Apr 13, 2013 (CIDRAP News) – Beijing health authorities today confirmed an H7N9 infection in a 7-year-old girl who lives in the city, the first case to be detected outside of eastern China, according to Chinese media sources.
All of the earlier cases were reported from Shanghai and surrounding provinces. Beijing is more than 650 miles in a straight line north and slightly west of Shanghai. The event raises more questions about the virus in birds and the threat it poses to humans.
China's Center for Disease Control and Prevention confirmed the findings early today, according to Xinhua, the country's state news agency. Officials from the Beijing Municipal Health Bureau said at a news briefing that the girl is hospitalized in stable condition, according to the report.
The girl's father works in live poultry trading. Two of the girl's close contacts are being monitored and have not shown any flu symptoms, Xinhua reported. Confirmation of the girl's illness lifts China's H7N9 total to 44 infections, including 11 deaths.
She is the second child to be infected since the outbreak was announced at the end of March. A 4-year-old child from Shanghai had a milder version of the illness and has since recovered, according to past media reports.
A translated statement from Beijing's health bureau posted by FluTrackers infectious disease message board suggests that the girl got sick on the morning of Apr 11, went to an emergency department, and was hospitalized, where her treatment included osteltamivir (Tamiflu).
A spokesman for the health bureau said at a press conference that was broadcast on China Central Television that Beijing has halted live-poultry trading to boost prevention of the disease, Bloomberg News reported today.
Earlier this week, Beijing officials announced several measures to prevent the spread of the virus, including suspending live poultry trading, barring live poultry and poultry products from public transport, cleaning up farms, and boosting wild bird and zoo bird surveillance, according to an Apr 8 report from China Daily.
Michael Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News, said the detection of H7N9 in Beijing, especially since it is far from the geographic center of the outbreak, is worrisome.
"It raises some very significant challenges to understanding what's going on with birds and poultry and controlling their movement," he said.
Three possibilities are that birds harboring H7N9 may have come from the same breeding flocks as the ones in eastern China where the virus had already been detected, infected birds are already in Beijing and the human infection is a sentinel event, or human-to-human spread of the virus has occurred, he said. "We don't know which one."
"We need to understand more clearly what the Chinese are doing with testing flocks and how they're deciding when to cull," Osterholm said. The primary reservoir for the virus isn't clear, but evidence seems clear that the source is poultry, with the question being which poultry.
A crucial task is preventing more infections in humans, because numbers of human infections raise the risk of additional mutations that could ease the spread of H7N9, he said. "The world has to shut the faucet of the bird virus transmitting to humans, and this case illustrates the challenges. There are no dead birds—no warnings."
Timothy O'Leary, communications team leader with the World Health Organization (WHO) Western Pacific Region office, which covers China, told CIDRAP News that the WHO is still awaiting formal notification from the Chinese government about the case in Beijing.
He said that, given the government's heightened disease surveillance, it wouldn't be surprising to learn of a case, or cases, of human H7N9 infections outside of Shanghai, Jiangsu, Zhejiang, and Anhui provinces.
There is still no evidence of human-to-human transmission, and none of the more than 800 close contacts of confirmed cases has tested positive for the virus, O'Leary said. "WHO continues to closely monitor the situation and the government to actively investigate."
Apr 13 Xinhua story
Apr 13 Bloomberg News report
Apr 8 China Daily report