Malaysia reports first H7N9 case outside China

Health officials announced an H7N9 avian flu infection in Malaysia today, the first case detected outside of China, along with eight other newly confirmed cases—one in Hong Kong and seven more from the mainland.

The patients who are sick with H7N9 infections in Hong Kong and Malaysia had travel links to China's Guangdong province, one of the main hotspots of disease activity in the outbreak's second wave.

Today's new cases lift the number of H7N9 cases reported in the second wave, which began in October, to 211, compared with 136 reported during the first wave last spring. For both waves, the total is 347, according to a list of confirmed cases kept by FluTrackers. The unofficial death count remains at 72.

CDC: Malaysia case underscores surveillance priority

Malaysia's patient is a 67-year-old woman who was part of a tour group from Guangdong province, according to a report today from Bernama, Malaysia's national news agency. The group was visiting Sabah. The woman is being treated in the intensive care unit at a private hospital in Kota Kinabalu.

The country's health minister, Datuk Seri Dr. S. Subramaniam said it was the first H7N9 case reported in the country and that health officials are taking steps to limit contact with the patient.

The US Centers for Disease Control and Prevention (CDC) today issued a statement on the Malaysian H7N9 case, which said the agency has been expecting the detection of H7N9 cases exported from China, including the scenario of an infected traveler. It said the illness in a traveler to Malaysia doesn't change its risk assessment for the H7N9 virus.

The CDC said the most important element in gauging the public health threat is transmissibility, and so far there is no evidence of sustained, ongoing person-to-person spread of H7N9. It emphasized, however, that the case underscores how important international surveillance is for H7N9 and other viruses that have pandemic potential.

Human infections in China linked to poultry exposure are likely to continue, the CDC said, and the virus could spread to neighboring countries, where it could infect people who are exposed to poultry. The most worrisome development would be if the virus gained the ability to spread easily among people, a possibility that the CDC said it and other international health partners are closely monitoring.

Hong Kong's travel-linked case

Meanwhile, Hong Kong's Centre for Health Protection (CHP) said it has detected an H7N9 infection in a 65-year-old resident who started having symptoms while visiting the city of Kaiping in Guangdong province. The case is the fifth H7N9 infection detected so far in Hong Kong, and all have had travel links to China's mainland.

During the patient's stay in Kaiping between Jan 24 and Feb 9, his family bought a slaughtered chicken in the village on Jan 29. Upon his return to Hong Kong on Feb 9 he saw a doctor, and yesterday the man was hospitalized and is now in critical condition in an isolation unit, according to a CHP statement.

Seven of the man's family members in Hong Kong are asymptomatic, and five of them that are close contacts will be admitted to the hospital for observation and testing, the CHP said. Further investigations are under way into the man's travel and exposure history, and the CHP is working with mainland authorities to identify the man's contacts during his stay in Kaiping.

Seven new H7N9 cases from the mainland

The seven latest H7N9 cases reported on the mainland include three from Guangdong province, three from Zhejiang, and one from Hunan, according to provincial health ministry reports in Chinese translated and posted by Avian Flu Diary (AFD), an infectious disease news blog, and FluTrackers, an infectious disease news message board.

Guangdong province's patients include an 8-year-old boy who is hospitalized in stable condition, a 46-year-old male farmer who is in critical condition, and a 65-year-old male farmer, also in critical condition.

In Zhejiang province, newly confirmed case-patients are all adult men who work as farmers, including an 84-year-old who is in critical condition, a 58-year-old who is in severe condition, and a 46-year-old who is also in severe condition.

The patient from Hunan province is a 19-year-old man who is hospitalized, according to AFD and FluTrackers.

Five more markets yield positive samples

In other developments, China's agriculture ministry yesterday reported five more detections of H7N9 in poultry and their environments, according to report to the World Organization for Animal Health (OIE).

One was at a livestock market in Guangxi province, an area that recently reported two human cases and shares a border with Vietnam, fueling worries that porous borders and frequent poultry trade could spread the virus beyond the China.

Tests on 261 samples from the market in the Guangxi city of Guigang yielded four positive samples, all from chickens, according to the OIE report.

Elsewhere, surveillance activities in a live-bird market in the Zhejiang province city of Zhuji found 1 positive environmental sample among 19 that were tested, and tests on 42 chicken samples from a live-bird market in the Guangdong province city of Meizhou also found 1 positive. At a wholesale market in Zhuhai in Guangdong, officials took 360 samples and found 2 positives from chickens.

The fifth detection was in from a live-bird market in the Hunan province city of Yueyang. Of 137 specimens collected, officials detected H7N9 in 2 chicken samples and 1 duck sample.

See also:

Feb 12 Bernama story

Feb 12 CDC statement

Feb 12 CHP statement

Feb 12 AFD post

Feb 12 FluTrackers thread

FluTrackers human H7N9 case count

Feb 12 OIE report

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