Monday, February 09, 2015

WHO H7N9 Update – China

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The World Health Organization has published a DON (Disease Outbreak News) report on China’s winter outbreak of H7N9, acknowledging 83 recent cases (most appear to be cases we’ve heard about previously), but devoid of the kind of detailed case information we’ve grown accustomed to seeing over the first two waves.


Previous updates, from both the Chinese MOH and the WHO, have included useful epidemiological details, such as the following case report from the WHO January 19th update:

A 52-year-old female from Fuzhou City, Fujian Province who developed symptoms on 11 December. The patient was admitted to hospital on 16 December and is now in critical condition. The patient had history of exposure to live poultry.


Along with sporadic - and often delayed - reporting of H7N9 cases out of China this winter, we’ve also seen a paucity of individual case data being released.  Hopes that WHO updates would be able to continue to fill in the missing pieces appear dashed at this point.

 

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

Disease outbreak news
8 February 2015

On 4 February 2015, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 83 additional laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus. Onset dates ranged from 20 December 2014 to 27 January 2015. Below is a breakdown of the 83 cases included in this notification by epidemiological week of symptom onset:

  • On 20 December 2014: 2 cases
  • Week 52 (22 – 28 December 2014): 8 cases
  • Week 1 (29 December 2014 – 4 January 2015): 16 cases
  • Week 2 (5 - 11 January 2015): 21 cases
  • Week 3 (12 – 18 January 2015): 20 cases
  • Week 4 (19 – 25 January 2015): 13 cases
  • 26 - 27 January 2015: 3 cases

Cases ranged in age from 1 to 88 years with a median age of 56 years. Of the 83 cases, there were 19 deaths reported, ranged in age from 7 to 78 years with a mean age of 50 years. 60 of these 83 cases were male. The majority (78 cases, 93%) reported exposure to live poultry or live poultry markets; the exposure history of 4 cases is unknown.

Three family clusters were reported, each comprised of 2 cases; all had exposure to live poultry or live poultry markets. Cases were reported from 8 provinces: Fujian (30), Guangdong (30), Jiangsu (7), Jiangxi (1), Shandong (1), Shanghai (2), Xinjiang (1), and Zhejiang (11).

The Chinese Government has taken the following surveillance and control measures
  • Strengthen surveillance and situation analysis.
  • Reinforce case management and medical treatment.
  • Conduct risk communication with the public and release information.

WHO, in close collaboration with China, is monitoring the epidemiological situation and conducting further risk assessment based on the latest information.

Further sporadic human cases of avian influenza A(H7N9) infection are expected in affected and possibly neighbouring areas. Should human cases from affected areas travel internationally, their infection may be detected in another country during or after arrival. If this were to occur, community level spread is considered unlikely as the virus does not appear to have the ability to transmit easily among humans.

(Continue . . .)

 

Of note, of the 16 provinces that have reported H7N9 cases over the first two waves, only 8 have reported cases this year.


While it may seem a small thing, the absence of individual case information effectively prevents us from matching up media reports, and local MOH announcements, to these bulk data dumps.  Epidemiological line listings – like the one maintained by FluTrackers – have become an important resource in recent years, but are badly diminished by this lack of patient data.

 

The same can be said for Dr. Ian Mackay’s excellent charts, graphs, and maps.

 

Sadly, this trend isn’t limited to China.   Egypt’s MOH has become far less communicative on H5N1 (see Regarding The Silence Of The Egyptian MOH), and after more than 18 months, the world is still waiting for a case-control study on MERS from Saudi Arabia.  


There are plenty other `dead zones’ for disease information around the world; areas that simply can’t due to a lack of resources, or don’t for political and economic reasons, report disease outbreaks until or unless they get completely out of hand. 

 

It is hard not to feel we are moving backwards in terms of disease surveillance and reporting around the world.  A dangerous trend for a world so globally interconnected, and one that could easily see us blindsided by the outbreak of a novel pathogen flying stealthily beneath our radar.

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