FAO - H7N9 Situation Update - February 2, 2016

[sharon sanders]

H7N9 situation update

2 February 2016, 17:00 hours; Rome

Disclaimer

Information provided herein is current as of the date of issue. Information added or changed since the last H7N9 situation update appears in red. Human cases are depicted in the geographic location of their report. For some cases, exposure may have occurred in one geographic location but reported in another. For cases with unknown onset date, reporting date was used instead. FAO compiles information drawn from multiple national (Ministries of Agriculture or Livestock, Ministries of Health, Provincial Government websites; Centers for Disease Prevention and Control [CDC]) and international sources (World Health Organization [WHO], World Organisation for Animal Health [OIE]) as well as peer-reviewed scientific articles. FAO makes every effort to ensure, but does not guarantee, accuracy, completeness or authenticity of the information. The designation employed and the presentation of material on the map do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country, territory or sea area, or concerning the delimitation of frontiers.


Overview

Situation: Influenza A(H7N9) virus with pandemic potential.

Country: China; three human cases originated in China and were reported in Malaysia (1) and Canada (2).

Number of human cases: 707 confirmed; 277 deaths (since February 2013)

Provinces/municipalities: Beijing and Shanghai; Anhui; Fujian; Guangdong; Hebei; Henan; Hunan; Jiangsu; Jiangxi; Shandong; Zhejiang; Guangxi; Guizhou; Jilin; Qinghai; Hubei; Taiwan Province of China; Hong Kong SAR; Macao SAR, Ningxia Hui and Xinjiang Uyghur Autonomous Regions; Sabah (Malaysia); British Columbia (Canada).

Animal/environmental findings: over 2,000 virological samples from the environment, chickens, pigeons, ducks and a tree sparrow tested positive; positives mainly from live bird markets, vendors and some commercial or breeding farms.

FAO actions: liaise with China and partners, monitor situation, monitor virus evolution, conduct market chain analysis, risk assessment, surveillance guidance and communication.

Map. Human cases and positive findings in birds or the environment


Click to enlarge - Note: Human cases are depicted in the geographic location where they were reported; for some cases, exposure may have occurred in a different geographic location. Precise location of 49 human cases in Fujian (28), Jiangsu (8), Zhejiang (11), Guangdong (1), Hunan (1) and Xinjiang (1) are currently not known. These cases are therefore not shown on the map. Imported cases in Canada (2) and Malaysia (1) are also not represented.



Situation update

Animals

• 29 January, Hunan Province: one sample (unspecified type) collected from Yinxin market in Hanshou County of Changde City tested positive for H7N9 [reference]
• 26 January, Guangdong Province: Guangzhou City will close its live poultry markets during 1-3 February and 16-18 February to implement thorough cleaning and disinfection [reference].
• 22 January, Guangdong Province: a provincial meeting was held on the implementation of "centralized poultry slaughtering, cold chain distribution and marketing of fresh meat". Full implementation of the above is expected before the end of February 2016 [reference].
• 16 January, Shanghai City: The city will suspend live poultry trade from 8 February to 30 April 2016. During this period, 400 retailers will provide chilled poultry meat [reference].
• 11 January, Guangdong Province: following the reports of two human cases, Shenzhen city closed all live poultry markets for 3 weeks, starting on 9 January [reference].

Figure 1. Number of positive virological samples from birds or the environment, by province and origin as of 2 February 2016

Click to enlarge

Humans

• Since the last update (18 January 2016), 5 new human cases have been reported inZhejiang Province (2), Guangdong Province (1), Fujian Province (1) and Hunan Province (1).

• For detailed information on human cases, please refer to WHO's Disease Outbreak News.

Figure 2. Number of officially reported human cases since February 2013 as of 2 February 2016

Click to enlarge

Figure 3. Incidence of officially reported human cases by month, based on onset date as of 2 February 2016

Click to enlarge - Note: For cases with unknown onset dates from wave 1 (n=7), wave 2 (n=2), wave 3 (n=146) and wave 4 (n=24), reporting dates were used instead.

Publications

• In addition to the surveillance findings by MoA and MoH, 1,728 virologically positive samples have also been reported in 12 peer-reviewed articles (1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12). A total of 71,920 samples have been collected in these studies since April 2013, of which 1,728(2.4%) were positive for H7N9 (1,215 environmental samples, 501 chickens, 1 goose and 1 tree sparrow).
• A retrospective study of 83 patients with confirmed H7N9 infection demonstrated that patients with bacterial coinfection had a more severe condition (APACHE II score), showed higher 90-day hospital mortality and were more likely to receive renal replacement, mechanical ventilation and extracorporeal membrane oxygenation treatments. The study also showed that elevated procalcitonin level was an accurate marker for diagnosing bacterial coinfection in H7N9 patients, thus enabling earlier antibiotic therapy [reference].

Figure 4. Publicly available genetic sequences by infection wave (October - September) and species

Click to enlarge- Source: OpenfluDB and GISAID


FAO’s support to countries

• FAO continues supporting at-risk countries with surveillance and preparedness for H7N9 incursion
• FAO is providing surveillance and sampling guidance for South and Southeast Asia
• Funding to date: US$ 8.1 million mobilized (US$6.2 million USAID, US$1.9 million TCPs)

http://www.fao.org/ag/againfo/progra...fbc7-183318473

[sharon sanders]

At this moment we have 717 confirmed cases listed, including cases in January 2016, which are most likely not included in the above report since the official China HFPC report for January is not issued yet. We have an additional 11 cases listed for January so our tabulation is very closely aligned with the FAO tabulation. We include 1 case which is an asymptomatic but test positive child that is usually not included on WHO or China HFPC lists: #61 - Child, 4, PCR positive in routine screening of contacts/neighbors of case #44 - asymptomatic Beijing

Our case list is here.