WHO Background & Summary Of H7N9 Virus – January 31st

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As CDC director Frieden indicated in his piece this morning on CNN, with the Chinese Lunar New Years celebration in full swing, there is growing concern over the spread of the avian H7N9 virus among people in Eastern China.  While no one can predict when – or even if – this virus will achieve efficient transmission between humans, it is currently considered the the virus to watch right now.

 

Today the World Health Organization has updated their background & summary document on the H7N9 virus, reflecting the knowledge gained over the past 10 months and 270+ plus human cases, along with the publication this week of an updated FAQs on human infection caused by the avian influenza A(H7N9) virus.

 

As this new summary document runs 5 pages, I’ll just excerpt some highlights.  Follow the link below to access the PDF file.

 

Background and summary of human infection with avian  influenza A(H7N9) virus – as of 31 January 2014

The influenza A(H7N9) virus is one subgroup among the larger group of H7 viruses, which normally circulate among birds.

Human infections with other subgroups of H7 influenza viruses (H7N2, H7N3, and H7N7) have previously been reported in Australia, Canada, Italy, Mexico, the Netherlands, the United Kingdom and the United States of America. Most of these infections occurred in association with poultry outbreaks. The infections mainly resulted in conjunctivitis and mild upper respiratory symptoms, with the exception of one death, which occurred in the Netherlands.

Since the first notification at the end of March 2013, China has been reporting to WHO cases of human infection with H7N9 virus. This is the first time infection with this virus has been found in humans.

Epidemiology

The laboratory-confirmed cases have been reported from 13 provinces/municipalities  in eastern mainland China, Hong Kong, Special Administrative Region, China, and the Taipei Centers for Disease  Control (Taipei CDC). Most cases are presumed to have contracted the infection directly from  infected animals or their environment, particularly as a result of visiting live animal markets. Only a few small clusters with possible human-to-human transmission have occurred among family members, but there has been no evidence of sustained human-to-human transmission to date.

 
As of 28 January 2014, the case fatality rate of all confirmed cases is 22%, but many cases are still hospitalized. Of all cases, 67% were male. The median age of reported cases is 58 years and that of fatal cases is 66 years.

Cases occurred in a first wave (n=133) from February through May 2013. Reports of human infection  decreased during the summer, with only two cases reported; they have increased since October, demonstrating a second wave,   likely  in conjunction with cooler temperatures.   

For the latest information on cases and outcomes, see:

Disease Outbreak News (DONs)

Virology  

Thus far the H7N9 viruses detected in China are homologues. The HA gene is most similar to that of A(H7N3) viruses detected in ducks in Eastern China. The NA gene is most similar to N9 NA genes from viruses circulating recently in domestic ducks in China and Korea. The six  internal genes are derived from influenza A(H9N2) viruses circulating in poultry in eastern Asia. Sequence analyses have shown that the genes of the H7N9 viruses from China are of avian origin, but with signs of adaptation to mammalian species. The adaptation includes increased ability to bind to mammalian cell receptors, and to grow at temperatures close to the normal body temperature of mammals, which is lower than that of birds. Antigenically, the H7N9 viruses are different from seasonal influenza viruses infecting humans, but closely related to A/Anhui/1/2013 (H7N9), the recommended virus for H7N9 vaccine development.

Human-Animal Interface  

The source of infection is assumed to be infected poultry or contaminated environments. Many of the human cases have reported visiting markets where live poultry were sold. This virus has been detected  in both poultry and in markets that patients reported visiting. However, because this virus does not appear to cause clinical signs in infected poultry, clear links between infections in poultry and human cases have been difficult to establish. 

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CDC Director Frieden: On Preventing A Pandemic

Photo Credit WHO

 

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Yesterday the CDC’s director Dr. Thomas Frieden held a telebriefing called  U.S. safer when CDC works with other countries to fight infectious diseases, to `discuss improvements in disease detection and response that may serve as a model for fighting infectious disease throughout the world’.

The transcript and audio are now available online, for those who were unable to attend.

 

Central to his presentation were two reports that appeared yesterday in the MMWR.

 

Rapidly Building Global Health Security Capacity — Uganda Demonstration Project, 2013

Strengthening Global Health Security Capacity — Vietnam Demonstration Project, 2013

 

Today, in a follow up, Dr. Frieden has penned a special blog post for CNN, where he discusses the dangers of a pandemic, and the steps that need to be put in place to prevent or mitigate its arrival.

 

08:49 AM ET

How to prevent the next pandemic

By Tom Frieden, Special to CNN

Editor’s note: Dr. Tom Frieden is the director for the Center for Disease Control. The views expressed are his own.

Today marks the Lunar New Year – and the world’s largest annual migration. There will be more than 3.6 billion transit trips within China, in addition to countless international trips. Yet this celebration comes at a time of growing concern about the H7N9 avian influenza virus. And this concern is not unfounded – should this virus change into a form that easily spreads between people, the world’s next pandemic could occur in the next three weeks.

This combination of mass travel and an emerging virus such as this should underscore the connectedness of health security between countries. Of course, H7N9 influenza is just one example of how the health security of all nations, including the United States, depends on the health security of each individual nation. And regardless of where outbreaks occur, stopping them at the source is the most effective and cheapest way to save lives at home and abroad.

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WHO H7N9 Human Infection Update – January 31st

 

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The World Health Organization has released a new GAR (Global Alert & Response) update on the H7N9 virus, detailing cases both from Mainland China and the most recent case reported in Hong Kong.

 

 

Human infection with avian influenza A(H7N9) virus – update

Disease outbreak news

31 January 2014 - On 29 January 2014, the National Health and Family Planning Commission (NHFPC) of China, and the Centre for Health Protection (CHP), Hong Kong SAR, China notified WHO of six additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus including one death.

All of the six cases are males. The age range is 2 to 63 years old. The cases are reported from Fujian (1), Guangdong (1), Hong Kong SAR (1), and Zhejiang (3). Four of the cases are currently in critical or serious condition. Four of the cases are reported to have had exposure to poultry or a live poultry market.

Details of the five additional cases as notified by NHFPC of China:

• A 37-year-old farmer from Wenzhou City, Zhejiang Province, who became ill on 19 January. He was admitted to hospital on 27 January and was transferred to another hospital on 28 January. He is currently in a critical condition. The patient has a history of exposure to a live poultry market.
• A 60-year-old man from Hangzhou City, Zhejiang Province, who became ill on 23 January. He was admitted to hospital on 28 January and is currently in a serious condition. The patient has a history of exposure to poultry.
• A 63-year-old man from Hangzhou City, Zhejiang Province, who became ill on 24 January. He was admitted to hospital on 27 January and is currently in a serious condition. He has a history of exposure to a live poultry market.
• A 2-year-and-8-month old boy from Xiamen City, Fujian Province, who became ill on 26 January. He was admitted to hospital on 28 January and has a mild illness. His family slaughter and sell ducks.
• A 17-year-old man from Guangzhou City, Guangdong Province, who became ill on 22 January. He was admitted to hospital on 27 January and is currently in a serious condition.

Details of the case as notified by the CHP, Hong Kong SAR:

• A 75-year-old man with underlying illnesses who travelled alone to Shenzhen between 20 to 26 January became ill while in Shenzhen on 26 January. He was admitted to hospital in Hong Kong on 28 January and died on 29 January. During his stay in Shenzhen it is reported that he stayed with relatives who lived close to a live poultry market. His five home contacts in Hong Kong have remained asymptomatic but have been admitted to hospital for observation. Further investigations into the man’s travel and exposure histories are ongoing, in parallel with tracing of other contacts of the case, including four patients with whom he shared a hospital room, and healthcare and ambulance staff. Preliminary findings suggest that the man was infected outside of Hong Kong SAR.

So far, there is no evidence of sustained human-to-human transmission.

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H7N9: CIDRAP & Mackay On Chinese MOA Statement

Credit FAO

 

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We’ve a couple of follow up reports on yesterday’s statement by China’s Minister of Agriculture regarding whether poultry are the source of H7N9 human infections (see China’s MOA Disputes Poultry As Source Of H7N9 Infections). 

 

Our first stop is CIDRAP NEWS, where Lisa Schnirring not only recaps yesterday’s parade of H7N9 stories, but also delves deeper into the issues surrounding the reliability of the testing procedures being used by the Chinese Ministry of Agriculture to detect the H7N9 virus in poultry.

 

As usual, Lisa makes coherent our daily jumble of H7N9 stories.  Follow the link below to read:

 

China’s second H7N9 wave tops spring wave

Lisa Schnirring | Staff Writer | CIDRAP News

|

Jan 30, 2014

Pushing the number of cases in the second H7N9 influenza wave higher than the first, China reported six more cases today, as well as two more deaths, one of which involved a previously confirmed case.

Today’s new cases lift the number reported in the second wave to 137, topping the 136 cases reported during the first wave last spring.

The country’s agriculture ministry also downplayed the role of poultry in spreading the disease based on its surveillance results, raising questions about whether the techniques used are the best for gauging infection levels in flocks.

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And from down under, Ian Mackay looks at the issue of poultry as the likely vector of H7N9 in:

 

If not poultry then what?

Mike Coston has written a nice post about the Chinese MOA denying that there is any proof of direct transmission of H7N9 from poultry to humans.

Technically, they are of course correct.

We have yet to see a human put in a cage downwind, but separated from, a flock of infected chickens or duck or geese to see if the human acquires H7N9 infection and disease. Nor have we seen any card-playing lockdown transmission scenarios to investigate aerosol, droplet and direct transmission routes.

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Ian also has posted an updated H7N9 Snapdate Chart, showing the avian virus’s activity by month both in 2013 and 2014.

 

H7N9 snapdate: cases in 2013 vs 2014...

Since I started tracking this beastie (and this blog) in April 2013, I've tended to use weekly data - because more is more!

This one presents the data by month and it really highlights that - at least to date - human infections with H7N9 have been focused on a single month.

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All three reports are highly recommended.

WHO H7N9 Update – January 30th

 

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We’ve a lengthy GAR (Global Alert & Response) update on the H7N9 virus from the World Health Organization detailing 15 more H7N9 cases reported from mainland China.

 

Although overall we continue to see a skewing of cases towards older males, over the past 2 days the WHO has announced a total of 21 cases, 2/3rds of which have been female.

 

The WHO also addresses the recent detection of H7N9 in poultry imported into Hong Kong, and warns that, `Further sporadic human cases of A(H7N9) infection are expected in affected and possibly neighbouring areas, especially given expected increases in the trade and transport of poultry associated with the upcoming Lunar New Year.’

 

Human infection with avian influenza A(H7N9) virus – update

Disease outbreak news

30 January 2014 - On 29 January 2014, the National Health and Family Planning Commission of China notified WHO of 15 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus.

Of these 15 cases, 10 are females. The age range among the cases is 31 to 81 years old. The cases are reported from Guangdong (4), Jiangsu (1), Shanghai (1) and Zhejiang Province (9). Thirteen of the cases are currently in a critical or serious condition. Fourteen of the cases are reported to have had exposure to poultry or a live poultry market/environment.

Details of 15 additional cases are as follows:

• A 61-year-old woman cook from Shanghai City who became ill on 6 January. She was admitted to hospital on 20 January. She is currently in a critical condition. The patient has a history of exposure to poultry.
• A 66-year-old woman from Shaoxing City, Zhejiang Province, who became ill on 15 January. She was admitted to hospital on 17 January. She is currently in a critical condition. The patient has a history of exposure to a live poultry market.
• A 71-year-old woman from Hangzhou City, Zhejiang Province, who became ill on 12 January. She was admitted to hospital on 18 January. She is currently in a critical condition. The patient has a history of exposure to a live poultry market.
• A 71-year- old farmer from Wenzhou City, Zhejiang Province, who became ill on 13 January. He was admitted to hospital on 19 January, and was transferred to another hospital on 21 January 2014. He is currently in a serious condition. The patient has a history of exposure to a live poultry market.
• A 59-year- old man from Ningbo City, Zhejiang Province, who became ill on 18 January. He was admitted to hospital on 20 January and was transferred to another hospital on 22 January. He is currently in a serious condition. He has a history of exposure to poultry.
• A 63-years-old woman farmer from Huzhou City, Zhejiang Province, who became ill on 11 January. She was admitted to hospital on 15 January and was transferred to another hospital on 18 January 2014. She is currently in a critical condition. The patient has a history of exposure to poultry.
• A 34-year- old woman from Shenzhen City, Guangdong Province, who became ill on 10 January. She was admitted to hospital on 20 January 2014, and was transferred to another hospital on 21 January 2014. She is currently in a critical condition.
• A 53-year- old man from Huai'an City, Jiangsu Province, who became ill on 22 January. He was admitted to hospital on 26 January. He is currently in a serious condition. The patient has a history of exposure to a live poultry market.
• A 43-year-old woman farmer from Hangzhou City, Zhejiang Province, who became ill on 23 January. She was admitted to hospital on the same day. She has a mild illness. The patient has a history of exposure to a live poultry market.
• An 81-year-old farmer from Huzhou City, Zhejiang Province, who became ill on 21 January. He was admitted to hospital on 23 January. He is currently in a critical condition. The patient has a history of exposure to poultry.
• A 63-year-old woman farmer from Huzhou City, Zhejiang Province, who became ill on 22 January. She was admitted to hospital on 24 January and was transferred to another hospital on 26 January 2014. She is currently in a serious condition. The patient has a history of exposure to a live poultry environment.
• A 57-year-old man from Ningbo City, Zhejiang Province, who became ill on 15 January. He was admitted to hospital on 23 January. He has a mild illness. The patient has a history of exposure to poultry.
• A 43-year-old woman from Shenzhen City, Guangdong Province, who became ill on 17 January. She was admitted to hospital on 26 January. She is currently in a serious condition. The patient has a history of exposure to a live poultry market.
• A 41-year-old woman from Shenzhen City, Guangdong Province, who became ill on 20 January. She was admitted to hospital on 26 January. She is currently in a critical condition. The patient has a history of exposure to a live poultry market.
• A 31-year-old woman from Shenzhen City, Guangdong Province, who became ill on 16 January. She was admitted to hospital on 23 January 2014. She is currently in a critical condition. The patient has a history of exposure to a live poultry market.

So far, there is no evidence of sustained human-to-human transmission.

The Chinese government continues to take the following measures:

• strengthen surveillance and situation analysis;
• reinforce case management and treatment;
• conduct risk communication with the public and release information;
• strengthen international collaboration and communication; and
• conduct scientific studies.

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Zhejiang, Guangdong & Jiangsu Provinces Report H7N9 Cases

Credit CDC

 

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So far this morning three provinces have announced a total of six new H7N9 cases, with five of those reported in serious or critical condition, and one death.  Unlike yesterday, which saw two pediatric cases (under age 18), today’s cases are all in their 60s and 70s.

 

First stop, Zhejiang province logs in with four new cases.

 

Zhejiang Province, four new cases of human infection of bird flu H7N9

Source: Ministry of Health and Family Planning Commission

January 30, 2014

Zhejiang Provincial Health and Family Planning Commission January 30 briefing, the province today added four cases of human infection with H7N9 avian influenza.

1, water certain patients, male, 75 years old, farmer, Yinzhou District, Ningbo people. January 29 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, a hospital for treatment in Ningbo.

2, patients Lin Moumou, male, 76 years old, retired, Zhenhai District, Ningbo people. January 29 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, in Ningbo, a hospital for treatment.

3, in certain patients, male, 78 years old, farmer, Yuhang District of Hangzhou people. January 29 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, in Hangzhou, a hospital for treatment.

4, the patient Moumou, male, 64 years old, retired, Jiangbei District, Ningbo people. January 29 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, a hospital for treatment in Ningbo.

Next up, Guangdong province, which reports a single new case and the death of a previously announced case.

 

Province added one case of human infection of bird flu H7N9

2014-01-30 11:32:35 Ministry of Health and Family Planning Commission | Views ( 333 ) | Text background color:

Ministry of Health and Family Planning Commission January 30 briefing, Jiangmen add one case of human infection with H7N9 avian influenza.

Daimou cases, female, 67 years old, live in Jiangmen City Xinhui District towns. January 24 the incidence of rescue in Jiangmen designated hospital January 28 died. January 29, the provincial CDC to review its throat swabs, the result is positive for H7N9 avian influenza virus nucleic acid.

Also, Meizhou City, January 24 confirmed cases of Hemou, on at 9:00 on January 30 after she died.

 

And our last stop (for now) is Jiangsu province,which also reports a single case.

Province 1 new confirmed cases of human infection with H7N9 avian influenza

Published :2014-01-30 

Provincial Health Department, the province confirmed cases of new H7N9 bird flu case of human infection.

Patients Qianmou, female, 75 years old. January 30 afternoon, Nanjing infected human H7N9 avian influenza cases diagnosed. Treatment in a hospital in Nanjing is currently in a critical condition.

 

 

Keeping excellent track of all of these cases is Sharon Sanders and the newshounds on FluTrackers.  Their (absolutely indispensible) H7N9 Case Line Listing already has these latest six cases added.

 

#268 - Man, 75, farmer, Yinzhou District, Ningbo. Confirmed on January 29, now in critical condition in a hospital for treatment in Ningbo. Zhejiang province

#269 - Man, 76, retired, Zhenhai District, Ningbo. Confirmed on January 29, now in serious condition in a Ningbo hospital for treatment. Zhejiang province

#270 - Man, 78, farmer, Yuhang District of Hangzhou. Confirmed on January 29, now in critical condition, in a Hangzhou hospital for treatment. Zhejiang province

#271 - Man, 64, retired, Jiangbei District, Ningbo. Confirmed on January 29, now in critical condition in a hospital for treatment in Ningbo. Zhejiang province

#272 - Woman, 67, Jiangmen City Xinhui District. Hospitalized on January 24, the patient died in a Jiangmen designated on January 28. Confirmed by CDC on January 29. Guangdong province Death

#273 - Woman, 75. Confirmed on January 30, currently in a hospital in Nanjing in critical condition. Jiangsu province

Korea: Avian Flu Continues To Spread In Poultry

Updated Outbreak Map – Credit http://www.maff.go.jp

 

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The headline from Yonhap news says it all, as Korea’s attempts to contain their HPAI outbreak have – thus far, anyway – failed to achieve their goals.

 

Bird flu spreads north, outbreak confirmed in Gyeonggi Province

2014/01/30 14:30

SEJONG, Jan. 30 (Yonhap) -- A bird flu case has been confirmed at a chicken farm in Gyeonggi Province the government said Thursday, a disturbing sign that all-out quarantine efforts are having limited impact.

 

The agriculture ministry said that tests showed a chicken breeding farm in Hwaseong came up positive for the H5 strain of avian influenza (AI) that is sweeping parts of the country. Past cases have been restricted to the Jeolla and Chuncheong region in the country's southwestern region.

 

"At present we are trying to determine if the latest case is a virulent AI strain," a ministry source said. He said that all poultry within a three-kilometer radius of the affected farm have been culled as a preventative measure.

This is the first time that a bird flu case has been detected so far north.

The Gyeonggi region that surrounds the capital city of Seoul is home to the largest number of chicken farms in the country.

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Another report, this time from Channel News Asia, indicates H5N8 virus has been confirmed in Gyeonggi.

 

South Korea's Lunar New Year marred by bird flu worries

SEOUL: South Korea has confirmed its latest case of H5N8 bird flu virus in a chicken farm in Gyeonggi province, home to the capital Seoul, despite quarantine efforts including the expansion of a poultry cull in the country.

No human infection has been reported yet, but there are rising concerns that the virus could spread further after the Lunar New Year holidays.

(Continue . . . )

 

Meanwhile, Hong Kong – which is already battling the H7N9 avian virus - has announced the suspension of poultry imports from parts South Korea.

 

HK bans import of poultry products from parts of Korea

The Centre for Food Safety (CFS) of the Food and Environmental Hygiene Department announced today (January 30) that, in view of a notification from the World Organisation for Animal Health (OIE) that outbreaks of highly pathogenic H5N8 avian influenza in South Chung Cheong Do and South Jeolla Do of Korea, it has banned the import of poultry meat and products (including poultry eggs) from the two areas with immediate effect for the protection of Hong Kong's public and animal health.

A CFS spokesman said about 5 000 tonnes of frozen and chilled poultry meat, as well as about 4.9 million poultry eggs, were imported into Hong Kong from Korea between January and November last year.

An import ban on the same items from North Jeolla Do, Korea, has been in effect since mid-January and is still in force, he added.

"We will be in close liaison with the Korean authorities over the issue and will closely monitor information issued by the OIE on the avian influenza outbreaks in the country. Appropriate action will be taken in response to the development of the situation," the spokesman said.

Ends/Thursday, January 30, 2014
Issued at HKT 18:15

 

For earlier reports on Korea’s HPAI outbreak, including background on the virus and the debate over how it was introduced into Korea, you may wish to revisit:

 

Korea: H5N8 Spreads, Debate Over Source Intensifies

Korea: Migratory Birds Likely Source Of H5N8 Outbreak

H5N8: Korea Testing More Migratory Birds

A Little More On South Korea’s H5N8 Poultry Outbreak

VDU: Update H7N9 Maps, Charts (And A MERS-CoV Bonus)

Credit Dr. Ian Mackay – VDU Blog

 

 

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Dr. Ian Mackay has been very busy the past couple of days updating his H7N9 charts and maps, with his latest post below:

 

H7N9 snapdate: new charts for sex and age distribution and region of acquisition...

Two new charts.

Click on image to enlarge.

Firstly, the "age pyramid", a revised and combined version of the age and sex distribution charts for 265/267 H7N9 cases to date. This one comes with many thanks to Shane Granger for helping me learn a new trick. Please follow him @gmggranger or visit his chart-tacular blog, Random Analytics at http://gmggranger.wordpress.com/.

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For more graphical goodness, you’ll want to check out Ian’s H7N9 post from yesterday:

 

H7N9 snapdate: charts bonanza...[UPDATED]

 

And just to prove that Ian isn’t a Johnny One-note, check out his two most recent blogs on the MERS Coronavirus:

 

MERS-CoV antibodies in dromedary camels from Dubai, UAE, as far back as 2005...

A date with Middle East respiratory syndrome coronavirus (MERS-CoV)..

China’s MOA Disputes Poultry As Source Of H7N9 Infections

Credit FAO

 

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While Chinese poultry – particularly poultry sold in live markets – are atop the suspect list for spreading the H7N9 virus, there remain many unanswered questions regarding where this virus resides, and how it is jumping to humans.  Prime among them, despite having the finger of suspicion directed at them, remarkably few birds have actually tested positive for the virus.

 

While only a few dozen H7N9 positive birds were detected last year out of tens of thousands tested, we saw an immediate and dramatic drop in the number of human cases once live bird markets were closed (see The Lancet: Poultry Market Closure Effect On H7N9 Transmission), making for a pretty compelling circumstantial case for live poultry being the prime vector.

As does the oft quoted (but hard to verify) statistic that 70% of human cases reported recent direct contact with live poultry.

 

The FAO, in their most recent update (see FAO Calls For Increased Regional Vigilance & Preparedness Over H7N9), stops short of making a definitive statement on the source of infection, but states:

 

There is strong evidence that people become infected following close contact with infected live poultry, mostly in live bird markets or when slaughtering birds at home.

 

As does the World Health Organization, in their most recent H7N9 Risk Assessment:

 

Source of human infection

Although much remains unknown about this virus, such as (1) the animal reservoir(s) in which it is circulating, (2) the main exposures and routes of transmission to humans, and (3) the distribution and prevalence of this virus among people and animals, human infection appears to be associated with exposure to live poultry or contaminated environments, including markets where live poultry are sold. This is based on the following:

• Most human cases report a history of exposure to birds or live poultry markets.

• The viruses isolated from humans are avian influenza viruses and genetically similar to those isolated from birds and the environment.

• Targeted testing of poultry and environment in live poultry markets that are epidemiologically linked with human cases of H7N9 infection has revealed more positive results than testing in areas not linked with human cases

 

While none of this equates to a `smoking chicken’, warnings regarding visiting live poultry markets have been prominently featured by Hong Kong’s CHP, Mainland China’s CDC, along with our own CDC, and the World Health Organization.

 

Unlike other dangerous avian flu viruses we’ve seen in the past, H7N9 doesn’t make poultry ill, making it very difficult to detect, control, or eradicate.  An avian virus that sickens and even kills people, carried stealthily by chickens or ducks, is the very definition of a nightmare scenario for the poultry industry.

 

But for China, where food insecurity remains high and poultry provides much of their diet’s protein – this scenario could prove economically, politically, and socially disastrous.

 

China, which produces more poultry than anyplace else on earth, reportedly raises over 15 Billion birds each year. Poultry - whether factory-farm produced or from backyard flocks - is a major source of income, and food, for hundreds of millions of people.

 

Anything that seriously threatens China’s poultry industry also raises the specter of mass hunger in the world’s most populous nation.  And with that comes political instability, and unpredictable outcomes.  Something which we looked at last April in Food Insecurity, Economics, And The Control Of H7N9.

 

While China’s CDC is primarily concerned with preserving the the health of the nation, their Minister of Agriculture (MOA) is concerned with feeding more than 1 billion people. With very different responsibilities and goals, and the price of failure high, I suppose we shouldn’t be too surprised to see conflicting messages regarding the H7N9 virus.

 

Today, on the eve of China’s biggest holiday celebration, their MOA has  publicly disputed the connection between live poultry and the infection of humans by the H7N9 virus.   This from CCTV.

 

No proof of direct poultry-to-human transmissions

China's Ministry of Agriculture says there is so far no proof of any direct transmission of the H7N9 bird flu from poultry to humans. The ministry said on Wednesday that it had collected over 1.6 million poultry and environment samples in 2013, of which only 88 samples had tested positive for the H7N9 virus.

 

So far in 2014, the ministry has taken another 33,000 samples, eight of which were found to be positive. All of the positive samples came from live poultry markets.

 

"So far we haven’t found any positive samples from live poultry farms. And we haven’t found any evidence to prove that poultry can pass the H7N9 virus directly to humans." Zhang Zhongqiu, bureau director of Ministry of Agriculture, said.

 

 

Admittedly, the paucity of positive tests out of more than a million samples introduces a degree of uncertainty regarding the transmission of this virus, and the possibility of there being more than one vector species can’t be ignored.

 

But until another vector can be identified, exposure to live market birds remains the most likely risk factor for contracting the virus.

 

Of course, should this virus ever acquire the ability to spread efficiently between humans, that point will quickly become moot.

Guangxi Province Reports Their First H7N9 Case

Credit Wikipedia

 

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We’ve a late entry in today’s H7N9 case list, with a case report coming for the first time from Guangxi Province, south and west of Guangdong Province.  This expands the geographic range of the virus further south, and moves it closer to Northern Vietnam.

 

A h/t to Ironorehopper for the link.

 

Guangxi confirmed one case of human infection with H7N9 avian flu virus

At 23:03 on January 29, 2014 / Source: China News Network

BEIJING, Jan. 29, according to the Guangxi Health Department website news, January 28, 2014, Hezhou report one case of severe acute respiratory tract infections, at 21:30 on the 29th, by the autonomous region and the Chinese Center for Disease Control and Prevention, Disease Prevention Control center for testing and review, nucleic acid sample results were positive for H7N9. The regional health department expert group of patients based on the history of epidemiology, clinical manifestations and laboratory test results to determine human infection of H7N9 avian flu, which is the first case of human infection with the H7N9 Guangxi confirmed bird flu cases.

The patient is a female, 56 years old, a farmer living in the town Lingfeng Hezhou Babu District. Patient has fever, cough six days, shortness of breath increased one day, worked in two private clinics, no improvement after the 27th to Lingfeng hospitals for treatment, hospital doctors consider the patient's condition serious immediately be transferred to the People's Hospital of Hezhou treatment. Currently, patient is in the ICU rescue Hezhou People's Hospital in a critical condition.

 

Autonomous medical expert group is being organized to rescue. The epidemiological investigation of live poultry before the onset of patient exposure history. The case of the 19 who have been in close contact with medical observation to take timely measures, has not yet found an exception.

(Continue . . . )

Xinhua News: More Details On Zhejiang Family H7N9 Cluster

Zhejiang Province – Credit Wikipedia

 

 

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Via Xinhua News we’ve the first real details on the Zhejiang family cluster I reported on early this morning (see  Zhejiang Investigating Family Cluster Of H7N9 Cases).

 

Perhaps the most significant details surround the onset dates, with the father falling ill, and being confirmed infected on January 20th, while his daughter fell ill three days later.  

 

The mother was confirmed infected on the 27th, a full week after the father.

 

While a common environmental source for infection is certainly possible, this timeline would also be consistent with human-to-human transmission as well.

 

 

Chinese family of three infected with H7N9

English.news.cn   2014-01-29 21:29:49
 

HANGZHOU, Jan. 29 (Xinhua) -- Chinese health authorities on Wednesday disclosed details of a family of three who were infected with the H7N9 bird flu in east China's Zhejiang Province.

A 49-old-man surnamed Yu from Hangzhou City was confirmed on Jan. 20 to have been infected with the bird flu virus. His 23-year-old daughter, who accompanied him at the hospital, was confirmed to have caught the flu three days later, according to the provincial health and family planning commission.

Yu's wife, who also accompanied him, was confirmed to have caught the virus on Jan. 27, according to the commission.

Yu has died. His daughter is in serious condition and his wife is slightly ill.

Experts so far have no final conclusion on how the virus spread among family members. Some think they all had contact with poultry, and others think the father transmitted the flu to his wife and daughter.

Even if the case is confirmed to be a person-to-person transmission, there is no need to panic, said Li Lanjuan, an academician at the Chinese Academy of Engineering and a specialist in H7N9 prevention.

"So far there have not been any cases in which one person transmits the flu to another, and the latter transmits the virus to a third person," said Li.

In this year's epidemic, the transmission has been limited to a second person, who does not transmit the virus to a third. The H7N9 bird flu is not likely to spread in schools, workplaces or gatherings, said Chen Zhiping, deputy head of the provincial disease control and prevention center.

The probability of continuous person-to-person transmission is very slim, said Feng Zijian, deputy head of the Chinese Center for Disease Control and Prevention.

Three new human H7N9 cases were reported in Zhejiang on Wednesday, bringing the number of infections in the province this year to 56, according to the commission.

Live poultry trading has been halted in the cities of Hangzhou, Ningbo and Jinhua in Zhejiang, which has reported the most human H7N9 cases of any province. The province has launched emergency surveillance of poultry farms, parks, and migratory bird habitats, and has halted the flying of domestic pigeons.

 

 

As stated above, a family cluster – even if transmission between these three is confirmed – isn’t a game changer.

 

We’ve seen other instances of H7N9 transmission between family members (see BMJ: `Probable Person-to-Person Transmission’ Of H7N9), just as we’ve seen limited transmission of the H5N1 virus.

Should we begin to see a large number of family clusters, however, that would suggest a change in the behavior of the virus.  Which is why we monitor and scrutinize these case reports so carefully.

Zhejiang, Fujian, Guangdong & Hong Kong Announce New H7N9 Cases

Credit CDC

 

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You know its a busy morning when the daily tally of H7N9 is the sixth blog of the day.

Anyway, with a great deal of help from the newshounds at FluTrackers and Sharon Sander’s constantly updated and invaluable H7N9 Line Listing, we’ve five new cases reported out of Mainland China, along with the earlier reported Hong Kong Fatality (see CHP Announces 4th H7N9 Case In Hong Kong).

 

First stop, Zhejiang Province which reports three new cases today:

 

Zhejiang Province, three new cases of human infection of bird flu H7N9

Release date :2014-01-29
Source: Ministry of Health and Family Planning Commission
 

Zhejiang Provincial Health and Family Planning Commission January 29 briefing, the province today added three cases of human infection with H7N9 avian influenza.

1, patients Moumou, male, farmer, aged 37, Wencheng County of Wenzhou. January 28 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition at a hospital in Wenzhou treatment.

2, patients Zhu Moumou, male, individuals, aged 60, Xiaoshan District, Hangzhou people. January 28 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

3, the patient Gu Moumou, male, retired, 63 years old, Hangzhou City people. January 28 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

 

Next stop, Guangdong Province, which yesterday reported three relatively young cases (ages 43, 41 & 31), reports a rare teenage infection today.

 

Province added one case of human infection of bird flu H7N9

2014-01-29 15:22:58 Ministry of Health and Family Planning Commission | 

Health and Family Planning Commission of Guangdong Province on January 29 briefing, the Guangzhou new case of human infection of H7N9 avian influenza.

Patients Zhang, male, 17 years old, high school student, who now lives in Tianhe District, Huangpu Road Street Village Street. January 29 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable in Guangzhou City, the designated hospital admission.

 

Last stop is Fujian province, where just as unusually, a toddler is reported infected by the virus.

 

Fujian Province, one case of human infection with the H7N9 new bird flu cases

Time :2014-01-29 

Health and Family Planning Commission of Fujian Province on the 29th Bulletin, 29 Nisshin province confirmed one case of human infection with the H7N9 avian influenza.

Patients Moumou, male, 2 Suiyu, now living Xiang'an District. Currently patients with mild disease, in recovery, isolation and treatment at a hospital in Xiamen. The case for the province routine influenza surveillance sentinel hospitals found cases. (Emergency Management Office)

 

Although reported H7N9 cases have skewed heavily towards older patients - among those younger cases identified - we’ve seen relatively mild illness, which may be affecting  the detection rate.  Simply put, those with mild illnesses are less likely to seek medical care, get tested, and end up counted. 

 

Whether younger people are actually infected less often than older people is something that probably can’t be firmly established until good, community wide seroprevalence studies can be conducted.

 

We may see additional cases announced later in the day, in which case I’ll post an update.

Korea: H5N8 Spreads, Debate Over Source Intensifies

Updated Outbreak Map – Credit http://www.maff.go.jp

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Yesterday, after the announcement by Korea: Migratory Birds Likely Source Of H5N8 Outbreak,  I wrote about the long-standing (and often bitter) debate between the poultry Industry and Wildlife conservation groups over the source, and spread, of avian flu viruses.  

 

Today, in a response to the claim by the South Korean government that migratory birds are the likely source, the Scientific Task Force on Avian Influenza and Wild Birds issued the following statement (h/t @Thijskuiken for sending me the link).

 

H5N8 Highly Pathogenic Avian Influenza in poultry and wild birds in Republic of Korea

Scientific Task Force on Avian Influenza and Wild Birds statement on:

H5N8 Highly Pathogenic Avian Influenza in poultry and wild birds in Republic of Korea January 2014

KEY MESSAGES

1. Highly pathogenic avian influenza (HPAI) outbreaks are most frequently associated with domestic poultry production systems and value chains.
2. H5N8 HPAI virus has recently emerged in domestic poultry in the Republic of Korea and has caused mortality of domestic poultry and wild birds.
3. As well as impact on the poultry industry, there is the potential for significant mortality of wild birds most notably in large flocks of Baikal teal.
4. There is currently no evidence that wild birds are the source of this virus and they should be considered victims not vectors.

(Continue . . .)

 

Meanwhile, with the annual Lunar New Year’s travel holiday about to begin, the number of suspected and confirmed HPAI infections in poultry and wild birds continues to mount.  This from the Korea Times.

 

Bird flu spreading to broader provinces

By Kim Da-ye

Bird flu reached two new regions ― Gyeonggi and South Gyeongsang provinces ― Wednesday as the mass exodus for the Lunar New Year holiday began.

The latest report of a suspected avian influenza case was filed by a poultry farm in Milyang, South Gyeongsang Province. The farm has about 9,000 chickens.

A chicken farm in Hwaseong, Gyeonggi Province, reported suspected bird flu Tuesday night; and some 18,000 birds there were slaughtered by Wednesday. The farm is about 15 kilometers away from Sihwa Lake where the H5N8 strain of avian influenza was found in the feces of migratory birds.

(Continue . . .)

Hong Kong Hospital Authority On Today’s H7N9 Fatality

 

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In a quick follow up to an earlier report  this morning (see CHP Announces 4th H7N9 Case In Hong Kong), Hong Kong’s Hospital Authority has released the following statement providing a few more details on the presentation and course of treatment of their latest H7N9 case.

 

Tuen Mun Hospital response to media enquiries on confirmed human case of avian influenza A(H7N9)
 

The following is issued on behalf of the Hospital Authority:

In response to media enquiries on a confirmed human case of avian influenza A(H7N9), the Tuen Mun Hospital (TMH) spokesman gave the following reply today (January 29):

A 75-year-old patient with heart disease and other chronic illnesses was sent by ambulance to the Accident and Emergency Department (AED) of TMH at about 9pm yesterday (January 28) for chest pain, shortness of breath and cough. The patient claimed that he had stayed in Shenzhen between January 20 and 26 and had no history of contact with live poultry.

Preliminary examination by AED medical staff found that the patient showed signs of heart failure, fever and pneumonia. The patient was then transferred to a medical ward for follow-up treatment. Physicians subsequently admitted the patient to an isolation ward as further examination indicated that the patient had severe pneumonia apart from the cardiac condition. The hospital also arranged an influenza test for the patient.

The patient's vital signs were stable in the isolation ward. He was prescribed broad-spectrum antibiotics. His condition deteriorated at about 6am this morning and he finally succumbed around 8am. The hospital has referred the case to the Coroner for follow up. Preliminary laboratory results available this afternoon were positive to H7. The results were later confirmed by the Centre for Health Protection of the Department of Health.

The hospital has introduced enhanced cleaning of the related wards and will work closely with the Centre for Health Protection in contact tracing.

Ends/Wednesday, January 29, 2014
Issued at HKT 19:42

 

In a related story, Hong Kong’s SFH (Secretary For Food & Health) Dr. Ko Wing-man made this statement regarding this most recent H7N9 case.

 

Following is the transcript of remarks made by the Secretary for Food and Health, Dr Ko Wing-man, after attending a public function today (January 29):

Reporter: (On measures the Government will take after confirmation of the fourth human case of avian influenza A (H7N9).)

Secretary for Food and Health: This is the fourth case of Hong Kong citizens contracting H7N9 virus after visiting the Mainland, mainly Shenzhen because of the geographical proximity. There is no way that we can stop the human traffic between the Mainland and Hong Kong. There are bound to be many HK citizens paying a visit to the Mainland, so the most important thing is to take precautions. If you are just a visitor to the Mainland, please avoid getting into contact with live poultry or wild birds and avoid visiting or getting close to wet markets with live poultry. If you are living or staying in the affected area for a longer time, and there is no way that you can avoid going to a wet market, then one should adopt more stringent personal protection, such as carrying a mask, and very importantly, washing hands before touching eyes, nose or mouth.

CIDRAP: Analysis of new H7N9 wave warns of coinfection threat

Credit AFD

 

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Lisa Schnirring at CIDRAP News continues to provide the best daily summation of H7N9 news, last night taking a look at the ECDC Rapid Risk Assessment released yesterday, and detailing the latest 8 cases reported out of China.

 

I would invite you to read Lisa’s report in its entirety, and after you return I’ll have a bit more on the history of influenza coinfections.

 

Analysis of new H7N9 wave warns of coinfection threat

Lisa Schnirring | Staff Writer | CIDRAP News

Jan 28, 2014

Though ongoing H7N9 influenza activity in China—with eight new cases reported today—is mainly a zoonotic event, its parallel rise with seasonal flu poses a virus reassortment threat, according to a new assessment today from European health officials.

Activities surrounding Chinese New Year on Jan 31 will put humans in the crosshairs of both H7N9 and seasonal flu strains, according to the European Centre for Disease Prevention and Control (ECDC) in a comprehensive look at China's second wave of disease activity and its first update since May 2013.

Three Chinese provinces reported H7N9 cases today: four from Zhejiang, three from Guangdong, and one from Jiangsu.

(Continue . . .)

 

Proof (as if we needed it) that mother nature doesn’t play fair:  While not common, it is possible for a human to be infected by more than one respiratory virus at the same time.

 

This can not only confuse and complicate a patient’s diagnosis and treatment, it can – in rare instances – result in the creation of a new, hybrid virus.

 

Last summer, in Lancet: Coinfection With H7N9 & H3N2, we looked at an early report on just that type of coinfection in a 15 year-old boy living in China - and while no reassorted virus was detected -  this is precisely the scenario a novel virus needs in order to quickly evolve into a more transmissible pathogen.

 

In 2011 we saw an influenza co-infection in Canada that led to the creation of a unique hybrid reassorted virus (see Webinar: pH1N1 – H3N2 A Novel Influenza Reassortment).

 

In this case, the patient was a 16-month old boy from the Greater Toronto Area who was admitted briefly to a local hospital for respiratory and gastrointestinal symptoms in January of 2011. The child was sent home, and recovered without incident, and no other family members or contacts reported flu-like symptoms.

 

In 2010, in EID Journal: Co-Infection By Influenza Strains, I wrote about a study in New Zealand during the opening months of the 2009 pandemic that discovered at least 11 co-infections (out of 1,044 samples tested) with the older seasonal H1N1 virus and the newly emergent pandemic H1N1 virus.

 

While rarely detected, influenza A coinfections are probably more common than we realize.  Luckily, most do not result in the production of a hybrid strain, else we’d be hip deep in novel viruses all the time.

 

But the reality is, while rare, reassortments (in any host, not just humans) are a fast track for viral evolution and development, and can quickly change alter a virus’s ability to infect and transmit efficiently.  So while we watch H7N9 intently for signs of change, we are also watching for any new H7 inspired hybrids to emerge.

CHP Announces 4th H7N9 Case In Hong Kong

Photo credit Hong Kong’s CHP

 

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From Hong Kong’s CHP this morning we are informed of that city’s 4th H7N9 case, that of a 75 year-old man who had recent travel history to Baoan, Shenzhen.  After returning to Hong Kong on the 26th he developed a cough, and was hospitalized on the 28th with fever and shortness of breath.  He was transferred to an isolation ward, and  succumbed the following morning.

 

Confirmed human case of avian influenza A(H7N9) in Hong Kong under CHP investigation

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 29) investigating a confirmed human case of avian influenza A(H7N9) in Hong Kong affecting a man aged 75.

The patient, with multiple underlying illnesses, lived in Tin Shui Wai. He developed cough with sputum in Shenzhen on January 26 and attended the Accident and Emergency Department of Tuen Mun Hospital (TMH) last night (January 28) for fever and shortness of breath. He was subsequently transferred to the isolation ward. His condition deteriorated and he passed away this morning.

His nasopharyngeal aspirate was positive for avian influenza A(H7) virus upon preliminary laboratory testing by TMH and was confirmed as H7N9 upon further testing by the CHP's Public Health Laboratory Services Branch.

Initial epidemiological investigations by the CHP revealed that the patient had travelled alone to Baoan, Shenzhen, from January 20 to 26 and had stayed in his relative's residence close to a live poultry market.

The patient's five home contacts in Hong Kong (regarded as close contacts) have remained asymptomatic. They will be admitted to Princess Margaret Hospital for testing and observation.

Further investigations into his travel and exposure history are ongoing, in parallel with tracing of other contacts of the patient, including four patients who stayed in the same cubicle with the patient in TMH, healthcare workers of TMH and the ambulance service, who will be put under medical surveillance.

The CHP will liaise with relevant Mainland health authority to follow-up the patient's contacts during his stay in Shenzhen.

The case has been referred to the Coroner for investigation.

"The Serious Response Level under the Government's Preparedness Plan for Influenza Pandemic remains activated and the CHP's follow-up actions are in full swing," a spokesman for the DH remarked.

This is the fourth confirmed human case of avian influenza A(H7N9) in Hong Kong. The CHP will notify the World Health Organization (WHO), the National Health and Family Planning Commission as well as health and quarantine authorities of Guangdong and Macao.

Locally, enhanced surveillance of suspected cases in public and private hospitals is underway. The CHP will continue to maintain liaison with the WHO, the Mainland and overseas health authorities to monitor the latest developments. Local surveillance activities will be modified upon the WHO's recommendations.

"In view of human cases of avian influenza A(H7N9) confirmed in Hong Kong and multiple cases reported in the Mainland, the activity of the virus is expected to be higher in the winter season. Those planning to travel outside Hong Kong during Lunar New Year should maintain good personal, environmental and food hygiene at all times," the spokesman urged.

"All boundary control points have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Random temperature checks by handheld devices have also been arranged. Suspected cases will be immediately referred to public hospitals for follow-up investigation," the spokesman added.

Regarding health education for travellers, distribution of pamphlets, display of posters in departure and arrival halls, in-flight public announcements, environmental health inspection and provision of regular updates to the travel industry via meetings and correspondence are all proceeding.

The spokesman advised travellers, especially those returning from avian influenza-affected areas and provinces with fever or respiratory symptoms, to immediately wear masks, seek medical attention and reveal their travel history to doctors. Healthcare professionals should pay special attention to patients who might have had contact with poultry, birds or their droppings in affected areas and provinces.

<SNIP>

Ends/Wednesday, January 29, 2014
Issued at HKT 17:31

Zhejiang Investigating Family Cluster Of H7N9 Cases

Zhejiang Province – Credit Wikipedia

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We’ve a terse statement from the Zhejiang Ministry of Health this morning announcing their investigation into a family cluster of H7N9 cases.  Details are scant at this time, but what we know is 3 members of a family in Hangzhou all contracted the virus. 

 

Whether this was due to a common environmental exposure, or human-to-human transmission is unknown at this time.  

 

As we’ve discussed before, when it comes to proving human-to-human (H-2-H) transmission of an emerging virus, the bar is set pretty high.  When there are other, equally plausible explanations (e.g. shared environmental, or live bird exposures), then H-2-H cannot be assumed.

 

Since we’ve seen suspected limited  H-2-H transmission of the H7N9 virus in the past (see BMJ: `Probable Person-to-Person Transmission’ Of H7N9), another occurrence – while of epidemiological interest - wouldn’t be a game changer.  We take notice primarily because it could be the first visible step in a chain of transmission.

 

First the (machine translated) statement, then I’ll be back with a bit more.

 

Hangzhou together on the progress of the investigation of human infection of avian influenza H7N9 cases in family aggregation

Release date :2014-01-29

January of this year, I appointed people infected with H7N9 reported confirmed cases of avian influenza have occurred in Xiaoshan District, a family clusters of cases, three people sick. In three patients before the onset of the existence of a common environmental exposure, there are close contacts, the exact cause of the infection, the national and provincial experts are studying, one has the final official results announced immediately to the public.

 

Additional reportage indicates this cluster consists of a couple and their daughter.  This from AFP news.

 

Three H7N9 cases in same Chinese family: Xinhua

January 29, 2014 12:53 pm

SHANGHAI - Three members of the same Chinese family have contracted H7N9 bird flu in the province worst-affected by the current spike in cases, the official Xinhua news agency reported. A couple and their daughter in Hangzhou, the capital of the eastern province of Zhejiang, were infected one after another, Xinhua said late Tuesday, without giving further details.

(Continue . . .)

 

 

In 2006, we saw large clusters of H5N1 infection in both Indonesia and Turkey, and yet, it never managed to gain enough momentum to spark a pandemic (see 2006 Karo Cluster Involved H2H Transmission).  Similarly, a family cluster in Pakistan in 2007 raised concerns, but once again failed to catch fire (see EID Journal: Unraveling Pakistan’s H5N1 Outbreak).

 

Should we begin to see evidence of efficient and sustained H-2-H transmission (ie. 3rd, 4th, 5th generation transmission) - then things begin to get more interesting. 

 

But for now, we’ve no indications of that happening.

Saudi MOH Announced 59th MERS Fatality

 

 

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The Saudi MOH Has announced a new MERS-CoV Fatality today, with little more in the way of details beyond his age (60) and general location (Riyadh).  A h/t to @Ironorehopper on Twitter for the link.

 

 

 

Health: recording cases of one virus (Corona) in the new area of ​​Riyadh

03/27/1435

In the context of the work of epidemiological investigation and ongoing follow-up carried out by the Ministry of Health for the virus (Corona) that causes Acquired Middle East respiratory MERS-CoV Ministry announces the registration of the case of HIV infection to the citizen in Riyadh at the age of 60 years, had been suffering from several chronic diseases, has passed away , may he rest in peace.

ECDC Rapid Risk Assessment On H7N9

Credit ECDC

 

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The ECDC has published an updated, 15 page PDF Risk Assessment on China’s H7N9 outbreak, with detailed discussions of the human epidemiology, clinical aspects, spectrum of disease, & treatment and animal infections and environment detection – among other topics.

As the content is too extensive to adequately excerpt, I’ll simply post a link to the entire document, which is well worth downloading and reading at length.

 

Rapid risk assessment: Human infection with a novel avian influenza A(H7N9) virus, China - Third update

28 Jan 2014

Available as PDF in the following languages

EN

This document is free of charge.

Abstract

​This updated risk assessment summarises all available information on the novel avian influenza A(H7N9) and assesses the situation as of 27 January 2014, focusing on new developments since the ECDC rapid risk assessments of 3 April 2013, 12 April 2013 and 8 May 2013.

The document assesses the risk associated with the outbreak of avian influenza in China to public health in the EU/EEA and attempts to anticipate future developments (disease scenarios, availability of vaccination, human-to-human transmission).