H7N9 discussion thread: January 24, 2014 to Feb 5 2014 (closed)

gsgs · Jan 24, 2014

Previous discussion at H7N9 – Discussion, April 1, 2013 to June 3, 2013

- - - - - -
worrying dynamic

where will it stop ? with that speed we will have thousands of cases soon

even if we assume it slows down again as last year in May,
until then it may grow a lot. Even without sustained H2H

CIDRAP:In the past 3 weeks, cases have almost mirrored the 17, 28, and 38 weekly pattern
that led to the 2013 peak
cases are trending slightly younger, with a lower case fatality rate
rapidly progressing severe pneumonia,
the hemagglutinin (HA) and neuraminidase (NA) genes are similar to viruses from the first wave,
the report said. It added that they are also similar to the influenza A/Anhui/1/2013

China: Hangzhou halts live poultry ...

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http://www.cidrap.umn.edu/news-perspective/2014/01/pace-h7n9-cases-china-continues-unabated
http://www.cidrap.umn.edu/news-perspective/2014/01/who-weighs-h7n9-risk-cases-mount
http://www.cidrap.umn.edu/news-perspective/2014/01/h7n9-cases-china-surge-past-200

http://www.who.int/influenza/human_animal_interface/RiskAssessment_H7N9_21Jan14.pdf?ua=1

http://afludiary.blogspot.de/2014/01/zhejiang-jiangsu-provinces-report-new.html

http://www.wpro.who.int/outbreaks_emergencies/H7N9/en/index.html

http://www.flutrackers.com/forum/showthread.php?t=202713

Giuseppe · Jan 24, 2014

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

There's not mean to stop the increase of human H7N9 human cases because infected animals continue to be present in every part of the country without a noticeable activity in prevention from veterinarian authorities.

In other words, H7N9 in China is out of control both in animals and in humans.

Local and national authorities favored no intervention against poultry business and by this way opening the door to a new, pathogenic virus to humans.

At this point, there is not further room for complacency from other world's countries before the disaster will materialize. Emergency plans have to be activated, drugs and medical supplies to be stockpiled in advance when possible.

No need to say that almost all world's population is and will be without any kind of defense against the H7N9 in the coming weeks and months.

sharon sanders · Jan 24, 2014

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

Unfortunately I have to agree with Giuseppe.

H7N9 is widespread in China in some officially undeclared animal - probably chickens and geese, at least.

This situation is a risk to all humans presently located in the affected areas. Also, there is a high risk of spread to humans in adjacent countries through illegal poultry trade.

Whether this disease is efficiently spread between humans is unclear. The data is puzzling. Very few children have been reported with this illness and there have been very few clusters reported. Yet, we know that the 1st reported case was part of a family cluster.

From the data we do have it appears that human-to-human spread - at this time - is not as efficient as H1N1pdm09, for example. But it does occur.

So - what to do about this? I think all nations should activate their pandemic plans at a preparation level. This is the only prudent option.

For families I think the same. Talk to your nearest friends and relatives about gathering a several day supply of essential prescription drugs, food and water. This is not a waste of time. Families can use these preparations for local natural disasters too. We have some links here that can help you via the US CDC.

Forget about any vaccine. There is none available. At this time it appears an early intervention with oseltamivir is effective. But those supplies are limited on a world wide basis. The best defense against H7N9 is to avoid becoming ill.

We do not know the future of H7N9 but if you think about it now and review some of the links above, you will be prepared for the natural disasters that occur routinely in your area.

Laidback Al · Jan 24, 2014

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

gsgs said:
worrying dynamic

where will it stop ? with that speed we will have thousands of cases soon

Yes, the trend appears to be increasing exponentially.

H7N9 projected growth in cases 20140124.webp

sharon sanders · Jan 24, 2014

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

The case data released by mainland China is related to hospitalized cases only. There is no data released about suspected or probable cases who are not hospitalized.

Of the hospitalized cases it appears in the last 3 weeks that the case fatality rate is approximately 11% with dozens still hospitalized in critical condition.

Shannon Bennett · Jan 24, 2014

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

Re: Discussion thread : recent (2014/01/23) increase in H7N9 cases

I am utterly convinced the carrier for this disease is not a typical fowl. Why? Because if it were the disease would have been seen in another country by now or, at least in a much larger portion of China. We know from past experience with H5N1 that wild birds took the virus out of China and into Southeast Asia within a very short time after it was first detected. This disease has yet to move out of eastern China. It is spreading but, at a much slower rate. That suggests to me the host can't fly. It also suggests to me that it isn't something that is moved routinely by shipping, such as chickens, ducks and other domestic fowl. The borders between Vietnam and China, have shown to be very porous to the trafficking of domestic fowl. Not that such movement was sanctioned but it proved to be the case with H5N1 transmission. Vermin, such as mice and rats, are also known to get the virus. And certain ferret studies have show it appears to replicate in lung cells fairly well.

I have to admit I am worried about a probable pandemic. While a flu season bump was fully expected, the actual number of known cases is worrying. I am certain we are not seeing every case of H7N9 in China. Medical care is not free unless you have been proven to be infected with this virus. Poor families will not have the wherewithal to seek medical attention on the off chance their malady is H7N9. We do know that there are thousands of children in pediatric hospitals suffering from pneumonia. As children do not seem to be suffering the same morbidity in the same numbers as those middle age and beyond, they would be a perfect reservoir. Since they are not sick enough to be thought to have the disease they are not tested. I, for one, would like a much more robust testing of the unexpectedly large number of child pneumonia cases.

Yesterday, we saw a National Geographic story linked to flutrackers. The article placed the origin of the 1918 pandemic in China. The thought is guest workers were brought to Canada and then shipped to England to help build up England's war effort. After arriving in Canada many were seen to be very sick. They were then quarantined. The disease was not in its most deadly mutation until a few months after the sequestering of the Chinese workers. Evidently there had been a lot of flu going around in China for approximately two years. Not many were actually dying. The most telling argument for the out of China theory was China did not suffer the same high mortality rates as did the rest of the world after the virus changed to its more deadly form. It was postulated they already had antibodies to the disease. Sound familiar?

I don't believe the virus has mutated to a pandemic inducing form yet. At least those who look at reassortments have not found this to be the case but, I don't think we are far off. I think it is better to be safe than sorry. So, just as you buy house insurance against the possible risk of fire, we should all plan and prepare for what might be a somewhat lengthy stay in our homes. It is also a good time to remind our civic leaders that disaster plans might need to be updated.

Tetano find. http://www.flutrackers.com/forum/showthread.php?t=216738

gsgs · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

unlike H5N1 in 2004, this is a chicken virus.
Not suitable for wild birds.
Too distant from the index.
It evolved and adapted decades already in chickens.
Except HA,NA.
See also H5N1, it's adapted meanwhile,
the wild birds hardly get it.

Shannon Bennett · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

It doesn't appear to be transmitted easily between chickens anymore.

http://www.flutrackers.com/forum/showthread.php?t=216738

gsgs · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

comparing with last year :

it was probably not so widespread in chickens last Jan.
Because the diversity is so low, no time for extensive evolution.
If that was the reason, why we didn't see so much in Jan.,Feb. 2013,
then we could expect that the current level is normal
and will reappear the next years, maybe spread further and increase.

There was hope that this strain does not transmit well in chickens
and may be replaced (recent paper) but we don't see this.

gsgs · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

maybe China should celebrate the new year in summer instead

AnnaLisa · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

I'm concerned but puzzled. The case that seems to shout human to human is the emergency room doctor, a thoracic surgeon, that died recently of H7N9. I would like to know more about the circumstances involving his death.

sharon sanders · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

The Shanghai Mayor said yesterday that the case of the doctor dying from H7N9 is not a human-to-human transmission event:

http://www.flutrackers.com/forum/showthread.php?p=522042#post522042

I do not necessarily believe that statement.

AnnaLisa · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

I don't believe it either. I would think other than exposure at work, that he was smart enough to avoid the typical places one could catch this. Personally I think this is on the uptick. It's worrisome.

Laidback Al · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Regarding Sharon's comment above.

Official media reports from China only seem to be reporting severe cases. Only a handful of cases are reported as "mild", probably contact cases. The actual number of mild or asymptomatic cases is unknown. No researchers have publicly estimated the number of infected individuals in China.

Regarding AnnaLisa's comments.

While the infection of one doctor suggests human-to-human transmission, the bulk of the cases officially reported are sporadic cases. Although there are a few small family clusters no large clusters signaling human-to-human transmission have been reported. In the provinces with the most cases, there are some general geographic clusters mostly in larger metropolitan areas which currently suggest widespread environmental distribution of the virus or its avian host.
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Shannon Bennett · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

This is obviously an attempt at damage control.

http://www.flutrackers.com/forum/showthread.php?p=522282#post522282

Shenzhen Wei Planning Commission rumor:
Shenzhen H7N9 death due to infection without a doctor

2014-01-25

Nanfang Daily (Reporter / Air to rain) yesterday, microblogging, letters and other network rumor "Shenzhen Second People's Hospital doctors infected by H7N9 bird flu death" and other information caused public panic, Shenzhen City Health and Population and Family Planning Commission On its official Weibo rumor: rumor, "a hospital doctor Shenzhen H7N9 bird flu death due to infection," rumors and other information for the community, without a doctor's Shenzhen H7N9 bird flu death due to infection. The Shenzhen Second People's Hospital said on its website, as of now, the hospital is not infected and treated any patients with H7N9 avian influenza.

For yesterday on the microblogging and micro-channel rumors "Shenzhen Second People's Hospital doctors infected by H7N9 bird flu death" and other rumors, the Shenzhen Municipal Center for Disease Control 马汉武 in an interview with reporters, said, as of now, Shenzhen reported a total of nine cases of H7N9 Avian influenza confirmed cases, two cases have been cured and discharged, and the remaining patients were treated in designated hospital, no deaths occurred.

Shenzhen Wei Planning Commission, said, spreading rumors, false epidemic intentionally disrupt public order, it is illegal, please the majority of users do not believe rumors rumors and jointly safeguard the network civilization.

zhttp://epaper.nfdaily.cn/html/2014-01/25/content_7270455.htm
__________________

Shannon Bennett · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

The H7N9 virus is resistant to Tamiflu.

http://www.sciencedaily.com/releases/2014/01/140116112718.htm?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+sciencedaily%2Fhealth_medicine+%28ScienceDaily%3A+Health+%26+Medicine+News%29

Expert advises patients to use anti-viral medication

01-25-2014 06:39 BJT

A leading Chinese respiratory expert has suggested that patients with the H7N9 virus should use the antiviral medication, Tamiflu, as early as possible.

Zhong Nanshan, who is the director of the Guangzhou Institute of Respiratory Diseases, says latest lab data shows that this year’s H7N9 strain is stronger than usual. He says severe cases, can host great amounts of the virus, which can live in the body for up to 30 days. The long survival duration of the potentially-deadly virus makes it harder to cure H7N9 patients than normal flu infections.
...
http://english.cntv.cn/program/newsu...5/100875.shtml

http://www.flutrackers.com/forum/showthread.php?t=217374

Emily · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

The H7N9 virus is resistant to Tamiflu.

http://www.sciencedaily.com/release...tm_campaign=Feed:+sciencedaily/health_medicin e+%28ScienceDaily%3A+Health+%26+Medicine+News%29

Potentially excellent news there Shannon!

In this study we report that Alferon N can inhibit wild type and Tamiflu-resistant H7N9 virus replication in vitro. Since Alferon N is approved for clinical use, this would allow a rapid regulatory approval process for this drug under pandemic threat."

Of course, I'm not familiar with Alferon N.

Shannon Bennett · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

LOL Neither am I familiar with that drug. Still depending on both mullein and curcumin to thwart the virus.

Emily · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

AnnaLisa said:
I'm concerned but puzzled. The case that seems to shout human to human is the emergency room doctor, a thoracic surgeon, that died recently of H7N9. I would like to know more about the circumstances involving his death.

Did you see that Dr. Zhang lived next door to someone who kept pigeons?

http://www.flutrackers.com/forum/showpost.php?p=521653&postcount=10

Another article in that thread indicates he was a very dedicated trauma surgeon, and worked for about a week with a fever. He passed away on the 18th, so if this were H2H, why no cases in his family, friends, co-workers or patients yet?

If he did indeed catch this from an undiagnosed patient, (whose illness perhaps was the cause of cognitive malfunctioning that caused some sort of accident that ended up being the patient's cause of death), why are no other HCW's infected yet?

Was the doctor the only HCW to be splashed with blood while desperately trying to save the life of a patient?

Shannon Bennett · Jan 24, 2014

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Re: H7N9 Discussion thread : recent (2014/01/23) increase in cases

Good questions. I am not convinced pigeons are the carriers. As far as I know from postings here, pigeons are not high on the suspect list of probable reservoirs. If pigeons were the reservoir it would answer one burning question in my mind, why has the H7N9 virus never left the east coast region of China. Pigeons are not big on heading south for the winter. however, as a skilled doctor I am skeptical the doctor wouldn't have avoided the pigeons.

H7N9 discussion thread: January 24, 2014 to Feb 5 2014 (closed)

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