Zhejiang Province – Credit Wikipedia
Reporting on H7N9 cases out of China has been `suboptimal’ for quite some time, with cases being announced via a mix of local media reports, occasional provincial MOH statements, or buried in EOM Epidemiological reports. Rarely do we get any useful detail beyond the age, gender, and general location, and so keeping reasonable track of cases is a real challenge.
Already this year we’ve seen reports of 3 cases out of Zhejiang Province (see Oct. 4th Media: Shengzhou Reports 1st H7N9 Case Of The Fall & Oct 13ths Hong Kong CHP: Zhejiang Province Reported 2 H7N9 Cases In September).
The two cases announced on the 13th were confirmed by the WHO on October 16th, but not the case announced on the 4th. Yesterday Chinese media began reporting on 4 H7N9 cases this fall, but without providing any details, making it impossible to match them against known cases.
This morning Hong Kong’s CHP reported on two new H7N9 cases, but one of those (the 62 y.o. from Shengzhou) we’ve known about since October 4th.
11 November 2015
The Centre for Health Protection (CHP) of the Department of Health (DH) today (November 11) was notified of two human cases of avian influenza A(H7N9) in Zhejiang by the National Health and Family Planning Commission (NHFPC), and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
According to the NHFPC, the cases comprise a woman aged 62 in Shengzhou, and a female farmer aged 51 in Hangzhou. They had poultry exposure history and are currently in serious condition.
"Based on previous seasonal patterns, it is likely that the activity of avian influenza viruses might increase in winter. Heightened vigilance is warranted. Locally, we will work closely with the World Health Organization and relevant health authorities to monitor the latest developments," a spokesman for the DH said.
So far, four cases have been reported by the NHFPC since October 2015 and all occurred in Zhejiang. From 2013 to date, 661 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities.
If things weren’t already confusing enough, while this report states `four cases have been reported by the NHFPC since October’, two of those four occurred back in September. This lack of consistency in reporting out of China will undoubtedly result in a fair amount of uncertainty over the the day-to-day status of their H7N9 epidemic this winter.
- #686 - Female, 62, [Moumou], test positive October 2, hospitalized in serious condition, poultry history, Shengzhou, Zhejiang province
- #687 - Female, 55, onset September 18, Huzhou city, Zhejiang province WHO rpt 19/10/15
- #688 - Male, 53, onset September 21, Jinhua, Zhejiang province WHO rpt 19/10/15
- #689 - Female, 51, farmer, serious condition, Hangzhou, Zhejiang province
These 689 cases only represent those who were sick enough to go to a hospital, and who were then lucky enough to tested for the virus. Since H7N9 doesn’t always produce severe illness – particularly in younger patients – it is expected that surveillance only picks up some fraction of the true number of cases.
Meanwhile, Zhejiang’s CDC has posted the following (translated) advice for avoiding H7N9 infection:
(Source: CDC Zhejiang Published: 2015-11-10)
Human infection with H7N9 avian influenza virus occurs mainly in autumn and winter. Since March 2013 the first reported cases of human infection with H7N9 bird flu in China has been popular three seasons. Since autumn 2015 the province, has reported human infection with H7N9 avian influenza 4 cases, it is characterized by its popularity: There are 50 years of age in rural cases underlying disease; and to have a history of contact with live poultry from raising poultry to master; the first case the whole genome sequencing with previous strains prevalent strains are highly homologous season, found no variation. Cases start to appear, show the province has entered human infection with H7N9 avian influenza epidemic of new season, and as the weather turns cold, the risk of human infection with the H7N9 avian influenza virus is increasing.
Avian flu mainly refers to the popularity of poultry infection caused by the influenza virus disease, H7N9 bird flu virus is one of them. Cases of human infection with H7N9 avian influenza is generally manifested as flu-like symptoms, such as fever, cough, sputum less, may be associated with headache, muscle aches and general malaise. The rapid development in patients with severe disease, manifested as severe pneumonia, mostly sustained body temperature above 39 ℃, difficulty in breathing, coughing up blood may be associated with sputum; can quickly progress to acute respiratory distress syndrome, shock, multiple organ failure, and even death.
Studies show: live bird markets exposure / exposure is a risk factor people live birds infected with H7N9 bird flu onset, carrying the virus in poultry and their droppings, secretions may be human infection with H7N9 avian influenza virus infection source. According to "Zhejiang live poultry transaction management approach" issued by the provincial government, the main city around the city permanently closed live poultry trading. But in the vast province county, township and rural areas, live poultry market is still widespread, and some live animal markets do not strictly enforce clean, closed, disinfection system. In addition, the lack of regulation of the informal market, street markets and other places there are still people infected with H7N9 avian influenza spread risk. According to the province waders risk outside environmental monitoring results show that in October 2015 the first half of my province environmental H7 positive rate was increased compared with September, the province's human infection with H7N9 avian influenza occurred sporadic outbreaks of large, especially in the vast rural areas area, backyard poultry and live birds household contacts onset of focus groups.
To reduce the risk of human infection with the H7N9 avian influenza virus occurred, the provincial CDC to remind the public:
In daily life should try to avoid direct contact with live poultry, birds or their droppings; after contact, shall wash their hands with soap and hand sanitizer as soon as possible; the elderly, have chronic underlying diseases or immunocompromised people should pay more attention to avoid contact with live poultry ; Do not buy live poultry slaughtered on their own, do not buy without quarantine certificates fresh, live and frozen poultry and their products; raw poultry, meat and eggs must be cooked fully cooked, after processing raw poultry meat and eggs to Wash hands thoroughly; food processing to achieve separate raw and cooked; cultivate a healthy lifestyle, physical activity; if fever and respiratory symptoms should wear a mask for treatment as soon as possible, remember to tell your doctor before the onset of poultry and other contact history.