FluTrackers: Zhejiang Province Reports 10 H7N9 Cases In March

Zhejiang Province – Credit Wikipedia

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With the exception of a couple of cases reported out of Shanghai over the past week, we’ve heard almost nothing out of China regarding H7N9 cases since early March (see H7N9: No News Is . . . . Curious).  Compared to the first two waves, reporting this year has been more sporadic and less detailed, and so the hope has been that some end of month `bulk announcements’ might be forthcoming.

 

Today Sharon Sanders of FluTrackers has picked up just such a report, this time from the Zhejiang Provincial Health and Family Planning Commission, that has buried deep inside a (Chinese language) spreadsheet; notification that Zhejiang Province detected 10 H7N9 cases during the Month of March.

 

Since Sharon has done the detective work here, I’ll link you to her post on FluTrackers.

 

China - 10 H7N9 cases including 10 deaths reported by Zhejiang province for March 2015 - 8 new cases not previously known - April 8, 2015

 

Zhejiang Provincial Health and Family Planning Commission announced in March 2015 the province's legal infectious diseases

Release Date: 2015-04-08
Source: Ministry of Health and Family Planning Disease Control Department
 

March 2015 (at 0:00 on March 1, 2015 to March 31 24), the province reported a total of 20,029 cases of notifiable infectious diseases, the death of 43 people. Among them, the Group reported no cases of infectious diseases. B infectious diseases, in addition to SARS, polio, highly pathogenic avian influenza, rabies, Japanese encephalitis, anthrax, diphtheria, leptospirosis, schistosomiasis incidence and deaths foreign reports, the remaining 17 kinds of infectious disease cases were reported in 10,210 cases, 43 deaths; reported incidence of the top five diseases were: tuberculosis, syphilis, viral hepatitis, gonorrhea, measles, accounting for reported cases of class B infectious diseases 94.1% of the total.

The same period, the province's Class C infectious diseases were reported in 9819 cases and no deaths reported. The top three reported cases of diseases were other infectious diarrhea, hand-foot-mouth disease and influenza accounted for 93.9% of the total reported cases of class C infectious diseases.
Schedule: March 2015 in Zhejiang Province of notifiable infectious disease, mortality tables

Zhejiang Provincial Health and Family Planning Commission
April 7, 2015

http://www.zjwst.gov.cn/art/2015/4/8...62_438460.html
machine translation

 

Interestingly, although included in the spreadsheet, there is no specific mention of H7N9 in the summary report. Kudos to Sharon for drilling down deep into the data to uncover this information.

 

Since we’ve seen nothing reported out of Guangdong Province – this year’s hotspot for H7N9 -  since March 7th, it will be interesting to see what ends up posted in their End of Month Epidemiological report as well.  Their reports tend to come out around the middle of the month.

Stay tuned.

Guangdong, Zhejiang & Shanghai Report H7N9 Cases

 

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We continue to see sporadic reports of H7N9 coming out of the Chinese Mainland, with four cases reported today from three separate provinces.  

 

First stop, a notice from  Guangdong province – which has now reported 18 cases during this third H7N9 season – that informs us of two new cases.

 

Shantou, Zhaoqing City, one case of H7N9 cases were reported

2015-01-23 16:59:29   Ministry of Health and Family Planning  |      Health and Family Planning Commission of Guangdong Province January 23 briefing, Shantou, Zhaoqing were reported one case of H7N9 cases. 

Case 1 Humou, male, 68 years old, currently living Shantou area. January 23 diagnosed cases of H7N9, sicker patients currently in Shantou City, admitted to inpatient hospitals.

Case 2 Leimou, male, 4 years old, now living in Zhaoqing Sihui City, January 22 H7N9 cases diagnosed, the patient's condition is currently stable, in Zhaoqing City hospitals admitted to hospital.

 

For the second time this week Shanghai is reporting a new case as well.

 

Shanghai reported one new confirmed cases of human infection with H7N9 virus

Published: 2015-1-22

Shanghai Health and Family Planning Commission on January 22 briefing, Shanghai reported confirmed cases of the new H7N9 virus one case of human infection.

Patients, Chen, female, 75 years old, the city residence. Confirmed on January 22, patients in critical condition, is now in active treatment.

 

And lastly, Hong Kong’s CHP reports a `new’ case from Zhejiang Province.   Whether this case belongs to the group reported earlier this week by Xinhua News (see Zhejiang province has seen 14 cases this winter) or is a fresh case, is impossible to tell from the information provided.   Despite the Xinhua report, Hong Kong is only showing 8 new cases this winter in Zhejiang. 

 

CHP closely monitors four additional human cases of avian influenza A(H7N9) in Mainland

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (January 23) closely monitoring four additional human cases of avian influenza A(H7N9) in the Mainland, and again urged the public to maintain strict personal, food and environmental hygiene both locally and during travel.

According to the notification of the Health and Family Planning Commission of Guangdong Province, the two cases involved a 68-year-old man in Shantou who was hospitalised for treatment in serious condition, and a 4-year-old boy in Zhaoqing who is in stable condition.

According to the Shanghai Municipal Commission of Health and Family Planning, the patient in Shanghai is a woman aged 75 who was under treatment in critical condition. In addition, according to the Health and Family Planning Commission of Yiwu Municipality, the patient in Yiwu, Zhejiang, is a man aged 45 who was under isolation and treatment.

To date, 489 human cases of avian influenza A(H7N9) have been reported by the Mainland health authorities, respectively in Zhejiang (146 cases), Guangdong (127 cases), Jiangsu (63 cases), Shanghai (44 cases), Fujian (28 cases), Hunan (24 cases), Anhui (17 cases), Jiangxi (nine cases), Xinjiang (nine cases), Shandong (six cases), Beijing (five cases), Henan (four cases), Guangxi (three cases), Jilin (two cases), Guizhou (one case) and Hebei (one case).

(Continue . . .)

  

The above listing showing 489 human cases represents only those cases hospitalized, tested, and diagnosed with the H7N9 virus and likely represents only a portion of the total number of cases. There are likely a number of mild, or even asymptomatic infections that go unnoticed, as well as serious or even fatal cases that are simply never diagnosed.

 

In 2013, a study appearing in  The Lancet (see Lancet: Clinical Severity Of Human H7N9 Infection) attempted to quantify that number - at a time when the `official count’ hovered around 130 cases -estimating `that between 1500 and 27 000 symptomatic infections with avian influenza A H7N9 virus might have occurred as of May 28, 2013’.

 

The accuracy of these estimates is unknown, but it is very likely that the official case counts under-represent the real burden of H7N9, perhaps by a sizable margin.

And this winter, the reporting of cases out of China seems more inconsistent than during previous H7N9 epidemic waves, with less detailed information provided, all of which adds a bit more `fog’ to obscure our view of this year’s outbreak.

Zhejiang Reports Additional H7N9 Cases

Zhejiang Province – Credit Wikipedia

 

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As noted before, unlike the past couple of years we don’t seem to be getting real-time H7N9 reports out of some of China’s provinces, and instead get bulk notifications – often lacking in case details – at irregular intervals, sometimes weeks after the fact (see Jiangsu Province’s Uncertain H7N9 Count). 

Zhejiang province, which ended the 2nd wave with 139 confirmed H7N9 cases (the largest number reported by any province), has been  unusually quiet this winter, reporting only 1 case in November (link), and two cases in mid-December (link), and then 4 cases in January (link).

Today Xinhua News is reporting 14 cases from Zhejiang province `this winter’,  but without onset date information, leaving open the question as to how many of the 7 cases previously acknowledged are included in this total.  I find no update on the Zhejiang Health Department website clarifying this.

Whether this represents 7 additional cases, or more, is something hopefully Hong Kong’s CHP will sort out for us in the next day or two.

 
In the meantime, here is the Xinhua report:

 

East China province reports 14 H7N9 cases this winter

English.news.cn   2015-01-21 20:37:15
 

HANGZHOU, Jan. 21 (Xinhua) -- East China's Zhejiang Province has reported 14 human cases of H7N9 avian influenza infection this winter, local authorities said Wednesday.

Of the 14, two died, eight are in a critical condition, two are in a stable condition and two have recovered, said Xie Guojian, spokesman with the Zhejiang Provincial Commission of Health and Family Planning.

Last winter, the province reported nearly 100 H7N9 human cases.

The closure of live poultry markets in the urban areas is given as one of the reasons for the smaller number of infections this winter, Xie said.

All 14 cases were from the countryside, small towns and city suburbs and most of the patients had contact with poultry, he said.

The official urged the public to stay away from birds, and seek treatment for fever and coughs.

Two More H7N9 Reports From Zhejiang Province

Zhejiang Province – Credit Wikipedia

 

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H7N9 reports out of Zhejiang Province, China continue to emerge piecemeal, with no single authority making announcements. The Zhejiang Health and Family Planning website, a place we’d normally look for such reports, remains strangely quiet on H7N9.

 

Over the past couple of days we’ve seen two H7N9 cases reported out of Zhejiang – a 57 year-old man from Jinhua on the 27th, and yesterday a 75-year-old man Zhoushan town.  These cases are geographically quite distant from one another and are not linked.

 

Today we are seeing reports of a 20 year-old from Shaoxing  City and a 33 year-old from Yongkang City having been diagnosed with the virus.  

 

Our first stop, the Shaoxing City Municipal Health Bureau (h/t Shiloh on FluTrackers for the link).

 

One case of H7N9 confirmed cases keqiao area

---

Source: Municipal Health Bureau Date: 2014-12-29 

December 28 Keqiao District confirmed one case of H7N9 cases, this is the first cases appeared in this winter of our city, our province, following the recent Jiaxing, Yiwu, Yongkang found after the first five cases of H7N9 cases.

According to CDC epidemiological investigation, the patient Xing Moumou, female, 20 years old, currently living area keqiao Anchang, one week prior to the onset has been to the farmers market, no clear history of exposure to poultry, currently in critical condition, still active treatment, the epidemic prevention and control measures are being ordered implemented.

Really good job in the prevention and control of H7N9 and other respiratory diseases in winter and spring, to protect people's lives and the safety and health of the city since the fall of the H7N9 prevention measures to further strengthen the government held a special meeting, a clear focus on the prevention and control tasks, strengthen epidemic patient monitoring and treatment of preparatory work, promote poultry "slaughter, kill white listed" to regulate the management of live poultry market transactions, joint special rectification, investigate and punish illegal trade of live poultry and other measures.

Experts advise consumers to prohibit live poultry trade, the implementation of cold fresh selling not only the government's requirements, but also to prevent bird flu, pay attention to science inevitable choice for a healthy lifestyle, the general public need to change consumer attitudes, and establish healthier eating chilled products, Safer scientific concept. At the same time, the current high season coincided respiratory diseases, people should pay attention to personal hygiene, indoor ground ventilation, air circulation and less places to go, do not contact with sick / dead poultry category, carefully touching live poultry, fever, cough, etc. Symptoms medical institutions should be approaching fever clinic.

 

Meanwhile, from Yongkang City (200km from Shaoxing), we get this report of a 33 year-old infected with the virus.  Additionally, it appears that one of the two cases reported earlier this week has died.

 

Yongkang third case confirmed H7N9 cases, 1 death

At 19:55 on December 29th, 2014
Source: China News Network

BEIJING, Dec. 29 Jinhua (Reporter Hu Fengsheng) 29 evening, according to the government press center Yongkang official microblogging "Yongkang release" message in the afternoon, Yongkang confirmed three cases of H7N9 flu cases first. It is in this winter, following Jiaxing, Zhejiang Yiwu confirmed two cases since the emergence of the first five cases. Zhejiang Province, according to the CDC epidemiological investigation, before the onset of the previous two patients had history of exposure to poultry. The former situation is different in the two cases is that the patient is female, Lee, 33, East Street who is now being treated in isolation.

Preliminary statistics, there are close contacts with Lee 4, currently in good health, fever, cough and other symptoms did not appear suspicious, other close contacts is under investigation.

According to information released by the relevant departments, two cases found in previous cases, one case has died and another is in critical rescue in one case.

Local representation, analysis of these three cases, no timely attention to flu symptoms is a key factor in exacerbations, and epidemiological point of view, H7N9 influenza in Yongkang still sporadic cases, there is no direct correlation. According to the law in previous years, winter and spring are people infected with H7N9 influenza virus in a high incidence of, based on this law, the health department said the next period of time, do not rule out the case there will be sporadic cases. Local government appeal: people cough, fever and other symptoms, be sure to go to hospital for treatment.

Health department Again, try not to touch live poultry, once exposed, must be cleaned and disinfected. Also, to develop good habits and a healthy lifestyle, a balanced diet, regular exercise, pay attention to rest, to improve their resistance to disease; wash their hands frequently ventilation, timely change clothes, to avoid the cold.

 

Admittedly, we try to document as many confirmed cases of novel influenza as possible. But it is with the knowledge that we are probably only seeing the tip of the iceberg.  For every hospitalized case, we suspect there may be a number of mild or asymptomatic infections that go undetected.

 

We’ve seen estimates (see Eurosurveillance Clinical severity of human infections with avian influenza A(H7N9) virus, China, 2013/14) that there may have been thousands of undetected H7N9 cases in China over the past two years, although no one really knows for sure.

 

While a few family clusters have been reported, reassuringly among close contacts of known H7N9 cases, very little transmission appears to have taken place.  For now, bird-to-human transmission appears to be the norm.

 

Although it may not be possible for surveillance and reporting systems to capture the full impact of these outbreaks, the ability to closely examine a subset of cases can still provide excellent insights into the behavior of, and risks posed by, this emerging virus.

Zhejiang Reports Another H7N9 Case

Zhejiang Province – Credit Wikipedia

 

 

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Yesterday we saw a report of a 57 year-old man at at hospital in Jinhua confirmed to have H7N9 (see Zhejiang Province: 1 H7N9 Case Reported), and today we learn of a second case in that province – apparently unrelated – of a 75 year old from Zhoushan.

Zhejiang Province – population 54 million – has reported the most H7N9 cases over the past 22 months, numbering 143.  

 

How many mild, or asymptomatic cases that may have gone undetected is unknown, but some scientists believe that number to be substantial (see Eurosurveilance Clinical severity of human infections with avian influenza A(H7N9) virus, China, 2013/14). 

 

Although we only have two waves under out belts, the history with this virus has been a slow trickle of cases in the fall, followed by a much larger outbreak in January-April, which slowly subsides by summer.

This report from Zhejiang Online.  

 

 

Yongkang two successive diagnosed two cases of H7N9 patients without association

At 9:45 on December 28, 2014

 Zhejiang Online News December 28 December 26, 27, Yongkang City Government News official microblogging "Yongkang issued" continuous release of the news that there have been two local was diagnosed with H7N9 patients.

25, 57-year-old man stone town Lin Jinhua when a hospital is listed as a suspected H7N9 cases confirmed on the 26th, has been treated in isolation in Jinhua. Have had close contact with its 17 objects have been placed under medical observation, all close contacts at present does not appear suspicious symptoms.

Yesterday afternoon, 75-year-old man Zhoushan town way of a patient was diagnosed with H7N9, 26 patients diagnosed with no direct relevance. 11 in a close contact with the process being carried out under medical observation, is currently in good health.

Provincial health and agriculture experts have to Yongkang guidance. Yongkang Committee secretary Xu Hua water, Mayor Kim Jung announced Yongkang entered the prevention and control of H7N9 status. In accordance with the relevant provisions of the city government has issued a circular, since the 27th, the main city of Yongkang live animal markets permanently closed, and the rest live bird markets a comprehensive suspension of trading, risk assessment, as appropriate, until after a reboot. At the same time, prohibiting exotic live birds enter the City, local live poultry quarantine after passing can kill white listing. (City Express)  

Zhejiang Province: 1 H7N9 Case Reported

Zhejiang Province – Credit Wikipedia

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The H7N9 virus - which emerged in Eastern China less than two years ago - has displayed a distinctly seasonal pattern, with case reports almost non-existent during the summer months, followed by a trickle of cases throughout the fall, and then a major rush in cases starting in January and peaking in late winter or early spring (see CHP CDW Chart below).

The level of activity over the past couple of months has been on par with what was seen during the lead up to last year’s wave, and so expectations are we will see a similar outbreak in the coming months. Unlike last year, there are at least three new avian flu viruses in the mix; H5N6, H10N8, and H5N8 (thus far, with no history of infecting humans).

 

Today, Zhejiang Province – which has reported the most cases to date  (n=142)  - is reporting a new H7N9 case, and that 17 close contacts of that case are under medical surveillance.

 

 

Zhejiang Yongkang confirmed case H7N9 17 workers exposed to patients with no suspicious symptoms

At 13:12 on December 27 2014
Source: China News Network

CNS, Jinhua, December 27 (reporters and Xi Jinyan)-27th reporter was informed last night, Yongkang city, Zhejiang Province, said Government news official micro-blog, the city's 157 years old male patient with diagnosed H7N9 strain of influenza, has been treated in isolation, instead of 17 participants have been in close contact were under medical observation, there are no developed suspicious symptoms.

, Jinhua city, according to the Centers for disease control and informed the Yongkang H7N9 influenza virus in patients with confirmed cases of infection. With Lin, male, 57 years old, shizhu town, when the 25th was treated in a hospital in Jinhua listed as suspected H7N9 cases, confirmed on 26th, has been treated in isolation in Jinhua. With 17 participants have been in close contact were under medical observation, all close contacts did not appear suspicious symptoms.

After receiving the report, immediately launched an emergency plan on the ground, Yongkang has brought on market regulation, agriculture, health, public order, administrative law-enforcement departments and town street meeting deployment of prevention and control measures. At present, various preventive and control measures have been effectively implemented.

 (Continue . . .)

Zhejiang Province Reports H7N9 Case

Credit Wikipedia

 

#9388

 

On Friday, in H7N9 Case In Guangdong Province, I mentioned there have been local media reports suggesting a couple of other H7N9 cases in China over the past week, but no announcement at the provincial level.

While the government health sites still aren’t carrying any notifications, today we have the next best thing;  China’s official news agency Xinhua is reporting details on a case from Jiaxing city (Zhejiang Province) from earlier in the week.

A quick check finds a recently posted H7N9 safety advisory on the Jiaxing City CDC website, where a tacit admission of a recent case appears.  As H7N9 generally produces no symptoms in poultry, it is often only when a human falls ill and is diagnosed that anyone realizes the virus is circulating in local birds.

This from the Zhejiang Xinhua Channel.

Jiaxing confirmed the first case of human infection with the H7N9 avian winter flu

• Time: 2014-11-30 09:16:32 Sunday

When the Ebola virus has not left the power from people's sight, H7N9 bird flu virus and "comeback" and that it appeared in our midst.

Reporter yesterday learned from the CDC Jiaxing, Jiaxing recently discovered case of human infection cases of H7N9 avian influenza. It is understood that this is the first case of this winter in Jiaxing City, Zhejiang Province, is the first case of human infection of H7N9 cases.

According to reports, the infected person because of roadside stalls to buy live poultry rearing to go home sick infection present, patients have been admitted to a local hospital for treatment, the situation is more critical.

More than 60-year-old aunt in the H7N9 virus trick

Reporters learned that, in patients infected with the H7N9 bird flu virus is a more than 60-year-old aunt, who lives in the urban areas in Jiaxing.

At first, her symptoms are fever, cough, so she will be sent to the family Jiaxing Second Hospital for treatment. However, according to a cold treatment a week later, his condition did not improve, so the hospital contacted the provincial expert testing, test results showed that the H7N9 virus infected aunt.

November 26 morning, the aunt was sent Jiaxing First Hospital of Infectious Diseases, floor, isolation and treatment.

According to relatives, said some time before the onset of the aunt, to Jiaxing Xincheng a roadside farmer's market to buy back two live chickens, chicken rearing in their own homes, it is estimated that chickens are carrying H7N9 avian influenza virus, so it is infected a.

It is understood that the patient is currently in critical condition comparison.

Jiaxing disease control department launched the emergency plan

For this case emerging, Jiaxing disease control department immediately launched the emergency plan, a sample of cases, the source of infection were detected and investigation, to have been in contact with patients who had blood, and make their health follow-up observation. Also strengthen fever clinics and major hospitals pre-triage process, once suspected cases immediately treated in isolation.

Jiaxing Municipal office November 28 is also the official government website message confirming Jiaxing found cases of avian influenza H7N9 virus in case of human infection.

The sources said that this is the first man since the winter, Jiaxing found cases of H7N9 infection, the third case of human H7N9 infection also occurs city level cases.

Jiaxing City CDC also issued a reminder that eating poultry is best cooked cooking, always pay attention to strengthening exercises, enhance immunity, wash their hands, fewer trips to crowded areas, so as to reduce the risk of infection.

(Continue . . . )

 

Xinhua News: More Details On Zhejiang Family H7N9 Cluster

Zhejiang Province – Credit Wikipedia

 

 

# 8244

 

Via Xinhua News we’ve the first real details on the Zhejiang family cluster I reported on early this morning (see  Zhejiang Investigating Family Cluster Of H7N9 Cases).

 

Perhaps the most significant details surround the onset dates, with the father falling ill, and being confirmed infected on January 20th, while his daughter fell ill three days later.  

 

The mother was confirmed infected on the 27th, a full week after the father.

 

While a common environmental source for infection is certainly possible, this timeline would also be consistent with human-to-human transmission as well.

 

 

Chinese family of three infected with H7N9

English.news.cn   2014-01-29 21:29:49
 

HANGZHOU, Jan. 29 (Xinhua) -- Chinese health authorities on Wednesday disclosed details of a family of three who were infected with the H7N9 bird flu in east China's Zhejiang Province.

A 49-old-man surnamed Yu from Hangzhou City was confirmed on Jan. 20 to have been infected with the bird flu virus. His 23-year-old daughter, who accompanied him at the hospital, was confirmed to have caught the flu three days later, according to the provincial health and family planning commission.

Yu's wife, who also accompanied him, was confirmed to have caught the virus on Jan. 27, according to the commission.

Yu has died. His daughter is in serious condition and his wife is slightly ill.

Experts so far have no final conclusion on how the virus spread among family members. Some think they all had contact with poultry, and others think the father transmitted the flu to his wife and daughter.

Even if the case is confirmed to be a person-to-person transmission, there is no need to panic, said Li Lanjuan, an academician at the Chinese Academy of Engineering and a specialist in H7N9 prevention.

"So far there have not been any cases in which one person transmits the flu to another, and the latter transmits the virus to a third person," said Li.

In this year's epidemic, the transmission has been limited to a second person, who does not transmit the virus to a third. The H7N9 bird flu is not likely to spread in schools, workplaces or gatherings, said Chen Zhiping, deputy head of the provincial disease control and prevention center.

The probability of continuous person-to-person transmission is very slim, said Feng Zijian, deputy head of the Chinese Center for Disease Control and Prevention.

Three new human H7N9 cases were reported in Zhejiang on Wednesday, bringing the number of infections in the province this year to 56, according to the commission.

Live poultry trading has been halted in the cities of Hangzhou, Ningbo and Jinhua in Zhejiang, which has reported the most human H7N9 cases of any province. The province has launched emergency surveillance of poultry farms, parks, and migratory bird habitats, and has halted the flying of domestic pigeons.

 

 

As stated above, a family cluster – even if transmission between these three is confirmed – isn’t a game changer.

 

We’ve seen other instances of H7N9 transmission between family members (see BMJ: `Probable Person-to-Person Transmission’ Of H7N9), just as we’ve seen limited transmission of the H5N1 virus.

Should we begin to see a large number of family clusters, however, that would suggest a change in the behavior of the virus.  Which is why we monitor and scrutinize these case reports so carefully.

Zhejiang, Fujian, Guangdong & Hong Kong Announce New H7N9 Cases

Credit CDC

 

# 8243

 

You know its a busy morning when the daily tally of H7N9 is the sixth blog of the day.

Anyway, with a great deal of help from the newshounds at FluTrackers and Sharon Sander’s constantly updated and invaluable H7N9 Line Listing, we’ve five new cases reported out of Mainland China, along with the earlier reported Hong Kong Fatality (see CHP Announces 4th H7N9 Case In Hong Kong).

 

First stop, Zhejiang Province which reports three new cases today:

 

Zhejiang Province, three new cases of human infection of bird flu H7N9

Release date :2014-01-29
Source: Ministry of Health and Family Planning Commission
 

Zhejiang Provincial Health and Family Planning Commission January 29 briefing, the province today added three cases of human infection with H7N9 avian influenza.

1, patients Moumou, male, farmer, aged 37, Wencheng County of Wenzhou. January 28 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition at a hospital in Wenzhou treatment.

2, patients Zhu Moumou, male, individuals, aged 60, Xiaoshan District, Hangzhou people. January 28 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

3, the patient Gu Moumou, male, retired, 63 years old, Hangzhou City people. January 28 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

 

Next stop, Guangdong Province, which yesterday reported three relatively young cases (ages 43, 41 & 31), reports a rare teenage infection today.

 

Province added one case of human infection of bird flu H7N9

2014-01-29 15:22:58 Ministry of Health and Family Planning Commission | 

Health and Family Planning Commission of Guangdong Province on January 29 briefing, the Guangzhou new case of human infection of H7N9 avian influenza.

Patients Zhang, male, 17 years old, high school student, who now lives in Tianhe District, Huangpu Road Street Village Street. January 29 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable in Guangzhou City, the designated hospital admission.

 

Last stop is Fujian province, where just as unusually, a toddler is reported infected by the virus.

 

Fujian Province, one case of human infection with the H7N9 new bird flu cases

Time :2014-01-29 

Health and Family Planning Commission of Fujian Province on the 29th Bulletin, 29 Nisshin province confirmed one case of human infection with the H7N9 avian influenza.

Patients Moumou, male, 2 Suiyu, now living Xiang'an District. Currently patients with mild disease, in recovery, isolation and treatment at a hospital in Xiamen. The case for the province routine influenza surveillance sentinel hospitals found cases. (Emergency Management Office)

 

Although reported H7N9 cases have skewed heavily towards older patients - among those younger cases identified - we’ve seen relatively mild illness, which may be affecting  the detection rate.  Simply put, those with mild illnesses are less likely to seek medical care, get tested, and end up counted. 

 

Whether younger people are actually infected less often than older people is something that probably can’t be firmly established until good, community wide seroprevalence studies can be conducted.

 

We may see additional cases announced later in the day, in which case I’ll post an update.

Zhejiang Investigating Family Cluster Of H7N9 Cases

Zhejiang Province – Credit Wikipedia

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We’ve a terse statement from the Zhejiang Ministry of Health this morning announcing their investigation into a family cluster of H7N9 cases.  Details are scant at this time, but what we know is 3 members of a family in Hangzhou all contracted the virus. 

 

Whether this was due to a common environmental exposure, or human-to-human transmission is unknown at this time.  

 

As we’ve discussed before, when it comes to proving human-to-human (H-2-H) transmission of an emerging virus, the bar is set pretty high.  When there are other, equally plausible explanations (e.g. shared environmental, or live bird exposures), then H-2-H cannot be assumed.

 

Since we’ve seen suspected limited  H-2-H transmission of the H7N9 virus in the past (see BMJ: `Probable Person-to-Person Transmission’ Of H7N9), another occurrence – while of epidemiological interest - wouldn’t be a game changer.  We take notice primarily because it could be the first visible step in a chain of transmission.

 

First the (machine translated) statement, then I’ll be back with a bit more.

 

Hangzhou together on the progress of the investigation of human infection of avian influenza H7N9 cases in family aggregation

Release date :2014-01-29

January of this year, I appointed people infected with H7N9 reported confirmed cases of avian influenza have occurred in Xiaoshan District, a family clusters of cases, three people sick. In three patients before the onset of the existence of a common environmental exposure, there are close contacts, the exact cause of the infection, the national and provincial experts are studying, one has the final official results announced immediately to the public.

 

Additional reportage indicates this cluster consists of a couple and their daughter.  This from AFP news.

 

Three H7N9 cases in same Chinese family: Xinhua

January 29, 2014 12:53 pm

SHANGHAI - Three members of the same Chinese family have contracted H7N9 bird flu in the province worst-affected by the current spike in cases, the official Xinhua news agency reported. A couple and their daughter in Hangzhou, the capital of the eastern province of Zhejiang, were infected one after another, Xinhua said late Tuesday, without giving further details.

(Continue . . .)

 

 

In 2006, we saw large clusters of H5N1 infection in both Indonesia and Turkey, and yet, it never managed to gain enough momentum to spark a pandemic (see 2006 Karo Cluster Involved H2H Transmission).  Similarly, a family cluster in Pakistan in 2007 raised concerns, but once again failed to catch fire (see EID Journal: Unraveling Pakistan’s H5N1 Outbreak).

 

Should we begin to see evidence of efficient and sustained H-2-H transmission (ie. 3rd, 4th, 5th generation transmission) - then things begin to get more interesting. 

 

But for now, we’ve no indications of that happening.

Zhejiang, Guangdong & Jiangsu Provinces Add H7N9 Cases

Credit CDC

 

# 8232

 

 

After a one-day break in reporting, Zhejiang is back today with four new cases, along with three new cases in Shenzhen City (Guangdong Province), and one new case in Jiangsu Province.   We may see additional announcements later in the day, but for now we have 8 new cases.

 

Of note, two of the four cases announced today from Zhejiang are described as `mild’ – which, while good for the patient – can make it more difficult to identify and isolate those infected with this avian virus. It is axiomatic that we are more likely to test those experiencing serious illness, as they tend to go to hospitals more frequently.  

 

So, one of great the unknowns with this H7N9 virus  is how many `mild’ or asymptomatic infections go undetected.

 

Last summer, a study appearing in  The Lancet (see Lancet: Clinical Severity Of Human H7N9 Infection) attempted to quantify that number - at a time when the `official count’ hovered around 130 cases -estimating `that between 1500 and 27 000 symptomatic infections with avian influenza A H7N9 virus might have occurred as of May 28, 2013’.

 

The accuracy of these estimates is unknown, but it is very likely that the official case counts under-represent the real burden of H7N9, perhaps by a sizable margin.

 

Zhejiang Province, four new cases of human infection of bird flu H7N9

Release date :2014 -01-28
Source: Ministry of Health and Family Planning Commission

 

Zhejian Provincial Health and Family Planning Commission January 28 briefing, the province today added four cases of human infection with H7N9 avian influenza.

1, the patient surname Wang, female, farmer, aged 43, Xiaoshan District, Hangzhou people. January 27 confirmed human cases of avian influenza H7N9 infection. Now the disease is mild, in Hangzhou, a hospital for treatment.

2, Shen certain patients, male, farmer, aged 81, Changxing County. January 27 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition at a hospital in Huzhou treatment.

3, the patient Xia Moumou, female, farmer, aged 63, Huzhou, Deqing County. January 27 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

4, the patient surname Wang, male, retired, 57 years old, Yinzhou District, Ningbo people. January 27 confirmed human cases of avian influenza H7N9 infection. Now the disease is mild, treatment in a hospital in Ningbo.

 

Shenzhen City, which is located just 20 miles north or Hong Kong, reports 3 new cases today.  Of note, Shenzhen’s cases today are running noticeably younger than most of those being reported the past few days.

 

 

Province added three cases of human infection with H7N9 bird flu

2014-01-28 15:26:06 Ministry of Health and Family Planning Commission |  color:

January 28, informed the Ministry of Health and Family Planning Commission: H7N9 confirmed cases of avian flu in Shenzhen City, three cases of human infection with the new report.

Case 1 Zengmou, female, 43 years old, a native of Guangdong, Shenzhen, currently residing in Bao'an District of Shenzhen City streets. January 27 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable in Shenzhen designated hospital admission.

Case 2 Cai, female, 41 years old, a native of Guangdong of the state, now living Longgang District streets. January 27 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in Shenzhen designated hospital admission.

Case 3 Lin, female, 31 years old, a native of Shantou, now live in the South Bay Street, Longgang District. January 27 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in Shenzhen designated hospital admission.

 

Our last stop is Jiangsu Province, which reports their 7th H7N9 case of 2014.

 

Province 1 new confirmed cases of human infection with H7N9 avian influenza

Published :2014 -01-28 

Provincial Health Department, the province confirmed cases of new H7N9 bird flu case of human infection.

Patient named Ma, male, 53 years old. January 27 was the night of Huai'an City confirmed human cases of avian influenza H7N9 infection. Currently in Huai'an a hospital for treatment, serious condition.

 

Despite this daily parade of fresh cases , thus far we haven’t seen any epidemiological evidence to indicate the virus is transmitting between humans in an efficient or sustained manner.

Zhejiang, Jiangsu & Guangdong Provinces Report H7N9 Cases

 

# 8220

 

 

While we continue to see a steady stream of H7N9 cases reported in Eastern China, thus far, we've not seen the kind of geometric increase in the numbers that would signify sustained human-to-human transmission.  Today, three provinces are reporting new cases, and as we've seen for more than the past two weeks, Zhejiang Province leads the way.

 

Zhejiang Province, three new cases of human infection of bird flu H7N9

Release date :2014 -01-25
Source: Ministry of Health and Family Planning Commission
January 25, 2014

Zhejiang Provincial Health and Family Planning Commission January 25 briefing, the province today added three cases of human infection with H7N9 avian influenza.

1, patients Moumou, male, worker, aged 49, Huzhou, Deqing County. January 24 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

2, patients Luomou, female, farmer, aged 60, who Ningbo area. January 24 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, in Ningbo, a hospital for treatment.

3, the patient Yao Moumou, female, farmer, aged 48, Cixi, Ningbo people. January 24 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, in Ningbo, a hospital for treatment.

 

Guangdong Province also adds one case today.

 

Province added one case of human infection of bird flu H7N9

2014-01-25 21:06:47 Ministry of Health and Family Planning Commission |  color:

 Health and Family Planning Commission of Guangdong Province on January 25 briefing, Shenzhen new confirmed cases of H7N9 avian influenza case of human infection.

Zhongmou patient, male, 82 years old, currently residing in Luohu District, Shenzhen, the evening of January 24 confirmed cases of human infection with H7N9 avian influenza is currently seriously ill patients, admitted in Shenzhen designated hospital.

 

As does Jiangsu Province.

 

Province 1 new confirmed cases of human infection with H7N9 avian influenza

Published :2014 -01-25 Provincial Health Department, the province confirmed cases of new H7N9 bird flu case of human infection.

Qianmou patient, male, 57 years old. The evening of January 24 was diagnosed Suzhou confirmed cases of human H7N9 avian influenza infection. Suzhou is currently in a hospital for treatment, serious condition.

 

The five H7N9 cases are in addition to the newly reported H10N8 case from Jiangxi province (see Jiangxi Province Reports Second H10N8 Infection) I blogged about earlier today.

Beijing, Zhejiang, Guangdong All Announce New H7N9 Cases

 

 

# 8212

 

Our morning round up of H7N9 case adds 10 new cases, although it is possible we’ll hear of additional cases later in the day. In addition to fresh reports Zhejiang and Guangdong provinces – both of which have reported multiple cases over the past few weeks – today Beijing announces their first case since May of last year.

 

First stop, this brief report from Xinhua News.

 

Beijing reports human H7N9 bird flu case

English.news.cn   2014-01-24 18:10:32
 

BEIJING, Jan. 24 (Xinhua) -- A man in Beijing has been confirmed to have contracted H7N9 bird flu, the first case reported in the city this year, authorities confirmed on Friday.

The city's disease control and prevention center said the man tested positive for H7N9 bird flu on Thursday night.

He is receiving treatment at Ditan Hospital.

The center said the patient had bought pigeons and ate them before being admitted to the hospital.

Additional information is not available.

It is the first human H7N9 case reported in Beijing this year. Last year, a seven-year-old girl and a six-year-old boy were confirmed to have caught the flu strain in the city on April 13 and May 28. No deaths were reported.

 

Next stop is Zhejiang Province, which has seen (by far) the most reported infections from the H7N9 virus. In just the past 24 hours the decision has been made to close some of the live markets – the suspected source of many infections – in the urban areas of Hangzhou (see Xinhua report Hangzhou, Shanghai to halt live poultry trading) after 15 consecutive days of reporting new cases.

 

Today, Zhejiang’s Ministry of Health announces 7 new cases.

 

Zhejiang Province 7 new cases of human infection of bird flu H7N9

January 24, 2014

Zhejiang Provincial Health and Family Planning Commission January 24 briefing, the province today added seven cases of human infection with H7N9 avian influenza.

1, patients Yang Moumou, female, 76 years old, retired, Yuyao people. January 23 confirmed human infection of H7N9 avian influenza. Is now in critical condition, in Hangzhou, a hospital for treatment.

2, patients with a certain song, female, 44 years old, individuals, now living in Ningbo Yinzhou District. January 23 confirmed human infection of H7N9 avian influenza. Now the condition is severe, in Ningbo, a hospital for treatment.

3, the patient Yu Moumou, female, 23 years old, staff, Xiaoshan District, Hangzhou people. January 23 confirmed human infection of H7N9 avian influenza. Now the condition is severe, treatment in a hospital in Hangzhou.

4, patients Zhou Moumou, female, 82 years old, retired, Hangzhou city people. January 23 confirmed human infection of H7N9 avian influenza. Is now in critical condition, in Hangzhou, a hospital for treatment.

5, patients Zhou Moumou, male, 73 years old, retired, Shaoxing City people. January 23 confirmed human infection of H7N9 avian influenza. Is now in critical condition, a hospital for treatment in Shaoxing.

6, the patient Jiang Moumou, female, 62 years old, farmer, Shaoxing Bridge District people. January 23 confirmed human infection of H7N9 avian influenza. Is now in critical condition, a hospital for treatment in Shaoxing.

7, the patient Ren Moumou, male, 33 years old, farmer, Shaoxing Paojiang people. January 23 confirmed human infection of H7N9 avian influenza. Is now in critical condition, a hospital for treatment in Shaoxing.

 

And our last stop is Guangdong province, which reports two new cases today.

 

Province added two cases of human infection with H7N9 avian influenza cases, two cases were cured

Health and Family Planning Commission of Guangdong Province on January 24 briefing, Meizhou, Huizhou City, and were reported confirmed cases of H7N9 avian influenza case of human infection.

Case 1 Yuan Mou, female, 58 years old, currently residing in Boluo, January 24 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in the Guangzhou designated hospital admission.

Case 2 Mou, male, aged 52, now lives Xingning Meizhou City, January 24 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition, in Meizhou City, the designated hospital admission.

Also, Foshan cases diagnosed January 5 and January 10 Xiemou diagnosed Ryu were cured and discharged on January 24. As of January 24, 2014, the province a total of nine cases of human infection with the H7N9 avian flu cured.

 

 

For the most complete, and continually updated list of H7N9 cases, you can’t do better than FluTrackers Linked Line Listings, which includes bulleted information on each case, plus links to the original reports.

 

While this daily parade of fresh cases is obviously a concern, thus far we haven’t seen any epidemiological evidence to indicate the virus is transmitting between humans in an efficient or sustained manner.

 

That said, there are a great many unanswered questions regarding how this virus is infecting humans, the incidence of mild or asymptomatic cases in the population, and its reservoir host.  With reports coming from multiple provinces – including the capital, Beijing – the virus is obviously widespread, and we should fully expect to see a good many more cases in the coming days and weeks.

Zhejiang, Shanghai & Guangdong Announce H7N9 Cases

 

 

# 8208

 

With just  a week to go before China’s New Year’s Eve celebrations really take off, the number of new H7N9 cases continues its slow rise, with the greatest concentration of cases coming from Zhejiang province.  

 

Overnight Crof had some good news to report in Zhejiang: Shaoxing wet markets closed over H7N9, where - at least in the city of a little more than 4 million in Zhejiang province (ttl pop. 54 million) - city officials are pulling the plug on live markets in an attempt to curb the transmission of the virus.

 

Despite the successful mitigation last spring, as described in The Lancet: Poultry Market Closure Effect On H7N9 Transmission, for the most part, market closures announced in Eastern China this year have been temporary to allow for `disinfection days’.

 

Today Zhejiang breaks its streak of 6 consecutive days of reporting 3 cases of H7N9 by  reporting 5.

 

Zhejiang Province, five new cases of human H7N9 avian influenza infection

Source: Ministry of Health and Family Planning Commission

January 23, 2014

Zhejiang Provincial Health and Family Planning Commission January 23 briefing, the province today five new cases of human infection of H7N9 avian influenza.

1, patients Moumou, female, 66 years old, retired, Shaoxing City people. January 22 confirmed human infection of H7N9 avian influenza. Is now in critical condition, a hospital for treatment in Shaoxing.

2, patients with the surname Wang, female, 71 years old, retired, Hangzhou Riverside area people. January 22 confirmed human infection of H7N9 avian influenza. Is now in critical condition, in Hangzhou, a hospital for treatment.

3 patients Xu X, male, 71 years old, farmer, Cangnan County of Wenzhou people. January 22 confirmed human infection of H7N9 avian influenza. Now the condition is severe, treatment at a hospital in Wenzhou.

4, the patient Moumou, male, 59 years old, workers, Yinzhou District, Ningbo people. January 22 confirmed human infection of H7N9 avian influenza. Now the condition is severe, in Ningbo, a hospital for treatment.

5, the patient Hu Moumou, female, 63 years old, farmer, Huzhou, Deqing County. January 22 confirmed human infection of H7N9 avian influenza. Is now in critical condition, in Hangzhou, a hospital for treatment.

 

Shanghai, which ranks second in the number of H7N9 cases reported to date, announces a new case as well.

 

Shanghai 1 new confirmed cases of human infection with H7N9 avian influenza

Published :2014 -1-23

Shanghai Health and Family Planning Commission January 23 briefing, Shanghai reported new confirmed cases of H7N9 avian influenza case of human infection.

Patients, Qin Moumou, female, 61 years old, the city residence. Confirmed on January 22, is now in active 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.

 

And our last stop (for now), Guangdong Province also reported a fresh case this morning.

 

Province added one case of human infection of bird flu H7N9 two cases were cured

2014-01-23 17:30:22 Ministry of Health and Family Planning Commission | 

Health and Family Planning Commission of Guangdong Province on January 23 briefing, Shenzhen 1 new confirmed cases of human infection with H7N9 avian influenza, the province there are two cases cured.

Patients Zhang, female, 34 years old, currently residing in Baoan, Shenzhen, January 23 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in Shenzhen designated hospital admission.

Also, Guangzhou City on January 18 confirmed cases Panmou and Foshan City on January 10 confirmed cases Ryu were cured and discharged on January 22. So far, the province a total of seven cases of human infection with the H7N9 avian flu cured.

 

It is possible we will see additional cases announced later in the day.

 

Despite this daily parade of new cases, thus far these cases appear to be sporadic in nature, and without direct links to one another, and so we’ve no evidence of sustained or efficient human-to-human transmission of this virus.

Zhejiang, Jiangsu Provinces Report New H7N9 Cases

Dr. Ian Mackay’s most recent `SNAPDATE’ of H7N9 cases

 

# 8207

 

As the chart above, from Ian Mackay’s Virology Down Under blog clearly indicates, the number of H7N9 cases reported out of Zhejiang province is roughly double that of the second place finisher – Shanghai – and it continues to climb like a homesick angel.

 

For the 6th day running, Zhejiang Province is reporting another 3 H7N9 cases today, further extending their less-than-desirable lead.

 

Zhejiang Province, three new cases of human infection of bird flu H7N9

Release date :2014-01-22
Source: Ministry of Health and Family Planning Commission

Zhejiang Provincial Health and Family Planning Commission January 22 briefing, the province today added three cases of human infection with H7N9 avian influenza.

1, patients Lin Moumou, male, 53 years old, farmer, now living in Xiaoshan District. January 21 confirmed human infection of H7N9 avian influenza. Is now in critical condition, in Hangzhou, a hospital for treatment.

2, patients with Ruan Moumou, male, 71 years old, farmer, Taizhou Jiaojiang people. January 21 confirmed human infection of H7N9 avian influenza. Is now in critical condition, a hospital for treatment in Taizhou.

3, the patient Lin Moumou, female, 63 years old, farmer, Wenling, Taizhou City People, January 21 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, in Hangzhou, a hospital for treatment.

 

We also saw an announcement late yesterday from Jiangsu province of a single case.

 

Province 1 new confirmed cases of human infection with H7N9 avian influenza

Published :2014-01-21 

Provincial Health Department January 21 Bulletin, the province 1 new confirmed cases of human infection with H7N9 avian influenza.

A quarter of patients, male, 71 years old. January 21 pm Nanjing infected human H7N9 avian influenza cases diagnosed. Treatment in a hospital in Nanjing is currently in a critical condition.

 

Despite this daily parade of new cases, thus far we haven’t seen compelling evidence of sustained or efficient human-to-human transmission of this virus.

Guangdong & Zhejiang Provinces Each Report 3 New H7N9 Cases

Credit CDC

 

 

# 8197

 

Our daily roster of announced H7N9 cases begins with three new cases in Shenzhen, located just over 20 miles north of Hong Kong, in Guangdong province. .

 

Province added three cases of human infection with H7N9 avian influenza cases, one case of cured cases

2014-01-21 16:28:51 Ministry of Health and Family Planning Commission |

Health and Family Planning Commission of Guangdong Province on January 21 briefing, Shenzhen, add three cases of human infection with H7N9 avian influenza confirmed cases, cases were sporadic, not associated epidemiology.

Case 1 Kongmou, female, 39 years old, business services personnel, currently residing in Longgang District. January 13 onset, January 21 confirmed cases of human infection of H7N9 avian influenza, the patient's condition is currently stable in Shenzhen designated hospital admission.

Case 2 Xu, female, 59 years old, retired, now living in Luohu District, Shenzhen City. January 13 onset, January 21 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in Shenzhen designated hospital admission.

Case 3 Jeong, male, 76 years old, retired, now living in Futian District, Shenzhen. January 9 onset, January 21 confirmed cases of human infection of H7N9 avian influenza, the patient is currently in critical condition in Shenzhen designated hospital admission.

Also, Foshan City, January 13, 2014 confirmed cases Po certain cured.

 

 

And for the 5th day in a row, Zhejiang reports 3 new cases, extending their reporting streak to 12 consecutive days with new cases.

 

Zhejiang Province, three new cases of human infection of bird flu H7N9

Release date :2014-01-21
Source: Ministry of Health and Family Planning Commission

January 21, 2014

Zhejiang Provincial Health and Family Planning Commission January 21 briefing, the province today added three cases of human infection with H7N9 avian influenza.

1, patients Lee, M, 57 years old, farmer, Linhai City People. January 19 confirmed human cases of avian influenza H7N9 infection. Is now in critical condition, a hospital for treatment in Taizhou.

2, the patient Yu Moumou, male, 49 years old, farmer, Xiaoshan District, Hangzhou people. January 20 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.mn         

3, F, certain patients, male, 70 years old, farmer, Shaoxing Bridge District people. January 20 confirmed human cases of avian influenza H7N9 infection. Now the condition is severe, treatment in a hospital in Hangzhou.

 

We may very well see additional cases announced later today from other provinces.

 

While we continue to see a steady stream of cases this month, particularly from Zhejiang and Guangdong Provinces, we aren’t seeing the kind of geometric rise in the number of cases one would expect to see if the virus were readily transmitting between humans.

 

Unknown, of course, are how many mild or asymptomatic cases might be out there, flying under the radar. The number of confirmed cases likely under represents the total number infected.

But even so, the number of severe cases reported each day has remained fairly constant.

 

Unless and until we see a major (and continuing) escalation in the number of severe cases being reported, it is pretty safe to assume this virus has not yet gained the ability to transmit efficiently between humans.

 

That said, the only real constant among influenza viruses is that they change, and so we watch these individual cases – and more importantly the case count trends – carefully, looking for any signs this avian virus is adapting better to human hosts.

Shanghai, Zhejiang Report New H7N9 Cases (2 Fatal)

 

# 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.