Saturday, February 04, 2017

The Skies Aren't The Only Thing Hazy In China

Eastern China Smog - Credit NASA Earth Observatory


Up until two years ago China was remarkably open about their H7N9 `problem', a commendable and welcomed change from the blatant cover ups of SARS in 2003 and their intermittent reporting on H5N1 over the years.

Starting in April of 2013, H7N9 updates were issued almost daily, with enough patient data to allow us to track their epidemic, often with timely epidemiological assessments as well.

It was as if we'd entered a new era of transparency with China.  

All of that ended  abruptly - and without explanation - during the height of their third epidemic wave, in March of 2015,  something I wrote about at the time in H7N9: No News Is . . . . Curious. China pulled the plug on their H7N9 updates just weeks after Egypt stopped reporting on their record-setting H5N1 outbreak (160+ cases) (see More Than One Way to `Contain An Outbreak’).  

Since then information has continued to be slow to trickle out of either country.  Our visibility of cases in the Middle East is probably worse than it is in China, because in China, at least some of the provincial governments still posted timely notices of cases.  
But even that practice - which was intermittent at best last year - has sharply declined over the past 60 days.

In March of 2016, I wrote:
Guangdong province - due to its close proximity to, and trade relations with Hong Kong - is generally pretty good about notifying Hong Kong's CHP (and posting on their own Health Ministry website), whenever new avian flu cases are detected.

By contrast, this year Guangdong province has been unusually quiet.

At the end of December, during a time when Hong Kong had already reported two cases with travel history to Guangdong Province, and Macao had seen 1 case in a poultry vendor selling chickens imported from Guangdong province, Guangdong Province had only announced a single case.

It wasn't until January 6th we saw - buried in an obscure EOM epidemiological report (see December 2016 Guangdong statutory A and B infectious diseases morbidity, mortality tables) - that there had actually been 14 H7N9 cases (7 fatal) reported in Guangdong Province during the month of December.
We are currently aware of at least 21 more cases in Guangdong province during January, courtesy of a pair of HK CHP updates, but they contained little or no detail, and they covered some cases that were nearly a month old when they were released.

While there have only been 35 cases acknowledged by Guangdong Province since this 5th epidemic began in November, Sharon Sanders of FluTrackers has compiled a list of no fewer than 8 cases believed to have been exported from Guangdong during that time period.

Reported Guangdong Exported Cases:

#816 - Male, 58, onset November 20, stall owner exposed to infected chickens tested positive December 13 in Macao, stable condition, from Guangdong provinceCHP rpt 20/12/16 WHO rpt 19/12/16

#817 - Male, 75, onset December 8, hospitalized December 9 in Hong Kong, test positive December 19, travel history to Dongguan, Guangdong province Death WHO rpt 23/12/16

#827 - Male, 70, onset December 26, hospitalized December 27, serious condition, in Hong Kong, possible exposure in Zhongshan, Guangdong province CHP rpt 3/1/17 WHO rpt 3/1/17

#846 - Male, 62, onset Jan 1, hospitalized Jan 2-3 in Guangdong, then hospitalized in critical condition in Hong Kong Jan 4, Guangdong province Death WHO rpt 17/1/17

#933 - Male, 10, onset January 8, hospitalized January 9, stable condition in Hong Kong - traveled from Foshan, Guangdong province CHP rpt 11/1/17

#941 - Female, 72, hospitalized January 8 in Zhongshan, traveled back to Macao and hospitalized again January 10, poultry contact, Zhongshan, Guangdong province CHP rpt 13/1/17

w. Male, 32, hospitalized in Nanning, Guangxi province, working in Guangdong province

x. Male, 69, hospitalized in ICU in Taiwan, imported from Guangdong province

Some reported poultry exported recently:

Macao - Health Bureau follows up on bird flu virus detected in poultry wholesale market in southern Guangdong Mainland - January 2017

China - Imported chicken in Macao, from the Mainland, infected with H7 avian flu virus in market - February 3, 2017

It would be remarkable (in a province of 109 million people) - that of 43  H7N9 cases (35 local + 8 exported) - almost 1 in 5 would have ended up exported to either Hong Kong, Macao, or another province.

While a few provinces (e.g.  Hunan and Hubei) continue to post updates, the hardest hit provinces (Zhejiang, Guangdong, Jiangsu, and Anhui) have been almost totally silent - apparently only talking specifics with  Beijing.

Hopefully we'll get a bit more insight on the size of China's 5th epidemic wave in another week, when the January EOM Epidemiological reports are usually released.  But those only contain the total number of cases (and deaths) by province, and tell us nothing about clusters or other epidemiological findings.

For now we've seen nothing to suggest that H7N9 is transmitting in an efficient or sustained manner in China, and this year's epidemic may very well end in a few months -  just as the last four did - albeit with a record number of cases.

But our lack of visibility in China (and to be fair, in the Middle East as well) makes it difficult to simply assume that their avian flu crisis is genuinely under control. And even if it is, this recent spiral into silence by both China and Egypt - even as multiple avian flu threats continue to spread around the world - doesn't bode well for the future.


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