Avian Influenza Weekly Update Number 909 | 1 Avian Influenza Weekly Update Number 909 18 August 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 17 August 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The last cases in the Western Pacific Region were reported from Cambodia on 23 and 24 February 2023. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 17 August 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 2 1 3 1 244 136 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 17 August, 878 cases of human infection with avian influenza A(H5N1) virus were reported from 23 countries. Of these 878 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. The last case was reported from Guilin city, Guangxi province, China, with an onset date of 3 July 2023. To date, a total of 86 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths (CFR 38 %) have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 909 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. The last case was reported from China with an onset of illness of 22 February 2023. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus, including 616 fatal cases (CFR: 39%), have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases related to the HPAI A(H7N9) virus has been detected. Human infection with avian influenza A(H9N2) virus Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H9N2) virus were reported to WHO in the Western Pacific Region. The last case was reported from China with an onset date of 22 June 2023. To date, a total of 90 cases of human infection with avian influenza A(H9N2), Avian Influenza Weekly Update Number 909 | 3 including two deaths (both with underlying conditions), have been reported to WHO in the Western Pacific Region since December 2015. Of these, 88 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 22 June 2023 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 11 August and 17 August 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang, China with an onset date of 11 June 2022. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently, available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 11 August and 17 August 2023, no new outbreak of highly pathogenic avian influenza among animals were notified to the World Organization for Animal Health (WOAH) from the Western Pacific Region. For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment 14 July 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022 • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2023-2024 northern hemisphere influenza season 24 February 2023 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance 20 September 2020
Avian Influenza Weekly Update Number 877 | 1 Avian Influenza Weekly Update Number 877 06 January 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 23 December 2022 and 5 January 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 5 January 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 5 January 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source). Human infection with avian influenza A(H5N6) virus Between 23 December 2022 and 5 January 2023, one new case of human infection with avian influenza A(H5N6) virus was notified to WHO in the Western Pacific Region. The case is a 54-year-old male from Changsa, Hunan Province. Illness onset was on 2 November 2022 and the case was hospitalized on 5 November 2022 and in a critical condition at the time of reporting with pneumonia. No source of exposure to the virus has been identified at the time of reporting. No family members have developed symptoms at the time of reporting. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 23 December 2022 and 5 January 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 877 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in numbers of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends Member States to remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 23 December 2022 and 5 January 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory- confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 23 December 2022 and 5 January 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory- confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between23 December 2022 and 5 January 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory- confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection Avian Influenza Weekly Update Number 877 | 3 may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behaviour to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 23 December 2022 and 5 January 2023, three new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. The first case is a 58-year-old male farmer from Wugang, Hunan province with onset of illness on 19 October 2022. At the time of reporting, the symptoms were severe, and the case was hospitalized on 19 October 2022. The case had exposure to live poultry market. There have been no reported cases in the rest of the family. The second case is a 5-year-old female from Dingxi, Gansu Province with onset of illness on 23 October 2022. At the time of reporting, the symptoms were reported to be mild. The source of exposure to the virus remains unknown. There have been no reported cases in the rest of the family. The third case is a 3-year-old male from Hainan, Anhui Province with onset of illness on 13 November 2022. At the time of reporting, the symptoms were reported to be mild. The case had exposure to live poultry market. There have been no reported cases in the rest of the family. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 20 September 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 23 December 2022 and 5 January 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 23 December 2022 and 5 January 2023, there has been one new outbreak of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 23 December 2022 highly pathogenic avian influenza H5 (N untyped) was detected in an Eastern Buzzard (WILD) in Seiro Town, Niigata, Japan. Surveillance was initiated within and outside of the restriction zone and official disposal of carcasses (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: Avian Influenza Weekly Update Number 877 | 4 • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 11 November 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022
Avian Influenza Weekly Update Number 878 | 1 Avian Influenza Weekly Update Number 878 13 January 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 6 January and 12 January 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 12 January 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 12 January 2023 ), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 6 January 2023 12 January 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 6 January and 12 January 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in numbers of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the Avian Influenza Weekly Update Number 878 | 2 viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends Member States to remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 6 January and 12 January 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 6 January and 12 January 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between6 January and 12 January 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behaviour to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 878 | 3 Human infection with avian influenza A(H9N2) virus Between 6 January and 12 January 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 6 January and 12 January 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 6 January and 12 January 2023, there have been seven new outbreaks of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 10 January 2023, 4 outbreaks of highly pathogenic avian influenza A(H5N1) were reported in Japan with Two events in Sera town, Hiroshima Prefecture; and one event each in Sayama-City in Saitama Prefecture and Maebashi-City in Gunma Prefecture. There was a total number of 122 cases, 115 deaths, and 546,885 domestic birds killed and disposed of (Source). On 11 January 2023, 3 outbreaks of highly pathogenic avian influenza A(H5N1) were reported in Japan with one event each in Asahi city, Chiba Prefecture; Koga-City in Fukuoka Prefecture; and Murakami-City in Niigata Prefecture. There was a total number of 65 cases, 65 deaths and 1,297,960 domestic birds killed and disposed of (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. Avian Influenza Weekly Update Number 878 | 4 • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020 •
Avian Influenza Weekly Update Number 879 | 1 Avian Influenza Weekly Update Number 879 20 January 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 19 January 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 19 January 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 13 January 2023 19 January 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in numbers of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the Avian Influenza Weekly Update Number 879 | 2 viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends Member States to remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behaviour to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Avian Influenza Weekly Update Number 879 | 3 Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 13 January to 19 January 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 13 January to 19 January 2023, there have been new outbreaks of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 18 January 2023, 28 new outbreaks of highly pathogenic avian influenza A(H5N1) were reported in the Philippines in areas that had outbreaks in 2022. The locations of these outbreaks include: Aurora, Batangas, Benguet, Bulacan, Danuman West, Ilocos Norte, Ilocos Sur, Isabela, Kalinga, Pampanga,Therewas a total of 37268 cases, 37179 deaths and 261721 birds were killed and disposed of (Source). On 18 January 2023 1 new outbreak of highly pathogenic avian influenza A(H5N1) weas reported in Philippines. There was a total of 168 cases, 163 deaths and 225 birds were killed and disposed of. The outbreak began on 25 November 2022 and occurred in a farm in Roxas City, Capiz (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. Avian Influenza Weekly Update Number 879 | 4 • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 880 | 1 Avian Influenza Weekly Update Number 880 27 January 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 20 January to 26 January 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 26 January 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 26 January 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 20 January to 26 January 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 20 January to 26 January2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in numbers of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the Avian Influenza Weekly Update Number 880 | 2 viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends Member States to remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 20 January to 26 January 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 20 January to 26 January 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between20 January to 26 January 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behaviour to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 880 | 3 Human infection with avian influenza A(H9N2) virus Between 20 January to 26 January 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 20 January to 26 January 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. The last case was reported from Zhejiang -China with onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 20 January to 26 January 2023, there have been several new outbreaks of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 20 January 2023, 1 new outbreak of high pathogenic avian influenza A(H5N2) was reported in Japan in Saiki city. There were 160 cases and 160 deaths in domestic birds and 55240 birds were killed and disposed (Source) On 23 January 2023, 49 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Izumi city. There were 171 cases and 171 deaths in wild birds species (Source) On 23 January 2023, 5 new outbreaks of high pathogenic avian influenza A(H5 (N untyped)) were reported in Japan in the following cities; Itoshima, Sapporo, Tottori, Natori, Ichinoseki and Seiro town. There were 6 cases and 6 deaths in wild bird species (Source). On 24 January 2023, 5 new outbreak of high pathogenic avian influenza A(H5 (N untyped)) were reported in Japan in the following cities; Miyashiro, Tateyama, Fukuoka, Sapporo, Tottori, Natori, Ichinoseki and Seiro town. There were the total of 6 cases and 6 deaths in wild bird species (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Avian Influenza Weekly Update Number 880 | 4 Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 881 | 1 Avian Influenza Weekly Update Number 881 3 February 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 2 February 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 2 February 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in numbers of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the Avian Influenza Weekly Update Number 881 | 2 viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends Member States to remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between27 January to 2 February 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 881 | 3 Human infection with avian influenza A(H9N2) virus Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 27 January to 2 February 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. The last case was reported from Zhejiang -China with onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 27 January to 2 February 2023, there have been several new outbreaks of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 27 January 2023, 7 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in 4 cities; Otsu-City 1, Sousa-City1, Sera-Town 5, Maebashi-city 2, there were total of 49 cases and 34 deaths in domestic birds and 716416 bird were killed and disposed (Source). . For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 Avian Influenza Weekly Update Number 881 | 4 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 882 | 1 Avian Influenza Weekly Update Number 882 10 February 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 9 February 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 2 February 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the Avian Influenza Weekly Update Number 882 | 2 response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 882 | 3 Human infection with avian influenza A(H9N2) virus Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 3 February and 9 February 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 3 February and 9 February 2023, there have been several new outbreaks of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 6 February 2023, 6 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in 5 cities: Otsu, Sosa, Kakuda, Maebashi and Gyoda. There were 260 cases and 260 deaths reported in domestic birds and 541212 were killed and disposed (Source). On 6 February 2023, 28 new outbreaks were reported in Japan in 23 cities (Takamatsu, Hanamatsu, Tatebayashi, Myashiro, Iwata, Ryugasaki, Hanamaki, Okayama, Sendai, Shibecha, Hamatonbetsu, Abashiri, Tadotsu, Otawara, Hakodate, Kushiro, Atsuma, Nanae, Toyama, Isahaya, Shari, Kesennuma, Urahoro). There was a total of 30 cases and 31 deaths in wild birds (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 Avian Influenza Weekly Update Number 882 | 4 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 883 | 1 Avian Influenza Weekly Update Number 883 17 February 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 16 February 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 2 February 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 Total C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 240 135 Globally, from January 2003 to 25 November 2022, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from Avian Influenza Weekly Update Number 883 | 2 the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory- confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory- confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory- confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 883 | 3 Human infection with avian influenza A(H9N2) virus Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 10 February and 16 February 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. The last case was reported from Zhejiang -China with onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 10 February and 16 February 2023, there have been several new outbreaks of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 14 February 2023, 1 new outbreaks of high pathogenic avian influenza A(H5N5) were reported in Chinese Taipei. There was a total of 2,000 cases, 1,150 deaths and 1,324 birds were killed and disposed of. The outbreak began on 12 January 2023 and occurred in a goose farm in Chiayi County (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 Avian Influenza Weekly Update Number 883 | 4 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 884 | 1 Avian Influenza Weekly Update Number 884 24 February 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 23 February 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China since 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 23 February 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 240 135 Globally, from January 2003 to 26 January 2023, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 83 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome from Avian Influenza Weekly Update Number 884 | 2 the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory- confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory- confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory- confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 884 | 3 Human infection with avian influenza A(H9N2) virus Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 82 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 80 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 13 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 17 February and 23 February 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus has been reported globally. The last case was reported from Zhejiang -China with onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among human is low. Animal infection with avian influenza virus Between 17 February and 23 February 2023, there has been no new outbreak of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 Avian Influenza Weekly Update Number 884 | 4 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 885 | 1 Avian Influenza Weekly Update Number 885 3 March 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 24 February to 2 March 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 26 January 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. This is the first case of avian influenza A(H5N1) reported from China in 2015. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 26 January 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 240 135 Globally, from January 2003 to 26 January 2023, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source). Human infection with avian influenza A(H5N6) virus Between 24 February to 2 March 2023, one case of human infection with avian influenza A(H5N6) virus was notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 24 February to 2 March 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the Avian Influenza Weekly Update Number 885 | 2 response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 24 February to 2 March 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 24 February to 2 March 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 24 February to 2 March 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 885 | 3 Human infection with avian influenza A(H9N2) virus Between 24 February to 2 March 2023, two cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 84 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 82 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 15 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 24 February to 2 March 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 24 February to 2 March 2023, there has been one outbreak of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 2 March 2023, one new outbreak of high pathogenic avian influenza A(H5N1) were reported in Lunbei Township, Taiwan, China. There were total of 10 cases and 10 deaths in domestic birds and 18 birds were killed and disposed (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 Avian Influenza Weekly Update Number 885 | 4 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 886 | 1 Avian Influenza Weekly Update Number 886 10 March 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 3 March 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The most recent cases in the WPR were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 3 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 244 136 NB: This table is updated monthly Source Globally, from January 2003 to 3 March 2023, there have been 873 cases of human infection with avian influenza A(H5N1) virus reported from 22 countries. Of these 873 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H5N6) virus was notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. Human infection with avian influenza A(H5) virus Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. Avian Influenza Weekly Update Number 886 | 2 The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Avian Influenza Weekly Update Number 886 | 3 Human infection with avian influenza A(H9N2) virus Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 84 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 82 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 15 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 3 to 9 March 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 3 to 9 March 2023, there has been four reports of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 6 March 2023, 1 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Cambodia in 1 city (Torb Sdarch) (Source). On 7 March 2023, 23 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in 17 cities (Nagasu, Hakodate, Izumi, Hamamatsu, Murakami, Yamagata, Sadowara, Shakotan, Miyazaki, Naka, Kumagaya, Niigata, Himi, Sano, Kanazawa, Chitose, Takamatsu). There were total of 1255 cases, 1254 deaths and 1killed and disposed in wild birds (Source). On 8 March 2023, 10 new outbreaks of high pathogenic avian influenza A(H5 (N untyped)) were reported in Japan in 6 cities (Hino, Sapporo, Kakuda, Izumi, Goshogawara, Koga). There were total of 39 cases, 38 deaths and 1killed and disposed in wild birds (Source). On 8 March 2023, 7 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Chinese Taipei in 7 cities (Bemin, Fangyuan, Guantian, Erlun, Gukeng, Yanpu, Chaozhou). There were total of 164,795 cases, 163,146 deaths and 617,699 killed and disposed in domestic birds (Source). Avian Influenza Weekly Update Number 886 | 4 For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 887 | 1 Avian Influenza Weekly Update Number 887 17 March 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 10 to 16 March 2023, one new case of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. The case is a 53-year-old female farmer from Anhui province who developed symptoms on 31 January 2023. On 4 February, she was hospitalized for severe pneumonia and currently under treatment in the Jiangsu hospital. She had exposure to backyard poultry in Anhui province. The environmental samples of sick poultry were collected and tested positive for H5N1. There have been no further cases detected among close household contacts. As of 16 March 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 16 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 240 135 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 26 January 2023, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H5N6) virus was notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 887 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Avian Influenza Weekly Update Number 887 | 3 Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, community level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 84 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 82 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 15 November 2022 and has since recovered. Human infection with avian influenza A(H10N3) virus Between 10 to 16 March 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 10 to 16 March 2023, there has been two reports of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 10 March 2023, 16 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in 2 city (Tainai and Fukuoka), there were total of 225 case and 225 deaths in domestic poultry (Source). On 14 March 2023, 22 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in several cities (Otawara, Shibata, Tome, Omitana, Fukuoka, Kobe, Hachirogata, Murakami, Bizen, Otsu, Hamamatsu, Toyama, Izumi, Nobeoka, Tamamura, Yamagata, Shimotsuke, Munakata, Morioka, Shirahama, and Marugame)). There were total of 1280 cases, 1277 deaths and 6 killed and disposed in wild birds (Source) On 16 March 2023, 15 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in 15 cities (Shibata, Imizu, Omitama, Naka, Komatsu, Kurihara, Moka, Sendai, Fukuoka, Utsunomiya, Avian Influenza Weekly Update Number 887 | 4 Murakmi, Kobe, Fukushima). There were total of 1295 cases, 1292 deaths and 6 killed and disposed in wild birds (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 888 | 1 Avian Influenza Weekly Update Number 888 24 March 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 23 March 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 23 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 240 135 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 26 January 2023, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H5N6) virus was notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Public health risk assessment for human infection with avian influenza A(H5) viruses Avian Influenza Weekly Update Number 888 | 2 Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. Avian Influenza Weekly Update Number 888 | 3 To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 17 to 23 March 2023, three new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. The first case is a 10-year-old female from Hunan province with probable exposure in Loudi city. She had the onset of illness on 19 October 2022. Her likely source of exposure to the virus is unknown. The second case is a 3-year-old female reported from Jiangxi Province, with probable exposure in Loudi city, Hunan province. She had the onset of illness on 31 January 2023. It was reported that the case had suspected exposure to backyard poultry. The third case is a 2-year-old male reported from Hunan province with probable exposure in Zhuzhou city. He had the onset of illness on 5 February 2023. The case reportedly had exposure to backyard poultry. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 17 to 23 March 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 17 to 23 March 2023, there has been one report of high pathogenicity avian influenza among birds reported to WOAH from the Western Pacific Region. On 23 March 2023, 169 new outbreaks of high pathogenic avian influenza A(H5N1) were reported in Japan in 2 cities (Kangasaki, and Jainai), and 169 deaths in domestic birds. There were a total of 10823 cases, 10736 deaths, and 15979508 killed and disposed of (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) Avian Influenza Weekly Update Number 888 | 4 • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 889 | 1 Avian Influenza Weekly Update Number 889 31 March 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 23 March 2023, a total of 240 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 135 were fatal, resulting in a case fatality rate (CFR) of 56%. The last case was reported from China, with an onset date of 22 September 2022 and died on 18 October 2022. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 30 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 56 37 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 54 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 127 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 240 135 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 26 January 2023, there have been 868 cases of human infection with avian influenza A(H5N1) virus reported from 21 countries. Of these 868 cases, 457 were fatal (CFR of 53%) (Source) Human infection with avian influenza A(H5N6) virus Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 889 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 2 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with no deaths have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Avian Influenza Weekly Update Number 889 | 3 Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 24 to 30 March 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 24 to 30 March 2023, no cases of high pathogenicity avian influenza among birds were reported to WOAH from the Western Pacific Region. For more information on animal infection with avian influenza viruses with potential public health impact, visit: World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) FAO Global Animal Disease Information System (EMPRES-i) Avian Influenza Weekly Update Number 889 | 4 Other updates Influenza at the human-animal interface summary and assessment, 5 January 2023 Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 WHO issues updated influenza vaccines position paper 1 June 2022 Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 889 | 1 Avian Influenza Weekly Update Number 890 7 April 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 3 March 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The most recent cases in the WPR were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 3 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 244 136 NB: This table is updated monthly Source Globally, from January 2003 to 3 March 2023, there have been 873 cases of human infection with avian influenza A(H5N1) virus reported from 22 countries. Of these 873 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 889 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 31 March to 6 April 2023, one new case of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. The case was a 56-year-old female from Guangdong province with an onset of illness on 22 February 2023. The case was detected through severe acute respiratory infection (SARI) surveillance systems. She was hospitalized for severe pneumonia on 3 March 2023 and subsequently died on 16 March 2023. The patient had multiple underlying conditions. She had a history of exposure to live poultry before the onset of the disease. No close contacts of the case developed an infection or symptoms of illness at the time of reporting. The environmental samples were collected from the patient's residence and the wet market where the patient was exposed before the onset of illness. The results of testing showed that the samples collected from the wet market were positive for H3. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Avian Influenza Weekly Update Number 889 | 3 Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 31 March to 6 April 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 31 March to 6 April 2023, no cases of high pathogenicity avian influenza among birds were reported to World Organization for Animal Health (WOAH) from the Western Pacific Region. For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza Avian Influenza Weekly Update Number 889 | 4 • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 891 | 1 Avian Influenza Weekly Update Number 891 14 April 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 3 March 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The last cases were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 3 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 244 136 NB: This table is updated monthly Source Globally, from January 2003 to 3 March 2023, there have been 873 cases of human infection with avian influenza A(H5N1) virus reported from 22 countries. Of these 873 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 891 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 7 April to 13 April 2023, no cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection Avian Influenza Weekly Update Number 891 | 3 may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 7 April to 13 April 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 7 April to 13 April 2023, two reports of high pathogenicity avian influenza among birds were reported to the World Organization for Animal Health (WOAH) from the Western Pacific Region. On 10 April 2023, 1,678 cases of high pathogenicity influenza A(H5N1) were reported in Taiwan, China 2 in two cities (Fangyuan and Taixi Township). There was a total of 217,580 cases, 215,911 deaths, and 766,331 killed and disposed of (Source). On 12 April 2023, 34 cases of high pathogenicity avian influenza A(H5N1) were reported in Japan in several cities (Chitose, Hokkaido, Kanegasaki, and Fukuoka). There was a total of 11,177 cases, 11,093 deaths, and 17,542,954 killed and disposed of (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) Avian Influenza Weekly Update Number 891 | 4 • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 5 January 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 25 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 892 | 1 Avian Influenza Weekly Update Number 892 21 April 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 3 March 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The most recent cases in the WPR were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 3 March 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 2 1 3 1 244 136 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 3 March 2023, there have been 873 cases of human infection with avian influenza A(H5N1) virus reported from 22 countries. Of these 873 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 892 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 14 April to 20 April 2023, no cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection Avian Influenza Weekly Update Number 892 | 3 may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 14 April to 20 April 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 14 April to 20 April 2023, three reports of high pathogenicity avian influenza among birds were reported to the World Organization for Animal Health (WOAH) from the Western Pacific Region. On 17 April 2023, outbreaks of high pathogenicity influenza A(H5N1) were reported in Xinpu, Dacheng Township and Dail District, Taiwan, China. There was a total of 219,579 cases, 217,910 deaths, and 789,030 killed and disposed of (Source). On 19 April 2023, outbreaks of high pathogenicity influenza A(H5N8) were reported in Japan in Izumi city. There was a total of 2 cases and 2 deaths (Source). On 19 April 2023, outbreaks of high pathogenicity influenza H5(N untyped) were reported in Japan in Goshogawara, Sapporo, and Hirosaki. There was a total of 52 cases, 51 deaths, and 1 killed and disposed of (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: Avian Influenza Weekly Update Number 892 | 4 • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 3 March 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 24 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 892 | 1 Avian Influenza Weekly Update Number 893 28 April 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 24 April 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The most recent cases in the WPR were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 24 April 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 2 1 3 1 244 136 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 24 April 2023, there have been 874 cases of human infection with avian influenza A(H5N1) virus reported from 23 countries. Of these 874 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 892 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 21 April to 27 April 2023, no cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection Avian Influenza Weekly Update Number 892 | 3 may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 21 April to 27 April 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang -China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 21 April to 27 April 2023, several new outbreaks of high pathogenicity avian influenza among birds were notified to the World Organization for Animal Health (WOAH) from the Western Pacific Region. On 21 April 2023, 22 outbreaks of high pathogenicity influenza A(H5N1) were reported in Japan in 14 cities (Nemuro, Tainai, Mukawa, Erimo, Murakami, Akabira, Morioka, Daisen, Yokote, Sagamihara, Sapporo, Kushiro, Fukuoka, Utsunomiya) There was a total of 27 cases and 26 deaths in wild birds (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates Avian Influenza Weekly Update Number 892 | 4 • Influenza at the human-animal interface summary and assessment, 24 April 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 24 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 894 | 1 Avian Influenza Weekly Update Number 894 05 May 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 24 April 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The last cases in the WPR were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 24 April 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 2 1 3 1 244 136 NB: This table is updated monthly Source Globally, from January 2003 to 24 April 2023, there have been 874 cases of human infection with avian influenza A(H5N1) virus reported from 23 countries. Of these 874 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 894 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus. Human infection with avian influenza A(H3N8) virus Between 28 April to 04 May 2023, no cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection Avian Influenza Weekly Update Number 894 | 3 may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 28 April to 04 May 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang province, China with an onset date of 11 June 2022, and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 28 April to 04 May 2023, no new outbreaks of high pathogenicity avian influenza among birds were notified to the World Organization for Animal Health (WOAH) from the Western Pacific Region. For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 24 April 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. Avian Influenza Weekly Update Number 894 | 4 • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 24 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020
Avian Influenza Weekly Update Number 894 | 1 Avian Influenza Weekly Update Number 895 12 May 2023 Human infection with avian influenza A(H5) viruses Human infection with avian influenza A(H5N1) virus Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H5N1) virus were reported to WHO in the Western Pacific Region. As of 24 April 2023, a total of 244 cases of human infection with avian influenza A(H5N1) virus have been reported from four countries within the Western Pacific Region since January 2003 (Table 1). Of these cases, 136 were fatal, resulting in a case fatality rate (CFR) of 56%. The most recent cases in the WPR were reported from Cambodia on 23 and 24 February 2023, in an 11-year-old girl who died and her father who survived. Table 1: Cumulative number of laboratory-confirmed human cases (C) and deaths (D) of influenza A(H5N1) virus infection reported to WHO, by date of onset (January 2003 to 24 April 2023), Western Pacific Region Country 2003-2009 2010-2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Total C D C D C D C D C D C D C D C D C D C D C D C D Cambodia 9 7 47 30 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 1 58 38 China 38 25 9 5 6 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 55 32 Lao PDR 2 2 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 2 Viet Nam 112 57 15 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 128 64 Total 161 91 71 42 6 1 0 0 0 0 0 0 0 0 1 0 0 0 2 1 3 1 244 136 NB: This table is updated on a monthly basis following the updates from the Source Globally, from January 2003 to 24 April 2023, there have been 874 cases of human infection with avian influenza A(H5N1) virus reported from 23 countries. Of these 874 cases, 458 were fatal (CFR of 52%) (Source). Human infection with avian influenza A(H5N6) virus Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H5N6) virus were notified to WHO in the Western Pacific Region. To date, a total of 84 laboratory-confirmed cases of human infection with influenza A(H5N6) virus including 33 deaths have been reported to WHO in the Western Pacific Region since 2014. The last case was reported from China, with an onset date of 17 December 2022. The case was hospitalized on 21 December 2022 with severe pneumonia and has since recovered. Human infection with avian influenza A(H5) virus Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H5) virus were notified to WHO in the Western Pacific Region. The last case was reported from Viet Nam, with an onset date of 22 October 2022 (one case, no death). This is the first case of avian influenza A(H5) reported from Viet Nam since 2014; NA subtype could not be determined. Avian Influenza Weekly Update Number 894 | 2 Public health risk assessment for human infection with avian influenza A(H5) viruses Whenever avian influenza viruses are circulating in poultry, there is a risk for sporadic infection and small clusters of human cases due to exposure to infected poultry or contaminated environments. Therefore, sporadic human cases are not unexpected. The rise in the number of reported human cases of A(H5N6) infection may reflect the continued circulation of the virus in birds, and enhanced surveillance system and diagnostic capacity as a direct outcome of the response to the COVID-19 pandemic. The zoonotic threat remains elevated due to the spread of the viruses among birds. However, the overall pandemic risk associated with A(H5) is considered not significantly changed in comparison to previous years. WHO recommends that Member States remain vigilant and consider mitigation steps to reduce human exposure to potentially infected birds to reduce the risk of additional zoonotic infection. For information on risk assessments on Avian Influenza, see: monthly risk assessment summaries and Assessment of risk associated with highly pathogenic avian influenza A(H5N6) virus . Human infection with avian influenza A(H3N8) virus Between 5 May to 11 May 2023, no cases of human infection with avian influenza A(H3N8) virus were reported to WHO in the Western Pacific Region. To date, a total of 3 laboratory-confirmed cases of human infection with influenza A(H3N8) virus with one death have been reported to WHO in the Western Pacific Region. Human infection with avian influenza A(H7N4) virus in China Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H7N4) virus were reported to WHO in the Western Pacific Region. To date, only one laboratory-confirmed case of human infection with influenza A(H7N4) virus has been reported to WHO. This case was reported from China on 14 February 2018. Human infection with avian influenza A(H7N9) virus in China Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H7N9) virus were reported to WHO in the Western Pacific Region. To date, a total of 1,568 laboratory-confirmed human infections with avian influenza A(H7N9) virus including 616 fatal cases (CFR: 39%) have been reported to WHO since early 2013. The last case of human infection with avian influenza A(H7N9) reported to WHO in the Western Pacific Region was in 2019. Of the 1,568 human infections with avian influenza A(H7N9), 33 have reported mutations in the hemagglutinin gene indicating a change to high pathogenicity in poultry. These 33 cases were from Taiwan, China (one case had a travel history to Guangdong), Guangxi, Guangdong, Hunan, Shaanxi, Hebei, Henan, Fujian, Yunnan, and Inner Mongolia. No increased transmissibility or virulence of the virus within human cases has been detected related to the HPAI A(H7N9) virus. WHO is continuing to assess the epidemiological situation and will conduct further risk assessments as new information becomes available. The number and geographical distribution of human infections with avian influenza A(H7N9) viruses in the fifth epidemic wave (1 October 2016 to 30 September 2017) were greater than previous waves and the subsequent waves. Further sporadic human cases of avian influenza A(H7N9) virus infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection Avian Influenza Weekly Update Number 894 | 3 may be detected in another country during or after arrival. However, if this were to occur, the community- level spread is considered unlikely as the virus does not have the ability to transmit easily among humans. To date, there is no evidence of sustained human-to-human transmission of avian influenza A(H7N9) virus. Human infections with the A(H7N9) virus are unusual and need to be monitored closely in order to identify changes in the virus and transmission behavior to humans as this may have serious public health impacts. Human infection with avian influenza A(H9N2) virus Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H9N2) were reported to WHO in the Western Pacific Region. To date, a total of 87 cases of human infection with avian influenza A(H9N2) including two deaths (both with underlying conditions have been reported to WHO in the Western Pacific Region since December 2015. Of these, 85 were reported from China and two were reported from Cambodia. The last case was reported from China, with an onset date of 5 February 2023, and has since recovered. Human infection with avian influenza A(H10N3) virus Between 5 May to 11 May 2023, no new cases of human infection with avian influenza A(H10N3) virus were reported to WHO in the Western Pacific Region. To date, two cases of avian influenza A(H10N3) virus have been reported globally. The last case was reported from Zhejiang - China with an onset date of 11 June 2022 and has since recovered. Most previously reported human infections with avian influenza viruses were due to exposure to infected poultry or contaminated environments. Since avian influenza viruses, including avian influenza A(H10N3) viruses, continue to be detected in poultry populations, further sporadic human cases could be detected in the future. Currently available epidemiologic information suggests that the avian influenza A(H10N3) virus has not acquired the ability for sustained human-to-human transmission, thus the likelihood of spread among humans is low. Animal infection with avian influenza virus Between 5 May to 11 May 2023, two new outbreaks of high pathogenicity avian influenza among birds were notified to the World Organization for Animal Health (WOAH) from the Western Pacific Region. On 09 May 2023, 3,616 cases of high pathogenicity of influenza A(H5N1) were reported in Taipei, China affected in 5 cities (East District, Lunbei Township, Dapi Township, Wanhua District, and Zhutang Township). There was a total of 223,195 cases, 221,503 deaths, and 802,174 Killed and disposed of domestic birds (Source). On 09 May 2023, 2 cases of high pathogenicity of influenza A(H5N1) were reported in Taipei, China affected in 3 cities (Budai Township, Ji'an Township, and Fanguan Township). There was a total of 513 cases, 513 deaths, and 18 Killed and disposed of wild birds (Source). For more information on animal infection with avian influenza viruses with potential public health impact, visit: • World Organization for Animal Health (WOAH) web page: Weekly disease information and Latest report on Avian Influenza Avian Influenza Weekly Update Number 894 | 4 • Emergency Prevention System for Transboundary Animal and Plant Pests and Diseases (EMPRES) • FAO Global Animal Disease Information System (EMPRES-i) Other updates • Influenza at the human-animal interface summary and assessment, 24 April 2023 • Assessment of risk associated with recent influenza A(H5N1) clade 2.3.4.4b viruses 21 December 2022. • Recommended composition of influenza virus vaccines for use in the 2023 southern hemisphere influenza season 23 September 2022 • WHO issues updated influenza vaccines position paper 1 June 2022 • Recommended composition of influenza virus vaccines for use in the 2022-2023 northern hemisphere influenza season 24 February 2022 • WHO SAGE Seasonal Influenza Vaccination Recommendations during the COVID-19 Pandemic Interim guidance. 20 September 2020