H5N1

China: Little known about H7N9 bird flu

Via CNTV News in China: Little known about H7N9 bird flu. The following text is the narration of a two-minute video clip; click through to watch it. Excerpt, unedited:

Although there have only been a few cases so far found in China, it has trigged people’s’ concern. The National Health and Family Commission and top medical experts are answering key questions for the public. has more. 

A new type of infectious virus, and we have little knowledge of its virulence and potential for spreading. 

Feng Zijian, Director of China Public Health Emergency Center, said, “In the three cases we found, two of them had been related to birds or chickens. But in the third case, he hadn’t left his home for two weeks before he started to get a fever. So based on what we have now, we still don’t know what the source of the infection was.” 

That means medical workers can’t tell us yet what we can do to prevent ourselves from being infected. And there are no vaccines against the H7N9 bird flu virus either at home or abroad. 

On the website of National Health and Family Planning Commission, the government has posted in detail what they know so far. 

The good thing is no cases of human-to-human infection have been found yet. 

It says the authorities are closely monitoring the development, gathering resources to treat the patients and investigating the virus. 

But only 3 cases have been confirmed of having the H7N9 virus, so the information available for research is very limited. 

And why have the deaths of the two patients over 2 weeks ago been released to the public so late? The ministry says it’s because the new disease has yet to be included in the Monitoring and Reporting System of Infectious Diseases.

H7N9: Update from Hong Kong

The South China Morning Post has updated its earlier report: Two men die in Shanghai in first human cases of bird flu strain. Excerpt:

There was no indication the three contracted the disease from each other and no signs of H7N9 infection among the 88 people who had closest contact with them, the medical agency said. 

However, two relatives of the 87-year-old victim developed pneumonia around the same time he did. Their diagnoses have yet to be confirmed. One of them - his 55-year-old son - has died. 

University of Hong Kong's Centre of Infection president Dr Ho Pak-leung said H7N9 infections seen in poultry were usually mild. "This time it has caused deaths and critical conditions, even in young patients. This shows that there is a chance of virus mutation," he said. 

But Guangdong Health Department spokesman Feng Shaomin said the department saw no need to launch emergency measures among tourists ahead of the Ching Ming Festival. 

Influenza diagnosis tests in Hong Kong target the more common swine influenza and the H5N1 avian influenza. Ho said H7 viruses were less common in Asia and adjustments to the tests may now be needed. 

H7N9 is a statutorily notifiable infectious disease in Hong Kong. 

There is no vaccine. Some Shanghai residents and internet users were angered at the delay in disclosing the three cases. But Ho said the delay was understandable as time was needed to identify the virus. 

Hong Kong's Centre for Health Protection said it was maintaining close contact with mainland health authorities and reminded the public to observe personal hygiene.

H7N9: A possible fourth case?

FluTrackers have done amazing work today, and the posts continue: China - Three confirmed cases of human infection with H7N9 avian influenza - Two fatalities - Page 2. The computer translations don't get any clearer, but scroll down to Catbird's posts (8:13 p.m. and 8:26 p.m.), where a Chinese-language source in Hong Kong suggests the son who died of pneumonia was actually a fourth case of H7N9. The next post indicates that Shanghai Fifth People's Hospital is clamping down on staff saying anything about these cases.

It's already noon on Monday in Shanghai, and I expect we'll get more news in the next twelve hours.

By the way, I apologize for dropping coverage of everything except H7N9 today. But it's not often (thank heaven) that a new disease shows up—and in such a dramatic fashion. I'll try to post on other news as well tomorrow.

H7N9: Bird flu strain 'may have mutated'

Thanks to EpiGal for posting the link to this RTHK report: Bird flu strain 'may have mutated'.

The Secretary for Health, Ko Wing-man, has said he is seeking more information from mainland health authorities about a deadly strain of avian flu that has been found in humans for the first time. 

This follows the deaths of at least two people in Shanghai after they contracted the H7N9 bird flu virus. 

Dr Ko said he was concerned about whether the virus had mutated and could be spread between people. He also said the Hong Kong government had stepped up inspections at border checkpoints. 

The former health chief, York Chow, warned it was very likely that the virus had mutated, as H7 itself is a low pathogenic form. 

He said the government must not take the matter lightly because of the high fatality rate.

H7N9: Hong Kong takes note

This March 31 report from the Hong Kong government website doesn't add anything new, but it shows the Special Administrative Region is still on top of the situation: 2 die of influenza A in Shanghai.

The Centre for Health Protection has received notification from the National Health & Family Planning Commission concerning three confirmed human cases of influenza A.    

Two men in Shanghai, aged 87 and 27, died on March 4 and 10.    A 35-year-old woman in Anhui is in critical condition.   

All three patients tested positive for H7N9.   According to the commission, the 27-year-old man was a butcher while the 35-year-old woman had exposure to poultry before she became ill.   

No epidemiological link between the three cases was identified. Eighty-eight people who are close contacts of the patients showed no symptoms.   

The centre is maintaining close liaison with the Mainland health authorities to obtain more information on the cases.

This is the jurisdiction that first dealt with H5N1 in 1997 when it learned how to attack humans, and with SARS in 2003. Hong Kong hasn't forgotten, and we'll all be following its response to this new virus.

H7N9: An update from China

Via China Daily.com.cn, a Xinhua/AP report datelined April 1: Two dead from rare avian flu. After a summary of the first three cases, the report continues:

The World Health Organization is "closely monitoring the situation" in China, regional agency spokesman Timothy O'Leary said. 

"There is apparently no evidence of human-to-human transmission, and transmission of the virus appears to be inefficient, therefore the risk to public health would appear to be low," O'Leary said. 

Initial symptoms of the infection include fever, cough and difficulties breathing. On Saturday, the three cases were confirmed to be human infections of H7N9 avian influenza, based on clinical observation, laboratory tests and epidemiological surveys. The Chinese Center for Disease Control and Prevention isolated the virus on Friday. 

The spokeswoman of the city's health bureau refused to say anything beyond the report released by the commission. 

The World Health Organization, Hong Kong and Macao and "related countries" have been notified of the case, the commission said in its report. 

H7N9 bird flu virus has not been contracted by human beings before. The virus shows no signs of being highly contagious for humans, according to clinical observation of people in close contact with those infected. 

"One of the main criteria to tell if the virus can infect humans is to see if it can be transmitted between humans," Jiang Qingwu, dean of the public health school of Fudan University in Shanghai, was quoted as saying by Shanghai Dragon TV. 

"So far, we see no signs of human transmission, which makes the virus still an animal one," said Jiang, who is also an expert on epidemiology. 

The expert team is studying the toxicity and capacity of the virus to infect humans, according to the commission. 

Two people confirmed by health authorities to have contracted avian influenza, or H5N1, died in Guizhou province earlier this year. A 21-year-old woman died of multiple organ failure on Feb 13 and a 31-year-old man died on Feb 22.

A rough chronology of H7N9 so far

From the very sketchy information we have, and drawing on information from Mike Coston and FluTrackers, I've cobbled together a chronology of the three cases. Here's what I get:

Thursday, February 14: First of three admissions to Shanghai No. 5 Hospital of men in the Li family in Shanghai. Two are sons aged 55 and 69; one is their father, aged 87, who reportedly falls ill on Tuesday, February 19. All three are diagnosed with pneumonia. The younger of the two sons dies in late February; the other recovers. Neither son tests positive for H7N9.

Wednesday, February 27: A 27-year-old Shanghai butcher, Mr. Wu, falls ill.

Monday, March 4: Mr. Li, the 87-year-old, dies 14 days after falling ill.

Saturday, March 9: A 35-year-old woman in Chuzhou City, Anhui province, falls ill. Chuzhou is 322 km (200 miles) from Shanghai.

Sunday, March 10: Mr. Wu, the butcher, dies 11 days after falling ill.

Sunday, March 31: The woman in Chuzhou City is in critical condition in a hospital in Nanjing, Jiangsu province, but still alive after 23 days. News of the H7N9 cases is made public and goes worldwide. 

I'll update this chronology as more information becomes available.

Very early thoughts about H7N9

The screenwriter William Goldman famously said about the art of making money in Hollywood, "Nobody knows anything." And the same is almost true of the H7N9 avian flu virus.

Until the news broke today, H7N9 was just another virus of concern only to birds and those farming them. Now we know that it can jump from birds to humans. What's more, it's done so almost simultaneously in three unconnected cases. 

Better said, we don't know of any connection. The woman with H7N9 is in Anhui province, and if you click through to its Wikipedia page you'll see it's a very big place with 59.5 million residents. It's also some distance from Shanghai, population 23 million. Shanghai and the capital of Anhui, Hefei, are some 390 km (243 miles) from one another.

These three people beat enormous odds to fall ill from this unlikely virus, and the odds were compounded by their falling ill within days of each other. This raises the suspicion that H7N9 has actually been active for some time, quietly adding to the background noise of minor unreported or unrecognized influenza. Even so, for three serious cases to emerge between February 19 and March 9—and for two of them to be fatal—is pretty remarkable.

It seems likely that a systematic review of recent flu and undiagnosed outbreaks in eastern China will turn up more such cases, fatal or otherwise. It's tempting to see a link to the bizarre case of the thousands of dead pigs, but they seem mostly to have come from the southwest of Shanghai, and the Anhui case is to the west-northwest of the city.

We may also find that the source of H7N9 is a small location, perhaps in eastern Anhui province, where poultry is raised and shipped to the Shanghai markets; one of the male fatalities was a butcher in Shanghai. 

But beyond that kind of cautious speculation, we still can't go. The next few days will be very interesting.

Coston updates H7N9

Using a March 8 FluTrackers report, Mike Coston at Avian Flu Diary updates us: More Details Emerge On Shanghai H7N9 Case.

Tracking FluTrackers tracking H7N9

It's been a quietly dramatic Easter Sunday in Flublogia as we all go out looking for new H7N9 information. But we're mostly following the dust cloud left by FluTrackers in this remarkable thread: China - Three confirmed cases of human infection with H7N9 avian influenza - Two fatalities.

Much of their information is based on computer translated reports, which I tend to suspect, but in this case those reports are critical. As well, FluTrackers can draw on countless other reports that may link to the development: pneumonia cases that could be connected to the two deaths, not to mention some intriguing speculation on a link to the thousands of dead pigs in the Huangpu and other nearby rivers. You should be following FluTrackers too.