#10,700
Having produced major outbreaks in human infections each winter (see graphic below) since it first emerged in 2013, China’s H7N9 virus seems well poised to kick off its fourth winter epidemic over the next couple of months. Cases are generally sporadic in the fall, and only begin to take off in December and January.
While the total number of confirmed human infections remains under 700, the true burden of the disease is unknown. Only those sick enough to seek hospitalization – and who are tested – end up identified. The assumption is that a great many mild or moderate infections are never reported (see Lancet: Clinical Severity Of Human H7N9 Infection).
Although no sustained transmission has been observed in the community (an observation reinforced by very few secondary infections in contacts of known cases), the H7N9 virus continues to evolve and change over time (see EID Journal: H7N9’s Evolution During China’s Third Wave – Guangdong Province).
As with any influenza virus, there are no guarantees that the virus we see this winter will act the same as it has in the past.
So far, we’ve only seen 4 cases reported this fall (see WHO H7N9 Update – China). Today China’s Ministry of Agriculture has issued the following statement on preparedness for H7’s expected return.
Provinces, autonomous regions, municipalities and cities of Animal Husbandry and Veterinary (animal husbandry, agriculture) department (bureau, committees, offices), the Xinjiang Production and Construction Corps of Animal Husbandry and Veterinary Bureau, subordinate institutions concerned, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences:
Autumn and winter flu season, to further improve the H7N9 flu prevention and control work, notice of the matter is as follows.
First, strengthen monitoring and early warning. All localities should follow national animal disease surveillance program requirements, combined with the national influenza H7N9 in poultry culling program, do a good job monitoring and epidemiological investigation. Timely detection, remove poultry farming, market liquidity and other key aspects of the pitfalls. Regional human infections appear to strengthen the monitoring of investigation and patient location and the surrounding areas of live bird markets and poultry farms. National Avian Influenza Reference Laboratory will continue to track the virus variation, increase the biological characteristics of the virus and other research, strengthen the prevention and control technical support.
Second, strengthen epidemic prevention management and live bird markets regulatory transporting live poultry. Around animal husbandry and veterinary departments should actively cooperate with relevant departments to strengthen the management of live poultry markets and epidemic prevention, the implementation of regularly closed, disinfection system. Animal health oversight agencies to strengthen the inter-provincial transportation of poultry and quarantine supervision. Inter-provincial transportation of avian species young, to strictly enforce the arrival report and quarantine system.
Third, strengthening sectoral collaboration. Around animal husbandry and veterinary departments to strengthen cooperation with relevant departments of family planning and other health, according to their respective division of responsibilities, strict source control, and strengthen measures linkage, effective implementation of prevention and control work.
Fourth, do the emergency preparedness. All localities should further strengthen the emergency prevention and control management, standardize emergency procedures, strengthening emergency team building and emergency supplies reserves, and improve emergency response capabilities. To strengthen emergency duty, strict implementation of staff on duty 24 hours and leadership with a class system. Once the animal H7N9 positive samples detected, disposal should be strictly in accordance with regulations and carry out follow-up investigation.
Fifth, strengthen advocacy and information dissemination. To continue to adhere to the "timely and accurate, open and transparent" principle, regularly publish information on the prevention and control, and enhance information dissemination initiative and effectiveness. Strengthen prevention and control knowledge popularization, guide public science rational consumption of poultry products.
Office of the Ministry of Agriculture
Live bird markets (LBMs) are considered the primary risk factor for the spread of H7N9 (see The Lancet: Poultry Market Closure Effect On H7N9 Transmission), and while many urban areas have attempted to shut down markets during the peak of the `bird flu season’, many LBMs continue to operate either legally or illegally.
There is a certain amount of irony surrounding the 5th tenet of this edict – one that calls for "timely and accurate, open and transparent" principal in communications – given the parsimonious release of information on H7N9 cases we’ve seen since the 3rd wave began.
Often, we only hear about cases in EOM epidemiological reports issued by the provinces, and rarely do those provide any substantive detail.
While the day-to-day reporting of H7N9 cases in China may be less than we might hope, we continue to see some excellent scientific papers coming out of China on the evolution and spread of the virus.
