# 2673
Twenty-four hours after the announcement of the 3rd human avian flu infection this month in China, the level of concern in places like Beijing and Hong Kong is almost palpable.
China had gone nearly a year without reporting a case, and now to have three in the space of 11 days is, not surprisingly, of considerable concern.
The three cases are widely separated geographically, and so there is no indication that they are directly linked. Single cases are, of course, less concerning (epidemiologically speaking) than clusters.
At last report, the 2 year-old remains in critical condition.
There are many unanswered questions, however.
First, there have been no reports of sick or dying poultry in the areas where these people lived or worked. Since the assumption is that the virus is generally passed from birds to humans, the lack of obviously sick birds presents a problem.
Are there asymptomatic birds shedding sufficient virus to infect these people in the region? Or, have these people picked the virus up from some other vector?
Second, is the sudden increase in cases. While we expect more cases during the winter months, three out of China in less than 2-weeks is worthy of notice.
Are we really seeing a jump in cases? Or, are we seeing the results of better surveillance, better testing, and more truthful reporting from the provinces in the wake of the Beijing case?
Third, with the Chinese New Year/Spring festival only a week away, millions of Chinese will be making the traditional trek to the town of their birth to celebrate with their families. They will then return to the major cities of China, and beyond.
How best can China prevent the spread of any contagious disease during this great human migration?
Three stories this morning. The first from Radio New Zealand, which carries a warning from China's officials.
More human bird flu cases likely, warns China
Updated at 9:41pm on 19 January 2009
China has warned of the risk of further human cases of bird flu in the run-up to the Lunar New Year holiday after two more cases during the weekend.
After not reporting any human infections in almost a year, China has confirmed three cases of the H5N1 virus in less than two weeks.
China's Agriculture Ministry says the frequent movement of poultry products as the holiday approaches is increasing the risk of virus outbreaks and transmission.
The latest infections bring China's total to 33 human bird flu cases. At least 22 people have died.
Whether this warning telegraphs any information about other suspect cases is unknown. We do know that Shanxi province has issued a warning to all hospitals to report any suspicious pneumonia cases.
A hat tip to Florida1 on Flutrackers for posting this edict.
At 9:09 on January 17, 2009
Taiyuan, Shanxi: Emphasize the importance of monitoring the first time issued pneumonia of unknown causes
Net new Shanxi Xinhua January 17 in winter and spring is a high incidence of respiratory diseases period, to more cases of pneumonia of unknown causes.
Yesterday, the City Health Bureau released 2009 document No. 6, called for the strengthening of unexplained pneumonia cases of monitoring, investigation, reporting and management of the City Health Department This is the first time the form of a document, stressing the monitoring pneumonia of unknown causes.
According to the briefing, "pneumonia of unknown causes" is following the SARS epidemic, the Ministry of Health in a timely manner in order to better detect and deal with SARS, bird flu and other similar performance, with certain infectious pneumonia proposed a term.
The main clinical manifestations of the disease have fever, cough, sputum, and breathing difficulties.
The cases of pneumonia of unknown causes of monitoring, including the counties (cities, districts) Health Bureau, the municipal medical and health units as well as in and more than two medical institutions.
These medical institutions to take the initiative to search for cases of pneumonia of unknown causes, the discovery of cases of pneumonia of unknown cause must be immediately treated in isolation timely Direct Network Report, the implementation of the first hospital and the attending doctor in charge of the first system.
Experts remind that the prevention of respiratory diseases such as pneumonia of unknown causes, it is necessary to do a good job in respiratory protection, keep the room ventilation, wearing masks, washing hands frequently.
Now is the time of migratory birds, but also to minimize contact with poultry.
Source: Shanxi Youth Daily
This sort of closer scrutiny may, indeed, result in the discovery of additional H5N1 infections.
The suspicion has been long held that local officials, not wanting to incur the scrutiny that reporting a human infection would bring, may have been reluctant to aggressively test or report `suspicious cases' in the past.
Hong Kong, meanwhile, watches and worries over the situation.
Tens of thousands of day-workers commute from mainland china to the city each day. And next week, hundreds of thousands of Hong Kong residents will travel to the mainland to celebrate the Spring Festival with their families.
This from News.Gov.HK.
January 19, 2009
Surveillance
More info sought on Mainland avian flu cases
Secretary for Food & Health Dr York Chow says the Government is concerned about the three recent human cases of H5N1 on the Mainland and has asked authorities for epidemiological study results when they are ready.
Speaking to reporters today Dr Chow said there are two main areas he is concerned about.
"One is if there is no avian flu outbreak in poultry and yet there are human cases, whether there is a change in the virus. Secondly, whether there are more so called 'silently infected chickens' that actually have the potential of carrying the virus and transmitting the disease and yet do not show any symptoms of illness or do not actually die from those illnesses.
"Because of that we have decided we will not increase the number of imported chickens from the Mainland this year so we will not change the pattern of trading and transport during this period."
Noting public concern about the rise in chicken prices Dr Chow said the decision not to increase live chicken imports during the festive period is appropriate.
He said the Government will be vigilant in combating smuggling, adding the public should be careful when they are approached by anyone selling chickens of unknown source.
