Avian Influenza A(H7N2) Virus in Human Exposed to Sick Cats, New York, USA, 2016

Atanaska Marinova-Petkova; Jen Laplante; Yunho Jang; Brian Lynch; Natosha Zanders; Marisela Rodriguez; Joyce Jones; Sharmi Thor; Erin Hodges; Juan A. De La Cruz; Jessica Belser; Hua Yang; Paul Carney; Bo Shu; LaShondra Berman; Thomas Stark; John Barnes; Fiona Havers; Patrick Yang; Susan C. Trock; Alicia Fry; Larisa Gubareva; Joseph S. Bresee; James Stevens; Demetre Daskalakis; Dakai Liu; Christopher T. Lee; Mia Kim Torchetti; Sandra Newbury; Francine Cigel; Kathy Toohey-Kurth; Kirsten St. George; David E. Wentworth; Stephen Lindstrom; C. Todd Davis

Disclosures

Emerging Infectious Diseases. 2017;23(12):2046-2049. 

In This Article

The Study

On December 19, 2016, the New York City Department of Health and Mental Hygiene collected a respiratory specimen from a veterinarian experiencing influenza-like illness after exposure to sick domestic cats at an animal shelter in New York, NY, USA. The specimen tested positive for influenza A but could not be subtyped. Specimen aliquots were shipped to the Wadsworth Center, New York State Department of Health (Albany, NY, USA), and to the Centers for Disease Control and Prevention (CDC; Atlanta, GA, USA). Next-generation sequencing performed at the New York State Department of Health generated a partial genomic sequence (6 of 8 influenza A virus gene segments) that aligned most closely with North American lineage LPAI A(H7N2) viruses. North American lineage H7 real-time reverse transcription PCR (rRT-PCR) testing and diagnostic sequence analysis performed at CDC confirmed the sample to be positive for influenza A(H7N2) virus. Virus isolation was attempted by inoculating the sample in 10-day-old embryonated chicken eggs and MDCK CCL-34 and CRFK (Crandell-Rees Feline Kidney) cell lines (American Type Culture Collection). A/New York/108/2016 was successfully isolated from eggs but not from MDCK or CRFK cells. Codon complete sequencing of the egg-isolated virus (GISAID accession nos. EPI944622–9; http://www.gisaid.org) showed no nucleotide changes compared with the hemagglutinin (HA) and neuraminidase (NA) gene segments sequenced directly from the clinical specimen. The virus was nearly identical (99.9%) to a virus isolated from a cat, A/feline/New York/16-040082-1/2016, from a New York shelter where the veterinarian had worked; the cat died of its illness. Phylogenetic analysis of the cat and human viruses showed that their genomes were closely related to LPAI A(H7N2) viruses that were circulating in the northeastern United States in the early 2000s (Technical Appendix Figure).

Analysis of the HA gene segments revealed that A/New York/108/2016 and A/feline/New York/16-040082-1/2016 were phylogenetically related to H7N2 viruses isolated from poultry in the eastern United States (New York, Virginia, Pennsylvania, North Carolina, Massachusetts) during 1996–2005, including 2 influenza A(H7N2) WHO-recommended candidate vaccine viruses. Although the internal protein coding gene segments (polybasic 1 and 2, polyacidic, nucleoprotein, matrix, nonstructural) were distant to sequences available in databases (average nucleotide identity to the closest genetic relative was 97.6%), analysis indicated that they were of LPAI virus origin and lacked known mammalian adaptive substitutions. The longer branch lengths of the internal protein coding gene segments highlighted the scarcity of sequence data available for contemporary H7N2 viruses in the United States.

Similar to well-characterized H7N2 viruses, such as A/turkey/Virginia/4529/2002 and A/New York/107/2003, A/New York/108/2016 had deletion of amino acids 212–219 in the mature HA protein (H7 numbering), known as the 220-loop of the HA receptor binding domain.[8] Such deletion has been previously shown to enhance binding and infectivity of H7 viruses to the mammalian respiratory tract and increase direct contact transmission between mammals.[9] Glycan microarray analysis showed that A/New York/108/2016 bound preferentially to α-2,3 avian-like receptors but also showed binding to the α-2,6 glycan with internal sialoside (LSTb, glycan #60), as well as to glycans with mixed α-2,3/α-2,6 receptors (Figure 1). Strong binding to the LSTb glycan has been previously reported for North America H7N2 viruses of avian origin[8,9] and 2013 human H7N9 viruses.[10] The role of the LSTb glycan binding remains unknown; it has been identified only in human milk.[11]

Figure 1.

Receptor binding specificity of A/New York/108/2016 (H7N2) influenza virus isolated from a human who experienced influenza-like illness after exposure to sick domestic cats at an animal shelter in New York, NY, USA, 2016. Figure indicates glycan microarray analysis. Colored bars represent glycans that contain α-2,3 sialic acid (SA) (blue), α-2,6 SA (red), α-2,3/α-2,6 mixed SA (purple), N-glycolyl SA (green), α-2,8 SA (brown), β-2,6 and 9-O-acetyl SA (yellow), and non-SA (gray). Error bars reflect SE in the signal for 6 independent replicates on the array. RFI, relative fluorescence intensity.

Additional molecular characterization of the HA1 protein showed 20 aa differences between A/New York/108/2016 and A/turkey/Virginia/4529/2002 (26 aa in both HA1 and HA2; Figure 2). The substitution A125S resulted in a gain of glycosylation in the HA protein of A/New York/108/2016, previously correlated with increased replication efficiency and wider tissue distribution of A/Netherlands/219/2003 (H7N7).[12] The substitution of T183I was shown in other avian influenza viruses (e.g., H5N1) to enhance binding to mammalian sialic acid receptors.[13] Four of the 20 aa changes were in residues associated with antibody recognition at antigenic site B (E177G, S180N, T183I, and S188N) and antigenic site C (R269G).

Figure 2.

Receptor binding specificity of A/New York/108/2016 (H7N2) influenza virus isolated from a human who experienced influenza-like illness after exposure to sick domestic cats at an animal shelter in New York, NY, USA, 2016. Figure shows A/New York/108/2016 hemagglutinin (HA) monomer structure. HA1 is shown in gray, HA2 in light purple, amino acid changes in comparison with reference virus A/turkey/Virginia/4529/2002 (H7N2) in red. On the cartoon view (left), all amino acid changes in the HA protein are labeled. The location of the receptor binding site (blue circle) includes the 120-loop and the 180-helix. The 220-loop is missing due to deletion of amino acids 212–219 in the mature HA protein (H7 numbering). On the surface model (right), only amino acid substitutions adjacent to the antigenic sites and receptor binding site are labeled. Antigenic site B is yellow, antigenic site C green.

To determine the effect of these differences on antigenicity, we assessed the relationships in a 2-way hemagglutination inhibition assay, using a panel of ferret antisera raised to related H7 viruses (Table). The results showed that A/New York/108/2016 and A/feline/New York/16-040082-1/2016 reacted with α-A/turkey/Virginia/4529/2002 postinfection ferret antiserum (2-fold reduction of the hemagglutination inhibition titer compared with the A/turkey/Virginia/4529/2002 homologous titer) and α-A/New York/107/2003 antiserum (8-fold reduction compared with the A/New York/107/2003 homologous titer). These data suggest that the A/turkey/Virginia/4529/2002 candidate vaccine virus would provide cross-protection if vaccination against the 2016 H7N2 viruses was needed. Both A/turkey/Virginia/4529/2002 and A/New York/107/2003, however, reacted poorly with the antiserum raised against A/New York/108/2016.

A 20-aa deletion in the NA stalk region, considered a genetic marker of poultry-adapted viruses,[14] was also identified in the human and feline H7N2 viruses. No genetic markers known to reduce susceptibility to the NA inhibitor class of antiviral drugs were identified in the NA gene. Results of the NA inhibition assay indicated that the H7N2 viruses were susceptible to 4 NA inhibitors: oseltamivir, zanamivir, peramivir, and laninamivir (data not shown).

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