Adjuvanted #H5N1 #influenza #vaccine enhances both cross-reactive memory B cell and strain-specific naive B cell responses in humans (Proc Natl Acad Sci USA, abstract)

[Source: Proceedings of the National Academy of Sciences of the United States of America, full page: (LINK). Abstract, edited.]

Adjuvanted H5N1 influenza vaccine enhances both cross-reactive memory B cell and strain-specific naive B cell responses in humans

Ali H. Ellebedy,  Raffael Nachbagauer, Katherine J. L. Jackson, Ya-Nan Dai, Julianna Han, Wafaa B. Alsoussi, Carl W. Davis, Daniel Stadlbauer, Nadine Rouphael, Veronika Chromikova, Megan McCausland, Cathy Y. Chang, Mario Cortese, Mary Bower, Chakravarthy Chennareddy, Aaron J. Schmitz, Veronika I. Zarnitsyna, Lilin Lai, Arvind Rajabhathor, Cheyann Kazemian, Rustom Antia, Mark J. Mulligan,  Andrew B. Ward,  Daved H. Fremont, Scott D. Boyd, Bali Pulendran, Florian Krammer, and Rafi Ahmed

PNAS first published July 13, 2020

Contributed by Rafi Ahmed, November 8, 2019 (sent for review April 19, 2019; reviewed by Robert L. Coffman and Marc K. Jenkins)



The development of a universal influenza vaccine is a major public health need globally, and identifying the optimal formulation will be an important first step for developing such a vaccine. Here we show that a two-dose immunization of humans with an inactivated, AS03-adjuvanted H5N1 avian influenza virus vaccine engaged both the preexisting memory and naive B cell compartments. Importantly, we show that the recruited memory B cells after first immunization were directed against conserved epitopes within the H5 HA stem region while the responses after the second immunization were mostly directed against strain-specific epitopes within the HA globular head. Taken together these findings have broad implications toward optimizing vaccination strategies for developing more effective vaccines against pandemic viruses.



There is a need for improved influenza vaccines. In this study we compared the antibody responses in humans after vaccination with an AS03-adjuvanted versus nonadjuvanted H5N1 avian influenza virus inactivated vaccine. Healthy young adults received two doses of either formulation 3 wk apart. We found that AS03 significantly enhanced H5 hemagglutinin (HA)-specific plasmablast and antibody responses compared to the nonadjuvanted vaccine. Plasmablast response after the first immunization was exclusively directed to the conserved HA stem region and came from memory B cells. Monoclonal antibodies (mAbs) derived from these plasmablasts had high levels of somatic hypermutation (SHM) and recognized the HA stem region of multiple influenza virus subtypes. Second immunization induced a plasmablast response to the highly variable HA head region. mAbs derived from these plasmablasts exhibited minimal SHM (naive B cell origin) and largely recognized the HA head region of the immunizing H5N1 strain. Interestingly, the antibody response to H5 HA stem region was much lower after the second immunization, and this suppression was most likely due to blocking of these epitopes by stem-specific antibodies induced by the first immunization. Taken together, these findings show that an adjuvanted influenza vaccine can substantially increase antibody responses in humans by effectively recruiting preexisting memory B cells as well as naive B cells into the response. In addition, we show that high levels of preexisting antibody can have a negative effect on boosting. These findings have implications toward the development of a universal influenza vaccine.



1 Present address: Division of Immunobiology, Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO 63110.

2 Present address: Immunology Division, Garvan Institute of Medical Research, Darlinghurst, NSW 2010, Australia.

3 Present address: Departments of Pathology, and Microbiology & Immunology, Institute for Immunity, Transplantation and Infection, Stanford University, Stanford, CA 94305.

4 Present address: Division of Infectious Diseases and Immunology, Department of Medicine, New York University, New York, NY 10016.

5 To whom correspondence may be addressed. Email:

Author contributions: A.H.E. and R. Ahmed designed research; A.H.E., R.N., Y.-N.D., J.H., W.B.A., D.S., N.R., V.C., M.M., C.Y.C., and C.K. performed research; K.J.L.J., M.C., M.B., C.C., A.J.S., L.L., A.R., M.J.M., A.B.W., D.H.F., S.D.B., B.P., and F.K. contributed new reagents/analytic tools; A.H.E., K.J.L.J., C.W.D., V.I.Z., R. Antia, D.H.F., and S.D.B. analyzed data; and A.H.E. and R. Ahmed wrote the paper.

Reviewers: R.L.C., University of California; and M.K.J., University of Minnesota.

The authors declare no competing interest.

Data deposition: Structures have been deposited in the Electron Microscopy Data Bank (accession codes: 1F03: EMD-20570 1H09: EMD-20571 1C01: EMD-20569) and BioProject Sequence Read Archive (accession no. PRJNA533650).

This article contains supporting information online  at Published under the PNAS license.

Keywords: Avian Influenza; H5N1; Vaccines.


#International external #quality #assessment for #SARS-CoV-2 #molecular #detection and #survey on #clinical #laboratory #preparedness during the #COVID19 pandemic, April/May 2020 (Euro Surveill., abstract)

[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]

International external quality assessment for SARS-CoV-2 molecular detection and survey on clinical laboratory preparedness during the COVID-19 pandemic, April/May 2020

Veerle Matheeussen1,6 , Victor M Corman2,6 , Oliver Donoso Mantke3,6 , Elaine McCulloch3 , Christine Lammens1 , Herman Goossens1 , Daniela Niemeyer2 , Paul S Wallace3 , Paul Klapper4 , Hubert GM Niesters5 , Christian Drosten2 , Margareta Ieven1 , on behalf of the RECOVER project and collaborating networks7

Affiliations: 1 Department of Medical Microbiology, Vaccine and Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Wilrijk, Belgium; 2 National Consultant Laboratory for Coronaviruses, Institute of Virology, Charité-Universitätsmedizin Berlin, Berlin, Germany; 3 Quality Control for Molecular Diagnostics (QCMD), Glasgow, United Kingdom; 4 School of Biological Sciences, Division of Infection, Immunity and Respiratory Medicine, The University of Manchester, Manchester, United Kingdom; 5 Division of Clinical Virology, Department of Medical Microbiology, University Medical Center Groningen, Groningen, the Netherlands; 6 These authors contributed equally to this work and share first authorship; 7 Details on these projects are noted in the Acknowledgements

Correspondence:  Oliver Donoso Mantke

Citation style for this article: Matheeussen Veerle , Corman Victor M , Donoso Mantke Oliver , McCulloch Elaine , Lammens Christine , Goossens Herman , Niemeyer Daniela , Wallace Paul S , Klapper Paul , Niesters Hubert GM , Drosten Christian , Ieven Margareta , on behalf of the RECOVER project and collaborating networks . International external quality assessment for SARS-CoV-2 molecular detection and survey on clinical laboratory preparedness during the COVID-19 pandemic, April/May 2020. Euro Surveill. 2020;25(27):pii=2001223.

Received: 17 Jun 2020;   Accepted: 30 Jun 2020



Laboratory preparedness with quality-assured diagnostic assays is essential for controlling the current coronavirus disease (COVID-19) outbreak. We conducted an external quality assessment study with inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) samples to support clinical laboratories with a proficiency testing option for molecular assays. To analyse SARS-CoV-2 testing performance, we used an online questionnaire developed for the European Union project RECOVER to assess molecular testing capacities in clinical diagnostic laboratories.

©  This work is licensed under a Creative Commons Attribution 4.0 International License.

Keywords: SARS-CoV-2; COVID-19; Pandemic Preparedness.


#Epidemiology and #Genotypic #Diversity of #EA #Avian-Like #H1N1 #Swine #Influenza Viruses in #China (Virol Sin., abstract)

[Source: Virologica Sinica, full page: (LINK). Abstract, edited.]

Epidemiology and Genotypic Diversity of Eurasian Avian-Like H1N1 Swine Influenza Viruses in China

Zhaomin Feng, Wenfei Zhu, Lei Yang, Jia Liu, Lijuan Zhou, Dayan Wang & Yuelong Shu

Virologica Sinica (2020)



Eurasian avian-like H1N1 (EA H1N1) swine influenza virus (SIV) outside European countries was first detected in Hong Kong Special Administrative Region (Hong Kong, SAR) of China in 2001. Afterwards, EA H1N1 SIVs have become predominant in pig population in this country. However, the epidemiology and genotypic diversity of EA H1N1 SIVs in China are still unknown. Here, we collected the EA H1N1 SIVs sequences from China between 2001 and 2018 and analyzed the epidemic and phylogenic features, and key molecular markers of these EA H1N1 SIVs. Our results showed that EA H1N1 SIVs distributed in nineteen provinces/municipalities of China. After a long-time evolution and transmission, EA H1N1 SIVs were continuously reassorted with other co-circulated influenza viruses, including 2009 pandemic H1N1 (A(H1N1)pdm09), and triple reassortment H1N2 (TR H1N2) influenza viruses, generated 11 genotypes. Genotype 3 and 5, both of which were the reassortments among EA H1N1, A(H1N1)pdm09 and TR H1N2 viruses with different origins of M genes, have become predominant in pig population. Furthermore, key molecular signatures were identified in EA H1N1 SIVs. Our study has drawn a genotypic diversity image of EA H1N1 viruses, and could help to evaluate the potential risk of EA H1N1 for pandemic preparedness and response.

Keywords: Avian Influenza; Swine Influenza; Influenza A; Reassortant strain; Pigs; H1N1; H1N2; H1N1pdm09; China.


Strengthening the #core #health #research #capacity of #national health systems helps build #country #resilience to #epidemics: a cross-sectional survey (F1000Res., abstract)

[Source: F1000 Research, full page: (LINK). Abstract, edited.]

Strengthening the core health research capacity of national health systems helps build country resilience to epidemics: a cross-sectional survey

[version 2; peer review: 3 approved]

Rony Zachariah, Dermot Maher, Abraham Aseffa, Mahnaz Vahedi, Pascal Launois, Mohammed Khogali, Garry Aslanyan, John C. Reeder

This article is included in the Disease Outbreaks gateway.

This article is included in the TDR gateway.




TDR, The Special Programme for Research and Training hosted at the World Health Organization, has long supported Low- and Middle-Income Countries in strengthening research capacity through three training programmes: the Postgraduate Training Scheme (PGTS), the Clinical Research and Development Fellowship (CRDF), and the Structured Operational Research Training InitiaTive (SORT IT). In the advent of the COVID-19 pandemic, we assessed whether those trained through these programmes were involved in the COVID-19 response and if so, in which area(s) of the emergency response they were applying their skills.


From the records for each training programme, we identified the individuals who had completed training during the relevant timespan of each programme: 1999-2018 for the CRDF scheme, 2015-2020 for PGTS, and 2009-2019 for SORT-IT. Between March and April 2020, we sent trainees an online questionnaire by e-mail.


Out of 1254 trained, 1143 could be contacted and 699 responded to the survey. Of the latter, 411 were involved with the COVID-19 response, of whom 315 (77%) were applying their acquired skills in 85 countries. With some overlap between programmes, 84% of those trained through CRDF were applying their skills in 27 countries, 91% of those trained through PGTS were applying their skills in 19 countries, and through SORT IT, this was 73% in 62 countries.  Skills were being applied in various areas of the emergency response, including: emergency preparedness, situation analysis/surveillance, infection control and clinical management, data generation, mitigating the effect of COVID on the health system, and research.  Depending on the type of training programme, 26-74% were involved in implementation, operational or clinical research.


Research training programmes build research capacity and equip health workers with transferable core competencies and skillsets prior to epidemics. This becomes invaluable in building health system resilience at a time of pandemics.

Keywords: COVID-19, Pandemic, Health systems, Training, Emergency preparedness

Corresponding author: Rony Zachariah

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright:  © 2020 Zachariah R et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Zachariah R, Maher D, Aseffa A et al. Strengthening the core health research capacity of national health systems helps build country resilience to epidemics: a cross-sectional survey [version 2; peer review: 3 approved]. F1000Research 2020, 9:583 (

First published: 09 Jun 2020, 9:583 (

Latest published: 29 Jun 2020, 9:583 (

Keywords: SARS-CoV-2; COVID-19. Pandemic preparedness.


#Variation in #Ventilator #Allocation #Guidelines by #US #State During the #Coronavirus Disease 2019 Pandemic – A Systematic Review (JAMA Netw Open, abstract)

[Source: JAMA Network Open, full page: (LINK). Abstract, edited.]

Variation in Ventilator Allocation Guidelines by US State During the Coronavirus Disease 2019 Pandemic – A Systematic Review

Gina M. Piscitello, MD1; Esha M. Kapania, MD1; William D. Miller, MD2; Juan C. Rojas, MD2; Mark Siegler, MD3,4; William F. Parker, MD2,4

Author Affiliations: 1 Department of Medicine, Rush University, Chicago, Illinois; 2 Department of Pulmonary and Critical Care, University of Chicago, Chicago, Illinois; 3 Department of Medicine, University of Chicago, Chicago, Illinois; 4 MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, Illinois

JAMA Netw Open. 2020;3(6):e2012606. doi:10.1001/jamanetworkopen.2020.12606


Key Points

  • Question  – How many US states have ventilator allocation guidelines and how do these guidelines compare with one another?
  • Findings  – In this systematic review of publicly available US state guidelines about ventilator allocation, only 26 states provided guidance on how this allocation should occur, and their guidelines varied significantly.
  • Meaning  – These findings suggest significant variation in US state ventilator guidelines, which could cause inequity in allocation of mechanical ventilatory support during a public health emergency, such as the coronavirus disease 2019 pandemic.




During the coronavirus disease 2019 pandemic, there may be too few ventilators to meet medical demands. It is unknown how many US states have ventilator allocation guidelines and how these state guidelines compare with one another.


To evaluate the number of publicly available US state guidelines for ventilator allocation and the variation in state recommendations for how ventilator allocation decisions should occur and to assess whether unique criteria exist for pediatric patients.

Evidence Review  

This systematic review evaluated publicly available guidelines about ventilator allocation for all states in the US and in the District of Columbia using department of health websites for each state and internet searches. Documents with any discussion of a process to triage mechanical ventilatory support during a public health emergency were screened for inclusion. Articles were excluded if they did not include specific ventilator allocation recommendations, were in draft status, did not include their state department of health, or were not the most up-to-date guideline. All documents were individually assessed and reassessed by 2 independent reviewers from March 30 to April 2 and May 8 to 10, 2020.


As of May 10, 2020, 26 states had publicly available ventilator guidelines, and 14 states had pediatric guidelines. Use of the Sequential Organ Failure Assessment score in the initial rank of adult patients was recommended in 15 state guidelines (58%), and assessment of limited life expectancy from underlying conditions or comorbidities was included in 6 state guidelines (23%). Priority was recommended for specific groups in the initial evaluation of patients in 6 states (23%) (ie, Illinois, Maryland, Massachusetts, Michigan, Pennsylvania, and Utah). Many states recommended exclusion criteria in adult (11 of 26 states [42%]) and pediatric (10 of 14 states [71%]) ventilator allocation. Withdrawal of mechanical ventilation from a patient to give to another if a shortage occurs was discussed in 22 of 26 adult guidelines (85%) and 9 of 14 pediatric guidelines (64%).

Conclusions and Relevance  

These findings suggest that although allocation guidelines for mechanical ventilatory support are essential in a public health emergency, only 26 US states provided public guidance on how this allocation should occur. Guidelines among states, including adjacent states, varied significantly and could cause inequity in the allocation of mechanical ventilatory support during a public health emergency, such as the coronavirus disease 2019 pandemic.

Keywords: SARS-CoV-2; COVID-19; Intensive Care; USA; Bioethics.


Active case #finding with case #management: the key to tackling the #COVID19 pandemic (Lancet, abstract)

[Source: Lancet, full page: (LINK). Abstract, edited.]

Active case finding with case management: the key to tackling the COVID-19 pandemic

Prof Zhongjie Li, PhD *, Qiulan Chen, PhD *, Prof Luzhao Feng, PhD, Lance Rodewald, MD, Yinyin Xia, PhD, Hailiang Yu, MMed, Ruochen Zhang, LLB, Prof Zhijie An, MPH, Prof Wenwu Yin, MMed, Prof Wei Chen, PhD, Ying Qin, PhD, Zhibin Peng, MMed, Ting Zhang, MMed, Prof Daxin Ni, MMed, Jinzhao Cui, BSMed, Qing Wang, BSMed, Xiaokun Yang, BSMed, Muli Zhang, BSMed, Xiang Ren, PhD, Dan Wu, MMed, Xiaojin Sun, MMed, Yuanqiu Li, PhD, Prof Lei Zhou, MMed, Xiaopeng Qi, PhD, Prof Tie Song, MMed, Prof George F Gao, DPhil  †, Prof Zijian Feng, MMed † and the China CDC COVID-19 Emergency Response Strategy Team

Published: June 04, 2020 | DOI:



COVID-19 was declared a pandemic by WHO on March 11, 2020, the first non-influenza pandemic, affecting more than 200 countries and areas, with more than 5·9 million cases by May 31, 2020. Countries have developed strategies to deal with the COVID-19 pandemic that fit their epidemiological situations, capacities, and values. We describe China’s strategies for prevention and control of COVID-19 (containment and suppression) and their application, from the perspective of the COVID-19 experience to date in China. Although China has contained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and nearly stopped indigenous transmission, a strong suppression effort must continue to prevent re-establishment of community transmission from importation-related cases. We believe that case finding and management, with identification and quarantine of close contacts, are vitally important containment measures and are essential in China’s pathway forward. We describe the next steps planned in China that follow the containment effort. We believe that sharing countries’ experiences will help the global community manage the COVID-19 pandemic by identifying what works in the struggle against SARS-CoV-2.

Keywords: SARS-CoV-2; COVID-19; Pandemic Preparedness; China.


#Pandemic #Preparedness: Developing #Vaccines and #Therapeutic #Antibodies For #COVID19 (Cell, abstract)

[Source: Cell, full page: (LINK). Abstract, edited.]

Pandemic Preparedness: Developing Vaccines and Therapeutic Antibodies For COVID-19

Gregory D. Sempowski, Kevin O. Saunders, Priyamvada Acharya, Kevin J. Wiehe, Barton F. Haynes

Published: May 26, 2020 | DOI:



The SARS-CoV-2 pandemic that causes COVID-19 respiratory syndrome has caused global public health and economic crises necessitating rapid development of vaccines and therapeutic countermeasures. The world-wide response to the COVID-19 pandemic has been unprecedented with government, academic and private partnerships working together to rapidly develop vaccine and antibody countermeasures. Many of the technologies being used are derived from prior government-academic partnerships for response to other emerging infections.

Publication stage In Press Accepted Manuscript

Identification DOI:

Copyright © 2020 Elsevier Inc.

Keywords: SARS-CoV-2; COVID-19; Pandemic preparedness.


#Pandemic #Influenza #Vaccines: What did We Learn from the 2009 Pandemic and are We Better Prepared Now? (Vaccines, abstract)

[Source: Vaccines, full page: (LINK). Abstract, edited.]

Pandemic Influenza Vaccines: What did We Learn from the 2009 Pandemic and are We Better Prepared Now?

by  Steven Rockman 1,2, Karen Laurie 1,2 and Ian Barr 2,3,*

1 Seqirus, 63 Poplar Road, Parkville, VIC 3052, Australia; 2 Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute of Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; 3 WHO Collaborating Centre for Reference and Research on Influenza, at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000,  Australia

*Author to whom correspondence should be addressed.

Vaccines 2020, 8(2), 211; (registering DOI)

Received: 4 April 2020 / Revised: 1 May 2020 / Accepted: 6 May 2020 / Published: 7 May 2020

(This article belongs to the Special Issue Influenza Virus and Vaccine Development)



In 2009, a novel A(H1N1) influenza virus emerged with rapid human-to-human spread and caused the first pandemic of the 21st century. Although this pandemic was considered mild compared to the previous pandemics of the 20th century, there was still extensive disease and death. This virus replaced the previous A(H1N1) and continues to circulate today as a seasonal virus. It is well established that vaccines are the most effective method to alleviate the mortality and morbidity associated with influenza virus infections, but the 2009 A(H1N1) influenza pandemic, like all significant infectious disease outbreaks, presented its own unique set of problems with vaccine supply and demand. This manuscript describes the issues that confronted governments, international agencies and industries in developing a well-matched vaccine in 2009, and identifies the key improvements and remaining challenges facing the world as the next influenza pandemic inevitably approaches.

Keywords: influenza vaccine; pandemic; pandemic  preparedness; influenza; A(H1N1)pdm09; seasonal influenza vaccine; pandemic influenza vaccine; pandemic vaccine

This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

Keywords: Influenza A; Pandemic Influenza; Pandemic Preparedness, Vaccines.


#Nipah Virus: Past #Outbreaks and Future #Containment (Viruses, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Viruses. 2020 Apr 20;12(4):E465. doi: 10.3390/v12040465.

Nipah Virus: Past Outbreaks and Future Containment

Vinod Soman Pillai 1, Gayathri Krishna 1, Mohanan Valiya Veettil 1

Affiliation: 1 Virology Laboratory, Department of Biotechnology, Cochin University of Science and Technology, Cochin 682022, Kerala, India.

PMID: 32325930 DOI: 10.3390/v12040465



Viral outbreaks of varying frequencies and severities have caused panic and havoc across the globe throughout history. Influenza, small pox, measles, and yellow fever reverberated for centuries, causing huge burden for economies. The twenty-first century witnessed the most pathogenic and contagious virus outbreaks of zoonotic origin including severe acute respiratory syndrome coronavirus (SARS-CoV), Ebola virus, Middle East respiratory syndrome coronavirus (MERS-CoV) and Nipah virus. Nipah is considered one of the world’s deadliest viruses with the heaviest mortality rates in some instances. It is known to cause encephalitis, with cases of acute respiratory distress turning fatal. Various factors contribute to the onset and spread of the virus. All through the infected zone, various strategies to tackle and enhance the surveillance and awareness with greater emphasis on personal hygiene has been formulated. This review discusses the recent outbreaks of Nipah virus in Malaysia, Bangladesh and India, the routes of transmission, prevention and control measures employed along with possible reasons behind the outbreaks, and the precautionary measures to be ensured by private-public undertakings to contain and ensure a lower incidence in the future.

Keywords: Nipah; control; emerging virus; outbreak; prevention; transmission.

Keywords: Pandemic preparedness; Nipah virus.


#Progress in #PublicHealth #Risk #Communication in àChina: Lessons Learned From #SARS to #H7N9 (BMC Public Health, abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Public Health. 2019 May 10;19(Suppl 3):475. doi: 10.1186/s12889-019-6778-1.

Progress in Public Health Risk Communication in China: Lessons Learned From SARS to H7N9

Melinda Frost 1 2, Richun Li 3 4, Ronald Moolenaar 3 4, Qun’an Mao 5, Ruiqian Xie 6

Affiliations: 1 Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA. 2 US  Centers for Disease Control and Prevention, Beijing, China. 3 Division of Global Health Protection, Center for Global Health, Centers for Disease  Control and Prevention, Atlanta, GA, USA. 4 US Centers for Disease Control and  Prevention, Beijing, China. 5 National Health Commission, Beijing, China. 6 Chinese  Center for Health Education, Beijing, China.

PMID: 32326919 DOI: 10.1186/s12889-019-6778-1




Following the SARS outbreak, the World Health Organization revised the International Health Regulations to include risk communication as one of the core capacity areas. In 2006, the U.S. Centers for Disease Control and Prevention’s Global Disease Detection [GDD] program began collaborating with China to enhance China’s risk communication capacity to address gaps in the SARS communication response. This article describes tangible improvements in China’s public health emergency risk communication capacity between the SARS and H7N9 outbreaks; documents U.S. CDC GDD cooperative technical assistance during 2006-2017; and shares lessons learnt to benefit other countries and contribute to enhance global health security.


A questionnaire based on the WHO Joint External Evaluation tool [Risk Communication section] was developed. A key communications official from the China National Health Commission [NHC] completed the questionnaire retrospectively to reflect China’s capacity to manage communication response before, during and after the outbreaks of SARS in 2003, influenza H1N1 in 2009, and influenza H7N9 in 2013. A literature search was also conducted in English and Chinese to further substantiate the results of the questionnaire completed by NHC.


China demonstrated significantly improved risk communication capacities of pre-event, during event and post event responses to H7N9 when compared to the SARS response. China NHC improved its response through preparedness, availability of dedicated staff and resources for risk communication, internal clearance mechanisms, standard operating procedures with national response parties external to NHC, rumor management, communication with international agencies and consistent messaging with healthcare and private sectors. Correspondingly, the perceived level of trust that the public had in the NHC following outbreaks rose between the SARS and H7N9 response.


Risk communication capacities in China have increased during the ten years between the SARS outbreak of 2003 and the H7N9 outbreak of 2013. Long-term risk communication capacity building efforts in bilateral collaborations are uncommon. The U.S. CDC GDD project was one of the first such collaborations worldwide. The lessons learned from this project may benefit lower and middle-income countries as they build their national emergency risk communication capacity.

Keywords: China; Global disease detection; Global health security; H7N9; International health regulations; Risk communications; SARS.

Keywords: Pandemic Preparedness; Public Health; China; Society; SARS; Avian Influenza; H7N9.