Based upon what will likely to prove to be incomplete information, Hong Kong's CHP has published this week's Avian Influenza Report, which adds just 10 new H7N9 cases from the mainland over the past 7 days. A sharp contrast to the 98 cases reported in the previous week.
Once again, case information is patchy.Of the 10 cases listed, 2 are in stable condition, 4 in critical condition, and the condition of the remaining 4 are not listed. Of the 7 which specify age and gender, 5 are male, with the youngest patient listed as 36 years of age. This matches the demographic for H7N9, which has skewed heavily towards males, and those over the age of 40.
None of this year's hardest hit provinces (Zhejiang, Guangdong, Jiangsu, Anhui, etc.) are represented in this week's report, and it appears that Guangdong province - which reported 11 cases in the first half of January - hasn't released any information since the middle of last month.Hong Kong can only print the information that the Mainland releases, and for the past two years we've seen considerable delays on the part of the NFHPC and many provinces in providing timely updates (see Tracking H7N9: A Game Of Very Incomplete Information).
When you add in the inevitable reporting delays brought on by Asia's extended New Year's holiday celebration, it seems a pretty good bet we are missing a substantial number of pieces to this puzzle.Some excerpts from today's report, followed by an announcement from the CHP on 4 recent cases on the mainland:
Avian Influenza Report
VOLUME 13, NUMBER 04
Reporting period: January 22, 2017 – January 28, 2017 (Week 04)
(Published on February 1, 2017)
1. Since the previous issue of Avian Influenza Report (AIR), there were 10 new human cases of avian influenza A(H7N9) reported by Mainland China health authorities in Henan (2 cases), Hubei (2 cases), Hunan (2 cases), Liaoning (2 cases), Guizhou (1 case) and Shandong (1 case). Since March 2013 (as of February 1, 2017), there were a total of 1043 human cases of avian influenza A(H7N9) reported globally. Since November 2016 (as of February 1, 2017), 239 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 28, 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.*
The Centre for Health Protection (CHP) of the Department of Health is today (February 1) closely monitoring four additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.
Among the four cases, two patients respectively from Kangping County in Shenyang and Beipiao City in Chaoyang, Liaoning are in a stable condition. A 67-year-old male patient from Hengyang, Hunan has a history of poultry contact and is in a critical condition, while the remaining patient from Wangmo County in Guizhou is currently under management in hospital.
"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.
A spokesman for the CHP said, "We strongly urge the public to avoid touching birds, poultry or their droppings and visiting poultry markets or farms during travel. 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.
"Adults and parents should also look after children with extra care in personal, hand, food and environmental hygiene against infections during travel.
"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."
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.
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;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.
• 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.
Ends/Wednesday, February 1, 2017Issued at HKT 17:33NNNN
Given that hundreds of millions of people are still on the move this week following last weekend's Chinese New Year's celebration (often in crowded trains and buses), the 7 to 10 day incubation period of H7N9, and the delays in reporting we've seen the past two years, it may be several weeks before we get a real handle on the extent of China's 5th H7N9 epidemic.