Sunday, February 26, 2017

Zhong Nanshan On China's Mutated H7N9 Virus

H7N9 Waves - Credit WHO


Fourteen years ago, when SARS was burning its way through parts of China - and the Chinese government actively hid that information from its people, its doctors, and the rest of the world - one man boldly went before the TV cameras and told the truth.
His name : Dr. Zhong Nanshan.
In 2003 he was the director of Guangzhou's Institute of Respiratory Diseases, a member of China’s Academy of Sciences, and pioneered some of the earliest (and most successful) treatments for SARS patients.

Zhong also did something that normally isn't conducive to good health and long life in China . . .  he publicly challenged official government statements on the epidemic. 

But in doing so, Zhong Nanshan not only helped to break the back of an epidemic, he became a much respected and revered household name in China - and the rest of the world. 
So, when Zhong Nanshan (now 80, and Editor-in-Chief of  The Journal of Thoracic Disease) speaks, we listen.

The following (translated) interview with Zhong Nanshan - where he discusses recent changes in the H7N9 virus,  and warns people to avoid contact with live poultry - has been making the rounds in the Chinese media overnight.

In it he confirms some degree of oseltamivir resistance in the two Guangdong patients (something previously announced in the Taiwan case), although he is quick to point out that most H7N9 infections are not anti-viral resistant.  
There are, however, many unknowns, including how widespread this new mutation will become in the months ahead.
I normally dislike using large excerpts from a media report, but seeing as I've not (yet) found a detailed English language version I can link to, and given the importance of the information provided, I've elected to use most of the report below.

Zhong Nanshan: H7N9 viruses resistant mutants public not to touch live poultry

2017-02-26 06:47 

Since the beginning of winter, the number of cases of human infection with the H7N9 virus of bird flu surge. 25, the Chinese Academy of Engineering academician Zhong Nanshan, in an interview with reporters said the two virus variants recently discovered in the highly pathogenic avian exhibit, and appears resistant to Tamiflu (oseltamivir phosphate). He called on members of the public do not contact with live birds, once the fever and other flu symptoms, to timely medical treatment.
Fatality rate more than 40%? "not necessarily"

Statistics show that this year's H7N9 epidemic mortality rate of over 40%, disease control experts believe that this is about to miss the best treatment time. However, this figure, Zhong Nanshan that "play a big question mark," "because the current total number of sick people not statistics, confirmed cases are generally severe, not necessarily have such a high mortality rate."
"A considerable part of the virus is not mutation"
February 19, the Chinese Center for Disease Control and Prevention of Guangdong provincial CDC sent from two cases of human infection with the H7N9 virus isolated cases have been reviewed, verified discovery of H7N9 virus variants from human infections.
Zhong Nanshan pointed out that the two cases of H7N9 virus variants recently discovered there are two characteristics: First, the mutant virus to become highly pathogenic in poultry. "In the past H7N9 virus in poultry is not the disease, pathogenic in humans, but the virus can also cause mutation of avian disease, it is also attach great importance to the agricultural sector."
Second, the emergence of resistant strains variation of Tamiflu. Zhong Nanshan said the two patients in Guangdong blood and the upper and lower respiratory tract were found in this variant virus, the treatment of preliminary findings are resistant to Tamiflu. However, Zhong Nanshan also pointed out that the majority of patients with Tamiflu treatment is effective, "explained the mutated virus strains did not become widely prevalent epidemic strains, that a considerable part of (virus) no variation."
Enhanced ability to communicate mutation has not yet appeared
H7N9 epidemic trends this year will be how? Zhong Nanshan believes that there are still many unknowns. For example, resistant strains of the virus mutation will become the predominant strains of a wide range of spread is unclear; or resistant mutant virus strains will make human morbidity, higher mortality was not sure.
The Chinese Center for Disease Control and Prevention earlier analysis, based on sequence analysis of the virus, the virus mutation occurs in human infectivity, virulence and transmissibility among humans enhanced mutation has not yet appeared.
After the emergence of resistant mutant virus strains, will make adjustments to the treatment plan? Zhong Nanshan explained, the mutated virus strains found just shortly (adjustment programs) too early. Currently there are methods of combination therapy, and treatment of the most critical H7N9 virus is supportive therapy. "From our experience, patients with lung damage largest, patients with severe avian influenza virus will harden the lungs, and finally respiratory failure, while the heart, kidneys also have different degrees of damage, so we antiviral therapy At the same time to take on these important organ support therapy, if these vital organs to support live, we will be able to passed the critical stage. "
● Nanfang all media reporter Yan Huifang Xu Jiang Ou

To date we've only been notified of three human infections with this HPAI H7N9 variant.  We don't yet know how representative these cases are, how well it spreads in birds, how easily it jumps from birds to humans, or if it has in any way become more virulent or transmissible in humans.
While we await more details, it is worth noting that there are literally dozens of other H7N9 genotypes spreading across China - along with a bevy of HPAI H5 viruses - each is on its own evolutionary path.
Which means that this new HPAI variant, while appearing to up the ante, isn't the only one with pandemic potential we need to keep our eyes on.