Evaluating the epizootic and zoonotic threat of an H7N9 low pathogenicity avian influenza virus (LPAIV) variant associated with enhanced pathogenicity in turkeys

Between 2013-2017, A/Anhui/1/13-lineage (H7N9) low pathogenicity avian influenza virus (LPAIV) was epizootic in chickens in China causing mild disease, with 616 fatal human cases. Despite poultry vaccination, H7N9 has not been eradicated. Previously we demonstrated increased pathogenesis in turkeys infected with H7N9, correlating with the emergence of the L217Q (L226Q H3 numbering) polymorphism in the haemagglutinin (HA) protein. A Q217 containing virus also arose and is now dominant in China following vaccination. We compared infection and transmission of this Q217 containing turkey-adapted (ty-ad) isolate alongside the H7N9 (L217) wild-type (wt) virus in different poultry species, and investigated the zoonotic potential in the ferret model. Both wt and ty-ad viruses demonstrated similar shedding and transmission in turkeys and chickens. However, the ty-ad virus was significantly more pathogenic than the wt virus in turkeys but not in chickens, causing 100% and 33% mortality in turkeys respectively. Expanded tissue tropism was seen for the ty-ad virus in turkeys but not chickens, yet the viral cell receptor distribution was broadly similar in visceral organs of both species. The ty-ad virus required exogenous trypsin for in vitro replication yet had increased replication in primary avian cells. Replication was comparable in mammalian cells and the ty-ad virus replicated successfully in ferrets. The L217Q polymorphism also affected antigenicity. Therefore, H7N9 infection in turkeys can generate novel variants with increased risk through altered pathogenicity and potential HA antigenic escape. These findings emphasise the requirement for enhanced surveillance and understanding of A/Anhui/1/13-lineage viruses and their risk to different species.