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.

H7N9 Bird flu virus

Update : Authorities in Shanghai said Thursday night that another person has died from H7N9 bird flu, bringing the death toll from the new deadly strain to five around the country. China has confirmed 14 H7N9 cases -- 6 in Shanghai, 4 in Jiangsu, 3 in Zhejiang and 1 in Anhui, in the first known human infections of the lesser-known strain. Of all, 4 died in Shanghai and one died in Zhejiang.

H7N9 bird flu virus, a deadly strain of bird flu which was previously unknown in humans but killed 3 people up to now: 2 in Shanghai and 1 in Jiangsu. The influenza virus have been reported to infect at least nine people. Two deaths have already been reported in Shanghai, while a third person is in a critical condition in nearby Anhui province:

A third person has died from H7N9 bird flu in China as the total number of confirmed cases rose to nine and concerns were raised that the virus might have mutated to infect other animals and humans more readily. 

The latest victim was a 38-year-old cook who fell ill early in March while working in the province of Jiangsu, where five of the other cases were found, authorities said. He died in hospital in on 27 March and a positive test for H7N9 flu came back on Wednesday.
Source : Third death from H7N9 bird flu 

The four new cases were reported on Tuesday in Jiangsu province, which borders Anhui to the east and lies north of Shanghai. The Jiangsu health bureau said three women, aged 45, 48 and 32, and a man (83) had been infected. Worryingly, the four cases were in four different cities, and all patients were in “critical condition” and “under emergency treatment”, Xinhua reported.
Source : Fears as more H7N9 cases in China

Among the four patients in Jiangsu only one, a woman of 45, had worked in the market slaughtering poultry, according to Xinhua News Agency. Jiangsu is a province next to Shanghai:

All four fell ill in mid-March and were hospitalized towards the end of the month. The four had reported varying symptoms of dizziness, fever, cough and breathlessness, Xinhua said.
Source : New strain of bird flu infects four others in China: Xinhua

Although Chinese government seems to believe that the virus is not highly contagious, China has a very bad record when it comes to dealing with bad news, which is often covered up by officials fearing it may attract unwanted attention from superiors and damage promotion prospects, despite government efforts to enhance transparency. In 2003, Beijing initially tried to cover up the epidemic of Severe Acute Respiratory Syndrome, which emerged in China and killed about a tenth of the 8,000 people it infected worldwide:

Some Chinese have complained that authorities took too long before announcing the deaths on Sunday, though the WHO says the government acted properly. Wu Fan, chief doctor and director general of the Shanghai Municipal Center for Disease Control, told reporters on Tuesday that the government had acted as quickly as it possibly could. "In this situation, to take 20 days to identify and confirm a new virus is already considered short," she said.
Source : New strain of bird flu infects four others in China: Xinhua

These worrying news came just after The World Health Organisation (WHO) played down fears over H7N9 but said it was crucial to find out how the virus infected humans:

"It's the first time that H7N9 was found in humans," the UN health agency's spokeswoman Fadela Chaib told reporters, referring to the deadly strain of avian influenza. "It is of concern to WHO and we will be following this with the health authorities in China to know more. But for the time being, it's only three cases and it has shown, for the time being, no human-to-human transmission," she added.
Source : WHO plays down China bird flu fears

Unlike H5N1 strain, which set off warnings when it began ravaging poultry across Asia in 2003, H7N9 virus appeared to be capable of infecting some birds without causing any noticeable symptoms. No single animal is found infected with the virus yet and how these 9 people are infected is a mystery.

If the latest virus continues to spread in China and beyond "it would be an even bigger problem than with H5N1, in some sense, because with H5N1 you can see evidence of poultry dying" said University of Hong Kong microbiologist Malik Peiris, who also examined the genetic information.
Source : Third death from H7N9 bird flu 

Avian influenza, known informally as avian flu or bird flu,  is an illness caused by strains of influenza viruses that have adapted to avian hosts. The highly pathogenic influenza A virus subtype H5N1 is already an emerging avian influenza virus that has been causing global concern as a potential pandemic threat (H5N1 is often referred to simply as "bird flu" or "avian influenza", even though it is only one subtype of avian influenza-causing virus). In January 2004 a major new outbreak of H5N1 surfaced in Vietnam and Thailand's poultry industry, and within weeks spread to ten countries and regions in Asia, including Indonesia, South Korea, Japan and China. In October 2004 researchers discovered H5N1 is far more dangerous than previously believed because waterfowl, especially ducks, were directly spreading the highly pathogenic strain of H5N1 to chickens, crows, pigeons, and other birds and that it was increasing its ability to infect mammals as well. From this point on, avian influenza experts increasingly refer to containment as a strategy that can delay but not prevent a future avian flu pandemic.

In 1918 an unusually deadly influenza pandemic infected 500 million people across the world (not sparing even remote Pacific islands and the Arctic). 50 to 100 million people (3 to 5 percent of the world's population at the time) died making it one of the deadliest natural disasters in human history.