Epidemic hazard

On March 25, 2026, Italy confirmed Europe's first-ever human case of H9N2 Avian Influenza in a patient in the Lombardy region. Based on the information officially reported, the patient, who is currently hospitalized, contracted the virus in a non-European country. This event has raised significant media concern at national and international level despite the authorities emphasizing that the public health risk remains low as H9N2 human infections are typically mild and there is no documented evidence of sustained human-to-human transmission. An RFI has been sent to EpiCore members to support in the collection of further details about this event, and more in general about Influenza H9N2 human cases worldwide, for risk assessment purposes. The EpiCore network has provided valuable details extracted from reliable sources about the specific case confirmed in Italy in addition to background information on H9N2 infections in humans. Based on this feedback, the patient presented with febrile illness and respiratory symptoms requiring hospitalisation in a local health facility in Monza area (Lombardy). Respiratory samples were immediately collected and analysed by the regional reference laboratory: subtyping and genomic characterization identified the virus as A(H9N2) confirming the first human detection of this subtype in Europe. WHO and ECDC have been immediately notified. Preliminary investigations carried by the local health authorities confirmed this as an imported case: the individual, who has significant underlying health conditions, likely contracted the virus in Western Africa, a region where H9N2 is increasingly common in poultry and has seen sporadic human cases (cf. Ghana, 2024). No secondary cases have been identified among close contacts. The authorities have assessed the health risk for the general population in the country related to this event as “low”. ECDC currently assesses the risk for the general population in the EU/EEA related to this event as “very low”. The network has informed that approximately 200 Influenza A(H9N2) human cases have been documented worldwide since 1998, primarily in the Western Pacific Region (90% of cases in China with an increasing trend in recent years: 11 in 2024, 29 in 2025 and already 10 in 2026). In Africa only sporadic human cases have been documented. As the virus is considered endemic in poultry across Eurasia and Africa, sporadic cases in humans are not unexpected in these areas due to spillover events. It should be noted that so far, no H9N2 human clusters have been described and that there has been no documented person-to-person transmission. The network has also reminded that most human cases have resulted so far in mild upper respiratory symptoms (fever, cough). Despite that, severe illness can occur in "frail" individuals, and two fatal infections have been described in patients presenting significant underlying health conditions. In addition, H9N2 virus presents a documented pandemic potential with frequent exchanges of genetic material (reassortment) with other avian flu viruses (and increasing signs of mammalian adaptation shown by the Asian Y280/G57 lineages). The network considers that the detection of H9N2 in West Africa and this recent imported case in Europe highlights three critical health priorities: 1) clinical vigilance: doctors must maintain a high level of suspicion when treating travellers from affected regions who present with unexplained fevers; 2) advanced testing: lab should use specialized molecular testing (PCR) to identify specific strains whenever a patient tests positive for a non-seasonal Influenza A virus; c) genetic tracking: scientists must continuously monitor the H9N2 virus for any mutations that would allow it to spread more easily among humans or other mammals. The RFI has been supported with relevant information for risk assessment purposes about this recent H9N2 human case and, more in general, about the pandemic potential of the virus. This summary may be updated in case of further technical comments shared by the network on the event. OFFICIAL SOURCES - https://www.ecdc.europa.eu/en/news-events/first-human-case-influenza-ah9n2-infection-imported-eu - https://cdn.who.int/media/docs/default-source/wpro---documents/emergency/surveillance/avian-influenza/ai_20260227.pdf?sfvrsn=c6ee21a9_1&download=true - https://www.who.int/emergencies/disease-outbreak-news/item/2024-DON534 PUBLICATIONS - Akanbi OB et al. Pathology and molecular detection of influenza A subtype H9N2 virus in commercial poultry in Nigeria, 2024. Open Vet J. 2024 Sep;14(9):2381-2391. doi: 10.5455/OVJ.2024.v14.i9.26. Epub 2024 Sep 30. PMID: 39553779; PMCID: PMC11563628. https://pmc.ncbi.nlm.nih.gov/articles/PMC11563628/pdf/OpenVetJ-14-2381.pdf - Asante IA et al. Characterization of the first detected Avian Influenza A(H9N2) human case in Ghana. Emerg Microbes Infect. 2025 Dec;14(1):2556717. doi: 10.1080/22221751.2025.2556717. Epub 2025 Oct 6. PMID: 40900100; PMCID: PMC12502110. https://pmc.ncbi.nlm.nih.gov/articles/PMC12502110/pdf/TEMI_14_2556717.pdf - Chen LL et al. Enhanced replication of a contemporary avian influenza A H9N2 virus in human respiratory organoids. Emerg Microbes Infect. 2025 Dec;14(1):2576574. doi: 10.1080/22221751.2025.2576574. Epub 2025 Nov 3. PMID: 41099079; PMCID: PMC12584838. https://pmc.ncbi.nlm.nih.gov/articles/PMC12584838/ - Kadja, M. C. et al. (2025). Molecular Detection and Genetic Characterization of H9N2 Avian Influenza Virus in Laying Hen and Broiler Farms in Dakar and Thiès Regions, Senegal. Veterinaria Italiana, 61(4). https://doi.org/10.12834/VetIt.3776.36100.3. https://www.veterinariaitaliana.izs.it/index.php/VetIt/article/view/3776/2570 - Peacock THP, James J, Sealy JE, Iqbal M. A Global Perspective on H9N2 Avian Influenza Virus. Viruses. 2019 Jul 5;11(7):620. doi: 10.3390/v11070620. 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