H7N9 疫情續報--2013-4-7

陸：H7N9共21例 6人死 【11:15】

 

〔中央社〕中國大陸衛生和計畫生育委員會今天召開記者會表示，大陸迄今已有21例人感染H7N9禽流感確診病例，其中6人死亡，且共有密切接觸患者621人，尚未發現異常。

此外，上海衛生部門則指出，4歲感染H7N9病毒男童經過救治後情況良好，已經康復。

大陸衛生計生委人感染H7N9禽流感疫情防控工作領導小組辦公室主任梁萬年上午10時在國務院新聞辦公室和世界衛生組織（WHO）駐大陸代表藍睿明召開記者會。

梁萬年指出，近期，上海、江蘇、安徽、浙江4省市發生人感染H7N9疫情，截至7日24時，共收到21例人感染H7N9禽流感確診病例報告。

他說，其中，上海10例（4例死亡）、江蘇6例、安徽2例、浙江3例（2例死亡）。

梁萬年強調，上述病例均為散發，未發現流行病學關聯，且共排查密切接觸者621人，尚未發現異常。

他表示，根據目前調查研究結果，專家研判認為，引起此次疫情的H7N9禽流感病毒是一個重組的新病毒，屬禽源性。目前病例處於散發狀態，未發現人傳人的證據。

梁萬年坦承，當前，由於對此疾病病原學特點和流行特徵的認識有限，疫情防控工作中仍然存在一些不確定因素。

他也公布大陸當局對防疫工作要點，包括由衛生計生委帶頭與多部門參加應對人感染H7N9疫情聯防聯控工作機制，由衛生計生委成立人感染H7N9禽流感疫情防控工作領導小組，協調部署全國衛生系統疫情防控工作。

此外，梁萬年說，將全力做好病例救治工作，制定下發診療、醫院感染控制等方案；積極開展感染來源調查和形勢研判，組織專家加強病原學和流行病學研究，跟蹤變異情況；切實落實各項防控措施；依法及時發布資訊；加強國際合作交流，向WHO提供H7N9病毒株。

 

Date: Sun, 7 Apr 2013 13:48:32 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Avian influenza, human (33): vaccine development

AVIAN INFLUENZA, HUMAN (33): VACCINE DEVELOPMENT
************************************************
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 posting:
[1] Vaccine research
[2] Neuraminidase sensitivity

******
[1] Vaccine research
Date: Fri 5 Apr 2013
Source: Center for Infectious Disease Research & Policy (CIDRAP)
[summ., edited]
<http://www.cidrap.umn.edu/cidrap/content/influenza/avianflu/news/apr0513cdc.html>


The Centers for Disease Control and Prevention (CDC) and manufacturers
are "developing a candidate virus that could be used to produce a
vaccine if one is needed. This will be done only if there is
widespread transmission," CDC Director Tom Frieden, MD, MPH, said. The
Chinese government has deposited the full genetic sequence for samples
of the H7N9 virus in an open database. Since they don't have an
isolate of the virus yet, the CDC and manufacturers are using the
genetic data to make a vaccine seed strain through reverse genetics,
Frieden said. At the briefing, Michael Shaw, PhD, associate laboratory
director in the CDC's Influenza Division, said the agency is making
the seed strain with synthetic genes that were created under a
contract with the Biomedical Advanced Research and Development
Authority (BARDA) of the US Department of Health and Human Services.
"Many different companies and organizations are working on this, to
make a strain that would be shared as widely as possible," he said.

The H7 viruses have been known to infect humans before, typically
causing only mild illness, and CDC officials said the agency already
has candidate vaccines for several of those. But because this novel
H7N9 is very different from those strains, the vaccines are not likely
to be protective, Frieden said today [5 Apr 2013]. Shaw told CIDRAP
News that the CDC has candidate vaccines for H7N1, H7N2, H7N3, and
H7N7 viruses, some of which the agency made and some of which were
produced by other labs in the World Health Organization's network.
Making flu vaccine seed strains using reverse genetics is nothing new,
as 29 approved vaccine candidates have been made in this way, Shaw
said. Those include 22 H5 vaccines, 3 H9, and 4 H7. When H7N9 isolates
become available, the CDC will also try using them to make a candidate
vaccine, Shaw said. "Nothing will be left to chance, so conventional
reassortment will be attempted," he commented. He referred to the fact
that making a flu vaccine involves combining surface proteins from the
target virus with a backbone of internal proteins from another flu
virus that is known to grow well in eggs.

In response to questions at the briefing, Frieden said, "There is no
population immunity to this strain. And there is no specific way to
say exactly what it would take to become better adapted" so that it
would spread from person to person. The CDC is not issuing any travel
advisories, but Frieden repeated the agency's long-standing advice
that tourists should avoid birds in live markets.

In its e-mailed health advisory to clinicians today [5 Apr 2013], the
CDC said they should consider the possibility of a novel H7N9
infection in persons with an appropriate travel or exposure history.
Although most of the cases have been severe and involved adults, the
virus may cause mild illness and can infect children, the agency said
[China reported a case in a 4-year-old -- see ProMED post Avian
influenza, human (26): China H7N9 case list & map, Archive Number:
20130404.1623110, near the end of the list].

Suspected infections in the USA should be reported to the CDC within
24 hours of 1st detection, and state health departments should notify
the CDC promptly of all patients under investigation for possible
infection, the advisory said. It also advised that all unsubtypeable
influenza A virus specimens should be turned over to the CDC for
further testing, since the agency is doing all confirmatory testing at
this point.

[Byline: Robert Roos]

- --
Communicated by:
ProMED-mail Rapporteur Mary Marshall

******
[2] Neuraminidase sensitivity
Date: Sun 7 Apr 2013
Source: China.org.cn [edited
<http://www.china.org.cn/china/2013-04/07/content_28461055.htm>


A new type of flu drug to treat the deadly H7N9 bird flu virus was
approved by the Chinese authorities on Saturday [6 Apr 2013].
According to the China Food and Drug Administration, preliminary tests
have proved that injections of peramivir diluted in sodium chloride
injection may be effective in treating H7N9 bird flu virus. Peramivir
is a neuraminidase inhibitor.

As of Saturday [6 Apr 2013], China has confirmed 18 H7N9 cases -- 8 in
Shanghai, 6 in Jiangsu, 3 in Zhejiang, and one in Anhui, in the 1st
known human infections of the lesser-known strain. Out of all of
these, 4 in Shanghai and 2 in Zhejiang have died.

- --
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[Subsequently 2 additional cases of elderly patients have been
reported in Shanghai and Anhui, bringing the overall total to 20.

Previously it has been reported that the H7N9 avian influenza virus is
likewise sensitive to the other neuraminidase inhibitors zanamivir
(Relenza; Glaxo Wellcome) and oseltamivir (Tamiflu; Gilead Sciences
and F Hoffmann-La Roche) currently used to treat epidemic influenza in
the human population. - Mod.CP]

****************************

Date: Fri 5 Apr 2013
Source: UN Food and Agriculture Organization (FAO) [edited]
<http://www.fao.org/news/story/en/item/173655/icode/>


Strong biosecurity measures required in response to influenza A(H7N9)
virus
- ----------------------------------------------------------------------
FAO supports China and neighbouring countries in disease detection and
animal health management.

Responding to the occurrence of the A(H7N9) influenza virus in China
requires strong biosecurity measures, FAO said today [5 Apr 2013].
Unlike other influenza strains, including highly pathogenic avian
influenza H5N1, this new virus is hard to detect in poultry because
the novel virus causes little to no signs of disease in animals.

"Unlike H5N1, where chickens were dying off on a large scale, with
this virus we don't have a red flag that immediately signals an
infection. This means farmers may not be aware that virus is
circulating in their flock. Biosecurity and hygiene measures will help
people protect themselves from virus circulating in seemingly healthy
birds or other animals," said Juan Lubroth, FAO Chief Veterinary
Officer.

FAO commends China's quick notification of human cases and subsequent
release of detailed information to the public on the nature of the
virus and other precautionary measures. With this information, FAO and
the international scientific community have been analyzing the virus
sequence in hopes of better understanding its behavior and its
potential impact on humans and animals.

"With the virus harder to detect, good biosecurity measures become
even more essential to reducing the risk of virus transmission to
humans and animals. Good biosecurity and hygiene measures implemented
by farmers, livestock producers, transporters, market workers, and
consumers represent the 1st and most effective way to protect the food
chain," Lubroth said.

While this new virus is being evaluated, FAO continues to recommend
the following standard precautions:

- - Keep all birds and livestock separate from people's living areas.
Close contact with infected animals can put people at risk. Since
A(H7N9) causes little to no signs of disease in birds, separate living
areas for animals and people are key.

- - Keep wild birds away from poultry and other animals; keep different
types of bird and species of animal apart. Screens, fencing, or nets
can be used to separate species and help prevent transmission.

- - Report sick or dead animals to the local veterinary (or public
health) authorities. If this is not possible, tell your neighbours or
community leaders. It is important that all signs of illness or sudden
and unexplained deaths in poultry, farmed birds, wild birds, or other
animals are reported to the authorities so that they can deal with
them safely and help stop the virus spreading.

- - Wash your hands often to kill and remove the virus. You should
always do so after handling birds or other animals, cooking or
preparing animal products, and before eating.

- - Eat well-cooked meat products.

- - Do not eat sick or dead animals and do not give or sell them to
others. Such animals should also not be fed to other animals.

- - Seek immediate advice from your doctor if you show signs of fever
after being in contact with poultry, farmed birds, wild birds, or
other animals.

- - If the human threat is confirmed as animal in origin, culling would
be appropriate as long as it is performed in a humane way with
appropriate compensation made.

FAO is monitoring the situation closely through its wide network of
country and regional offices and key partners, including the World
Health Organization (WHO) and the World Organisation for Animal Health
(OIE).

The FAO and OIE reference centre, the Harbin Veterinary Research
Institute of the Chinese Academy of Agricultural Sciences, is leading
laboratory analysis in response to the situation. The scientific
community and FAO are currently working to optimize diagnostic
approaches in order to better detect this new strain of influenza
virus.

- --
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[Sound advice. This H7N9 strain with a low virulence in birds is hard
to detect but is clearly already widespread in [eastern] China. So
owners and veterinary authorities need to have a high level of
suspicion when checking flocks and market birds. - Mod.MHJ]

**********************

Date: Sun 7 Apr 2013
Source: Xinhua News Agency [edited]
<http://news.xinhuanet.com/english/health/2013-04/07/c_132290381.htm>


Local authorities said Sunday [7 Apr 2013], 2 more people in Shanghai
have been confirmed to be infected with the deadly H7N9 bird flu
[avian A/(H7N9) influenza virus]. One is a Shanghai resident and the
other is from neighboring Anhui Province.

The 2 male patients, 67 and 59 years old, respectively, developed flu
symptoms in late March [2013] and were diagnosed with pneumonia over
the last week, the city's health and family planning commission said
in a statement. An initial investigation showed that 6 people who have
had close contact with the 2 have not exhibited flu symptoms.

Shanghai had 10 confirmed H7N9 cases as of Sunday evening [7 Apr
2013], with 4 resulting in death. The other 6 patients have been
quarantined and are undergoing treatment.

The local Authorities have placed 194 people who had close contact
with the 10 infected people under medical observation. 2 have
exhibited symptoms, although bird flu has been ruled out as the cause
of their illness.

To prevent the further spread of the virus, the authorities have
ordered the slaughter of 98 000 poultry and incinerated them,
according to the municipal agriculture commission.

[Byline: Yang Yi]

- --
Communicated by:
ProMED-mail Rapporteur Kunihiko Iizuka

[These 2 cases, one in Shanghai and one in Anhui province, appear not
to have been reported previously and raise the total of confirmed
avian A/(H7N9) influenza virus cases in China to 20. The death total
remains at 8, and no cases have been reported outside Mainland China.
- - Mod.CP

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/2Tbe>.]

****************************

Date: Sat 6 Apr 2013
Source: CTV News, Associated Press (AP) report [edited]
<http://www.ctvnews.ca/world/number-of-cases-of-bird-flu-in-china-rises-to-18-1.1226868


Shanghai has reported 2 more cases of human infection of a new strain
of bird flu [avian influenza virus infection], raising the number of
cases in eastern China to 18. 6 of the people who contracted the virus
have died.

Health officials believe people are contracting the H7N9 [avian
influenza] virus through direct contact with infected fowl and say
there's no evidence the virus is spreading easily between people.

Shanghai's government said Saturday [6 Apr 2013] the latest victims
are a 74-year-old peasant and a 66-year-old retiree. The city has been
ordered by the agriculture ministry to halt its live poultry trade and
slaughter all fowl in markets where the virus has been found.

- --
Communicated by:
Ryan McGinnis

[ProMED-mail thanks its rapporteurs Kunihiko Iizuka and Mary Marshall
for also contributing this report. - Mod.JW]

******
[2]
Date: Sat 6 Apr 2013
Source: QQ News [in Chinese, trans. Mod.YMA, edited]
<http://news.qq.com/a/20130406/000731.htm>


At 18:30 [Shanghai time] today [6 Apr 2013], the city confirmed 2 new
cases of H7N9 avian influenza infection and the patients are still
under active treatment. Close contacts of these 2 patients do not show
any abnormal symptoms yet. Up to now, Shanghai has confirmed a total
of 8 human cases of H7N9 avian influenza infection, of which 4 have
died and 4 are under treatment.

The Shanghai Health Development Planning Commission announced today
[6 Apr 2013] at 19:00, that Shanghai confirmed 2 new human cases of
H7N9 avian influenza infection, a 74-year-old farmer from Shanghai and
a 66-year-old retired man from Shanghai.

Editor's note: as of 6 Apr 2013, a total of 18 human cases including 6
deaths from H7N9 avian influenza infection have been identified in the
whole country. There were 8 cases including 4 deaths from Shanghai,
one case from Anhui, 6 cases from Jiangsu, and 3 cases including 2
deaths from Zhejiang.

***************************

Date: Fri 5 Apr 2013
Source: WHO Global Alert and Response (GAR), Disease Outbreak News
[edited]
<http://www.who.int/csr/don/2013_04_05/en/index.html>


Human infection with influenza A(H7N9) virus in China - update
- --------------------------------------------------------------
As of 5 April 2013 (14:00 CET), the Chinese health authorities
notified WHO of an additional 5 laboratory-confirmed cases, including
one death due to human infection with influenza A(H7N9) virus. Of the
latest laboratory-confirmed cases, three are from Shanghai and 2 from
Jiangsu.

Among the Shanghai cases, a 52-year-old woman with illness onset on 27
Mar 2013 has died, a 67-year-old man with illness onset on 22 Mar 2013
is in critical condition, and a 4-year-old boy with illness onset on
31 Mar 2013 has mild illness.

The 2 patients from Jiangsu are both in critical condition. They
include a 61-year-old woman with illness onset on 20 Mar 2013 and a
79-year-old man with illness onset on 21 Mar 2013.

To date, a total of 16 patients have been laboratory confirmed with
influenza A(H7N9) virus in China; of these, 6 people have died.

More than 520 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.

- --
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[As of 5 Apr 2013 WHO now recognises 16 patients with laboratory
confirmed influenza A(H7N9) virus infection in China; of these, 6
people have died. Several patients are in critical condition and the
number of fatalities may increase. 520 close contacts of the confirmed
cases are being closely monitored, but so far none have contracted
H7N9 avian influenza virus infection. Virus isolates tested so far are
susceptible to the neuraminidase inhibitors oseltamivir and
zanamivir.

No cases have been detected outside of China so far and no travel
restrictions are recommended at present. - Mod.CP]

[I miscounted off the computer the number of confirmed cases listed by
Commonground in (26) in the human thread (see below), there were only
14 including 5 deaths when the list was made. I should have taken the
time to print the list out and check. That will be corrected in the
website archives. Abject apologies. - Mod.JW]

------------------------------

Date: Sat, 6 Apr 2013 12:11:53 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Avian influenza, human (26): China H7N9 case list & map, correction

AVIAN INFLUENZA, HUMAN (26): CHINA H7N9 CASE LIST AND MAP, CORRECTION
*********************************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Sat 6 Apr 2013
From: Jack Woodall <promed@promedmail.org>


I miscounted off the computer the number of confirmed cases listed by
Commonground in my comment in ProMED-mail posting (26) in the human
thread (see below). There were only 14, including 5 deaths, when the
list was made. I should have taken the time to print the list out and
check. That will be corrected in the website archives. Abject
apologies.

- --
Jack Woodall
Co-founder & Associate Editor, ProMED-mail
<woodall@promedmail.org>

Date: Sat 6 Apr 2013
Source: Zhejiang Online [in Chinese, trans. Mod.YMA, edited]
<http://hangzhou.zjol.com.cn/hangzhou/system/2013/04/06/019259247.shtml>


On 3 Apr 2013, the Zhejiang Provincial Health Department released
information about the 2 previous confirmed [human] cases of H7N9 avian
influenza infection in Hangzhou City. The epidemiological
investigation on the 2nd confirmed case showed that before onset of
illness, the patient had bought and eaten quails from the live poultry
stalls in Binsheng agricultural firm in Shangcheng District, thereby
confirming that these are risk factors for the infection.

In order to ensure public health safety, the authorities in the city
have rapidly organized teams in the early morning today [6 Apr 2013]
and culled the live poultry stored in the Binsheng agricultural firm.
Trading of live poultry [presumably birds in other stalls. - Mod.MHJ]
in the firm was also suspended.

- --
Communicated by:
PRO/MBDS
<promed-mbds@promedmail.org>

[I suspect that until an effective avian vaccine can be developed any
control attempts are of minimal impact, especially when retroactive as
in this instance and in a poultry industry with no biosecurity or
proactive disease management. - Mod.MHJ

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/6ddq>.]
------------------------------

Date: Sat, 6 Apr 2013 16:35:31 -0400 (EDT)
From: ProMED-mail <promed@promed.isid.harvard.edu>
Subject: PRO/AH/EDR> Avian influenza, human (30): China (Hong Kong, Taiwan) H7N9, NOT

AVIAN INFLUENZA, HUMAN (30): CHINA (HONG KONG, TAIWAN) H7N9, NOT
****************************************************************

In this posting:
[1] Hong Kong
[2] Taiwan

******
[1] Hong Kong
Date: Sat 6 Apr 2013
Source: South China Morning Post [summ., edited]
<http://www.scmp.com/news/hong-kong/article/1207791/first-suspected-case-human-h7h9-hong-kong>


The Hospital Authority said that a 7-year-old girl who travelled to
Shanghai at the end of last month [March 2013] had developed a fever
and flu symptoms. She was in quarantine in Queen Elizabeth Hospital's
paediatric department. But officials revealed the tests for the H7N9
strain were negative shortly before midnight.

The news emerged as it was announced the virus had claimed its 6th
victim, a 64-year-old farmer from Huzhou, Zhejiang province. He was
confirmed to have the virus on Thursday [4 Apr 2013] and died that
night.

Health officials in Jiangsu said on Friday [5 Apr 2013] that 2 new
cases had been confirmed in the provincial capital Nanjing. One was a
61-year-old woman, said to be in a critical condition, and the other a
79-year-old man in a serious condition. The cases take the total
number of people confirmed to have been infected in the Yangtze River
Delta region to 16.

In Shanghai, markets trading in live poultry will be closed
temporarily and sales of live birds suspended elsewhere, said
municipal government spokesman Xu Wei. More than 20 000 birds were
culled on Friday [5 Apr 2013] at the Huhuai Farm Products Market in
the city where the H7N9 virus was detected in a pigeon sample on
Thursday [4 Apr 2013]. Shao Linchu, deputy director of Shanghai's
Agricultural Commission, said: "The government will pay compensation
to the vendors of at least 50 per cent of the market price of the
poultry slaughtered."

The WHO said yesterday [5 Apr 2013] there was no sign of a sustained
spread of the H7N9 virus.

[Byline: Zhuang Pinghui, Daniel Ren, Amy Nip]

*******************************

[2] Taiwan
Date: Sat 6 Apr 2013
Source: The China Post, Taiwan [summ., edited]
<http://www.chinapost.com.tw/taiwan/national/national-news/2013/04/06/375315/Six-suspected.htm>


6 suspect cases of [avian influenza virus infection] were reported in
Taiwan and tested for the H7N9 strain, the Centers for Disease Control
(CDC) announced yesterday [5 Apr 2013], adding that 4 of the cases
[strains] were not H7N9 and 2 are still to be [identified].

CDC Deputy Director-General Chou Chih-hau said on Thursday [4 Apr
2013] that 6 people reported fever symptoms after arriving in Taiwan
from China recently. 2 of them were infected with the H1N1 influenza,
2 people had bacterial infections, while diagnoses for 2 people was
yet be confirmed.

Chou said the 2 people awaiting results -- a Taiwanese and a Chinese
- -- had been to Shanghai and Jiangsu province respectively. Both areas
are considered H7N9-infected areas.

According to the CDC, 20 passengers from China, Hong Kong, and Macau
were found to have fever symptoms upon arrival at Taiwan's airports on
Thursday [4 Apr 2013]. These passengers, however, were not coming from
infected areas, such as Shanghai, Anhui, Jiangsu, or Zhejiang. Those
20 people therefore do not need to be quarantined, the CDC said,
adding that health officials have told the 20 passengers to keep
monitoring their own health conditions.

- --
Communicated by:
ProMED-mail
<promed@promedmiail.org>

[So far all human cases of avian influenza A/(H7N9) virus infection
have been confined to Mainland China, and within China there has been
no confirmation of human-to-human transmission of infection. Mod.CP

A HealthMap/ProMED-mail map can be accessed at:
<http://healthmap.org/r/1s3->, <http://healthmap.org/r/1ob5>.]