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Volume 22, Number 8—August 2016

Influenza A(H7N7) Virus among Poultry Workers, Italy, 2013

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To the Editor: In August 2013, an outbreak of infection with highly pathogenic influenza A(H7N7) virus occurred in Emilia-Romagna, Italy, and >1 million birds were culled (1). Prevention measures were immediately applied, and all workers involved in culling activities wore personal protective equipment (PPE), including face masks with eye protection. These workers were monitored for clinical symptoms, and 3 workers with laboratory-confirmed cases of conjunctivitis caused by infection with influenza A(H7N7) virus were reported during the 3-week outbreak (2). Workers did not receive chemoprophylaxis.

A serologic study was conducted in December 2013 to identify potential asymptomatic infections following exposure to influenza A(H7N7) virus. This study was approved by the ethics committee of the Istituto Superiore di Sanità (protocol no. PRE787/13CE13/401).

A total of 93 of 140 workers directly involved in culling activities, including the 3 confirmed case-patients with conjunctivitis, participated in the study. All participants completed a questionnaire that obtained information for demographics, poultry exposure, and use of PPE.

Paired acute-phase and convalescent-phase serum samples were available only for the 3 H7 subtype–positive persons with conjunctivitis. We tested these paired serum samples and single serum samples obtained from virus-exposed workers for antibodies against influenza A(H7N7) virus strain A/Italy/3/2013 (2) by using hemagglutination inhibition (HI) and microneutralization (MN) assays (3,4). Other H7 subtype viruses previously circulating in Italy were included in the analysis to rule out potential cross-reactivity with influenza A(H7N7) virus (5). HI titers >10 and MN titers >20 were considered positive; only HI-positive serum samples confirmed 3 times by MN assay were considered positive results for influenza A(H7N7) virus.

We detected antibodies against influenza A(H7N7) virus in convalescent-phase serum samples from the 3 H7 subtype-positive patients and 2 asymptomatic persons but found no seropositivity against other H7 subtype viruses (Table). Because of lack of acute-phase serum samples, we could not assess whether seropositivity for the 2 asymptomatic persons, 1 (RA32) of whom worked with poultry before the outbreak, was caused by infection acquired during the outbreak. All workers were trained and most participants, including the 2 asymptomatic influenza A(H7N7) virus–seropositive persons, reported that PPE was commonly used during culling on infected premises. Nevertheless, it is likely that worker compliance with PPE was not always 100% during the 3-week outbreak because of poor knowledge and real perception of biologic risks among workers.

Future efforts should ensure timely collection of paired serum samples from all workers involved in avian influenza outbreaks, especially when infections occur in humans. Strict compliance with recommended preventive control measures and serologic surveillance programs are crucial to avoid and eventually assess risk for infections with avian influenza viruses in persons exposed to infected poultry.



This study was supported by the Italian Ministry of Health (grants CCM 2012 and RF-2010-2318269).


Simona Puzelli1Comments to Author , Caterina Rizzo1, Concetta Fabiani, Marzia Facchini, Paolo Gaibani, Maria P. Landini, Carlo Gagliotti, Maria L. Moro, Roberto Rangoni, Luisa Loli Piccolomini, Alba C. Finarelli, Marco Tamba, Giovanni Rezza, Silvia Declich, Isabella Donatelli, and Maria R. Castrucci
Author affiliations: Istituto Superiore Sanità, Rome, Italy (S. Puzelli, C. Rizzo, C. Fabiani, M. Facchini, G. Rezza, S. Declich, I. Donatelli, M.R. Castrucci); St. Orsola University Hospital, Bologna, Italy (P. Gaibani, M.P. Landini); Agenzia Sanitaria Regionale Emilia-Romagna, Bologna Region (C. Gagliotti, M.L. Moro, R. Rangoni, L.L. Piccolomini, A.C. Finarelli); Istituto Zooprofilattico Sperimentale della Lombardia e dell’Emilia Romagna, Brescia, Italy (M. Tamba)



  1. Bonfanti  L, Monne  I, Tamba  M, Santucci  U, Massi  P, Patregnani  T, Highly pathogenic H7N7 avian influenza in Italy. Vet Rec. 2014;174:382 .DOIPubMedGoogle Scholar
  2. Puzelli  S, Rossini  G, Facchini  M, Vaccari  G, Di Trani  L, Di Martino  A, Human infection with highly pathogenic A(H7N7) avian influenza virus, Italy, 2013. Emerg Infect Dis. 2014;20:17459. DOIPubMedGoogle Scholar
  3. Centers for Disease Control and Prevention. Modified hemagglutination-inhibition (HI) assay using horse RBCs for serologic detection of antibodies to H7 subtype avian influenza virus in human sera. Version 1 [cited 2016 April 8].
  4. World Health Organization. Serological detection of avian influenza A(H7N9) infections by microneutralization assay. Version 23, May 2013 [cited 2016 April 8].
  5. Puzelli  S, Di Trani  L, Fabiani  C, Campitelli  L, De Marco  MA, Capua  I, Serological analysis of serum samples from humans exposed to avian H7 influenza viruses in Italy between 1999 and 2003. J Infect Dis. 2005;192:131822. DOIPubMedGoogle Scholar




Cite This Article

DOI: 10.3201/eid2208.160246

1These authors contributed equally to this article.

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Please use the form below to submit correspondence to the authors or contact them at the following address:

Simona Puzelli, National Influenza Centre, Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy

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Page created: July 15, 2016
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