Abstract
A novel avian-origin influenza A(H7N9) virus emerged in China in March 2013 and by 27 September 2017 a total of 1533 laboratory-confirmed cases have been reported. Occurrences of animal-to-human and human-to-human transmission have been previously identified, and the force of human-to-human transmission is an important component of risk assessment. In this study, we constructed an ecological model to evaluate the animal-to-human and human-to-human transmission of H7N9 during the first three epidemic waves in spring 2013, winter/spring 2013–2014 and winter/spring 2014–2015 in China based on 149 laboratory-confirmed urban cases. Our analysis of patterns in incidence in major cities allowed us to estimate a mean incubation period in humans of 2.6 days (95% credibility interval, CrI: 1.4–3.1) and an effective reproduction number Re of 0.23 (95% CrI: 0.05–0.47) for the first wave, 0.16 (95% CrI: 0.01–0.41) for the second wave, and 0.16 (95% CrI: 0.01–0.45) for the third wave without a significant difference between waves. There was a significant decrease in the incidence of H7N9 cases after live poultry market closures in various major cities. Our analytic framework can be used for continued assessment of the risk of human to human transmission of A(H7N9) virus as human infections continue to occur in China.
Highlights
We found that closures of LPMs in the different waves were associated with significant decreases in incidence rates in each city (Fig. 3)
Our findings show that LPM closures were associated with significant decreases in the incidence of animal-to-human transmission in the different cities considered in this study, consistent with previous reports[2,3]
Our estimates of the reproduction number are slightly higher to those reported in a cluster analysis, i.e. considering only the human-to-human transmission component, during the first two waves of H7N9 cases where the authors estimated a mean basic reproduction number Re to be 0.08 and estimates range from 0.07 to 0.127
Summary
We aimed to evaluate transmission from animal-to-human and human-to-human using an ecological approach
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