Italy reports Europe's first imported human case of H9N2 avian flu

Italy has reported the first imported human case of avian influenza A(H9N2) in WHO's European Region, the agency said in a Disease Outbreak News notice published on 10 April 2026 [s1]. The patient, an adult man who had spent more than six months in Senegal before travelling to Italy in mid-March, carried the poultry-adapted virus; WHO assesses the risk to the general population as low and reports no onward human transmission [s1].

The case is unusual less for its severity than for where it turned up. Human infections with A(H9N2) have been reported from countries in Africa and Asia, where the virus also circulates in poultry, and the majority have been recorded in China [s1]. None had previously been detected as an imported case in Europe [s1].

How the case was found

Italy's National IHR Focal Point notified WHO on 21 March 2026 [s1]. The man had arrived from Senegal and presented to an emergency department with fever and a persistent cough [s1]. A bronchoalveolar lavage specimen taken on 16 March returned a positive result for Mycobacterium tuberculosis and also detected an influenza A virus that could not initially be subtyped [s1]. He was placed in a negative-pressure isolation room with airborne precautions and treated with antitubercular medication and the antiviral oseltamivir; by 9 April his condition was stable and improving [s1].

A regional reference laboratory identified the A(H9) subtype on 20 March, and next-generation sequencing confirmed influenza A(H9N2) on 21 March [s1]. Further characterisation at Italy's National Influenza Centre found the virus closely related to strains previously identified in poultry in Senegal, and initial genetic findings suggest the infection was acquired from an avian source linked to that country [s1]. No direct contact with animals, wildlife or rural environments was identified, and the man reported no contact with symptomatic or confirmed human cases [s1].

Contact tracing ran on two continents. Contacts identified in Senegal were asymptomatic; all traced contacts in Italy tested negative for influenza, completed active monitoring and quarantine, and received oseltamivir as a preventive measure [s1].

What circulates in Senegal

The notice's attribution to a Senegalese poultry source fits independent surveillance. Active monitoring of two live-bird markets in Dakar between December 2023 and October 2024 tested 499 samples and detected avian influenza virus in 58.3% of them; A(H9N2) was the only subtype found in either market [s2]. The detection rate was 47.7% (82 of 172) at Thiaroye and 35.3% (42 of 119) at Tilene, an overall positivity of 42.6% (124 of 291) [s2].

Sequencing of 22 isolates placed the market viruses in a single cluster closely related to a Senegalese human strain, A/Senegal/0243/2019, identified through national sentinel surveillance, and to G1-lineage A(H9N2) viruses circulating in neighbouring countries — evidence of cross-border spread [s2]. The isolates carried a low-pathogenicity cleavage motif but also several amino-acid substitutions linked to human adaptation, including HA-Q226L, alongside M2-S31N, which confers resistance to the older adamantane class of antivirals [s2]. WHO separately notes that Senegal reported a human A(H9N2) infection in 2020 [s1].

How worried to be

WHO's assessment is measured. Most human A(H9N2) infections follow exposure to infected poultry or contaminated environments and cause mild illness, and sporadic cases can be expected while the virus remains enzootic in poultry [s1]. Crucially, the agency states that none of the A(H9N2) viruses characterised so far has acquired the ability for sustained transmission between humans, so the likelihood of sustained human-to-human spread is low at this time [s1].

The International Health Regulations require notification precisely because the category matters more than any single case: under Article 6, all human infections caused by a new influenza A subtype are notifiable, as an event with the potential for high public-health impact [s1]. That framing is why a single, recovering patient generated an international notice and coordination among Italy, Senegal, WHO and the European Centre for Disease Prevention and Control [s1].

WHO advises no travel or trade restrictions on the basis of this event and no specific measures for travellers, while recommending the standard precautions for anyone handling live or dead poultry: avoid high-risk settings such as live-animal markets, use respiratory protection, and practise hand hygiene [s1].

What to watch

The signal worth tracking is not this man's recovery but the mutation profile in the reservoir. The Dakar market viruses already carry changes associated with mammalian adaptation [s2], and WHO's standing concern with animal influenza is the accumulation of such changes in a virus that people are repeatedly exposed to. The agency says its risk assessment would be revisited if further epidemiological or virological information emerges [s1]. Until then, the case reads as a surveillance system working as designed — an imported infection detected, sequenced, contained and reported — rather than as a change in the threat.

Sources

• Disease Outbreak News: Avian Influenza A(H9N2) - Italy — World Health Organization, 10 April 2026
• Genetic and Molecular Characterization of Avian Influenza A(H9N2) Viruses from Live Bird Markets (LBM) in Senegal — Viruses (MDPI), 8 January 2025