Saturday, April 13, 2013

Keeping Track of the H7N9 Outbreak

I am very grateful for all of the followers on my Twitter Page, as well as all of you that follow this blog.  As Mike Coston says in his post, there are many out there keeping track.  I have decided to take a break from the blog and get on with a few other hobbies that I am anxious to pursue.  I thank all of my followers for staying with me.
~Commonground

Avian Flu Diary Post:

image
ECDC Map


# 7129

With the confirmed case count nearing 50, and those numbers in all likelihood to rise, keeping track of individual cases, and outcomes, has become a demanding, and at times, frustrating job.

Gleaning data from press releases and news stories (which can vary in the type, and reliability, of data), flublogians around the world are trying various means to keep information straight and organized.  

Aiding flu-literate journalists like Helen Branswell, Maggie Fox, Jason Gale, and Dr. Richard Besser and bloggers like Crof and Maryn McKenna, and myself, there’s a small army of (mostly volunteer) analysts crunching numbers and making charts available online.

Dr. Ian M. Mackay from the University of Queensland in Australia maintains the  Virology Down Under website and blog, where he is keeps tabs of mew cases and analyzes the data  (link).

As you can see by his terrific chart below, the dataset is beginning to get crowded.  But the trend in onset dates revealed by this graphic provides a much better sense of how this outbreak is progressing. You’ll find more than just charts on the VDU H7N9 website, and so it is worth visiting every day.

Timeline-H7N9-WEEKS

Similarly, the newshounds on FluTrackers are continually scouring the Internet for new case reports, which Sharon Sanders uses to update their running list of confirmed and suspected cases.


2013 Human Case List for Confirmed and Suspected H7N9 Type Influenza*

#1 - Man, 87, onset date February 19, died March 4 - Shanghai Death+ #2 - Man, 27, onset date February 19, died March 10 - possible pork contact - Shanghai Death #3 - Woman, 35, onset date March 15, hospitalized in critical condition - possible poultry contact - Chuzhou City, Anhui Province Death++ #4 - Woman, 45, onset date March 19, hospitalized March 27 - poultry culler - Jiangning district of Nanjing, Jiangsu province #5 - Woman, 48, onset date March 19, hospitalized March 30 - Shuyang county of Suqian City, Jiangsu province #6 - Man, 83, onset date March 20 - hospitalized March 29 - Wujiang district of Suzhou, Jiangsu province Death #7 - Woman, 32, onset date March 21 - hospitalized March 28 - Binhu district of Wuxi City, Jiangsu province #8 - Man, 38, onset date March 7, hospitalized March 18, died March 27 - reported to be a cook - Taicang, Zhejiang province Death #9 - Man, 67, onset date March 25, hospitalized March 25, died April 2? Hangzhou, Zhejiang province #10 - Man, 64, onset date hospitalized March 29, Zhejiang province Death #11 - Man, 48, onset date March 28, engaged in chickens and ducks transportation work - Shanghai Death #12 - Woman, 67, onset date March 22, hospitalized on March 25 in critical condition - Shanghai #13 - Woman, 52, onset date March 27, died on April 3 - Shanghai Death #14 - Child, 4, onset date March 31, mild case. Shanghai #15 - Woman, 61, onset date March 20, from a retirement home - in critical condition Qinhuai District, Nanjing, Jiangsu province #16 - Man, 79, onset date March 21, from a retirement home. Qinhuai District in Nanjing, Jiangsu province, in critical condition #17 - Man, 74, onset date March 28, hospitalized March 3, farmer, died April 11 Shanghai Death note
#18 - Man, 66, onset date March 29, hospitalized April 2, in treatment - from a retirement home, Shanghai #19 - Man, 59, onset on March 25, hospitalized on March 30 Shanghai #20 - Man, 67 - onset on March 29. Hospitalized on March 30 - in treatment - Shanghai #21 - Man, 55, onset date March 28, hospitalized April 1 in stable condition - poultry worker - Anhui province #22 - Age 64, onset date: April 1. Hospitalized on April 7. - Shanghai Death #23 - Man, 85, onset date March 28, hospitalized April 8 in critical condition, retirement home, Nanjing Shimonosek Jiangsu province #24 - Woman, 25, pregnant, onset date: March 30. - In critical condition. Zhenjiang City area, Jiangsu province #25 - Woman, 51, onset date March 13, hospitalized, Huzhou City, Zhejiang Province #26 - Man, 79, onset date March 29, hospitalized in critical condition, Hangzhou, Zhejiang Province #27 - Man, 62, onset date April 1, hospitalized April 5, retired Shanghai #28 - Man, 77, onset date April 3, hospitalized April 7, retired Shanghai #29 - Man, 65, hospitalized - a farmer Hangzhou, Zhejiang Province #30 - Man, 70, onset date March 29, Wuxi Huishan, Jiangsu province #31 - Man, 74, onset date April 2, Jiangyin City, Wuxi City, Jiangsu province #32 - Woman, 76, onset date April 1, hospitalized April 5, Shanghai #33 - Woman, 81, hospitalized April 4, farmer , Shanghai #34 - Man, 31, chef, Yangzhou City, Jiangsu province #35 - Man, 56, teacher, Suzhou Industrial Park, Jiangsu province #36 - Man, 74, onset date March 31, hospitalized April 5, died April 11 retiree, Shanghai Death #37 - Woman, 83, onset date April 2, hospitalized April 7, Shanghai #38 - Man, 68, onset date April 4, hospitalized April 9, Shanghai #39 - Man, 53, onset date April 3, hospitalized April 10, Shanghai #40 - Man, 86, onset date April 3, hospitalized April 6, Shanghai #41 - Man, 66, onset date April 8, hospitalized April 9, Hangzhou, Zhejiang province #42 - Man, 74, onset date April 6, hospitalized April 11, Hangzhou, Zhejiang province #43 - Woman, 54, onset date April 6, hospitalization April 12, Huzhou, Zhejiang province #44 - Child, 7, hospitalized April 11 Shunyi District Beijing #45 - Woman, 77, Nanjing former Baixia District, Jiangsu province #46 - Man, 72, Changshu, Jiangsu province #47 - Man, 56, onset date April 1, hospitalized April 4; his wife was confirmed positive on April 4, Shanghai #48 - Man , 65, onset date April 3, hospitalized April 9. Zhejiang Province #49 - Man , 38, onset date April 6, hospitalized April 11. Zhejiang Province

Laidback Al on FluTrackers also updates charts and maps on this outbreak on this thread.

Another graphical representation of cases, along with links to individual news reports, can be found on Healthmap’s H7N9 page.

image

And the ECDC continues to provide almost daily epidemiological updates (April 13th edition), including charts and maps, on this emerging virus.  Check the ECDC home page for new updates.

image

image


There are dozens of newshounds on flu forums like FluTrackers and The Flu Wiki, scores of people on twitter, and likely hundreds working behinds the scenes at public health organizations like Hong Kong’s CHP, the World Health Organization, the CDC, China’s CDC, and the ECDC who make it their job to keep the numbers straight, and the information flowing.
 
Admittedly, given the non-stop internet news cycle, and the leapfrogging of updates, it can still be difficult to keep abreast of the latest case counts. 

But without the efforts and generosity of the people mentioned above, and many more like them, it would probably be impossible.

At some point, if this outbreak grows substantially, it may become impractical to keep track of each individual case.

Nevertheless , the work being done right now is invaluable to those of us trying to make sense of the situation. And so a tip of my hat, and a world of thanks, to all those who are pitching in to keep the information rolling.

http://afludiary.blogspot.ca/2013/04/keeping-track-of-h7n9-outbreak.html

WHO: Human infection with influenza A(H7N9) virus in China - update 4/13/13

13/04/2013


As of 13 April 2013 (17:30 CET), the National Health and Family Planning Commission notified WHO of an additional six laboratory-confirmed cases of human infection with influenza A(H7N9) virus. Of the latest laboratory-confirmed cases, one is from Beijing, one from Shanghai, two from Jiangsu and two from Zhejiang.

The first patient reported from Beijing is a seven-year-old girl who became ill on 11 April 2013. The patient from Shanghai is a 56-year-old man who became ill on 1 April 2013. The two patients from Jiangsu are a 77-year-old woman who became ill on 5 April 2013, and a 72-year-old man who became ill on 1 April 2013. The two patients from Zhejiang are a 65-year-old man who became ill on 3 April 2013 and a 38-year-old man who became ill on 6 April 2013.

To date, a total of 49 patients have been laboratory-confirmed with influenza A(H7N9) virus in China; including 11 deaths. More than a thousand close contacts of the confirmed cases are being closely monitored.

Investigations into the possible sources of infection and reservoirs of the virus are ongoing. Until the source of infection has been identified, it is expected that there will be further cases of human infection with the virus in China. So far, there is no evidence of ongoing human-to-human transmission.

WHO does not advise special screening at points of entry with regard to this event, nor does it recommend that any travel or trade restrictions be applied.

About this Disease Outbreak News
1. WHO is currently publishing information on laboratory-confirmed cases received through the official notification from the Chinese National International Health Regulations (IHR) Focal Point once a day. This formal notification and publication follows verification of the information, and may therefore come after, or not include, some cases reported through public media and other sources.

2. To date, there is limited information to determine whether the reported number of cases represents some or all of the cases actually occurring. As some relatively mild cases of illness have now been reported, it is possible that there are other such cases that have not been identified and reported.

3. If the current pattern of sporadic infections continues, WHO will cease frequent reporting of case numbers, and focus its Disease Outbreak News on new developments or changes in the pattern or presentation of infections.

http://www.who.int/csr/don/don_updates/en/index.html

Forbes: Urgent Warning On New Bird Flu H7N9: Could Pose Global Threat


4/12/2013
As new death reports come in, a team of experts from China published a scary report yesterday in the New England Journal of Medicine (NEJM) suggesting that the new H7N9 avian flu virus is even more deadly than previously believed.
The conclusions: H7N9 causes unusually severe respiratory infection, sepsis and brain damage, and appears to be resistant to vaccination and treatment.
But here’s where it gets really worrisome. In a commentary on “global concerns” pertaining to H7N9, also in the NEJM, influenza experts Timothy Uyeki, MD and Nancy Cox discuss the potential of H7H9 to cause a pandemic (a fast-moving global epidemic) and warn that this possibility is real.

Continued:
http://www.forbes.com/sites/melaniehaiken/2013/04/12/new-bird-flu-danger-worse-than-believed-says-urgent-report/ 

Updated Map Confirmed H7N9 Cases

Below is the map of cases, including the cluster, which is depicted by a Purple postmark.
You can enlarge the map to get a better look at the cases in Shanghai.  The map is permanently located on the right side-bar for reference.  Link is below.

https://maps.google.com/maps/ms?msid=203813299286646113648.0004d960a9b0bb31cd70c&msa=0&ll=35.924645,117.619629&spn=11.769214,12.65625

Zhejiang Province - 2 Confirmed Cases - 4/13/13

4/13/13
Translation
Hat-tip:  Flu Trackers
 
Zhejiang Provincial Health Department Bulletin, as of April 13, 2011 14:00 April 13, Zhejiang add two cases of human infection with the H7N9 avian influenza.

Patients Kwak, male, 65 years old, retired, and now lives in Hangzhou. Incidence on April 3, to Hangzhou, a hospital in the 9th. April 13, Zhejiang Province CDC report patient specimens positive for H7N9 avian influenza virus nucleic acid.

Patients with Jo, male, 38 years old, workers, now living in Hangzhou. Disease, to a hospital on the evening of 11 April 6. April 13, Zhejiang Province CDC report patient specimens positive for H7N9 avian influenza virus nucleic acid.

I Office organization expert clinical manifestations of these two patients, discuss the epidemiological data and laboratory test results, the diagnosis of human infection confirmed cases of the H7N9 avian flu. Currently, more than two patients in critical condition, have been transferred to a hospital at the provincial level, being rescue work.
 

#H7N9 First Confirmed Cluster in Shanghai

I have posted below the two family members that are confirmed with H7N9.  One has died.


Shanghai – Confirmed Cluster
Date of Report:  4/4/13
Name:  52(F)
From:  Shanghai
3/27: Emer. Rm -fever, chills, X-ray showed small patchy shadow in lower lob of right lung.  Antibiotics intravenously for 3 days.
Emer. Rm again (date ?) – shortness of breath.  Put on vent.  Diag: sev. flu, pneumonia, hypoxia.  Treated w/methylprednisolone, antibiotics, immune globulin treatment.
Adm:  Huashan Hospital
DOD:  4/3/13
Confirmed:  4/4/13
Note:  Husband developed fever and runny nose.  Husband later tested negative.  Case had no contact with poultry.  Poultry conf. at local market near her.
Group said animal-to-human transmission and human-to-human transmission are both being considered in her case.
Update 4/13:  Husband Tests Positive - See Report 4/13/13  Gumou (56)M



Shanghai – Confirmed Cluster
Date of Report:  4/13/13
Name:  Gumou (56)M
From:  Shanghai
Onset:  4/1
4/2 & 4/3:  2 trips to Huashan Hospital
4/4:  Shanghai Public HCC
4/5:  Shanghai CDC throat swab sample nucleic acid negative
4/10:  Shanghai CDC sampled again + lower resp. tract secretions.
Confirmed:  4/11 Shanghai CDC nucleic acid
Notes:  4 contacts monitored. 
Update:  4/13:  Wife Tests Positive – See Report 4/4/13 52(F)

New confirmed cases of human infection of H7N9 avian influenza cases in Shanghai

 Xinhua Shanghai, April 13 (Chou Yi), according to the Shanghai Municipal Health and Family Planning Commission, Shanghai Municipal Center for Disease Control on the 13th Bulletin, Shanghai confirmed cases of human infection with H7N9 avian influenza cases diagnosed before her husband. The experts said, is still not enough to determination husband Gumou incidence is due to certain infectious wife.
    In the evening of April 12, the National Health and Family Planning Commission and the Shanghai Municipal Health and Family Planning Commission jointly organized the experts had a full discussion on the epidemiological association of the two cases, and other issues, according to the information currently available, insufficient to determine the husband Gu an incidence is due to certain infectious wife. Experts should pay attention to the research, to strengthen co-exposure history of cases, clusters of cases of human infection with the H7N9 avian influenza virus pathogenic characteristics with the study of the natural history of disease.
    Wife couple in particular fever was found on March 27, 2013, and died on the evening of April 3.April 4 patients collected respiratory specimens were found positive for H7N9 avian influenza virus nucleic acid, and after municipal clinical expert consultation diagnosis of human infection of H7N9 avian influenza confirmed cases. It is reported that the law of her life, every day on farms procurement, although the home does not eat chicken duck, but frequented the stalls and live poultry stalls near.
    The couple husband Gumou, 56-year-old Shanghai, officer. April 1 onwards, fatigue, fever and other symptoms. April 3, 4, two to the Huashan Hospital for treatment, April 4, 2011 18 at Huashan Hospital Gumou the treatment go to the Shanghai Public Health Clinical Center, patients are further treatment in a critical condition. April 5, City CDC of the cases in accordance with the conventional throat swab sample to check the results for the H7N9 avian influenza virus nucleic acid negative. On April 6 Gumou high fever, the disease continues to progress. On April 10, the CDC is sampled again, plus adopted a patient's lower respiratory tract secretions samples. April 11, the City CDC and another in Shanghai National Influenza Network Laboratory for testing, the test results were positive for H7N9 avian influenza virus nucleic acid. Experts said the birds feeding near the patient's family, there is the risk of exposure.
    As at 16:00 on the the 13th, were found in 21 cases of human infection with the H7N9 avian influenza confirmed cases, of which 7 died.
    Wu Fan, director of Shanghai Municipal Center for Disease Control said, still determine the virus does not have the sustained human-to-human transmission capacity across the country in all cases are sporadic cases, further epidemiological investigations found no association.

BBC China: Shanghai new confirmed case of H7N9 his wife previously infected

4/13/13
Translation:


The Information Office of Shanghai, China announced on Saturday (April 13), Shanghai new confirmed case of human infection of H7N9 avian influenza. His wife had 4 April infected with the same virus.
Informed that new patients Gumou, male, 56 years old, the people of Shanghai. Fatigue, fever and other symptoms on April 1, April 3, 4, two trips to the Huashan hospital; 4 go to the treatment of the Shanghai Public Health Clinical Center. April 11 test results positive for H7N9 avian influenza nucleic acid.
Total of 4 people with Gumou close contact so as to implement a strict medical observation, not unusual.
The notification said: "March 27, his wife certain fever and other symptoms detected the H7N9 avian influenza virus nucleic acid positive patient respiratory specimens collected on April 4, and municipal clinical expert consultation diagnosis of human infection of H7N9 avian influenza confirmed cases. "
The notification said: "According to the information currently available, insufficient determine Gumou incidence is due to an infection caused by."
This message is a Chinese netizens to speculate the "dignitaries interpersonal infected?" See this is really a little scared. "
Monday (April 8), the National Health and Family Planning Commission and the World Health Organization (WHO) held a joint news conference, said the eight gene fragments of the H7N9 human gene fragments, expert judgment has not yet seen significant evidence of human-to-human transmission.
On April 11, the laboratory of the Chinese Academy of Sciences, said that the H7N9 avian influenza virus genes from wild birds of East Asia and China Shanghai, Zhejiang, Jiangsu flocks gene reassortment.
The day Saturday, the first case of human infection of H7N9 cases, Jiangsu also augmented by a further two cases.
Up to now, China has a total of 47 confirmed cases, including 11 deaths. "Hardest hit" Shanghai were found in 21 cases, of which 7 died.

http://www.bbc.co.uk/zhongwen/simp/china/2013/04/130413_shanghai_h7n9_husband_wife.shtml

Husband & Wife Confirmed Positive #H7N9

 4/13/13
Shanghai newly confirmed cases of human infection with H7N9 his wife died of H7N9 in the 3rd

[Xinmin Reuters] April 11, 2013, the Shanghai Municipal Health and Family Planning Commission, then the Shanghai Municipal Center for Disease Control report, the city found one cases of laboratory detection of the H7N9 avian influenza virus positive patients. The patient has been municipal expert group consultation confirmed.  

As of 16:00 this afternoon, a total of 21 cases of human infection with the H7N9 avian influenza confirmed cases, of which 7 died and another 13 cases are being isolated treatment, one children have been discharged.  

Add one patient as follows:
 Gumou, male, 56 years old, from Shanghai staff. Fatigue, fever and other symptoms start to appear on April 1, April 3, 4, two to the Huashan Hospital for treatment, on April 4, 2011 18 Huashan Hospital will Gumou to go to the treatment of the Shanghai Public Health Clinical Center, The patient is further treatment. April 5th City CDC routinely the cases throat swab sample test results for the H7N9 avian influenza virus nucleic acid negative. In April 6 Gumou high fever, the disease continues to progress. City CDC sampled again on April 10, plus mining the patient's lower respiratory tract secretions samples. April 11, Municipal Center for Disease Control and the city another National Influenza Network Laboratory testing, the test results were positive for H7N9 avian influenza virus nucleic acid.

Organization of municipal clinical expert group in accordance with the relevant requirements of the City Health and Family Planning Commission to hold consultations on the cases, the experts based on the clinical manifestations, laboratory testing and epidemiological data, the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases. 

After investigation, the close contacts of the cases a total of four people have been implementing strict medical observation, have not yet found an exception. His wife than some found on March 27, 2013 the fever and other symptoms, the patient respiratory specimens collected on April 4 detection N7N9 avian influenza virus nucleic acid positive, and municipal clinical expert consultation diagnosis of human infection of H7N9 avian influenza confirmed cases .

 In the evening of April 12, should be invited by the Shanghai Municipal Health and Family Planning Commission, the National Health and Family Planning Commission and the Shanghai Municipal Health and Family Planning Commission jointly organized experts on two cases of human infection confirmed cases of the H7N9 avian flu epidemiological association fully discussed, based on currently available information, not enough judge Gumou incidence is due to an infection. Experts should pay attention to the research, to strengthen co-exposure history of cases, clusters of cases of human infection with the H7N9 avian influenza virus pathogenic characteristics with the study of the natural history of disease. (Xinmin Network reporter Li Ruonan Li Xin)

http://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/13/24186161_0.shtml

Confirmed Case of H7N9 in Beijing - 4/13/13

In the early morning of April 13, the China CDC review, the city comprehensive judgment first case of human infection with the H7N9 avian influenza confirmed cases. The patients are in stable condition, two close contacts found no abnormalities. The case, the situation is as follows: the  
  patients Yaomou, female, 7 years old, living in the old village center in Shunyi District Houshayu Town Street. The patients parents live engaged in the live birds trafficking work. Children symptoms such as fever, sore throat, cough, headache in the morning of April 11, 11:00 to Ditan Hospital emergency department visits, admitted to the hospital for lung infection in 13:00. Based on further examination results and the progression of the disease after admission, the hospital in the early morning 1:50 on the 12th reported cases of influenza surveillance Chaoyang District CDC, 3:00 specimens sent to Chaoyang District CDC. At 10:00 on the 12th Chaoyang District CDC confirmed influenza A universal primer nucleic acid testing positive, and the specimens were sent at 11:00 Beijing CDC review detection. At 15:30 on the 12th Beijing Municipal Center for Disease Control detected the H7N9 avian influenza virus nucleic acid in accordance with the provisions of the National Health and Family Planning Commission, and suspected cases of the samples sent to China CDC review of detection. In the early morning of the 13th, the Chinese Center for Disease Control feedback the outcome of the review. Clinical expert in Beijing, according to the Chinese Center for Disease Control and the Beijing CDC pathogen detection and review results, combined with the patient's clinical manifestations, epidemiological investigation, in accordance with the National Health and Family Planning Commission to develop the people infected with the H7N9 avian flu clinics program (2013, second edition) ", the overall judgment of the cases of human infection of H7N9 avian influenza confirmed cases. 
  The children admitted to hospital, hospital to be anti-infection and symptomatic treatment.Confirmed cases of influenza surveillance, hospital give children Tamiflu antiviral rehydration supportive care, after given ECG are too sick to go to the ICU ward, give suck in at 23:50 on the 11th (15 hours from the time of onset) oxygen therapy; same time, Chinese proprietary Yinqiao the Powder Plus White Tiger Decoction given in Chinese medicine services. After active treatment, children with cough hold your breath symptoms improved, body temperature down to 37 ° C from the highest of 40.2 ℃, lung wet rales disappeared. The patient's condition is stable. 
  Recognized as suspected cases, the Beijing Municipal Center for Disease Control, Shunyi District and Chaoyang District CDC disposal to investigate the scene, confirmed that two close contacts and medical observation measures. As of now, the two close contacts found no abnormalities. 
  The first case of human infection with the H7N9 avian influenza diagnosis and treatment process, from the first visit to the diagnosis process, only a day and a half's time, children with the disease will soon be effectively controlled, fully display the city early prevention and control work results. First, the children according to the publicity to get the information directly to the designated hospitals Ditan Hospital for treatment, to improve the treatment efficiency, reduce close contacts. Clinics behavior Ditan Hospital in strict accordance with the provisions of the protective measures to ensure the safety of medical staff, attention to the popular history of interrogation, and influenza A universal primers monitoring and timely reporting of outbreaks, created the conditions as soon as possible diagnosis, the early application Tamiflu anti viral treatment, children with the disease remission quickly brought under control. Third District, city and national levels, the CDC rapid response and seamless connection, day and night, working overtime, and be completed within 24 hours to detect, review and re-review process. 
  The Beijing municipal government attaches great importance to the H7N9 avian flu prevention and control work. National Health and Family Planning Commission recently informed Shanghai and other places found that people infected with the H7N9 bird flu cases, the party secretary, Comrade Guo Jinlong, Mayor Wang Anshun Comrade high degree of attention, made ​​important instructions and instructions on strengthening the monitoring, prevention and control, and advocacy work. In the morning of April 6, Wang Anshun mayor held a special meeting, listen to health, COAG, industrial and commercial departments to report for deployment to the prevention and control work. According to the Health and Family Planning Commission, the deployment of the municipal government, the Beijing Municipal Health Bureau, well-arranged, well-organized, solid implementation, mobilization Capital Region Health System good program to develop surveillance and testing, medical treatment, training of personnel, material reserves, emergency drills, promote education, joint prevention and control work.These are the first cases to quickly keen found that timely and effective treatment. 
  Li Shixiang, Linke Qing vice mayor found suspected cases of H7N9 avian influenza in the evening of the 12th, the night meeting, listen to the reporting of health, agriculture, industry and commerce departments, researchers agree that the recommendations put forward by the Health Bureau and other departments, based on previous work, the prevention and control of the next stage of deployment. First, relying on public health emergencies emergency headquarters in Beijing, the start of human infection with the H7N9 avian influenza prevention and control headquarters, set up under the monitoring group, medical group, epidemiological survey group, and material support groups, advocacy groups, animal husbandry and veterinary groups, social anti- control of the steering group.The headquarters office is located in the Municipal Health Bureau. Is strictly banned live poultry markets of all kinds of tangible and intangible, to stop live animal, stop the pigeon flying to increase poultry (wildfowl) monitoring by sectors such as agriculture and gardening. Medical institutions and high-risk groups to carry out the monitoring of influenza-like illness, health departments to strengthen protection of the four categories of high-risk groups (poultry breeding, slaughter, storage, transportation personnel; the poultry trading operations staff; Park poultry operation personnel; flora and fauna by the community and migratory bird monitoring) the implementation of the health monitoring network laboratory start 55 infectious diseases, and the implementation of human infection with the H7N9 avian influenza virus screening for influenza-like illness. The four is Health Bureau held a meeting of the city's health system video released epidemic, the implementation of the "early" approach, urging medical institutions to implement prevention and control measures, to start emergency squad and epidemiological survey squad and a 24-hour Beiqin. 5 is a strict market surveillance by the Drug Administration Department, do drugs reserve, reserves of 200 million units of Tamiflu. Sixth, the group led by the Commerce Department set up a material reserves, good reserves of the social aspects of prevention and control of protective materials. 7 by the education sector to further strengthen the the schools morning the afternoon inspection system, the implementation of the students infectious disease early warning monitoring system. Eighth Municipal TCM Bureau of Traditional Chinese Medicine experts involved in the clinical treatment, accumulated experience and improve treatment options and, if necessary, start in preventive medicine medication. Nine public opinion monitoring mechanism, the establishment of human infection of H7N9 avian influenza Public Opinion Special Report. Municipal Health Bureau in conjunction with the Municipal Bureau of Agriculture held a news conference to release information to the community. 10 is in accordance with the requirements of the "Quartet responsibility, supervision and inspection, carried out by the municipal government organizations to implement prevention and control measures. (Source: Beijing Health Information Network)
http://www.moh.gov.cn/wsb/pdfgzdt/201304/510d4c334ef8406ea372ace68eab5c3b.shtml 

Jiangsu Province: 2 New Cases of H7N9 - 4/13/13

Health Department of Jiangsu Province, April 13 Bulletin, Jiangsu Province, the new confirmed cases of human infection of H7N9 avian influenza. 

  Patient Gumou, female, 77 years old, live in Nanjing, the former Baixia. On April 13, the provincial expert group diagnosed cases of human infection of H7N9 avian influenza confirmed cases.Currently, where a critical condition in a hospital in Nanjing. After investigation, the close contacts of the cases of a total of seven people, far showed no abnormality. 
  The patients named Ma, male, 72 years old, live in Changshu. On April 13, the provincial expert group diagnosed cases of human infection of H7N9 avian influenza confirmed cases. Currently in a hospital in Suzhou City, where a critical condition. After investigation, close contacts of the cases of a total of nine people, far showed no abnormality.

http://www.moh.gov.cn/wsb/pdfgzdt/201304/b7b2f97f68f74d2b96e8c177a664c591.shtml 

Friday, April 12, 2013

Beijing found the first case of human infection with the H7N9 avian flu suspected cases

 April 14, 2013

From the Beijing Municipal Health Center website: 2013 , the Beijing CDC laboratory testing to confirm the Ditan Hospital treated a 7- year-old children with human infection of H7N9 avian influenza suspected cases. This is the first case of human infection of H7N9 avian influenza in Beijing found suspected cases. Currently, Beijing Ditan Hospital is taking active measures to treat children, children in stable condition. City CDC has implemented two close contacts under medical observation, flu-like symptoms is not found. In accordance with the provisions of the National Health and Family Planning Commission, Beijing Municipal Health Bureau specimens were sent to the Chinese Center for Disease Control for review, so that the final diagnosis.

http://www.bjhb.gov.cn/wsxw/201304/t20130413_59447.htm

Beijing Suspected 1 Case #H7N9

2013-04-13

As of 10:30 last night, Of the total 43 people infected with the H7N9 avian flu, including 11 deaths. The epidemic is still concentrated in the the Chinese three northeastern provinces and one city. For treatment costs, the National Health Planning Commission official said, has asked all over the H7N9 avian flu in local urban and rural residents serious illness insurance subsidies and disease emergency medical rescue fund to pay range.
Beijing News News yesterday afternoon, the Beijing CDC laboratory testing to confirm Ditan Hospital from a 7-year-old children with human infection of H7N9 avian influenza suspected cases. This is the first case of human infection of H7N9 avian influenza in Beijing found suspected cases. Currently, Beijing Ditan Hospital is taking active measures to treat children, children in stable condition. City CDC has implemented two close contacts under medical observation, flu-like symptoms is not found. In accordance with the provisions of the National Health and Family Planning Commission, Beijing Municipal Health Bureau specimens were sent to the Chinese Center for Disease Control for review, so that the final diagnosis.

#H5N1 Vietnam First Time Man-raised Salangane Birds Were Found Dead


HANOI, April 12 (Xinhua) -- Nearly 5,000 salangane birds, which are raised by local people in Vietnam's central Phan Rang city were found dead and said to be infected with avian flu strain H5N1, reported local Tuoi Tre newspaper on Friday.

According to Vice Chairwoman of Phan Rang City People's Committee Nguyen Thi Hue, from March 28 to April 11, about 4,900 salangane birds out of the flock's 10,000 heads raised by the Yen Viet Company Limited were found dead in Phan Rang City of Ninh Thuan province. Among the dying birds to be tested at the local Veterinary Department 6, eight samples were found positive to the avian flu strain H5N1.

This is the first time man-raised salangane birds were found dead in Vietnam because of the avian flu strain H5N1, so there is not yet specific measures to control the expansion of the disease, except those applied to the H5N1-infected poultry, said Nguyen Xuan Binh, director of the Veterinary Department 6.

Since news about the death of H5N1 infected salangane birds were reported, local veterinary agencies had brought samples of the young and grown-up salangane birds, and their manures and nests to be tested, whose results would not be announced until April 16.

Meanwhile, strict supervision is applied to 54 salangane breeding houses in Phan Rang City, until final results of the tests are reported.

Preventive measures are also implemented in other localities where salangane birds are breeding en mass, including central Khanh Hoa province, southern Tien Giang province and Ho Chi Minh City.

Specifically, 12 salangane samples from Can Gio district (HCM City) are now being tested at the HCM City Veterinary Department, Phan Xuan Thao, head of the department told Tuoi Tre reporter, adding that in 2012 and during the first quarter of this year, the department had tested 94 samples of the salangane, and all results showed negative to the H5N1 virus.

Salangane birds are raised for the high nutritious value of their nest. Currently in Vietnam, one kilo of salangane nests is sold from 125 U.S. dollars to 158 U.S. dollars depending on their quality.
Editor: Fang Yang 

http://news.xinhuanet.com/english/health/2013-04/12/c_132304553.htm 

New Flu: Still No Proof Spread Between People

4/12/13
Public health officials have admitted that there is concern surrounding the emergence of avian-origin influenza A (H7N9) in China, although there is still no confirmed evidence of person-to-person transmission.

Continued:  http://www.medpagetoday.com/InfectiousDisease/URItheFlu/38411

#H7N9: Takes its Toll Economically in China

4/12/13
Excerpt:

On Friday, Hong Kong's Food and Environmental Hygiene Department announced that poultry imported from companies in mainland China would be subjected to "fast tests" for the H7N9 and H5N1 strains of the virus.
According to a statement, "Officers will randomly select 30 birds from each consignment of around 1,000 (birds), to collect swabs and blood samples for the rapid test detecting the H5 and H7 antigen and antibodies."
Results will available within five hours, with cleared poultry then taken to a temporary wholesale market in the city for sale.
"When there are birds infected by H7 or H5, all the import of poultry will be suspended according to the World Organization for Animal Health's recommendations," said Allen Chan, senior veterinary officer with the city's health department.
The current outbreak has started to take its toll economically, after Yum Brands, the parent company of KFC in China, warned this week that sales at its restaurants across the country had suffered a sharp fall.
Xinhua also reported that the price of poultry had fallen by up to 50% in some eastern cities in the past week, hurting farmers economically. Shanghai has now completely banned the sale of life poultry.

Additional three cases of human infection with the H7N9 avian flu cases in Zhejiang Province in April 12

China MOH Website
Zhejiang Provincial Health Department informed that, as of January 12, 2011 18:00 April 12 , Zhejiang 3 new cases of human infection of H7N9 avian influenza.
  Patients Lee, male, 66 years old, retired, Hangzhou. Incidence on January 8 , 9 days admission to a hospital. 12 , Zhejiang CDC report patient specimens positive for H7N9 avian influenza virus nucleic acid.
  Patients Hemou, male, 74 years old, retired, Hangzhou. Incidence at 6 months , 11 days were treated in a hospital in Hangzhou. 12 , Zhejiang CDC report patient specimens positive for H7N9 avian influenza virus nucleic acid.
  Patients Wu, female, 54 years old, farmers, Huzhou. Incidence in 6 months , 12 days admitted to a hospital in Huzhou. 12 , Zhejiang CDC report patient specimens positive for H7N9 avian influenza virus nucleic acid.

Organized by the Office of Health expert clinical manifestations of these three patients, epidemiological data and laboratory test results to discuss the diagnosis of human infection confirmed cases of the H7N9 avian flu. More than 3 patients are severe, the condition is still stable, the hospital is active treatment. (Source: Zhejiang Provincial Health Department website)
 http://www.moh.gov.cn/wsb/pdfgzdt/201304/3f3fbaf718c04556a8cb8b7ef9ce8005.shtml

HK: Five more human cases of Influenza A (H7N9) verified by NHFPC

hat-tip:  http://flutrackers.com/forum/showthread.php?p=492442#post492442

Press Release
The Centre for Health Protection (CHP) of the Department of Health (DH) verified with the National Health and Family Planning Commission (NHFPC) today (April 12) two human cases of Influenza A (H7N9) in Shanghai and three cases in Zhejiang.

     The two cases in Shanghai involve two men aged 53 and 86. The 16 close contacts of the duo are asymptomatic so far.

     The three cases in Zhejiang involve a 66-year-old man, a 74-year-old man and a 54-year-old woman.

     Specimens of the five cases were tested positive for H7N9 upon laboratory testing by the Mainland health authority.

     As of 10pm today, a total of 43 cases have been laboratory confirmed with Influenza A (H7N9) in Shanghai (20 cases), Jiangsu (12 cases), Zhejiang (nine cases) and Anhui (two cases).

continued:  http://www.info.gov.hk/gia/general/201304/12/P201304120693.htm

NEJM Details on First 3 Confirmed Cases of #H7N9 Outbreak

An excerpt from the New England Journal of Medicine Article that I posted here.  Bolding is mine.  I have updated the 3 cases mentioned below to reflect these findings.  My case list can be found on the right side-bar for reference.

Results

Patients

Patient 1 was an 87-year-old man with chronic obstructive pulmonary disease (COPD) and hypertension who reported a cough and sputum production at the onset of illness. High fever and dyspnea developed 1 week after the onset of illness. He had no known history of exposure to live birds during the 2 weeks before the onset of symptoms.

Patient 2 was a 27-year-old man with a history of hepatitis B virus infection with positive hepatitis B surface antigen who presented to the hospital with high fever and cough. This patient was a butcher who worked at a market where there were transactions involving live birds. He sold pork but had not butchered bird meat before the onset of illness. Both Patient 1 and Patient 2 lived in Min-hang District, Shanghai, and were admitted to the Fifth People's Hospital.

Patient 3 was a 35-year-old woman who lived in Anhui Province. She had a history of depression, hepatitis B virus infection, and obesity. Patient 3 also had high fever and cough at the onset of the illness. She had visited a chicken market 1 week before the onset of symptoms. The demographic and epidemiologic characteristics of the three patients are summarized in Table 1 






Table 1Demographic, Epidemiologic, and Virologic Characteristics and Complications, Treatment, and Clinical Outcomes of Three Patients Infected with Avian-Origin Influenza A (H7N9) Virus..

HK well stocked with antiviral drugs

April 12, 2013
The Hospital Authority is well prepared to fight any local H7N9 outbreak, with a stock of 18 million doses of Tamiflu and other medicine.

This was the message from its Chief Executive Dr Leung Pak-yin today, briefing the media on the authority’s preparedness for any avian influenza outbreak in Hong Kong.

The authority has adopted an early identification, testing and isolation strategy in fighting the H7N9 virus.

Dr Leung said they plan to curb any spread of the virus by isolating infected patients and their close contacts.

Chief Infection Control Officer Dr Dominic Tsang said patients in emergency wards will be isolated once clinical symptoms are found and risk assessments made. Medical staff with protective gear will notify the management and take patient specimens to the Public Health Laboratory Services Branch and the hospital laboratory for testing.

In recent weeks many suspected H7N9 cases have been ruled out after four hours, he said, adding the authority will continue to conduct swift tests.

Authority Director (Cluster Services) Dr Cheung Wai-lun said if there is an outbreak of the disease, the authority will reduce non-emergency and appointment services to alleviate the pressure on emergency, medical, and paediatrics wards.

More outreach teams will be sent to elderly centres to reduce hospital admissions by their residents, and designated clinics will be assigned for fever patients.

The authority has 5,300 doctors and 21,800 nurses, he said, adding it can deploy more manpower by recruiting retired and part-time medical staff.

The authority has 38 million surgical masks, 1.4 million N95 masks, and adequate protective equipment for medical staff.

Chair of Infectious Diseases, University of Hong Kong Department of Microbiology, Prof Yuen Kwok-yung said as H7N9 is in eastern region of the Mainland, Hong Kong and the Pearl River area are safe at this stage. However, he said Hong Kong must be vigilant as local poultry may be infected in winter when birds fly here.

http://www.news.gov.hk/en/categories/health/html/2013/04/20130412_144223.shtml

HK: Update on number of suspected human cases of Influenza A (H7) notified to CHP

Press Release

The Centre for Health Protection (CHP) of the Department of Health (DH) today (April 12) provided an update on the latest number of suspected human cases of Influenza A (H7) notified to the CHP, including suspected human cases of Influenza A (H7) fulfilling reporting criteria, as well as the remaining ones not fulfilling reporting criteria.

     From noon yesterday (April 11) to noon today, the CHP received notification of one case which fulfilled the reporting criteria of suspected human cases of Influenza A (H7), and five cases which did not fulfil the reporting criteria. Please see case details in the attachment.

     This brings the total number of notifications received by the CHP since March 31, 2013, of cases which fulfilled the reporting criteria of suspected human cases of Influenza A (H7) to nine, and the total number of notifications which did not fulfil the reporting criteria to 19.

     "Influenza A (H7) is a statutorily notifiable infectious disease in Hong Kong and no confirmed human cases of Influenza A (H7N9) have been recorded so far," a spokesman for the DH stressed.

     The spokesman also reminded doctors to report any suspected cases of Influenza A (H7) to the CHP, and the Public Health Laboratory Services Branch of the CHP is ready to receive and test specimens whenever necessary.

     The public may visit the Avian Influenza page of the CHP (www.chp.gov.hk/en/view_content/24244.html) for further information.
Ends/Friday, April 12, 2013
Issued at HKT 18:58

HK: Suspected H7 case reported

April 12, 2013
The Centre for Health Protection has received notification of one case fulfilling the reporting criteria of suspected human cases of Influenza A (H7), and five cases which did not fulfil the criteria. All have tested negative for H7.

The case fulfilling the criteria involves a nine-year-old girl who had visited Jiangsu and was exposed to poultry. She is stable in Prince of Wales Hospital.

The update covers noon yesterday to noon today.

It brings the total number of notifications received by the centre since March 31 of cases fulfilling the reporting criteria to nine, and those which did not fulfil the criteria to 19.

No confirmed human cases of H7N9 have been recorded in Hong Kong so far.

http://www.news.gov.hk/en/categories/health/html/2013/04/20130412_183540.shtml?pickList=ticker

HK: Cluster of Influenza A cases in Siu Lam Hospital

Press Release:
The following is issued on behalf of the Hospital Authority:

     The spokesperson for Siu Lam Hospital (SLH) made the following announcement today (April 12):

     Three patients (aged 41 to 48) in a female ward for the severely intellectually disabled had presented with respiratory symptoms since April 8. Appropriate viral tests were arranged for the patients and their test results were positive for Influenza A. The patients concerned are being treated under isolation with stable condition.

     Admission to the ward has been suspended and restricted visiting has been imposed. Infection control measures have already been stepped up according to established guidelines. All other patients in the ward concerned are under close surveillance.

     The cases have been reported to the Hospital Authority Head Office and the Centre for Health Protection for necessary follow-up.

http://www.info.gov.hk/gia/general/201304/12/P201304120552.htm

Shanghai 2 Latest Confirmed & 1 Death Detailed Article

4/12/13
Excerpt:
2 new cases as follows:
    Patients Shen, male, 53 years old, the people of Shanghai, freelance. Feels unwell patients on April 3, chills, fever on April 5, Go to Jiading District Nanxiang hospital, the diagnosis of upper respiratory tract infection. April 10 patients sicker, Ruijin Hospital North hospital, diagnosed with severe pneumonia. April 11, City CDC test results for the H7N9 bird flu virus nucleic acid positive. City Health and Family Planning Commission organized municipal clinical expert group to discuss the cases in accordance with the relevant requirements, the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases. Patients are under active treatment. After investigation, the close contacts of the cases and a total of three, have been implemented under medical observation, so far not found exception.
    Patients with a certain segment, male, 86 years old, the people of Shanghai, retirees. Patients with symptoms on April 3, April 6 to Yangpu District, East hospital doctor diagnosed as right lower pneumonia day, admitted to the hospital by the City East. April 11, City CDC test results for the H7N9 avian influenza virus nucleic acid positive. Organization of municipal clinical expert group in accordance with the relevant requirements, the City Health and Family Planning Commission to discuss the cases, the diagnosis of the cases of human infection of H7N9 avian influenza confirmed cases. Patients are medically stable, in being active treatment.After investigation, the close contacts of the cases there were 13 people, have been implemented under medical observation, so far not found exception.
    In addition, human infection with the H7N9 avian flu was confirmed on April 6 Zhou died on April 11, the rescue is invalid.

NEJM: Human Infection with a Novel Avian-Origin Influenza A (H7N9) Virus

New England Journal of Medicine
Rongbao Gao, M.D., Bin Cao, M.D., Yunwen Hu, M.D., Zijian Feng, M.D., M.P.H., Dayan Wang, M.D., Wanfu Hu, M.D., Jian Chen, M.D., Zhijun Jie, M.D., Haibo Qiu, M.D., Ph.D., Ke Xu, M.D., Xuewei Xu, M.D., Hongzhou Lu, M.D., Ph.D., Wenfei Zhu, M.D., Zhancheng Gao, M.D., Nijuan Xiang, M.D., Yinzhong Shen, M.D., Zebao He, M.D., Yong Gu, M.D., Zhiyong Zhang, M.D., Yi Yang, M.D., Ph.D., Xiang Zhao, M.D., Lei Zhou, M.D., Xiaodan Li, M.D., Shumei Zou, M.D., Ye Zhang, M.D., Xiyan Li, M.D., Lei Yang, M.D., Junfeng Guo, M.D., Jie Dong, M.D., Qun Li, M.D., Libo Dong, M.D., Yun Zhu, M.D., Tian Bai, M.D., Shiwen Wang, M.D., Pei Hao, M.D., Weizhong Yang, M.D., Yanping Zhang, M.D., Jun Han, M.D., Hongjie Yu, M.D., Dexin Li, M.D., George F. Gao, Ph.D., Guizhen Wu, M.D., Yu Wang, M.D., Zhenghong Yuan, Ph.D., and Yuelong Shu, Ph.D.

April 11, 2013DOI: 10.1056/NEJMoa1304459

Abstract:

Background

Infection of poultry with influenza A subtype H7 viruses occurs worldwide, but the introduction of this subtype to humans in Asia has not been observed previously. In March 2013, three urban residents of Shanghai or Anhui, China, presented with rapidly progressing lower respiratory tract infections and were found to be infected with a novel reassortant avian-origin influenza A (H7N9) virus.

Full Article:  http://www.nejm.org/doi/full/10.1056/NEJMoa1304459#t=article