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PostPosted: Wed Apr 17, 2013 2:35 pm 
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Media reports cite the H7N9 confirmation of at least one of the sons of the first confirmed case has also been confirmed. Thus, the father and at least one of his sons has been lab confirmed.

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PostPosted: Wed Apr 17, 2013 2:36 pm 
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Authorities test family infected by H7N9
Updated: 2013-04-18 01:59
By SHAN JUAN ( China Daily)


China's top health authority confirmed that a family infected by H7N9 in Shanghai might involve human-to-human transmission of the new bird flu strain.

The family involves two brothers and their 87-year-old father, who died on March 4 and was reportedly China's first human death from H7N9.


Authorities test family infected by H7N9

The elder son, who has recovered from the disease, was previously confirmed to have contracted the virus, the Chinese National Health and Family Planning Commission said on Wednesday at a media briefing.

However, the results of a test on the younger son were not available.

"Further investigations are still under way to figure out whether the family cluster involved human-to-human transmission," said Feng Zijian, director of the health emergency center of the Chinese Center for Disease Control and Prevention.

Previous reports said the father had not been outside his home during the two weeks before the onset of his disease, which was five days after one or both of his sons were hospitalized with pneumonia symptoms.

Premier Li Keqiang vowed at a State Council meeting on Wednesday to use nationwide medical resources to cope with the flu.

The virus mainly jumps from birds to humans, and "human-to-human transmission, in theory, is possible, but is highly sporadic", Feng said.

Bird flu viruses, including the new strain of H7N9, do not easily infect humans, he added. "Notably, long-term and unprotected exposure to the infected person might result in another human infection."

Zeng Guang, chief epidemiologist with China CDC, said people infected with H7N9 can transmit the virus within a period of time, in which they could possibly infect others.

"But that's highly rare and could be limited to within a family," Feng said, explaining that only genetically vulnerable groups like close family members might be get infected.

The ability of the virus to spread among people is very weak, so transmission cannot spread beyond one person, he added. That belief is based on experience and studies with other bird flu strains such as H5N1.

"People don't need to panic, because such limited human-to-human transmission won't prompt a pandemic," he said.

Michael O'Leary, the World Health Organization's China representative, agreed and said there is no evidence to date of sustained or efficient human-to-human transmission, which would pose a real risk of a pandemic.

Feng said the government has been drafting plans for a pandemic response, and has initiated research and development of vaccines against H7N9.

As of Wednesday, China has reported 82 human infections of H7N9, including 17 deaths.

About 40 percent of the patients had no contact with poultry or environments where birds were located, previous epidemiological studies found. It remains a mystery how they became infected, Zeng said.

However, Feng raised questions over the accuracy of information collected.

"Only half of the sufferers could tell clearly if they were exposed to fowl or related environments," he said.


http://www.chinadaily.com.cn/china/2013 ... 416968.htm

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PostPosted: Wed Apr 17, 2013 4:45 pm 
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Commentary

http://www.recombinomics.com/News/04171 ... _Conf.html

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PostPosted: Wed Apr 17, 2013 4:52 pm 
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Beijing Times News 87-year-old Lee is the first case of human infection with the H7N9 avian influenza confirmed cases, and therefore death. The national guard Planning Commission, introduced yesterday, with Lee admitted to hospital for treatment of his two sons, the eldest son has been cured by serum testing confirmed infected with the H7N9 virus, Lee youngest son has died unable to collect specimens. This was a case of familial aggregation.

Poster Retrospective diagnosed cases in the previous night, including Shanghai Lee family of three cases of pneumonia of unknown causes. Feng Zijian, director of the Chinese Center for Disease Control Health Emergency Center said at the press conference yesterday, several cases including patients with the first confirmed cases of Lee's eldest son, he was diagnosed patients sera. In this way, Li 2 in 3 patients have been diagnosed with, another person has died can not collect specimens. This familial aggregation of cases, as the father and sons co-exposure to poultry or pollute the environment or between infection caused, is still under investigation, there is no final conclusions. But even a small number of cases of familial aggregation, does not mean that the virus has the ability to have effective human-to-human transmission.

Once it is how to deal with human-to-human transmission occurs, Feng Zijian, China developed influenza pandemic contingency plans, has taken appropriate preparations for pandemic response.

Earlier reports said that the H7N9 virus is mutating at an alarming rate, even given the new avian flu virus mutation rate may be 8 times faster than ordinary flu virus figures. Feng Zijian pointed out that the virus is not as fast variation. Him, just to get the patient's virus samples are doing testing, such as the timely publication of the results came out.

http://news.ifeng.com/mainland/special/ ... 26_0.shtml

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PostPosted: Wed Apr 17, 2013 5:24 pm 
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Map updated

https://maps.google.com/maps/ms?ie=UTF8 ... bdee9261c0

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PostPosted: Wed Apr 17, 2013 9:48 pm 
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H7N9 sickens 5 more in China; family cluster suspected

Lisa Schnirring * Staff Writer


Apr 17, 2013 (CIDRAP News) – The number of people infected with H7N9 influenza in China grew by five today, with Shanghai and Zhejiang province reporting fresh cases, and news reports described an H7N9 family cluster apparently linked to one of the outbreak's first confirmed cases.

The five new cases announced today are all in adults. Three are seniors, two are younger adults, and all are hospitalized, according to official and media sources.

The family cluster of infections is reportedly connected to an 87-year-old man from Shanghai whose illness and death were announced on Mar 31 when China first revealed the detection of the novel virus and the first three known human cases. At the time, media reports said two of his sons, ages 55 and 69, were hospitalized with similar symptoms at about the same time in late February, but local officials had said neither had the virus.

A news report today from China Daily, citing the Chinese National Health and Family Planning Commission, said an H7N9 infection was confirmed in the older son, who recovered, but results on the younger son, who died, were not available.

Another report from Xinhua today, citing the same source, said the man and his two sons all had H7N9 infections. The Xinhua report also said officials from the China Center for Disease Control and Prevention (China CDC) have not determined if the man and his sons were exposed to the virus from infected poultry, a contaminated environment, or from other infected people.

Shanghai's health bureau yesterday reported five retrospective lab-confirmed H7N9 cases, but it's not clear if either of the two sons is included in that group, and the WHO and other official organizations have not detailed or confirmed any connection between any of those cases and the family cluster described in the news stories.

If confirmed by official sources, the cases would be the second instance of family-contact infections in China's H7N9 outbreak. The other one involved a wife and husband in Shanghai. The 52-year-old woman died from her infection on Apr 3, and on Apr 13 Chinese officials said they had detected the virus in her 56-year-old husband.

Family clusters of infections aren't surprising and can result from common-source exposures or from human-to-human contact. Thorough investigations are needed to confirm human transmission. Health officials have said they expect some limited human-to-human spread as the H7N9 outbreak unfolds. Several similar instances have been documented with the H5N1 virus.

Close-contact infections among family members don't represent the type of ongoing, sustained human-to-human that would signal a pandemic threat.

Among the newly reported cases today from Zhejiang province are a 37-year-old woman and three men, ages 41, 74, and 86, according to a report today from Hong Kong's Centre for Health Protection. Their illness-onset dates range from Apr 8 to Apr 14.

All four of the patients are hospitalized, and all except for the younger man are in critical condition, Xinhua, China's state news agency reported today.

The fifth new H7N9 case reported today is in an 89-year-old man from Shanghai, according to the CHP report. He is hospitalized in stable condition, Xinhua reported.

The World Health Organization (WHO) today included all of the new cases reported yesterday and today in its official total, which is 82 infections and 17 deaths. (The WHO's total does not include the asymptomatic case announced last weekend.) The update appears to include one more death in an earlier reported case, but it's not clear which one.

Official and news reports of today's new cases contained few details about how the patients may have been exposed to the virus. A report from the Zhejiang province health bureau, translated and posted by FluTrackers, an infectious disease message board, said the 37-year-old woman is a farmer.

Dr. Zeng Guang, chief epidemiologist at the China CDC, told the Beijing News that about 40% of the H7N9 patients had no clear history of exposure to poultry, Reuters reported today. Gregory Hartl, a spokesman for the WHO, said on Twitter today that there are some lab-confirmed cases that had no history of contact with poultry, which builds the case for a wide investigation net.

Meanwhile, influenza experts suspect that poultry or contact with poultry environments, such as live-bird markets, is a likely source of the virus, but the exact source or sources remains a puzzling aspect of the outbreak. Because the virus has low pathogenicity in birds, birds and poultry aren't visibly ill or dead, which often provides a vital clue in H5N1 avian flu outbreaks.

New information on poultry and bird surveillance from China's agriculture ministry today shed little new light on how humans are becoming infected Of 47,801 samples from more than 1,000 poultry markets, habitats, farms, and slaughterhouses across the country, only 39 samples were positive for the virus, according to a report from Xinhua, which quoted an agriculture ministry statement.

Of the 39 positive samples, 38 were from live-poultry markets in the areas where most of the human cases have been reported: the city of Shanghai, plus Jiangsu, Zhejiang, and Anhui provinces.

The other sample that yielded the virus was from a wild pigeon in Jiangsu province. That detection was noted in a report yesterday from the World Organization for Animal Health (OIE).

See also:

Apr 17 CHP statement

Apr 18 China Daily story

Apr 18 Xinhua story on family cluster

Apr 17 WHO update

Apr 17 Xinhua report on family cluster

Apr 17 Xinhua report on new Zhejiang cases

Apr 17 Xinhua report on new Shanghai case

FluTrackers thread

Apr 17 Reuters story

Apr 17 Xinhua story on poultry sampling

http://www.cidrap.umn.edu/cidrap/conten ... inabr.html

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PostPosted: Wed Apr 17, 2013 9:50 pm 
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Family-clustered H7N9 cases unable to prove human-to-human transmission: expert



English.news.cn 2013-04-18 00:53:34
BEIJING, April 17 (Xinhua) -- The family-clustered H7N9 cases reported in Shanghai were unable to prove human-to-human transmission, an expert said Wednesday in an exclusive interview with Xinhua.

According to the National Health and Family Planning Commission, a man and one of his sons in Shanghai died from the bird flu, and his second son was also infected but has since recovered.

It has not been confirmed whether the three people contracted the virus from infected fowl or the contaminated environment or through human-to-human transmission, said Feng Zijian, an official with Chinese Center for Disease Control and Prevention.

Active screenings of human infections across the nation have not been required by the commission, and China will continue its current measures to prevent and control the spread of the H7N9, said Li Xingwang, an infectious disease expert of Beijing Ditan Hospital of the Capital Medical University

http://news.xinhuanet.com/english/china ... 317834.htm

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PostPosted: Thu Apr 18, 2013 9:28 am 
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Shanghai, a three-acquired pneumonia two people died


Social VientianeEvening News [ microblogging ] He Tianbao 2013-03-08 13:06

Original title: network transmission a family of four, the incidence of false

  Evening News yesterday afternoon, there are users on the microblogging said, the Fifth People's Hospital of Shanghai appeared a few cases of unknown deaths, initially diagnosed as influenza, respiratory failure symptoms, the college and publish the truth, but then delete the original post, and change the microblogging names. City Hospital, Shanghai Municipal Health Bureau yesterday after another through the official micro-Bo to clarify, the verification of the health sector, a family of four sudden onset, hospital unreported and fifth cases. City Hospital has treated a family of three, epidemiological investigation and laboratory testing, has been ruled out SARS and other infectious diseases.

  According to the City Hospital, the three patient age at the age of 55,69,87, February 14 -24 have come to the hospital. 26 am, the hospital started the plan at Minhang District Center for Disease Control to collect and do epidemiological investigation. Expert consultation to confirm the three patients had pneumonia, and an inspection of the product by the Shanghai Public Health Clinical Center, has been ruled out SARS, avian flu, the new coronavirus highly pathogenic infectious diseases.

  Despite actively rescue, 3 among 55-year-old and 87-year-old patient, because the suffering from a number of underlying medical conditions, coupled with the lungs severe infection have died. In addition, a 69-year-old patients still in the hospital hospitalized in stable condition. Admitted to City Hospital patients with pneumonia after inspection with the family epidemic associated, in close contact with patients in the hospital medical staff and their families had no incidence. Experts said that the recent increase in respiratory tract infection, and seasonal variation.

http://news.qq.com/a/20130308/001167.htm

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PostPosted: Thu Apr 25, 2013 12:22 am 
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One family cluster was identified with two confirmed and one suspected H7N9 cases.
The confirmed cases were a 69-year-old man and his father, an 87-year-old retired
man, a resident of Shanghai City. The suspected case, aged 57 years, was the first ill
person in the household and developed high fever (maximum temperature 41 ºC),
cough, sputum production, chills and nausea on Feb 11th (Figure 2). After the
suspected case became ill, his brother (confirmed case 1) and the father (confirmed
case 2) had close contact with him, including eating together, providing care, and
accompanying him to seek medical care before his hospitalization. The suspected case
was hospitalized on Feb 20th, diagnosed with pneumonia, placed on mechanical
ventilation and isolated in an ICU the next day. He died of ARDS and multi-organ
failure on Feb 28th. The throat swab collected from him on Feb 26th tested negative for
H7N9, and no specimens were available for H7N9 testing because of his death.
Before his isolation in the hospital, the two confirmed cases had close contact with
him without use of any personal protective equipment. Confirmed case 1 developed
fever (40 ºC), cough, sputum production, nausea and vomiting on Feb 19th, was
admitted to hospital on Feb 25th with a diagnosis of pneumonia, and was isolated the
next day. A throat swab collected from him on Feb 26
th tested negative for H7N9. He
improved and was discharged on Mar 13th. Paired serum specimens collected 7 and 46
days after illness onset were tested by turkey red blood cell hemagglutinin inhibition
assay and demonstrated a four-fold rise in antibody titer (HAI titer <10 and 80,
respectively), indicative of serological confirmation of H7N9 virus infection. The 8
87-year old father (confirmed case 2) developed cough and sputum production on Feb
19th and had high fever (40.2 ºC) on Feb 24th, was admitted to hospital on Feb 25th
with a diagnosis of pneumonia, and isolated the next day. A throat swab collected on
Feb 26th tested positive for H7N9 virus. He died on Mar 4th. The suspected case and
his father (confirmed case 2) lived together and the brother (confirmed case 1) lived
with his wife nearby. All three cases did not raise poultry or other animals, and did not
bring live poultry into their home. None of the three cases in this family cluster had
any direct contact with sick or dead poultry. The suspected case had visited a live
poultry market, purchased a well-appearing chicken, observed the slaughtering
process, brought the freshly killed chicken home, prepared, cooked and ate the
chicken within 2 weeks before his illness onset, but the exact exposure date was
unclear because he was severely ill and died before he could be interviewed.

http://www.nejm.org/doi/suppl/10.1056/N ... pendix.pdf

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