Population behavior and attitude towards influenza A(H7N9) in Hong Kong, 2013-2015

Abstract

BACKGROUND: Avian influenza A(H7N9) virus has caused multiple epidemic waves in mainland China leading to over 700 laboratory-confirmed cases since early 2013 when it was first identified. Low pathogenesis of avian H7N9 virus infection made it difficult to reduce human exposure to infected poultry through early detection of the virus in poultry. Relatively high severity of human H7N9 virus infection caused substantial anxiety and behavioral changes in the public. METHOD: In total ten independent cross-sectional telephone surveys were conducted in Hong Kong adults between April 2013 and April 2015 to investigate temporal changes in population psychological and behavioral responses to H7N9 epidemics in the three waves. Similar survey instruments were applied in each survey. We examined population exposure to poultry, anxiety and risk perception to H7N9, behavioral changes in response to epidemics and attitude towards the government’s decision on closure of live poultry markets through the data collected from the surveys. RESULTS: Hong Kong adults had relatively low exposure to live poultry, and population exposure was generally lower during the 3rd wave of H7N9 epidemic than that in the first two waves although the reported consumption preference of poultry reported by participants was not substantially different across the surveys. Respondents perceived a higher risk of infection with H7N9 and were more likely to adopt preventive measures during the peak of an epidemic in comparison to other time periods during the 2-year study. Fewer respondents supported closure of local live poultry markets to control H7N9 in more recent surveys. CONCLUSION: Adults in Hong Kong perceived an increased risk of infection with H7N9 associated with exposure to live poultry during the three epidemic waves in 2013-2015. Preventive measures were likely to be adopted to reduce potential contact with the virus during the peak season. However the public seemed less likely to accept closure of local live poultry markets as an effective intervention to control H7N9 epidemics.