Thursday, February 20, 2014

China’s MOA: H7N9 Fatalities Higher Than Previously Announced


Credit Dr. Ian Mackay VDU Blog




# 8317



Although China has been refreshingly open about announcing new H7N9 cases over the past year, one area where it has been difficult to keep track has been patient outcomes.  Often patients are hospitalized in critical condition for weeks, or even months, and only rarely do we get an update as to whether they were discharged or died.


A little over a week ago, Dr. Ian Mackay looked at the number of fatal outcomes in H7N9 snapdate; the number of surviving and fatal human cases.…, and discussed the variable numbers we’ve seen coming from the individual Provinces and the media.


Late in January, the ECDC published their 3rd Rapid Risk Assessment on H7N9, where – based on 56 reported deaths out of 251 cases – they estimated a mortality rate of 22.3%.


Over the past month we’ve seen roughly 100 more cases reported, and an extrapolation would put the number of deaths in the upper 70s,  but today we learn from China’s Ministry of Agriculture that the number of deaths is quite a bit higher.


A big hat tip goes to Tetano and Sharon Sanders on FluTrackers for picking up a pair of reports (one directly from the MOA) indicating that – so far – H7N9 has resulted in 347 reported cases and 109 deaths.

A (tentative) CFR closer to  31.4%  - or 40% higher than previously disclosed.


This from the Chinese MOA’s General Office of the Ministry of Agriculture to seek "national poultry H7N9 influenza eradication program (draft)" opinion letter:


Office of the Ministry of Agriculture

February 19, 2014

National Poultry H7N9 influenza eradication program

To further improve the people infected with H7N9 avian influenza outbreak response work, to discover, excluding H7N9 avian influenza virus, and effectively protect poultry production safety, animal product quality and safety and public health and safety, according to the "Animal Epidemic Prevention Law" and other laws and regulations, the development of this plan.

I. Background

2013 China experienced H7N9 avian influenza confirmed cases since the first case of human infection, infection and disease has caused many deaths. As of February 18, 2014, has a total 347 cases of reported cases and 109 deaths. People infected with H7N9 bird flu on China's poultry industry has brought a serious impact. According to the China Animal Husbandry Association statistics, in the first half of 2013 the poultry industry, the direct loss of $ 60 billion since 2014 has lost 20 billion yuan.

National Avian Influenza Reference Laboratory report, the current environment isolated from poultry and out of the H7N9 avian influenza virus in poultry AVIRULENT performance, but the presence of the virus to mutate into highly pathogenic strains of possibilities, will the poultry industry greater risk. National surveillance and epidemiological findings suggest that, H7N9 avian influenza virus can infected poultry and contaminated the environment in the patient's body to the separation, the current positive samples mainly from the live poultry trade field point, but does not rule out the existence of a small number of contaminated poultry farms .

Developed and implemented national eradication program, quickly take unified action, master virus space, time, inter-group distribution of live poultry trade field points, poultry farms and other key aspects to take timely monitoring Excluding measures to strengthen source control, is significant.

(Continue . . .)


The next obvious question – assuming these numbers are right – is: 


Has the CFR gone up appreciably during this second wave or has the reporting on fatalities lagged behind all along? 


A sudden spike in mortality would be significant, as discussed last week, in Eurosurveillance:The Evolving Threat From New, Reassorted H7N9 Viruses. There we learned of three new reassortant H7N9 viruses detected during this second wave.  The report cautioned:


. . .  the new reassortments generated by A(H7N9) and local A(H9N2) strains may produce avian influenza virus strains that are more adaptive and have a higher pathogenicity in humans [16], emphasising the importance of continuously monitoring the A(H7N9) epidemic.


Whether today’s revised CFR number is due to a change in the virus’s behavior or simply the result of a long-term lapse in fatality reporting  is too early to know.

But either way, H7N9 deserves our ongoing attention and vigilance.