A INFLUENZA AVIÁRIA tipo H7N9

Actualização da incidência humana desta virose na China. 20 casos letais em 102 infectados. Impacto social da doença.
AVIAN INFLUENZA, HUMAN (55): H7N9, UPDATE

During the 24-hour period ending at 4 p.m. on Sunday [21 Apr 2013],
China confirmed 6 new cases of human H7N9 avian influenza, including 5
in Zhejiang and one in Jiangsu.

The National Health and Family Planning Commission said in its daily
update on H7N9 cases that a total of 102 H7N9 cases have been reported
in China, including 20 that have ended in death.

Of the total, 12 H7N9 patients have been discharged from hospitals
after receiving treatment, and the other 70 patients are being treated
in designated hospitals, according to the commission.

A total of 33 cases, including 11 that have ended in death, have been
reported in Shanghai. 24 cases, including 3 deaths, have been reported
in Jiangsu Province, and 38 cases, including 5 deaths, in Zhejiang
Province. Anhui Province has reported 3 cases, with one ending in
death. Beijing has reported one case, and 3 have been reported in
Henan Province.

China officially confirmed the human cases infected with the H7N9
virus late last month [March 2013].

According to the commission, China’s confirmed H7N9 cases are
isolated, and there has been no sign of human-to-human transmission.

Communicated by:
ProMED-mail
promed@promedmail.org

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[2] Zhejiang cases
Date: Sun 21 Apr 2013
Source: English News, Xinhua report [edited]
http://news.xinhuanet.com/english/china/2013-04/21/c_132328090.htm
Two people have died of H7N9 bird flu in east China’s Zhejiang
Province, bringing the total number of deaths from the disease to 20
nationwide, health authorities said on Sunday [21 Apr 2013].

A 76-year-old farmer died on Sunday [21 Apr 2013] morning after he
came down with flu symptoms on 8 Apr 2013, and 62-year-old woman, a
native of Huzhou City, died despite medical efforts on Saturday [20
Apr 2013] evening, after she was diagnosed with H7N9 avian influenza
on 14 Apr 2013, said a statement of the provincial health department.

The department also reported 5 more cases of H7N9 bird flu infections,
including the 76-year-old farmer above. The other 4 patients,
including a 68-year-old female, a 58-year-old male, a 79-year-old
female, and a 81-year-old male, were in critical condition, it said.

In addition, a 68-year-old retired man from Jiangsu Province was also
confirmed to have caught H7N9 bird flu, bringing the total number of
infected cases to 102 in the country, said a statement issued by the
Shanghai Health and Family Planning Committee. He was receiving
treatment in Shanghai, said the statement. He showed symptoms of high
fever, cough and expectoration on 13 Apr 2013 in the city of Liyang in
Jiangsu and was diagnosed with H7N9 avian influenza in Shanghai on
Saturday [20 Apr 2013], it said.

The committee said 3 people on Sunday [21 Apr 2013] were discharged
from hospital after they had recovered from the flu. So far, a total
of 12 patients have recovered from the disease.

More people will be discharged from hospital, said Zhang Jianliang,
deputy chief of the Shanghai Municipal Public Health Clinic Center,
adding doctors will further track health conditions of the people
discharged.

—
Communicated by:
ProMED-mail
promed@promedmail.org

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Social impact
Date: Sun 21 Apr 2013
Source: Los Angeles Times [edited]
http://touch.latimes.com/#section/-1/article/p2p-75548618/
On a subway car in Shanghai, a commotion breaks out when someone spots
a live chicken poking its head out of a bag tucked under one of the
seats. On a highway in Zhejiang province, a motorist is so panicked by
bird droppings landing on her windshield that she stops the car and
calls the traffic police for help. Internet photos of dead sparrows on
a Nanjing sidewalk are ordered removed by police, fearing they might
go viral.

The fowl phobia gripping China is the result of a new strain of avian
flu that has led to 18 [now 20] deaths and 95 [now 102] diagnosed
illnesses over the last month. Health authorities are concerned
because of the unpredictable nature of the virus, known as H7N9.
Unlike in previous incarnations of avian flu, infected birds here are
showing no signs of being sick, making it harder to stem the disease
at its source.

So far, there is no evidence that the strain of flu can be easily
transmitted from human to human; such transmission is an earmark of a
potential pandemic. But the number of people having direct contact
with birds is limited, so researchers are not quite sure how this
year’s [2013] patients have been getting sick. Although the earliest
cases involved farmers and poultry dealers, in more than half of the
more recent infections, the people had no direct contact with birds,
Michael O’Leary, head of the World Health Organization’s China office,
said at a briefing Friday [19 Apr 2013].

Pigeon fanciers around China have canceled events. Notices have gone
up in diplomatic residences around Beijing instructing people not to
take children to the zoo. Tables at Beijing’s most popular Peking duck
restaurant are now available without a reservation. “People are
scared. Nobody is buying chickens or ducks,” said Li Guoli, a young
man standing at a Beijing fresh market counter where the chicken legs
weren’t selling. At the next stall, business was so slow that the
vendor was sound asleep.

15 experts from the United Nations’ top health agency have launched an
investigation of the outbreak, concerned that it could become far more
deadly. “What we don’t know is the size of the iceberg under this
tip,” O’Leary said. The Chinese government appears to be struggling to
contain the problem, without taking steps that would result in
outright panic. “It is a really challenging road to walk. You don’t
want to be hyperbolic and scare people, but you want to prepare for
the worst-case scenario,” said Myles Druckman, a vice president with
International SOS, which advises companies on health issues.

As with other outbreaks in China, fear itself can prove economically
devastating. The 2003 outbreak of Severe Acute Respiratory Syndrome
(SARS), which killed nearly 800 people, caused USD 40-80 billion in
financial losses. China is already seeing an effect on travel,
restaurant visits and food production. Sales at KFC’s nearly 5000
restaurants in China dropped about 16 percent in March 2013, according
to parent company Yum Brands. Health experts advise that there is no
danger in eating cooked poultry. Also trying to reassure a worried
public, an official in Hunan province hosted a banquet Wednesday [17
Apr 2013] for about 150 workers at which he served only poultry: chile
fried chicken, chicken wings, chicken intestines and duck eggs.

One problem is that many Chinese do not believe their government’s
reassurances, especially given the well-documented cover up of the
SARS epidemic a decade ago. Another is that previous outbreaks of bird
flu — the H5N1 strain — in China resulted in 30 deaths, according to
the latest World Health Organization statistics. The unease has been
compounded by the sight of more than 10 000 dead pigs washing up last
month [March 2013] on the banks of Shanghai’s main river. There have
also been unexplained deaths of many ducks in Sichuan province and a
few black swans in Anhui province, as well as the sparrows in Nanjing.
Authorities have not tied any of the animal deaths to the [H7N9] bird
flu, but they have not given clear explanations either.

Beijing authorities have now banned the sale of live birds in markets
across the capital. In Shanghai and elsewhere, hundreds of thousands
of chickens and other poultry have been killed as a precaution in an
attempt to prevent the spread of the illness. One farmer was shown
using plastic bags to suffocate thousands of ducklings. “If you have
one sick bird on a farm, the farmer has to kill all of them,” said
Zhao Kai, sales manager of Beijing-based CECO Environmental Protection
Technology, which makes an incinerator that can cremate 30 000
chickens a day. Cremation is the preferred method for disposing of the
remains. “We are selling many machines these days,” Zhao said. “Our
business is one that is doing well.”

[Byline: Barbara Demick]