〔編譯魏國金、記者邱宜君／綜合報導〕中國爆發人得H7N9禽流感病例昨日又增四例，四位患者都在江蘇一省但不同城市，之前的兩死一病重三病例，分居上海及安徽；我國疾病管制局昨晚向中國疾病預防與控制中心查證後確認屬實，由於七起病例分屬不同地區，疾管局官員認為，中國感染區域已經擴大。
ＳＡＲＳ10週年 中爆疫情
十年前，全球發生ＳＡＲＳ危機，當時全世界有八千多件確診病例，其中七百七十五人死亡，中國死亡案例有三百四十八人、香港死亡二百九十九人、台灣死亡四十七人、加拿大死亡三十八人，為當時死亡病例最多的四個國家地區；不少網友發表憂心看法，在ＳＡＲＳ十週年之際是否又再度有「類ＳＡＲＳ」襲擊全世界。
在昨晚中國公布新增四個H7N9禽流感病例之前，我國衛生署署長邱文達昨日上午就警告說：「防疫等級一定要提高，未來會愈來愈緊張。」疾管局今日將召開專家會議，評估是否有需要建議行政院成立跨部會防疫中心。疾管局副局長周志浩昨表示，疾管局會透過一切可能的管道，試圖取得中國的病毒株。
3女1男 住江蘇不同城市
江蘇衛生廳昨在官網公布新增的四例病例資料，其中四十五歲許姓女患者是南京市江寧區人，從事活禽宰殺工作
，三月十九日出現發熱、頭暈等症狀，病情危急，有四十九人與她有密切接觸。另一名四十八歲桑姓女患者，宿遷市人，從事板材加工，也是三月十九日出現發熱、頭暈咳嗽等症狀。與桑姓患者的密切接觸者達六十人。
另兩名患者分別為八十三歲的沈姓男子，蘇州市吳江區人，為三月二十日出現發燒、咳嗽等症狀，三十二歲的張姓女子，常州人，現居無錫市濱湖區，為三月二十一日出現發燒、咳嗽等症狀；兩人目前病情嚴重。曾與兩人密切接觸者分別達十五人及四十三人。江蘇衛生廳宣稱說，這些與發病者有接觸的民眾，均未發現有發熱或呼吸道症狀。以上四人發病時間集中在三月十九日至二十一日，已引起中外醫界注意。
專家：未來恐有更多的病例
另外，上海市政府昨晚說，之前因H7N9禽流感死亡的八十七歲老人，其兩子因肺炎一死、一痊癒，但兩人均未驗出H7N9病毒，排除院內傳染的可能性。另外，根據對近期打撈的死豬抽查，在三十四個樣本中，均未發現禽流感病毒。
「比爾蓋茲與梅琳達基金會」的北京辦事處主任葉雷博士說，以前不知道有這種病毒株，現在既然知道要找的對象，未來恐會有更多病例出現。
世界衛生組織發言人柴依布（Fadela
Chaib）二日在日內瓦表示，目前的調查顯示，H7N9病毒的感染者間沒有關聯，「不是人際間的傳染」，「現階段對於這次H7N9感染事件仍所知甚少」。
Date: Tue 2 Apr 2013
Source: The Washington Post, Associated Press report [edited]
http://www.washingtonpost.com/business/how-lesser-known-bird-flu-strain-killed-2-isnt-known-yet-but-human-spread-seen-as-unlikely/2013/04/01/ee4e7176-9b2e-11e2-9219-51eb8387e8f1_print.html
China reported Tuesday [2 Apr 2013] that 4 more people in one province were seriously sickened by a bird flu virus new to humans, while cities along the eastern seaboard stepped up public health measures to guard against a disease that has already caused 2 deaths.
The health bureau of eastern Jiangsu province said in a notice on its website that 3 women, aged 45, 48 and 32, and an 83-year-old retired man, from different cities in the province were all critically ill with H7N9 avian influenza virus infection, a diagnosis confirmed by the provincial disease prevention centre. Based on the bureau's statement, only one of the patients appeared to come into daily contact with birds, the 45-year-old woman, who was described as a poultry butcher. The 4 cases did not appear to be connected, and people who have had close contact with the patients have not reported having fevers or respiratory problems, it said. The provincial health bureau said it was strengthening measures to monitor suspicious cases and urged the public to stay calm, joining Beijing and China's financial capital, Shanghai, in rolling out new steps to respond to the relatively unknown virus.
The 4 latest cases follow 3 earlier ones reported Sunday [31 Mar 2013], including 2 men who died in Shanghai, resulting in the city activating an emergency plan that calls for heightened monitoring of suspicious flu cases. Under the contingency plan, schools, hospitals and retirement facilities are to be on the alert for fevers, and administrators are to report to health authorities if there are more than 5 cases of flu in a week. Cases of severe pneumonia with unclear causes are to be reported daily by hospitals to health bureaus, up from the weekly norm. The plan also called for stronger monitoring of people who work at poultry farms or are exposed to birds. The level-3 response plan, the 2nd-lowest in a 4-stage scale, reflects higher concern after the H7N9 bird flu virus led to the deaths of 2 men in Shanghai and seriously sickened a woman in the city of Chuzhou, 360 km (230 miles) [to the] west.
"The health bureau will take effective and powerful measures to prevent and control the disease, to make sure the flu epidemic is effectively guarded against, and to safeguard the health of the city's residents," said Xu Jianguang, head of the Shanghai Health Bureau.
The H7N9 avian influenza virus has previously been considered not easily transmitted to humans, unlike the more virulent H5N1 strain, which began ravaging poultry across Asia in 2003 and has since killed 360 people worldwide.
Health officials said this week there was no evidence that any of the 3 earlier cases, who were infected over the past 2 months, had contracted the disease from each other and no sign of infection in the 88 people who had closest contact with them.
Health authorities in Beijing also upped the capital's state of readiness, ordering hospitals to monitor for cases of bird flu and pneumonia without clear causes, the official Xinhua News Agency reported.
[Byline: Fu Ting]
--
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[Jiangsu province can be located in the map of the provinces of China at: http://www.sacu.org/provmap.html. It lies to the west of Anhui province.
The number of confirmed human cases of avian A(H7N9) influenza virus infection has now risen to 7; the number of fatalities remains at 2. The condition of the 4 new cases is critical, and all remain in hospital. None of the 4 new cases are related to the previous 3 cases or to each other. Only one of the new cases has had daily contact with birds, a 45-year-old woman who is described as a poultry butcher. The pattern remains the same, presumptive direct infection from poultry and no evidence of person-to-person transmission. The overall situation is becoming more serious, suggesting that many people may be directly susceptible to a strain of avian A(H7N9) influenza virus that may be widespread in the avian population (wild or farmed) in China. The consequences of infection by this virus appear to be severe. - Mod.CP
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/33jB.]
Date: Tue 3 Apr 2013
Source: Avian Flu Daily [abridged, edited]
<http://afludiary.blogspot.jp/2013/04/statement-from-jiangsu-province-health.html>
Statement From Jiangsu Province Health Department On H7N9
- -----------------------------------------------------
The Jiangsu Provincial Health Department Bulletin, April 2, Jiangsu
Province, diagnosed 4 cases of human infection with the H7N9 avian
influenza.
[1] Female, 45 years old, Jiangning District, engaged in live poultry
slaughter. 19 Mar 2013, fever, dizziness, body aches, fatigue and
other symptoms. In the morning of 27 Mar 2013, went to Nanjing sicker,
ICU treatment in a hospital. Currently, patient is in critical
condition. On the afternoon of 30 Mar 2013, the Jiangsu Provincial
Center for Disease testing was positive for H7N9 avian influenza virus
nucleic acid. In the afternoon of 2 Apr 2013, review by China CDC
influenza center laboratory for the H7N9 avian influenza virus nucleic
acid positive. In accordance with the relevant requirements, on the
afternoon of 2 Apr 2013, the provincial Health Department organized
experts; according to the clinical manifestations, laboratory testing
and epidemiological findings, the diagnosis of the cases was confirmed
cases of human infection with the H7N9 avian flu. The patients are the
province's 1st cases of infection with the H7N9 avian flu. After
investigation, the close contacts of the cases were 49 people. Medical
observation, so far, shows all close contacts of the cases were not
found to have a fever or respiratory symptoms.
[2] Patient with a mulberry [sic], female, 48 years old engaged in
sheet metal processing. 19 Mar 2013, fever, dizziness, coughing and
other symptoms. 30 Mar 2013, sicker, patient transferred to a Nanjing
hospital for ICU treatment. Currently, patient is in critical
condition. On 30 Mar 2013, the Jiangsu Provincial Center for Disease
Detection H7N9 found avian influenza virus nucleic acid weakly
positive. In the afternoon of 2 Apr 2013, review by China CDC
influenza center laboratory for the H7N9 avian influenza virus nucleic
acid positive. In accordance with the relevant requirements, on the
afternoon of 2 Apr 2013, the provincial Health Department organized
experts; according to the clinical manifestations, laboratory testing
and epidemiological findings, the diagnosis of the cases was confirmed
human infection of the H7N9 avian flu. After investigation, the close
contacts of the cases were a total of 60 people. Medical observation,
until now, shows they were not found to have a fever or respiratory
symptoms.
[3] 83-year-old male, Suzhou Wujiang District. 20 Mar 2013 fever,
cough, sputum production, accompanied by symptoms such as chest
tightness, shortness of breath and chest pain. On 29 Mar 2013, the
patient is sicker, went to Wujiang Area hospital for treatment.
Currently, patient is in critical condition. On 1 Apr 2013, the
Jiangsu Provincial Center for Disease Detection identified the [agent
as] H7N9 avian influenza virus nucleic acid positive. In accordance
with the relevant requirements, on the afternoon of 2 Apr 2013, the
provincial Health Department organized experts; according to the
clinical manifestations, laboratory testing and epidemiological
findings, the diagnosis was a confirmed case of human infection with
the H7N9 avian flu. After investigation, the close contacts of the
case were a total of 15 people. Under medical observation, until now,
none were found to have a fever or respiratory symptoms.
[4] 32-year-old female now lives in Wuxi city, unemployed. 21 Mar
2013, fever, cough, and other symptoms. On 28 Mar 2013, the patient is
sicker and transferred to a hospital in Wuxi for ICU treatment.
Currently, patients in critical condition. 31 Mar 2013, identified as
the H7N9 avian influenza virus nucleic acid positive by the Jiangsu
Provincial Center for Disease Detection. In accordance with the
relevant requirements, the afternoon of 2 Apr 2013, the provincial
Health Department organized experts, according to the clinical
manifestations, laboratory testing and epidemiological findings, the
diagnosis of the cases human infection confirmed cases of the H7N9
avian flu. After investigation, the close contacts of the cases of a
total of 43 people. Under medical observation, until now, none were
found to have a fever or respiratory symptoms.
[Byline: Michael Coston]
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The description of the 4 new cases in Jiangsu is consistent with the
general pattern: sporadic occurrence, confirmation of H7N9 diagnosis
by molecular methods, variable association with poultry trade,
severity of illness, and lack of evidence of human to human
transmission of infection. - Mod.CP]
[Also regional proximity. Jiangsu province borders both Shanghai
municipality & Anhui province on the north -- not to be confused with
Jiangxi province on the southern border of Anhui.
<http://healthmap.org/r/33jB>
Click on the plus sign to zoom in & see the names of towns.
A clearer map of provinces is at
<http://www.chinatoday.com/city/MAP_0000.JPG>
Watch out for cases from Zhejiang province next (southeast of Anhui &
south of Shanghai). - Mod.JW]
Date: Wed 3 Apr 2013
Source: AP - CBS News [edited]
<http://tinyurl.com/d7dzntg>
Scientists taking a 1st look at the genetics of the bird flu strain
that recently killed 2 men in China say the virus could be harder to
track than its better-known cousin H5N1 because it might be able to
spread silently among poultry without notice.
The scientists said Wed [3 Apr 2013] that the H7N9 virus seems
troubling because it can generate no symptoms in poultry while
seriously sickening humans.
Dr. Masato Tashiro, a WHO scientist studying the virus' genetic data,
says the virus also appears to have mutated into a form that enables
it to more easily infect animals such as pigs, meaning they could
serve as hosts that spread the virus more widely among humans.
H7N9 is previously known only to have infected birds. The preliminary
findings need further testing.
- --
Communicated by:
ProMED-mail <promed@promedmail.org>
[Since human-to-human infection of the current H7N9 virus seems to
have, so far, not been confirmed, animals remain as the suspected
direct source for human infection. The animal-health related
characteristics of the strain need urgent elucidation, preferably
including experimental trials to study its infectivity and
pathogenicity in various candidate animal species.
In addition to domestic poultry (chickens, geese, ducks etc.), mammals
- -- in particular pigs -- deserve special attention, as also suggested
above by Dr Masato Tashiro. China's pig population is the world's
largest; its cohabitation with populations of humans and wild and
domestic fowl has long been regarded as favourable for genetic
reassortment.
The need for enhanced veterinary surveillance and improved biosecurity
in China's pig industry has been recently illuminated by the mass
deaths of pigs pulled from rivers in the Shanghai area, so far without
satisfactory etiology becoming available.
***This is just indicative of the need for enhanced surveillance, and
should by no means be interpreted as a suspicion that an avian
influenza virus has been involved in the (continuing) pig mortality
event (see also http://tinyurl.com/c54ut25).
It will be interesting to note whether and in which animal species AIV
H7N9 has been discovered in China during recent years. One publication
described the isolation of an LPAI (low-pathogenic avian influenza)
strain, namely A/duck/Mongolia/119/2008(H7N9), in north-central
Mongolia in 2008 (See E.-O. Tseren-Ochir, B. Damdinjav, T. Sharkhuu et
al. International Journal of Infectious Diseases, Vol 14, Supplement 1
, Pages e164-e165, March 2010.
<http://www.sciencedirect.com/science/article/pii/S1201971210018862>).
H7 viruses in animals are notifiable to the OIE, even if they are of
low pathogenicity. - Mod.AS
Statement From Jiangsu Province Health Department On H7N9
- -----------------------------------------------------
The Jiangsu Provincial Health Department Bulletin, April 2, Jiangsu
Province, diagnosed 4 cases of human infection with the H7N9 avian
influenza.
[1] Female, 45 years old, Jiangning District, engaged in live poultry
slaughter. 19 Mar 2013, fever, dizziness, body aches, fatigue and
other symptoms. In the morning of 27 Mar 2013, sicker, went to Nanjing
for ICU treatment in a hospital. Currently, patient is in critical
condition. On the afternoon of 30 Mar 2013, the Jiangsu Provincial
Center for Disease testing was positive for H7N9 avian influenza virus
nucleic acid. In the afternoon of 2 Apr 2013, review by China CDC
influenza center laboratory for the H7N9 avian influenza virus nucleic
acid positive. Also in the afternoon of 2 Apr 2013, the provincial
Health Department organized experts; according to the clinical
manifestations, laboratory testing and epidemiological findings, the
diagnosis of the cases was confirmed as human infection with the H7N9
avian flu [virus]. The patients are the province's 1st cases of
infection with the H7N9 avian flu. After investigation, the close
contacts of the cases were 49 people. Medical observation, so far,
shows no close contacts of the cases were found to have a fever or
respiratory symptoms.
[2] Patient with a mulberry [sic], female, 48 years old engaged in
sheet metal processing. 19 Mar 2013, fever, dizziness, coughing and
other symptoms. 30 Mar 2013, sicker, patient transferred to a Nanjing
hospital for ICU treatment. Currently, patient is in critical
condition. On 30 Mar 2013, the Jiangsu Provincial Center for Disease
Detection H7N9 found avian influenza virus nucleic acid weakly
positive. In the afternoon of 2 Apr 2013, review by China CDC
influenza center laboratory for the H7N9 avian influenza virus nucleic
acid positive. On the afternoon of 2 Apr 2013, the provincial Health
Department organized experts; according to the clinical
manifestations, laboratory testing and epidemiological findings, the
diagnosis of the cases was confirmed human infection by the H7N9 avian
flu [virus]. After investigation, the close contacts of the cases were
a total of 60 people. Medical observation, until now, shows none were
found to have a fever or respiratory symptoms.
[3] 83-year-old male, Suzhou Wujiang District. 20 Mar 2013 fever,
cough, sputum production, accompanied by symptoms such as chest
tightness, shortness of breath and chest pain. On 29 Mar 2013, the
patient is sicker, went to Wujiang Area hospital for treatment.
Currently, patient is in critical condition. On 1 Apr 2013, the
Jiangsu Provincial Center for Disease Detection identified the [case
was] H7N9 avian influenza virus nucleic acid positive. On the
afternoon of 2 Apr 2013, the provincial Health Department organized
experts; according to the clinical manifestations, laboratory testing
and epidemiological findings, the diagnosis was a confirmed case of
human infection with the H7N9 avian flu [virus]. After investigation,
the close contacts of the case were a total of 15 people. Under
medical observation, until now, none were found to have a fever or
respiratory symptoms.
[4] 32-year-old female now lives in Wuxi city, unemployed. 21 Mar
2013, fever, cough, and other symptoms. On 28 Mar 2013, the patient is
sicker and transferred to a hospital in Wuxi for ICU treatment.
Currently, patient is in critical condition. 31 Mar 2013, identified
as H7N9 avian influenza virus nucleic acid positive by the Jiangsu
Provincial Center for Disease Detection. In the afternoon of 2 Apr
2013, the provincial Health Department organized experts; according to
the clinical manifestations, laboratory testing and epidemiological
findings, the diagnosis was confirmed cases of the H7N9 avian flu
[virus]. After investigation, the close contacts of the cases were a
total of 43 people. Under medical observation, until now, none were
found to have a fever or respiratory symptoms.
[Byline: Michael Coston]
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka
[The description of the 4 new cases in Jiangsu is consistent with the
general pattern: sporadic occurrence, confirmation of H7N9 diagnosis
by molecular methods, variable association with poultry trade,
severity of illness, and lack of evidence of human to human
transmission of infection. - Mod.CP]
[Also regional proximity. Jiangsu province borders both Shanghai
municipality & Anhui province on the north -- not to be confused with
Jiangxi province on the southern border of Anhui.
A map of provinces is at
<http://www.chinatoday.com/city/MAP_0000.JPG>
Cases have now been reported from Zhejiang province (southeast of
Anhui & south of Shanghai)-- check ProMED later today.
On the HealthMap map of Jiangsu, click on the plus sign to zoom in &
see the names of the towns. - Mod.JW
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