Is H7N9 Spreading from Human to Human in China?

[jeffrey]

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

Thank you Giuseppie for putting some calm on this whole "Pandemic" flu. Not saying it wont go that way, and I certainly have none of your expertise or anyones, but I do read alot and at this time I think we need to all wait and see when we get the proper information and we will. IMO, because of H1N1 and H5N1, people are just a little uneasy, I know I am, but it is this type of calm nature that helps people put things into perspective. Thank you!

[Giuseppe]

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

But, regarding the Shanghai familiar cluster, here the tweets of the day:

@HelenBranswell Good news MT @HaertlG: @WHO

''#H7N9 serosamples are apparently being collected and will be tested when serotest is available.''

@ironorehopper--> @HelenBranswell--> @HaertlG--> @newprof1--> @WHO

''It seems that among 5 patients identified retrospectively in Shanghai, some was discovered w/Serum''

@HaertlG--> @ironorehopper--> @HelenBranswell--> @newprof1--> @WHO-->

''The existing #H7N9 seratest is unreliable and has to be confirmed with further lab work.''

@ironorehopper--> @HaertlG--> @HelenBranswell--> @newprof1--> @WHO-->

''Really! It's strange, thus, to have almost a couple of conf. cases with this method...''

@HaertlG--> @ironorehopper--> @HelenBranswell--> @newprof1--> @WHO-->

''#H7N9 seratests followed up by other tests in order to confirm.''

----

[Laidback Al]

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

I am not ready to concede H2H transmission in this family cluster. The details are hazy and given how little we know about H7N9 these individual could have all been exposed to the same source, e.g. pet animals, a big chicken dinner, who knows.

What is significant is that clusters are not yet increasing in numbers. Counting this family as a confirmed cluster, we are only up to three clusters (link).

I don't think anyone here at FluTrackers is "crying wolf". We are all just trying to understand what is going on so we can make prudent decisions about the future.

[Emily]

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

So, the mantra for the next few weeks will be no "sustained" H2H transmission.

And it could be the mantra for years.

[Giuseppe]

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

But if the Hartl said that 'serodiagnostics' is unrealiable, then how did Chinese make the diagnosis after four-fold increase in Abs titer for the above mentioned case?

[curiosity]

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

And it could be the mantra for years.

Let's hope.

[JimO]

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

I can assure you that I haven't lost my mind over this and I certainly am not trying to spread alarm. If you go to the post I linked, Michael Coston provides a commentary on this cluster. There is new information. The two sons were indeed tested and the results were just reported. That seems worthy of discussion to me. This is The Pandemic Discussion Forum, right? It's a place to discuss information and not a place to make accusations. If there are topics that are off limits, then just say so and I'd be happy to no longer participate in the Discussion Forums.

Please, I would like to pray all of us to not leave our mind behind and fear to surpass rationality.

[Giuseppe]

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

I would like only to invite all of us - included myself - to be fair and kindly during this crisis. It is likely a long way before we can see the end of the dark tunnel. Please excuse me for any incidental wording regarded as offensive.

[Catbird]

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

Recent tweets from@HaertlG:

"Gregory H?rtl @HaertlG 55m

.@Laurie_Garrett @CFR_org @BanningGarrett Remember within a family #H7N9 infection could be from a common environmental source, so no h2h."

"Gregory H?rtl @HaertlG 47m

.@STEWest @Laurie_Garrett @CFR_org @BanningGarrett Good point. But again can't rule nout environ source without more investigations. #H7N9"



I understand his point about a possible common environmental source. But, according to an article I posted on Apr. 1 (http://www.flutrackers.com/forum/sho...5&postcount=59), an official survey conducted by the Shanghai CDC showed that the family had NO CONTACT with poultry prior to becoming ill and seldom left the home.

"...According to the Shanghai Municipal Center for Disease Control survey, surnamed Li, father and sons before the onset of no contact with birds, but also did not go out history."

So I'm wondering what environmental source all 3 of them might have possibly shared that would have infected them all.

[Catbird]

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

The following article gives the official position of China's CDC regarding H2H. It also notes that pregnant women (3rd trimester) are now considered high-risk. Although that seems obvious, given the history of increased complications in pregnant women from other types of flu, this is the first time that they are being specifically identified as high risk.



"Expert: advanced high-risk groups of pregnant women are infected with the H7N9 avian influenza

2013 04 18 at 03:05
Source: Beijing Times

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.

...Focus and infectious

A small number of cases of familial aggregation is not equal to the effective human-to-human transmission

Recently, the Hong Kong Health Department issued a notice that the medical institutions in Hong Kong, close contact with a very slight possibility of human-to-human transmission.

Feng Zijian, this view of public health agencies in Hong Kong, but also make a guess based on the cases of familial aggregation phenomenon see, the Chinese Center for Disease Control also highly concerned about this family clusters of cases, and in-depth analysis which possibilities is the first occurrence of avian-to-human transmission, human-to-human infections, or patients with common history of exposure or were exposed to contaminated objects or the environment. However, even a small number of cases of familial aggregation, does not mean that the virus has had the ability to effective human-to-human transmission.

Feng Zijian, H5N1 was found for the first time be able to infect humans, from family clusters of cases occurred up to now, has lasted more than a decade, remained infection from birds to people, and the number of infections is limited, worldwide in hundreds, China a total of 45 cases.

He stressed that there is no evidence that H7N9 continued infection, not only is the Chinese Center for Disease Control, which is the international public health agencies and disease control institutions common understanding of the virus.

Dispel doubts >>

Limited human-to-human transmission and more parent-child relationship

Feng Zijian, human-to-human transmission of limited human-to-human transmission and effective human-to-human transmission, that is sustained human-to-human transmission. The former refers to such human-to-human transmission is very accidental, mostly related susceptibility and the family, the patient is often the parent-child relationship, genetic susceptibility is genetically related to a few specific people in the crowd with some susceptible physiological mechanism, so that he can be infected. This case does not appear multiple generations of infection, at most, a second-generation patients, three generations of patients and more patients will no longer appear, but generally does not appear to a person infected a number of secondary cases, this is the limited human-to-human transmission.

When the disease evolved into a human influenza virus is effective human-to-human transmission. We often see during a pandemic of influenza A H1N1 influenza outbreak crowd, such as at school or in the community, many patients, a patient can infect a number of patients can continue to spread, you can see a clear chain of transmission, the disease can also be far from the spread, which is the effective human-to-human transmission.

Market of live birds "scalding" to suspect

Since poultry infection, why about 40% of those infected poultry or poultry market exposure history?

Feng Zijian pointed out that not every patient can clearly recall the history of exposure. Inferred or poultry contaminated environment or direct contact with poultry that exposure to infection from birds to people, and then lead to infection.

"We recognize that an important city of live poultry markets and sell freshly slaughtered cause disease risk factors." Said Feng Zijian, the market in live poultry stalls often hair removal device, which has hot water, put the chicken inside the high-speed rotation, easy to form aerosols, if any virus, may inhale through the neighborhood. This is also the experts suspect that the important cause human infections exposed to the environment.

...In the late pregnant women infected with high-risk

Media groups of pregnant women, prevention, diagnosis and treatment of the problem, Beijing Ditan Hospital infectious disease treatment center director Li Xingwang Judging from the experience in the treatment of influenza, at 27 weeks, before the early pregnancy, pregnant women feel and general no difference. Doctors are more concerned about in the late pregnant women, this population is infected with influenza high-risk groups. In the treatment to be positive, but in the middle and late after the drugs may have certain effects on the fetus. As for the early pregnant women, but also to do the assessment."


xhttp://news.ifeng.com/mainland/special/h7n9/content-3/detail_2013_04/18/24337126_0.shtml

[sharon sanders]

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

The suspected family cluster appears to be true. Even if the antibody test is not perfect, added to the information that we have, I have adjusted our chart to reflect that they all had H7N9. It is the most reasonable explanation with all of the data that we have compiled.

The only issue is whether they transmitted it to each other. I think we do not know for sure either way.

Still there is no proven carrier of this disease. Today the Ministry of Agriculture announced that poultry and pigs farms have tested negative. So have slaughterhouses and wild bird habitats. Only pigeons and samples from live markets have resulted in positive tests.

So where does this leave us?

It is back to the old H5N1 situation again. Both the Medical Establishment and the Agricultural Establishment in China are denying.

The Chinese CDC has said several times in the last few days that they have this situation under control. How can they say that when no realistic explanation has been established for the spread?

I can see that the Emperor is wearing no clothes.

And so can the world.

We are not idiots.

It is time for China to open its doors to "boots on the ground" teams of infectious disease experts to fully investigate this situation.

[sharon sanders]

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

The China CDC just announced that the World Health Organization is invited to come next week with a team.

Finally!



World Health Organization is concerned about China is not in contact with poultry H7N9 avian influenza

Time :2013-04-18 font:


Date: 04/18/13 09:37:38 Source: China News Network
China news agency, New York, April 17 (Reporter Ruan Yulin) - World Health Organization said 17 confirmed cases of H7N9 avian influenza in China, some patients and not with the poultry had contact with the avian influenza virus has become more and more mysterious.

As of the 17th, 82 patients were diagnosed with H7N9 avian influenza infection, including 17 deaths. New cases from East China.

World Health Organization spokesman said that some patients had not been in contact with poultry. Piece of the puzzle has not been solved and therefore require more large-scale surveys.

Chinese Center for Disease Control epidemiological Zeng Guang, chief scientist, said publicly that there are now nearly 40% of patients with H7N9 avian influenza is no clear history of poultry exposure, it is urgent to find the source of infection.

"These people are infected in the end is how? Still a mystery." Zeng said. And recommended screening carried out in some areas, take a look at healthy people carry the H7N9 avian influenza virus is isolated phenomenon or a common phenomenon.

The state health department said that the current bird flu cases in the dissemination of state, has not yet found evidence of human-to-human transmission. Confirmed cases are located in Beijing, Shanghai, Jiangsu, Zhejiang, Anhui and Henan provinces and cities. Shanghai has confirmed 31 cases of infection and 11 deaths.

World Health Organization will send next week influenza virus experts to China to assist in the investigation of new avian influenza H7N9 virus. They were from Europe, USA, Australia and China, eight experts is expected to be launched in China three-week investigation.

Taken from: http://www.cdctj.com.cn/main/shownew...6&newsid=31363

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

http://www.chinacdc.cn/mtdx/crbxx/201304/t20130418_80062.htm

[Vibrant62]

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

Hoorah! As this is potentially a global problem (if it goes pandemic) it is great that the world's best scientists can finally join forces to help solve the mystery, quantify the risks, and develop solutions.

[Vibrant62]

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

I have frequently mentioned rodents as a potential vector to rule out.

There is some precedent here. Whilst this particular species is not resident in China, it does show that rats could be a vector. I dont know if all species of rats or only some have dual sialic acid receptors, but it must be worth looking at?

Receptor Characterization and Susceptibility of Cotton Rats to Avian and 2009 Pandemic Influenza strains.

We show that cotton rats (Sigmodon hispidus) are susceptible to avian and swine influenza viruses. Cotton rats express α2-3-linked sialic acid (SA) and α2-6-linked SA residues in the trachea, and α2-6-linked SA residues in the lung parenchyma. Prototypic avian influenza viruses (H3N2, H9N2, and H5N1) and swine-origin 2009 pandemic H1N1 viruses replicated in the nose and in the respiratory tract of cotton rats without prior adaptation and produced strong lung pathology that was characterized by early lung neutrophilia, followed by subsequent pneumonia. Consistent with other natural and animal models of influenza, only the H5N1 virus was lethal for cotton rats.

http://www.ncbi.nlm.nih.gov/pubmed/23192875

[gsgs]

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

as have quails.

How would the virus go from poultry to rats and back ?
We have zero rat-sequences but thousands poultry sequences


Avian, Bat, Blow fly, Camel, Canine, Cat, Cheetah, Civet, Environment, Equine, Feline,
Ferret, Giant anteater, Human, Leopard, Mink, Muskrat, Pika, Raccoon dog, Reassortant,
Seal, Stone marten, Swine, Tiger, Unknown, Whale