Friday, January 20, 2017

HK CHP: Another 84 H7N9 Cases Reported By Mainland China


The number of new H7N9 infections in Mainland China continues to rise, with an unusual (for China) mid-month announcement that between Jan 1st - Jan 15th another 84 cases were reported to the NFHPC.  Some of these cases had onset in December. 

According to the HK CHP's numbers, that brings this winter's tally (since November) to 227 cases, although that number already appears to be out of date (Hunan Province has reported at least 5 cases since the 15th). 

This is - by far - the fastest, and most intense early start to China's yearly H7N9 epidemic, which began in 2013.  This from Hong Kong's CHP, after which I'll return with more.

    The Centre for Health Protection (CHP) of the Department of Health today (January 20) received notification from the National Health and Family Planning Commission that 84 additional human cases of avian influenza A(H7N9), including seven deaths, were recorded from January 1 to 15. The CHP strongly urged the public to maintain strict personal, food and environmental hygiene both locally and during travel, in particular during the upcoming Lunar New Year holidays.
     The 60 male and 24 female patients aged from 3 to 79 had their onset from December 13, 2016 to January 13, 2017. The cases were from Jiangsu (34 cases), Zhejiang (23 cases), Anhui (14 cases), Fujian (five cases) and four cases each in Hunan and Jiangsu. Among them, 28 reported exposure to poultry or poultry markets while the source of infection of 52 cases was still under investigation.
     "Since November 2016, the Mainland health authorities have already recorded 227 human H7N9 cases thus far. We would also like to remind the public that human H7N9 cases continue to occur in neighbouring Guangdong and the positive percentage for H7 virus of environmental samples is substantial. We again urge the public to pay special attention to health risks of the places of visit," a spokesman for the CHP said.
     "While local surveillance, prevention and control measures are in place, we will remain vigilant and work closely with the World Health Organization and relevant health authorities to monitor the latest developments," the spokesman said.
     As the H7N9 virus continues to be detected in animals and environments in the Mainland, additional human cases are expected in affected and possibly neighbouring areas. In view of the heavy trade and travel between the Mainland and Hong Kong, further sporadic imported human cases in Hong Kong every now and then are expected, especially in the coming few months.
     "Therefore, we strongly urge the public to avoid touching birds, poultry or their droppings and visiting poultry markets or farms during travel, particularly in the upcoming Lunar New Year holidays. If feeling unwell, such as having a fever or cough, wear a mask and seek medical advice at once. Travellers returning from affected areas should consult doctors promptly if symptoms develop, and actively inform the doctors of their travel history for prompt diagnosis and treatment," the spokesman added.
     The CHP's Port Health Office conducts health surveillance measures at all boundary control points. Thermal imaging systems are in place for body temperature checks on inbound travellers. Suspected cases will be immediately referred to public hospitals for follow-up.
     The display of posters and broadcasting of health messages in departure and arrival halls as health education for travellers is under way. The travel industry and other stakeholders are regularly updated on the latest information.
     The public should maintain strict personal, hand, food and environmental hygiene and take heed of the advice below while handling poultry:
  • Avoid touching poultry, birds, animals or their droppings;
  • When buying live chickens, do not touch them and their droppings. Do not blow at their bottoms. Wash eggs with detergent if soiled with faecal matter and cook and consume them immediately. Always wash hands thoroughly with soap and water after handling chickens and eggs;
  • Eggs should be cooked well until the white and yolk become firm. Do not eat raw eggs or dip cooked food into any sauce with raw eggs. Poultry should be cooked thoroughly. If there is pinkish juice running from the cooked poultry or the middle part of its bone is still red, the poultry should be cooked again until fully done;
  • Wash hands frequently, especially before touching the mouth, nose or eyes, before handling food or eating, and after going to the toilet, touching public installations or equipment such as escalator handrails, elevator control panels or door knobs, or when hands are dirtied by respiratory secretions after coughing or sneezing; and
  • Wear a mask if fever or respiratory symptoms develop, when going to a hospital or clinic, or while taking care of patients with fever or respiratory symptoms.

       The public may visit the CHP's pages for more information: the avian influenza page, the weekly Avian Influenza Report, global statistics and affected areas of avian influenza, the Facebook Page and the YouTube Channel.
Ends/Friday, January 20, 2017

Issued at HKT 18:11

In addition to Hunan, as of last night reporting 13 cases when today's announcement by Hong Kong only brings their total to 7,  there is no mention of  January cases from Guangdong province in this update, which is only second to Zhejiang Province in the total number of cases reported. 
Given China's reluctance over the past two years to release H7N9 numbers in anything resembling `real time', today's announcement - just 11 days after announcing 83 mainland cases in December - is a pretty good indication that the size and scope of this year's epidemic continues to rise.
With the Chinese New Year just over a week away, and millions of people already traveling to visit their families across Asia - often in overcrowded buses and trains - public health officials around the world are on heightened alert for the possibility of seeing imported cases (see H7N9: Korean CDC Warns Travellers To China During Seollal).

Stay tuned.

Thursday, January 19, 2017

H5N8 Outbreaks Continue To Mount In France - 152 Farms Affected


Yesterday morning, in a report called France Expands Preventative Culling As HPAI Outbreaks Continue To Rise,  the MOA indicated 136 farms affected across 8 Departments.  Since then, the MOA has posted two new updates, increasing the number of outbreaks to 152 since early December. 

Avian Influenza: France in the home monitoring

19/01/2017 avian influenza
© Pascal Xicluna / Min.Agri.Fr

In France
Situation on January 19, 2017: 152 H5N8 outbreaks in farms and 8 cases in wildlife confirmed and communicated.

List of homes in the departments
  • Landes: 46 homes
  • Tarn: 8 homes
  • Gers: 72 homes
  • Lot-et-Garonne: 7 homes
  • Hautes-Pyrénées: 11 homes
  • Pyrénées-Atlantiques: 3 homes
  • Aveyron: 2 homes
  • Deux-Sèvres: 3 homes

List of outbreaks in wildlife

  • Pas-de-Calais: 1 home
  • Haute-Savoie: 2 homes
  • Tarn: 2 homes
  • Channel: 1 home
  • Ain : 1 foyer
  • Lot et Garonne 1 home
  • Landes: 1 home


the data updated 01/08/2017

Since the last point location January 2, 84 new outbreaks of HPAI were reported in Europe, which also includes Switzerland, mainly in Bulgaria (25 breeding households), and France (20 breeding households).

The virus has now been detected:
- Slovenia (Maribor swan 1)
- and the Czech Republic (Moravia, 3 wild cases and aged in household).

The total number of outbreaks of HPAI and reported cases continues to increase and is now 809 (against 724 last week) including 368 in wild birds (58 species affected), 428 livestock and 13 in of captive birds.

Catching Up With FluTracker's H7N9 Case List

Credit CDC


After last week's flurry of H7N9 reports (see HK CHP: China Reports An Additional 83 H7N9 Cases For December), official reports have once again slowed, but we continue to get reports suggesting the virus is still very much active in Eastern China.

The problem is, given the lack of details provided on these cases, matching up against earlier reports (equally devoid of detail), becomes a major challenge.

Trying to make sense of all of this  is Sharon Sanders of FluTrackers, whose H7N9 case list provides the best conservative listing of cases (with links to reports) publicly available. 

Since we last looked in on Monday, Sharon and the newshounds of FT have added 17 new cases.

FluTrackers 2013-16 Human Case List of Provincial/Ministry of Health/Government Confirmed Influenza A(H7N9) Cases with Links

#948 - Patient, 79, Kaili City, Quiadongnan, Guizhou province CHP rpt 16/1/17

#949 - Female, 36, [Zhang], hospitalized in critical condition, contact with poultry, Hengyang City, Hunan province

#950-957 - This line adds 8 cases and 1 death. Hong Kong CHP confirmed 11 cases & 2 deaths on Jan 17. We have 3 cases & 1 death listed above. Guangdong province CHP rpt 17/1/17 Death

#958-962 - This line adds 5 cases and 3 deaths. On January 16 Hunan province CDC announced case #949 and referred to a total of 8 cases/3 deaths for 2017. We have 3 of those cases listed above. 3 Death

#963-964 - The line adds 2 cases and 1 death. On January 18 Hunan province HFPC announced 10 total cases and 4 deaths so far for 2017.We have 8 of those cases and 3 deaths noted in lines above. Death

Given China's practice of belatedly announcing many of their cases in EOM epidemiology reports (released on or about the 10th of the following month), it is likely this only represents a portion of the cases detected over the past week or so.

HK CHP Epidemiological Assessment Of H7N9

Credit CHP CDW  Vol 14 Issue 1


With China's 5th H7N9 winter epidemic off to an unusually early and vigorous start, and already 4 imported cases detected in Hong Kong, their Centre for Health Protection is on heightened alert and is actively warning residents to take precautions over the New Year's Spring Travel Holiday (see CHP alerts public to high avian influenza A(H7N9) activity in Guangdong).
As discussed in Beneath The H7N9 Pyramid, getting reasonably good surveillance numbers out of any disease outbreak is always a challenge, but China's penchant for releasing case information in large batches - often weeks after the fact (see HK CHP: China Reports An Additional 83 H7N9 Cases For December) - makes real-time assessments of their epidemic very difficult. 

That said, we have no indication of sustained of efficient human-to-human spread, and most cases still appear to be linked to exposure to (asymptomatically) infected poultry.  The caveat being (see MMWR: Assessing The 4th Epidemic Wave Of H7N9 In China), influenza viruses are constantly changing, and what has been true up until now may not hold true forever.

Today Hong Kong's CHP has published an epidemiological update on the H7N9 virus in their Communicable Diseases Watch journal, which is published every two weeks.  While very `current', the article warns `Some of the cases occurring in January 2017 have not been reported yet and hence not included.'

Some excerpts from the report follow,  but you'll want to hit the link to read it in its entirety.

 Update on situation of avian influenza A(H7N9)
Reported by Dr Albert AU, Senior Medical and Health Officer, and Dr Francis WONG, Medical and Health Officer, Respiratory Disease Office, Surveillance and Epidemiology Branch, CHP.

The activity of avian influenza A(H7N9) viruses has been increasing markedly since the end of 2016, indicating the start of a new wave of human infection this winter. There has been large increase in reports of human infections with avian influenza A(H7N9) in various parts of Mainland China recently.We reviewed the latest situation of H7N9 in this article.

Epidemiological situation Human infections

The first two human H7N9 cases in the current wave reported by the National Health and Family Planning Commission (NHFPC) occurred in October 2016. The number of cases has been increasing markedly since November. The NHFPC has reported that six and 106 cases were detected in Mainland China in November and December 2016 respectively. This wave has been progressing much faster than that in the previous winter. In the fourth wave which occurred between late 2015 and mid-2016, only six cases were reported in the first three months since the first report in September 2015, as compared with 114 cases in the first three months in this wave. 

Since October 2016, 143 human H7N9 cases have been reported by health authorities in 11 provinces/municipalities in the Mainland* (Figure 1), including 57 cases in Jiangsu (江蘇), 26 cases in Guangdong (廣東), 22 cases in Zhejiang(浙江), 14 cases in Anhui (安徽), 7 cases in Jiangxi (江西), 4 cases each inHunan (湖南) and Shanghai (上海), 3 cases each in Fujian (福建) and Guizhou(貴州), 2 cases in Shandong (山東), and one case in Hubei (湖北). Thereported cases in Guangdong occurred in various areas including Dongguan (東莞), Foshan (佛山), Guangzhou (廣州), Jiangmen (江門), Jieyang (揭陽),Meizhou (梅州), Qingyuan (清遠), Shenzhen (深圳), Zhaoqing (肇慶) andZhongshan (中山). Among these 143 cases, their ages ranging from 23 to 91(median=54). The male-to-female ratio was about 2:1. Most cases presented with severe conditions.

According to the information from the NHFPC, among the 114 cases detected from October to December 2016, at least 85 (75%) were known to have exposure to poultry or poultry markets before onset of symptoms while the sources of infection of most of the remaining cases were reported to be under investigation.


Since the emergence of human H7N9 infections in Mainland China in March 2013, at least 947 human H7N9 cases have cumulatively been reported globally. In the previous four waves, the majority of cases occurred between December and April (Figure 2). Apart from an asymptomatic case with exposure to infected poultry in Macau, all the remaining cases occurred in Mainland China with 28 cases exported to other areas outside Mainland China.The case fatality rate was about 40%. 

In Mainland China, the provinces with the greatest number of reported cases included Zhejiang (25%), Guangdong (23%) and Jiangsu (17%). In Hong Kong, since the detection of the first imported case in December 2013, 20 human H7N9 cases (including seven deaths) have been confirmed so far.Among them, 19 were imported from Guangdong and one was imported from Jiangsu.

Public health risk assessment

According to the World Health Organization, most human cases were exposed to avian influenza viruses through contact with infected poultry or contaminated environments, including live poultry markets. Since the viruses continue to be detected in animals and environments, further human cases are expected to occur from time to time. Locally, since the H7N9 virus continues to be detected in poultry and environments in Mainland China especially Guangdong, further human cases are expected in affected and possibly neighbouring areas. In the past few years, most human H7N9 cases in the Hong Kong were detected in the first quarter of a year and were imported from Guangdong. In view of the heavy trade and travel between Mainland China and Hong Kong, further sporadic human cases and affected poultry imported to Hong Kong every now and then are expected, especially in the coming few months.

Even though small clusters of human H7N9 infections have been reported previously including those involving healthcare workers, current epidemiological and virological evidence suggests that H7N9 viruses have not acquired the ability of sustained transmission among humans, thus the likelihood of human-to-human transmission of avian influenza viruses is low.With oseltamivir prophylaxis and medical surveillance of the close contacts of any confirmed cases, the risk of secondary spread from cases imported into Hong Kong is considered to be low at the present moment provided that the avian influenza viruses still have not acquired the ability of efficient human-to-human transmission

(Continue . . .)

Wednesday, January 18, 2017

Chile: MOA Reports 2nd LPAI H7 Outbreak Near Valparaiso


Two weeks ago (see Chile Culling Turkeys Over H7 Avian Flu) we saw a large outbreak over LPAI H7 which required the culling of roughly 34,000 birds.  Low path H5 & H7 viruses are taken very seriously because they have the potential to mutate into HPAI strains, and so they are reportable to the OIE, and require immediate action to stamp out.

Today, Chile's SAG (Agriculture and Livestock Service) has announced a second turkey farm - which they describe as `directly related' to the first outbreak- has tested positive for the virus, and another 35,000 turkeys will  have to be destroyed. 

SAG diagnosed second turkey farm affected by avian influenza
January 18, 2017

Santiago, January 18, 2017.- The Agriculture and Livestock Service confirmed the diagnosis of avian influenza in a turkey farm second fattening Sopraval located in the El Melon district of Nogales, in the region of Valparaiso .

Although there has been no mortality in birds and only respiratory signs have been observed from January 16, they began to take steps to isolate the site and remove any presence of virus. According to research SAG, this new event is directly related to the focus identified two weeks ago in Quilpué, so that the above measures have simply been extended to the new zone.

The SAG took samples immediately after observed respiratory signs, which were analyzed in the official laboratory of the Service, confirmed Tuesday 17, the presence of avian influenza H7. According to history, it would be a low pathogenic virus, which is confirmed by the fact that there have been no bird deaths.

Along with the above, all protocols exist to prevent the spread of the virus biosafety were triggered, and the immediate slaughter of about 35,000 turkeys of the sector, the sanitary landfill in the same place and the implementation of actions determined disinfection.

Parallel additional monitoring plan started to every bird of the area to detect any leakage of the virus outside the farm. It should be noted that following the case detected in the commune of Quilpué, SAG has performed the sampling of all poultry farms and backyards of the affected area (over 8,000 samples to date), the results were all negative for the virus.

The effort to eliminate the focus quickly is because it is an exotic disease of importance to the health and production of domestic and wild birds. From the point of view of the health of the population, this event no risk, since the consumption of their meat and byproducts transmission is of no danger to people. Otherwise, all poultry farms in the country are monitored, the disease having negative results, confirming that domestic production is commercially maintains the highest standards of health worldwide.

Somewhat remarkably, with as much HPAI that has been reported around the world over the past 12 years, the OIE has no reports of highly pathogenic avian flu in South America (see OIE Map from Jan 2005-Present  below). 


OIE Notification: H5N8 Poultry Outbreak In Greece


In late December Greece reported finding H5N8 in a dead mute swan recovered in the northeastern part of the country, very near the Turkish border.   Today, Greece has notified the OIE of their first outbreak in poultry, on a farm with 28,000 caged laying hens in the south of the country, very near the capital of the  Peloponnese region, Tripoli.