Discussion ? Why is China is not reporting details of recent H7N9 deaths? (Part 1)

Laidback Al · May 7, 2013

Why is China is not reporting details of recent H7N9 deaths?

Through April 27, provincial/municipality department of health offices in China were reporting the details of A(H7N9) case-patients who died. The last official reported death was on April 27 when the People's Republic of China National Health and Family Planning Commission announced a death of an individual from Jiangxi province (link) who died in a Hunan hospital.

Since then the National Health and Family Planning Commission has reported an additional 6 deaths for A(H7N9) patients from three provinces without providing any details about the individuals who died (see table and links below).

Why is China withholding the information on the A(H7N9) infected individuals that have died recently?

H7N9 Unreported deaths by province 201230506.webp

Links to PRC Ministry of Health Reports
April 24, 2013
http://www.moh.gov.cn/mohwsyjbgs/s3578/201304/1872ab5a8e06429ea71e61f1b084d2ec.shtml
May 1, 2013
http://www.moh.gov.cn/mohwsyjbgs/s3578/201305/0f0c5a697d10406ea99a6ef78b99f947.shtml
May 6, 2013
http://www.moh.gov.cn/mohwsyjbgs/s3578/201305/d0f566bb5db5426d89911c70dd3c455a.shtml
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Corn · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

The speed of providing the seed viruses, sequences and WHO invitation to access the situation was practically overnight in the very early stages of the outbreak.

Their openness from the beginning of the outbreak was a surprise to all and then the powers to be reverted back to same as usual for China. Very unusual world wide responses and for China with just a hand full of initial cases.

Vaccine production worldwide is now under full tilt.

This has been jumped all over.

I speculate that their beginning openness what due to a lab escape or accident.

They went Oh $h!t and figured we need to alert the world cuz they are going to find out anyway just like SARS.

It's well know they are being condemned internationally right now by the scientific community for humanizing many viral strains.

Also that might explain why they cannot find the precise vector cuz it's people from a lab escape?

Also a virus with 4 different geens H9, H11, and a couple of others I cannot recall right now. What's the odds of that?

Can't say it hasn't happened before somewhere in the world....

I figured that when China went to weekly reporting and they were going to be on the up and up. With everything gaining control there would be at least 20 more or so cases. While gaining control there would be a little up tick before falling hopefully. That would be an honest report. Going up some but not like it could have and we are battling the virus. Then maybe a gradual decrease in cases.

But when they reported only two cases? I knew something is amiss.

I have read a post out of China somewhere by medical staff that they were told to mislabel cases and the usual obfuscation. In fact it was a medical personal who first broke the story on twitter in the beginning if I recall. (Mad because they had no gear, mask, gloves to treat the inital infected?)

Either way we will know the truth in time. Bodies don't lie.

IMO IMO IMO

On a side note Al. Could you check the spread patterns on th CoNv in Saudi Arabia by looking at the map? One is almost a perfect circle around the city and the other city is a pattern a straight line also almost evenly spaced. Never seen outbreak patterns like that before. Almost like perfectly placed. Biological attack? Naw. All is well in the Middle East. Same with Saudi though... tight lipped.

Giuseppe · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

I am risking to repeat himself when saying that since the first cases happened in a huge megacity AND global travel & trade hub, Chinese had not choice to share both cases and viral isolated BEFORE cases would be identified abroad through imported infections.

They knew well the risk of international dispersion of the new pathogen because of the nature of pathogen and the interconnected global area firstly affected.

There is not mean to stop the virus if it will become fully transmissible between humans and the very high population density of affected area makes any censhorship attempt not suitable: BEFORE censorship attempts, cases would likely land elsewhere in the world.

H7N9 is a reassortant and it is obvious that is made by a gene constellation from different strains, like H3N2v in the US or H1pdm09 in Mexico, and all other XX century pandemic strains.

In addition this strain seems to grow very well in chicken eggs, paving the way for a quick selection of seed reassortant for vaccine use.

gsgs · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

in retrospect it looks, that they might well have succeeded to keep it secret

no viruses abroad, dies now, the cases of severe pneumonia could have been
blamed to seasonal flu

gsgs · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

to me the virus doesn't look unnatural, lab-created
the H7N9+H9N2 reassortment looks plausible,normal although
surprising that it spreads. Nature proved it's viable.

mixin · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

How do you think a lab reassorted virus would look?

We wouldn't expect to see a bunch of strange mutations as we see in the sequencing errors, etc., would we?

gsgs · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

I'd expect a lab-escape to be
similar to those viruses that are usually used in labs
i.e. not one that has 50 differences to the best known matches
in HA and NA. And not one, that fits with poultry H9N2 in the
6 inner segments in the numbers of acquired mutations
over the years

mixin · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

...
The researchers found dramatic mutation of haemagglutinin in one of the four flu strains released for study by the central government. Nine of the protein's 560 amino acids had changed. In a typical flu virus, only one or two amino acids could change in such a short period of time, He said.

"It happened in just one or two weeks. The speed may not have caught up with the HIV, but it's quite unusual for a flu."
...

http://www.scmp.com/news/china/arti...mutate-8-times-faster-regular-flu-study-finds

Why do you think this has the ability to mutate so fast?

They say 9 amino acids changed; what are they using as a concensus to compare these to?

gsgs · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

they compared S1 with A1+S2

I think they are not happy now with what they had written there

There is no unusual mutation speed now in the other viruses
the reason for those 9 mutations in S1 is still unclear

Laidback Al · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Corn said:
. . .
On a side note Al. Could you check the spread patterns on the CoNv in Saudi Arabia by looking at the map? One is almost a perfect circle around the city and the other city is a pattern a straight line also almost evenly spaced. Never seen outbreak patterns like that before. Almost like perfectly placed. Biological attack? Naw. All is well in the Middle East. Same with Saudi though... tight lipped.

There is only limited geolocational information about NCoV cases in Saudi Arabia. I have posted a map at this link based on available information. The distribution is what you would expect from a natural outbreak. There is nothing to suggest that the spread of NCoV is a result of a biological attack.

AnnaLisa · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

It seems to me, that there should still be more cases of H7N9 if they were diagnosing and reporting them. It 'died out' too fast for me to think that is believable. Statements from CDC and WHO and other governmental agencies seemed fairly dire regarding H7N9. Now it is suddenly gone? Poof!

On nCoV, I suspect many more cases gone undiagnosed all over the Middle East. Reporting on nCoV has had a similar pattern to the reporting on H7N9. Slow uptick in cases, never enough for major alarm, then suddenly nothing, and now it's showing an uptick. How many people die of unspecified pneumonia in those regions without any one batting an eyelash?

I smell a rat, in both cases.

JimO · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

We shouldn't be surprised at anything the Chinese do with an outbreak like this. Past behavior suggests to me that Chinese leaders are far more concerned about the nation's honor, reputation, and prosperity than they are about individual Chinese citizens. We have to remind ourselves that the Chinese government has a very different world view than most of us and they probably regard disease outbreaks within their borders as nobody's business. I'm convinced they only released information, as someone stated above, because they feared the consequences of it being discovered only after showing up in another country.

I wouldn't be at all surprised to find out that the release of information was carefully choreographed to show the pattern we are seeing - gradual rise in cases, discovery of viruses in poultry (but limited so as not to destroy the poultry industry), control measures put in place, and a sharp drop in cases and fatalities.

The one glitch was having bloggers report what they saw. A swift deployment of the freedom police and the bloggers were silenced - likely sent away to rot in a prison camp.

I hope this goes no further, but I fully expect to see it showing up elsewhere - perhaps Australia or South America - now that the flu season is in full swing in the Southern Hemisphere. Then we might get some real data to work with.

Giuseppe · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

H7N9 is not going to disappear anytime soon, I suspect, although with flu viruses all chances are possible.

Pandemic flu dynamics may not follow seasonal flu winter outbreaks, and if the virus will become transmissible imported cases will start regional outbreaks around the main international travel hub in the world, irrespectively of their geographic location.

It is also not known the reciprocal interference between seasonal flu H1pdm09 and H3N2 and this new strain.

In addition, further reassortment events in dually infected humans or swine with H7N9 and H1pdm09 cannot be discounted at this joint.

Other pathogens interference may act as game-changer or may delay the spread (or accelerating it). It was suggested that RSV slowed H1pdm09 in children during the first French wave. I will search this for reference...

Giuseppe · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Found!

[Source: Eurosurveillance, full text: (LINK). Edited.]

Eurosurveillance, Volume 14, Issue 44, 05 November 2009

Letters

Rhinoviruses, A(H1N1)v, RSV: The race for hivernal pandemics, France 2009-2010

J S Casalegno 1,2, M Bouscambert-Duchamp1,2, F Morfin1,2, B Lina1,2, V Escuret1,2

Hospices Civils de Lyon, National Influenza Centre, Laboratory of Virology, Lyon, France
Universit? de Lyon, Department of Virology , Lyon, France

_________

Citation style for this article: Casalegno JS, Bouscambert-Duchamp M, Morfin F, Lina B, Escuret V. Rhinoviruses, A(H1N1)v, RSV: The race for hivernal pandemics, France 2009-2010. Euro Surveill. 2009;14(44)ii=19390. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19390
Date of submission: 23 October 2009
_________

To the editor: The A(H1N1)v circulation in France, like in other European countries (Sweden), is still reported as sporadic. The incidence of A(H1N1)v infections monitored in the community by the French National Influenza Centre has remained stable for 6 weeks from week 37 to week 42 (159 cases per 100,000 inhabitants). This is right above the epidemic cut-off of 114 cases per 100,000 inhabitants two months after the start of the new school year. This delay in the A(H1N1)v outbreak expansion is puzzling. At the same time, we report a high rhinovirus activity (34.5 % of samples positive for rhinovirus) in the community and in the hospital (unpublished data).

It has been postulated by A. Linde et al. [1] that the viral interaction between the A(H1N1)v and the rhinoviruses may explain partly this delay. This is an interesting hypothesis, indeed it is well known [2,3] that during winter, rhinovirus, respiratory syncytial virus (RSV) and influenza viruses epidemic peaks happen one after the other and occasionally overlap. The seasonal epidemiology of influenza is surely dependent on weather conditions such as low relative humidity and cold temperature [4]. These features were observed in our laboratory last winter.

Indeed, during the 2008-2009 winter, our laboratory analysed samples from the paediatric hospital of Lyon. The laboratory diagnosis was based on cellular culture for RSV and influenza viruses detection and on specific RT-PCR technique for the influenza and the rhinoviruses detection. Between week 31 of 2008 and week 9 of 2009, 6516 respiratory samples (nasal swabs or nasopharyngeal aspirates) were analysed (culture and PCR) in our laboratory. The number of confirmed rhinoviruses, RSV and Influenza A viruses is reported week by week in the Figure.
_________

Figure. Number of laboratory confirmed cases of rhinovirus, RSV and influenza A during autumn and winter 2008-2009, Lyon.

________

This year, rhinovirus detection started on week 37, peaked on week 40 and decreased on week 43. At that moment, we can report the first detection of RSV and an increasing activity of A(H1N1)v. Regarding what was observed during last winter on the circulation of rhinovirus, RSV and A(H3N2) virus , it will be of much interest to follow the impact of the A(H1N1)v pandemic on the coming RSV peak. In other words, which respiratory virus between RSV or A(H1N1)v, will win the race for second place ?
________

References

Linde A, Rotz?n-?stlund M, Zweygberg-Wirgart B, Rubinova S, Brytting M. Does viral inteference affect spread of influenza? Eurosurveill. 2009;14(40): pii: 19354. Available from: www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19354
?nestad G. Interference between outbreaks of respiratory syncytial virus and influenza virus infection. Lancet. 1982;1(8270):502.
Lina B, Valette M, Foray S, Luciani J, Stagnara J, See DM, et al. Surveillance of community-acquired viral infections due to respiratory viruses in Rhone-Alpes (France) during winter 1994 to 1995. J Clin Microbiol. 1996;34(12):3007-11.
Lowen A C, Mubareka S, Steel J, Palese P. Influenza virus transmission in dependent on relative humidity and temperature. PLoS Pathogen. 2007; 3(10):1470-6.

-
-------

gsgs · May 7, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

OK, this is off-topic, but

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440351/
In Reunion Island, 2009
Non-Influenza Respiratory Viruses (NIRVs) were more likely to infect pH1N1 negative
individuals than pH1N1 positive peers (relative risk: 3.13, 95% CI: 1.80-5.46, P<0.001).
Viral shedding was significantly shorter (P = 0.035) in patients who were co-infected
by pH1N1 and NIRV or by two different NIRVs compared to those who were infected
with only one virus, whatever this virus was (pH1N1 or NIRVs).

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

I don't see any interaction in the seasonal curves for RSV and influenza
as we see it with H1N1,H3N2 or even flu-A and flu-B

AlaskaDenise · May 8, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

AnnaLisa said:
It seems to me, that there should still be more cases of H7N9 if they were diagnosing and reporting them. It 'died out' too fast for me to think that is believable. Statements from CDC and WHO and other governmental agencies seemed fairly dire regarding H7N9. Now it is suddenly gone? Poof! .........

Don't forget that human H5N1 was essentially supressed after 1997 (by killing all poultry in HK) until 2003 (except for a smattering of cases in 1998 and 2001). So it is possible to have a true "slowdown". Even avoiding sick people can slow the spread - so the speed may be reduced, but I doubt it's gone.

.

IanM · May 8, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

I'll throw in my own paper since interference is popping up....

Do rhinoviruses reduce the probability of viral co-detection during acute
respiratory tract infections?
Greer et al in J Clinical Virology (2009) 45

10-15.

Background: Human rhinoviruses (HRVs) are often concurrently detected with other viruses found in the respiratory tract because of the high total number of HRV infections occurring throughout the year. This feature has previously relegated HRVs to being considered passengers in acute respiratory infections.
HRVs remain poorly characterized and are seldom included as a target in diagnostic panels despite their pathogenic potential, infection-associated healthcare expenditure and relatively unmoderated elicitation of an antiviral state.

Objectives: To test the hypothesis that respiratory viruses are proportionately more or less likely to cooccur,particularly the HRVs.

Study design: Retrospective PCR-based analyses of 1247 specimens for 17 viruses, including HRV strains,identified 131 specimens containing two or more targets.We investigated the proportions of co-detections and compared the proportion of upper vs. lower respiratory tract presentations in the HRV positive group.
Both univariate contingency table and multivariate logistic regression analyses were conducted to identify trends of association among the viruses present in co-detections.

Results: Many of the co-detections occurred in patterns. In particular, HRV detection was associated with a reduced probability of detecting human adenoviruses, coronaviruses, bocavirus, metapneumovirus, respiratory syncytial virus, parainfluenza virus, influenza A virus, and the polyomaviruses KIPyV and WUPyV (p≤0.05). No single HRV species nor cluster of particular strains predominated.

Conclusions: HRVs were proportionately under-represented among viral co-detections. For some period, HRVs may render the host less likely to be infected by other viruses.

sharon sanders · May 8, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Thank you IanM and Welcome!

sharon sanders · May 8, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

added reference to above:

J Clin Virol. 2009 May;45(1):10-5. doi: 10.1016/j.jcv.2009.03.008. Epub 2009 Apr 18.
Do rhinoviruses reduce the probability of viral co-detection during acute respiratory tract infections?

Greer RM, McErlean P, Arden KE, Faux CE, Nitsche A, Lambert SB, Nissen MD, Sloots TP, Mackay IM.
Source: School of Veterinary Science, University of Queensland, St Lucia, Queensland, Australia.

http://www.ncbi.nlm.nih.gov/pubmed/19376742

gsgs · May 8, 2013

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

Re: Discussion ? Why is China is not reporting details of recent H7N9 deaths?

thanks. I saw, some institutes are regularly testing for HRV now
(among others)

would it be practicable to deliberately infect yourself with HRN at the
height of a hypothetical severe flu-wave so to reduce flu-risk ?

Maybe for HCWs ... only get those with HRN to the flu-patients

-------------------------------------------------------------
they had weekly amounts of several virii here until 2011
http://www.pid-ari.net/index.htm

I wished, there were more such surveillance sites
(are there ?)

Discussion ? Why is China is not reporting details of recent H7N9 deaths? (Part 1)

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