Human infections caused by A (H7N9) influenza virus: emergence, evolution and pandemic risk

Since 2013, avian influenza A(H7N9) viruses were responsible for five epidemics in China (at least 1,557 human cases, 605 deaths). A(H7N9) viruses emerged upon multiple reassortments of avian influenza viruses and its internal genes are coming from enzootic A(H9N2) viruses in poultry. Human infections are severe with pneumonia (>80 %) and rapid evolution to acute respiratory distress syndrome. However, moderate forms are suggested by seroprevalence studies and severe infections are associated with older age and comorbidity factors. Infections arose after exposure to live infected poultry, in addition, 10 % of analyzed viruses had oseltamivir-resistance mutations in NA. A(H7N9) viruses are low pathogenic for poultry and surveillance is difficult. Recently, a four basic amino-acids insertion in HA cleavage site was detected, suggesting a possible evolution towards highly pathogenic avian viruses. H7 can bind to ɑ2,6 or ɑ2,3 sialic-acid but the limited respiratory droplet transmission in ferret model is consistent with a non-sustained human-to-human transmission. With a potential pandemic risk, A(H7N9) viruses remain under close surveillance.