Changwen Ke

Gastroenteritis Outbreaks Caused by Norovirus GII.17, Guangdong Province, China, 2014-2015.

In the past decade, the most prevalent norovirus genotype causing viral gastroenteritis outbreaks worldwide, including China, has been GII.4. In winter 2014–15, norovirus outbreaks in Guangdong, China, increased. Sequence analysis indicated that 82% of the outbreaks were caused by a norovirus GII.17 variant.

Role for migratory wild birds in the global spread of avian influenza H5N8

Migration of influenza in wild birds Virus surveillance in wild birds could offer an early warning system that, combined with adequate farm hygiene, would lead to effective influenza control in poultry units. The Global Consortium for H5N8 and Related Influenza Viruses found that the H5 segment common to the highly pathogenic avian influenza viruses readily reassorts with other influenza viruses (see the Perspective by Russell). H5 is thus a continual source of new pathogenic variants. These data also show that the H5N8 virus that recently caused serious outbreaks in European and North American poultry farms came from migrant ducks, swans, and geese that meet at their Arctic breeding grounds. Because the virus is so infectious, culling wild birds is not an effective control measure. Science, this issue p. 213; see also p. 174 High pathogenicity avian H5 influenza disperses around the Northern Hemisphere in long-distant migrant geese and ducks. Avian influenza viruses affect both poultry production and public health. A subtype H5N8 (clade 2.3.4.4) virus, following an outbreak in poultry in South Korea in January 2014, rapidly spread worldwide in 2014–2015. Our analysis of H5N8 viral sequences, epidemiological investigations, waterfowl migration, and poultry trade showed that long-distance migratory birds can play a major role in the global spread of avian influenza viruses. Further, we found that the hemagglutinin of clade 2.3.4.4 virus was remarkably promiscuous, creating reassortants with multiple neuraminidase subtypes. Improving our understanding of the circumpolar circulation of avian influenza viruses in migratory waterfowl will help to provide early warning of threats from avian influenza to poultry, and potentially human, health.

Hand, foot and mouth disease in Guangdong, China, in 2013: new trends in the continuing epidemic.

Millions of incidents of hand, foot and mouth disease occur annually in China, with EVA71 and CVA16 as two major causative pathogens. A provincial surveillance system has been implemented in Guangdong for almost 5 years to analyze the aetiological spectrum and epidemic changes. An unusual enterovirus type, CVA6, was identified as the predominant serotype associated with an HFMD epidemic from late 2012 to 2013. In contrast to virus strains isolated before, all CVA6/CHN/2012-2013 strains segregated into one major genetic cluster. This study suggested that one cluster of circulating CVA6 strain had emerged as a new and major cause during a continuing HFMD epidemic in Guangdong, China.

Human Infection with Highly Pathogenic Avian Influenza A(H7N9) Virus, China

The recent increase in zoonotic avian influenza A(H7N9) disease in China is a cause of public health concern. Most of the A(H7N9) viruses previously reported have been of low pathogenicity. We report the fatal case of a patient in China who was infected with an A(H7N9) virus having a polybasic amino acid sequence at its hemagglutinin cleavage site (PEVPKRKRTAR/GL), a sequence suggestive of high pathogenicity in birds. Its neuraminidase also had R292K, an amino acid change known to be associated with neuraminidase inhibitor resistance. Both of these molecular features might have contributed to the patient’s adverse clinical outcome. The patient had a history of exposure to sick and dying poultry, and his close contacts had no evidence of A(H7N9) disease, suggesting human-to-human transmission did not occur. Enhanced surveillance is needed to determine whether this highly pathogenic avian influenza A(H7N9) virus will continue to spread.

Virological and Epidemiological Evidence of Avian Influenza Virus Infections Among Feral Dogs in Live Poultry Markets, China: A Threat to Human Health?

TO THE EDITOR— Since its first detection in March 2013, the novel H7N9 avian influenza virus (AIV) has quickly spread among poultry and people in China. As of 16 February 2014, a total of 348 laboratory-confirmed human H7N9 infections in China have been confirmed by the World Health Organization [1–3]. The H7N9 virus has spread widely with little sign of infection among poultry [4]. Epidemiologic studies have identified poultry exposure as an important risk factor for human infections with H5N1 and H7N9, especially for those individuals associated with live poultry markets (LPMs) [5–8]. As dogs in China have been shown to be infected with AIVs, we sought to investigate whether dogs living in close proximity to LPMs and H7N9-affected farms might have been infected with the novel H7N9 virus or other influenza viruses. From August 2011 to August 2013, we studied a total of 2357 dogs that lived in close proximity to LPMs and poultry farms in the rural areas of Shanghai, Guangdong, Zhejiang, and Jiangsu provinces in China where novel H7N9 AIV had been previously detected (forMaterials and Methods, see Supplementary Data). Overall, 68.18% (n = 1607) of the 2357 stray dog samples were collected in rural areas, with the remaining samples collected in LPMs (Table 1). Of the 2357 nasal swab samples collected, 93 (3.9%) were positive for influenza A virus by realtime reverse transcription polymerase chain reaction (PCR), and 11 viruses were isolated from these samples (see Supplementary Data). Hemagglutination inhibition (HI) assays and hemagglutinin antigen–specific enzyme-linked immunosorbent assays against H7N9 viral antigens revealed no evidence of H7N9 infection. Results of the HI and microneutralization (MN) assays are reported in Table 1 and in the Supplementary Data. A total of 19 serum samples had HI antibody titers of ≥1:20 against H5 antigen (Table 1), and 3 of these 19 samples were also positive by MN assay. Dogs that were sampled in LPMs had a greater probability of having elevated HI antibodies against avian H9N2, avian H5N1, and canine H3N2 viruses (Table 2), compared with the dogs that were raised in poultry farms. Our study supports this premise in that, although we failed to find evidence of previous H7N9 infections among the dogs, we found the world’s first evidence of previous H5N1 and H9N2 infection among dogs by real-time PCR, HI, and MN assay. These findings were unexpected but biologically plausible. In LPMs and farms in rural China, stray dogs and cats have considerable contact with poultry or poultry products. This can occur indirectly through aerosol and fecal transmission or directly through the consumption of dead bird carcasses or entrails. LPMs are particularly problematic as they offer a mixing of animal species from often diverse geographical areas, frequent venues for contact with the public, and often nonhygienic behavior of workers who handle and process the birds for sale. Both rural farms and LPMs provide opportunities for wild aquatic birds, domestic poultry, stray dogs, and humans to closely interact and potentially share pathogens (Supplementary Figure 1). Additionally, compared

Continuing Reassortment Leads to the Genetic Diversity of Influenza Virus H7N9 in Guangdong, China

ABSTRACT On 30 March 2013, a novel avian influenza A H7N9 virus causing severe human respiratory infections was identified in China. Preliminary sequence analyses have shown that the virus is a reassortant of H7N9 and H9N2 avian influenza viruses. In this study, we conducted enhanced surveillance for H7N9 virus in Guangdong, China, from April to August 2013. We isolated two H7N9 viral strains from environmental samples associated with poultry markets and one from a clinical patient. Sequence analyses showed that the Guangdong H7N9 virus isolated from April to May shared high sequence similarity with other strains from eastern China. The A/Guangdong/1/2013 (H7N9) virus isolated from the Guangdong patient on 10 August 2013 was divergent from previously sequenced H7N9 viruses and more closely related to local circulating H9N2 viruses in the NS and NP genes. Phylogenetic analyses revealed that four internal genes of the A/Guangdong/1/2013 (H7N9) virus—the NS, NP, PB1, and PB2 genes—were in clusters different from those for H7N9 viruses identified previously in other provinces of China. The discovery presented here suggests that continuing reassortment led to the emergence of the A/Guangdong/1/2013 (H7N9) virus as a novel H7N9 virus in Guangdong, China, and that viral adaptation to avian and human hosts must be assessed. IMPORTANCE In this study, we isolated and characterized the avian influenza A H7N9 virus in Guangdong, China, from April to August 2013. We show that the viruses isolated from Guangdong environmental samples and chickens from April to May 2013 were highly similar to other H7N9 strains found in eastern China. The H7N9 virus isolated from the clinical patient in Guangdong in August 2013 was divergent from previously identified H7N9 viruses, with the NS and NP genes originating from recent H9N2 viruses circulating in the province. This study provides direct evidence that continuing reassortment occurred and led to the emergence of a novel H7N9 influenza virus in Guangdong, China. These results also shed light on how the H7N9 virus evolved, which is critically important for future monitoring and tracing of viral transmission.

Chikungunya outbreak in Guangdong Province, China, 2010.

A disease outbreak with dengue-like symptoms was reported in Guangdong Province, China, in October 2010. Testing results confirmed that the pathogen causing the outbreak was chikungunya virus. Phylogenic analysis indicated that this virus was a member of the Indian Ocean clade of the East/Center/South African subgroup of chikungunya virus.

The Evolution and Transmission of Epidemic GII.17 Noroviruses

BACKGROUND In recent decades, the GII.4 norovirus genotype has predominated in epidemics worldwide and been associated with an increased rate of evolutionary change. In 2014, a novel GII.17 variant emerged and persisted, causing large outbreaks of gastroenteritis in China and sporadic infections globally. The origin, evolution, and transmission history of this new variant are largely unknown. METHODS We generated 103 full capsid and 8 whole-genome sequences of GII.17 strains collected between August 2013 and November 2015 in Guangdong, China. Phylogenetic analyses were performed by integrating our data with those for all publically available GII.17 sequences. RESULTS The novel emergent lineage GII.17_Kawasaki_2014 most likely originated from Africa around 2001 and evolved at a rate of 5.6 × 10(-3) substitutions/site/year. Within this lineage, a new variant containing several important amino acid changes emerged around August 2013 and caused extensive epidemics in 2014-2015. The phylodynamic and epidemic history of the GII.17_Kawasaki lineage shows similarities with the pattern observed for GII.4 norovirus evolution. Virus movements from Hong Kong to neighboring coastal cities were frequently observed. CONCLUSIONS Our results provide new insights into GII.17 norovirus evolution and transmission and highlight the potential for a rare norovirus genotype to rapidly replace existing strains and cause local epidemics.

Circulation of Reassortant Influenza A(H7N9) Viruses in Poultry and Humans, Guangdong Province, China, 2013

Influenza A(H7N9) virus emerged in eastern China in February 2013 and continues to circulate in this region, but its ecology is poorly understood. In April 2013, the Guangdong Provincial Center for Disease Control and Prevention (CDC) implemented environmental and human syndromic surveillance for the virus. Environmental samples from poultry markets in 21 city CDCs (n = 8,942) and respiratory samples from persons with influenza-like illness or pneumonia (n = 32,342) were tested; viruses isolated from 6 environmental samples and 16 patients were sequenced. Sequence analysis showed co-circulation of 4 influenza A(H7N9) virus strains that evolved by reassortment with avian influenza A(H9N2) viruses circulating in this region. In addition, an increase in human cases starting in late 2013 coincided with an increase in influenza A H7 virus isolates detected by environmental surveillance. Co-circulation of multiple avian influenza viruses that can infect humans highlights the need for increased surveillance of poultry and potential environmental sources.

Laboratory-Based Surveillance of Non-typhoidal Salmonella Infections in Guangdong Province, China

Salmonella is one of the most common foodborne pathogens in humans. Laboratory-based surveillance for non-typhoidal Salmonella infection was conducted in Guangdong Province, China to improve understanding about the disease burden and detection of dispersed outbreaks. Salmonella isolated from patients with diarrhea were sent from 16 sentinel hospitals to local public health laboratories for confirmation, serotyping, antimicrobial susceptibility testing, and pulsed-field gel electrophoresis (PFGE). PFGE patterns were analyzed to identify clusters representing potential outbreaks. Between September 2009 and October 2010, 352 (4%) Salmonella isolates were obtained from 9167 stool specimens. Salmonella enterica serotype Typhimurium (45%) and Salmonella enterica serotype Enteritidis (13%) were the most common serotypes, and multidrug resistance was high, especially in Salmonella Typhimurium isolates. PFGE patterns of obtained Salmonella isolates were found to be diverse, but a unique PFGE pattern comprising 53 Salmonella Typhimurium isolates were found to occur almost exclusively in infants. Epidemiologic studies are ongoing to determine whether a common exposure is the source of the Salmonella Typhimurium strain frequently isolated from infants.