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Avian Flu (H7N9) in China

Warning - Level 3, Avoid Nonessential Travel
Alert - Level 2, Practice Enhanced Precautions
Watch - Level 1, Practice Usual Precautions

What is the current situation?

According to the World Health Organization, 667 cases and 229 deaths from H7N9 flu have been reported globally from March 2013 through October 14, 2015, most from the mainland of China. Cases have been confirmed in the following administrative areas of China: Anhui, Beijing, Fujian, Guangdong, Guangxi, Guizhou, Hebei, Henan, Hubei, Hunan, Jiangsu, Jiangxi, Jilin, Shandong, Shanghai, Xinjiang, and Zhejiang. Smaller numbers of cases have been identified in travelers from Hong Kong, Taiwan, Malaysia, and Canada.

CDC advises people traveling to China to avoid contact with poultry (including poultry markets and farms), birds, and their droppings. There are no recommendations against travel to China.

What is avian influenza A (H7N9)?

Avian influenza A (H7N9) is an influenza (flu) virus found in birds that does not normally infect humans. However, in spring of 2013, China began reporting infections with the virus in people. Most of these infections have been associated with contact with infected poultry or contaminated environments (such as poultry markets) in China. Early symptoms are consistent with seasonal flu and may include fever, cough, sore throat, muscle aches and fatigue, loss of appetite, and runny or stuffy nose. However, infection with this virus often causes severe respiratory illness and, in some cases, death (see

What can travelers do to protect themselves?

There is no vaccine to prevent H7N9 flu.

  • Do not touch birds, pigs, or other animals.
    • Don’t touch animals, whether they are alive or dead.
    • Avoid live bird or poultry markets.
    • Avoid other markets or farms with animals (wet markets).
  • Eat food that is fully cooked.
    • Eat meat and poultry that is fully cooked (not pink) and served hot.
    • Eat hard-cooked eggs (not runny).
    • Don’t eat or drink dishes that include blood from any animal.
    • Don’t eat food from street vendors.
  • Practice hygiene and cleanliness.
    • Wash your hands often.
    • If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol.
    • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
    • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
    • Try to avoid close contact, such as kissing, hugging, or sharing eating utensils or cups, with people who are sick.
  • If you feel sick and think you may have avian flu after visiting China:
  • Talk to your doctor or nurse if you feel seriously ill, especially if you have a fever, cough, or shortness of breath.
  • Avoid contact with other people while you are sick.

Clinician information

Clinicians should consider the possibility of avian influenza A (H7N9) virus infection in people presenting with respiratory illness within 10 days of travel to China, particularly if the patient reports exposure to birds or poultry markets. Although most H7N9 cases have resulted in severe respiratory illness in adults, infection may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness of unknown etiology may identify human cases of avian influenza A or new cases of variant influenza (such as human infections caused by influenza viruses from pigs) in the United States. Patients with H7N9 are expected to have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction (RT-PCR testing) that will be unsubtypeable by most assays. Nonmolecular rapid test results may be variable. Clinicians who suspect avian influenza A (H7N9) should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours.

Additional information