After Friday's bare bones report from Hong Kong (see Another 84 H7N9 Cases Reported By Mainland China), along with fragmented (and at times contradictory) provincial and media reports, our ability to track individual (and cumulative) H7N9 cases on the Mainland has deteriorated.
FluTrackers, which has maintained a fully linked, H7N9 case list since early in 2013, was forced on Saturday to halt - at least temporarily - individual case updates (see Tracking H7N9: A Game Of Very Incomplete Information).
Today Hong Kong's CHP has published their weekly Avian Influenza Report, and while it sheds valuable additional light on last week's cases, and includes cases reported to them by Mainland China health authorities (through Jan 23rd), it isn't entirely clear how current some of that data really is.
In one example, they show Hunan Province with a total of 10 cases, but the Hunan Provincial CDC website announced their 13th case on the 20th, and their 16th case today. In another, all of the new Guangdong cases were announced a week ago, and all apparently occurred before the 15th.
First some excerpts from today's much larger report, then I'll be back with more.
VOLUME 13, NUMBER 03
Reporting period: January 15, 2017 – January 21, 2017 (Week 03)
(Published on January 24, 2017)
1. Since the previous issue of Avian Influenza Report (AIR), there were ninety-eight new human cases of avian influenza A(H7N9) reported by Mainland China health authorities in Jiangsu (34 cases), Zhejiang (23 cases), Anhui (14 cases), Guangdong (11 cases), Hunan (7 cases), Fujian (5 cases) and Jiangxi (4 cases). Since March 2013 (as of January 23, 2017), there were a total of 1033 human cases of avian influenza A(H7N9) reported globally. Since November 2016 (as of January 23, 2017), 229 cases have been recorded in Mainland China.
2. Since the previous issue of AIR, there were no new human cases of avian influenza A(H5N6). Since 2014 (as of January 21, 2017), 16 human cases of avian influenza A(H5N6) were reported globally and all occurred in Mainland China. The latest case was reported on December 1, 2016.
3. There were no new human cases of avian influenza A(H5N1) reported by the World Health Organization (WHO) in 2017. From 2011 to 2015, 32 to 145 confirmed human cases of avian influenza A(H5N1) were reported to WHO annually (according to onset date). In 2016, there have been 10 cases in Egypt.*
With the understanding that Hong Kong can only print the information that the NFHPC provides, it is worth noting that the decline in the level of detail in this report vs. their last big report (week #1) is considerable. Of the 98 cases listed, fully half (n=49) are listed as `Under Investigation', and so their Clinical Condition is not provided.
In the week 1 report, only about 12% of 108 cases were so listed (see HK Avian Flu Report: A Look At The Demographics Of H7N9).
Today's report indicates 10 fatal outcomes, and just 21 cases with Severe Pneumonia or in Critical Condition, but with half of the data missing, it makes it difficult to draw any conclusions.
None of the cases are listed as in `good' or `stable' condition.The demographics are still skewing very heavily towards males (69%), with only 4 of 98 cases listed as under the age of 30 (ages 24, 28, 17, and 3). This age shift towards older patients is something we've repeatedly seen with H7N9, as opposed to the shift to younger cases with H5N1.
As I write this, I see that HK's CHP has posted the following update on Hunan's 16th case, which I mentioned earlier in this report.
The Centre for Health Protection (CHP) of the Department of Health is today (January 24) closely monitoring an additional human case of avian influenza A(H7N9) in Hunan, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.(Continue . . .)
According to the Hunan Provincial Center for Disease Control and Prevention, a female patient, aged 37 from Yueyang City who was exposed to poultry, is in critical condition.
"According to a report from the Chinese Center for Disease Control and Prevention, under the routine environmental surveillance in affected provinces like Jiangsu, Zhejiang and Guangdong, the positive rate of H7N9 among environmental samples collected from live poultry markets or other live poultry-related environments increased in December 2016 and was higher than the rates in the same period in previous years.
Today's HK update helps to firm up some of the numbers from last week, but given the lag in reporting by individual provinces to Beijing - and then from Beijing to Hong Kong - it seems likely the numbers we have are already well out of date.