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Outbreak of Influenza A(H7N2) Among Cats in an Animal Shelter With Cat-to-Human Transmission—New York City, 2016

Outbreak of Influenza A(H7N2) Among Cats in an Animal Shelter With Cat-to-Human Transmission—New York City, 2016 Lee CT, Slavinski S, Schiff C, et al; for the Influenza A(H7N2) Response Team. Clin Infect Dis. 2017;65:1927–1929. Influenza A(H7N2), a low pathogenic avian-lineage influenza virus, circulated in live poultry markets in the eastern and northeastern United States during 1994–2006 and caused outbreaks among poultry in Pennsylvania during 1997–1998 and 2001–2002, and in Virginia, West Virginia and North Carolina in 2002. Two previously documented U.S. human infections have occurred with this North American H7N2 lineage. On December 14, 2016, the New York City Department of Health and Mental Hygiene (NYC DOHMH) was notified of a cat admitted to a Manhattan shelter on 12 November that died on 25 November and was confirmed positive for influenza A(H7N2) virus. Subsequent testing of oropharyngeal aspirates of animals in the same shelter by the University of Wisconsin identified widespread infection with influenza A(H7N2) virus among cats, but no evidence of infection among dogs, chickens or rabbits. Case finding to detect human infections from cat-to-human transmission was conducted and measures to reduce the risk for transmission to humans and cats were implemented. Case finding among persons who had adopted cats from, or were employed by or volunteered at the Manhattan shelter during November 12–December 29, 2016, was conducted. On December 19, NYC DOHMH was notified of an ill veterinarian who was not a regular employee or volunteer at the Manhattan shelter but who had obtained deep oropharyngeal aspirates from symptomatic cats at the Manhattan shelter to test for influenza during the previous week. This activity resulted in prolonged exposure, without a mask, respirator or face shield, to respiratory secretions of cats infected with A(H7N2). Illness onset date was December 18, the same day that the patient traveled by commercial airline. The patient reported a mild illness, characterized by sore throat, myalgia and cough. On December 19, NYC DOHMH interviewed the patient and collected a nasopharyngeal specimen, from which influenza A virus RNA, unsubtypeable as H3 or H1, was detected by real-time reverse-transcription polymerase chain reaction at NYC Public Health Laboratory. The patient was treated with oseltamivir and symptoms resolved without hospitalization. The Centers for Disease Control and Prevention performed genetic sequencing from the specimen collected on December 19 and confirmed influenza A(H7N2) infection. The virus (A/New York/108/2016 (H7N2)) sequence was nearly identical to the virus isolated from the infected cat, which had been sequenced by the U.S. Department of Agriculture National Veterinary Services Laboratories and the University of Wisconsin Veterinary Diagnostic Laboratory. Analysis of viruses isolated from the human and cat revealed that they were North American lineage low pathogenic avian influenza A(H7N2) viruses and were similar to H7N2 viruses that circulated and evolved in live bird markets in the eastern and northeastern United States during the early 2000s and resulted in 2 human infections in 2002 and 2003. Contact tracing of persons who had prolonged, close contact to the person with the confirmed case was conducted to determine whether human-to-human transmission had occurred. No additional cases of H7N2 influenza in humans were identified. Further testing of cats identified feline A(H7N2) infection at 2 other NYC-operated shelters that had received cats from the Manhattan shelter. On December 15, all 3 shelters ceased adoptions and movement of cats between shelters and limited intakes of new cats. A temporary biosecure shelter was established to allow affected shelters to disinfect and resume normal operations and to provide a contained space to care for more than 500 ill or exposed cats. The temporary facility was closed on March 14, 2017, after repeat oropharyngeal testing indicated that viral shedding had ended.