Emily
Editor, Senior Moderator
https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2022.27.5.2200061
Oliver Isabel, Roberts Jonathan, Brown Colin S, Byrne Alexander MP, Mellon Dominic, Hansen Rowena DE, Banyard Ashley C, James Joe, Donati Matthew, Porter Robert, Ellis Joanna, Cogdale Jade, Lackenby Angie, Chand Meera, Dabrera Gavin, Brown Ian H, Zambon Maria. A case of avian influenza A(H5N1) in England, January 2022. Euro Surveill. 2022;27(5)
ii=2200061. https://doi.org/10.2807/1560-7917.ES.2022.27.5.2200061 Received: 19 Jan 2022; Accepted: 03 Feb 2022
We present a case report of the first confirmed human case of avian influenza A(H5N1) in England in January 2022 following identification of the strain in a duck flock kept at their residence. We describe the clinical epidemiological and virological aspects, and discuss the importance of surveillance through an asymptomatic testing programme.
Case detection and description
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An outbreak of high pathogenicity avian influenza (HPAI) H5N1 was confirmed by the United Kingdom (UK) chief veterinary officer in a flock of ca 125 Muscovy ducks in a domestic setting in South West England on 22 December 2021. After the death of one bird on 18 December, followed by additional deaths and clinical signs of illness in the flock on 20 December, 20 Muscovy ducks were sampled on 21 December and samples submitted to the National Reference Laboratory at the Animal and Plant Health Agency (APHA), Weybridge, UK with 19 live birds testing positive for H5N1 HPAI virus.
On confirmation of the avian outbreak, the owner, in their early 80s and who had no signs of infection, was prescribed a prophylactic dose of oseltamivir (75 mg once per day) on 24 December since they had been exposed to infected birds and their secretions without personal protective equipment (PPE). On the same day, a routine nasal swab was collected from the owner as part of the UK Health Security Agency’s (UKHSA) avian influenza surveillance programme, which includes testing of asymptomatic people exposed to the virus. The sample tested positive for influenza A by PCR in two different UKHSA laboratories. Human seasonal influenza viruses, H1 and H3, were not detected by subtyping PCR assays and the circumstances in which the individual resided – close contact with avian influenza H5N1-infected birds, heavily contaminated environment and lack of plausible human contacts for seasonal influenza – led to the individual being managed as a presumptive case of avian influenza A virus. As such, the case was requested to isolate at home and received an extended treatment course of oseltamivir (75 mg twice per day) for 10 days until two consecutive PCR tests were negative at the reference laboratory; the individual remained asymptomatic throughout. Of note, the affected individual had been vaccinated on 23 November 2021 with the Fluad Tetra vaccine (Seqirus, Maidenhead, UK), containing inactivated influenza virus haemagglutinin and neuraminidase surface antigens.
Oliver Isabel, Roberts Jonathan, Brown Colin S, Byrne Alexander MP, Mellon Dominic, Hansen Rowena DE, Banyard Ashley C, James Joe, Donati Matthew, Porter Robert, Ellis Joanna, Cogdale Jade, Lackenby Angie, Chand Meera, Dabrera Gavin, Brown Ian H, Zambon Maria. A case of avian influenza A(H5N1) in England, January 2022. Euro Surveill. 2022;27(5)
ii=2200061. https://doi.org/10.2807/1560-7917.ES.2022.27.5.2200061 Received: 19 Jan 2022; Accepted: 03 Feb 2022We present a case report of the first confirmed human case of avian influenza A(H5N1) in England in January 2022 following identification of the strain in a duck flock kept at their residence. We describe the clinical epidemiological and virological aspects, and discuss the importance of surveillance through an asymptomatic testing programme.
Case detection and description
Go to section...
An outbreak of high pathogenicity avian influenza (HPAI) H5N1 was confirmed by the United Kingdom (UK) chief veterinary officer in a flock of ca 125 Muscovy ducks in a domestic setting in South West England on 22 December 2021. After the death of one bird on 18 December, followed by additional deaths and clinical signs of illness in the flock on 20 December, 20 Muscovy ducks were sampled on 21 December and samples submitted to the National Reference Laboratory at the Animal and Plant Health Agency (APHA), Weybridge, UK with 19 live birds testing positive for H5N1 HPAI virus.
On confirmation of the avian outbreak, the owner, in their early 80s and who had no signs of infection, was prescribed a prophylactic dose of oseltamivir (75 mg once per day) on 24 December since they had been exposed to infected birds and their secretions without personal protective equipment (PPE). On the same day, a routine nasal swab was collected from the owner as part of the UK Health Security Agency’s (UKHSA) avian influenza surveillance programme, which includes testing of asymptomatic people exposed to the virus. The sample tested positive for influenza A by PCR in two different UKHSA laboratories. Human seasonal influenza viruses, H1 and H3, were not detected by subtyping PCR assays and the circumstances in which the individual resided – close contact with avian influenza H5N1-infected birds, heavily contaminated environment and lack of plausible human contacts for seasonal influenza – led to the individual being managed as a presumptive case of avian influenza A virus. As such, the case was requested to isolate at home and received an extended treatment course of oseltamivir (75 mg twice per day) for 10 days until two consecutive PCR tests were negative at the reference laboratory; the individual remained asymptomatic throughout. Of note, the affected individual had been vaccinated on 23 November 2021 with the Fluad Tetra vaccine (Seqirus, Maidenhead, UK), containing inactivated influenza virus haemagglutinin and neuraminidase surface antigens.