[Source: European Centre for Disease Prevention and Control (ECDC), full PDF document: (LINK). Edited.]
ECDC TECHNICAL DOCUMENT
Proposed interim case definition and case finding algorithm for reporting patients infected by the avian influenza A(H7N9) virus in EU/EEA Member States - 26 April 2013
Objectives
For surveillance purposes:
Limitations
This case definition and case finding algorithm have been prepared for surveillance purposes only. They do not provide guidance for clinical diagnosis, nor for management of persons requiring investigation or confirmed cases as this is outside of ECDC?s mandate. However, Member States may wish to adapt the document for this purpose as has already been done by some EU countries with diagnosis management algorithms.
The algorithm and the case definition will be adjusted as the current avian influenza A(H7N9) situation develops.
Current situation for application
Sources of information
The following information on cases, case definitions and protocols were analysed:
(i) Latest influenza risk assessments are available at http://ecdc.europa.eu/en/healthtopics/avian_influenza/risk_threat_assessments/Pages/risk_threat_assessments.aspx
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(i) Diagnostic preparedness in Europe for detection of avian influenza A(H7N9) viruses. Available from http://ecdc.europa.eu/en/publications/Publications/avian-influenza-H7N9-microbiology-diagnostic-preparedness-for-detection.pdf
(ii) WHO Interim Global Surveillance Standards for Influenza. Available from http://www.who.int/influenza/resources/documents/INFSURVMANUAL.pdf
(iii) Risk area: regions or countries in which transmission of laboratory-confirmed human infection with influenza A(H7N9) is known to have occurred or where influenza A(H7N9) was detected in domestic birds or poultry: http://www.who.int/influenza/human_animal_interface/influenza_h7n9/Data_Reports/en/index.html
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ECDC TECHNICAL DOCUMENT
Proposed interim case definition and case finding algorithm for reporting patients infected by the avian influenza A(H7N9) virus in EU/EEA Member States - 26 April 2013
Objectives
For surveillance purposes:
- to propose a case definition for reporting cases of avian influenza A(H7N9) virus infection at EU level;
- to propose an algorithm for laboratory investigation of persons requiring testing for infection with the novel avian influenza A(H7N9) virus.
Limitations
This case definition and case finding algorithm have been prepared for surveillance purposes only. They do not provide guidance for clinical diagnosis, nor for management of persons requiring investigation or confirmed cases as this is outside of ECDC?s mandate. However, Member States may wish to adapt the document for this purpose as has already been done by some EU countries with diagnosis management algorithms.
The algorithm and the case definition will be adjusted as the current avian influenza A(H7N9) situation develops.
Current situation for application
- Refer to ECDC Risk Assessments and epidemiological updates for the current situation (i).
- The rapid availability of specific diagnostic testing for human A(H7N9) in all EU/EEA Member States in National Influenza Centres.
Sources of information
The following information on cases, case definitions and protocols were analysed:
- Li Q, Zhou L, Zhou M, Chen Z, Li F, Wu H, et al. Preliminary Report: Epidemiology of the Avian Influenza A(H7N9) Outbreak in China. NEJM April 24, 2013. DOI: 10.1056/NEJMoa1304617 and Supplementary Material.
- US Centers for Disease Control and Prevention. Interim Guidance on Case Definitions to be Used for Novel Influenza A (H7N9) Case Investigations in the United States. Available from: http://www.cdc.gov/flu/avianflu/h7n9-case-definitions.htm
- Public Health England. Investigation & management of possible human cases of avian in_uenza A/H7N9, in returning travellers. Available from: http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1317138620910
- Robert Koch Institute. Respiratorische Erkrankungen in Verbindung mit Influenza A(H7N9). Available from: http://www.rki.de/DE/Content/InfAZ/A/AviaereInfluenza/Falldefinition_H7N9.pdf?__blob=publicationFile
- Institut National de Veille Sanitaire. Surveillance des infections li?es au nouveau virus aviaire A(H7N9). Point au 5 avril 2013. Available from: http://www.invs.sante.fr/Actualites/Actualites/Surveillance-des-infections-liees-aunouveau-virus-aviaire-A-H7N9-.-Point-au-5-avril-2013
- Case definition of avian influenza A(H7N9) infection
- Confirmed case:
- A patient for which avian influenza A(H7N9) nucleic acid has been detected by RT-PCR according to ECDC/WHO Regional Office Guidancei.
- Probable case:
- Not applicable.
- Possible case:
- Not applicable.
- All confirmed cases should be reported to the national authorities and to ECDC through the EWRS platform.
- Confirmed case:
- Person requiring laboratory testing for avian influenza A(H7N9) infection
- A person with both the following clinical and exposure criteria.
- Clinical criteria:
- A severe acute respiratory infection (SARI)(ii) with onset within the last 10 days:
- 1. History of fever or measured fever of ≥ 38? C; AND
- 2. Cough; AND
- 3. Requiring hospitalisation for clinical care purposes.
- A severe acute respiratory infection (SARI)(ii) with onset within the last 10 days:
- Exposure criteria:
- 1. Recent travel (within 10 days of illness onset) to a risk areaiii where human cases of avian influenza A(H7N9) viruses were notified or where avian influenza A(H7N9) viruses are known to be circulating in animals; OR
- 2. Close contact with confirmed case (within 10 days of illness onset)
- Clinical criteria:
- A person with both the following clinical and exposure criteria.
- Algorithm for laboratory testing
- A person meeting the clinical and exposure criteria for laboratory testing for avian influenza A(H7N9) infection as defined in section 2 should be investigated using the algorithm below. Member States could consider testing close contacts with a confirmed case presenting with clinical criteria 1 and 2, even if they do not require hospitalisation (criteria 3).
(i) Latest influenza risk assessments are available at http://ecdc.europa.eu/en/healthtopics/avian_influenza/risk_threat_assessments/Pages/risk_threat_assessments.aspx
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(i) Diagnostic preparedness in Europe for detection of avian influenza A(H7N9) viruses. Available from http://ecdc.europa.eu/en/publications/Publications/avian-influenza-H7N9-microbiology-diagnostic-preparedness-for-detection.pdf
(ii) WHO Interim Global Surveillance Standards for Influenza. Available from http://www.who.int/influenza/resources/documents/INFSURVMANUAL.pdf
(iii) Risk area: regions or countries in which transmission of laboratory-confirmed human infection with influenza A(H7N9) is known to have occurred or where influenza A(H7N9) was detected in domestic birds or poultry: http://www.who.int/influenza/human_animal_interface/influenza_h7n9/Data_Reports/en/index.html
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