Wednesday, April 24, 2013

H7N9 bird flu is in Taiwan

Yesterday Taiwan has reported the first case of the deadly H7N9 outside of mainland China. A 53-year-old man who has recently returned from eastern Chinese city of Suzhou to Taiwan showed symptoms had been hospitalized on April 16. He is in a critical condition.

Here is a part from the press release by Taiwan's Central Epidemic Command Center (CECC):
In the late afternoon of April 24, 2013, the Central Epidemic Command Center (CECC) confirmed the first imported case of H7N9 avian influenza in a 53-year-old male Taiwanese citizen who worked in Suzhou, Jiangsu Province, China prior to illness onset.  He developed his illness three days after returning to Taiwan.  Infection with avian influenza A (H7N9) was confirmed on April 24, 2013.  The patient is currently in a severe condition and being treated in a negative-pressure isolation room. 
Minister of Health, Dr. Wen-Ta Chiu, and Commander of CECC, Dr. Feng-Yee Chang, have full knowledge of the situation and have instructed implementation of subsequent prevention and control measures.  In addition, CECC has reported the case to the World Health Organization through the IHR Focal Point.  Furthermore, according to the Cross-strait Cooperation Agreement on Medicine and Public Health Affairs, CECC has also reported the case to the contact point in China.
CECC indicated that the case is a hepatitis B carrier with history of hypertension.  Due to the fact that he worked in Suzhou, Jiangsu Province before his illness, he had been traveling back and forth regularly between Suzhou and Taiwan for a long time.  During March 28 and April 9, 2013, the patient traveled to Suzhou.  On April 9, he returned to Taiwan from Shanghai.  According to the case, he had not been exposed to birds and poultry during his stay in Suzhou and had not consumed undercooked poultry or eggs.  On April 12, he developed fever, sweating, and fatigue, but no respiratory or gastrointestinal symptoms.  On April 16, he sought medical attention at a clinic when he developed high fever and was transferred to a hospital by the physician. He was then hospitalized in a single-patient room for further treatment. On April 16, he was administered Tamiflu.  On April 18, his chest x-ray showed interstitial infiltrate in the right lower lung.  On the night of April 19, his conditions worsened.  On April 20, he was transferred to a medical center for further treatment. He was then intubated due to respiratory failure and placed in the negative-pressure isolation room in the intensive care unit. During his stay in the hospitals, two throat swab specimens were collected and both tested negative for avian influenza A (H7N9) virus by real-time RT-PCR.  On April 22, the medical center collected a sputum specimen from the patient and the specimen was tested positive for influenza A.  In the morning of April 24, avian influenza A (H7N9) virus was detected in the sputum specimen using real-time RT-PCR.  In the later afternoon of April 24, the National Influenza Center in Taiwan confirmed the identification and completed the genome sequencing of the virus. 

As of today there are 108 confirmed cases of H7N9 in China and 22 people, mostly elderly, died from the virus. The infection path of the virus us still mystery. Many patients hospitalized due to the virus had no direct contact with poultry. Last week a boy was found to be infected with the virus and showed no symptoms. This suggests that many people may be already infected without knowing it. Taiwanese patient also said that he had not been in contact with poultry or eaten under-cooked birds or eggs while staying in Suzhou.

Meanwhile, an international team of experts investigating the cases in China has said that "H7N9 is an unusually dangerous virus for humans":

From what is known so far, H7N9 "is more easily transmissible from poultry to humans than H5N1," the avian influenza virus that has circulated in poultry in Asia for more than a decade, occasionally causing human fatalities. The team also reported that the available evidence points to live bird markets as being the most likely pathway for the virus from poultry to humans. Positive samples have been retrieved from poultry and from contaminated surfaces at the markets. Nancy Cox, a flu expert at the Centers for Disease Control and Prevention in Atlanta, cautioned that while it is still early, "we can now understand that the likely source of infection is poultry—that the virus originates from poultry."

The virus kills 20 per cent of known infections.

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