Buried deep within a government line list of infectious disease reports for the month of September is a line item showing two – previously undisclosed – H7N9 cases that occurred sometime last month, somewhere in China, and whose circumstances and outcomes are currently undisclosed.
After an admirable start in 2013 and early 2014, China ceased their open announcing of H7N9 cases last year, and their reporting to the World Health Organization has dwindled in both frequency and detail.
The last WHO update was on July 18th (for May-June cases), and the `complete description’ of 5 cases was accomplished in just over 80 words. This is a regrettable trend – and one not restricted to just avian flu in China.
Between November of 2014 and April of this year Egypt endured the biggest H5N1 outbreak in history, but you’d scarcely know that based on the Egyptian MOH website announcements or the local press. And as frustrating as MERS reporting has been out of Saudi Arabia, it is even murkier out of Jordan, the UAE, and other Middle Eastern nations.
Frankly, we’ve `lost visibility’ of many emerging diseases around the world because of `selective surveillance and/or reporting’ by governments, and a tightly controlled press.
The good news in today’s self-reporting out of China is that only 2 H7N9 cases were recorded in September (another was reported by local media on Oct. 2nd).
What we don’t know, however, is how exhaustive the testing and surveillance for avian flu cases has been over the summer, or for that matter, whether provinces are diligently reporting their numbers to the NHFPC (they didn’t during the 2003 SARS outbreak).
People's Republic of China National Health and Family Planning 2015-10-10
September 2015 (at 0:00 on September 1 to September 30 24), the national (excluding Hong Kong, Macao and Taiwan, the same below) reported a total of 585,322 cases of legal infectious diseases, died 1433 people. Among them, the CPI infectious plague incidence and deaths have been reported, the incidence of cholera were reported in two cases and no deaths. B infectious SARS, polio, diphtheria and highly pathogenic avian influenza incidence and deaths have been reported, and the remaining 22 kinds of infectious diseases were reported incidence of 299,542 cases, 1424 people died. Before the reported incidence of five diseases were viral hepatitis, tuberculosis, syphilis, bacillary and amoebic dysentery and gonorrhea, accounting for 92% of the total reported cases of class B infectious diseases.
Over the same period, the country reported a total of 285,778 cases of Class C infectious diseases, died 9 people. Where filariasis morbidity, mortality report, the number of reported incidence of the previous three diseases were hand, foot and mouth disease, other infectious diarrhea and mumps, accounting for 95% of the total reported cases of class C infectious diseases.
2015 years 9 month's national legal infectious diseases reported incidence, mortality tables
A final note: Even the best surveillance and reporting system in the world wouldn’t pick up all, or even the majority, of H7N9 cases in China. This virus can cause a wide range of symptoms, ranging from mild or asymptomatic presentation to severe and life threatening pneumonia.
Generally speaking, only the the `sickest of the sick’ will turn up at a hospital, and of those, only some subset will be tested for the virus.
During the first wave of 135 cases in 2013, researchers estimated the true incidence of infection could have ranged into the thousands (see Lancet: Clinical Severity Of Human H7N9 Infection).That said, the reporting of only 2 H7N9 cases in all of China during the month of September (usually a slow time of year for avian flu) would normally be highly reassuring.
But as long as governments continue to treat infectious disease reports like state secrets, you can never be overly sure about anything.