The outbreak of highly pathogenic avian influenza A virus subtype H7N7 started at the end of February, 2003, in commercial poultry farms in the Netherlands. In this study, published in The Lancet in 2004, it is noted that an unexpectedly high number of transmissions of avian influenza A virus subtype H7N7 to people directly involved in handling infected poultry, providing evidence for person-to-person transmission.

Although the risk of transmission of these viruses to humans was initially thought to be low, an outbreak investigation was launched to assess the extent of transmission of influenza A virus subtype H7N7 from chickens to humans.

Most H7 cases were detected in the cullers. The attack rate (proportion of persons at risk that developed symptoms) of conjunctivitis was highest in veterinarians, and both cullers and veterinarians had the highest estimated attack rate of confirmed A/H7N7

453 people had health complaints—349 reported conjunctivitis, 90 had influenza-like illness, and 67 had other complaints. We detected A/H7 in conjunctival samples from 78 (26·4%) people with conjunctivitis only, in five (9·4%) with influenza-like illness and conjunctivitis, in two (5·4%) with influenza-like illness only, and in four (6%) who reported other symptoms. Most positive samples had been collected within 5 days of symptom onset.

A/H7 infection was confirmed in three contacts (of 83 tested), one of whom developed influenza-like illness. In three of these exposed contacts an A/H7N7 infection was confirmed. All three were household contacts.The first contact was the 13-year-old daughter of a poultry worker, who developed conjunctivitis approximately 10 days after onset of symptoms in her father.Six people had influenza A/H3N2 infection. After 19 people had been diagnosed with the infection, all workers received mandatory influenza virus vaccination and prophylactic treatment with oseltamivir. More than half (56%) of A/H7 infections reported here arose before the vaccination and treatment programme.