China reports three more H7N9 cases; total to 112

Apr 25, 2013 (CIDRAP News) – Two of China's provinces today reported three more H7N9 influenza infections, while another province awaits test results for what may be its first case, according to official and media reports today.

The new case-patients include a 56-year-old man from Henan province who is hospitalized in critical condition and two women, ages 50 and 60, from Zhejiang province who are hospitalized in serious condition, Hong Kong's Centre for Health Protection (CHP) said in an update today.

The new cases raised the number of lab-confirmed H7N9 infections to 112, which includes 22 deaths.

Both of the provinces are in eastern China, where the outbreak is centered. Yesterday, China's agriculture ministry reported new H7N9 findings from markets in Henan and Zhejiang provinces. The virus was found in two environmental samples from two different markets in Henan province, as well as in bird samples from a market in Zhejiang province, according to a report from the World Organization for Animal health (OIE).

Meanwhile, health officials in Jiangxi province are investigating a suspected H7N9 infection in a 69-year-old man, according to the CHP report. The Chinese Center for Disease Control and Prevention (China CDC) is conducting confirmation tests on the man's samples.

If confirmed, the case would the first for Jiangxi province, which is located about 450 miles southwest of Shanghai. Jiangxi would be the southernmost province in which the H7N9 was detected. In the middle of April, Chinese officials reported a mild H7N9 infection in a Shanghai child who got sick while traveling in Hunan province, but it wasn't clear if the youngster was exposed to the virus in Hunan or Shanghai.

The World Health Organization (WHO) Western Pacific Region Office (WPRO) said in an update today that no new illness clusters have been reported, and there is no evidence of sustained human-to-human transmission.

There have been no reports of H7N9 in animals outside of China, the WHO WPRO said.

In other developments, China's finance ministry announced yesterday that it will put $48.6 million toward H7N9 prevention efforts, Xinhua, China's state news agency, reported. Projects include monitoring H7N9 cases, conducting respiratory illness surveillance, and expanding health insurance programs to cover more medication and services for H7N9 patients.

Also, a medical team from China has published a new case report of two men who were hospitalized with H7N9 infections in Shanghai in late March and early April. The report appears in the latest issue of BioScience Trends, a peer-reviewed journal published by a medical research organization in Japan.

The 74-year-old man described in the report had been exposed to poultry, but the 65-year-old had not. Both had underlying medical conditions. The older man had coronary and liver disease, and the younger of the two had hypertension.

Both patients had a similar clinical course, with respiratory symptoms, fever, rapid progression of lower respiratory disease, and significant hypoxemia. They were treated with oseltamivir (Tamiflu), antibiotics, and immunoglobulin. The authors said they saw no reason to administer hormone (corticosteroid) treatment.

The conditions of both men have improved, and their illnesses appear to have stabilized.

See also:

Apr 25 CHP update

Apr 24 OIE report

Apr 25 WHO WPRO update

Apr 25 WHO update

Apr 24 Xinhua story

April BioScience Trends case report

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