Saturday, February 04, 2017

Taiwan CDC Announces An Imported H7N9 Case

Taiwan In Relation To Mainland China


Given its close proximity to, and cultural ties with Mainland China it comes as little surprise that Taiwan is second only to (but still well behind) Hong Kong in the number of imported H7N9 cases from China. Prior to today, Taiwan had recorded 4 cases - three of which occurred during China's second H7N9 epidemic wave of the winter-spring of 2014.
Overnight Taiwan's CDC announced their first imported case of this 5th H7N9 epidemic wave - that of a 69-year-old man who developed a fever (and sought medical care) 12 days ago while working in China's Guangdong province - and who returned to Taiwan on January 25th.

Despite domestic hospital visits on the 26th (where he tested negative for avian flu), and again on the 29th, he was diagnosed with pneumonia and apparently sent home with antivirals and other meds.  His condition worsened, and he was finally admitted to the hospital on February 1st, and sometime after that he test positive for H7N9.

The CDC's (translated) statement follows, then I'll be back with a bit more.

The first case of H7N9 influenza confirmed in the country was reported in this year

A case of H7N9 was identified in the country as a 69-year-old man with a history of contact in Yangjiang, Guangdong Province, China, with no bird or suspected history of illness. The first case of foreign immigrants. Health units have been related to the case-related contacts for investigation and booklet, for all close contacts are given adequate health education and the opening of independent health management notice, and take the initiative to track to remove the tube, if the contact with fever, cough and other influenza Symptoms will assist with medical treatment. In addition, the DSD has also been informed of the World Health Organization (WHO) and land contact windows through the IHR Contact Window.

The Commissioner for Disease Control (DSCD) said that the case was reported to have fever and chills on January 23, 2006 in Guangdong Province of China. She was admitted to the hospital on 25 January and was reported to the hospital on 26 January. A new type of influenza, the correlation test results were negative, because no symptoms of fever after treatment with antiviral agents to use home health management.
The case of fever, cough with phlegm, respiratory and asthma again to the hospital for treatment, and the diagnosis of suspected pneumonia in February 1st admitted to hospital, and informed the new type A influenza and unexplained pneumonia, and mining inspection, (February 4) confirmed H7N9 positive, is still hospitalized. Among the 6 cases in mainland China, 2 had upper respiratory symptoms and the symptoms had been relieved after medical treatment. The other two families had no symptoms at present and the health unit would keep track of the health condition.

In recent years, the number of H7N9 cases in China has increased continuously since the fall of the Qing Dynasty (October 1, 2016), with a total of 261 cases of H7N9 influenza in Jiangsu Province, 45 cases in Zhejiang Province, 33 cases in Anhui Province and 27 cases in Guangdong Province. Mainland China in November last year to May next year for the epidemic season, the season in December and January cases of rapid rise, the cumulative number of cases the highest over the same period last year. Current recommendations for the new type of human influenza A travel epidemic recommendations, mainland China Jiangsu Province, Zhejiang Province, Anhui Province, Guangdong Province, Fujian Province, Guizhou Province, Shanghai, Hubei, Hunan, Henan, Jiangxi, Shandong, Guangxi Tourism, tourism in Sichuan, Hebei, Hebei, Beijing, Tianjin, Liaoning and Yunnan are listed as the second level: Alert, other provinces (excluding Hong Kong and Macao) as the first level: Watch).

CDC reiterated its call for the continuation of the H7N9 influenza epidemic in mainland China. Both local Taiwanese and people planning to travel to the region should be vigilant and be sure to implement personal hygiene measures such as hand washing and avoid contact with birds and birds Market; eat chicken, duck, goose and eggs to be cooked to avoid infection. Return to the country in the event of fever, cough and other flu-like symptoms, should take the initiative to inform the airline personnel and airport port quarantine personnel; returned to the country after the above symptoms, should wear a mask as soon as possible, and contact physicians and history of exposure . Information can be obtained from the website of the CDC (, or by calling the toll free immunization line 1922 (or 0800-001922).
Based on the somewhat syntax-challenged (translated) narrative above (and aided by Focus Taiwan media report), this appears to be an atypical early presentation of H7N9 - something we've seen in the past with H7N9, H5N1, and other influenza subtypes (see Atypical Influenza (H5N1,H7N9, pH1N1) Presentations).

While influenza normally starts with a rapid onset of  cough, fever, and body aches, this patient reportedly only experienced fever and chills for the first few days.  

Not unlike the reports we saw from 2014 of an ER doctor in Shanghai who deteriorated rapidly and died from H7N9 after complaining of (but continuing to work with) a fever for several days (see Shanghai, Zhejiang Report New H7N9 Cases (2 Fatal)  and BMC ID: Epidemiological Investigation Of Doctor Killed By H7N9 In Shanghai).

Like most viruses, H7N9 can produce a wide spectrum of illness – ranging from asymptomatic, to severe and even fatal illness.

It is for this reason we don't have a really good feel for just how many cases there truly are in China, as only the `sickest of the sick' are ever hospitalized and tested. And as todays' report illustrates - even when conducted, laboratory tests aren't infallible - they can sometimes come back negative even when the patient is infected with the virus.

While human-to-human transmission of H7N9 has only rarely been documented, Taiwan's CDC will endeavor to track down and monitor all of this patent's contacts since he returned home.   With luck, the antivirals he was prescribed on the 26th may have further reduced his ability to transmit the virus.

In any event, we will undoubtedly hear more about this case in the coming days.  Stay tuned.      

No comments: