Taipei, April 3 (CNA) The Department of Health (DOH) decided Wednesday to list two Chinese provinces and two cities as areas affected by a deadly bird flu virus, but stopped short of restricting entry to Taiwan by tour groups from those regions.

"The mainland Chinese provinces of Jiangsu and Auhui, as well as Shanghai and Nanjing cities, have been listed as H7N9-affected areas," said Chang Feng-yee, director-general of the DOH's Centers for Disease Control.

"While we have not restricted tour groups from those areas, we have tightened health monitoring of visitors from mainland China, especially those from the H7N9-affected regions," Chang said.

The decision was made at a brainstorming session of health experts, hosted by Health Minister Chiu Wen-da.

It was decided at the meeting that the H7N9 infection would be listed as a Category 5 notifiable disease starting Wednesday, a day after China confirmed four more cases of the bird flu virus crossing over to humans.

To date, nine H7N9 cases have been confirmed, with three fatalities and six people in critical condition.

Chang said Category 5 notifiable diseases refer to newly detected infectious pathogens.

The designation of H7N9 as a notifiable disease requires physicians to report cases to health authorities within 24 hours of detection and to quarantine contagious patients, in accordance with the country's health regulations.

Chang said the DOH has also decided to set up a national H7N9 epidemic prevention and control center, which he will head.

Responding to media criticism that the DOH might have overreacted to the situation, Chang said H7N9 seems similar to the virulent H5N1bird flu strain.

"We need to heighten alerts at an early stage," Chang said, adding that it would be hardly enough to rely only on fever screening stations at ports of entry to prevent the spread of the virus.

Given the geographic proximity of Taiwan and China, the DOH needs to take precautionary measures as early as possible, he said.

He further said the DOH has informed Chinese authorities that it will like to send epidemologists to join the field studies in China and gain firsthand information about the virus.

"We have not yet received a response," Chang said.

According to the gene sequence of the H7N9 virus published online by China, the virus originated in poultry and does not contain any human or pig genes, Chang said, adding that the sequence did not show any mutation.

At the moment, he said, the virus is being transmitted mainly from poultry or other birds and has not yet reached a stage of person-to-person transmission.

Because the exact number of H7N9 cases in China is not yet known, it is too soon to estimate the disease's rates of mortality and transmission, Chang said.

It took about 10 years to detect the H5N1 virus in humans, Chang said, adding that the mortality rate of H5N1 in humans has reached 59 percent.

The H7N9 cases in China were the first recorded human infections of the virus, but it is not clear how the Chinese patients became infected.

A Chinese epidemiologist said more cases of H7N9 infection may be reported soon.

According to China's official records, three of the confirmed cases came into contact with poultry or pigs before falling ill. 

Wei Planning Commission: the fastest 6-8 months R & D new vaccine for H7N9 avian influenza

 2013 04 03, 2010 21:43 Related Articles Securities Times Online　

　　中广网 reported that the National Health and Family Planning Commission, said today that pre-human infection with the H7N9 avian influenza vaccine research work is in progress, vaccine research is about to start, 6-8 months is expected to be the fastest to develop new vaccines. http://news.cnfol.com/130403/101,1277,14784074,00.shtml

Severe respiratory disease associated with a novel influenza A virus, A(H7N9) - China

Severe respiratory disease associated 
with a novel influenza A virus, 
A(H7N9) - China
3 April 2013Main conclusions and recommendations
On 31 March, the Chinese authorities announced the identification of a novel influenza A virus, A(H7N9), in
three seriously ill people in two provinces. Two male cases in Shanghai without any epidemiological link aged
87 and 27 years old became ill with respiratory infections in mid to late February and both have died. In Anhui
Province, a 35-year-old woman became ill on 9 March and is now in critical condition. The three cases
presented with acute high fever onset, cough and respiratory tract infection symptoms. After five to seven
days, the patients developed severe pneumonia, progressing rapidly into acute respiratory distress syndrome.
The influenza A viruses from the three cases were non-subtypeable and were sent to the WHO Influenza
Collaborating Centre at the Chinese Center for Disease Control and Prevention (CDC). They were sequenced
and found to be almost identical. China CDC posted an announcement on its website (31 March) and lodged
the genetic information on the publicly accessible GISAID website. It identified genes from both A(H7N9) and
A(H9N2) viruses, thus indicating a novel reassortant avian influenza A virus. No similar viruses have been seen 
before and they differ genetically from A(H7) and A(H9) viruses that have been detected in Europe and
elsewhere worldwide. This is the first time that human infection with influenza A(H7N9) virus has been 
identified. It is also the first time that human infection with a low pathogenic avian influenza A virus has been 
associated with a fatal outcome.
The Chinese CDC reports that most close contacts of the confirmed cases from Shanghai and Anhui have not 
shown similar symptoms so far. However, there are reports of a small family cluster of severe disease around 
the first case. There are no links between the three cases and no obvious association with bird die-offs (which 
may not have any relevance, since this is a low-pathogenic avian influenza virus and will not cause any poultry 
die-offs). Chinese authorities have notified the event to WHO under the International Health Regulations (IHR)
for assessment. Local investigations are underway in China and it is too early to anticipate the outcome of
these as additional patients with severe respiratory disease are under investigation.
RAPID RISK ASSESSMENT
S  http://ecdc.europa.eu/en/publications/Publications/AH7N9-China-rapid-risk-assessment.pdf

Scientists race to gauge pandemic risk of new bird flu

Wed, 3 Apr 2013 12:57 GMT

Source: Reuters // Reuters

* WHO says human cases of H7N9 flu are serious and unique

* Nine confirmed cases so far in China, three patients dead

* DNA data suggest virus has some worrisome mutations

By Kate Kelland

LONDON, April 3 (Reuters) - Genetic sequence data on a deadly strain of bird flu previously unknown in people show the virus has already acquired some mutations that might make it more likely to cause a human pandemic, scientists say.

But there is no evidence so far that the H7N9 flu - now known to have infected nine people in China, killing three - is spreading from person to person, and there is still a chance it might peter out and never fully mutate into a human form of flu.

Just days after authorities in China announced they had identified cases of H7N9, flu experts in laboratories across the world are picking through the DNA sequence data of samples isolated from the patients to assess its pandemic potential.

One of the world's top flu experts, Ab Osterhaus, who is based at the Erasmus Medical Centre in The Netherlands, says the sequences show some genetic mutations that should put authorities on alert and entail increased surveillance in animals and humans.

"The virus has to a certain extent already adapted to mammalian species and to humans, so from that point of view it's worrisome," he told Reuters in a telephone interview.

"Really we should keep a very close eye on this."

China's National Health and Family Planning Commission confirmed on Sunday that three people had been infected with the new H7N9 flu, with two deaths of men in Shanghai aged 87 and 27 who fell sick in late February. Chinese authorities have in the past two days confirmed another six cases, including another fatal one.

The World Health Organization (WHO) says the cases of H7N9 are "of concern" because they are the first in humans.

"That makes it a unique event, which the World Health Organization is taking seriously," the Geneva-based United Nations health agency said on Wednesday.

Other strains of bird flu, such as H5N1, have been circulating for many years and can be transmitted from bird to bird, and bird to human, but not from human to human.

So far, this lack of human-to-human transmission also appears to be a feature of the H7N9 strain.

Flu viruses are classified based on two types of protein found on their surface, haemagglutinin and neuraminidase, which are abbreviated to H and N.

Although it is very early days, scientists says initial analysis also suggests H7N9 does not appear to make birds particularly ill - in other words it is what is known as a low pathogenic avian influenza, of LPAI.

Unfortunately, this doesn't necessarily mean it will be mild in humans, says Wendy Barclay, a flu virology expert at Britain's Imperial College London.

FINDING THE SOURCE

"We can't be complacent. We have to be cautious," she said, stressing that other H5 and H7 flu subtypes have been able to mutate from LPAI to the more dangerous highly pathogenic avian influenza (HPAI) as they circulate in various hosts, particularly in chickens.

Its mildness in birds could also mean H7N9 is a "silent spreader" - harder to detect than highly pathogenic flu strains such as H5N1 that can wipe out entire flocks of wild birds or domestic poultry and are therefore far more visible.

"It's a sort of double-edged sword, because if and when it becomes highly pathogenic and all the chickens start dying, that's very bad for the poultry farmers, but it means we can see much more easily where the virus is," Barclay said.

"At the moment, we can't see where this virus is coming from. We don't know yet what animal source is feeding this."

Finding that source, and tracking the genetic mutations to see if, how and when this new strain might gain the ability to spark a human pandemic are now the priorities for researchers in China and around the world, Barclay and Osterhaus said.

The WHO praised the Chinese government, saying it was responding to the situation with various important measures such as enhanced surveillance, detailed case management and treatment, tracing contacts of all those known to have been infected so far, and training healthcare professionals.

Experts said the fact that H7N9 had been identified and swiftly reported, and that genetic sequence data was already available for researchers around the world to analyse, was a sign of how things have changed.

In 2003, China initially tried to cover up an epidemic of Severe Acute Respiratory Syndrome, which emerged in China and killed about a tenth of the 8,000 people it infected worldwide.

Ian Jones, a professor of virology at Britain's University of Reading, said the heightened awareness of flu and of the possibility that unusual respiratory diseases may turn out to be new strains of flu means more cases get referred to hospitals.

"It's quite possible these cases ... are being detected because flu is way up there" on disease priority lists, he said. (Editing by Ben Hirschler and Will Waterman) http://www.trust.org/alertnet/news/scientists-race-to-gauge-pandemic-risk-of-new-bird-flu

Frequently Asked Questions on human infection with A(H7N9) avian influenza virus, China

Updated 2 April 2013

1. What is the concern about A(H7N9)?

Many influenza viruses are animal – porcine, avian or other species – viruses which normally do not cross the species barrier. The cases of A(H7N9) are of concern because these are the first reported cases of this avian influenza virus in humans. See Disease Outbreak News for updates.

2. Can A(H7N9) avian influenza virus be transmitted from person to person?

At this point in time, there has been no evidence of human to human transmission among contacts of or between the confirmed cases. The ongoing investigation is exploring all the possible sources of infection, including the possibility of human-to-human transmission.
It is very important to further investigate the extent of the outbreak, the source of infection, the mode of transmission, the best clinical treatment and necessary prevention and control measures and to be vigilant so as to be able to identify additional cases should they appear.

3. Is this infection related to more than 16,000 pig carcasses recently found dumped in rivers around Shanghai?

While the dead pigs were part of the overall investigation, there was no evidence of any connection.

4. Is the general population at risk from the A(H7N9) avian influenza virus?

At this point in time, there has been no evidence of human to human transmission among contacts of or between the confirmed cases. The risk associated with A(H7N9) avian influenza virus to the general population in China and beyond is being investigated and will be shared to the public when information becomes available.

5. What action has been taken? What support is WHO providing?

The Chinese government is responding to the event and has taken the following actions and measures:
• Enhanced surveillance;
• Reinforced case management and treatment;
• Epidemiological investigation and close contact tracing;
• Laboratory strengthening;
• Training of health care professionals and issuing of guidelines; and
• Enhanced communications.

These are the first reported cases of A(H7N9) in humans. That makes it a unique event, which the World Health Organization is taking seriously. WHO is working closely with the national authorities to better understand the situation. and will communicate important updates as they become available.

6. How can individuals prevent A(H7N9) avian influenza infection?

Basic hygiene practices and food safety measures are prerequisites to prevent the transmission of many infectious diseases, including A(H7N9).
• Wash your hands often, especially: before, during, and after you prepare food; before you eat; after you use the toilet; after handling animals or animal waste; when your hands are dirty; and, more frequently, when someone in your home is sick.
• Hand hygiene is also necessary to prevent transmission in clinical settings to other patients and health care workers. Pathogens are removed by the mechanical action of hand washing. Alcohol disinfects (kills the pathogens).
• Cover your mouth and nose with a tissue when coughing or sneezing.
• In environments where any highly pathogenic avian influenza virus may be present, hand hygiene, which includes hand washing and the use of alcohol-based hand rubs, is critical to prevent possible viral inoculation of the nose, mouth and conjunctiva by contaminated hands. http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/index.html

Clear the H7N9 avian flu incubation period of 7 days

Apr. 03, 2013 8:47 PM 

　China news agency, Beijing, April 3 (Ouyang Kai-Yu) According to the findings of the incubation period for influenza and the the existing H7N9 avian influenza virus infections, H7N9 avian influenza virus incubation period is generally less than 7 days. This is the information released by the National Health and Family Planning Commission, the evening of 3.

　　The above information is written at the same time the day of the National Health and Family Planning Commission announced the "human infection with the H7N9 avian flu clinic program (2013) being.

　　Described the program from the etiology, epidemiology, clinical manifestations, laboratory tests, diagnosis and differential diagnosis "and other aspects of human infection with the H7N9 avian influenza.

　　The program said the avian flu virus, Orthomyxoviridae Influenza A virus is. The emergence of human infection of H7N9 avian influenza virus, the virus is a new reassortant virus, its internal genes from the H9N2 avian influenza virus.Problem for the source of infection, the official document that is not clear, based on past experience and the epidemiological investigation, speculated that might carry the H7N9 avian influenza virus in poultry and poultry secretions or excretions.

　　The route of transmission of the disease spread through the respiratory tract, may also be infected through close contact with infected poultry secretions or excretions, direct contact with the virus may also be infected. Now there is no conclusive evidence of human-to-human transmission.

　　At the same time, it is not yet conclusive evidence susceptible of human H7N9 avian influenza virus. Existing confirmed cases are adults.For high-risk groups, the program said that, at this stage is mainly engaged in poultry breeding, sale, slaughter and processing industry, as well as 1 week prior to the onset of contact with birds by.

　　In the clinical manifestations, patients generally showed flu-like symptoms, such as fever, cough, little phlegm, may be associated with headache, muscle aches, and general malaise. Rapidly in patients with severe progression of the disease, manifested as severe pneumonia, the body temperature is mostly sustained above 39 ℃, difficulty in breathing, can be associated with hemoptysis sputum; rapid progress acute respiratory distress syndrome, mediastinal emphysema, sepsis, shock, awareness disorder and acute kidney injury.

　　The program also mentioned, you should note that the H7N9 avian influenza and human infection of highly pathogenic H5N1 avian influenza, seasonal influenza (including H1N1), bacterial pneumonia, infectious atypical pneumonia (SARS), a new coronavirus pneumonia Adenovirus pneumonia, Chlamydia pneumoniae, Mycoplasma pneumonia and other diseases for differential diagnosis. Differential diagnosis depends on pathogenic examination. http://www.chinanews.com/gn/2013/04-03/4703140.shtml

Cambodia reports 10th bird flu case this year

English.news.cn   2013-04-03 19:25:27 PHNOM PENH, April 3 (Xinhua) -- A six-year-old boy from Southwestern Kampot province was confirmed to have contracted with Avian Influenza H5N1, bringing the number of the cases to 10 and the death toll remained at eight in 2013, a health expert said Wednesday. "The boy was admitted to the Kantha Bopha Hospital in Phnom Penh on March 31 for severe pneumonia, and he was tested positive for H5N1 at the Instituts Pasteur on Tuesday,"Dr. Denis Laurent, deputy director of the hospital, told Xinhua."The boy is still alive, but in severe conditions." The country sees the worst outbreak of the virus this year since the disease was first identified in 2004. To date, the country has recorded 31 human cases of the virus, killing 27 people. Cambodian Prime Minister Hun Sen repeatedly appealed to television and radio stations to broadly educate people about the outbreaks of Avian Influenza H5N1 virus, which has killed eight people so far this year. "I'd like to appeal to television and radio stations to jointly broadcast educational spots about bird flu prevention as much as possible in order to reach people in remote areas," he said late last month at a graduation ceremony in Phnom Penh. "Television and radio hosts should also spread their educational messages to educate people about the virus." "Health officials alone cannot prevent the virus spread, but participation from everyone is very important to prevent and eliminate it," he said. The noticeable signs of bird flu included fever with temperature higher than 38 degrees Celsius, difficulty in breathing, and before having fever, the patient must have touched or eaten poultry. http://news.xinhuanet.com/english/world/2013-04/03/c_132283023.htm

1 dead in Zhejiang confirmed two cases of H7N9 avian influenza

Zhejiang Provincial Health Department briefing today, the province confirmed two people infected with the H7N9 bird flu cases, including one death.Male patients, 38-year-old surnamed Hung Hangzhou Jiande person, last month the disease, later transferred to Xiaoshan a hospital for treatment last week, three deaths, China CDC influenza center laboratory detected the H7N9 avian influenza virus nucleic acid positive. The other folks Male patients 67 years of age, retirement home. On 25 January symptoms such as cough, fever, Check a hospital in Hangzhou, yesterday to go to the Affiliated Hospital of Zhejiang University School of Medicine, today confirmed as H7N9 avian influenza.v http://news.on.cc/cnt/china/20130403/bkn-20130403183526238-0403_00922_001.html

Notice of issuance of people infected with the H7N9 bird flu prevention and control program (first edition)

State Health and Family Planning Commission www.moh.gov.cn    

　　

Provinces, autonomous regions and municipalities health bureau, health bureau of Xinjiang Production and Construction Corps, Chinese Center for Disease Control:
　　for the good of the people infected with the H7N9 bird flu prevention and control work to protect the people's health and life safety, I appointed organization developed of human infection with the H7N9 avian flu prevention and control program (first edition). Is issued to you (electronic version is available from the National Health and Family Planning Commission website www.moh.gov.cn download), combined with the actual reference implementation.

 

　　Attachment: people infected with the H7N9 bird flu prevention and control program (first edition). doc http://www.moh.gov.cn/ewebeditor/uploadfile/2013/04/20130403185633700.doc

No H7N9 Influenza Infections in Animals

   2013-04-03 20:16:13  

China's Ministry of Agriculture said Wednesday that epidemiological investigations have found no H7N9 bird flu infections in animals. Experts from the ministry said it remained unknown where the virus came from and how it had spread. Data from the ministry showed that a total of 25 H7N9 bird flu strains have been detected in wild birds around the world and that the virus had not been found in poultry. Strains can be transmitted globally by migratory birds and have been detected in North America and Eurasia, said experts. China is on the migratory flyway of virus carriers and at great risk of infections, they said. After reports of human infections in east China's Shanghai, Anhui and Jiangsu, the ministry immediately organized epidemiological investigations in animals in these regions, said a ministry official, adding that sample collection and detection work is underway. Two more infections of the H7N9 bird flu, involving one death, were reported in the eastern Zhejiang Province, bringing the total number of infected people in the country to nine, local authorities said Wednesday. http://english.cri.cn/6909/2013/04/03/2821s757561.htm

Japan reminded the nationals to guard against avian flu Consulate General in Shanghai to issue a notice

Japanese media reported on April 3, the Japanese Consulate General in Shanghai, Jiangsu Province of China, there are a number of patients diagnosed with the H7N9 avian influenza virus infection, called for attention to health management in China, the Japanese would like to avian influenza. In addition, the Japanese Ministry of Health, Labor and Welfare Ministry also began to appeal to the Chinese or Japanese in China not to close to the bazaar and other places animal, requires both active hands and gargle well against viruses.

　　According to Japan's Kyodo News reported on April 3, the Japanese Consulate General in Shanghai announced that the site, called (in Japanese, Chinese) "in the sale of live poultry market, etc. Do not accidentally close to poultry and livestock" in the crowd based on the need to wear a mask, a high fever and breathing difficulties and other symptoms appears to be to the hospital immediately.

　　Reported that the long-term Japanese living in Shanghai as many as 5.6 million people, ranking first in China over the adjoining Jiangsu Province, more than 10,000 Japanese. Up to now, Shanghai, China, two patients died from infection with the H7N9 avian flu.

According to Japanese news reports, the Japanese Ministry of Health, Labour and 3rd in the country's airports and ports in Japan put up notices to remind the Japanese tourists.The report also said, to enter Japan from China in case of fever or cold symptoms, airport quarantine officers to talk. Entering Japan within 10 days to find the same symptoms in hospital for treatment, the report to the doctor at the same time had been stranded in China for the facts.

http://world.huanqiu.com/exclusive/2013-04/3796260.html2013-04-03 19:58

Mainland has confirmed nine cases

Up to now, China has confirmed nine cases of human infection with the H7N9 avian influenza cases, located in the tourist city, of which the Shanghai two cases (deaths), Jiangsu four cases (critically ill), two cases one cases respectively in Nanjing , Suzhou and Wuxi, Anhui 1 case, Hangzhou 2 cases (1 death) http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/03/23856965_0.shtml?_from_ralated

Nanchang 17 official, said two students suspected to be infected with avian flu rumors

Source: 2013-4-3 18:19:25April 2, microblogging users broke the news that two students suspected to be infected with avian flu quarantine inspection, triggered widespread concern, Nanchang XVII. The morning of April 3, Nanchang XVII through the school's official website said in a news release has been verified, the school has no students of illness is isolation, true news network transmission.

　　"We attach great importance to see the online news, the first time for verification, found that schools do not students suspected to be infected with the avian flu, and no student illness is isolation morning today (April 3), we announced through the school website Nanchang seventeen principals remind teachers and students not to listen to rumors. "Tao Yan told reporters.

　　It is learned from the Health Department of Jiangxi Province, as of now, Jiangxi Province have not yet found of human infection with the H7N9 avian influenza. http://www.022net.com/2013/4-3/513242132537358.html

Zhejiang diagnosed two cases of human infection with the H7N9 avian flu start Level IV emergency response

Time :2013-04-03 19:47:44

    BEIJING, Hangzhou, April 3 (Reporter Zhao Ye Jiao Shao Yanfei) 3, the Zhejiang Provincial Health Department issued notification, the province confirmed two cases of human infection with the H7N9 avian influenza deaths. Afternoon, the Zhejiang Provincial Government urgently convene a special meeting to make the deployment of good prevention and control work, such as: Start Level IV emergency response, and to treat the patient, the health sector, the active surveillance and prevention and control work, do a good job.

http://news.cnwest.com/content/2013-04/03/content_8876947.htm

(H7N9 watch) Chef, 38, dies, scientists suggest testing birds in markets to trace silent killer

(41 mins ago)

A man in China’s Zhejiang Province has died of the H7N9 strain of bird flu, state media said, bringing the total deaths attributed to the virus to three since the first human cases.
He was one of two more H7N9 avian influenza infections reported in Zhejiang, in the east of the country, Xinhua news agency said citing local authorities. This brings the total number of cases to nine.
The latest fatality was a 38-year-old man who worked as a chef, Zhejiang media reported. The province's other case was a 67-year-old retiree being treated in hospital, the Zhejiang Daily newspaper said.
Two other deaths have been reported, both in Shanghai. Other cases have been reported in eastern Jiangsu and Anhui, the government has said.
Meanwhile, scientists said that based on information from genetic data and lab tests in China, the H7N9 virus appears to infect some birds without triggering noticeable symptoms, AP reported.
“We speculate that when this virus is maintained in poultry the disease will not appear, and similar in pigs, if they are infected, so nobody recognizes the infection in animals around them, then the transmission from animal to human may occur,'' said Dr Masato Tashiro, director of the World Health Organization's influenza research center in Tokyo and one of the specialists who studied the genetic data. “In terms of this phenomenon, it's more problematic.’’
This behavior is unlike the virulent H5N1 strain, which set off warnings when it began ravaging poultry across Asia in 2003. H5N1 has since killed 360 people worldwide.
“In that sense, if this continues to spread throughout China and beyond China, it would be an even bigger problem than with H5N1 in some sense, because with H5N1 you can see evidence of poultry dying, but here you can see this would be more or less a silent virus in poultry species that will occasionally infect humans,'' said University of Hong Kong microbiologist Dr Malik Peiris, a Sri Lankan expert who also examined the information.
Dr Peiris praised Chinese health authorities for being forthcoming with data and information, but said animal health agencies needed to step up and act quickly. He urged China to widely test healthy birds in live animal markets in the parts of the country where the human infections have been reported to find out what bird species might be hosting the virus and stop the spread.
“If you don't stamp it out earlier now, there won't be any chance of stamping it out in the future,'' Dr Peiris said. “It already may be too late, but this is the small window of opportunity that really one has to grasp, as quickly as possible.''
Other information gleaned from the genetic data was that the H7N9 virus was what scientists call a “gene re-assortant’’ _ in which three bird viruses swapped genes among themselves _ undergoing changes that allowed it to adapt more easily, though not fully, to human hosts, WHO's Tashiro said. One change has allowed it to lodge onto the surfaces of cells of mammals, making it easier to infect humans.
“The tentative assessment of this virus is that it may cause human infection or epidemic. It is still not yet adapted to humans completely, but important factors have already changed,'' Tashiro said.
In the wake of the outbreak, the Chinese Center for Disease Control and Prevention shared the genetic sequence of the new virus with the global health community. http://www.thestandard.com.hk/breaking_news_detail.asp?id=34300

Hangzhou the two have H7N9 avian flu one death

Zhejiang Provincial Health Department briefing Wednesday (3 days), Zhejiang Province confirmed two cases of human infection with the H7N9 avian influenza, including patient death.

Patients, Mr. Hong, male, 38 years old, Hangzhou Jiande, in Jiangsu Taicang work. Onset, 18 back Zhejiang March 7, the 20th transferred to Xiaoshan a hospital for treatment, after she died on the morning of the 27th.

April 3, China CDC influenza center laboratory for review of the H7N9 avian influenza virus nucleic acid positive. Currently, all close contacts of the cases were not found to have a fever or respiratory symptoms.

Patients Yang, male, 67 years old, Hangzhou people, retirement home.Check in Hangzhou hospital because of cough, fever and other symptoms on March 25, April 2 go to the Affiliated Hospital of Zhejiang University School of Medicine.

April 3, China CDC influenza center laboratory for review of the H7N9 avian influenza virus nucleic acid positive. The close contacts of the cases of 58 people, were not found to have fever or respiratory symptoms.

http://translate.google.com/translate?sl=zh-CN&tl=en&js=n&prev=_t&hl=en&ie=UTF-8&eotf=1&u=http%3A%2F%2Fwww.bbc.co.uk%2Fzhongwen%2Fsimp%2Fscience%2F2013%2F04%2F130403_brief_china_birdflu_deaths.shtml

the country has found nine cases of H7N9 avian flu Zhejiang added two cases

Source: Jiangsu Government Network

[Zhejiang infected with avian influenza] Zhejiang Provincial Health Department briefing today, Zhejiang Province confirmed two cases of human infection with the H7N9 avian flu cases, one case of death in patients.

http://news.cn.yahoo.com/ypen/20130403/1690016.html

Hangzhou man dies of H7N9 avian flu virus

• 

Authorities in some Chinese regions have ordered health institutions to step up monitoring of H7N9 bird flu. Photo: Xinhua

Health authorities in the eastern Chinese province of Zhejiang had confirmed that one person infected with the H7N9 avian flu virus had died in the provincial capital city of Hangzhou, a Chinese newspaper reported.

Another patient diagnosed as being infected with the virus was still under going treatment, said The Beijing News, a prestigious newspaper based in the Chinese capital, via one of its Weibo social media accounts on Wednesday afternoon.

The paper did not give further details. The two new cases bring the total number of confirmed human infections of H7N9 avian flu virus in China to nine. At least three of these patients have died, according to the latest media reports.

All the confirmed patients so far live in the Yangtze River delta region.  http://www.scmp.com/news/china/article/1206299/hangzhou-man-dies-h7n9-avian-flu-virus

New flu virus in China shows signs it has adapted to mammals: Will it take off?

By: Helen Branswell, The Canadian Press

2/04/2013 8:27 PM

The new flu virus that has exploded onto the global radar is already showing signs that it is adapting to mammals, suggesting what was once a bird virus is now probably spreading in a mammalian host, an influenza expert said Tuesday.

And while it's not clear what that mammalian host is, the two most obvious choices are pigs or humans, said Dr. Richard Webby, head of the World Health Organization's influenza collaborating centre at St. Jude Children's Research Hospital in Memphis, Tenn.

"I think that's what's concerning about this ...This thing doesn't any longer look like a poultry virus," Webby, a swine flu expert, said in an interview.

"It really looks to me like it's adapted in a mammalian host somewhere."

If the virus is spreading in mammals, finding that source is critical to try to reduce human exposure and prevent additional cases, he said.

As Webby sees it, the virus will either take off in humans — "and it's way, way too early to tell that" — or will melt back into nature.

While that might sound like wishful thinking, it's actually been known to happened in the past.

After a 1997 outbreak in Hong Kong, the H5N1 bird flu virus wasn't seen again until late 2003, when it began the outbreak that continues to this day.

The new virus is an H7N9, named for the type of hemagglutinin (H) and neuraminidase (N) proteins it wears on its outer shell. H7N9 viruses have not been known to have infected people before this outbreak.

First announced to the outside world over the weekend by the Chinese government — via the World Health Organization — there are already seven confirmed human infections in three Chinese provinces. Two of the infections have been fatal and the other five people are critically ill.

Genetic sequences of viruses isolated from the first three cases have already been mapped and deposited in databanks accessible to influenza scientists. And as they study the viral blueprints, some clues to where to look for the virus are starting to emerge.

Webby said the H7N9 viruses are showing changes that are hallmarks of adaptation to mammals, the same types of mutations that have been seen when other flu viruses — which all have their origins in water birds like ducks — learn to infect mammalian species.

One of the changes is in what's know as the receptor binding site. Bird viruses use a different receptor to latch on and trigger infection than flu viruses that have adapted to infect humans and other mammals. And the genetic sequences of the H7N9 viruses show they have started to make that change, Webby said.

As well there are a couple of other mutations seen in these H7N9 sequences that are known to be indicators of viruses that have switched to mammalian hosts from avian hosts, he said.

"There's clear evidence of mammalian adaptation. So the big question to me is where is that mammalian adaptation occurring? Is it in the human cases we've seen or is it perhaps in a mammalian animal reservoir?"

These changes suggest looking for the virus in poultry would not be the most productive approach, suggested Michael Osterholm, director of the Centre for Infectious Diseases Research and Policy at the University of Minnesota.

Concerns have already been raised about whether pigs are playing a role in the spread of this virus. That's because of late, thousands of dead pigs have been found floating in the Huangpu River near Shanghai. At least two of the human cases of H7N9 have been in residents of Shanghai.

Some have suggested the pigs were killed in an outbreak of circoviruses, another pathogen which infects swine. Others have said farmers are dumping pigs they can no longer sell to slaughterhouses after authorities moved to block dead pigs from entering the food chain.

But others worry the pigs are part of the H7N9 story.

Webby thinks pigs may be playing a role, but he's not convinced the dead animals were killed by the H7N9 virus. While pigs are highly susceptible to influenza viruses — and often serve as intermediary for bird viruses to become mammalian viruses — influenza doesn't generally kill pigs, he said.

Even H5N1 viruses, which are so deadly to poultry and to people, don't cause severe illness in swine, said Webby. "It would be very, very surprising to see that amount of death (in pigs) with a flu virus. Even H5N1, pigs kind laugh at that virus."

The H7N9 situation is being assessed with concern, both by the World Health Organization in Geneva and by governments around the world.

So far the WHO has not discussed raising its pandemic alert level, the warning system that tells countries to kick their pandemic preparedness activities into higher gear.

"(But) we are certainly concerned about this. We're taking this very seriously," WHO spokesperson Gregory Hartl said from Geneva. The WHO is offering expertise to China on risk assessment.

Currently the Canadian government estimates the risk to Canadians as "quite low," said Dr. Barbara Raymond, director for pandemic preparedness at the Public Health Agency of Canada.

"But we're still in a fairly intensive intelligence gathering and analysis sort of phase," she said.

Canada is also taking other steps.

Scientists at the National Microbiology Laboratory in Winnipeg have been designing the primers and probes needed to test for this new virus and will be rolling them out to provincial and territorial laboratories, Raymond said.

But at this point there is no talk of activating the country's standing order for pandemic flu vaccine production, she said.

Raymong noted that the concurrent threat posed by the novel coronavirus — which has been causing severe respiratory infections in and emanating from parts of the Middle East — actually has an upside — it has put staff throughout the health-care system on high alert for people sick with severe respiratory infections.

"Our ICU folk, our critical care folk, even Emerg folk are very much on the lookout for severe respiratory illnesses right now. They're already on a heightened state of alert," Raymond said. http://www.brandonsun.com/lifestyles/breaking-news/new-flu-virus-in-china-shows-signs-it-has-adapted-to-mammals-will-it-take-off-201158801.html?thx=y

Hefei start of an influenza pandemic contingency plans

Case of suspected cases to be immediately reported to
Hefei has yet suspicious cases suspicious poultry influenza virus

http://ah.anhuinews.com/system/2013/04/03/005569312.shtml

Chuzhou investigation patients residence

...

Reporters yesterday learned from the Provincial Animal Husbandry and Veterinary Bureau the province emergency organization to carry out the series of outbreaks of highly pathogenic avian influenza in poultry, investigation, and disease monitoring and emergency response work, and has not yet received any suspected poultry outbreaks of avian flu.

It is understood that the of Chuzhou local agricultural committee in the investigation within 10 km of the patient's place of residence, while 32 farmers' markets live poultry market in citywide sampling, epidemiological investigation, and pathogen detection of avian flu. On April 1, the province of avian flu in the province-wide investigation deployment. The high fever super 38 ° C should seek immediate medical attention

WASHINGTON recently been coughing very fact that yesterday came to the provincial capital to a hospital, to exclude the possibility of influenza infection.http://news.hefei.cc/2013/0403/021591714.shtml

Wuxi found 21 cases of human infection of H7N9 avian flu cases close contacts has been discharged under medical observation

■ patients after the Spring Festival is not out Wuxi no history of exposure of poultry 
■ city to carry out monitoring of human infection with the H7N9 avian influenza 
■ this year, reports of influenza cases H3 and H1 

Yesterday, the provinces and detection and expert consultation, confirmed that the city found a case of human infection of H7N9 avian influenza. The city's health department in accordance with the relevant requirements, is organizing further epidemiological investigation to clarify the scope of the epidemic spread, while the implementation of the next epidemic prevention and control measures, organizational hospital good cases isolation treatment and hospital infection control. 

March 31, after the confirmation of the provinces and detection City CDC immediately broken down into smaller groups, go to the treatment of patients with hospital and place of residence to carry out further epidemiological investigation, the investigation of close contacts and possible source of infection. According to the survey, the patients after the Spring Festival is not out Wuxi, no history of poultry contact. 43 close contacts of the current investigation, has been implemented in a period of seven days of medical observation. Up to now, these close contacts, 21 people had been lifted under medical observation, the rest of the observed object was not found to have a fever or respiratory symptoms. 

At the same time, the Municipal Health Bureau began to be deployed to strengthen the work of the medical treatment of patients, the organization City avian flu expert group of cases for consultation and appropriate treatment measures, and actively carry out the medical treatment of cases, to improve the treatment success rate. City CDC guidance admitted to hospital to enhance the disinfection and isolation ward, and the personal protection of medical personnel, medical waste disposal of hospital infection control measures. 

It is reported that the city's disease control departments have been organized to carry out the monitoring of influenza and other respiratory diseases, in particular to conduct H7N9 monitoring of suspected cases and close contacts. From the current influenza surveillance analysis, 1 to 3 months, the city reported flu cases, reports of influenza-like illness decreased by 75.45% and 21.55%, respectively, compared to the same period last year. Which report flu cases, monitoring to H3 and H1 influenza virus subtype. 

City CDC is actively monitoring based on reserves influenza and avian flu detection capability. Has reserves H7 detection reagents and other influenza detection reagents. The good individual protective equipment, emergency preventive drugs, anti-viral treatment and symptomatic treatment drugs, Xiaosha Medical Device, detection reagents, and other emergency supplies reserve. 

Also actively carry out health education and health promotion, is organizing a special health education material for the preparation of human infection of avian influenza, the plan to carry out health education work in various media, to raise public awareness of disease prevention. And strengthen communications with the agriculture, forestry, industry and commerce sector, strengthen the prevention and control of collaboration, to implement of poultry outbreaks disposal and poultry slaughter and other key groups monitoring and prevention and control work...
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husband is also in the hospital for observation

The hospital appealed Shensi poultry colds speed treatment

　The microblogging and revealed, 29, City CDC preliminary testing positive for influenza A virus, the 30th, the positive result of the review of the provincial CDC, initially identified as H7N9 positive. Preliminary view that the cases of human infection with influenza A H7N9 influenza, at present, to be reported to the State Health and Family Planning Commission confirmed.

　To about 10:00, the official at the Nanjing Gulou Hospital Chief microblogging said, the treatment status of the patient is completely isolated, and called no cause for alarm, Admission active treatment rescue, has not yet been officially confirmed, do not eat poultry products broiled recent cooked and then eaten. Subject to cold and fever phenomenon timely treatment.

　Our reporter yesterday afternoon to the Drum Tower Hospital interviews, learned that the named TIANJIN TRADE UNION ADMINISTRATORS patients hospitalized on the fifth floor ICU, but when the reporter arrived at the 5th floor, found the the ward door closed, and out of the medical staff also refused to be interviewed. It is reported that TIANJIN TRADE UNION ADMINISTRATORS's husband is also in the hospital for observation. http://paper.wenweipo.com/2013/04/03/YO1304030001.htm

Avian Influenza A (H7N9)

On April 1, 2013, the World Health Organization reported three human infections with avian influenza A (H7N9) viruses in China. This is the first time avian influenza A (H7N9) viruses have been detected in humans. Each of the three confirmed cases had severe respiratory illness; two of them died. According to WHO, no human-to-human transmission has been identified at this time, and the cases do not have a known epidemiological link to one another. An investigation by Chinese health authorities is ongoing to determine the source of infection and detect any additional cases. The sequences of these viruses are posted and publicly available in GISAID.

CDC is following this situation closely and coordinating with domestic and international partners in a number of areas, including gathering more information to make a knowledgeable public health risk assessment and developing a candidate vaccine virus. CDC also is reviewing posted genetic sequencing of the new H7N9 viruses and assessing possible implications in terms of the viruses’ transmissibility and severity and whether existing influenza diagnostic tests need to be enhanced or new ones developed. All of these actions are routine preparedness measures taken whenever a new novel influenza virus is detected in humans.

This is an evolving situation and there is still much to learn. It is too soon to speculate regarding the significance of these cases/viruses, however, CDC will provide updated information as it becomes available.

Additional Information

The World Health Organization has posted an update available at "H7N9 avian influenza human infections in China."

The Chinese Center for Disease Control and Prevention has posted a Question & Answer document related to this situation available at "Questions and Answers about human infection withA(H7N9) avian influenza virus."

General information about avian influenza viruses and how they spread is available at Avian Influenza A Virus Infections in Humans. http://www.cdc.gov/flu/avianflu/h7n9-virus.htm