will continue to work closely with the Chinese Center for Disease Control and Prevention to support the response to this epidemic. Guidance for U.S. clinicians who might be evaluating patients with possible H7N9 virus infection and travelers to China is available online (https://www.cdc.gov/flu/avianflu/h7n9-virus.htm).

Early Release / Vol. 66 March 3, 2017 U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report Increase in Human Infections with Avian Influenza A(H7N9) Virus During the Fifth Epidemic — China, October 2016–February 2017 A. Danielle Iuliano, PhD1; Yunho Jang, PhD1; Joyce Jones, MS1; C. Todd Davis, PhD1; David E. Wentworth, PhD1; Timothy M. Uyeki, MD1; Katherine Roguski, MPH1; Mark G. Thompson, PhD1; Larisa Gubareva, PhD1; Alicia M. Fry, MD1; Erin Burns, MA1; Susan Trock, DVM1; Suizan Zhou, MPH2; Jacqueline M. Katz, PhD1; Daniel B. Jernigan, MD1 https://www.cdc.gov/mmwr/volumes/66/wr/mm6609e2.htm?s_cid=mm6609e2_w

Isolate detail Isolate name: A/Anhui/60935/2016 Isolate ID: EPI_ISL_242898 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-12-19 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Anhui Patient age: 37 Year(s) Gender: Female Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Wang,Dayan; Zhou,Shumei; Li,Xiyan; Li,Xiaodan; Zhang,Ye; Bo,Hong; Shu,Yuelong Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A_ANHUI_60935_2016_DEC-PB2 2280 EPI888057 PB1 A_ANHUI_60935_2016_DEC-PB1 2274 EPI888058 PA A_ANHUI_60935_2016_DEC-PA 2151 EPI888056 HA A_ANHUI_60935_2016_DEC-HA 1683 EPI888060 NP A_ANHUI_60935_2016_DEC-NP 1497 EPI888053 NA A_ANHUI_60935_2016_DEC-NA 1398 EPI888059 MP A_ANHUI_60935_2016_DEC-MP 982 EPI888055 NS A_ANHUI_60935_2016_DEC-NS 838 EPI888054 Submitter information Submitter: Yang, Lei Submission Date: 2017-01-25 Last modifier: Yang, Lei Last modified: 2017-01-25 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Jiangsu/60452/2016 Isolate ID: EPI_ISL_242899 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-12-19 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Jiangsu Patient age: 46 Year(s) Gender: Female Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Wang,Dayan; Zhou,Shumei; Li,Xiyan; Li,Xiaodan; Zhang,Ye; Bo,Hong; Shu,Yuelong Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A_JIANGSU_60452_2016_DEC-PB2 2280 EPI888065 PB1 A_JIANGSU_60452_2016_DEC-PB1 2274 EPI888066 PA A_JIANGSU_60452_2016_DEC-PA 2151 EPI888064 HA A_JIANGSU_60452_2016_DEC-HA 1683 EPI888068 NP A_JIANGSU_60452_2016_DEC-NP 1497 EPI888061 NA A_JIANGSU_60452_2016_DEC-NA 1398 EPI888067 MP A_JIANGSU_60452_2016_DEC-MP 982 EPI888063 NS A_JIANGSU_60452_2016_DEC-NS 838 EPI888062 Submitter information Submitter: Yang, Lei Submission Date: 2017-01-25 Last modifier: Yang, Lei Last modified: 2017-01-25 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Anhui/60926/2016 Isolate ID: EPI_ISL_242900 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-12-21 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Anhui Patient age: 66 Year(s) Gender: Female Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Wang,Dayan; Zhou,Shumei; Li,Xiyan; Li,Xiaodan; Zhang,Ye; Bo,Hong; Shu,Yuelong Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A_ANHUI_60926_2016_DEC-PB2 2280 EPI888073 PB1 A_ANHUI_60926_2016_DEC-PB1 2274 EPI888074 PA A_ANHUI_60926_2016_DEC-PA 2151 EPI888072 HA A_ANHUI_60926_2016_DEC-HA 1683 EPI888076 NP A_ANHUI_60926_2016_DEC-NP 1497 EPI888069 NA A_ANHUI_60926_2016_DEC-NA 1398 EPI888075 MP A_ANHUI_60926_2016_DEC-MP 982 EPI888071 NS A_ANHUI_60926_2016_DEC-NS 838 EPI888070 Submitter information Submitter: Yang, Lei Submission Date: 2017-01-25 Last modifier: Yang, Lei Last modified: 2017-01-25 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Fujian/54840/2016 Isolate ID: EPI_ISL_242901 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-11-16 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Fujian Patient age: 60 Year(s) Gender: Male Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Wang,Dayan; Zhou,Shumei; Li,Xiyan; Li,Xiaodan; Zhang,Ye; Bo,Hong; Shu,Yuelong Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A_FUJIAN_54840_2016_NOV-PB2 2280 EPI888081 PB1 A_FUJIAN_54840_2016_NOV-PB1 2274 EPI888082 PA A_FUJIAN_54840_2016_NOV-PA 2151 EPI888080 HA A_FUJIAN_54840_2016_NOV-HA 1683 EPI888084 NP A_FUJIAN_54840_2016_NOV-NP 1497 EPI888077 NA A_FUJIAN_54840_2016_NOV-NA 1398 EPI888083 MP A_FUJIAN_54840_2016_NOV-MP 982 EPI888079 NS A_FUJIAN_54840_2016_NOV-NS 838 EPI888078 Submitter information Submitter: Yang, Lei Submission Date: 2017-01-25 Last modifier: Yang, Lei Last modified: 2017-01-25 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Guangdong/17SF006/2017 Isolate ID: EPI_ISL_249308 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2017-01-12 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Guangdong Patient age: 57 Year(s) Gender: Male Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A/Guangdong/17SF006/2017-PB2 2280 EPI919596 PB1 A/Guangdong/17SF006/2017-PB1 2274 EPI919597 PA A/Guangdong/17SF006/2017-PA 2151 EPI919595 HA A/Guangdong/17SF006/2017-HA 1695 EPI919599 NP A/Guangdong/17SF006/2017-NP 1497 EPI919592 NA A/Guangdong/17SF006/2017-NA 1398 EPI919598 MP A/Guangdong/17SF006/2017-MP 982 EPI919594 NS A/Guangdong/17SF006/2017-NS 838 EPI919593 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-21 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Guangdong/17SF003/2016 Isolate ID: EPI_ISL_249309 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2017-01-03 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Guangdong Patient age: 43 Year(s) Gender: Female Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A/Guangdong/17SF003/2016-PB2 2280 EPI919604 PB1 A/Guangdong/17SF003/2016-PB1 2274 EPI919605 PA A/Guangdong/17SF003/2016-PA 2151 EPI919603 HA A/Guangdong/17SF003/2016-HA 1695 EPI919607 NP A/Guangdong/17SF003/2016-NP 1497 EPI919600 NA A/Guangdong/17SF003/2016-NA 1398 EPI919606 MP A/Guangdong/17SF003/2016-MP 982 EPI919602 NS A/Guangdong/17SF003/2016-NS 838 EPI919601 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-21 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Guangdong/17SF003/2016 Isolate ID: EPI_ISL_249309 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2017-01-03 Host Human Additional host information: Zip code: Patient status: Last vaccinated: In-vivo pathogenicity test: Location: China Additional location information: Guangdong Patient age: 43 Year(s) Gender: Female Outbreak: Treatment: Specimen source: Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A/Guangdong/17SF003/2016-PB2 2280 EPI919604 PB1 A/Guangdong/17SF003/2016-PB1 2274 EPI919605 PA A/Guangdong/17SF003/2016-PA 2151 EPI919603 HA A/Guangdong/17SF003/2016-HA 1695 EPI919607 NP A/Guangdong/17SF003/2016-NP 1497 EPI919600 NA A/Guangdong/17SF003/2016-NA 1398 EPI919606 MP A/Guangdong/17SF003/2016-MP 982 EPI919602 NS A/Guangdong/17SF003/2016-NS 838 EPI919601 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-21 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Environment/Guangdong/C16283222/2016 Isolate ID: EPI_ISL_249310 Passage details/history: E1 Type: A / H7N9 Lineage: Sample information Collection date: 2016-11-07 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence PB2 A/Environment/Guangdong/C16283222/2016-PB2 2280 EPI919612 PB1 A/Environment/Guangdong/C16283222/2016-PB1 2274 EPI919613 PA A/Environment/Guangdong/C16283222/2016-PA 2151 EPI919611 HA A/Environment/Guangdong/C16283222/2016-HA 1695 EPI919615 NP A/Environment/Guangdong/C16283222/2016-NP 1497 EPI919608 NA A/Environment/Guangdong/C16283222/2016-NA 1398 EPI919614 MP A/Environment/Guangdong/C16283222/2016-MP 982 EPI919610 NS A/Environment/Guangdong/C16283222/2016-NS 838 EPI919609 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Environment/Guangdong/KGZ4075/2016(H7,H9,N2,N9) Isolate ID: EPI_ISL_249311 Passage details/history: E1 Type: A Lineage: Sample information Collection date: 2016-12-12 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence HA A/Environment/Guangdong/KGZ4075/2016-HA 1695 EPI919617 NA A/Environment/Guangdong/KGZ4075/2016-NA 1398 EPI919616 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Environment/Guangdong/KGZ4068/2016(H7,H9,N2,N9) Isolate ID: EPI_ISL_249312 Passage details/history: E1 Type: A Lineage: Sample information Collection date: 2016-12-12 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence HA A/Environment/Guangdong/KGZ4068/2016-HA 1695 EPI919619 NA A/Environment/Guangdong/KGZ4068/2016-NA 1398 EPI919618 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Environment/Guangdong/KGZ4048/2016(H7,H9,N2,N9) Isolate ID: EPI_ISL_249313 Passage details/history: E1 Type: A Lineage: Sample information Collection date: 2016-12-12 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence HA A/Environment/Guangdong/KGZ4048/2016-HA 1695 EPI919621 NA A/Environment/Guangdong/KGZ4048/2016-NA 1398 EPI919620 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Environment/Guangdong/C16283277/2016(H7,H9,N2,N9) Isolate ID: EPI_ISL_249314 Passage details/history: E1 Type: A Lineage: Sample information Collection date: 2016-12-07 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence HA A/Environment/Guangdong/C16283277/2016-HA 1695 EPI919623 NA A/Environment/Guangdong/C16283277/2016-NA 1398 EPI919622 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate detail Isolate name: A/Environment/Guangdong/C16283219/2016(H7,H9,N2,N9) Isolate ID: EPI_ISL_249315 Passage details/history: E1 Type: A Lineage: Sample information Collection date: 2016-11-02 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence HA A/Environment/Guangdong/C16283219/2016-HA 1695 EPI919625 NA A/Environment/Guangdong/C16283219/2016-NA 1398 EPI919624 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

Isolate name: A/Environment/Guangdong/C162811110/2016(H7,H9,N2,N9) Isolate ID: EPI_ISL_249316 Passage details/history: E1 Type: A Lineage: Sample information Collection date: 2016-11-07 Host Environment Additional host information: Location: China Additional location information: Guangdong Institute information Originating lab: Sample ID given by the sample provider: Address: Submitting lab: WHO Chinese National Influenza Center Sample ID given by the submitting laboratory: Authors: Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China Publication Publication In vivo antiviral resistance Phenotype Genotype Unspecified Antiviral resistance tested by experimental procedures Adamantanes: Unknown Oseltamivir: Unknown Zanamivir: Unknown Peramivir: Unknown Other: Unknown Additional information Antigenic characterization: Note: Sequence segment identifier length accession # INSDC Sequence HA A/Environment/Guangdong/C162811110/2016-HA 1695 EPI919627 NA A/Environment/Guangdong/C162811110/2016-NA 1398 EPI919626 Submitter information Submitter: Yang, Lei Submission Date: 2017-02-20 Last modifier: Yang, Lei Last modified: 2017-02-20 Address: WHO Chinese National Influenza Center Virology Institute, Chinese CDC 155 Changbai Road, Changping District, Beijing 102206 China

All of the above sequences were submitted to GISAID by the WHO influenza Center in Beijing. The first sequences (7 environmental and 2 human) have an HA size of 1695 (due to the polybasic cleavage site created by the insertion of 12 nucleotides). The next 60 sequence are human low path with an HA size of 1683. These sequences were from samples collected in late 2016 (Nov & Dec) and early 2017 (Jan). This sequences were made public prior to the WHO pressor on March 1.