H5N1

H7N9 worries bring bird-free holiday

Via Xinhua: Around China: H7N9 worries bring bird-free holiday.

The arrival of the H7N9 bird flu has affected China's tourism industry, with tourists shunning wetlands and farms while restaurants eliminate chicken and duck from their menus. 

More than 120 human H7N9 infections, including 23 fatal cases, have been reported in China thus far, raising concerns about a possible lull in domestic tourism that occurred during the SARS epidemic a decade ago. 

The three-day May Day holiday begins on April 29, with many urban Chinese travelling around the country for short trips. 

Tour agencies in Shanghai said local "agritainment" farms have been hiding their fowl in order to quell concerns about the virus. H7N9 cases have been reported in the eastern city, as well as nearby provinces of Zhejiang, Jiangsu and Anhui that are favored by holiday makers in Shanghai. 

"All free-ranging fowl have been penned," said Chen Zhennian, manager of a Shanghai-based tour agency. Tourists used to enjoy the sight of roaming birds in farm-style hotels but now fear their presence, he said. 

Other farms have canceled activities that could expose tourists to live poultry, while rural restaurants have eliminated chicken and duck dishes, according to Chen. 

H7N9 cannot be acquired by eating chicken or duck, as the virus is killed by high temperatures when the meat is cooked thoroughly. 

According to a nationwide survey of tourist agencies conducted by Hongyuan Securities, group tour packages in east China that were hit hardest by the bird flu have not seen a drop in price, although wetland visits have been removed from the agencies' recommendation lists. 

In Shanghai, where more than 30 H7N9 cases have been confirmed, train stations are gearing up for an influx of tourists and shopping malls have put up discount flyers to attract non-local shoppers.

H7N9: Japan is not optimistic

Via The Japan Times: An avian flu outbreak in Japan could kill 'Abenomics'. Excerpt:

The decline in value of the Japanese yen by roughly 20 percent since late last year is likely to attract more Chinese visitors to Japan. “It’s just a matter of time until a tourist brings the virus into Japan,” Inoue predicts. Or just as likely, the virus might be carried by one of the hundreds of Japanese returning from abroad during the Golden Week period, which began yesterday. 

The scary countdown, reports Shukan Shincho (April 25) is really a count-up — with the growing number of reported cases in China. Fourteen days from now, the magazine predicted, these numbers are likely to explode. Fourteen is the number of days it took from the time human-to-human transmission of the H5N1 swine flu began in 2009 until the number of reported cases reached 4,379 — pandemic proportions. 

If the rate follows the same exponential growth pattern — and since no vaccine will be available in Japan for at least six months — the bad news should hit the newsstands around the end of Golden Week. 

How bad can things possibly get? Sunday Mainichi (April 28) spins out a worst-case scenario of how a flu pandemic would impact on Japan’s economy — perhaps spelling doom for the “Abenomics” policies upon which the nation has pinned hopes for economic recovery. 

The article envisages a scenario in which Tokyo Gov. Naoki Inose would discourage residents from leaving their homes unless necessary. All grades of schools would be closed, and working hours would be dispersed to reduce crowding on public transportation. Baseball games at Tokyo Dome and events such as concerts would be postponed. 

In the most extreme case, Tokyo’s 13 million residents would all be sent home and for two weeks — the incubation period of the current strain of flu — the capital might very well come to resemble a ghost town.

The author confuses "H5N1" with "H1N1," and the parallel is a dubious one at best. H1N1 was a champion at human-to-human transmission right from the start, making its spread easy to track. With H7N9, its spread is recognizable only as human cases pop up sporadically over a vast area.

UK measles: 'Greater risk of infection' in private schools

Via The Guardian: Measles: 'greater risk of infection' in private schools. Excerpt:

Children at private schools are at greatest risk from the measles outbreak and could pose a health threat to the rest of the population, the north-west regional director of public health has warned. 

Professor John Ashton said Britain's 600,000 privately-educated children were at much greater risk of infection than those in state schools, due to the many middle-class children whose parents did not vaccinate them because of the MMR vaccine scare in the 1990s and pupils from overseas with incomplete or unknown records. 

Ashton, who represents the UK's public health doctors, added that private schools could become "reservoirs of disease". 

He said the risk was similar to that from groups such as gypsies and travellers, who have acted as "reservoirs" for the infection. 

Ashton, who will soon become president of the Faculty of Public Health, said middle-class parents who send their children to private schools were more likely to have avoided the MMR vaccine. 

"Layered on top of that you have got a lot of children from abroad, especially from the far east, from countries such as Hong Kong and China, and there are few checks being done to establish their immunisation records," he told the Daily Telegraph. 

He said private schools were a "law unto themselves", and warned both pupils and the wider population were being put at risk from infectious diseases because the schools do not have proper policies to protect children and are bad at keeping adequate medical records of pupils from abroad. 

"The danger is that you have a population that can potentially become a reservoir of infection. Normally when you are talking about subsections of the population that are at particular risk of disease outbreaks, such as measles, you are talking about groups like gypsies and travellers. But actually children in private schools, and in particular boarding schools, are one of the categories most at risk." 

He urged independent schools to check immunisation records of overseas pupils as a matter of urgency, and advised them to "engage with" families who refused to vaccinate their children.

Taiwan CDC updates testing directives for H7N9

Via the Taipei Times: CDC updates testing directives for H7N9 avian flu. Excerpt:

The Centers for Disease Control (CDC) yesterday updated H7N9 avian influenza virus testing directives for hospitals following the first confirmed H7N9 infection in Taiwan, whose throat swab samples tested negative twice for the virus before the infection was finally confirmed via sputum specimen testing. 

The Central Epidemic Command Center confirmed the first imported case of H7N9 infection in Taiwan on Wednesday, and doubts had been raised over its delayed announcement of the confirmation and the ineffective testing. 

CDC Director-General Chang Feng-yee (張峰義) said the center had to undertake genome sequencing of the virus before making the confirmed case public and it is incorrect to say that throat swab testing is “ineffective.” 

“The H7N9 virus was detected in the sputum sample using a real-time polymerase chain reaction [PCR] test kit. However, to be absolutely sure of the result, it is necessary to use genome sequencing, which later confirmed the infection and found that the virus strain was highly similar to the one found in Shanghai, confirming that the virus was imported,” Chang said. 

“Because the throat swab samples tested negative twice after the patient was hospitalized does not mean that the testing was ineffective. There were no such pathogens in his throat. The patient developed a fever, but exhibited no respiratory or gastrointestinal symptoms when he first sought medical attention. It indicates that the virus is most active in the lower respiratory tract and the lungs,” Chang said. 

CDC physician Philip Yi-chun Lo (羅一鈞) said the center now advises hospitals to obtain sputum samples from suspected cases that have coughed up phlegm, recently had pneumonia or exhibited other symptoms. 

Lo said that based on the latest international research on H7N9 avian influenza, the virus’ estimated incubation period has been increased to 10 days from seven days. 

“This change will affect the time needed to conduct self-health management for those who have come into close contact with an infected patient. They now have to be followed closely by health authorities until Tuesday, three days longer than the previously stated,” Lo said, adding that the three contacts who exhibited upper respiratory symptoms are recovering and all the other contacts have not exhibited any symptoms.

The report doesn't say anything about the condition of the H7N9 patient.

H7N9 outbreaks cause China travel slump

Via the Taipei Times: H7N9 outbreaks cause China travel slump. Excerpt:

Sales of tours to China have dropped by more than half since the end of last month, amid fears over the spread of the H7N9 avian influenza virus there, tour operators said yesterday at a travel fair in Taipei. 

“The situation is terrible,” said Larry Lai, a manager at Gloria General Travel Service Co, which relies on China-bound travel for 40 percent of its sales. 

Lai said the firm has suspended all tours to coastal Chinese cities amid rising concern over the H7N9 outbreak in those areas. 

The best that operators can do is offer tours to inland destinations such as Xinjiang Province, he said. 

As of yesterday morning, China had reported 112 confirmed H7N9 cases, with 23 deaths, according to data on the Web site of Taiwan’s Centers for Disease Control. 

At least 50 percent of travelers who had planned to visit China have canceled their bookings, and the percentage could rise in light of the Central Epidemic Command Center on Thursday issuing a Level-2 travel advisory for five Chinese provinces and two metropolitan areas, Lai said. 

The alert advises travelers to exercise extreme caution and take protective measures if they visit the provinces of Jiangsu, Henan, Zhejiang, Anhui and Shandong, or the cities of Shanghai and Beijing. 

The center yesterday also added Jiangxi and Fujian provinces to the travel alert.

Taiwan warns against underestimating H7N9 bird flu

Via Taiwan News Online, an informative article: Taiwan warns against underestimating H7N9 bird flu. Excerpt:

Doctors warned against underestimating the dangers of the H7N9 bird-flu virus while the country prepared for an influx of Chinese tourists during the May 1 holiday. 

Taiwan’s only official case of the virus so far, a 53-year-old man surnamed Lee who frequently worked in China, was only taken ill after returning home. He was transferred to the National Taiwan University Hospital in Taipei on April 20 and is still reported in critical condition but stable. 

The man is reportedly a former employee of computer giant Acer Inc., and an estimated eight employees of the firm visited him recently. As a result, the company ordered them to spend seven days working from home in isolation beginning Thursday, reports said. The group did not form part of an estimated 139 people mentioned earlier as having been in contact with Lee. 

NTUH top pediatric epidemiologist Huang Li-min warned that with a mortality rate of 10 percent, H7N9 was more dangerous than the Severe Acute Respiratory Syndrome or SARS which hit Taiwan a decade ago. 

New research from Hong Kong showed that the infection process could very rapidly lead to death in a patient of the bird flu, with breathing becoming increasingly difficult. 

Huang said middle-aged and elderly people were most at risk of contracting the virus, only partly because children were less likely to frequent markets and farms where poultry was abundant. 

Taipei City’s Renai Hospital said Friday that it had quarantined and was testing a man who showed some symptoms of the virus and whose father recently returned from China, even though his condition did not fully correspond to the official definition of risky cases. 

The central health authorities said they received notifications about ten similar cases per day.

H7N9: Taiwan puts 5 Chinese provinces on travel alert

Via the Taipei Times, an April 26 report: Five Chinese provinces on travel alert. Excerpt:

Taiwan yesterday issued a Level-2 travel advisory for five Chinese provinces and two metropolitan areas after confirming a day earlier the first H7N9 avian influenza case reported locally, but contracted in China. 

The Central Epidemic Command Center announced the listing of the five Chinese provinces — Jiangsu, Henan, Zhejiang, Anhui and Shandong — and two cities — Shanghai and Beijing — in its Level-2 travel alert after an inter-ministerial meeting. 

“We referred to the three-level travel advisory system used by the US Centers for Disease Control and Prevention when deciding to issue a Level-2 advisory for the seven destinations,” said Centers for Disease Control Director-General Chang Feng-yee (張烽義), head of the epidemic command center. 

Under the system, a Level-1 advisory urges those who are bound for listed destinations to exercise vigilance and take health precautions, while a Level-2 alert calls for would-be travelers to maintain a high degree of caution and take strengthened protective measures, especially when they visit certain high-risk places. 

A Level-3 travel advisory warns against travel to listed destinations. 

“Because all seven of the listed destinations have reported confirmed H7N9 cases, people planning to travel there should pay close attention to their personal health and hygiene,” Chang said. 

Tourists visiting these areas are advised to take extra precautions, and risks to travelers are higher in certain locations within those areas, the center added. 

In light of the nation’s first confirmed H7N9 case, reported on Wednesday, the Council of Agriculture (COA) yesterday also announced it would move forward the date banning traditional markets from live poultry slaughter by one month, from its original date of June 17. 

Starting in May 17, all traditional markets with the exception of outlying islands and rural areas will be barred from slaughtering livestock on site in markets, the council said. 

Meanwhile, Taipei Mayor Hau Lung-bin (郝龍斌) dismissed speculation that Taipei will launch the ban today, as some local media outlets quoted COA Minister Chen Bao-ji (陳保基) as saying earlier yesterday. 

“What we will do starting on Friday is to enhance communication with vendors that still offer live poultry slaughtering at traditional markets and encourage them to sell frozen meat instead,” he said. 

Taipei Deputy Mayor Chen Hsiung-wen (陳雄文), who also serves as the director of Taipei’s H7N9 emergency response center, said the city government would meet with directors of traditional market associations and 177 vendors that continued to sell live poultry to explain the ban. 

To smooth the implementation of the ban, the city government will give a NT$100,000 subsidy to poultry vendors that become frozen poultry suppliers. 

Those who decide to quit the business altogether will receive a subsidy of NT$600,000 for returning their vending booths to city markets. 

Chen said vendors who insisted on selling live poultry after May 17 will be fined for violating the Animal Industry Act (畜牧法). 

According to Taipei City’s Market Administration Office, between 50,000 and 60,000 birds are slaughtered in the city a day, with between 20,000 and 30,000 slaughtered at Huanan Public Market in Wanhua District (萬華). 

Chen said that the city would start sending all live poultry to the public market, which has 14 slaughtering lines, to handle the poultry slaughter.

Taiwanese H7N9 patient in 'serious but stable' condition

Via Taiwan Focus: Taiwanese H7N9 patient in `serious but stable' condition: DOH.

Taiwan's first H7N9-infected patient is in "serious but stable" condition following treatment, a senior Department of Health (DOH) official said Thursday. 

The patient, a 53-year-old Taiwanese businessman operating in China who returned to Taiwan from Shanghai April 9, was confirmed a day earlier to have been infected with the deadly H7N9 avian flu virus. 

"The man remains in serious but stable condition and is still receiving treatment in a negative pressure quarantine ward at a northern Taiwan medical center," said Chou Jih-haw, deputy director-general of the DOH's Centers for Disease Control (CDC). 

Meanwhile, Chou said, initial tests showed that three hospital personnel who had developed respiratory symptoms after coming into contact with the H7N9 patient were not infected with the virus.

Shanghai tourism: H7N9 worries

Via beyondbrics, an economics blog at FT.com: Shanghai tourism: bird flu worries. Excerpt:

There has been a noticeable decline in tourists since the outbreak of the bird flu in late March – at Shanghai Spring Tour, one of the city’s three largest travel agencies, the number of travellers to the city has slumped by around a third in late March and around a quarter in the first week of April. 

The company is still calculating the number of tourists for the forthcoming three-day May Day holiday that starts on Monday. Unlike the three-day Qingming Festival (normally in early April) which is the occasion for visiting ancestral graves, the May Day holiday usually attracts more people into domestic or overseas short trips thanks to the warmer weather. 

“Although we see signs of recovery, the situation this year is definitely worse than last May Day holiday,” Yi Si, spokesman of Spring Tour told beyondbrics, adding that “agro-tourism [including farm visits] is affected the most, notably tour activities involving chickens and ducks.” 

Datong, a Shanghai-based travel agency specialising in short trips in eastern China, is in a similar position to Spring Tour. The number of registered tourists during the May Day holiday was down by about 10 per cent compared with the same period last year, due to public panic over the bird flu. 

A spokesman for Datong told beyondbrics: “Bird flu has obviously affected our business. We are in a relatively difficult situation.” Datong added that because of rising inflation and other incurred costs, the company’s loss was more than 10 per cent. 

Datong has removed poultry dishes from the menu and no longer recommended countryside or garden tours to clients. “We’ve even adjusted the travel plan in the Qinhu National Wetland Park in Taizhou [near Shanghai] to avoid red-crowned cranes,” the company spokesman He Yiwei confirmed. 

But these measures are not enough to allay people’s concerns. Vivienne Lu, a mother of a 2-year-old boy in Shanghai, said the family had planned to visit the city’s botanical garden during the holiday, but they cancelled the trip. 

“Little kids always love touching birds or other animals, so I think it is risky. We will just take him to the nearby shopping mall or play with his cousins in our neighbourhood.” 

At the ongoing 15th Shanghai auto show, however, it’s another story. On the first day alone, the event attracted over 150,000 visitors, with people complaining that they could see “only people, not cars”, according to the city’s biggest newspaper Shanghai Morning Post. 

Visitors told beyondbrics there were no temperature checkpoints at the entrances or sanitizer machines inside the exhibition hall. McDonalds booths were still offering chicken burgers.

H7N9: Taiwan healthcare workers seem to test negative

Thanks to Ryan Wilmer for sending the link to this Microsoft-translated report from CNA: H7N9 first condition serious but stable. It's hard to excerpt and format properly, but click through and you'll see that the three healthcare workers under suspicion of contracting the virus appear to be OK.