Friday, April 5, 2013

New strain of bird flu - H7N9

Update 06.12.2015:
There isn't much new to tell. CDC updated about two weeks ago: "According to the World Health Organization, 667 cases and 229 deaths from H7N9 flu have been reported globally from March 2013 through October 14, 2015, most from the mainland of China."

Original text of this blogpost:

A new strain of bird flu has caused 5 deaths of humans and infection of 12 people so far. Now all poultry is slaughtered at a Shanghai market. See details in the Huffington Post: This new strain of bird flu H7N9 will be harder to detect than H5N1 as birds might be infected without developing the disease. As pigeons had also been infected, the disease might spread beyond raised poultry.
There are different serotypes of influenza A H1N1 caused the Spanish flu in 1918 and swine flu in 2009, H2N2 caused the Asian flu in 1957, H3N2 the Hongkong flu in 1968, etc. H5N1 caused the bird flu in 2004/2005. H stands for the hemagglutinin type and N for the neuraminidase type. More on Wikipedia:
Flu might spread easily and beyond species, but we are already past the peak season for influenza … on the Northern hemisphere. If this bird flu starts causing problems there will be at least enough time to develop vaccinations. The swine flu in 2009 caused more problems by hysteria than by the disease itself, at least here in Germany. Our hospital had to make precautions, but we didn’t ever have one patient admitted because of the swine flu.
Let’s look at the new strain of bird flu with interest but without hysteria.
P.S. by WHO, as I write this 05.04., the FAQ sheet has been updated on 03.04.2013P.p.s.: FAQ sheet has been updated on 05.04.2013 (30.04.2013)15.04.2013

Up till now there hasn't been any human to human infection - that's the good part of the story. The bad part is, that 13 people have already died because of this new strain of bird flu (H7N9). See more at:

Altogether 60 people have been infected - see:

Health authorities are worried now about a 4 year old boy, who is a healthy (asymptomatic) carrier of H7N9. See: Healthy carriers are problematic, because you can't identify them easily, which is essential for disease control. China is quite rigorous in applying quarantine, which would be essential for stopping the disease to spread. With "71 confirmed cases of H7N9 and 14 confirmed deaths" it is a serious disease. But until now, even if there is an asymptomatic carrier, human to human infection of H7N9 hasn't been noticed up to now.

P.S. China's government publishes gene sequence of the new H7N9 strain; Global Initiative of Sharing All Influenza Data - restricted access.

Phoenix net (凤凰网) informs in an article about Shanghai. There have been 32 infected persons in the vicinity of Sghanghai, 11 people died, 16 are treated under quarantine, and 5 persons have been dismissed from hospital after treatment. One female patient aged 80 fell ill on the 9th of April, had been admitted to Shuguang-Hospital (曙光医院) on the 16th of April, and diagnosis of H7N9 influenza has been confirmed on the 17th of April; seven close contacts of this patient are under medical observation.

The discussion has already been opened wheter H7N9 can also be transmitted from human to human. Still this hasn't been confirmed and so it seems that humans only get infected by infected poultry. See also:

Other provinces like Jiansu (江苏省) and Zhejiang (浙江省) also report about N7H9 infections. Link: 浙江新增3例人感染H7N9禽流感病例 全国共95例

The CDC issued an "Interim Guidance on the Use of Antiviral Agents for Treatment of Human Infections with Avian Influenza A (H7N9)", in which an "antiviral treatment with a neuraminidase inhibitor as early as possible" is recommended. Link:

China and Canada are working together. 中国同意向加拿大实验室提供最新H7N9禽流感病毒样本 - China agreed to provide Canadian laboratory samples of the latest H7N9 avian influenza virus. Link: Later in the article:

The public health agency Canada's Federal Government recommends people, who travel to China to avoid contact with live poultry or other birds in markets. Returning back to Canada and suffering from fever, and cold symptoms, one should left best telephone the family doctor instead of going to his practice or a hospital.

I think that't a good precaution in avoiding a spread of the disease.

Chinese sources give lots of information on the current endemic spread of H7N9;
For instance: "患者张某,男,60岁,现住无锡市滨湖区。江苏省专家组5日诊断该病例为人感染H7N9禽流感疑似病例。26日,从该患者标本中分离出H7N9禽流感病毒,省专家组诊断该病例为人感染H7N9禽流感确诊病例。目前在无锡某医院救治,病情危重。"
Translation: Male patient, 60 years of age, now lives in Wuxi City Binhu district. The 5th expert group in Jiangsu Province diagnosed him as suspected case of human infection of H7N9 avian influenza. On the 26th H7N9 avian influenza viruses were isolated in specimens from the patient, and provincial experts team diagnosed the case as confirmed case of human infection H7N9 avian influenza . Currently under treatment in a hospital in Wuxi, in critical condition.

Whereas China has been accused in the past to be too silent about SARS, nowadays we flooded with very detailed infomation.

Let's look at the latest numbers, publishes by

The chart looks at differen cities and provinces and lists: confirmed cases, deaths, and healed person.

截至4月26日11时,内地已确诊H7N9禽流感病例112例,23人死亡,15人痊愈。Until the 26th of April there were 112 confirmed cases, with 23 patients having died, 15 patients have recovered.

The numbers may seem low, but WHO considers this H7N9 influenza as serious. Keiji Fukuda, WHO's assistant director-general for health, security and the environment, labelled it as an "unusually dangerous virus for humans".

美国《洛杉矶时报》网站4月26日报道】 题:此次的禽流感更难检测(记者埃米莉·阿尔珀特) is a Chinese translation of an article by the Los Angeles Times. It shows, that there is more transparency in China than for instance during the SARS endemic. The article commented on the fact, that infected bird must not necessarily show signs of the disease. The article cautions about the transparency issue, but close that "there is no doubt that technology makes it increasingly difficult to hide sensitive information".
I see it a bit more favourable on the Chinese side - but maybe my sinophily leaves me a bit prejudiced.
"China Premier Asks to Stay on High Alert on H7N9 Bird Flu" according to Bloomberg -

The CDC in Atlanta commented on the H7N9 Avian Flu:
"Since H7N9 is not spreading easily from person to person at this time, CDC does not recommend that people delay or cancel trips to China. The World Health Organization also is watching this situation closely and does not recommend any travel restrictions."
I like it, if people in charge don't act hysterically! The recommendations will surely change if this strain of avian flu combines with a human flu strain and learn how to spread from human to human. As this might not happen at all, we don't have to worry today.
In Chinese news there are only a few new infections, now also in Fujian province.

The disease has also arrived in Taiwan, but it seems that there is another risk to be taken into account - poultry smuggle. In this article (台湾卫生官员: 如果H7N9出现人传人,将限制中国观光客来台) you can find the following quote (此外,打击禽鸟走私是目前防疫的重点。): In addition, combat poultry smuggling is currently the focus of epidemic prevention.

The WHO updated its FAQ sheet yesterday (30.04.2013):

On there is an article ( 两大监测网及时捕捉H7N9) comparing SARS and the recent human infection h7n9 avian influenza outbreak. The article is based on an expert meeting in Beijing this week and gives an account of the history of this outbreak. It tells on how and how many tests were spread in the beginning (early April). A monitoring management information system was set up and updated.
Feng Zijian, Director of China's CDC (Centers for disease control and prevention) was quoted that China's public health emergency response system for outbreak detection reacted to the H7N9 outbreak in a timely manner, concerning confirmation of the disease, and taking control measures, including emergency mechanisms.
Even taking into accound that it is an official publication, China has done much better than in the past. And I didn't detect the hystery we saw with the swine flu here in Germany/Europe in 2009/2010.

There's a good overview in the South China Morning Post; on a map you can look at the distribution of patients and click on individual patients. (Sorry the page doesn't exist anymore - 17.05.2013)
Interesting is one patient in Hunan province, Yueyang, who had already died on April 1st:
"50-year-old patient, gender unknown. Hospitalised on March 26. Diagnosed as having been infected with the new H1N1 strain of flu virus, not the H7N9 strain. Died on April 1." His fate shows the dangers of influenza. People may die from this disease, also from other strains.
"Europe's top flu expert on alert for bird flu spread", an article by Kate Kelland at "Nicoll added that he thought the Chinese were doing an "impressive job" handling, reporting, investigating and seeking to contain the outbreak."

防H7N9病毒传播 中国每天烫死数万小鸡 (China scalds to death tens of thousands H7N9 virus proved chickens every day)
But more interestig is the following paragraph of this article:

The World Health Organization (WHO) said there is no evidence that the new strain of bird flu can be easily spread from person to person. Chinese scientists claim that H7N9 virus is spread from chickens to humans, but WHO said that 40% of the infected people did not come into contact with poultry."
There's another article based on the Xinhua Net:
国外专家如何看H7N9 - How do the Foreign Expert look at H7N9?
I'll refer to a few highlights:
H7N9, H5N1, H1N1 are obvious different. H7N9 and H5N1 spread mainly in animals, and occasionally infects humans. H5N1 is highly pathogenic to poultry, but H7N9 avian flu symptoms are relatively mild in poultry and therefore less likely to be found.

The SARS outbreak and recent H7N9 in China both have their own specific reasons.
The virus might survive normal cooking temperatures, but it's safe as long as all parts of the food reach 70° C. (However, the expert didn't state for how long - as as most of the readers won't have this problem, it's academical.)

If you like to know more on the genetics of H7N9, please look at: Rongbao Gao and colleagues: "Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus", published in the New England Journal od Medicine, link: The authors concluded: "Novel reassortant H7N9 viruses were associated with severe and fatal respiratory disease in three patients."
The Chinese network of BBC published an article: "中国H7N9禽流感死亡人数升至32" (China: H7N9 Avian Flu Death Toll Rises to 32). In China, so far H7N9 avian influenza has been confirmed in 130 people, killed 32 people, while 44 people have been rehabilitated.

中新网 截至目前,我国内地共报告130例确诊病例,其中死亡35人,康复57人。目前病例处于散发状态,尚未发现人传人的证据。
The China News Network gives the following numbers for China: confirmed H7N9 influenza in 130 people, the disease killed 35 people, while 57 people have been rehabilitated.

Phoenix Network has: 中国家禽养殖业因H7N9禽流感受损超400亿元 - China's poultry business has been damaged by H7N9 avian flu exceeding 40 billion Yuan.

To sum it up: there haven't been new cases of H7N9 avian influenza. China is spending much money to reduce the impact of the disease on humans as well as on the poultry business.

The Chinese edition of Deutsche Welle has a sad story ending: "When my mother died, my father was holding her hand and said: 'You wait for me, I will go with you'." ("我母亲去世的时候,我父亲拉着她的手说:'你等我,我会去那边陪伴你。'"). Link:
The 中国网·滨海高新 (Chinese Net - Seaside News) has a happy story: 山东首例H7N9患者出院 鞠躬谢医护人员 Shandong first H7N9 patient bow to thank the medical staff. Link: So, there are also happy endings in this influenza epidemic.
There's a risk map, but not updated The reason for not updating might be that the epidemic dwindles.

"The end of H7N9? No new bird flu cases reported in over a week" - coverage by The Verge:

"It ain't over till it's over!"
The Guardian recently published, that two people died of H7N9 avian influenza because of a newly developped drug resistance against Tamiflu.
Experts at Fudan University in Shanghai (复旦大学上海医学院) found H7N9 virus "nucleic acid" in individual patients after 19 days of treatmen and published the data in The Lancet (the article of The Guardian is based on this data). Tamiflu is still effective in most patients. Treatment should be initiated once the diagnosis has been made. Link: 33例H7N9禽流感病例全报告:中国式菜市场成焦点
So we can't call it day!

ScienceNet China reports: OIE spoke highly of China H7N9 avian influenza prevention and control (世界动物卫生组织高度评价中国H7N9禽流感防控). At 81st session of the International Conference the Chinese Government has been congratulated for having taken firm and decisive measures to timely and effectively reduce H7N9 avian flu risk in just two months. Link:

The Chinese Wikipedia has been updated two days ago: The authors give other statistics than the newspapers. H7N9 caused 131 infections, killed 31 people, while 44 people have been rehabilitated. The authors cited 207 references!

So, all in all, not much has happened during the past two days concerning H7N9.

05.06.2013 (尚都网) published an article: 中国H7N9疫区应急响应全终止 (China terminated H7N9 area emergency response). China terminated full emergency response in H7N9 infected areas. This does not mean that the virus disappeared. The risk for infection still exists in the South are of China. Daily monitoring of H7N9 in poultry will continue. Link:

Not much new! The Chinese Science Net has published an article; link:
H7N9 in China developed Tamiflu resistance / Experts believe that there is no reason for concern (H7N9在中国对达菲出现抗药性 / 专家认为值得关注无须紧张). With the start of Summer the high risk period is past. Liao Ming (廖明), the Vice President of the South China Agriculture University, stresses the need to strengthen the monitoring of birds and outbreaks of human infection with avian influenza.

I've just seen a new development on Symposier (via Twitter): . So if the strain comes back, there's a vaccine now.

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