Watch: Level 1, Practice Usual Precautions

Watch: Level 1, Practice Usual Precautions
Avian Flu (H7N9) in China

This information is current as of today, April 05, 2013 at 19:22 EDT

Released: April 05, 2013

What is the current situation?

On April 1, the World Health Organization (WHO) announced that influenza A (H7N9), a type of flu usually seen in birds, has been identified in a number of people in China. Cases have been confirmed in the following provinces: Shanghai, Jiangsu, Anhui, and Zhejiang.

This is the first time this virus has been seen in people. Symptoms include fever, cough, and shortness of breath. Infection with the new virus has resulted in severe respiratory illness and, in some cases, death. Chinese health authorities are conducting investigations to learn the source of the infections with this virus and to find other cases.

CDC is following this situation closely and coordinating with domestic and international partners in a number of areas. More information will be posted as it becomes available.

There is no recommendation against travel to China at this time.

What can travelers and Americans living in China do to protect themselves?

There is currently no vaccine to prevent H7N9. At this time, we do not know the source of this virus.  CDC is repeating its standard advice to travelers and Americans living in China to follow good hand hygiene and food safety practices and to avoid contact with animals.

• Do not touch birds, pigs, or other animals.
  • Do not touch animals whether they are alive or dead.
  • Avoid live bird or poultry markets.
  • Avoid other markets or farms with animals (wet markets).

• Eat food that is fully cooked.
  • Eat meat and poultry that is fully cooked (not pink) and served hot.
  • Eat hard-cooked eggs (not runny).
  • Don’t eat or drink dishes that include blood from any animal.
  • Don’t eat food from street vendors.

• Practice hygiene and cleanliness:
  • Wash your hands often.
  • If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol.
  • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
  • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
  • Try to avoid close contact, such as kissing, hugging or sharing eating utensils or cups, with people who are sick.

• See a doctor if you become sick during or after travel to China.
  • See a doctor right away if you become sick with fever, coughing, or shortness of breath.
  • If you get sick while you are still in China, visit theUS Department of State website to find a list of local doctors and hospitals. Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website (www.jointcommissioninternational.org).
  • Delay your travel home until after you have recovered or your doctor says it is ok to travel.
  • If you get sick with fever, coughing, or shortness of breath after you return to the United States, be sure to tell your doctor about your recent travel to China.

Clinician information:

Clinicians should consider the possibility of novel influenza A (H7N9) virus infection in persons presenting with respiratory illness within 10 days of an appropriate travel or exposure history. Although the majority of novel influenza A (H7N9) cases have resulted in severe respiratory illness in adults, infection with this virus may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness for whom an etiology has not been confirmed may identify human cases of avian influenza A virus infection or new cases of variant influenza in the United States. Patients with novel influenza A (H7N9) virus infections should have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction (RT-PCR) testing but be unsubtypeable. Clinicians suspecting novel influenza A (H7N9) should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours. For more information, see the Health Alert Notice  issued April 5, 2013. http://wwwnc.cdc.gov/travel/notices/watch/avian-flu-h7n9-china.htm

"The Huadu now H7N9 patients" rumors untrue yet found cases of bird flu in Guangzhou

Source: Guangzhou Daily

Published: 2013-04-06 07:51

Comment

    The City CDC: Guangzhou within not found avian influenza

　　(Reporter Wu Ren) at noon yesterday, microblogging netizens said, the Guangzhou Huadu has been one case of H7N9 avian flu cases and patients in critical condition. " Guangzhou CDC responded that found no suspected or confirmed cases of avian influenza in the Guangzhou area as of yesterday evening, from the current situation, the Guangzhou public does not need to worry too much.

　　Yesterday at noon, the authentication information for local media commentator microblogging users post, said: "friends of the hospital informed the Guangzhou avian influenza patients dying friends in Guangzhou attention." And refers to the cases occurred in the flower are. The news caused widespread concern netizens and forwarding. However, that section microblogging deleted after a few hours.

　　"We understood to Huadu district hospital, district hospital has not yet received the suspected or confirmed cases of avian flu. Within all Guangzhou did not." Guangzhou Center for Disease Control and Prevention the main Ren Wangming yesterday 18 am told reporters.

　　In recent days, the news about the H7N9 avian flu recent fever, runny nose and other symptoms people feel worried.

　　Rosanna said that this time Guangzhou itself is the high incidence of seasonal influenza, from the current situation, the people of Guangzhou H7N9 do not need to be too worried about the "flu and H7N9 flu vaccine injection. Proposed conditional public or each

In the end of flu vaccine launched vaccination and prevention work in front of lost opportunities, and will not now fever, respiratory symptoms panic better. ' http://i.dayoo.com/news/v2-news-guangzhou/201304/06/73437_29904345.htm?&ctg=top&listpageID=1

Background and summary of human infection with influenza A(H7N9) virus– as of 5 April 2013

In the past few weeks, WHO has received from China reports of human infection with influenza A(H7N9) virus. The influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses, which normally circulate among birds. 

Human infections with other subgroups of H7 influenza viruses (H7N2, H7N3, and H7N7) have previously been reported in the Netherlands, Italy, Canada, United States of America, Mexico and the United Kingdom. Most of these infections occurred in association with poultry outbreaks. The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands. 

These recent reports from China are the first cases of human infection with H7N9 viruses. 


Epidemiology

The reported laboratory-confirmed cases have come from several different provinces in eastern China and are not known to be linked. All patients so far have been severely ill, and some have died (for the latest information on cases and outcomes, see Disease Outbreak News.

Two family clusters have been reported. 

Beyond these two clusters, no cases have been reported among contacts or in health care workers associated with confirmed cases. 

The source of infection and the mode of transmission are currently unknown. 

No association with outbreaks of disease among animals or clear exposure to animals has been established. 

Some of the confirmed cases had contact with animals or with environments in which animals were located. 

The virus has been found in a pigeon in a market in Shanghai. 

The possibility of animal-to-human transmission is being investigated, as is the possibility of human-to-human transmission. 

The family cluster raises the possibility of human-to-human transmission, but two of the cases in that cluster have not been laboratory confirmed and there is no other evidence pointing toward sustained transmission among people.

Clinical presentation

The main clinical feature among most patients is respiratory diseases resulting in severe pneumonia. 

Symptoms include fever, cough and shortness of breath. 

Patients have required intensive care and mechanical ventilation. 

Information is, however, still limited about the full spectrum of disease that this infection might cause.


Virology

The HA gene is genetically distinct from the HA gene of other H7 viruses. 

The six internal genes are derived from influenza A(H9N2) viruses circulating in birds in eastern Asia. 

The NA gene is similar to the NA genes from influenza A(H11N9) viruses detected in birds in previous years. 

We do not know why cases of influenza A(H7N9) virus infection are being detected now , as we do not know how these persons were infected. 

Sequence analyses have shown that the genes of the influenza A(H7N9) viruses from the first human cases in China are of avian (bird) origin. 

However, these genes also show signs of adaption to growth in mammalian species. These adaptations include an ability to bind to mammalian cell receptors, and to grow at temperatures close to the normal body temperature of mammals (which is lower than that of birds). 


Treatment

Laboratory testing conducted in China has shown that the influenza A(H7N9) viruses are sensitive to the anti-influenza drugs known as neuraminidase inhibitors (oseltamivir and zanamivir). When these drugs are given early in the course of illness, they have been found to be effective against seasonal influenza virus and influenza A(H5N1) virus infection. There is no experience yet with the use of these drugs for the treatment of H7N9 infection. 


Prevention

No vaccine for the prevention of influenza A(H7N9) infections is currently available, although viruses have already been isolated and characterized from the initial cases. 

The first step in development of a vaccine is the selection of candidate viruses that could go into a vaccine. 

WHO, in collaboration with partners, will continue to characterize available influenza A(H7N9) viruses to identify the best candidate viruses. 

These candidate vaccine viruses can then be used for the manufacture of vaccine should this become necessary. 

While the source of infection and the mode of transmission have not yet been determined, it is prudent to follow good hygiene practices to prevent infection. 

For advice on infection prevention, contact with animals and food preparation, see:http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/. 

Guidance for infection prevention and control in health care settings is available athttp://www.who.int/csr/resources/publications/swineflu/WHO_CDS_EPR_2007_6/en/index.html.


Current activities

WHO has closely monitored the situation since detection of the first case and has been working with partners to ensure a high degree of preparedness should the new virus be found to be sufficiently transmissible to cause community outbreaks. 

We have also been working with animal health partners to investigate possible circulation in animals. 

Some viruses are able to cause limited human-to-human transmission under condition of close contact, as occurs in families, but are not transmissible enough to cause larger community outbreaks. 

Actions taken by WHO in coordination with national authorities and technical partners include the following:

• Information is being provided to countries under the International Health Regulations (IHR).
• Enhanced surveillance for pneumonia cases of unknown origin to ensure early detection and laboratory confirmation of new cases.
• Epidemiological investigation, including assessment of suspected cases and contacts of known cases.
• Close collaboration with animal health partners, specifically the World Organization for Animal Health (OIE), the Food and Agriculture Office of the United Nations (FAO) and the OIE/FAO Network of Expertise on Animal Influenza (OFFLU), to investigate possible circulation of this virus in animals and to ensure that materials and information, including laboratory test reagents, are shared between animal health and public health laboratories.
• Continuous risk assessment of the situation in collaboration with the WHO Global Influenza Surveillance and Response System (GISRS), which is comprised of WHO Collaborating Centres for Reference and Research on Influenza, National Influenza Centres and Essential Regulatory Laboratories (seehttp://www.who.int/influenza/gisrs_laboratory/en/); in animal health laboratories, coordinated by the WHO-OFFLU collaboration; and with other technical partners.

WHO recommendations

Based on the current situation and available information, WHO advises the following:

• When laboratories testing for influenza viruses detect an influenza A virus by RT-PCR assays using primers for the conserved M genes and then find that tests using currently available H1, H3 and H5 primers are negative, such unsubtypable influenza A viruses should be sent urgently to a WHO Collaborating Centre for further analysis (seehttp://www.who.int/influenza/gisrs_laboratory/collaborating_centres/en/ ).
• When a laboratory or Member State finds such an unsubtypable influenza A virus, the finding should be reported to WHO through the International Health Regulations national focal point as is required under the IHR.
• The same surveillance strategy applies as for human infections with highly pathogenic avian influenza A (H5N1) virus.
• Clinicians and laboratory specialists should consider the possibility of human infection with influenza in any person presenting with severe acute respiratory disease.
• Clinicians are reminded of standard guidance for infection control and contact tracing around such cases.
• Standard guidance should also be applied for vigorously investigating clusters of severe respiratory infections and such infections in health care workers who have been caring for patients with severe acute respiratory disease.
• WHO does not advise special screening at points of entry with regard to this event nor does it recommend that any travel or trade restrictions be applied.

Summary

Any animal influenza virus that develops the ability to infect people can theoretically cause a pandemic. However, whether the influenza A(H7N9) virus could actually cause a pandemic is unknown. Experience has shown that some animal influenza viruses that have been found to occasionally infect people have not gone on to cause a pandemic while others have done so. Surveillance and the investigations now underway will provide some of the information needed to make this determination. 

WHO continues to work closely with national authorities and technical partners to gain a better understanding of this disease in humans and will continue to provide updated information. WHO will continue to reassess the situation as it evolves. As more information becomes available WHO will revise its guidance and actions accordingly.  http://www.who.int/influenza/human_animal_interface/update_20130405/en/index.html

NOVEL CORONAVIRUS - EASTERN MEDITERRANEAN (15): CAMEL EXPOSURE

Date: 4 Apr 2013
Source: ScienceInsider [edited]
http://news.sciencemag.org/scienceinsider/2013/04/german-researchers-to-probe-came.html


On [26 Mar 2013], a 73-year-old man from Abu Dhabi, the capital of the United Arab Emirates, died at the Klinikum Schwabing, a hospital in Munich [Germany]. He was the 11th known fatality related to infection with the novel coronavirus (nCoV), a pathogen that was 1st reported in September 2012 and is attracting substantial interest from researchers. Overall, officials have reported 17 cases of nCoV infection.

Clemens Wendtner, a professor of medicine and assistant medical director at the University of Cologne, is a physician at the Munich hospital. ScienceInsider asked Wendtner how the case was handled and why he thinks the patient may have been infected by one of his racing camels. Questions and answers have been edited for brevity and clarity.

Q: Why did the patient seek treatment in Germany and why did he come to the Klinikum Schwabing?

C.W.: We are one of 7 reference centers for infectious diseases in Germany; the Klinikum Schwabing has a unit for highly contagious patients, and one of the 1st SARS patients was treated here in 2003. This particular patient was treated in Munich for multiple myeloma, which had been diagnosed in 2009. He flew into Germany on a frequent basis to get chemotherapy and even stem cell transplantation at a private center.

While in Abu Dhabi, his condition deteriorated, and his treating hematologist here in Munich asked to fly him in to get a closer look; the family also wanted him to be transferred. At this point, we only knew he had some pulmonary problems, but we were not aware of any coronavirus testing; this was not done in the United Arab Emirates.

Q: When did you suspect he might have the virus?

C.W.: When we examined his condition and saw his medication list; he had even started on [the influenza drug] Tamiflu, but his condition didn't improve. So we said: "Maybe it's a good idea to check for the coronavirus." So we did a bronchoalveolar lavage, [a procedure to sample fluid from the lungs,] and sent the material to Christian Drosten's lab at the University of Bonn; this is the German reference lab for the new coronavirus. The results came back on [23 Mar 2013]. At this point, the patient's medical condition was quite bad.
Q: Did you take special precautions once you knew he was infected to prevent further infections?

C.W.: That was done from the beginning. We are trained with difficult infectious disease situations, so this is what we do when we don't know what is going on. He was in an intensive care unit and put in special isolation; the staff used special precaution measures, such as 3M masks. We also tested staff for the virus, but nobody was positive.

Q: How many people did you test?

C.W.: We had a group of roughly 60 people, and not only staff members. ... The patient flew in on a private jet, and we screened the crew members as well as 4 relatives who had come with him. But we did PCR testing only for people who had symptoms, such as coughing and flu-like symptoms. There were fewer than 10 of those, and all were negative. The others were put on surveillance screening, but if they didn't develop symptoms, they weren't tested.

Q: Have these precautions ended now?

C.W.: Yes.

Q: Is it worrying that quite a few patients with the new coronavirus have sought medical attention in Germany and the United Kingdom? With SARS, you saw people infecting others on planes or seeding new outbreaks in the countries where they arrived.

C.W.: This virus is not in the same category as SARS in terms of the risk of spread. But one point is very valid: The screening tests, especially in the [Arabian Peninsula], are underdeveloped. So there may be a higher number of undetected cases. I was approached by officials from the U.A.E.; they were worried about this 1st case, because most other cases have been in Saudi Arabia, and they are quite interested in getting testing set up in their country. We will help them, together with professor Drosten in Bonn.

Q: You have said in interviews that he may have become infected through contact with a camel. What is the evidence for that?

C.W.: So far, it's only circumstantial evidence. The patient owned racing camels. One of them got ill and was very weak; the patient was in close contact with that camel, and on the evening the camel got very sick, the patient developed flu-like symptoms. Three days later, he was in a medical unit in Abu Dhabi. There is another family member who also had close contact with the camel; he also got ill, but we could not follow up with that gentleman.

We are really interested to find the missing link, to maybe get some material, some blood, some stool, out of this camel. Professor Drosten may send one of his scientific colleagues to Abu Dhabi. We will also get some help from the U.A.E. consulate in Munich.

Q: So the United Arab Emirates is willing to collaborate on this?

C.W.: Yes, they have understood that it's in their best interest to get a better understanding of how the disease might spread from animals to humans.

Q: Is the camel still alive?

C.W.: Yes, at least it was alive a couple of days ago.

Q: When will this investigation start?

C.W.: As you can imagine, we are very interested insolving this issue, so this would probably have to happen in the next couple of days.

Q: Have you heard about other camels in Abu Dhabi or the United Arab Emirates getting sick?

C.W.: No, I don't have any information on this. Even the consulate could not tell me. But maybe they didn't pay attention before. This just popped up as a problem, so they may have a closer look at this in the future.


[Byline: Martin Enserink]

--
Communicated by:
ProMED-mail


[Of interest in the above report/interview is the history of contact with an ill animal prior to onset of illness. In earlier reports of cases in the Eastern Mediterranean region, there had been reports of contact with farm animals; in one case, there was report of contact with a sick animal prior to onset of illness as well.

ProMED-mail looks forward to reports of additional studies performed in the UAE with respect to this case and the above mentioned possible link with a sick camel.
- Mod.MPP]


[Picture of camel racing in Abu Dhabi:
http://news.bbcimg.co.uk/media/images/58560000/jpg/_58560033_camel4_afp.jpg 
- Mod.JW  http://www.promedmail.org/direct.php?id=20130405.1623188

Guangzhou CDC deny local people infected with bird flu cases

It is understood that Guangzhou is not found someone infected with avian influenza, including H5N1 and H7N9, the two types of virus infection. However, in east China's bird flu cases increasing number of recent unstable weather, Guangzhou is a high incidence of influenza, many people are worried quietly infected with the avian influenza virus.http://news.qq.com/a/20130406/000040.htm?utm_source=feedburner&utm_medium=twitter&utm_campaign=Feed%3A+baidu%2FCGwj+%28%E4%B8%AD%E5%9B%BD%E5%9B%BD%E5%86%85%E7%84%A6%E7%82%B9%E6%96%B0%E9%97%BB%29

more pics

April 4, Zhejiang Province reported two cases of confirmed human infection of H7N9 avian influenza, which Jiande 38-year-old Mr. Hong has passed away on March 27. Another example of a critically ill patient Yang, Hangzhou people, male, 67 years old, to rescue the First Affiliated Hospital, Zhejiang University School of Medicine. It is reported that Yang is staying in negative pressure rooms, isolation highest level of patients suffering from infectious diseases ward. The surveillance footage showed medical staff into patient wards are "heavily armed" patient Yang opened his mouth, stuck ventilator lying in bed. Bedside wall power outlet holes 10 are studded, respectively connected to breathing machines, monitors, pagers.

http://news.qq.com/a/20130405/000333.htm#p=1

Apr. 05, 2013 08:25 

New Bird Flu Seen Having Some Markers of Airborne Killer

By Simeon Bennett - Apr 5, 2013 12:39 PM ET

The new bird influenza that’s killed six people in eastern China has some of the genetic hallmarks of an easily transmissible virus, according to the scientist who showed how H5N1 avian flu could become airborne.

The H7N9 strain, which is a new virus formed as a result of two others merging their genetic material, has features of viruses that are known to jump easily from birds to mammals, and a mutation that may help it attach to cells in the respiratory tract, said Ron Fouchier, a professor of molecular virology at Erasmus Medical Center in the Netherlands, in a telephone interview yesterday.

“That’s certainly not good news,” said Fouchier, who reviewed a gene sequencing of H7N9 published by Chinese health authorities. “This virus really doesn’t look like a bird virus anymore; it looks like a mammalian virus.”

To curb the spread of H7N9, officials in Shanghai have halted trading in live poultry, closed bird markets and slaughtered more than 20,000 birds. The outbreak, in which 16 people have been infected, caused soybean futures and airline stocks to fall yesterday on concern the virus may spark a pandemic.

While there’s no evidence yet of human-to-human transmission, scientists are scrutinizing the virus’s genetic makeup for clues to the threat it may pose.

Fouchier authored a study last year that showed five genetic tweaks to the deadly H5N1 virus, which has killed more than 600 people since 2003, made it airborne in ferrets, the mammals whose response to flu most closely resembles that of humans.

‘More Concern’

One of the mutations he made is in an enzyme called polymerase; another was in a protein called hemagglutinin on the surface of the virus. H7N9 has both mutations, he said.

“This virus is certainly of more concern than the vast majority of bird flu viruses,” Fouchier said. “Most bird flu viruses that we know do not have these mutations.”

Whether those mutations alone are enough to make the virus easily transmissible isn’t clear, and should be “high on the research agenda,” Fouchier said. Still, there’s no evidence yet that the virus is more likely to become more dangerous than H5N1, he said.

“Even if we see relatively high numbers of human cases, it doesn’t mean a pandemic is imminent,” he said. “H5N1 has circulated for 16 years and not become mammal-to-mammal transmissible.”

Heightened Vigilance

As part of its surveillance effort, China needs to conduct blood serum testing among all people who have been in contact with confirmed cases to look for antibodies that form in response to an infection, said Roy Anderson, a professor of infectious disease epidemiology at Imperial College London. That will indicate how many people have been infected with the virus, including those who aren’t showing symptoms, he said.

“Heightened vigilance needs to be in place at the moment,” said Anderson. While no human-to-human transmission has yet occurred, once an epidemic gets established, the doubling time can be very fast. “That’s why much needs to be done very thoroughly at the beginning to ascertain whether this is a risk or not.”

Unlike H5N1, which is highly lethal for birds, H7N9 is a so-called low-pathogenic virus in birds, meaning it may be widespread without causing severe sickness, Fouchier said. That would make it difficult to eradicate, he said. It doesn’t necessarily follow that the virus will be mild in humans, he said.

Spanish Flu

The Spanish flu of 1918, which killed about 50 million people worldwide, wasn’t highly pathogenic in birds, he said. He and colleagues plan to test the new virus in ferrets to see how deadly and how easily transmissible it is, and to test vaccines and antiviral drugs against it.

H7N9 also is more difficult to track because it’s not highly lethal to birds, said Alex Thiermann, technical adviser to the director general of the World Organisation for Animal Health in Paris.

“That indicates we need to take very careful surveillance measures because it will not be as obvious as in 2001,” Thiermann said in a telephone interview yesterday. “Symptoms are not going to help us. The Chinese are doing an intensive surveillance on poultry, pigs and wildlife. We need to continue to do that intensively.”

To contact the reporter on this story: Simeon Bennett in Geneva atsbennett9@bloomberg.net

http://www.bloomberg.com/news/2013-04-05/new-bird-flu-seen-having-some-markers-of-airborne-killer.html

The netizens said Nanjing, a district the tree constantly falling dead sparrow

The district found an unknown cause of death Sparrow

Nanjing Zero: [a district in Nanjing found an unknown cause of death Sparrow] It is the the users @ cat xiao embarrassing: in the Southern District of Nanjing Jianye District Tea Billiton Park East area, the middle of a road on both sides of the magnolia tree kept off dead sparrow down. Both sides of a road are like this, I do not know from where flying die, I hope the relevant departments to pay attention to it, at least take away and check the cause of death, might be able to find some clues? http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/06/23898487_0.shtml

Human infection with influenza A(H7N9) virus in China – update

hattip Giuseppe Michieli

5 APRIL 2013


As of 5 April 2013 (14:00 CET), the Chinese health authorities notified WHO of an additional five laboratory-confirmed cases, including one death due to human infection with influenza A(H7N9) virus.

Of the latest laboratory-confirmed cases, three are from Shanghai and two from Jiangsu.

Among the Shanghai cases, a 52-year-old woman with illness onset on 27 March 2013 has died, a 67-year-old man with illness onset on 22 March 2013 is in critical condition and a four-year-old boy with illness onset on 31 March 2013 has mild illness.

The two patients from Jiangsu are both in critical condition. They include a 61-year-old woman with illness onset on 20 March 2013 and a 79-year-old man with illness onset on 21 March 2013.

To date, a total of 16 patients have been laboratory confirmed with influenza A(H7N9) virus in China; of these, six people have died.

More than 520 close contacts of the confirmed cases are being closely monitored.

In Jiangsu, investigation is ongoing into a contact of an earlier confirmed case who developed symptoms of illness.

The Chinese government is actively investigating this event and has heightened disease surveillance. Retrospective testing of recently reported cases with severe respiratory infection may uncover additional cases that were previously unrecognized.

An inter-government task force has been formally established, with the National Health and Family Planning Commission leading the coordination along with the Ministry of Agriculture and other key ministries. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus.

WHO is in contact with national authorities and is following the event closely.

The WHO-coordinated international response is also focusing on work with WHO Collaborating Centres for Reference and Research on Influenza and other partners to ensure that information is available and that materials are developed for diagnosis and treatment and vaccine development.

No vaccine is currently available for this subtype of the influenza virus.

Preliminary test results provided by the WHO Collaborating Centre in China suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir).

At this time there is no evidence of ongoing human-to-human transmission.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied. http://www.who.int/csr/don/2013_04_05/en/index.html-

The mainland chickens found H7N9 virus

China's Ministry of Agriculture, the latest addition to pigeons, chickens also found that the H7N9 avian influenza virus. At the same time, the mainland H7N9 avian flu has spread to the signs outside. Hong Kong, a 7-year-old girl suspected disease, currently being treated in isolation in the hospital last month girls to Shanghai and had contact with birds. In addition, Jiangsu Province, on Friday added two confirmed cases, Zhejiang Province, also added a number of deaths. The country has increased to 16 cases, six of whom he was certified dead. Have been four deaths in Shanghai from Saturday to suspend the city's live poultry trading and close all live poultry markets.
 (Von day away reported) and the Chinese Ministry of Agriculture announced on Friday night, 10 chicken samples, and two pigeons samples, as well as seven environmental samples found to have H7N9 bird flu virus. All the samples from the Shanghai region. 

The Ministry of Agriculture has requested to close the relevant market, culling all birds within the market. Outside mainland suspected to be infected by a seven-year-old girl in Hong Kong, the Hong Kong Hospital Authority total Infection Control Officer, Mr Dominic the girls at the end of last month had visited Shanghai, and contact with bird flu-like symptoms after returning to Hong Kong, fever to 39 degrees, being isolated from the Queen Elizabeth Hospital, the authorities have to take samples, testing whether the infection of H7N9 avian influenza. http://www.rfa.org/cantonese/news/birdflu-04052013093946.html?encoding=simplified

Avian Influenza Guidance and Algorithms

Avian influenza (AI), in particular H5N1 and now H7N9, is still considered a threat. Algorithms have been developed to assist with the managment of possible or confirmed cases. Please contact your local Health Protection Team for advice and support, particularly in situations that are outside the scope of the algorithms.

Algorithms

A/H7N9: Investigation and management of possible human cases of avian influenza A/H7N9, in returning travellers

Investigation and management of possible human cases of avian influenza A H7N9 in returning travellers (PDF, 364 KB)

A/H5N1: Management of suspected or confirmed human cases of avian influenza A/H5N1

Case management of suspected human case (PDF, 305 KB)

This algorithm helps manage the initial assessment of suspected human cases of avian influenza. Advice is provided on infection control measures, the investigation and the reporting mechanisms to be used.

AI Cases: Management of contacts of human cases of avian influenza A/H5N1

Algorithm and management of contacts of confirmed human cases of avian influenza A/H5N1 (PDF, 25 KB) 

AI Cases: Reporting 

HPA case report form for suspected human cases of avian influenza (PDF, 44 KB)

Please report all suspected human cases of avian influenza using the form above. 

Travel advice

Advice for travellers and useful links for clincians is available at: Travel Advice Page.

Avian Influenza Standard Operating Procedure

The HPA avian influenza standard operating procedures should be referred to in the first instance

Guidance for Health Protection Units on dealing with human health implications of avian influenza in poultry and wild birds (PDF, 367 KB) 

Occupational guidance is also provided for those involved in the response to an avian influenza incident.

Occupational Health: For those responding to a suspected or confirmed avian influenza incident

Occupational Guidance (PDF, 80 KB)

This guidance helps address occupational health issues that may arise during an avian influenza incident.

Exposure: Management of people exposed to birds where avian influenza is suspected or confirmed

Management of people exposed to birds where avian influenza is suspected/confirmed and who have not used PPE at the time of exposure (PDF, 72 KB)    

Laboratory Guidance

Microbiological guidance for taking and handling specimens for avian influenza testing
Health and Safety Executive (HSE) laboratory advice [External Link]

Last reviewed: 4 April 2013

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/AvianInfluenza/Guidelines/influaAvianInfluenzaGuidanceandAlgorithms/

MESSAGE FOR U.S. CITIZENS-H7N9 INFLUENZA INFORMATION FROM CDC

As of April 4, the Chinese authorities confirmed 14 cases of a new strain of avian influenza (H7N9) in Shanghai, Jiangsu, Zhejiang, and Anhui.  A small number of new cases have been reported each day since Sunday, March 31 when three cases were initially reported by the Chinese authorities.  Thus far, no human-to-human transmission has been reported and no link has been found between the laboratory-confirmed cases.  Individuals in close contact with the infected were tested and the results have all been negative. 

The Chinese authorities are actively monitoring and investigating this situation and has heightened disease surveilance.  At this point the risk for international disease spread is considered low.  The latest advisory from the World Health Organization as of April 4 is that no travel or trade restrictions with China should be applied based on the current information. 

How can I protect myself and my family?

Cover the nose and mouth while sneezing or coughing.

Wash your hands frequently, especially before and after preparing foods and before eating.

Thoroughly cook all poultry and poultry products, including eggs. 

Avoid contact with sick animals and do not go to live animal markets or farms. 

What are the signs and symptoms?

The flu is a contagious respiratory illness caused by the flu virus. Flu is different from the cold and the symptoms come on suddenly. Symptoms of fever, cough, sore throat, fatigue, headache, body aches are some of the symptoms associated with the flu.

What should I do if I have the flu?

Most individuals who get the flu will recover within a few days but some people can develop complications. Individuals with certain lung problems such as asthma or COPD, those with diabetes, heart disease and those over the age of 65 are at a greater risk of developing complications. 

If you do get the flu:

Stay hydrated. If you get sick with flu symptoms and are at high risk of flu complications or you are concerned about your illness, call your health care provider for advice. You should stay home for at least 24 hours after your fever is gone except to get medical care or for other things you have to do and no one else can do for you. You should stay home from work, school, travel, shopping, social events, and public gatherings.

Where can I find more information?

The U.S. Centers for Disease Control and Prevention (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. All of these actions are routine preparedness measures taken whenever a new novel influenza virus is detected in humans.

CDC will provide updated information as it becomes available.

http://www.cdc.gov/flu/avianflu/h7n9-virus.htm     

The Chinese Center for Disease Control and Prevention also provides regular updates on the ongoing developments.  You can view the information at http://www.chinacdc.cn and http://www.chinacdc.cn/en/.  

We strongly recommend that U.S. citizens traveling to or residing in China enroll in the Department of State's Smart Traveler Enrollment Program (STEP) at https://step.state.gov/step.  STEP enrollment gives you the latest security updates, and makes it easier for the U.S. Embassy or nearest U.S. Consulate to contact you in an emergency.  If you don't have Internet access, enroll directly with the nearest U.S. Embassy or Consulate.

Regularly monitor the State Department's website athttp://travel.state.gov, where you can find current Travel Warnings, Travel Alerts, and the Worldwide Caution.  Read the Country Specific Information for China athttp://travel.state.gov/travel/cis_pa_tw/cis/cis_1089.html. For additional information, refer to "A Safe Trip Abroad" on the State Department's website.

Contact the U.S. Embassy or Consulate for up-to-date information on travel restrictions.  You can also call 1-888-407-4747 toll-free from within the United States and Canada, or 1-202-501-4444 from other countries.  These numbers are available from 8:00 a.m. to 8:00 p.m. Eastern Time, Monday through Friday (except U.S. federal holidays).  Follow us on Twitter at https://mobile.twitter.com/travelgov and Facebook athttps://www.facebook.com/travelgov, and download our free Smart Traveler iPhone App at https://itunes.apple.com/us/app/smart-traveler/id442693988?mt=8 to have travel information at your fingertips.

The American Citizen Services unit of the U.S. Consulate General in Shanghai is located at 1038 West Nanjing Road, 8th Floor, Shanghai 200041.  For the American Citizen Services operation hours, please refer to our website: http://shanghai.usembassy-china.org.cn/service.html.  If you are a U.S. citizen in need of urgent assistance, the emergency number for the U.S. Consulate General in Shanghai is (86) (21) 3217-4650.

http://beijing.usembassy-china.org.cn/04052013u.html