Benefit-cost analysis of a H7N9 vaccination program in poultry in Guangxi, China.

China launched a H7N9 vaccination program in poultry, starting from the Guangxi and Guangdong provinces in July 2017, followed by other provinces in September 2017, as a response to a steep increase of H7N9 influenza human infections from September 2016. Since then, H5-H7 bivalent vaccine has been used in the nationwide avian influenza compulsory vaccination program to replace the existing H5N1 vaccine. However, the economic returns of the H7N9 vaccination program in China have never been adequately assessed. This study was designed to evaluate the economic value of the H7N9 vaccination program in Guangxi by assessing the benefits and costs of the program compared to not vaccinating against H7N9. A benefit-cost analysis (BCA) was undertaken to evaluate the adoption of a vaccination program against H7N9 in each of three consecutive years from July 2017 to June 2020 with the baseline scenario (the absence of H7N9 vaccination in the 12-month period July 2016 to June 2017). Both animal and public health perspectives were included in the BCA framework and took account of both the private and public sectors. Benefit-Cost Ratio (BCR) of the three-year H7N9 vaccination program was 18.6 (90 %PI: 15.4; 21.8), and total Net Present Values reached to CNY 1.63 billion (90 %PI: 1.37 billion; 1.89 billion). The extra revenue generated by the yellow broiler industry comprised 93.8 % of the total benefits after adoption of H7N9 vaccination program in Guangxi. While cost-savings in public health and animal health expenditure avoided were 3.6 % and 2.6 %, respectively. Total costs arising from adoption of the revised vaccination program over the three years were CNY 12.46 million (90 %PI: 11.49 million; 14.14 million), CNY 34.87 million (90 %PI: 31.88 million; 40.06 million), and CNY 44.28 million (90 %PI: 39.66 million; 52.27 million), respectively. Sensitivity analysis found the yellow broiler wholesale prices contributed 97.7 % of the variance of the total NPV of three vaccination years. The study results demonstrate the significant economic advantage of implementing a vaccination program against H7N9 in Guangxi. It also offers a new set of evidence to China's H7N9 vaccination policy and debates around economic values of conducting routine avian influenza vaccination.

Analysis of the movement of live broilers in Guangxi, China and implications for avian influenza control.

Most Chinese provinces have a daily-updated database of live animal movements; however, the data are not efficiently utilized to support interventions to control H7N9 and other avian influenzas. Based on official records, this study assessed the spatio-temporal patterns of live broilers moved out of and within Guangxi in 2017. The yearly and monthly networks were analyzed for inter- and intra-provincial movements, respectively. Approximately 200,000 movements occurred in 2017, involving the transport of 200 million live broilers from Guangxi. Although Guangxi exported to 24 out of 32 provinces of China, 95% of inter-provincial movements occurred with three bordering provinces. Within Guangxi, counties were highly connected through the live broiler movements, creating conditions for rapid virus spreading throughout the province. Interestingly, a peak in movements during the Chinese Lunar New Year celebrations, late January in 2017, was not observed in this study, likely due to H7N9-related control measures constraining live bird trading. Both intra- and inter-provincial movements in March 2017 were significantly higher than in other months of that year, suggesting that dramatic price changes may influence the movement's network and reshape the risk pathways. However, despite these variations, the same small proportion of counties (less than 20%) exporting/importing more than 90% of inter- and intra-provincial movements remains the same throughout the year. Interventions, particularly surveillance and improving biosecurity, targeted to those counties are thus likely to be more effective for avian influenza risk mitigation than implemented indiscriminately. Additionally, simulations further demonstrated that targeting counties according to their degree or betweenness in the movement network would be the most efficient way to limit disease transmission via broiler movements. The study findings provide evidence to support the design of risk-based control interventions for H7N9 and all other avian influenza viruses in broiler value chains in Guangxi.

A mixed methods study of stakeholders' practices and attitudes on avian influenza H7N9 vaccination for the yellow broiler industry in Guangxi, China.

In response to a sudden increase in H7N9 human infections, China introduced an H5/H7 bivalent inactivated vaccine for poultry in Guangxi and Guangdong provinces in July 2017, which subsequently became integrated into the existing compulsory national H5N1 vaccination programme from September 2017. Although the vaccination programme effectively reduced H7N9 infections in humans and poultry, there are ongoing arguments against continuing this long-term vaccination. These discussions have drawn policymakers to think about the possibility of stopping routine vaccination for H7N9 avian influenza viruses (AIVs) in China; however, they have not considered the poultry industry stakeholders' practices on and attitudes towards this vaccination. This study investigated H7N9 vaccination practices in the yellow broiler industry in Guangxi and stakeholders' attitudes on H7N9 vaccination, using a mixed methods design. The study found H7N9 vaccination was well adopted in the yellow broiler industry in Guangxi regardless of the source of the vaccines. Most stakeholders believed vaccination was the best measure to control H7N9 and H5N1 AIVs, and they showed a strong willingness to continue with vaccination even without government subsidies or freely provided vaccines. The motivations by stakeholders for using vaccines to control H7N9 and H5N1 were different due to the epidemiological differences between the two strains. Understanding poultry industry stakeholders' practices and attitudes on H7N9 vaccination has important practical implications in planning vaccination policies, particularly when considering the possibility of vaccination withdrawal.

Characterization and influencing factors of the pig movement network in Hunan Province, China.

In terms of pig production in China, Hunan was the third largest province where the number of hogs accounted for 9.0 % of the national number of hogs in 2017. To propose the precise strategy for supervision of pig movements in Hunan Province, a weighted directed one-mode network was constructed using the data from the electronic animal health certificate platform in 2017. The nodes were designed as districts in Hunan and edges as flows of pig movement between districts. Social network analysis was used to analyse network characteristics and generalized linear models were performed to ascertain the socioeconomic factors that affect the pig movement network. During 2017, the pig movement network within the Hunan Province was composed of 122 nodes and 8562 directed connections, with a total of 510,973 shipments and 17,815,040 pigs moved. The network displayed a small-world topology, which had a higher clustering coefficient (0.4 vs. 0.1) and shorter average shortest path length (1.8 vs. 3.7) compared with equivalent random networks. The degree centrality positively correlated with closeness centrality (r = 0.99, P < 0.001) as well as betweenness centrality (r = 0.91, P < 0.001). After restricting the cross-regional pig movements in areas with the top 10 % of degree centrality, the number of pigs was reduced by nearly 50 % in the network, whereas the number of pigs was reduced by 94.0 % when movement restrictions were implemented in areas with the top 50 % of degree centrality. Observed network metrics showed an upward trend during the months of 2017, peaking in November and December. Generalized linear models showed that the size of the human population and per capita gross domestic product were the most important socioeconomic drivers of pig movements. The pig movement network in Hunan Province is a small-world network in which the introduction and spread of diseases may be quicker. More human, material, and financial resources should be allocated to areas with higher centrality. Swine movements were seasonal, and the inspection and quarantine work should be reinforced in the fourth quarter, especially in November and December. Pig movements were more active in areas with larger populations and advanced economy, and stricter supervision in these areas should be implemented. Our findings contribute to understanding the movement of pigs and the associated influencing factors in a big pig producing province in China, and the supervision strategies proposed in this study can be extended to other regions in China if proved to be viable.

Value chain analysis of yellow broiler industry in Guangxi, China to inform H7N9 influenza control strategies.

Yellow broilers are the primary source of poultry consumption in China and the predominant trade of live poultry. However, knowledge of the value chain is limited, which is vital evidence for the effective control of H7N9 and other zoonotic avian influenzas. The aim of the study was to map the yellow broiler value chain in Guangxi Zhuang Autonomous Region, China and investigate its governance structure and practices relevant to the risk of H7N9 transmission. A value chain analysis was conducted in five areas of Guangxi from May to August 2018. To map the value chain, three focus group discussions (FGDs) were conducted and stakeholders, products and premises involved and their interactions were identified. Then, 55 key informant interviews (KIIs) collected qualitative data on stakeholders' profile, practices and interactions with other stakeholders and rules/norms that exist along the value chain. On-site observations were also carried out at different types of premises along the value chain to complement and validate findings of KIIs and FGDs. Participants were also asked to provide proportional estimates of each component in the value chain where possible. The qualitative data from FGDs, KIIs and on-site observations were analysed to create stakeholder profiles and a diagram of product flows and stakeholders' interactions. Thematic analysis was used to identify the governance structure of the value chains and practices relevant to the risk of H7N9 transmission. The stakeholders and premises involved in Guangxi yellow broiler production, wholesale and retail were described, as well as their interactions. Contract farming is extensively adopted in Guangxi; consequently yellow broiler grower companies are the dominant stakeholders. The trading platform was identified as a key premise linking farms and live bird markets. The thematic analysis highlighted poor biosecurity practices in different premises along the value chain, which was supported by on-site observations. The operation of trading platforms reported in this study presents a disease risk but is not considered in the current H7N9 control programs. The study suggested that biosecurity management gaps need to be addressed through government-industry partnerships that require engagement with private stakeholders in the planning and implementation of H7N9 control strategies incentivising participation of grower companies, wholesalers and retailers.

Prevalence, distribution and risk factors for brucellosis infection in goat farms in Ningxiang, China.

BACKGROUND: In south China, goats are the major source of Brucellosis for human infection. However, there are few studies on the prevalence of and risk factors for goat brucellosis in south China. In this study, we conducted a cross-sectional study to investigate the herd prevalence, spatial distribution and relevant risk factors for goat brucellosis in Ningxiang county, south China. Commercial goat farms (n = 457) were randomly selected, and their disease status was ascertained by testing serum samples of chosen individuals using the Rose Bengal Test (screening test) and the Serum Agglutination Test (confirmatory test) in series. A farm with at least two positive individuals was defined as a case farm. Standardized questionnaires were used to collect information on management and hygiene practices in farms. A logistic model with a binomial outcome was built to identify risk factors for being seropositive. RESULTS: The true herd prevalence in commercial goat farms was 4.5% (95%CI: 0.2%-12.2%) and the townships in the centre of the county had higher herd prevalence. The risk factors associated with seropositive on local goat farms include "Introduction in the past 12 months" (OR= 61, 95%CI: 16-333), "Improperly disposal of the sick or dead goats" (OR= 33, 95%CI: 5-341) and "Poor hygiene in lambing pen" (OR= 25, 95%CI: 5-192). CONCLUSIONS: These findings will aid in the development of control strategies of Brucellosis in south China and risk factors identified in this study should be taken into consideration when designing a control strategy.

Risk of zoonotic transmission of swine influenza at the human-pig interface in Guangdong Province, China.

A cross-sectional survey was conducted from 2015 to 2018 to assess the risk of zoonotic influenza to humans at the human-pig interface in Guangdong Province, south China. One hundred and fifty-three pig farmers, 21 pig traders and 16 pig trade workers were recruited using convenience sampling and surveyed at local pig farms, live pig markets and slaughterhouses, respectively. Questionnaires were administered to collect information on the biosecurity and trading practices adopted and their knowledge and beliefs about swine influenza (SI). Most (12 of 16) trade workers said they would enter piggeries to collect pigs and only six of 11 said they were always asked to go through an on-farm disinfection procedure before entry. Only 33.7% of the interviewees believed that SI could infect humans, although pig farmers were more likely to believe this than traders and trade workers (p < .01). Several unsafe practices were reported by interviewees. 'Having vaccination against seasonal flu' (OR = 3.05, 95% CI: 1.19-8.93), 'Believe that SI can cause death in pigs' (no/yes: OR = 8.69, 95% CI: 2.71-36.57; not sure/yes: OR = 4.46, 95% CI: 1.63-14.63) and 'Keep on working when getting mild flu symptoms' (OR = 3.80, 95% CI: 1.38-11.46) were significantly and positively correlated to 'lacking awareness of the zoonotic risk of SI'. 'Lacking awareness of the zoonotic risk of SI' (OR = 3.19, 95% CI: 1.67-6.21), 'Keep on working when getting mild flu symptoms' (OR = 3.59, 95% CI: 1.57-8.63) and 'Don't know SI as a pig disease' (OR = 3.48, 95% CI: 1.02-16.45) were significantly and positively correlated to 'not using personal protective equipment when contacting pigs'. The findings of this study would benefit risk mitigation against potential pandemic SI threats in the human-pig interface in China.

Geographical variation in the risk of H7N9 human infections in China: implications for risk-based surveillance.

The influenza A (H7N9) subtype remains a public health problem in China affecting individuals in contact with live poultry, particularly at live bird markets. Despite enhanced surveillance and biosecurity at LBMs H7N9 viruses are now more widespread in China. This study aims to quantify the temporal relationship between poultry surveillance results and the onset of human H7N9 infections during 2013-2017 and to estimate risk factors associated with geographical risk of H7N9 human infections in counties in Southeast China. Our results suggest that poultry surveillance data can potentially be used as early warning indicators for human H7N9 notifications. Furthermore, we found that human H7N9 incidence at county-level was significantly associated with the presence of wholesale LBMs, the density of retail LBMs, the presence of poultry virological positives, poultry movements from high-risk areas, as well as chicken population density and human population density. The results of this study can influence the current AI H7N9 control program by supporting the integration of poultry surveillance data with human H7N9 notifications as an early warning of the timing and areas at risk for human infection. The findings also highlight areas in China where monitoring of poultry movement and poultry infections could be prioritized.

African Swine Fever in a commercial pig farm: Outbreak investigation and an approach for identifying the source of infection.

African Swine Fever (ASF) is a contagious disease of domestic and wild pigs caused by the African Swine Fever Virus (ASFV). The disease has spread globally in recent years with serious economic consequences to pork production. This report describes an ASF outbreak that occurred in a large-scale Chinese commercial pig farm. The outbreak started in 2018 and presents the spatial and temporal spread of infection in an intensive pig farm. Pig houses adjacent to exit rooms had a higher risk of infection (Odds ratio = 14.4, 95%CI: 1.5-140). Introduction of disease is presumed to have occurred through a contaminated vehicle used in the sale of pigs with poor productivity. This investigation shows the process of ASFV infection and spread in a facility with presumed adequate biosecurity measures. These findings may benefit others in the control of ASF in large-scale pig farms.

Pig trade networks through live pig markets in Guangdong Province, China.

This study used social network analysis to investigate the indirect contact network between counties through the movement of live pigs through four wholesale live pig markets in Guangdong Province, China. All 14,118 trade records for January and June 2016 were collected from the markets and the patterns of pig trade in these markets analysed. Maps were developed to show the movement pathways. Evaluating the network between source counties was the primary objective of this study. A 1-mode network was developed. Characteristics of the trading network were explored, and the degree, betweenness and closeness were calculated for each source county. Models were developed to compare the impacts of different disease control strategies on the potential magnitude of an epidemic spreading through this network. The results show that pigs from 151 counties were delivered to the four wholesale live pig markets in January and/or June 2016. More batches (truckloads of pigs sourced from one or more piggeries) were traded in these markets in January (8,001) than in June 2016 (6,117). The pigs were predominantly sourced from counties inside Guangdong Province (90%), along with counties in Hunan, Guangxi, Jiangxi, Fujian and Henan provinces. The major source counties (46 in total) contributed 94% of the total batches during the two-month study period. Pigs were sourced from piggeries located 10 to 1,417 km from the markets. The distribution of the nodes' degrees in both January and June indicates a free-scale network property, and the network in January had a higher clustering coefficient (0.54 vs. 0.39) and a shorter average pathway length (1.91 vs. 2.06) than that in June. The most connected counties of the network were in the central, northern and western regions of Guangdong Province. Compared with randomly removing counties from the network, eliminating counties with higher betweenness, degree or closeness resulted in a greater reduction of the magnitude of a potential epidemic. The findings of this study can be used to inform targeted control interventions for disease spread through this live pig market trade network in south China.

Knowledge, attitudes, and practices associated with avian influenza along the live chicken market chains in Eastern China: A cross-sectional survey in Shanghai, Anhui, and Jiangsu.

The avian influenza (AI) virus of the H7N9 subtype emerged in China in 2013. Live bird markets (LBMs) selling live meat chickens were indicated to present a high-risk of the virus dissemination. This study aimed to quantify the level of knowledge, attitudes, and practices (KAP) on AI and to measure the associated risk factors among different actors along the live chicken market chain within H7N9-affected Eastern provinces in China. A cross-sectional survey was conducted in these provinces from June to July 2014. Structured questionnaires about KAP on AI were delivered to chicken farmers, chicken vendors, and consumers in LBMs. Multivariable generalized least squares regression models were developed to identify predictors of KAP scores among different actors. Our results indicate that KAP scores of chicken farmers were generally higher than those of chicken vendors. Chicken farmers who worked for more than 15 years had significantly lower total KAP scores than those who worked for less than 6 years. Chicken farmers who worked more than 15 hrs in a day had significantly lower attitude scores than those who worked less than 6 hrs. For chicken vendors, females and individuals > 35 years old had significantly lower knowledge scores compared to the reference categories. Practice scores were significantly higher in female vendors and those vendors who also conducted slaughter compared to males and vendors who did not conduct slaughter. Consumers who bought chicken at least once every month had better risk awareness compared to those who bought chicken at least once every week. In addition, female consumers had significantly better practice scores than male consumers. In conclusion, risk-based health promotion interventions should be developed and implemented by animal health agencies (targeting farmers and vendors) and public health agencies (targeting frequent and male consumers) to prevent transmission of H7N9 along the market chain in China.

Closure of live bird markets leads to the spread of H7N9 influenza in China.

Following the emergence of H7N9 influenza in March 2013, local animal and public health authorities in China have been closing live bird markets as a measure to try to control the H7N9 influenza epidemic. The role of live bird market (LBM) closure on the spread of N7N9 influenza following the closure of LBMs during March to May 2013 (the first wave) and October 2013 to March 2014 (the second wave) is described in this paper. Different provinces implemented closure actions at different times, and intensive media reports on H7N9 in different provinces started at different times. Local broiler prices dropped dramatically in places with outbreaks and more live chickens were transported to other LBMs in neighboring areas without human cases from infected areas when live bird markets were being closed. There were six clusters of human infection from March to May 2013 and October 2013 to March 2014 and there may have been intensive poultry transportation among cluster areas. These findings provide evidence that the closure of LBMs in early waves of H7N9 influenza had resulted in expansion of H7N9 infection to uninfected areas. This suggests that provincial authorities in inland provinces should be alert to the risks of sudden changes in movement patterns for live birds after LBM closure or increased publicity about LBM closure.

Epidemiology of pseudorabies in intensive pig farms in Shanghai, China: Herd-level prevalence and risk factors.

Pseudorabies (PR), also known as Aujeszky's disease, is a highly contagious disease affecting pigs and a wide range of animals. Pseudorabies is enzootic in many countries. In China, it is a priority animal disease for control and eradication, however the data on disease frequency in intensive pig farms and the information on associated risk factors is inadequate. A cross-sectional study of intensive pig farms (≥350 sows) in Shanghai was conducted to determine herd-level prevalence of PRV and associated risk factors. Following a two-stage random sampling design, a total of 1349 sow serum samples were tested by gpI-ELISA from a total of 91 intensive pig farms in Shanghai. A herd was classified as positive if at least one PRV test-positive sow was present. Information on putative risk/protective factors was collected using questionnaires to pig farm owners or veterinarians. A logistic regression model was built to identify risk/protective factors for herd positivity. The results indicated that the herd-level true prevalence was 67.6% (95% CI：57.0-77.0). In the multivariable logistic regression model using backward stepwise procedure, two risk factors were found to be significantly associated with herd positivity: 'Breeding with introduced sows in the last 12 months' (OR = 3.5, 95%CI:1.2, 10.3) and 'Presence of stray dogs or cats' (OR = 4.0, 95%CI: 1.2, 12.6). The multivariable logistic model fitted the data well. Hosmer-Lemeshow goodness of fit test showed χ2 = 10.86 (df = 8, p = 0.21 > 0.05) and the predictability (area under the ROC curve) was 0.86. This study suggested that PR was highly endemic in intensive pig farms in Shanghai. The risk and protective factors identified in this study could be useful to improve the prevention policy of PR in Shanghai and other areas of China.

Panorama phylogenetic diversity and distribution of type A influenza viruses based on their six internal gene sequences.

BACKGROUND: Type A influenza viruses are important pathogens of humans, birds, pigs, horses and some marine mammals. The viruses have evolved into multiple complicated subtypes, lineages and sublineages. Recently, the phylogenetic diversity of type A influenza viruses from a whole view has been described based on the viral external HA and NA gene sequences, but remains unclear in terms of their six internal genes (PB2, PB1, PA, NP, MP and NS). METHODS: In this report, 2798 representative sequences of the six viral internal genes were selected from GenBank using the web servers in NCBI Influenza Virus Resource. Then, the phylogenetic relationships among the representative sequences were calculated using the software tools MEGA 4.1 and RAxML 7.0.4. Lineages and sublineages were classified mainly according to topology of the phylogenetic trees and distribution of the viruses in hosts, regions and time. RESULTS: The panorama phylogenetic trees of the six internal genes of type A influenza viruses were constructed. Lineages and sublineages within the type based on the six internal genes were classified and designated by a tentative universal numerical nomenclature system. The diversity of influenza viruses circulating in different regions, periods, and hosts based on the panorama trees was analyzed. CONCLUSION: This study presents the first whole views to the phylogenetic diversity and distribution of type A influenza viruses based on their six internal genes. It also proposes a tentative universal nomenclature system for the viral lineages and sublineages. These can be a candidate framework to generalize the history and explore the future of the viruses, and will facilitate future scientific communications on the phylogenetic diversity and evolution of the viruses. In addition, it provides a novel phylogenetic view (i.e. the whole view) to recognize the viruses including the origin of the pandemic A(H1N1) influenza viruses.