H5N1

Hong Kong: No new human case of avian influenza A (H7N9) in the Mainland

Via the Centre for Health Protection: No new human case of avian influenza A (H7N9) in the Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) verified with the National Health and Family Planning Commission (NHFPC) no new human case of avian influenza (H7N9) in the Mainland today (May 19).      

As of 9pm today, a total of 130 cases have been laboratory confirmed with avian influenza (H7N9) in the Mainland, which included Zhejiang (46 cases), Shanghai (33 cases), Jiangsu (27 cases), Jiangxi (six cases), Fujian (five cases), Anhui (four cases), Henan (four cases), Shandong (two cases), Hunan (two cases) and Beijing (one case).     

A spokesman for the DH stressed that the CHP is closely monitoring the situation and will continue to maintain close liaison with the Mainland health authorities for more case information, as well as keep a close eye on the latest advice from the World Health Organization.

Taiwan: H7N9 case has drug- and non-resistant strains

Via AsiaOne.com: H7N9 case has drug- and non-resistant strains.

The only H7N9 patient so far in Taiwan was carrying two strains of the same virus, with one being drug resistant and the other not, making it tricky to treat to him, doctors said. 

Huang Li-min, a doctor from National Taiwan University Hospital (NTUH), explained that it was possible the avian flu virus was not drug resistant when the patient was first infected, but mutated later to become resistant to Tamiflu. 

With Tamiflu failing, NTUH later switched to another intravenous drug, Huang said. Because of the presence of the two strains simultaneously, it was difficult for doctors to determine how much the virus' drug resistance had undermined the therapy. 

Chou Chi-hao, deputy director-general of the Centers for Disease Control (CDC), said it is natural for viruses to mutate, saying the H1N1 flu strain mutated after infecting human beings. 

But Huang said H7N9 has limited chances of human-to-human transmission through respiratory secretions because the virus has difficulty surviving the environments of human upper respiratory systems. Patients do not have symptoms of a runny nose or sneezing. 

The patient, surnamed Lee, got sick on April 12, three days after returning from a business trip in China. His condition was initially critical, but has improved much. He has already been transferred from the intensive care unit to an ordinary ward at NTUH. 

The findings by the NTUH and CDC about H7N9 are to be published in a local medical journal next month.

China: H7N9 more likely to transmit among humans than other bird flu (updated)

Via Xinhua: H7N9 more likely to transmit among humans than other bird flu. Excerpt:

A China, World Health Organization (WHO) joint report said the H7N9 bird flu virus has a higher potential for human-to-human transmission than any other known bird flu virus. 

The report, compiled after the WHO's week-long field assessment of the influenza, was publicized by China's National Health and Family Planning Commission on Saturday. 

It said, the H7N9 virus, compared with other bird flu virus, has infected more in a shorter time, and some H7N9 virus have shown genetic alterations which means they have adapted to be more contagious than other avian influenza virus. 

Besides, the WHO offered the Chinese government several suggestions, including staying alert despite the virus' seasonal weakening during the summer, as the virus poses grave hazards and a lot of its basic information are still not known. 

The report admitted there are still uncertainties surrounding this fresh strain of virus, asserting that exposure to live poultry is a major risk factor. 

The WHO last month sent a joint mission of experts to China to survey areas affected by H7N9 in Shanghai and Beijing for a week-long assessment of the influenza.

Update: Thanks to Helen Branswell for tweeting the link to the report, which is detailed and written with admirable clarity.

Indonesia: No H7N9 found

Via The Jakarta Globe: No H7N9 Bird Flu Infections in Indonesia, Govt Says. Excerpt:

The Agriculture Ministry on Friday confirmed that no poultry in Indonesia was infected with bird flu, following speculation the H7N9 virus strain had spread to the country. 

In a letter to the Jakarta Globe, Tjahjani Widiastuti, the ministry’s director for animal health, said the government had found no cases of poultry infected with the virus during preliminary checks conducted in various parts of the country. 

“The Indonesian government, through the Agriculture Ministry, confirms that so far no H7N9 had been found in Indonesia,” Tjahjani said. 

She disputed a Jakarta Globe report on Monday stating that the Indonesian government had confirmed cases of H7N9 infection in poultry in some parts of the country. 

“We will continue to conduct surveillance activities to anticipate the emergence of the H7N9 virus in the field,” she said.

North Korea sets up emergency committee to deal with "bird flu"

Via Yonhap News: N. Korea sets up emergency committee to deal with bird flu threat. Apparently the North Koreans aren't distinguishing between H7N9 and H5N1; it's all just "bird flu." Excerpt:

North Korea has set up an emergency committee as part of a country-wide effort to cope with the bird flu threat, a media report monitored in Seoul said.    

The Rodong Sinmun, an organ of the ruling Workers’ Party of Korea (WPK) said anti-bird flu measures have been implemented at all administrative levels of the government.    

The daily said the Ministry of Public Heath also published information outlining what measures ordinary people should take to prevent the avian influenza (AI) from spreading, and said authorities are checking the health of hundreds of people every day.    

It then said that H7N9 strain of AI found in China can be fatal to people and pointed out that global efforts are underway to help contain the virus and future outbreaks.    

Pyongyang, while reporting outbreaks in the neighboring country, has not once admitted an outbreak took place at a duck farm near the capital city.    

South Korean authorities were notified about the outbreak of the highly pathogenic H5N1 strain in North Korea on Tuesday by the Paris-based World Organization for Animal Health on Tuesday.

Zhong Nanshan: Guangdong eating habits increase risk of H7N9

Thanks to Lucie Lecomte for sending the link to this report at Health.ycwb.com: Zhong Nanshan: Guangdong occurrence of human infection of H7N9 cases risk further increase. Dr. Zhong became the most famous physician in China thanks to his role in fighting SARS. Excerpt from a Google translation:

Guangdong Provincial Government on the 17th emergency meeting of the province's human infection of H7N9 avian influenza prevention and control expert group meeting to implement the instructions of the member of the Political Bureau of the CPC Central Committee, Guangdong Provincial Party Secretary Hu Chunhua, and Guangdong Governor Zhu Xiaodan, experts in Guangdong H7N9 avian flu prevention and control of the situation. 　　

Zhong Nanshan, Guangdong Province, although not yet found of human infection with the H7N9 avian influenza, but further increase of human infection of H7N9 cases risk; Cantonese known to eat live birds eating habits, which makes the prevention and control to further increase the difficulty in meeting. 　　

Zhong Nanshan said that the focus of prevention and control of Guangdong from the source to do a good job of prevention and control, to control the source of infection, cut off the transmission, to reduce the incidence of infection, at the same time, actively carry out the preparation of medical treatment, so early detection, early diagnosis, early treatment, to reduce the severe cases and deaths.

WHO: Four more H7N9 deaths in China

WHO has published Human infection with avian influenza A(H7N9) virus – update for May 17. Excerpt:

Since 8 May 2013, no new laboratory-confirmed cases of human infection with avian influenza A(H7N9) have been reported to WHO by the National Health and Family Planning Commission, China. However, four additional deaths have been reported from previously laboratory-confirmed cases. 

To date, WHO has been informed of a total of 131 laboratory-confirmed cases, including 36 deaths. 

Authorities in affected locations continue to maintain enhanced surveillance, epidemiological investigations, close contact tracing, clinical management, laboratory testing and sharing of samples as well as prevention and control measures. 

In the past week, the Shanghai and Zhejiang provincial governments have started to normalize their emergency operations into their routine surveillance and response activities. WHO offices in country, regional and headquarters continue to work closely to ensure timely information updates. 

Until the source of infection has been identified and controlled, it is expected that there will be further cases of human infection with the virus.

So far, the case fatality rate among confirmed cases is 27%. 

Meanwhile Xinhua reports that Jiangsu and Shandong provinces have also ended their emergency responses to H7N9.

The Lancet on the state of the H7N9 outbreak

Thanks to Greg Folkers for sending the link to this fascinating update in The Lancet Respiratory Medicine: China's H7N9 outbreak slows but experts remain wary. Excerpt:

Some aspects of the outbreak that were murky in the first weeks have grown clearer. It is evident that the virus can cause severe illness: most reported cases required hospital admission and more than 20% of patients died. However, authorities have been concerned about the possibility of mild, unreported infections in the general population, which could provide the virus with additional opportunities to adapt to human hosts. 

Last week, a team of researchers from the Chinese and US Centers for Disease Control and Prevention (CDC) offered evidence to rebut these concerns. In a study of 20 739 cases of influenza-like illness in Chinese provinces where the disease is present, just six individuals tested positive for H7N9, which suggests that few mild infections are going undetected by the country's surveillance system. 

Other puzzles remain. Surprisingly, authorities still do not know where the virus is coming from. Unlike other strains of avian influenza that leave a trail of ill or dead birds when they pass through a flock, H7N9 is not highly virulent and could remain invisible. 

The virus has also eluded tests by the public health authorities.Juan Lubroth, Chief Veterinary Officer of the Food and Agriculture Organization, says that although about 400 000 samples have been taken from birds and other animals at markets in the immediate vicinity of confirmed human cases, only around 50 have tested positive for H7N9. “That is a very low number compared to what we would have anticipated”, he explains. 

The virus displays genetic hallmarks of having originated in an avian species, says Andrew Pekosz, an expert on respiratory viruses at Johns Hopkins University (Baltimore, MD, USA), but it is difficult to respond effectively to the outbreak without confirming the animal reservoir. 

“Something out there is moving the virus into contact with humans and until we can really identify that, it's going to be a very difficult struggle to put countermeasures in place”, he comments. Authorities have begun serological testing of animals for the presence of viral antibodies, because these detect past exposure even if the infection is no longer present.

 If incidence of the disease continues to fall, public health authorities might have to work against public indifference, especially because the outbreak has not ended. 

“This infection is simmering”, says Pekosz. “That's still a concern, because any significant number of human cases represent interactions with the virus and its host that you want to minimise.”

CHP: No new human H7N9 in the Mainland

Via the Centre for Health Protection in Hong Kong: No new human case of avian influenza A (H7N9) in the Mainland. Excerpt:

The Centre for Health Protection (CHP) of the Department of Health (DH) verified with the National Health and Family Planning Commission (NHFPC) no new human case of avian influenza A (H7N9) in the Mainland today (May 17).      

As of 9pm today, a total of 130 cases have been laboratory confirmed with avian influenza A (H7N9) in the Mainland, which included Zhejiang (46 cases), Shanghai (33 cases), Jiangsu (27 cases), Jiangxi (six cases), Fujian (five cases), Anhui (four cases), Henan (four cases), Shandong (two cases), Hunan (two cases) and Beijing (one case). 

A spokesman for the DH stressed that the CHP is closely monitoring the situation and will continue to maintain close liaison with the Mainland health authorities for more case information, as well as keep a close eye on the latest advice from the World Health Organization.

Guangzhou halts exports from poultry farm to HK after H7N9 found nearby

Via South China Morning Post: Guangzhou halts exports from poultry farm to HK after bird flu found nearby. Excerpt:

Exports from a Guangzhou poultry farm have been suspended after the bird flu virus was found in a nearby market. 

The Centre for Food Safety said it learned from the Guangdong Entry-Exit Inspection and Quarantine Bureau that a H7 subtype of the virus was found in a poultry sample taken from a market stall in Zengcheng on Wednesday. 

Poultry from the registered farm, located within a 13-kilometre radius of the market, tested negative for the virus. 

But the Guangzhou health authorities temporarily suspended exports of the farm's live poultry and other products - including frozen poultry and eggs - to Hong Kong. 

Currently, all live poultry from the mainland have to come from registered farms and pass the test for bird flu before being exported. 

Since April 11, samples of the mainland's live poultry also undergo H7 tests at the Man Kam To Animal Inspection Station when they enter Hong Kong. None of the samples so far have tested positive for the virus. 

If the sample collected from the market in Licheng town, Zengcheng, tests positive for H7N9, it would be the second discovery of the fatal strain of bird flu in Guangdong. 

Last month in the province's Dongguan city - about 90 kilometres from Hong Kong - a sample out of 130 collected from poultry in a wholesale market tested positive for the H7 subtype of the virus. 

But no human infection of the virus has so far been found in Guangdong province.