First case of human infection with avian influenza H10N3 post COVID-19 pandemic ：A case report

First case of human infection with avian influenza H10N3 post COVID-19 pandemic ：A case report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report First case of human infection with avian influenza H10N3 post COVID-19 pandemic ：A case report Zhenxi Zhao, Siyi Luo, Yudong Gao, Min Dai, Jun Yan, Ying Yang, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4315345/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 04 Sep, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted 4 You are reading this latest preprint version Abstract Background: On March 16 th 2024, the first case of Human infection with avian influenza H10N3 since the end of the global COVID-19 Pandemic was reported in Kunming, China. To enhance comprehension of the source of infection and risk factors of the H10N3 virus infection, this case report summarizes the clinical features, epidemiological investigation, and laboratory test results. Provides recommendations for the prevention and control of Human infection with avian influenza H10N3. Case presentation: A 51-year-old male with a history of COVID-19 infection and a smoking habit of 30 years, worked in livestock breeding and was exposed to sick and dead poultry before falling ill with fever and chills on 28 th February 2024. A week later, he was diagnosed with severe pneumonia, influenza, and respiratory failure by the Third People's Hospital of Kunming(KM-TPH). He was discharged on 17 th April and none of his 6 close contacts showed any symptoms of illness. Environmental samples taken from the epidemic spot revealed that peacock feces tested positive for avian influenza sub-type H9 and waterfowl specimens showed positive results for avian influenza sub-type H5. Gene sequencing conducted on positive specimens from the patient's respiratory tract by the Chinese Centre for Disease Control and Prevention (CCDC) showed a high degree of similarity (98.6-99.5%) with the strain responsible for the second global case of human infected with H10N3 (reported from Zhejiang, China 2022). Conclusions: According to the available epidemiological information, there is limited evidence to suggest that H10N3 viruses are excessively lethal. However, adaptive site mutations have been observed in the H10N3 isoform of mammals. While it is unlikely that the H10N3 virus will spread among humans, the possibility of additional cases cannot be entirely ruled out. Symptoms of human infection with H10N3 avian influenza are similar to those of common respiratory infections, which may result in them being overlooked during initial clinical consultations. Therefore, it is essential to improve surveillance of the H10 sub-type of avian influenza and to increase the awareness of hospital-related workers of cases of pneumonia of unknown origin. Avian Influenza H10N3 Post-COVID19 Pandemic Case Report Epidemiological investigations 1 Introduction Avian influenza virus sub-type H10 was first isolated from poultry in 1949 (A/Chicken/Germany/N/1949 [H10N7]) [ 1 ].The first human case of avian influenza H10N3 was reported in Jiangsu Province, China in April 2021[ 2 , 3 ].As of the latest WHO weekly report on avian influenza surveillance until March 8th 2024, only two human cases of avian influenza sub-type H10N3 have been reported globally, both in China[ 4 ]. This has become a public health concern worldwide [ 5 – 7 ]. In March 2024, a third case of avian influenza H10N3 was reported in Kunming, Yunnan Province, China. This was the first case of avian influenza H10N3 in a patient with a history of COVID-19 infection. This report provides a comprehensive description of the clinical presentation, epidemiological investigation, and laboratory testing to improve our interpretation of the pathogenesis, high-risk exposures, and control policy recommendations associated with human-infected H10N3 virus. 2 Case presentation The case under consideration in this report is a 51-year-old male (BMI 25.35) working in commercial services and livestock breeding in the Kunming,Yunnan province,China. He had a history of COVID19 infection ,and he was a smoker with 30-year history. There was no previous history of infectious or chronic diseases, food or drug allergies or blood transfusions.He had a clear history of exposure to sick and dead poultry within 10 days prior to the onset of illness. 2.1 Clinical history On 28th February 2024, the patient experienced clinical symptoms of fever and chills. Despite he self-treatment with ibuprofen, the symptoms did not subside (Fig. 1 ). From 1st March to 5th March, the patient's condition deteriorated, exhibiting symptoms of influenza-like illness (recurrent high fever ,Maximum temperature of 39°C, chills, cough, and shortness of breath).The patient received infusion treatment multiple times at the clinic and the Community Health Service Centre (CHSC) near his residence (the detail was unknown), but his condition did not improve significantly after treatment. On 5th March, the patient's chest X-ray at the CHSC revealed an infection in the lower lobe of the right lung. The patient was diagnosed at the Respiratory Department of the KM-TPH on 6 March with (1)severe pneumonia; (2)type I respiratory failure; (3)influenza; (4)hepatic insufficiency; (5)hypercoagulable state; and (6)renal insufficiency (Table 1). The chest CT scan showed the presence of an infection(Fig. 2 ). At 12:09 AM on 7th March, the patient was transferred to the intensive care unit (ICU) due to significant wheezing(PCO 2 32 mmHg, PO 2 34 mmHg, and SPO 2 66%). Between 7th and 15th March, the ICU provided non-invasive ventilator to improve his respiratory functioning(mode S/T, f18 beats/min, IPAP 14 cmH20, EPAP 10 cmH20, Fi02 95%)while administering drugs to control the infection (Omadacycline, Mefenamic acid,Marbofloxacin, and Oseltamivir). On 17th March, the patient's oxygen saturation dropped to 65–75% due to non-cooperation with the non-invasive ventilator. ICU performed orotracheal intubation to improve his respiratory function. The patient was discharged on 17 April at 3:00 PM and was recommended to receive continuous home oxygen therapy and regular follow-up after discharge. Table 1 Clinical characteristics of the H10N3 patient(see supplement,P 22). 2.2 Field epidemiology investigation History of suspected exposure and contact : The patient's history of suspected exposure and contact was investigated retrospectively. It was found that the patient followed a consistent and uniform weekday routine without any recent travel abroad. Additionally, the patient had not come into contact with anyone who had respiratory symptoms before experiencing symptoms. Since January 2023, the patient has been farming livestock including chickens, ducks, geese, peacocks, and goats within a particular area. All of the poultry and livestock that the patient raises are purchased from local markets. The patient is primarily responsible for the upkeep of the farm as well as any sales of animals, he visits once a day to feed the animals. From mid-February to 29th February, there were reported illnesses and deaths among the farmed animals, with approximately 10 chickens, 5 geese, and 5 sheep dying (Table 2 ). During the period, patients were fed animals and disposed livestock faeces, as well as dead poultry on the farm, without the use of any personal protective equipment (PPE). His family Members later stated that the dead poultry and animals had been disposed of by the patient. Though no carcasses were discovered during our epidemiological investigation. Table 2 Changes in the type and number of animals kept by patient Image Livestock Jan 7th Feb Mid-Feb to 29th Feb 16th Mar Quantity Chicken 50 30 20 10 Goose 8 13 8 8 Peacocks 3 3 3 3 Pheasant 7 7 7 7 Goat 10 15 10 10 Duck 7 7 7 7 Dog 2 2 2 2 Chick & Duckling - - - A few Epidemic spot investigation : The epidemic spot occurred in a wasteland located southwest of the Panlong District of Kunming (KM-PL). The site is located next to the local forest fire prevention station (FFPS) to the west (Fig. 2 ). To the south, about 10 meters away from the site in a straight line, there is a residential area (RA). The East Baisha River Reservoir(BRR)in Kunming is located approximately 1.5 km southeast of the epidemic spot in a straight line distance. This area covers around 1,000 square meters and is open-air. The hygiene conditions in the area are inadequate, with livestock excreta contaminating livestock troughs and personnel areas. The farming pattern in the epidemic spot was mixed captive and free-range farming with no clear regional division. This shows the phenomenon of co-habitation and co-existence of humans, animals, and poultry (Fig. 3 ). Identification and Tracing of close contacts : According to the Technical Guidelines for the Prevention and Control of Influenza of Human Infection of Animal Origin, a person who had direct contact with a patient between February 28th and March 5th 2024 without using any PPE is considered a close contact. In this case, there were a total of 6 close contacts identified for daily monitoring, including 4 family members (3 of whom lived with the patient and 1 who accompanied the patient to the clinic) and 2 management farm workers employed by the patient. None of these individuals had shown any symptoms related to H10N3 or any other respiratory illness within the 10 days following their last exposure to the patient. 2.3 Laboratory testing On 15th March, TPH submitted a sputum specimen from the patient to KMCDC for testing. The results showed that the patient was positive for influenza A virus universal primer test and influenza virus A (H10N3) sub-type nucleic acid. On the same day, the Yunnan Provincial Disease Control (YNCDC) reviewed the specimen and confirmed the test results. The CCDC gene sequencing results from March 25th indicate that the specimen from this case has a high sequence homology of 98.6–99.5% with the human-infected avian influenza H10N3 sub-type virus that was reported in Zhejiang Province in 2022. The virus may have dual receptor binding since the amino acids 226–228 at the HA (Hemagglutinin) receptor binding site are L/RSG. The amino acid 701 of the PB2 protein is N, indicating a mutation that is adaptive to mammals. No resistance mutations associated with neuraminidase inhibitor analogues and polymerase inhibitor analogues were detected in the genetic sequences obtained from the patients. Suggests sensitivity to neuraminidase inhibitors (e.g. Oseltamivir) and polymerase inhibitors (e.g. Baloxavir). The six internal genes identified in the specimens originated from the H9N2 virus.Two times nucleic acid tests conducted by the KMCDC on 6 close contacts on 15th March and 19th March were negative. On 16th March, the PLCDC collected the samples from breeding sites, including poultry, livestock, and eggs (Table 3 ). The KMCDC has detected positive nucleic acid for avian influenza virus A (H9 sub-type) in peacock fecal samples. The Animal Disease Prevention and Control (ADPC)collected 23 biological samples from animals at the exposure site. Among these, three waterfowl anal samples tested positive for influenza virus A (H5 sub-type) nucleic acid, while the remaining samples tested negative. Table 3 Results of environmental and animal specimen sampling Sample Type Sample Object Sample Size A type A General H5 H7 H9 H10 N3 Surface Water cup, door handle 1 - - - - - - Car 1 - - - - - - Livestock thoughts 1 - - - - - - Egg 1 - - - - - - Electromobile 1 - - - - - - Goat's eye 1 - - - - - - Chicken yard 1 - - - - - - Throat swab Pheasant 1 - - - - - - Chicken 1 - - - - - - Goat 1 - - - "+" Ct:34 - - Dog 1 - - - - - - Faeces Pheasant 1 - - - - - - Chicken 1 - - - - - - Chick 1 - - - - - - Anal swab waterfowls 3 - “+” - - - - Pheasant 1 - - - - - - Chicken 1 - - - - - - “-”: Negative result, “+”: Positive result 3 Conclusion Our report meticulously describes the first case of human-infected avian influenza H10N3 virus since the end of the COVID-19 pandemic. Similar to the onset of the first two globally reported cases [ 5 , 8 ], human infection with the H10N3 virus initially presents with common symptoms of respiratory disease, such as fever, cough, shortness of breath, and fatigue. These symptoms could be easily overlooked, leading to delayed treatment. The three reported cases worldwide were all caused by delayed treatment in the early stages of the disease, resulting in severe pneumonia, systemic infection, and respiratory failure a week later. The initial two reported H10N3 cases(reported in Jiangsu and Zhejiang) were discharged from the hospital after approximately one month of treatment. However, in this case, the patient was hospitalized for over a month before his infection was initially controlled. Although the inflammation in the lungs had subsided, the patient still required ventilator assistance. It is possibly related to the fact that the patient's exposure history of COVID-19 and prolonged smoking increased the rate of respiratory viruses or even aggravated the severity of the influenza host infection [ 9 , 10 ]. Moreover, the evidence available could not confirm that the H10N3 virus is highly lethal compared to other highly pathogenic sub-types of avian influenza. Resistance testing suggests that neuraminidase inhibitors (e.g., oseltamivir) and polymerase inhibitors (e.g., baloxavir) may be used to treat H10N3 virus infection. This case report was preceded by a clear history of exposure to sick and dead poultry, as well as prolonged exposure to mixed farming. The proximity of case-exposed epidemic spot to BRR may increase the risk of cross-infection between different species of poultry and wildfowl. Research by Wang and Zhang et al. showed that inter-population transmission of avian influenza sub-type H10 and other human-infected avian influenza sub-types occurs through the alteration of a certain gene segment after poultry infection by wild birds carrying the virus, particularly wild waterfowl. This alteration increases the affinity of avian influenza viruses to bind to human receptors [ 11 – 13 ]. Furthermore, the H10N3 sub-type avian influenza virus is a recombinant virus with surface genes derived from the H7 and H9 sub-types of viruses circulating in chickens and ducks [ 12 ]. This is despite the limitations of the report, as no poultry carcasses were found. Based on the available epidemiological investigations and genetic sequencing results, it could be deduced that the mixed farming pattern of the epidemic spot and the detection of avian influenza viruses (sub-types H5 and H9) in different animals may provided the conditions for this case of human infection with H10N3. Currently, none of the close contacts of the three reported human cases of H10N3 infection worldwide have exhibited clinical symptoms related to avian influenza or tested positive for the H10N3 virus. The H10N3 virus has not acquired the ability for sustained human-to-human transmission, therefore the probability of transmission among humans is currently low [ 7 ]. This reported case in Kunming is over 2,000 km away from the locations of the first two cases of homozygosity in Jiangsu and Zhejiang. It could be inferred that avian influenza H10 sub-type viruses have been spreading for a longer period within Yunnan Province even in the wider avian population. Further cases of human-infected H10N3 avian influenza may be reported locally or in other regions of the world. Thus, in terms of the current state of global prevalence. Enhanced surveillance of H10 sub-type viruses in avian influenza-prone areas worldwide is necessary. It's particularly important to reviewed test nucleic acid-positive specimens of excluded seasonal influenza viruses (H1N1, H3N2, B Victoria, B Yamagata) to prevent the spread of this virus. To reduce the risk of human infection with various animal-borne diseases due to lack of formal regulation and health education. We recommend the following based on this report: (1)The departments of agriculture and rural areas should enhance the regulation and approval process for privately contracted land used for breeding farms. Government agencies should thoroughly review and document the use of contracted land under their jurisdiction. (2)ADPC should improve surveillance and risk identification of animal diseases in live poultry trading markets and private breeding sites. In addition, it is highly recommended that health education be provided to high-risk groups. (3)Clinical staff are advised to improve their sensitivity in the diagnosis and recognition of avian influenza. The focus should be on individuals who have a history of respiratory infectious diseases and smoking. Clinical diagnosis needs to be combined with epidemiological information on the case. (4)The diagnosis must be promptly reported to the CDC for investigation and disposition to interrupt the spread of the disease early. Abbreviations KM-TPH Third People's Hospital of Kunming KMCDC Kunming Centre for Disease Control and Prevention CCDC Chinese Centre for Disease Control and Prevention CHSC Community Health Service Centre ICU Intensive Care Unit PPE Personal Protective Equipment KM-Pl Panlong District of Kunming FFPS Forest Fire Prevention Station RA Residential Area BRR Baisha River Reservoir PLCDC Panlong district for Disease Control and Prevention YNCDC Yunnan province for Disease Control and Prevention ADPC Animal Disease Prevention and Control COVID-19 Corona Virus Disease 2019 Declarations Ethics approval and consent to participate This case report was reviewed by experts from the Ethics Committee of the Kunming Centre for Disease Control and Prevention. The Research Program are considered to meet the requirements of Chinese ethics and are approved for implementation. Informed consent was obtained from all study participants in this study. Consent for publication The cases reported in this study signed informed consent. A copy of the consent form is available for review by the Editor of this journal. Availability of data and materials Data is provided within the manuscript or supplementary information files. Competing interests The all authors declare that they have no competing interests in this section. Funding There are no funds for this study. Authors' contributions ZZ and SL both contributed significantly to the conception of the study and equally to this work. ZZ took responsibility for the initial draft preparation and preliminary data collection, while SL handled SL carries out substantive translation and finished manuscripts. YG completed the visualization section. MD participated actively in the discussions. JY and YY furnished the laboratory test results. HL set up the field epidemiology. YZ conducted clinical investigation. ZM provided oversight and supervision for the entire project. All authors have carefully reviewed and approved the final version of the manuscript. Acknowledgements We would like to sincerely thank to Chinese Centre for Disease Control and Prevention for support and help in confirming laboratory test results and gene sequencing of this incident, Yunnan Province for Epidemic Surveillance/Public Health Emergency Preparedness and Response center for their guidance and help in the investigation of this incident, and Yunnan Province for Acute Infectious Disease Prevention and Control Institute for its help in rechecking laboratory test results of this incident. Thank the Panlong District for Disease Control and Prevention for their cooperation and support in the investigation. References Feldmann H, Kretzschmar E, Klingeborn B, Rottj R, Klenk H-D, Garten W. The structure of serotype H10 hemagglutinin of influenza A virus: Comparison of an apathogenic avian and a mammalian strain pathogenic for mink. Virology. 1988;165(2):428–37. 10.1016/0042-6822(88)90586-7 . Jing J, Wang L, Wang G, Dai Z, Ren W, Yi C, et al. A human infection case with avian-origin H10N3 influenza virus. Quant Imaging Med Surg. 2021;11(10):4508–10. 10.21037/qims-21-592 . Qi X, Qiu H, Hao S, Zhu F, Huang Y, Xu K, et al. Human infection with an avian-origin influenza A (H10N3) virus. N Engl J Med. 2022;386(11):1087–8. 10.1056/nejmc2112416 . Avian influenza weekly update 2024 [Internet]. World Health Organization. 1970 [cited 2024 Apr 2]. https://iris.who.int/handle/10665/375483 . Skufca J, Bell L, Molino J, Saulo D, Lee C, Otsu S, et al. An epidemiological overview of human infections with HxNy avian influenza in the Western Pacific Region, 2003–2022. Western Pac Surveillance Response J. 2022;13(4):24–9. 10.5365/wpsar.2022.13.4.987 . To KKW, Tsang AKL, Chan JFW, Cheng VCC, Chen H, Yuen K-Y. Emergence in China of human disease due to avian influenza A(H10N8) – cause for concern? J Infect. 2014;68(3):205–15. 10.1016/j.jinf.2013.12.014 . Arzey GG, Kirkland PD, Arzey KE, Frost M, Maywood P, Conaty S, et al. Influenza virus A (H10N7) in chickens and poultry abattoir workers, Australia. Emerg Infect Dis. 2012;18(5):814–6. 10.3201/eid1805.111852 . Zhang W, Zhang Z, Wang M, Pan X, Jiang X. Second identified human infection with the avian influenza virus H10N3: A case report. Ann Intern Med. 2023;176(3):429–31. 10.7326/l22-0376 . Gualano RC, Hansen MJ, Vlahos R, Jones JE, Park-Jones RA, Deliyannis G, et al. Cigarette smoke worsens lung inflammation and impairs resolution of influenza infection in mice. Respir Res. 2008;9(1). 10.1186/1465-9921-9-53 . Wu W, Alexander JS, Metcalf JP. In vivo and in vitro studies of cigarette smoke effects on innate responses to influenza virus: A matter of models? Viruses. 2022;14(8):1824. 10.3390/v14081824 . Lv X, Tian J, Li X, Bai X, Li Y, Li M, et al. H10NX avian influenza viruses detected in wild birds in China pose potential threat to mammals. One Health. 2023;16:100515. 10.1016/j.onehlt.2023.100515 . Zhang Y, Shi J, Cui P, Zhang Y, Chen Y, Hou Y, et al. Genetic analysis and biological characterization of H10N3 Influenza A viruses isolated in China from 2014 to 2021. J Med Virol. 2023;95(2). 10.1002/jmv.28476 . Wang D, Zhu W, Yang L, Shu Y. The epidemiology, virology, and pathogenicity of human infections with avian influenza viruses. Cold Spring Harbor Perspect Med. 2020;11(4). 10.1101/cshperspect.a038620 . Tables Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 04 Sep, 2024 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 30 Apr, 2024 Editor assigned by journal 30 Apr, 2024 Submission checks completed at journal 27 Apr, 2024 First submitted to journal 24 Apr, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4315345","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":297163848,"identity":"741a837c-9b86-4532-a192-23d1f07852d7","order_by":0,"name":"Zhenxi Zhao","email":"","orcid":"","institution":"Kunming Center for Disease Control and Prevention","correspondingAuthor":false,"prefix":"","firstName":"Zhenxi","middleName":"","lastName":"Zhao","suffix":""},{"id":297163850,"identity":"b59accfd-f68e-4742-871c-0d7d64adc57e","order_by":1,"name":"Siyi Luo","email":"","orcid":"","institution":"Kunming Center for Disease Control and 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04:15:54","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4315345/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4315345/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-024-09830-y","type":"published","date":"2024-09-04T15:57:45+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":64186032,"identity":"98fda248-8ef7-49cd-b528-ef92bb01b33b","added_by":"auto","created_at":"2024-09-09 16:23:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":639119,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4315345/v1/a6973522-a6cb-4c7d-93fe-4f004c937016.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"First case of human infection with avian influenza H10N3 post COVID-19 pandemic ：A case report","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eAvian influenza virus sub-type H10 was first isolated from poultry in 1949 (A/Chicken/Germany/N/1949 [H10N7]) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].The first human case of avian influenza H10N3 was reported in Jiangsu Province, China in April 2021[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].As of the latest WHO weekly report on avian influenza surveillance until March 8th 2024, only two human cases of avian influenza sub-type H10N3 have been reported globally, both in China[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This has become a public health concern worldwide [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In March 2024, a third case of avian influenza H10N3 was reported in Kunming, Yunnan Province, China. This was the first case of avian influenza H10N3 in a patient with a history of COVID-19 infection. This report provides a comprehensive description of the clinical presentation, epidemiological investigation, and laboratory testing to improve our interpretation of the pathogenesis, high-risk exposures, and control policy recommendations associated with human-infected H10N3 virus.\u003c/p\u003e"},{"header":"2 Case presentation","content":"\u003cp\u003eThe case under consideration in this report is a 51-year-old male (BMI 25.35) working in commercial services and livestock breeding in the Kunming,Yunnan province,China. He had a history of COVID19 infection ,and he was a smoker with 30-year history. There was no previous history of infectious or chronic diseases, food or drug allergies or blood transfusions.He had a clear history of exposure to sick and dead poultry within 10 days prior to the onset of illness.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003e2.1 Clinical history\u003c/h2\u003e\n \u003cp\u003eOn 28th February 2024, the patient experienced clinical symptoms of fever and chills. Despite he self-treatment with ibuprofen, the symptoms did not subside (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). From 1st March to 5th March, the patient\u0026apos;s condition deteriorated, exhibiting symptoms of influenza-like illness (recurrent high fever ,Maximum temperature of 39\u0026deg;C, chills, cough, and shortness of breath).The patient received infusion treatment multiple times at the clinic and the Community Health Service Centre (CHSC) near his residence (the detail was unknown), but his condition did not improve significantly after treatment. On 5th March, the patient\u0026apos;s chest X-ray at the CHSC revealed an infection in the lower lobe of the right lung. The patient was diagnosed at the Respiratory Department of the KM-TPH on 6 March with (1)severe pneumonia; (2)type I respiratory failure; (3)influenza; (4)hepatic insufficiency; (5)hypercoagulable state; and (6)renal insufficiency (Table 1). The chest CT scan showed the presence of an infection(Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). At 12:09 AM on 7th March, the patient was transferred to the intensive care unit (ICU) due to significant wheezing(PCO\u003csub\u003e2\u003c/sub\u003e 32 mmHg, PO\u003csub\u003e2\u003c/sub\u003e 34 mmHg, and SPO\u003csub\u003e2\u003c/sub\u003e 66%). Between 7th and 15th March, the ICU provided non-invasive ventilator to improve his respiratory functioning(mode S/T, f18 beats/min, IPAP 14 cmH20, EPAP 10 cmH20, Fi02 95%)while administering drugs to control the infection (Omadacycline, Mefenamic acid,Marbofloxacin, and Oseltamivir). On 17th March, the patient\u0026apos;s oxygen saturation dropped to 65\u0026ndash;75% due to non-cooperation with the non-invasive ventilator. ICU performed orotracheal intubation to improve his respiratory function.\u003c/p\u003e\n \u003cp\u003eThe patient was discharged on 17 April at 3:00 PM and was recommended to receive continuous home oxygen therapy and regular follow-up after discharge.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;1\u003c/strong\u003e Clinical characteristics of the H10N3 patient(see supplement,P 22).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003e2.2 Field epidemiology investigation\u003c/h2\u003e\n \u003cp\u003e\u003cem\u003eHistory of suspected exposure and contact\u003c/em\u003e:\u003c/p\u003e\n \u003cp\u003eThe patient\u0026apos;s history of suspected exposure and contact was investigated retrospectively. It was found that the patient followed a consistent and uniform weekday routine without any recent travel abroad. Additionally, the patient had not come into contact with anyone who had respiratory symptoms before experiencing symptoms. Since January 2023, the patient has been farming livestock including chickens, ducks, geese, peacocks, and goats within a particular area. All of the poultry and livestock that the patient raises are purchased from local markets.\u003c/p\u003e\n \u003cp\u003eThe patient is primarily responsible for the upkeep of the farm as well as any sales of animals, he visits once a day to feed the animals. From mid-February to 29th February, there were reported illnesses and deaths among the farmed animals, with approximately 10 chickens, 5 geese, and 5 sheep dying (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). During the period, patients were fed animals and disposed livestock faeces, as well as dead poultry on the farm, without the use of any personal protective equipment (PPE). His family Members later stated that the dead poultry and animals had been disposed of by the patient. Though no carcasses were discovered during our epidemiological investigation.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eChanges in the type and number of animals kept by patient\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eImage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\" style=\"width: 23.359%;\"\u003e\n \u003cp\u003eLivestock\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eJan\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e7th Feb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMid-Feb to 29th Feb\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e16th Mar\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003cth colspan=\"2\" style=\"width: 40.3748%;\"\u003e\u003cbr\u003e\u003c/th\u003e\n \u003ctd colspan=\"4\" style=\"width: 59.501%;\"\u003e\u003cbr\u003e \u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Quantity\u003c/strong\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cimg 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H4kV9/Xu2LHjc25ubuh9GM49jHpRP7s7wJ2BX74GPiyAeue5TqHARS0CHkQFaiFQMYuBmAPUorAY7B0wBC7LeYNjG6JwbOMan6PncT8ERO9CABiHelE/3i0wuAPwy9fABckcPOHFWi+okwgoLASAhzk0UKGcShPQAMDCqMUBEZADeRihTqZwbfQ4jGXgnF0ewqndmg1Dvagf+YmBcxiMXwZ4gBN7ALirBaizCCj8AHuEVgwWhEXRegqIwwBOpiwGjIQgaqDX2Xh2e/QsvIuNZ+NYfHUnMHAOHuAEfmoB6iUCCj/kSAz+ZWFYHPYSFgPhwq4LQdC7EEUNjmdcx70wHj2M3oZxLDKLXxuYi1qAehmvLmohGKwsQy2OWgwYoA4Tzh9sqBrs8lrjuVfVhqnb04KvMTc1b6cUdYVaqAUBGZBW5w8YpY5lNfh/CKZ1aTae668LtNyapKgbZCJqMdg7YBgLowVfc9Trjgy7Fe5YUZPQiqEGC6OG+jobfjPj1aW2a3e8qImxQQzuYYb2uvpZ4P+2aA0BtMY6gvaZJiguLv8DW1wDS06lX30AAAAASUVORK5CYII=\"\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChick \u0026amp; Duckling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA few\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003e\u003cem\u003eEpidemic spot investigation\u003c/em\u003e:\u003c/p\u003e\n \u003cp\u003eThe epidemic spot occurred in a wasteland located southwest of the Panlong District of Kunming (KM-PL). The site is located next to the local forest fire prevention station (FFPS) to the west (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). To the south, about 10 meters away from the site in a straight line, there is a residential area (RA). The East Baisha River Reservoir(BRR)in Kunming is located approximately 1.5 km southeast of the epidemic spot in a straight line distance. This area covers around 1,000 square meters and is open-air. The hygiene conditions in the area are inadequate, with livestock excreta contaminating livestock troughs and personnel areas. The farming pattern in the epidemic spot was mixed captive and free-range farming with no clear regional division. This shows the phenomenon of co-habitation and co-existence of humans, animals, and poultry (Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cem\u003eIdentification and Tracing of close contacts\u003c/em\u003e:\u003c/p\u003e\n \u003cp\u003eAccording to the Technical Guidelines for the Prevention and Control of Influenza of Human Infection of Animal Origin, a person who had direct contact with a patient between February 28th and March 5th 2024 without using any PPE is considered a close contact. In this case, there were a total of 6 close contacts identified for daily monitoring, including 4 family members (3 of whom lived with the patient and 1 who accompanied the patient to the clinic) and 2 management farm workers employed by the patient. None of these individuals had shown any symptoms related to H10N3 or any other respiratory illness within the 10 days following their last exposure to the patient.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003e2.3 Laboratory testing\u003c/h2\u003e\n \u003cp\u003eOn 15th March, TPH submitted a sputum specimen from the patient to KMCDC for testing. The results showed that the patient was positive for influenza A virus universal primer test and influenza virus A (H10N3) sub-type nucleic acid. On the same day, the Yunnan Provincial Disease Control (YNCDC) reviewed the specimen and confirmed the test results. The CCDC gene sequencing results from March 25th indicate that the specimen from this case has a high sequence homology of 98.6\u0026ndash;99.5% with the human-infected avian influenza H10N3 sub-type virus that was reported in Zhejiang Province in 2022. The virus may have dual receptor binding since the amino acids 226\u0026ndash;228 at the HA (Hemagglutinin) receptor binding site are L/RSG. The amino acid 701 of the PB2 protein is N, indicating a mutation that is adaptive to mammals. No resistance mutations associated with neuraminidase inhibitor analogues and polymerase inhibitor analogues were detected in the genetic sequences obtained from the patients. Suggests sensitivity to neuraminidase inhibitors (e.g. Oseltamivir) and polymerase inhibitors (e.g. Baloxavir).\u003c/p\u003e\n \u003cp\u003eThe six internal genes identified in the specimens originated from the H9N2 virus.Two times nucleic acid tests conducted by the KMCDC on 6 close contacts on 15th March and 19th March were negative.\u003c/p\u003e\n \u003cp\u003eOn 16th March, the PLCDC collected the samples from breeding sites, including poultry, livestock, and eggs (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e). The KMCDC has detected positive nucleic acid for avian influenza virus A (H9 sub-type) in peacock fecal samples. The Animal Disease Prevention and Control (ADPC)collected 23 biological samples from animals at the exposure site. Among these, three waterfowl anal samples tested positive for influenza virus A (H5 sub-type) nucleic acid, while the remaining samples tested negative.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults of environmental and animal specimen sampling\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSample Type\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSample Object\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSample Size\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"6\"\u003e\n \u003cp\u003eA type\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eA General\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eH5\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eH7\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eH9\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eH10\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN3\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"7\"\u003e\n \u003cp\u003e\u003cstrong\u003eSurface\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWater cup, door handle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCar\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLivestock thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEgg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElectromobile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGoat\u0026apos;s eye\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChicken yard\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003e\u003cstrong\u003eThroat swab\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePheasant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChicken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGoat\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026quot;+\u0026quot;\u003c/p\u003e\n \u003cp\u003eCt:34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDog\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eFaeces\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePheasant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChicken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChick\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"3\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnal swab\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ewaterfowls\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ldquo;+\u0026rdquo;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePheasant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eChicken\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"9\"\u003e\n \u003cp\u003e\u0026ldquo;-\u0026rdquo;: Negative result, \u0026ldquo;+\u0026rdquo;: Positive result\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"3 Conclusion","content":"\u003cp\u003eOur report meticulously describes the first case of human-infected avian influenza H10N3 virus since the end of the COVID-19 pandemic. Similar to the onset of the first two globally reported cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], human infection with the H10N3 virus initially presents with common symptoms of respiratory disease, such as fever, cough, shortness of breath, and fatigue. These symptoms could be easily overlooked, leading to delayed treatment. The three reported cases worldwide were all caused by delayed treatment in the early stages of the disease, resulting in severe pneumonia, systemic infection, and respiratory failure a week later. The initial two reported H10N3 cases(reported in Jiangsu and Zhejiang) were discharged from the hospital after approximately one month of treatment. However, in this case, the patient was hospitalized for over a month before his infection was initially controlled. Although the inflammation in the lungs had subsided, the patient still required ventilator assistance. It is possibly related to the fact that the patient's exposure history of COVID-19 and prolonged smoking increased the rate of respiratory viruses or even aggravated the severity of the influenza host infection [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Moreover, the evidence available could not confirm that the H10N3 virus is highly lethal compared to other highly pathogenic sub-types of avian influenza. Resistance testing suggests that neuraminidase inhibitors (e.g., oseltamivir) and polymerase inhibitors (e.g., baloxavir) may be used to treat H10N3 virus infection.\u003c/p\u003e \u003cp\u003eThis case report was preceded by a clear history of exposure to sick and dead poultry, as well as prolonged exposure to mixed farming. The proximity of case-exposed epidemic spot to BRR may increase the risk of cross-infection between different species of poultry and wildfowl. Research by Wang and Zhang et al. showed that inter-population transmission of avian influenza sub-type H10 and other human-infected avian influenza sub-types occurs through the alteration of a certain gene segment after poultry infection by wild birds carrying the virus, particularly wild waterfowl. This alteration increases the affinity of avian influenza viruses to bind to human receptors [\u003cspan additionalcitationids=\"CR12\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Furthermore, the H10N3 sub-type avian influenza virus is a recombinant virus with surface genes derived from the H7 and H9 sub-types of viruses circulating in chickens and ducks [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. This is despite the limitations of the report, as no poultry carcasses were found. Based on the available epidemiological investigations and genetic sequencing results, it could be deduced that the mixed farming pattern of the epidemic spot and the detection of avian influenza viruses (sub-types H5 and H9) in different animals may provided the conditions for this case of human infection with H10N3. Currently, none of the close contacts of the three reported human cases of H10N3 infection worldwide have exhibited clinical symptoms related to avian influenza or tested positive for the H10N3 virus. The H10N3 virus has not acquired the ability for sustained human-to-human transmission, therefore the probability of transmission among humans is currently low [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis reported case in Kunming is over 2,000 km away from the locations of the first two cases of homozygosity in Jiangsu and Zhejiang. It could be inferred that avian influenza H10 sub-type viruses have been spreading for a longer period within Yunnan Province even in the wider avian population. Further cases of human-infected H10N3 avian influenza may be reported locally or in other regions of the world. Thus, in terms of the current state of global prevalence. Enhanced surveillance of H10 sub-type viruses in avian influenza-prone areas worldwide is necessary. It's particularly important to reviewed test nucleic acid-positive specimens of excluded seasonal influenza viruses (H1N1, H3N2, B Victoria, B Yamagata) to prevent the spread of this virus.\u003c/p\u003e \u003cp\u003eTo reduce the risk of human infection with various animal-borne diseases due to lack of formal regulation and health education. We recommend the following based on this report: (1)The departments of agriculture and rural areas should enhance the regulation and approval process for privately contracted land used for breeding farms. Government agencies should thoroughly review and document the use of contracted land under their jurisdiction. (2)ADPC should improve surveillance and risk identification of animal diseases in live poultry trading markets and private breeding sites. In addition, it is highly recommended that health education be provided to high-risk groups. (3)Clinical staff are advised to improve their sensitivity in the diagnosis and recognition of avian influenza. The focus should be on individuals who have a history of respiratory infectious diseases and smoking. Clinical diagnosis needs to be combined with epidemiological information on the case. (4)The diagnosis must be promptly reported to the CDC for investigation and disposition to interrupt the spread of the disease early.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKM-TPH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eThird People's Hospital of Kunming\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKMCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eKunming Centre for Disease Control and Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChinese Centre for Disease Control and Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCHSC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCommunity Health Service Centre\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICU\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIntensive Care Unit\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePPE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePersonal Protective Equipment\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eKM-Pl\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePanlong District of Kunming\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFFPS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eForest Fire Prevention Station\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResidential Area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBRR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBaisha River Reservoir\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePLCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePanlong district for Disease Control and Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eYNCDC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eYunnan province for Disease Control and Prevention\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eADPC\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eAnimal Disease Prevention and Control\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCOVID-19\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eCorona Virus Disease 2019\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch4\u003eEthics approval and consent to participate\u003c/h4\u003e\n\u003ch4\u003eThis case report was reviewed by experts from the Ethics Committee of the Kunming Centre for Disease Control and Prevention. The Research Program are considered to meet the requirements of Chinese ethics and are approved for implementation. \u0026nbsp;Informed consent was obtained from all study participants in this study.\u0026nbsp;\u003c/h4\u003e\n\u003ch4\u003eConsent for publication\u003c/h4\u003e\n\u003ch4\u003eThe cases reported in this study signed informed consent. A copy of the consent form is available for review by the Editor of this journal.\u003c/h4\u003e\n\u003ch4\u003eAvailability of data and materials\u003c/h4\u003e\n\u003cp\u003eData is provided within the manuscript or supplementary information files.\u003c/p\u003e\n\u003ch4\u003eCompeting interests\u003c/h4\u003e\n\u003cp\u003eThe all authors declare that they have no competing interests in this section.\u003c/p\u003e\n\u003ch4\u003eFunding\u003c/h4\u003e\n\u003cp\u003eThere are no funds for this study.\u003c/p\u003e\n\u003ch4\u003eAuthors\u0026apos; contributions\u003c/h4\u003e\n\u003cp\u003eZZ and SL both contributed significantly to the conception of the study and equally to this work. ZZ took responsibility for the initial draft preparation and preliminary data collection, while SL handled SL carries out substantive translation and finished manuscripts. YG completed the visualization section. MD participated actively in the discussions. JY and YY furnished the laboratory test results. HL set up the field epidemiology. YZ conducted clinical investigation. ZM provided oversight and supervision for the entire project. All authors have carefully reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003ch4\u003eAcknowledgements\u003c/h4\u003e\n\u003cp\u003eWe would like to sincerely thank to Chinese Centre for Disease Control and Prevention for support and help in confirming laboratory test results and gene sequencing of this incident, Yunnan Province for Epidemic Surveillance/Public Health Emergency Preparedness and Response center for their guidance and help in the investigation of this incident, and Yunnan Province for Acute Infectious Disease Prevention and Control Institute for its help in rechecking laboratory test results of this incident. Thank the Panlong District for Disease Control and Prevention for their cooperation and support in the investigation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eFeldmann H, Kretzschmar E, Klingeborn B, Rottj R, Klenk H-D, Garten W. The structure of serotype H10 hemagglutinin of influenza A virus: Comparison of an apathogenic avian and a mammalian strain pathogenic for mink. Virology. 1988;165(2):428\u0026ndash;37. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/0042-6822(88)90586-7\u003c/span\u003e\u003cspan address=\"10.1016/0042-6822(88)90586-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJing J, Wang L, Wang G, Dai Z, Ren W, Yi C, et al. A human infection case with avian-origin H10N3 influenza virus. 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The epidemiology, virology, and pathogenicity of human infections with avian influenza viruses. Cold Spring Harbor Perspect Med. 2020;11(4). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1101/cshperspect.a038620\u003c/span\u003e\u003cspan address=\"10.1101/cshperspect.a038620\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Avian Influenza H10N3, Post-COVID19 Pandemic, Case Report, Epidemiological investigations","lastPublishedDoi":"10.21203/rs.3.rs-4315345/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4315345/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOn March 16\u003csup\u003eth \u003c/sup\u003e2024, the first case of Human infection with avian influenza H10N3 since the end of the global COVID-19 Pandemic was reported in Kunming, China. To enhance comprehension of the source of infection and risk factors of the H10N3 virus infection, this case report summarizes the clinical features, epidemiological investigation, and laboratory test results. Provides recommendations for the prevention and control of Human infection with avian influenza H10N3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA 51-year-old male with a history of COVID-19 infection and a smoking habit of 30 years, worked in livestock breeding and was exposed to sick and dead poultry before falling ill with fever and chills on 28\u003csup\u003eth\u003c/sup\u003e February 2024. A week later, he was diagnosed with severe pneumonia, influenza, and respiratory failure by the Third People's Hospital of Kunming(KM-TPH). He was discharged on 17\u003csup\u003eth\u003c/sup\u003e April and none of his 6 close contacts showed any symptoms of illness. Environmental samples taken from the epidemic spot revealed that peacock feces tested positive for avian influenza sub-type H9 and waterfowl specimens showed positive results for avian influenza sub-type H5. Gene sequencing conducted on positive specimens from the patient's respiratory tract by the Chinese Centre for Disease Control and Prevention (CCDC) showed a high degree of similarity (98.6-99.5%) with the strain responsible for the second global case of human infected with H10N3 (reported from Zhejiang, China 2022).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the available epidemiological information, there is limited evidence to suggest that H10N3 viruses are excessively lethal. However, adaptive site mutations have been observed in the H10N3 isoform of mammals. While it is unlikely that the H10N3 virus will spread among humans, the possibility of additional cases cannot be entirely ruled out. Symptoms of human infection with H10N3 avian influenza are similar to those of common respiratory infections, which may result in them being overlooked during initial clinical consultations. Therefore, it is essential to improve surveillance of the H10 sub-type of avian influenza and to increase the awareness of hospital-related workers of cases of pneumonia of unknown origin.\u003c/p\u003e","manuscriptTitle":"First case of human infection with avian influenza H10N3 post COVID-19 pandemic ：A case report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-07 15:54:00","doi":"10.21203/rs.3.rs-4315345/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-30T10:13:15+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-04-30T07:07:09+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-04-27T13:51:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2024-04-24T04:05:02+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"585d4ec7-a2ba-4e79-b4c7-e1667f65d019","owner":[],"postedDate":"May 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-09-09T16:15:19+00:00","versionOfRecord":{"articleIdentity":"rs-4315345","link":"https://doi.org/10.1186/s12879-024-09830-y","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2024-09-04 15:57:45","publishedOnDateReadable":"September 4th, 2024"},"versionCreatedAt":"2024-05-07 15:54:00","video":"","vorDoi":"10.1186/s12879-024-09830-y","vorDoiUrl":"https://doi.org/10.1186/s12879-024-09830-y","workflowStages":[]},"version":"v1","identity":"rs-4315345","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4315345","identity":"rs-4315345","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}