15 Apr 2013
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ECDC
Since 31 March 2013, sixty cases of human infection with influenza A(H7N9) have been reported from six provinces in eastern China with a combined population of about 330 million. Onset of disease has been between 19 February and 9 April 2013 in: Shanghai (24), Jiangsu (16), Zhejiang (15), Anhui (2), Henan (2)and Beijing (1). See Figure 1 below. The date of disease onset is currently unknown for five patients. Most cases have developed severe respiratory disease and only three cases are reported to have mild clinical course. Thirteen patients died (case-fatality ratio=21%). The median age is 65 years with a range between 4 and 87 years; 17 of them are females.
The Chinese health authorities are responding to this public health event by enhanced surveillance, epidemiological and laboratory investigation and contact tracing. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus. The authorities reported to the World Organisation for Animal Health (OIE) that avian influenza A(H7N9) was detected in samples from pigeons, chickens and ducks, and in environmental samples from live bird markets ('wet markets') in Shanghai, Jiangsu, Anhui and Zhejiang provinces. Authorities have closed markets and culled poultry in affected areas.
The source and mode of transmission have not been confirmed. The outbreak is caused by a reassortant avian influenza virus with low pathogenicity for birds, hence it does not cause the signal 'die-offs' in poultry associated with highly pathogenic strains of avian influenza viruses. Genetic analyses of the isolates have shown changes which suggest that the H7N9 virus may have greater ability to infect mammalian species, including humans, than most other avian influenza viruses. Pathogenicity for humans appears to be high and higher age appears to be a risk factor for disease.
The most likely scenario is that of A(H7N9) spreading undetected in poultry populations and occasionally infecting humans who have close contact with poultry or poultry products but this will have to be validated as further data become available.
At this time there is no evidence of sustained human-to-human transmission. More than 1 000 close contacts of confirmed cases are reported to have been followed up without evidence of person-to-person transmission.
There is one family cluster with two confirmed cases for which human-to-human transmission cannot be ruled out but where common exposure is the most likely explanation.
The rapid geographic spread and the increase of confirmed cases is likely to be the result of strengthened case finding and increased testing. A(H7N9) test kits have been distributed to over 400 laboratories across China and this increased ascertainment is expected to provide important epidemiological information.
An increasing incidence of sporadic cases and expansion of geographic spread in China and possibly neighbouring countries are expected over the coming weeks. Individual imported human cases to Europe cannot be ruled out and countries need to prepare for detecting and diagnosing such cases. Critical developments that would change this assessment would be evidence of sustained human-to-human transmission and detection of avian influenza A(H7N9) in bird populations in Europe.
ECDC is closely monitoring developments and is continuously re-assessing the situation in collaboration with WHO, US CDC, China CDC and other partners.
ECDC published an updated risk assessment on April 12.
Figure 1: Distribution of influenza A(H7N9) cases by province, China, as of 14 April 2013
Figure 2: Distribution of influenza A(H7N9) cases by week of onset of symptoms, China, as of 14 April 2013
-China-week-onset-14-April-2013.png)
Figure 3: Distribution of cumulative number of influenza A(H7N9) cases by province, China, 19 February – 14 April 2013
-China-cumulative-number-province-14-Apr-2013.jpg) |
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Monday, April 15, 2013
ECDC-Epidemiological update of 15 April: avian influenza A(H7N9) virus in China
Statement on H7N9 Virus and Illnesses in China
Recently, the World Health Organization issued an update confirming that a number of people in the People's Republic of China were infected by a type of avian influenza virus identified as A(H7N9).
The Canadian Food Inspection Agency (CFIA) is committed to protecting human and animal health and is working closely with Public Health Agency of Canada (PHAC) to monitor the situation in China.
Avian influenza does not affect food safety. The strain of H7N9 avian influenza causing illness in people in China has not been identified in birds in Canada. In addition, Canada does not import raw poultry products or live birds from the People’s Republic of China.
The CFIA in collaboration with provinces, industry groups and other stakeholders, closely monitors commercial poultry and wild birds in Canada for avian influenza viruses.
For additional information on illnesses visit the PHAC website at: http://www.phac-aspc.gc.ca
Symptom-Free Bird Flu Case Suggests Wider H7N9 Spread
By Bloomberg News - Apr 15, 2013 8:26 AM ET
Bird flu was found in a 4-year-old Beijing boy who has no symptoms of the infection, health authorities said, suggesting more people may be catching the H7N9 influenza virus than reported.
The first asymptomatic H7N9 case was discovered by health- care workers searching for possible cases, the Beijing Municipal Health Bureau said in a statement on its website today. The boy’s parents are poultry and fish sellers, and their neighbors across the street had bought chicken sold by the family of a 7- year-old girl whose H7N9 infection was reported two days ago.
The boy is under medical observation. The case suggests some H7N9 infections may be going unrecorded because of a lack of obvious symptoms. Almost all of the 64 people diagnosed with the virus so far have been extremely unwell, with complications extending to brain damage, multi-organ failure and muscle breakdown.
“With asymptomatic cases around, I think everything changes,” said Ian Mackay, an associate professor of clinical virology at the University of Queensland in Brisbane, in a telephone interview today. “There has been a spike in pneumonia cases that have drawn the health officials’ attention, but the virus may have been going around as a normal cold.”....
Pandemic Threat
“The risk of this becoming a pandemic is increasing,” Yin said in an interview at the company’s headquarters in the Chinese capital, where a second H7N9 infection was reported today.
Sinovac has notified its suppliers that it may need to order additional fertilized chicken eggs to produce H7N9 vaccine, Yin said.
Under an agreement with China’s Food and Drug Administration, a Sinovac vaccine for pandemic flu doesn’t need to undergo clinical testing because its production methods have already been approved and the pandemic flu vaccine would represent only a change in the viral strain, he said.
Based on typical vaccine development and production schedules, batches could be ready for commercial use as early as late July, Yin said, adding that he is urging the World Health Organization and its affiliated labs to expedite the preparation of seed strains.
Sinovac has the capacity to produce about 30 million to 40 million doses of flu vaccine annually, said Yin, who founded the company in 2001 to make immunizations for hepatitis. The price to the Chinese government is about 20 yuan ($3.23) a piece, he said....Four international flu experts will arrive in China within days to help authorities respond to the country’s widening bird- flu emergency, acchttp://www.bloomberg.com/news/2013-04-15/symptom-free-bird-flu-case-suggests-wider-h7n9-spread.html
China reports 3 new H7N9 cases, another death
2013-04-15 20:50:14 |
BEIJING, April 15 (Xinhua) -- Another death from H7N9 bird flu was reported in China on Monday, bringing the nationwide death toll to 14.
The Department of Health of east China's Jiangsu Province reported that a woman surnamed Gu, a 77-year-old who had previously tested positive for the H7N9 virus, died on Sunday night after emergency treatments failed.
The province also reported one new infection case. A 60-year-old man surnamed Kong tested positive for H7N9 on Monday and is receiving treatment in a hospital in Suzhou. Three people who have had close contact with him have not exhibited any abnormal symptoms.
Meanwhile, a 79-year-old patient has been transferred from the intensive care unit to a regular ward in the Second Hospital of Nanjing, according to the local health bureau.
The H7N9 virus was confirmed in a man surnamed Lu on April 5. He was in a critical condition, but has been recovering steadily and tested negative for H7N9 bird flu virus twice, the bureau added.
Another infection case was confirmed in neighboring Zhejiang Province on Monday, according to a statement issued by the provincial health department at 4 p.m. A 68-year-old woman surnamed Wang began exhibiting flu-like symptoms on April 3 and is now in a critical condition.
A man surnamed Chen in Anhui Province also tested positive for the strain of bird flu on Monday, according to the provincial health department. Of the 25 people who had been in close contact with the 60-year-old man, none have exhibited any abnormal symptoms.
A total of 63 H7N9 cases have been reported across China, with 24 in Shanghai, 17 in Jiangsu, 16 in Zhejiang, three in Anhui, two in Henan and one in Beijing.
| English.news.cn |
A girl waves as she is being transferred to a public ward from the ICU at Ditan hospital in Beijing
A girl, who was previously infected with the H7N9 bird flu virus, waves as she is being transferred to a public ward from the ICU at Ditan hospital in Beijing, April 15, 2013. According to a hospital spokesperson, the H7N9 virus is no longer detected in the girl's body. Two people in the central Chinese province of Henan have been infected by the new strain of avian influenza, the first cases found in the region, while the death toll has risen to 13 from a total of 60 infections after two more deaths in Shanghai. http://www.trust.org/alertnet/multimedia/pictures/detail.dot?mediaInode=71144bea-2f28-4f7b-bed4-8a68fe07e54d
China will work jointly with the WHO assessment of H7N9 outbreak
Since March, Shanghai, Jiangsu, Zhejiang, Anhui and other places have reports of human infection with the H7N9 avian influenza. Recent days, Beijing, Henan have also found that the epidemic. Up to now, the Chinese people infected with the H7N9 avian flu cases has more than 60 cases.
After the outbreak, the Chinese official with the World Health Organization to maintain close cooperation, the first time the WHO has informed epidemic information, and by the Chinese Center for Disease Control, the World Health Organization Collaborating Centre for the WHO and the United States, the United Kingdom, Australia Japan Cooperation Center shared the H7N9 strain of the virus.
For the current epidemic situation, the Chinese Ministry of Health and Family Planning Commission and the World Health Organization (WHO) agreed jointly organized "people infected with the H7N9 bird flu prevention and control joint study group" to carry out a week-long joint assessment of the epidemic in China, analysis and assessment of the epidemic and the prevention and control work provide recommendations for the next step in the prevention and control measures in China.
Earlier, the World Health Organization representative in China Blue Ruiming, WHO will provide more support. In the world, the World Health Organization's responsibility is to ensure that it can become a link between China and the other countries of the world to share information.
According to the news that the Chinese Center for Disease Control, the center has with the United States Center for Disease Control, the European Center for Disease Control, as well as Canada, Japan, Korea, the Netherlands and other disease control agencies maintained daily epidemic reporting mechanism, and working with national disease The control experts jointly epidemic information analysis to assess the risk of a pandemic.(End)http://news.cnwest.com/content/2013-04/15/content_8968946.htm
Chinese urged to eat poultry despite bird flu cases
Updated 15 April 2013, 22:41 AEST
Chinese state media have urged people to keep eating chicken and help revive the country's poultry industry, as the number of bird flu deaths rises to 14.
The Chinese poultry industry lost 10 billion yuan (USD $1.6 billion) in the week after the H7N9 bird flu virus began infecting humans.
Altogether 61 people have been confirmed as infected and 14 have died in the two weeks since Chinese authorities said they found the strain in humans for the first time.
"The public should somewhat restrain their anxieties to avoid this becoming a disaster for the whole poultry industry," the Global Times said in an editorial, adding that not eating poultry was "unfair to farmers".
The newspaper has called the avoidance of such foods "excessive anxiety" and urged people instead to "demonstrate a collective spirit beyond individualism".
According to the World Health Organization (WHO), influenza viruses are inactivated by temperatures above 70 degrees Celsius and it is therefore safe to eat well-cooked meat products.
The number of cases jumped from 40 over the weekend and spread for the first time beyond Shanghai and three nearby provinces, with two cases reported just west in Henan and one in Beijing.
Beijing health officials said on Monday a boy in the capital, who had been put under observation because he was a close contact of a H7N9 patient, tested positive for the virus but was suffering no symptoms of illness.
Experts fear the prospect of such viruses mutating into a form easily transmissible between humans, which would have the potential to trigger a pandemic.
But WHO says there is not yet evidence of human-to-human transmission of the H7N9 bird flu virus.
Earlier WHO China representative, Michael O'Leary, said more cases of infection were to be expected.
"I think there's no way to predict how it'll spread," Mr O'Leary said.
"We are still looking intensively for the reservoir of infections but the suspicions remain in birds, chickens, ducks and poultry.
"Because it is sporadic...we are sure that other cases will emerge." http://www.radioaustralia.net.au/international/2013-04-15/chinese-urged-to-eat-poultry-despite-bird-flu-cases/1116582?
Beijing H7N9 Cluster Raises Pandemic Concerns
Recombinomics Commentary 12:00 April 15, 2013 Zhu has so far shown no flu symptoms and is receiving medical observation in Beijing Ditan Hospital. Local health officials said a neighbor of the boy had bought chicken from the family whose seven-year-old girl became Beijing's first H7N9 case. The carrier was discovered after local disease control authorities tested 24 people who raise poultry in a village of Cuigezhuang township, Chaoyang District. The above comments provide information on the relationship between the first confirmed H7N9 case (7F) in Beijing, and the second (4M), who isasymptomatic. Both are being treated and/or observed in the same hospital in northeastern Beijing area (see map), further suggesting they both live in the same neighborhood. This cluster raises serious pandemic concerns. The WHO statements on the absence of sustained H7N9 transmission is based on limited detection of H7N9 in contacts of confirmed cases. Two familial clusters in Shanghai have been acknowledged. One clusterinvolved the first confirmed H7N9 case (87M). Two of his sons (69M and 55M) were hospitalized for pneumonia and one, 55M, died (as did the index case). However, the two sons tested negative. The second cluster involved a husband and wife. The index case (64F) also died and her husband initially tested negative. A subsequent sample from the lower respiratory tract was positive. Both of the clusters raise serious lab detection issues. Moreover, media reports suggests that most of the contacts of confirmed cases are being monitored via phone interviews, which may not identify milder cases. Thus, the WHO claim of no sustained transmission is based on negative data generated by highly suspect methodologies. The two cases in Beijing are relatively mild (one is asymptomatic and the other has been transferred out of the ICU). The current case fatality rate for H7N9 is 93% because 14 of the 15 outcomes of confirmed cases have been fatal. The two cases In Beijing will lower that rate when discharged, but the majority of cases have been reported as critical or severe. Moreover, the most recent death was for a case that was initially reported as stable, raising concerns that some cases WHO has classified as mild will also be fatal. Sequences from four fatal cases have been released and all have PB2 E627K. In contrast, E627K was not found in the three avian sequencesmade public. However, the avian sequences have Q226L, which is a receptor binding domain change that increases affinity for receptors in the human upper respiratory tract. Thus, it is possible that some human cases have an H7N9 infection lacking E627K. However, E627K increases the polymerase activity at lower temperatures, leading to higher levels of virus in the upper respiratory tract and the Beijing screening primarily involved samples collected from the upper respiratory tract, suggesting that the asymptomatic case described above has E627K. Release of sequences from the Beijing cases would be useful. The presence of E627K would raise serious questions about the WHO claim of no sustained H7N9 transmission and would increase pandemic concerns. |
WHO Joins Vietnam In Response To H7N9
HANOI, April 15 (Bernama) -- To further strengthen preventive measures against the new avian influenza strain of H7N9, Vietnam, in cooperation with the World Health Organisation (WHO) in Vietnam, will establish a task force to cope with the virus, China's Xinhua news agency reported quoting an official statement as saying Monday.
Besides, a control centre will also be set up to timely monitor and respond to any possible circumstances caused by the bird flu, according to the statement by Vietnamese Minister of Health (MOH) Nguyen Thi Kim Tien at a meeting here late last week with the Ministry of Agriculture and Rural Development (MARD) on deploying preventive measures against H7N9.
MOH will work closely with international organisations, particularly the WHO, to keep up-to-date with the epidemic's progress and seek their support in the form of medicine and medical equipment, said the health official at the meeting.
According to MOH, strict controls over poultry trade and strengthened coordination among localities nationwide are two of the most important measures to effectively prevent the spread of avian influenza H7N9 in Vietnam.
Other preventive measures include keeping good personal hygiene, regularly washing hands with warm water and soap, and avoiding possible sources of infection from poultry markets, the MOH advised.
Meanwhile, MARD head Cao Duc Phat instructed supervision and safe preventive measures to be strictly implemented, especially at poultry breeding farms, while border poultry trade are put under tight control.
Dr. Takeshi Kasai, WHO representative in Vietnam, said the WHO will continue to support Vietnamese health sector in defining the potential risks of H7N9 with updated information about the new strain, including exchange of news with the US Centre for Diseases Control (USCDC) and the United Nations' Food and Agriculture Organisation (FAO), as well as providing the country with necessary equipment to test with the virus.
Capital Hanoi's health department also had a meeting late last week with its partners in the northern border provinces with China, including Quang Ninh, Cao Bang, Lang Son, Lao Cai and Dien Bien, to discuss joint implementation of preventive measures, including tightening control of cross-border poultry trade.
Hanoi has set up five mobile response teams that are working around the clock to fight against H7N9. The teams are asked to respond to outbreaks within 30 minutes since they receive an order.
Equipped with first aid equipment and medicines, they are also tasked with guiding technical skills in diagnosis, treatment and prevention, reported the health department.
Meanwhile, central Da Nang City's health department has planned to buy more medical appliances in service of emergency cases. Special attention will be particularly paid during the upcoming national holidays, including the Liberation Day (April 30) and Labour Day (May 1), during which an international fireworks festival will be held in the city.
Remote control temperature measuring machines will be installed at Da Nang international airport and test will be applied to all entries. Any doubts about a sudden fever or infection will be put into separated rooms and carefully monitored, reported the local authorities.
While Vietnam has not yet reported any cases of humans infected with the H7N9 virus, the country reported the first case of death caused by the H5N1 strain this year on April 9, in which a four-year-old boy from southern Dong Thap province died. In addition, eight samples among nearly 5,000 dying salangane birds in central Phan Rang city were tested positive to the H5N1 virus.
As of April 14, the H7N9 bird flu spread to six Chinese localities, causing 60 infections and claiming 13 lives, reported state-run Vietnam News on Monday.
According to medical specialists, the source and means of this avian influenza's spread is not known yet. No vaccine is currently available for this subtype of the influenza virus and there is so far no evidence of human-to-human transmission. http://www.bernama.com/bernama/v7/wn/newsworld.php?id=942149
Bird Flu Surge in China Spurs H7N9 Pandemic Vaccine Preparations
Apr 15, 2013 2:03 AM ET
A surge in bird flu cases in China increases the pandemic potential of the H7N9 strain, according to a Beijing-based supplier of influenza vaccines to the Chinese government.
Sinovac Biotech Ltd. (SVA), the first company to win regulatory approval for a swine flu shot in 2009, is preparing to make immunizations against the new virus that’s infected dozens of people in China and killed 13. The Nasdaq-traded company will hold off producing the shots until it’s received an order from the state, said Chief Execu.. http://www.bloomberg.com/news/2013-04-15/bird-flu-surge-in-china-spurs-h7n9-pandemic-vaccine-preparations.html?
H7N9 expert warns human transmission possible
China Daily, April 15, 2013
Although no human-to-human infection of the H7N9 has been detected, a leading medical expert has cautioned that could happen as the virus mutates.
Respiratory expert Zhong Nanshan said during an interview on CCTV program One on One on Sunday that human transmission can't be ruled out.
More observation on the H7N9 influenza is needed, warned Zhong who reminded people the SARS virus had a low infection rate in the early stage of its outbreak. Hundreds died in the SARS outbreak in 2003. http://www.china.org.cn/china/2013-04/15/content_28545581.htm?
So far, 60 people have been infected with H7N9 in China with 13 deaths and a report of a new case in the capital Beijing.
Global Concerns Regarding Novel Influenza A (H7N9) Virus Infections
Timothy M. Uyeki, M.D., M.P.H., M.P.P., and Nancy J. Cox, Ph.D.
April 11, 2013DOI: 10.1056/NEJMp1304661
Severe disease in humans caused by a novel influenza A virus that is distinct from circulating human influenza A viruses is a seminal event. It might herald sporadic human infections from an animal source — e.g., highly pathogenic avian influenza (HPAI) A (H5N1) virus; or it might signal the start of an influenza pandemic — e.g., influenza A(H1N1)pdm09 virus. Therefore, the discovery of novel influenza A (H7N9) virus infections in three critically ill patients reported in the Journal by Gao and colleagues is of major public health significance. Chinese scientists are to be congratulated for the apparent speed with which the H7N9 virus was identified, and whole viral genome sequences were made publicly available in relatively short order. Because this H7N9 virus has not been detected in humans or animals previously, the situation raises many urgent questions and global public health concerns.
The key question for pandemic risk assessment is whether there is evidence of either limited or, more important, sustained human-to-human transmission — the latter being indicative of an emerging pandemic. If human-to-human transmission occurs, transmission dynamics, modes of transmission, basic reproductive number, and incubation period must all be determined. It is possible that these severely ill patients represent the tip of the iceberg and that there are many more as-yet-undetected mild and asymptomatic infections. Determining the spectrum of illness will help us understand the scope of the problem and assess severity. Enhanced surveillance for H7N9 virus infection is therefore urgently needed among hospitalized patients and outpatients of all ages with less severe respiratory illness. Other useful information can be derived from monitoring close contacts of patients with confirmed H7N9 cases to assess whether family members or health care personnel who provided care for patients with H7N9 virus infection have respiratory illness and laboratory-confirmed H7N9 virus infection. Such investigations will clarify whether H7N9 virus transmission in people appears efficient, or whether limited, nonsustained human-to-human transmission is occurring in persons with prolonged unprotected exposures, such as in clusters of HPAI H5N1 cases in blood-related family members. So far, the information provided by Chinese health officials provides reassurance that sustained human-to-human transmission is not occurring.
In addition to causing severe illness and deaths, the novel H7N9 viruses reported by Gao and colleagues have genetic characteristics that are of concern for public health. The hemagglutinin (HA) sequence data suggest that these H7N9 viruses are a low-pathogenic avian influenza A virus and that infection of wild birds and domestic poultry would therefore result in asymptomatic or mild avian disease, potentially leading to a “silent” widespread epizootic in China and neighboring countries. If H7N9 virus infection is primarily zoonotic, as reports currently suggest, transmission is expected to occur through exposure to clinically normal but infected poultry, in contrast to HPAI H5N1 virus infection, which typically causes rapid death in infected chickens.
The gene sequences also indicate that these viruses may be better adapted than other avian influenza viruses to infecting mammals. For example, the presence of Q226L in the HA protein has been associated with reduced binding to avian-like receptors bearing sialic acids linked to galactose by α-2,3 linkages found in the human lower respiratory tract,1 and potentially an enhanced ability to bind to mammalian-like receptors bearing sialic acids linked to galactose by α-2,6 linkages located in the human upper airway.1 Equally troubling is that Q226L in HA has been shown to be associated with transmission of HPAI H5N1 viruses by respiratory droplets in ferrets, one of the animal models for assessing pathogenicity and transmissibility of influenza viruses.2,3 These H7N9 viruses also possess the E627K substitution in the PB2 protein, which has also been associated with mammalian adaptation and respiratory-droplet transmission of HPAI H5N1 virus in ferrets.3 This H7N9 virus is a novel reassortant with HA and neuraminidase (NA) genes from an ancestral avian H7N9 virus and the six other genes from an avian H9N2 virus. The animal reservoir now appears to be birds, but many experts are asking whether these viruses might also be able to infect pigs, another common reservoir for zoonotic infections. The viral sequence data indicate antiviral resistance to the adamantanes and susceptibility to neuraminidase inhibitors, except for a 292K mutation in the NA protein of the A/Shanghai/1/2012 virus. Because this mutation has been associated with in vitro resistance to neuraminidase inhibitors in another N9 NA subtype virus, additional analyses must be undertaken to understand its significance. It is not known whether this mutation arose de novo in the host or is associated with oseltamivir treatment. Ongoing surveillance is crucial to assessing the emergence and prevalence of H7N9 viruses resistant to available antivirals.
Since available diagnostic assays used in clinical care (e.g., rapid influenza diagnostic tests) may lack sensitivity to identify H7N9 virus and since existing molecular assays will identify H7N9 virus as a nonsubtypeable influenza A virus, a critical public health issue is the rapid development, validation, and deployment of molecular diagnostic assays that can specifically detect H7N9 viral RNA. Such assays have been developed in China and are in development in many countries including the United States, and they will be deployed as they were for the 2009 H1N1 pandemic.4Having available H7-specific assays will facilitate surveillance of H7N9 virus infections and help address key questions such as the duration of viral shedding, the infectious period, the optimal clinical specimens for laboratory confirmation, and the spectrum of clinical illness.
The clinical features described in the three patients with H7N9 virus infection, including fulminant pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), septic shock, multiorgan failure, rhabdomyolysis, and encephalopathy, are very troubling. Clinical care of severely ill patients should be focused on evidence-based supportive management of complications such as ARDS. Adherence to recommended infection-control measures in clinical settings to reduce the risk of nosocomial transmission cannot be overemphasized.
All three patients with H7N9 virus infection reported by Gao and colleagues received late treatment with oseltamivir starting on day 7 or 8 of illness while critically ill. Data related to human infections with seasonal, pandemic, and HPAI H5N1 viruses indicate that the earlier antiviral treatment is initiated, the greater the clinical benefit. Therefore, oral oseltamivir or inhaled zanamivir should be administered to patients with suspected or confirmed H7N9 virus infection as soon as possible. Secondary invasive bacterial infections associated with influenza can cause severe and fatal complications, and appropriate empirical antibiotic treatment for community-acquired bacterial infections may be indicated for initial management of severe H7N9 pneumonia. Caution should be exercised regarding the use of glucocorticoids, which are not indicated for routine treatment of influenza. Clinical research, including randomized, controlled trials and observational studies, is urgently needed on new antiviral agents, including parenteral neuraminidase inhibitors and drugs with different mechanisms of action, combination antiviral treatment, and immunotherapy. To inform clinical management, rapid clinical data collection, data sharing, analysis, and timely feedback are needed worldwide.5
Because H7N9 virus infections have not occurred in humans before, it is expected that persons of all ages might be susceptible worldwide. Serologic assays must be developed so that studies can be conducted to determine whether some people have cross-reactive antibodies to these viruses from prior influenza A virus infections. Existing H7-vaccine viruses are not well matched to this novel H7N9 virus, and extensive efforts are under way to develop potential H7N9 vaccines as quickly as possible. These efforts have started worldwide using the H7N9 sequence data obtained from these early cases, and sharing of H7N9 viruses will further facilitate vaccine development. There are many challenges to making H7N9 vaccines available. Previously studied H7 vaccines were poorly immunogenic in humans, and clinical trials to assess the safety and immunogenicity of H7N9 vaccine candidates will be needed. But even if new vaccine manufacturing technologies, such as tissue-cell-culture–derived vaccine antigens, are utilized, the process from vaccine development to availability will probably take many months.
The 2009 H1N1 pandemic taught us many lessons, including that a pandemic virus can emerge from an animal reservoir in an unexpected location and be spread rapidly through air travel. The focus on critically ill adults early in the pandemic led to elevated public concern about pandemic severity. Clear communication of key messages to the public and the clinical community is critical in implementing successful prevention and control activities. The detection of human H7N9 virus infections is yet another reminder that we must continue to prepare for the next influenza pandemic. The coming weeks will reveal whether the epidemiology reflects only a widespread zoonosis, whether an H7N9 pandemic is beginning, or something in between. The key is intensified surveillance for H7N9 virus in humans and animals to help answer important questions. We cannot rest our guard.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
This article was published on April 11, 2013, at NEJM.org.http://www.nejm.org/doi/full/10.1056/NEJMp1304661
Anhui Province new case
Anhui Province new case of human infection with H7N9 avian influenza
Anhui Provincial Health Department Bulletin, April 15 in Anhui Province confirmed case of human infection of H7N9 avian influenza. So far, Anhui Province reported a total of three cases of human infection with the H7N9 avian flu, and 1 died.
Patients Chen, male, 60 years old, Tianchang people, retirees, a company in the local guard. Patients with disease, Tianchang a hospital on April 11 to April 10. April 14, Chuzhou CDC influenza the network laboratory detection of influenza virus in patients with Universal nucleic acid positive, H7 subtypes positive; April 15, the provincial CDC detects review man infected with the H7N9 avian influenza virus nucleic acid positive. The same day, the provincial expert group based on national human infection with the H7N9 avian flu clinic program (2013 Edition) ", and the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases. Patients in critical condition, has been transferred to a hospital in Chuzhou isolation treatment. Close contact with a total of 25 people, until now, were not unusual. http://news.youth.cn/gn/201304/t20130415_3103610.htm
Sunday, April 14, 2013
Fluffy puppies, pretty flowers and fairy tales
61 cases in 2 weeks that we KNOW of. Very many on tamiflu. Sound fishy to me.Try to be prepared, since they refuse to give us timely information, they in fact WILL NOW DELAY INFORMATION EVEN MORE.
There are a lot of these kind of reports..here are a few.
Soon, They will be telling you how mild it is.. and that many people are sick and we are only reporting on the very sick ones.
*All uses of “bird flu” on this page refer to avian influenza A (H5N1). There are other types of bird flu, but these are not known to infect humans. http://wwwnc.cdc.gov/travel/page/human-infection-avian-flu-h5n1-advice-for-travelers-current-situation.htm
Adolfo Garcia-Sastre, a microbiology professor at Mount Sinai School of Medicine in New York and principal investigator for the Center for Research on Influenza Pathogenesis, said while it was “too early to be able to conclude anything … the probabilities are very low” that a global pandemic is looming..
http://behindthewall.nbcnews.com/_news/2013/04/13/17720122-it-started-with-a-cough-deadly-china-bird-flu-outbreak-raises-fears-of-pandemic?lite
There are a lot of these kind of reports..here are a few.
Soon, They will be telling you how mild it is.. and that many people are sick and we are only reporting on the very sick ones.
CDC: expected summer H7N9 epidemic will be controlled
2013 04 15, 2010 02:39 Currently, H7N9 virus to heat sensitive, the avian influenza virus is generally sensitive to heat, as temperatures rise, the activity of the virus will be reduced. As the city into the summer, rising temperatures, the expected epidemic or the initial control..
The Chinese CDC Expert: public infected with the H7N9 virus risk is still low
Avian Flu (H7N9) in China
*All uses of “bird flu” on this page refer to avian influenza A (H5N1). There are other types of bird flu, but these are not known to infect humans. http://wwwnc.cdc.gov/travel/page/human-infection-avian-flu-h5n1-advice-for-travelers-current-situation.htm
Adolfo Garcia-Sastre, a microbiology professor at Mount Sinai School of Medicine in New York and principal investigator for the Center for Research on Influenza Pathogenesis, said while it was “too early to be able to conclude anything … the probabilities are very low” that a global pandemic is looming..
http://behindthewall.nbcnews.com/_news/2013/04/13/17720122-it-started-with-a-cough-deadly-china-bird-flu-outbreak-raises-fears-of-pandemic?lite
O'Leary, head of WHO's office in China, said "the good news" was that there was still no evidence that humans had passed on the virus to other humans.
"As far as we know, all the cases are individually infected in a sporadic and not connected way," he said, adding that the source of infection was still being investigated.
Malaysia Safe From H7N9
http://www.tv3.com.my/beritatv3/berita_terkini/LIOW_H7N9.html?utm_source=twitterfeed&utm_medium=twitter
"On the morning of April 11, I found my child had a fever , and I soon remembered H7N9, which I saw from TV , so I took her to the hospital ," Yao was quoted as saying by Beijing Youth Daily .
"But I 'm still not sure she caught H7N9 from our chickens , because I had killed chickens , cooked chicken and ate chicken , and I 'm still fine . But my girl had never touched the chickens . She stood at least one or two steps away from the chickens watching them ," he said .
Yao and his wife are now quarantined at home .A dealer surnamed Tai who lives in Baodi district in Tianjin , said he had sold chickens to Yao . The chickens were from a farm in Wuqing district of Tianjin .
TheTianjin government tested Tai 's chickens and chickens at the farm in Wuqing . No H7N9 virus was detected .
The
http://www.chinadaily.com.cn/china/2013-04/15/content_16400644.htm?
The Beijing old village girls infected with H7N9 control the whole village
H7N9 avian flu in Beijing Shunyi District, the first girl living surnamed Yao old village, comprehensive control and out yesterday, all entrances guarded by security personnel, people and vehicles shall be registered and out of the village outsiders visited the object could not answer, were refused to enter the village .
Old village is located in the northern suburb of Shunyi District of Beijing East, nearly 20 km from the Beijing area, vertical composition of the village by the East Main Street, Centre Street, West Street, three streets belong to the large local villages; As for the surrounding farmland, The newly developed communities and traditional villages pastoral areas, population and settlements distribution and relatively urban open space.
The southern end of the old village streets, the main gateway of the villagers out of the village, has obvious archway archway with iron gates, but usually does not close. As for the northern end of the part of export and other alleys, with an iron gate, but usually have never closed.
However, since the village surnamed Yao girls identified as infected with H7N9, all entrances of the old village has 1 to 2 security personnel guarded and out all required registration documents, write your name, license plate number and visited object. Village outsiders want to enter, if not answer the visits to the object, it will be rejected into the village.
A visit to the ancient city of village friends people told the Central News Agency reporter since yesterday, surnamed Yao girls doorstep fixed four security guard is intended to isolate the parents of the girls, if the two need a meal or buy some necessities. shall call a neighbor purchasing.Yesterday to today, there are a number of epidemic prevention staff repeatedly go the disinfection and exploration.
According to the Beijing News reported, the ancient city village usually has been trafficking in live chickens, including the parents of the girl surnamed Yao. Girls infected with H7N9 avian influenza , the village a total of 503 live birds were slaughtered and harmless treatment.
1 o'clock yesterday morning, the first case of bird flu in Wenzhou been diverted Hangzhou.http://news.66wz.com/system/2013/04/15/103607696.shtml
No clinical symptoms to confirm a 4-year-old boy carrying the H7N9 virus
2013 04 15, 2011 03:45
30 points, on April 14, 2013, the Beijing Municipal Health Bureau received a the Beijing CDC report found a father first case of human infection of H7N9 avian influenza confirmed cases of trafficking poultry populations Active screening monitoring 4-year-old bamboo surname boys H7N9 avian influenza virus nucleic acid positive. The boy is currently no clinical symptoms. Clinical expert in Beijing, according to its clinical manifestations, epidemiological investigation and laboratory test results, the overall judgment of the boy man infected with the H7N9 avian flu virus carriers. Out of concern for the health of the children, the Ministry of Health goalkeeper sent to the Ditan hospital for close medical observation. The active screening monitoring implementation by the Chaoyang District CDC, milk range including Chaoyang District, Cuigezhuang is the East Village poultry farmers a total of 24 people, the way of collecting a throat swab specimens were sent to the Beijing CDC for testing. The boys' parents engaged in the sale of poultry fish, its across the street neighbor bought the family of the first confirmed cases of trafficking chicken.The discovery carriers, Beijing extends from the passive "syndromic surveillance" to carry out the initiative pathogen monitoring of high-risk groups "to further improve the prevention and control work initiative, the forward-looking results achieved. Expert analysis, monitoring the active screening results with some reference to judge the virulence of the H7N9 avian flu virus susceptible populations. 
andhttp://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/15/24206394_0.shtml?_from_ralated
andhttp://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/15/24206394_0.shtml?_from_ralated
Guangzhou pigeons file female boss early morning sudden death
2013 04 15, 2011 03:58
Southern News reporter Liu Jun Wang Daobin early yesterday morning, the Guangzhou Baixing three birds wholesale market in the sudden death of a dove file female boss, causing a burst of panic within the line. The family of the deceased and experts said, should be independent of and H7N9.
Witnesses said the corpses away at 6:00 in the morning yesterday, the police far stood "not close". The inner line of the message a few minutes, spread, many people tried to get to the market stall owners call message. "Brain haemorrhage death, the results are out. Assured that is definitely not the avian flu." Worried that their business affected everyone's answer seems resolutely simply and unified.
Named Li and month of the dead, 48-year-old, Huaihua, Hunan Mayang County. The memories of her husband Huang, more than 11:00 last night, when the wife to get up on the toilet, and also told him to go to bed early to stop the beating of mahjong, no abnormalities were found. 0:00, Huang found his wife shortness of breath, unable to speak by phone light to find wife face right, and quickly began to do artificial respiration. After a child is not improved, Huang quickly hit 120. The ambulance arrived seven minutes later. But his wife is still away at 1:00 yesterday.
Huang said that the body has been a good wife, before no fever, no cold, no illness, and certainly not the avian flu. Recent sluggishness, his wife the day before head dyed red hair back. 120 VMOs stated in the coroner's column: "cardiopulmonary arrest." Guangzhou CDC has not yet received the report, people die so suddenly like H 7N 9 due. Currently forensic corpse dissected diagnostic results are not yet out. http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/15/24206716_0.shtml?_from_ralated
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