Italy - Imported human case of avian influenza LP H9N2 from Senegal in Lombardy (March 25, 2026) - WHO DON (4/10/26)

[Pathfinder]

Translation Google

A case of avian influenza has been confirmed in Lombardy: the first in Europe.

Human H9N2 infection in the EU: "No critical issues detected, situation is being monitored."

March 25, 202 6

Updated at12:18


The Lombardy Region has identified a case of infection with the low-pathogenicity avian influenza A(H9N2) virus in a frail individual with underlying health conditions who contracted the infection from a non-European country and is currently hospitalized. The Ministry of Health announced this. This is the first human case of the H9N2 avian influenza strain detected in Europe.

Based on the scientific information available to date, the ministry explains in a statement, infection occurs through direct exposure to infected poultry or contaminated environments or materials. Human cases are characterized by mild illness, and person-to-person transmission has never been reported. All required tests were promptly conducted, and the case's contacts were identified as part of routine prevention and surveillance activities. The Ministry of Health immediately activated coordination with the Lombardy Region, the Istituto Superiore di Sanità, and the national reference laboratory expert group, and ensured the coordination and updating of the relevant international organizations. "Currently, no critical issues are identified, and the situation," the ministry concludes, "is being constantly monitored."


https://www.lastampa.it/cronaca/2026...-15559574/amp/

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March 25, 2026

Europe's first human infection with the H9N2 strain of avian flu occurred in Lombardy.

This is a frail person with concomitant illnesses from a non-EU country, the Ministry: "Currently no critical issues have been identified and the situation"

The Lombardy Region has identified a case of infection with the low-pathogenicity avian influenza A(H9N2) virus in a frail individual with underlying health conditions who contracted the infection from a non-European country and is currently hospitalized. The Ministry of Health announced this. This is the first human case of the H9N2 avian influenza strain detected in Europe.

"The patient," explained Guido Bertolaso, Regional Welfare Councilor, "is currently hospitalized in isolation at the San Gerardo Hospital in Monza . In addition to treatment for the viral infection, the medical team is managing other comorbidities the patient is suffering from. The epidemiological investigation was conducted promptly by ATS Brianza ."

Based on the scientific information available to date, the ministry explains in a statement, infection occurs through direct exposure to infected poultry or contaminated environments or materials. Human cases are characterized by mild illness, and person-to-person transmission has never been reported . All required tests were promptly carried out, and the case's contacts were identified as part of routine prevention and surveillance activities.

The Ministry of Health immediately initiated coordination with the Lombardy Region, the National Institute of Health, and the national reference laboratory expert group, and ensured the coordination and updating of the relevant international bodies. " Currently, no critical issues are identified, and the situation ," the ministry concluded, "is being constantly monitored."

https://www.giornaledibrescia.it/cronaca/influenza-aviaria-prima-infezione-umana-europa-g1dvw4sw

[Michael Coston]

Not much detail, but here is Italy's MOH Statement (translated)

Influenza A (H9N2) virus case identified in Lombardy. Routine surveillance and prevention procedures activated.

Press release number 8

Press release date March 25, 2026

The Ministry of Health informs that the Lombardy Region has identified a case of infection with the low-pathogenicity avian influenza A(H9N2) virus of animal origin, in a frail person with concomitant illnesses, who came from a non-European country where he contracted the infection, and is currently hospitalized.

This is the first human case of H9N2 avian influenza detected in Europe. Based on the scientific information available to date, infection occurs through direct exposure to infected poultry or contaminated environments or materials. Human cases are characterized by mild illness, and human-to-human transmission has never been reported.

All the required checks were promptly carried out and the relevant contacts were identified, as part of the ordinary prevention and surveillance activities.

The Ministry of Health immediately activated coordination with the Lombardy Region, the Istituto Superiore di Sanità, and the national reference laboratory expert group, and ensured the coordination and updating of the relevant international bodies.
Currently, no critical issues have been identified and the situation is being constantly monitored.

[Michael Coston]

Italy: MOH Statement on First LPAI H9N2 Human Case in Europe (imported)



#19,096


With a hat tip to Pathfinder on FluTrackers who posted a media story, I've tracked down the Italian MOH's statement on what appears to be the first H9N2 human infection to be reported in Europe.

Details are vague, but this appears to have been someone who recently arrived from a `non-European' country where they were likely exposed.

At least one media report identifies the patient as a 'a boy who returned from Africa and was hospitalised a few days after his arrival at Milan Malpensa', although I have yet to find official confirmation.


First the MOH's statement, after which I'll have a bit more.

(Translated)
Influenza A (H9N2) virus case identified in Lombardy. Routine surveillance and prevention procedures activated.

Press release number 8
Press release date March 25, 2026

The Ministry of Health informs that the Lombardy Region has identified a case of infection with the low-pathogenicity avian influenza A(H9N2) virus of animal origin, in a frail person with concomitant illnesses, who came from a non-European country where he contracted the infection, and is currently hospitalized.

This is the first human case of H9N2 avian influenza detected in Europe. Based on the scientific information available to date, infection occurs through direct exposure to infected poultry or contaminated environments or materials. Human cases are characterized by mild illness, and human-to-human transmission has never been reported.

All the required checks were promptly carried out and the relevant contacts were identified, as part of the ordinary prevention and surveillance activities.

The Ministry of Health immediately activated coordination with the Lombardy Region, the Istituto Superiore di Sanità, and the national reference laboratory expert group, and ensured the coordination and updating of the relevant international bodies.

Currently, no critical issues have been identified and the situation is being constantly monitored.

While 90% of the human H9N2 cases reported have come from China, we've seen sporadic cases in places like Cambodia, Vietnam, and India. We've also seen a handful of cases in Africa (4 in Egypt, 1 in Senegal, and the most recent in Ghana).

The Asian Y280/G57 lineages have shown increasing signs of mammalian adaptation (see EM&I: Enhanced Replication of a Contemporary Avian Influenza A H9N2 Virus in Human Respiratory Organoids)), while the African and Middle Eastern Lineages (mostly European G1-like) are older and less evolved.

Worth noting, LPAI H9N2 has also been detected in African bats (see Preprint: The Bat-borne Influenza A Virus H9N2 Exhibits a Set of Unexpected Pre-pandemic Features).

Given their relatively scarcity outside of Asia, WGS (Whole Gene Sequencing) and antigenic characterization of this latest case will be of considerable interest.

https://afludiary.blogspot.com/2026/03/italy-moh-statement-on-first-lpai-h9n2.html

[tetano]

The first European patient to have contracted avian flu is hospitalized at the San Gerardo hospital in Monza. He is a boy in his early twenties "fragile with concomitant diseases", as Health Minister Orazio Schillaci said. He would have contracted the disease in Africa. It is a form of the influenza A(H9N2) virus with "low pathogenicity". The man, therefore, is not in danger of life. The patient, who arrived at Malpensa in the night between Thursday and Friday and was immediately taken to hospital.

The symptoms, including a high fever, immediately triggered the alarm. After the samples, examinations and typing of the virus, the diagnosis was made. The Councilor for Welfare of the Lombardy Region, Guido Bertolaso, says that all the patient"s contacts have been traced and that no one has tested positive for the virus.

https://milano.corriere.it/notizie/cronaca/26_marzo_25/aviaria-al-san-gerardo-di-monza-il-primo-paziente-europeo-ad-aver-contratto-l-influenza-ha-20-anni-e-non-e-in-pericolo-7b66d650-1e75-4c5f-a7a7-1b065e1f3xlk.shtml

[sharon sanders]

Please see:

:FluTrackers Global Cumulative H9N2 Partial Case List 1998 - Current

[Pathfinder]

Translation Google

March 25, 2026

Last updated: 1:45 PM

A case of avian flu in Lombardy is the first human infection in Europe. The ministry states, "It was contracted abroad."

Of Louisiana Gaita

The patient is a young man with other medical conditions who arrived at Malpensa from Africa and is now in isolation at the San Gerardo Hospital in Monza. Regional Councilor Bertolaso: "The population is not at risk."


The first human case of the H9N2 avian influenza strain detected in Europe has been identified in Lombardy . The patient is a young man in his twenties , returning from Africa and hospitalized a few hours after arriving at Milan Malpensa . "In addition to treatment for the viral infection, the medical team is managing other concomitant pathologies from which the patient is suffering," clarified Guido Bertolaso , Lombardy's Regional Welfare Councilor , emphasizing that " the population is not at any risk ." This is a low-pathogenicity infection and, the councilor emphasized, a "non-native" case, precisely because the patient had arrived in Italy shortly before. The young man is currently hospitalized in isolation at the San Gerardo Hospital in Monza . The official communication came from the Ministry of Health , which has activated coordination with the Lombardy Region , the Istituto Superiore di Sanità , and the group of experts from the national reference laboratory, and has ensured the liaison and updating of the competent international organizations. "Currently, no critical issues have been identified and the situation," the ministry explained in a statement, "is being constantly monitored."

What is known about the patient hospitalized in Monza (and the infection)

The patient "was admitted with symptoms during the night between Thursday and Friday," Bertolaso explained . After undergoing comprehensive tests at the San Gerardo Hospital, the virus was identified "thanks to Lombardy's surveillance system." All those who had been in contact with the patient were identified and examined. "They were typed, and fortunately, no cases of contamination have been confirmed to date. Regarding the plane, we have informed the airport authorities and the airline . The patient had only been in contact with a few people," he added, "so they were all tested, and no further positive cases have been confirmed." The young man has "previous medical conditions, some of which were significant," although "the clinical picture does not cause particular concern." The epidemiological investigation was conducted "promptly by ATS Brianza ," while the molecular analyses that allowed the precise identification of the virus were performed by the University of Milan and confirmed by the Regional Center for Infectious Diseases (composed of the General Directorate of Welfare - Prevention Operational Unit of the Lombardy Region, the Fatebenefratelli-Sacco and San Matteo Hospitals of Pavia) and the National Institute of Health . As explained by the Ministry of Health, "based on the scientific information available to date, contagion occurs through direct exposure to infected poultry or contaminated environments or materials. Human cases are characterized by mild illness, and person-to-person transmission has never been reported," even though, as experts recently explained, it is a strain of influenza that is better adapted to infecting humans .

The various strains of avian flu, an ever-present threat

But attention in Italy is very high , also due to the outbreaks of the H5N1 strain, identified especially in farms in the North in recent months ( Read the in-depth article ) and which in recent years has spread to various animal species. Not only wild and farmed birds (for which there has been a sharp increase in cases), but also felines, bears, seals, cats, pigs and dairy cows. Then, in December 2025, the World Health Organization confirmed the world's first human case of infection with the avian influenza A(H5N5) virus , identified in the United States in an adult with pre-existing pathologies, resident in the State of Washington. The man, hospitalized in early November for a severe illness, died a couple of weeks later . But experts have also been monitoring the strain identified in this case from the patient who landed at Malpensa, the H9N2 , for some time . Potentially even more dangerous because, as explained in October 2025, during the Pandemic Research Alliance International Symposium in Melbourne , Australia, it would have been better adapted to infecting humans .

Virologist Pregliasco: "The case requires attention, but not alarmism."

According to virologist Fabrizio Pregliasco , director of the School of Specialization in Hygiene and Preventive Medicine at the University of Milan , the human case of infection with the A(H9N2) influenza virus of animal origin confirmed in Lombardy "is an event that requires attention, but without alarmism . Cases of transmission of avian influenza to humans, although rare," he explains, "have been monitored for years and are part of already active surveillance systems. It is essential to strengthen epidemiological tracking and maintain high vigilance, especially in high-risk contexts, such as livestock farms." For now, as the virologist emphasizes, there is no evidence of sustained transmission between humans, but, he adds, "these episodes are a warning bell on the evolution of influenza viruses. Collaboration between public health, veterinary medicine, and institutions is key to preventing any critical issues." This is also because the alert from the European Centre for Disease Prevention and Control dates back to a few months ago . "This autumn, Europe has seen a sharp increase in cases of avian influenza A/H5N1 in wild birds and poultry. Widespread circulation among birds increases the risk of human exposure to infected animals and subsequent transmission of the virus to humans," it wrote, reporting "unprecedented outbreaks" of avian influenza in birds and publishing guidance aimed at "helping European countries identify and respond to potential threats."

https://www.ilfattoquotidiano.it/2026/03/25/aviaria-primo-caso-umano-europa-lombardia-news/8335986/

[Pathfinder]

Hat tip Commonground

First human case of influenza A(H9N2) infection imported in the EU

News
25 March 2026

A human case of avian influenza A(H9N2) infection in a returning traveller from a non-European country where the virus has previously been identified in birds, has been reported in the Lombardy region of Italy. This is the first human case of avian influenza A(H9N2) reported in the EU/EEA.

The patient has co-existing medical conditions and is currently in hospital isolation, receiving medical treatment. Italian public health authorities performed contact tracing as a precaution to identify and control possible onward transmission and initiated several epidemiological and microbiological investigations.

Since 1998, and as of 27 February 2026, 195 human cases of A(H9N2) had been reported worldwide by 10 countries in Asia and Africa. Only two infections were fatal. No clusters of human influenza A(H9N2) infections, nor documented instances of person-to-person transmission, have ever been reported. Direct contact with infected birds or contaminated environments has been the most likely source of human infection for avian influenza viruses. Sporadic human cases of avian influenza are not unexpected in areas where the virus is circulating in birds.

Based on information shared by Italian public health authorities and knowledge of the virus epidemiology, ECDC currently assesses the risk for the general population in the EU/EEA of influenza A(H9N2) related to this event as very low. ECDC is in contact with authorities in Italy and is monitoring the situation closely and will reassess the risk as more information becomes available.

ECDC monitors the epidemiology of zoonotic influenza and the circulation of avian influenza strains through epidemic intelligence activities and sharing information among international partners worldwide. Together with the European Food Safety Authority (EFSA) and the EU Reference Laboratory for Avian Influenza, ECDC produces a quarterly report on the avian influenza situation in the EU/EEA. The most recent report was published in March 2026. ECDC has also published a protocol for the investigation and management of human infections in the EU/EEA, as well as a pre-pandemic influenza scenario framework with suggested public health actions when human cases in the EU/EEA are detected.

https://www.ecdc.europa.eu/en/news-events/first-human-case-influenza-ah9n2-infection-imported-eu

[Pathfinder]

Translation Google

Avian flu, Terregino (IZSVe): Non-Italian case, but one that demonstrates functioning surveillance system

By Editorial Staff-March 26, 2026

LEGNARO (PD) – “First of all, it must be emphasized that the protocols worked: the immediate identification of the H9 genotype of the virus demonstrates that zoonotic influenza virus surveillance in Italy is effective.”

Furthermore, we have no evidence of human-to-human transmission. This is a typically avian virus, not an H5, but an H9N2, well known to the international scientific community as one of the subtypes that can cause human infections. In the vast majority of cases, these infections are asymptomatic—detectable through serological studies—or flu-like syndromes, with fever and symptoms very similar to seasonal flu.

This is what Calogero Terregino , Director of the National and European Reference Centre for Avian Influenza at the Istituto Zooprofilattico delle Venezie (IZSVe), declared .

"This is not an Italian case, but an imported one," Terregino explains. "It's a person who became infected through contact with contaminated material or infected birds in their country of origin, Africa. Different viruses than those present in Italy and Europe are circulating in many parts of Africa. Here too, through surveillance, we're identifying avian influenza viruses, but with genetic and biological characteristics different from those found in Africa."

"In those contexts," Terregino continues, "human cases are also being recorded precisely because specific genotypes are circulating that aren't present in Europe. This means that the Italian population isn't at risk of becoming infected with these viruses through poultry."

"The patient," Terregino explains, "who already had several health problems that complicated his clinical picture, is being treated for a series of comorbid conditions he suffers from. Meanwhile, those who were in close contact with him—healthcare workers, family members, and even passengers on the same flight—have been tested and tested negative. Therefore, there has been no human-to-human spread, as is common with human H9 virus infections."

"H9, H5, H7, and other subtypes are closely monitored. They have been shown to be capable of infecting humans, but they struggle to transmit effectively between humans. As the Avian Flu Reference Center, we operate both nationally, collaborating with the Ministry of Health and the Regions in the prevention and management of avian influenza, and internationally, analyzing viruses circulating in Europe and other parts of the world to study their genetic evolution and identify any dangerous mutations. It's not possible to completely eliminate the risk, but we are working to reduce its impact through biosecurity, land management, and surveillance of people at risk of infection. There is now a consolidated synergy between veterinary services and public health in a One Health perspective," concludes the Director of the Avian Flu Reference Center.

https://www.agricultura.it/2026/03/26/aviaria-terregino-izsve-caso-non-italiano-ma-che-dimostra-funzionamento-sistema-di-sorveglianza/

[Pathfinder]

Translation Google

First case of avian flu in Europe, negative tests on the patient's contacts: "No human-to-human transmission"

by Alessandra Corica

The man arrived at Malpensa from Africa and is now in isolation at the San Gerardo Hospital in Monza.

March 26, 2026, at 5:00 AM

He returned to Lombardy during the night between Thursday and Friday, after several months spent in West Africa. After landing at Malpensa , he began showing symptoms, leading him to be taken by ambulance to the San Gerardo hospital in Monza a few hours later . He remains hospitalized, in isolation, and is also being treated for other underlying conditions that make him particularly fragile.

A thirty-year-old man of foreign origin living in Lombardy is the first patient in a European country diagnosed with an infection with the influenza A(H9n2) virus of animal origin. This is a strain of the so-called " avian flu ." The thirty-year-old apparently contracted the infection abroad and is not in life-threatening danger, given the disease's "low pathogenicity," as explained by the Ministry of Health.

Immediately after the diagnosis, the boy was placed in isolation in the Infectious Diseases ward. All those who came into contact with him were tested to determine whether there was any human-to-human transmission of the virus, which "has never been reported," the ministry emphasizes. "The patient already had health problems that complicated his clinical picture. He is undergoing treatment for a series of comorbidities, while the people who had contact with him, including healthcare workers, family members, and even passengers on the same flight, have been traced and tested negative. Therefore, there has been no human-to-human transmission," emphasizes Calogero Terregino , head of the National and European Reference Center for Avian Influenza at the Istituto Zooprofilattico delle Venezie.

Avian flu infection occurs through contact with infected animals, "but not through the ingestion of meat or eggs: there's no need to be alarmed," emphasizes Fabrizio Pregliasco, virologist at the University of Milan and health superintendent of the Galeazzi Hospital. "The experience of COVID-19 has taught us to monitor potentially risky situations: in this case, we're dealing with an infection with a very limited number of cases, which can be identified, contained, and contained." This message is also emphasized by Guido Bertolaso, Councilor for Welfare : "We acted very quickly: the identification of this case shouldn't be a cause for alarm for the public, but it is tangible proof that our prevention system works with extreme precision."

According to WHO data, from the beginning of 2003 to last January, 481 cases of human infection with the avian influenza A(H5N1) virus were reported in just six countries in the Western Pacific region, with a mortality rate of 66.3 percent. Be careful, however: the strain isolated in Monza is different, "much less aggressive: since 1998, approximately 170 human cases have been recorded worldwide," notes Gianni Rezza , associate professor of Hygiene at Vita-Salute University. The virus, he explains, "is present in birds, especially in Asia, the Middle East, and Africa, particularly Western Africa, and is low in virulence in humans. It's not a major concern for humans. But it does indicate that it's circulating widely in countries where the virus is present."

https://milano.repubblica.it/cronaca/2026/03/26/news/primo_caso_influenza_aviaria_europa_negativi_test_contatti_paziente_esperti-425245870/amp/

[Michael Coston]

WHO DON: Avian Influenza A(H9N2) - Italy (Ex Senegal)



Senegal - Base Map Credit Wikipedia

#19,114

In late March we learned of the first (imported) human infection with H9N2 in Europe when Italy's MOH announced a hospitalized case (see Italy: MOH Statement on First LPAI H9N2 Human Case in Europe (imported)).

At that time, few details were made available, including the country of origin.

Yesterday the WHO released a detailed DON (Disease Outbreak News) report, where we learn that the infected individual was a man who had traveled to Italy after staying in Senegal for more than 6 months - who presented at a local hospital with fever and persistent cough - and who tested positive for both Mycobacterium tuberculosis and LPAI H9N2.

Unlike most H9N2 infections we've seen in Asia and (less often) in Africa, this patient denied having contact with poultry, birds, wildlife, or a rural environment. The source of his infection remains unknown.

This is the second human case to be reported from Senegal.

The first occurred during the opening wave of COVID (January 2020); no WHO DON was generated, and most of what we know about it comes from a report (Genetic characterization of the first detected human case of low pathogenic avian influenza A/H9N2 in sub-Saharan Africa, Senegal) published several months later.

The first case - involving a 16 month-old child - occurred before H9N2 had been identified in Senegal's poultry. While details on this 2020 case are scant, I can find no indication of a likely exposure.

In 2023's Influenza A Virus in Pigs in Senegal & Risk Assessment of AIV Emergence and Transmission to Humans, we saw a study that found evidence of A/H9N2, A/H5N1, A/H7N7 and A/H5N2 in local pigs, with H9N2 and H7N7 antibodies detected in > 50% of samples tested.

The authors wrote:

Serological analyses revealed that 83.5% (95%CI = 81.6–85.3) of the 1636 sera tested were positive for the presence of antibodies against either H9N2, H5N1, H7N7 or H5N2. Influenza H7N7 (54.3%) and H9N2 (53.6%) were the dominant avian subtypes detected in Senegalese pigs.

Given the co-circulation of multiple subtypes of influenza viruses among Senegalese pigs, the potential exists for the emergence of new hybrid viruses of unpredictable zoonotic and pandemic potential in the future.

In 2024, Ghana (also in West Africa) reported a human case; that of a 5 y.o. (see WHO DON: Avian Influenza A(H9N2) - Ghana), who once again, reportedly had `. . . no known history of exposure to poultry or any sick person with similar symptoms prior to onset of symptoms.'


Yesterday's WHO DON report follows, after which I'll have a bit more.

Avian Influenza A(H9N2) - Italy
10 April 2026

Situation at a glance

On 21 March 2026, the National International Health Regulations (IHR) Focal Point for Italy notified the World Health Organization (WHO) of the identification of a human case of avian influenza A(H9) in an adult male returning from Senegal. Next generation sequencing confirmed Influenza A(H9N2). According to epidemiological investigations, the patient had no known history of exposure to poultry or any person with similar symptoms prior to the onset of symptoms.

Authorities in Italy have implemented a series of measures aimed at monitoring, preventing and controlling the situation. According to the IHR (2005), a human infection caused by a novel influenza A virus subtype is an event that has the potential for high public health impact and must be notified to the WHO. This is the first imported human case of avian Influenza A(H9N2) reported in the European Region. Based on currently available information, WHO assesses the current risk to the general population posed by A(H9N2) viruses as low but continues to monitor these viruses and the situation globally.

Description of the situation

On 21 March 2026, the National IHR Focal Point for Italy notified WHO of the identification of a human case of avian influenza A(H9) in an adult male.

The patient had been in Senegal for more than six months and traveled to Italy in mid-March. Upon arrival, he visited the emergency department with a fever and a persistent cough.

On 16 March, a bronchoalveolar lavage specimen was collected, which showed a positive Mycobacterium tuberculosis result, as well as detection of un-subtypeable influenza A virus. The patient was placed in a negative-pressure isolation room with airborne precautions. He was treated with antitubercular medication and antiviral oseltamivir. By 9 April, his condition was stable and improving.

On 20 March, a regional reference laboratory identified the A(H9) subtype, and on 21 March, next-generation sequencing confirmed influenza A(H9N2). Initial genetic findings suggest the infection was likely acquired from an avian source linked to Senegal. Additional samples have been sent to Italy’s National Influenza Center, where further characterization confirmed virus subtype Influenza A(H9N2), with close genetic similarity to strains previously identified in poultry in Senegal.

No direct exposure to animals, wildlife or rural environments was identified. There was also no reported contact with symptomatic or confirmed human cases. Further epidemiological investigations on the source of exposure are ongoing.

Contacts identified in Senegal were asymptomatic. All identified and traced contacts in Italy have tested negative for influenza and completed the period of active monitoring for the onset of symptoms and the quarantine required by national guidelines. They also received oseltamivir as a preventive measure.

Epidemiology

Animal influenza viruses normally circulate in animals but can also infect people. Infections in humans have primarily been acquired through direct contact with infected animals or through indirect contact with contaminated environments. Depending on the original host, influenza A viruses can be classified as avian influenza, swine influenza, or other types of animal influenza viruses.

Avian influenza virus infections in humans may cause diseases ranging from mild upper respiratory tract infection to more severe diseases and can be fatal. Conjunctivitis, gastrointestinal symptoms, encephalitis and encephalopathy have also been reported.

Laboratory tests are required to diagnose human infection with influenza. WHO periodically updates technical guidance protocols for the detection of zoonotic influenza using molecular methods.

Human infections with influenza A(H9) viruses have been reported from countries in Africa and Asia, where these viruses are also detected in poultry. The majority of cases of human avian influenza A(H9N2) infection have been reported from China. This is the first imported human case of avian Influenza A(H9N2) virus infection reported in the European Region.

Public health response

Contact tracing procedures have been initiated, and relevant authorities in Italy, as well as internationally (National IHR Focal Point for Senegal, WHO, and European Centre for Disease Prevention and Control (ECDC)) have been informed through IHR channels. Once avian influenza was suspected, the response moved quickly from hospital-level management to regional laboratory confirmation and national coordination. Additionally, the regional surveillance system was notified, integrated within the One Health avian influenza reporting framework.

WHO risk assessment

Most reported human cases of A(H9N2) virus infection have been linked to exposure to infected poultry or contaminated environments, with the majority of cases experiencing mild clinical illness. Sporadic human cases following exposure to infected birds or contaminated environments can be expected since the virus remains enzootic in poultry populations.

Avian influenza A(H9N2) viruses have been detected in poultry and environmental samples collected at live bird markets in Senegal and authorities in the country reported a human case of infection with an A(H9N2) virus in 2020.

Current epidemiological and virological evidence indicates that none of the characterized influenza A(H9N2) viruses thus far have acquired the ability for sustained transmission among humans. Thus, the likelihood of sustained human-to-human spread is low at this time. Infected individuals traveling internationally from affected areas may be identified in another country during or after arrival. However, if this were to occur, further community-level spread is considered unlikely. The risk assessment would be revisited if and when further epidemiological and virological information becomes available.

WHO advice

This case does not change the current WHO recommendations on public health measures and surveillance of influenza.

The public should avoid contact with high-risk environments such as live animal markets/farms or surfaces that might be contaminated by poultry feces. Respiratory protection is highly recommended for those handling live or dead (including slaughtering) poultry in occupational or backyard-farming settings. Good hand hygiene, i.e. frequent washing of hands or the use of alcohol-based hand sanitizer is recommended. WHO does not recommend any specific additional measures for travelers.

Under Article 6 of the IHR, all human infections caused by a new subtype of influenza virus are notifiable. The case definition for notification of human influenza infection caused by a new subtype under the IHR is provided here. State Parties to the IHR are required to immediately notify WHO of any laboratory-confirmed case of a human infection caused by such an influenza A virus.

WHO advises against the application of any travel or trade restrictions based on the current information available on this event.

As we've discussed often, our ability to detect novel flu in the community is limited, and is often heavily dependent on luck. Most people with mild or moderate flu never consult a doctor - and even of those that do - few will be tested for a novel subtype.

In 2024 the ECDC issued guidance for member nations on Enhanced Influenza Surveillance to Detect Avian Influenza Virus Infections in the EU/EEA During the Inter-Seasonal Period., which cautioned:

Sentinel surveillance systems are important for the monitoring of respiratory viruses in the EU/EEA, but these systems are not designed and are not sufficiently sensitive to identify a newly emerging virus such as avian influenza in the general population early enough for the purpose of implementing control measures in a timely way.

It is fair to assume that novel flu detection is even less likely in medically underserved communities. Which means there could easily be more community cases in West Africa than have been reported.

https://afludiary.blogspot.com/2026/04/who-don-avian-influenza-ah9n2-italy-ex.html

[Pathfinder]

Translation Google

H9N2 avian flu in Senegal: "No current threat," reassures Dr. Mamadou Ndiaye

The Director of Prevention, Dr. Mamadou Ndiaye, sought to reassure the public following the WHO's report of a case of avian influenza A (H9N2) in a traveler who had recently been in the country. In an interview with the newspaper L'Observateur, the specialist stated that investigations confirm the absence of any current threat, specifying that "more than a month after his departure, the absence of local outbreaks proves that the chain of transmission is nonexistent." Although the patient's contacts could not be reached, authorities emphasized that the risk of human-to-human transmission remains extremely rare from a scientific standpoint.

In light of this situation, the Ministry of Health is maintaining rigorous surveillance in close collaboration with veterinary services to monitor for any potential mutations of the strain. Dr. Ndiaye stressed that there is no need for restrictive measures for travelers and reiterated the importance of barrier gestures. However, he calls for vigilance, "we call for vigilance, particularly among poultry farmers, in the face of any abnormal mortality of poultry", in order to guarantee early detection of any possible animal outbreak.

Fodé Bakary Camara

https://www.pressafrik.com/Grippe-aviaire-H9N2-au-Senegal-Aucune-menace-actuelle--rassure-le-Dr-Mamadou-Ndiaye_a303896.html

[Pathfinder]

Home Eurosurveillance Volume 31, Issue 15, 16/Apr/2026 Article

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Imported case of avian influenza A(H9N2) virus infection in a patient with miliary tuberculosis, Italy, March 2026

Elena Pariani1 , Simona Puzelli2 , Gabriele Del Castillo3,4 , Greta Romano4,5 , Luca Mezzadri6,7 , Cristina Galli1 , Irene Maria Sciabica8 , Luigi Vezzosi3 , Francesca Sabbatini6 , Cristina Paduraru1 , Irene Mileto4,5 , Marcello Tirani9 , Anna Teresa Palamara2 , Paola Stefanelli2 , Fausto Baldanti4,5,10 , Danilo Cereda3,4 , Paolo Bonfanti6,7 , Collaborating Centres’ Study Group on Influenza11
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In March 2026, avian influenza A(H9N2) virus was identified in Italy in a patient with weakened immune system. They had recently travelled to West Africa, which raised concerns about the potential importation of zoonotic influenza viruses into Europe, as H9N2 has been endemic in poultry across the region since 2017, with widespread outbreaks and two human cases reported in Senegal (one in 2020) and Ghana (one in 2024) [1,2]. Here we present the results of the virological and epidemiological investigation of this case, including molecular characterisation of the virus and an assessment of the likelihood of onward transmission.

Case description and virological findings

In mid-March 2026, an adult patient presented to the emergency department of our hospital, major tertiary referral centre in the Lombardy Region, Italy. They had experienced fever and cough since mid-January, accompanied by notable weight loss. They had returned from Senegal on the day of admission, having stayed there for more than 6 months [2]. The patient did not seek medical care or take any medication during their stay in West Africa. They recognised and self-monitored fever. Upon arrival, they were clinically stable, with an oxygen saturation of 97% on room air and a body temperature of 38.1°C. Laboratory findings showed anaemia, hyponatraemia and elevated lactate dehydrogenase (Table 1). A nasal-pharyngeal swab (NPS) tested negative for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), influenza A virus (IAV), influenza B virus and respiratory syncytial virus (RSV) (Table 2). A chest X-ray showed consolidation in the right middle and lower lung fields, and a small pleural effusion. A chest computer tomography (CT) scan revealed extensive consolidation of the left upper lobe, diffuse bilateral micronodules and a large right pleural effusion. An abdominal CT scan showed multiple hypodense lesions on the spleen and moderate ascites. As miliary tuberculosis was suspected, the patient was admitted to a single negative-pressure isolation room under airborne isolation precautions. Two days after admission, analysis of a sample from bronchoalveolar lavage (BAL) confirmed the presence of Mycobacterium tuberculosis. Anti-tuberculosis therapy comprising rifampicin, isoniazid, ethambutol and pyrazinamide was initiated. Further immunological evaluation revealed considerable cellular immunosuppression (Table 1).
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The sample from BAL was tested using two commercial multiplex assays for respiratory virus detection, revealing a positive result for IAV. However, the H1pdm09 and H3 subtyping assays were negative (Table 2). According to the regional pandemic preparedness plan for influenza, all respiratory samples testing positive for IAV but negative for the seasonal subtypes should be sent immediately to a regional reference laboratory (RRL). There are three RRLs in the Lombardy region: the University of Milan, the Fondazione IRCCS Policlinico San Matteo and the ASST Fatebenefratelli-Sacco [3]. Further real-time RT-PCR testing at the University of Milan RRL confirmed the presence of IAV, with no detection of the H1pdm09 or H3 seasonal subtypes or avian A(H5N1) or A(H7N9). Given the suspicion of a zoonotic IAV infection, the regional authorities and the National Influenza Centre (NIC) were alerted at once, and oseltamivir therapy (75 mg twice daily) was initiated. On day 6 after admission, real-time RT-PCR was performed to detect avian IAV subtypes H5, H7 and H9, and a positive result was obtained for H9. On that day, nasal and throat swabs were collected from the patient, with only the throat swab testing positive for IAV. According to the national procedure [4,5], an aliquot of BAL sample was sent to the NIC where it was confirmed as an IAV subtype H9 (Table 2). The virus was isolated in Madin–Darby canine kidney (MDCK) cells (American Type Culture Collection (ATCC), CRL-2935) at both Fondazione IRCCS Policlinico San Matteo RRL and NIC.

On day 12 after admission, thoracocentesis was performed due to worsening pleural effusion, and the pleural fluid was tested for IAV, with negative result; the NPS collected tested positive for IAV H9. On day 16, a BAL was repeated and still tested positive for IAV H9, with a high viral load (Table 2). Over the following days, no notable clinical changes were observed. As of day 30, the patient was clinically stable and breathing on room air, although still febrile (Table 1).

Public health actions

Epidemiological data were collected through direct interviews with the patient, their friends, household members and healthcare workers. In collaboration with the Italian Ministry of Health, potential close contacts on the return flight from Senegal were identified. During their time in West Africa, the patient stated that they lived in an urban household and that they were not in direct contact with animals, rural environments or individuals known to be unwell. They limited their activities to urban settings, including restaurants, supermarkets and local vendors, as well as making one visit to a coastal area. Contact tracing was carried out among the passengers of the return flight and the contacts in Italy according to the Italian Ministry of Health and the European Centre for Disease Prevention and Control (ECDC) guidelines [5,6]. This identified 13 individuals, including those seated next to the patient during the flight. These individuals were interviewed for early identification of their symptoms, possible modes of transmission and hygiene measures. A 14-day isolation at home from the time of exposure was recommended for those who had not worn personal protective equipment. Local health authorities also began monitoring these individuals for symptoms by daily phone calls. Eight of the 13 contacts were tested for influenza virus 7–10 days after the contact; all tested negative and received oseltamivir chemoprophylaxis. Six passengers seated adjacent to the patient and within two rows behind could not be traced.

Molecular characterisation of influenza A(H9N2) virus

Whole genome sequencing was performed directly on the BAL sample using the Microbial Amplicon Prep—Influenza A/B kit (Illumina, San Diego, the United States (US)) and with a metagenomic shotgun short-reads sequencing. Resulting reads were mapped using MINIMAP2 [7] against the closest reference sequence, A/Oman/2747/2019. A nucleotide basic local alignment search tool (BLAST-N) analysis, on non-redundant databases, revealed the greatest genetic similarity with A/Layers/Senegal/17VIR44551/2017(H9N2). A maximum likelihood phylogenetic tree classified the virus as influenza A(H9N2) belonging to the G5.5 subclade and confirmed that the most closely related sequences were from Senegal (Figure 1). The sequence was uploaded onto GISAID (https://gisaid.org/) under the accession number EPI_ISL_20404890. The haemagglutinin (HA) sequence showed the highest nucleotide similarity (nearly 96%) with A(H9N2) strains identified in Senegal in December 2023. The similarity was also high (nearly 95%) compared with all H9N2 IAVs from West Africa isolated between 2019 and 2024 (Figure 2). Analysis of the amino acid sequences revealed that HA exhibited the Q226L substitution (H3 numbering), which is associated with enhanced binding to α2–6-linked sialic acid receptors. Additionally, it exhibited the HA-R156Q and HA-I212T mutations (H3 numbering), which have been linked to increased viral replication in mammalian and avian cells [8]. The HA cleavage site is typical of low pathogenic viruses. None of the main amino acid changes associated with adaptation to mammalian species were observed in PB2 (E627K, D701N) [9,10]. The NP-52N substitution, which is associated with evasion of a potent inhibitor of avian IAVs, was also identified [11]. Further amino acid substitutions observed in the internal protein genes of the A(H9N2) virus are presented in Table 3. No molecular markers associated with resistance to neuraminidase inhibitors were identified in the NA gene (including N2-H274Y) [12-14]. The PA-L28P substitution, which is associated with reduced susceptibility to baloxavir in human influenza A(H3N2) viruses, was identified [15].
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Discussion

To our knowledge, this is the first reported human case of avian influenza A(H9N2) in Europe [2,17]. The detection of an unsubtypable IAV in the patient with severely weakened immune system prompted a thorough molecular investigation, including characterisation of the virus, which highlights the effectiveness of the diagnostic and surveillance system. The regional public health authorities identified, tested and interviewed 13 contact persons. Nevertheless, contact tracing is challenging when airline companies and tour operators are involved. Several individuals could not be traced; however, all those who were successfully traced and tested, returned negative results.

The genetic similarity of the virus to previously detected strains in West Africa suggests that the patient may have been exposed to the virus during their time in the region, despite reporting no direct contact with animals. The presence of molecular markers associated with human receptor binding further highlights the zoonotic potential of A(H9N2) viruses. However, there is currently no evidence of human-to-human transmission.

Notably, the initial NPS was negative for IAV, potentially due to inadequate specimen collection or a low viral load in the upper respiratory tract at the time of sampling. In this patient with weakened immune system, the infection was initially detected in the lower respiratory tract, as evidenced by BAL positivity. Later NPS positivity, however, was associated with high quantification cycle (Cq) values and suggested the detection of residual viral RNA rather than active replication in the nasopharynx [18].

Conclusion

The potential for prolonged replication in patients with weakened immune systems raises concerns about the emergence of escape variants, emphasising the need for continued vigilance. This case underlines the importance of considering non-seasonal influenza viruses in patients with compatible symptoms and relevant travel history and highlights the added value of genomic characterisation in the public health response.
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https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2026.31.15.2600285