Is H7N9 Spreading from Human to Human in China?

Laidback Al · Apr 3, 2013

Is H7N9 Spreading from Human to Human in China?

Despite the official pronouncements that there is no human-to-human (H2H) spread of H7N9 in China, the body of circumstantial evidence suggests otherwise.

While it is not certain how long China has been aware of human infections of this novel influenza virus, by early March Chinese micro bloggers were calling attention to a cluster of 4-5 patients in Shanghai Fifth People's Hospital with an unidentified illness (link).

On March 31<sup>st </sup>China officially reported this new strain from three individuals, two from Shanghai and one from Anhui (link). However, only one of the patients from the Shanghai cluster, an 87-year-old man, was reported as infected with H7N9. China reported that none of the other patients in the cluster were infected with H7N9. There is also another report that the daughter of the confirmed case from Anhui recovered from a cold and fever before her mother had symptom onset (link).

In the past four days, 6 additional human cases of H7N9 have been reported by China (link). Each of these is reported as an isolated case with no epidemiological link between any of the nine cases. However, no animal source of infection is reported for any of these individuals.

While one or two of the individuals worked as poultry cullers or butchers, the occupation of others would not put in them in contact with infected animals. What is more concerning is the following statement from China?s Ministry of Agriculture.

China's Ministry of Agriculture said Wednesday that epidemiological investigations have found no H7N9 bird flu infections in animals.
Experts from the ministry said it remained unknown where the virus came from and how it had spread. . . .

http://news.xinhuanet.com/english/health/2013-04/03/c_132283110.htm

To claim that there is no animal vector for transmission only reinforces the conclusion that there is H2H transmission in China with possibly many mild cases, with only the more severe cases being tested and reported.

The growing frequency of reported cases, always officially reported as isolated and always from widely separated geographic areas, can only lead to the conclusion that H7N9 is now spreading in eastern China from human to human.

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Giuseppe · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

I think it is important to see the median age of the infected patients, too.

Also, close contacts seem to be disease-free after one or two week after relatives or cases illness onset.

The median age may be biased by the SARI nature of the cases but could suggest us something else?

sharon sanders · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

If H7N9 is not present in animals then it must be spread human to human.

The Chinese government can not claim Martians as a viable vector.

I have not seen 1 report about any poultry culling or any kind of remediation at live markets, or poultry farms. In fact, I have not seen any attempts to contain this virus in any animals.

If actions speak louder than words, the conclusion is that this virus is spread human to human.

If the Chinese government decides to claim it is spread by wild birds - where are the OIE reports and corresponding backup data for the last several weeks, months, or years?

Laidback Al · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

For the 9 officially reported cases

5 males 4 females

median age = 45

range 27-87

It is interesting that no one under 27 years old is reported to have been infected.

Giuseppe · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

It may be only a case - due to small number of cases - but may signal something else: ie. Young people have been exposed to donor strain (H5/H9?, perhaps H3?) recently, enough to Mount a cross-protective immunity.

Laidback Al · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Giuseppe Michieli said:
It may be only a case - due to small number of cases - but may signal something else: ie. Young people have been exposed to donor strain (H5/H9?, perhaps H3?) recently, enough to Mount a cross-protective immunity.

I agree. It certainly deserves further investigation.

Nika · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

re: no bird culling and no H7N9 detected in domestic animals (really?) dont forget to factor in the science community concerns that avian infection may, in fact, be silent (no symptoms)

sharon sanders · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Nika said:
re: no bird culling and no H7N9 detected in domestic animals (really?) dont forget to factor in the science community concerns that avian infection may, in fact, be silent (no symptoms)

Sure. The protocol in an H5N1 human infection is to cull all poultry (sick or not) within an area. Usually it is all around the person's neighborhood and village. If it is a farm, they usually cull the entire farm and maybe a few close by depending on the situation. For wet markets, it is the same procedure - culling of all birds and a biological cleaning.

So where are these actions in the current situation? Apparently case #3 frequented a farm to buy her poultry.

curiosity · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

It is still too early to assume children are not as affected by this virus as adults.

The initial alert in Mexico City when pH1N1 erupted in March 2009 happened because several adults - young and healthy - as well as hospital employees became ill with atypical and fatal pneumonias. Initial reports did not include children as severe cases. Then as the disease progressed, it proved to be a significant illness in the pediatric population.

If there is H2H spread, I am curious why there has not been any released evidence of nosocomial infections? Are there any covert blog posts indicating this type of event?

The novel/pathogenic disease canary hasn't become ill yet? Or have they and information is not being released?

On a side note: The flu trackers, experts, amateurs and bloggers on this site are doing an exceptional job tracking this event. You are all AWESOME! Thank you for your hard work and dedication to this and all the events you watch for us :tiphat:

Laidback Al · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

curiosity said:
It is still too early to assume children are not as affected by this virus as adults.

The initial alert in Mexico City when pH1N1 erupted in March 2009 happened because several adults - young and healthy - as well as hospital employees became ill with atypical and fatal pneumonias. Initial reports did not include children as severe cases. Then as the disease progressed, it proved to be a significant illness in the pediatric population.

If there is H2H spread, I am curious why there has not been any released evidence of nosocomial infections? Are there any covert blog posts indicating this type of event?

The novel/pathogenic disease canary hasn't become ill yet? Or have they and information is not being released?

On a side note: The flu trackers, experts, amateurs and bloggers on this site are doing an exceptional job tracking this event. You are all AWESOME! Thank you for your hard work and dedication to this and all the events you watch for us :tiphat:

On behalf of all the members here, thanks for the compliment.

Yes, pediatric cases may be eventually reported. Nosocomial infections, which would be clear signs of H2H transmission, will most likely not be reported immediately.

Remember, the Chinese government controls the media reports that the world is receiving. We have have no idea how accurate the reports are or whether any information is being purposefully withheld.

We need to wary when reviewing both official and unofficial reports from China.

Shannon Bennett · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

After reading most of the posts regarding H7N9, I have come to the conclusion there are some oddities. From what we understand as the primary evolution of flu virus all known variants are found in wild birds. Over time the tremendously unstable

virus changes to a form that infects domestic poultry. Primarily chickens but, ducks and geese may also be the intermediate hosts. The next host is typically either pigs or humans. In this case Chinese scientists have reported the disease is

subclinical in chickens. This may mean the disease is already widespread. As it is subclinical how would anyone know if any chickens were sick? Pigs have been reported as dying in very large numbers in China over the last months. Chinese

authorities have unequivocably stated that they have not found H7N9 in any of the carcasses they tested. One, possibly two of the victims was a butcher. None of the rest of the victims worked with amimals. So, where did they come in contact

with a disease carrier? As a dot map indicates these poor souls were not in close proximity to each other. Some were infected in differing provences. Therefore, it is obvious that the source of the infection must be fairly widespread or, something

that all have in common such as a water source. So, if it wasn't the pigs that were dumped in the rivers that contaminated the water these people drank, then we are left with the assumption that a HUGE number of chickens are infected and

therefore beyond the scope of finding and culling or, the disease is now passing human to human. My guess is it is in the human population. It is still fairly difficult to infect human hosts or we would be seeing a lot more victims. Given the small

number of patients we should see fairly soon pediatric patients and then nosocomial victims if this is indeed H2H. In any case, the most worrying aspect of this is we cannot find a common source as of yet. And if we do, can we contain it?

Emily · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

http://www.cbsnews.com/8301-204_162-57577666/chinas-deadly-new-h7n9-bird-flu-virus-may-be-harder-to-track-than-predecessors-scientists-say/

April 3, 2013, 6:31 AM

BeijingScientists taking a first look at the genetics of a bird flu strain that has killed three people in China said Wednesday that the virus could be harder to track than its better-known cousin H5N1 because it might be able to spread among poultry without showing any signs.

The scientists, at several research institutes around the world, urged Chinese veterinary authorities to widely test animals and birds in affected regions to quickly detect and eliminate the H7N9 virus before it becomes widespread.

They said the virus is troubling because it can infect poultry without producing any symptoms, while seriously sickening humans. The virus, previously known to have infected only birds, appears to have mutated, enabling it to more easily infect other animals, including pigs, which could serve as hosts and spread the virus more widely among humans, they said.

The findings are preliminary and need further testing...

ETA: Genetic data and Chinese lab testing are reported to be the data for the findings.

Vibrant62 · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

There is an additional possibility that must be considered.

IF the dead pigs were indeed infected with H7N9 and thrown in the river, the water would have become contaminated far and wide. It is still winter and water would be at low temperatures which would mean long virus survival times. The issue of dead pigs has been ongoing for some time - and potentially could cover the infective period where human cases have been reported?? I am not sure on this.

If the water supply had been contaminated and there are areas that draw water directly from rivers and it was not boiled or used in its raw state for washing, this - possibly - could have been a source of infection.

Time and transparency from China will tell the tale quite quickly; however, at least some H2H transmission seems probable.

Emily · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Jim looked at the timeline here:
http://www.flutrackers.com/forum/showpost.php?p=490238&postcount=25

Based on the timelines I've seen, the first two cases of H7N9 were contracted in mid- to late-February, but the dead pigs were not reported in the river until a couple of weeks later.

Farmer · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Remember that chlorine disinfection appears to be effective against (at least) H5N1. It appears that the Huangpu River is heavily chlorinated. I am not aware of any flu viruses that are chlorine-resistant.

http://www.purelivingchina.com/learning-center/water-quality/

This does not rule out drinking water from the river as a source of infection, but I believe it makes it much less likely, especially given the distribution of cases.

Vibrant62 · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

There is an additional possibility that springs to mind: vermin. Again, H7N9 infected pigs or other dead animals that had washed ashore would have been fed upon, and vermin are pervasive in cities and buildings and could be a spread vector.

curiosity · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Shannon said:
Pigs have been reported as dying in very large numbers in China over the last months. Chinese authorities have unequivocably stated that they have not found H7N9 in any of the carcasses they tested.

Unreliable

Shannon said:
One, possibly two of the victims was a butcher. None of the rest of the victims worked with amimals. So, where did they come in contact with a disease carrier? Some were infected in differing provences. Therefore, it is obvious that the source of the infection must be fairly widespread or, something that all have in common such as a water source.

Would have more, many more simultaneous pockets of cases in a more concentrated area with a shared water source

Shannon said:
So, if it wasn't the pigs that were dumped in the rivers that contaminated the water these people drank, then we are left with the assumption that a HUGE number of chickens

simultaneously infected? and becoming infectious to humans simultaneously ALSO?

Shannon said:
disease is now passing human to human

It would be great to know we were getting legitimate information but that's not the case. There isn't any way we know because of censorship and government control whether there is also a coinciding, milder respiratory epidemic happening at the same time. With a low CFR, there could be thousands of cases out there - with a 1918 like CFR, there would be less, but still a considerable amount.

Perhaps, humans gave it to the piggys hence the reason they started dying AFTER the first known human cases? Could ground zero for the first human epidemic be upriver from Shanghai?
H2H controversy will stay unclear until the first case is detected outside of China.

Nika · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

curiosity said:
H2H controversy will stay unclear until the first case is detected outside of China.

Bingo

until this pierces the veil and is found in a Western country we cant possibly say anything with certainty - well except that we certainly do not have the full story

(sadly lets hope it shows up in a competent country like Germany because then the transparency will be considerably better)

Laidback Al · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

Perhaps the biggest problem with the pig hypothesis as the source is that there are so few confirmed cases from Shanghai as noted by Farmer. The Huangpu River is the major water source for the largest city in the world and is now heavily chlorinated (Wikipedia link), although Wikipedia reports that some of the dead pigs had ear tags from Jiaxing, Zhejiang Province. Background information on the Huangpu River from 1997 can be found here.

Pigs share a lot in common with humans regarding influenza viruses. Curiosity's suggesting that humans infected pigs up river is a speculative, but possible, alternative scenario, until we get further information.

Giuseppe · Apr 3, 2013

Re: Is H7N9 Spreading from Human to Human in China?

There are so many unknown about this event that is almost impossible to speculate what is going to happen in few days.

But a thing is almost sure: Shanghai is a global travel and trade hub.

If this virus is really prone to human-to-human transmission without further adaptation, in few weeks all cities in the world will be able to detect new cases.

So, our media scanning should target main travel route from Shanghai to other region of the Pacific, for example.

US west coast?

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