China - 355 have been infected by H7N9, 112 deaths, cumulative, as of February 20, 2014 - WHO confirmed

[tetano]

People's Network, February 20 (XINHUA) -- According to the Ministry of Agriculture website, the Ministry of Agriculture's Office has recently published the National poultry H N 7 9 flu eradication program (draft for soliciting opinions). Draft for Solicitation of Opinions, 2013 my first case where people are infected with H N 7 9 bird flu case, has caused many people are infected and get sick and die. As February 18, 2014, the accumulated case reports 347 cases, 109 deaths. In addition, according to China's Livestock Industry Association statistics, in 2013 the first half poultry industry direct loss 60 billion won in 2014 has lost 20 billion dollars. It has been reported. National Avian Influenza Reference Laboratory reported that the current from poultry and the environment from the H N 7 9 avian influenza virus in the poultry show no pathogens. However, the presence of the virus mutate into highly pathogenic strains of the possibility that the poultry industry development with greater risk. The national monitoring and epidemiological findings indicate that H N 7 9 avian influenza viruses can in the patient, Infected poultry, and the pollution of the environment, the separation, the current positive samples mainly from live poultry farm, but does not exclude a few poultry farms contamination.


zhttp://news.163.com/14/0220/13/9LHGELTR00014JB6.html

[sharon sanders]

Re: The national report (MoA): 347 have been infected by H7N9, 109 deaths

Index: 07B130405201400110 Information Affiliation: Veterinary Bureau
Information Name: General Office of the Ministry of Agriculture to seek "national poultry H7N9 influenza eradication program (draft)" opinion letter
Text: Agriculture Office Medical Letter [2014] 8
Creation date: February 19, 2014 Publication Date: February 20, 2014
Content: To further improve the people infected with H7N9 bird flu prevention and control work, to discover and remove poultry H7N9 influenza virus, effectively protect the safety of the poultry industry, animal product safety and public health and safety, the development of the "National Poultry H7N9 influenza eradication program", is now soliciting local livestock veterinary sector views.
General Office of the Ministry of Agriculture to seek "national poultry H7N9 influenza eradication program (draft)" opinion letter
Provinces, autonomous regions, municipalities and cities Animal Husbandry and Veterinary (farming, agriculture) department (bureau, commissions, offices), the Xinjiang Production and Construction Corps Animal Husbandry and Veterinary Bureau:

　　To further improve the people infected with H7N9 bird flu prevention and control work, to discover, excluding poultry H7N9 influenza virus, effectively protect the safety of poultry, animal product quality and safety and public health and safety, the ministry organized the drafting of a "national poultry H7N9 influenza eradication program (Draft). " Now seek the views of your unit, please February 24 will modify my views in writing to the Department of Veterinary Services feedback.

　　Contact: Veterinary Bureau Hou Yuhui Chen Guosheng

　　Tel 010 -59191401, 59191403

　　Fax 010 -59192861

Office of the Ministry of Agriculture

　　February 19, 2014

National Poultry H7N9 influenza eradication program

　　To further improve the people infected with H7N9 avian influenza outbreak response work, to discover, excluding H7N9 avian influenza virus, and effectively protect poultry production safety, animal product quality and safety and public health and safety, according to the "Animal Epidemic Prevention Law" and other laws and regulations, the development of this plan.

　　I. Background

　　2013 China experienced H7N9 avian influenza confirmed cases since the first case of human infection, infection and disease has caused many deaths. As of February 18, 2014, has a total 347 cases of reported cases and 109 deaths.

People infected with H7N9 bird flu on China's poultry industry has brought a serious impact. According to the China Animal Husbandry Association statistics, in the first half of 2013 the poultry industry, the direct loss of $ 60 billion since 2014 has lost 20 billion yuan.

　　National Avian Influenza Reference Laboratory report, the current environment isolated from poultry and out of the H7N9 avian influenza virus in poultry AVIRULENT performance, but the presence of the virus to mutate into highly pathogenic strains of possibilities, will the poultry industry greater risk. National surveillance and epidemiological findings suggest that, H7N9 avian influenza virus can infected poultry and contaminated the environment in the patient's body to the separation, the current positive samples mainly from the live poultry trade field point, but does not rule out the existence of a small number of contaminated poultry farms .

　　Developed and implemented national eradication program, quickly take unified action, master virus space, time, inter-group distribution of live poultry trade field points, poultry farms and other key aspects to take timely monitoring Excluding measures to strengthen source control, is significant.

　　Second, prevention goals

　　Provincial and county levels to enhance avian influenza surveillance capacity of veterinary laboratories to achieve full coverage of the surface monitoring of key sites, to detect and remove poultry farming and market circulation of the H7N9 bird flu virus, found one case, excluding one case, efforts to reduce the virus to people spread risk, reduce risk of virus spread by the live bird markets to poultry farms, poultry industries to reduce market risk.

　　Third, the technical route and control measures

　　(A) to find out the virus contaminated surfaces

　　Etiology and serological surveillance carried out in live animal markets, poultry farms and bird habitat and other places, to detect infected flocks and contaminated sites.

　　Zoning classification monitored. According to whether the virus discovered in the provinces (autonomous regions and municipalities) is divided into provinces focus on monitoring and general surveillance provinces, the former face strive to cover all aspects of monitoring, the latter to monitor the surface circulation and avian field based. Monitoring the implementation of dynamic management partition.

　　Focus on monitoring the provinces. One covers all live poultry wholesale markets and farmers markets (trading of live poultry stall / stalls), monthly monitoring of wholesale markets, farmers markets monitored at least twice a year, serological surveillance and pathogen monitoring simultaneously. Second of all avian field (including GGP, grandparent, parent on behalf of the national poultry breeder farm and avian gene pool) monitoring, centralized monitoring at least twice a year to serological surveillance based. The third is to increase poultry farm (village) to monitor the frequency and quantity, etiology and serological monitoring of both.

　　General monitoring provinces. One covers all live poultry wholesale market, at least monitored twice a year to focus, serological surveillance and pathogen monitoring simultaneously, select some key farmers market (trading of live poultry stall / stalls) when necessary to carry out the monitoring. Second of all avian field (including GGP, grandparent, parent on behalf of the national poultry breeder farm and avian gene pool) monitoring, centralized monitoring at least twice a year to serological surveillance based. The third is a combination of H5 avian influenza surveillance tasks on poultry farms (village) while carrying out monitoring work to serological surveillance based.

　　Activities closely related to wild birds in Poyang Lake, Dongting Lake, Taihu Lake, Lake, Chaohu Lake and other lakes and wetlands in Qinghai and the Yangtze River Delta region and other water network, to carry out sampling and monitoring of wild birds to pathogen monitoring based.

　　According to the actual situation of the environment all over the field point sampling, conducted pathogen monitoring.

　　(B) Excluding the positive flocks

　　First on the etiology positive flocks, in accordance with the "animal H7N9 avian flu emergency guide" requires decisive disposal. The second is for seropositive avian direct culling and safe disposal. Third seropositive flocks, but other etiological negative ban the circulation, local slaughter. Above the same field (village) in other flocks infected group than in the disposal group to be monitored after infection again, no infection were monitored before allowing movement. Contaminated environment for a thorough cleaning and disinfection.

　　Monitoring in poultry or environmental samples to positive, to carry out a retrospective survey. Understand the source of the virus and possible contamination of the field point, the field of possible points of contamination risk assessment and take appropriate action.

　　Once the H7N9 bird flu virus mutate and become highly pathogenic avian influenza strains, according to the "major animal disease emergency regulations", "National HPAI contingency plan" and related technical specifications for disposal.

　　State culling and harmless treatment given subsidies, subsidies methods refer to "bird flu prevention and control of financial management practices" implementation.

　　(C) regulatory transported in circulation

　　Engaged in inter-provincial transporting live poultry should provide vehicle quarantine certification of origin, as well as the poultry farms within 21 days of the H7N9 bird flu laboratory testing compliance report. Quarantine and laboratory testing costs borne by the owner, according to the charges, "the National Development and Reform Commission and Ministry of Finance on lower animals and animal products and quarantine fees and related issues notice" (NDRC Price [2011] No. 2021) executed.

　　On inter-provincial transport from breeders, seed breeding poultry chicks and continue to strictly enforce reach reporting and quarantine system. Upon arrival, the owner should be transferred to the county animal health supervision agencies reported within 24 hours and transferred to institutions under the supervision of animal health supervision, in an isolated farm or farms (farming community) in isolated homes isolation observation, isolation period of 21 days. Isolated for observation after passing mixed feeding group; unqualified should be handled in accordance with the relevant regulations.

　　Encourage the slaughter of live poultry place, chilled products to market. Transport vehicles, loading tools and related personnel must be disinfected.

　　Epidemic prevention supervision (four) other links

　　Live poultry and poultry farms trading venues should be prepared biosecurity measures.

　　1 live poultry market place. Around animal husbandry and veterinary departments with industry and commerce, food and drug supervision departments do live poultry vaccination trading venues regulated and strictly implement regularly closed, disinfection system, establish a unified live poultry market place "Rest disinfection day." Market trading of live poultry, must hold the animal quarantine certification. Unsold live poultry is prohibited shipped back to the farm, farmers market ban (live poultry trade booth / stall) retention of live poultry overnight, after the sale of live birds should be culled out the market.

　　Once detected positive, animal husbandry and veterinary departments should advise the local government to close the trading market. Be thoroughly cleaned and disinfected after 21 days, the provincial animal husbandry and veterinary authorities and relevant departments to analysis and evaluation of qualified only after the open market.

　　2 poultry farms point. Health and epidemic prevention system should be established, regular cleaning and disinfection. Animal Epidemic Prevention strict censorship farms, for failure to review the conditions of the epidemic through farms, local animal health supervision institution shall not issue an animal quarantine certification (animal A). And out of the transport vehicle, loading tools and associated personnel for disinfection, prevention and control of wild birds and other wild animals in contact with poultry.

　　Encouraged to strengthen the construction of bio-security isolation area to improve breeding sites biosecurity levels.

　　Four other requirements

　　(A) to strengthen the organization and leadership

　　Provinces (autonomous regions and municipalities) to develop animal husbandry and veterinary authorities to implement the program in accordance with this plan, set goals, a clear timetable and roadmap to promote implementation of the scheme. Under the unified leadership of the local government, strengthen sectoral cooperation, and jointly improve prevention and control work. Please country before the end of March 2014 the program will be implemented in the Ministry of Agriculture.

　　(B) increase investment

　　Around animal husbandry and veterinary departments should actively communicate and coordinate with the local financial sector, the implementation of the eradication program requirements, effective protection monitoring, culling, personal protective funding prevention, investigation, disinfection, treatment and disposal facilities, etc. and the corresponding equipment.

　　(C) to strengthen scientific and technological support

　　Strengthening laboratory capacity building, county veterinary laboratories should have serological testing capabilities, the provincial veterinary laboratories should have the ability to pathogen detection. Etiology of depth and strengthen poultry H7N9 influenza rapid diagnostic technology research, the establishment of sensitive, specific, and convenient detection methods, complete set of standardized diagnostic reagents accelerate the formation. Establish a regular expert consultation system, promptly judged prevention and control situation, provide technical support.

　　(D) advocacy training

　　Through the issuance of brochures, understand the paper, flip charts and organization of training courses and other methods to increase awareness training efforts to improve the production of various types of employees according to the law business sense. Poultry farming practitioners, strengthen farm biosecurity management training to improve biosafety level; brokers and live birds to transport personnel, major publicity disinfection methods cages, vehicles and other means of delivery, reducing the risk of the spread of the virus across districts; on live poultry market place management and sales personnel, and strengthen measures to promote comprehensive prevention, improve the standard operating level.

http://www.moa.gov.cn/govpublic/SYJ/201402/t20140220_3791429.htm

[sharon sanders]

Re: China - 347 have been infected by H7N9, 109 deaths, cumulative, as of February 18, 2014 - Ministry of Agriculture

The 109 deaths count exceeds any previously documented number. We have been only able to fully document 65 deaths on our list because in wave 1 of the outbreak many deaths were not identified.

Since the Ministry of Agriculture is slightly behind on their case count, the deaths number might be slightly higher than 109. For instance, today the death of a previously known case was announced by Guangdong province.

Even so, using the MoA numbers the case fatality rate is approximately 32%. This is double the previously estimated fatality rate.

And remember - our list is really the list of hospitalized cases. I am sure we are missing many more.

[sharon sanders]

Re: China - 347 have been infected by H7N9, 109 deaths, cumulative, as of February 18, 2014 - Ministry of Agriculture

China’s MOA: H7N9 Fatalities Higher Than Previously Announced



Credit Dr. Ian Mackay VDU Blog



# 8317


Although China has been refreshingly open about announcing new H7N9 cases over the past year, one area where it has been difficult to keep track has been patient outcomes. Often patients are hospitalized in critical condition for weeks, or even months, and only rarely do we get an update as to whether they were discharged or died.

A little over a week ago, Dr. Ian Mackay looked at the number of fatal outcomes in H7N9 snapdate; the number of surviving and fatal human cases.…, and discussed the variable numbers we’ve seen coming from the individual Provinces and the media.

Late in January, the ECDC published their 3rd Rapid Risk Assessment on H7N9, where – based on 56 reported deaths out of 251 cases – they estimated a mortality rate of 22.3%.

Over the past month we’ve seen roughly 100 more cases reported, and an extrapolation would put the number of deaths in the upper 70s, but today we learn from China’s Ministry of Agriculture that the number of deaths is quite a bit higher.

A big hat tip goes to Tetano and Sharon Sanders on FluTrackers for picking up a pair of reports (one directly from the MOA) indicating that – so far – H7N9 has resulted in 347 reported cases and 109 deaths.

A (tentative) CFR closer to 31.4% - or 40% higher than previously disclosed.

This from the Chinese MOH’s General Office of the Ministry of Agriculture to seek "national poultry H7N9 influenza eradication program (draft)" opinion letter:

Office of the Ministry of Agriculture

February 19, 2014

National Poultry H7N9 influenza eradication program

To further improve the people infected with H7N9 avian influenza outbreak response work, to discover, excluding H7N9 avian influenza virus, and effectively protect poultry production safety, animal product quality and safety and public health and safety, according to the "Animal Epidemic Prevention Law" and other laws and regulations, the development of this plan.
I. Background
2013 China experienced H7N9 avian influenza confirmed cases since the first case of human infection, infection and disease has caused many deaths. As of February 18, 2014, has a total 347 cases of reported cases and 109 deaths. People infected with H7N9 bird flu on China's poultry industry has brought a serious impact. According to the China Animal Husbandry Association statistics, in the first half of 2013 the poultry industry, the direct loss of $ 60 billion since 2014 has lost 20 billion yuan.
National Avian Influenza Reference Laboratory report, the current environment isolated from poultry and out of the H7N9 avian influenza virus in poultry AVIRULENT performance, but the presence of the virus to mutate into highly pathogenic strains of possibilities, will the poultry industry greater risk. National surveillance and epidemiological findings suggest that, H7N9 avian influenza virus can infected poultry and contaminated the environment in the patient's body to the separation, the current positive samples mainly from the live poultry trade field point, but does not rule out the existence of a small number of contaminated poultry farms .
Developed and implemented national eradication program, quickly take unified action, master virus space, time, inter-group distribution of live poultry trade field points, poultry farms and other key aspects to take timely monitoring Excluding measures to strengthen source control, is significant.


(Continue . . .)

The next obvious question – assuming these numbers are right – is: Has the CFR gone up appreciably during this second wave or has the reporting on fatalities lagged behind all along?

A sudden spike in mortality would be significant, as discussed last week, in Eurosurveillance:The Evolving Threat From New, Reassorted H7N9 Viruses. There we learned of three new reassortant H7N9 viruses detected during this second wave. The report cautioned:

. . . the new reassortments generated by A(H7N9) and local A(H9N2) strains may produce avian influenza virus strains that are more adaptive and have a higher pathogenicity in humans [16], emphasising the importance of continuously monitoring the A(H7N9) epidemic.

Whether today’s revised CFR number is due to a change in the virus’s behavior or simply the result of a long-term lapse in fatality reporting is too early to know.

But either way, H7N9 deserves our ongoing attention and vigilance.

Posted by Michael Coston at <a class="timestamp-link" href="http://afludiary.blogspot.com/2014/02/chinas-moh-h7n9-fatalities-higher-than.html" rel="bookmark" title="permanent link"><abbr class="published" itemprop="datePublished" title="2014-02-20T10:59:00-05:00">10:59 AM</abbr>

[Giuseppe]

Re: China - 347 have been infected by H7N9, 109 deaths, cumulative, as of February 18, 2014 - Ministry of Agriculture

Figures are quite uncertain at this joint

If we had around 220+ cases during 2nd wave, and the first wave Death toll was less than 50, we should have had from January to date 109-45=64 fatalities. 64/220*100=29%, not distant from firstly observed apparent case fatality rate.

Taking into consideration that an ARDS patient has 50% (often) likelihood to have a bad outcome, than these figures should not be surprising.

We have not a precise account for paediatric cases, sporadic or in cluster, and so far these cases had mild clinical manifestations of illness.

The picture is not clear and the sudden drop in cases' reporting may be due either to live birds markets closures or delaying reporting after business and financial pressure on local health departments.
gm

[sharon sanders]

Re: China - 347 have been infected by H7N9, 109 deaths, cumulative, as of February 18, 2014 - Ministry of Agriculture

hat tip tetano

WHO update dated today:

snip

During this period 220 additional human cases of avian influenza A(H7N9) virus infection have been reported. All cases were in China with the exception of a single case detected in Malaysia in an individual travelling from Guangdong Province, China. Since February 2013, a total of 355 cases with 112 deaths have been reported

http://www.who.int/influenza/vaccines/virus/recommendations/201402_recommendation.pdf?ua=1

The case fatality rate is still approximately 32&#37; using the WHO updated numbers.

[sharon sanders]

Re: China - 355 have been infected by H7N9, 112 deaths, cumulative, as of February 20, 2014 - WHO confirmed

H7N9 deaths jump significantly....


<table class="tr-caption-container" style="float: right; margin-left: 1em; text-align: right;" cellpadding="0" cellspacing="0"><tbody> <tr><td style="text-align: center;"></td></tr> <tr><td class="tr-caption" style="text-align: center;">Click on image to enlarge.</td></tr> </tbody></table> Twitter was buzzing this morning with news that several sources had announced a new total number of deaths in human cases of H7N9 infection.

It was not a total surprise that there were more deaths than we had heard about, and that is for several reasons:

• In Wave 1, Spring 2013 in South east China, there had been a greater proportion of deaths than we have seen in Wave 2. That's seemed unusual.
• After Wave 1, the proportion of fatal cases (PFC; see background here) sat up as high as 33%. Wave 2's high case numbers but few reported deaths had lowered that to 18% at one point. If the virus hadn't changed and human-to-human transmission had not changed then that was incongruous
• The media were reporting higher numbers than we had data for in early Feb and in late Jan, Xinua reported 26 deaths in Zhejiang alone for 2014 - this far outstripped any publicly data available

So now we see that the tally is 112 fatal H7N9 cases among people infected with a laboratory confirmed H7N9 virus, since the outbreak began in 2013; that tally includes both waves of human cases. That makes the PFC among the 361 confirmed human cases at 31%.


So this one new piece of news has bumped up the PFC by 10%. From 1:5 (22% last week) to nearly 1:3 cases dying after acquiring infection.


Thankfully, H7N9 is not spreading efficiently among humans (or chickens according to reports). But these are numbers to care about.


For comparison, my Excel sheet has 64 cases with data that I can cross-check (I believe that agrees with the FluTracker's count also).


The last media update I looked at had a tally of 77 fatal outcomes.


So we have between 35-48 people have died without any ability for anyone outside China to link them to:

• their age
• when they became ill
• where they were
• how they may have acquired their infection
• their sex
• time to hospitalization and diagnosis
• length of stay in hospital
• what contacts they had and how they have fared.

I think that this is a ball that has been not just been dropped, but buried in a hole and covered over with feathers. I'm disappointed by such a gaping data loss. And don't get me started about the absence of H7N9 sequences from 2014 cases!


Sources...

1. SCMP with higher death tallies than public data indicated
   http://www.scmp.com/news/china/artic...-h7n9-outbreak
2. Xinhua lists 26 deaths in Zhejiang alone for 2014
   http://news.xinhuanet.com/english/ch..._133060657.htm
3. VDU blog on missing deaths
   http://virologydownunder.blogspot.co...?q=deaths+h7n9
4. Mike Coston's Aviann Flu Diary take one the new data, with other sources
   http://afludiary.blogspot.fr/2014/02...medium=twitter
5. FluTracker's thread with links to eth WHO report
   http://www.flutrackers.com/forum/sho...996#post525996
6. China's Ministry of Agriculture report of enlarged H7N9 death tally
   http://translate.google.com/translate?u=http%3A%2F%2Fwww.moa.gov.cn%2Fgovpubli c%2FSYJ%2F201402%2Ft20140220_3791429.htm&hl=en&lan gpair=auto|en&tbb=1&ie=UTF-8
7. The WHO report under the "vaccines" section
   http://www.who.int/influenza/vaccine...ation.pdf?ua=1

Posted by Ian M Mackay

http://virologydownunder.blogspot.com.au/2014/02/h7n9-deaths-jump-significantly.html