H7N9 cases grow by 7, along with China poultry industry outcry

China reported seven more H7N9 influenza cases today, including the second one this year from Beijing, amid media reports that the country's poultry-farming groups have asked local authorities to tamp down their case reporting to minimize financial losses to the industry.

The seven new cases add to a brisk momentum of infections that has lifted the number of people infected in the second wave well above the first one last spring. So far 181 cases have been reported in the second wave, compared with 136 in the first.

Seven cases from Beijing, four provinces

Aside from Beijing, areas reporting fresh cases include Zhejiang, Jiangsu, Guangdong, and Hunan provinces, according to health ministry reports picked up, translated, and posted by Avian Flu Diary (AFD), an infectious disease news blog, and FluTrackers, an infectious disease news message board. The lion's share of cases in the second wave have been reported from Zhejiang and Guangdong, which between them account for 136 of the 181 second-wave infections.

Beijing, located hundreds of miles north of the main outbreak area, reported that a 73-year-old man who works as a chicken farmer is hospitalized in critical condition with an H7N9 infection, according to a report today from Xinhua, China's state news agency. The report said he had raised, traded, and slaughtered live poultry before he started having symptoms and sought treatment on Jan 30. Tests confirmed his H7N9 infection yesterday.

Zhejiang province today reported two cases, a 64-year-old man who is critical condition and a 39-year-old man who is hospitalized in severe condition, according to local ministry statements posted by AFD and FluTrackers.

Meanwhile, Jiangsu province also reported two infections, a 66-year-old man who bought chickens at a farm and slaughtered them before he got sick and is now in critical condition and a 63-year-old man who visited a poultry market before he became ill and is listed in critical condition.

Guangdong province's latest case is a 36-year-old woman who is in critical condition, and Hunan province's latest patient is a 61-year-old woman with a history of poultry contact who is hospitalized.

The new cases lift the outbreak total to 317 cases, according to a running count compiled by FluTrackers. The unofficial number of fatalities grew by 1, to 68, based on a report that a patient from Beijing infected in the middle of January, a 58-year-old man, died from his infection.

Poultry industry asks officials to reduce disease publicity

In other developments, poultry-farming industry groups have asked health officials through open letters to share less information about the outbreak, because news of increasing deaths have hurt the sales of poultry, the South China Morning Post (SCMP), an English-language newspaper based in Hong Kong, reported today. Requests to stop reporting individual cases came from the national association of poultry farmers and provincial groups in Guangxi and Guangdong provinces.

A separate statement from the National Animal Husbandry Association said that referring to the H7N9 virus as a bird flu strain has hurt the poultry industry and has led to losses of more than 100 billion yuan ($16.5 billion USD), according to the report.

The letters from the poultry organizations said the stigma of the bird flu name and media reports that the virus is spread by birds have cost the industry 20 billion yaun ($33 million USD). They want the virus to be referred to simply as flu.

Genetic analyses have determined that H7N9 is a novel reassortant virus, all from avian sources. It contains internal H9N2 proteins from viruses isolated in Chinese poultry. Its hemagglutinin is from a Eurasian H7 avian influenza virus lineage and its neuraminidase is most similar to avian H11N9 and H7N9 viruses.

Virus naming issues have proved controversial in other recent infectious disease outbreaks because of possible stigmas on food products and regions of the world.

When the 2009 H1N1 emerged in the middle of 2008, the pork industry raised objections to calling the virus "swine flu." Last May the World Health Organization (WHO) announced that it accepted the name of Middle East respiratory syndrome coronavirus (MERS-CoV) on the basis of a consensus recommendation of an international virus taxonomy working group.

The WHO had said it prefers that virus names not reflect regions or places of virus detection to avoid unnecessary discrimination.

Experts raise worries about ag group stance

News of the poultry industry requests drew criticism today from an infectious disease expert and risk communication specialists.

Michael T. Osterholm, PhD, MPH, director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), publisher of CIDRAP News, said he worried that the concerns of agriculture officials might trump rapid and important case reporting. He said ministry officials have already downplayed poultry as a source of the virus, despite the fact that a vast number of patients had contact with poultry or visited live poultry markets before they got sick.

"It would be a fatal public health mistake for the Chinese government to go along with it [renaming the virus]," he said, adding that it would cast a long shadow over the openness that China has achieved with disease reporting after the SARS outbreak.

Jody Lanard, MD, and Peter Sandman, risk communication consultants based in Brooklyn, NY, told CIDRAP News in an e-mail response that consumer concern in China is justified, with evidence so far showing that most victims are catching the virus from poultry or poultry environments, and at most only occasionally from other people. The United States and other nations urge China travelers to avoid contact with live poultry and animal markets, they noted.

"It is not foolish for Chinese consumers to try to be as cautious as their food-purchasing and food-consumption patterns permit," Lanard and Sandman wrote. "This is especially true in the face of massive expert uncertainty about how this new virus behaves."

The industry's recommendations could backfire, based on the risk communication principle that mistrust arouses outrage, they said. "When sources cannot be trusted, small risks look big and big risks look bigger."

China has come far since the days of SARS, when officials reportedly hid developments from outside observers. Global health officials have so far praised China for its transparent handling of H7N9, even to the point of using China as an example of openness when criticizing Saudi Arabia's relative opacity about MERS-CoV, another novel virus, Lanard and Sandman wrote.

"Any effort to suppress or understate the risk of H7N9—or its link to poultry—would reverse this progress and undermine trust," they wrote, adding that China's poultry industry is sending a clear signal that it considers industry well-being more important than consumer health.

Mistrust of China's agriculture and food production is already extremely high, due to events such as discovering melamine in pet food ingredients, and the suspicions are directly relevant to the basic H7N9 problem, according to Lanard and Sandman. If Chinese people liked and trusted frozen poultry, their H7N9 infection risk would be lower. However, because they assume that sick birds are often sold, many Chinese consumers insist on inspecting live birds before they buy them, fueling the spread of the virus and making it difficult to close live poultry markets, they added.

Lanard and Sandman emphasize that China isn't alone with the inherent conflict of interest when foods threaten human health, a problem Western countries grapple with as well.

Rather than soft-pedaling the H7N9-poultry connection, a savvy risk communication approach would be to emphasize it, the two wrote.

"Share with Chinese consumers the concern and sadness that contact with live poultry is not risk-free, and offer concrete advice on ways for consumers to minimize their risk," they wrote, pointing out that covering up crucial health information is never justified. "Then and only then would agricultural officials have any right to ask for public compassion about H7N9's catastrophic effect on the industry they regulate and promote."

See also:

Feb 6 AFD post

Feb 6 FluTrackers thread

FluTrackers human H7N9 case count

Feb 6 SCMP story


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