H7N9 Avian Flu: May You Live in Interesting Times

H7N9 avian flu chinaI hope this H7N9 avian flu story stays small, but I’ve been getting a lot of patient questions already this week. So to keep people updated, I thought I would quickly cut and paste the official statements from the US Centers for Diease Control and the World Health Organization Global Alert and Response (GAR) team. The China CDC has an excellent English update but it’s already dated, from March 31st. Their Chinese H7N9 page likely has more updated information. So let’s first read the US CDC update from yesterday:

Watch: Level 1, Practice Usual Precautions
Avian Flu (H7N9) in China

This information is current as of today, April 05, 2013 at 19:22 EDT

Released: April 05, 2013

What is the current situation?

On April 1, the World Health Organization (WHO) announced that influenza A (H7N9), a type of flu usually seen in birds, has been identified in a number of people in China. Cases have been confirmed in the following provinces: Shanghai, Jiangsu, Anhui, and Zhejiang.

This is the first time this virus has been seen in people. Symptoms include fever, cough, and shortness of breath. Infection with the new virus has resulted in severe respiratory illness and, in some cases, death. Chinese health authorities are conducting investigations to learn the source of the infections with this virus and to find other cases.

CDC is following this situation closely and coordinating with domestic and international partners in a number of areas. More information will be posted as it becomes available.

There is no recommendation against travel to China at this time.

What can travelers and Americans living in China do to protect themselves?

There is currently no vaccine to prevent H7N9. At this time, we do not know the source of this virus.  CDC is repeating its standard advice to travelers and Americans living in China to follow good hand hygiene and food safety practices and to avoid contact with animals.

  • Do not touch birds, pigs, or other animals.
    • Do not touch animals whether they are alive or dead.
    • Avoid live bird or poultry markets.
    • Avoid other markets or farms with animals (wet markets).
  • Eat food that is fully cooked.
    • Eat meat and poultry that is fully cooked (not pink) and served hot.
    • Eat hard-cooked eggs (not runny).
    • Don’t eat or drink dishes that include blood from any animal.
    • Don’t eat food from street vendors.
  • Practice hygiene and cleanliness:
    • Wash your hands often.
    • If soap and water aren’t available, clean your hands with hand sanitizer containing at least 60% alcohol.
    • Don’t touch your eyes, nose, or mouth. If you need to touch your face, make sure your hands are clean.
    • Cover your mouth and nose with a tissue or your sleeve (not your hands) when coughing or sneezing.
    • Try to avoid close contact, such as kissing, hugging or sharing eating utensils or cups, with people who are sick.
  • See a doctor if you become sick during or after travel to China.
    • See a doctor right away if you become sick with fever, coughing, or shortness of breath.
    • If you get sick while you are still in China, visit the US Department of State websiteExternal Web Site Icon to find a list of local doctors and hospitals. Many foreign hospitals and clinics are accredited by the Joint Commission International. A list of accredited facilities is available at their website (www.jointcommissioninternational.orgExternal Web Site Icon).
    • Delay your travel home until after you have recovered or your doctor says it is ok to travel.
    • If you get sick with fever, coughing, or shortness of breath after you return to the United States, be sure to tell your doctor about your recent travel to China.

Clinician information:

Clinicians should consider the possibility of novel influenza A (H7N9) virus infection in persons presenting with respiratory illness within 10 days of an appropriate travel or exposure history. Although the majority of novel influenza A (H7N9) cases have resulted in severe respiratory illness in adults, infection with this virus may cause mild illness in some and may cause illness in children as well. Influenza diagnostic testing in patients with respiratory illness for whom an etiology has not been confirmed may identify human cases of avian influenza A virus infection or new cases of variant influenza in the United States. Patients with novel influenza A (H7N9) virus infections should have a positive test result for influenza A virus via reverse-transcription polymerase chain reaction (RT-PCR) testing but be unsubtypeable. Clinicians suspecting novel influenza A (H7N9) should obtain appropriate specimens and notify their local or state health department promptly. State health departments should notify CDC of suspected cases within 24 hours. For more information, see the Health Alert Notice  issued April 5, 2013


And here’s the update (April 5) from the WHO GAR:

Human infection with influenza A(H7N9) virus in China – update

5 APRIL 2013 – As of 5 April 2013 (14:00 CET), the Chinese health authorities notified WHO of an additional five laboratory-confirmed cases, including one death due to human infection with influenza A(H7N9) virus.

Of the latest laboratory-confirmed cases, three are from Shanghai and two from Jiangsu.

Among the Shanghai cases, a 52-year-old woman with illness onset on 27 March 2013 has died, a 67-year-old man with illness onset on 22 March 2013 is in critical condition and a four-year-old boy with illness onset on 31 March 2013 has mild illness.

The two patients from Jiangsu are both in critical condition. They include a 61-year-old woman with illness onset on 20 March 2013 and a 79-year-old man with illness onset on 21 March 2013.

To date, a total of 16 patients have been laboratory confirmed with influenza A(H7N9) virus in China; of these, six people have died.

More than 520 close contacts of the confirmed cases are being closely monitored. In Jiangsu, investigation is ongoing into a contact of an earlier confirmed case who developed symptoms of illness.

The Chinese government is actively investigating this event and has heightened disease surveillance. Retrospective testing of recently reported cases with severe respiratory infection may uncover additional cases that were previously unrecognized. An inter-government task force has been formally established, with the National Health and Family Planning Commission leading the coordination along with the Ministry of Agriculture and other key ministries. The animal health sector has intensified investigations into the possible sources and reservoirs of the virus.

WHO is in contact with national authorities and is following the event closely. The WHO-coordinated international response is also focusing on work with WHO Collaborating Centres for Reference and Research on Influenza and other partners to ensure that information is available and that materials are developed for diagnosis and treatment and vaccine development. No vaccine is currently available for this subtype of the influenza virus. Preliminary test results provided by the WHO Collaborating Centre in China suggest that the virus is susceptible to the neuraminidase inhibitors (oseltamivir and zanamivir).

At this time 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.


Stay tuned…

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