Hard to track, hard to stop’: Unusual bird flu strain kills 3 humans in China

Reuters / Kham

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Asia, Biology, China, Health, Medicine

A Chinese man has died of a new strain of bird flu, H7N9, bringing the death toll to three. He was one of the two more recently diagnosed people. Scientists warn the virus spreads silently and could be harder to track than its famous congener H5N1.

The most recent death has been reported in Zhejiang Province, one of the three areas hit by the lesser-known H7N9 virus.

The news of a yet another two cases comes the next day after four cases in Jiangsu Province were confirmed as being infected with the flu. The four are a 45-year-old woman from Nanjing, a 48-year-old woman from Suqian, an 83-year-old man from Suzhou, and a 32-year-old woman from Wuxi.

Thus, so far nine cases have been reported in Eastern China with three of them fatal.

Human infection cases with the rare bird flu have also been registered in Shanghai, where two have died in March, and Nanjing (Jiangsu Province) and Anhui province, where a first case, a 35-year-old woman, was registered.  

Chinese Xinhua reports as very few sick people have been detected, relatively little research has been done on the virus previously known to have infected only birds.

The scientists from research institutes around the world have warned Wednesday that a new strain of bird flu can generate no noticeable symptoms in birds while seriously sickening humans.

Reuters / Samrang Pring

Thus, according to China's National Health and Family Planning Commission, the men who died in Shanghai became ill with coughs and fevers before developing pneumonia and breathing problems.

However, after taking a first look at the genetics of the H7N9 virus, scientists have come up with a warning supposition: the new virus could be harder to track than H5N1 that started spreading in 2003 and has killed 360 people worldwide since then, according to the WHO.

Chinese authorities are trying to find the source of the human infections, but they could face a challenge in that and then stopping the spread as there is no visible outbreak of dying chickens or birds.

"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," AP quoted the University of Hong Kong microbiologist Malik Peiris.

Scientists have so far said there are no signs of transmission of the H7N9 virus between any of the victims or people they have come into close contact with. However, they still monitor bird flu viruses closely, fearing they may change and become easier to spread among humans, possibly sparking a pandemic.

There are no vaccines against the H7N9 bird flu either in China or abroad, but Peiris said that existing anti-flu drugs are likely to work against the H7N9 strain. http://rt.com/news/china-bird-flu-kills-276/

 time: April 03, 2013 14:27

AVIAN INFLUENZA, HUMAN (19): CHINA, H7N9 PANDEMIC POTENTIAL

A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org

Date: Tue 2 Tue 2003
Source: Nature, Breaking News [edited]
http://www.nature.com/news/novel-bird-flu-kills-2-in-china-1.12728


Scientists and public health officials worldwide are on alert after China announced on 31 Mar 2013 that 2 people had died and a 3rd had been seriously sickened from infections with a new avian flu virus, H7N9, that has never been seen before in humans. The emerging, if preliminary, analyses of the virus's genome point to the possible spectre of a pathogen that might spread silently in poultry without causing serious disease. That would make the virus difficult to monitor even as it causes serious disease in humans. Should the virus become established in birds [poultry], regular human infections might then occur, providing opportunities for it to adapt better to humans, and ultimately spread between them, potentially sparking a pandemic.

Scientists stress that it is far too early to make a full risk assessment of the potential pandemic threat. But the initial analysis of viral sequences is "worrisome" because they show several features suggestive of adaptation to humans, says Masato Tashiro, a virologist at the Influenza Virus Research Center in Tokyo, the World Health Organisation (WHO)'s influenza reference centre in Japan.

The epidemiological picture is troubling too, says Malik Peiris, a flu virologist at Hong Kong University. "Any time an animal influenza virus crosses to humans, it is a cause for concern, and with 3 severe cases [of disease] over a short period of time, we certainly have to take it seriously," he says. "There's no obvious indication of human to human spread, so we should not overreact, but neither should we be complacent."

The cases

---------

The 1st case of the novel H7N9 was an 87-year-old man in Shanghai who became ill on 19 Feb 2013 and died on 4 Mar 2013. A 27-year-old man in the same city fell ill on 27 Feb 2013 and died on 10 Mar 2013. A 35-year-old woman in Chuzhou City in Anhui province, several hundred km west of Shanghai, fell ill on 9 Mar 2013 and remains seriously ill. All 3 developed flu-like symptoms before developing severe pneumonia. The cases were announced on 31 Mar 2013 by China's health ministry, the China Health and Family Planning Commission, which informed the WHO on the same day.

So far, there appears to be no sustained spread between people. Chinese authorities tracked dozens of contacts of the 3 cases and reported that none showed relevant symptoms or tested positive for the virus. Some uncertainty hangs over whether family members of the 1st case -- who were hospitalized with severe pneumonia just before their father -- might have passed on the virus to the elderly, housebound man. Though the family members reportedly tested negative for the virus, these might have been false negatives. Still, for the moment, experts say that if any human spread is occurring, it is not happening easily.

Chinese researchers have moved swiftly to decipher the new virus. The WHO Chinese National Influenza Center in Beijing has sequenced isolates from each of the 3 cases and on 31 Mar 2013 published them on the GISAID flu sequence database. Researchers around the world have since been racing to discover what clues the genome might hold as to the source of the virus and to its pathogenicity and potential to infect and spread between humans. Analyses suggest the virus is a new one that has been generated by reassortment, which occurs when different virus strains infect a host at the same time and swap genes with each other.

Flu viruses have 8 genes, including 2 that carry codes for the haemagglutinin (H) and neuraminidase (N) proteins that stud the surface of the virus, and 6 that code for internal proteins. Analyses so far suggest that in the new human cases, the genes coding for the internal proteins appear to come from H9N2 viruses, a class that is endemic in birds, including poultry, in Asia and elsewhere. More specifically, the sequences appear similar to recent H9N2 viruses found in China and South Korea.

The gene for the N protein, says Tashiro, appears similar to avian H11N9 viruses that were found in South Korea in 2011; in Hongze, Jiangsu, in 2010; and the Czech Republic in 2005. The gene for the H protein is especially critical, because this protein allows the virus to bind to host cells and seems to belong to a Eurasian group of H7 avian flu viruses.

The new virus, in other words, seems to stem from reassortment of 3 virus strains that purely infect birds, in contrast with the 2009 H1N1 pandemic virus, which was a mix of viruses that infect birds, pigs and humans. Most of the genetic analyses are still being carried out confidentially within WHO's global flu research networks. But some researchers, such as a team at the University of Edinburgh, have also started posting their preliminary analyses online athttp://epidemic.bio.ed.ac.uk/. - Mod.CP]

Does not sicken birds

---------------------

A striking feature of the novel virus is that its H protein is structurally similar to that of viruses that don't cause severe sickness in birds and different from those that do, such as the H5N1 virus that has been ravaging poultry flocks in Asia since late 2002. Flu viruses that don't sicken birds can, however, cause severe disease in humans simply because we lack any immunity to them. They also may be more lethal in people depending on how they bind to receptors in the human airways.

Though analysis is in the early days, scientists say it seems clear from the sequence that the novel virus has acquired key mutations that permit the H protein to latch onto receptors on mammalian cells in the airways instead of avian receptors. The virus also contains several other genetic variations that are known from past studies in mice and other animals to cause severe disease.

Initial data suggest, too, that the virus is affecting cells deep in the lung, which would fit with a picture of a virus, much like that of the novel coronavirus, that can cause severe disease. But it may also indicate a virus that doesn't spread as easily as one that affects the nose and throat and can thus be coughed and sneezed out more readily. Still, the full pattern of receptor binding has yet to be worked out, cautions Peiris.

Public health implications

--------------------------

The fact that the virus appears not to sicken birds has potential epidemiological and possibly public health implications, Peiris adds. It could be spreading in poultry undetected and thus could create a reservoir of infection that would lead to frequent sporadic human infections that crop up without warning. A highly pathogenic virus like H5N1 is easy to spot as it wipes out flocks, and can then be controlled by extended culling. But it might be next to impossible to control a virus in birds that offers few visible symptoms, says Peiris. "That really would be quite a problem," he says. "The question is whether it's already too late to stamp out or not." Indeed, China has not reported any recent H7 flu infections in birds, perhaps because such infections would not show up as serious disease, or maybe because of shortcomings in surveillance or reporting. A key need now, Peiris says, is to track down from which birds or animals the affected humans caught the virus.

Though H7 viruses are common in wild birds, but much less so in poultry, it seems highly unlikely that 3 human cases [now 9 - Mod.CP] in such a short time could result from contact with wild birds, he says. Domestic fowl are the most likely alternative. But given that the virus has mutations that are adapted to infection of mammals, a source might also be pigs, says Tashiro.

Flu experts say that other urgent needs include testing any human cases of serious pneumonia for traces of the virus and tracking down contacts of any new human cases. Among researchers and public health officials, says Peiris, "It's not an atmosphere of alarm, but an atmosphere of concern."


[Byline: Declan Butler]

--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[The initial analysis of viral sequences is showing several features suggestive of adaptation to humans. The H7N9 virus seems to originate from reassortment of 3 virus strains that only infect birds, in contrast to the 2009 H1N1 pandemic virus, which was a mix of viruses that infect birds, pigs and humans. Some sequence information is already becoming available. Readers interested in data as distinct from comment should visit the University of Edinburgh at:http://epidemic.bio.ed.ac.uk/(http://epidemic.bio.ed.ac.uk/influenza_H7N9_analysisandhttp://epidemic.bio.ed.ac.uk/influenza_H7N9_mutations).

The sequence data available so far suggest that the H7N9 virus may have acquired key mutations that permit the haemagglutinin protein to latch onto receptors in mammalian airways instead of avian-type receptors. The virus also contains several other genetic variations that are known from past studies in mice and other animals to cause severe disease. - Mod.CP http://www.promedmail.org/direct.php?id=20130403.1619096

New bird flu strain creates fear and surveillance

By Peter Christian Hall

 

APRIL 2, 2013

An emerging bird flu that is mysterious and deadly is haunting China. With four fresh H7N9 casesreported in Jiangsu Province and no indication as to how three Chinese adults caught the little-noted avian flu virus that killed two of them in March, the global medical community is hoping the new flu will calm down until China’s health system can determine how it spread.

“I can tell you this thing is real and definitely has the markings of being a killer,” says Jason Tetro, coordinator of the Emerging Pathogens Research Centre in Ottawa, which on Monday examined gene sequences from three of China’s H7N9 cases.

“I don’t wish to cause panic,” Tetro said in an interview, noting that if the subtype were proven to have emerged from a small farm, he wouldn’t be much alarmed. Infecting a big poultry reservoir, on the other hand, might well enable H7N9 to access Asia’s wild bird population. The upstart subtype could then become as menacing as H5N1, which since 2005 has officially taken 371 lives in 622 cases, mostly in China, Southeast Asia and Egypt, according to the World Health Organization. The additional Chinese cases have convinced Tetro that “close contact with birds” has been involved. “And I think the CAFOs [industrial chicken farms] have definitely contributed to the evolution of this virus,” he says.

Already, “the internal genes of H7N9 are very close to those of H5N1,” says Mike Coston, a widely read American flu blogger, in an interview. (Coston’s Avian Flu Diary noted on March 14 that a paper in the U.S. Centers for Disease Control’s Emerging Infectious Disease Journal had identified the Shanghai area as one well suited to breed a new genetic subtype of influenza.)

In a development unwelcome to Chinese authorities, many Chinese microbloggers are associating the H7N9 deaths with the still-unexplained swine carcasses that last month floated down the Huangpu River, which provides Shanghai’s drinking water. (Local health officials announced on Monday that the dead pigs contained no bird flu virus.)

Memories of China’s repression of news during its tumultuous 2002-03 SARS outbreak could fuel panic and unrest at home and suspicion in the West. A Tuesday editorial in China Daily reminded readers that China’s minister of health and the mayor of Beijing were dismissed 10 years ago “for trying to cover up the disease.” And there are signs that authorities this time, too, have been less than forthcoming; the Jiangsu Province Health Department announced the four new H7N9 cases only after a microblogger whose Weibo profile says he is a hospital administrator posted a shot of what looked like a patient’s diagnosis on Tuesday.

This might explain why FluTrackers, a U.S. website that hosts a global volunteer disease-surveillance network, has been suffering renewed denial-of-service attacks that it says are originating in China. The Florida-based site first noted server overloads in April 2011 and was told by its server provider in mid-December 2012 that page views from China were running at an “astonishing” level that closed the month at almost 10 million, said Sharon Sanders, FluTrackers’ president and editor-in-chief, in a series of e-mail exchanges.

After FluTrackers banned Chinese IP addresses that were sending thousands of requests, traffic slowed by more than two-thirds, only to rebound in March to almost 6.7 million page views from China. “When the site goes down, it is extremely inconvenient,” wrote Sanders, but a backup site that uses “multiple social media venues” makes it “really impossible to take us down.”

Why would Chinese authorities care about FluTrackers? For one thing, the nonprofit website is watching China. An item Sanders posted on March 7 seems to have constituted the first overseas mention of the Shanghai H7N9 cases. While journalists in China and Hong Kong dig for stories there, FluTrackers has about 50 regular posters and several hundred intermittent volunteers tracking and documenting threats to public health — particularly emerging diseases — around the world. The site, which Sanders founded with some fellow H5N1 watchers in 2006, publishes daily in English, French, Dutch and Italian, biweekly in Spanish, and occasionally in German, operating 24 hours a day, seven days a week. “No one is paid. Everyone is a volunteer,” she wrote. “We do not accept any advertisements and we do not sell anything.”

On Monday, for instance, Chinese authorities and the World Health Organization took heart that no signs of human-to-human H7N9 transmission had surfaced. That evening, FluTrackers posted amachine-translation of a bylined report that had just been posted at wenweipo.com, a Hong Kong newspaper’s website. The story tells of unusual pneumonia cases afflicting four men and a woman in a Shanghai hospital — all aged 60 to 70 and with no history of interpersonal contact. Speaking anonymously, a doctor is quoted as saying the hospital annually copes with about three cases of “unexplained severe pneumonia,” but that all five of the special cases are being labeled as such, though they have not been isolated. A second report indicated that three of them may have died.

So does H7N9 have pandemic potential? “I’d say that the majority of virus comes from H9N2, which many researchers have suspected could be the next pandemic. The makeup of this virus is similar to one that researchers have suspected could be the next pandemic. However it’s not quite there yet,” says Tetro. “We know that it is not spreading from human to human, but we know that in some cases, direct or close contact with poultry or birds is a route of infection.”

On the other hand, he finds the revelation of fresh cases in Jiangsu comforting: “This is actually an official statement. I’m more optimistic that we’re going to have a better epidemiological understanding of what is happening in China.”

“Many epidemics break out, spread and burn themselves out all the time in China. We just never hear about them,” says Coston. “But I think it’s already in the birds.”

We’ll all be watching. http://blogs.reuters.com/great-debate/2013/04/02/new-bird-flu-strain-creates-fear-and-surveillance/

Nipah Infection in 2013 Update on 2 April, 2013

Nipah Outbreak

View Nipah Outbreak-2013 in a larger map

Nipah Infection in 2013

Update on 2 April, 2013

Situation Update:

2 April 2013:  24 Nipah cases were identified among them 21 died  (mortality rate 88%);. These cases are from 14 districts (Gaibandha, Natore, Rajshahi, Naogaon, Rajbari, Pabna, Jhenaidah, Mymensingh, Nilphamari, Chittagong, Kurigram, Kustia, Magura, Manikganj). Age distribution of cases are 8 months to 60 years among them 15 are male and 9 are female. http://www.iedcr.org/index.php?option=com_content&view=article&id=106

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