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Zhou X, Gao L, Wang Y, Li Y, Zhang Y, Shen C, Liu A, Yu Q, Zhang W, Pekin A, Guo F, Smith C, Clements ACA, Edwards J, Huang B, Soares Magalhães RJ. Geographical variation in the risk of H7N9 human infections in China: implications for risk-based surveillance. Sci Rep 2020; 10:10372. [PMID: 32587266 PMCID: PMC7316858 DOI: 10.1038/s41598-020-66359-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 04/23/2020] [Indexed: 11/09/2022] Open
Abstract
The influenza A (H7N9) subtype remains a public health problem in China affecting individuals in contact with live poultry, particularly at live bird markets. Despite enhanced surveillance and biosecurity at LBMs H7N9 viruses are now more widespread in China. This study aims to quantify the temporal relationship between poultry surveillance results and the onset of human H7N9 infections during 2013-2017 and to estimate risk factors associated with geographical risk of H7N9 human infections in counties in Southeast China. Our results suggest that poultry surveillance data can potentially be used as early warning indicators for human H7N9 notifications. Furthermore, we found that human H7N9 incidence at county-level was significantly associated with the presence of wholesale LBMs, the density of retail LBMs, the presence of poultry virological positives, poultry movements from high-risk areas, as well as chicken population density and human population density. The results of this study can influence the current AI H7N9 control program by supporting the integration of poultry surveillance data with human H7N9 notifications as an early warning of the timing and areas at risk for human infection. The findings also highlight areas in China where monitoring of poultry movement and poultry infections could be prioritized.
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Affiliation(s)
- Xiaoyan Zhou
- School of Veterinary Science, The University of Queensland, Brisbane, Australia.
| | - Lu Gao
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China
| | - Youming Wang
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China
| | - Yin Li
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China.,School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Australia
| | - Yi Zhang
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China
| | - Chaojian Shen
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China
| | - Ailing Liu
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China
| | - Qi Yu
- Beijing Center for Animal Disease Prevention and Control, Beijing, PR China
| | - Wenyi Zhang
- Institute of Disease Control and Prevention, Academy of Military Medical Science, Beijing, PR China
| | - Alexander Pekin
- School of Veterinary Science, The University of Queensland, Brisbane, Australia
| | - Fusheng Guo
- Food and Agriculture Organization of the United Nations (FAO), Bangkok, Thailand
| | - Carl Smith
- School of Business, The University of Queensland, Brisbane, Australia
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - John Edwards
- School of Veterinary Science, The University of Queensland, Brisbane, Australia.,China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China.,School of Veterinary and Biomedical Sciences, Murdoch University, Perth, Australia
| | - Baoxu Huang
- China Animal Health and Epidemiology Centre, Ministry of Agriculture and Rural Affairs, Qingdao, PR China.
| | - Ricardo J Soares Magalhães
- School of Veterinary Science, The University of Queensland, Brisbane, Australia.,Child Health Research Centre, The University of Queensland, Brisbane, Australia
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2
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Zhou X, Zhang Y, Shen C, Liu A, Wang Y, Yu Q, Guo F, Clements ACA, Smith C, Edwards J, Huang B, Soares Magalhães RJ. Knowledge, attitudes, and practices associated with avian influenza along the live chicken market chains in Eastern China: A cross-sectional survey in Shanghai, Anhui, and Jiangsu. Transbound Emerg Dis 2019; 66:1529-1538. [PMID: 30891947 DOI: 10.1111/tbed.13178] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/11/2019] [Accepted: 03/09/2019] [Indexed: 12/01/2022]
Abstract
The avian influenza (AI) virus of the H7N9 subtype emerged in China in 2013. Live bird markets (LBMs) selling live meat chickens were indicated to present a high-risk of the virus dissemination. This study aimed to quantify the level of knowledge, attitudes, and practices (KAP) on AI and to measure the associated risk factors among different actors along the live chicken market chain within H7N9-affected Eastern provinces in China. A cross-sectional survey was conducted in these provinces from June to July 2014. Structured questionnaires about KAP on AI were delivered to chicken farmers, chicken vendors, and consumers in LBMs. Multivariable generalized least squares regression models were developed to identify predictors of KAP scores among different actors. Our results indicate that KAP scores of chicken farmers were generally higher than those of chicken vendors. Chicken farmers who worked for more than 15 years had significantly lower total KAP scores than those who worked for less than 6 years. Chicken farmers who worked more than 15 hrs in a day had significantly lower attitude scores than those who worked less than 6 hrs. For chicken vendors, females and individuals > 35 years old had significantly lower knowledge scores compared to the reference categories. Practice scores were significantly higher in female vendors and those vendors who also conducted slaughter compared to males and vendors who did not conduct slaughter. Consumers who bought chicken at least once every month had better risk awareness compared to those who bought chicken at least once every week. In addition, female consumers had significantly better practice scores than male consumers. In conclusion, risk-based health promotion interventions should be developed and implemented by animal health agencies (targeting farmers and vendors) and public health agencies (targeting frequent and male consumers) to prevent transmission of H7N9 along the market chain in China.
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Affiliation(s)
- Xiaoyan Zhou
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia
| | - Yi Zhang
- Department of Epidemiology Survey, China Animal Health and Epidemiology Centre, Ministry of Agriculture, Qingdao, PR China
| | - Chaojian Shen
- Department of Epidemiology Survey, China Animal Health and Epidemiology Centre, Ministry of Agriculture, Qingdao, PR China
| | - Ailing Liu
- Department of Epidemiology Survey, China Animal Health and Epidemiology Centre, Ministry of Agriculture, Qingdao, PR China
| | - Youming Wang
- Department of Epidemiology Survey, China Animal Health and Epidemiology Centre, Ministry of Agriculture, Qingdao, PR China
| | - Qi Yu
- Beijing Centre for Animal Disease Prevention and Control, Beijing, PR China
| | - Fusheng Guo
- Food and Agriculture Organization of the United Nations (FAO), Bangkok, Thailand
| | - Archie C A Clements
- Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Carl Smith
- School of Business, The University of Queensland, Brisbane, Queensland, Australia
| | - John Edwards
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia.,Department of Epidemiology Survey, China Animal Health and Epidemiology Centre, Ministry of Agriculture, Qingdao, PR China.,School of Veterinary and Life Sciences, Murdoch University, Murdoch, Western Australia, Australia
| | - Baoxu Huang
- Department of Epidemiology Survey, China Animal Health and Epidemiology Centre, Ministry of Agriculture, Qingdao, PR China
| | - Ricardo J Soares Magalhães
- School of Veterinary Science, University of Queensland, Gatton, Queensland, Australia.,UQ Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
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3
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Ge E, Zhang R, Li D, Wei X, Wang X, Lai PC. Estimating Risks of Inapparent Avian Exposure for Human Infection: Avian Influenza Virus A (H7N9) in Zhejiang Province, China. Sci Rep 2017; 7:40016. [PMID: 28054599 PMCID: PMC5214706 DOI: 10.1038/srep40016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 11/09/2016] [Indexed: 11/09/2022] Open
Abstract
Inapparent avian exposure was suspected for the sporadic infection of avian influenza A(H7N9) occurring in China. This type of exposure is usually unnoticed and difficult to model and measure. Infected poultry with avian influenza H7N9 virus typically remains asymptomatic, which may facilitate infection through inapparent poultry/bird exposure, especially in a country with widespread practice of backyard poultry. The present study proposed a novel approach that integrated ecological and case-control methods to quantify the risk of inapparent avian exposure on human H7N9 infection. Significant associations of the infection with chicken and goose densities, but not with duck density, were identified after adjusting for spatial clustering effects of the H7N9 cases across multiple geographic scales of neighborhood, community, district and city levels. These exposure risks varied geographically in association with proximity to rivers and lakes that were also proxies for inapparent exposure to avian-related environment. Males, elderly people, and farmers were high-risk subgroups for the virus infection. These findings enable health officials to target educational programs and awareness training in specific locations to reduce the risks of inapparent exposure.
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Affiliation(s)
- Erjia Ge
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Renjie Zhang
- Zhejiang Provincial Center for Disease Prevention &Control, Hangzhou, P.R. China
| | - Dengkui Li
- School of Mathematics &Statistics, Xi'an Jiaotong University, Xi'an, P.R. China
| | - Xiaolin Wei
- Division of Clinical Public Health and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Xiaomeng Wang
- Zhejiang Provincial Center for Disease Prevention &Control, Hangzhou, P.R. China
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BETHMONT A, BUI CM, GARDNER L, SARKAR S, CHUGHTAI AA, MACINTYRE CR. Quantified degree of poultry exposure differs for human cases of avian influenza H5N1 and H7N9. Epidemiol Infect 2016; 144:2633-40. [PMID: 27267621 PMCID: PMC9150466 DOI: 10.1017/s0950268816001035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 04/01/2016] [Accepted: 04/29/2016] [Indexed: 11/06/2022] Open
Abstract
Preliminary evidence suggests that direct poultry contact may play a lesser role in transmission of avian influenza A(H7N9) than A(H5N1) to humans. To better understand differences in risk factors, we quantified the degree of poultry contact reported by H5N1 and H7N9 World Health Organization-confirmed cases. We used publicly available data to classify cases by their degree of poultry contact, including direct and indirect. To account for potential data limitations, we used two methods: (1) case population method in which all cases were classified using a range of sources; and (2) case subset method in which only cases with detailed contact information from published research literature were classified. In the case population, detailed exposure information was unavailable for a large proportion of cases (H5N1, 54%; H7N9, 86%). In the case subset, direct contact proportions were higher in H5N1 cases (70·3%) than H7N9 cases (40·0%) (χ 2 = 18·5, P < 0·001), and indirect contact proportions were higher in H7N9 cases (44·6%) than H5N1 cases (19·4%) (χ 2 = 15·5, P < 0·001). Together with emerging evidence, our descriptive analysis suggests direct poultry contact is a clearer risk factor for H5N1 than for H7N9, and that other risk factors should also be considered for H7N9.
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Affiliation(s)
- A. BETHMONT
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C. M. BUI
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - L. GARDNER
- School of Civil and Environmental Engineering, University of New South Wales, Sydney, NSW, Australia
| | - S. SARKAR
- Section of Integrative Biology, University of Texas, Austin, TX, USA
| | - A. A. CHUGHTAI
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - C. R. MACINTYRE
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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5
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Zhou X, Li Y, Wang Y, Edwards J, Guo F, Clements AC, Huang B, Soares Magalhaes RJ. The role of live poultry movement and live bird market biosecurity in the epidemiology of influenza A (H7N9): A cross-sectional observational study in four eastern China provinces. J Infect 2015; 71:470-9. [DOI: 10.1016/j.jinf.2015.06.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 05/25/2015] [Accepted: 06/27/2015] [Indexed: 12/09/2022]
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Gautret P, Gray GC, Charrel RN, Odezulu NG, Al-Tawfiq JA, Zumla A, Memish ZA. Emerging viral respiratory tract infections--environmental risk factors and transmission. THE LANCET. INFECTIOUS DISEASES 2014; 14:1113-1122. [PMID: 25189350 PMCID: PMC7106556 DOI: 10.1016/s1473-3099(14)70831-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The past decade has seen the emergence of several novel viruses that cause respiratory tract infections in human beings, including Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia, an H7N9 influenza A virus in eastern China, a swine-like influenza H3N2 variant virus in the USA, and a human adenovirus 14p1 also in the USA. MERS-CoV and H7N9 viruses are still a major worldwide public health concern. The pathogenesis and mode of transmission of MERS-CoV and H7N9 influenza A virus are poorly understood, making it more difficult to implement intervention and preventive measures. A united and coordinated global response is needed to tackle emerging viruses that can cause fatal respiratory tract infections and to fill major gaps in the understanding of the epidemiology and transmission dynamics of these viruses.
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Affiliation(s)
- Philippe Gautret
- Assistance Publique Hôpitaux de Marseille, CHU Nord, Pôle Infectieux, Institut Hospitalo-Universitaire Méditerranée Infection, Marseille, France; Aix Marseille Université, Unité de Recherche en Maladies Infectieuses et Tropicales Emergentes (URMITE), Faculté de Médecine, Marseille, France.
| | - Gregory C Gray
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Remi N Charrel
- Aix Marseille Université, IRD French Institute of Research for Development, EHESP French School of Public Health, EPV UMR-D 190 "Emergence des Pathologies Virales" and IHU Méditerranée Infection, APHM Public Hospitals of Marseille, Marseille, France
| | - Nnanyelugo G Odezulu
- College of Public Health and Health Professions and Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Jaffar A Al-Tawfiq
- Johns Hopkins Aramco Healthcare, and Indiana University School of Medicine, Indiana, USA
| | - Alimuddin Zumla
- Center for Clinical Microbiology, Division of Infection and Immunity, University College London, and NIHR Biomedical Research Center, University College London Hospitals, London, UK
| | - Ziad A Memish
- WHO Collaborating Center for Mass Gathering Medicine Ministry of Health and Al-Faisal University, Riyadh, Saudi Arabia
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Paul MC, Gilbert M, Desvaux S, Rasamoelina Andriamanivo H, Peyre M, Khong NV, Thanapongtharm W, Chevalier V. Agro-environmental determinants of avian influenza circulation: a multisite study in Thailand, Vietnam and Madagascar. PLoS One 2014; 9:e101958. [PMID: 25029441 PMCID: PMC4100877 DOI: 10.1371/journal.pone.0101958] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/12/2014] [Indexed: 11/18/2022] Open
Abstract
Outbreaks of highly pathogenic avian influenza have occurred and have been studied in a variety of ecological systems. However, differences in the spatial resolution, geographical extent, units of analysis and risk factors examined in these studies prevent their quantitative comparison. This study aimed to develop a high-resolution, comparative study of a common set of agro-environmental determinants of avian influenza viruses (AIV) in domestic poultry in four different environments: (1) lower-Northern Thailand, where H5N1 circulated in 2004-2005, (2) the Red River Delta in Vietnam, where H5N1 is circulating widely, (3) the Vietnam highlands, where sporadic H5N1 outbreaks have occurred, and (4) the Lake Alaotra region in Madagascar, which features remarkable similarities with Asian agro-ecosystems and where low pathogenic avian influenza viruses have been found. We analyzed H5N1 outbreak data in Thailand in parallel with serological data collected on the H5 subtype in Vietnam and on low pathogenic AIV in Madagascar. Several agro-environmental covariates were examined: poultry densities, landscape dominated by rice cultivation, proximity to a water body or major road, and human population density. Relationships between covariates and AIV circulation were explored using spatial generalized linear models. We found that AIV prevalence was negatively associated with distance to the closest water body in the Red River Delta, Vietnam highlands and Madagascar. We also found a positive association between AIV and duck density in the Vietnam highlands and Thailand, and with rice landscapes in Thailand and Madagascar. Our findings confirm the important role of wetlands-rice-ducks ecosystems in the epidemiology of AI in diverse settings. Variables influencing circulation of the H5 subtype in Southeast Asia played a similar role for low pathogenic AIV in Madagascar, indicating that this area may be at risk if a highly virulent strain is introduced.
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Affiliation(s)
- Mathilde C. Paul
- Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), UR AGIRs, Montpellier, France
- Université de Toulouse, INP-ENVT, UMR ENVT INRA 1225 IHAP, Toulouse, France
- * E-mail:
| | - Marius Gilbert
- Biological Control and Spatial Ecology, Université Libre de Bruxelles, Brussels, Belgium
- Fonds National de la Recherche Scientifique, Brussels, Belgium
| | - Stéphanie Desvaux
- Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), UR AGIRs, Montpellier, France
- Direction Régionale de l’Alimentation, de l’Agriculture et de la Forêt de Languedoc- Roussillon, Montpellier, France
| | | | - Marisa Peyre
- Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), UR AGIRs, Montpellier, France
| | | | | | - Véronique Chevalier
- Centre de coopération internationale en recherche agronomique pour le développement (CIRAD), UR AGIRs, Montpellier, France
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