H7N9 cases in China top 100 as deaths reach 20

Apr 21, 2013 (CIDRAP News) – The number of novel H7N9 flu cases in China rose steadily over the weekend, with reports of 11 more infections pushing the total so far to 102, according to official sources.

Three more people died from the disease, a newly reported patient from Shanghai and two previously reported case-patients from Zhejiang province. The additional deaths lift the outbreak's fatality total to 20.

The flurry of new cases comes as China's government responded to an earthquake at the opposite side of the country from where most of the H7N9 cases have been detected and as a team of international experts are touring some of the outbreak areas and consulting with Chinese experts.

All of the new cases were reported from the area of eastern China that has been the center of the outbreak. Most of the newly reported infections are in men over age 50, though two of the patients are in their 30s and one is in his 40s. Only two of the new cases are in women.

Illness-onset dates for the new cases range from Mar 30 to Apr 16, which suggests that the outbreak is ongoing.

The World Health Organization (WHO) said in an update today that 70 of the H7N9 patients reported so far are still in the hospital and that 12 have been discharged.

Eight of the cases reported over the past 2 days are from Zhejiang province, according to updates yesterday and today from the WHO. That group includes two women, ages 35 and 68, and six men ages 37, 56, 58, 76, 79, and 84.

Shanghai's cases involved two men, ages 68 and 75. The younger of the two died from his infection. He got sick on Apr 13. No other details were available about his illness.

The patient from Jiangsu province is a 43-year-old man who started having symptoms on Apr 7.

The WHO said that until the source of the virus is identified, it expects more human H7N9 cases to be reported.

So far the virus does not appear to spread easily from person to person, but health officials are watching it closely, because analysis of genetic sequences so far suggests that it may be adapting to mammals, including humans.

Three small family clusters have been reported, but the WHO said there is no evidence of the type of ongoing transmission that would signal a great threat.

In other developments, Public Health England (PHE) on Apr 19 released clinical guidance for assessing and investigating patients with severe flulike illness within 7 days of returning from China. (Before Apr 1 the PHE was known as the Health Protection Agency.)

PHE said the symptoms of H7N9 infection are similar to a pattern seen with H5N1 illness, including high fever and cough that progresses to breathing difficulty, pneumonia, and acute respiratory distress syndrome. If the clinician is considering H7N9 as a possible diagnosis in a traveler returning from China, he or she should isolate the patient, ask him or her to wear a mask, and wear personal protective equipment during the evaluation, including eye protection, according to the PHE guidance.

The guidance covers what steps to take when patients with possible H7N9 infections are hospitalized and how to monitor suspected cases in outpatient settings.

See also:

Apr 21 Chinese Center for Disease Control and Prevention update

Apr 19 PHE press release

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