# 8189
The end-of-day H7N9 reports for Monday are beginning to filter in and thus far we have two fatal cases – including an Emergency Room doctor – from Shanghai and, for the 12th day running, Zhejiang province is reporting new cases as well. Additional case reports may appear later in the day.
For now, our first stop is Shanghai, where an two people who died on Saturday were later determined to have had the H7N9 infection.
In the most high profile case – that of an ER doctor who worked at Pudong New Area People's Hospital – media reports suggest his early symptoms were atypical for influenza, consisting primarily of fever for the week before his death (see Atypical Influenza (H5N1,H7N9, pH1N1) Presentations)
According to a Shanghai Daily report overnight (see Doctor suspected to have died from H7N9), the doctor worked his shifts up until Friday despite his ongoing fever, but his condition suddenly deteriorated on Friday and he died Saturday morning of pneumonia and respiratory failure. How, and where, he acquired the infection is unknown.
As we have only limited evidence of human-to-human transmission of the virus, it is impossible to even guess whether this doctor might have passed the virus on to others while he worked in the emergency room.
His co-workers were likely at greatest risk, and presumably will be monitored.
This somewhat less detailed report from Shanghai’s Ministry of Health and Family Planning.
Shanghai 2 new confirmed cases of human infection with H7N9 avian influenza
Published :2014 -1-20
Shanghai Health and Family Planning Commission January 20 briefing , Shanghai reported new confirmed cases of H7N9 avian flu two cases of human infection .
Patients First, Moumou , male, 31 years old , Shanghai household registration , medical personnel . Patients were around at 4:00 on January 18 , after she died . January 19 , samples of laboratory test results for patients with H7N9 avian influenza virus nucleic acid positive clinical expert by the municipal cases based on clinical manifestations , laboratory test results and epidemiological investigation , the overall judgment of the people infected with H7N9 avian case confirmed cases of influenza .
Two patients , Wu Moumou , male, 77 years old , Shanghai household registration , farmers. Patients were around at 0:00 on January 18 , after she died . January 19 , samples of laboratory test results for patients with H7N9 avian influenza virus nucleic acid positive clinical expert by the municipal cases based on clinical manifestations , laboratory test results and epidemiological investigation , the overall judgment of the people infected with H7N9 avian case confirmed cases of influenza .
Since July this year, the city reported a total of confirmed cases of human infection with H7N9 avian influenza , are sporadic cases . Close contacts of all cases , have been observed to implement health measures , the current situation is no exception .
According to state regulations , from November 1, 2013 the city began infected with H7N9 avian influenza has been incorporated into human B infectious management.
Zhejiang Province meanwhile is reporting three new cases, bringing to 27 the total number reported out of that province since the start of 2014.
Zhejiang Province, three new cases of human infection of bird flu H7N9
Release date :2014 -01-20
Source: Ministry of Health and Family Planning Commission
January 20, 2014
Zhejiang Provincial Health and Family Planning Commission January 20 briefing, the province today added three cases of human infection with H7N9 avian influenza.
1, patients Jin Moumou, female, 71 years old, farmer, Yuhang District, Hangzhou people. January 19 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, in Hangzhou, a hospital for treatment.
2, the patient Fang Moumou, male, 63 years old, farmer, Longyou County, Zhejiang Province, Jiaxing County is now live. January 19 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.
3, the patient Cao Moumou, male, 55 years old, farmer, Yinzhou District, Ningbo people. January 19 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, a hospital for treatment in Ningbo.
Despite enhanced awareness in hospitals across Eastern China, it is apparent that some of these cases are not being diagnosed until they have progressed to a severe level of illness, or even after the patient’s death. Not only does this bode ill for the individual patient, it allows potentially infectious patients to expose others to the virus.
The difficulty is, that in its early stages, H7N9 infection looks like any other respiratory or viral illness. And this time of year, literally millions of people across China (and the globe) are experiencing typical winter respiratory infections. In an ideal world, every flu-like case would be tested for novel influenza, but logistically, that simply isn’t going to happen.
Unknown also is how many mild, or even asymptomatic H7N9 infections are going undetected. While we see a high percentage of severe illness among the cases that are diagnosed, we really have no idea how much of the big picture we are seeing.
While this daily parade of new cases is concerning, thus far we haven’t seen compelling evidence of sustained or efficient human-to-human transmission of this virus.
The virus, however, continues to evolve, and so we continue to track these cases carefully, looking for any signs that its behavior has changed.
