Taiwan Intl Airport – Credit China News Agency
# 7204
Yesterday, in H7N9: Fujian Province Reports Second Case, I posed the question : `exactly what criteria is being used (in China) to decide whether to test patients for the H7N9 virus?’
While the answer to that question remains elusive on the Mainland, I have run across revised criteria -issued late last week to doctors and hospitals - in Hong Kong.
As of today, Hong Kong’s Centre for Health Protection has received notification of 18 cases that fulfill their reporting criteria for suspected H7N9 infection, but as of yet, none have tested positive for the virus.
Reporting criteria for Human Influenza A (H7N9) infection
(Last updated on 25 April 2013)
An individual fulfilling both the Clinical Criteria AND Epidemiological Criteria should be reported to CHP for further investigation.
Clinical Criteria
Patient with
- influenza-like-illness (fever >38 oC with cough or sore throat); OR
- person with severe pneumonia; OR
- person died of unexplained acute respiratory illness.
Epidemiological Criteria
One or more of the following exposures in the 10 days prior to symptom onset:
- contact with a human case of influenza A (H7N9); OR
- contact with poultry or wild birds or their remains or to environments contaminated by their faeces in countries/areas with documented avian influenza A (H7N9) infection in birds and/or humans in the recent 6 months (see List of affected areas); OR
- consumption of raw or undercooked poultry products in countries/areas with documented avian influenza A(H7N9) infection in poultry and/or humans in the recent 6 months (see List of affected areas), OR
- close contact with a confirmed influenza A(H7N9) infected animal other than poultry or wild birds; OR
- worked in a laboratory that is processing samples from persons or animals that are suspected from avian influenza infection
The list of affected areas is regularly uploaded to the Centre for Health Protection (CHP) website
(http://www.chp.gov.hk/files/pdf/global_statistics_avian_influenza_e.pdf
While an argument could be made for broader testing – with no evidence of H2H spread, and no cases reported in humans or poultry in Hong Kong – the requirement for a plausible route of exposure is not unreasonable.
Exactly what criteria is being used in Mainland China - in provinces where the virus has already been detected - isn’t clear.
This latest letter to doctors also extends the incubation period of the virus to 10 days.
In view of the latest best available evidence, the longest incubation period of human infection with avian influenza A(H7N9) virus has been revised from 7 days to 10 days and the epidemiological criteria of the reporting criteria has been revised accordingly (see attached). Please also note that Taiwan has not been included as an affected area as the case recorded was classified as an imported infection
This week, Hong Kong – along with Mainland China and many other nations – celebrates Labor Day (May 1st). Each year, millions of visitors from the mainland pour into Hong Kong during this `golden week’ to shop, and to visit.
While an economically important period for businesses in Hong Kong, this year, concerns over the possible importation of the H7N9 virus run high.
For more on this, the Wall Street Journal has details on Hong Kong’s plans to thwart the viruses’ arrival.
Hong Kong Steps Up Flu Fight
- Updated April 28, 2013, 3:38 p.m. ET
Hong Kong immigration and hospital officials are stepping up efforts to fend off the spread of H7N9 bird flu, which surfaced outside China for the first time last week, as floods of mainland Chinese tourists descend on Hong Kong for the Labor Day holiday.
The government is deploying greater manpower at the border at the mainland Chinese city of Shenzhen, one of the busiest border crossings in the world, to screen travelers for elevated body temperatures, and tour operators are being urged to monitor the condition of individual tourists.
