It's Time to Worry About the New Chinese Bird Flu

By JEFF NESBIT

April 26, 2013
It's time for the world's public health officials to pay very close attention to the new bird flu outbreak in China first detected in March. To put it bluntly, there are now some seriously dangerous developments occurring around the new disease outbreak in China that infectious disease specialists and international public health specialists need to track closely.

Let's start with three new developments reported on earlier this week by Jason Koebler, U.S. News & World Report's science and technology correspondent: the first reported case of the new bird flu strain outside China; the fact that any potential vaccine tests in animals (not humans) may be up to six weeks out; and, more ominously, that Chinese officials suspect that there may be cases of human-to-human transmission in the 100-plus reported cases (which includes 22 deaths).

"The situation remains complex and difficult and evolving. When we look at influenza viruses, this is an unusually dangerous virus for humans," Keiji Fukuda, the World Health Organization's assistant director-general for health security, said Wednesday at a briefing.

Chinese officials – and public health officials around the world – had hoped that this potentially virulent and deadly bird flu strain (H7N9) could be contained inside China and that it would not progress or mutate to the point where humans could transmit the strain to other humans. But, of the patients analyzed so far, half appear to have had no contact whatsoever with poultry

Now, we have the first reported case outside China appearing in Taiwan this week. A 53-year-old male, Taiwanese citizen who worked in the Jiangsu Province in China, developed symptoms three days after returning home, according to Taiwan's Central Epidemic Command Center. And because Chinese officials are also publicly saying at least some of the existing cases may have involved human-to-human transmission, this new bird flu strain could spread – and fast.

None of this is good.

Right now, 18 percent of the cases in China have ended in death. While this is still less deadly than the previous avian flu outbreak in China six years ago – the H5N1 bird flu virus eventually killed more than 300 people after spreading from China to other countries in 2006 – the death rate for this new Chinese bird flu epidemic is more than triple the mortality rate of tuberculosis in China today.

Despite widespread fears among public health officials that the earlier bird flu strain years ago might become a human-to-human pandemic, that didn't occur. Nearly all reported cases of the earlier bird flu strain, while deadly, seemed to jump from poultry to humans who were handling them or in contact with them. For this reason, despite dozens of outbreaks, it was easier to contain the spread.

But if this new bird flu strain does, in fact, become capable of human-to-human transmission, and it takes awhile for a suitable vaccine to be developed, then international public health officials are going to start sweating. And the public, rightly so, will be worried.

One flu virology expert, John Oxford from Queen Mary University in London, told Reuters this week that the emergence of this completely new strain of bird flu infection in humans was "very, very unsettling." This new strain is, in fact, a mixture of three different types of bird flu variants and "seems to have been quietly spreading in chickens without anyone knowing about it," he said. This has likely been going on for at least two years.

Public health officials, in general, have been worried about bird flu viruses for years. Research several years ago showed the virus could be transmitted from an expectant mother to a fetus, and that the virus isn't just contained in the lungs – it can also migrate throughout the body. This new strain is likely to have similar capabilities.

What's more, it could re-ignite fears about the possibility of deadly global pandemics. A decade ago, several well-known virologists and public health experts warned in published papers that the world was at risk for of pandemics that could kill tens of millions of people – or even more – without adequate infectious disease monitoring and medical research. The 2006 Chinese bird flu outbreak came on the heels of those global pandemic warnings.

The good news is that China is more transparent about disease epidemics now than it was a decade ago, and the number of reported cases with the new bird flu strain has not jumped dramatically so far. And China learned a lot about how to limit the spread of bird flu during previous outbreaks, simply by closing down poultry markets that appear to be a likely starting point.

But the fact the new H7N9 strain has now moved outside China – and that Chinese officials are taking a close look at human-to-human transmission possibilities – should send up more than a few red flags. Just because the previous bird flu outbreak in China didn't spread quickly and prove as deadly as some had feared does not mean that this new outbreak will follow a similar course.

If the suspicions of human-to-human transmission potential are confirmed, that alone makes the threat of a pandemic – as opposed to a series of local outbreaks that can be contained with efforts to close down poultry markets or the sale of infected birds – more likely. Chinese media have said in recent days that officials believe some of the cases to be likely human-to-human transmissions. WHO officials have said that this new strain transmits to humans more easily than the previous strain.

In the case of a pandemic, a vaccine would need to be developed and distributed quickly. A California company (Inovio) is in the early stage of developing a potential vaccine, with plans to get access to the virus in a highly protected lab environment for its initial tests. In a worst-case scenario, a vaccine could skip animal tests and be administered to humans.

Let's hope it doesn't come to that –and that public health officials are paying attention. http://www.usnews.com/news/blogs/at-the-edge/2013/04/26/its-time-to-worry-about-the-new-chinese-bird-flu

Influenza A virus: Specimen to be tested

Nadira Gunatilleke

Arrangements will be made to test the specimen obtained from the influenza affected closed and sterilized ICU at the Castle Street Maternal Hospital, and re-open it after confirming its safety, Director General Health Services, Dr. Palitha Mahipala said.

According to Dr. Mahipala, only one ICU at the Castle Street Maternal Hospital was closed after the Influenza A virus

was found although various other viruses have been found at other hospitals, such as Mahamodara, Colombo National Hospital etc in the past. "It is a common phenomena in the world and not all viruses are dangerous. Similarly in the past, a committee of experts were appointed on the issue and arrangements have been made now to implement its recommendations.

"Only two pregnant mothers died of complications, while eight others who were infected recovered. The experts' committee headed by the Castle Street Maternity Hospital Director had representative from the IDH, MRI, NHSL, Epidemiology Unit of the Health Ministry etc. http://www.dailynews.lk/2013/04/27/news13.asp?

People infected with H7N9 can shed virus for 3 weeks, potentially infecting others

On March 31, 2013, the China Health and Planning Commission notified WHO of three human infections in Shanghai and Anhui with a novel influenza virus characterised as avian influenza A H7N9 (illness onset between Feb 19 and March 15, 2013).

The severity of disease was remarkable, as was the fact that patients were from towns located 400 km apart, and had no epidemiological connection
Yu Chen and colleagues report details of their first H7N9-infected patient from Zhejiang province, and three additional cases who were identified by retrospectively testing 486 patients admitted to hospital with pneumonia between March 7 and April 9, 2013. Combined with those described by Gao and coworkers, Chen and colleagues' findings show a disease profile characterised by bilateral pneumonia progressing to acute respiratory distress syndrome, and multiorgan dysfunction that resembles human infections with highly pathogenic avian influenza A H5N1 virus or severe seasonal or pandemic influenza.

Chen and coworkers' findings add some essential pieces of information to further understanding of the emerging virus. First, viral RNA shedding can be prolonged (up to 11, 17, and 20 days in three patients), which might indicate absent previous immunity or the presence of comorbidities, or both. 

Second, the virus might not be detected in upper-respiratory-tract specimens, such as throat swabs, but could still be readily detectable in lower-respiratory-tract specimens, which, as for H5N1 infections, emphasises the importance of collecting lower-respiratory-tract specimens (if possible) when H7N9 infection is suspected in severely ill patients.

Third, although data for only two patients are presented, the concentrations of some cytokines and chemokines and viral loads were higher in a patient who died than in one who was recovering at the time of writing.3

Such findings have also been noted in H5N1 and the 2009 H1N1 infections.

Finally, whereas most reported cases of H5N1 infection were in previously healthy children or young adults (median age 27 years in China), the seven patients infected with H7N9 virus reported so far had comorbidities, and the age profile of cases is skewed (median age 63 years).

Most known patients were identified when they were admitted to hospital with severe respiratory disease, and the retrospective case-finding described by Chen and colleagues shows that diagnosis might have been missed, even in patients with severe disease. Besides surveillance in patients with mild respiratory symptoms, which could easily overwhelm diagnostic capacities, targeted serological studies could be considered to test whether seroprevalence is higher in people who regularly visit live markets than in those who do not regularly visit markets, and possibly look for other sources of infection.

Almost a third of notified patients up to now did not have any recognised exposure to poultry, and only a small proportion of birds tested have been positive for the virus.

Subcription required.
http://www.thelancet.com/journals/lancet...ntId=login

Acer asks 8 employees to stay home after they visit H7N9 patient

Home > Latest

2013/04/26 22:49:13

Taipei, April 26 (CNA) Taiwan's computer maker Acer Inc. asked eight of its employees, who recently went to the hospital to visit a patient infected with the H7N9 bird flu virus, to work from home, but a doctor said Friday that such a decision is not necessary.

Luo I-chun, a physician at Taiwan's Centers for Disease Control (CDC), said his agency is aware of the eight Acer employees' visit.

However, Luo said that since the eight people did not have direct contact with the patient and merely met with the patient's family at the hospital, Luo said the preventive measures taken by the company was unnecessary.

According to Acer, the eight employees paid a visit to the 53-year-old patient Tuesday, before he was confirmed to be infected with the H7N9 virus the following day.

The patient, who is a businessman working in China, was reported to be an former employee of the computer maker, although authorities did not reveal his identity.

The company said it has asked the eight workers to work from home for seven days from Thursday, and during that period, to regularly monitor their own health, following the government's instructions.

Acer added that the company has begun reducing employees' trips to China after the country reported H7N9 human cases starting March 31.

The 53-year-old patient is the first and the only confirmed H7N9 case in Taiwan. Health officials are still awaiting test results of 13 possible patients, as of 5 p.m. Friday, according to the CDC's press release.

Meanwhile, China has confirmed 112 H7N9 human cases, with 23 fatalities, the CDC release said. No case has been reported outside Taiwan and China. http://focustaiwan.tw/news/aall/201304260038.aspx

H7N9 spread in nine provinces and municipalities the correct disease cases increased to 114 cases 24 dead

 April 26, 2013 - (Epoch Times reporters Yang Yifan roundup) According to official Chinese reports, as of the evening of 26, the mainland reported a total of 114 cases of human infection with the H7N9 avian influenza confirmed cases, 24 deaths. 26, 2009, Fujian Province confirmed case of human infection with H7N9 avian influenza. Jiangxi Province, also confirmed the first case of human infection with the H7N9 avian influenza.Zhejiang and Henan, a new celebrity each confirmed cases of the H7N9 avian influenza infection...

http://www.epochtimes.com/gb/13/4/26/n3856585.htmH7N9%E8%94%93%E5%BB%B69%E7%9C%81%E5%B8%82-%E7%A1%AE%E7%97%87%E7%97%85%E4%BE%8B%E5%A2%9E%E8%87%B3114%E4%BE%8B24%E6%AD%BB.html?utm_source=twitterfeed&utm_medium=twitter

Frequently Asked Questions on human infection caused by the avian influenza A(H7N9) virus, China

Update as of 26 April 2013

Note that this document supersedes the previous version. Updates will be posted as new information becomes available.

1. What is the avian influ...

4. Why is this virus infecting humans now?

We do not know the answer to this question yet, because we do not know the source of exposure for these human infections. However, analysis of the genes of these viruses suggests that although the viruses have evolved in birds, they may infect mammals more easily than other avian viruses.

7. How are people becoming infected with the avian influenza A(H7N9) virus?

At this point it is not known how persons are becoming infected. Some of the confirmed cases had contact with animals or with environments where animals are housed. The virus has now been found in chickens, ducks, and captive-bred pigeons at live bird markets near locations where cases have been reported. The possibility of an animal source of the infection is being investigated, as is the possibility of person-to-person transmission.

12. Is the source of infection poultry and live poultry markets?

Although some evidence points to live poultry as a source of infection, it cannot yet be confirmed that live poultry is the primary or the only source of infection. Neither is there enough evidence to exclude other possible animal or environmental sources of infection.

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

We do not yet know enough about these infections to determine whether there is a significant risk of community person to person spread. This possibility is the subject of epidemiological investigations that are now taking place.

19. Does this influenza virus pose a pandemic threat?

An animal influenza virus that develops the ability to infect people could theoretically carry a risk of causing a pandemic. However, whether the avian influenza A(H7N9) virus could actually cause a pandemic is unknown. Other animal influenza viruses that have been found to infect people occasionally have not gone on to cause a pandemic...

http://www.who.int/influenza/human_animal_interface/faq_H7N9/en/index.html

H7N9 Update; CDC Pandemic Preparedness Activities Progress

April 26, 2013 – The number of human infections with avian influenza A (H7N9) in China has risen to 109; with 23 deaths.* There are still no reports of H7N9 in the United States. While there is no evidence of sustained human-to-human spread of this virus, CDC is taking routine pandemic preparedness measures to prepare for that possibility. This update contains information on CDC laboratory activities to date, an update on the H7N9 outbreak in China and background information on RT-PCR tests.

CDC Activities to Date Include:

A CDC scientist uses a pipette to transfer H7N9 virus into vials for sharing with partner laboratories for public health research purposes.

Growing and Sharing the Virus

The first H7N9 virus isolate from China was received by CDC on Thursday, April 11, 2013. The virus was immediately inoculated into hundreds of eggs to grow more of the virus. The virus replicated well in eggs – not unusual for an avian influenza virus – and CDC was able to begin packaging vial samples of virus to distribute to other laboratories on Monday April 15, 2013. At this time, CDC has sent H7N9 isolates to 5 laboratories, including the United States Department of Agriculture. Only laboratories with the proper permits can receive the H7N9 virus isolate.

Conducting Studies with the Virus

CDC is using the H7N9 virus isolate to learn more about how the virus causes disease and its potential to spread among humans. Studies using cell cultures and animals will provide information about the severity of associated disease, as well as the pathology of the infection (what the virus does to the body either directly or indirectly). Additionally, animals are used to conduct studies on how the virus spreads. So far these studies have confirmed that this virus spreads between animals through close contact, which was expected. Studies to determine whether this virus can be spread in respiratory droplets through the air are ongoing.

Collecting Antiserum

Animal studies also allow for the collection of antiserum (antibodies) to these viruses so that the animals’ immune responses to the virus can be examined and other studies on immunity can be performed. Methods to detect immune responses in human serum are under development and will be used to study population immunity to the H7N9 virus. These studies are just getting underway; results are not expected for some time. The antibody tests also will be used to see if the candidate H7 vaccine viruses in development are a good match to the wild virus detected in China.

Creating a Test to Detect This Virus

CDC has completed work on new laboratory diagnostic test materials to identify human infections with the new avian influenza A (H7N9) virus. Influenza diagnostic tests already in use at qualified public health laboratories identify the new H7N9 virus as “unsubtypable” influenza A viruses, but cannot specifically identify the H7N9 subtype. The CDC H7N9 test materials are intended for use with real-time RT-PCR (reverse-transcriptase polymerase chain reaction), a highly accurate and sensitive laboratory test for detecting and identifying flu viruses in respiratory specimens by type and subtype. Providing this test to qualified public health laboratories will allow for more rapid testing of H7N9, though any H7N9-positive samples will continue to be sent to CDC for confirmation. Domestic and international shipping of these diagnostic test materials began this week.

CDC was able to develop the diagnostic test before receiving the H7N9 virus isolate using posted genetic sequences on GISAID. The actual virus isolate was used to confirm the sensitivity and specificity of the test. The test has been authorized for use in the United States under an “Emergency Use Authorization (EUA),” a regulatory step that allows the Food and Drug Administration (FDA) to swiftly authorize the use of new laboratory diagnostic test kits in the United States. While these tests are being distributed under an EUA, it’s important to note that there is not a public health emergency in the United States. Distribution of diagnostic test kits domestically is a preparedness measure.

Developing a Vaccine Virus Candidate

CDC reports continued progress in developing an H7N9 candidate vaccine virus that could be used to manufacture H7N9 vaccine should that become necessary.

Testing for Antiviral Susceptibility

CDC also has tested the H7N9 virus isolate it received from China to see if it is susceptible to the influenza antiviral drugs oseltamivir/Tamiflu® and zanamivir/Relenza®. Laboratory testing at CDC indicates that this first virus isolate received on April 11 is sensitive (susceptible) to these “neuraminidase inhibitors,” (NAIs) the two antiviral drugs now recommended to treat seasonal flu. Testing showed the virus would be resistant to the adamantanes, another class of antiviral drugs that are not currently recommended for use because of widespread resistance.

It’s important to note that influenza viruses can be, or can become, resistant to influenza antiviral drugs, and if this happens, these medications may not be fully effective. The H7N9 virus detected in China is a new virus and there is a lot to learn about its properties. In addition, the virus is still evolving. As new H7N9 virus isolates are received, CDC will conduct testing to determine their susceptibility to existing antiviral drugs. Now, CDC recommends oseltamivir/Tamiflu® and zanamivir/Relenza® for treatment of patients with suspected or confirmed H7N9.

All work with live H7N9 virus is being done in Biosafety Level-3 (BSL-3) enhanced containment. A BSL-3 facility with specific enhancements includes primary (biological safety cabinets, bio-isolator chambers, personal protective equipment) and secondary (facility construction, HEPA filtration treatment of exhaust air barriers to protect laboratory workers and the public from accidental exposure. Specific enhancements include change-of-clothing and shower-out requirements, and the use of a powered air purifying respirator (PAPR) as part of the workers’ personal protective equipment.

Supporting Investigation in China

CDC received a request for bi-lateral assistance from China and a CDC team is in country now supporting the domestic outbreak investigation and response.

Top

Update on H7N9 in China

While some mild illness has been reported in H7N9 patients, most have had very severe illness. China is reportedly treating H7N9 cases and recommending treatment of their symptomatic contacts with oseltamivir.

Since this H7N9 virus is a novel influenza virus with pandemic potential, the source of the human infections and how this virus spreads is being carefully investigated. H7N9 has been detected in Chinese poultry. While the investigation is ongoing, the current working assumption is that most people have been infected with the virus after having contact with infected poultry or contaminated environments. A New England Journal of Medicine (NEJM) article authored by Chinese public health officials released on Wednesday, April 24, 2013 reports that 77% of the first 82 H7N9 patients had some animal exposure.

China also is conducting follow-up investigations among close contacts of people infected with H7N9 virus to try to assess whether any human-to-human spread of this virus is occurring. According to the NEJM article, more than 1,200 close contacts of the first 82 H7N9 patients were followed for 7 days to see whether they would develop symptoms. While some people have developed flu-like symptoms, all tested negative for H7N9. However, the NEJM article also reports on two small clusters of cases where human-to-human spread could not be ruled out, but it is possible there may have been other animal exposures in those cases as well. The results of China’s investigations to date suggest that if any human-to-human transmission is taking place, it is very rare and it is not sustained (ongoing). In the past,limited and unsustained human-to-human transmission has been observed with other avian influenza viruses, most notably H5N1. There is no evidence that sustained (ongoing) spread of this virus from person to person is occurring.

Human infections with avian influenza viruses are rare and most often occur after people are in direct or very close contact with an infected bird (either live or dead) or environments contaminated with avian flu virus. The extent of the H7N9 avian outbreak in poultry is still being assessed, but China has reportedly begun culling birds in live markets. Infected birds can shed a lot of flu virus, for example, in their droppings or their mucus. If someone touches an infected bird or an environment contaminated with virus and then touches their eyes, nose or mouth, they may be infected with bird flu virus. There is some evidence that infection may also occur if the flu virus becomes airborne, such as when an infected bird flaps its wings. If someone were to breathe in airborne virus, it’s possible they could get infected.

This situation continues to evolve rapidly and CDC will provide updates are more information becomes available.

http://www.cdc.gov/flu/spotlights/h7n9-cases-update.htm

Philippines NAIA starts bird flu screening

Authorities at the Ninoy Aquino International Airport (NAIA) on Friday advised passengers who will be arriving from China and Taiwan

to approach airport quarantine officers first to determine if they manifest flu-like symptoms that can be associated
with the H7N9 flu virus.

The virus, according to the World Health Organization (WHO), has already infected more than 100 people and has caused 22 deaths.

The Department of Health (DOH) however said it is still not definite if the virus could be passed through human-to-human transmission.

Still, the DOH said people who manifest flu-like symptoms and have difficulty in breathing after a trip from China or Taiwan should immediately see a doctor.

The health department, in earlier advisories, said that young children and old people with serious medical condition are more prone to the H7N9 virus.

Asian countries on Thursday urged renewed vigilance against a spread of H7N9 bird flu after Taiwan reported a case of the deadly strain, the world’s first outside mainland China.

The self-governing island urged its residents to take “enhanced precautions” when visiting China—placing Shanghai, Beijing and five Chinese provinces on particular alert for travellers after at least 22 deaths were confirmed there.

Taiwan’s Centers for Disease Control (CDC) confirmed on Wednesday that a 53-year-old Taiwanese man, who had been working in the eastern Chinese city of Suzhou, showed symptoms three days after returning home via Shanghai on April 9.

The man, who was infected in China, has been hospitalized since April 16 and is in a serious but stable condition, it said.

There have been at least 111 confirmed cases of human infection with H7N9 avian influenza in China, including the fatalities, figures from Chinese authorities and the World Health Organization showed Thursday.

State news agency Xinhua reported early Friday that the eastern province of Jiangxi had reported its first case. Xinhua, citing local health authorities, said a 69-year-old man was in a critical condition in hospital.

On Thursday the WHO maintained its global advisory for combating the bird flu, urging against contact with live poultry but not recommending any restrictions against travel to China. http://www.manilatimes.net/index.php/news/top-stories/46276-naia-starts-bird-flu-screening?

The patients stained fecal clothing suspect broadcast H7N9 Jiangxi

The patients stained fecal clothing suspect broadcast H7N9 Jiangxi fall diagnosed

On April 25, the Third Hospital of Nanchang is taking measures to actively treat the first case of human infection of H7N9 avian influenza in Jiangxi patients with suspected cases.

 Homes forum

H7N9 avian influenza remains sporadic communication, together with the new yesterday 4 (2 Zhejiang Province, Henan Province, one, Jiangxi 1) has been accumulated to 113 cases. And "New England Journal of miscellaneous shake Fun Pi ⒈ anchor vent Research results, half of the H7N9 avian influenza disease within 11 days of the deceased death, shows that the virus can quickly kill; a suspected family group, dissemination of case may be infested with daughter diarrhea father washing underwear in contact fecal infection.

H7N9 avian influenza \ & homes forum

Chinese researchers have collected in February this year to April 17 of the 82 confirmed H7N9 patients medical records and analysis of epidemiological data (see table). The study pointed out that 77 people may come into contact with birds. Relative infected with the H5N1 patient median, and acute respiratory distress syndrome (ARDS), 7 and 7.5, a median of 8, 19 H7N9 patients with ARDS onset to hospitalization bit number of 4.5. 17 patients from the median onset to death was 11 days, shows that the virus can quickly kill.

Half of the dead 11 days of death

Currently, there are five groups of close contact with suspected cases of H7N9 infections. The researchers analyzed two suspected family group dissemination of case, including the first in the pathogenesis of Shanghai, surnamed Li and his son; surname and a pair of father and daughter living in Lakeside District, Wuxi City.

Which ZhangFu March 1 have been to a live poultry market, and women there is no contact with live poultry, but the father of the disease to rest at home and during hospitalization, women are in the absence of protective measures to take care of him, and parent turn into the intensive care unit after 3 days, women had to wear @ gloves to be the father of diarrhea wash the laundry, 3 days later even female incidence admission daughter was subsequently confirmed as infected with H7N9.

The study pointed out that the lack of evidence of the spread of H7N9 and the group spread, but given the two suspected family group dissemination of case, it can not rule out the virus can be transmitted person to person. Studies suggest that to enhance the monitoring and investigation of birds and environmental risk data.

Respiratory Medicine, Zhongshan University, Hong Kong Professor Xu Shuchang of, the Zhang father has only been suspected cases, depends on whether he has to produce antibodies to the virus, in order to confirm whether the infection; risk of infection through contact with feces or urine, far below the fly The foam spread of the estimated the Zhang women in addition to the contact father stool, daily life is also possible that contaminated droplets to the father contracted the disease. Intensive care practitioner also considers that the fecal transmission may be a channel of communication, but there may be female Zhang contaminated droplets to the father contracted the disease.

Needles: live bird markets the source of the virus

, Xu Shuchang said, the past H5N1 virus infection after the onset of approximately 9 days fatal, the H7N9 disease in patients 11 days after the fatal love @ is not considered the most serious.

In addition, Yuen Kwok-yung to lead by the Department of HKU microbial HKU and Zhejiang University team joint research H7N9 virus analysis in Zhejiang four people infected cases, found that people infected with the H7N9 virus, with live chickens in poultry markets are detected out of the H7N9 virus is highly same source (column sequence homology of more than 99.4%), so that the live poultry market is the source of the virus, the study in the medical journal "needles" (The Lancet). http://www.iask.ca/news/china/2013/0426/194743.html

H7N9 Spread To Fujian Province

Recombinomics Commentary 13:00
April 26, 2013

Fujian Province confirmed case of human infection with H7N9 avian influenza. Patients Luomou, male, 65 years old, Yongding County, Longyan City, Fujian Beizhen. On April 18 patients no obvious incentive to repeated coughing, with active chest tightness, fever. At 14:50 on the 23rd "cough, sputum, fever, shortness of breath two days," the chief complaint of stay in Longyan City Hospital. The provinces and expert consultation diagnosis of severe pneumonia, human infection of H7N9 avian influenza be diagnosed. Given anti-viral treatment, non-invasive respiratory support and comprehensive treatment of Chinese medicine, the condition has improved.

Chinese Center for Disease Control at 11 o'clock on the April 26 review of test results for the H7N9 avian influenza virus nucleic acid positive.

The above translation describes the first confirmed H7N9 bird flu case in Fujian province.  This case (65M) represents a significant geographic spread.  This week cases were reported for the first time in Shandongand Jiangxi Provinces, which represented an incremental spread.  Similarly, the detection of the case in Taiwan represented an infection that originated in Jiangsu, just north of Shanghai.

However, the confirmation of H7N9 represents a significant jump, and the upcoming May 1 travel will likely spread H7N9 throughout China and beyond.
 
Although the sequences from human cases are closely related to those found in birds in live markets, the human PB2 sequences contain mammalian adaptation changes (E627K or D701N) signaling human to human transmission.  

The movement of such changes to Fujian Province raises serious pandemic concerns.

Distribution of confirmed cases of human infection with H7N9 expanded the scope of the ten provinces and cities

2013-04-26 18:39:13Source: infzm.com

As of April 26, 18, ​​the country reported a total of 115 confirmed cases, of which 23 people died. (With Li Xia / Chart)

• Label
• H7N9
• Avian influenza
• Infectious disease
• Public Health
• Epidemic prevention

On April 26, the Fujian Health Department Bulletin, Fujian Province confirmed case of human infection with H7N9 avian influenza. 25, Jiangxi diagnosed cases. These two provinces are the first confirmed human infection of H7N9 avian influenza. As of the 26th, the distribution of the H7N9 avian influenza has been expanded to 10 provinces and cities.

Specific distribution: As of April 26, 18, across the country health sector has reported 115 confirmed cases, of which 23 people died. Distribution of cases in Beijing (1) Shanghai (33 cases, 12 patients died), Jiangsu (24 patients, 4 patients died), Zhejiang (45 cases, 6 died), Anhui (4 cases, 1 death), Shandong (1), Henan (4 cases), Taiwan (1), Jiangxi (1 case), Fujian (1) 10 provinces and cities.

According to the Health and Family Planning Commission Bulletin, April 24 release of the relevant provisions under public health emergencies, with effect from April 24, people infected with the H7N9 avian flu information by day week released instead.

Recently, new patients, mostly the elderly

Fujian Health Department informed that the April 26 patients Luomou, male, 65 years old, Yongding County, Longyan City, Fujian Beizhen. On April 18 patients no obvious incentive to repeated coughing, chest tightness, with active low heat. At 14:50 on the 23rd "cough, sputum, fever, shortness of breath two days," the chief complaint of stay in Longyan City Hospital. 26, Luomou confirmed human infection of H7N9 avian influenza confirmed cases, the first case of human infection of H7N9 avian influenza confirmed cases of Fujian Province.

Health Department of Jiangxi April 25 informed that the patient Xiong, male, aged 69, who lives in Nanchang Qingshan Lake, a retirement home. The evening of April 19 due to fever, accompanied by chest pain, diarrhea, Nanchang hospital treatment. 22 sicker patients, the maximum temperature of 40 ° C. 25 confirmed human infection of H7N9 avian influenza confirmed cases. Currently, patients in critical condition, the hospital is under active treatment.

Patients with no history from Chang to go out, no sick or dead poultry history of exposure to a live poultry market, residence about 100 meters.

Zhejiang Provincial Health Department Bulletin, as of April 25, 2011 15:00 April 25, Zhejiang Province to add two cases of human infection with the H7N9 avian influenza. Patients Wang, female, 60 years old, farmers, Huzhou onset on April 17, Hangzhou, a hospital for treatment. The patient Shumou, female, aged 50, the farmers, Shaoxing, onset on April 18, now a hospital for treatment.

Zhejiang Provincial Health Department Bulletin, as of April 26, 2011 15:00 April 26, Zhejiang day new case of human infection with H7N9 avian influenza. Patients Lee, male, aged 38, farmer, Huzhou, onset on April 17, Hangzhou, a hospital for treatment.

Henan Health Department Bulletin, April 25, Zhengzhou City, Henan date of new cases of human infection of H7N9 avian influenza confirmed cases. Patients Choi, male, 56 years old, Zhongyuan District, Zhengzhou City, members of the public. Currently, patients in critical condition, receiving treatment in a hospital in the city of Zhengzhou. http://www.infzm.com/content/90071

Malaysia,Kyrgyzstan,PHL bans import of poultry products from China

Malaysia has imposed a temporary freeze on all imports of chicken products from China following the outbreak of a new strain of avian flu there that has killed 22.. http://thestar.com.my/news/story.asp?file=/2013/4/26/nation/20130426140242&sec=nation

PHL bans poultry imports from China

The government has imposed a temporary ban on the importation of poultry and poultry products from China because of an outbreak of highly pathogenic avian influenza in Shanghai.

In a memorandum order dated April 17, Agriculture Secretary Proceso Alcala said the Ministry of Health of the People's Republic of China confirmed the presence of highly pathogenic H7N9 Avaian influenza in poultry in Shanghai and neighboring regions on the Eastern seaboard... http://www.gmanetwork.com/news/story/305743/economy/agricultureandmining/phl-bans-poultry-imports-from-china?

Kyrgyzstan bans import of poultry products from China

26/04-2013 12:01, Bishkek – 24.kg news agency , by Julia KOSTENKO

Kyrgyzstan imposed ban on import of poultry and poultry products from China, Economy Ministry of the Kyrgyz Republic reported.

According to information of director general of the International Epizootic Bureau, new type of bird flu N7T9 has been registered among wild birds in Shanghai, Beijing, Jiangsu, Zhenjiang, Anhui, Henan of China. . http://eng.24.kg/business/2013/04/26/26778.html?

Fujian confirmed the first case of human infection with the H7N9 avian influenza

　Fujian Provincial Health Bureau informed that the 26th Fujian Province confirmed case of human infection with H7N9 avian influenza. The case is Fujian first case of human infection of H7N9 avian influenza confirmed cases. 

　　Patients Luomou, male, 65 years old, Yongding County, Longyan City, Fujian Beizhen.On April 18 patients no obvious incentive to repeated coughing, chest tightness, with active low heat. At 14:50 on the 23rd, "cough sputum, fever, shortness of breath two days" chief complaint Check the Second Hospital of Longyan City, the condition has improved. 
　　At 11:00 on the 26th the China CDC review of test results for the H7N9 avian influenza virus nucleic acid positive. Fujian Provincial Health Bureau a comprehensive case the clinical manifestations of the Group of Experts, the results of laboratory testing and epidemiological investigation, diagnosis confirmed cases of human infection of H7N9 avian influenza. 
　　After investigation, the close contacts of the cases of 37 people, to take timely measures of medical observation. Up to now, all close contacts of the cases were not unusual. http://news.cnstock.com/msbt/201304/2563508.htm

Taiwan 13 suspected cases

H7N9 hit Taiwan! The hypochondriacal Bulletin 13 cases of single Nisshin high incubation period, tightened extension of 10 days, 7 days

Philip Chan Kai
April 26, 2013 14:53


After diagnosis of the first case of H7N9 imported cases, Taiwan suspected of notified cases also a new high! The popular central epidemic command center on the 26th day of receipt of the 13 suspected cases Bulletin, hit a new high; another reference to the authority of the international medical journal the latest research, the CDC also urgently amend H7N9 incubation period of 10 days 7 days tightened.
Reporter Philip Chan Kai / Taipei

The star first case of H7N9 imported cases in Taiwan suspected of notified cases also a new high! Central Epidemic Command Center today (26) days, the past 24 hours, received a total of 13 suspected cases Bulletin, hit the airport, hospital and quarantine the largest number since the day; another reference to international authoritative medical journal published the latest research, the CDC emergency modify H7N9 incubation period, 10 days 7 days tightened screening extend the scope of monitoring. The CDC immunization physician, said Luo Yijun, according to the international authority of the medical journal study, the CDC decided to amend the current H7N9 incubation period of 7 days defined, extended to 10 days, in other words, the future has a fever, cough and other symptomspatients went to the mainland as long as 10 days before the infected area or have a history of exposure to birds, had to strengthen quarantine.

CDC sync modify mild contacts "own health" period, the same extended from seven days to 10 days; therefore, that would have been observed to April 27, the first case of H7N9 confirmed Taiwanese contacts observed, must be extended to 30 days.

Luo Yijun said the research also showed that the accuracy of the specimen collecting sputum than throat swabs, the future for mild cough, sputum, pneumonia, severe patients, all Canadian mining sputum examination. http://www.nownews.com/2013/04/26/11490-2931518.htm

Japan on alert after H7N9 bird flu spreads to Taiwan

TOKYO —

Japan on Thursday urged renewed vigilance against a spread of H7N9 bird flu after Taiwan reported a case of the deadly strain, the world’s first outside mainland China.

Japan is anticipating an influx of Chinese tourists during the two long weekends which are part of Golden Week. The foreign ministry also reissued a travel advisory to Japanese citizens planning to visit China or Taiwan, warning them to stay away from bird farms and wear masks in crowded areas.

Reviving a SARS-era precaution, Japan has been checking inbound travelers with body temperature monitors.

“We are taking every possible measure just in case,” Chief Cabinet Secretary Yoshihide Suga told reporters on Thursday.

Taiwan urged its residents to take “enhanced precautions” when visiting China—placing Shanghai, Beijing and five Chinese provinces on particular alert for travelers after at least 22 deaths were confirmed there.

Taiwan’s Centers for Disease Control (CDC) confirmed on Wednesday that a 53-year-old Taiwanese man, who had been working in the eastern Chinese city of Suzhou, showed symptoms three days after returning home via Shanghai on April 9.

The man, who was infected in China, has been hospitalised since April 16 and is in a serious but stable condition, it said.

There have been 108 confirmed cases of human infection with H7N9 avian influenza in China, including the 22 deaths, figures from Chinese authorities and the World Health Organization show.

The WHO maintained its global advisory for combating the bird flu, urging against contact with live poultry but not recommending any restrictions against travel http://www.japantoday.com/category/national/view/japan-on-alert-after-h7n9-bird-flu-spreads-to-taiwan

Barbados On alert for bird flu

THU, APRIL 25, 2013 - 6:02 PM

The Ministry of Health has intensified its surveillance for Avian Influenza A (H7N9), also known as bird flu.

Chief Medical Officer, Dr Joy St. John, told the media this morning that the Ministry already had surveillance systems in place for acute respiratory infections and severe acute respiratory infections for a number of years. However, following confirmation of the first human cases of Avian Influenza A in China late last month, Barbados, along with other Caribbean countries, had been put on alert by the Caribbean Public Health Agency (CARPHA).

 “CARPHA - the CAREC arm - has specifically put all of us in the Caribbean on alert and what we have been asked to do is to intensify our surveillance systems for acute respiratory infections and submit any viruses that we cannot subtype…We have stepped it up to involve all doctors to ensure that if they see any unusual clinical pictures, any unusual displays of respiratory illness that they should alert us and send in samples of the nasal pharyngeal swabs with a clear travel history and all of the other required information.

“We have surveillance [for acute respiratory and severe acute respiratory illnesses] that has been going on for years. In the Caribbean region, we are very strong on this. So every week, the Epidemiology Unit checks how many of these cases we’ve had and we have sentinel sites around the island mainly through the polyclinics. We

have been specifically getting reports on a daily basis on the International Health Regulations (IHR) focal points.

“As part of the normal system, we were already checking and then we have had alerts from WHO and back-ups from PAHO directly on the IHR focal points and then now we have the overlay of the Caribbean putting us on alert and asking us to do specific things that we were already doing,” the CMO stated.

St John explained that Barbados was part of a regional network in addition to the PAHO Americas and WHO networks. She said health officials had been “characterising and keeping a careful watch of all levels of illness”, adding that the

Ministry had not detected any strange patterns, “but as soon as we do we will ramp up our measures and inform as we always do”.

She further added that severe acute respiratory infections were reported by the Queen Elizabeth Hospital, samples were sent to the public health laboratory and any information was submitted to CARPHA.

“…So that they have a record of what are the viruses circulating in Barbados and they give us reports on what is circulating in the region. So that feeds into the PAHO and the WHO system that has been monitoring these viruses around the world,” she disclosed, adding that she was not aware of any cases of avian flu in other Caribbean territories

http://www.nationnews.com/articles/view/on-alert-for-bird-flu/

CDC joins bird flu fight

Published : Thursday, 25 Apr 2013, 7:26 PM EDT

• Erika Edwards (NBC News)

(NBC NEWS) - The H7N9 influenza virus circulating in China has public health officials on edge.

It's the most lethal form of the virus they've seen in years, with one out of five infected patients dying from the illness.

Lab workers at the Centers for Disease Control's headquarters in Atlanta are working nonstop trying to develop a vaccine for H7N9.

So far those in China affected by the virus have had direct contact with infected but healthy-looking birds and there's no evidence the virus is spreading between humans, but the strain could mutate into a form that makes it contagious.

"If it develops the capacity to spread from one person to another, then it could cause very severe disease both in China and neighboring countries and around the world, including in the US," warns CDC Director Dr. Thomas Frieden.

It could take a year or more to develop a vaccine, and once it is available patients will likely need two shots to build immunity.

In the meantime, the CDC is alerting doctors to be on the lookout for cases among travelers so patients who test positive can be isolated immediately.

"There have already been two dozen travelers from China with severe illness in the US, we've tested them at CDC, all negative for this strain of flu," Dr. Frieden says.

Unlike past strains of bird flu H7N9 is not making birds sick, so it is hard to tell where the virus is spreading and which type of bird is infected.

If the virus does not mutate experts say H7N9 will likely not cause a pandemic.

Temporarily closing poultry markets, isolating infected patients and an active surveillance system could prevents its spread. http://www.wwlp.com/dpp/news/national/cdc-joins-bird-flu-fight

Ministry of Agriculture and the World Organization for Animal Health (OIE) joint mission animal H7N9 avian flu prevention and control work

　On April 25, the Ministry of Agriculture and the World Organization for Animal Health (OIE) animal H7N9 avian influenza prevention and control of the joint study group, Shanghai, Zhejiang, National Avian Influenza Reference Laboratory and other places will be a week-long visits. Expedition veterinary epidemiologist at home and abroad , the new poultry disease prevention and control policy experts.

　　Examine kick-off meeting, the Ministry of Agriculture, the National Health and Family Planning Commission, State Forestry Administration, animals, wild birds, the H7N9 avian influenza prevention and control work. OIE that the joint mission is the concrete practice of the "One Health" concept, timely information on the basis of the epidemic invited OIE experts to visit China to further reflect the epidemic management open, transparent, not only conducive to the international community to understand the Chinese animal H7N9 avian influenza prevention and control, but also conducive to China to deepen cooperation with international organizations.  http://www.zgqxcg.com/news/show.php?itemid=7487

H7N9 changed weekly has been questioned

2013-04-26 02:26:00

Core Tip: the mainland yesterday least three new confirmed cases of avian influenza, the National Health and Family Planning Commission decided earlier avian flu communications from daily to weekly, daily new confirmed number is not known, Legislative Council members questioned the practice of the mainland attempted to play down the epidemic.

　　【Reporters Johnnie report the Mainland yesterday least three new confirmed cases of avian influenza, the National Health and Family Planning Commission decided earlier avian flu communications from daily to weekly, daily new confirmed number not and know, Legislative Council members questioned the practice of the mainland attempted to play down the epidemic. Looming epidemic, the Government today from a three-day "Clean Campaign, more than the Secretaries opt off the area of ​​street washing.

　　Found in Jiangxi, the first case of human infection of H7N9 avian influenza suspected cases, are waiting for the Chinese Center for Disease Control for review. Henan surnamed Zheng (56 years old) men, and Zhejiang Province Wang (60 years old) and farmer surnamed Yu (50 years old) diagnosed with H7N9 avian influenza infection in a critical condition. Wei Planning Commission changed weekly epidemic, Legislative Council members of the Civic Party the ki and worried public vigilance will be reduced, increasing the chance of an outbreak of SARS in Hong Kong, sought to maintain published daily in the "V." golden weeks ago .

　　University of Hong Kong Joint Zhejiang University team published a new study in the Journal of International Medical authority "needles" (The Lancet) found that chickens found in four cases and live poultry markets in Zhejiang highly homologous H7N9 virus identified live poultry markets It is the source of the virus. http://www.singpao.com/xw/gat/201304/t20130426_431690.html