Location Shanghai China
# 8126
In a very brief announcement on their website, Shanghai’s Municipal Commission of Health & Family Planning, has reported their first H7N9 case of 2014 – that of an 86 year-old man who is currently hospitalized. First the Shanghai statement (machine translated), followed by Hong Kong’s publication of the notification, after which I’ll return with more.
Confirmed cases of H7N9 avian influenza reported one case of human infection in Shanghai
Shanghai Health and Family Planning Commission January 3 briefing, H7N9 bird flu case in Shanghai, reported one case of human infection.
Patients Zhou Moumou, male, 86 years old, the city residence. Confirmed on January 3, is now a city hospital for treatment.
According to state regulations, from November 1, 2013 the city began infected with H7N9 avian influenza has been incorporated into human B infectious management.
From Hong Kong’s CHP:
Additional human case of avian influenza A(H7N9) in Shanghai verified by NHFPC
The Centre for Health Protection (CHP) of the Department of Health (DH) today (January 4) verified with the National Health and Family Planning Commission (NHFPC) an additional human case of avian influenza A(H7N9) in Shanghai affecting a man aged 86.
The case was confirmed yesterday (January 3) and the patient is currently admitted to a local hospital for treatment.
To date, a total of 145 human cases of avian influenza A(H7N9) have been confirmed in the Mainland, including Zhejiang (51 cases), Shanghai (34 cases), Jiangsu (28 cases), Guangdong (six cases), Jiangxi (six cases), Fujian (five cases), Anhui (four cases), Henan (four cases), Beijing (two cases), Hunan (two cases), Shandong (two cases) and Hebei (one case).
The CHP will follow-up with the Mainland health authorities for more case details.
"Locally, enhanced disease surveillance, port health measures and health education against avian influenza are ongoing. We will remain vigilant and maintain liaison with the World Health Organization (WHO) and relevant health authorities. Local surveillance activities will be modified upon the WHO's recommendations," a spokesman for the DH remarked.
All border control points (BCPs) have implemented disease prevention and control measures. Thermal imaging systems are in place for body temperature checks of inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up investigation.
Although it seems as if we’ve been discussing H7N9 for a long time, in truth, we first learned of this emerging virus about 9 months ago, when China’s CDC announced the first two cases from Shanghai (see More Details Emerge On Shanghai H7N9 Case) on March 31st.
In the two months that followed, we learned that cases had begun to appear in February of 2013, and continued to appear until aggressive controls on live bird markets were imposed in April and May (see The Lancet: Poultry Market Closure Effect On H7N9 Transmission).
After a quiescent summer, as expected (see Chinese CDC: Be Alert For H7N9), colder fall and winter temperatures have brought a resurgence in the number of human infections being reported. As we saw last spring, thus far, these appear to be sporadic cases, without any epidemiological evidence of efficient and sustained transmission.
Of concern is that Chunyun - or the Spring Festival travel season - begins about 15 days before the Lunar New Year (January 31st this year) and runs for about 40 days total, is only a couple of weeks away. Over these six weeks more than 2 billion passenger journeys will be made (mostly via crowded rail and bus) across Asia.
During this time poultry sales in China also reach record levels, as duck and chicken are popular dishes served during these reunion dinners. It is probably no coincidence that the first outbreak of the H7N9 virus emerged during and just after the last (2013) Spring Festival, and that has public health officials concerned.
On December 1st, we saw a preventative measure announced - Shanghai To Close Poultry Markets Over Lunar New Years To Curtail H7N9 - but the plan was to keep live bird markets open up until the Lunar New Year’s Eve – January 31st. Whether today’s announcement will influence that decision is something we’ll have to wait to see.
Over the years we’ve seen occasional attempts to close live bird markets in Asia – as they are often linked to the spread of avian (and other) pathogens to humans - only to be met with tremendous public resistance (see 2009 blog China Announces Plan To Shut Down Live Poultry Markets In Many Cities). Their ambitious plans, announced 4 years ago to `shut live poultry markets in all large and medium-sized cities throughout China’, obviously never happened.
Purchasing live market birds is deeply ingrained in Asian culture, and in a part of the world where refrigeration isn’t always available, it reassures the buyer that the bird is both fresh and healthy.
While concerns run high that Chunyun could usher in another mini-epidemic of H7N9 cases like we saw last spring – and patient reports and laboratory testing have suggested it is unusually well-adapted to mammalian physiology (see mBio: H7N9 Naturally Adapted For Efficient Growth in Human Lung Tissue) – thus far this virus has failed to demonstrate the ability to transmit efficiently among humans.
And it may be that it never will.
But – like H5N1 – over time this virus will likely mutate and evolve into multiple clades (see EID Journal: The Expanding Variants Of H5N1). And we could discover H7N9 version 2.0 (or beyond) to be better adapted to humans than this first incarnation.
So anything that can be done to reduce the spread – and opportunities for adaptation –of the H7N9 virus today could go a long ways towards preventing a possible pandemic tomorrow.
Complicating matters, this virus is a stealthy one - at least in birds - making eradication and containment more difficult than with other more pathogenic avian viruses. Often, the only indication we get that local birds are infected is when a human in contact with them falls ill.
Which illustrates the importance of surveillance and testing of humans with flu-like symptoms over the coming months in China, if this virus is to be detected and contained.
