China: Man Dies; Infected Father "Improving"; More Suspects

[Laidback Al]

Re: China: Man Dies; Infected Father "Improving"; More Suspects

Link for close friend

http://www.recombinomics.com/News/03210603/H5N1_Azerbaijan_Cluster_Confirmed.html

A 17-year-old girl died on 23 February. Her first cousin, a 20-year-old woman, died on 3 March. The 16-year-old brother of this woman died on 10 March. A 17-year-old girl, a close friend of the family, died on 8 March. All four of these cases lived together or near each other. The source of their infection is presently under investigation.

All four of these individuals were confirmed by WHO. Additionally there were two other teenage girls from the same community who were infected and confirmed by WHO. Both survived, but the relationship between these two survivors and the other victims is unclear, one of these other girls was apparently another cousin of the 20 year old female.

[HenryN]

Re: China: Man Dies; Infected Father "Improving"; More Suspects

AVIAN INFLUENZA, HUMAN (159): CHINA (JIANGSU), WHO
***********************************************
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: Sun 9 Dec 2007
Source: World Health Organisation (WHO), CSR, Disease Outbreak News [edited]
<http://www.who.int/csr/don/2007_12_09/en/index.html>


China: Avian influenza situation - WHO Update 5
-------------------------------------------------------------
The Ministry of Health in China has reported a new case of human
infection with the H5N1 avian influenza virus in Jiangsu Province.
The case was confirmed by the national laboratory on Thu 6 Dec 2007.

The 52-year-old male is the father of the 24-year-old man who died
from H5N1 infection on Sun 2 Dec 2007. He is one of the close
contacts placed under medical observation by national authorities. He
developed symptoms on Mon 3 Dec 2007 and was sent immediately to
hospital for treatment.

Of the 27 cases confirmed to date in China, 17 have been fatal.

--
Communicated by:
ProMED-mail Rapporteur Marianne Hopp

[This is the official confirmation by WHO of the 2 most recent cases
of H5N1 avian influenza virus infection in China.

A ProMED correspondent has drawn attention to a discrepancy between the
WHO statement and a local press account (see: Avian influenza, human
(155): China (Jiangsu) 20071207.3945) wherein it appears likely that
the father was not hospitalized until 5 Dec 2006, 2 days after he
developed pneumonia rather than "immediately" as stated in
the WHO report. The text of the local press account stated that,
"After their son's sudden death, his father and mother were
devastated. On the 6th day after eating chicken, when the father
developed fever he did not have the heart to seek treatment. Only
after others begged him did he go to the Nanjing Municipal Infectious
Disease Hospital where the diagnosis of avian influenza was made." - Mod.CP]

[HenryN]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

AVIAN INFLUENZA, HUMAN (159): CHINA (JIANGSU), WHO


[This is the official confirmation by WHO of the 2 most recent cases
of H5N1 avian influenza virus infection in China.

A ProMED correspondent has drawn attention to a discrepancy between the
WHO statement and a local press account (see: Avian influenza, human
(155): China (Jiangsu) 20071207.3945) wherein it appears likely that
the father was not hospitalized until 5 Dec 2006, 2 days after he
developed pneumonia rather than "immediately" as stated in
the WHO report. The text of the local press account stated that,
"After their son's sudden death, his father and mother were
devastated. On the 6th day after eating chicken, when the father
developed fever he did not have the heart to seek treatment. Only
after others begged him did he go to the Nanjing Municipal Infectious
Disease Hospital where the diagnosis of avian influenza was made." - Mod.CP]

This Promed thread is starting to look like a tag team pro-wrestling match. Now CP uses a reader's comment to once again bring up the partially cooked white meat on the mystery chicken that caused symptoms in 1 day in the index case and 11 days in the father.

H2H is linked to disease onset dates. The date of hospitalization has little to do with anything other than a reason to post again about the mystery chicken.

[cartski]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

H2H is linked to disease onset dates.

What are the minimum and maximum durations involved when determining H2H (in other words, the duration analogous to a confidence interval)?

Is there not a gradation, categorization or nomenclature of the types of H2H that would help us distinguish a common source, an exposure to a large amount of viral shedding, and a casual contact with airborn droplets or fomites?

J.

[Anne]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

I have a question: why the donor of the serum must be of the same blood group as the Chinese patient (B) (according to a Chinese article) ?
the serum does not contain blood cells nor factors of coagulation.

[cartski]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Link for close friend

http://www.recombinomics.com/News/03210603/H5N1_Azerbaijan_Cluster_Confirmed.html

A 17-year-old girl died on 23 February. Her first cousin, a 20-year-old woman, died on 3 March. The 16-year-old brother of this woman died on 10 March. A 17-year-old girl, a close friend of the family, died on 8 March. All four of these cases lived together or near each other. The source of their infection is presently under investigation.

And so has the S227N involvement since been confirmed?


"The proximity of the Azerbaijan cases to the Dogubeyazit cluster in eastern Turkey raises the possibility that S227N may be involved. Donor sequences were identified in H9N2 isolates that are endemic to the region, so new recombinants could be generated. However, the S227N change only reduces affinity for avian receptors, so S227N detected in the index case in Turkey could have also been transmitted to the index case in Azerbaijan via infected birds."

J.

[HenryN]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

And so has the S227N involvement since been confirmed?


"The proximity of the Azerbaijan cases to the Dogubeyazit cluster in eastern Turkey raises the possibility that S227N may be involved. Donor sequences were identified in H9N2 isolates that are endemic to the region, so new recombinants could be generated. However, the S227N change only reduces affinity for avian receptors, so S227N detected in the index case in Turkey could have also been transmitted to the index case in Azerbaijan via infected birds."

J.

Only in multiple cases in Turkey and Egypt.

[HenryN]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

And so has the S227N involvement since been confirmed?


"The proximity of the Azerbaijan cases to the Dogubeyazit cluster in eastern Turkey raises the possibility that S227N may be involved. Donor sequences were identified in H9N2 isolates that are endemic to the region, so new recombinants could be generated. However, the S227N change only reduces affinity for avian receptors, so S227N detected in the index case in Turkey could have also been transmitted to the index case in Azerbaijan via infected birds."

J.

http://www.recombinomics.com/News/02090703/Egypt_S227N_2007.html

[Treyfish]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Jiangsu human avian flu cases trigger panic local people dare not eating chickens and ducks (AP)

请看博讯热点： 禽流感

Here博讯hot: The avian flu

( <SMALL>博讯北京时间2007年12月09日转载</SMALL> )

<SMALL>(博讯- December 9, 2007 reproduced)</SMALL> <!--bodystart-->
Yesterday, the Morning Post reporters from Jiangsu Provincial Health Department was informed, Jiangsu on the 7th confirmed the second case of human bird flu patients, the full treatment, the current condition improved signs.


Three experts to the rescue



According to the Jiangsu Provincial Health Department circular, the second confirmed cases of human bird flu patients, Jiangsu Province, Nanjing people陆某52-year-old, is December 2 diagnosed Jiangsu first human cases of avian influenza with the father.

December 2, Jiangsu Province, the Ministry of Health confirmed a case of human infection with the highly pathogenic avian flu cases,陆某24-year-old son on November 24 fever, chills and other symptoms, November 27 "lower left pneumonia," admitted the treatment, but the condition deteriorated rapidly, to treat as null and void, in the December 2 deaths.
<TABLE cellPadding=0 align=right><TBODY><TR><TD style="PADDING-RIGHT: 0px; BORDER-TOP: 0px; PADDING-LEFT: 0px; FONT-SIZE: 10pt; PADDING-BOTTOM: 0px; LINE-HEIGHT: 10pt; PADDING-TOP: 0px; FONT-FAMILY: 宋体" align=middle> </TD></TR></TBODY></TABLE>

Yesterday, a staff member at Nanjing poultry markets to spray disinfectant on the ducks.

新华／路透图

Xinhua / Reuters Fig.

People in Jiangsu Province prevention and control of avian flu expert group to an expert,陆某reality is the son of close contacts. During the in-home medical observation fever symptoms, responsible for overseeing the implementation of his home medical observation disease prevention and control professionals through dedicated ambulances will be immediately transferred to the designated hospitals implement his treatment.
After national, provincial and municipal related to the three-tier senior clinical specialist of the expert group of experts to treat patients from the beginning of the incidence of disease progress rapidly, the current has been improving signs.


Local people did not dare eat poultry


After the epidemic occurred, Jiangsu province, city, district Grade 3 disease prevention and control institutions, according to the World Health Organization and the Ministry of Health has been in close contact on the definition and criteria, look to the above two cases in close contact with all the patients, and in accordance with people contingency plans for bird flu prevention and control provisions, they implemented a strict medical observation measures, such as relative isolation, regular daily temperature measurements, such as preventive medication.
At present, other close contacts were not unusual circumstances.

After the epidemic occurred, a number of local people dare not eat on the market chickens, ducks and other poultry and its products, Jiangsu Province, prevention and control of human avian influenza expert group of experts said that according to information provided by the agriculture and forestry sector, the province's poultry against bird flu Control measures are in place work, the bird flu vaccine this year poultry vaccination rate reached 100 percent, "So far, not found around the Jiangsu bird flu in poultry."


Anti-human avian flu can be controlled governance



Jiangsu prevention and control of avian flu expert group of experts who recently said that anti-human avian flu can be controlled governance.



Condition: we should pay attention to fever headache


Experts, human suffering from bird flu after incubation period is generally in the seven days within, and the early symptoms are very similar to other influenza, mainly fever, runny nose, nasal obstruction, cough, throat-ache, headache, general malaise, and some patients may have dioxin heart, abdominal pain, diarrhea, would dilute water samples such as gastrointestinal symptoms, some patients with visible eye conjunctivitis, body temperature are continuing at 39 ? C and above.

Experts suggest that the patients more than once symptoms should promptly seek medical treatment, and if it is suspected to be infected with avian flu virus, they should immediately report the epidemic and patient isolation to prevent the spread of infection and illness worsened.

As for the human cases of bird flu mortality rate, depending on a variety of factors, including the discovery of time, the patient's age, physique, and whether there is a basis for disease, and other factors.

性。

Experts say people from the avian flu epidemic poultry, poultry strengthen bird flu prevention and control work, to eliminate at the source of human avian influenza occurred possibilities. For human avian flu epidemic, as long as it can be early detection, early reporting, early isolation and early treatment, but also to the prevention and control.

Experts say public to be more self-controlled prevention awareness, change bad habits, attention to the family and personal hygiene, pay attention to indoor ventilation, strengthen physical exercise, fatigue, and enhance the body resistance; no contact with ill or dead birds.

In restaurants, we must pay attention to hygiene will be cooked in the kitchen knives and knife plate separately, when the food must be stored separately from raw and cooked, do not eat food or半熟food hygiene when fever, chills and other abnormal symptoms should promptly seek medical treatment.

_

http://64.233.179.104/translate_c?hl...12091204.shtml

[Giuseppe]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Research Article Abstract
------
Evidence for a Heritable Predisposition to Death Due to Influenza
Frederick S. Albright,1
Patricia Orlando,1
Andrew T. Pavia,2
George G. Jackson,3 and
Lisa A. Cannon Albright4

1Department of Pharmacotherapy, University of Utah College of Pharmacy, and Departments of 2Pediatrics, 3Internal Medicine, and 4Biomedical Informatics, University of Utah School of Medicine, Salt Lake City

Received 27 March 2007; accepted 17 May 2007; electronically published 11 December 2007.

Potential conflicts of interest: none reported.

Presented in part: Second Annual Rocky Mountain Regional Bioinformatics Conference, Aspen, Colorado, December 2004.

Financial support: Partial support for all data sets within the Utah Population Data Base was provided by the University of Utah Huntsman Cancer Institute (Salt Lake City).

(See the editorial commentary by Mubareka and Palese, on pages XXX?XX.)

Reprints or correspondence: Dr. Lisa A. Cannon Albright, Genetic Epidemiology, 391 Chipeta Way, Ste. D, Salt Lake City, UT 84108 (lisa.albright@utah.edu).
Animal model studies and human epidemiological studies have shown that some infectious diseases develop primarily in individuals with an inherited predisposition. A heritable contribution to the development of severe influenza virus infection (i.e., that which results in death) has not previously been hypothesized or tested. Evidence for a heritable contribution to death due to influenza was examined using a resource consisting of a genealogy of the Utah population linked to death certificates in Utah over a period of 100 years. The relative risks of death due to influenza were estimated for the relatives of 4855 individuals who died of influenza. Both close and distant relatives of individuals who died of influenza were shown to have a significantly increased risk of dying of influenza, consistent with a combination of shared exposure and genetic effects. These data provide strong support for a heritable contribution to predisposition to death due to influenza.

-

http://www.journals.uchicago.edu/doi/full/10.1086/524064?cookieSet=1

-----

[Giuseppe]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Research Article Abstract - EDITORIAL to precedent
-------
EDITORIAL COMMENTARY
Human Genes and Influenza
Samira Mubareka1 and
Peter Palese1,2

1Department of Microbiology and 2Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Received 5 July 2007; accepted 5 July 2007; electronically published 11 December 2007.

Potential conflicts of interest: none reported.

Financial support: W. M. Keck Foundation (to P.P.); National Institutes of Health (grant P01 AI158113 to P.P.); Northeast Biodefense Center (grant U54 AI057158 to P.P.); Center for Investigating Viral Immunity and Antagonism (grants U19 AI62623 and U01 CI 000354 [R21 to P.P.]); Ruth L. Kirschstein Physician Scientist Research Training in Pathogenesis of Viral Diseases Award (to S.M.); Sunnybrook Health Sciences Centre, University of Toronto, Canada (salary support to S.M.).

(See the article by Albright et al., on pages XXX–XX.)

Reprints or correspondence: Dr. Samira Mubareka, Dept. of Microbiology, Mount Sinai School of Medicine, 1 Gustave Levy Pl., Box 1124, New York, NY 10029 (samira.mubareka@mssm.edu).
-

http://www.journals.uchicago.edu/doi/full/10.1086/524067

-
[EXCERPT - 1st Paragraph]
Why some individuals resist infection or recover quickly, whereas others experience severe disease associated with infection, is a fundamental question that medicine has struggled to answer. Pathogens and host immune factors have been extensively investigated for many infectious diseases, to address these questions. However, limited information is available concerning the influence of host genetics on the response to viral infections. Genetic determinants have the potential to play a role at numerous points during the course of viral infection, including viral attachment and entry, replication, disease progression and development of severity, and, finally, transmission. In this issue of the Journal, Albright et al. [1] propose that the severity of influenza illness may have a heritable component. To investigate this hypothesis, the authors used as a resource the Utah Population Data Base, which contains data from founding families and their descendants, comprised primarily of members of the Church of Jesus Christ of Latter‐Day Saints (i.e., Mormons), thus representing a relatively ethnically homogeneous population.

(....)
-------

[HenryN]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Research Article Abstract - EDITORIAL to precedent
-------
EDITORIAL COMMENTARY
Human Genes and Influenza
Samira Mubareka1 and
Peter Palese1,2

1Department of Microbiology and 2Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Received 5 July 2007; accepted 5 July 2007; electronically published 11 December 2007.

Potential conflicts of interest: none reported.

Financial support: W. M. Keck Foundation (to P.P.); National Institutes of Health (grant P01 AI158113 to P.P.); Northeast Biodefense Center (grant U54 AI057158 to P.P.); Center for Investigating Viral Immunity and Antagonism (grants U19 AI62623 and U01 CI 000354 [R21 to P.P.]); Ruth L. Kirschstein Physician Scientist Research Training in Pathogenesis of Viral Diseases Award (to S.M.); Sunnybrook Health Sciences Centre, University of Toronto, Canada (salary support to S.M.).

(See the article by Albright et al., on pages XXX–XX.)

Reprints or correspondence: Dr. Samira Mubareka, Dept. of Microbiology, Mount Sinai School of Medicine, 1 Gustave Levy Pl., Box 1124, New York, NY 10029 (samira.mubareka@mssm.edu).
-

http://www.journals.uchicago.edu/doi/full/10.1086/524067

-
[EXCERPT - 1st Paragraph]
Why some individuals resist infection or recover quickly, whereas others experience severe disease associated with infection, is a fundamental question that medicine has struggled to answer. Pathogens and host immune factors have been extensively investigated for many infectious diseases, to address these questions. However, limited information is available concerning the influence of host genetics on the response to viral infections. Genetic determinants have the potential to play a role at numerous points during the course of viral infection, including viral attachment and entry, replication, disease progression and development of severity, and, finally, transmission. In this issue of the Journal, Albright et al. [1] propose that the severity of influenza illness may have a heritable component. To investigate this hypothesis, the authors used as a resource the Utah Population Data Base, which contains data from founding families and their descendants, comprised primarily of members of the Church of Jesus Christ of Latter‐Day Saints (i.e., Mormons), thus representing a relatively ethnically homogeneous population.

(....)
-------

The number of H5N1 cases is small and the original hypothesis was based on no examples of clusters involving individuals who were not blood relatives. The basis for the original hypothesis was false (and was largely based on the Karo cluster and a MATERNAL linkage).

[Theresa42]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Here is a SusanC translation (hat-tip, Sue!) of this article from Takungpao...

http://www.takungpao.com/news/07/12/12/MW-835799.htm

Nanjing Military region: prevention of avian flu to be treated as seriously as SARS outbreak
Dec 12, 2007

Nanjing military authorities have asked all units to set up avian flu prevention teams, to be led by senior officers. They are asked to report daily on the health condition of personnel in the unit, especially when they have unusual symptoms such as fever. These have to be reported immediately. According to sources, the military is treating the avian flu prevention "as seriously as SARS" when it was happening.

In addition, all units are ordered to slaughter all poultry being kept by the families, and to remind officers and soldiers not to go to the neighborhood of the Confucius temple. There have been no reports of unusual symptoms in the military in Nanjing.

Patient gradually improving

According to sources, the second confirmed H5N1 patient in Jiangsu Lu Wei is now stable, and gradually improving. He is eating and sleeping normally, and is now able to read newspapers for a period of time every day, to get information from outside, and to overcome the monotony of being in hospital.

Experts have been holding daily meetings to analyze his condition and make adjustments to treatment; these meetings have now been changed to once every two days. He is still on antivirals and nutritional support, but dosages have been reduced. He is still under 24 hour observation by experienced doctors and nurses, who are not taking any chances. They are monitoring his temperature, pulse, respiration, and blood pressure.

Province needs comprehensive poultry industry regulations

In addition, the provincial government today placed large advertisements in higher-circulation newspapers in Nanjing, with information on how to prevent avian flu. The ads explicitly tell citizens not to buy life poultry to be slaughtered at home.

According to these articles, experts say that control of HPAI H5N1 involve different elements of the production, processing, marketing, transport, and storage of poultry. Inside the city itself, the major focus is on the operation of life poultry markets. In order to protect consumers, the agency for prevention of animal epidemics in Jiangsu issued a special notice recently, asking all regions to increase life poultry market surveillance, and banning the purchase of life poultry from farm markets to be slaughtered at home.

The province is asking all regions to establish comprehensive measures for regulating poultry and poultry product industries, including requirements for certification (probably of vaccination or testing), disinfection and safe disposal. All live poultry transactions in wholesale markets have to be registered per vehicle. Live poultry sold in retail markets must be slaughtered in the market. Consumers are banned from bringing live poultry home.

At the same time, all regions are told they must enforce disinfection of business premises, equipment, garbage and excreta in a rigorous manner. Any businesses not adhering to strict animal disease prevention regulations, or sell unvaccinated or infected live poultry and poultry products will be severely punished.

People told not to eat chicken if there

Provincial authorities also say the next step is to strengthen the surveillance, inspection, and regulation of live poultry and poultry product industries, and logistics, and to establish thorough live poultry inspection, certification, and fixed slaughtering locations.

The government is reminding people that it is safe to eat chicken if they only buy from licensed farm markets or supermarkets, and buy only chicken that have passed the certification process. They emphasized to the public not to eat any chicken if the origin is uncertain, if the meat is not fully cooked, especially if there is there is blood on the meat. Eggs have to be fully cooked.

People who were infected with SARS had a death rate of 10-20%, whereas those infected with avian flu has over 60% mortality. However, many doctors were infected by the SARS virus, but worldwide, up to now there has been no report of doctors being infected by avian flu. A history of contact with sick poultry is present in 60% of H5N1 patients.

http://www.newfluwiki2.com/showComment.do?commentId=76347

[Theresa42]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Here's another SusanC translation (hat-tip, Sue!) of another article from Takungpao...

http://www.takungpao.com/news/07/12/10/ZM-834826.htm

(Nanjing, 9th December) The patient Lu Wei's residence is under heavy guard. This building (address given but I can't be bothered to translate that!) is the location of the Nanjing military region communication and maintenance office. Both the offices and residences/barracks are located in the same compound. According to (unspecified) sources, this building/courtyard/compound has been sealed off for more than a week. There is no number at the front of the building, or any other identifying signs. The big metal gates that were open before are now closed. Only a small side gate is open for people to enter or exit. This door is guarded by two armed soldiers.

(As far as the reporter understands) all the residents of the building where LuWei lived are under quarantine and observation, with daily temperature taking, and various tests done.

The doctors and nurses who resuscitated Lu Wei's son at the Jiangsu People's hospital are all under medical observation and quarantine.

More than 60 healthcare workers at the Nanjiang neurology hospital who had contact with the deceased's mother are also under quarantine and observation.

http://www.newfluwiki2.com/showComment.do?commentId=76389

[Gert van der Hoek]

Re: China: Man Dies; Infected Father &quot;Improving&quot;; More Suspects

Chinese military-controlled region bans poultry purchases in wake of bird flu case


2007-12-13

BEIJING (AP) - A military command in eastern China has banned poultry purchases in the wake of a human bird flu case in the area, an official said Thursday.

The move by the Nanjing Military Region comes about a week after a 52-year-old man was confirmed to have been infected with the H5N1 virus days after his son died of the disease in Nanjing.

&#171;We have already had a meeting for all staff including those who have retired to notify us of the human bird flu case,&#187; said a man who answered the telephone at the region's administrative bureau. &#171;We were also told not to purchase poultry products.

He refused to give his name or any other details, a standard practice among officials when dealing with sensitive issues, especially in the secretive military.

The Ta Kung Pao, a Hong Kong newspaper backed by China's communist authorities, said this week the father was a retired regiment commander of the Nanjing Military Region, a critical division that covers the provinces of Jiangsu, Zhejiang, Anhui, Fujian, and Jiangxi.

It also faces Taiwan, China's rival, and is the front-line launching point for an assault on the island.

The newspaper said the man, surnamed Lu, and his family are believed to have eaten a dish called &#171;Beggar's Chicken,&#187; which is traditionally made by wrapping the bird in lotus leaves and baking it.

Earlier this week, Chinese health officials said they were investigating the case of the 24-year-old son, the country's 17th fatality from bird flu.

He died Dec. 2 and his father started showing symptoms a day later and was confirmed to have the disease, health officials have said.

Investigators have said human-to-human transmission was possible, although both men could also have been infected by the same source or been infected separately from different sources. None of the possibilities have been ruled out, both Chinese and World Health Organization officials have said.

Hans Troedsson, the WHO's representative in China, said Monday the father was recovering after being treated with the antiviral medicine Tamiflu at the onset of symptoms.

Eighty-two other people who had contact with the father and son were being monitored for symptoms. China's Health Ministry on Thursday refused to answer questions over the telephone.

The Animal Husbandry and Veterinary Bureau in Jiangsu province, where Nanjing is located, said last week no bird flu epidemic had been discovered in the province.

Out of the 27 human cases reported in China so far, only one had been forewarned by a poultry outbreak in the vicinity, WHO has said, an indication the country needs to improve its surveillance systems.

Scientists have warned if outbreaks among poultry are not controlled, the virus may mutate into a form more easily passed between people, potentially resulting in millions of deaths.

http://www.pr-inside.com/chinese-military-controlled-region-bans-r346449.htm