We continue to see sporadic reports of H7N9 coming out of the Chinese Mainland, with four cases reported today from three separate provinces.
First stop, a notice from Guangdong province – which has now reported 18 cases during this third H7N9 season – that informs us of two new cases.
2015-01-23 16:59:29 Ministry of Health and Family Planning | Health and Family Planning Commission of Guangdong Province January 23 briefing, Shantou, Zhaoqing were reported one case of H7N9 cases.
Case 1 Humou, male, 68 years old, currently living Shantou area. January 23 diagnosed cases of H7N9, sicker patients currently in Shantou City, admitted to inpatient hospitals.
Case 2 Leimou, male, 4 years old, now living in Zhaoqing Sihui City, January 22 H7N9 cases diagnosed, the patient's condition is currently stable, in Zhaoqing City hospitals admitted to hospital.
For the second time this week Shanghai is reporting a new case as well.
Shanghai Health and Family Planning Commission on January 22 briefing, Shanghai reported confirmed cases of the new H7N9 virus one case of human infection.
Patients, Chen, female, 75 years old, the city residence. Confirmed on January 22, patients in critical condition, is now in active treatment.
And lastly, Hong Kong’s CHP reports a `new’ case from Zhejiang Province. Whether this case belongs to the group reported earlier this week by Xinhua News (see Zhejiang province has seen 14 cases this winter) or is a fresh case, is impossible to tell from the information provided. Despite the Xinhua report, Hong Kong is only showing 8 new cases this winter in Zhejiang.
The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 23) closely monitoring four additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
According to the notification of the Health and Family Planning Commission of Guangdong Province, the two cases involved a 68-year-old man in Shantou who was hospitalised for treatment in serious condition, and a 4-year-old boy in Zhaoqing who is in stable condition.
According to the Shanghai Municipal Commission of Health and Family Planning, the patient in Shanghai is a woman aged 75 who was under treatment in critical condition. In addition, according to the Health and Family Planning Commission of Yiwu Municipality, the patient in Yiwu, Zhejiang, is a man aged 45 who was under isolation and treatment.
To date, 489 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities, respectively in Zhejiang (146 cases), Guangdong (127 cases), Jiangsu (63 cases), Shanghai (44 cases), Fujian (28 cases), Hunan (24 cases), Anhui (17 cases), Jiangxi (nine cases), Xinjiang (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).
The above listing showing 489 human cases represents only those cases hospitalized, tested, and diagnosed with the H7N9 virus and likely represents only a portion of the total number of cases. There are likely a number of mild, or even asymptomatic infections that go unnoticed, as well as serious or even fatal cases that are simply never diagnosed.
In 2013, a study appearing in The Lancet (see Lancet: Clinical Severity Of Human H7N9 Infection) attempted to quantify that number - at a time when the `official count’ hovered around 130 cases -estimating `that between 1500 and 27 000 symptomatic infections with avian influenza A H7N9 virus might have occurred as of May 28, 2013’.
The accuracy of these estimates is unknown, but it is very likely that the official case counts under-represent the real burden of H7N9, perhaps by a sizable margin.
And this winter, the reporting of cases out of China seems more inconsistent than during previous H7N9 epidemic waves, with less detailed information provided, all of which adds a bit more `fog’ to obscure our view of this year’s outbreak.