Gene data show China bird flu mutated "under the radar"

* Diversity already as great as large outbreaks

* Circulation probably taken place in birds or mammals

* H7N9 so far infected 87 people in China, killing 17

By Kate Kelland

LONDON, April 19 (Reuters) - The new strain of bird flu that has killed 17 people in China has been circulating widely "under the radar" and has acquired significant genetic diversity that makes it more of a threat, scientists said on Friday.

Dutch and Chinese researchers who analysed genetic data from seven samples of the new H7N9 strain say it has already acquired similar levels of genetic diversity as much larger outbreaks of other H7 strains of flu seen previously in birds.

"The diversity we see in these first few samples from China is as great as the diversity we have seen with a large outbreak in the Netherlands several years ago and one in Italy," said Marion Koopmans, head of virology at the Dutch National Institute for Public Health and the Environment, who worked on the study as part of a nine-member team.

"This means it (the H7N9 strain in China) has been spreading quite a bit and it's important to understand where exactly that is going on."

Its genetic diversity shows the virus has an ability to mutate repeatedly and is likely to continue doing so, raising the risk that it may become transmissable among humans.

Koopmans, whose research was published in the online journal Eurosurveillance, said the circulation would probably have taken place in either birds or mammals, but said exactly which animals were involved was not yet clear.

"Simply the fact that this virus is spreading under the radar - because that is what this data confirms - is of concern," she told Reuters in a telephone interview.

The H7N9 virus is so far known to have infected 87 people in China, killing 17 of them. Health officials raised further questions on Friday about the source of the new strain after data indicated that more than half of patients had had no contact with poultry.

MUTATIONS

A scientific study published last week showed the H7N9 strain was a so-called "triple reassortant" virus with a mixture of genes from three other flu strains found in birds in Asia. One of those three strains is thought to have come from a brambling, a type of small wild bird.

For their study, Koopmans and her team compared some data from the first two weeks of the China H7N9 outbreak with data from a large H7N7 flu outbreak in birds and people the Netherlands in 2003 and an H7N1 epidemic in birds in Italy in 1999 and 2000.

The Dutch outbreak resulted in infection of poultry on 255 farms and led to the culling of about 30 million chickens. Some 89 people were also diagnosed as having the H7N7 virus and one person, a vet, died as a result of the infection.

The comparison suggested that "widespread circulation (of the H7N9 strain in China) must have occurred, resulting in major genetic diversification", the researchers wrote in their study.

They added: "Such diversification is of concern, given that several markers associated with increased risk for public health are already present."

Flu experts in China and at the World Health Organisation say there is no evidence so far that H7N9 is passing easily between people.

But scientists who analysed the genetic sequence data from three early samples from China say the virus has already acquired some mutations that might make it more likely to be able to do so in the future, raising the risk of a human pandemic.

"Although human infections with H7 influenza viruses have occurred repeatedly over the last decades without evidence of sustained human-to-human transmission, the absence of sustained human-to-human transmission of H7N9 viruses does not come with any guarantee," Koopmans' team wrote in their study. http://www.reuters.com/article/2013/04/19/health-birdflu-circulation-idUSL5N0D54WN20130419?rpc=401&feedType=RSS&feedName=rbssHealthcareNews&rpc=401

U.S. Hospitals Told to Be on Lookout for H7N9 Bird Flu

By Anna Edney - Apr 19, 2013 11:29 AM ET

U.S. hospitals are being urged to head off a spread of the new H7N9 avian influenza by looking out for people exhibiting flu-like symptoms who have traveled to China or had contact with someone who has the illness.

The Centers for Disease Control and Prevention held a conference call with health-care professionals yesterday to review procedures for treating bird-flu patients and controlling infections, Erin Burns, an agency spokeswoman, said in an e- mail. The Atlanta-based agency today issued interim guidance on the use of antiviral agents to treat H7N9 infections.

Issuing the guidance and holding the clinician calls “would be considered routine preparedness measures for an outbreak with pandemic potential,” Burns said.

China has recorded 92 human infections of the H7N9 strain of bird flu, with 17 of the cases fatal, according to data compiled by Bloomberg from national and provincial governments and the World Health Organization. The source of the infection hasn’t been identified and there is no evidence of person-to- person transmission, with many of the cases involving human contact with poultry, according to the CDC’s website.

There haven’t been any cases reported in the U.S. and sustained person-to-person spread is needed for a pandemic to occur. The H7N9 virus is novel and has the potential to cause a pandemic if it were to change and spread through human-to-human contact, CDC said.

No Vaccine

H7N9 viruses have been detected in poultry in the same area in China where human infections have occurred, according to the CDC. A vaccine for the strain isn’t available.

Clinicians should consider the possibility of the H7N9 virus infection in people with respiratory illness and an appropriate travel history or exposure, CDC said in a notice April 5. The agency issued guidance on the same day for how to test for the virus. On April 11, the CDC released interim infection control guidelines for U.S. health-care workers, Burns said.

Suspected cases should be reported to the CDC within 24 hours, the agency advised. Clinicians should request testing and a diagnosis from a state public health laboratory or CDC. http://www.bloomberg.com/news/2013-04-19/u-s-hospitals-told-to-be-on-lookout-for-h7n9-bird-flu.html?

Armenia bans China-imported products amid bird flu fear

April 19, 2013 - 15:37 AMT

PanARMENIAN.Net - The head of the State Service for Food Safety at Agriculture Ministry, Abraham Bakhchagulyan signed a decree for a temporary ban of a number of China-imported goods in view of recent fear of H7N9 virus.

The ban, however, doesn’t cover products exported from China before April 4, 2013.

The H7N9 virus has so far infected 87 people in China and killed 17. China has culled thousands of birds and shut down some markets selling live poultry to try to stave off the spread http://www.panarmenian.net/eng/news/154939/?

CDC begins actively looking for H7N9 in the United States

CDC begins actively looking for H7N9 in the United States

Posted on Thursday, April 18, 2013 at 02:42PM by Scott McPherson 

In a conference call this afternoon with clinicians, the U.S. Centers for Disease Control and Prevention has officially asked hospitals and doctors to begin looking for signs of human infection with H7N9 avian flu.

Some takeaways from the 2PM EDT conference call:

Persons exhibiting influenza-like illness and/or severe respiratory distress, and who have either traveled to China or have had close contact with someone who has traveled to China, need to be considered in a separate category and closely monitored.

Any Influenza-Like Illness within this subset that cannot be conclusively diagnosed as seasonal influenza needs to be considered suspected H7N9, and samples are to be sent to the CDC immediately.

Suspected patients should be put into isolation, preferably in an appropriate environment, negative-air-pressure room (AIIR).

It is unknown whether rapid office tests could detect avian influenza.  Therefore, all commercially available influenza tests should be disregarded when testing for H7N9. It should be assumed they are inaccurate.

The CDC is currently the only testing facility in the United States that can test reliably for H7N9.  This will change as the CDC certifies states with the ability to detect H7N9.

The CDC is advising organizations to review and revise their pandemic plans.

International airports with frequent travel to and from China have begun listing H7N9 information on their electronic signs, particularly in Customs areas.

Limited human-to-human transmission has occurred in China. Which is a) not surprising and b) probably expected.

Put people on Tamiflu immediately upon suspicion of H7N9, even if they have presented symptoms for more than 48-hours.

CDC can have test results within hours of receipt of the samples.

Clinicians need to collect specimens and notify their state health department for instructions.

There have been cases, as recently as March, where people tried to illegally smuggle Chinese poultry into the United States. 

(Of course, this was a concern back in 2007.  Recalal than in July, 2006, a Troy, Michigan warehouse was raided for suspicion of illegally-imported goose parts.  The boxes were later stolen from the Government-sealed warehouse.  )

This is getting real interesting real fast.  http://www.scottmcpherson.net/journal/2013/4/18/cdc-begins-actively-looking-for-h7n9-in-the-united-states.html

Hong Kong Various ports to strengthen the detection of inbound travelers temperature

2013-04-18 (18:24)

In response to the avian influenza A H7N9 virus, the concern of the Secretary for Food and Health, Ko Wing-man, number of the flow of people between the Golden Week, Hong Kong and the Mainland will greatly increase the body temperature of the detection of incoming passengers have been strengthened in various ports. Ko Wing-man, addition to infrared sketch, the authorities have stepped up manpower has been increased to 80 direct temperature detection, the Department of Health also plans to increase the number of staff to over 100 before Golden Week. http://www.singtao.com/breakingnews/20130418a182731.asp

Interim Guidance on the Use of Antiviral Agents for Treatment of Human Infections with Avian Influenza A (H7N9)

This interim guidance provides recommendations for antiviral treatment of confirmed cases, probable cases, and cases under investigation of human infection with avian influenza A(H7N9) virus in the United States (updates on the latest information on H7N9 are available at Avian Influenza A (H7N9) Virus). These recommendations were developed by experts at the Centers for Disease Control and Prevention (CDC), in consultation with non-CDC influenza antiviral experts, and are based upon expert opinion and all available data on the treatment of seasonal, pandemic, and zoonotic influenza. This guidance will be updated as additional information on H7N9 virus transmissibility, epidemiology, and antiviral susceptibility patterns becomes available.

These interim recommendations are based upon current information and the following considerations:

• Current lack of a vaccine for H7N9 virus
• Severe H7N9 disease with substantial mortality to date
• Limited current human-to-human H7N9 virus transmission but potential for increased transmission in the future

Clinicians should consider the possibility of avian influenza A(H7N9) virus infection in persons presenting with acute febrile respiratory illness and an appropriate recent travel or exposure history (see Interim Guidance on Case Definitions to be Used for Novel Influenza A (H7N9) Case Investigations in the United States).

Randomized controlled trials of currently approved influenza antivirals have demonstrated decreased time to symptom improvement when used to treat otherwise healthy persons with acute uncomplicated influenza caused by circulating seasonal influenza strains within the first few days of illness [1-9]. On the basis of these trials and additional pooled analyses and observational studies [10-12], many experts believe that when antiviral agents are given early in the course of uncomplicated influenza illness, both the duration of symptoms and the likelihood of complications are reduced. Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset [1-16]. Among patients hospitalized with seasonal influenza A (including 2009 H1N1) or B, or avian influenza A(H5N1) virus infections, observational studies suggest that early treatment reduces disease severity and mortality [17-26]. Although earlier antiviral treatment results in greater clinical benefit, observational studies support the use of antiviral treatment in hospitalized patients even when started after 48 hours of illness [17, 27-33].

While no data are available regarding early neuraminidase inhibitor treatment of persons infected with H7N9 virus, laboratory testing with functional assays indicates that H7N9 viruses are susceptible to neuraminidase inhibitors (oseltamivir and zanamivir), but resistant to adamantanes (amantadine and rimantadine). Therefore, amantadine and rimantadine are not recommended for treatment of H7N9 virus infection.

Influenza Antiviral Treatment Recommendations

• Because of the potential severity of illness associated with H7N9 virus infection, it is recommended that all confirmed cases, probable cases, and H7N9 cases under investigation (see Interim Guidance on Case Definitions to be Used for Novel Influenza A (H7N9) Case Investigations in the United States) receive antiviral treatment with a neuraminidase inhibitor as early as possible. Treatment should be initiated even if it is more than 48 hours after onset of illness.
• Laboratory testing and initiation of antiviral treatment should occur simultaneously;treatment should not be delayed for laboratory confirmation of influenza or H7N9 infection. (For information regarding case investigation, specimen collection and laboratory testing, please see theCDC Health Alert Network issued on April 5, 2013.
• Please see Antiviral Drugs: Dosage (ACIP) for additional guidance on the use of influenza antiviral agents, including dosage recommendations for treatment by age group. Oseltamivir is recommended for treatment of persons of any age; zanamivir is recommended for children aged 7 and older. Clinicians may refer to the manufacturer’s package inserts for additional information regarding dosing, contraindications, and potential adverse events.

Uncomplicated Illness in Outpatients

• Given the anticipated lack of preexisting immunity to H7N9 viruses, the potential for rapid progression, severe disease, and fatal outcomes with H7N9 infection, and low adverse event profile of neuraminidase inhibitors, treatment with oseltamivir or inhaled zanamivir should be initiated when confirmed cases, probable cases, or H7N9 cases under investigation are recognized, even if more than 48 hours from illness onset and even for apparently uncomplicated illness.
  • Antiviral treatment is recommended as soon as possible for all persons, even for previously healthy persons, and especially for those considered to be at increased risk of complications associated with influenza such as children aged <2 a="" adults="" aged="" and="" at="" be="" certain="" complete="" complications="" conditions.="" considered="" for="" groups="" higher="" href="http://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm" influenza="" link="" list="" medical="" of="" persons="" please="" pregnant="" risk="" see="" style="margin: 0px; padding: 0px; text-decoration: none;" to="" underlying="" with="" women="" years="">Influenza Antiviral Medications: Summary for Clinicians

).

For outpatients with uncomplicated disease in whom fever is absent and symptoms are nearly resolved, decisions to initiate antiviral treatment should be based on clinical judgment. Persons who are not treated with antiviral medications should be monitored for progression of illness.

Inhaled zanamivir is not recommended for persons with underlying airway disease (e.g., asthma or chronic obstructive pulmonary disease).

Recommended duration of treatment for uncomplicated illness is 5 days.

Hospitalized Patients

• Initiation of antiviral treatment is recommended as early as possible for hospitalized patients, even if more than 48 hours from illness onset.
• For hospitalized patients and patients with severe or complicated illness, treatment with oral oseltamivir (and not inhaled zanamivir) is recommended because of the lack of data for inhaled zanamivir in patients with severe influenza illness.
• The optimal duration and dose of therapy are uncertain in severe or complicated influenza. Pending further data, longer courses of treatment (e.g., 10 days of treatment) should be considered for severely ill hospitalized H7N9 patients...
• http://www.cdc.gov/flu/avianflu/h7n9-antiviral-treatment.htm

CDC officials: In the past more than 50 days H7N9 virus does not mutate

2013-04-19 01:36:59 Source: CCTV 　April 18, 2013 - H7N9 avian influenza, has become even more dangerous?

(Program guide)

Commentary:

Henan, Jiangsu, Shanghai, human infection with the H7N9 new cases continue to emerge.

Feng Zijian, director of the China CDC health emergency center:

Did not carry out the national screening, there is no evidence to change the prevention and control measures.

Commentary:

In the face of the spread of the virus, China has invited WHO to send a team of international experts to investigate and assess the H7N9 avian influenza.

WHO spokesman Glenn Thomas:

We have been warily watching the virus and the disease progresses.

Commentary:

Faced with the two families of clusters of cases, the public worried about the spread of the virus changes.

Feng Zijian:

There are currently no evidence that sustained human-to-human transmission of H7N9.

Commentary:

Nanjing City chickens, Barry sent to the public chicken, Hunan Secretary to take the lead in chicken. Faced with H7N9, the prevention and control of how to expand? "News 1 +1" Today's Focus: H7N9 avian influenza and become more dangerous?

Commentator Bai Yansong:....

http://news.163.com/13/0419/01/8SPNTCD40001124J.html

Chinese Government Suspects Human-to-Human Transmission of H7N9 Bird Flu

H7N9 continues to spread through China

April 18, 2013

By JASON KOEBLER

As the Chinese government openly begins to speculate about the possibility of human-to-human transmission of the H7N9 bird flu strain, an international team of experts, including some from the World Health Organization, have been deployed to investigate the disease in the country.

If true, the development would quickly raise concerns of the disease outbreak leading to a pandemic. Flu experts have long warned once a particularly deadly strain of the flu, as H7N9 appears to be – it has killed 17 of the 87 people it has infected – becomes transmissible between humans, it can quickly spread.

The World Health Organization has said some of those who have contracted the virus have had "no history of contact with poultry," and the state-run China Daily newspaper says a boy in Shanghai may have caught the disease from his brother.

"Further investigations are still under way to figure out whether the family cluster involved human-to-human transmission," Feng Zijian, of the Chinese Center for Disease Control and Prevention, told the newspaper.Glenn Thomas, a spokesperson for WHO, tells U.S. News that "it's still too early to say" whether there have been human-to-human transmission, but that the team they've sent there will be investigating the possibility.

"There's no evidence yet of sustained human-to-human transmission, but the team will be looking into this," he says.

Even if the disease can be spread between humans, a pandemic is not a certainty, experts say. In order to spread quickly, the virus would need to mutate to a form that is spread through incidental or casual contact. Transmission between family members is often a first step, because they generally have prolonged contact over the course of several days.

According to Zijian, human-to-human transmission "is possible, but is highly sporadic." Zijian said "people don't need to panic, because such limited human-to-human transmission won't prompt a pandemic."??

Health officials in the country are still working to track down the origin of the disease, which has been found in Beijing, the Henan province and Shanghai.

Joseph Kim, president of Inovio, a company currently working on a vaccine for H7N9, says the virus' low pathogenicity in poultry – many of them have not been killed by the disease – is making the search more difficult.

"That's scary in a way because it's harder to detect – it can spread faster in chickens and other bird flocks without authorities knowing it," he says.

Kim also notes though the virus is less deadly in humans than H5N1 – a deadly bird flu that has killed more than 60 percent of the people it has infected but has not become transmissible between humans – it is still an extremely dangerous strain.

"The Spanish flu which killed millions only had a couple percent mortality rate," he says. "If this virus mutates to be transmissible from human-to-human it will be a major issue. You have the perfect storm of pandemic flu virus in that it's highly pathogenic and could potentially be spread easily."http://www.usnews.com/news/articles/2013/04/18/chinese-government-suspects-human-to-human-transmission-of-h7n9-bird-flu

Beijing: in hundreds of dead birds no H7N9 virus tests

Apr 19, 2013 01:53

......

　　Epidemic, the emergence of the dead birds, so many people feel uneasy. Yesterday, the Beijing Municipal Bureau of Agriculture organized experts to answer questions on the H7N9 avian influenza of the public to report three or four one hundred cases of dead birds have been for testing and no H7N9 positive.

Test results

　　34-one hundred cases of dead birds no positive

　　"Side just Electronics Building found a dead bird!" Wangjing home to spend Xili first school was across the road from the lawn a dead magpie. "" This is the second time I walk the dog on the road found dead sparrow "Since the emergence of the H7N9 avian influenza virus, some users will encounter dead birds in the park or roadside photos sent to online forums or Twitter, the uneasy suspicion and avian influenza.

　　The reporters Browse found dead birds include Wangjing Fengtai and stepping Bridge, Huai-long Road, Huairou, Fangshan Riverfront Park, Haidian on the village of wetlands and so many. Liu Yue Ying, Beijing Academy of Agriculture and Forestry Sciences researcher at the Institute of Animal Science, said the bird deaths for many reasons, there may be the consumption of unidentified chemicals, such as pesticides death, there may be other ways, there is no anatomical analysis not clear conclusions.

　　Director of Beijing Municipal Bureau of Agriculture emergency Yao Jie Zhang told reporters that the death of migratory birds is a normal phenomenon, further diagnosis requires laboratory.According to reports, the Municipal Bureau of Agriculture on duty 24 hours hotline received daily about 200 members of the public to report phone, have carried out tests on the dead pigeons, dead crows, dead tits birds, three or four one hundred cases were detected test results and no H7N9 positive.....

http://news.cntv.cn/2013/04/19/ARTI1366307473130696.shtml

Hebei rumors of human infection of H7N9 cases official rumor

 Over the past few days, the province Tangshan, Handan, Baoding, Shijiazhuang and other places there have been rumors that the local people have been found infected with H7N9 avian influenza. In this regard, the director of the emergency office of the provincial CDC public health emergencies SHI Jian made it clear that the province has launched a comprehensive monitoring of unexplained pneumonia and influenza-like illness, if it is found suspected or confirmed cases in the first time publicly and immediately launched the emergency plan. "At present, the province's Influenza Surveillance Network Laboratory can do on duty 24 hours a day, specimen pick seized Once an outbreak will soon be released through formal channels, such as news media." SHI Jian said that the timely release of the confirmed cases of the outbreak prevention and control needs, the official will not be concealed and unreported. The province's monitoring network At present, the province has not yet found that people infected with the H7N9 avian influenza and monitoring cases. He believes that, over the past few days emerging epidemic rumors, people may be due to excessive stress. The anxiety of the people, SHI Jian said, has not yet found evidence of human-to-human transmission of the H7N9 virus, with the province adjacent to Beijing, Henan cases currently is distributed sporadic cases.Overall, human infection with the H7N9 avian influenza virus occurred in the province or the spread of the epidemic is still in a low level of risk.

Moreover, the province has established a comprehensive prevention and control and treatment network, ready to deal with the preparation of the H7N9 epidemic. Province of the possibility of human infection with the H7N9 avian influenza, but even confirmed cases, in the case of early detection, early treatment, the cure rate is still very high. Patients in Beijing a few days has recovered and been discharged is a good example, SHI Jian said that in the face of H7N9, people in our province do not have to panic too much.

For the current market, poultry, eggs slow-moving, the provincial CDC virus prevention expert interview with reporters, said the virus to survive temperature, heated to high temperatures can be anti-virus. The avian influenza virus is generally sensitive to heat, 65 ° C heat for 30 minutes or boil 2 minutes (100 ° C) can be killed, cooked poultry, eggs safe to eat.

http://news.qq.com/a/20130419/000035.htm?utm_source=twitterfeed&utm_medium=twitter

5 Mainland H7N9 cases reported

April 18, 2013

The Centre for Health Protection verified with the National Health & Family Planning Commission today one human case of avian influenza A(H7N9) in Henan, one in Shanghai, one in Jiangsu and two in Zhejiang.
 
The Henan case involves a 38-year-old man who is receiving treatment in hospital. His current condition is serious. His seven close contacts are asymptomatic so far.  
 
The Shanghai case involves an 80-year-old woman who is receiving treatment in hospital. Her current condition is stable. Her seven close contacts are asymptomatic so far.
 
The case in Jiangsu involves a 26-year-old woman. Her five close contacts are asymptomatic so far.
 
The two cases in Zhejiang involve a 54-year-old woman and a 69-year-old man. They are receiving treatment in hospital and both are in serious condition.
 
As of 9pm today, a total of 87 cases have been laboratory confirmed with avian influenza A(H7N9) in Shanghai (32 cases), Zhejiang (27 cases), Jiangsu (21 cases), Anhui (three cases), Henan (three cases) and Beijing (one case).
 
No human case of avian influenza A(H7N9) has been identified so far in Hong Kong.http://www.news.gov.hk/en/categories/health/html/2013/04/20130418_195450.shtml

China suspends wild bird transactions to prevent H7N9

English.news.cn   2013-04-18 22:17:04

BEIJING, April 18 (Xinhua) -- The government has ordered suspension of wild bird sales to prevent spread of the H7N9 bird flu.

The State Forestry Administration Thursday urged local authorities to beef up epidemic surveillance, suspend transactions of wild birds and ban close contact between humans and animals in zoos, according to an emergency notice issued by the administration.

The notice also asks relevant authorities to train staff in the treatment of animals that have died from unidentified diseases. http://news.xinhuanet.com/english/china/2013-04/18/c_132320962.htm

Russia Asks China for H7N9 Flu Sample

MOSCOW, April 18 (RIA Novosti) – Moscow has asked Beijing to send it a sample of the H7N9 strain of bird flu that has already killed 17 people across China, Russia’s chief public health official said on Thursday.

“We have officially requested China, via the Foreign Ministry, to send us this strain of the virus,” Gennady Onishchenko told journalists.

China has so far confirmed 82 human cases of H7N9 avian influenza since first announcing late last month that it had detected the strain in people for the first time. Chinese health officials believe the disease is crossing from humans to birds.

The disease has so far been mainly concentrated in eastern China provinces, although one person has died in Beijing.

There is currently no vaccine to protect against the virus.

“We need to get to work on this virus,” he added.

The World Health Organization has said there is no evidence of human-to-human transmission of the flu. 

http://en.rian.ru/russia/20130418/180708878.html?

China reports four new H7N9 cases

English.news.cn   2013-04-18 20:43:31 BEIJING, April 18 (Xinhua) -- Four new cases of H7N9 bird flu were confirmed on Thursday in Shanghai and the provinces of Jiangsu and Zhejiang, according to local authorities. A 26-year-old woman surnamed Wang from Jiangsu's capital of Nanjing was confirmed to be infected on Thursday. Five people who were in close contact with her have not shown flu symptoms. Two other cases were confirmed in neighboring Zhejiang, according to the provincial health department. A 54-year-old woman surnamed Shen and a 69-year-old man surnamed Xu tested positive for the new strain of avian influenza. Both are in serious condition. A Shanghai woman surnamed Ma also tested positive for the virus on Thursday, according to a statement issued by the Shanghai Municipal Health and Family Planning Commission. Of the seven people who had been in close contact with Ma, none have exhibited any abnormal symptoms. Meanwhile, an H7N9 patient surnamed Yang was discharged from a hospital at 2 p.m. Thursday after being successfully treated, according to the commission. The 66-year-old Shanghai man showed flu symptoms on March 31 and was confirmed to be infected on April 6. Doctors said he now carries antibodies against the virus and will not be infected again. China has reported a total of 87 cases of H7N9, of which 17 have died.

Shanghai soared to a human infection of H7N9 avian influenza

Shanghai Municipal Health and Family Planning Commission Bulletin, as of 17:00 today, the Shanghai add a human infection of H7N9 avian influenza. The patient was a 80-year-old woman surnamed Ma, on the 9th of this month, fever, cough and asthma symptoms, and go to the hospital, the day before yesterday was diagnosed with severe pneumonia, were positive for H7N9 avian influenza virus nucleic acid detection by the Municipal Center for Disease Prevention and Control Center yesterday, patients in stable condition under active treatment.http://news.on.cc/cnt/china/20130418/bkn-20130418182530680-0418_00922_001.html

Siu Lam Hospital 4 female patients swine flu

 uh huh..

Siu Lam Hospital 4 female patients dye swine flu

[20:12] 2013/04/18Siu Lam Hospital spokesman said a female ward of the hospital with severe intellectual disabilities Branch since April 13, there have been four patients (aged 48-60 years) presented with respiratory symptoms . Had been arranged for the patient to carry out necessary tests, the results were positive for influenza virus (human swine influenza). Among them, three patients are now being treated in isolation in stable condition; while another 56-year-old patient died because of their chronically ill yesterday.http://news.on.cc/cnt/news/20130418/bkn-20130418201232429-0418_00822_001.html

ICU beds to double if bird flu hits hard

Thursday, April 18, 2013
The number of intensive care beds will be doubled should there be a H7N9 pandemic here, the Hospital Authority said.
In the mainland yesterday, there were two more deaths from the new bird flu strain and 14 more infections. This brought the number of deaths to 16 and infections to 77.
Chan Wai-ming, working group convener of the Hospital Authority Intensive Care Unit, said the number of beds in units will be increased to 127 with territory-wide isolation facilities should the situation escalate.
In the worst scenario there will be 156 beds.
Chan said the authority also has special equipment, extracorporeal membrane oxygenation machines, at four leading hospitals for use by critically ill patients.
The machines, traditionally operated during bypass surgery, were also used on swine flu patients.
They help alleviate acute respiratory distress, which is responsible for most swine flu fatalities.
"They act like an artificial lung by removing carbon dioxide from the blood and adding oxygen outside the body," Chan said.
Meanwhile, Director of Health Constance Chan Hon-yee said more staff will be deployed at border points to conduct temperature checks for visitors during the May 1 Golden Week.
Chan said airlines have already been told to increase broadcasts on flights to remind passengers to report any illnesses.
In Beijing, the seven-year-old girl treated for H7N9 was discharged from hospital following treatment after she tested negative for the virus four times.
The daughter of poultry traders was the first confirmed human case in the capital.
Wearing a bright blue coat and pink backpack, she said she was feeling much better. "I miss home ... I want to return home and play," she said.
Mainland health authorities say they do not know exactly know how the virus is spreading, but it is believed to be crossing to humans from birds.
The World Health Organization says there is no evidence of human-to-human transmission. CANDY CHAN  http://www.thestandard.com.hk/news_detail.asp?we_cat=4&art_id=132986&sid=39508378&con_type=1&d_str=20130418&fc=7

IF..

Virus induced by mutation of the possibility of human-to-human transmission is increased

2013-04-18 09:00:04 Hangzhou

Yesterday, the Hong Kong Economic Times "reported for the H7N9 avian flu, the Hong Kong Centre for Health Protection issued a letter to all the doctors in Hong Kong, referring to the deadly new virus or limited human-human transmission. Tsang Tak-yin, on behalf of the Hong Kong Society for Infectious Diseases, said the H7N9 virus because of the the Q226L location of genetic variation, the virus can multiply in the upper respiratory tract, which is similar with a lot of seasonal influenza viruses, so when the person coughs, the virus can be upper respiratory tract spray infected with another one to increase the opportunities for human-to-human transmission. But Tsang Tak-yin, genetic mutation of the virus, at present, can theoretically increase the opportunities for human-to-human transmission, but yet see the emergence of the virus on the behavior of human-to-human transmission, so we must carry more Epidemiological and laboratory research. To solve this problem, the reporter interviewed the deputy director of the Center for Disease Control and Prevention of Disease Control and Prevention of Zhejiang Province CHEN En-fu, he said, the virus has been in the variation, but no evidence of human infection with the H7N9 avian influenza virus is infect humans, The survey results show that poultry infect humans. Although a wide range of human transmission of H7N9 virus is unlikely, but if the virus continues to mutate, then the situation may change.The same time, CHEN En-fu, deputy director of the H7N9 avian influenza people are concerned about the four focus answered their questions. Q: Hong Kong media reported the H7N9 virus or limited human-human transmission, does that mean that human-to-human transmission of H7N9 will? Our province detected, how? Answer: because in Hong Kong found no cases of H7N9 avian influenza, so he is based on cases in the Mainland, from the gene sequence, bit become analyzed. Although the in Q226L position on ge.. http://hznews.hangzhou.com.cn/kejiao/content/2013-04/18/content_4699181.htm

Yanshi a large number of pigs and dogs cause of death is still under investigation by the villagers examination was disease

 Dahe 2013-04-17 10:32    The sudden death of Luoyang Yanshi Mountain of Town Tuncun, a large number of pigs, dogs and other domestic animals, has progressed. Yesterday, Yanshi official response, has organized local villagers to undergo a medical examination, the villagers suspected chemical plant stand sits a thing has been a power outage closed.As of press time, the cause of the incident is still under investigation.

Livestock cause of death is what is what? "Near the village people will not get?" Cause of death and avian influenza have no contact? "Yesterday, our hotline has been ringing off the hook, inside and outside the province asked the reason readers have made, and Concerned about the latest developments. As of 5 pm yesterday, the reporter Baidu search revealed the news has been reprinted more than 30,000, including Phoenix, Southern Network Financial Network and other media, at the same time, the report also become a hot topic of Sina microblogging, more than 3.3 million Article discussion.

Yesterday morning, Yanshi emergency response work leading group for the first time to the Dahe sent the latest progress of the accident investigation. Yanshi organizations and environmental protection, health, animal husbandry, public security, the mountain town, while carefully checking the cause of the accident, was in full swing deal with the aftermath, "Yanshi health sector organizations of nine medical experts in the mountain town of hospitals, medical examination the East Tuncun some people, not yet detected the disease. "

According to another survey, the Luoyang Municipal Environmental Protection Bureau experts on the site of the incident East Tuncun, air testing, found no harmful gases such as ammonia, chlorine, hydrogen chloride, hydrogen fluoride. Water samples is underway to identify the cause of the accident, the Luoyang Municipal Environmental Protection Bureau will conduct a 24-hour monitoring. Furthermore, the Luoyang City Bureau of Animal Husbandry medical experts on the death of livestock anatomy, has been ruled out by the H7N9 avian influenza infection factors, the mountain of the town and the Bureau of Animal Husbandry with centralized treatment and disposal of dead livestock carcasses and to take disinfection measures to eliminate sources of pollution. At present, the local public security departments are speeding up the investigation, to find clues.

"From the current results today undergo a medical examination of the villagers body has not yet found none of the disease, a chicken farm in the village and the homes of villagers backyard chicken died." Local government staff, said. Yesterday afternoon, the Dahe reporters the incident to view the discovery, the Luoyang Chemical Factory villagers suspected of being a "murderer" has gone out of business, doorman security briefing: "On the day the factory on the power, the workers are absent from work .http://news.lyd.com.cn/system/2013/04/17/010243782.shtml

First-ever Israel visit by WHO secretary-general

By JUDY SIEGEL-ITZKOVICH

04/17/2013 23:21

An expert in infectious diseases, Dr. Margaret Chan was born in the People’s Republic of China.

WHO director Dr. Margaret Chan Photo: WHO

Dr. Margaret Chan, secretary-general of the World Health Organization, will arrive at the end of this week to make her first visit – and the first by any WHO secretary-general – to Israel. Chan, who has been WHO secretary-general since 2006, is now in her second term, which is due to end in June 2017.

An expert in infectious diseases, Chan was born in the People’s Republic of China, studied medicine at Canada’s University of Western Ontario and then joined the Hong Kong department of health in 1978 and the UN organization in 2003.

Israel has long been part of the European division of the WHO, rather than the Eastern Mediterranean division it had previously joined, because the latter consists mostly of Arab countries that are hostile to the Jewish state.

Early in her first term, Chan told The Jerusalem Post in Geneva that she respected Israelis for their expertise in public health and invited more of them to contribute their professional skills to the WHO.

In her tenure so far as chief of the WHO, she has launched new services to prevent the spread of disease and promote better health. She has also introduced new initiatives to improve communicable disease surveillance and response, enhance training for public-health professionals and establish better local and international collaboration.

Chan is regarded as a strong and activist secretary-general. She has managed outbreaks of avian influenza and of severe acute respiratory syndrome (SARS).

She came under criticism in 2009 for what was claimed to be the WHO’s “failure” to control H1N1 avian flu before it spread from Southeast Asia and killed some 17,000 around the world.

But she was widely praised for dealing with the epidemic after it spread globally.

The WHO, which coordinates UN policy on health, has 190 members.

Chan will be accompanied by Zsuzsanna Jakab, who is the WHO’s regional director for Europe, and by Dr. Ala Alwan, who is a native of Iraq.

Prof. Ronni Gamzu, the Health Ministry’s director-general, invited Chan to Israel. She agreed but asked that a tour of the Palestinian Authority’s health facilities be included.

On Sunday, the delegation will visit ministry officials at its Jerusalem headquarters and then tour community clinics of Clalit Health Services and Maccabi Health Services in Modi’in. She will then visit Tel Aviv Sourasky Medical Center, including its Dana Hospital, and meet people who run the clinic for African and other refugees in Tel Aviv. Chan will also tour Sheba Medical Center’s medical simulation center (MSR), headed by Prof. Amitai Ziv of Tel Hashomer.

On Sunday night, Health Minister Yael German will host the delegation for dinner, to be attended by senior health system leaders.

Chan will visit Yad Vashem on Monday and leave in the afternoon, when she will go to the Palestinian Authority and be hosted by its health minister. http://www.jpost.com/Health/Article.aspx?ID=310153&R=R1

Bird flu found on Bernard Matthews farm in East Anglia

17 April 2013 | By Ben Briggs

BIRD flu has been discovered at a Bernard Matthews farm in Suffolk, Defra has confirmed.

Initial tests on the poultry have ruled out the H5 or H7 strains of the disease, which have the potential to be highly pathogenic and spread quickly.

Defra said as a precaution the premises will remain under restriction pending further routine veterinary investigations.

It added: “Poultry keepers should remain vigilant by looking for any signs of disease in their birds. Any concerns should be reported immediately to their local vet or the Animal Health and Veterinary Laboratories Agency.”

This is the thrid time bird flu has been discovered on a Bernard Matthews farm. In statement, the compnay said: “Bernard Matthews can confirm that some of the birds at one of the business’ farms showed signs of ill health over the weekend.

“The company felt it was appropriate to report this to DEFRA. They have detected the presence of an avian influenza virus, but not the virulent H5 or H7 form.
Some restrictions are in place as a precaution, but are expected to be lifted in the next few days.”

The BBC is reporting that the farm in question is based at Ubbeston, near Halesworth.

Bird flu was previosuly at farms run by the turkey giant in 2009 and2007. http://www.farmersguardian.com/home/livestock/bird-flu-found-on-farm-in-east-anglia/54972.article

Experts: H7N9 avian influenza still no human-to-human transmission evidence of

 prevention and control measures not changed

2013 04 17, 20:18International Online reports (Reporter Pan Ying): human infection with the H7N9 avian flu, the National Health and Family Planning Commission on the 17th organized experts answering questions from reporters. The experts said that the current route of transmission of the virus from birds to humans, there is no formation of an effective human-to-human transmission, will not change the existing prevention and control strategies.

　　17, 2009, media reported that the Hong Kong Centre for Health Protection wrote Dr. Xiang Quangang that this virus may be limited human-human transmission occurs. Feng Zijian, director of the Chinese Center for Disease Control Health Emergency Center, said, This is mainly for family clusters of cases made earlier speculated. Family clusters of cases, whether it is caused by infection due to each other, or due to exposure to common environmental cause is still under investigation. Infection continues from birds to people, there is no formation of an effective human-to-human transmission.

　　And poultry contact number, but very few people incidence, indicating that the H7N9 virus does not easily infect occasionally infect humans from birds, can lead to the specific susceptible population, which is the basis of limited human-to-human transmission is not a transmission of a few people, or the spread of multi-generational, three generations of cases of secondary cases, do not have this phenomenon. "

　　Feng Zijian example, H5N1 avian influenza have been many incidents of family clusters of cases, but in 15 years, the H5N1 virus is still maintained route of transmission from birds to people around the world in hundreds, only 45 cases.

　　Discharged from the first confirmed cases in Beijing in the afternoon of the 17th, but the vast majority of patients are still in a severe state.According to the Beijing Ditan infectious diseases treatment center director Li Xingwang In order to improve the success rate of treatment of cases, medical institutions body temperature more than 38 degrees in patients with flu-like symptoms will be screening found that nucleic acid testing positive patients, Tamiflu as soon as possible antiviral therapy.

　　Treatment in advance to influenza stage (development) pneumonia (Tamiflu) drug treatment is effective, but this drug, usually within 36 hours, up to more than 48 hours effective all influenza symptoms, the first to be collected specimens for screening, early drug treatment, the risk of such severe development. "

　　At present, H7N9 avian influenza, health and disease control departments to take active screening strategy, found a human infection with the H7N9 avian influenza virus carriers, but in other cases areas has not started active screening. Feng Zijian, director of Chinese Center for Disease Control Emergency Office said that this prevention and control measures should be encouraged, but at the national level, it will not change the existing prevention and control strategies.

　　"Did not carry out the national screening program, there is no evidence that you want to change the prevention and control measures taken around the active surveillance measures, it is difficult as the national measures deployment, but the place of work or should be encouraged, our understanding of disease limited screening for future work, but it is not national measures. "

　　According to reports, the burden of medical expenses for human infection with the H7N9 avian influenza patients, Health and Family Planning Commission recently issued a notice requirements the H7N9 medical expenses included in the new rural cooperative medical reimbursement, to effectively reduce the burden on patients medicine. The relevant person in charge of Health and Family Planning Commission, Zhu said Hiroaki never allowed to be affected due to cost issues and give up the treatment of the phenomenon.

　　"Designated medical institutions, has made it clear to those who bear the H7N9 clinics tasks fully integrated into the designated medical institutions, the scope of reimbursement, if they meet the treatment program, all the drugs included in the scope of the new rural cooperative reimbursement proportion disease needs for treatment at the provincial level, we require reference to the county level of reimbursement of treatment as soon as possible and to avoid delay treatment due to cost issues. "http://news.sina.com.cn/o/2013-04-17/201826857758.shtml

Suzhou farmers 6,000 ducks died

Epoch Times, April 17, 2013 along with the H7N9 epidemic continues to be disclosed, multi-continent unexplained poultry deaths, April 16 exposure Suzhou farmers 6,000 ducks were killed.

According to Longhu news, April 16, Jiangsu Zhangjiagang public Mr. Tang said that their farming 8,000 ducks died only 6,000, local veterinary stations also can not find the reason.

It is reported that Mr. Tang is the Zhangjiagang Changyinsha Management District Chang Tung Community poultry farmers, more than 8,000 ducks raised in the home. In the evening of April 3, 5, 6 ducks, have died. On the morning of April 4, more than 100 ducks died April 5, more than 2,000 ducks were killed, there are already 6,000 ducks died.

Mr. Tang communities where veterinary stations and Zhangjiagang City Veterinary Station were not to identify the specific cause of death by ducks.

Multi-continent unexplained bird deaths

People from the mainland by the H7N9 epidemic rise to panic, unexplained bird deaths also in the mainland and more frequent, the rapid spread of avian flu.

According to mainland media reports, recently, a number of people in the micro-Bo said that the streets of Beijing dead sparrows, and upload pictures.

April 15, Luoyang, Henan Yanshi Mountain of Town Tuncun, burst 238 pigs died mysteriously in 89 dogs, cats, mice have not been spared.

From April 7,, Mengjin County of Ma Tunzhen Dutie Shan, Luoyang City chicken farm is less than three days, more than two thousand chickens small farms nearly 1,000 chickens died.

April 3, Jingzhou a residential area a large number of dead birds, dead birds mouth water. Near, Huang Gangmin, the public one second on Mars "fall from the sky dead pigeons photos posted on the microblogging.

April 5, people exposed material Nanjing Jianye District Tea Extension of the Southern District Park East district middle of a road on both sides of the magnolia tree kept falling dead sparrow, witnesses said, a dead sparrow falls from a tree with under the dumplings. 

http://www.epochtimes.com/gb/13/4/17/n3849234.htm