〔記者邱宜君、羅添斌／綜合報導〕總統馬英九昨上午視察中央流行疫情指揮中心表示，「戰爭才剛開始，一定要打贏，不可有任何疏忽」。十年前「兩岸沒有直航，病毒卻一個禮拜就傳過來了」，現在兩岸直航每週六百一十六班，邊境把關更要加強，因此「把病毒擋在境外」是最高指導原則，「料敵從寬、禦敵從嚴」，防疫之戰是一場只能贏不能輸的戰爭。
衛生署署長邱文達、防疫指揮官張峰義、ＳＡＲＳ時擔任台北區傳染病防治醫療網正副指揮官張上淳、璩大成都在現場，馬英九也指示應盡快改善ＳＡＲＳ後未使用的老舊器材。
中國國台辦昨天指出，「應台灣方面的要求，大陸主管部門同意向台灣方面提供病毒毒株，目前正在辦理相關手續」。
國台辦發言人范麗青並表示，將繼續認真履行兩岸醫藥衛生合作協議，與台灣有關方面加強聯繫。
新華社十日報導，中國科技部表示，預計在兩個月內完成核酸診斷試劑的臨床實驗，七個月內完成人類感染H7N9禽流感疫苗研製。
馬英九說，疫苗研發「不排除和任何方面的合作」，美方已向駐外代表承諾，只要做成疫苗株會立刻分給台灣，「若美國先做好，就跟它合作」。
張峰義報告時提及，第一階段防疫工作包括將克流感粉劑製作成膠囊、檢驗、人力動員、資訊系統支援，估計需經費四．五億，將提報動用行政院第二預備金。但總統當場未有回應。
前幾年禽流感大流行時，克流感大缺貨，疾管局緊急採購保存期限較久的粉劑，缺點是使用前必須先經代工製成膠囊，目前備有一千六百公斤，可製成一百六十萬人份，每份十顆，膠囊代工費是四億元。疾管局副局長周志浩強調，如果整批粉劑報銷、重買膠囊，需要十四億元，用代工處理，已經省了十億元。
現有的克流感膠囊兩百多萬人份、瑞樂沙一百五十多萬人份，加上粉劑一百六十萬人份，共備超過五百萬人份，夠供應二十二．五％的國人使用。
陸委會指出，旅遊警示燈號若有發佈或改變必要，將依指揮中心決議與衛生署專業建議，再由陸委會處理。
Date: Wed, 10 Apr 2013 16:56:06 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Avian influenza human (39): China (SH, JS, ZH) H7N9 update
AVIAN INFLUENZA HUMAN (39): CHINA (SHANGHAI, JIANGSU, ZHEJIANG) H7N9
UPDATE
***************************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
In this update:
[1] Origin
[2] Mutation rate
[3] Case count
[4] WHO update
******
[1] Origin
Date: Wed 10 Apr 2013
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/china/2013-04/10/c_132299005.htm>
A top Chinese biology lab has ascribed the H7N9 avian influenza to
genetic reassortment of wild birds from east Asia and chickens from
east China. The researchers found that no genes in H7N9 were traceable
to pigs, thus excluding pigs as intermediate hosts for the deadly new
strain of bird flu, the Chinese Academy of Sciences' Key Laboratory of
Pathogenic Microbiology and Immunology said on Wednesday [10 Apr
2013]. According to the researchers, the genetic reassortment is
likely to have occurred in east China's Yangtze River Delta areas
covering Shanghai, Zhejiang, and Jiangsu [provinces]. They found that
a virus carried by wild birds from the Republic of Korea and other
east Asian regions mingled with the avian influenza virus carried by
ducks and chickens in the Yangtze River Delta during migration. The
lab's research shows the H7 and N9 gene segments in H7N9 [outbreak
strain] are similar to those in avian influenza samples collected from
wild birds from east Asia, while the other 6 genes are traceable to
chickens in China's Shanghai, Zhejiang, and Jiangsu.
As to why the H7N9 is less harmful to animals than to humans,
researchers said it's because of viral mutation, adding that they had
monitored mutation of the N9 genes. Animal experts and scientists have
stepped up monitoring of bird migration paths to prevent the H7N9 from
spreading, according to the China Wildlife Conservation Association.
The new bird flu has killed 9 of the 33 people infected with H7N9 in
the country. Some have speculated that the new virus is related to the
dead pigs found floating along Shanghai's Huangpu River last month
[March 2013], though local government has repeatedly underlined that
this is not the case. On Wednesday [10 Apr 2013], police in southwest
China's Guizhou Province announced they have detained 3 people for
fabricating rumors online that the deadly virus had been detected
locally.
[Editor: An]
- --
Communicated by:
ProMED-mail
<promed@promedmail.org>
******
[2] Mutation rate
Date: Wed 10 Apr 2013
Source: The South China Morning Post [summ., edited]
<http://www.scmp.com/news/china/article/1211077/h7n9-bird-flu-may-mutate-8-times-faster-regular-flu-study-finds>
The new bird flu [A/(H7N9) influenza virus] could be mutating up to 8
times faster than an average flu virus around [that is, in] a protein
that binds it to humans, a team of research scientists in Shenzhen
says. Dr He Jiankui, an associate professor at South University of
Science and Technology of China, said yesterday [9 Apr 2013] that the
authorities should be alarmed by the results of their research and
step up monitoring and control efforts to prevent a possible
pandemic.
With genetic codes of [H7N9] viruses obtained from mainland
authorities, the team scrutinised the haemagglutinin, a protein that
plays a crucial rule in the process of infection. The researchers
found dramatic mutation of haemagglutinin [gene] in one of the four
flu strains released for study by the central government. 9 of the
protein's 560 amino acids had changed. In a typical flu virus, only
one or 2 amino acids could change in such a short period of time, he
said. The fast mutation [rate] makes the virus' evolutionary
development very hard to predict. "We don't know whether it will
evolve into something harmless or dangerous," He said. "Our samples
are too limited.
The origin of the virus was puzzling due to its novelty, but his
research suggested some clues that differ from the mainland
authorities' theories. His team compared the new virus strain to all
other H7N9 viruses identified in Europe and in other Asian countries
that were cited by the Ministry of Agriculture as possible origins of
the new bird flu, but found them all very different. In fact, the [HA
of the] new bird flu was quite similar to [the HA genes] of some
familiar domestic viruses such as H9N2, H11N9, and H7N3 found in
Zhejiang and Jiangsu.
He said researchers could not rule out the possibility that the new
virus was carried into China by wild birds, but it was more likely to
be of local origin.
[Byline: Stephen Chen]
- --
Communicated by:
ProMED-mail Rapporteur Mary Marshall
******
[3] Case count
Date: Wed 10 Apr 2013
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/china/2013-04/10/c_132298870.htm>
Two more human cases of H7N9 bird flu were reported on Wednesday [10
Apr 2013] in Shanghai Municipality, bringing the total number of
infected people in the country to 33, health authorities said.
A local [76-year-old retired woman] developed a cough, sore throat and
weakness on 1 Apr 2013. On 2 Apr 2013 she developed a high fever and
went to the hospital on 5 Apr 2013. Doctors confirmed Tuesday night [9
Apr 2013] that she has H7N9 avian flu, according to a statement issued
by the city's health and family planning committee. The patient is now
in stable condition, said the statement. An 81-year-old woman, who is
a farmer, went to the hospital with symptoms of diarrhea and fever of
unknown origin, and was subsequently diagnosed with acute enteritis
and pneumonia. On Tuesday night [9 Apr 2013], the city's disease
prevention and control center confirmed that she has H7N9 bird flu, it
said. 9 people who came into contact with the 2 women have so far
shown no abnormal symptoms.
Apart from the 2 cases reported in Shanghai, 3 other new cases were
also reported in Jiangsu and Zhejiang provinces Wednesday [10 Apr
2013], bringing the country's total H7N9 infection count to 33 as of 5
pm. Wednesday [10 Apr 2013]. 9 of these individuals have died.
A 4-year-old boy, who had been hospitalized for H7N9 influenza, was
discharged from a Shanghai hospital Wednesday [10 Apr 2013] after
fully recovering.
[Editor: An]
- --
Communicated by:
ProMED-mail
<promed@promedmail.org>
and ProMED-mail Rapporteur Kunhiko Iizuka
******
[4] WHO update
Date: 10 Apr 2013
Source: WHO Global Alert and Response
<http://www.who.int/csr/don/2013_04_10/en/index.html>
Human infection with influenza A(H7N9) virus in China - update 10 Apr
2013
- ------------------------
As of 10 April 2013 (18:00 CET), the National Health and Family
Planning Commission notified WHO of an additional 4
laboratory-confirmed cases of human infection with influenza A(H7N9)
virus. Of the laboratory-confirmed cases, 2 are from Shanghai and 2
from Zhejiang.
The 1st patient is a 62-year-old man from Shanghai who became ill on
[1 Apr 2013], the 2nd patient is a 77 year-old man from Shanghai who
became ill on [3 Apr 2013], the 3rd patient is a 51 year-old woman
from Zhejiang who became ill on [13 Mar 2013], and the 4th patient is
a 79 year-old man from Zhejiang who became ill on [29 Mar 2013].
In addition, 2 patients earlier reported from Jiangsu (83-year-old
man) and Anhui (35-year-old woman) have died.
To date, a total of 28 cases have been laboratory confirmed with
influenza A(H7N9) virus in China, including 9 deaths, 14 severe cases
and 5 mild cases.
More than 600 close contacts of the confirmed cases are being closely
monitored. In Jiangsu, investigation is ongoing into a contact of an
earlier confirmed case who developed symptoms of illness.
The Chinese government is actively investigating this event and has
heightened disease surveillance. Retrospective testing of recently
reported cases with severe respiratory infection may uncover
additional cases that were previously unrecognized. An
inter-government task force has been formally established, with the
National Health and Family Planning Commission leading the
coordination along with the Ministry of Agriculture and other key
ministries. The animal health sector has intensified investigations
into the possible sources and reservoirs of the virus.
WHO is in contact with national authorities and is following the event
closely. The WHO-coordinated international response is also focusing
on work with WHO Collaborating Centres for Reference and Research on
Influenza and other partners to ensure that information is available
and that materials are developed for diagnosis and treatment and
vaccine development. No vaccine is currently available for this
subtype of the influenza virus. Preliminary test results provided by
the WHO Collaborating Centre in China suggest that the virus is
susceptible to the neuraminidase inhibitors (oseltamivir and
zanamivir).
At this time there is no evidence of ongoing human-to-human
transmission.
WHO does not advise special screening at points of entry with regard
to this event, nor does it recommend that any travel or trade
restrictions be applied.
About this Disease Outbreak News
1. WHO is currently publishing information on laboratory confirmed
cases received through the official notification from the Chinese
National International Health Regulations (IHR) Focal Point once a
day. This formal notification and publication follows verification of
the information, and may therefore come after, or not include, some
cases reported through public media and other sources.
2. To date, there is limited information to determine whether the
reported number of cases represents some or all of the cases actually
occurring. As some relatively mild cases of illness have now been
reported, it is possible that there are other such cases that have not
been identified and reported.
3. If the current pattern of sporadic infections continues, WHO will
cease frequent reporting of case numbers, and focus its Disease
Outbreak News on new developments or changes in the pattern or
presentation of infections.
- --
Communicated by:
ProMED-mail Rapporteur Marianne Hopp
[There have been significant advances in determining the origin and
genetic characteristics of the A/(H7N9) influenza virus responsible
for human disease in eastern China. From genome sequence data it has
been deduced that no genes in H7N9 were traceable to pigs, thus
excluding pigs as intermediate hosts. Rather the H7 and N9 gene
segments in the H7N9 outbreak strain are similar to those in avian
influenza samples collected from wild birds from east Asia, while the
other 6 genes are traceable to chickens in China's Shanghai, Zhejiang,
and Jiangsu provinces. Other research, focussing on the sequence of
the HA gene, suggests that the HA gene new bird flu virus could be
mutating up to 8 times faster than the HA of an average flu virus.
Human cases of the H7N9 virus continue to be reported, mainly
involving the middle-aged and the elderly. There has still been no
confirmed transmission of this virus from person to person.
Currently the number of confirmed human cases is 33, and the number of
fatalities is now 9. - Mod.CP]
[The discrepancies between the media reports of numbers of cases and
the WHO official report on numbers of cases is explained at the bottom
of the WHO update from today (10 Apr 2013). The WHO numbers reflect
those cases that have been laboratory confirmed and are reported
through official channels. At present we reflect a difference of 5
cases between the WHO report and the newswire tallies. - Mod.MPP]
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