The epidemic potential of avian influenza A (H7N9) virus in humans in mainland China: A two-stage risk analysis

Shan, Xuzheng, Lai, Shengjie, Liao, Hongxiu, Li, Zhongjie, Lan, Yajia and Yang, Weizhong (2019) The epidemic potential of avian influenza A (H7N9) virus in humans in mainland China: A two-stage risk analysis. PLoS ONE, 14 (4), [e0215857]. (doi:10.1371/journal.pone.0215857).

Abstract

BACKGROUND: From 2013 to 2017, more than one thousand avian influenza A (H7N9) confirmed cases with hundreds of deaths were reported in mainland China. To identify priorities for epidemic prevention and control, a risk assessing framework for subnational variations is needed to define the epidemic potential of A (H7N9).

METHODS: We established a consolidated two-stage framework that outlined the potential epidemic of H7N9 in humans: The Stage 1, index-case potential, used a Boosted Regression Trees model to assess population at risk due to spillover from poultry; the Stage 2, epidemic potential, synthesized the variables upon a framework of the Index for Risk Management to measure epidemic potential based on the probability of hazards and exposure, the vulnerability and coping capacity.

RESULTS: Provinces in southern and eastern China, especially Jiangsu, Zhejiang, Guangzhou, have high index-case potential of human infected with A (H7N9), while northern coastal provinces and municipalities with low morbidity, i.e. Tianjin and Liaoning, have an increasing risk of A (H7N9) infection. Provinces in central China are likely to have high potential of epidemic due to the high vulnerability and the lack of coping capacity.

CONCLUSIONS: This study provides a unified risk assessment of A (H7N9) to detect the two-stage heterogeneity of epidemic potential among different provinces in mainland China, allowing proactively evaluate health preparedness at subnational levels to improve surveillance, diagnostic capabilities, and health promotion.

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Contributors

Author: Shengjie Lai

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