Second case from Hunan raises H7N9 total to 128

May 1, 2013 (CIDRAP News) – The new H7N9 avian flu virus has been detected in one more patient in China, a finding that edges the number of cases in the outbreak to 128, which includes 24 deaths.

The patient is a 69-year-old man from Hunan province, located in south central China, according to a statement today from Hong Kong's Centre for Health Protection (CHP). The man—Hunan province's second H7N9 case-patient—is hospitalized in critical condition.

Today is International Worker's Day in China, a public holiday. May 1 is known as Labor Day in Hong Kong, where it is also designated as a public holiday.

The World Health Organization (WHO) yesterday updated its frequently asked question background information on the H7N9 virus, which said that although evidence points to live poultry as the source of infections, investigations haven't confirmed that the birds are the primary or only source.

Addressing the role of live-bird markets in the transmission of the virus, the WHO said the markets should be periodically closed and emptied of all birds for regular cleaning. New birds brought into the market should be regularly sampled and tested to detect diseases early.

The WHO said regular maintenance of market environments can help minimize economic disruptions and the impact on a key source of protein for people. It also noted that the markets help ensure that the bird trade isn't diverted to channels of uncontrolled sales.

Until more information is known about the infections, it's difficult to determine if the H7N9 virus poses a significant risk of person-to-person spread in the community, the WHO said. "This possibility is the subject of epidemiological investigations that are now taking place."

It's not known yet whether H7N9 is a pandemic threat, the agency said. Animal viruses that infect people theoretically carry a pandemic risk, but some animal influenza viruses known to infect people haven't sparked pandemics.

Regarding potential risks to healthcare workers, the WHO said standard and extra precautions should be taken when caring for patients with suspected or confirmed H7N9 infections. In China and Taiwan, monitoring of close contacts of H7N9 patients turned up some instances of respiratory symptoms in health workers who cared for H7N9 patients, but so far tests have not confirmed H7N9 flu in any worker.

In other developments, a rush to publish scientific papers based on H7N9 genetic sequences that the Chinese National Influenza Center uploaded to the GISAID database early in the outbreak has sparked worries that China might not receive credit for its efforts to isolate and sequence the virus, according to a news report in Nature today.

One of the points of conflict involves a genetic analysis and case study that Chinese scientists submitted to the New England of Journal of Medicine on Apr 5. At about that time, the researchers learned that other groups were preparing papers or had already published studies on the sequences that Chinese researchers had uploaded to GISAID.

At that time the Chinese researchers also learned that pharmaceutical company Novartis and the J. Craig Venter Institute had used the uploaded sequences to develop US-funded H7N9 vaccine without collaboration with the Chinese team, according to Nature. The Chinese researchers believed that the usage wasn't handled in the spirit of the GISAID database, which requires scientists who use the sequences to credit and propose collaboration with those who deposited the data.

A spokeswoman from Novartis said the company explored research collaboration with China and is committed to sharing meaningful insights from the vaccine work with Chinese officials, Nature reported.

Kristine Sheedy, PhD, associate director of communication science at the National Center for Immunization and Respiratory Diseases, with the US Centers for Disease Control and Prevention (CDC), told Nature that the CDC's use of the sequences isn't part of the misunderstandings. She added that the agency has had strong ongoing collaborations with China since the start of the outbreak.

See also:

May 1 CHP statement

Apr 30 WHO FAQ update

May 1 Nature report

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