|4 Waves of H7N9 - Credit WHO|
During the first two H7N9 epidemic waves (2013-2014) China earned high marks for providing almost daily, detailed, updates on new cases. It was a remarkable, and welcomed, reversal of policy from the bad old days of the SARS epidemic in 2003, when China literally hid cases from the WHO.
But, in January of 2015 - and without explanation - that policy changed, and case reports dropped much of the detail we'd become used to, appeared far less frequently, and were often weeks old when we got them.While some contemporaneous H7N9 reports still manage to leak out, or are published on provincial websites, it is usually around the 10th of the month when most provinces report their previous month's infectious disease numbers.
And so today we learn that - in addition to the cases we already knew about - China is announcing another 83 human cases of H7N9, including 25 deaths, from the end of 2016.
This brings December's numbers to well over 100 cases, making it the biggest and fastest early start to China's yearly H7N9 epidemic we've seen. First the statement from Hong Kong's CHP, then I'll return with a bit more.
The Centre for Health Protection (CHP) of the Department of Health today (January 9) received notification from the National Health and Family Planning Commission that 83 additional human cases of avian influenza A(H7N9), including 25 deaths, were recorded last month. The CHP again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
The 54 male and 29 female patients aged from 23 to 91 from Jiangsu (52 cases), Zhejiang (21 cases), Anhui (nine cases) and Fujian (one case) had their onset from November 22 to December 29, 2016. Among them, 58 reported exposure to poultry or poultry market while the source of infection of 17 cases was under investigation.
In addition, the CHP is closely monitoring an additional human H7N9 case in Jiangxi yesterday (January 8). According to the Health and Family Planning Commission of Jiangxi Province, the female patient aged 55 from Yichun was hospitalised in Nanchang in critical condition.
The Guizhou Center for Disease Control and Prevention reported an additional case affecting a female patient aged 49 from Sandu involved in poultry selling who was hospitalised in critical condition.
"Most human cases occurred in winter and spring while disease activity was low in summer and autumn. From 2013 to date, 900 human cases have been reported by the Mainland health authorities, 125 of which have been recorded from November 2016 thus far," a spokesman for the CHP said.
"While local surveillance, prevention and control measures are in place, we will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments," the spokesman said.
As the H7N9 virus continues to be detected in animals and environments in the Mainland, additional human cases are expected in affected and possibly neighbouring areas. In view of the heavy trade and travel between the Mainland and Hong Kong, further sporadic imported human cases in Hong Kong every now and then are expected, especially in the coming few months.
"Therefore, we strongly urge the public to avoid touching birds, poultry or their droppings and visiting poultry markets or farms during travel, particularly in the upcoming Lunar New Year holidays. If feeling unwell, such as having a fever or cough, wear a mask and seek medical advice at once. Travellers returning from affected areas should consult doctors promptly if symptoms develop, and actively inform the doctors of their travel history for prompt diagnosis and treatment," the spokesman added.
The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.
The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.
The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below while handling poultry:
- Avoid touching poultry, birds, animals or their droppings;
- When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
- Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
- Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
- Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.
The public may visit the CHP's pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.Ends/Monday, January 9, 2017Issued at HKT 17:34NNNN
HK's CHP reports 125 cases during the first couple months of this 5th winter outbreak, which is more than 12 times greater than the number we were at last year at this time (n=9).
In last month's MMWR: Assessing The 4th Epidemic Wave Of H7N9 In China, researchers warned of `the continued geographic spread, identification of novel reassortant viruses, and pandemic potential of the virus' - themes we've covered often in the past, including here, here, and here.
The also stated that `using the Influenza Risk Assessment Tool (10), CDC found that A(H7N9) virus has the highest potential pandemic risk of any novel influenza A viruses that have been assessed.'While H7N9's sudden surge is concerning, so far - in the limited reporting coming out of China - we haven't heard of any large clusters, or or sustained human-to-human spread of the virus. Were the Chinese reporting today as detailed it was back in 2013 and 2014, that absence of data would be, admittedly, a lot more comforting.
With the Chinese Lunar New Year less than 3 weeks away, with hundreds of millions of people traveling across Asia, the next six weeks are going to be a very very closely watched by both Chinese, and global, public health agencies.