H7N9 cases in China surge past 200

The number of new infections in China’s H7N9 outbreak continues a steep ascent, with 23 more cases reported over the past 4 days, along with four deaths, one of them in a health worker at a Shanghai hospital.

The daily number of new H7N9 cases equals the pace of disease activity seen during the peak of the outbreak last spring. The disease is thought to be spreading from poultry to people in settings such as live markets, and the surge of new cases comes at a time of increased demand for poultry ahead of China's Lunar New Year celebrations later this month.

Global health groups take notice

The United Nations Food and Agriculture Organization (FAO) yesterday warned in a statement that the rising number of human cases and the upcoming holidays pose the threat of further spread of the virus to birds and humans. It said millions of people and poultry will be on the move, and many households will slaughter poultry in their homes to celebrate the New Year. The FAO called on neighboring countries to be vigilant for H7N9 and other avian flu viruses, such as H5N1.

Tests on H7N9 samples at FAO reference labs show that the virus has not changed significantly since it emerged last spring, according to the statement.

Juan Lubroth, DVM, PhD, the FAO’s chief veterinary officer, said Chinese authorities are taking several steps to reduce the risks to humans. "This includes temporary closures of live bird markets, regular market rest days, improved hygiene in markets, heightened and ongoing surveillance in poultry and live bird market environment, and control of poultry movement,” he said.

Though the disease doesn’t spread easily from person-to-person, Chinese health officials have aired concerns about holiday travelers getting sick in urban areas, which appear to be the epicenter for the outbreak, and bringing the virus back to their rural homes.

Margaret Chan, MD, the World Health Organization (WHO) director-general, weighed in on the outbreak yesterday in Geneva during her address to the group’s executive board. She said vigilance is needed for monitoring Middle East respiratory syndrome coronavirus (MERS-CoV), H7N9, and other avian influenza viruses.

“Nothing can be predicted with certainty, but on present evidence, none of these viruses shows a potential to spread widely or cause an explosive outbreak,” she said, according to the text of her speech posted on the WHO’s Web site. “Nonetheless, this situation reinforces the importance of building the core capacities of the International Health Regulations to detect cases, report, and respond.”

Hot spots report 23 new cases, 4 deaths

The new cases are from provinces in eastern and southern China that have already reported several H7N9 illnesses: Zhejiang (12), Guangdong (6), Fujian (3), and the city of Shanghai (2).

Most of the patients are middle-aged and older adults, but one is a 5-year-old girl from Guangdong province. Seventeen of the patients are male, while six are female.

Basic information for 17 cases was included in statements on Jan 18 and Jan 20 from Hong Kong’s Centre for Health Protection (CHP), based on information it received from the mainland. Fifteen of the patients are hospitalized. The other two are men from Shanghai, both of whom died from their infections—including the 31-year-old health worker. The two men died on Jan 18, according to the Jan 20 CHP statement.

Announcements of the other six cases appeared in statements today in Chinese released by provincial health authorities. According to translations posted by Avian Flu Diary, an infectious disease news blog, three patients are from Guangdong and three are from Zhejiang.

Aside from the two men from Shanghai, the other fatalities include an 86-year-old male tourist from the mainland who was diagnosed with H7N9 in Taiwan and a patient from Guangdong whose death was reported by provincial officials yesterday, according to media reports. Xinhua, China’s state news agency, said the older man died yesterday. He was from the mainland’s Jiangsu province and had been hospitalized in Taiwan since late December, when he was diagnosed as having H7N9, marking Taiwan’s second such imported case.

WHO case confirmations

In related developments, the WHO yesterday released two statements detailing information it received from China between Jan 16 and 20 concerning 23 patients, many of whom were also included in the CHP statements.

Nineteen of the patients were in critical condition, one was in serious condition, and two were in stable condition, including the 5-year-old girl mentioned in Hong Kong’s notification, the WHO said. She is from Guangdong province. One death was reported in the WHO’s announcement, in a 38-year-old man from Guizhou province who had been working in Zhejiang province.

The WHO said 13 of the 23 patients covered in its two reports had been exposed to poultry before they got sick. One had been exposed to a live poultry market. I

In a Twitter post today, the WHO said China has notified it of five more lab-confirmed H7N9 cases.

The flurry of new H7N9 reports over the last 4 days lifts the outbreak total to 217 cases, 57 of them fatal.

See also:

Jan 20 FAO statement

Jan 20 Chan speech

Jan 18 CHP statement

Jan 20 CHP statement

Jan 21 Avian Flu Diary post

Jan 20 Xinhua story

Jan 21 Xinhua story

Jan 20 WHO statement on Jan 17-Jan 20 reports

Jan 20 WHO statement on Jan 16 reports

WHO Twitter feed

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