Is H7N9 Spreading from Human to Human in China?

[Emily]

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

Have there been any "new onset" cases since April 1? All reported cases so far with known symptom onset date, appear to be from March and February.

Does anyone know the answer to this question?

[jflorida]

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

I think thats true Emily. None I have seen reported but I have read about some testing problems(?) and it seems people were not tested unless they were really sick - so later in infection.

If that poultry indeed it, as it is looking - People eat a lot of poultry these days in many countries. Birds are everywhere. I imagine the outside of eggs also, for sure, could be contaminated as well.

[Ronan Kelly]

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

Does anyone know the answer to this question?

The most recent two cases confirmed today became ill on the 28th & 29th of March. The 4 yo boy developed fever on March 31st. I haven't seen any onsets later than that.

[Emily]

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

Thank you jflorida, Ronan and curiosity - I hope this is an indication that control measures are helping.

[JimO]

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

I hope this is true, but I would not be surprised if the release of information out of China slows to a trickle now that they have the bloggers under control. I just don't trust them to release any more information than they absolutely have to in order to project some thin perception of credibility to the world health community. I'll feel better if we get to the end of April and there are no cases outside mainland China.

Shiloh pointed out that there are political forces at work between the US and China due to the unstable situation with North Korea. So, if the Chinese want to keep information to themselves, it appears, based on the CDC press conference yesterday, that we will happily accomodate them.

Meanwhile, despite this being characterized as isolated cases with no H2H transmission, the following actions have been taken:

1. CDC quickly issued guidance to medical professionals in the US regarding what to look for and how to treat potential H7N9 cases - including the use of antivirals at the onset of symptoms without waiting for test results.
   
2. CDC has already begun work developing a vaccine.
   
3. China, in an unprecidented move, released sequences from the first cases (perhaps to get help developing a vaccine) in a very timely manner.
   
4. Japan, Hong Kong, Malaysia (and maybe others) have each implemented some kind of surveillance program out of concern over potential spread of the virus.
   
5. Bejing reversed a decision yesterday and implemented an H7N9 emergency control plan, which I'm sure is no small effort, despite claiming there were no cases reported there.

As they say, actions speak louder than words. The extraordinary actions taken so far are not consistent with the characterization of the outbreak by China and our own CDC.

Thank you jflorida, Ronan and curiosity - I hope this is an indication that control measures are helping.

[sharon sanders]

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

I do not believe anything that China says.

I just want to be clear on that issue.

I have been following and documenting disease patterns in China for 7 years and I know that they under-report.

I also do not support the various official statements from various governments about how great the Chinese government is for sharing the H7N9 isolates in such a rapid manner. I feel that this situation has been developing for some time and no such isolates were offered earlier before the news broke wide open last week.

Besides, why should we praise any government for sharing isolates? Isn't this the humanitarian thing to do?

I do not want this thread to turn into a China "bash" thread but I thought I should state my opinion based on my experiences for 7 years.

Thanks to all of you on all the sites and in the "real" world for helping to lessen suffering.

We at FluTrackers remain committed to be driven by the facts to ascertain the truth.

Thanks for staying with us.




p.s. I also want to add that I personally have never taken 1 penny from the Chinese government, nor has FluTrackers. With China's growing financial prominence in the public health arena how many public health related individuals and/or groups can say that?

[Giuseppe]

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

Well. I think there's nothing else to do that standing into a West Coast intl airport and personally swab people from China...

[NS1]

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

There may be more mild cases going unreported, but the current genotype of H7N9 includes genes that make it probable that H2H transmission is going on.
It has the same genes that were recorded in H5N1 including D225G and Q226L and the PB2 E627K gene that heralds deeper lung penetration and higher pathogenicity in mammals. It may have been in wild birds or in caged poultry for some time before somehow establishing itself in the early cases in China. I don't dismiss the reports of 10,000 dead swine thrown into the river around Shanghai, but I think there'd be huge numbers of human cases if that was the vector of transmission.
And the fact that cases are now reported from Hangzhou to Shanghai to Nanjing, all eastern China cities close to one another makes H2H transmission more likely especially with cluster early case links within families. If so, we should see a breakout soon in Hong Kong or other regions. The good news is that spring has come and that may reduce other stressor factors such as cold and smog contributing to the breakout scenario of people being stuck indoors in close proximity as much.
It's all speculation at this juncture, but thanks to FluTrackers and the collegiality of today's scientific communities and medical staffs, word will get out if it has gone H2H. Good luck to everyone in the meantime.
Thanks to Sharon and Al and Alaska Denise and Shannon and Emily and Giuseppe and Vibrant and all you wonderful reporters for keeping the world aware of developments.

The environmental temperature will have little effect on a transitional Influenza virus. Recall the pH1N1 operating with vigour throughout the summer of 2009.

[jflorida]

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

Even though some species seem to be weathering it well I wouldn't assume all birds will be asymptomatic. I also wouldn't assume all reports are real (or not):

Posted today (also another gold level translation) :

The Witnesses said Nanjing Sparrow death follows dumplings, like falling from a tree [ http://translate.googleusercontent.c...G2Y5hQwAE2sUTA ]

Yesterday, an "unnatural deaths" dozens of sparrows Billiton Park, Jianye District, Nanjing microblogging online crazy turn. But when the Modern Express ( microblogging ) Reporter arrived, Jianye District Tea Southern district Billiton Park between 11 and 12 on the ground clean, not a sparrow Hair. Nearby residents would rather Bypass, is not willing to walk from here. "Dead dozens of sparrows, who know not avian flu." Said a district residents. Currently, relevant departments have been sampled, is under investigation.

In a linked Q &A I also noticed what I thought was unusual advice :

The recommended prevention, try not to touch these birds, is not going to amuse them. If you come into contact with birds or their droppings, and to pay attention to your hands thoroughly with disinfectant and water. The avian flu virus does not heat. Sulfate, are very sensitive to ultraviolet radiation, mercury, chlorine and other commonly used disinfectants. Pay attention to the life of appliances disinfected. Poultry sickness and death situation, you should contact the local agricultural sector.

I checked and they do indeed still use mercury bichloride to disinfect surfaces and also mercuric compounds are still used in traditional medicine in China (and are available in some OTC treatments in the US).

Mercury: Element of the Ancients [ http://www.dartmouth.edu/~toxmetal/mercury/history.html ]

The line between alchemy and medicine was not always clear. In 2nd century China, the study of mercury centered on a search for an elixir of life to confer longevity or immortality. The prominent Chinese alchemist Ko ****, who lived in the 4th century, believed that man is what he eats, and so by eating gold he could attain perfection. Yet, he reasoned, a true believer was likely to be poor, and so it was necessary to find a substitute for the precious metal. This, in his estimation, could be accomplished by making gold from cinnabar. Ko ****'s other uses for cinnabar included smearing it on the feet to enable a person to walk on water, placing it over a doorway to ward off thieves, and combining it with raspberry juice to enable elderly men to beget children.

[gsgs]

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

humans are animals
no exponential increase of cases
hundreds of contacts are asymptomatic
cases connected to birds
the virus circulates in poultry in big numbers since ~1 year
(is it going to replace H9N2 ?)

[curiosity]

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

Are there positive H7N9 in chickens, pigeons, quail and/or environment in any of the other locations where human cases were detected?

Is it possible humans are infecting birds?

[gsgs]

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

A/quail/Nanchang/12-340/2000,2000//,H1N1

but this is the only example that I have --> very rare

----------------------------

also
A/quail/QC/FAV-10/2008/05/09/H3N2

QC=Quebec,Canada (?)

so maybe quail can catch it from humans occasionally

American turkeys from swine, also turkeys with novel mexican pandemic H1N1

[AlaskaDenise]

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

Quail are intermediaries, due to their dual receptors for avian and humans.
See: Quail carry sialic acid receptors compatible with binding of avian and human influenza viruses

THere were some large quail die offs during the early HP H5N1 days. Here's a report of almost 15,000 quails dying of AI: http://www.oie.int/downld/AVIAN%20INFLUENZA/Thailand%20Follow-up%20Report%20No61.pdf

Another interesting article about quail: Role of Quail in the Interspecies Transmission of H9 Influenza A Viruses: Molecular Changes on HA That Correspond to Adaptation from Ducks to Chickens

an interesting piece of quail trivia: "......infected quail have a longer disease period than do chickens and thus are more likely to transmit the virus....." .

.

[Giuseppe]

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

I wonder whether someone has tested last year H9N2 Bangladeshi human case sequence with internal genes of this novel H7N9 virus...

[Toaster2]

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

I agree that it does not look like sustained h2h

But lets keep in mind that there is a public holiday - monday we will know more

humans are animals
no exponential increase of cases
hundreds of contacts are asymptomatic
cases connected to birds
the virus circulates in poultry in big numbers since ~1 year
(is it going to replace H9N2 ?)