Date: Mon 27 Jan 2014
Source: CIDRAP News [abridged & edited]
China’s agriculture ministry said tests showed no H7N9 in farm poultry, but Hong Kong reported the virus in chickens imported from a mainland farm.
China’s steady rise in H7N9 avian flu cases continued over the past 3 days, with 14 new cases from 5 provinces, as the latest test results in poultry showed a conflicting picture of the virus on farms, including positive samples found today [27 Jan 2014] in birds sent to Hong Kong.
The fresh round of infections — coming at a pace matching last year’s  peak — could soon eclipse last spring’s outbreak totals and come as poultry trade and consumption are high in the lead-up to Lunar New Year celebrations later this week. So far, 116 cases have been reported since October 2013, a number that could soon reach or exceed the 136 H7N9 illnesses reported during the outbreak’s 1st wave last spring, a number that includes 2 July 2013 cases.
Hong Kong’s Centre for Health Protection (CHP), in 2 separate statements, announced initial details for 8 new H7N9 illnesses: 5 reported on 25 Jan 2014 and 3 reported on 26 Jan 2014. 5 of those patients are from Zhejiang province, 2 from Jiangsu, and one from Guangdong. In addition, 4 provinces reported 6 new cases today [27 Jan 2014], 2 from Fujian province, 2 from Guangdong, one from Hunan, and one from Jiangsu.
According to provincial statements in Chinese translated and posted by the Avian Flu Diary, the patients include 3 men ages 68, 69, and 72, and 3 women ages 58, 74, and 77. The 68-year-old man died from his infection, according to the statement from Guangdong province. The World Health Organisation (WHO) fleshed out more details about 19 cases reported over the past 4 days, including the ones reported yesterday [26 Jan 2014], according to separate statements from 25 Jan 2014 and today [27 Jan 2014]. Patient illness onsets range from 10-20 Jan 2014. All are adults ranging in age from 23 to 82. Ten are men, and 9 are women. Eleven of the patients are in critical condition and 8 in serious condition. Investigations so far have found that 10 patients had been exposed to poultry, and 4 had been exposed to live-poultry markets.
Over the past few weeks, China has averaged about 5 to 7 new H7N9 cases each day, and the new cases reported over the past 3 days boost the outbreak total to 252, according to a case list compiled by FluTrackers.
Less clear is the number of deaths. Most of the patients reported over the last several weeks were said to be in severe or critical condition and may still be hospitalized. China’s Center for Disease Control and Prevention (China CDC) said today [27 Jan 2014] that 19 deaths have been reported so far this year  among 96 cases reported so far, Xinhua, China’s state news agency reported. The unofficial number of deaths is 57.
Shu Yuelong, director of the Chinese National Influenza Center, told Xinhua that the case-fatality rate (CFR) ranges from 20-30 percent and that the risk assessment is unchanged, because so far no H7N9 virus mutations that could affect transmissibility have been found, and so far there is no sign of sustained human-to-human transmission.
An updated risk assessment from the WHO last week said so far the CFR is not as high as the 1st wave of infections last spring  and that virus samples from the 2nd wave are similar to the 1st wave, as well as to strains recommended for H7N9 vaccine development.
Meanwhile, China’s agriculture ministry said today [27 Jan 2014] that tests on farms so far this year  have found no H7N9 in poultry, according to a separate report from Xinhua. It said no positives were found among 33 400 samples tested from 2402 sites. It added, though, that 8 positive samples were found among samples from live-poultry markets in Guangdong, Fujian, Zhejiang, and Guangxi Zhuang autonomous region.
In a report today [27 Jan 2014] to the World Organisation for Animal Health (OIE), China’s agriculture ministry described H7N9 findings at agricultural markets in Guangdong and Fujian provinces. Of 185 chicken specimens collected in Guanzhou in Guangdong, 2 from different markets were positive, and 1200 birds were culled to curb the spread of the virus. In the Fujian province city of Quanzhou, tests on 220 specimens — from chickens, pigeons, ducks, and environments — found only one H7N9-positive result in an environmental sample.
A similar pattern was seen during agriculture ministry testing after the virus was 1st detected last spring : no positive samples were found on farms, and only a few were detected in poultry market samples. The results are puzzling, because provincial health ministry reports have said several of the patients infected with the virus were farmers, and official reports say that a large percentage of H7N9 cases were exposed to poultry or visited live-poultry markets.
Fueling more questions about H7N9 circulation on China’s poultry farms, Hong Kong’s government today [27 Jan 2014] said it detected the virus in a number of samples from a shipment of live chickens that were imported from a registered poultry farm near the Guangdong province city of Foshan, according to a statement posted on the government’s Web site. Hong Kong said it has been testing live poultry imported from the mainland since April 2013, and the findings are the 1st for H7. In response, the government is closing the agricultural market that received the birds for 21 days and will cull 20 000 poultry that are at the site.
[Byline: Lisa Schnirring]